Evidence-based Practice Recommendations for a practice change

Formulating PICO(T) question Assignment
May 26, 2021
Institute of Nursing Research
May 26, 2021

Evidence-based Practice Recommendations for a practice change

Evidence-based Practice Recommendations for a practice change

Evidence-based Practice Recommendations

NUR 440 Final Project Guidelines and Rubric Overview

The world of professional nursing practice and health policy is ever-evolving to meet the new dynamics of care needs in every setting. As a registered nurse, you are accountable and responsible for making decisions that are consistent with safe, competent, and ethical practice on a daily basis. You also face a variety of complex issues that impact the delivery of your nursing care.A professional practice issue is any issue or situation that either compromises client care/service by placing a client at risk, or affects a nurse’s ability to provide care/service consistent with standards and guidelines, and agency or organization policies or procedures.For this final project, you will develop an integrative review of literature about a clinical problem or issue of your choosing encountered in nursing practice. The purpose of an integrative review of literature assignment is to assist in preparing a scholarly paper that systematically collects, classifies, and analyzes a body of research evidence about a clinical topic in order to make evidence-based practice recommendations for a practice change.Evidence-based Practice Recommendations for a practice change. The project is divided into four milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules One, Two, Four, and Five. The final product will be submitted in Module Seven.In this assignment, you will demonstrate your mastery of the following course outcomes:? Assess diverse ways of knowing in nursing for their appropriateness in conducting nursing research and evidence-based nursing practice? Critique relevant primary research sources for their potential to provide evidence-based solutions to clinical nursing problems? Employ principles of ethical conduct of research in seeking evidence-based resources that support professional nursing practice changes? Propose evidence-based recommendations for practice changes that address clinical nursing problems for improving quality of care Prompt Choose a clinical problem or issue, with your instructor’s approval, that might be encountered in nursing practice. For this assessment, prepare a scholarlyintegrative review of the literature that will support a recommendation for a practice change to solve or improve the identified clinical problem or issue. To coverthe appropriate range of the research, you should search for and retrieve six current and relevant nursing research studies from primary sources that are relevantto your clinical topic of interest (these should be the articles from your annotated bibliography). Follow the assignment guidelines below to prepare a scholarlyintegrative review of the research literature you retrieved.Specifically, your integrative review of the literature should include the following critical elements:I. IntroductionA. What is the purpose of the integrative review? B. Clearly articulate the topic of interest, problem statement, and the research question being studied.C. What variables of interest (such as concepts, target population, setting, interventions, etc.) will be used to guide the review of literature?D. Discuss the background and significance of the problem to nursing. Be sure to substantiate your claims with specific examples from your research.II. Literature Search MethodsA. Identify keywords, subject headings, and combinations used in the initial search.B. Which databases were searched?C. State the inclusion/exclusion criteria for the sample of research reports. In other words, how did you make decisions to narrow the search and focusthe literature review? How was the final sample of research reports determined?III. Data Analysis and Critical AppraisalA. Evidence-based Practice Recommendations for a practice change. Analyze the quality of each study. In other words, is the problem well formulated and the purpose of the study clear? Is the study approach welldesigned and executed? Does the study demonstrate understanding of related studies? Do the findings advance knowledge?B.

