NURS 8003 Week 7 Evidence Appraisal Example

Course	NURS 8003 Foundations and Essentials in Nursing
Week	Week 7
Paper type	Evidence appraisal
Length	About 1,040 words, 6 pages
Format	APA 7 student paper
School	Walden University
Program	Doctor of Nursing Practice (DNP)
Updated	September 2026

Free sample paper for NURS 8003 Week 7

What the Literature Has Settled About POLST Orders Across Care Transitions, and What It Leaves Open: An Appraisal of Eight Sources

Student Name

College of Nursing, Walden University

NURS 8003: Foundations and Essentials in Nursing

Instructor Name

Month Day, Year

What this page is doingThe title promises two lists, settled and unsettled, which is the distinction the appraisal is built to draw.

What the Literature Has Settled About POLST Orders Across Care Transitions, and What It Leaves Open: An Appraisal of Eight Sources

Introduction

Last week's problem statement described POLST forms completed during a hospital stay that do not reliably reach skilled nursing facilities with the patient. Before any change can be justified, it is necessary to establish what the literature has already decided about POLST orders and transitions. This appraisal examines eight sources, rates each for level of evidence using Melnyk and Fineout-Overholt's hierarchy and for quality using rapid critical appraisal questions (Melnyk & Fineout-Overholt, 2023) and then separates what the evidence has settled from what it leaves unresolved for a setting like the composite hospitalist service. Level describes the strength of a design for answering a question about effects; quality describes how well a particular study was carried out. A well-conducted descriptive study can be high in quality and low in level.

What this page is doingDefining level and quality separately at the start prevents the most common confusion in appraisal papers.

Appraisal Table

Table 1 lists the sources with their design, level, quality and key finding.

Table 1

Eight Sources on POLST and Care Transitions

Source	Design	Level	Quality	Key finding
Hickman et al. (2010)	Comparative observational study in nursing facilities	IV	Good	Residents with POLST had preferences documented more often and fewer unwanted treatments than those with traditional methods
Hickman et al. (2011)	Retrospective descriptive study of facility records	VI	Good	Treatments generally matched POLST resuscitation orders; consistency lower for some other orders
Hammes et al. (2012)	Retrospective descriptive review in one community	VI	Good	POLST widely used among decedents; care largely consistent with orders
Fromme et al. (2014)	Retrospective cohort using a state registry	IV	Good	Orders for comfort measures associated with fewer in-hospital deaths than full-treatment orders
Richardson et al. (2014)	Retrospective cohort of cardiac arrests	IV	Good	Resuscitation in and out of hospital largely concordant with registry POLST choices
Lee et al. (2020)	Retrospective cohort of hospitalized patients	IV	Good	Treatment-limiting POLST associated with less intensive care use, but many patients still admitted to intensive care
Mirarchi et al. (2012)	Survey of clinicians	VI	Fair	Clinicians often misinterpreted living wills and do-not-resuscitate orders in scenarios
Tolle and Teno (2017)	Expert commentary	VII	Good	Registries and statewide processes help orders travel, but complexity remains

How Quality Was Judged

Quality ratings used three rapid appraisal questions for each source: were the population and setting clearly described, were the measures defined and applied consistently and did the authors acknowledge the main threats to their conclusions? The registry studies scored well on all three, since registries define orders precisely and link them to outcomes such as place of death. The nursing facility studies scored well on description and measurement but depend on chart documentation, which may not capture every treatment decision. The clinician survey was rated fair because it used hypothetical scenarios, which may not reflect decisions made with a real patient and chart, and because response rates in such surveys are often modest. The expert commentary was rated good as commentary, drawing on long experience with a statewide program, but as opinion it cannot carry the weight of data.

One pattern across the sources matters for the hospitalist service. Almost all the strongest evidence comes from Oregon and a few communities with mature programs and registries. Those settings are where POLST should work best, so their results may overstate how well orders travel and are followed in places without such infrastructure.

What the Evidence Has Settled

Across settings and designs, the sources agree on one point: when a current POLST is present, care generally follows it. In nursing facilities, residents with POLST forms had their preferences documented more often and received fewer unwanted life-sustaining treatments than residents whose preferences were recorded in traditional ways (Hickman et al., 2010), and treatments provided largely matched resuscitation orders (Hickman et al., 2011). In Oregon, where a statewide registry exists, POLST orders for comfort measures were associated with fewer in-hospital deaths (Fromme et al., 2014), and resuscitation decisions during cardiac arrest were largely consistent with registry orders (Richardson et al., 2014). A community with well-established advance care planning reported similar consistency (Hammes et al., 2012).

