Enrolled in an MSN….and wondering what to do for an evidence-based clinical project?
Recently a former student contacted me about that very question. Part of my response to her is below:
“One good place to start if you are flexible on your topic is to look through Cochrane Reviews, Joanna Briggs Institute, AHRQ Clinical Practice Guidelines, or similar for very strong evidence on a particular topic and then work to move that into practice in some way. (e.g., right now I’m involved in a project on using evidence of a Cochrane review on the benefits of music listening–not therapy–in improving patient outcomes like pain, mood, & opioid use).
Once you narrow the topic it will get easier. Also, you can apply only the best evidence you have, so if there isn’t much research or other evidence about the topic you might have to tackle the problem from a different angle” or pick an area where there IS enough evidence to apply.
Yes. Change can be painful.
Yes. It is easier to do things the way we’ve always done them (and been seemingly successful).
Yet, most of us want to work more efficiently or improve our own or patients’ health.
So, there you have the problem: a tension between status quo and change. Perhaps taking the easy status quo is why ‘everyday nurses’ don’t read research.
Ralph (2017) writes encountering 3 common mindsets that keep nurses stuck in the rut of refusing to examine new research:
- I’m not a researcher.
- I don’t value research.
- I don’t have time to read research.
But, he argues, you have a choice: you can go with the status quo or challenge it (Ralph). And (admit it), haven’t we all found that the status quo sometimes doesn’t work well so that we end up
- choosing a “work around,” or
- ignoring/avoiding the problem or
- leaving the problem for someone else or
- ….[well….,you pick an action.]
How to begin solving the problem of not reading research? Think of a super-interesting topic to you and make a quick trip to PubMed.com. Check out a few relevant abstracts and ask your librarian to get the articles for you. Read them in the nurses’ lounge so others can, too.
Let me know how your challenge to the status quo works out.
Bibliography: Fulltext available for download through https://www.researchgate.net/ of Ralph, N. (2017 April). Editorial: Engaging with research & evidence is a nursing priority so why are ‘everyday’ nurses not reading the literature, ACORN 30(3):3-5. doi: 10.26550/303/3.5
Practice based in evidence (EBP) means that you must critique/synthesize evidence and then apply it to particular setting and populations using your best judgement. This means that you must discriminate about when (and when NOT) to apply the research. Be sure to use best professional judgment to particularize your actions to the situation!
Add to your repertoire of EBP tools, the Number Needed to Treat (NNT). This is not mumbo -jumbo. NNT explained here–short & sweet: http://www.thennt.com/thennt-explained/
CRITICAL THINKING: Check out this or other analyses at the site. How does the info on antihypertensives for mild hypertension answer the question of whether more is better? Are there patients in whom you SHOULD treat mild HTN? (“We report, you decide.”) http://www.thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/
MORE INFO: Check out what the data say about other risk/benefit treatments at http://www.thennt.com/
Want to know the standardized format for writing up your research study, QI report, case study, systematic review, or clinical practice guideline? Check out these standardized reporting guidelines: http://www.equator-network.org/reporting-guidelines/
Of course you should always give priority to the author instructions for the particular journal in which you want to publish, but most adhere generally or fully to these standardized guides.
Ok, so you found some GREAT, new & improved clinical guidelines that exactly fit the problem that you are trying to solve on your unit. Now What??? How do you get from the guidelines from paper to practice? & How do you know that the guidelines are any good any way? Where are the tools for all this?
Like the old cartoon Mighty Mouse, here comes the Registered Nurses Association of Ontario to save the day! (cue the music) You can download a FREE toolkit. Yes, that’s right. FREE.
It comes complete with examples & step-by-step instructions. Check it out! And if I haven’t been persuasive enough, here’s the table of contents! This is waaay cooool. Don’t miss it.
For more info here’s the site to download: http://rnao.ca/bpg/resources/toolkit-implementation-best-practice-guidelines-second-edition