Nursing Scientific Foundations Discussion
ORDER CUSTOM, PLAGIARISM-FREE PAPERS ON Nursing Scientific Foundations Discussion
Question Description
Your Discussion postings should be written in standard edited English and follow APA guidelines as closely as possible given the constraints of the online platform. Be sure to support your work with specific citations from this week’s Learning Resources and additional scholarly sources as appropriate. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct. Initial postings must be 250–350 words (not including references).
YOU MUST USE THE REQURED READINGS AS REFERENCES FOR THIS DISCUSSION POST
Discussion – Week 11
Evidence-Based Practice
For this Discussion, you will consider the various EBP models as well as the difference between EBP and clinical research.
To prepare:
- Reflect on the EBP models presented in the Learning Resources and their application in clinical practice.
- Recall the clinical practice problem you identified for Application #5, and consider which EBP model would best support investigating that problem.
- Also, contemplate the difference between the application of research in evidence-based practice and clinical research and the role of the DNP-prepared nurse in both.
By Day 3 post a cohesive response that addresses the following:
- Which EBP model would best support the exploration of the practice problem you utilized for Application #5? Include a brief summary of your practice problem and the rationale for your EBP model selection.
- Provide a summary of how evidence-based practice differs from clinical research, and include your perception of the role of DNP-prepared nurses in both.
REQUIRED READINGS
McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.
- Chapter 19, “Application of Theory in Nursing Research”
- Chapter 19 delves into the application of theory to nursing research and provides examples of its importance and use.
Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.
- Review Chapter 1, “Discovering the World of Nursing Research”
- Review Chapter 1 focusing on how theory is applied to nursing through evidence-based practice.
- Chapter 19, “Evidence Synthesis and Strategies for Evidence-Based Practice”
- This section of Chapter 19 presents strategies for transitioning the nursing profession toward EBP.
Fitzpatrick, J. (2010). Connecting or disconnecting the dots between research and evidence-based practice. Applied Nursing Research, 23(1), 1. doi:10.1016/j.apnr.2009.10.001
This brief editorial calls for practitioners to be aware of the difference between research and evidence-based practice.
Ganz, F., Fink, N., Raanan, O., Asher, M., Bruttin, M., Nun, M., & Benbinishty, J. (2009). ICU nurses’ oral-care practices and the current best evidence. Journal of Nursing Scholarship, 41(2), 132–138. doi:10.1111/j.1547-5069.2009.01264.x
This article explores the use of evidence-based practices in the ICU.
Kenny, D. J., Richard, M. L., Ceniceros, X., & Blaize, K. (2010). Collaborating across services to advance evidence-based nursing practice. Nursing Research, 59. S11–S21.
This article discusses the implementation of EBP through the collaborative efforts of nurses at two medical facilities.
Krom, Z., Batten, J., & Bautista, C. (2010). A unique collaborative nursing evidence-based practice initiative using the Iowa model: A clinical nurse specialist, a health science librarian, and a staff nurse’s success story. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 24(2), 54–59. doi: 10.1097/NUR.0b013e3181cf5537
This article discusses the efforts of a clinical nurse specialist, a health science librarian, and a staff nurse to heighten staff nurse awareness of the evidence-based practice process.
University of Iowa Hospitals and Clinics (2010). The Iowa model of evidence-based practice. Retrieved from http://www.uihealthcare.org/otherservices.aspx?id=…
This website provides numerous resources that explain and support the Iowa Model of EBP.
REQUIRED MEDIA
Laureate Education (Producer). (2011). Theoretical and scientific foundations for nursing practice: An evidence-based practice model [Video]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 10 minutes.
In this media presentation, Dr. Kathleen White discusses the Johns Hopkins model for evidence-based practice. Dr. White presents how the model was developed and provides examples of how each stage of the model is applied in nursing practice.
OPTIONAL RESOURCES
Dufault, M. (2004). Testing a collaborative research utilization model to translate best practices in pain management. Worldviews on Evidence-Based Nursing, 1. S26–S32. doi:10.1111/j.1524-475X.2004.04049.x
Fineout-Overholt, E., & Johnston, L. (2005). Teaching EBP: Asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2(3), 157–160.
Maramba, P., Richards, S., Myers, A., & Larrabee, J. (2004). Discharge planning process: applying a model for evidence-based practice. Journal Of Nursing Care Quality, 19(2), 123–129.
Newhouse, R.P. (2007). Diffusing confusion among evidence-based practice, quality improvement, and research. JONA: The Journal of Nursing Administration, 37(10), 432–435. doi:10.1097/01.NNA.0000285156.58903.d3
Newhouse, R., Dearholt, S., Poe, S. Pugh, L., & White, K. (2005). Evidence-based practice: Practical approach to implementation. Journal of Nursing Administration, 35(1), 35–40.
