The Appraisal Of Qualitative Research Assignment Paper

The Appraisal Of Qualitative Research Assignment Paper

The appraisal of qualitative research requires the article to be reliable, valid, credible and dependable (Wu et al., 2016). The two qualitative articles presented, in regard to the research question, gathered information through means of questionnaire, perspective, and phenomenological research styles. What is the effect of early patient mobilization, in adult ventilated patients, in the intensive care unit, compared to those with sedation and complete bedrest practices, in regard to mortality and morbidity rates, length of stay, respiratory function, and readmission, within 72 hours of intubation? The articles both present aspects of early mobilization of ventilated patients in the intensive care unit (ICU), as well as risks, benefits, and obstacles that are brought to fruition by the staff and care providers utilized in the articles. The sample size of both qualitative research articles included groups of less than 32 including nurses, respiratory therapists, physical and occupational therapists. The Appraisal Of Qualitative Research Assignment Paper

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The first article titled “Making of a Successful Early Mobilization Program for a Medical Intensive Care Unit”, studied nurse, respiratory, physical and occupational therapists’ early mobilization of ventilated patients in the ICU at John Hopkins University (Sigler et al., 2016). “Making of a Successful Early Mobilization Program for a Medical Intensive Care Unit”, concluded that cooperation is the most beneficial way to keep patients and employees safe, and addressing analgesia and sedation are the primary obstacles presented to staff and patients (Sigler et al., 2016). The study also found that patients had shorter hospital stays, decreased mortality and morbidity rates and patients’ likelihood of readmission decreased (Sigler et al., 2016)The Appraisal Of Qualitative Research Assignment Paper.

The second article “Ambulation of patients who are mechanically ventilated: nurses’ views”, is a perspective of nurses who utilize early mobilization of ventilated ICU patients in Buckinghamshire United Kingdom hospital (Curtis & Irwin, 2017). The study addresses concerns of safety and obstacles faced by eight nurses who have direct contact and care with ICU ventilated patients (Curtis & Irwin, 2017).  A questionnaire of open-ended questions, which asked about overall thoughts on the study, was performed within the article from the nurses’ point of view of the study and aggregate consensus of treatment results (Curtis & Irwin, 2017). The article concluded that nurses have great anxiety about early ambulation of critically ill patients. However, they also found that the results of early mobilization are beneficial to patient outcomes and hospital charges (Curtis & Irwin, 2017). Hospital and ICU stays are costly and longer admissions increase financial burdens of both hospital and patients. Through early mobilization, the nurses found patients stays are shorter and readmissions rates decreased (Curtis & Irwin, 2017)The Appraisal Of Qualitative Research Assignment Paper.

The PICOT question I proposed, “What is the effect of early patient mobilization in adult ventilated patients in the intensive care unit, compared to those with sedation and complete bedrest practices, in regard to mortality and morbidity rates, length of stay, respiratory function, and readmission, within 72 hours of intubation?”, is supported by the two qualitative articles for their validity of first hand perception and evidence of improved patient outcomes compared to patients who are not ambulated within 72 hours of intubation. Curtis & Irwin state, “Ambulation of mechanically ventilated patients is a treatment modality with short- and long-term benefits for patients and can decrease financial costs by reducing the length of overall hospital stay, readmission rates, and primary care resources” (2017). The nurses and staff perception of patients who do not receive early ambulation within 72 hours of intubation, or patients who do not receive ambulation at all, is addressed. The nurses in these studies express that their patients who do not receive early ambulation have prolonged ICU stays and that the patients who remain on bedrest and mechanical ventilation have more decubitus ulcers and ventilator acquired pneumonia. This, in return, introduces more infection and higher morbidity (Sigler et al., 2016). Research also supports these nurses’ viewpoints; “complete bed rest is a highly non-physiological and harmful form of therapy, and patients should be mobilized as early as possible (Urner et al., 2018). Prolonged bedrest and mechanical ventilation research have shown, “in subjects who survived ICU stay reveal that long-term sequelae of immobilization included persistent physical impairments and incomplete recovery of neuromuscular function” (Urner et al., 2018)The Appraisal Of Qualitative Research Assignment Paper.

