Cardiac Complications: Direct Practice Improvement Project Prospectus

Introduction

The quality of care in coronary care units (CCUs) has undergone considerable changes and improvements. Many methods are available to achieve positive results, avoid cardiac complications, and predict deaths or other negative health outcomes in patients. In this prospectus of a direct practice involvement (DPI) project, the idea of using capnography during cardiopulmonary resuscitation (CPR) of patients in the CCU will be developed to evaluate its efficacy on recovery dynamics and the associated level of patient satisfaction regarding care. This topic is worth investigating because while various treatment scenarios have already been developed, nurses still demonstrate uncertainty in using this method to monitor patients’ end-tidal carbon dioxide (ETCO2) levels. In their studies, Lin et al. (2017), Novais and Moreira (2015), and Pantazopoulos et al. (2015) proved the need for volumetric or another type of capnography for patients having bronchoscopy sedation, post-surgery anesthesia, and defibrillation. The need to develop similar research from new perspectives and under different conditions is evident. This DPI project will focus on the use of capnography during cardiac arrest.

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Introduction
This section briefly overviews the research focus or problem, why this project is worth conducting, and how this project will be completed.
The recommended length for this section is one paragraph.
  1. Direct Practice Improvement Project topic is introduced.
  1. Describes how the project extends prior research or fills a “need” or “defined gap” from current literature.
NOTE: This Introduction section elaborates on Point #1(the Topic) from the 10 Strategic Points. This Introduction section provides the foundation for the Introduction section in Chapter 1 of the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Background of the Problem

Patients may ask for professional help for different reasons and under various conditions. The nurse’s task is to examine people and record their vital signs, ensuring readiness to provide effective care. Carbon dioxide (CO2) is a major product of metabolism that is transported via perfusion or expelled via ventilation, and nurses must know how to monitor the ETCO2 level (Dioso, 2014; Duckworth, 2017). If ETCO2 levels are poorly or incorrectly measured, the patient’s condition may worsen quickly, and the process of resuscitation can be a challenge. One possible outcome is the return of spontaneous circulation (ROSC), when nurses and other medical staff must monitor the duration of the condition and any changes in a patient (Bullock, Dodington, Donoghue, & Langhan, 2017). Fatal results are possible even if the staff is properly prepared and all preventive measures are taken (Israel, 2014; Kuisma et al., 2017). Therefore, it is vital to learn methods that can be applied in a CCU and fill in any existing gap in practice.

Capnography is offered as a possible measurement tool in resuscitation that helps to evaluate coronary perfusion pressure (CPP) and track any changes in coronary blood flow. Cardiac arrest results in approximately 1,000 deaths per day in the United States, and nurses must take a number of steps, including the promotion of CPR and control of ROSC (Edelson et al., 2014; Kodali & Urman, 2014; Mader, Coute, Kellogg, & Harrism, 2014). Normal levels of ETCO2 are between 35 and 45 mmHg, and capnography indicates when remarkable changes occur, provoking new cardiac problems, poor ventilation functioning, and abnormal chest compressions (Kiekkas, Stefanopoulos, Konstantinou, Bakalis, & Aretha, 2016; Liu, Poon, & Tsui, 2016; Sheak et al., 2015; Venkatesh & Keating, 2017). The use of capnography has already been successfully researched in patients with chronic hypercapnic respiratory failure because of hypoventilation, severe hypothermia, or metabolic changes (Cereceda-Sánchez & Molina-Mula, 2017; Chhajed et al., 2016; Darocha et al., 2017). Nurses must continue to improve their knowledge regarding cardiac arrest, capnography, and quality of care in order to avoid potential gaps and shortfalls in their practice.

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Background of the Problem
The background section explains both the history of and the present state of the problem and project focus.
The recommended length for this section is two-three paragraphs.
  1. Identifies the “need,” or “defined gap” that will lead to the research problem statement in a following section. Citations from the literature in the last 5 years describe the problem as a current “need” or “gap” for further research.
  1. Discusses how the “need” or “defined gap” has evolved historically into the current problem or opportunity to be addressed by the proposed project.
  1. ALIGNMENT: The problem statementfor the Direct Practice Improvement Project will be developed from and justified by the “need” or “defined gap” that is described in this section and supported by the Literature.
NOTE: This Background of the Problemsection uses information from Point #2 (Literature Review) in the 10 Strategic Points.This Background of the Problemsection becomes the Background of the Projectin Chapter 1 in the Proposal. It is then expanded to develop the comprehensive Background to the Problem section in Chapter 2 (Literature Review) in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as, uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Theoretical Foundations and Review of the Literature/Themes

An understanding of theoretical foundations is a critical step in developing the DPI project. This will facilitate identifying the characteristics of resuscitation and the use of capnography in a CCU. Two middle-range theories will be applied in the chosen context: the conceptual model of nursing (CMN) and the middle-range nursing theory of self-efficacy (NTSE). The literature review is another stage of the DPI project where the researcher must be able to find sufficient applicable material and will divide the discussion into several logical themes, enhancing knowledge of the practical use of capnography in nursing care.

Theoretical foundations

In this quantitative project, two major variables for discussion must be noted. The first involves capnography as a nursing tool used to carry out certain duties. The CMN offers a good contribution to this foundation as it allows developing a multidimensional analysis of tasks, monitoring and defining the types of work to be performed (Lin, Guerguerian, Laussen, & Trbovich, 2015; Yen et al., 2016). Dependent variables, including patient satisfaction and the quality of recovery dynamics, may be evaluated in terms of the NTSE, the essence of which is to clarify the relationship between self-efficacy and outcome expectations (Smith & Liehr, 2018). This theory explains the value of care quality and its dependence on the level of professionalism that nurses demonstrate. The combination of models shows that the use of capnography requires not only an satisfactory level of knowledge but also the ability to identify and meet patients’ expectations as well as encourage compliance.

Review of the literature/themes

Cardiac arrest plays a crucial role in the study as a condition that requires the use of capnography. This phenomenon is explained as “the cessation of cardiac mechanical activity confirmed by the absence of a detectable pulse, unresponsiveness, and apnea” (Tobi & Amadasun, 2015, p. 132). Capnography and its main features must be clearly defined in the project as this tool promotes positive outcomes in resuscitation and effective measurement of the stroke volume index (Kalmar et al., 2018; Langhan, Shabanova, Li, Bernstein, & Shapiro, 2015; Turle, Sherren, Nicholson, Callaghan, & Shepherd, 2015).