Note each study’s strengths and limitations.C. Identify gaps in the literature and reflect on why these may exist.D. Identify similarities and inconsistencies across the studies.IV. Synthesis, Interpretation and Presentation of ResultsA. Develop an evidence table of your results that addresses the following criteria for each study: report citation, design, method, sample, data collection,data analysis, validity, and reliability of the findings. This table should appear in the Appendix of your paper.B. Identify major trends or patterns in the research reviewed.C. Can you make generalizations across the studies? Why or why not?D. What conclusions can you draw? Be sure to use a logical chain of evidence to support them.E. Provide a scholarly summary of the research reviewed that describes the “state of the science” presented by the research reports.F. Make practice recommendations based on the research reviewed.V. ConclusionsA. Identify the limitations of the literature review.B. Discuss the relevance of the results of your literature review to clinical practice.C. Discuss implications of the recommended practice change on future nursing practice and research.VI. Abstract: Include an abstract at the beginning of your paper that summarizes each of the following elements:A. Aims and objectivesB. BackgroundC. MethodsD. ResultsE. Conclusions F. Evidence-based Practice Recommendations for a practice change. Relevance to clinical practiceVII. Appendix: Provide an appendix at the end of your paper that includes the following elements:G. Search method flow chartH. The table of evidence that you developed in Step IV.A Milestones Milestone One: Topic ProposalIn Module One, you will submit your topic proposal for instructor approval. You will briefly explain your interest and what you hope to gain through a review ofthe literature. This milestone will be graded with the Milestone One Rubric.Milestone Two: PICO(T) QuestionIn Module Two, you will submit your PICO(T) question, which will guide your research and review of the literature. This milestone will be graded with theMilestone Two Rubric.Milestone Three: Annotated BibliographyIn Module Four, you will submit an annotated bibliography to help gather resources for your final project. This milestone will be graded with the MilestoneThree Rubric.Milestone Four: Evidence TableIn Module Five, you will submit an evidence table to organize your resources and as part of your final project. This milestone will be graded with the MilestoneFour Rubric.Final Submission: Integrative Review of the LiteratureIn Module Seven, you will submit your final project. It should be a complete, polished artifact containing all of the critical elements of the final product. It shouldreflect the incorporation of feedback gained throughout the course. This submission will be graded with the Final Project Rubric. Deliverables Milestone Deliverable Module Due GradingOne Topic Proposal One Graded separately; Milestone One RubricTwo PICO(T) Question Two Graded separately; Milestone Two RubricThree Annotated Bibliography Four Graded separately; Milestone Three RubricFour Evidence Table Five Graded separately; Milestone Four Rubric Final Submission: Integrative Review of theLiterature Seven Graded separately; Final Project Rubric. Evidence-based Practice Recommendations for a practice change

Evidence-Based Practice (EBP) is a thoughtful integration of the best available evidence, coupled with clinical expertise. As such it enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past research, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings.Evidence-based Practice Recommendations for a practice change


Evidence based practices was founded by Dr.Ardice Cochrane , a British epidemiologist.Cochrane was a strong proponent using evidence from randomized clinical trials because he believed that this was the strongest evidence on which clinical practice division is to be based.

Evidence based health care practices are available for a number of conditions such as asthma,smoking cessation,heart failure and others.However these practices are not be implemented in care delivery and variation of practices[CMS,2008;Institute of medicine ,2001].Recent findings in the united states and Netherlands suggest that 30% to 40 % of patients are not receiving evidence based care,and 20% to30% of patients are receiving unneeded or potentially harmful care. Evidence-based Practice Recommendations for a practice change


The most common definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996) Muir Gray suggests that evidence based health care is:

“an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best”(Muir Gray, 1997). Evidence-based Practice Recommendations for a practice change


1. Evidence based practice is an approach which tries to specify the way in which professionals or other decision mkers should make decisions by identifying such evidence that there may be for a practice and rating it according to how scientifically sound it may be. 2. Its goal is to eliminate unsound or excessively risky practices in favour of those that have better outcomes. 3. Evidence based practices has contributed a lot towards better patient outcomes. 4. The ultimate goal of evidenced based nursing is to provide the highest quality and most cost-efficient nursing care possible. 5. The purpose of evidence based practice in nursing is mainly to improve the quality of nursing care. Evidence-based Practice Recommendations for a practice change

For example: If you are caring for a child who was in a motor vehicle accident and sustained a severe head injury, would you want to know and use the effective ,empirically supported treatment established from randomized controlled trials to decrease his or her intracranial pressure?

If the answer is “yes“,the empirical evidences are essentially very important in most of the clinical decision-making situations. The goal of EBP is the integration of: (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver values to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve. Conceptually, the trilateral principles forming the bases for EBP can be represented through a simple figure: Evidence-based Practice Recommendations for a practice change


Evidence based practice process involves 5 steps as:
1. Formulating a clear question based on a clinical problem 2. Literture review to search for the best available evidences 3. Evaluating and analyzing the strengths and weaknessof that evidence in terms of validity and genelisability 4. Implementing useful findings in clinical practice based lon valid evidence 5. Evaluating efficacy and performance of evidences through a process of self reflection , audit, or peer aseessment 1.Formulating a clear question based on a clinical problem:[ ASK the question ] The first step is to formulate a clear question based on clinical problems.Ideas come from different sources but are categorized in two areas: Problem focused triggers and Knowledgee focused triggers. Problem focused triggers are identified by healthcare staff through quality improvement,risk surveillance,benchmarking data,financial data, or recurrent clinical problems.Problem focused triggers could be clinical problems,or risk management issues. Evidence-based Practice Recommendations for a practice change

