This week builds on that foundational awareness with a focus on the application of evidence-based practice models as a strategy to improve patient safety and other quality dimensions. In this Discussion, consider how these strategies can sustain practice changes.

To prepare:

Read: Newhouse, R.P. (2007) Diffusing confusion among evidence-based practice, quality improvement and research. JONA 37,432-535 (see attached pdf)

Read: Mazurek Melynk B., Gallagher-Ford, L., English Long, L., & Fineout-Overholt, E. (2014) The establishment of Evidence-Based practice competencies for practicing registered nurses and advanced practice nurses in real world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing 11(1),5-15. (see attached pdf)

We all agree that research is the highest form of reliable evidence, when implemented in an organization that provides the basis for an evidence based practice. FIND a research study published in a peer reviewed journal related to a clinical practice problem that is of interest to you, and which would ultimately contribute to an evidence based practice (See “TeamSTEPPS Improves Operating Room Efficiency and Patient Safety” attached article).

The discussion assignment:

ANSWER the following discussion questions. Include the research study in your post (attach it to the post and post it in doc sharing). See page 11 #15 in Mazurek Melynk, Gallagher Ford, English Long and Fineout-Overholt. In this assignment, you are being asked to critically appraise a single research study for its relevance to a QI practice problem.

Discussion questions:

1) Briefly summarize study findings, conclusions and recommendations. Do you agree with these?

2) As a DNP prepared nurse, would you recommend a change in nursing practice based on the study? Defend and/or justify your decision based on research evaluation principles. In other words, does the evidence generated by this research article signify a need to change nursing practice? If not, why not; if so, why?

By tomorrow Friday February 02, 2018 by 12 pm America New/York time 

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This is an individual assignment. Using your group’s assigned case study, create a PICO question using the PICO template.*  Using the PICO format leads to effective searches and best available evidence pertaining to interventions’ effectiveness. Conduct a literature search for best available evidence supporting best practices. The Joanna Briggs Institute (JBI) Library of Systematic Reviews is one of several databases you may search. Refer to Search Resources: Weblinks to Resources for Search and Appraisal* for search assistance and instruction. The documentExample of a Search Table* shows one way to organize your search process. Appraise the evidence using a critical appraisal tool (e.g., AGREE II,* CASP,* JBI*).

These are components that must completed as part of your final QI Report of Project. Together, these EBP tasks directly relate to course objective “integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.”  

*item found in QI Project Resources

You should include the following:

• What is your PICO question? Post completed PICO template and question
• Summarize your search strategy
• Indicate the tool you selected to use for critical appraisal and rationale for selection (Note: You will likely identify and appraise several items to determine the “best available evidence” to include in final report. In this discussion post, you are required to post only one appraised item)
• Post completed appraisal/checklist; this should include appraisal criteria and how you applied the appraisal process to your selected resource
• Include any questions you have and/or challenges encountered

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Discussion Board  2: End of Life Care.  Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management  Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.  Practice   1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.   2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.   3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.   4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.      Education   1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.   2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.   3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.   4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.      Research   1. Increase the integration of evidence-based care across the dimensions of end-of-life care.   2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.   3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.   4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.   5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.      Administration   1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.   2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.   3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury.   4. Support the development and integration of palliative care services for all in- and outpatients and their families.

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To Prepare:

• Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.
• Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.

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