Comment 1

Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician’s expertise in making decisions about a patient’s care. There are a variety of rating systems and hierarchies of evidence that grade the strength or quality of evidence generated from a research study or report. Being knowledgeable about evidence-based practice and levels of evidence is important to every clinician as clinicians need to be confident about how much emphasis they should place on a study, report, practice alert or clinical practice guideline when making decisions about a patient’s care (AAFP, 2015). As the name suggests, evidence-based medicine (EBM), is about finding evidence and using that evidence to make clinical decisions. Physicians are encouraged to find the highest level of evidence to answer clinical questions. 

The levels of evidence from strongest to weakest are as follows:

• · Systemic review of experimental studies (well-designed randomized controlled trials [RCTs])
• · Meta-analyses of experimental (RCT) & quasi-experimental studies
• · Integrative reviews of experimental (RTC) & quasi-experimental studies
• · Single experimental study (RCT)
• · Single quasi-experimental study
• · Meta-analysis of correlational studies
• · Integrative reviews of correlational & descriptive studies
• · Qualitative research meta-synthesis & meta-summaries
• · Single correlational study
• · Single qualitative or descriptive study
• · Opinions of respected authorities based upon clinical evidence, reports of expert committees (Grove, Gray, & Burns, 2015, p. 24).

Thus, different types of research questions require different types of research designs. Therefore, an experimenter or researcher should always ask: is this research design appropriate (or as optimal as possible) for the research question? Therefore, from an EBMgt point of view, a study design is never strong or weak in itself: it all depends on the question and the availability.

Comment 2( Please answer the question at the borrow from my professor)in base to your comment)

YOUR POST in the last assignment is this ((((Extraneous variables may affect the dependent variable and can change the result of research. Extraneous variables are independent variables that are available in each investigation, for example, clamor, lighting, and temperature, or could relate to the subjects, distinctive foundations, identities, tallness, and weight. These are viewed as additional factors that change persistently and can be found in the subjects, and in the states of the investigation. An analyst might have the capacity to decline or control unessential factors by recognizing the factors that could influence the dependent variable. “To control an extraneous variable the specialist needs to initially distinguish those factors that are well on the way to impact the dependent variable. This is done in light of the specialist’s presence of mind, basic consistent thinking, and experience.” (Simmons, Benskin, Cosgrove, Duncker, Ekman, Martyniuk, & Sherry, 2015)

Extraneous variables ought to be controlled if conceivable. One approach to control extraneous variable is with irregular examining. Arbitrary inspecting does not kill any independent variable; it just guarantees it is equivalent between all gatherings. If arbitrary inspecting is not utilized, the impact that a superfluous variable can have on the examination comes about turn into significantly more of a worry. Once the extraneous distinguished it can be controlled by either holding variable steady or coordinating qualities crosswise over treatment conditions. Example, if there is boisterous development going ahead outside the room that the trial is being held, it might be exceptionally diverting, so the analyst can either locate a calm place to play out the exploration, or the scientist can hold the incidental factors consistent by making an institutionalized domain, and method with the goal that all factors are the same in each condition and along these lines cannot be bewildering.)))))

NOW this is the professor  comment. Please can you answer it. Thanks. 

Hi, Rosy. Great post. Considering your PICOT question, what extraneous variables would you expect if conducting a study? 

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Comment 1

Nursing research falls within paradigms which are positivist and naturalistic. Both paradigms oppose assumptions about views and reality of the world. Example of reality, the positivist believes that a single reality exists and that can be measured, while naturalistic paradigm are multiple realities that are continually changing and this makes it very difficult to measure. The two main types of research methods are quantitative and qualitative.

Quantitative research aligns with the positivist paradigm, while qualitative research aligns with the naturalistic paradigm. Quantitative research is a formal, objective, deductive approach to problem solving. While qualitative research is more informal, subjective, inductive approach to problem solving.

       Both methods are appropriate for conducting research; Selection of method to use depends primarily on the research questions being asked. These questions move from the research problem and purpose statement. For example, testing a new fall prevention program within hospital would require to obtain a baseline fall rate before the program and then again after full implementation of the program. Statistically, one could compare rate of falls before the new program with the rate of falls after the new program.  Unit of analysis would be numbers and would lend itself to a quantitative design. However, if interested in studying the impact of falls on patient’s quality of life, obtain that information through a personal interview. The unit of analysis would be words, and a qualitative method would be the most appropriate approach to analyze this data (Houser, 2008).

