Evidence-Based-Practice Proposal

hlt_490v_assigment_grading_rubric_module_1_1 hlt_490v_module_1_lecture_2 resource_8_the_pico_method_3.ppt

Problem, Purpose, and the Question (Due in Module 1) i) Problem and Purpose (1) Think about what you have learned with regard to the five critical steps of evidenced-based practice. (2) In a formal paper of no more than 500 words: (a) Identify and describe one topic that may resolve a patient-care-quality problem or issue. (b) Draft a possible problem statement (3) Describe a problem, explain why it is a problem, and why it is significant to your discipline; gathering the literature as support for why this is a problem in relationship to your practice (4) The problem should focus on the resolution of an issue or problem significant to improving patient care. (5) Draft a purpose statement in relationship to your problem statement that states what you hope to accomplish if you implemented this project ii) Defining a Searchable, Answerable Question (1) From what you wrote about your problem and purpose, write a question that will be the basis for your implementation plan. Word count is not relative in this section. (2) The background should include the students’ research question in a PICO format (3) Include evidence-based resources. iii) Use APA format including a title page, introduction, and conclusion. An abstract is not required. Cite in-text and in the References section iv) Submit the formal paper and the question to your instructor by the end of Module 1 on Sunday, December 11th before midnight.

Professional Capstone Project

HLT 490V

Resource 1 Literature Review and Theory Grading Rubric

Guidelines

Use the headings listed below and the specific criteria within the rubric to ensure that your paper contain the needed information for each section. The assignment is worth 10 points/10% of your grade.

1) Length is 500 – 750 words

2) Draft a problem statement that addresses a patient-care or quality of practice issue and possible plan of resolution

3) Define a searchable, answerable question that will serve as the basis of the study and whose answer will provide evidence supporting problem resolution.

Feedback to student

Expectations	Does Not Approach Expectations (1-72%)	Approaches Expectations (72% – 75%)	Meets Expectations (76% – 83%)	Exceeds Expectations (84% – 91%)	Outstanding (92% – 100%)	Points Earned
Content: _____% ___8__points possible	Problem is poorly or not described; no relevance to patient-care or quality of practice given; no correlated references	Problem is not well described; relationship to patient-care or quality of practice is not well defined; few correlated references	Problem is generally described in relationship to patient-care or quality of practice with some correlated references	Problem is well described in relationship to patient-care or quality of practice with some supporting references and evidence of its relevance and significance	Problem is thoroughly defined with strong supporting references and evidence of its relevance and significance
Potential for resolution and desired outcome of project implementation are not given	Potential for resolution and desired outcome of project implementation are not clearly stated	Potential for resolution and desired outcome of project implementation are clearly stated	Potential for resolution is presented with supporting references; desired outcome of project implementation is clearly stated	Argument for resolution is critically presented with supporting references; desired outcome of project is well defined with a clear description of its implementation.
Searchable, answerable question not provide as basis for the implementation plan.	Searchable, answerable question provided as basis for the implementation plan does not correlate well with problem and purpose	Searchable, answerable question that correlates well with problem and purpose provided as basis for the implementation plan.	Searchable, answerable question for the implementation plan aligns well with the stated problem and purpose; PICO format was used; resources are referenced	Searchable, answerable question for the implementation plan clearly aligns with problem and purpose; PICO format was used; resources used provide the evidence-based research necessary to achieve the stated outcome
	Feedback to student
Presentation and APA guidelines: ______% __2__points possible	Does not meet minimum assigned length; Numerous errors in spelling, punctuation, and grammar; Inappropriate in three or more of the following: appearance of document (font size or style, use of white space, use of headings), tone, word choice, or sentence structure (incomplete sentences; run-on sentences; incorrect subject-verb agreement, etc.).	Does not meet minimum assigned length; Repeated specific types of errors in spelling, punctuation or grammar, e.g. paper consistently has subject-verb disagreement; Inappropriate in two of the following: appearance of document (font size or style, use of white space, use of headings), tone, word choice, or sentence structure, tone, word choice, or sentence structure.	Meets assigned length criteria; Occasional errors in spelling, punctuation, and grammar; Inappropriate in one of the following: appearance of document (font size or style, use of white space, use of headings), tone, word choice, or sentence structure, tone, word choice, or sentence structure.	Meets assigned length criteria; Few errors in spelling, punctuation, and grammar; Appropriate in all of the following: appearance of document (font size or style, use of white space, use of headings), tone, word choice, or sentence structure, tone, word choice, or sentence structure.	Meets assigned length criteria; No major errors in spelling, punctuation, and grammar; Professional appearance of document (font size or style, use of white space, use of headings), professional tone, word choice and sentence structure; Uses headings to organize paper.
No title page; No reference section; More than one requested section is missing; No correctly cited references within the body of the paper.	Title page incomplete or inaccurate; One requested section is missing; Reference section includes sources, many citation errors; References within the body of the paper included, but many citation errors.	More than one of the following is identified: Title page has minor errors; Section differentiation is not clear; Reference section includes sources, not consistently cited correctly; References included within the body of the paper, some citation errors.	One of the following is identified: Title page has minor errors; Section differentiation is not clear; Reference section includes sources, not consistently cited correctly; References included within the body of the paper, some citation errors.	Title page complete; All requested sections are included; Reference section includes correctly cited sources; in-text citations are included and correctly cited.
Total Score

