Application 2: Laying the Foundation for New Approaches to Practice

Application 2: Laying the Foundation for New Approaches to Practice

As frequently noted in the literature, there is often a gap between research evidence and practice. This is not a new phenomenon; however, with the rapid growth of knowledge, it is essential that nurses hone their ability to identify this gap, determine best practices based on the evidence, and then apply this evidence to practice through the development of new approaches. In order for that to transpire, nurses must be skilled in leading change efforts so that adoption of new practice approaches can be successful. Application 2: Laying the Foundation for New Approaches to Practice. Application 2: Laying the Foundation for New Approaches to Practice

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For your EBP Project in Week 2 (Application 1 [SEE ATTACHED FILES] ), you identified an issue in your practicum setting in which the outcome is different from what would be expected according to the research literature. This week continue to explore current research literature looking for new evidence to address the problem. In addition, you build on the work you began in this week’s Discussion and select an evidence-based practice model ( The Iowa Model of Evidence-Based Practice to Promote Quality Care” Or you can use the Johns Hopkins Model) and change theory (USE THE THEORY OF PLANNED BEHAVIOR) or framework that will support your efforts. Application 2: Laying the Foundation for New Approaches to Practice

To prepare for Application 2 address the following:

  • How      current is the science underlying the practices related to your EBP      Project issue?
  • Consider      possible causes of the difference in outcomes from what would be expected      according to the research literature.
  • Evaluate      the effect the EBP Project issue is having in practice.
  • Using      the Walden Library and other credible sources, locate current research      evidence of new practices that are effective in addressing the issue.
  • Use      the GRADE model presented in the      Guyatt et al. (2011) article to evaluate the research evidence (see      attached file for the article)

The full Application 2 is due by Day 5 of this week. Instructions for how to prepare for previous sections of this Application have been provided in Week 4. Application 2: Laying the Foundation for New Approaches to Practice

To complete:

Write a 3- to 5-page paper, in APA format with a minimum of 6 scholarly references. PLEASE CITE OFTEN. include the following level one headers as numbered below:

1) Introduction

2) A brief summary of the currency of the science underlying the practices used to address your EBP Project issue

3) Possible causes of the difference in outcomes from what would be expected according to the research literature

4) The effect the EBP Project issue is having in practice

5) Current research evidence on new practices for addressing the EBP Project issue

6) A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue. Application 2: Laying the Foundation for New Approaches to Practice

7) Summary

PLEASE FOLLOW THE EXACT FORMAT IN THE GRADING RUBRIC. WRITE THE HEADERS EXACTLY AS IN THE GRADING RUBRIC AND ADD AN INTRODUCTION AND SUMMARY. INSERT MY PIICOT QUESTION IN THE BEGINNING OF THE PAPER.

  • Please do not go       over 5 pages. Being concise, but scholarly       and well-cited is a skill. Make sure each word is needed and refrain from       using unnecessary verbiage.  CITE OFTEN
  • Use       level 1 APA headers for each component of the assignment! See assignment       directions and grading rubric for components graded and note the items in       blue should be your headers.
  • You will need a theory to guide your work. For more information on theories… (for mine, please use the theory of       planned behavior that you chose on the first assignment). Application 2: Laying the Foundation for New Approaches to Practice
  • You will need to EBP model to frame your course-related (6410) EBP project EBP models give you steps       for proceeding in a logical manner. I would recommend you look up the       following article to help you.
    • Schaffer, M. A.,  Sandau, K. E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: Overview and practical applications.  Journal of Advanced Nursing, 69(5), 1197-1208.  doi:10.1111/j.1365-2648.2012.06122.x        (see attached article)

P.S. I’M ATTACHING THE PREVIOUS PAPER TO HELP REFRESH YOUR MEMORY AND ALSO SEE THE CORRECTIONS THE PROFESSOR MADE SO THAT YOU DON’T REPEAT THE SAME MISTAKES. I DIDN’T GET A GOOD GRADE ON THAT PAPER, PLEASE PAY CAREFUL ATTENTION TO EACH AND EVERY INSTRUCTION HERE. I NEED AN ‘A’ ON THIS PAPER TO MAKE UP THE FIRST ONE. Application 2: Laying the Foundation for New Approaches to Practice

PIICOT Question

In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients? Application 2: Laying the Foundation for New Approaches to Practice

P: Adult patients

I: in extended intensive care within an urban acute care facility

I: increased mobilization of the patients

C: minimal mobilization of the patients

O: early transfers of the patients from intensive care

T: 6 months

REQUIRED READINGS

 

Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. & Stillwell, S.B. (2011). Evidence-based practice step-by-step: Implementing an evidence-based practice change. American Journal of Nursing, 111(3), 54-60.

