| Course | NUR-8050 Scholarly Inquiry The Basis for Evidence-Based Practice |
|---|---|
| Module | Module 3 |
| Paper type | Guideline appraisal |
| Length | About 1,058 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for NUR 8050 Module 3
Strong on Ventilators, Thinner Beyond Them: An AGREE II Appraisal of the 2022 Compendium for Preventing Hospital-Acquired Pneumonia
Student Name
Doctor of Nursing Practice, Thomas Edison State University
NUR-8050: Scholarly Inquiry: The Basis for Evidence-Based Practice
Mentor Name
Month Day, Year
Strong on Ventilators, Thinner Beyond Them: An AGREE II Appraisal of the 2022 Compendium for Preventing Hospital-Acquired Pneumonia
Introduction
The aim on my unit is fewer pneumonias in never-ventilated patients through brushing that actually happens. In Module 2 I appraised the most relevant single study and judged it moderate-quality evidence. A clinical practice guideline could carry more weight, because it synthesizes the evidence and represents expert consensus. The most relevant document is the 2022 compendium update on preventing pneumonia in acute care hospitals (Klompas et al., 2022), which covers ventilated adults, children and neonates and, for the first time in detail, patients who are not ventilated. This paper appraises it with AGREE II and decides how much it should guide my protocol.
The Instrument
An international collaboration built AGREE II so that anyone choosing a guideline could rate how well it was made. Brouwers et al. (2010) set out 23 questions grouped under six headings (what the guideline is for, who wrote it, how rigorously, how clearly, how usable it is and how independent its authors were), then ask for two global ratings. Every item is marked from 1 (no agreement) to 7 (full agreement), and the manual wants two independent markers, ideally four. Domain scores are scaled as a percentage of the possible range, so domains with different numbers of items can be compared.
For this appraisal, I and a clinical nurse specialist from my hospital rated the document independently and then discussed differences of more than two points.
Scope and Purpose, and Stakeholder Involvement
The objectives, health questions and populations are clearly described: the document aims to help acute care hospitals prioritize prevention of pneumonia and ventilator events, and it defines the populations each section covers. This domain scored highly. Stakeholder involvement was more mixed. The authors are infection prevention, critical care and hospital epidemiology experts from several professional organizations, and the document was reviewed by the partner organizations. Nurses and respiratory therapists are represented, but patient or public views are not described, and the target users are implied rather than stated for each recommendation. Our scaled score was moderate.
Rigor of Development
This is the domain that matters most for deciding whether to follow a guideline. It covers how evidence was searched, how it was selected, how its strength was judged, how recommendations were formed, whether benefits and harms were weighed, whether recommendations link explicitly to evidence, whether external review occurred and whether an update procedure exists. The compendium grades the quality of evidence for each recommendation, links recommendations to cited studies and states that it is part of a series updated over time. The search strategy is described less fully than a systematic review would require, and the method for moving from evidence to recommendation relies on expert consensus.
Benefits and harms are weighed for most recommendations, which is one of the items appraisers often find missing. For oral care the harms are small: a brief time cost for staff, the small chance of aspiration during brushing in a patient with a poor swallow and the cost of supplies. Naming those harms matters for my unit, because the nursing assistants' first question was whether brushing a patient with dysphagia was safe. The compendium's framing allows the protocol to address that worry directly by pairing brushing with suction toothbrushes for patients at high aspiration risk.
The scaled score is calculated from the ratings. With eight items and two appraisers, the lowest possible total is 16 and the highest is 112. Our combined ratings totaled 80. The scaled score is (80 minus 16) divided by (112 minus 16), or 64 divided by 96, which is 67 percent.
| Domain | Items | Scaled score |
|---|---|---|
| Scope and purpose | 3 | 86 percent |
| Stakeholder involvement | 3 | 58 percent |
| Rigor of development | 8 | 67 percent |
| Clarity of presentation | 3 | 83 percent |
| Applicability | 4 | 56 percent |
| Editorial independence | 2 | 75 percent |
Clarity, Applicability and Independence
The recommendations are specific and easy to find, arranged as essential practices and additional approaches with evidence ratings, which earned a high clarity score. Applicability was lower. Implementation advice and suggested measures are included, but resource implications and barriers are discussed only briefly, which matters for a unit-level project with no extra budget. Editorial independence was judged moderate to high: author conflicts of interest are disclosed, and the document was developed by professional societies rather than a commercial sponsor.
The gap can be filled locally. Before launch I will cost the supplies for 34 beds, map the oral care steps against the assistants' workload on a typical day shift and ask the unit practice council which barriers they expect, so the protocol answers the applicability questions the guideline leaves open.
The Section That Matters for My Project
The overall appraisal hides an important difference between sections. The recommendations for ventilated adults draw on a large body of trials and observational studies. The section on patients who are not ventilated is newer and rests on fewer and weaker studies, many of them before and after initiatives like the one appraised in Module 2. The authors acknowledge this, and the practices for this population carry lower evidence ratings. National data on how often the condition occurs and how often preventive care is missed, such as the 21-hospital study by Baker and Quinn (2018), strengthen the case that the problem is real but do not by themselves show that any one practice prevents it.
