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- QUESTION
Best Practices in Nursing Specialties
1A) Developing an Evidence-Based Practice (EBP) Project Question)
Consider issues related to your nursing practice. What stands out to you about your specialty area? What questions or concerns do you think are especially in need of attention? Why? How would you most like to contribute to the knowledge base of your profession?
The EBP Project provides a significant opportunity for furthering the nursing profession. Formulating a specific, applicable question is a necessary first step for developing your project. The question defines the focus of the EBP Project and guides your selection of research methods and tools. Think about aspects of your specialty area, and begin to formulate a question that relates to your nursing practice.
The primary purpose of this Discussion is to provide a forum in which you and your colleagues can support each other in cultivating a practice-related question.
To prepare:
- Develop yourEBP Project question using the PICO (patient group, issue or intervention, comparison, outcome) method as described in Chapter 2 of Clinical Research for the Doctor of Nursing Practice (p. 22) and other resources. Depending on your specialty area, you may modify the PICO method as necessary to be appropriate for your target population.
- Begin to complete the “Literature Review Matrix,” reviewing at least four to six research articles relevant to your specialty area and yourEBP Project question. Note any areas of difficulty that you encounter, as well as any strategies or insights that might be beneficial to others.
- Reflect on the information presented in the McCurry, Revell, and Roy article listed in the Learning Resources.
- What questions or concerns, if any, do you have about how to develop your project question and/or expand your expertise in your specialty area?
By Day 3, post a cohesive scholarly response that addresses the following:
- Share your project question, as you have developed it thus far.
- Discuss salient elements that inform your project question: theory, current research, nursing practice, and specialty knowledge.
- Pose any questions or concerns you may have related to developing your project question or literature review. You may also include any other issues related to expanding your expertise within your specialty area.
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week's assigned Learning Resources.
Readings
- Course Text:Terry, A. J. (2015). Clinical research for the doctor of nursing practice. (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
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- Chapter 2, “Developing the Researchable Problem”
This chapter describes considerations for developing a sound practice (research) question, noting that the practice-oriented doctorate incorporates elements of multiple fields of study, such as management, finance, and technology. It also outlines the PICO method, which may be useful for developing your DNP Project practice question. (Note:You may modify the PICO framework as necessary to be appropriate to your specialty area as you develop your practice question.)
- Chapter 2, “Developing the Researchable Problem”
- Article:McCurry, M. K., Revell, S. M. H., & Roy, C. (2009). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.
Retrieved from the Walden Library using the Academic Search Complete database.According to the authors, “Nursing as a profession has a social mandate to contribute to the good of society through knowledge-based practice” (p. 42). This article addresses the intersections of philosophy, disciplinary goals, theory, and practice and how the resulting synthesis can promote achievement of this social mandate.
- Article:Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice.American Journal of Nursing, 110(3), 58–61.
Retrieved from the Walden Library using the Ovid database.This article is part of a series that is intended to help promote the implementation of evidence-based practice. This particular article in the series asserts that a well-developed question is an essential step in this process: "Formulating a clinical question in a systematic way makes it possible to find an answer more quickly and efficiently, leading to improved processes and patient outcomes" (p. 58). Note that for the purposes of this course, the DNP Project practice question does not have to be a "clinical" question depending on your area of specialty.
- Handout:Literature Review Matrix [Microsoft Word .doc]
- Handout:NURS 8410 Practicum Journal Template [Microsoft Word .doc]
Optional Resources
- Article:Winsett, R. P., & Cashion, A. K. (2007). The nursing research process. Nephrology Nursing Journal, 34(6), 635–643.
Retrieved from the Walden Library using the CINAHL Plus database.
1B) Reasoning in a Specialty Area
Bring to mind an important practice-related decision you have made recently. How did you approach this decision? What aspects of your specialty expertise informed your decision-making?
Evaluate your decision now in light of the principles of clinical reasoning presented in the Learning Resources this week. What new insights arise about your decision making as you look at it through this lens? What questions emerge as you reflect how you use reasoning in your practice?
In this Discussion, you and your colleagues examine the application of reasoning strategies in your specialty area of practice, particularly as it is connected to your EBP Project question.
