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).
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.
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 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)?
In the NICU, what is the effect of hand washing compared to hand sanitizers on infection control over 6 months?
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:
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
• 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.
• << Previous: Evidence-Based Practice
• Next: Levels of Evidence Pyramid >>
Commonly, another structure, regularly in parallel with the current hierarchical structure, is built up by the initiative to seek after the topic. Activity, generally portrayed under the name of the topic, is legitimized, resourced, and energized. As opposed to composed activity streaming down the chain of command, these activity steps for the most part happen in a decentralized, impromptu way, regularly by uniquely made gatherings, for example, 'teams' or 'arranging gatherings.' The move steps frequently make the type of 'prospecting', searching for, and following up on effective activities – as opposed to a precisely thoroughly considered foreordained arrangement of activities. Slide 14, Step Three: Amid the activity steps, administration takes part in and advances intelligent coordinating all through the association. This comprises of rehashed, and frequently open, occasions and interchanges that depict the moves made, the outcomes accomplished, lessons learnt and how these connection to the subject. This is done to offer importance to the topic, to comprehend the subject. The topic is additionally characterized by the moves that are made in its name. Associations talk to find what they are stating and act with a specific end goal to find what they are doing. The topic of 'better patient care' begins to mean the moves that are made to accomplish it. Along these lines, the subject advances and develops, ending up more modern and important. Activities decide and depict the targets, instead of the a different way. Intelligent coordinating isn't an aloof procedure; it is the key segment of the initiative's commitment. 10.5 | Formal vital arranging in unverifiable conditions The arranging typology plot in the action on the former screen would recommend that established formal vital arranging would just properly happen in settings of low vulnerability about 'what' and 'how'. Nonetheless, we watch endeavors at vital arranging in the full scope of settings. For what reason may this be so? Associations appear to participate in formal making arrangements for an assortment reasons that fall into two classes: either to give off an impression of being sound or as an instrument of authoritative control. 10.5.1 | Planning to seem sane A few people propose that vital arranging is only a ploy associations use to seem objective. 'Arranging isn't improved the situation what it achieves, however for what it symbolizes – judiciousness.' Associated with this thought is the perception that numerous associations just deliver a formal vital arrangement when required to do as such to meet an outside need. Most regularly, this will be the point at which a firm needs to get to outside capital, through either a bank or the value showcase. On these events, arranging isn't utilized to 'make technique to such an extent as program a methodology that as of now existed'.4 Wellbeing administrations are regularly required by their Acts to take part in formal key arranging. For instance, Ambulance Victoria, for which I have been Chair of the Board of Directors, is so required under Section 25E(1) of the Ambulance Services Act 1986: 'The Board of a rescue vehicle benefit must, at the course of the Minister ... get ready and submit to the Minister for endorsement a key arrangement for the task of the rescue vehicle benefit.' Situation A neighborhood Victorian case of this emblematic explanation behind arranging was the advancement of "A more beneficial future: an arrangement for metropolitan human services administrations". Melbourne's (at that point) six Metropolitan Hospital Networks were built up in August 1995 after a unique Government request coming about because of the political emergency related with the execution of extreme spending cuts. The view was put that while working as 35 singular healing centers, there was no motivator for administrations to be supported, yet alone exchanged to the under-resourced fringe populace development halls. Besides, the execution of the spending slices through a case-blend financing recipe implied that all doctor's facilities were enduring 'torment'. Wouldn't it be less demanding in the event that at least one internal city healing facilities were shut and the assets spared used to meet the spending cut, with what remained exchanged to regions of need? This would have the political preferred standpoint of constraining the 'agony' to maybe a couple seats, as opposed to the entire metropolitan zone. As a component of a realist, recommended administration motivation, the new systems were required to create key designs inside a half year. The systems grasped this arranging errand with an assortment of procedures. Some settled focal arranging groups, with increasingly (or less) meeting. Some occupied with non-brief procedures. One month before the procedure designs were expected to be presented, the Government called a race, and all further arranging was illegal. Where systems had drawn in outer partners in the key arranging process, any new procedures that were disputable (for instance, conclusion of a healing center) turned out to be a piece of the electioneering, at times putting the thought and its advocates in danger. In the occasion, the Government was come back to control, another Minister named, and the technique arranging restarted. At the point when the accumulated system procedure designs were at last discharged, towards the finish of 1996, 50 particular techniques were recognized. In 19 of these methodologies, 'keeping up current part' was the primary element. Three systems included the conclusion of little unimportant group healing centers under the code word of 'migrate administrations'. The rest of basically capital works recommendations. The key designs were not really an explanation of a coveted future and the methods for accomplishing it. Or maybe, they reacted to the political needs (advertising) of the time and gave the premise on which the Department of Human Services could manage its financier, the Department of Treasury and Finance. 10.5.2 | Planning for control Numerous individuals have noticed that vital plans (and their joined capital designs, program designs, and spending plans) frequently essentially express the known business as usual, or exceptionally peripheral modifications thereto. Plans 'gave an instrument through which prior vital choices were affirmed'; as such, arranging systematized and in addition formalize and adjust 'settled upon objectives, duty examples, and activity sequences'.4 10.6 - Reading | Chapter 10 Read Chapter 10, "Vital Thinking and Achieving Competitive Advantage" in your course book. 10.7 | Formal arranging in general wellbeing For understudies concentrated on general wellbeing, a vital arranging model called 'Rationale Model' is regularly utilized. You can discover a manual for this model in the accompanying perusing: W.K. Kellogg Foundation: Logic Model Development Guide. W.K. Kellogg Foundation; 2004. 10.8 | Consumer Engagement (This Section composed by Peter Bradford) It is fitting to finish the theme of Strategic Planning, and our Subject of Clinical Leadership and Management, with some editorial on the part of purchasers in human services administration and arranging (and administration). >GET ANSWER