The learner describes the process of data collection, analysis, and implementation of evidence that can improve clinical practice from an interprofessional perspective.
identify a healthcare problem, develop an evidence-based practice (EBP) question, and review selected research-based and non-research-based evidence to find answers to that question.
B. Discuss the impact of a clinical practice problem on the patient or patients and the organization it affects.
1. Identify each of the following PICO components of the clinical practice problem:
• P: patient, population, or problem
• I: intervention
• C: comparison
• O: outcome
2. Develop an evidence-based practice (EBP) question based on the clinical practice problem discussed in part B and the PICO components identified in part B1.
Note: Refer to the “Appendix B: Question Development Tool” web link for information on the creation of an EBP question.
C. Select a research-based article that answers your EBP question from part B2 to conduct an evidence appraisal.
Note: The article you select should not be more than five years old.
1. Discuss the background or introduction (i.e., the purpose) of the research-based article.
2. Describe the research methodology used in the research-based article.
3. Identify the level of evidence for the research-based article using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model.
Note: Refer to the “Appendix E: Research Evidence Appraisal Tool” web link for information on how to level a research-based article.
4. Summarize how the researcher analyzed the data in the research-based article.
5. Summarize the ethical considerations of the research-based article. If none are present, explain why.
6. Identify the quality rating of the research-based article according to the JHNEBP model.
Note: Refer to the “Appendix E: Research Evidence Appraisal Tool” web link for information on how to establish the quality rating.
7. Analyze the results or conclusions of the research-based article.
a. Explain how the article helps answer your EBP question.
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
References
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.
A. The Process of Data Collection, Analysis, and Implementation of Evidence in Interprofessional Practice
The process of data collection, analysis, and implementation of evidence to improve clinical practice from an interprofessional perspective is a cyclical and collaborative endeavor. It involves healthcare professionals from various disciplines working together to identify a clinical problem, formulate a focused question, systematically search for and critically appraise relevant evidence, synthesize the findings, implement the evidence into practice, and evaluate the impact of the change.
1. Identifying a Healthcare Problem: The process often begins with a recognized gap between current clinical practice and desired patient outcomes. This might arise from direct observation, quality improvement data, patient feedback, or new research findings. An interprofessional team, including nurses, physicians, pharmacists, therapists, and others, collaborates to clearly define the problem and its scope.
2. Developing an Evidence-Based Practice (EBP) Question: Once the problem is identified, the team formulates a specific and answerable EBP question, often using the PICO (Population, Intervention, Comparison, Outcome) framework. This structured question guides the search for relevant evidence.
3. Reviewing Selected Evidence: The interprofessional team then conducts a systematic search for the best available evidence. This includes research-based evidence (e.g., randomized controlled trials, systematic reviews, meta-analyses, cohort studies, case-control studies, descriptive studies) and non-research-based evidence (e.g., clinical practice guidelines, expert opinions, organizational experience, patient preferences). The team critically appraises the selected evidence for its rigor, relevance, and applicability to the specific clinical context. This appraisal involves evaluating the study design, sample size, methodology, findings, and potential biases.
A. The Process of Data Collection, Analysis, and Implementation of Evidence in Interprofessional Practice
The process of data collection, analysis, and implementation of evidence to improve clinical practice from an interprofessional perspective is a cyclical and collaborative endeavor. It involves healthcare professionals from various disciplines working together to identify a clinical problem, formulate a focused question, systematically search for and critically appraise relevant evidence, synthesize the findings, implement the evidence into practice, and evaluate the impact of the change.
1. Identifying a Healthcare Problem: The process often begins with a recognized gap between current clinical practice and desired patient outcomes. This might arise from direct observation, quality improvement data, patient feedback, or new research findings. An interprofessional team, including nurses, physicians, pharmacists, therapists, and others, collaborates to clearly define the problem and its scope.
2. Developing an Evidence-Based Practice (EBP) Question: Once the problem is identified, the team formulates a specific and answerable EBP question, often using the PICO (Population, Intervention, Comparison, Outcome) framework. This structured question guides the search for relevant evidence.
