Rows for studies, columns for outcomes: the peanut ball evidence for MN600 Unit 5 is arranged so that agreement, disagreement and silence all show across one table. Searches like "mn 600 unit 5 assignment example", "mn600 unit 5 sample" and "mn600 unit 5 example" land here.
Evidence Matrix: Peanut Ball Positioning in Labor With Epidural Analgesia, Organized by Outcome
[Student Name]
Purdue University Global
MN600: Evidence-Based Practice Project
Unit 5 Assignment
[Instructor Name]
[Date]
Row 5 is the composite cohort appraised in Unit 4 and is labeled as such; every other row is a published source listed in the references, with results taken from the published abstract.
Method
The matrix follows Garrard's Matrix Method, in which each source takes a row and each topic a column, so that patterns across sources become visible (Garrard, 2017). Identifying columns come first: citation, design, level and who was studied. Outcome columns follow. Each outcome cell holds a direction and the effect as reported in the published abstract, or the words not reported. A final column records overlap between sources.
Matrix
Row 1. Tussey et al. (2015). Design: randomized controlled trial. Level II. Who: 198 laboring patients with epidurals, mixed parity, one hospital. First stage: shorter by 29 minutes, not quite significant (p = .053). Second stage: shorter by 11 minutes (p < .001). Cesarean: lower with the ball, odds ratio 0.41 (p = .04). Other: not reported. Overlap: appears to be pooled in Row 6.
Row 2. Roth et al. (2016). Design: randomized controlled trial. Level II. Who: elective inductions at 39 weeks or later with planned epidurals, mixed parity. First stage: shorter with the ball in first-time mothers (p = .018); no significant difference in experienced mothers. Second stage: no difference in pushing time. Cesarean: not reported. Other: not reported. Overlap: appears to be pooled in Row 6.
Row 3. Mercier and Kwan (2018). Design: randomized controlled trial. Level II. Who: 96 nulliparous patients randomized at 6 cm or more with an epidural. First stage: no significant difference in dilation rate or active labor, 315 against 387 minutes (p = .14). Second stage: not reported separately. Cesarean: no difference, 33 against 35 percent. Other: occiput posterior at full dilation 28 against 9 percent (p = .09). Overlap: appears to be pooled in Row 6.
Row 4. Hickey and Savage (2019). Design: quasi-experimental comparison. Level III. Who: 343 patients with epidurals, 164 with the ball, one hospital. Labor length: reported with adjustment in a regression model. Cesarean: about 50 percent less likely with the ball. Other: not reported. Overlap: none.
Row 5. Composite cohort appraised in Unit 4 (teaching case, not published). Design: retrospective cohort. Level IV. Who: 2,118 NTSV labors with epidurals, three hospitals. First and second stage: not reported. Cesarean: adjusted OR 0.71 (0.52 to 0.97). Overlap: none.
Row 6. Grenvik et al. (2019). Design: pooled analysis of randomized trials after a systematic search. Level I. Who: term, singleton, cephalic labors in the included trials. Total labor length: 79 minutes shorter, not significant, interval minus 204.9 to 46.7. Cesarean: risk ratio 0.8, interval 0.6 to 1.0. Other: spontaneous vaginal birth risk ratio 1.1, interval 1.0 to 1.2. Overlap: pools randomized trials that appear to include Rows 1 to 3.
Column Summaries
First stage of labor. Four sources measured it in some form. The direction mostly favors the ball, but the only clearly significant finding is confined to first-time mothers having an induction, and the pooled estimate for total labor length does not reach significance. Certainty: low.
Second stage of labor. Two trials measured it and disagree: one found 11 fewer minutes, the other no difference in pushing time. Certainty: low.
Cesarean birth. Five sources measured it. One trial, the quasi-experimental study and the composite cohort favor the ball; one trial in nulliparous patients found no difference; the pooled trial estimate points toward benefit with an interval that reaches one. Because the review appears to pool the trials in Rows 1 to 3, they are not counted as independent confirmations. Certainty: low to moderate that the ball does not increase cesarean birth; low that it reduces it.