The consistency of these findings, drawn from different populations and methods, gives them weight despite their observational designs. None is a randomized trial, and none could be, since assigning patients to have or not have their preferences documented would be unethical. Within that limit, the evidence is as strong as the question allows.

What the Evidence Leaves Unresolved

Three questions matter for the hospitalist service and remain open. First, no source directly studies whether a POLST completed during a hospital stay reaches the next facility. The studies above assume the form is present; they measure what happens when it is. The registry in Oregon addresses transmission at a state level (Tolle & Teno, 2017), but most states lack one, and the literature offers little on hospital-to-facility transfer processes where no registry exists.

Second, the evidence shows that orders are not always followed even when present. Among hospitalized patients with orders limiting treatment, a substantial share were still admitted to intensive care (Lee et al., 2020). Whether discordance arises from changed patient wishes, missing forms or clinician misreading is not clear.

Third, clinicians misread related documents. In scenario-based surveys, clinicians frequently confused living wills and do-not-resuscitate orders with broader limits on treatment (Mirarchi et al., 2012). That study did not examine POLST forms, but it warns that a form reaching a facility is not the same as a form being understood.

What this page is doingSeparating what studies assume from what they test shows the author read the methods, not only the conclusions.

Why the Appraisal Does Not Recommend an Intervention

The evidence supports the value of current POLST orders at the destination, but it does not test any method of getting them there. Recommending a specific intervention, such as adding the form to the automatic discharge packet or calling the receiving nurse, would go beyond what the sources show. The appropriate conclusion is narrower: the problem is worth solving because current orders are followed when present, and any solution must be designed and evaluated locally because the literature offers no tested model for hospital-to-facility transmission outside registry states. The next step is a baseline audit, followed by a small test of change with measures of whether current forms arrive and whether receiving staff interpret them correctly.

References

Fromme, E. K., Zive, D., Schmidt, T. A., Cook, J. N. B., & Tolle, S. W. (2014). Association between Physician Orders for Life-Sustaining Treatment for scope of treatment and in-hospital death in Oregon. Journal of the American Geriatrics Society, 62(7), 1246-1251. https://doi.org/10.1111/jgs.12889

Hammes, B. J., Rooney, B. L., Gundrum, J. D., Hickman, S. E., & Hager, N. (2012). The POLST program: A retrospective review of the demographics of use and outcomes in one community where advance directives are prevalent. Journal of Palliative Medicine, 15(1), 77-85. https://doi.org/10.1089/jpm.2011.0178

Hickman, S. E., Nelson, C. A., Moss, A. H., Tolle, S. W., Perrin, N. A., & Hammes, B. J. (2011). The consistency between treatments provided to nursing facility residents and orders on the Physician Orders for Life-Sustaining Treatment form. Journal of the American Geriatrics Society, 59(11), 2091-2099. https://doi.org/10.1111/j.1532-5415.2011.03656.x

Hickman, S. E., Nelson, C. A., Perrin, N. A., Moss, A. H., Hammes, B. J., & Tolle, S. W. (2010). A comparison of methods to communicate treatment preferences in nursing facilities: Traditional practices versus the Physician Orders for Life-Sustaining Treatment program. Journal of the American Geriatrics Society, 58(7), 1241-1248. https://doi.org/10.1111/j.1532-5415.2010.02955.x

Lee, R. Y., Brumback, L. C., Sathitratanacheewin, S., Lober, W. B., Modes, M. E., Lynch, Y. T., Ambrose, C. I., Sibley, J., Vranas, K. C., Sullivan, D. R., Engelberg, R. A., Curtis, J. R., & Kross, E. K. (2020). Association of Physician Orders for Life-Sustaining Treatment with ICU admission among patients hospitalized near the end of life. JAMA, 323(10), 950-960. https://doi.org/10.1001/jama.2019.22523

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Mirarchi, F. L., Costello, E., Puller, J., Cooney, T., & Kottkamp, N. (2012). TRIAD III: Nationwide assessment of living wills and do not resuscitate orders. Journal of Emergency Medicine, 42(5), 511-520. https://doi.org/10.1016/j.jemermed.2011.07.015

Richardson, D. K., Fromme, E., Zive, D., Fu, R., & Newgard, C. D. (2014). Concordance of out-of-hospital and emergency department cardiac arrest resuscitation with documented end-of-life choices in Oregon. Annals of Emergency Medicine, 63(4), 375-383. https://doi.org/10.1016/j.annemergmed.2013.09.004