Overall Judgment and Use
Our overall quality rating was 5 of 7, and both appraisers would recommend the guideline with modifications. For my project, the compendium provides authoritative support for making oral care part of routine prevention and for measuring the outcome with a defined surveillance approach. It does not provide strong evidence that toothbrushing alone will reduce pneumonia on my unit. I will therefore cite the compendium as expert support for the intervention, describe its evidence ratings honestly in my proposal and rely on my own evaluation design to test whether the change works locally.
Conclusion
An AGREE II appraisal of the 2022 compendium found strong scope and clarity, solid rigor and weaker stakeholder involvement and applicability. Its section on patients who are not ventilated is the least supported by evidence, which limits how much it can carry my project. The guideline supports trying the intervention and measuring carefully, which is the plan the next modules build.
References
Baker, D., & Quinn, B. (2018). Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. American Journal of Infection Control, 46(1), 2-7. https://doi.org/10.1016/j.ajic.2017.08.036
Brouwers, M. C., Kho, M. E., Browman, G. P., Burgers, J. S., Cluzeau, F., Feder, G., Fervers, B., Graham, I. D., Grimshaw, J., Hanna, S. E., Littlejohns, P., Makarski, J., & Zitzelsberger, L. (2010). AGREE II: Advancing guideline development, reporting and evaluation in health care. Canadian Medical Association Journal, 182(18), E839-E842. https://doi.org/10.1503/cmaj.090449
Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E. C., Greene, L. R., Lee, G., Maragakis, L. L., Powell, K., Priebe, G. P., Speck, K., Yokoe, D. S., & Berenholtz, S. M. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infection Control and Hospital Epidemiology, 43(6), 687-713. https://doi.org/10.1017/ice.2022.88
Reading the NUR 8050 Module 3 assignment instructions
The catalog description for NUR-8050 names practice guidelines alongside research as evidence to appraise and synthesize, and without a public syllabus to confirm the sequence, this third module is set on guideline appraisal. Expect a paper that applies a recognized instrument, most often AGREE II, to a guideline relevant to your PICOT question, reports domain scores, gives an overall rating and decides how the guideline will be used. Some classrooms combine guideline appraisal with a synthesis table of all the evidence found so far. Check whether your directions require a second appraiser, a scoring appendix or a specific template. Choose the guideline that most directly addresses your intervention, even if it covers a broader topic.
Inside the NUR 8050 Module 3 example
The paper explains why a guideline could outweigh the single study appraised before, then describes AGREE II, its six domains, its 7-point scale and the use of two appraisers who reconciled large differences. Scope and stakeholder involvement are judged, then rigor of development is examined item by item with a full scaled score calculation. A six-row table gives every domain score. Clarity, applicability and editorial independence follow. A separate section explains that the section on non-ventilated patients is weaker than the rest of the document. The overall rating and a decision on how the guideline will be used close the paper, with a promise that the local evaluation will test what the guideline cannot settle.
NUR 8050 Module 3 rubric: what earns full marks
A guideline appraisal is judged on whether the instrument was used as designed, whether each domain score is backed by something in the document and whether the paper decides what to do with the guideline. Mentors check that the scaled score formula is applied correctly and that judgments are supported by features of the document, not by its reputation. Recognizing that different sections of a guideline can differ in strength shows careful reading. A recommendation for use that links back to the PICOT question demonstrates synthesis. Using two appraisers, or explaining why one was used, adds credibility. APA formatting, accurate citations and a table of domain scores complete the grade, and a short appendix of item ratings is often credited.
Common NUR 8050 Module 3 mistakes, and how to avoid them
The most frequent weakness in guideline appraisals is reporting scores without explaining them. Each domain score should be supported by what the guideline does or does not include. Students also skip the scaled score formula or apply it incorrectly; show one calculation. Do not appraise a guideline by its publisher's prestige. Look for the section that addresses your question, since a strong guideline may be weak on your topic. State how you will use the guideline in the project, and be honest if it supports your intervention only weakly. If your classroom uses a different tool, follow the same logic. If a guideline turned up in your NUR-8050 search, the desk will score it with whatever instrument your mentor prefers, starting with one free appraisal.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 8050 Module 3 questions, answered
Where can I find a free NUR 8050 Module 3 sample paper?
Scroll up for the full appraisal. It appraises the 2022 SHEA compendium on hospital pneumonia with AGREE II and decides how a DNP project should use it.
What are the six AGREE II domains?
Six headings: purpose, who took part, rigor, clarity, ease of use and independence; two whole-guideline ratings follow.
How is an AGREE II domain score calculated?
Subtract the minimum possible score from the obtained total, divide by the maximum minus the minimum and multiply by 100. Minimum and maximum depend on the number of items and appraisers.
How many appraisers does AGREE II recommend?
At least two, and preferably four, rating independently, to improve reliability.
Is the SHEA compendium strong evidence for oral care to prevent pneumonia?
It supports oral care as part of prevention, but its section on non-ventilated patients rests on fewer and weaker studies than its ventilator sections.