Overview of Semester-Long EBP Project

 In this section, we will learn about the semester-long EBP project for this course.

 Content includes:

• What is This EBP Project?
• Overview of EBP Steps
• Detailed Sections of the EBP Poster

Objectives:

1. Describe the purpose of the semester-long group EBP project
2. Describe the components of the project

Evidence-Based Practice 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 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 first 3-4 steps can be completed in a college classroom setting and are often given as a research paper or EBP assignment. Steps 5 and 6 require the use of a healthcare environment. Remember, these steps are all interlocking. For our EBP Project, we will only be completing steps 1-3. However, never stop assessing the need for change or evaluating what you find. The following diagram, adapted from Larrabee (2009), illustrates this:

The overall purpose of our EBP Project includes:

• Collaborating in a group
• Creating a poster in which to share published data
• Project will include:
  • Retrieval of evidence via a database search for peer-reviewed articles
  • Appraisal of best evidence via a literature review of published peer-reviewed articles
  • Synthesis of best evidence to answer a clinical question
  • Dissemination of a literature review on a chosen clinical nursing topic

Components of the Project

The overall project itself will result in a poster that you will present to other. The poster will summarize your review of published evidence that helps to answer your clinical question (more on that in the next module). However, there will be some key assignments leading up to the end product. These will include:

• Group selection
• Group contract
• Topic selection
• Creating a PICO and Clinical Nursing Question
• Synthesis of Evidence Worksheet
• Submitting a draft of your poster
• Peer review of others’ posters
• Self-evaluation
• Peer evaluation of others in your group

The structure of an evidence-based practice research paper (remember, we are creating a poster in this class, instead of a paper) typically requires 4 major parts, and often includes subheadings:

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

Detailed Sections of the EBP Poster:

However, for our EBP Project Poster, which is basically in lieu of a paper, you are to summarize your findings and we will include the following sections:

1. 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 following methodology section. You will need to include your clinical question in the Introduction section (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.
   • Of important note: The information you list in your Introduction section is considered the problem statement/s. The information here is not to answer your eventual clinical question. Therefore, the sources that you use to complete the introduction section will be different than the sources you use to answer your eventual clinical question.
   • The introduction provides the information you found to help formulate your clinical question, not to answer it.

2. Methodology – This is how you found your information. What databases did you search? 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 or parentheses around a phrase)? It needs to be specific enough, that another person could utilize 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 proposing 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. Because quantitative and qualitative studies measure different things, it will be difficult to integrate and synthesize the sources you acquire unless they are similar. Your evidence-based practice review will use quantitative reviews only to keep it a bit more simply for the short length of this course. This will help to eliminate differences in non-similar studies.

If you are having trouble telling the difference 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.

3. 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 (of participants), 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.

4. Discussion – Here is the “meat” of what you found or didn’t find. It is usually a pretty meaty section. It is also subjective. You do not list results here (you did that in the Results section), but you interpret the results for the implications to the clinical setting.

• • 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 were 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 may/may not 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 and PubMed are good sources for these articles.

5. References – The top articles that best address your clinical question. However, we only limit this to 8 for the space on the poster itself. We will be filling in a Synthesis of Evidence Worksheet in which the minimum number of articles is much higher. Only the top 8 (you can select which 8 to use) will be listed on the actual poster. The references must be in APA format, as well as all in-text citations.

On that note, anything submitted from this point forward in your nursing program must use proper APA formatting when utilizing any sources for your writing. This means, you must use an APA-formatting in-text citation for every place in your writing that used a source to help you with your information. You must give credit where credit is due. For every in-text citation you use, this must have the appropriate full reference at the bottom of the document. You cannot have an in-text citation without a full reference for that source.

Hot Tip! In module 3, there is a posted video that will cover each part of the poster. That video exists to guide you all semester long with a detailed narration of your project. Be sure to refer to it frequently throughout the semester.

Another framework to know is the 5-Step EBP Process that we will use as a foundation for our EBP Project. The “Ask, Access, Appraise, Apply, and Assess” process. We will be utilizing the first 3 steps of this process. We will ask our clinical question, track down the best evidence, and then appraise that evidence.

That’s it! In summary, your EBP Project will be a limited (but as comprehensive as possible) rapid review of evidence from published literature to help answer a clinical nursing question that you developed based on a problem or gap that you either see or know about in clinical practice. You will appraise (critically examine) the literature that you find, then analyze it, and then synthesize it. The results of the data you find will first be listed objectively and then you will subjectively discuss the implications of the studies as to how they may relate to current clinical practice.

EBP Poster Application! Be sure to download the EBP Poster template, if you haven’t already. Start looking at the sections of the poster and jot down some potential ideas. Review the EBP Poster rubric as well.

References & Attribution

“Green check mark” by rawpixel licensed CC0.

“Orange flame” by rawpixel licensed CC0.

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