Tolle, S. W., & Teno, J. M. (2017). Lessons from Oregon in embracing complexity in end-of-life care. New England Journal of Medicine, 376(11), 1078-1082. https://doi.org/10.1056/NEJMsb1612511

The Walden NURS 8003 Week 7 instructions

Appraisal assignments in Week 7 typically ask you to rate a set of sources on your practice problem for level and quality and to state what the evidence supports. Six to seven pages with a table is common. Define level and quality separately at the start. Use one recognized hierarchy and a consistent set of quality questions. Summarize each source in a table with its design, ratings and key finding. Then write separate sections on what the literature has settled and what it leaves open for your setting. Note where most of the evidence comes from, since that affects transfer. Stop short of recommending a specific intervention if the evidence does not test one.

How this NURS 8003 Week 7 example is built

The introduction restates the problem and defines level and quality, citing Melnyk and Fineout-Overholt. Table 1 lists eight sources with design, level, quality and finding. A section explains the three quality questions and why each source was rated as it was, and notes the concentration of evidence in Oregon. A settled section cites Hickman and colleagues, Fromme and colleagues, Richardson and colleagues and Hammes and colleagues. An unresolved section cites Tolle and Teno on registries, Lee and colleagues on intensive care admissions despite limiting orders and Mirarchi and colleagues on misread documents. A final section explains why no intervention is recommended. The appraisal ends by naming a baseline audit as the next step.

Reading the NURS 8003 Week 7 rubric

Evidence appraisals are commonly scored on correct use of the hierarchy, defensible quality ratings, synthesis of findings and honest conclusions. Hierarchy credit requires that each design be placed at the right level. Quality ratings should follow stated questions. Synthesis is rewarded when the writer groups findings into what is settled and what is not. Conclusions score well when they stay within what the sources test, which often means declining to recommend an intervention. Faculty also credit attention to where evidence comes from. A clear table and complete APA references complete the criteria. Appraisals that read methods rather than abstracts tend to stand out.

NURS 8003 Week 7 help from the desk

Appraisals lose marks when level and quality are treated as the same thing, so a flawed trial outranks a careful observational study without comment. Another common loss is summarizing each source without saying what the sources settle together. Some papers recommend an intervention the evidence never tested. Others ignore that most studies come from one kind of setting. Define both ratings, apply one hierarchy, explain your quality judgments, separate settled from open questions and conclude only what the evidence supports. The desk can draft an appraisal on your own problem. Check each source's design in its methods section, not its abstract. Write the settled and open sections before you look at your favored solution again.

Get a NURS 8003 Week 7 example written to your instructions

Upload the appraisal prompt, rubric and whichever tool or hierarchy the course specifies, and an appraisal using that framework is drafted. The first one comes free, returned in 24 to 48 hours. Its conclusions concern an imagined hospital only; deciding what any evidence means for your own workplace is a call you remain accountable for.

More NURS 8003 papers and DNP samples

NURS 8003 Week 7 questions, answered

What is the difference between level and quality?

Level describes what a study design is capable of showing; quality describes how well a particular study was carried out. The example rates them separately for every source, which is why a flawed trial can sit below a careful observational study in its overall weight. Your course may use a hierarchy that combines the two, and following your assigned framework matters more than the example's choice.

What number of sources suits an appraisal?

Enough to show where the literature agrees and where it does not, which usually means more than four. The example appraises eight. Prompts in NURS 8003 frequently set a range, and your rubric's figure governs. Including a source only to reach a number weakens the appraisal if it is poorly related to the problem, since its relevance then has to be defended.

Why does the appraisal refuse to recommend an intervention?

Because the evidence it examined does not reach that far for the setting described, and acknowledging that limit is precisely what the week is testing. The example states what the literature supports and stops there. Faculty grading NURS 8003 generally credit restraint of that kind as accountability, and appraisals recommending beyond their evidence are among those most often returned for revision.

Where can I find a free NURS 8003 Week 7 sample paper?

The full appraisal, definitions, eight-source table, quality reasoning, settled and open questions and conclusion, is on this page free. An appraisal for your own practice problem can be requested.

What does the NURS 8003 Week 7 appraisal say is settled?

That when a current POLST is present, care across settings generally follows it, a finding consistent across nursing facility, community and registry studies.

NURS 8003 Week 7 evidence appraisal example