See rubric in Syllabus Supplement for additional information and grading guidelines.
2
11
Patient Violence Against Nursing Staff and De-Escalation Courses: Literature Review
Name
NSG 410 Research and Evidence- Based Nursing Practice
Dr. Coffin
Patient Violence Against Nursing Staff and De-Escalation Courses: Literature Review
Overview and Introduction
Patient violence against nursing staff is an ongoing, and rising, issue in the healthcare field not just in the U.S., but worldwide. According to The Joint Commission (2018), workplace violence (WPV) occurs four times more in nurses in hospital settings than any other worker in the private sector. Nurses working in emergency departments are at the greatest risk of verbal and/or physical assault than any other unit of nursing due in part to being the first point of contact with the patient from the outside (Wong et al., 2015). That being said, WPV still occurs in all nursing fields putting each nurse working bedside at risk. Using meticulous technique, a literature review was conducted using primary sources in the span of several weeks. Search terms such as “violence in nursing”, “workplace violence”, “occurrences”, and “de-escalation training” were combined and inputted into databases such as ProQuest, National Institutes of Health, and CINAHL with additional search terms applied when needed for clarification. The articles that will be discussed in this review were chosen because they are primary sources that moved the discussion forward on solutions to reduce patient violence against nurses. Knowles’ Adult Learning Theory was the theoretical framework used to guide this research with the understanding that adult learning is mainly self-directed and self- motivated, so in order to be able to implement successful education programs, such as that of this intervention, this understanding must be acknowledged (Casey, 2019). Comment by Rebecca Coffin: The problem is clearly presented and data is provided to show the magnitude of the problem Comment by Rebecca Coffin: Search terms are provided Comment by Rebecca Coffin: No need to use a theory to guide your paper, but you are welcome to do so if you wish Comment by Rebecca Coffin [2]: Great introduction!
Clinical Question
The clinical research question in focus for this literature review is as follows: Among nursing staff in acute hospital units, what is the effect of de-escalation training courses in reducing the number of violent events compared with learning de-escalation on the job, within 12 months of implementation. Comment by Rebecca Coffin [2]: PICOT
Appraisal of Articles
With Knowles’ Adult Learning Theory in mind, articles were chosen that exemplified the integration of adult learning into their interventions. In the article “Management of Aggressive Patients: Results of an Educational Program for Nurses in Non- Psychiatric Settings,” by Casey (2019), a non- experimental one-group, pre-post test design was used to evaluate the effectiveness of an education program that utilized multiple teaching strategies. The study recruited 36 registered nurses from a neurological unit in an adult hospital in southern United States. The program was delivered in a hybrid format over 6 weeks that utilized online presentations as well as in person classroom sessions. In line with the theoretical framework, the researchers utilized case studies to foster critical thinking, face to face role play was used demonstrate and build up de-escalation techniques, and group reflections were used to collectively bring together what was learned. Data was collected using self- reported Likert scale questionnaires that were validated by experts in emergency and psychiatric nursing. Analysis of the data concluded significant improvement in demonstration of preparedness and increased confidence in managing aggressive behaviors through the use of the designed educational program. Comment by Rebecca Coffin [2]: Don’t need to include the title of the article in APA style
The major limitation of the study was the small sample size not being significant enough to be generalizable. There was also time constraints limiting the amount of time for learning but was necessary in this study to feasibly allow maximum number of participants due to having to work around shift schedules. The researcher in this study recommends expanding similar interventions into other acute hospital units.
The article, “Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomized controlled trial” by Bowers et al. (2015) implemented 10 carefully selected interventions into a clustered randomized control trial to study its effects on rates of conflict and containment. The study came about from the understanding that there is a need for RCT’s in this topic. The study comprised of 15 psychiatric wards surrounding central London with inclusion criteria being acute psychiatric inpatient wards and were excluded if the wards had any major changes coming up in the course of the 18-month study, if they didn’t have a permanent nurse manager on post, and if the staff vacancy rate was greater than 30%. With these criteria put in place, nurses in the included wards chose to participate bringing the total number of participants to 564 (88% of the potential total). The confidence in this sample size was confirmed in each category with a power analysis. Baseline data was collected for 8 weeks, then participants had 8 weeks to implement the trained interventions, and 8 weeks additional were for observation of the implementation. This study was double blind in that both researchers and participants were unaware of which was the control and which was the intervention. Wards were visited 2-3 times a week by researchers who delivered and collected questionnaires and answered any questions about the interventions in order to ensure strong reliability. Results showed the interventions implemented in the Safewards interventions were significantly effective in reducing patient conflict and containment. Given that the primary source of data collection came from questionnaires, the main limitation of this study was missing data from unsubmitted questionnaires by charge nurses working the participating shifts. After accounting for these deficits however, they concluded that the missing data was not significant enough to shift the findings. The second limitation and recommendation for future research was that the study length was too short of a time period to really see significant change after implementation. Comment by Rebecca Coffin: Good critique! Look for whether a power analysis was performed in quantitative studies Comment by Rebecca Coffin [2]: What effect does this have on the study? Is this a good thing to do?
