| Course | NR 716 Analytic Methods |
|---|---|
| Week | 4 |
| Paper type | Evidence appraisal table |
| Length | About 1,110 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NR 716 Week 4
Evidence Appraisal Table: Nine Sources on Early Fascia Iliaca Blocks After Hip Fracture in Older Adults, Each Ending in a Verdict
Student Name
College of Nursing, Chamberlain University
NR 716: Analytic Methods
Instructor Name
Month Day, Year
Evidence Appraisal Table: Nine Sources on Early Fascia Iliaca Blocks After Hip Fracture in Older Adults, Each Ending in a Verdict
How the Table Was Built
Each row appraises one of the nine sources kept by the search: one systematic review, five randomized trials, one cohort study and two clinical practice guidelines. The left columns hold the facts a reader needs to test the judgment: design in standard terms, sample and setting, and what moved, with direction and size. The right columns hold the appraisal: an evidence level and a quality rating using the Johns Hopkins hierarchy and its research and non-research appraisal tools (Dang et al., 2021), the reason for the rating in a phrase and a verdict on what the source can be used for in this project. Ratings are the appraiser's own, made against the tool's criteria, not taken from the authors' limitations sections. Where a rating sits on a boundary, the reason column says which way it leaned.
The Table
Table 1
Appraisal of Evidence on Early Fascia Iliaca Blocks for Hip Fracture
| Source | Design | Sample and setting | What moved | Level and quality | Reason | Verdict |
|---|---|---|---|---|---|---|
| Guay and Kopp (2020) | Systematic review and meta-analysis of randomized trials, risk of bias tool and GRADE | 49 trials, 3,061 adults with hip fracture | Pain on movement within 30 minutes fell, about 2.5 points on a 0 to 10 scale; acute confusional state risk ratio 0.67, number needed to treat 12; mortality uncertain | I, A | Rigorous methods; people with dementia often excluded from the trials | Anchor for pain and delirium |
| Morrison et al. (2016) | Randomized trial, no sham described | 161 adults, three New York hospitals; femoral block in the emergency department, then a fascia iliaca catheter | Pain at 2 hours 3.5 against 5.3; opioid side effects 3% against 12.4%; 33% to 40% fewer morphine equivalents; farther walking on day 3 | I, B | Two blocks combined, so effect of a single shot cannot be isolated; recruited 2009 to 2013 | Supports emergency department placement and functional gain |
| Pasquier et al. (2019) | Double-blind randomized trial with sham injection | 30 adults over 70 after prehospital morphine; Swiss emergency department; landmark technique | No difference in pain profiles over 24 hours or in morphine use | I, B | Strong blinding, but small and with low pain at baseline | Benefit may be small when pain is already controlled; does not test ultrasound |
| O'Connor et al. (2025) | Double-blind, placebo-controlled randomized trial | 53 analyzed adults, Dutch emergency department; ultrasound-guided block with patient-controlled morphine | No difference in 6-hour morphine; pain at 1 hour 1.5 points lower; 24% against 4% stayed opioid-free | I, C | Stopped early, underpowered by its authors' account | Signal for early pain relief, too imprecise to rely on alone |
| Di Pietro et al. (2025) | Randomized trial, two blocks compared | 64 adults, Italian emergency department; pericapsular block against fascia iliaca block | Greater first-hour pain relief with the pericapsular block; no difference in rescue opioid or adverse events | I, B | No usual-care arm; one hour of follow-up | Informs technique choice, not block against none |
| Thompson et al. (2020) | Randomized trial | 47 older adults, one trauma center; block by an anesthesiologist just before surgery | Postoperative morphine 0.4 mg against 19.4 mg; higher satisfaction; no difference in function | I, C | Small, borderline significance, outcome measured after surgery | Little bearing on early emergency department timing |
| Gawthorne et al. (2021) | Cohort from a medical record audit | 472 eligible patients, Australian emergency department, 2013 to 2017; 72 blocks by nurses, 207 by doctors | No differences between nurse and doctor placement in pain at 1 and 4 hours, delirium, opioid use or time to block; no adverse events found | III, B | Record audit; clinician not documented for 43 blocks; rare harms beyond its reach | Supports trained non-physician placement |
| O'Connor and Switzer (2022), summary of the national orthopedic guideline | Clinical practice guideline from systematic review | Older adults with hip fracture | Recommends regional nerve blocks within pain management | IV, A | Transparent methods and strength ratings | Supports blocks; silent on timing and who places them |
| National Institute for Health and Care Excellence (2023) | Clinical practice guideline | Adults with hip fracture, United Kingdom | Advises considering nerve blocks when acetaminophen and opioids are not enough, given by trained staff | IV, B | Older evidence base for this recommendation; different health system | Supports blocks as an addition, by trained staff |
Note. Note. Ratings use the Johns Hopkins hierarchy, levels I to V, and its quality grades A to C. Effect sizes are as reported by each source.