Unformatted Attachment Preview
Available online at www.sciencedirect.com Applied Nursing Research 23 (2010) 1 www.elsevier.com/locate/apnr Editorial Connecting or disconnecting the dots between research and evidence-based practice What constitutes the evidence for evidence-based practice? Do we necessarily rely only on research and/or scientific evidence? Or are there other dimensions or types of evidence that are equally important or necessary for expert practice? I am constantly struck by the presentation in the literature equating research and evidence-based practice without the acknowledgment that there is a distinction. Often, evidencebased practice is described as research applied to practice. Further, the hierarchy of necessary evidence often refers to randomized controlled trials (RCTs) as the most valid form of evidence to weigh in the application of evidence to practice. Does the absence of RCTs in most of the areas in which we practice mean that we are without solid evidence on which to base our interventions? Evidence-based practice requires attention to more than science and research; it requires the expert judgment of the seasoned clinician as well as the knowledge generated from science. We all can judge expert clinicians based on the outcomes of their interventions but often find it difficult to describe their knowledge base or how they obtained their knowledge. Most of them have learned their art from practice. Yet, the expert clinician is more than someone with years of practice experience. The synthesis of knowledge from a range of sources is an absolute necessity for expert clinical practice. Further, 0897-1897/$ – see front matter © 2010 Published by Elsevier Inc. doi:10.1016/j.apnr.2009.10.001 evidence-based practice requires that conceptual understandings are embedded in the second core dimension of science, that of theory. I imagine that the equation of evidence-based practice and research is based on our efforts to simplify and to quantify, for what is observable and quantifiable is more often easier to understand. Objectifying and counting something seem to make it more real, especially to those of us used to the predominant scientific model. However, this merging of concepts may be suppressing the need to think more clearly about the nature of our clinical discipline. We have had evidence for some time that multiple ways of knowing provide a more complete picture of our interventions and their outcomes. The holistic nature of nursing deserves more than a one-sided perspective on knowing and more than scientific knowledge alone can teach us. Evidence-based practice thus demands attention to the broad evidence, to what we know as expert clinicians, and to what we know as scientists. We expect this integration of our beginning students in nursing as we teach them the art and science of nursing. We also should expect the integration within our own practice as scientists.
Joyce J. Fitzpatrick (Editor) E-mail address: anrjournal@hotmail.com © Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt, or otherwise reuse any or all content from this article, e-mail pubpermissions@ons.org. To purchase high-quality reprints, e-mail reprints@ons.org. Evidence-Based Practice Carlton G. Brown, PhD, RN, AOCN®, FAAN—Associate Editor The Iowa Model of Evidence-Based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing Carlton G. Brown, PhD, RN, AOCN®, FAAN Evidence-based practice (EBP) improves the quality of patient care and helps control healthcare costs. Numerous EBP models exist to assist nurses and other healthcare providers to integrate best evidence into clinical practice. The Iowa Model of EvidenceBased Practice to Promote Quality Care is one model that should be considered. Using an actual clinical example, this article describes how the Iowa Model can be used effectively to implement an actual practice change at the unit or organizational level. Overview of Model (Melnyk et al., 2012). Numerous EBP models are available to help nurses organize and systematically track progress in implementing evidence into practice, including the Stetler Model of Research Utilization (Stetler, 2001), the Iowa Model of Evidence-Based Practice to Promote Quality Care (hereafter referred to as the Iowa Model) (Titler et al., 2001), and the Johns Hopkins Nursing Model (Newhouse, Dearholt, Poe, Pugh, & White, 2005). These models provide a step-by-step guide on how to take a clinical problem and match it with an intervention based on research to make an organizational or departmental change to practice. Using a model for EBP change also can assist nursing departments in better focusing their limited fiscal and personnel resources on critical EBP activities (Gawlinski & Rutledge, 2008). Nursing Scientific Foundations Discussion
The current article will focus on one such model, the Iowa Model (Titler et al., 2001), as an example of how using a model can help focus on the process of implementing evidence-based changes (see Figure 1). The Iowa Model was selected because nurses find it intuitively understandable and it has been used in numerous academic settings and healthcare institutions (Gawlinski & Rutledge, 2008). The Iowa Model can help nurses and other healthcare providers translate research findings into clinical practice while improving outcomes for patients. The first step in the Iowa Model is to identify either a problem-focused trigger or a knowledge-focused trigger where an EBP change might be warranted. Problemfocused triggers are those problems that derive from risk management data, financial data, or the identification of a clinical problem (e.g., patient falls). Knowledgefocused triggers are those that come forward when new research findings are presented or when new practice guidelines are warranted. The next step in the Iowa Model is for the nurse or team to determine whether the problem at hand is a priority for the organization, department, or unit in which they work. Those problems that may have higher volume or higher costs associated likely will have higher priority from the