3. Reviewing Selected Evidence: The interprofessional team then conducts a systematic search for the best available evidence. This includes research-based evidence (e.g., randomized controlled trials, systematic reviews, meta-analyses, cohort studies, case-control studies, descriptive studies) and non-research-based evidence (e.g., clinical practice guidelines, expert opinions, organizational experience, patient preferences). The team critically appraises the selected evidence for its rigor, relevance, and applicability to the specific clinical context. This appraisal involves evaluating the study design, sample size, methodology, findings, and potential biases.
4. Synthesizing the Evidence: The team then synthesizes the findings from the appraised evidence, looking for consistent patterns, strengths of evidence, and any conflicting results. This involves summarizing the key findings and determining the overall body of evidence’s strength and direction in relation to the EBP question.
5. Implementing the Evidence into Practice: Based on the synthesized evidence, the interprofessional team develops a plan for implementing the evidence-based change in clinical practice. This plan should consider the feasibility, resources required, potential barriers, and strategies for overcoming them. It also involves clear communication and collaboration among all involved disciplines.
6. Evaluating the Impact: After implementing the change, the team evaluates its impact on patient outcomes, processes of care, and organizational factors. This involves collecting data relevant to the outcomes identified in the EBP question and analyzing it to determine if the implemented change has led to the desired improvement. The evaluation findings then inform further adjustments to practice or the identification of new clinical problems.
This iterative process emphasizes collaboration, critical thinking, and the integration of the best available evidence with clinical expertise and patient values to achieve optimal patient care.
B. Impact of a Clinical Practice Problem: Delayed Ambulation Post-Surgery
Clinical Practice Problem: Delayed ambulation (walking) in adult patients following major abdominal surgery.
Impact on the Patient:
Delayed ambulation after major abdominal surgery can have significant negative impacts on patients:
- Increased Risk of Complications: Prolonged immobility increases the risk of developing postoperative complications such as deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, atelectasis, and pressure ulcers. These complications can lead to increased morbidity, prolonged hospital stays, and even mortality.
- Delayed Functional Recovery: Early ambulation is crucial for regaining strength, mobility, and independence. Delayed ambulation can lead to muscle weakness, reduced cardiovascular fitness, and a slower return to pre-operative functional status.
- Increased Pain and Discomfort: Immobility can exacerbate pain and stiffness, making it more difficult for patients to participate in other recovery activities like coughing and deep breathing.
- Prolonged Hospital Stay: The development of complications or a slower functional recovery due to delayed ambulation often necessitates a longer hospital stay, increasing the burden on the patient and the healthcare system.
- Negative Psychological Impact: Prolonged bed rest and dependence can lead to feelings of frustration, anxiety, and depression, hindering the patient’s overall recovery and well-being.
Impact on the Organization:
Delayed ambulation also has significant implications for the healthcare organization:
- Increased Healthcare Costs: Longer hospital stays, treatment of postoperative complications, and readmissions associated with delayed ambulation significantly increase healthcare costs.
- Decreased Bed Turnover: Prolonged hospital stays reduce the availability of beds, leading to decreased bed turnover and potential delays in admitting new patients.
- Lower Patient Satisfaction: Patients experiencing complications, prolonged stays, and slower recovery are likely to have lower satisfaction with their care.
- Increased Risk of Penalties and Reduced Reimbursement: Healthcare organizations are increasingly being penalized for high rates of preventable complications and readmissions, which can be linked to delayed ambulation.
- Strain on Staff Resources: Managing patients with postoperative complications and providing prolonged care due to delayed recovery places a greater burden on nursing and other healthcare staff.
B.1. PICO Components:
Based on the clinical practice problem of delayed ambulation post-surgery:
- P (Patient, Population, or Problem): Adult patients who have undergone major abdominal surgery.
- I (Intervention): Implementation of a standardized early ambulation protocol (initiated within 24 hours post-surgery).
- C (Comparison): Standard postoperative care without a standardized early ambulation protocol (ambulation initiated based on individual assessment and tolerance, often later than 24 hours).
- O (Outcome): Reduction in postoperative complications (DVT, PE, pneumonia, atelectasis, pressure ulcers), shorter length of hospital stay, improved functional recovery (e.g., time to first independent walk, pain levels), and increased patient satisfaction.
B.2. Evidence-Based Practice (EBP) Question:
In adult patients following major abdominal surgery (P), does the implementation of a standardized early ambulation protocol initiated within 24 hours post-surgery (I) compared to standard postoperative care without a standardized early ambulation protocol (C) result in a reduction in postoperative complications and a shorter length of hospital stay (O)?
