Assumptions, Making Recommendations, and Dissemination
This section challenges assumptions, explores making intervention recommendations, and dissemination of findings.
Content includes:
- Assumptions
- Making recommendations
- Dissemination
Objectives:
- List two assumptions related to an evidence-based project.
- Check assumptions related to an evidence-based project.
- Describe recommended interventions for an EBP project.
As we move forward with creating your EBP Poster, you will need to really evaluate your own assumptions. As a beginning nursing student, it is fairly reasonable and expected to insert one’s own experiences and assumptions into the published research. It’s easy to “not” see results objectively. This is where the phrase, “Never make assumptions without seeking clarification” comes into play.
What are assumptions? Assumptions are statements or perceptions thought to be true and taken for granted; a thing that is accepted to be true or certain. Assumptions are ingrained in thinking and are strongly impacted by one’s unique personality and culture. Assumptions are the often used as the basic for thinking. People tend to create assumptions into habits of thinking and doing (Brookfield, 1987). By asking and answering questions, one can develop skills in uncovering assumptions (Paul & Elder, 2008).
Strive to become aware of your assumptions and integrate this cognitive skill into your daily life. This will help you to prevent thinking errors. The act of making assumptions is a good thing, as this is the basis for thinking. However, some assumptions are incorrect, so critical thinkers develop the skill of checking their assumptions. In this module, the meaning of an assumption, how to check assumptions, and how assumptions relate to evidence-based practice is the primary focus. Since assumptions are so ingrained in people, part of being a critical thinker is to practice assumption awareness.
Remember, we would not walk into a room, look at a flat line on a monitor, and simply assume the patient is dead, right? We would assess the situation – airway, breathing, circulation, and so on. In doing so, we are seeking clarification. We are asking, “Is that monitor accurate?”, “What is going on?”, “I need to find out if this what I see is true”, etc. We would not just pronounce the person dead and move on. Part of clarifying our thinking while performing assessments, having conversations with peers and instructors, and reading research articles is to constantly seek clarification. This takes advanced skill and is not as easy as one might think.
Here is an example.
I made a very erroneous assumption while I was a young nursing student. We had some very important assignments that were due at the end of the semester. It was noted that there were no late grace periods for those assignments as the turnaround for final grades was soon thereafter. I missed the due date. I turned it in the next day. Unfortunately, the instructor could offer no lenient point deduction for that assignment. I received a zero. My course grade dropped from an A to a B. I proceeded to get very angry at her, assuming she had the choice to let my assignment slip by since I had turned everything else in on time all semester and had received great grades on everything. I then proceeded to discuss it with another instructor and was quickly schooled that it was not the choice or decision of that particular instructor, but that it was a program policy due to the assignment being so close to the end of the semester. To this day, I regret my assumption in that the instructor was being mean. My assumption produced negative thoughts and almost resulted in me giving her a bad evaluation. Do you see how quickly it can happen? Assumptions can sometimes lead to very destructive actions that can affect others, including our patients. Assumptions are so often based on our emotions, our previous experiences in life, and others’ influences on us.
Checking Assumptions
A very important point to make is that all people make assumptions. Some assumptions are accurate, and others can really lead to mislead our thinking. The act of checking assumptions is a critical skill for critical thinkers.
Brain Workout: Let’s Practice Being Aware of and Checking Assumptions
Knowledge to application link. Think about today and assumptions you made today—remember, these are things you took for granted.
What is an assumption you made today?
Did you assume this module was going to be complete? (It might have been blank.)
Did you assume the electricity would work?
Did you assume class would start on time? Get out early? Have a break every 50 minutes?
What is an assumption you made about the PICO statement you wrote for your EBP project?
This is usually very difficult for most people to learn the skill of checking assumptions, because they are so ingrained that people do not realize they are even making assumptions.
One way to improve your skills with checking assumptions is to consciously question your assumptions every single day. Ask me questions in class to seek clarification! I love clarifying questions and it shows me that you are ready to become a critical thinker!
Application Practice
When driving a car and you have to suddenly stop for a red light. What do you do besides brake?
Most people look in the rearview mirror to see if the car behind them is also stopping. This is checking an assumption!
Strive to be aware of checking your assumptions.
When I ride my motorcycle, I assume that I am absolutely invisible. I assume no one can see me. My superpower! My invisibility cloak. I assume that no one can see me, and this mindset helps me to be more aware of myself and cars. Sometimes, assumptions can be of help in life so that we can predict consequences.