This study understood that there was a lack of quantitative research on violence against nurses in the form of randomized control trials, so the research design itself was created with the hopes of being the trailblazers for future research to continue RCT’s in the study of this concept. By explicitly highlighting each limitation set forth in their study, they were able to use their limitations to pave the path for future research.
In the study “Educational and Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study” Hemati- Esmaeili et al. (2018), look beyond education at the bedside nurse level to go a step up the ladder to include managerial interventions. This study took place in Iran but many issues presented in this study are parallel universally to many other hospital settings. With a sample size of 44 nurses confirmed by a p value test, a workplace violence prevention program was developed in conjunction with the development of a new nursing position called the violence prevention nurse, whose role was to screen patients and their families upon arrival to the hospital for potentially aggressive behaviors. Careful analysis using SPSS software analyzed the results of the self-report surveys and focus groups and concluded that the implementation of the program significantly reduced fear associated with these violent events because the nurses felt more prepared to handle them. This study went a step further than the previously discussed studies by including a managerial intervention where a protocol was put in place of how to take care of staff who had been attacked. Comment by Rebecca Coffin [2]: Good point to highlight!
This study did an excellent job of highlighting the need for interventions that are individualized to each unique unit. They explained that many aspects of the design, such as altering the questionnaire scales used to better suit Iranian culture, was a big step in improving fidelity in the study because the nurses could answer more accurately. Unique to this study and also not included in the previously mentioned studies, was a follow up survey four months after conclusion of the study. Researchers could still see strong evidence of the interventions being implemented. Follow up studies should be included in future research in this topic to measure long term effects. Comment by Rebecca Coffin [2]: That is a good thing to do to check how long the effect lasts
The study “Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation- Enhanced Interprofessional Curriculum further enhance the findings from all the previously mentioned studies by integrating teamwork into simulation scenarios using larger sample sizes. Wong et al. (2015) hoped that through implementation of an interprofessional curriculum into simulation enhanced education, teamwork and staff attitudes toward patient violence would improve. Ten 3-hour simulation sessions were conducted for this study. In the simulation, formal roles were predetermined, meaning each member of the healthcare team knew exactly what their roles were immediately once a violent event was occurring. The study recruited 162 ED staff members. Surveys used to collect data were published from a British nursing education group that showed reliability and internal validity. Data collected was reflective of participant’s changing attitudes through the duration of the course. Risk for bias in response was present though in that evaluators of the program were in leadership positions within the participating department, which may have confounded responses with staff members answering in responses favorable to the evaluators. As was the main theme with all the studies discussed thus far, the main limitation of the study was time constraints and lack of longitudinal data. Comment by Rebecca Coffin: Another great critique!
Given the emotional magnitude of this research topic, it was necessary to include a qualitative study into this review to increase the magnitude of its relevance to the nursing profession and place further emphasis that research in this field is what the people directly involved want. The qualitative phenomenological study “The Patient Care Paradox: An Interprofessional Qualitative Study of Agitated Patient Care in the Emergency Department” by Wong et al. (2016), took their research further from the previously discussed study to look at the experience of these healthcare workers to provide a broader perspective of ED patient violence. Convenience, but purposive, sampling was used to recruit participants. This study took careful measures to reduce bias in all aspects of the study. For example to balance out and decrease bias during data collection, the research team consisted of 2 board certified ED physicians, but also 2 nurses working outside of the ED (palliative and midwifery) so as to maintain an insider/ outsider approach and to bracket potential personal biases which could have skewed the data collection. In the research design, 1 member of the research team with no prior relationships to any of the participants was trained for qualitative data collection while another member assisted in equipment setup and took field notes. The interview process was standardized and data was cross-checked. Interview responses and focus group discussions were all recorded, transcribed, and later professionally transcribed by a third party. In this study, data saturation was reached at 31 participants. Comment by Rebecca Coffin: Spell out “two” Comment by Rebecca Coffin: Here also, “two” should be spelled out Comment by Rebecca Coffin [2]: Spell out numbers <10 per APA style Comment by Rebecca Coffin [2]: Good!
