Nursing Study

Week 2 Discussion

The readings this week included details about ‘building a spirit of inquiry’.  In these readings, Melynk, Fineout-Overholt, Stillwell, and Williamson (2009) described that nurses are in positions daily where they perform interventions that should stimulate questions about the evidence supporting their use. They provide some excellent questions to spark the spirit of inquiry.  This week’s discussion will focus on Steps 0 and 1 in the process of evidence-based practice.

 

INITIAL POST (Due Wednesday, 2359)

After you have completed your readings for this week, complete your initial response using the following criteria:

1. Using the “Questions that Spark a Spirit of Inquiry” to assist you, in your own words (first person) describe a clinical problem or inquiry that you currently have. Describe it from the heart – no citations or references needed.
2. Present your background question.
3. Write an introductory paragraph describing the significance of the clinical problem you identified, supported with scholarly literature(See the ‘Exemplar’ in this week’s readings).
4. Based on the clinical problem you identified, think of ONE intervention that might improve ONE  Then, use the details you learned in the Week 2: Readings and Resources to develop a PIOT.  While you learned about PICO(T) in your readings, for the purposes of this course, you will focus on only a PIOT. This is meant to help you stay focused in your literature search specifically on the intervention you are investigating.  Also, consider using the Template provided in this week’s readings to guide you.
5. Lastly, present your foreground question.  Consider using the template provided in this week’s readings to guide you.  Remember to stay focused on a PIOT only.
6. YOU MAYNOT CHOOSE ANY OF THE TOPICS THAT ARE ALREADY INTEGRATED INTO PRACTICE (e.g. Door to Balloon, CAUTI, Bundle protocols, early warning scores, VAPs). The whole point is for you to find something new that is not currently being done.

 

This is a student sample of the project

 

Course Reading:

 

Moving Clinical Problems to Questions to EBP

During your professional development as a baccalaureate prepared nurse, incorporating evidence-based practice into your nursing will require new skills, including moving a clinical problem to a focused question, and becoming efficient with literature searching and evaluating the evidence. Next week we will focus on literature searching and evaluation of evidence. This week, we will discuss the movement of a clinical problem, to a focused question to begin the EBP process. The seven steps of the EBP are as follows:

Step 0	Cultivate a spirit of inquiry
Step 1	Ask the PICO(T) question
Step 2	Search for the evidence
Step 3	Critically appraise the evidence
Step 4	Integrate the evidence with clinical expertise and patient preferences to make the best clinical decision
Step 5	Evaluate the outcome(s) of the EBP practice change
Step 6	Disseminate the outcome(s)

(Melnyk & Fineout-Overholt, 2009)

Spirit of Inquiry

Melnyk and Fineout-Overhold (2009) describe the first step as “Step 0” as they suggest that the cultivation of a spirit of inquiry should be a continual process. Step 1 in the process of EBP is identifying a clinical problem and then developing the clinical questions. The clinical question is written using the PICO(T) format. This mnemonic helps you to remember the key components of a well focused question. The question needs to identify the key problem of the patient, what treatment, interventions, or tests you are considering for the patient, what alternative treatment, interventions, or tests are considered (if any), and what is the desired outcome to promote or avoid.

P = Patient problem	How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the gender, age, or race of a patient might be relevant to the diagnosis or treatment being considered.
I = Intervention, prognostic factor or exposure	Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Or what factor may influence the prognosis of the patient – age, co-existing problems, or previous exposure?
C = Comparison (not always required)	What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Your clinical question may not always have a specific comparison.
O = Outcome	What can you hope to accomplish, measure, improve, or affect? What are you trying to do for the patient? Relieve or eliminate the symptom? Reduce the number of adverse events? Improve function or test scores?
T = Time (not always required)	What is the anticipated time that it will take to achieve the outcome?

Exemplar

Let’s walk through an example. Image you are a nurse on a medical unit caring for a 65 year old male with a history of type 2 diabetes and obesity. He does not smoke. He had bilateral knee replacement surgery 10 years ago. Over the years he has tried numerous diets and exercise programs to reduce weight, but has not been successful. His granddaughter just started high school and he wants to see her graduate and go to college. He understands that his diabetes puts him at high risk for heart disease and is frustrated that he cannot lose weight. He tells you that his neighbor recently had “stomach stapling” and lost over 100 lbs and “cured” his diabetes. He then asks you if he should consider this for himself.

As a nurse committed to evidence based practice, you know that the next step is to take the clinical problem and construct a question that is relevant to the case and phrased in such a way as to facilitate finding an answer using PICO(T).

For the case presented here, I might consider the following:

P = obese, diabetes type 2, male

I = stomach stapling (gastric bypass surgery, bariatric surgery)

C = standard care

O = remission of diabetes, weight loss, mortality

T = six months

I would then take the time to refine the question to be specific and focused as follows:

Question: In patients with type 2 diabetes and obesity, is bariatric surgery more effective than standard care at improving HgA1C after a six month period?

Looking ahead:

Now take the time to review the required readings (3 articles, 11 pages in total) and video resources on the following tabs to further enhance your learning on this topic. Included in this week’s readings are an exemplar and a template for developing a question. Just a quick comment about the dates of the articles provided for your required readings on the step by step process used in evidence-based practice. While some of these articles are more than 5 years old, they are not research articles, but educational in nature. These steps are evidence based and still used in practice today.

References

Content from this page has been adapted from materials created by Duke University Medical Center Library and the Health Sciences Library at the University of North Carolina at Chapel Hill under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 United States License.

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Igniting a spirit of inquiry: An essential foundation for evidence-based practice. American Journal of Nursing, 109(11), 49-52.

 

Other course readings: