Writing a clear evidence-based practice (EBP) question using the PICO format is the first step in developing a change in practice
Identify a Practice Problem
Writing a clear evidence-based practice (EBP) question using the PICO format is the first step in developing a change in practice. In this Discussion, you will explore the steps involved in EBP and develop a researchable EBP question in the PICO format that addresses a patient quality and safety issue.
To prepare for this Discussion,
Review the following from this week’s resources:
AWE Checklist (Level 4000)
Discussion Rubric, provided in the Course Information area
This week’s Writing Resources and Program Success Tools (link to e-guide)
This week’s articles and media
Post the following:
In this Discussion you will identify three clinical practice problems in your current (or past) practice as a nurse that risk compromise to quality of care and patient safety. You will select one of these problems to clearly define the risk and ask a question using the PICO format. Asking the question and selecting the problem is the first step of the Impact Model that is discussed in the textbook. Evidence-based practice questions are asked and written in the PICO format and you will use this process as you develop an evidence-based practice project that will be completed in steps during the course.
Note Initial Post: A three-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphraseto incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5-years-old.)
NURS4100
Week 2 Discussion
Levels of Evidence to Change Practice
What are the different types of evidence and how does one evaluate a source’s reliability?
Understanding the different levels, or hierarchy, of research evidence and how they relate to your research question will help you in determining the appropriate levels of support when engaged in the research process. To that end, you must consider how primary and secondary sources contribute to research as well as the meaningfulness of peer-reviewed articles and meta-analyses for promoting future research.
To prepare for this Discussion,
Review the following from this week’s resources:
· AWE Checklist (Level 4000)
· Discussion Rubric, provided in the Course Information area.
· This week’s Writing Resources and Program Success Tools (link to e-guide)
· This week’s articles and media
Post the following:
Explain the challenges of performing a literature search. Then, describe the databases and the search terms that you used in your online search related to your specific clinical problem for your EBP Project. Explain what went well, what were the challenges, and the amount of time needed to complete the search. In the responses to classmates’ posts please discuss what recommendations that you would give your classmates to improve their searches.
Note Initial Post: A three-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5-years-old.)
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues.
Post a Discussion entry on 3 different days of the week. See the Discussion Rubric found in the Course Information area.
NURS4100
Week 3 Discussion
Common Flaws in Quantitative Studies
When nurses have a question about a clinical practice issue that they can turn to the literature to see what scientific evidence is available that addresses their question. However, as discussed in Week 2, not all evidence is created equal. When looking at the literature, it is important to evaluate each research study. Before assumptions can be made about the applicability of a study’s results, specific elements of a research design must be evaluated.
This week, you will examine elements of the strength of a quantitative research study’s design, including sample size, generalizability, statistical analysis and conclusions. Keep in mind all studies have flaws or are not valid for your population. Consequently, one study by itself will not warrant a change in practice. It is important to find a number of studies to support your change in practice.
To prepare for this Discussion,
Review the following from this week’s resources:
AWE Checklist (Level 4000)
Discussion Rubric, provided in the Course Information area
This week’s Writing Resources and Program Success Tools (link to e-guide)
This week’s articles and media
By Day 3
Post the following:
After viewing the Week 3 Webinar: Critical Appraisal of Quantitative Research, complete the Appraisal Guide: Findings of a Quantitative Study in this week’s resources. Of the questions discussed on the second page of the critique form, titled Credibility, which ones were identified in the article reviewed during the webinar? Describe one of the most serious flaws in this study and why it leaves you wondering if the study findings should be used as evidence in an assessment of patient handoff?
Note Initial Post: A three-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5-years-old.)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues.
Post a Discussion entry on 3 different days of the week. See the Discussion Rubric found in the Course Information area.
NURS4100
Week 4 Discussion
Evaluation of Qualitative Research
Qualitative research provides evidence from the individual/family/group/culture perspective. It is vital to understand that life experiences are an important source of evidence. The rich evidence gathered with qualitative research provides an in-depth examination of the human experience and cultural health beliefs of individuals and families. This week, you will be analyzing a qualitative research design including problem, data collection and analysis, and conclusions.
