Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project

Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project

Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project

Discussion week 12 NURS8410 SOLVED

Evidence-based Practice Project: PICOT Statement

Student’s Name

Institution

Date

Evidence-based Practice Project: PICOT Statement

Delayed patient transfers from the intensive care unit (ICU) is a significant practice problem that affects the quality and safety of healthcare delivery as well as the costs and efficiency of service delivery in a healthcare institution. It is nurses’ role to identify issues and develop strategies for quality improvement (Stillwell, Fineout-Overholt, Melnyk & Williamson, 2012). The following PIICOT Statements seeks to develop an intervention to reduce the rates of delayed transfers to enhance patient experiences and outcomes.

PICOT Statement

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

Salient Elements that Inform the Research Question

The research question above has been developed based on observations in clinical practice of patients in intensive care, who overstay their admission in the ICU. Past research shows that delayed transfers of patients from the ICU to non-intensive care wards or the community settings have a negative effect on patient experiences and the patient outcomes. Some of the common negative effects of delayed patient transfers that have been identified by past researchers include an increased risk of infection, a higher rate of readmission, and increased costs of care, which may cause issues for the patients and their families in the future (Schneider et al., 2012). Therefore, this research seeks to determine methods that can be used to help speed up the process of discharging patients from intensive care to the regular units or the community settings when applicable.

The intervention of increasing patient mobility has been developed based on the theory of Dorothea Orem’s Self Care Deficit Nursing Theory. Orem’s theoretical model puts forward three major theories: self-care, nursing systems, and self-care deficit theory. In the self-care theory, Orem emphasizes behaviors, deliberate actions, and knowledge that help the patients to care for themselves. This theory links a person’s beliefs to their behaviors. A person’s attitudes towards something affects their controlled behaviors related to it (Holdsworth et al., 2015). For ICU patients, increasing mobility enhances their attitudes towards recovery and in turn, increases the progression of their recovery process; thus, speeding up the process of discharge from the ICU.

The intervention of focus in this research is increasing patient mobility to enhance their recovery process. Literature reveals that mobilization of ICU patients is an effective method of increasing the chances of achieving positive outcomes. The mobilization can be done in various ways depending on the patient characteristics. Some of the benefits associated with mobilization, which are expected to contribute to the early discharge include reduced risks of pressure ulcers, reduced risks of muscle atrophy, and decreased inflammation among others (O’Mahony et al., 2011). Therefore, based on this research, it is likely that nurses can enhance patient recovery and reduce the length of ICU stay by improving the mobility of patients.

Concerns Related to the Research

The primary concern with conducting this research is the critical nature of most of the ICU patients. It will require a lot of collaboration with other healthcare professionals and approval from relevant authorities to implement increased mobility on ICU patients to enhance their recovery and reduce their delay of transfer from the ICU. Other than that, there is adequate research demonstrating the safety and quality issues associated with over staying in ICU, which make this research project an essential tool for improving the quality of care delivery. The research will be beneficial not only for nursing practice but also for other health care professionals and the efficiency of healthcare institutions. Most importantly, it will help to improve the outcomes and experiences of ICU patients.

References

Holdsworth, C., Haines, K. J., Francis, J. J., Marshall, A., O’connor, D., & Skinner, E. H. (2015). Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior. Journal of critical care, 30(6), 1243-1250.

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.

O’Mahony, R., Murthy, L., Akunne, A., & Young, J. (2011). Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Annals of internal medicine, 154(11), 746-751.

Schneider, E. B., Hyder, O., Brooke, B. S., Efron, J., Cameron, J. L., Edil, B. H., … & Pawlik, T. M. (2012). Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. Journal of the American College of Surgeons, 214(4), 390-398.

Klopper, H. C., Coetzee, S. K., Pretorius, R., & Bester, P. (2012). Practice environment, job satisfaction and burnout of critical care nurses in South Africa. Journal of Nursing Management, 20(5), 685-695.

Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project

In many of the courses in the DNP program, you have been asked to analyze research literature when exploring issues in health care. Reflect now on an issue in your practice area that has different outcomes from what is supported by the literature. For example, the literature evidence notes that nosocomial infections are reduced when procedures such as hand washing, glove use, and isolation strategies are implemented. In your clinical area, you have implemented these strategies and you are not seeing a reduction in nosocomial infections.

For Application 1, you select an issue that will serve as the launching point for your Evidence-Based Practice (EBP) Project.

Before you proceed with this assignment, you may wish to review the overview of the full EBP Project assignment. (see attached file)

To prepare for Application 1:

• Consider      the specifics of your practicum setting, as well as practice-related      challenges in your specialty area that interest you. Brainstorm practice      issues in which an outcome is different from what would be expected      according to the research literature (based      on the PICOT Question previously formulated).
• Select one issue to focus on for this assignment (based on the PICOT Question previously formulated).
• This will be your issue for the entire EBP Project, so be sure it is one that will enable you to fulfill the project requirements (e.g., you can develop new approaches to practice). You may wish to speak with your  Practicum Mentor about your selection.
• Explore the research literature on this issue.

To complete:

In a 2-page paper, in APA format and at least 3 references, address the following as numbered below:

1) Introduction ending with a purpose statement (e.g. the purpose of this paper is…)

2) 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.)

3) Conclusion

PICOT Statement

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?

P: Adult patients 

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients 

C: minimal mobilization of the patients

To students:

In addition to the Learning Resources and facilitated discussions provided each week, you are expected to integrate articles from peer-reviewed journals to inform and support your positions and conclusions in the Application Assignments. Graduate-level scholarship provides the foundation for your work and requires a higher level of evidence than lay references, such as the dictionary, Wikipedia, general Internet sites, nursing newspapers, expert opinion, and the like. 

Must include at least 1 reference from the list of provided Required Readings and at least 2 references from scholarly articles from peer-reviewed journals

Best Practices in Nursing Specialties

The following is an overview of the four Applications that are assigned in this course.

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 2-page paper, address the following:

· Introduction

· 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.)

· Conclusion

Application 1 is due by Day 3 of Week 2.

Application 2: Laying the Foundation for New Approaches to Practice (developed in Weeks 4 and 5)

In a 3- to 5-page paper, include the following:

· Introduction

· 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

· Conclusion

Application 2 is due by Day 3 of Week 5.

Application 3: Becoming a Leader in the Translation of Evidence to Practice (developed in Weeks 6 and 7)

Write a 2- to 3-page paper that synthesizes:

1) Introduction

2) Your vision of yourself as a leader—specifically:

a. How you would continue to increase your knowledge and awareness of financial, economic, and other concerns related to new practice approaches

b. How translating evidence would enable you to affect or strengthen health care delivery and nursing practice

c. How you would advocate for the use of new evidence-based practice approaches through the policy arena

3) Conclusion

Application 3 is due by Day 3 of Week 7.

Application 4: Planning for Change, Implementing and Evaluating EBP Projects (developed in Weeks 8–10)

· Write a 4- to 8-page paper that addresses the following:

1) Introduction

2) Planning for Change

a) Analyze the impact of implementing change in your practice environment, including the factors that need to be considered regarding stakeholders and end users.

b) Summarize the methods you would use to ensure that those are adequately addressed.

c) Conclusion

d) 3) Implementing EBP Projects

e) Identify the desired outcomes of your EBP Project.

f) Describe any macro or micro systems issues that may inhibit implementation and strategies for resolving those issues.

g) Explain how resolving your EBP Project issue will improve quality and patient safety.

h) 4) Evaluating EBP Projects

i) Describe evaluation strategies.

j) Formulate new practice guidelines based on the possible results of the evaluation of outcomes.

k) Describe, if appropriate, new standards of care relevant to the new practice guidelines.

5) Conclusion

Application 4 is due by Day 3 of Week 10

8410 Application 1:

Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project

Note: Have an APA Level 1 header for Each Area Noted below in Blue (a level 1 header is centered, bolded, using upper and lower case letters—see APA manual area 3.03)

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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