Why the Ratings Differ
The reasons vary because the weaknesses do. The Cochrane review is rated high quality because its methods were rigorous, and its main limit for this project, the exclusion of people with dementia from many trials, matters for applicability rather than for quality. The New York trial lost a grade for combining two blocks, which makes it relevant to the department but unclear about what a single injection achieves. The Swiss trial held its grade despite its size because blinding was strong and it answered the question it asked; its finding of no benefit is limited by low baseline pain after morphine in the ambulance. The Dutch trial and the American perioperative trial both received the lowest rating, the first because it stopped early and the second because it was small and measured outcomes after surgery. The Australian cohort is lower in the hierarchy but well suited to the question of who can place the block, which no trial in the set addresses.
What the Table Says Together
For pain soon after placement and for delirium, the evidence is strong and consistent, carried by the Cochrane review and supported by the New York trial. For opioid use, it is mixed: two trials found reductions and two found none, and the trials that found none were the ones where patients started with little pain or controlled their own morphine. For who can place the block, the evidence is a single cohort, enough to justify a trial of trained non-physician placement but not enough to assume it is equally safe. The synthesis will need to explain the disagreement on opioids rather than average it away. For the department's March decision, that means the case for the block can rest on pain and delirium, where the table is firm, and should not promise a fall in opioid use that the evidence does not yet support. It also means the pilot should collect its own opioid figures rather than assume them.
References
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
Di Pietro, S., Maffeis, R., Jannelli, E., Mascia, B., Resta, F., De Silvestri, A., Musella, V., Centurioni, C. E., Regeni, E., Grassi, F. A., Locatelli, A., & Perlini, S. (2025). Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: A randomised clinical trial. Anaesthesia, 80(12), 1484-1492. https://doi.org/10.1111/anae.16695
Gawthorne, J., Stevens, J., Faux, S. G., Leung, J., McInnes, E., Fasugba, O., Mcelduff, B., & Middleton, S. (2021). Can emergency nurses safely and effectively insert fascia iliaca blocks in patients with a fractured neck of femur? A prospective cohort study in an Australian emergency department. Journal of Clinical Nursing, 30(23-24), 3611-3622. https://doi.org/10.1111/jocn.15883
Guay, J., & Kopp, S. (2020). Peripheral nerve blocks for hip fractures in adults. Cochrane Database of Systematic Reviews, 2020(11), Article CD001159. https://doi.org/10.1002/14651858.CD001159.pub3
Morrison, R. S., Dickman, E., Hwang, U., Akhtar, S., Ferguson, T., Huang, J., Jeng, C. L., Nelson, B. P., Rosenblatt, M. A., Silverstein, J. H., Strayer, R. J., Torrillo, T. M., & Todd, K. H. (2016). Regional nerve blocks improve pain and functional outcomes in hip fracture: A randomized controlled trial. Journal of the American Geriatrics Society, 64(12), 2433-2439. https://doi.org/10.1111/jgs.14386
National Institute for Health and Care Excellence. (2023). Hip fracture: Management (Clinical guideline CG124). https://www.nice.org.uk/guidance/cg124
O'Connor, M. I., & Switzer, J. A. (2022). AAOS clinical practice guideline summary: Management of hip fractures in older adults. Journal of the American Academy of Orthopaedic Surgeons, 30(20), e1291-e1296. https://doi.org/10.5435/JAAOS-D-22-00125
O'Connor, R. D., Postma, S., Van Kamp, D., Benraad, A. C., Lommen, A., Korver, S., Ten Bosch, J. A., & Reinders, M. K. (2025). Effect of ultrasound-guided fascia iliaca compartment block on pain management in hip fracture patients: A double-blind placebo-controlled randomized clinical trial. Medicine, 104(40), Article e44622. https://doi.org/10.1097/MD.0000000000044622
Pasquier, M., Taffe, P., Hugli, O., Borens, O., Kirkham, K. R., & Albrecht, E. (2019). Fascia iliaca block in the emergency department for hip fracture: A randomized, controlled, double-blind trial. BMC Geriatrics, 19, Article 180. https://doi.org/10.1186/s12877-019-1193-0
Thompson, J., Long, M., Rogers, E., Pesso, R., Galos, D., Dengenis, R. C., & Ruotolo, C. (2020). Fascia iliaca block decreases hip fracture postoperative opioid consumption: A prospective randomized controlled trial. Journal of Orthopaedic Trauma, 34(1), 49-54. https://doi.org/10.1097/BOT.0000000000001634
Reading the NR 716 Week 4 instructions
Give each source a row with the facts a reader needs to test your judgment: citation, design in standard terms, sample and setting, and what was measured and what moved, with direction and size. Then give the appraisal: a level and a quality rating from the instrument your course names, the reason for the rating in a short phrase and a verdict on what the source can be used for in your project. Use the instrument suited to each source, since a guideline and a trial need different tools. Make your ratings your own rather than copying the authors' limitations sections. Expect the reasons to vary, because studies fail in different ways. Under the table, explain why the ratings differ and what the rows say together, including where the evidence is firm and where it is not.
