Comment1.

In medicine, Levels of evidence (LoE) are arranged in a ranking system used in evidence based practices to describe the strength of the results measured in a clinical trial or research study (Wikipedia, 2018). A method utilized in evidenced based medicine to determine the clinical value of a study (Moore, n.d.). In grading scheme, scientific evidence can range from level 1 that is the most scientifically valid; to level 5 that is the weakest form of evidence (Sharma, n.d)

Different levels of evidence is categorized as follows:

Level 1: Randomized controlled trial (RCT) is a study in which the patients are randomly assigned to the treatment or controlled group and are followed prospectively. It can also be in a form of Meta-analysis of randomized trials with homogenous results (Moore, n.d). Sharma (n.d) states that optic neuritis treatment trial study is a perfect example of this level of evidence.

Level 2: Lesser quality RCT is a prospective comparative study. It is a study in which patient groups are separated non-randomly by exposure or treatment, with exposure occurring after the initiation of the study (Moore, n.d). Example of this study according to Sharma (n.d) is a scatter laser photocoagulation for occult choroid neovascularization.

Level 3: Retrospective cohort study pertains to the study in which groups are separated by the current presence or absence of disease and examined for the prior exposure of interest. A perfect example of this level is thrombolytic therapy for acute retinal arterial occlusion (Sharma, n.d).

Level 4: Moore (n.d) states that a level 4 is a Case Series, which means a report of multiple patients with the same treatment, but no control groups or comparison group. Example is macular translocation surgery for the treatment of Chroidal neovascular membrane (CNVM) and Age-related Macular Degeneration (AMD) (Sharma, n.d).

Level 5: Is a case report, or expert opinion, a mere personal observation. An interventional case reports can be classified as level 5 evidence, example is a removal of choroid neovascular membrane (Sharma, n.d).

Comment2

Meta-analyses –This is a high level of evidence due to the ability of meta-analyses being able to establish statistical significance across studies that may have had contradictory results.  By evaluating multiple studies at one time this increases the statistical significance than with just one study alone. Practice changes in psychology can occur as a result of meta-analyses.  The researcher looks over published studies, and then studies the results for trends.

Experimental studies and Quasi-experimental studies-These types of studies help to determine how effective certain nursing interventions are for patient outcomes.  As a result this could lead to many practice changes in nursing.

Nonexperimental studies-Descriptive and correlational studies are sometimes referred to as nonexperimental and the reason being is that evaluating the study variables is observed naturally and not under any type of control set by the researcher.

Program Evaluations, RU studies, quality improvement projects, case report.  In our textbook there is an example of a descriptive study design where women were studied with postpartum depression after having pregnancy complications.  The purpose was to describe barriers to treatment, use on internet resources for assistance for postpartum and their inclination for Internet treatment for postpartum depression.

 Does association imply causation? Why or why not?

Comment 1

Qualitative and quantitative methods differ in many ways, one being that quantitative data collection is much more structured than qualitative data collection method (DeFranzo, 2011). Qualitive research focuses on generating meaning and understanding to data that are related to opinions, concepts, values and behaviors of people in a social context. Quantitative research focuses on gathering numerical data to explain a particular phenomenon.  The use of either qualitative and quantitative methods depend on the research question of the study. However, researchers are now using mixed methodology research, which involves the use of both qualitative and quantitative methods with the assumption that it will address the research question more comprehensively then qualitative and quantitative method alone (Tarig & Woodman, 2013). Mixed methodology can be extremely beneficial to studies addressing complex multifaceted issues such as health service interventions.

A potential challenge in conducting mixed method research would be that qualitative and quantitative research methods belong to separate and incompatible paradigms. Both have different and conflicting ways of how they view the world and gather research data (Tariq & Woodman, 2013). Another challenge would be that it can be extremely time consuming to the researcher that it would benefit if it was conducted by a large team instead of just one researcher in order to conduct the study in a timely manner. Studies involving both quantitative and qualitative research can be challenging at times, however it also provides the researcher with a wider range of tools to answer their study question more efficiently.

Comment 2

With modern medicine advancing and new treatments invented each year, healthcare professionals including nurses need a reliable source of information to improve their practice and stay updated. Evidenced-based practice was implemented as a great tool that helps nurses to better provide their nursing care and improve patient’s outcomes. According to the article, “ Evidence-based practice (EBP) results from the integration of available research, clinical expertise, and patient preferences to individualize care and promote effective care decision-making”. ( Wyant, 2017)

There are few EBP models that are used nowadays in nursing. They all have five basic phases that make the process more effective:

1. Identification of a clinical problem.
2. Review of the relevant literature.
3. Critical appraisal of the evidence.
4. Evaluation for practice change and potential implementation.
5. Evaluation of he outcomes.

( Wyant, 2017)

Certain organizations use specific EBP models. However, their only goal is to identify the problem and find the solution in order to improve nursing practice and patient’s outcomes.

Comment 1

Science and religion is ongoing controversy that will remain in society as people’s beliefs are tested and trialed.  Science is a belief that if it cannot be proven, then it does not exist, and that all other beliefs that cannot be proven are merely false (Clark, 2015).  This can create many tense moments when someone’s loved one is in a hospital and maybe the end of life for them.  Their faith is tested and many turn away from God and ask, “Why are doing this to me, what did I do to deserve this?”  As stated, doctors are not saviors and they cannot heal all people, therefore to accept and understand the process may bring religion closer to the individuals (Meliaender, 2013).  Medicine has been more scientific than it has been religious in modern day, but more like older days, medicine has made a come around to become a more holistic approach to caring for individuals, which also includes religion in the practice.  I believe that there is a balance between science and religion when caring for patients.  If a patient or family member wishes to have a sentimental item or belief within a picture, rosary, or specific items, then the medical staff should honor those wishes as it will create a calming effect over the family to allow the medical professionals to care for the patient.

Comment 2

The perceived tension between science and religion stems from William Passavant’s description of the differences between the roles of deaconesses and nurses in 1899. Passavant defined the care provided by a deaconess as eternal service, providing care through love, and caring for the body to reach the soul (Shelly & Miller, 2009, p. 21). He defined the care provided by a nurse as service for financial compensation, with a motive based on a system rather than love, and a concern for the present welfare of a patient instead of their eternal future (Shelly & Miller, 2009, p. 21). The tension between these two concepts with regards to nursing care is ironic because regardless of the foundational discipline under which a provider has earned or accepted the responsibility to care for the ill or injured, the primary goal is the same; return the patient to the best state of well-being as physically, emotionally, mentally, and spiritually possible. Although the primary goal is the same, the philosophical and cultural differences between science and religion have the capability of pushing each discipline further from the other. With a scientific approach lacking a spiritual focus and a religious approach lacking a pathophysiologic focus, it is evident that a combination of the two is necessary to achieve the best possible outcome for our patients.