Interventions provided in these two comparison groups within the research articles are comparable to the PICOT as they walk through concerns of safety and stability of the patients. The timeframe of the study is within a 72-hour post intubation period. A nurse’s statement in one study states, “I think nurses should be more proactive in rehabilitation of the patient as well, but I think most of us are, like, quite scared to ambulate the patient on a ventilator” stressing that concerns of early mobilization have risk but early mobilization and proactive is a concern of nurses (Curtis & Irwin, 2017). Another nurse states in “Making of a Successful Early Mobilization Program for a Medical Intensive Care Unit”, that early mobilization of mechanically ventilated ICU patients “benefits include reduced duration of mechanical ventilation, reduced length of intensive care unit (ICU) stay, and reduced length of hospital stay (Sigler et al., 2017)The Appraisal Of Qualitative Research Assignment Paper.

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The qualitative articles utilized methods of phenomenological, such as when one article specifically states, “the methodology used for this qualitative study was interpretative phenomenological analysis (IPA), a case-based idiographic approach that attempts to emphasize, capture and interpret the lived experience of those studied” (Curtis & Irwin, 2017). Curtis and Irwin’s phenomenological approach promotes a theme of nurses’ perspective throughout the entire article. Curtis and Irwin have multiple statements from nurses performing the intervention of early mobilization of ventilated ICU patients. Sigler, Nugent, Alalawi, Selvan, Tseng, Edriss, Turner, Valdez, Krause article approaches nursing from the nurse and care giver point of view but utilizes grounded theory by proposing the theory of a successful early mobilization protocol in the ICU, while implementing the proposed protocol (2016). The article not only enhances the importance of early mobilization in mechanically ventilated patients it, “provides additional supportive evidence that early mobilization in the ICU is safe and effective” (Sigler et al., 2016)The Appraisal Of Qualitative Research Assignment Paper.

The ethics provided throughout these articles is acknowledged, as each researcher gives reference to importance of analgesia and sedation as being a key requirement for the patients to participate and be ethically valid. The researchers provide information throughout each article on how appropriate lifting equipment and staff participated in providing early mobility. Ensuring patient physiologic and emotional stability, prior to early mobilization, is emphasized throughout both articles.

“Guidelines for mobilizing critically ill patients, based on a series of parameters, would support evaluation of their suitability for ambulation. There are guidelines that support ICU practitioners to evaluate patients’ suitability for mobilization, and to identify barriers to active mobilization” (Curtis & Irwin, 2017).

The researchers in these articles observe and provide insight into the perspective of ICU nurses and staff experiences with early mobilization programs of mechanically ventilated patients. Viewing the perspective of nurses and staff in these programs provides credibility to their importance and obstacles that are presented throughout the studies. A research article needs to have validity, credibility and dependability in order to be considered a reliable article of qualitative research (Wu et al.,2016)The Appraisal Of Qualitative Research Assignment Paper.

References

 

Curtis, L., & Irwin, J. (2017). Ambulation of patients who are mechanically ventilated: Nurses’ views. Nursing Management, 24(4), 34-39. doi:10.7748/nm.2017.e1599

Sigler, M., Nugent, K., Alalawi, R., Selvan, K., Tseng, J., Edriss, H., . . . Krause, D. (2016). Making of a Successful Early Mobilization Program for a Medical Intensive Care Unit. Southern Medical Journal, 109(6), 342-345. doi:10.14423/smj.0000000000000472

Urner, M., Ferreyro, B., Douflé, G., & Mehta, S. (2018, December 01). Supportive Care of Patients on Mechanical Ventilation. Retrieved from https://doi.org/10.4187/respcare.06651

Wu, Y. P., Thompson, D., Aroian, K. J., Mcquaid, E. L., & Deatrick, J. A. (2016). Commentary: Writing and Evaluating Qualitative Research Reports. Journal of Pediatric Psychology, 41(5), 493-505. doi:10.1093/jpepsy/jsw032

Qualitative Paper Directions for Assignment

Please read through these step by step directions for a better understanding of the assignment. At the end you will see a video presentation going over the rubric and how to submit.

Approximate lengths of each section outlined below.

Step 1: Introduction

Write an introduction to the topic and end the paragraph with a thesis statement. The introduction should include 2-3 attention grabbing statements and end with 1 concise thesis statement that describes the overall purpose of your paper.