To prepare:
- Consider the definition ofclinical reasoning and how it is distinguished from other terms in the Simmons article.
- Bring to mind key characteristics of your specialty area. Is the concept of clinical reasoning relevant and sufficient to describe theprocess you utilize as you make decisions and solve problems in your area of specialization? Why or why not? If not, what terminology would be more useful for defining or characterizing this process?
- Review the literature to identify at least two specific examples of reasoning strategies used in your specialty area. These may be part of your literature review related to yourEBP Project question(s).
- Reflect on yourEBP Project question(s). Reexamine your project question(s) through this lens of clinical, or alternately termed, reasoning.
By Day 3, post a cohesive scholarly response that addresses the following:
- How are reasoning strategies most often applied in your specialty area? Provide at least two specific examples supported by the literature.
- How can you apply reasoning strategies to the refinement of yourEBP Project question(s)?
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week's assigned Learning Resources.
Readings
- Course Text:Terry, A. J. (2015). Clinical research for the doctor of nursing practice. (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
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- Chapter 1, "The Importance of Research in the Doctor of Nursing Practice Degree"
Read pages 16-23 beginning with "The DNP Graduate With an Aggregate Focus"In this section of Chapter 1, the author explains relationship between the DNP clinician, the research process, and developing an effective evidence-based practice. The author also discusses facilitating change in practice based on critically appraised and validated evidence. In addition, Carper’s four essential patterns of "knowing" in nursing and Rosswurm and Larrabee’s six-phase model for reviewing research are highlighted.
- Chapter 1, "The Importance of Research in the Doctor of Nursing Practice Degree"
- Article:Banning, M. (2008). Clinical reasoning and its application to nursing: Concepts and research studies. Nurse Education in Practice, 8(3), 177-183.
Retrieved from the Walden Library using the ScienceDirect database.In this article, Banning offers a definition of clinical reasoning as it applies to the field of nursing. She pays special attention to its application in evaluating available evidence in order to make professional judgments that affect the care of the individual patient. The author also discusses the use of patient-centered prototypes, protocol analysis, and the think aloud approach, and the advantages and disadvantages of these methods of clinical reasoning.
- Article:Simmons, B. (2010). Clinical reasoning: Concept analysis. Journal of Advanced Nursing, 66(5), 1151-1158.
Retrieved from the Walden Library using the Academic Search Complete database.In this article, Simmons provides a concept analysis and definition of "clinical reasoning" and distinguishes it from other concepts. She opines that clinical reasoning is what separates professional nurses from ancillary health care providers and that clinical reasoning is a precursor to decision and action. Simmons also discusses several formal and informal strategies, including deliberation, heuristics, inference, metacognition, logic, information processing, intuition, and analysis.
Optional Resources
- Article:Price, B. (2011). Improving clinical reasoning in children's nursing through narrative analysis. Nursing Children & Young People, 23(6), 28-34.
Retrieved from the Walden Library using the CINAHL Plus database. - Article:Standing, M. (2008). Clinical judgement and decision-making in nursing - nine modes of practice in a revised cognitive continuum. Journal of Advanced Nursing, 62(1), 124-134.
Retrieved from the Walden Library using the CINAHL Plus database. - Article:Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.
Retrieved from the Walden Library using the Education Research Complete database.
Evidence-Based Practice (EBP) Project
- Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project (developed in Week 2)
In a 1- page paper, address the following:
- Provide a summary of the selected practice issue in which the outcome is different from what would be expected according to the research literature. (Note: The issue you select must be suitable for completing the entire EBP Project.)
- Application 2: Laying the Foundation for New Approaches to Practice (developed in Weeks 4 and 5)
In a 4 page paper, include the following:
- A brief summary of the currency of the science underlying the practices used to address your EBP Project issue
- Possible causes of the difference in outcomes from what would be expected according to the research literature
- The effect the EBP Project issue is having in practice
- Current research evidence on new practices for addressing the EBP Project issue
- A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue
- Application 3: Becoming a Leader in the Translation of Evidence to Practice (developed in Weeks 6 and 7)
Write a 3-page paper that synthesizes:
- Your vision of yourself as a leader—specifically:
- How you would continue to increase your knowledge and awareness of financial, economic, and other concerns related to new practice approaches
- How translating evidence would enable you to affect or strengthen health care delivery and nursing practice
- How you would advocate for the use of new evidence-based practice approaches through the policy arena
- Application 4: Planning for Change, Implementing and Evaluating EBP Projects (developed in Weeks 8–10)
Write a 5-page paper that addresses the following:
Planning for Change- Analyze the impact of implementing change in your practice environment, including the factors that need to be considered regarding stakeholders and end users.