C. Evidence Appraisal of a Research-Based Article
Selected Research-Based Article:
O’Connell, M., Gardner, S., Betihavas, V., & Keogh, J. B. (2019). Early mobilisation within 24 hours of abdominal surgery: A systematic review and meta-analysis. Surgery, 165(2), 301-309.
C.1. Background or Introduction (Purpose):
The background of this systematic review and meta-analysis highlights the established benefits of early mobilization in preventing postoperative complications and promoting recovery after various surgical procedures. However, the authors note that the optimal timing and specific protocols for early mobilization following major abdominal surgery remain less clearly defined. The purpose of their research was to systematically review and synthesize the evidence from randomized controlled trials (RCTs) to determine the effect of early mobilization (initiated within 24 hours post-surgery) on postoperative outcomes in adult patients undergoing abdominal surgery.
C.2. Research Methodology:
This study employed a systematic review and meta-analysis methodology. The researchers systematically searched several major electronic databases (e.g., MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) for RCTs that compared early mobilization (initiated within 24 hours post-surgery) to later or standard mobilization in adult patients undergoing abdominal surgery. They defined early mobilization as any form of physical activity such as sitting out of bed, standing, or walking initiated within the first 24 postoperative hours. The researchers then critically appraised the included studies for methodological quality and extracted relevant data on various postoperative outcomes. Finally, they performed a meta-analysis to statistically pool the results of the comparable studies to determine the overall effect of early mobilization on the outcomes of interest.
C.3. Level of Evidence (Johns Hopkins Nursing Evidence-Based Practice Model):
Based on the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, a systematic review or meta-analysis of RCTs is considered Level I evidence. This level represents the highest quality of evidence due to the rigorous methodology of systematically synthesizing findings from multiple well-designed studies.
C.4. Data Analysis:
The researchers analyzed the extracted data using statistical methods appropriate for meta-analysis. For dichotomous outcomes (e.g., presence or absence of complications), they calculated risk ratios (RR) and 95% confidence intervals (CIs). For continuous outcomes (e.g., length of hospital stay), they calculated mean differences (MD) and 95% CIs. They used random-effects models for the meta-analysis to account for potential heterogeneity between the included studies. Heterogeneity was assessed using the I² statistic. The researchers also conducted subgroup analyses and sensitivity analyses to explore potential sources of heterogeneity and assess the robustness of their findings.
C.5. Ethical Considerations:
As this study is a systematic review and meta-analysis, it does not involve direct human subjects research. Therefore, it would not have required specific ethical approvals such as informed consent or institutional review board (IRB) review at the level of this study itself. However, the researchers would have relied on the ethical conduct and approvals obtained by the primary researchers of the included RCTs. The authors of this systematic review should have ensured that the included studies reported adherence to ethical principles relevant to human subjects research, such as informed consent, protection of privacy, and minimization of harm. This would typically be mentioned within the methodology sections of the primary studies they reviewed. If the included studies did not address ethical considerations, this would be a limitation noted in the systematic review’s appraisal of the evidence base.
C.6. Quality Rating (Johns Hopkins Nursing Evidence-Based Practice Model):
To determine the quality rating according to the JHNEBP model, we would need to evaluate the methodological quality of the included RCTs and the systematic review process itself. Based on the description provided:
- Systematic Review Process: The researchers systematically searched multiple databases, defined inclusion and exclusion criteria, critically appraised studies, extracted data, and performed a meta-analysis. This suggests a rigorous systematic review process.
- Methodological Quality of Included RCTs: The quality rating would depend on the specific appraisal of each included RCT based on criteria such as randomization, blinding, attrition rates, and reporting of results.
Assuming the researchers used a recognized tool for quality assessment of RCTs (e.g., Cochrane Risk of Bias tool) and reported the findings, and that the systematic review methodology was sound, the overall quality rating for this systematic review and meta-analysis would likely be High (A) if the majority of included studies were of high quality and the synthesis was conducted rigorously with consistent results. If there were significant methodological limitations in the included studies or inconsistencies in the findings, the rating might be Good (B) or even Low (C). Without the specific quality assessment results from the article, we can infer a likely rating based on the study design (meta-analysis of RCTs being inherently strong)