Clinical indicators include its use in CCUs, patient safety, and evaluation of vital signs (Kiekkas et al., 2016). Nurses must be familiar with the available types of capnography because its use depends on many factors. Volume, time, and side-stream capnography are frequently used in CCUs (Jaffe, 2017; Nassar & Schmidt, 2016). Nursing awareness of capnography must be encouraged in conditions when ETCO2 levels remain unknown (Hamrick et al., 2017). Finally, patients and nurses may experience various outcomes after the use of capnography, and reorganization of care may be required.

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Theoretical Foundations and/or Conceptual Framework
This section identifies the theory(s) or model(s) that provide the foundation for the project. This section should present the theory(s) or models(s) and explain how the problem under investigation relates to the theory or model. The theory(s) or models(s) guide the clinical questions and justify what is being measured (variables) as well as how those variables are related (quantitative) or the phenomena being investigated (qualitative).
Review of the Literature
This section provides a broad, balanced overview of the existing literature related to the proposed project topic. It describes the literature in related topic areas and its relevance to the proposed project topic findings, providing a short one-two sentence description of each theme/topic and identifies its relevance to the project topic supporting it with at least one citation from the literature.
The recommended length for this section is two-three paragraphs
  1. Theoretical Foundationssectionidentifies the theory(s), model(s) relevant to the variables (quantitative project) or phenomenon (qualitative project). This section should explain how the project topic or problem coming out of the “need” or “defined gap” in the Background to the Problemsection relates to the theory(s) or model(s). (One paragraph)
  1. Review of the Literature Themes/Topics section: This section lists the major themes or topics related to the project topic. It provides a short one-two sentence description of each theme/topic and identifies its relevance to the project topic supporting it with at least one citation from the literature. (One or two sentences per theme/topic).
  1. ALIGNMENT: The Theoretical Foundationsmodels and theories need to be related to and support the problem statement or project topic. The sections in the Review of the Literatureare topical areas needed to understand the various aspects of the phenomenon (qualitative) or variables/groups (quantitative) being studied; to select the design needed to address the Problem Statement; to select surveys or instruments to collect information on variables/groups; to define the population and sample for the project; to describe components or factors that comprise the phenomenon; to describe key topics related to the project topic, etc.
NOTE: The two parts of this section use information from Point #2 (Literature Review) from the 10 Strategic Points.This Theoretical Foundations section is expanded upon to become the Theoretical Foundationssection in Chapter 2 (Literature Review). The Theoretical Foundationssection is also used to help create the Advancing Scientific Knowledgesection in Chapter 1. This Review of Literature Themes/Topicssection is expanded upon to provide the Review of the Literaturesection in Chapter 2 (Literature Review). The Review of the LiteratureThemes/Topicssection is also used to provide the basis for the Significance of the Project section in Chapter 1.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Problem Statement

Taking into consideration recent findings in the field along with the background of the problem, a new statement must be developed for this DPI project. Despite significant contributions to the discussion of capnography, it is not known to what degree the use of capnographs can be effective in patients undergoing cardiac arrest during resuscitation in CCUs (Heradstveit & Hetne, 2014). In addition, it is important to investigate the level of knowledge of nurses who are responsible for performing capnography. Their task is not only to use the machine and check the level of ETCO2 but also to be ready to share the obtained information with other medical staff and apply the data in further diagnosis and treatment (Hassankhani, Aghdam, Rahmani, & Mohammadpoorfard, 2015; Lin et al., 2015). It is important for nurses to improve their understanding of capnography in the context of CCUs, especially in the case of patients during resuscitation.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
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Problem Statement
This section includes the problem statement, the population affected, and how the project will contribute to solving the problem.
The recommended length for this section is one paragraph.
  1. Presents a clear declarative statement that begins with either:
    “It is not known how or why…” (qualitative),

or
“It is not known if or to what degree/extent…” (quantitative).

  1. Clearly describes the magnitude and importance of the problem, supporting it with citations from the literature.
  1. ALIGNMENT: The problem statement is developed from and justified by the “need” or “defined gap” defined by the Literature that is discussed in the Background to the Problemsection above.
NOTE: This section elaborates on Points #3 (Problem Statement) from the 10 Strategic Points. This section becomes the foundation for the Problem Statement section in Chapter 1(and other Chapters where appropriate) in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format
Comments from Evaluator:

Clinical Questions and Variables

The idea of this quantitative project is to investigate capnography as an opportunity to achieve positive health outcomes and predict cardiac complications. The research is organized to compare the conditions and results when capnography is used or is not used during resuscitation of patients in a CCU. The main PICO question is as follows: “In the patients of a coronary care unit (P), how will the implementation of time capnography (I), compared to non-use of this intervention (C), influence the efficacy of the resuscitation process and the transition to ROSC (O)? Taking into consideration the already-discussed problem statement and theoretical foundations, the intervention, capnography, must be defined as an independent variable in the project. The success of the resuscitation process depends on how well nurses monitor ETCO2 levels and achieve positive recovery dynamics after cardiac arrest. Finally, it is necessary to evaluate overall satisfaction with the quality of care offered to patients. In total, the study includes three dependent variables and one independent variable:

  • DV1: recovery dynamics after cardiac arrest;
  • DV2: effectiveness of ETCO2 level monitoring in CCUs;
  • DV3: patient satisfaction;
  • IV1: capnography.

Additional clinical questions are based on these variables and the necessity to discuss the basics of capnography in CCUs:

  1. How effective is capnography in monitoring ETCO2 levels among cardiac patients in CCUs?
  2. What is the relationship between recovery dynamics after cardiac arrest and patient satisfaction in the context of capnography use?