Neonatal outcomes and safety. Not reported in the abstracts reviewed. The matrix does not infer safety from silence; full texts will be checked before the synthesis.
Who Was Studied
Much of the disagreement follows the populations. The trials differ in parity mix, in whether labor was induced and in when the ball was introduced, from epidural placement to 6 cm or more. The trial that enrolled only nulliparous patients late in labor found no effect, while the one limited to inductions found an effect only in first-time mothers. The proposal's population, NTSV patients with epidurals, overlaps most closely with Rows 3 and 5.
References
Garrard, J. (2017). Health sciences literature review made easy: The matrix method (5th ed.). Jones and Bartlett Learning.
Grenvik, J. M., Rosenthal, E., Saccone, G., Della Corte, L., Quist-Nelson, J., Gerkin, R. D., Gimovsky, A. C., Kwan, M., Mercier, R., & Berghella, V. (2019). Peanut ball for decreasing length of labor: A systematic review and meta-analysis of randomized controlled trials. European Journal of Obstetrics and Gynecology and Reproductive Biology, 242, 159-165. https://doi.org/10.1016/j.ejogrb.2019.09.018
Hickey, L., & Savage, J. (2019). Effect of peanut ball and position changes in women laboring with an epidural. Nursing for Women's Health, 23(3), 245-252. https://doi.org/10.1016/j.nwh.2019.04.004
Mercier, R. J., & Kwan, M. (2018). Impact of peanut ball device on the duration of active labor: A randomized control trial. American Journal of Perinatology, 35(10), 1006-1011. https://doi.org/10.1055/s-0038-1636531
Roth, C., Dent, S. A., Parfitt, S. E., Hering, S. L., & Bay, R. C. (2016). Randomized controlled trial of use of the peanut ball during labor. MCN: The American Journal of Maternal/Child Nursing, 41(3), 140-146. https://doi.org/10.1097/NMC.0000000000000232
Tussey, C. M., Botsios, E., Gerkin, R. D., Kelly, L. A., Gamez, J., & Mensik, J. (2015). Reducing length of labor and cesarean surgery rate using a peanut ball for women laboring with an epidural. Journal of Perinatal Education, 24(1), 16-24. https://doi.org/10.1891/1058-1243.24.1.16
How this MN600 Unit 5 example is structured
Organizing by outcome rather than by study is the matrix's main decision, because the proposal needs to know what the evidence says about each result, not what each paper says overall. Down the first-stage column, the studies that measured labor length mostly point toward shorter labor, but only one finding reaches significance and it is confined to first-time mothers. The cesarean column is split: one trial positive, one null, a quasi-experimental comparison and the composite cohort favoring the ball, and a pooled estimate whose interval reaches one. Neonatal cells mostly read not reported, and the matrix says so rather than implying safety. The who-was-studied column explains much of the disagreement, since the trials differ in parity mix and in whether labor was induced. The overlap column prevents double counting: the meta-analysis and the trials it appears to pool are never tallied as independent confirmations. Each column summary ends with a certainty phrase.
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MN600 Unit 5 questions, answered
What is Garrard's Matrix Method?
An approach to organizing literature, described by Judith Garrard in a health sciences text, that sets studies in rows and chosen topics in columns so a reviewer can compare them systematically. The columns are decided by the review question rather than fixed in advance. Evidence-based practice courses often adapt it, adding design, level and outcome columns suited to a clinical question.
Which levels of evidence scheme should the matrix use?
The one the course names. Melnyk and Fineout-Overholt's seven levels, the Johns Hopkins levels and quality ratings, and others differ in how they rank designs, so mixing them creates confusion. The sample uses the seven-level hierarchy, placing systematic reviews of randomized trials at level I and cohort studies at level IV, and states that choice in the matrix header.
Should quality improvement reports appear in the matrix?
They can, clearly labeled. Reports of local projects show whether a change was workable on real units and what problems arose, which matters for a proposal. They seldom account for other changes arriving in the same months, so their outcome cells deserve caution. Giving them their own design label keeps a reader from weighing them like trials.