organization. Organizational buy-in is crucial when working on EBP issues, so knowing the prioritization of the problem is important. Once the priority has been determined, the next step is to form a team consisting of members that will help develop, evaluate, and implement the EBP change. The composition of the team will be determined by the problem at hand. Titler et al. (2001) pointed out that the team should include interested interdisciplinary stakeholders. This step is important and should include team players outside of those from nursing. Once a team has been formed, the next step is to gather and critique pertinent research related to the desired practice change. The most important portion of this step is to form a good question (using the PICOT method [Guyatt, Drummond, Clinical Journal of Oncology Nursing • Volume 18, Number 2 • Evidence-Based Practice 157 Carlton G. Brown, PhD, RN, AOCN®, FAAN, is the director of Professional Services at the Oregon Nurses Association in Tualatin. The author takes full responsibility for the content of the article. The author did not receive honoraria for this work. No financial relationships relevant to the content of this article have been disclosed by the author or editorial staff. Brown can be reached at cgenebrown@gmail.com, with copy to editor at CJONEditor@ons.org. Key words: evidence-based practice; research; decision making Digital Object Identifier: 10.1188/14.CJON.157-159 N urses understand that evidencebased practice (EBP) improves the quality of patient outcomes while controlling the cost of healthcare (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). But even in the year 2014, barriers and roadblocks exist to implementing EBP at the bedside or chair side. The Institute of Medicine estimated that it takes more than 17 years to implement a research finding into clinical practice (Institute of Medicine, 2001). Nursing Scientific Foundations Discussion
Although research may exist that should be translated into practice, the time it takes to deliver these research-based interventions to patients takes too long. In their study of 1,054 RNs, Melnyk et al. (2012) discovered that although nurses value EBP, they required education, access to information, and time to implement EBP into daily practice. Nurses and other healthcare providers want their practice based in evidence, but they also acknowledge the barriers of lack of education and time to actually implement and use EBP. EBP is a problem-solving approach to clinical decision making that integrates the best evidence from well-designed studies with a clinician’s expertise along with patients’ preferences and values Meade, & Cook, 2008]) and then conduct a literature search for actual research studies that pertain to the question at hand. This is an excellent time to enlist a medical librarian who can help search for and retrieve studies to aid in choosing an Problem-Focused Triggers 1. Risk management data 2. Process improvement data 3. Internal/external benchmarking data 4. Financial data 5. Identification of clinical problem Knowledge-Focused Triggers 1. New research or other literature 2. National agencies or organizational standards and guidelines 3. Philosophies of care 4. Questions from institutional standards committee Consider other triggers Is this topic a priority for the organization? No Yes Form a team Assemble relevant research and related literature Critique and synthesize research for use in practice Is there a sufficient research base? Yes Base Practice on Other Types of Evidence 1. Case reports 2. Expert opinion 3. Scientific principles 4. Theory Pilot the Change in Practice 1. Select outcomes to be achieved 2. Collect baseline data 3. Design evidence-based practice (EBP) guideline(s) 4. Implement EBP on pilot units 5. Evaluate the process and outcomes 6. Modify the practice guidelines Continue to evaluate quality of care and new knowledge No No Is change appropriate for adoption in practice? Disseminate results Yes Conduct research Institute the change in practice Monitor and Analyze Structure, Process, and Outcome Data • Environment • Staff • Cost • Patient and family FIGURE 1. The Iowa Model of Evidence-Based Practice to Promote Quality Care Note. Figure courtesy of Marita Titler. Used with permission. 158 intervention or answer to the problem or knowledge-focused question. The next step is that the team must critique the available studies to determine whether the study with the tested intervention is scientifically sound. Not every research article published in a professional journal has appropriate scientific merit. Sometimes articles have a small sample size or perhaps use a tool lacking reliability or validity, so critiquing every article prior to considering the results of that study for implementation into a practice change is important. Advanced practice nurses are ideal members of the team to assist with the critique of respective research studies (Titler et al., 2001). Titler et al. (2001) also suggested pairing novice team players with members who are experts or more experienced in critiquing research. At this juncture, the team needs to decide whether sufficient research exists to implement a practice change. Titler et al. (2001) suggested the following criteria be considered when determining whether research can be implemented into practice: (a) consistent findings exist from numerous studies to support the change, (b) the type and quality of the studies, (c) the clinical relevance of the findings, (d) the number of studies with similar sample characteristics, (e) the feasibility of the findings in practice, and (f) the risk-benefit ratio. If a majority of the criteria can be met, the team should then plan to implement the intervention in a pilot practice change. If adequate research does not exist, an actual research study might be conducted. The next step would be to implement the intervention into a pilot practice change. Notice here that the team would not conduct a full practice change for the entire organization, but rather would implement a pilot change in one or two smaller practice areas first; the team needs to ensure the change is feasible and will result in improved outcomes before full-scale implementation. If the intervention is successful in pilot implementation, it can be converted to an organization practice change. Even after a practice change has been implemented, the team should continue to evaluate the practice change, watching for any April 2014
