The following practice question serves as the basis for this research: Among pregnant women at a community health setting (P), does self-management education (I) compared to normal practice (C) reduce cardiovascular disease-related mortality and morbidity (O) within six months?
The DNP student carried out an extensive literature search to retrieve evidence supporting self-management education in reducing cardiovascular disease associated mortality and morbidity. The DNP scholar conducted an electronic search on various databases. The relevant and up-to-date publications were retrieved from online databases, including PubMed Central, CINAHL Complete, Medline, Ebscohost, Ovid Nursing Full Text Plus, Nursing Journals, and Cochrane Library. Other electronic databases included Health & Medical Collection, Nursing & Allied Health, and Public Health Database.
The search strategy also involved the deployment of varying search terms to aid in searching relevant studies related to self-management education impact on cardiovascular disease. Key search terms included self-management, normal practice, CVD mortality, “CVD morbidity, and cardiovascular disease, and self-care, CVD outcomes of self‐management, pregnant women, and prevention of CVD in pregnant women. However, the initial literature search generated fewer studies. Consequently, the DNP scholar applied Boolean operators, such as AND, NOT, and OR, to connect the above-listed search terms. The search process was further augmented by backward and forward citation. The approach facilitated the retrieval of additional studies.
The literature search strategy followed strict inclusion and exclusion criteria. The DNP scholar only included studies published in English between 2016 and 2021 (the last five years), ensuring that only up-to-date literature was reviewed. The DNP scholar was interested in experimental studies, such as randomized controlled trials (RCTs) and quasi-experimental articles. Besides, the scholar focused on systematic reviews and meta-analysis. Only studies related to whether self-management education reduces cardiovascular disease-related mortality and morbidity among pregnant women were included. Studies were excluded if they did not focus on pregnant women as the target population or sample. Besides, studies were excluded if they were published more than five years ago. Overall, the search yielded a total of 160 studies. The DNP scholar reviewed abstracts of all retrieved studies to determine their relevance to the PICOT question and project’s topic. A total of 90 studies were excluded based on the exclusion criteria. Full copies of the remaining 70 publications were retrieved and read to determine if they met the inclusion criteria. Twenty-five more studies were further excluded for being duplicates (n = 10) and irrelevant (n = 15) to the topic of interest. The remaining 45 studies were further appraised to decide whether it was appropriate to retain them.
The DNP scholar appraised the remaining studies (n = 45) using the Joanna Briggs Institute Critical Appraisal checklist (Porritt, Gomersall, & Lockwood, 2014) to determine which studies to retain. The JIB critical appraisal is interested in evidence and methods employed to synthesize or yield different kinds of evidence. Based on the JIB critical appraisal tool, all studies with “no” or “not applicable” answers to more than two checklist questions were excluded. As a result, 30 studies were excluded, and 15 remaining considered for review and synthesis. Articles selected for literature synthesis were further assessed for level of evidence and quality using the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide (Dang & Dearholt, 2017). The JIB critical appraisal checklist and John Hopkins’ guide helped the DNP scholar determine which studies to retain based on quality.
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines. Indianapolis, IND: Sigma Theta Tau.
Porritt, K., Gomersall, J., & Lockwood, C. (2014). JBI’s systematic reviews: study selection and critical appraisal. AJN the American Journal of Nursing, 114(6), 47-52. https://doi.org/10.1097/01.NAJ.0000450430.97383.64