Three themes were discovered as a result of these interviews. The first is the patient care paradox: that in the process of providing high- quality care for these potentially aggressive patients, staff are putting themselves at greater risk of a violent incident, and finding a balance is not easy. Under this theme, direct quotes were included that talked about injuries many of the participants sustained as a result of trying to provide quality care. The second theme was that teamwork is key to resolution of a violent situation, however, pre-existing conflicts up the linear ladder of command make it hard to fluidly work as a team. In this particular hospital, quotes were included that talked about how techs can’t do anything to de-escalate a situation unless the nurse is involved, and the nurse can’t prophylactically prevent a violent incident unless he/she gets orders from a doctor, and it causes delay in action when not all members are on the same page. The third theme was environmental factors that further exacerbate aggressive behaviors such as lack of privacy, volume of people. The main limitation of this study is that while data saturation was reached, this data may not be generalizable to all ED’s because it was conducted in a heavy volume, urban ED in New York City. Researchers also stated that descriptions of patient population were reliant on descriptions from participants and not confirmed with demographic statistical data, thus increasing the likelihood of personal and recall bias. Comment by Rebecca Coffin [2]: Fantastic review of the articles! The articles were relevant to the PICOT and you captured all the highlights
Conclusion
A literature review was conducted using five primary sources to examine the effect of de-escalation courses and interventions on patient violence against nursing staff in acute hospital units. Across each article presented in this literature review was the same recurring theme: change needs to occur to decrease the rate of patient violence against nurses and healthcare staff. The articles in review were not limited to the United States to allow a comparison of occurrence of patient violence worldwide. The similarities in research topic of each of these articles is enough to attest to the ongoing need for a long-lasting intervention. Each article highlighted that this is a significant problem that is only getting worse with time. Each article was able to recognize that any intervention showed improvements than no intervention. Comment by Rebecca Coffin [2]: Was there one intervention that was better than others? Why or why not?
Limitations encountered in the search for literature included a saturation of studies conducted in emergency departments and psychiatric wards. The study by Casey (2019) was conducted in an adult neurological unit but even in their discussion they explained how they borrowed scales more suited for emergency departments. Another limitation noted in these studies was that no matter what statistical data is published on rates of workplace violence in nursing, the number is always higher because there is always the incidences that don’t get reported. One strength of these studies was their use of self-report data collection to foster an outlet for these nurses and healthcare workers to have their thoughts heard that they might otherwise have been too scared to report for fear of job security or backlash. The limitation of time led to many gaps and inconsistencies in the results of a number of these studies. For example, the articles by Wong(year) and Bowers (year)both explained how implementing a new protocol for an entire hospital unit is a very time- consuming task in and of itself. They both explained how by the time their interventions were taught at the level suitable to continue on with the study, weeks had already gone by. In both discussions, it was highlighted that longer time for data collection would have allowed more significant results. Research must continue on this topic for the improvement of the nursing field as a whole. Comment by Rebecca Coffin [2]: Not surprising, I’m sure! Comment by Rebecca Coffin [2]: Yes but what do we know about the limitations of self-report? Comment by Rebecca Coffin [2]: Nicely done! I think you could have had a more definitive conclusion, but you did a great job in comparing / contrasting the studies overall
References Comment by Rebecca Coffin: References are formatted per APA guidelines
Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D., & Hodsoll, J. (2015). Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomized controlled trial. International Journal of Nursing Studies, 52(9), 1412-1422.
Casey, C. (2019). Management of aggressive patients: Results of an educational program for nurses in non-psychiatric settings. MEDSURG Nursing, 28(1), 9-21.
Hemati-Esmaeili, M., Heshmati-Nabavi, F., Pouresmail, Z., Mazlom, S., & Reihani, H. (2018). Educational and managerial policy making to reduce workplace violence against nurses: An action research study. Iranian Journal of Nursing and Midwifery Research, 23(6), 478–485.
https://doi.org/10.4103/ijnmr.IJNMR_77_17
The Joint Commission. (2018). Physical and verbal violence against health care workers. Sentinel Event Alert.
Wong, A. H., Wing, L., Weiss, B., & Gang, M. (2015). Coordinating a team response to behavioral emergencies in the emergency department: A simulation- enhanced interprofessional curriculum. The Western Journal of Emergency Medicine, 16(6), 859-865.
https://doi.org/10.5811/westjem.2015.8.26220
Wong, A. H., Combellick, J., Wispelwey, B.A., Squires, A., & Gang, M. (2016). The patient care paradox: An interprofessional qualitative study of agitated patient care in the emergency department. Academic Emergency Medicine, 24(2), 226-235.
https://doi.org/10.1111/acem.13117
Stratford
University School of Nursing
Syllabus Supplement
1
Course: NSG 410, Research and Evidence-Based Nursing Practice
Term: 01, 2022
Faculty: Dr. Coffin
School of Nursing Standard Course Information:
1. Understand and follow all Stratford University and School of Nursing policies and procedures
as identified in the Stratford Catalog and the School of Nursing Student Handbook.
2. Students are expected to do their own work on exams, quizzes, and individual assignments.
When an assignment or homework is completed within a group process, the faculty will clearly
indicate it.
3. All assignments have a due date and time posted, and it is the student’s responsibility to know
when the assignment is due. If the student has a problem with accessing or turning in an
assignment due to Moodle/computer/technology issues, email the instructor so the problem can
be addressed.
4. All assignments/homework must be submitted via Moodle, not via email, by the due date to
receive full credit. If there is an extenuating circumstance and the student is not able to submit
the work by the due date, the student must contact the instructor prior to the due date.
5. Unless otherwise identified by the course faculty, all assignments submitted shall be submitted
as a “final” copy. Do not submit assignments as a draft.