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1/20/2009
© 2008. Grand Canyon University. All Rights Reserved

HLT490B.v1R1

HLT 490V
Selecting the

P

roblem, Purpose, and Question

I

ntroduction

Advancing an original point of view either in a written or oral format (often a combination of both) as a result of research done at a master’s level is called a thesis; completed at a doctoral level, it is called a dissertation. For the professional capstone project proposal, however, students do not conduct original research; they prepare an evidence-based practice plan for a project whose focus is the resolution of an issue or clinical problem significant to improving patient care.

Project

O

verview

C

apstone projects, or professional project proposals, serve to demonstrate and integrate what students have learned over the course of their curriculum. The final challenge is for students to analyze and resolve a managerial, clinical, health care issue or patient problem.

Students will develop a proposal that may include an intervention, a policy change, or other type of solution. In an evidence-based project, the student becomes familiar not only with the problem but with all of the pros and cons of the solution through their reading, analyzing, and synthesizing of relevant literature. The goal is to articulate recommendations, in a written format, for practice based on existing research findings.

Knowing what and knowing how, with regard to leadership and management theories, will be inherent parts of the project. Students will want to ensure that they discuss social, economic, and political environments, as well as how their project is affected by, or affects, those environments.

Decisions in practice are made from a position of experience, authority, and solid evidence. Students’ critical thinking skills also will be demonstrated by the development of this project.

Capstone projects offer students the opportunity to demonstrate their ability to synthesize, integrate, and apply the best clinical evidence. It also gives them an opportunity to demonstrate newly acquired communication skills and to explain how those communication skills can be used for disseminating the findings of the project.

The project proposal should reflect a synthesis and integration of program content and professional practice. To demonstrate integration of many concepts, consider how the values and perceptions of patients influence health; a clinician may wish to relate short stories to demonstrate how he/she employed the clinical process in the spiritual care of adults, for example. Regardless of your idea, the entire project proposal should revolve around evidence-based practice.

Selecting a Problem

Clinical problems are often derived from practice or from theory. For this project, the problem selected should address an issue related to patient care quality. The problem statement should be stated clearly and with enough contextual detail to establish why it is important. Just as in clinical research, which is a systematic gathering of information (Macnee, 2004), the project should be a summary of what the evidence says.

Problems in clinical situations promote the development of clinical questions. The problem is that one question usually leads to ten more, making it more difficult to narrow the question. Finding the answer to the problem is finding and asking the right clinical question. Questions can be answered generally in four ways.

1) Consulting an authority to answer the question.

2) Using intuition and subjective judgment to answer the question.