By Day 3
Post the following:
Like Week 3, after viewing the Week 4 Webinar: Critical Appraisal of Quantitative Research, complete the Appraisal Guide: Findings of a Qualitative Study in this week’s resources. Of the questions discussed on the second page of the critique form, titled Credibility, which ones were identified in the article reviewed during the webinar? Describe one of the most serious flaws in this study and why it leaves you wondering if the study findings should be used as evidence in an assessment of patient safety in the home.
Note Initial Post: A three-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5-years-old.)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues.
Post a Discussion entry on 3 different days of the week. See the Discussion Response and Grading Rubric found in the Course Information area.
NURS4100
Week 5 Discussion
Using Evidence-Based Practice Models to Guide Practice Change and Developing a Plan for the Evidence-Based Practice Project
Facilities often establish EBP committees who are charged with reviewing the evidence and proposing changes in practice. The committees work together to synthesize plans and engage in activities that will promote EBP in to promote quality care and patient safety. Integral to developing and implementing EBP change are the need to utilize effective communication and leadership skills.
The required readings this week provide an overview of different evidence-based models that can be used as guides to conducting evidence-based practice change projects. In the videos for Week 5, an EBP committee discusses the evidence-based steps they used to identify, assess, propose and implement a practice change in their work settings. For this Discussion, you will see a committee as it completes it work. There are two scenarios with the videos. In the first one, there are issues that develop that need to be resolved. You will be asked to pause the video and identify how you would address the conflict that seems to be developing over the EBP change. In the second scenario, you will see how leadership skills are utilized to help focus the committee on the EBP project.
By Day 3
Post the following:
After viewing the videos, use the flow chart in the [Iowa EBP Model to Promote Quality Care] found in the Grove, Gray, and Burns text, to discuss how closely the EBP project did or did not follow each step in this model. In what ways do you think the project would have benefited from implementing any step(s) that were not used?
Note Initial Post: A three-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5-years-old.)
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues.
Post a Discussion entry on 3 different days of the week. See the Discussion Rubric found in the Course Information area.
NURS4100
Week 6 Discussion
Implementing and Evaluating Evidence-Based Practice Change in Health Care Settings
You have reached the final step of the EBP process. You have submitted the final evidence-based practice project paper to your Instructor. This week, you will develop a voice-over PowerPoint presentation on your EBP project to present to your classmates in the Discussion.
To prepare for this Discussion,
Review the following from this week’s resources:
· AWE Checklist (Level 4000)
· Discussion Rubric, provided in the Course Information area
· This week’s Writing Resources and Program Success Tools (link to e-guide)
· This week’s articles and media
· Prepare a PowerPoint Presentation on your EBP project (see Rubric for guidelines)
By Day 3
Post the following:
Post the voice-over PowerPoint presentation on your EBP Project to the Discussion. Students will discuss projects with each other, asking for clarification as needed, offering suggestions to prep, and offering support and encouragement to each other.
By Day 7
Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).
Respond with a comment that asks for clarification, provides support for, or contributes additional information to two or more of your colleagues.
Post a Discussion entry on 3 different days of the week. See the Discussion Rubric found in the Course Information area.
Note: Please be advised that you will be graded for both your final PowerPoint presentation as well as your Discussion posts.
NURS4100
Week 1 Assignment
Evidence-Based Problem and Question
To begin your EBP project for the course, you will develop your PICO statement and practice question using the Evidence-Based Problem and Question template in this week’s resources. The template covers all three parts of this assignment:
Identify one nurse sensitive indicator that you think is a problem in your workplace. Focus on everyday nursing practice issues such as, falls, pressure ulcers, unsafe work environment, pain assessment, peripheral intravenous, physical restraints, healthcare associated infections, or education.
