Description
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
Required readings
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Chapter 2, “Asking Compelling Clinical Questions” (pp. 37–60)
Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 62–104)
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks
Links to an external site.
for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting
Links to an external site.
. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help…
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice.
Links to an external site.
American Journal of Nursing, 110(3), 58–61.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009).Evidence-based practice: Step by step: Igniting a spirit of inquiry
Links to an external site.
.
Links to an external site.
American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Searching for evidence.
Links to an external site.
American Journal of Nursing, 110(5), 41-47.
Walden University Library. (n.d.-a). Databases A-Z: Nursing
Links to an external site.
. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Walden University Library. (n.d.-c).Evidence-based practice research: CINAHL search help
Links to an external site.
. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthe…
Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help
Links to an external site.
. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthe…
Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help
Links to an external site.
. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthe…
Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean terms
Links to an external site.
. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/…
Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searching
Links to an external site.
. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/…
Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing?
Links to an external site.
Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670
Walden University Library. (n.d.-i). Systematic review.
Links to an external site.
Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthe…
Unformatted Attachment Preview
Matrix Worksheet
Template
Matrix Worksheet Template
Use this document to complete Part 1 of the Module 2 Assessment, Evidence-Based Project, Part 1: Identifying Research
Methodologies
Full citation of
selected article
Article #1
Karasneh, R., AlMistarehi, A.-H., AlAzzam, S.,
Abuhammad, S.,
Muflih, S. M.,
Hawamdeh, S., &
Alzoubi, K. H. (2021).
Physicians’ knowledge,
perceptions, and
attitudes related to
patient confidentiality
and data sharing.
International Journal of
General Medicine,
Volume 14, 721–731.
https://doi.org/10.2147/i
jgm.s301800
Article #2
Liang, Z., Xu, M., Liu,
G., Zhou, Y., &
Howard, P. (2022).
Patient-centred care
and patient autonomy:
Doctors’ views in
Chinese hospitals.
BMC Medical Ethics,
23(1).
https://doi.org/10.1186/
s12910-022-00777-w
© 2021 Walden University, LLC
Article #3
Plaiasu, M. C.,
Alexandru, D. O., &
Nanu, C. A. (2022).
Physicians’ legal
knowledge of informed
consent and
confidentiality. A crosssectional study. BMC
Medical Ethics, 23(1).
https://doi.org/10.1186/
s12910-022-00835-3
Article #4
Zhang, H., Zhang, H.,
Zhang, Z., & Wang, Y.
(2021). Patient privacy
and autonomy: A
comparative analysis of
cases of ethical
dilemmas in China and
the United States. BMC
Medical Ethics, 22(1).
https://doi.org/10.1186/
s12910-021-00579-6
1
Why you chose this
article and/or how it
relates to the clinical
issue of interest
(include a brief
explanation of the
ethics of research
related to your clinical
issue of interest)
I selected the article for its
elaborative research on
physicians’ knowledge,
perceptions, and attitudes
concerning patient
confidentiality and data
sharing. These aspects are
central to the clinical issue
of patient autonomy and
confidentiality and can help
inform them. The study is
further significant due to its
unbiased focus on the
ethical and legal aspects of
patient data privacy, a
crucial element in
maintaining patient trust and
autonomy in healthcare.
The study also elucidates
the complexities of
healthcare organizations
and facilities where data
sharing and confidentiality
are multifaceted and
complex. The study informs
the clinical issue by
illustrating the potential
gaps between physicians’
knowledge and the ethical
standards required to
uphold patient privacy.
Regarding ethical
considerations related to the
research, the study was
executed meticulously,
The article was chosen for
its relevance to
contemporary clinical
matters, focusing on patientcentered care and
autonomy within Chinese
public hospitals. Central to
this study is an exploration
of healthcare professionals’
roles, particularly doctors, in
promoting patient
autonomy. Navigating the
evolving terrain of patient
rights, this research
underscores the need to
balance medical expertise
and respect patient
preferences. The study
sheds light on the
challenges in implementing
patient-centered care by
delving into the perspectives
and practices of doctors,
who are integral to ethical
application in clinical
settings. The research by
Liang et al. (2022) thus
offers key insights into the
practicalities of ethical
principles in healthcare,
guiding improvements in
patient autonomy and
confidentiality.