Step 2: Describing Qualitative Research

Describe what qualitative research is in your own words. Then discuss how and what type of Qualitative Data you would collect related to your POI. For example, if I was interested in knowing what it is like to be a parent in the hospital, then I might decide to interview (how) mothers and fathers of Neonatal Intensive Care Unit patients. I would look for themes (based on data saturation collected in interviews) in their answers until I collected enough information to find trends in the data. I might use that data to then develop new teaching methods to better prepare parents for caring for the baby based on the themes uncovered. Be sure to clearly identify that the information you are gathering is qualitative in nature. Sometimes, you might describe a process that could be used qualitatively or quantitatively, like a questionnaire, so it is important to provide enough information to ensure you are demonstrating a thorough understanding of qualitative literature collection. (2-3 paragraphs)The Appraisal Of Qualitative Research Assignment Paper

Step 3: Appraisal Tools, Studies and Matrix

Locate your 2 qualitative studies so you can appraise each separately with the tool below. Students must include one (1) of your studies should be a (Qualitative) meta-ethnography, meta-study, meta-summary, critical interpretive synthesis, thematic synthesis, systematic review, or meta-synthesis. (Keep in mind that a meta-synthesis is not a literature review, but more of a compilation of findings that are examined, broken down and looked at for similar phenomena, others may refer to them as interpretations of findings). No Rapid or Scoping Reviews are not permitted. (A systematic review can be either quantitative or qualitative. A quantitative systematic review will include studies that have numerical data. A qualitative systematic review derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. Be sure you are correctly choosing the right type of study for this assignment to avoid loss of points.

The other study must be a qualitative single study; examples of qualitative single studies include: phenomenology, grounded theory, ethnography, case study, and a narrative analysis. Once you have found 2 different qualitative study designs as specified, complete an appraisal tool for each study using the following link. Only complete the section of the tool related to the qualitative appraisal The Appraisal Of Qualitative Research Assignment Paper.

Keep in mind that you may need to vary your search strategy to find your qualitative literature. For example, if I am looking at pain tools in children, I may not be able to find any qualitative literature on this specific search, so I will look for a similar topic that impacts the patient such as: anxiety, depression, ICU pscyhosis, sleep disturbances. All of these subtopics may also be impacted by pain in children. Talk to your instructor for guidance if needed.

Use this tool to complete the appraisals for both qualitative studies separately. Attach the completed tool to your paper or with your assignment. Use the link below to complete. You can save the document as a pdf, use the edit function to fill in or handwrite and scan back into the assignment area.
Appraisal Tool pdf or
Microsoft word version Microsoft word version
Follow all steps carefully as the tool will guide you which steps to move to in each section of the tool.
For help on how to complete the tool, watch this video: “How to Complete the Appraisal”
Creating an Evidence Matrix

The matrix is a continuation of the matrix you originally submitted in Module 3. Therefore, you will now have 4 studies included on the matrix. Highlight or Bold the NEW studies for the qualitative paper appraisal. You need to correct any mistakes or issues that you may have had with the matrix submitted with the quantitative paper or you will be counted off again on this paper. This document will be used again in 611 if you are in the DNP track, so be sure to put it in a safe place that you will be able to easily find again. The matrix should be included as an appendix OR you may upload as a separate attachment if needed. Use either link below to complete, one is a pdf, the other is a word document. You will need to complete the matrix for this assignment The Appraisal Of Qualitative Research Assignment Paper

Matrix pdf version

or Microsoft version

SUBMISSION:
You will need to submit your 2 studies, completed appraisal tools and completed matrix (with each qualitative study included on it) along with your assignment. The documents may be submitted separately or merged to the paper.
Step 4: Article Discussion

Use the information from your appraisal tool to discuss in detail the following information for each study: (2-3 pages)

Purpose or phenomenon, research design and Methodology (steps, procedures and strategies for gathering and analyzing data) used in each study
Data Collection: the discussion must include phenomenon or themes discovered, sample of participants or studies included, how selected, if data saturation was used, etc.
Credibility and Trustworthiness: Discuss concepts of credibility and trustworthiness which include dependability, confirmability and transferability. Each of these terms should be fully discussed to demonstrate understanding. Support the concepts with evidence from each study.
To understand trustworthiness and credibility, check out these links: The Appraisal Of Qualitative Research Assignment Paper

Trustworthiness and Credibility Video

Results and Clinical Implications should be discussed.
Level of evidence and quality of evidence ratings (according to tool). Discuss what the level and quality ratings mean in relation to strength of the evidence and decision to sue (or not use) this information to guide practice. You need to fully support this section from evidence in the study and other resources. Understanding the levels of evidence tells you about the type of study performed, design, methods, etc. and if those findings should be applied to your own practice area. Grade of Recommendation is important because it helps you make a judgement about the quality of evidence; together they impact the decision about implementation into practice.
The following tool can be used to help you determine strength and quality, but this information is also listed directly on the tool.

