Evidence-based practice proposal

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Evidence-Based Practice Proposal

PART 1An EBP proposal is like a road map or a thoroughly thought out plan to improve patient safety and quality of care. Evidence-Based Practice in nursing focuses on the idea that medical practices ought to be developed and adapted based on an ongoing cycle of evidence.Instructions:Develop a one-page topic proposal that should include: 

  1. Briefly describe and explain your evidence-based topic and its importance. 
  2. You should describe why you think this topic is particularly relevant to our practice and why it is an important area of study. 
    • Do we have a need for change and why? 
  3. Be specific what unit or patient population within an organization. 
  4. What is the Purpose of your project? What are trying to achieve? 
  5. What “sparked” you to look up evidence about this problem (why do you care)? 
  6. What are the anticipated outcomes (benefits) if the problem goes away? 
  7. View  grading rubric grading rubric 

NUR3165 – Nursing Research

Evidence-Based Practice – Part 1

Proposal

Criteria Outstanding Acceptable Unacceptable

Statement of PICO

Questions

(Population;

Intervention;

Comparison Group;

Outcome)

1 points

Correct format

followed: Each element

addressed with detail

and correctly

.5 point

Correct format followed

but information not

correctly identified

0 point

Correct format not

followed: PICO

elements not clearly

identified

Introduction 1 points

The introduction is

engaging,

states the main topic and

is clearly stated and

discussed.

.5 point

Introduction stated with

some discussion.

0 point

The introduction is

disorganized with not

clear main topic

Clear statement of the

research problem

Scope of the problem

1 points

Problem clearly stated

and discussed.

.5 point

Problem stated with

minimal discussion.

0 point

Problem statement not

included.

Purpose of the paper 1 points

Establishes strong sense

of purpose, either

explicitly or implicitly.

.5 point

Purpose or controlling idea

is established initially, but

inconsistently attended to.

Paper shows some unity of

purpose, though some

material may not be well

aligned.

0 point

Fails to establish purpose

for writing.

No clear point or

purpose; no central

argument to paper.

Paper drifts substantially

from initial purpose or

controlling idea

APA Citation and

References

1 points

APA format corrects.

References correct.

.5 point

APA format with some

errors. References with

some errors

0 point

APA format is not used.

References not cited

TOTAL 5 points

9/24/21, 3)25 PMAsking the Searchable and Answerable Question

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Asking the Searchable and
Answerable Question

Determine the type of question (therapy, dx, prognosis)

Finding the right information in the most efficient manner is key
to successfully practicing evidence-based decision making.

Developing the question requires:

You may have a question about:

Intervention (that is, treatment)—for example, in
adults with rheumatoid arthritis, is education about
joint protection techniques effective in reducing
hand pain and improving function?

Diagnosis for example, in adults admitted to a
Coronary care Unit, which elements of serial
diagnostic testing are the most sensitive and specific predictors of
cardiac involvement?

Prognosis for example, in people undergoing total knee replacement
for osteoarthritis, what improvement in walking ability is expected
after six weeks?

Evidence Based Practice
Asking the Relevant Clinical Question

9/24/21, 3)25 PMAsking the Searchable and Answerable Question

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Clients’ experiences and concerns, understanding of the patient
and what are the outcomes and beliefs that matter to this patient
Death? Disability? Quality of life? Cost? Improvement of
symptoms?

9/24/21, 3)25 PMThe Need for Change

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The Need for Change
Many questions arise during patient care. Some are general
questions about a clinical problem or a disease process.

Before Choosing your EBP questions you must identify the
following:

Asses your Practice

The assessment of
practice drives the
formulation of a clinical
question that can be
answered from research,
clinical judgment, and
patient preferences.

Identify
Need for
Change

It is important to identify where the need for change
has arisen.
It may be related to new knowledge that needs to be

Evidence Based Practice
Asking the Relevant Clinical Question

9/24/21, 3)25 PMThe Need for Change

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examined for implementation into the clinical setting.
It may be related to a clinical problem which has been
identified by clinicians and existing knowledge is being sought
to provide solutions or improvements to the clinical problem.

Identify Change Agents
The earlier that participants who will be instrumental in
bringing about the change are identified and included in the
process, the more likely the change is to be successful.

