Module 4 Assignment

Ashley Bryan

College of Health Professions and Wellness, Jacksonville State University

DNP 711: Biostatistics and Translating Evidence

Dr. Betsy Gulledge

October 9, 2022
 Analysis Questions

The Doctor of Nursing Practice (DNP) project is described as the utilization of modified

early warning scores (MEWS) to decrease in-hospital cardiac arrests (IHCA). The primary

analysis question will be, “Does utilizing MEWS-based rounding in the non-intensive care unit

(ICU) population decrease IHCA? ”The DNP project will also answer the question, “Does

implementing MEWS-based rounding improve the patient’s survival to discharge after an

IHCA?” Another analysis question would be, “Does the amount of unplanned ICU admissions

decrease because of MEWS-based rounding in the non-ICU patient population?” The DNP

project may also answer, “Does the DNP project increase the amount of rapid response calls the

rapid response nurse responds to?”

Description of Analysis Questions

During the DNP project, the following PICOT statement will be explored: "Among non-

ICU hospital inpatients, does the implementation of MEWS and rapid response team rounding,

as compared to no intervention, decrease IHCA over eight weeks" (Bryan et al., 2022). DNP

projects with fully developed analysis questions usually fall into evaluative or descriptive

categories (Sylvia & Terhaar, 2018). Descriptive questions are when the study tries to grasp the

problem, population or event, organization, or other phenomena (Sylvia & Terhaar, 2018). Data

analysis is expressed as aims and outcomes when the purpose of the study is evaluation (Sylvia

& Terhaar, 2018). The DNP project is considered an evaluative analysis question.

Unit of Analysis Explanation

The unit of analysis is typically categorized as events or populations (Sylvia & Terhaar,

2018). The decision to utilize population or event for the data analysis depends on the analysis

question of interest (Sylvia & Terhaar, 2018). When determining the unit of analysis, the
analysis plan usually begins with a detailed description (Sylvia & Terhaar, 2018). Nurses,

physicians, and staff are included when considering the population unit of analysis (Sylvia &

Terhaar, 2018). A population unit of analysis is chosen when the experience of individuals is

under question (Sylvia & Terhaar, 2018). The second category is known as the occurrence of

some event or activity, or delivery of a healthcare service or procedure (Sylvia & Terhaar, 2018).

The DNP project is considered an event unit of analysis. The project aims to decrease IHCA,

which is an event that occurred necessitating the need to intervene with the DNP study. The

rapid response rounding based on a MEWS>4 is a healthcare service delivery (Sylvia & Terhaar,

2018).

Elements Used to Describe Units of Analysis

The elements used to describe the unit of analysis include subgroupings, sources, a

number expected, inclusion criteria, exclusions criteria, and the time frame for identification

(Sylvia & Terhaar, 2018). Subgroupings are comparison groups of the overall population

/collection of events (Sylvia & Terhaar, 2018). Sources are data identification, such as the origin,

location, or purpose for generating the data (Sylvia & Terhaar, 2018). The data source is used to

create exclusion and inclusion for a population of events (Sylvia & Terhaar, 2018). The number

expected quantifies the total inclusion in the population or events to be evaluated (Sylvia &

Terhaar, 2018). The number expected is also broken down by subgroupings (Sylvia & Terhaar,

2018). The inclusion criteria are defined by the rules which the event or individual is a part of in

the population or any of the subgroupings (Sylvia & Terhaar, 2018). The exclusion criteria

include the rules for which an event or individual that meets all inclusion criteria is not included

(Sylvia & Terhaar, 2018). The exclusion criteria are not the opposite of inclusion (Sylvia &
Terhaar, 2018). The time frame for identification is the time period in which the population is

identified (Sylvia & Terhaar, 2018).

The DNP project is estimated to have 216 full-time, part-time, and per diem registered

nurses. The subgroupings will be a pre-post implementation of MEWS>4 compared to the before

and after IHCA statistics. The sources of data will be MEWS>4. Inclusion data is any registered

nurse on the non-ICU units, patients with a MEWS>4, and those who have suffered an IHCA.

Exclusion is anyone that does not have a MEWS>4. The time frame will be eight weeks for the

DNP project.

Type of Descriptive Variable Information Impacting Outcomes

The descriptive variables include variables that may be related to or impact the evaluation

of outcomes (Sylvia & Terhaar, 2018). An important part of this process is carefully considering

information that should be collected to decide if any biases in subgroupings could affect the

outcome (Sylvia & Terhaar, 2018). Types of descriptive variables include person-specific,

context-specific, event-specific, and context-specific (Sylvia & Terhaar, 2018). Person-specific

information includes gender, age, race, income, diagnosis, and education level (Sylvia &

Terhaar, 2018). Event-specific information includes the variables date, time, unit/department,

equipment brand, and procedure method (Sylvia & Terhaar, 2018). The context-specific

information includes variables such as patient identifier, nurse identifier, physician identifier, or

family members (Sylvia & Terhaar, 2018). Descriptive variables include the description, name,

data sources, level of measurement, range or values, and time frame for collection (Sylvia &

Terhaar, 2018). The DNP project will utilize examples from each descriptive variable category.

Outcome Statement
 Patients experiencing IHCA have survival to discharge rate of less than 25%, as

identified by the AHA (Tsao et al., 2022). The AHA GWTG aims to increase that survival

percentage to 35%. Underutilization of MEWS presents a survival to discharge rate of 25.8%

after IHCA at the facility (Bryan et al., 2022). The project is being conducted to improve

outcomes at the facility by improving the survival to discharge after the patient suffers an IHCA.

The outcome will be measured by comparing the number of patients surviving to discharge after

IHCA from before and after the implementation of MEWS-based rounding in non-ICU inpatients

(Bryan et al., 2022).

 References

Bryan, A., Head, D., Black, K., Davis, M. Ellenburg, A., Puckett, J. Kleiman, R., (2022). Rapid

response data tracking. Microsoft Excel. Wellstar Health System.

https://wellstarhealthsystem.org 

Sylvia, M., Terhaar, M. (2018). Clinical analytics and data management for the DNP. (2nd ed.).

Springer Publishing Company.

Tsao, C., Aday, A., Almarzooq, Z., Alonso, A., Beaton, A., Bittencourt, M., Boehme, A.,

Buxton, A., Carson, A. (2022). Heart disease and stroke statistics-2022 Update: A report

from the American heart association. https://doi.org/10.1161/CIR.0000000000001052