© 2021 Walden University, LLC
I chose the article by
Plaiasu et al. (2022) due to
its relevance to my clinical
issue of interest.
Specifically, the study’s
exploration of physicians’
legal knowledge concerning
informed consent and
confidentiality can help
inform the issue. The
research’s focus on legal
understanding among
physicians further
addresses a critical gap in
ensuring compliance with
ethical standards in
healthcare. Patient
autonomy and
confidentiality cannot be
accomplished in healthcare
settings if the healthcare
professionals are unaware
of what to follow and how to
do it. That being said, the
article by Plaiasu et al.
(2022) provides a guide
through issues from a legal
perspective, w, which can
help healthcare
professionals in
contemporary healthcare
facilities to be aware of what
is expected of them. The
study’s results further offer
insights into how legal
The article by Zhang et al.
(2021) was chosen for its
insightful exploration of
patient autonomy and
confidentiality, a pivotal
issue in clinical ethics. Their
analysis, central to clinical
ethics, navigates the
delicate equilibrium between
patient rights and the
operational demands of
healthcare professionals
and institutions. The
significance of ethical
considerations in this
sphere is profound,
requiring a discerning
appreciation of the cultural,
legal, and individual
elements that shape patient
choices and confidentiality.
Their comparative
examination further
illuminates the variations in
the interpretation and
execution of these ethical
norms across cultural
boundaries while
emphasizing the fluidity of
legal structures that protect
patient rights. The
comparative lens is
instrumental in
comprehending the practical
application of ethical
2
adhering to the Helsinki
Declaration. The
Institutional Review Board
at the authors’
establishment, identified
with the reference number
16/121/2019, granted
ethical endorsement. In this
process, collecting
participants’ personal
information, including
names and addresses, was
extensively avoided to
ensure privacy.
Brief description of
the aims of the
research of each
peer-reviewed article
Karasneh et al.’s (2021)
study’s primary objective
was to assess practicing
physicians’ understanding,
perceptions, and attitudes
about patient confidentiality
and data sharing, especially
within the framework of
developing countries, with
Jordan serving as a case
study. The research sought
to ascertain the prevalence
of ethical dilemmas in
various medical
departments and the extent
to which physicians
comprehended and adhered
to ethical codes and laws
regarding patient data
security and sharing. By
evaluating physicians’
The study aimed to explore
the perspectives and
practices of doctors on
patient-centered care in
Chinese public hospitals.
Amidst increasing patient
disputes and strained
doctor-patient relations in
China, this research sought
insights into doctors’
implementation of patient
consultation, preference,
and consent in medical
procedures. Examining
doctors across various
hospital levels, specialties,
and demographics strived to
uncover variations in
practices and attitudes
toward patient-centered
care. The investigation was
© 2021 Walden University, LLC
knowledge aligns with
ethical principles in clinical
settings and underscore the
need for enhanced legal
and ethical education
among medical
professionals. The research
ethics related to my clinical
area of issue were not
addressed in the research.
standards and pinpointing
opportunities for
enhancement in policies
and practices across varied
healthcare systems.
Plaiasu et al.’s (2022)
research primarily aimed to
evaluate the legal
understanding of Romanian
physicians about informed
consent and confidentiality.
Contextualized against
Romania’s evolving medical
legislation, this study
examined physicians’
awareness and adherence
to laws protecting patient
rights. The research
focused on determining if
the clinical behaviors of
physicians correlated with
their legal understanding or
were influenced by other
factors like inadequate
training, time constraints, or
customary practices.
The primary aim of the
research conducted by
Zhang et al. (2021) was to
execute a comparative
analysis of ethical dilemmas
about patient privacy and
autonomy between China
and the United States. The
comparison was anchored
on examining four
empirically significant cases
– two from each country.
