Week 2 Overview

After identifying a topic for your project proposal, this week you will write your question in PICOT format, and identify a process model to guide your project. In upcoming weeks, you will use the PICOT question to find relevant evidence when searching the literature.
As a nurse, you must maintain an inquisitive mind, not taking everything in the clinical environment at face value. While policies and procedures may guide how you practice, asking on what evidence they are based is the first step to improving the quality of health care and patient outcomes. This “spirit of inquiry” is the basis of evidence-based practice.
Two types of questions can be asked to formulate that “burning question” that will lead to searching for and identifying the best evidence. Background questions, or those broad questions for which the answers can be found in textbooks, are often the first that come to mind. Determining the background questions can be a good starting place for writing foreground questions. It is the foreground questions that will guide you to the research that, once analyzed, will clarify the best evidence.
Writing foreground questions in the PICOT format will compel you to specify:
1. The patient population (and setting if pertinent) (P)
2. The intervention or issue of interest (I)
3. Comparison intervention or no intervention (C)
4. The outcome (O)
5. The time frame (if pertinent) (T)
This focused framework will drive the literature search to determine what external evidence exists. Writing this question looks easier than it is. You will find your mind wandering to research questions that require random assignment and a control group—a quantitative research study. However, taking the time in this step to clarify the question will pay off in terms of time well spent in searching the literature.
In addition to writing your PICOT question, this week you will determine which model you will use to guide you through the steps of the process. In your text, Evidence-based practice in nursing and healthcare, the authors discuss process models and change models. Process models provide a roadmap of the steps of evidence-based practice change, while change models guide you, as the change agent, in gaining stakeholder support for the project. Some of the models included in your text do both. Below is a list of the models discussed in your text divided into these categories.
1. Models used to guide the EBP process only
a. Clinical scholar model
2. Models used to guide organizational change primarily
a. ARCC
b. PARIHS
c. Duck’s change curve model
d. Kotter and Cohen’s model of change
e. Rogers’ theory of diffusion of innovation
f. Prochaska’s transtheoretical model of behavior change (recent applications)
3. Models used to guide both the process and change
a. Stetler
b. Iowa
c. Rosswurm and Larrabee
d. Johns Hopkins nursing evidence-based practice model (JHNEBP)
Summary

This week you crafted a PICOT question and identified a process model that will guide you along the way toward developing your evidence-based practice proposal. Obtaining feedback from classmates and faculty helped to fine-tune the question to aid your search.
Assignment 1: Discussion
As you work on your capstone project proposal, you may want to share your progress with your peers and instructor and seek or provide guidance or share insights. By Tuesday, December 8, 2015, go to the Discussion Area and post responses to the discussion question. All responses should be posted to the appropriate topic in this Discussion Area. It is important to support what you say with relevant citations in the APA format from both the course materials and outside resources. Include the South University online library in your research activities utilizing not only the nursing resource database, but also those pertaining to education, business, and human resources.
.
Discussion Question
Melynk and Fineout-Overholt (2011) note that there are seven steps to the evidence-based practice (EBP) process. The first step is to cultivate a spirit of inquiry. To encourage this spirit of inquiry, you are asked in this discussion to:
• Briefly describe the problem or issue that you have decided to be the topic for your project proposal in order to orient your classmates and faculty
• Indicate how it relates to your area of specialization
• State your PICOT question. Indicate in parentheses after each segment, what part of PICOT the preceding 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 keep you focused during the project. Process models included in your text (Melnyk & Fineout-Overholt, 2011) are:
o Clinical scholar model
o Stetler model of evidence-based practice
o Iowa model of evidence-based practice to promote quality care
o Model for evidence-based practice change by Rosswurm and Larrabee
o Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model
• Provide feedback to your classmates that focuses on:
o The use of correct PICOT format for the question to guide the literature search.
o Does the question reflect a clinical research question or one appropriate for an evidence-based practice project?
WEEK 2 DISCUSSION COMPLETED
Patients and their families often feel they cannot rely on the healthcare system to control symptoms or follow their wishes (Almark, Cox, Maghaddam, Pollock & Seymour, 2012). To be sure, care of the dying is a major stress to nurses who often report a sense of suffering while treating their dying patients; they experience feelings of frustration, helplessness, failure, uselessness, disappointment, while having an increased awareness of their own vulnerability and mortality (Almark et. al., 2012). Nevertheless, some of the factors that exacerbate the nurse distress in caring for the dying may include fear of dying, inadequate training, poor communication skills, conflicts goals of care, unrealistic expectations, and uncertainty about treatment (Almark et. al., 2012).
There is a need for increased education on end of life planning, not only with individuals, but within the healthcare system. The research proposal plan to address the lack of advanced planning that exists, research education materials available, and devises an evidence-based education plan to implement teaching other health professionals. People face death on a daily basis, but no one wants to talk about it. Almack and his colleagues (2012) also reported that there is lack of communication between patient, family and healthcare provider about wanted end of life care (Almack et. al., 2012).
As an advance Nurse Educator, I am interested in the research and development of an educational program that can be implemented to help health providers be more comfortable with this important discussion. Thus, I developed the following two PICOT questions in the anticipation of some great feedback from you all:
In patients admitted under hospice care in a rural region (P), are there statistically significant differences in safety, quality, and effectiveness of care outcomes (I) between patients cared for by educated, certified palliative care nurse (C) to suggest care provided by uneducated palliative care nurses (O) over a three month period (T)?
I plan to utilize the Johns Hopkins Nursing Evidence-Based Practice (JHNEDP) Model for this project. This model consists of the following three components: (a) practice question, (b) evidence, and (c) translation (Melnyk & Fineout-Overholt, 2011). During the first phase, a question is developed in answerable terms. During the evidence phase, a search is conducted and evidence is screened, abstracted, appraised, and summarized. Next, recommendations are made based on the evidence strength, quality, and quantity. In the final phase, a plan is developed for implementation of recommendations. Hence, the JHNEDP Model can be applied to clinical, administrative, and educational nursing practice (Melnyk & Fineout-Overholt, 2011).
References
Almack, K., Cox, K., Moghaddam, N., Pollock, K., & Seymour, J. (2012). After you: conversations between patients and healthcare professionals in planning for end of life care. BMC Palliative Care, 11(1), 15-24. doi:10.1186/1472-684X-11-1
Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing & Healthcare. [Vital Source digital version]. Philadelphia, PA. Lippincott Williams & Wilkins.

TO HAVE YOUR ASSIGNMENTS DONE AT A LOW PRICE FOR A QUALITY PAPER,PLACE THIS ORDER OR A SIMILAR ORDER NOW.