John Hopkins Evidence Rating Scale

Other helpful links to understanding this information can be found in the required and recommended resources.

Be sure that you attach your 2 studies to the paper/assignment.

Step 5: Applicability to Practice and Future Research

Discuss the findings from each study in practice and how you will use them to make a change. Review your model selected from the Forum Discussion and determine where you are in the next step of the process of implementation. The discussion should include the EBP or QI model that demonstrates best fit for your POI. Be sure to include why it is a better fit than the other. Next consider what is still needed before changes can be made. Careful consideration of who, what, and how you would implement changes is needed and should detail: stakeholder involvement, financial, structural or process changes needed (at least one of these concepts must be discussed), technology support, ethical considerations such as HIPAA or Institutional Review Board approvals. Support with peer reviewed references. (2-3 paragraphs)The Appraisal Of Qualitative Research Assignment Paper

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Step 6: Conclusion

Provide a conclusion paragraph to the paper summarizing all main points. A conclusion should NOT state any new information that was not previously addressed in the paper. While it can re-state the purpose of your writing, it should not repeat the thesis verbatim. Additionally, it should summarize the main points of each section.

Step 8: Turnitin

Be sure to submit your paper to turnitin. You do not have to submit your matrix or the appraisal tools to turnitin as they will skew your similarity report findings. If this happens, please just let your instructor know and re-submit the paper without those items. See Rubric for specific directions on references, APA and scholarship.

See Rubric for specific Scholarship deductions.

Page limit: 6 pages, excluding title page, references, appendices and/or attachments. The paper should be submitted to the assignment area as a Microsoft word or Adobe PDF Document.

References: you must include at least 2 additional peer reviewed references. All References should be current, no older than 5 years.

To see the rubric, go the next section of the Module and click on the rubric link.

Please review directions and video before submitting the assignment.

All assignments must be submitted electronically as a Microsoft Word or PDF. More than 1 document may be submitted in the assignment area.
The paper should also be submitted to turnitin and exclude title page, references or attachments when submitting to the turnitin repository. Students are responsible for reviewing their turnitin reports and making any necessary changes to their final paper. Students must still submit a final paper to the assignment area. The Appraisal Of Qualitative Research Assignment Paper
Students are NOT permitted to use first person in this writing. Quotes are highly discouraged. Students should be paraphrasing material from refereed/peer reviewed journals.
Please note that you are permitted to expand your topics (to some degree), however you should discuss these concerns with your faculty member. Because qualitative literature is rather challenging to find, students are not required to submit an exact match to their original topic, however it is expected that the studies selected will have a relationship to the originally approved topic. For example, if I chose Sickle Cell care in the pediatric setting, but can’t find any studies related to this topic, I may decide to review studies related to: pain scales in pediatrics as pain is a huge component in Sickle Cell or coping mechanisms as pediatric patients miss a lot of school related to this disease or even self-confidence due to this disease impacting their overall well being.
Point Allocations
Points may be adjusted higher or lower than specific allocated points for each criteria. For example, you may receive 1.25 points instead of 1.0 or 1.5 points as indicated in the column depending on the criteria that was met or unmet. This may apply to any of the criterion and will be based on faculty discretion.
Printing: apply the landscape mode and print to a pdf for the best view.
Copy of the Rubric for printing: Qualitative Appraisal Paper-6.pdf
Students are responsible for submitting assignment by the due date/time. Assignments that are not complete or missing items will be graded “as is” and students will not be permitted to submit items after the grade has been returned. Students submitting their work early are not permitted to re-submit or revise work once the grade has been returned.

Please Complete the 2 matrix for both qualitative research articles. Points were deducted last time The Appraisal Of Qualitative Research Assignment Paper.