The research sought to
understand how cultural and
legislative differences
between the two countries
influenced the handling and
outcomes of these ethical
dilemmas. The study aimed
to elucidate the societal
impact and legal
3
Brief description of
the research
methodology used
Be sure to identify if
the methodology used
was qualitative,
quantitative, or a
mixed-methods
approach. Be specific.
familiarity with fundamental
rules governing patient data
access and confidentiality,
the study aimed to reveal
the influence of this
knowledge—or its
absence—on their attitudes
and practices. The research
endeavored to provide a
detailed understanding of
physician awareness and
conduct related to patient
confidentiality, an aspect
pivotal for ethical healthcare
delivery.
vital for assessing patient
autonomy in healthcare and
pinpointing areas for service
quality enhancement and
better doctor-patient
relations.
Karasneh et al. (2021)
conducted their study using
a descriptive, questionnairebased, cross-sectional
design, which conforms to
the definition of quantitative
research methodology.
Physicians working in
diverse healthcare
environments in Jordan
were solicited through email
to partake in an online
survey hosted on Google
Forms. After an extensive
review of relevant literature,
the survey included
questions on
sociodemographic
characteristics, awareness
The research adopted a
quantitative research
methodology. The study
specifically utilized paperbased questionnaires
distributed to doctors in two
hospitals in Jinan,
Shandong province, China.
Initially developed in English
and then translated into
Mandarin Chinese, the
questionnaire comprised 37
multiple-choice questions.
The queries in the survey
document covered
demographic information,
educational background,
clinical position, and
ranking. However, the data
© 2021 Walden University, LLC
implications of these
dilemmas by delving into
specific cases, thereby
shedding light on the
broader topic of patient
rights in different cultural
and legal contexts. The
research’s intent was not
just to narrate these cases
but to critically analyze the
supporting and opposing
views for each, thereby
offering a comprehensive
perspective on the ethical
challenges encountered in
the healthcare sectors of
both countries.
The study utilized a crosssectional study design to
assess the legal knowledge
of attending physicians
regarding informed consent
and confidentiality. The
study design utilized
conforms to the quantitative
research method
paradigms. The study was
conducted in nine Dolj
County, Romania hospitals,
where questionnaires were
distributed to physicians.
The questionnaire
administered consisted of
ten scenario-based
questions focused on
queries about informed
The research approach
Zhang et al. chose (2021)
was fundamentally
qualitative. Focusing on four
critical cases, two from each
country, they explored
substantial ethical issues in
patient privacy and
autonomy. These cases
were selected for their
societal influence and
capacity to showcase the
differences between China
and the United States in
managing ethical matters in
healthcare. The researchers
provided detailed narratives
for each case,
encompassing the
4
of ethical conduct,
perceived confidentiality in
clinical scenarios, and
attitudes toward data
sharing. The knowledge
section consisted of
questions with set answers,
scored on accuracy.
Attitudes concerning
confidentiality and data
protection were gauged
using a Likert scale. To
validate the survey’s content
and appearance, field
experts reviewed it, and a
pilot test was conducted.
Data from the study were
analyzed with IBM SPSS,
applying descriptive
analysis, Pearson’s
correlation, and multiple
regression tests to explore
connections between
knowledge, attitudes, areas
of specialization, and
demographic traits.
A brief description of
the strengths of each
of the research
methodologies used,
The cross-sectional survey
methodology applied by
Karasneh et al. (2021)
instrument placed a specific
focus on 12 questions,
which were aimed at
acquiring doctors’ views and
actions related to patient
consultation, preference,
and consent in medical
procedures. Data from the
questionnaires were
manually entered into Excel,
followed by statistical
analysis using IBM SPSS.
consent and confidentiality
and a self-assessment
question. Physicians were
asked to select answers
reflecting their regular
practice. The responses
extracted from the surveys
were then compared to
applicable laws to evaluate
their legal knowledge. The
methodology also included
a scoring system for
physicians who admitted to
committing legal breaches.
background, ethical
dilemma, various
arguments, and outcomes.
The methodology, therefore,
granted a deep
comprehension of the cases
within their specific sociocultural and legal
environments.