- Summarize the methods you would use to ensure that those are adequately addressed.
Implementing EBP Projects- Identify the desired outcomes of your EBP Project.
- Describe any macro or micro systems issues that may inhibit implementation and strategies for resolving those issues.
- Explain how resolving your EBP Project issue will improve quality and patient safety.
Evaluating EBP Projects- Describe evaluation strategies.
- Formulate new practice guidelines based on the possible results of the evaluation of outcomes.
- Describe, if appropriate, new standards of care relevant to the new practice guidelines.
| Subject | Nursing | Pages | 15 | Style | APA |
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Answer
Planning for Change
Implementing change is critical for an organization that seeks to avoid stagnation due to maintained status quo. A better nurse practice environment and a higher nurse staffing levels are critical factors that contribute to improved quality of health care and lower mortality rate among patients in multiple patient populations (Donaldson, Bolton, Aydin, Brown, Elashoff, Sandhu, 2005). Notably, implementation of changes in hospital nursing characteristics directly impacts the patient outcomes within the setting. Implementing changes in the hospital-level proportion of nurse staffing and the nurse practice environment impacts on patient outcomes directly by influencing the nurse performance, quality of care received by the patients and the entire organization’s efficiency (Needleman, Buerhaus, Pankratz, Leibson, Stevens, Harris, 2011). For instance, improvements in nurse staffing significantly contribute to reduced patient mortality rates. For example, past research posit that, when controlling for patient characteristics, every 10 percent increase in the proportion of nurses, induce an average reduction of patient mortality of 5.07 for every 1,000 patients (Vanak, 2014). Therefore, implementing changes that are focused on lowering patient-to-nurse ratios within hospitals impacts the practice environment positively by contributing to improvement in outcomes of patients.
However, implementing changes on nurse staffing must take into consideration the factors regarding stakeholders and end users. These stakeholders include nurses, patients, physicians, unions, nursing organizations, researchers, particular hospital employers, and federal and state governments. When implementing the changes in nurse staffing, the organization’s manager must consider workload on nurses and physicians and their job satisfaction as factors that affect the performance of these stakeholders (Sangster‐Gormley, Martin‐Misener, Downe‐Wamboldt, DiCenso, 2011). Besides, to be considered is the patient outcome and their satisfaction as this is the driving force behind the organization’s goals and objectives. As noted above, implementing changes that lower patient-to-nurse ratios within hospitals impacts the practice environment positively by contributing to improvement in outcomes of patients, hence, high patient satisfaction. Nursing organizations and unions are critical to ensuring effective implementation of changes in nurse staffing. Therefore, their recommendations on appropriate patient-to-nurse ratios should be considered in the change implementation process to ensure job satisfaction among nurses. Researchers are integral stakeholders in nursing practice as they contribute immensely to evidence-based nursing practice by conducting studies and researchers whose findings are critical for improving patient outcomes. Information from researchers is critical in assisting individuals to make informed healthcare decisions and helps to improve the quality of health care services. Consequently, the health organization managers should consider evidence-based research recommendations on how the nurse staffing issue affects patient outcomes. Finally, particular hospital employers and the two levels of government are critical stakeholders on whose shoulders rest the financial burden of nurse staffing (Gerrish, Nolan, McDonnell, Tod, Kirshbaum, Guillaume, 2012). Therefore, the health organization manager must consider the financial factor of increasing nurse staffing when implementing the changes on nurse staffing.