 EBP Guideline/Position Statement Paper

Nurse burnout is a significant clinical challenge facing nurses in the United States, especially during the COVID-19 pandemic. Jaber et al. (2022) reported a dramatic increase in mental health issues among healthcare workers, including stress, anxiety, depression, and burnout during the COVID-19 pandemic. The trend in mental health disorders is associated with a high workload due to increased demand for healthcare services or self-isolation among nurses who have tested positive for the Corona Virus. For this reason, the paper proposes an evidence-based intervention for reducing the high rate of nurse burnout.

The Phenomenon of Interest (POI)

The phenomenon of interest is the high rate of burnout among nurses. The prevalence of nurse burnout has increased dramatically during the COVID-19 pandemic due to the high workload and working hours among nurses. The high burnout rate among the nurses results in adverse events, including medication errors. Additionally, nurse burnout has resulted in high turnover rates among the nurse, leading to nursing staff shortage, which raises nurse to patient ratio, nurses’ workload, and working hours. According to Havaei and MacPhee (2020)The Appraisal Of Qualitative Research Assignment Paper, high nurses’ workload compromises the quality of patient care, resulting in adverse health outcomes. Hence, the high nurse-to-patient ratio, increased workload, and long working hours contribute to poor-quality care and adverse patient outcomes in the practice area.

Significance of the high Rate of Nurses’ Burnout

The phenomenon of interest is significant to the acute care setting since it proposes interventions for reducing the high rate of nurse burnout. Providing psychological support and counseling will enable the nurses to cope with job-related stress during the COVID-19, preventing burnout. Consequently, the high rate of job turnover among nurses will decrease, reducing nurse to patient ratio, high workload among nurses, and long working hours, which will improve the quality and safety of care, prevent adverse events, optimize health outcomes, and reduce overall healthcare cost in the nursing practice. According to Lee Adler et al. (2018)The Appraisal Of Qualitative Research Assignment Paper, healthcare organization incurs considerable costs in treating health complications associated with safety issues and medication errors. Hence, preventing safety issues and inpatient harm through appropriate workload among nurses will eliminate extra treatment costs in the acute care setting.

Differences among Process, Structural, and Outcome Measures

Quality indicators are categorized into the process, structural, and outcome. Process measures portray the degree of compliance with actions implemented to attain QI project goals (Lorini et al., 2018). An example of a process measure is administering thrombolytic therapy to a patient within 90 minutes following the onset of clinical symptoms. Outcome measures focus on the patient’s health status. For this reason, outcome measures are considered the most pertinent among the three indicators of quality of care (Lorini et al., 2018). Post-MI 30-day mortality is an example of an outcome measure. Lastly, structural measures portray an organization’s capacity to provide quality care, including processes and systems (Lorini et al., 2018)The Appraisal Of Qualitative Research Assignment Paper. An example of a structural measure includes cardiac catheterization laboratory availability 24 hours a day. An example of a quality measure related to the high rate of nurses’ burnout is the patient-to–emergency nurse ratio. The type of measure in the provided example is structural since it reflects the organization’s capacity.

The Criteria for P.I.C.O.T. Framework

 A PICOT framework provides the basis for resolving the high rate of nurse burnout in the practice setting. It was developed following a review of the existing literature on nurse burnout in various clinical settings. Thus, the PICOT framework was based on the evidence-based interventions presented in the reviewed articles. The proposed PICO framework is as follows.

Population (P): Nurses working in the acute care setting,

Intervention (I): Practicing stress management and accessing mental health resources safeguards,

Comparison (C): Compared to nurses that do not practice stress management or access mental health resources safeguards,

Outcome (O): Influence nurse burnout rates, care, and patient outcomes, and

Time (T): Within 30 days.

Clinical Question

The proposed clinical question is, “Among nurses working in the acute care setting (P), does practicing stress management, and accessing mental health resources safeguards (I) compared to nurses that do not practice stress management nor accessing mental health resources safeguards (C) influence nurse burnout rates, care, and patient outcomes (O) within 30 days (T)?” The Appraisal Of Qualitative Research Assignment Paper

Critique of Guideline/Position Statement

 

1. The primary purpose of the position statement is clearly stated. The position statement was developed in 2019 to evaluate the burnout reporting rate. Hence, the guideline was recently published and is relevant to nurse burnout.
2. The main objective of preparing the guideline was to evaluate and report issues facing nurse leaders in acute care, including burnout, compassion satisfaction, and secondary trauma.