6. The School of Nursing requires written work to comply with the most current APA standards
and formatting and comply with the Academic Integrity standards of Stratford University.
References and citations are expected when material submitted is not the student’s original
work (i.e., definitions, evidence-based practices, interventions, lists, descriptions, etc.).
Students are encouraged to use plagiarism websites to review for plagiarism as needed. A good
resource for APA formatting is https://owl.purdue.edu
7. Students must achieve a minimum grade of 80% (B-) to pass a Nursing course. When a course
has a clinical or lab component (pass/fail), the student must pass that component to pass the
course. Students passing the theory but failing the clinical/lab will earn an overall grade of not
more than C+.
8. Course assignments and homework are identified in the table below along with the topic
outline. Detailed directions and rubrics for assignments and homework are found in the
Important Documents area of the Moodle site for the course. Students are responsible for
following the directions and meeting the requirements of the assignments, homework, and
rubric(s).
The Syllabus Supplement contains additional information to the E-Syllabus for this course. The
contents of the Syllabus Supplement are an extension of the E-Syllabus for the course, and therefore,
are viewed as part of the official contract and requirements for the course. Students are responsible for
all information in the E-syllabus, the Syllabus Supplement, and all guides, rubrics, assignment
directions, etc., posted on the Moodle site.
https://owl.purdue.edu/
Stratford University School of Nursing
Syllabus Supplement
2
9. Read your Stratford email daily. All official course communication will be done via Stratford
email and/or the course Moodle site.
10. Some Nursing courses require completion of a practice and/or proctored assessments via a
product called ATI. Specific requirements for each course are identified in a separate
document. The student is responsible for completing all ATI requirements for the course.
11. Some courses include a simulation learning activity. Guidelines and learning outcomes for
each simulation are provided to the student.
12. Tests/exams and quizzes are given on the date and at the time listed for the course.
a. Students are expected to be in their seats and ready to begin class at the appointed time.
b. Exams will be the first item of class business and will start no later than 5 minutes after
the published class start time.
c. Students who arrive to class after the exam has been distributed, and the instructor has
announced that the exam has begun may not be allowed into the classroom as this
disrupts other students.
d. The student may be allowed to take the test elsewhere provided there is a room and a
proctor available and will be expected to return to class at the time appointed to resume
class after the exam is completed.
e. Students who arrive more than 30 minutes late for class will have the option of taking
the test but within a shortened time frame as they will be expected to return to class at
the time appointed for resuming class after the exam is completed.
f. In the event a student is cognizant of a situation that will prohibit the student from
attending class (i.e., hospitalization, emergency, etc.) the student is responsible to and
must contact the instructor prior to the exam to schedule a time to take the exam.
g. Students who miss the exam due to an approved absence or documented emergency
may be required to submit evidence supporting these claims within 5 workdays of the
exam date. If the claims are verified, the students will be allowed to make up the exam
without a point penalty. Students are allowed one make-up exam per term. The make-up
must be completed within 5 workdays from the absence including
the day of absence.
h. Students who miss an exam due to an unexcused absence, undocumented emergency or
tardiness will
receive a zero without an opportunity to the make-up exam.
i. All students will bring personal items to the front of the classroom. Cell phones will be
turned off, and students may be required to place the phone on the front table during all
exams.
13. Stratford University School of Nursing uses remote proctoring software to support on-line
test security. It is a requirement for all students enrolled in any course that begins with the
prefix NSG to have the following computer support available:
a. Students are required to allow electronic or web-based monitoring for exams and / or
quizzes. It may be a requirement to turn your camera on for the proctoring period (or
use a lock down browser). Failure to permit either of these types of monitoring
Stratford University School of Nursing
Syllabus Supplement
3
modalities will result in a “0” grade for the exam. This is considered an academic
integrity violation.
b. Desktop or laptop computer (no iPads, tablets) with the ability to download Google
Chrome
c. Google Chrome: version 80 or higher
d. PC: version Windows 10 or later; Min resolution 1024 x 60
0
e. Mac-version: Mac OS® X 10.13 or later; Min resolution 1024 x 600
f. Internet speed: The internet speed required is 0.092 – 0.244 Mbps. Internet speed can
be tested by using w w w . sp e e dt es t . ne t
g. Microphone: Any microphone, either internal or external
h. Webcam: 320×240 VGA resolution (minimum) internal or external
General School of Nursing Classroom Policies
1. Cell phones are a disruption to learning even in the ‘vibrate’ mode. Cell phones must be turned
off during class.
2. Laptops may be used for notetaking and desktop PowerPoint use. Wandering from the
appropriate Moodle site or ‘surfing the web’ will adversely affect the policy on use of laptops.
Students wandering from appropriate sites will be required to close and not reopen laptops for
the remainder of the course.
3. Eating is prohibited in the classroom. Beverages are permitted in non-laboratory classrooms.
4. Attendance is required by the University. Late arrival and early departures will directly affect
both the student’s understanding of the material and therefore potentially the final grade the
student earns.