To adequately address the concerns off all stakeholders, I would adopt an all-inclusive method of change implementation in which all the middle- and upper-level managers are directly involved in the organizational and practice change initiatives (Sandström, Borglin, Nilsson, Willman, 2011). This method would ensure engagement of staff at all levels, across departments and shifts in the change initiative in consultation with nurse organizations and unions to earn their support in the implementation process. Moreover, the particular hospital employer and both federal and state governments will be aligned to the implementation process through consultations and seeking their approval to increase nurse staffing. This way, the implementation of the changes in nurse staffing will acquire the much needed financial backing from the governments and particular hospital employers (Sandström, Borglin, Nilsson, Willman, 2011). For instance, the Agency for Healthcare, Research and Quality, the U.S. Department arm of health services research and Human Services, are governmental stake holders that have federally funded Evidence-Based Practice Centers to explore clinical issues with the aim of improving healthcare quality, effectiveness, safety and efficiency for all patients. Besides, the method would be focused on active engagement of department heads and unit nurses in planning the change initiative.
Implementing Evidence-Based Practice Projects
Inadequate translation of evidence into practice in nursing environments has contributed to patient safety issues through medical errors that sometimes result in patient deaths. Implementing evidence-based practice projects is critical for improvement and achieving quality patient care and outcomes. It is focused on using the highest quality of practice knowledge in providing care so as to achieve the greatest positive impact on patients’ healthcare outcomes (Levin, Fineout-Overholt, Melnyk, Barnes, Vetter, 2011). Therefore, the desired outcomes of this evidence-based practice project are to ensure a safe, effective, efficient, timely, patient-centered, and equitable health care services by lowering patient-to-nurse ratios within the hospital setting. Notably, implementing this evidence-based practice project involves addressing these six key aims that seek to meet patient needs by providing a safer, reliable, effective, more responsive, accessible, and integrated patient experience through ensuring increased job satisfaction and reduced workload for nurses (Davies, Tremblay, Edwards, 2010).
The escalating rise in healthcare costs is a macro systems issue that may inhibit implementation of this evidence-based practice project. To resolve this issue, policymakers have faced the challenge to examine healthcare practices and identify the gap that exists between healthcare services delivered and patient outcomes in line with the quality of care. As a result, a strategy that involves the use of a new model for healthcare delivery is critical to assure a cost effective quality care that is safe, while promoting shared decision making for patient and health care provider (Palinkas, Soydan, 2011). By ensuring a cost-effective quality care, the nurse staffing changes will effectively be implemented due to reduced financial burden for the project’s implementation. However, the development of this new model of care will call for spirited commitment and collaboration of healthcare providers, consumers, policymakers and the health care industry as a whole. This model, the Magnet Model, is comprised of five key components; transformational leadership, exemplary professional practice, structural empowerment, new knowledge, innovations and improvement and, finally, the empirical outcomes (American Nurses Credentialing Center, 2011). Notably, the new knowledge, innovation and improvements standards are critical for new models of care and, the application of existing evidence as well as new evidence of nursing practice by ensuring the integration of research and evidence-based practice in clinical and operational processes.
Resolving the Evidence-Based Practice Project issue will significantly improve the quality of care and patient safety by promoting the translation of evidence into practice thereby enabling nurses to be uniquely positioned to perform the leading roles to enhance quality health care outcomes (Levin, Fineout-Overholt, Melnyk, Barnes, Vetter, 2011). By resolving the Evidence-Based Practice Project issue, nurses would embrace the Evidence-Based Practice paradigm shift thereby closing the chasm by improving Evidence-Based Practice decision making that would result in narrowing the gap between research and translation of research evidence to practice (Levin, Fineout-Overholt, Melnyk, Barnes, Vetter, 2011). Consequently, there would be improved quality of care and patient safety when nurses embrace the Evidence-Based Practice paradigm shift that would see research evidence translated into practice leading to quality services and reduced medical errors.