Use the four PICO categories to describe this clinical problem. For the purposes of this class it is not recommended students attempt to select the topics of staff ratios/mix or turnover, job satisfaction, nursing care hours provided per patient day, or insurance issues.
Develop an answerable EBP question.
A “PICO Advice” discussion forum has been added to the Contact the Instructor section of the course to assist in development of the PICO related information. This forum is to provide students a centralized place to ask the instructor questions related to formation and revision of their PICO. All students are encouraged to review the discussion board as a way to learn from each other as PICO questions are explored and developed.
NURS4100
Week 2 Assignment
Finding the Research Evidence
Continuing on with step one of the Impact Model is the need to search for the studies to support your project. There are different classes of evidence that can guide changes in clinical practice.
To prepare for this Assignment, review the following:
· Academic Writing Expectations Checklist 4000 Level Courses.
· Walden paper template. (No abstract required for AWE 4000.)
Write a 2-page paper (exclusing title page and reference page) to address the following:
· For the evidence-based problem that you identified in Week 1 for your project, locate two different articles/sources representing two different types of evidence from the following categories: (a) systematic review, (b) national clinical guidelines and/or (c) peer-reviewed quantitative / qualitative studies.
· For each article/source of evidence:
o Summarize the article/source in your own words without the use of direct quotes.
o Using the Peterson et al., (2014) article located in Week 2 Resources address the level of evidence (hierarchy). Then discuss the usefulness of the evidence from the article/source in addressing the identified practice problem. Be sure to site evidence in-text and in a final reference page.
o Describe where your two sources fit into the hierarchy of evidence and explain why.
o Describe the value of these two sources in better understanding and addressing your evidence-based problem.
· Use the writing template to follow APA formatting and follow AWE level 4000 guidelines.
Note: Before you submit any final paper in the course for grading, submit it to Safe Assign within the course in the week’s draft area. Use the information provided in the Originality Report (Walden University, n.d.) to revise your paper. Paraphrasing and citing your sources in-text will decrease the Similarity Index. Revise your paper before submitting it.
NURS4100
Week 4 Assignment
Appraisal Guide
The assignment for this week is to submit the Appraisal Guide for two of the resources that you have selected for your Evidence-Based Practice Project. You will need to select the Appraisal Guide that is appropriate for the type of study that was conducted. The Appraisal Guide: Findings of a Qualitative Study and the Appraisal Guide: Findings of a Quantitative Study are located in this week’s resources.
· Access the Appraisal Guide that is appropriate for the study that was conducted
· Complete the sections of the Appraisal guide for each of the two resources you have selected for your Evidence-Based Practice Project
NURS4100
Week 5 Assignment
EBP Project Paper
For this Assignment, review the following:
· Academic Writing Expectations Checklist 4000 Level Courses.
· Walden paper template. (No abstract required for AWE 4000.)
Using AWE Level 4000 writing guidelines submit a 3- to 4-page paper (not including the title page, reference list, and appraisal guides) on your EBP project including:
· PICO clinical question
· Recommended change in practice citing high-level evidence to support your suggested change in practice
· Evaluation strategies and outcome measures
· Select at least 5 sources of evidence from the following categories: (a) systematic review, (b) national clinical guidelines and/or (c) peer-reviewed quantitative / qualitative studies. Attach appraisal guides for all peer-reviewed articles.
Pay specific attention to the Writing Expectations 4000 Checklist. Paraphrase, avoid direct quotes, and use your own words supported by evidence to exhibit scholarly writing. Do not use articles older than 5 years unless they have been confirmed as seminal articles by your Instructor. At least 5 sources of evidence are required for your paper. Attach appraisals after the reference page for each article used. (See the Clinical Guideline Appraisal and Systematic Review Appraisal in this week’s Resources.)
NURS4100
Week 6 Assignment
EBP Project Paper
For this Assignment, review the following:
The Week 6 Assignment Rubric
Create a Voice Over PowerPoint presentation that summarizes your Evidence Based Practice Paper. Include a minimum of 6 slides (15 maximum) and the information provided in the Week 6 Assignment Rubric.
