Evidence-Based Practice Project (Poster) Overview

This EBP Project is a culmination of a semester-long project to include an EBP poster in which student groups are answering their developed clinical question by presenting evidence found in literature to help inform and improve clinical outcomes.

You will be critically appraising primary, quantitative, peer-reviewed research articles in order to answer the nursing clinical question that you develop.

Project Includes:

Throughout the semester, the course will cover general guidelines that parallel the portions of the EBP project to include:

1. Selecting a group.
2. Completing a group contract.
3. Choosing a clinical nursing topic in which to develop a nursing clinical question and gather data.
4. Further narrowing the nursing topic into which population to explore, which nursing intervention to measure, the comparison (or opposite) of the intervention, and the outcome that you are questioning.
5. Developing a PICO statement.
6. Development of a clinical question based on the inadequacies or gap in knowledge of current practice.
7. Locate the best evidence with methodology of data gathering via a literature search.
8. A synthesis of literature via systematic methods
9. Design/discuss the potential change, applying the synthesized evidence to present & discuss implications in practice that reflects this new understanding.
10. Peer review of another group’s poster
11. Application of edits from received peer review
12. Presentation of findings/dissemination of knowledge via a poster presentation.
13. Self-evaluation
14. Peer evaluation of others in your group

EBP Poster Content Overview (see below in document for detailed descriptions):

The Final EBP Poster will include the following sections, utilizing the template provided:

• Introduction, including nursing clinical question
• Methodology (Databases utilized, inclusion/exclusion criteria, Boolean operators, key terms and/or phrases, publication years, etc.)
• Results (Objective)
• Discussion
• References

In addition, a presentation will be required as part of the Final EBP Project grade.

A template for the poster has been provided. Please see rubric under the assignment. Students will present their poster in a live presentation in which all headings/points of discussion must be covered in a semi-formal presentation. This presentation serves as a method of dissemination of your findings.

The EBP Poster will be submitted through Canvas and will generate a Turn It In score in order to avoid unintended plagiarism.

Rubrics are posted in Canvas for each of these assignments for further details, criteria, and grading schemes.

What is this EBP Project?

Person-centered care is holistic, individualized, just, respectful, compassionate, coordinated, evidence-based, and developmentally appropriate. Person-centered care builds on a scientific body of knowledge that guides nursing practice regardless of specialty or functional area.

As one of the key attributes of professional nursing, clinical judgment refers to the
process by which nurses make decisions based on nursing knowledge (evidence,
theories, ways/patterns of knowing), other disciplinary knowledge, critical thinking,
and clinical reasoning (Manetti, 2019). This process is used to understand and interpret
information in the delivery of care. Clinical decision making based on clinical judgment,
is directly related to care outcomes.

Evidence-based practice in nursing focuses on the idea that nursing practices ought to be developed and adapted on an ongoing cycle of evidence, theory, and research. As changes in practice prompt further research, the theories developed from that research serve as evidence to produce more changes in practice. The investigation of evidence-based practice in nursing, also called Systematic Review (or Literature Review, for the sake of our EBP Project in this course), requires the review of such research with the intention of targeting and improving inadequate practice.

The delivery of optimal health care requires the integration of current evidence and clinical expertise with individual and family preferences. Evidence-based practice is a problem-solving approach to the delivery of health care that integrates best evidence from studies and patient care data with clinician expertise and patient preferences and values (Melnyk, Fineout-Overhold, Stillwell, & Williamson, 2010). In addition there is a need to consider those scientific studies that ask: whose perspectives are solicited, who creates the evidence, how is that evidence created, what questions
remain unanswered, and what harm may be created? Answers to these questions are paramount to incorporating meaningful, culturally safe, evidence-based practice.

The review of outside research attempts to make sense of the large body of information available in order to implement change effectively. How can this research be applied on an individual basis to improve patient care?

