Evidence-Based Practice (EBP) Process, PICOT Question, and Rapid Clinical Appraisal (RCA) Tools
Week 1 – Assignment 2 Discussion
Melnyk and Fineout-Overholt (2011) outline seven steps in the evidence-based practice (EBP) process. The first step is to cultivate a spirit of inquiry. To encourage this mindset, you are asked in this discussion to:
- Identify a problem or issue from your specialty area that requires improvement. The Doctor of Nursing Practice site (http://www.doctorsofnursingpractice.org/resources/dnp-scholarly-projects/) offers many examples of relevant projects. Below are areas that may help focus your thoughts:
- Educational program
- Evidence-based healthcare policy change
- Evidence-based clinical issue or protocol for a specific disease/condition
- Discuss the relevance of the issue from your perspective (not from literature) in relation to your selected advanced role.
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- What piqued your interest about this issue?
- How does it relate to your specialization?
- What led you to believe that evidence exists to support this change? (See note below).
- Provide a rationale explaining why this will be an evidence-based project to improve outcomes, rather than research to generate new evidence.
Note: The project will not be implemented during this course, and no data will be collected. The course outcome is to complete a project proposal only.
Week 2 – Assignment 1 Discussion
Melnyk and Fineout-Overholt (2011) identify seven steps in the EBP process, with cultivating a spirit of inquiry as the first. For this discussion:
- Briefly describe the problem or issue that you have selected for your project proposal, to inform your classmates and faculty.
- Explain how it relates to your area of specialization.
- State your PICOT question. Indicate in parentheses after each part what segment of PICOT the words represent. For example: In patients recently discharged from the hospital following care for heart failure (P), do hand-off calls by the nurse to the primary care provider using the SBAR format (situation, background, assessment, recommendation) (I) compared to no calls (C) decrease readmission rates (O) over a one-year period (T)?
- Discuss which process model resonates with you and will help guide your project. Models included in your text (Melnyk & Fineout-Overholt, 2011) are:
- Clinical scholar model
- Stetler model of evidence-based practice
- Iowa model of evidence-based practice to promote quality care
- Model for evidence-based practice change by Rosswurm and Larrabee
- Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model
- Provide feedback to your classmates focusing on:
- Correct use of the PICOT format to guide the literature search.
- Does the question reflect a clinical research question or one suitable for an EBP project?
Week 3 – Assignment 1 Discussion
For this discussion, share your search strategies for finding evidence for your study:
- State your PICOT question. Did the terms you used lead to useful research studies?
- What MESH terms have you tried? Did they help you find additional studies? Are MESH terms helping to expand or delimit your search?
- Are you finding relevant articles? If not, how did you adjust your search to increase productivity?
- Indicate which databases you used—those that were useful and those that were not.
- What levels of evidence do the studies represent?
Post any questions or concerns, and provide feedback and recommendations to your classmates. Collaboration on search strategies can be very helpful.
- Use the Search Tracker to keep track of search terms.
- Using the appropriate Rapid Clinical Appraisal (RCA) Tools, appraise one or two articles and add the information to your Evaluation Table for faculty feedback. Your table is a work in progress and will be completed in Week 4.
Week 4 – Assignment 1 Discussion
Discuss your experience completing the rapid critical appraisal process:
- Was it truly “rapid” or more laborious?
- Did reading the abstract help you quickly decide whether to include or exclude the study?
- What approach worked best for completing the appraisal and Evaluation Table? What didn’t work?
Post questions or concerns, and provide feedback to your classmates. Sharing search strategies is beneficial.
Week 5 – Assignment 1 Discussion
This week’s discussion focuses on creating Synthesis Table(s) to summarize and organize the body of evidence from the Evaluation Table. The Synthesis tables will be included in the Appendix of your formal proposal. In the body of the paper, you will describe the “keeper” studies in narrative form.
- Share your approach to synthesizing the evidence. What variables of interest did you identify?
- Practice scholarly writing: Summarize two articles from your Synthesis Table. Include the level of evidence, study design, and evidence of rigor, citing in APA format.
- In addition to research studies, consider patient preferences and clinical expertise. Discuss how you will incorporate these into your project proposal.
Week 6 – Assignment 1 Discussion
For this week’s discussion:
- Briefly describe the clinical issue or problem for your project, the setting, and the population of interest.
- Write your clinical question.
- Describe the intervention you plan to test.
- What type of study will you conduct? Will it be experimental or quasi-experimental? Provide your rationale.
Provide feedback on the clinical questions of your classmates.
Week 7 – Assignment 1 Discussion
This discussion focuses on measurement tools to evaluate change from your intervention. For feedback, discuss:
- Write a brief description of your project, including your clinical question and planned intervention.
- Will you need to develop your own evaluation tools, or are valid and reliable tools available?
- If creating your own tools, will you pilot test them? How?
- Will you gather baseline data? Use pre- and posttests? How will you measure change?
- How will you identify participants for your study? How does the sampling method influence the type of study?
- How will you ensure participant confidentiality?
Week 8 – Assignment 1 Discussion
This week’s discussion focuses on the analysis phase of your project:
- Begin with a brief project description, including your clinical question, intervention, study type, and evaluation methods.
- What type of statistical analysis will you perform?
- What is a reasonable project timeline?
- What expenses should be considered, including hidden costs such as time?
- Will you need funding?
Week 9 – Assignment 1 Discussion
For this discussion, develop a strategic plan for implementing your project. Consider:
- Who are the stakeholders? Identify them by role, not by name.
- Are there “champions” who can support your project?
- What potential barriers might you face? What strategies will help overcome them?
- What change theory will guide your implementation?
Week 10 – Assignment 1 Discussion
Reflect on the student learning outcomes for the course. Discuss how you met them:
- Demonstrate synthesis of the knowledge and skills acquired in your graduate nursing program.
- Evaluate current health policy, legal, and ethical considerations for promoting health and disease prevention.
- Integrate this synthesis in creating a scholarly project proposal.
- Disseminate key components of the project in both written and oral forms.
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