3) Turning to experience to answer the question

4) Reading clinical research to find an answer to the question (Macnee, 2004, p. 4)

Describing the Purpose

The purpose statement is exactly as it sounds, it is a statement about what the researcher will be accomplishing through the implementation of his/her project. This statement is closely aligned with the problem statement, but worded in such a way that it guides readers to understand the issue to be resolved.

The PICO question is usually buried in the purpose statement, because the purpose statement usually includes the population, and the dependent and independent variables. For instance, one problem may be the rising cost of heart failure. It is significant to clinical practice because providing ways to keep patients who are diagnosed with heart failure out of the hospital decreases direct and indirect costs. The purpose of this study may be to evaluate if telephonic programs are cost effective. My PICO question may read as follows:

P	Patients diagnosed with heart failure
I	Telephonic programs
C	Heart failure clinics
O	Decrease readmission rates

How to Ask the Question

Bridging the gap from research to clinical practice can be accomplished by multiple means, but the first step is knowing how to ask the question.

It is no longer acceptable for clinicians to simply surf the Internet or pull out old teaching material when questions are being asked by peers, patients, and families. Relying on knowledge that does not come from current, valid research is no longer acceptable. The public expects clinicians to know how to clinically appraise the evidence used in clinical practice (Melnyk and Fineout-Overholt, 2004).

Remember the seven levels of evidence? These can guide the search:

Level 1 – From a systematic review or meta-analysis of all RCT or EB clinical practice guidelines based on systematic reviews of RCT

Level 2 – From at least one well designed RCT

Level 3 – From at least one well designed controlled trial without randomization

Level 4 – From a well-designed case control and cohort studies

Level 5 – From a systematic review of descriptive and qualitative studies

Level 6 – From a single descriptive or qualitative study

Level 7 – From the opinion of authorities and/or reports of expert committees

Answering Questions

According to Macnee (2004, p. 4), four commonly used approaches to answering questions posed by patients include:

1) Consulting an authority to answer the question

2) Using intuition and subjective judgment to answer the question

3) Turning to experience to answer the question

4) Reading nursing research to find an answer to the question

“Knowledge is what is understood and recognized about a subject” (Macnee, 2004, p.7), and finding the answer to certain questions to increase our knowledge can be a difficult task. Figuring out what the question is can be an even harder task.

Finding answers to questions can be very time consuming. How often have you searched the Internet or databases for something specific yet still could not find what you were looking for? How many research papers have been read, only to discover that they were not about what it was thought they were?

According to Melnyk and Fineout-Overholt (2004), there are two types of questions: background questions and foreground questions. Background questions ask for general information about a clinical issue, and foreground questions are those that can be answered from scientific evidence. Melnyk and Fineout-Overholt give the following examples:

Background question: How does acetaminophen work to affect fever?

Foreground question: Which is more effective in reducing fevers in children, acetaminophen or ibuprofen?

CONCLUSION:

The key to a successful evidence based project is to ensure that each step of the process is done well. As each step of the process builds off each other, if one step is not completed thoroughly, then following steps will be completed from poor work. Remember the term, garbage in, garbage out. Having a complete understanding of the problem will allow the student to create a strong purpose statement and question.

REFERENCES:

Macnee, C. (2004). Understanding nursing research: reading and using research in practice. Philadelphia: Lippincott Williams & Wilkins.

Melnyk, B. & Fineout-Overholt, E. (2004). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.