Example:Increased incidence of deep vein thrombosis and pulmonary emboli in trauma and neurosurgical patients.Diagnosis and proper treatment of a DVT is a very important task for health care professionals and is meant to prevent pulmonary embolism.This is an example of an important re tht more research can be conducted to add into evidence –based practice. Knowledge focused triggers are created when health care staff read research, listen to scientific papers at research conferences.Knowledge based triggers could be new research findings that further enhance nursing ,or new practice guidelines. Example: Pain management .,prevention of skin breakdown , assessing placement of nasogastric tubes, and use of saline to maintain patency of arterial lines. Evidence-based Practice Recommendations for a practice change

When selecting a question ,nurses should formulate questions that are likely to gain support from people within the organization.The priority of the question should be considered as well as the sevearity of the problem.Nurses should consider whether the topic would apply to many or few clinical areas.Also,the availability of the solid evidence should be considered.This will increase the staff willingness to implement into nursing practice.

When forming a clinical question the following should be considered:the disorder or disease of the patient, the intervention or finding being reviewed, possibly a comparison intervention and the outcome.An acronym used to remember this is called the PICO model.:

P-Who is the patient population?
I-What is the potential intervention or area of interest?
C-Is there a a comparison intervention or control group?
O-What is the desired outcome? Evidence-based Practice Recommendations for a practice change

2.Literature review to search for the best available evidence :[ ACQUIRE the evidence ]

Once the topic is selected ,the research relevant to the topic must be reviewed . It is important that clinical studies , integrative literature reviewes , meta analysis, and well known and reliable existing evidence based practices guidelines are accessed in the literature retrieval process .The article can be loaded with optionated nd or biased statements that would clearly taint the findings, thus lowering the credibility and quality of article.Time management is crucial to information retrieval.To maintain high standards for evidence based practice implementation, education in research review is necessary to distinguish good research from poorly conducted research.it is important to review the current materials.Once the literature is located, it is helpful to classify the articles either conceptual or data-based.Before reading and critiquing the research ,it is useful to read theoretical and clinical articles to have a broad view of the nature of the topic and related concepts , and to then review existing evidence based practice guidelines. 3. Evaluating and analyzing the strengths and weakness of that evidence in terms of validity and generalisability: [APPRAISE the evidence]

Use of rating systems to determine the quality of the research is crucial to the development of evidence based practice. Once you have found some potentially useful evidence it must be critically appraised to determine its validity and find out whether it will indeed answer your question. When appraising the evidence the main questions to ask, therefore, are: Can the evidence (e.g. the results of the research study) be trusted? What does the evidence mean? Evidence-based Practice Recommendations for a practice change

Does this answer my question?
Is it relevant to my practice?

Different appraisal and interpreting skills must be used depending on the kind of evidence being considered. Additionally, guidance and training on appraising different types of evidence are available from some of the websites listed on the Useful Internet Resources. 4.Implimenting useful findings in clinical practice based on valid evidence :Evidence is used alongside clinical expertise and the patient’s perspectives to plan care:[ APPLY:talk with the patient ]

After determining the internal and external validity of the study ,a decisions is arrived at whether the information gathered does apply to your initial question.It is important to address questions related to diagnosis ,therpy ,harm, and prognosis. Once you have concluded that the evidence is of sound quality, you will need to draw on your own expertise, experience and knowledge of your unique patient and clinical setting. This will help you to decide whether the evidence should be incorporated into your clinical practice. Evidence-based Practice Recommendations for a practice change

You must consider both the benefits and risks of implementing the change, as well as the benefits and risks of excluding any alternatives. This decision should be made in collaboration with your patient, and in consultation with your manager or multidisciplinary team where appropriate.The information gathered should be interpreted according to many criteria and should always be shared with other nurses . 5.Evaluating efficacy and performance of evidences through a process of self reflection ,audit , or peer assessment: [self-evaluation ]

Finally after implementation of the useful findings for the clinical practices;efficacy and performance is evaluated through process of self reflection ,internal or external audit or peer assessment.Part of the evaluation process involves following upto determine if your actions or decisions achieved the desired outcome. Evidence-based Practice Recommendations for a practice change