As a result, several important hypotheses can be developed for this qualitative project:

  • H1: The use of capnography results in positive health outcomes in patients during resuscitation compared to non-use of the same tool.
  • H2: In CCUs, capnography is an important tool for monitoring ETCO2 levels in cardiac patients.
  • H3: Capnography is an effective tool to enhance positive recovery dynamics in patients who experience cardiac arrest.
Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
(0-3)
Chairperson or Reviewer Evaluation Score
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Research Question(s)
This section narrows the focus of the project and specifies the clinical questions to address the problem
statement. Based on the clinical questions, it describes the variables or groups and their hypothesized
relationship for a quantitative project or the phenomena under investigation for a qualitative project.
(2-3paragraphs)
  • The recommendation is a minimum of two clinical questions along with related hypotheses and variables is required for a quantitative project.
  • Also recommended is a minimum of two clinical questions along with the phenomenon description is required for a qualitative project.
  • Put the Clinical Questions in the appropriate Table in Appendix B based on whether the project is qualitative or quantitative.
  1. Qualitative Designs: States the clinical question(s) the project will answer, and describes the phenomenon to be studied.
    or
  2. Quantitative Designs: States the clinical question(s) the project will answer, identifies the variables, and presents the hypotheses.
  1. ALIGNMENT: The clinical questions are based on both the Problem Statement and Theoretical Foundation model(s) or theory(s). There should be no clinical questions that are not clearly aligned to the Problem Statement.
NOTE: This section elaborates on Points #5 (Clinical Questions) & #6Variables or Phenomena)from the 10 Strategic Points. This section becomes the foundation for the Clinical Question(s) section in Chapter 1 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Significance of the Project

The results of this project will show how capnography should be implemented in CCUs in order to stabilize the condition of patients who undergo cardiac arrest. Even though capnography helps to monitor and measure CO2, its implementation remains a poorly investigated topic due to a lack of nursing experience. If all the hypotheses are proved or partially proved, it may be recommended for all hospitals to turn attention to capnography during resuscitation. The improvement of nursing knowledge about the chosen technique can be promoted via the CMN with its multitasking and prolonged monitoring or via the NTSE with its expectations of self-efficacy. The same ideas may be extended in terms of qualitative or mixed methods projects by discussing capnography or resuscitation as phenomena in nursing practice. The health condition of patients who experience cardiac arrest will be stabilized and improved because nurses will be enabled to monitor vital signs effectively and predict cardiac complications in a timelier manner.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
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Chairperson or Reviewer Evaluation Score
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Significance of the Project
This section identifies and describes the significance of the project and the implications of the potential results based on the clinical questions and problem statement, hypotheses, or the investigated phenomena. It describes how the research fits within and will contribute to the current literature or body of research. It describes potential practical applications from the project.
The recommended length for this section is one paragraph.
  1. Describes how the proposed project will contribute to the Literature, relating it specifically to other studies from the Background to the Problem and Problem Statement above.
  1. Describes how the proposed project will contribute to the literature on the selected theory(s) or model(s) that comprise the Theoretical Foundation for the project.
  1. Describes how addressing the problem will have practical value for the real world considering the population, community, and/or society.
  1. ALIGNMENT:

Part 1 is based on specific studies from the Background to the Problemand Problem Statementssections above and identifies how this project will contribute to that Literature. Part 2 is based on specific model(s), theory(s) or variables from the Theoretical Foundationssection above and identifies how this research will contribute to the knowledge on those model(s) or theory(s). Part 3 reflects on potential practical applications of the potential research findings based on Literature in the field of practice.

NOTE: This section does not directly come from any section of the 10 Strategic Points. However it does build on the Background to the Problem, Problem Statementand Theoretical Foundationssections that are developed from the 10 Strategic Points.This section becomes the Significance of the Projectsection in Chapter 1 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Rationale for Methodology

Quantitative methodology has been chosen for conducting this DPI project. The main task is to identify whether capnography can bring positive results in caring for patients undergoing cardiac arrest and if it is effective during resuscitation. The essence of a quantitative study is to gather large amounts of data from different individuals, relying on their attitudes toward care and knowledge about capnography (Austin & Sutton, 2014; Barnham, 2015; Heale & Twycross, 2015). The efficacy of capnography can be proved by means of well-calculated numbers and statistical results that will facilitate determining whether hypotheses should be accepted or rejected (Center for Innovation in Research and Teaching, n.d.b). To answer the PICO question, an experiment must be organized to collect measurable data and discuss results that are generalizable to a large group of people (Gunnell, 2016). The offered method does not require much time or money to be developed, and credible information will be used.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
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Rationale for Methodology
This section clearly justifies the methodology the researcher plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. It uses citations from textbooks and articles on research methodology and/or articles on related studies.
The recommend length for this section is one paragraph and completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
  1. Identifies the specific project methodology for the project (quantitative, qualitative, or mixed).
  1. Justifies the research methodology to be used for the project by discussing why it is the best approach for answering the clinical question and addressing the problem statement. Uses citations from original sources in the literature on the specific research methodology to support the arguments. (NOTE: Books such as those by Creswell, which are secondary sources summarizing others approaches to research, may not be used as sources in this section).
  1. ALIGNMENT: The selected methodology should be justified based on the Problem Statementand Research Questions.
NOTE: This section elaborates on the methodology part of Point #7(Methodology and Design) in the 10 Strategic Points.
This section becomes the foundation for the Project Methodology in Chapter 1 of the Proposal and the basis for developing Chapter 3, Project Methodology.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format
Comments from the Evaluator:

Nature of the Project Design

Based on the selected quantitative methodology, an experimental design must be applied to the discussion of the current research questions. This method can be quantitatively measured without introducing new ideas and discussing well-known phenomena (Center for Innovation in Research and Teaching, n.d.a). The already-known capnography technique will be used as the intervention in the experiment with optimal variable control and manipulation (ETCO2 levels, recovery dynamics by way of the number of fatal outcomes, and the quality of care through patient satisfaction levels). Randomized control trials will be used to investigate the effects of capnography on the treatment of patients experiencing cardiac arrest. In experimental designs, subjects are measured before and after a technique is applied (Stephanie, 2016). In this case, the participants will be divided into two groups where one has access to capnography and the other receives standard monitoring without capnography. The comparison of results after the intervention will prove or disprove the efficacy of capnography.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
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Chairperson or Reviewer Evaluation Score
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Nature of the Project Design
This section describes the specific research design to answer the clinical questions and why this approach was selected. It describes the research sample being studied as well as the process that will be used to collect the data on the sample.
The recommend length for this section is one paragraph and completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
  1. Identifies the specific type of project design as well as a sample appropriate for the design. (e.g., Quantitative designs include descriptive/survey, correlational, causal-comparative, quasi-experimental, and experimental. Qualitative designs include case project, narrative, grounded theory, historical, and phenomenological.) Other designs are possible.
  1. Discusses why the selected design is the best design to address the research questions as compared to other designs.
  1. ALIGNMENT: The selected Project Design should be justified based on the research questions as well as the hypotheses/variables (quantitative) or phenomenon (qualitative). It should also be aligned with the selected Project Methodology.
NOTE: This section also elaborates on the Design part of Point #7 (Methodology and Design) in the 10 Strategic Points. This section provides the foundation for Nature of the Project Design in Chapter 1.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from Evaluator:

Purpose of the Project

The purpose of this quantitative DPI project with experimental (randomized control trial) design is to examine the degree to which capnography (independent variable) can be defined as effective in the improvement of care quality (dependent variable), recovery dynamics (dependent variable), and ETCO2 level monitoring (dependent variable) for patients undergoing cardiac arrest (participants) during resuscitation in CCUs (location). The independent variable should not be measured or changed during the project but must be defined as a technique to control exhaled CO2 partial pressure (Kiekkas et al., 2016). Nurses will be required to check their level of knowledge about capnography through the Nurses’ Knowledge about Capnography Test (NKCT). The dependent variables such as the recovery dynamics and ETCO2 levels will be measured by ordinal scales that allow comparison of the degree to which positive outcomes are achieved. Patient satisfaction with the quality of care will be measured via nominal scales with specifically characterized responses (“Satisfied,” “Neutral,” and “Dissatisfied”).

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
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Purpose of the Project
The purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the proposed project will contribute to the field.
The recommend length for this section is one paragraph.
  1. Presents a declarative statement: “The purpose of this _______project is….” that identifies the project methodology, research design, target population, variables/groups (quantitative), or phenomena (qualitative) to be studied, and geographic location. It often includes a version of the Problem Statement as a way to define the phenomenon or variables/hypotheses.
  1. ALIGNMENT: The Purpose Statement includes: Project Methodology, Project Design, and Problem Statementfrom the previous sections. It also includes the target population, which should be of sufficient size to provide a large enough sample to complete the project and provide significant (quantitative) or meaningful (qualitative) results.
NOTE: This section elaborates on Points #8 (Purpose Statement) in the 10 Strategic Points.This section becomes the foundation for the Purpose of the Projectin Chapter 1 of the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Instrumentation

The NKCT is a questionnaire intended to evaluate nurses’ level of knowledge about the tool of capnography. It is recommended that participating nurses take this test before and after the intervention to identify whether progress can be identified in terms of capnography use and its effects on recovery dynamics (Kiekkas et al., 2016). In this project, the data collection method will be quantitative observation. The same instrument has already been applied in various fields, including technology, education, health care, and psychology (Campbell, 2017; Guo et al., 2016; Katz-Buonincontro & Anderson, 2018). The larger the sample size, the more credible and valid the results of observations (Bhat, 2019). Questionnaires provide an easy and practical way to ask questions and receive definite answers that can be applied in further discussions (Flanagan, Greenfield, Coad, & Neilson, 2015; Kłak, Mińko, Siwczyńska, & Samoliński, 2015; Marques et al., 2014; Rowley, 2014). Patients will be given a questionnaire to gather their opinions about the quality of care and the effectiveness of capnography as a monitoring tool in treatment.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
(0-3)
Chairperson or Reviewer Evaluation Score
(0-3)
Instrumentation or Sources of Data
Describes, in detail, all data collection instruments and sources (tests, questionnaires, interviews, data bases, media, etc.). Discusses the specific instrument or source to collect data for each variable or group (quantitative project). Discusses specific instrument or source to collect information to describe the phenomena being studied (qualitative project).
The recommend length for this section is one paragraph AND completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
  1. Identifies and describes the types of data that will be collected to answer each Clinical Question for a qualitative project. Identifies the data that will be collected for each Variable/Group in a quantitative project.
  1. Identifiestools, instruments, or databases to be used to collect the data (e.g., observations, interviews, questionnaires, documents, media (qualitative), standardized tests, surveys, and databases (quantitative)). For a qualitative project, identify the specific tools, instruments, or databases for each research question in a qualitative project. For a quantitative project, identify the name of the specific “validated” and “previously used in quantitative research” survey or data source to be used to collect data for each variable, providing a citation for the instrument or data source.
  1. ALIGNMENT: Aligns with the Clinical Questions (qualitative) or Variables (quantitative) previously described in theClinical Question(s) and Phenomena orClinical Questions, Hypotheses, and Variables section above.Identifies and describes the data and data source that will be used to answer each Clinical Question for a qualitative project. Identifies, describes, and namesthe type of numerical data and specific data collection instrument or source that will be used for each variable and group in a quantitative project.

NOTE: This section elaborates on Point #9 (Data Collection) from the 10 Strategic Points.

This information is summarized high level in Chapter 1 in the Proposal in the Nature of the Project Design for the Projectsection. This section provides the foundation for Instrumentation (quantitative)orSources of Data (qualitative)section in Chapter 3.

NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Comments from the Evaluator:

Data Collection Procedures

In the chosen quantitative observations and questionnaires, quantitative data obtained during the implementation of the intervention is a core issue. Quantitative data collection is based on the decisions made and the level of involvement on the part of the participants (Hannigan, 2018; Watson, 2015). Observation of 80 patients will be carried out during the implementation of the offered intervention. Participants will be divided into two groups: experimental and control. Forty patients will be monitored with the help of a time capnograph (the experimental group), and the other 40 patients will be monitored using standard methods (the control group; avoiding capnography). The division into groups will be random, depending on the results documented in an envelope (there will be one envelope for each patient with the name of a tool to be used to be opened during an intervention). Ten nurses will take tests to check their level of knowledge about capnography and to share their opinions about recovery dynamics and ETCO2 level monitoring.

By means of a questionnaire after the intervention, patients who survive cardiac arrest will share their opinions about capnography along with an overall impression about the care offered during resuscitation and effects experienced after cardiac arrest. In general, patients would likely find it difficult to explain the value of capnography for measuring CO2 levels, and that is why the opinions of nurses by way of the NKCT tests are anticipated to be informative and effective sources of quantitative information.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
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Chairperson or Reviewer Evaluation Score
(0-3)
Data Collection Procedures
This section details the entirety of the process used to collect the data. It describes each step of the data collection process in a way that another investigator could replicate the project.