The Voice Over PowerPoint Presentation is worth a maximum of 200 points and is to be posted in the Week 6 Discussion Board by Day 3 and to the Week 6 Assignment submission area by Day 7.
NURS4100
Week 3 Quiz
Question 1: The purpose of the study was to:
Answers:
a. Evaluate the effectiveness of a process for providing patient report
b. Evaluate the effectiveness of a process for decreasing medication errors
c. Test the effectiveness of the “Patient Views on Nursing Care” survey
d. Test the effectiveness of the “Nursing Assessment of Shift Report” survey
Question 2:The research design for the study was:
Answers:
a. Correlational
b. Ethnographic
c. Experimental
d. Quasi-experimental
Question 3: The literature review indicated there were gaps in knowledge
Answers:
a. About the effectiveness of using the “Patient Views on Nursing Care” survey with acute inpatients.
b. About quantitative patient and nurse outcomes related to patient report
c. About the usefulness of bedside report in promoting nurse staff retention
d. About the family perception of bedside reporting
Question 4: The Patient Views on Nursing Care survey was reported to have a Cronbach’s alpha of 0.96. This means that the survey tool:
Answers:
a. Has face validity
b. Has content validity
c. Needs to be used carefully since the value is not 1.00
d. Provides consistent results with repeated use
Question 5: The nursing sample were recruited by:
Answers:
a. E-mail and flyers
b. Employee number
c. Personal invitation
d. Supervisor recommendation
Question 6: The type of sample selection used in the study was:
Answers:
a. Convenience
b. Purposive
c. Random
d. Snowball
Question 7: The significant results of the Patient Views on Nursing Care survey over the three administration times were:
Answers:
a. Help me feel comfortable
b. Listen carefully without interrupting
c. Made sure I knew who my nurse was
d. Tell about plans for discharge
Question 8: Significant results can be identified in Table 1, “Patient Views on Nursing Care Survey”, by a p value of:
Answers:
a. >1.00
b. <1.00
c. <0.05
d. >0.50
Question 9:The results of the data collection indicated:
Answers:
a. The fall rate decreased during the 13 months while the study was being conducted.
b.The medication error rate increased after the first three months of implementing the change.
c. The overtime rate for the nursing staff increased significantly after the implementation of the new process.
d. There was no change in any of the patient safety outcome measures during the study period.
Question 10: Table 3, “Nurse Perceptions of the Report Format”, provide which of the following results?
Answers:
a. Combined mean values for the three survey times
b. Mean values for each of the three survey times
c. Only non-significant items from the survey
d. Only significant items from the survey
Question 11: Limitations of the study included
Answers:
a. Changing the way overtime was calculated during the study
b. Lack of education on the change in the reporting process
c. Only one acute care unit was used for the study
d. Use of a convenience sample
Question 12: Recommendations for future research are to:
Answers:
a. Conduct a pilot study to be sure the survey instruments can be answered by the patients
b. Identify change champions and nursing staff who support the blended bedside report
c. Include one or more items in both the patient and nurse surveys that would help quantify any inconsistencies in implementation of the practice change
d. Repeat the study using different survey tools
Question 13: The statistical test used to analyze the differences among the three groups of responses was:
Answers:
a. ANOVA
b. Means and standard deviation
c. Pearson Correlation
d. T-Test
Question 14: The authors indicated the findings of the practice change evaluation:
Answers:
a. Are relevant to clinical practice
b. Are not relevant to clinical practice
c. Need additional study before relevance to clinical practice can be determined
d. Need to include all members of the health care in order to be relevant to clinical practice
Question 15: The authors recommend outcome measures need to be monitored for at least: __________months to determine if the change in practice has been sustained.