5. Students arriving late for class or from breaks may be asked to remain outside the room until
the next break.
NSG 410 Student Learning Outcomes
Upon completion of this course, the student will be able
to:
1. Identify the critical components of a research report.
2. Discuss appropriate use of theory and conceptual frameworks in research.
3. Develop a research / evident-based practice question in an area of interest.
4. Conduct a literature search on a specific research / practice related topic and write a literature
review.
5. Analyze methods design, sample and variable measurements, and data collection procedures in
research studies and identify the strengths / limitations and appropriateness for practice within
each study.
6. Utilize national databases to find evidence to support practice as appropriate.
http://www.speedtest.net/
Stratford University School of Nursing
Syllabus Supplement
4
COURSE OUTLINE
Date Topic/Content Reading Activities
Week 1
Jan. 3-9,
2022
Introduction to Research and
Evidence-Based
Practice
Lobiondo-Wood &
Haber,
Chapters 1 & 2
Introduction Forum
Initial Post Due: 1/5
Introduce Yourself
Practice Quiz with
Respondus
Week 1 Worksheet
Week 2
Jan. 10-16, 2022
Theory in
Research
Literature Reviews
Lobiondo-Wood &
Haber,
Chapters 3, 4, & 11
Discussion Forum #1
Initial Post Due: 1/12
Responses Due: 1/14
Quiz #1: Jan. 14
Work on
PICOT
Assignment
Week 2 Worksheet
Week 3
Jan. 17-23, 2022
Qualitative Research
Appraising Qualitative
Research
Lobiondo-Wood &
Haber,
Chapters 5,6, & 7
Discussion Forum #2
Initial Post Due: 1/19
Responses Due: 1/21
Quiz #2: Jan. 21
PICOT Due: 1/22
Week 3 Worksheet
Work on APA Citations
Week 4
Jan. 24-30, 2022
Quantitative Research
• Experimental
• Quasi-Experimental
• Nonexperimental
Appraising Quantitative
Research
Lobiondo-Wood &
Haber,
Chapters 8, 9, 10, &
18
Discussion Forum #3
Initial Post Due: 1/26
Responses Due: 1/28
APA Citations Due: 1/29
Week 4 Worksheet
Week 5
Jan. 31-Feb. 6,
2022
Sampling
Legal and Ethical Issues
Lobiondo-Wood &
Haber,
Chapters 12 & 13
Discussion Forum #4
Initial Post Due: 2/2
Responses Due: 2/4
Quiz #3: Feb. 4
Work on Literature Table
Week 5 Worksheet
Stratford University School of Nursing
Syllabus Supplement
5
Week 6
Feb. 7-13, 2022
Quantitative Research
• Data Collection
Methods
• Reliability and Validity
Lobiondo-Wood &
Haber,
Chapters 14 &
15
Discussion Forum #5
Initial Post Due: 2/9
Responses Due: 2/11
Literature Table Due: 2/12
Week 6 Worksheet
Work on
Literature Review
Week 7
Feb. 14-20, 2022
Quantitative Research
• Data Analysis
Lobiondo-Wood &
Haber,
Chapter 16
Discussion Forum #6
Initial Post Due: 2/16
Responses Due: 2/18
Quiz #4: Feb. 18
Work on Literature Review
Week 7 Worksheet
Week 8
Feb. 21-27, 2022
Understanding Research
Findings
Lobiondo-Wood &
Haber,
Chapter 17
Literature Review
Due: 2/26
Week 8 Worksheet
Week 9
Feb. 28-Mar. 6,
2022
Evidence-Based Nursing
Practice
Quality Improvement
Lobiondo-Wood &
Haber,
Chapters 20 & 21
Discussion Forum #7
Initial Post Due: 3/2
Responses Due: 3/4
Quiz #5: Mar. 4
Week 9 Worksheet
Week 10
Mar. 6-13, 2022
Course Wrap-Up Discussion Forum #8
Reflection Post
Stratford University School of Nursing
Syllabus Supplement
6
Readings
Students should expect to spend a minimum of two hours studying or completing assignments outside
of class for every credit hour. This course is 4.5 credit hours, so the expectation is that each student
will spend at least 9 hours at home studying and completing assignments for this course.
It is an expectation that students will read the assigned chapters of the textbook. The lecture will
enhance but not substitute for the assigned readings. Videos and interactive learning materials will also
be posted on the Moodle page to support learning of concepts. Students are expected to review posted
material.
This is an online course. It is very important that you communicate effectively with the
course instructor in person or via email. Students are expected to use their Stratford email
account when communicating with the instructor. It is best practice to read SU Email and
Moodle daily for current updates.
