DNP 810 Explain why research articles that fail to meet these criteria cannot be used to provide evidence for the DPI Project

DNP 810 Explain why research articles that fail to meet these criteria cannot be used to provide evidence for the DPI Project

DNP 810 Explain why research articles that fail to meet these criteria cannot be used to provide evidence for the DPI Project

The collection of facts that are true, through intense research is called evidence. Therefore, there are different levels of evidence in the form of a pyramid to determine the validity of any research from the lowest being the weakest to the highest being the most authentic. However, as much as there is a level of evidence, there is not one standardized way of interpreting evidence. The level of evidence also known as the hierarchy of evidence is used as a guide to the various types of research that could be performed and helps to place them in categories, so that if the research is conducted properly, the answers will be most reliable (Melnyk, & Fineout-Overholt, 2018).

The highest-ranking level of evidence is the quantitative research which is the systematic review of the randomized control trials (RCT). It gives the best answer for what caused a situation and the effect of the situation because it synthesizes several studies compared with the lower levels of evidence which is based on descriptive and case studies, expert opinions. It is the strongest research method that produces the same results from multiple studies to produce the same outcome results (Melnyk, & Fineout-Overholt, 2018).

The DPI project that I have chosen is about finding out what is causing the reoccurrence of stroke and how it can be prevented. In my facility, there are many patients who are readmitted for stroke reoccurrence. So, the first article is a prospective study that is attempting to discover the clinical and the neuro imaging aspects that may be contributing the reoccurrence of stroke in these patients after they had been treated and are on medications (Hervella, et al., 2021). They conducted a retrospective study with a large number of people and it is primary research because there was ongoing observation and participation by the researchers and the participants (GCU, 2022).

The second article is also primary research because it is a summary of the study data that was conducted by others (GCU, 2022). Though the method used was the RCT method that was taken from a multiple center randomized double blind controlled trial. The purpose of the article was to asses the effect of the medication aspirin to prevent the reoccurrence of stroke compared to the other medicine nicametate and to identify the cause of stroke recurrence (Wang, et al., 2021).

These articles demonstrate support for my DPI project to find what is causing stroke reoccurrence and what interventions that needs to be taken to prevent the stroke reoccurrence.


Grand Canyon University (GCU), (2022). Levels of evidence in research.

Hervella, P., Pérez-Mato, M., Rodríguez-Yáñez, M., López-Dequidt, I., Pumar, J. M., Sobrino, T., Campos, F., Castillo, J., Da Silva-Candal, A., & Iglesias-Rey, R. (2021). STWEAK as predictor of stroke recurrence in ischemic stroke patients treated with Reperfusion therapies. Frontiers in Neurology12

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. LWW.

Wang, T., Wu, T., Pan, S., Chen, H., & Chiu, S. Y. (2021). Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients. Scientific Reports11(1).

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Stroke is one of the leading causes of death similar to STEMI’s and Sepsis. I have never analyzed the thought of recurring stroke however as I think back to all the patients I have cared for there are multiple causes of stroke-like symptoms after the initial stroke. I gathered information from a prospective cohort study that found recurring stroke has a higher mortality rate. The associated risk factors with second stroke were hypertension, chronic infarcts, and age. An astonishing 35.7% of the 1872 patients died during the follow-up of this study (Khanevski,, 2019). The organization I work for has recently became a stroke center and I receive data on all the patients our department activates a hyper-acute stroke protocol on. For 2021, the department activated approximately 54 potential stroke patients and of the 54, three were diagnosed with stroke. The challenging portion is educating patients and families to call 911 if stroke-like symptoms occur as time is brain. Patient and families decline to use ‘911’ and decide to drive themselves to clinics, their primary care offices and to the department I work in, Advanced Urgent Care. Patients tend to report they don’t want to “wait” in the ED. Nurses and providers continue to educate the population in our area that there is no wait when it comes to stroke-like symptoms.


I look forward to hearing about your progress with the DPI project.


Khanevski AN, Bjerkreim AT, Novotny V, Naess H, Thomassen L, Logallo N, Kvistad CE; NOR-STROKE study group. Recurrent ischemic stroke: Incidence, predictors, and impact on mortality. Acta Neurol Scand. 2019 Jul;140(1):3-8. doi: 10.1111/ane.13093. Epub 2019 Apr 11. PMID: 30929256; PMCID: PMC6594196.

Evidence is key for a successful evidence-based implementation project such as the Direct Practice Improve (DPI)

DNP 810 Explain why research articles that fail to meet these criteria cannot be used to provide evidence for the DPI Project
DNP 810 Explain why research articles that fail to meet these criteria cannot be used to provide evidence for the DPI Project

project. The different levels of evidence in research are based on the methodology of the study (Dang & Dearhold, 2018). For instance, level one includes randomized-controlled trials, systematic reviews, and meta-analyses while level two includes cohort studies. Such levels are important as they determine the grade and strength of the study (Dang & Dearhold, 2018). In addition to the levels of evidence, research can be divided into primary and secondary research. Primary research refers to studies that include active participation by the research, while secondary research are summaries or synthesis of data. Research articles that fail to meet the required level of evidence cannot be used as the lack of strength may lead to issues and ultimately lead to poor outcomes.

The DNP project that I would like to focus on revolves around the skill of inserting intravenous (IV) catheter skills and the confidence levels of nurses in an acute medical-surgical unit.


The first article by Ramer et al. (2016) qualifies as a primary research article because it utilized a randomized controlled trial to determine the effectiveness of using intravenous assistive devices (such as the VeinViewer) when inserting IV catheters. In the study, 53 patients were randomly assigned to either the standard methods group or the VeinViewer group. After each IV insertion, nurses filled out a questionnaire that evaluated their confidence level and competency assessment (Ramer et al., 2016).


The second article by Marsh et al. (2018) also qualifies as a primary research article because a randomized control trial was performed to determine which insertion method was more effective in eliminating complications (such as phlebitis and infiltration) while increasing dwell time, insertion attempts, and insertion success (March et al., 2018).




Dang, D., & Dearholt, S.L. (2018). Johns Hopkins nursing evidence-based practice : Model & guidelines (3rd ed). Sigma Theta Tau International

Marsh, N., Webster, J., Larsen, E., Genzel, J., Cooke, M., Mihala, G., Cadigan, S., & Rickard, C. (2018). Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomised controlled trial. Trials,

19(1), 1–10.

Ramer, L., Hunt, P., Ortega, E., Knowlton, J., Briggs, R., & Hirokawa, S. (2016). Effect of intravenous (IV) assistive device (VeinViewer) on IV access attempts, procedural time, and patient and nurse satisfaction. Journal of Pediatric Oncology Nursing33(4), 273–281.