There are several strengths
exhibited through the
study’s research
methodology. The first
The research methodology
utilized demonstrates
several strengths. First, it
allowed for efficient data
The qualitative methodology
Zhang et al. (2021) adopted
exhibits several advantages.
First, the detailed case
© 2021 Walden University, LLC
5
including reliability
and validity of how
the methodology was
applied in each of the
peer-reviewed articles
you selected.
offers several strengths.
The approach allowed for
data collection from a
diverse pool of physicians
across different specialties,
yielding a broad perspective
on knowledge and attitudes
regarding patient
confidentiality and data
sharing. A structured, online
survey enabled efficient
data gathering and wide
participation, enhancing the
representativeness of the
findings for Jordan’s
physician community.
Besides, the survey’s
design, encompassing both
knowledge assessment and
attitude evaluation,
facilitated a comprehensive
analysis of how physicians’
understanding of ethical and
legal standards is reflected
in their clinical practices.
Such a holistic approach
yielded valuable insights
into the interplay between
knowledge and behavior
concerning patient
confidentiality.
Regarding reliability and
validity, the methodology
implemented by Karasneh
et al. (2021) demonstrates
notable efficacy. The
strength is that structured
questionnaires enabled data
collection from many
participants efficiently. The
strategy facilitated a broad
representation of views from
doctors across different
hospital levels and
specialties. The second
strength manifested is that
the quantitative design
facilitated objective
measurement and statistical
data analysis, which allowed
for identifying significant
trends and correlations
between different variables.
The use of the indicated
research design is further
crucial as it helped uncover
the extent of inconsistencies
in doctors’ views and
practices concerning patient
autonomy and consultation.
The reliability and validity of
the methodology employed
in the study are evident. The
reliability was achieved by
employing a robust
sampling method by
selecting participants from
different levels of hospitals
and various specialties.
Using a large pool of
research subjects enhances
the reliability of the findings
© 2021 Walden University, LLC
collection from many
physicians across various
hospital settings. The data
collected provided a broad
overview of legal knowledge
in the medical community,
effectively identifying
general trends and patterns
in legal understanding
among physicians. The
second evident advantage
of the design was its use of
scenario-based questions in
the questionnaire. The
utilization facilitated a
practical assessment of
physicians’ knowledge, as it
simulated real-life situations
they might encounter in
clinical practice. The
method was further
instrumental in evaluating
theoretical understanding
and the application of legal
knowledge in practical
scenarios.
The validity of the results in
the study was achieved
through the design of the
questionnaire and its
scenario-based approach.
The strategy ensured that
the assessment of legal
knowledge was grounded in
practical, real-world
applications, enhancing the
validity of the results.
study approach allowed for
an in-depth exploration of
each ethical dilemma. The
exploration provided a rich
contextual understanding of
the issues under
examination. Secondly, the
comparative nature of the
study is another significant
strength. By juxtaposing
cases from two culturally
and legally different
countries, the research
provided a unique lens
through which the principles
of patient privacy and
autonomy could be
examined. The comparative
analysis highlighted the
differences and potential
lessons that each
healthcare system could
learn from the other. It
facilitated a broader
understanding of how
ethical principles are
interpreted and
implemented across
different socio-cultural
landscapes, contributing to
a more global perspective
on bioethics.
Several aspects are
noteworthy regarding the
reliability and validity of the
methodology employed in
6
General
Notes/Comments
survey’s construction
involved an exhaustive
literature review and expert
consultations, assuring
content validity. Pilot testing
further fortified the reliability
of the survey instrument.
Applying recognized
statistical methods in data
analysis, including
Pearson’s correlation and
multiple regression,
conferred authenticity to the
results and bolstered the
study’s validity. The
calculated Cronbach’s alpha
values for the knowledge
and attitudes sections
indicated satisfactory
internal consistency,
reinforcing the survey’s
reliability. Nevertheless, it is
crucial to acknowledge
potential limitations such as
respondent bias and the
study’s cross-sectional
nature, which might impact
the generalizability of the
findings.
as they reflect a diverse
range of perspectives within
the healthcare sector. The
validity of the methodology
is evident through the
careful development of the
questionnaire, including its
translation and backtranslation. Translating the
study instrument was a
smart approach that allowed
the researchers to ensure
the clarity and accuracy of
the questions, thereby
enhancing the validity of the
responses.