NOTE:It is recommended that the researcher get written approval (or at the very least unofficial approval) to conduct their practice project in their selected organization. Ensure the person (who is usually a school superintendent, school boards, or corporate officer) providing approval is authorized by the organization to grant approval for research. Do not assume your organization will allow you to collect data since many organization do not allow research to be completed within the organization.
The recommended length for this section is two paragraphs.

  1. Defines the target population and the expected sample size, which comprises the people or organizations being studied, as defined in the problem statement. For quantitative studies, it justifies why the target population and expected sample size (final number of people or organizations being studied for which data will be collected) is large enough to produce statistically significant results (quantitative) or meaningful results (qualitative).
  1. Provides an overview the proposed step-by-step procedure to collect data using the tools, instruments, or databases from the section above. Includes the steps (e.g., obtaining initial informed consent from participating organization; IRB review; sample selection; groupings; protecting rights/well-being; maintaining data security; sample recruitment; data collection instruments and approaches; field testing instruments; notifying participants; collecting the data, etc.) in a way another researcher can replicate the project. Steps may be provided in a list format.
  1. ALIGNMENT: Shows the steps and approach to collect data for each and every data source identified in the Instrumentation or Sources of Data section. Defines the sample as the set of people or organizations being studied for which data will be collected. The sample size must be correct for the type of design selected to get statistically significant (quantitative) or meaningful (qualitative) results.
NOTE: This section elaborates on Points #4 (Sample and Location) and #9 (Data Collection) in the 10 Strategic Points.
This section provides the foundation for the Data Collection Proceduressection in Chapter 3 in the Proposal. And it is summarized high level in Chapter 1 in Nature of the Project Design in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Data Analysis Procedures

Participants will include 80 patients undergoing cardiac arrest, 40 of which will receive capnography to monitor the ETCO2 level. Information about patients will be stored in an Excel spreadsheet for further analysis using SPSS statistical software. A Chi-square test will be used to identify and analyze the characteristics of the participants and achieved results (Ali & Bhaskar, 2016). Two-sided statistical tests with p-value <0.05 must also be developed (Leppink, O’Sullivan, & Winston, 2016). Five nurses will be responsible for monitoring patients and evaluating the value of capnography versus not using this tool. This quantitative project includes three hypotheses and three questions for statistical analysis. The first question and the hypothesis about the effectiveness of capnography use in patients during resuscitation will be analyzed via SPSS. The second question and hypothesis about ETCO2 level monitoring by means of capnography will be analyzed via an Excel spreadsheet. The third question and hypothesis about recovery dynamics will be analyzed via SPSS. Inferential analysis such as correlation will help in describing the relationship between the chosen variables, and a descriptive statistical analysis of the frequency of fatal and positive care outcomes will be conducted.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
(0-3)
Chairperson or Reviewer Evaluation Score
(0-3)
Data Analysis Procedures
This section describes how the data were collected for each variable or group (quantitative project) or for each research question (qualitative project). It describes the type of data to be analyzed, identifying the descriptive, inferential, and/or non-statistical analyses. Demonstrates that the data analysis is aligned to the specific project design.
The recommend length for this section is one paragraph AND completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
  1. Describes the analysis to examine each stated research question and/or hypothesis. For quantitative projects, describes the analyses including the inferential and/or descriptive statistics to be completed. For qualitative projects, describes the specific analytic approach appropriate for the Project Design and each clinical question to be completed. In qualitative projects the different clinical questions may require different approaches to doing qualitative data analysis, as well as descriptive statistics.
  1. ALIGNMENT: For qualitative projects, there is a clear and obvious alignment between each research question, data to be collected, tool or data source, as well as data analysis to understand/explain the phenomenon. For quantitative projects, there is a clear and obvious alignment between each variable, data to be collected, instrument or data source, as well as data analysis for each hypothesis.
NOTE: This section elaborates on Point #10 (Data Analysis) from the 10 Strategic Points.This section provides the foundation for Data Analysis Procedures section in Chapter 3 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Ethical Considerations

Ethical concerns must be properly identified and explained in quantitative research. These include norms for conduct and the ability to differentiate where right and wrong steps are taken, addressing such concepts as honesty, objectivity, and respect (Sanjari, Bahramnezhad, Fomani, Shoghi, & Cheraghi, 2014; Zyphur & Pierides, 2017). Such ethical concerns as voluntary participation, fabrication of information, and safety of participants will be solved by having a local Institutional Review Board provide oversight. Informed consent will be offered to every participant with an explanation of the goals and details of the project. Potential participants must learn the essence of this DPI project before they give their approval. They may also withdraw from the research study at any time without giving reasons. The personal data of the participants will be protected due to such issues as confidentiality and anonymity. A system of codes will be developed to avoid using actual names or even mentioning the gender or age of a participant.

Criteria (Required Components): score 0-3 Learner Self-Evaluation Score
(0-3)
Chairperson or Reviewer Evaluation Score
(0-3)
Ethical Considerations
This section discusses the potential ethical issues surrounding the project, as well as how human subjects and data will be protected. It identifies how any potential ethical issues will be addressed.
The recommended length for this section is one paragraph.
  1. Discusses potential ethical concerns that might occur during the data collection process.
  1. Describes how the identities of the participants in the project and data will be protected.
  1. Describes subject recruiting, informed consent and site authorization processes.
  1. ALIGNMENT: Ethical considerations are clearly aligned with, and relate directly to the specific Data Collection Procedures. This section also identifies ethical considerations related to the target population being researched and organization or location as described in the Purpose Statement section.
NOTE: This section does use information from any of the 10 Strategic Points.
This section provides the foundation for Ethical Considerationssection in Chapter 3 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

