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Evidenced-based Practice Proposal Using the Research Process
Research is a systematic review of an issue using different approaches. It collects and evaluates data to support problem solving. It provides new data and information in solving problems. Evidenced-based practice combines clinical expertise with research. In this paper, we will discuss an overview of my selected EBP project which provides foundation to the MSN EBP project, identify nursing concern to be improved, the purpose statement for the EBP proposal, PICOT question and literature search process, the theoretical framework to be used in this EBP proposal, and conclusion.
Overview of Selected Evidenced-based Practice Project
Research is the process to gather new data and discover new knowledge. According to the U.S. Department of health and Human Services (n.d.), “research is a systemic investigation designed to develop knowledge”. Research is a systematic process, not just about discovering knowledge. Research is considered valid and reliable when a scientific method is used in consecutive steps by the researcher. Research assists in applying new treatments, methods, and practices to patient care, which results in increased effectiveness.
Evidence-based practice is a moderately new concept. EBP is a problem-solving approach to clinical decision-making to make patient outcomes better. EBP incorporates knowledge of the research process, and clinical judgement and decision-making. EBP is to improve safety and quality, and enhance optimal care of patient (CCN, 2017). According to Melnyk et al. (2010), there are seven steps of the evidence-based practice process starting with inquiry, come up with clinical questions, Search for the best literature, review the evidence, combine literature review with one’s clinical expertise to make changes, assess the outcomes of changes, and disperse the results. EBP reflects high-quality evidence from research, clinician expertise, patient preferences, available resources, and the context in which care is delivered (Dadich & Hosseinzadeh, 2016). EBP doesn’t always utilize research. It also relies on best evidence by leaders and experts.
Evidence-based practice can’t be implemented without research. Research is conducted to generate new knowledge or to validate existing knowledge based on theories. Evidence-based practice doesn’t validate existing knowledge or develop new knowledge. According to Conner (2014), research is about developing new knowledge, whereas EBP is finding and translating the best evidence into clinical practice. Research uses quantitative or qualitative methodology to develop new knowledge, while EBP uses first-rate clinical evidence from research to make safe decisions for patients (Conner, 2014). EBP is combination of best research evidence, clinical expertise, and patient values in making decisions about the care of individual patients”(Straus and Sackett, 1998).
My MSN program specialty track is Family Nurse Practitioner. My practice focus is primary care setting. Advance practice and master prepared nurses have a better understanding of evidence-based research and implement. As the nursing profession continues to evolve, expectation is that the nurse follows scientific foundation to support the care. As a master’s-prepared advanced practice nurse, we combine past and current evidence-based knowledge and skills, and apply them to current practice to improve patient outcome (CCN, 2017). Masters prepared nurses are responsible for implementing EBP into current practice. The Master’s-prepared advanced practice nurse is expected to improve practice in selected specialty track by examining knowledge gaps, come up with research, and find solutions to improve practice (National League for Nursing [NLN], 2010). Research has proven that when nurses practice using EBP, patient outcomes improve (Black et al., 2014).
Identification of the Nursing Concern to be Improved
I currently work in emergency room, and have seen increased number of patients admitted due to congestive heart failure. Heart failure is also known as Congestive Heart Failure because of fluid buildup in different body organs and extremities (CDC, 2015). In patients with CHF, the heart muscle is too weak to pump enough blood to meet the body’s requirements. Majority of the heart failure cases are chronic or long-term. It affects about 5.7 million adults in the United States (CDC, 2016). According to CDC, approximately 50% of the people who are diagnosed with heart failure die within 5 years of diagnosis. The selected nursing concern is CHF patients fail to manage their care at home, and increased hospital readmissions. More than 20% of the heart failure patients are readmitted within 30 days and up to 50% by 6 months (O’Connor, 2017). Patients with CHF do not weigh themselves at home on regular basis or stop taking their Lasix. By the time they become symptomatic, it is a little late to treat at home. Those patients get admitted to the hospital. It affects their quality of life and affects them financially. Heart failure costs the nation an estimated $30.7 billion each year including the cost of health medical services, pharmacy expenses, and disability. Proposed solution to the selected concern is for CHF patients to use smart phone app where they can record their weight daily, which will be sent to the provider directly and have it recorded in patient’s chart automatically. If patient has gained significant amount of weight, the provider can then call the patient with adjusted Lasix dose or with other medical advice depending on the case. How can the care of CHF patients be improved in order to decrease hospital readmissions and improve quality of life?
PICO also known as PICOT is a mnemonic to describe the four elements of a good clinical question. It stands for P: Patient/Problem, I: Intervention, C: Comparison, O: Outcome and T: Time. PICO helps clarify the research question which makes it easier to find answers. PICO terms can be used to re-write your research question or vice versa. My PICOT question for quantitative research approach is: Is there decrease in number of hospital readmissions among CHF patients above the age of 65 who utilize smart phone app or telehealth to manage their care, compared to the patients who do not, over the course of 6 months? The expected outcome is decreased hospital readmissions and improved quality of life. If CHF patients can be monitored routinely by their primary care providers, CHF exacerbation can be caught early and hospital admission can be avoided. With the use of telehealth, patients can be managed more closely. As a future NP, I will be taking care of patients with CHF, and improved care and quality of life of those patients is my responsibility.