Assignments
Discussion Forums (17.5% of total grade): Students will participate in online forum discussions. See
rubric in Syllabus Supplement for grading. Weekly discussion items are to stimulate and engage
learning. The student will be asked to critically analyze a topic or concept discussed in class and
submit your comments on a threaded discussion board. The student will be responsible for submitting a
weekly, two-part assignment:
• Part 1: The first part will be a summary of the topic in the student’s own words (minimum of
250 words) to demonstrate understanding of the topic. The student is required to cite all sources
used in forming the post using proper APA format. Most initial posts will require a “cosmic
question” at the end of the summary. The question should be thought -provoking and related
to the week’s discussion topic. Part 1 is due on Wednesdays by 2359.
**Students will not receive credit for late posts.
• Part 2: The second part of the discussion forum aims to keep the student thinking about the big
picture. Each student is required to provide a substantive response (minimum of 150 words) to
at least two of their classmates’ posts and cosmic questions. Sources used to inform the
response should be cited using proper APA format. Part 2 is due on Fridays by 2359.
**Students will not receive credit for late posts.
Other Assignments (32.5% of total grade)
Assignments must be professional in format. All work must be proofread for context, spelling, syntax,
and grammatical errors. Formatting must follow accepted academic standards to include proper APA
formatting for references and citations. References and citations are expected when material submitted
Stratford University School of Nursing
Syllabus Supplement
7
is not the student’s original work (i.e., definitions, evidence-based practices, lists, descriptions, etc.)
and to support statements that are not general knowledge. The level of matching on the Turnitin link
should be less than 30% and the use of quotations should be kept to a minimum. A maximum of two
quotations will be accepted in any assignment.
1. PICOT/The Research Question (5%)
The student will reflect on clinical nursing practice and write a research question. The question
will be developed by using the PICOT framework (Population, Intervention, Comparison,
Outcome, Time). The student will identify a nursing clinical question as follows:
• What individual or group am I curious about? (population)
• What key intervention am I curious about? (intervention)
• What intervention will I be comparing? (comparison)
• What do I hope to accomplish, or What would happen if I did this? (outcome)
• How much time will the intervention take to achieve the desired effects? (time)
The aim of the PICOT is to discover current research and promote best practices. The PICOT
will guide the Literature Review. The PICOT must have a nursing clinical focus. A rationale
for each element of the PICOT question must be provided and supported by a credible source.
Students will be able to resubmit the PICOT assignment one time.
2. APA Citations Assignment (5%)
Select 5 primary research articles published in peer reviewed journals. Write a simple
sentence for each article to demonstrate your knowledge of formatting in-text citations using
current APA guidelines. Then provide an APA-formatted reference list for the 5 articles.
3. Literature Review Table (7.5%)
A Literature Review Table provides a succinct overview of each article. The table is especially
useful when synthesizing the information from articles, as the main elements are clearly
identified. Complete the Literature Review Table using the articles identified from your
literature search that will be used in your Literature Review.
Students will be able to resubmit the Literature Review Table assignment one time.
4. Literature Review (15%)
Each student must prepare a literature review in relation to the PICOT. This is an opportunity
to read as a scholar and develop competence in analyzing the key elements of a research article.
The student should select five primary research studies from the literature search that was
conducted – each study must have been published in a peer-reviewed journal within the last 5-8
years with at least one study published in a nursing journal. Next, analyze and appraise the
merits of each manuscript. Then, synthesize the findings to compare the studies and determine
the strength of the evidence to answer your PICOT question. Last, write a paper (6-9 pages).
See rubric to guide development of the assignment.
**No review articles of any kind are appropriate for this assignment – select only primary
research articles.**
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Syllabus Supplement
8
Quizzes (50%)
1. Quizzes (10% each): Students will complete five quizzes. Each quiz must be completed with
Respondus LockDown Browser on the assigned date. The student’s entire face must be
visible in the camera during the entire quiz. No hats, sunglasses, headphones/earbuds may be
worn during the quizzes – these are grounds for suspicious student activity. Following the
quiz, the instructor will review all Respondus LockDown Browser reports and footage. Any
abnormal or suspicious activity detected by Respondus LockDown Browser could result in
the student’s grade being changed to a “0.”
The quizzes are challenging, and lack of preparation puts the student at risk for failing the quiz and
possibly the course. Avoid procrastination and use resources posted on Moodle to prepare.
Exam items are selected based on course content and the level of the course in the program progression
schema. Exam questions are selected to primarily evaluate Bloom’s cognitive levels of analysis,
synthesis, and evaluation. Exam questions may be multiple choice, multiple select, or other alternate
item formats.
Students who begin the quiz late will have the option of taking the test but within a shortened period.
Students who do not score a minimum of 80% on an exam are required to meet with faculty.
Exam Make-up
In the event a student is cognizant of a situation that will prohibit them from taking an exam
(i.e., hospitalization, emergency, etc.), the student is responsible to and must contact the
instructor by email/ office phone prior to the exam to schedule a time to take the exam.
Students who miss the exam due to an approved absence or documented emergency may be
required to submit evidence supporting these claims. If the claims are verified, the student will
be allowed to make up the exam without a point penalty. Students are allowed one make-up
exam per term. The make-up must be completed within 5 workdays from the absence including
the day of absence.