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Appendix A

10 Strategic Points Comments/Feedback
Broad Topic Area “Use of Capnography during Resuscitation of Patients in CCU”
The topic area of this Direct Practice Involvement (DPI) Project includes any improvements that can be made in the coronary care unit (CCU) on the basis of capnography being one of the possible methods to monitor the well-being of patients. The process of resuscitation is complex, and medical staff members have to be prepared to take any necessary steps, as well as recognize the various scenarios of threat development. This DPI project helps to develop a framework that ensures control over the levels of end-tidal carbon dioxide (ETCO2) is possible. Cardiac outputs of patients in a CCU setting and decreased mortality rates have to be investigated. In addition, special attention should be paid to the level of awareness of capnography among nurses, and their readiness to apply this technique to the patients in the CCU.
Literature Review Background of the Problem/Literature Gap
  • Nurses are responsible for monitoring and taking care of patients regardless of any individual’s condition, need, and expectations;
  • A patient’s condition may worsen anytime, and nurses have to be ready to respond quickly and apply all the necessary standards and skills for resuscitation (Dioso, 2014);
  • Resuscitation outcomes may be improved in a variety of ways, and the measurement of ETCO2levels is a crucial step within this activity (Langhan, Shabanova, Li, Bernstein, & Shapiro, 2015);
  • The return of spontaneous circulation (ROSC) during a heart attack may lead to fatal outcomes in different patients, including children, and it is essential for medical staff to employ accurate time management strategies (Bullock, Dodington, Donoghue, & Langhan, 2017; Kuisma et al., 2017);
  • Capnography is one of the possible methods to measure the level of ETCO2 during resuscitation, but not many hospitals use it to improve patients’ outcomes;
  • Although this tool helps to measure the coronary perfusion pressure (CPP) rate, there is a lack of opportunities to track the changes in the patient’s coronary blood flow and ETCO2levels (Hamrick et al., 2017; Pantazopoulos et al., 2015);
  • Therefore, it is necessary to investigate the peculiarities of the process of using capnography in order to create a sustainable environment for patients with cardiac arrests and be able to predict the worst possible outcomes.

Theoretical Foundations

  • Positive outcomes in understanding the process of resuscitation and the worth of capnography as the main monitoring tool can be achieved in terms of the application of two middle-range theories;
  • The aim of the chosen theoretical approach is to combine the need for interdisciplinary communication and specific nursing skills, and understand the benefits and challenges of capnography;
  • The Conceptual Model of Nursing (CMN) is based on the idea of multidimensional analysis that includes the necessity to deal with a variety of tasks, also known as multi-tasking, and sustained prolonged monitoring (Lin, Guerguerian, Laussen, & Trbovich, 2015);
  • The chosen framework allows to complete tasks at the necessary level, requiring conscious shifts in attention and defining the types of work that should be done: concurrent, dual, parallel, interleaved, or sequential (Yen et al., 2016);
  • The Middle Range Nursing Theory of Self-Efficacy (NTSE) promotes the idea of the development of competent relationships between nursing and medical staff members regarding two main components – self-efficacy expectations and outcome expectations (Smith & Liehr, 2018);
  • This framework makes the researchers pay special attention to such aspects as care, education, competency, and the level of professionalism in order to predict behavioral outcomes (Smith & Liehr, 2018);
  • The combination of these two perspectives provides a good opportunity to study the significance of capnography during resuscitation in patients in the CCU setting from the point of view of coordinating nurses’ actions, controlling the available data, and decision-making;
  • The chosen frameworks should help to improve the existing guidelines, cover the lack of nursing knowledge about capnography, and encourage compliance of the hospital standards.

Review of Literature Topics with Key Concepts
Cardiac Arrest and Cardiopulmonary Resuscitation (The Lazarus Phenomenon)

  • Cardiac arrest is one of the most urgent emergencies in a CCU (Pantazopoulos et al., 2015);
  • It is characterized by high rates of mortality because of poor prognosis and leads to more than 1000 deaths per day in the United States (Pantazopoulos et al., 2015);
  • Tobi and Amadasun (2015) use the following definition for this concept: “the cessation of cardiac mechanical activity confirmed by the absence of a detectable pulse, unresponsiveness, and apnea” (p. 132);
  • Cardiopulmonary resuscitation (CPR) is a spontaneous and personal call that is required to be developed by nurses and other medical staff to deal with cardiac arrest (Kodali & Urman, 2014);
  • Regardless of the fact that a number of advances are associated with CPR, the chances of survival are still only 10-20% of patients (Pantazopoulos et al., 2015);
  • According to the existing resuscitation guidelines, chest compressions have to be delivered “at a rate of at least 100 min-1and a depth of at least 50 m” (Sheak et al., 2015);
  • Resuscitation is the method that promotes the ROSC (Mader, Coute, Kellogg, & Harrism, 2014), but if it occurs after CPR, the nurses use the term “the Lazarus phenomenon”, also known as autoresuscitation (Kuisma et al., 2017);
  • It is important to follow clear and step-by-step guidelines to monitor this situation (10-minute monitoring is recommended before calling the time of death) (Kuisma et al., 2017);
  • To avoid the number of negative outcomes during CPR because of cardiac arrest, the measurement of expired carbon dioxide (CO2) is recommended (Kodali & Urman, 2014). Capnography is one of the available tools to complete this task.

Definition of Capnography

  • Capnography is defined as the promotion of ventilator function which aims to measure exhaled CO2partial pressure (Kiekkas, Stefanopoulos, Konstantinou, Bakalis, & Aretha, 2016);
  • The use of this method makes it possible to maintain the normal level of ETCO2,between 35 and 45 mmHg, and prevent its decrease to 10 mmHg or increase to more than 45 mmHg (Kiekkas et al., 2016);
  • Capnography has to be included within the available set of the device to monitor changes in patients in a short period of time;
  • It is a non-invasive technique and its use can help control the trend of ETCO2partial pressure in addition to the readiness for making a final decision about implementing ROSC (Venkatesh & Keating, 2017);
  • As well as cardiac problems, capnography can also be used as a method to control and predict hypoventilation that depends on such factors as respiratory drive and muscle tone (Lin et al., 2017);
  • It is effective in measuring the stroke volume index and cardiac outcome as the main possible achievement (Kalmar et al., 2018);
  • There are four main steps of capnography: “inspiratory baseline, expiratory upstroke, expiratory plateau and inspiratory downstroke” (Kiekkas et al., 2016, p. 40).