• Highly competent and credible individuals developed the guideline. However, the authors did not receive funds to cater to guideline-related expenses, which were associated with biases in one healthcare system. The authors did not depict a valued interest in nurse burnout.

1. The information presented in the guideline is highly credible. It was authored by knowledgeable, competent, and experienced individuals. The authors are holders of Ph.D. in nursing and registered nurses assigned leadership roles in their respective clinical settings. Additionally, the authors were guided by the Professional Quality of Life Scale while studying nurse burnout. They also interviewed a co-investigator via the phone to get the required information. The SPSS version 23 was used to analyze data collected during the study.
2. Based on the John Hopkins Nursing EBP appraisal tool, this guideline’s evidence level is level IV. The authors collected data from 15 sources when conducting their research. They used mixed methods research design in their study. The strength of research that formed the guideline involves collecting data from recent peer-reviewed articles on various nursing-related topics.
3. The level of evidence of the guideline is level IV, which portrays good quality. This quality encourages the APNs to adopt recommendations proposed in the guideline to resolve nurse burnout, which is a significant challenge in clinical practice. On the contrary, the APNs would not adopt the recommended guidelines to prevent nurse burnout in their clinical practice if the quality of the personal statement was low.

 

The Impact of the Guideline on the Quality of Care

The guideline was primarily developed to provide nurse leaders and APNs with recommendations for resolving nurse burnout. According to Dall’Ora et al. (2020)The Appraisal Of Qualitative Research Assignment Paper, nurse burnout is associated with reduced job performance, poor patient safety and quality of care, adverse events, and negative patient outcomes. The nurse leader would use recommendations proposed in the guideline to prevent nurse burnout and improve nurses’ job performance and motivation, which will result in high-quality healthcare services and positive health outcomes.

Additionally, preventing nurse burnout and improving the quality of care will contribute to adherence to ethical principles during care delivery. The first ethical principle is beneficence. This ethical guideline states that healthcare providers should focus on doing good to their patients. By providing high-quality care, nurses will be doing good for their patients. Another ethical principle influenced by preventing nurse burnout is nonmaleficence. The ethical principle of nonmaleficence holds that healthcare providers should harm their patients intentionally. Using the guideline to prevent burnout among nurses will prevent harm and safety issues that might occur when a nurse is experiencing burnout.

Conclusion

Burnout is a significant challenge facing registered nurses in their respective clinical settings. It compromises nurses’ job performance, resulting in poor quality care and adverse patient outcomes. Safeguards should adopt evidence-based interventions, mainly practicing stress management and accessing mental health resources, to prevent burnout among nurses in the acute care setting. Additionally, nurse leaders should adhere to the recommendations proposed in the guideline to resolve nurse burnout, which will improve the quality of care in their respective clinical settings The Appraisal Of Qualitative Research Assignment Paper

References

Adler, L., Yi, D., Li, M., McBroom, B., Hauck, L., Sammer, C., Jones, C., Shaw, T., & Classen, D. (2018). Impact of inpatient harms on hospital finances and patient clinical outcomes. Journal of Patient Safety, 14(2), 67–73. https://doi.org/10.1097/pts.0000000000000171

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review. Human Resources for Health, 18(1). https://doi.org/10.1186/s12960-020-00469-9

Havaei, F., & MacPhee, M. (2020). The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of human factors framework. Nursing Open, 7(3), 731–741. https://doi.org/10.1002/nop2.444

Jaber, M. J., AlBashaireh, A. M., AlShatarat, M. H., Alqudah, O. M., Du Preez, S. E., AlGhamdi, K. S., AlTmaizy, H. M., & Abo Dawass, M. A. (2022). Stress, depression, anxiety, and burnout among healthcare workers during the covid-19 pandemic: A cross-sectional study in a tertiary centre. The Open Nursing Journal, 16(1). https://doi.org/10.2174/18744346-v16-e2203140

Lorini, C., Porchia, B., Pieralli, F., & Bonaccorsi, G. (2018). Process, structural, and outcome quality indicators of nutritional care in nursing homes: A systematic review. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2828-0 The Appraisal Of Qualitative Research Assignment Paper