Students who miss an exam due to an unexcused absence, undocumented emergency or tardiness will
receive a zero without an opportunity to the make-up exam.
Exam Item Analysis
Following each exam, and before grades are posted, each exam question is analyzed. The exam
item analysis is used to evaluate student performance as well as the validity of exam items.
Should an exam question fail analysis, the question(s) will be eliminated and only the total
number of questions answered correctly out of the total number of remaining questions will be
scored for all students. Under no circumstances can a student receive a grade more than 100%.
Late Work
Discussions/assignments must be submitted on or before the scheduled date and time. All assignments
have a due date and time posted, and it is the student’s responsibility to know when the assignment is
due. Assignments will close at the designated time.
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Syllabus Supplement
9
No work will be accepted beyond this time, and a grade of zero will be posted. Emailed
assignments will not be accepted.
Moodle provides students a 30-minute window only to make edits before discussion/assignment is
“final.” The time posted on the assignment is used to determine the submission time. Be sure to post at
least 30 minutes earlier than the discussion/assignment is due to avoid late submissions. Forums for
Moodle assignments open and close automatically based upon due times. If the student has a problem
with the Moodle page, then the student must take a screen print of the error message and include it in
an email to the helpdesk and instructor at the time it occurs. Late assignments will not be accepted,
and a grade of zero will be entered into the discussion/forum/assignment.
Grade Item Unit Percentage Percentage of Total Grade
Quizzes and Examinations 50%
Quiz 1 10
Quiz 2 10
Quiz 3 10
Quiz 4 10
Quiz 5 10
Written Assignments 32.
5%
PICOT 5
APA Assignment 5
Literature Table 7.5
Literature Review 15
Discussions 17.5%
Discussion 1 2.5
Discussion 2 2.5
Discussion 3 2.5
Discussion 4 2.5
Discussion 5 2.5
Discussion 6 2.5
Discussion 7 2.5
Discussion 8 0 – attendance
Total 100%
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Office Hours
Office hours for this class are available by appointment. Please email to arrange an appointment.
Students may wish to purchase the study guide that accompanies the textbook, as it has many exercises
that will assist them to practice the main concepts of research.
Learning Resource Center (LRC)
Each Stratford University campus has a LRC with a dedicated staff. The LRC offers computer
terminals, a physical collection developed specifically for Stratford’s programs, and access to multiple
research databases and eBooks. Students are encouraged to use the LRC resources throughout their
program to supplement classroom instruction and assigned textbooks. Please visit your campus LRC
for information about policies and procedures. The electronic resources, along with information about
LRC holdings, can be accessed through the Stratford University website.
Students are expected to use the 7th Edition of the APA Publication Manual:
American Psychological Association. (2020). Publication manual of the American Psychological
Association (7th ed.). Washington, DC: American Psychological Association. (ISBN-13: 978-
1433832161 or ISBN-10: 143383216X )
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Grading Rubrics:
Discussion Forums
Discussion
Forums
Item Expectation % Points Total Item
percentage
Total
percentage
Timing Initial post
Posted by the due date. 10% 15% 25%
At least 250 words.
5%
Response
post
Posted by the due date. 5% 10%
At least 150 words.
5%
Content Initial post Answer must address and be relevant
to all questions
35% 40% 65%
Readability
5%
Cosmic
Question
Must be related to the chapter under
discussion.
10% 10%
Response Must respond to two peers’ cosmic
question.
15% 15%
Citation Referencing
in in APA
7th edition
style
Must have both intext citation and a
reference list.
10% 10% 10%
Total 100%
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PICOT Rubric
PICOT Weight Present Absent
Patient/Population (add rationale with reference) Required
Intervention (add rationale with reference) Required
Comparison (add rationale with reference) Required
Outcome (add rationale with reference) Required
Timing (add rationale with reference) Optional
Total:
(100% possible)
PICOT demonstrates applicability to nursing
profession
PICOT will be returned if
not nursing-related
Submitted by deadline
No late assignments
accepted
APA Assignment grading Rubric
APA Assignment grading Rubric % Total
5 in-text citations formatted using current
APA guidelines
10% for each correctly cited in-text citation 50%
Reference list of 5 articles formatted
using current APA guidelines
10% for each correctly cited reference list 50%
Grand total
100%
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Literature Review Table Rubric
Literature Review Table Rubric
Unsatisfactory
0
Partially
Proficient
15
Proficient
20
Exemplary
25
Score
Articles
0-1 primary research
articles are identified
2-3 primary research
articles
are identified.
4 primary
research articles
are identified.
5 primary research
articles are identified.