Case Study: An Error in Judgment
A nurse stated that patients with diabetes should all be taking their medications and eating as ordered and most of them were non-compliant. She pointed to a patient with diabetes who was admitted with sepsis as an example. She said the patient had a high glucose on admission to the ICU and that is proof they were not being compliant. The patient’s physician came a few minutes later and shared that the patient was one of the most stable patients with diabetes he had ever seen in his practice. He said the patient has had normal A1C values (a lab test that measures the average blood glucose over a 3-month period) at every checkup. He said the patient’s elevated glucose was a result of the massive infection.
The nurse had judged the patient incorrectly, based on false assumptions. Had the nurse checked her assumptions, she would have noted the normal A1C value in the patient’s chart and/or withheld judgment until gathering more information from the physician. A normal A1C value in a patient who is acutely ill usually indicates the patient had been stable with diabetes until becoming acutely ill. The elevated glucose is a sign of the body’s physiological response to stress.
Knowledge to application link.
Now You Try! Case Study: The Patient and Pulse
A nurse was assessing a patient with a history of congestive heart failure who was just admitted to the intensive care unit with a heart rate of 30-32 and complete heart block. The physician visited with the nurse about possible causes of the complete heart block and slow heart rate. The patient stated he was faint feeling, and his blood pressure was 102/50. The patient had his medications adjusted about a month ago. The nurse was present in the patient’s room and heard the physician ask the patient if he checks his pulse at home. The patient replied, “Yes, and it is always 60.”
What are two assumptions about this case so far? List two assumptions.
1.
2.
The nurse was curious about the heart rate. Something did not seem right. The nurse wanted to check into how the patient checks his pulse.
What assumption is the nurse checking? (Hint: assumptions are usually the most obvious–but so obvious that they can be missed.)
1.
The nurse asked the patient to show how he checked his pulse and asked him if he could see the clock on the wall with the second hand. He answered yes and told her which number on the clock the second hand was pointing. The nurse was checking his vision–the first assumption she was checking.
Next, the nurse asked the patient to show how he checks his pulse. The nurse felt the patient’s radial pulse while he also checked his radial pulse on his other arm. The nurse watched silently as the patient watched the clock and counted to 60. Then he stopped and said his pulse was 60. However, the nurse counted 30 beats per minute. Then she realized what happened! He watched the clock and counted to 60–he was not counting his pulse!
The nurse was checking the assumption the patient knew how to correctly count his pulse. He did not. Once the patient’s heart rate was improved, he was taught how to correctly count his pulse.
Take time to think about assumptions and EBP projects.
For example, should one assume all the staff nurses will be delighted to implement a EBP project?
Should one assume all nurses understand EBP?
Should one assume all nurses value EBP?
Will the organization support an EBP project?
Assumptions and Evidence-Based Practice
Think about the evidence-based practice topic you have chosen for your EBP project. What are two or three assumptions related to your project? Your project may be hypothetical (we won’t actually be implementing your project in a clinical setting) to learn the steps of EBP in a course. Even for a hypothetical EBP interventional project, think of some assumptions that should be checked. List your assumptions. Remember these are usually so obvious that it is easy to miss them, because they may be taken for granted.
Ideas to help start thinking:
Will supplies be needed for the project? Who will pay for the supplies? Who will order the supplies? Are the supplies expensive?
What permissions will be (if any) required for the EBP project?
Who will be involved with the EBP project?
Will staff want to participate with the EBP project?
Will staff need orientation to the EBP project?
Hot Tip! Remember, assumptions are an important part of critical thinking because assumptions are often the basis for thinking. So, if the assumptions are unchecked and incorrect, this may be the root cause of faulty thinking.
EBP Recommendations for Interventions
Interventions based on research evidence that are suggested as part of an EBP project is one step in the process. Remember from a previous module that EBP interventions are based on research evidence, clinician expertise, and patient/family/community interventions (Schmidt & Brown, 2019). EBP recommendations are founded by current research evidence with findings that support improved outcomes for the patient/family/community. Sometimes EBP recommendations include one single intervention, while other times they are a bundle of interventions. This is where the term bundles came about in EBP. A bundle has a group of interventions implemented together because the best outcomes are found when the interventions are done together.