Asking a Searchable, Answerable Question
Evidence-Based Practice in Clinical Practice

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Crossing the Quality Chasm
5 Core Competencies (Summit on Healthcare Profession Education)
Employ evidence-based practice
Provide patient-centered care
Apply quality improvement
Work in interdisciplinary teams
Utilize informatics

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Research…
Asks, “Does it support what we are doing?”
Generates new theory, support, evidence

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Evidence-Based Practice
Asks, “What is the research telling us?”
Asks, “What is known about a certain subject?”
Helps us make decisions about the type of care being provided

5 Steps
PICO
P – Patient or Population
I – Intervention or Interest
C – Comparison Intervention or Group
O – Outcome

Note: You can use this method without a Comparison

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Levels of Evidence
Level 1
From a systematic review or meta-analysis of randomized control trial (RCT) or EB clinical practice guidelines based on systematic reviews of RCT
Level 2
From at least one well designed RCT

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Levels of Evidence
Level 3
From at least one well designed controlled trial without randomization
Level 4
From a well-designed case control and cohort studies
Level 5
From a systematic review of descriptive and qualitative studies

*

Levels of Evidence
Level 6
From a single descriptive or qualitative study
Level 7
From the opinion of authorities and/or reports of expert committees

Evidence
Books
Less reliable (become outdated quickly)
Landmark books are okay

Scenario – Asian Man
A 40 year-old Asian man is admitted to the GI unit after three days of severe nausea and vomiting. His medical and social histories are benign; the only drug he is taking is acetaminophen, 1 gram T.I.D., for a backache, reportedly attributed to a vigorous workout 3 days ago. The patient was found to have a hepatitis B infection, for which he will receive appropriate treatment.
The patient’s wife tells you she has heard that Tylenol can cause liver problems, and she wonders if, given his diagnosis, her husband should ever take this drug in the future.

Scenario – Infant Temps
You notice that infants with cardiac disease seem to experience more respiratory effort and discomfort when temperatures are taken rectally versus axillary.
You believe that axillary temperatures are just as accurate as rectal temperatures if done correctly.

Scenario – Carrots
Parents have begun to ask you if their kids will become obese by eating baby carrots.
They watched a TV program about a boy, a body builder, who refused to eat carrots because he believed they were too high in sugar.

Scenario – Ligament Displacement
You notice an increasing trend in children diagnosed with annular ligament displacement. Because you are concerned with their safety, you discuss the situation with the healthcare team at the clinic and discover that this is not an abuse issue.
You therefore wonder what has led to the increase in cases and are suspicious of an activity at the local fall carnival where parents pull their children through a pumpkin “tunnel.”

Scenario – Children & Healthcare
You care for a group of children newly diagnosed with cancer. You notice certain characteristics about this group that seem to influence how they interact with their healthcare team and engage their healthcare plan.
You wonder if there is evidence that may assist you, and other members of the healthcare team, understand these children more fully.

Forming a Therapy Question
Scenario:
P
Middle aged Asian male with hepatitis – what is the effect of…
I
acetaminophen compared to…
C
Ibuprofen
O
on liver function

*

Forming a Diagnosis or Diagnostic Test Question
Scenario:
Are (I) Axillary temps,
compared to (C) Rectal temps,
more accurate in diagnosing (O) fever in
(P) Infants with cardiac disease?

What is the topic of focus?

Forming a Prevention Question
Scenario:
In (P) Adolescent teens, does the eating of
(I) carrots or baby carrots compared to
(C) broccoli (or other low-glycemic vegetable) increase the risk of
(O) high blood sugar?

*

Forming a Prognosis Question
Scenario:
In toddlers who have (P) annular ligament,
does (I) intervention
influence (O) displacement?

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Forming a Scenario: Meaning
Scenario:
How do school aged children (P)
with newly diagnosed cancer (I)
Perceive hospitals, nurses, etc. (O)
What is the interest?

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Content Validity
Formulate a well built question
Determine the type of study design that would best answer the question
Using PICO, search keywords or subjects
Combine and further limit searches by English/human/gender/age
Apply inclusion/exclusion criteria

References
Fineout-Overholt, E., Baldwin, C. M., & Greenberg, E. A. (2004). Using evidence-based practice for clinical decision making in the holistic nursing process. Retrieved March 21, 2006, from http://www.ahna.org/Portals/4/docs/Research/Evidence%20Based%20Practice
Melnyk, B. & Fineout-Overholt, E. (2004). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.
National Guideline Clearinghouse. (2006). Retrieved March 21, 2006, from http://www.guideline.gov/