Articles
appropriate
to PICOT
0-1 primary research
articles appropriate to
PICOT
2-3 primary research
articles appropriate to
PICOT
4 primary research
articles appropriate to
PICOT
5 primary research
articles appropriate to
PICOT
Articles
uploaded to
Moodle
0-1 primary research
articles are included
with table
2-3 primary research
articles are included
with
table
4 primary research
articles are included
with table
5 primary research
articles are included with
table
Table There are major
errors in the table
There are several
errors and/or
incomplete data
There are some
missing data and/or
errors
The table is completed
appropriately
Total /100
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Literature Review Rubric
Introduction:
• Provides rationale for
student selection of
literature
• Discussed search terms
and techniques.
• Demonstrates the need for
this research question
Clinical Question (PICOT)
• Includes the clinical
question
Appraisal of Articles:
Uses established critical appraisal
criteria to evaluate essential
components of each reviewed
study, including but not limited
to:
• Type and size of sample
• Reliability and validity of
instruments
• Methodology
• Consistency of data
collection and procedures
• Appropriate data analysis
• Results
• Identification of
limitations
Synthesis/Conclusion:
• Reflection on the analysis
and synthesis of material
• Identifies gaps and
inconsistencies
• Summarizes overall
strengths and weaknesses of
the studies reviewed
• Discuss similarities and
differences of articles
Grammar
15-10 10-5 5-0
Meets all outlined criteria
and is succinct and
sufficient. Logically
demonstrates the need for
this research question
Does not meet one of
the criteria but is well
organized, and
sufficient. Logically
demonstrates the need
for this research
question.
Does not meet two or
more of the criteria and/
or is not organized, and
sufficient. The reader
cannot conclude the “so
what”.
5 3 0
Clinical question is clearly
stated
Clinical question can
be implied but was not
clearly stated.
Clinical question was
not stated and/or were
not apparent from the
literature review.
35-25 25-15 15-0
The appraisal reflects
accurate analysis of the
essential components for
all
studies
Five
appropriate articles
are reviewed.
The appraisal reflects
most (lacking 2 or
more elements) of the
essential components
for one or all the
studies
Four appropriate
articles are reviewed.
The appraisal reflects
some (lacking 4 or
more elements) of the
essential components
for either study
Three or fewer
appropriate articles
are reviewed.
25-15 15-10 10-5
Meets criteria. Well
organized, follows a
logical sequence that
allows the reader to arrive
at a logical conclusion.
PICOT conclusion is
clear and well-supported
by
the literature.
Does not meet 1-2 of
the criteria but is
organized, and/or
demonstrates illogical
sequencing
or structure.
Conclusions relating to
PICOT are vague
and/or unsupported by
the literature.
Does not meet >2
criteria and/or is
weakly organized with
no logical sequencing
or structure.
Conclusions relating
to PICOT cannot be
made.
10-7 6-4 3-0
There are no major
grammatical errors.
There are a few
grammatical errors.
There are major
grammatical errors.
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Support and Referencing:
• See Turn-It-In
• SEE SON
INTEGRITY
STATEMENT
10-8 7-5 4-0
Incorporates the text,
course materials, and
selected readings; does not
use Wikipedia or other
non-academic resources.
There are minimal to no
errors in formatting,
referencing and style.
There are moderate
errors in APA
formatting, style, and
referencing.
Severe errors in APA
style, formatting, or
referencing. Violates
the School of Nursing
Student’s Personal
Integrity Statement
more than 2 times.
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Student Personal Integrity Statement
I, (print your name here), am provided a hard copy (or e-copy for
online courses) of the Syllabus and Syllabus Supplement in NSG 410. I am aware of:
• All due dates, including exams, assignments, and penalties associated with late work/exams,
• Attendance policies and student’s responsibilities related to attendance and student nurse dress
code,
• Policies related to classroom and clinical behavior.
I recognize that personal integrity and truth telling is essential to the professional practice of Nursing
as discussed in the School of Nursing Handbook. I have read the syllabus and agree that:
• I alone am responsible for my personal behavior and academic conduct.
• Any academic misconduct or dishonesty are grounds for course failure and may result in
probation, suspension or dismissal from the Nursing Program and Stratford University. These
include but are not limited to:
o Cheating on exams,
o Using papers written by anyone other than myself, my team or from a concurrent class
o Using papers turned in for grade during previous or current terms
o Copying work from the internet or books or articles and not giving full credit to the
authors of that work; no more than 2 sentences may be quoted or paraphrased with in-
text citation per 6 sentences.
o Falsifying documents, records or presentations,
o Claiming to have done required course work (theory or clinical) that in fact I did not do
o Providing my work (papers, exams, presentations) to another student
• I am expected to arrive at class on time, stay for the entire time allotted course
• I am expected to follow class rules outlined in the Syllabus/Syllabus Supplement. Example: No
food in classrooms
• I am expected to treat my professor and my classmates with respect even when we disagree.
I accept all policies as written and agree to follow the Syllabus/Syllabus Supplement as outlined.
Signed:
Student Signature / Date
Dr. Rebecca Coffin January 3, 2022
Faculty Signature / Date
[Student keeps one copy/faculty files signed copy in students nursing file]