Evaluating Evidence-Based Practice Project
The evaluation strategy of this Evidence-Based Practice Project involves surveying the staff to understand the staff’s beliefs, implementation effectiveness, and organization’s cultural readiness for evidence-based practice (Melnyk, Fineout-Overholt, 2011). The initial survey process would involve the staff completing the demographic surveys and would be done before any work is undertaken the implementation process. Six months after the initial surveys are completed and during the implementation process, the staff would repeat the demographic surveys and the data collected from the surveys presented for analysis. The internal survey consistencies would be completed utilizing SPSS, Version 21 through further analyses (Pallant, 2013). The demographic surveys would involve 141 healthcare professionals as participants aging between 23-64 years and the descriptive statistics obtained from the data collected would be calculated for the pre and post-survey responses. First, the standard deviation and the mean summed score would be calculated for each survey then the mean and standard deviation would be calculated for each item on each survey (Purcell, Kutash, Cobb, 2011). Organizational Culture Readiness for System-wide Integration of Evidence-based Practice (OCRSIEP) scale would be utilized to assess the culture and readiness of the organization for Evidence-Based Practice Implementation. The OCRSIEP is a 25- item Likert scale survey that would be utilized to identify organizational characteristics such as the organizational strengths and opportunities for fostering Evidence-Base Practice within the healthcare organization (Wallen, Mitchell, Melnyk, Fineout‐Overholt, Miller‐Davis, Yates, Hastings, 2010).
Based on the possible results of the evaluation of outcomes, the new practice guidelines would focus on lowering patient-to-nurse ratio by increasing nurse staffing in particular hospitals. To achieve the project objective, each nurse should attend to a maximum of four patients (Vanak, 2014). Besides, there should be increased level of nurse education and rating of the practice environment to improve quality care and nurse satisfaction that would translate to better patient outcomes (Vanak, 2014).
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References
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Vanak, J. M. (2014). The effects of changes in the hospital nursing workforce and practice environment on the outcomes of surgical oncology patients: A two-stage panel study. Donaldson, N., Bolton, L. B., Aydin, C., Brown, D., Elashoff, J. D., & Sandhu, M. (2005). Impact of California’s licensed nurse-patient ratios on unit-level nurse staffing and patient outcomes. Policy, Politics, & Nursing Practice, 6(3), 198-210. Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. Sangster‐Gormley, E., Martin‐Misener, R., Downe‐Wamboldt, B., & DiCenso, A. (2011). Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review. Journal of Advanced Nursing, 67(6), 1178-1190. Gerrish, K., Nolan, M., McDonnell, A., Tod, A., Kirshbaum, M., & Guillaume, L. (2012). Factors Influencing Advanced Practice Nurses’ Ability to Promote Evidence‐Based Practice among Frontline Nurses. Worldviews on Evidence‐Based Nursing, 9(1), 30-39. Sandström, B., Borglin, G., Nilsson, R., & Willman, A. (2011). Promoting the implementation of evidence‐based practice: A literature review focusing on the role of nursing leadership. Worldviews on Evidence‐Based Nursing, 8(4), 212-223. Levin, R. F., Fineout-Overholt, E., Melnyk, B. M., Barnes, M., & Vetter, M. J. (2011). Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model. Nursing Administration Quarterly, 35(1), 21-33. Davies, B., Tremblay, D., & Edwards, N. (2010). Sustaining evidence-based practice systems and measuring the impacts. Evaluating the impact of implementing evidence-based practice, 166-188. Palinkas, L. A., & Soydan, H. (2011). Translation and implementation of evidence-based practice. OUP USA. American Nurses Credentialing Center. (2011). The magnet model components and sources of evidence. (2nd ed.). Silver Spring, MD: American Nurses Association Levin, R., Fineout-Overholt, E., Melnyk, B., Barnes, M. & Vetter, M. (2011). Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the Advancing Research and Clinical Practice through Close Collaboration. Nursing Administration Quarterly, 35(1), 21-35. Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins. Pallant, J. (2013). SPSS survival manual. McGraw-Hill Education (UK). Wallen, G. R., Mitchell, S. A., Melnyk, B., Fineout‐Overholt, E., Miller‐Davis, C., Yates, J., & Hastings, C. (2010). Implementing evidence‐based practice: effectiveness of a structured multifaceted mentorship programme. Journal of advanced nursing, 66(12), 2761-2771. Purcell, S. R., Kutash, M., & Cobb, S. (2011). The relationship between nurses' stress and nurse staffing factors in a hospital setting. Journal of Nursing Management, 19(6), 714-720.
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