Nursing Research and Evidence-Based Practice

 

Please write an evaluation of the use, or lack thereof, of EBP in a recent clinical experience. Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization.

In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.

Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).

To prepare:
Consider a recent clinical experience in which you were providing care for a patient.
Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
What questions have you thought about in a particular area of care such as a procedure or policy?
Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

Introduction
The first step in doing evidence-based practice research is forming a researchable question. Questions that are too broad or too narrow can make your research difficult, if not impossible. For example:
• Too broad: How do you control infection?
o This topic is so broad that you’d have difficulty wading through all of the results.
• Too narrow: At the Johns Hopkins Neonatal Intensive Care Unit, what is the best way to control infection among Asian American babies born at 32 weeks?
o This question is so specific that there probably hasn’t been anything published on that specific location regarding that specific population.
• Just right: In the NICU, what is the effect of hand washing on infection control compared with hand sanitizers, over 6 months?

On this page we will cover:
• using PICOT as a guide in developing a researchable question
• turning your research question into search terms
PICOT
PICOT is a mnemonic that helps you remember the key components of a well-focused question. It stands for:

• P = Patient, Population or Problem
• I = Intervention, Prognostic Factor, or Exposure
• C = Comparison (optional)
• O = Outcome
• T = Time

Once you’ve identified each aspect of your PICOT, here is a formula that you can use to turn it into a question:

In ___________ (P), what is the effect of ___________ (I) compared to _____________ (C) on __________ (O) over _____________ (T)?

For example:
In the NICU, what is the effect of hand washing compared to hand sanitizers on infection control over 6 months?
Search terms
Once you’ve developed a PICOT question, it’s time to find keywords or search terms that you can use in the Library databases to find articles relevant to your question.
Here are a few strategies that will help you turn each aspect of your topic into relevant search terms:
• Brainstorm synonyms
• Expand out acronyms
• Look at subjects

Brainstorm synonyms: For each aspect of your topic, think of other words or phrases that have a similar meaning. For example, some synonyms for hand sanitizers could be:
• hand rubs
• hand disinfection

Expand out acronyms: If your topic includes acronyms, like NICU, you’ll want to search using both the acronym and the actual phrase:
• NICU OR Neonatal Intensive Care Unit

Look at subjects: Most of the Library databases assign an item subjects based on the main topics covered in that item. These subjects make great search terms, since they will help you search for the terms the database uses to categorize your topic.
Here is an example of how to find subjects in the CINAHL Plus with Full Text database:
1. Once you are in the database, enter an aspect of your topic in the first search box. For example:
Hand Sanitizers

2. Then run your search by clicking on the Search button.
Note: This search is just to help you identify relevant subjects, so you don’t want to add additional search terms or limits to your search.
3. Under the citation information for each result, look at the Subjects area to determine which subjects best fit your topic. For this topic, a few promising subjects are: Handwashing Standards, Handwashing Equipment and Supplies, Antiinfective Agents, and Cross Infection Prevention and Control.

To learn more about picking and combining appropriate search terms, please see our guides:
• Keyword Searching: Keyword Search Strategy
• Keyword Searching: Boolean
Additional resources
• Duke University Medical Center Library: Asking the Well Built Clinical Question
• University of Oxford: Centre for Evidence-Based Medicine: Asking Focused Questions
• Moyer, V. (2008). Weighing the Evidence: PICO Questions: What Are They, and Why Bother? AAP Grand Rounds, 19(1). doi:10.1542/gr.19-1-2
• Huang, X., Lin, J., & Demner-Fushman, D. (2006, November). Evaluation of PICO as a Knowledge Representation for Clinical Questions. AMIA Annual Symposium Proceedings, 359–363.
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Sample Solution

ACED ESSAYS