For the EBP project, you will write statements in the Discussion section explaining the intervention(s) based on the research evidence. Be sure to cite the research evidence on the poster to actually support the intervention choices. State exactly what you are recommending. State in clear and specific terms what is recommended. For example, if you say you recommend an adjustment of how often the central line dressings are changed, will everyone know what you mean? However, if you say you recommend central line dressing changes be required every 48 hours, this is more specific. Will in-service/orientation for staff be required? And if so, what will be the time needed to receive the in-service/orientation education about the interventions? The specifics will vary greatly depending on the organization and actual topic/interventions. Insight about these items should be included with the recommendations.
The Words “Proof” and “Proves” and Nursing Science
Again, back to this concept. It cannot be stressed nearly enough. Research evidence only supports what we believe to be true. The word “proof” or “proves” is not used with research as we really do not prove anything (Boswell & Cannon, 2020; Houser, 2018; Siegel, 2017). Proof is a very strong word that means absolute or definitive. Most nursing science is relative to the times and new innovations. So, research evidence supports what is believed to be true. Avoid using the words proof and proves in nursing science.
For example, years ago, we believed the best way to provide care for patients with acute myocardial infarction was to admit them to a critical care bed with cardiac monitoring and administer morphine sulfate intravenous and xylocaine intravenous drips. Patients would be watched over as they had their myocardial infarctions. We would treat any complications as they happened. Most patients were quite confused and delirious after the morphine/xylocaine intravenous cocktails. Many patients would describe vivid hallucinations while having their heart attacks! One lady thought we were at the airport and wanted help with her luggage so she would not miss her flight! She was quite adamant about this hallucination and only after being weaned from her xylocaine intravenous drip, did she stop obsessing about catching the flight. At the time, this was the best evidence available to help patients. Clinicians literally watched patients have myocardial infarctions and treated the complications as they happen. The goal was to keep them alive.
Today, interventional cardiology is used to treat patients having acute myocardial infarctions with the intent to prevent as much permanent damage as possible. Patients are taken to the catheter lab for immediate intervention. This dramatic change in cardiology practice is all due to the application of research evidence. The point is this: what we believe to be true is relevant to the time and research evidence available. This is why we avoid using prove or proof in nursing and health sciences. We do not seek to prove; we seek to advance the research evidence and application of research evidence in practice. We use evidence to support practices that promote the best outcomes for patients/families/communities.
Hot Tip! Please do not use the words proof or proves in your scholarly nursing writing. Doing so undermines your credibility to scholars.
Dissemination
Dissemination is extremely important. It simply means “getting the findings of research to the people who can make use of them”. This step is often either delayed or never occurs. Dissemination usually occurs either by written or spoken word. The traditional means to dissemination include academic publishing (e.g. academic journals) and conferences and workshops (e.g. posters, presentations, etc.). It “seems” easy, right? However, unfortunately, there are many reasons that findings are never shared. Mainly, it takes a lot of effort. It is laborious to get published. It often requires financial backing to attend a conference.
To disseminate our EBP Projects, we will be conducting a semi-formal poster session-style presentation much like at a conference setting. It is recommended that you should introduce your poster presentation with a “1 Minute Pitch” that can sometimes stretch a bit longer than one minute. You don’t want to “give everything away” so to speak, but rather capture the audience’s interest, introduce yourself and the project, and spark a dialogue. We will spend time in class going over the parameters for presentation.
EBP Poster Application! Did you make any assumptions when reading the research articles to answer your clinical question? Is your poster completely objective (except for the Discussion section)? Go back and double-check. Sometimes assumptions are so subconscious that they are not obvious to you, but they will be very obvious to your instructor.
References & Attribution
“Green check mark” by rawpixel licensed CC0.
“Light bulb doodle” by rawpixel licensed CC0.
“Orange flame” by rawpixel licensed CC0.
Boswell, C. & Cannon, S. (2020). Introduction to nursing research: Incorporating evidence-based practice (5th ed.). Jones & Bartlett Learning.
Brookfield, S. (1987). Challenging adults to explore alternative ways of thinking and acting. Jossey-Bass, Inc., Publishers.
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones & Bartlett Learning.
Paul, R. & Elder, L. (2008). Critical thinking: The art of Socratic questioning, part III. Journal of Developmental Education, 31(3), 34-35. Retrieved from https://eric.ed.gov/?id=EJ832681
Schmidt, N. A. & Brown, J. M. (2019). Evidence-based practice for nurses: Appraisal and application of research (4th ed.). Jones & Bartlett Learning.
Seigel, E. (2017). Scientific proof is a myth. Forbes, (11), Retrieved from https://www.forbes.com/sites/startswithabang/2017/11/22/scientific-proof-is-a-myth/#3f6972672fb1