Karasneh et al.’s (2021)
study makes a significant
contribution to
understanding the
landscape of physician
knowledge and attitudes
toward patient confidentiality
The study by Liang et al.
(2022) is highly effective in
providing a research
perspective on
implementing patientcentered care and patient
autonomy in Chinese public
© 2021 Walden University, LLC
The reliability of the
research findings was
facilitated by including a
diverse group of physicians
from different hospital types
in Dolj County, which
generalized the results.
The study is largely
informative concerning
physicians’ legal knowledge
regarding informed consent
and confidentiality. The
findings reveal a concerning
gap in legal understanding
Zhang et al.’s (2021) study.
The reliability of the
qualitative research hinges
on the systematic and
transparent approach taken
in selecting and analyzing
the case studies. The
authors chose cases
representative of broader
ethical patient privacy and
autonomy issues, ensuring
the findings could reflect
wider trends in both
countries. Besides, the
comprehensive presentation
of each case, including a
balanced discussion of
various perspectives,
enhances the reliability of
the analysis.
The article by Zhang et al.
(2021) is largely informative
on the issues they strived to
explore. A key insight from
this study is the profound
influence of cultural and
legal frameworks on the
7
and data sharing. The
research highlights a
problematic gap in
physicians’ knowledge
about patient confidentiality,
potentially leading to data
privacy violations and
affecting patient trust. The
study underscores the
necessity of enhancing
education in medical ethics,
both in initial training and
through continuous
professional development.
The observed correlation
between physicians’
experience and their
attitudes towards
confidentiality underscores
the importance of ongoing
education and
consciousness-raising about
patient rights and data
protection. The research is
particularly pertinent in
developing countries, where
implementing data
protection laws and ethical
guidelines may pose
challenges. The insights
from this study can inform
policymakers and
healthcare institutions in
crafting strategies to
improve physicians’
understanding and
adherence to ethical
hospitals. The study
specifically highlights the
role of the perspective
doctors or physicians in
implementing the process.
One key observation is the
apparent inconsistency in
doctors’ attitudes towards
patient consultation and
autonomy, regardless of
hospital category or
specialty. The identified
inconsistency underscores
the need for systemic
changes and enhanced
training to foster a culture of
patient-centered care. The
research further reveals
deeper systemic issues. For
example, issues such as the
influence of hospital funding
schemes on medical
practices portray a potential
conflict between patient
welfare and revenue
generation.
© 2021 Walden University, LLC
among physicians,
particularly in complex
ethical dilemmas. The
evident gap poses
significant implications for
patient autonomy and
confidentiality. It especially
exemplifies the need for
enhanced legal education in
medical training. The
research is further
informative on the actions to
improve the physicians’
legal knowledge of patient
confidentiality and informed
consent. For example, the
study calls for systemic
changes in medical
education and continuous
professional development.
According to the study, the
approach can help
physicians have the legal
knowledge to make
informed and ethical
decisions in their clinical
practice. The strategy can
also mitigate potential
ethical mistakes and
associated lawsuits about
patient confidentiality and
informed consent.
interpretation and
application of ethical
principles in healthcare. The
marked contrasts in
addressing similar ethical
dilemmas in China and the
United States highlight the
necessity of grasping the
cultural and legal
foundations guiding ethical
decisions in varying
healthcare systems. The
knowledge therein is vital for
devising more effective and
culturally sensitive policies
and practices in patient
care. The research also
underscores the dynamic
nature of bioethical
standards and legal
structures in both countries,
indicating an ongoing
evolution in response to
societal demands and
values. The evolving aspect
of bioethics suggests that
continual dialogue and
learning among diverse
healthcare systems are
imperative for advancing
ethical practices globally in
patient care.
8
standards in patient care.
Such measures are
essential for reinforcing the
patient-physician
relationship and
safeguarding patient
autonomy and
confidentiality.
© 2021 Walden University, LLC
9
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