Clinical Indicators of Capnography

  • Cardiopulmonary resuscitation is one of the main applications for capnography when the absence of cardiac outcome and the inability to stabilize the pulmonary blood flow are observed;
  • This method of help may be offered to patients in the Intensive Care Unit or the Emergency Department;
  • Capnography may be used to rescue patients when such factors as central vascular resistance, pulse pressure variation, blood pressure, heart rate, and the level of ETCO2 are evaluated (Kalmar et al., 2018);
  • According to Kiekkas et al. (2016), low values of ETCO2 may also be signs of hyperventilation or hyperthermia in patients;
  • The evaluation of the arterial pressure and its analysis in terms of ETCO2 can also signal problems such as sepsis or partial obstruction of airways (Kiekkas et al., 2016);
  • The promotion of safety in patients is one of the major tasks for medical staff, and special attention is recommended to be paid to obese patients, those who have chronic pulmonary diseases, or who have survived abdominal operations (Kiekkas et al., 2016);
  • Although capnography is not the only method in detecting changes in ETCO2 or respiratory depression, this method is regarded as more effective and easier in comparison to other approaches such as pulse oximetry (Kiekkas et al., 2016).

Types of Capnography

  • The decision to use capnography depends on a variety of factors.
  • This method may be classified into time and volume capnography, given the fact that CO2concentration may be plotted against time or expired volume (Kodali & Urman, 2014);
  • Volume capnography is based on using special equipment that records CO2 concentration in regards to the expired volume to estimate the dead space (Jaffe, 2017);
  • Time capnography is a frequently used technique that is based on infrared technology to analyze CO2, its absorbing qualities, and concentration (Kodali & Urman, 2014);
  • Time capnography can be of two types: side-stream (disposal tubing and a T-piece adapter that has to be placed between the breathing circuit and endotracheal tube) and main-stream (an adapter is placed between the breathing circuit and the endotracheal tube) (Kodali & Urman, 2014);
  • Side-stream capnographers are mostly used due to their advantage in helping even non-intubated patients, whilst main-stream capnography has to be applied immediately after endotracheal intubation (Liu, Poon, & Tsui, 2016);
  • As a result, capnography should also be defined as clear evidence of the correct placement of an endotracheal tube and the possibility to avoid negative outcomes and deaths of patients who suffer cardiac arrest (Kodali & Urman, 2014).

Nursing Knowledge of Capnography

  • The success of capnography depends on the level of knowledge about this technique nurses and other medical workers have;
  • Despite certain benefits of the chosen tool, the literature review proves that there are some gaps in understanding capnography and its benefits to patients and hospitals (Kiekkas et al., 2016);
  • It is not enough for nurses to learn how to use capnographers and measure the levels of ETCO2, they must also understand how to interpret the available readings and various waveforms (Kiekkas et al., 2016);
  • The lack of knowledge about capnography directly influences the quality of care that may be offered to a patient in a hospital;
  • Ventilation and circulation are the processes that undergo considerable changes in situations where nurses fail to determine the changes in ETCO2 levels;
  • Some investigations show that the medical staff still face some problems in using capnographers because of the inability to have a clear explanation of why the level of ETCO2 is increased, and what may be done to improve the indicators (Hamrick et al., 2017);
  • The quality of care and the level of knowledge nurses can gain are closely connected with the chosen theoretical guidelines and clinical experiences (Hassankhani, Aghdam, Rahmani, & Mohammadpoorfard, 2015);
  • The goal of any DPI project is to improve nurses’ understanding of the matter and motivate them to develop and hone their best skills and traits;
  • Hassankhani et al. (2015) recommend promoting self-efficacy as the major tool to increase learning motivation and underline the potential outcomes and expected results;
  • Nurses have to want to improve their awareness about capnography because of the improvements that can be achieved in CCU settings.

Outcomes of Capnography on Nurses and Patients

  • Patients who have experienced cardiac arrest can receive high-quality care in the CCU in a short period of time;
  • The rearrangement of the existing roles of nurses will be recommended;
  • A multimodal approach to decision-medical in hospital settings should be promoted (Lui et al., 2016);
  • Simultaneous usage of various technologies may considerably influence the patient status and increase the need for multimodal monitoring (Lin et al., 2015);
  • Nurses will learn how to interpret the results of capnography and predict the cases of resuscitation in different care units (Pantazopoulos et al., 2015);
  • Targets of intervention, as well as the types of capnography, are chosen with regard to available data and the history of diseases;
  • The changes in ETCO2 levels are thoroughly controlled and predicted, leading to a significant decrease in lethal outcomes among patients with heart problems.