Evidence-based practice involves the following six steps*:

1. Assess the need for change: Formulate the research question based on the inadequacies of current practice.
2. Locate the best evidence: Obtain sources and assess their credibility and relevancy to the research question.
3. Synthesize evidence: Compare and contrast the available sources to find similarities and differences in the various approaches taken.
4. Design the change: Apply the synthesized evidence to create a change in practice that reflects the new understanding.
5. Implement and evaluate: Apply the necessary changes and assess the changes to acquire new evidence.
6. Integrate and maintain changes: Reassess based on new evidence to continue improvement.

The structure of an evidence-based practice research paper typically requires 4 parts, and often includes subheadings:

1. Introduction.
2. Methodology.
3. Findings.
4. Discussion.

Detailed Sections of the EBP Poster:

For our EBP Project Poster, which is basically in lieu of a paper, you are to summarize your findings. We will include the following sections:

Introduction – This includes the “background” as to why this topic is important, what might be known/unknown, and the problem. This section will be much bigger than the methods section. You will need to include your clinical question here (in a question format, clearly defined as “Nursing Clinical Question”). You need to provide a reason for reviewing literature for your clinical question. For example, if you are reviewing evidence regarding adjunctive pain management, your background may include data that opioids have many side effects, perhaps that patients often ask about alternative pain management modalities, and that your population (ex: patients with cancer) has a well-documented poor pain management plan. All of this needs to come from evidence before you start reviewing additional evidence that answers your specific clinical question. This is basically your first review of literature for your poster. You will need to state facts from evidence that proports the underlying issue, and then cite.

Methodology – This is how you found your information. What databases did you search (CINAHL, PubMed, Cochrane, etc.)? Years? Search terms/phrases? Inclusion/exclusion criteria? Boolean operators? This section will be very brief. However, it needs to be very specific. Did you search for heart failure or “heart failure” (big difference with the quotation marks around a phrase)? It needs to be specific enough, that another person could replicate exactly what you wrote in your methodology section and find the exact same articles that you found.
Selecting evidence can be difficult, especially when you are considering suggesting making changes to common practices. You must assess the dependability of the source itself. Do not select sources simply because they work well with your topic. Using sources that are not credible will only serve to discredit your own ideas. Be prepared to discuss the following in a concise, scientific manner:

• What databases did you search? What search terms did you use? How many total articles on the subject did you find? A search that returns few results may be the results of using search terms that are too narrow. Search terms need to use the specific vocabulary of the specific field of research. Try varying terms to match the genre of research you need.
• What criteria led you to include or exclude sources? You may wish to present these criteria in the form of lists or tables. When evaluating sources, consider the following:

Credibility: Is the study from reputable researcher or journal? Databases can produce results from magazines or general reading material; these are not always peer-reviewed. Limit your search to scholarly journals.

Validity: Does the study measure what it says it measures? What demographic sample did the study survey? The methods of examination and procedures of analysis make a big different in the validity of results. Does the study present a margin of error? If so, is it narrow enough to make the results accurate?

Reliability: Will the same test yield the same result? Did the study end as soon as favorable results were obtained? Were the reports consistent? A study should mention its own limitations; did the study have limitations that were not noted?

You will want to use similar studies as much as possible. Because quantitative and qualitative studies measure different things, it will be difficult to integrate and synthesize the sources you acquire unless they are fairly similar. Your evidence-based practice review may use quantitative reviews, qualitative reviews, or other evidence-based practice reviews; comparing mixed methods will likely make your methodology more difficult to understand.

If you are having trouble telling the different between quantitative and qualitative studies, look at the methodology listed. Quantitative studies deal only with objective figures that can be measured, counted, and calculated. Qualitative studies will still use numbers to describe the sample and/or control groups, but they will focus on subjective analysis, descriptions, and interviews.

Results –This is objective data. These are the results that the researchers found.

Your results/findings will be an analysis. You should present the studies you selected as the most appropriate sources for studying your problem and instituting your proposed change.

