Evidence Based


Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of the selected article. Article #1 Article #2 Article #3 Article #4
  De Vries, K., & Plaskota, M. (2017). Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer. Palliative & supportive care, 15(2), 148-157.


Dwarswaard, J., & van de Bovenkamp, H. (2015). Self-management support: a qualitative study of ethical dilemmas experienced by nurses. Patient education and counseling, 98(9), 1131-1136. Ganz, F. D., Wagner, N., & Toren, O. (2015). Nurse middle manager ethical dilemmas and moral distress. Nursing Ethics, 22(1), 43-51. Sasso, L., Bagnasco, A., Bianchi, M., Bressan, V., & Carnevale, F. (2016). Moral distress in undergraduate nursing students: A systematic review. Nursing Ethics, 23(5), 523-534
Evidence Level *

(I, II, or III)


This is a level I research article Level I research article Level I research article Level II research article
Conceptual Framework

Describe the theoretical basis for the study (If there is no one mentioned in the article, say that here).**


A phenomenological approach to the study was utilized. The adaptation of self-management and medical ethics There was no conceptual framework identified There was no conceptual framework identified

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

Descriptive design: semi-structured interviews were conducted with a purposive sample of seven hospice nurses who had cared for a terminal patient in the last year in the South of England A qualitative study with a descriptive design: semi-structured interviews were conducted involving six experts on self-management and medical ethics and 15 nurses. A qualitative study with a descriptive design: Primary focus was on personal characteristics questionnaire Qualitative research through the use of systematic reviews was conducted.

The number and characteristics of

patients, attrition rate, etc.

Seven hospice nurses who had cared for a patient in the last 12 months were selected.


6 experts in self-management and 15 nurses were selected The convenience of a sample of middle managers was used. 157 articles were selected for review.
Major Variables Studied

List and define dependent and independent variables

IV: Ethical dilemmas faced by hospice nurses (they are dilemmas existing as part of their work.

DV: palliative sedation to patients with terminal cancer (The cause of the dilemma that is being measured)

IV: Self-management support (How nurses undertake their self-support mechanisms when handling different cases)

DV: Ethical dilemmas experienced by patients (these are the dilemmas being measured against their impact on self-care)

IV: Middle managers (the subject of the study upon whom considerations are made)

DV: Ethical dilemmas and moral distress (range of ethical problems they face).

IV: Undergraduate nursing students (the subject upon which the moral dilemmas have an impact)

DV: Moral dilemmas they face (the elements that influence the undergraduate nurses)


Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

It was established that various concepts and prevailing assessments influence the dying process that promotes the understanding of ethical dilemmas. They include the use of terms such as peaceful death, comfortable, relaxed, calm, juggling the drugs, causing death, and requesting sedation. Three critical dilemmas were used to measure the outcome of the study, including. Consequently, respecting patient autonomy was compared to reaching optimal health outcomes, stimulating patient involvement, and safeguarding professional boundaries. Mid-level managers experience low to moderate frequency and intensity of ethical dilemmas. Inequalities in healthcare disparities, relationships with mentors, and the nursing care provided determine how one deals with moral distress.
Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

Qualitative findings: Seven key phrases for discussing various levels of ethical considerations were determined.


Qualitative findings: three ethical considerations were determined. Qualitative findings: Low to moderate intensities of moral distress were established. Qualitative findings: Studies indicated various levels of disparities and ethical dilemmas have been studied over time.
Findings and Recommendations

General findings and recommendations of the research

Hospice nurses frequently encounter ethical and emotional dilemmas when administering palliative sedation Nurses providing self-management support were at risk of difficulties facing ethical and professional considerations of care. Middle Managers experience some form of moral distress hence the need to focus their attention on critical challenges they have. There have been critical studies that have been conducted that are central to the understanding of ethical and moral dilemmas faced by undergraduate nurse students.
Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of the study?

What are the risks associated with the implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

This research is critical in understanding how hospice nurses should manage care.

The research is very informative on what nurses should undertake to manage care, while at the same time the document offers limited information on progressive care. Implementing the proposals provided may provide hospice nurses with options for managing their patients and themselves in the long term.

This article is critical in understanding self-management support, especially with regards to the ethical dilemmas experienced by nurses. It offers a depth analysis of ethical issues, even though it is lacking in the breadth of research. Moreover, the article gives a clear process of application of the risks facing nurses who wish to implement the ethical issues they face in the long term. Moreover, the outcome of the research is practical and easy to apply in the long term. In nursing practice, it is necessary to underscore the various levels of healthcare adaptations. This article is important in understanding the middle managers’ moral distress and ethical dilemmas they face in the long term. It offers a strong appreciation of the values of healthcare and the minimal characteristics of care they face. On the flip side, the article does not provide critical detail on how to manage different expectations. Nonetheless, it is a feasible output to the development of nursing care in various capacities. This article is essential in understanding how undergraduate nurses can adapt to the various levels of care and how this offers them the opportunity to learn how to dispense their duties when they reach this stage. The greatest challenge of this article is that it offers a limited analysis. Nonetheless, it is a process that builds a strong position for the nursing profession by preparing nurses while in training to build their position as professionals.
Key findings


Hospice nurses often encounter difficulties and other challenges such as healthcare disparities when administering palliative sedation. Supporting this practice, therefore, requires critical skills and professionalism to overcome these challenges. Ethical dilemmas and moral distress are subjectively interpreted by nurses, hence making their determination a consequence of individual adaptation capacity. Middle-managers experience lower levels of ethical dilemmas and moral distress compared to nurses. The key findings of this research include the understanding that in nursing education, it is important to set moral distress as an important area of consideration to promote their long-term well-being as they begin their influence in the profession.


Critical care is promoted through a thorough training of the professionals expected to handle these assignments. The underlying relationship between patients and nurse professionals should provide a critical guiding principle in handling care because values between the nurse and the patient may clash while they are delivering the service to the patient. The interventions developed to assist nurses in growth are a critical element in promoting and evaluating long-term care. It is also essential to consider nurses when handling such interventions because of the high-intensity moral distress they undergo. This research demonstrates that nurse students face some critical challenges with regards to the alignment of healthcare needs for caregivers such as nurses and that this care should begin when they are still in training.
General Notes/Comments The nurse professional in charge of hospice care must be able to undertake their professional responsibilities while avoiding any unacceptable or unprofessional emotional interactions during their work. The underlying influence of personal relationships is a central theme in self-management since it presents critical positioning in building and sustaining ethical standards that limit different dilemmas. Middle-level managers must take a more proactive role in assisting nurses to overcome certain challenges with regards to building and sustaining long-term care for nurses. Nurse students are critical in understanding some of the moral distress challenges nurses face from early on in their research education.

* These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

· Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

· Level II

Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

· Level III

Nonexperimental, a systematic review of RCTs, quasi-experimental with/without meta-analysis, a qualitative, qualitative systematic review with/without meta-synthesis

· Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

· Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

· The following information is from Walden academic guides which help explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework

· Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

· As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study are unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

· Theoretical and conceptual frameworks provide evidence of academic standards and procedures. They also explain why the study is pertinent and how the researcher expects to fill the gap in the literature.

· Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.


The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: Appendix C: evidence level and quality guide. https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your house. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. https://academicguides.waldenu.edu/library/conceptualframework

Critical Appraisal Tool Worksheet Template

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now