Literature review is not a criticism or a compilation of everything written on a particular topic. Literature review is an analysis of scholarly papers that are related to your topic of interest, research question or proposal. It provides background information on your topic. It could be a work of one person or an introduction to a larger research paper. Reviewing literature leads to more research question. Literature review might make you think there is a need to rewrite or rethink your research question, and you need to find more literature related to a specific aspect of research question (UWF, 2018). It helps you find what studies are already done, and what were the outcomes. Steps of conducting a literature review are as follow: First you need to choose a topic and define your research question, decide on possibility of review, choose the database, find the literature, and review the literature (UWF, 2018). The specific library databases used for this EBP proposal are Chamberlain University online library and American Academy of Family Physicians. The key search terms used were Congestive Heart Failure and Telehealth, CHF and smart phone app, and CHF and readmission rate. Specialty organizations that are relevant to this EBP proposal are American Heart Association and CHF International.
Theoretical framework requires literature review, and defines concepts that are important to your research. Before you define the key concepts of your research, it is important to do a literature review of theories and models that are relevant. It provides scientific justification for your investigation. For my EBP proposal, I have chosen the Patient Centered Nursing and Nola Pender’s Health Promotion model. PCN framework was originally developed in 2006 by McCormack and McCance with intention to evaluate the use of patient-centered nursing. This model addresses all four concepts within the metaparadigm: Person, health, nursing, environment. The PCN framework is developed with the patient at the center of nursing care (McCormack & McCance, 2017). The goal of the patient-centered care is to make patient health and outcomes better. Outcomes are the results of an effective patient-centered care. The expected outcomes with PCN framework include patient experience and satisfaction, engaging patients in their care, feeling of wellbeing, and incorporate mind, body, and soul (McCormack & McCance, 2017). Another theoretical framework which will be used in this EBP proposal is Nola Pender’s Health Promotion model. It was developed after she realized the professional only intervened after patients developed acute or chronic problems. She believed those problems could be prevented before they occurred. It would improve patients’ quality of life and save health care money. The PCN framework is applied to this EBP proposal by involving patients and family in the care planning, which in turn, helps achieve the patient-centered outcomes. In order to prevent CHF exacerbation and avoid hospitalization, it has to be maintained at home, and it cannot be done without patient or family involvement. Pender’s theoretical framework will be applied to this EBP by preventing problems before they occur. It will require the patients to follow their medical regimen such as weigh themselves as per provider’s instructions or take lasix as prescribed so CHF can be maintained and prevent exacerbation.
As we already know research is the process to gather new data and discover new knowledge. It uses systematic process called scientific method. Evidence-based practice is a problem-solving approach to clinical decision-making. EBP is built upon research. However, it doesn’t always use research. EBP uses evidence with clinical expertise. Masters prepared nurses are responsible for implementing EBP into current practice to improve patient outcomes. PICOT question for quantitative research approach was presented along with theoretical framework to be used in this proposal. The PCN and Pender’s theoretical framework will be applied to this EBP proposal.
- Black, A., Balneaves, L., Garossino, C., Puyat, J., & Qian, H. (2014). Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians. JONA: The Journal of Nursing Administration, 45(1), 14-20. Doi:1097/NNA.0000000000000151
- Center for Disease control (2015). Other Conditions Related to Heart Disease. Retrieved from https://www.cdc.gov/heartdisease/other_conditions.htm
Chamberlain College of Nursing. Scholarship and Evidence-Based Practice: A Process for Change. Retrieved from https://chamberlain.instructure.com/courses/24563/pages/week-5-lesson?module_item_id=2691110
- Connor, B, T. (2014). Differentiating Research, Evidence-based Practice, and Quality Improvement. American Nurse Today, 9(6). Retrieved from https://www.americannursetoday.com/differentiating-research-evidence-based-practice-and-quality-improvement/
- Dadich, A., & Hosseinzadeh, H. (2016). Communication channels to promote evidence-based practice: A survey of primary care clinicians to determine perceived effects. Health Research Policy and Systems, 14(1). Doi:10.1186/s12961-016-0134-z
- McCormack, B., & McCance, T. (2017). Person-centered practice in nursing and healthcare: Theory and practice. (2nd ed.). Chichester, West Sussex; Ames, Iowa: John Wiley & Son LTD.
- Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: The seven steps of evidence-based practice: Following this progressive, sequential approach will lead to improved healthcare and patient outcomes. American Journal of Nursing, 110(1), 51–53.
- National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate, and research doctorate programs in nursing. New York, NY: National League for Nursing.
- O’Connor, C. M. (2017). High Heart Failure Readmission Rates. JACC: Heart Failure, 5(5), 393. doi:10.1016/j.jchf.2017.03.011
- McCance, T. McCormack, B., & Dewing, J. (2011). An exploration of person-centeredness in practice. Online Journal of Issues in Nursing, 16(2). doi:10.3912/OJIN.Vol16No02Man01
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- Straus, S.E. & D.L. Sackett. (1998). Using research findings in clinical practice. British Medical Journal 317 (7154):339-42
- U.S. Department of Health and Human Services. (n.d.). Module 1: Introduction: What is Research? Retrieved from https://ori.hhs.gov/module-1-introduction-what-research
- University of West Florida (2018). Literature Review: Conducting & Writing. Retrieved from https://libguides.uwf.edu/litreview
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