Be sure to compare the following aspects of each study:

• Demographics, pools, and samples
• Methods of discovery and analysis
• Results and limitations

Remember that these studies are supposed to be the most reliable and valid studies available for answering the problem you found or the practice you wish to change. Your findings should lay the groundwork for you to make this argument in your discussion section.

Discussion – Here is the “meat” of what you found or didn’t find. It is usually a pretty big section. Is there a trend? Is there an even bigger gap in evidence than you expected? With the information you found, what are the implications? How does this relate to literature you found? What where the most major findings (don’t repeat from your results section, but highlight it in different terms)? Should more research be done, or is there more than enough evidence to support a change? The subheadings should be: Implications, Strengths, Limitations, and Future Recommendations/Studies.

In a professional research environment, the discussion should discuss the changed practice, its implementation, and its evaluation. However, this is impossible to do in a classroom situation. Therefore, do the following:

• Argue that the findings lead to the specific change in practice you identified in your institution.
• Suggest a strategy for implementation. Will the change you recommend (and that these studies probably also recommend) work in your situation or not? Why? What changes might be needed?

For further help in evidence-based practice, read samples of published evidence-based practice studies to get a good idea of how other healthcare professionals write these studies. Databases like CINAHL are good sources for these articles.

References – The top 8 (it is difficult to fit more than that onto the poster) that best address your clinical question are to be on your poster. There is a requirement for much more than 8 (see requirements) for your Synthesis of Evidence.

Course Outcomes and BSN Essentials:

This project provides each student the opportunity to master the following Course Outcomes:

1. Person-Centered Care: Demonstrate an understanding of the basic elements of the research process, differentiate questions and methods suitable for quantitative and qualitative nursing research, and apply strategies and resources to promote evidence-based practice, especially in areas of quality and safety.
2. Clinical Judgment: Appraise clinical decisions based on appraisal on the triad of evidence-based practice: evidence, patient preferences, and clinical expertise.
3. Communication: Using information technology to retrieve hierarchical levels of evidence, appraise the credibility of sources of information, including but not limited to databases and internet resources to address clinical questions.
4. Compassionate Care: Distinguish the role of evidence-based practice in organizational and systems leadership to support quality patient care and apply principles of evidence-based practice with diverse populations.
5. Professionalism: Assess practice discrepancies between identified standards and practice that may adversely impact patient outcomes and utilize the process of retrieval, appraisal, and synthesis of evidence to improve patient outcomes.

This EBP Project also covers the following American Association of Colleges of Nursing BSN Essentials:

Domain 2.5d: Incorporate evidence-based intervention to improve outcomes and safety.
Domain 4.2: Integrate best evidence into nursing practice
Domain 4.1: Advance the scholarship of nursing.
Domain 4.1a: Demonstrate an understanding of different approaches to scholarly practice.
Domain 4.2a: Evaluate clinical practice to generate questions to improve nursing care.
Domain 4.2b: Evaluate appropriateness and strength of the evidence.
Domain 4.2c: Use best evidence in practice.
Domain 4.1d: Demonstrate an understanding of basic elements of the research process.
Domain 4.1e: Participate in scholarly inquiry as a team member.
Domain 4.1f: Evaluate research.
Domain 4.1g: Communicate scholarly findings.
Domain 4.3: Promote the ethical conduct of scholarly activities.
Domain 4.3a Explain the rationale for ethical research guidelines, including Institutional Review Board (IRB) guidelines.
Domain 4.3b: Demonstrate ethical behaviors in scholarly projects including quality improvement and EBP initiatives.
Domain 4.3c: Advocate for the protection of participants in the conduct of scholarly initiatives.
Domain 4.3d: Recognize the impact of equity issues in research.

References

Larrabee, J. H. (2009). Nurse to nurse: Evidence-based practice. New York: McGraw-Hill.

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,
54(1), 102-110.

Melnyk, B., Fineout-Overhold, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based
practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49-52.