How the NR 716 Week 4 example is put together
The sample's opening section explains the table's left and right halves and names the Johns Hopkins hierarchy. The table's nine rows run from the Cochrane review, rated level I and high quality with its exclusion of people with dementia noted, to the British guideline, rated level IV with an older evidence base. The New York trial is marked down for combining a femoral block with a later catheter; the Swiss trial keeps its grade for strong blinding despite thirty patients; the Dutch and perioperative trials receive the lowest grade for stopping early and for measuring outcomes after surgery. A section explains each difference in rating. The closing paragraph groups the findings by outcome and says the case to the council should rest on pain and delirium, not opioid savings.
Reading the NR 716 Week 4 grading rubric
The first loss is a table with no verdict, every column filled and no cell saying whether a study can be used. Next is one instrument applied to everything, so a guideline or interview study gets a rating built for trials. Marks are also lost when quality ratings are copied from the article's limitations section, when results are replaced with the authors' conclusions and when every row gets the same rating, which suggests nothing was really judged. Graders take points for designs named loosely and for effect sizes left out. Tables score well when the reasons for ratings vary with the studies, when each row ends in a clear verdict and when a short section beneath the table says what the rows establish together.
Common NR 716 Week 4 mistakes, and how to avoid them
Most appraisal tables describe studies well and then stop short of judging them. Send us your sources and the appraisal tool your course uses, and we can help you name each design in standard terms, pull out direction and size, assign levels and quality ratings with reasons that fit each study and write a verdict at the end of every row. Under the table, a few sentences on what the rows establish together and where they part ways can be shaped with you. The ratings and verdicts reflect your own reading of each source, not ours.
Get a NR 716 Week 4 example written to your instructions
Send the Week 4 instructions, the table your section issues and the studies you have retained, and a custom example is filled into your own columns and returned inside 24 to 48 hours. The first one is free. Which studies stay in and which drop out is your call.
More NR 716 papers and DNP samples
- NR 716 Week 1: Model Placement Post
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- NR 716 Week 5: Literature Matrix
- NR 716 Week 6: Critical Appraisal Write-up
- NR 716 Week 7: Evidence Synthesis Paper
- NR 716 Week 8: Practice Recommendation Presentation
- NR 715 Week 4: Framework Analysis
- NR 714 Week 4: Paired Analysis Write-Up
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NR 716 Week 4 questions, answered
Which appraisal instrument should the table use?
Whichever your section names, and put it in the header. Where the choice is left open, match the tool to the design: one for trials and cohorts, another for qualitative work, a third for guidelines and existing syntheses. Naming the instrument in the row is what allows a reader to check a rating rather than take it on trust.
What goes in the row for a study that turned out to be poor?
It stays, carrying the verdict that says so. A table holding only strong studies has usually been curated rather than appraised, and the weak entries are what later let the synthesis state how thin the evidence really is. Record why it fails, in your own words, and carry that reason forward instead of deleting the row.
How is this different from the matrix later in the term?
This table judges studies one at a time, so it reads across a row and finishes with a verdict about that paper. The matrix arranges the same studies to be compared down a column, which is what makes a pattern visible. Same studies, different instrument, and a table built like a matrix usually never delivers its verdicts.
Where can I find a free NR 716 Week 4 sample paper?
The complete nine-row appraisal table, with a verdict on every source about nerve blocks for hip fracture, is available on this page.
Why do two small trials get different ratings in the NR 716 Week 4 sample?
The Swiss trial kept its grade because blinding was strong and it answered its question, while the Dutch trial stopped early and was underpowered.