• Volume 18, Number 2 • Clinical Journal of Oncology Nursing deviation in practice or a decrease in the outcomes. An Illustrated Example A clinical example will now be used to illustrate how a group of nurses and other healthcare providers could use the Iowa Model to make a change to clinical practice and improve overall patient outcomes. A group of oncology nurses working on an inpatient stem cell transplantation unit were particularly concerned about the high level of patient falls, some of which resulted in patient injury. The group, led by an advanced practice nurse, decided to use the Iowa Model to help guide the process of finding a potential practice change. The team learned that patient falls with injury were an overall concern for the organizational, given that they not only resulted in poorer patient outcomes but also had significant financial costs for the organization. Nursing Scientific Foundations Discussion
The group of oncology nurses formed a falls prevention team and invited interested interdisciplinary members, including physicians, nurses, physical therapist, occupational therapists, and other hospital employees, to join. The team then asked the medical librarian to help them collect relevant randomized, controlled trials and other studies, and the team critiqued those studies for scientific merit. The team came across numerous studies that supported patients wearing bright-colored, non-skid socks when at risk for falls. The socks were implemented as a practice change to two inpatient units as a pilot. During the four- month pilot, the team documented a decrease in patient falls on units where the patients were wearing the bright-colored, non-skid socks. The team then decided to implement the practice change in the entire organization and are continuing to monitor monthly patient fall levels. Conclusion Nurses want to implement interventions in their practice based on the highest levels of evidence. However, nurses also have noted that they need time and more education to translate current evidence into practice. The use of an EBP model, such as the Iowa Model (Titler et al., 2001), can help nurses organize the practice change and provide them with a step-bystep process on how make the change for a unit or organization. References Gawlinski, A., & Rutledge, D. (2008). Nursing Scientific Foundations Discussion
Selecting a model for evidence-based practice changes: A practical approach. AACN Advanced Critical Care, 19, 291–300. doi:10.1097/01.AACN.0000330380.41766 .63 Guyatt, G., Drummond, R., Meade, M., & Cook, D. (2008). Users’ guides to the medical literature: A manual for evidencebased clinical practice (2nd ed.). New York, NY: American Medical Association. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century (pp. 8–25). Washington, DC: National Academies Press. Melnyk, B.M., Fineout-Overholt, E., GallagherFord, L., & Kaplan, L. (2012). Nursing Scientific Foundations Discussion
The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42, 410–417. doi:10.1097/ NNA.0b013e3182664e0a Newhouse, R., Dearholt, S., Poe, S., Pugh, L.C., & White, K.M. (2005). Evidence-based practice: A practical approach to implementation. Journal of Nursing Administration, 35, 35–40. doi:10.1097/00005110 -200501000-00013 Stetler, C.B. (2001). Updating the Stetler Model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49, 272–279. doi:10.1067/mno.2001 .120517 Titler, M.G., Kleiber, C., Steelman, V.J., Rakel, B.A., Budreau, G., Everett, L.Q., . . . Goode, C.J. (2001). The Iowa Model of evidencebased practice to promote quality care. Critical Care Nursing Clinics of North America, 13, 497–509. Do You Have an Interesting Topic to Share? Clinical Journal of Oncology Nursing • Volume 18, Number 2 • Evidence-Based Practice 159 Copyright of Clinical Journal of Oncology Nursing is the property of Oncology Nursing Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. Nursing Research January/February 2010 Vol 59, No 1S, S11–S21 Collaborating Across Services to Advance Evidence-Based Nursing Practice Deborah J. Kenny 4 Maggie L. Richard b Background: Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population.
These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. b Objectives: The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. b Methods: A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. b Results: Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidencebased clinical practice guidelines were developed at each facility and are currently in various stages of implementation. b Discussion: Nursing Scientific Foundations Discussion
Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Militaryspecific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a common mission of providing high-quality care for war-injured service members. Nursing Scientific Foundations Discussion
Lessons learned from this project can be generalized to civilian facilities. b Key Words: evidence-based practice & practice guideline & quality assessment 4 Xochitl Ceniceros 4 Kelli Blaize A s in the civilian healthcare community, in military medical treatment facilities (MTFs), attention has been focused on the importance of using scientific evidence to guide nursing practice and improve patient outcomes in both fixed facilities (Weisgram & Raymond, 2008) and in environments related to wartime activities such as evacuation aircraft (Schmelz, Bridges, Duong, & Ley, 2003) and combat support hospitals in war zones (D. Hopkins-Chadwick, personal communication, 2007). Since the early 1990s, the Veteran’s Administration has partnered with the Department of Defense (DoD) to … Nursing Scientific Foundations Discussion