Comment 2

Using both methods can be advantageous to researchers because both methods can be used to conduct studies. Qualitative studies use word to develops theory and frameworks and quantitative studies use numbers to test theory. It is also advantageous to use both studies when one study is conducted , the researcher can continue to validate the study after it is found to be reliable (Biddix, 2018).

Disadvantages of both studies comes into play in relations to bias and analyzing data. Bias takes away from the truthfulness of the study because the researcher will use the findings to their advantage.  Elimination of bias in a quantitative study is “achieved when validity and reliability are established and in qualitative study it is achieved “when reliability, applicability and consistency are established” (Biddix, 2018). 

Qualitative researchers use print media and electronic media to analyze data.  The disadvantage of data analysis is getting the necessary information for the study when the information from these sources are very large (Biddix, 2018).

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Comment 1

Qualitative and quantitative methods differ in many ways, one being that quantitative data collection is much more structured than qualitative data collection method (DeFranzo, 2011). Qualitive research focuses on generating meaning and understanding to data that are related to opinions, concepts, values and behaviors of people in a social context. Quantitative research focuses on gathering numerical data to explain a particular phenomenon.  The use of either qualitative and quantitative methods depend on the research question of the study. However, researchers are now using mixed methodology research, which involves the use of both qualitative and quantitative methods with the assumption that it will address the research question more comprehensively then qualitative and quantitative method alone (Tarig & Woodman, 2013). Mixed methodology can be extremely beneficial to studies addressing complex multifaceted issues such as health service interventions.

A potential challenge in conducting mixed method research would be that qualitative and quantitative research methods belong to separate and incompatible paradigms. Both have different and conflicting ways of how they view the world and gather research data (Tariq & Woodman, 2013). Another challenge would be that it can be extremely time consuming to the researcher that it would benefit if it was conducted by a large team instead of just one researcher in order to conduct the study in a timely manner. Studies involving both quantitative and qualitative research can be challenging at times, however it also provides the researcher with a wider range of tools to answer their study question more efficiently.

Comment 2

With modern medicine advancing and new treatments invented each year, healthcare professionals including nurses need a reliable source of information to improve their practice and stay updated. Evidenced-based practice was implemented as a great tool that helps nurses to better provide their nursing care and improve patient’s outcomes. According to the article, “ Evidence-based practice (EBP) results from the integration of available research, clinical expertise, and patient preferences to individualize care and promote effective care decision-making”. ( Wyant, 2017) 

There are few EBP models that are used nowadays in nursing. They all have five basic phases that make the process more effective: 

1. Identification of a clinical problem.
2. Review of the relevant literature.
3. Critical appraisal of the evidence.
4. Evaluation for practice change and potential implementation.
5. Evaluation of he outcomes.

( Wyant, 2017)

Certain organizations use specific EBP models. However, their only goal is to identify the problem and find the solution in order to improve nursing practice and patient’s outcomes. 

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comment 1

When a new director makes a decision of reorganizing the department without consulting the nurses who have been operating there for some time develops a conflict issue. This director rules autocratically which a style which builds tension among the management as well as employees. Nurses are important in the execution of better health care in the community and their roles are undisputable (Huber, 2018). Thus, nurses are supposed to be involved in changes that an organization wants and in decision making. 

Conflict may be described as the perceived threat that can be external or internal, positive or negative and disruptive or competitive. Leaders are supposed to be attentive to negative and disruptive conflicts that impact people’s actions and feeling in an undesired way. In case a change is made without involving nurses lead to high turnover, resentment, frustration and negative patient results. Conflict resolution leads to the adoption of different strategies which include the following; defensive mode like avoiding the subject to prevent escalation as well as gain time. The other one is a compromise as well as meeting at halfway to ensure each party gains something and finally, creative problem solving which includes empathy with the involved parties, discussing in a constructive manner and developing an assertive dialogue which results in solution agreement (Huber, 2018). 

As a nurse leader, in case of conflict, I would employ creative problem solving as a method of conflict resolution. I would make sure am familiar with the changing scope initiated by the director and understand the concerns of the staff as well as how the changes may negatively affect patient care, influence staff feelings and emotion and disrupt the entire nursing process. I would talk to the management to meet with the nurse staff to address the problem. Communication is a safe way for the management to share changes to the staff. I would motivate the nurses to speak out their concerns, remain assertive and communicate their ideas. I would also encourage an external mediator who is trusted, objective and knowledgeable. 

comment 2

We have worked so hard to attain all of your nursing credentials, yes, now it’s time to put your skills to work in a professional setting and make your contribution to the healthcare profession, but you cannot just do it alone. Therefore, building a professional network is the opportunity you need so it can bring career advancement. In addition to helping grow your professional network and making lifelong friends, attending conferences can also give nurses a chance to break away from the stress of their everyday work and give your brain a break. Creating  a connection maybe able to offer direct help or put you in contact with someone who can directly help you, but you may be able to return the favor at some point by keeping the connection open for other people. Moreover, every professional connection should be based on interactions that involve knowledge sharing and mutual professional development

  In fact, networking may play an even larger role when it comes to nursing jobs.  Nurses must develop strong relationships with peers and managers at both their current and former jobs. This means maintaining some level of contact with former coworkers to ensure relationships stay fresh and relevant and open. It also means developing relationships that are strong enough to be able to ask for and receive a glowing professional reference when needed. Given that nurse’s central role in patient care is maintaining current knowledge of trends and advancements, teamwork is vital too.

  A situation in which I have networked for the health of a population or your community was when our facility lagged really behind in wound care, our new admissions from hospital always come with very bad wound and before we could start our own policy on wound care some are worse, I made my director of nursing hire a wound doctor I met when I was in school. The doctor created a wound tracking every Wednesday and sent some interested nurses to wound care training, since then we are one of the best if you ask me in our community.

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Comment 1

Continuous quality improvement (CQI) is taken very serious at my organization, as I am sure it is taken serious at my fellow classmates facilities. CQI is a quality management process that encourages the health care team members to continuous ask “how are we doing” and “can we get better” (Moran, 2012). CQI is for the safety and education of the patients and staff members. We report out each morning about 30-day readmissions in house or patients at high risk for a 30-day readmit. We have a team that identifies the trends of the readmission predictors in order to identified patients currently in house at high risk for 30-day readmission. After the identification of the high risk patients, a structured discharge plan is put in place. Education on the disease process and discharge instructions is immediately started with the patient and care givers. Outside resources are immediately identified, such as home health and hospice, and the patient is given the patient choice form to pick the company that they would like to use on discharge. On discharge, the patient will know their disease process and how to manage at home. The patient will state what medications they are taking and what they are taking them for.
The patient will also state what time of day the medication is due. The patient will receive a phone call within forty eight hours after discharge from the hospital to make sure the patient continues to understand all discharge instructions and medications.

Comment 2

Continuous quality improvement, CQI, is a viewpoint or attitude for evaluating processes and improving them to attain customer satisfaction (Huber, 2014). CQI focus in healthcare is usually related to improving patient outcomes (Conner, 2014).

There is no delaying that hospitals need to deal a brand in today’s medical world. I can speak for the organization where our brand is high-quality care at low cost. A part of growing a brand that delivers high-quality care consistently it is vital to continue to maintain an emphasis/focus on identified quality improvement initiatives. To create a hospital culture supportive of quality improvement, respondents stressed the importance of hospital leadership being in the vanguard to engage nurses and other staff. As a representative of an accrediting organization said, “For any quality improvement project to be successful, the literature shows that support has to trickle down from the top (Draper, Felland, Liebhaber, & Melichar, 2008).

The chief nursing officer, CNO, is passionate about the delivery of high-quality care, she talks about it each month at nursing leadership, and it is a constant in my staff meeting minutes. It is vital that we empower the nurses who are delivering the care at the front line to buy into initiatives. We have encouraged staff to participate in hospital-wide performance improvement and report out our progress as a healthcare system in unit councils.

One example of how we are applying CQI in our current practice is through our CAUTI initiative. We have developed an education package for the staff which was accompanied by a nurse-driven protocol for patients that have a foley. If we have a patient who comes through the emergency department, they need to meet specific criteria before a foley can be inserted. We have seen great successes in this project, and the results have been extremely positive.

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