Identify Target Audience
In this step, those who will be affected by
the change are identified so the practice
change can be tailored to fit the audience.

Identify
Stakeholders

Knowing the individuals or groups who have a vested interest
in the project and anticipating their acceptance, support, or
resistance is critical to the success of the project.

9/24/21, 3)25 PMThe Need for Change

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Identify Problem and
Formulate a Specific
Question

There are many reasons nurses may start to look for evidence
to inform a decision they would wish to make: it could be to
support a change of practice, to consider the best option from
a range of choices or to do a cost comparison of different
forms of treatment.
Whatever the reason the first place to start is by Formulate
an answerable question.

Why formulate a clear clinical question?
If done properly it can help you to:

Locate the evidence quickly
Determine what you already know or don’t know about the
issue
Decide what you really need to know vs. “the nice to know”
Helps to clarify your ideas
Help you to search for the evidence effectively
Help you save time

9/24/21, 3)25 PMDefining a Nursing Problem

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Defining a Nursing Problem

The PICOT Principle
PICOT is a taxonomy
used in evidence-based
practice to help
formulate questions.

PICOT is a framework
that clinicians can use to formulate effective clinical
questions in a step-by-step manner.

PICOT is not prescriptive in that it doesn’t tell you how to do
an intervention or a comparison. You have to make those
determinations.

A focused question allows you to create a search strategy
that will get you relevant, precise results.

For example treatment of Pneumococcal Pneumonia SHOULD be
different for

Terminal Cancer Patient
Elderly, Severely Demented Patient
Young, mother of 2 children

Evidence Based Practice
Asking the Relevant Clinical Question

9/24/21, 3)25 PMDefining a Nursing Problem

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What to include what to
exclude?
Identifying the relevance to situational practice and how it
improves the present patient experience.

9/24/21, 3)25 PMFraming the Clinical Question for Making Search Decisions

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Framing the Clinical Question
for Making Search Decisions

Background Questions:

Background questions are formulated to
look for general knowledge or ‘facts’ or
etiology: Who, what, when, why, how

What are the differential diagnostic
criteria for meningitis?
What are the side effects of Morphine?

What are the risk factors for extravasation in neonates
receiving peripheral IV fluids?
How is HCV transmitted?

Best answers are often found in textbooks or databases like
UpToDate , DynaMed.

“Patient Centered Questions”

Evidence Based Practice
Asking the Relevant Clinical Question

9/24/21, 3)25 PMFraming the Clinical Question for Making Search Decisions

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Foreground Questions

Foreground questions ask for specific
knowledge one can apply to a specific
patient or problem.

They often compare two things: two
drugs or treatments, the prognosis of
two groups, two diagnostic tests, or the
harms or benefits of two approaches.

They often require primary sources that synthesize a wide range
of knowledge, and are more difficult to answer than background
questions.To formulate a good foreground question, practitioners
apply the acronym P-I-C-O-T also known as “PICOT” as a
framework to outline the clinical question.

Hand washing helps to prevent the spread of nosocomial
infections. Is the use of soap and water or alcohol-based rubs
more effective in preventing these infections?

Hip fracture is common in elderly patients after falling. I have
an elderly patient who exhibits an unsteady gait. Would a hip
protector be a useful preventative measure for this patient?

The physician prescribes warfarin to control an elderly
patient’s atrial fibrillation. What is the major risk associated
with the drug? Should dosage level be a concern in the elderly
population?

In middle aged women with migraine headaches, is there any
evidence that acupuncture compared to sham treatment,
biofeedback, relaxation training, and cognitive-behavioral

9/24/21, 3)25 PMFraming the Clinical Question for Making Search Decisions

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therapy

9/24/21, 3)26 PM What Makes a Clinical Question Well Built?

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What Makes a Clinical
Question Well Built?

In the scenario about Mrs. R one
foreground question may be,

“In this middle-aged Hispanic woman
whose is slightly obese with moderate
hypertension (the P), would treating her
(the I) with a weight loss plan (the C) be
beneficial to reduce her blood pressure

(the O)?”

Remember!

Question should be directly relevant to the problem at hand.

Question should be phrased to facilitate searching for a precise
answer.

