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.
Key points from our efforts: EBP/research learning should be fun. Content, serious!
The related publication that records some of our fun efforts and the full collaborative picture: Highfield, M.E.F., Collier, A., Collins, M., & Crowley, M. (2016). Partnering to promote evidence-based practice in a community hospital: Implications for nursing professional development specialists, Journal of Nursing Staff Development, 32(3):130-6. doi: 10.1097/NND.0000000000000227.
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
Reliability & validity are terms that refer to the consistency and accuracy of a quantitative measurement questionnaire, technical device, ruler, or any other measuring device. It means that the outcome measure can be trusted and is relatively error free.
Reliability– This means that the instrument measures CONSISTENTLY
Validity – This means that the instrument measures ACCURATELY. In other words it measures what it is supposed to measure and not something else.
For example: If your bathroom scale measures weight, then it is a valid measure of weight (e.g. it doesn’t measure BP or stress). You might say it had high validity. If your bathroom scale measures your weight as the same thing when you step on and off of it several times then it is measuring weight reliably or consistently; and you might say it has high reliability.
Want to know how to write an introduction/background section of a paper? Pay attention to STRUCTURE & evidence-based ARGUMENT in order to DIY (do-it-yourself) your own intro/background for a school paper or research report!
Focus only on the INTRO/BACKGROUND section for now. Check out the STRUCTURE then the EVIDENCE-BASED ARGUMENT of the Intro/Background. This is how you should write your own.
STRUCTURE of INTRO/BACKGROUND in Sørbø et al. (2015):
Where is the Intro/Background section located in the article?
What heading is used for the section?
Where are the research questionslocated in the Intro/Background? (HINT: this is the standard place in all papers & in this case the authors call them “aims.)
ARGUMENTS in INTRO/BACKGROUND in Sørbø et al. (2015):
Look at the first (topic) sentence of each paragraph in INTRO/BACKGROUND & listen to the systematic argument the researchers are making for WHY their study is important.
“Breast feeding has long been acknowledged as the optimal infant nutrition conferring beneficial short-term and long-term health effects for both infants and mothers.1–5 …
Abuse of women is common worldwide, as one in three women during lifetime suffer partner or non-partner abuse.10…Adverse effects [of abuse]… are barriers to breast feeding.*…
Given the overwhelming evidence of the positive effects of breast feeding, knowledge about factors influencing breastfeeding behaviour is essential….
We explored the impact of abuse of women on breastfeeding behaviour in a large prospective population in Norway where the expectations to breast feed are high, and breast feeding is facilitated in the work regulations….” (pp. 1-2)
Now look at the research & other evidence written down AFTER each of above key sentences that SUPPORT each idea.
Notice that the INTRO/BACKGROUND is NOT a series of abstracts of different studies!! Instead evidence is grouped into key arguments for the study: Breast feeding is best, Abuse is common, Abuse creates barriers to breastfeeding, & Therefore, knowing about factors affecting breastfeeding is important). [Note: Of course, if your particular professor or editor asks you to do a series of abstracts, then you must, but do group them in arguments like the topic sentences.]
All this leads naturally, logically to …(drum roll please!)…the research questions/hypotheses, which are the gaps in our knowledge that the research will fill. This sets up the rest of the research article!
Critical Thinking: Your turn! Write your own Intro/Background using
Structure:Placement in article, heading, placement of research question/hypothesis
Argument:Key idea topic sentences (make a list 1st) with supporting research & other evidence (your literature review).
The Purpose of evidence-based practice (EBP) = BEST PATIENT CARE, &
The Definition of EBP = Best evidence +Clinical judgment +Patient/Family preferences & values
THEN…How do I get started with EBP to improve patient care?
One of the 1st steps is to identify clearly the clinical issue that needs solving. One way to do that is by using PICO.*
WHAT IS PICO? PICO is an acronym to help you clarify the clinical problem & to help you prepare to search the literature for evidence
P = Patient population or problem
I = Intervention or treatment that you want to try out & is based in best evidence
C = Comparison intervention or treatment (This might be some standardized care on your unit; or un-standardized care given by individual nurses based on their individual expertise)
O = Outcome you want to achieve.
EXAMPLE: Let’s say you work with post-op patients and want to speed up patients’ return of normal GI function. Right now on your unit, patients are NPO post-op progressing to ice chips and so on as their bowel sounds start returning. But you have 2 concerns: a) some patients’ GI function seems quite slow to return; & b) quicker return to a nutritious diet may speed healing. You read an article that gum chewing can reduce the time of postoperative ileus. With that information, here is how your PICO problem would look:
P = Postoperative patients with ileus
I = Gum chewing postop
C = NPO with gradual diet progression when bowel sounds start returning
O = Reduce time of postop ileus with sooner return to nutritious eating
CRITICAL THINKING: Now you try it. What is problem for patients (or nurses) on your unit? Try writing it out in a sentence or two and then put it into PICO format. You are now on your way with beginning an EBP project that will promote the very BEST PATIENT CARE.
*Note: Some use PICOT that includes “T”. The “T” stands for the time it will take to show an outcome. Because the timing does not seem to me relevant to all questions I typically omit it, but you may find it helpful. If so, use it!