Rosswurm, M. A., & Larrabee, J. H. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322. (See attached file). Application 2: Laying the Foundation for New Approaches to Practice

Pryse, Y., McDaniel, A., & Schafer, J. (2014). Psychometric analysis of two new scales: The evidence-based practice nursing leadership and work environment scales. Worldviews on Evidence-Based Nursing, 11(4), 240-247.

Sadeghi-Bazargani, H., Tabrizi, J.S., & Azami-Aghdash, S. (2014). Barriers to evidence-based medicine: A systematic review. Journal of Evaluation in Clinical Practice, 20, 793-802.

Schaffer, M.A., Sandau, K.E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209 (see attached file). Application 2: Laying the Foundation for New Approaches to Practice

6410 Application 2: Laying the Foundation for New Approaches to Practice

Note: Have an APA Level 1 header for each area noted below in blue (a level 1 header is centered, bolded, using upper and lower case letters—see APA manual area 3.03)

 

Grading Area Points Possible Points Earned
Potential areas for earning points:
Header: Currency of Science

A brief summary of the currency of the science underlying practices used to address your EBP Project issue

1
Header: Difference in Outcomes

Possible causes of the difference in outcomes from what would be expected according to the research literature

1
Header: Effect of Issue on Practice

The effect the EBP Project issue is having in practice

1
Header: Research Evidence on New Practices

Current research evidence on new practices for addressing the EBP Project issue

2
Header: Evidence-Based Practice Model

A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue. Application 2: Laying the Foundation for New Approaches to Practice

1
Potential areas for losing points:
Grammar, Spelling, and APA errors Up to 2 pt. deduction
Went Over Page Limit (3-5 pages max) Up to 2 pt. deduction
Improper credit & citation issue

(see TurnItIn Report)

1-6 pt. deduction
Late Submission 20% deduction (1.2 pts) per day late (per syllabus)
Application 2: Laying the Foundation for New Approaches to Practice 6 Total Points Possible Total Points Earned

Application 1:

Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project

Note: Have an APA Level 1 header for Each Area Noted below in Blue (a level 1 header is centered, bolded, using upper and lower case letters—see APA manual area 3.03)

Grading Area Points Possible Points Earned
Potential areas for earning points:
Header: Summary of Practice Issue

Summary of practice issue. (Note: The issue you select must be suitable for completing the entire EBP Project in 8410.)

2 1.5
Header: Exploration of Research Literature

Exploration of the research literature on

this issue. Application 2: Laying the Foundation for New Approaches to Practice

3 2.75
High level of scholarship commensurate with doctoral level evident 1 1
Potential areas for losing points:
Grammar, Spelling, and APA errors Up to 2 pt. deduction -0
Went Over Page Limit (2 pages max) Up to 2 pt. deduction -0
*Improper credit & citation issue 1-6 pt. deduction -0
Sent back to re-do 1 pt deduction -1
Late Submission

(posted X.XX.20XX, due X.XX.20XX )

20% deduction (1.2 pts) per day late (per syllabus) n/a: posted on time
6 Total Points possible 4.25 Total Points Earned

In this assignment you were consider a practice issue at your practicum site, summarize that issue, and outline the research literature associated with it. Please see my edits/notes below. Good job! Application 2: Laying the Foundation for New Approaches to Practice

Some things for ALL to remember/consider (you may have done this already-this is just a gentle reminder):

· Use a heading for each of the main areas noted in the assignment grading rubric for all assignments (I posted the rubrics in the announcement area-the headers to be used are in blue font).

· Related to your topic of interest, does the agency have a process/policy/clinical practice guideline/practice approach/nurse education/patient education in place already? All of them? Are they being implemented according to the best evidence? If not, could that be an appropriate focus for your project?

· How will you go about updating the processes/policies/education materials so they are more consistent with national recommendations/guidelines/research?

· What is your revised PICOT for this EBP (PICOT was not a mandatory part of the paper—but it is nice to tie this all together at the end of your paper with that information). Application 2: Laying the Foundation for New Approaches to Practice

· *All students should review their Safe Assign reports regularly (use the draft folders to run a report prior to submitting your assignment). You should not have more than 3 words in a row that are the same as another source unless you use quotation marks and properly cite that source (with author, year, and page number). You need to reword your paper to avoid this. You should reserve using quotations for the rare instances wherein you cannot reword information without losing meaning. Also, you need to cite each sentence with information that a layperson would not know. There are many resources online that you can use to review proper citation and common plagiarism errors. All students should review the Walden Plagiarism Tutorial at http://academicguides.waldenu.edu/ASCtii/ASCtiitutorial . Please explore these topics. Application 2: Laying the Foundation for New Approaches to Practice