Summary

  • Cardiac arrests lead to increased cases when resuscitation is obligatory (Bullock et al., 2017);
  • Resuscitation result in various unfavorable consequences for patients and nurses, including the decreased level of care, failure to read all important indicators, and even death;
  • New tools have to be introduced and properly learned by the medical staff to improve the current situation;
  • Capnography is suggested as one of the possible additions to the already existing strategies that aim at addressing patients’ needs;
  • Capnography makes it possible to control the changes in vital indicators;
  • The level of ETCO2 should be normalized and monitored among all inpatient hospitals;
  • Nurses must improve their level of knowledge about this technique and be prepared to incorporate crucial improvements and innovations;
  • In the CCU context, the re-organization of recent nurse duties and guidelines can be observed;
  • The improvement of nurses’ skills and qualities is an expected outcome that results in the reduction of negative healthcare outcomes.
Problem Statement While the analysis of the literature shows that capnography is a valuable technique in measuring the concentration of CO2, its implementation in the coronary care unit remains a poorly investigated issue despite its potential benefits such as the improvement of care quality and monitoring of patients’ well-being.
Clinical/PICO Questions In the patients of a coronary care unit (P), how can the implementation of time capnographers (I) compare to non-use of this intervention (C) and influence the efficacy of a resuscitation process and the transition to ROSC (O)?
Sample The collection of data for this DPI project depends on a properly defined sample. It is expected to identify clearly such aspects of work as the location of the setting, the population to work with, and the number of people to be involved in the research. At this moment, the following decisions are made:
Location: New Jersey;
Population: Two neighborhood cities which are characterized by an equal distance from the nearest primary care provider with a coronary care unit (with 15 beds in the unit and 109 beds in the whole hospital);
Sample: 80 participants will be included in the study to investigate the worth of capnography as the main method to control the level of ETCO2 during a period of six months. Ten registered nurses from the CCU will be staffed to promote the intervention.
Define Variables There are two types of variables that will be used for this DPI project. On the one hand, there is one independent variable that should not be changed during the project. On the other hand, there are several dependent variables that have to be checked during and after the intervention.
Independent variable: a capnography tool.
Dependent variables: the recovery dynamics after cardiac arrests, the level of patient satisfaction about the quality of care, and the efficacy of ETCO2 level monitoring.
Methodology and Design This project will be based on a quantitative methodology that is supported by a randomized controlled trial. This study design includes the participation of people who will be divided into two groups: experimental and control. It is expected that there will be a difference between the results obtained from the experimental group (the participants should undergo the intervention) and the control group (the participants do not receive the intervention). A qualitative process evaluation will be carried out in the chosen trial. It should help to identify the peculiarities of the intervention (a capnography tool is applied) through a strong understanding of the chosen process and its progress within the frames of the trial. The peculiar feature of quantitative research methods in nursing research is the possibility to succeed in three different tasks. First, it is necessary to investigate the pre-trial achievements and study results (focusing on the results of the literature review). The second step is the analysis of the intervention process (introducing a capnography program to the chosen experimental group). Finally, the third step is the determination of the connection between the changes (the dynamics of the recovery process in CCU patients).
This experimental design has to be measured quantitatively, meaning that no new ideas and approaches are introduced. The task is to take the already known technique (capnography) and apply it to a certain group of people (CCU patients in one of the local hospitals). In the end, it is expected to receive accurate measurements of the ETCO2 levels in the patients with cardiac arrests and compare the results of their monitoring process in regard to the possibility of reducing the number of fatal outcomes and increase the quality of care. The latter can be defined through the level of satisfaction of patients who receive care during the intervention. In this project, a qualitative experimental research design should allow the researcher to prove the idea that capnography is characterized by positive effects on CCU patients.
Purpose Statement The purpose of this qualitative research that is undertaken with a randomized controlled trial is to understand the possible efficacy of capnography to monitor resuscitation processes and promote the recovery dynamics among patients in the coronary care unit in New Jersey.
Data Collection Approach The peculiar feature of the data collection approach in this project is the necessity to gather the material during the implementation of the intervention. Eighty patients will be divided into two groups. 40 of them will receive capnography as the main method to monitor the ETCO2levels. The other 40 patients will receive standard monitoring at the CCU setting. The information about patients and their health conditions will be gathered from their cards after informed consent is obtained. The main inclusion criteria for patients are the diagnosis of cardiac arrest, hospitalization, and their presence in the CCU setting at the moment of the intervention. The exclusion criteria are rehabilitation, previously stated high levels of ETCO2, and the already survived Lazarus phenomenon.
Observation and monitoring are the chosen data collection methods in this study. A special portable capnographer will be offered to the team to monitor any changes. An envelope with the final decision as to whether to use capnography or not is opened before the intervention and the method of monitoring is followed. The primary outcome measure will include the status of patients (well-being) after the implementation of the intervention. The secondary outcome measure will be patient satisfaction with the technique and the level of knowledge of capnography among nurses. The CCU staff should give their approval to check what they know about capnography before the intervention. Then, training on the interpretation of capnography must be received, and the NKCT will help to check the changes in nurse awareness of the technique. The nurses, who participate in this intervention, in their turn, will be obliged to take the Nurses’ Knowledge about Capnography Test (NKCT) to evaluate their level of knowledge (Kiekkas et al., 2016). This test should be taken before the intervention (pre-test) and after the intervention (post-test), so that the researcher can define the progress that is associated with the adoption of the technique.
Data Analysis Approach The data analysis approach should be based on prior information about patients and the repeated measures design that are chosen for this trial. Eighty patients have to be observed fully, 100%, to detect the difference of their well-being. The data has to be entered into Excel, and the analysis will be developed using SPSS statistical software. All tests to compare the levels of ETCO2must be 2-sided with a specially identified p-value of <0.05 from the available patient characteristics and indicators. It is the only statistically significant factor in the study analysis. A Chi-square test will be used to indicate the main characteristics. Fifty percent of the nursing staff will be invited to monitor data as a part of a committee.
The goal of the data analysis is to test the idea that capnography is an effective tool to monitor significant factors of patients and to predict the development of a critical situation when ROSC will be inevitable. The level of nurses’ awareness of capnography and its effects on patients’ well-being will be analyzed using the results of the NKCT. A paired t-test can be appropriate to meet the goal of the study. Taking into consideration a small sample, a non-parametric approach will help to clarify the relationship between the variables. For example, the Wilcoxon signed-rank test will help to compare the outcomes among two related samples, match them, and identify the differences.

Appendix B

Variables/Groups, Phenomena, and Data Analysis

Table 1. Quantitative Studies.

Clinical Questions:
State the clinical questions
Hypotheses:
State the hypotheses to match each clinical question
List of Variables/Groups to Collect Data For:
Independent and Dependent Variable(s)
Instrument(s)
To collect data for each variable
Analysis Plan
Data analysis approach to (1) describe data and (2) test the hypothesis
  1. 1. In the patients of a coronary care unit (P), how will the implementation of time capnographers (I), compared to non-use of this intervention (C), influence the efficacy of a resuscitation process and the transition to ROSC (O)?
H1: The use of capnography results in positive health outcomes in patients during resuscitation compared to non-use of the same tool. IV: Capnography
DV: Recovery dynamics after a cardiac arrest
DV2: Effectiveness of ETCO2 level monitoring in CCUs
DV3: Patient satisfaction
A questionnaire and quantitative observation Inferential analysis such as correlation will help to describe the relationship between the chosen variables, and descriptive statistical analysis of the frequency of fatal and positive care outcomes will be developed.
SPSS and an Excel spreadsheet will be used to analyze quantitative data of the study.
2. How effective is capnography in monitoring ETCO2 levels among cardiac patients in CCUs? H2: In CCUs, capnography is an important tool for monitoring ETCO2 levels in cardiac patients. IV: Capnography
DV2: Effectiveness of ETCO2 level monitoring in CCUs
Quantitative observation
3. What is the relationship between recovery dynamics after cardiac arrests and patient satisfaction in the context of capnography use? H3: Capnography is an effective tool to enhance positive recovery dynamics in patients with a cardiac arrest. IV: Capnography
DV: Recovery dynamics after a cardiac arrest
DV3: Patient satisfaction
A questionnaire