Asking a well-built question, like many clinical skills, needs practice.

If you would like more practice go to the Center for EBM Toronto
and Practice Formulating Questions (https://ebm-
tools.knowledgetranslation.net/resource/formulating-answerable)

Evidence Based Practice
Asking the Relevant Clinical Question

9/24/21, 3)26 PM What Makes a Clinical Question Well Built?

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Resources for PICOT
Several sources are available to help nurses develop PICOT
questions. Below are some links to valuable resources.

Florida Gulf Coast University Library PICO tutorial :
https://fgcu.libguides.com/EBP/pic
(https://fgcu.libguides.com/EBP/pico)

University of North Carolina–Chapel Hill Health Science Library:
http://www.hsl.unc.edu/services/tutorials/pico_tutorial/index.cfm

(https://guides.lib.unc.edu/pico)

Boston University: http://medlib.bu.edu/tutorials/ebm/pico
(http://www.bumc.bu.edu/medlib/resources/tutorials/ebmebd-
tutorials/ebd-pico-tutorial/ebd-pico-p10/)

Napa Valley College
http://www.napavalley.edu/Library/Pages/AskClinicalQ
uestionsinPICOTFormat.aspx
(http://www.napavalley.edu/Library/Pages/AskClinicalQuestionsinPICOTFormat.aspx)

9/24/21, 3)26 PMPICOT

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PICOT

Patient, Population, or Problem (or Disease or Condition)
First, think about the patient, population and/or setting you
are dealing with.
Try to be as specific as possible (In children under 12 years
with diabetes).
Try to identify all of their clinical characteristics that
influence the problem, which are relevant to your practice and
which would affect the relevance of research you might find
How would you describe patients similar to your own – what
are their most important characteristics?
This can include the primary disease, co-existing conditions,
gender, age, or race of the patient.

Example:

In this example, the patient is a middle-aged Hispanic woman,
slightly obese with moderate hypertension.

Evidence Based Practice
Asking the Relevant Clinical Question

9/24/21, 3)26 PMPICOT

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Think about the factors that you need to consider (disease or
condition, age, sex, symptoms, setting)

It will help your search if you can be as specific as possible at
this stage, but you should hear in mind that if you are too
narrow in searching you may miss important articles.

Interventions, Exposure ,Maneuver (diagnostic tests, foods,
drugs, environmental hazards etc)

Try to be as specific as possible with the intervention.
Next, think about what you are considering doing. An
intervention is something planned to be done (… would adding
drug Y to their current therapy…)
Which intervention, risk factor, or exposure is being
considered (treatment regime, diagnostic test, specific risk
factors, advice or information) – what will you be doing for the
patient?
This can include treatments or diagnostic tools. Was the
patient exposed to something environmental or occupational?

Example:

Mrs. R.’s blood pressure and obesity will be treated with a diet
plan and exercise.

Comparison or Control
Compared to what? (to another group)
Better or worse than no intervention at all or than another
intervention?
What is the main alternative to compare with the

9/24/21, 3)26 PMPICOT

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intervention, are you trying to decide between two drugs, a
drug and a placebo, or two diagnostic tests?
Is there an alternative to compare to your intervention? (A
“good” clinical question does not always need a comparison or
control to be valid.)

Example:

Mrs. R. not being on a diet before a

9/24/21, 3)25 PMCreating a PICO problem

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Creating a PICO problem
Clinical Scenario
Lets stimulate the process by finding answers to a clinical question
by using a real life scenario, We will use this scenario throughout
tutorials.

Rosa, a 45-year-old Hispanic woman, 5’4″ weighing 200 lbs.,
presents to her primary care provider (PCP) with complaints of
malaise and “pressure in her head”. The exam reveals she has
moderate hypertension.

Rosa wants to try exercise and dietary alterations to promote
weight loss as she has heard on the evening news that for q 10 lbs.
of weight loss, B/P was reduced by 5 mmHg. You want to make
sure Rosa is safe, so you inform her that you will do a little
homework to get the latest EBP.

Example:

In the above scenario, sample background questions are:

What’s hypertension?
What’s moderate hypertension?
How overweight is a woman to be considered slightly obese?

Evidence Based Practice
Asking the Relevant Clinical Question

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