Thank you! Tracy

Practice Issue for the Evidence-Based Practice (EBP) Project

Anne Marie WouapetName

Walden UniversitySchool

NURS 8410 6410 Section 01, Best Practices in Nursing Specialties

September 12, 2018

Summary of Practice Issue

Patients in need of critical care have a lot of demands for the safety and quality of their care to be maintained. One clinical issue that has been identified in care for critically ill patients is hospital admission over an extended period. Several patients in the intensive care unit (ICU) are admitted for too long leading to negative impacts on their experiences and health outcomes. Delayed discharge of ICU patients is a problem that affects many healthcare facilities. Many researchers have studied the effects of delayed discharge, and some studies indicate a close relationship between delayed discharge and factors such as hospital readmission and patient mortality. Throughout this paragraph—you have made several statements that are not well-known concepts by a lay person—thus you need to cite each of those sentences. This evidence-based project aims to prove that early mobilization of ICU patients can speed up their recovery process and lessen the time of admission leading to positive patient outcomes and experiences. Comment by Tracy Wright: This is not in line with an EBP project. EBP project are not research…they are not to “prove” anything. Rather, they take high-level and multi sources of research that have already proved a concept and implement that evidence in a practice setting.  Application 2: Laying the Foundation for New Approaches to Practice

Exploration of Research Literature

A longer length of stay has been confirmed as a serious practice issue in healthcare by numerous studies—you can’t say this without giving citations. For example, Schneider et al. (2012) conducted a study investigating how a longer hospital stay affected patients of colon cancer who had undergone a colorectal surgery. The study found that the length of stay is directly proportional to readmission and mortality rates (Schneider et al., 2012). This evidence shows that it is crucial to develop strategies to speed up patients' recovery process to reduce their admission length of stay in critical care. This project recommends that early mobilization of the patients be used as a strategy to reduce the length of ICU stay and in turn cause positive patient experiences and outcomes. Application 2: Laying the Foundation for New Approaches to Practice

This intervention has been studied in the past and found to have positive effects on critical care patients. Adler and Malone (2012) conducted a study that found that enhanced physical activity in critical care patients improves the recovery process. Similarly, Denehy, Lanphere and& Needham (2017) evaluated various positive effects that mobilization of ICU patients can have on their health outcomes. These studies confirm that the proposed intervention for this project will yield positive results. This literature evidence also shows that early mobilization of patients can aid in quick recovery. Nonetheless, this method has been applied in my clinical area; however, but there has not been any significant change in the patients' speedy recovery, and hence, length of ICU stays. Therefore, there is a need to implement some changes in the way this intervention is implemented to yield positive results. Application 2: Laying the Foundation for New Approaches to Practice

What makes this intervention different is that it puts focus on the challenges and barriers that have prevented previous mobilization strategies from being effective. Holdsworth (2015) found that the perceptions of clinicians and the limitation of staff members prevent consistent mobilization of patients. This project will pay attention to these barriers by focusing on assigning specific health workers to critical care patients and educating them on the importance of the process so that they can do it efficiently. The consistency of this intervention is likely to yield better results that have been done in the past. Application 2: Laying the Foundation for New Approaches to Practice

Conclusion

It is essential to reduce the length of stay for ICU patients to increase the rate of positive outcomes in critical care. As this paper demonstrates, research shows that longer hospital admissions are associated with adverse outcomes. This evidence-based project proposes a strategy of early patient mobilization to speed up the recovery process so that patients can be ready for discharge within a shorter period. Application 2: Laying the Foundation for New Approaches to Practice

References

Adler, J., & Malone, D. (2012). Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary physical therapy journal, 23(1), 5. Retrieved from: https://eds-a-ebscohost-com.ezp.waldenulibrary.org

Denehy, L., Lanphere, J., & Needham, D. M. (2017). Ten reasons why ICU patients should be mobilized early. Intensive care medicine, 43(1), 86-90.  doi:10.1007/s00134-016-4513-2 Application 2: Laying the Foundation for New Approaches to Practice

Holdsworth, C., Haines, K. J., Francis, J. J., Marshall, A., O’connor, D., & Skinner, E. H. (2015). Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior. Journal of critical care30(6), 1243-1250. doi: 10.1016/j.jcrc.2015.08.010

Schneider, E. B., Hyder, O., Brooke, B. S., Efron, J., Cameron, J. L., Edil, B. H., ... & Pawlik, T. M. (2012). Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. Journal of the American College of Surgeons, 214(4), 390-398. doi: 10.1016/j.jamcollsurg.2011.12.025

Application 2: Laying the Foundation for New Approaches to Practice