Answers:
a. 2
b. 4
c. 12
d. 24
NURS4100
Week 4 Quiz
Question 1 – The purpose of this study was to:
a. Describe patient safety incidents from emergency call records
b. Explore patient safety incidents as described by patients in hospice care
c. Explore patient safety incidents as described by health care team members
d. Extract patient safety incidents from documentation in medical records
Question 2 – The methodology used in this qualitative study is appropriate because:
a. Administering a questionnaire with open-ended questions is the best method to described lived experiences
b. Broad interview questions are the best method to describe lived experiences
c. Observing patients and families in the hospice environment is the best method to describe patient safety issues
d. Using focused interview questions requiring a yes or no answer is the best method to describe lived experiences
Question 3 – The study design is:
a. Ethnography
b. Exploratory descriptive
c. Grounded theory
d. Historical
Question 4 – The subjects selected to participate:
a. Are a convenience sample which is appropriate for qualitative research
b. Should have been randomly selected from the hospice agencies
c. Should have been purposely selected based on years of experience in home hospice
d. Would have provided better descriptions of issues if they had been identified through the snowball method
Question 5 – The research team was described as meeting to discuss and corroborate on the coding. This method:
a. Introduces bias into the data analysis process
b. Is an accurate process in qualitative research
c. Is a threat to the internal validity of the study
d. Should have included several of the interviewees to expand the perspective of how to code the results
Question 6 – The phase 2 data review panel is an appropriate process because it strengthens the ____________________ of the phase 1 results.
a. Credibility
b. Reliability
c. Sustainability
d. Validity
Question 7 – The results of the study are presented as themes that emerged from the data analysis. To provide an accurate reflection, they need to be supported by:
a. A table listing the number of times the theme was mentioned by the interviewees
b. Direct quotes from previous studies that reported the same theme
c. Direct quotes and examples from the interview transcription
d. Paraphrased quotes from the interview transcription
Question 8 – The summary of common patient safety harms and contributing factors that were categorized under the themes in Table 1 includes all but:
a. Caregiver’s physical and/or cognitive limitations
b. Medical errors made by the health care providers
c. Patient or caregiver difficulty in understanding care instructions
d. Poor or physically hazardous living conditions
Question 9 – The most commonly cited contributing factor for patient safety incidents discussed in the phase 1 interviews was:
a. Frail or debilitated patients living alone, or being left alone by caregivers
b. Injuries from falls
c. Medication diversion by family members or caregivers
d. Non-adherence to instructions provided by the hospice team
Question 10 – The limitations of the study were identified as:
a. Sample size
b. Selection of interview process
c. The type of opening questions may have prompted responses from the interviewees
d. The data analysis process
Question 11 – The authors recommend additional research should be conducted.
a. This is an expected result of qualitative research
b. This should only be discussed in quantitative research articles
c. This should be presented as a hypothesis to be tested
d. This skews the results of the data analysis
Question 12 – The researchers controlled bias and preconceptions by:
a. Asking the interviewees to critique and recommend changes to the questions
b. Recruiting participants from the Population-based Palliative Care Research Network
c. Selecting interview questions from a national data bank of qualitative interview questions
d. Using the International Classification for Patient Safety definition as a guide when developing the interview questions
Question 13 – The data collection method was appropriate for qualitative research because it used:
a. Administration of a questionnaire to families of hospice patients
b. Extraction of patient safety incidents from medical records
c. Interviewing health care providers about experiences with home hospice patient safety incidents which gives first- hand knowledge
d. Participant observation of care being provided to home hospice patients
Question 14 – Which of the following qualitative appraisal credibility criteria would be of concern to the nurse evaluating the results?
a. Conducting the participant interviews by telephone
b. Improving the interview guide to probe for additional types of patient safety incidents in the home
c. The study was published in a non-peer reviewed journal
d. Using a computer program with qualitative analysis software to assist in the data analysis
Question 15 – Which statement accurately reflects analysis of the sample of 62 hospice workers in Phase 1?
a. The sample is too small for qualitative research to provide any significant results.
b. The sample is too large for the study to be classified as a qualitative study.
c. Sample size isn’t of concern as sampling continues until data saturation is met.
d. Sample size isn’t of concern as sampling continues until all interested persons have the opportunity to be interviewed.
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