The following textbooks are available to you as e-texts within this course. You will be directly linked to the specific readings required within the activities that follow.
Note: These e-texts are available to you as part of your program tuition and fees, but you may purchase hard copies at your own expense through a retailer of your choice. If you choose to do so, please use the ISBN listed to ensure that you receive the correct edition.
Jones & Bartlett Supplemental Textbook Companion Site
The online content provided by Schmidt & Brown for Evidence-Based Practice for Nurses: Appraisal and Application of Research offers additional online learning materials, available for review prior to the final assessment:
The following e-reserve materials will be used in this course:
WGU Library Articles
The following WGU library articles will be used in this course. You will be directly linked to the specific readings required within the activities that follow.
Helpful Tips for C301
The development of a sound PICO statement is important as it guides your literature search for evidence. Using the PICO to frame a practice change is foundational and provides a framework to apply information about the research in a practical way. Your PICO statement does not need to be approved by a Course Mentor, but your CM is always happy to provide you with feedback and guidance. For additional information about the PICO Model, go to the Evidence-Based Practice page in the C301 course of study.
(P)roblem: Identify a nursing practice problem that you are noticing at your place of employment.
(I)ntervention: What is the solution that you “think” might fix the problem? One of the aims of this course is to emphasize the connection between the evidence and current practice. The WGU librarians are on duty 24/7 to assist with the mechanics of the search.
Another approach to finding evidence that supports a practice is to generally search the practice and problems that are stemming from the current practice observed at your facility. Possibly the best solution will be a “bundled” approach that identifies a number of related strategies, rather than a single recommendation. Your Course Mentor is a great resource to help you refine your thinking, and find applicable literature.
Avoid interventions that require a provider’s order.
(C)urrent Practice: This is what is happening at your facility right now. Conceptualizing the current practice can be tricky if the intervention is directed at filling a void. Something is still happening and perhaps it is underutilized or ineffective describe what you are currently doing.
(O)utcome that you hope to improve after implementing the Intervention. When describing an Evidence-Based Practice, the outcome is assumed to be a resolution of the problem.
Click here for the PICOT Example.
Identifying a Nursing Practice
After completing the C301 readings, you will begin to identify opportunities for practice change in your work setting. Answer the question, “What is the current practice?” Be sure to consider the practice without judgment or prejudice. When something is wrong, the natural human reaction is to focus on what is wrong with the practice – as a nurse, using a scholarly, evidence-based approach to practice, you must be objective in your thinking. Thoughtfully consider the problems or issues resulting from the current practice. Why is it so important that this practice needs to change?
Objective thinking helps you question what can (or should) be done to remedy the problem. Remember, any proposed solution or plan will need to be supported by scholarly evidence that defends the change in practice.
Ranking and Analyzing Literature
The Course of Study provides valuable information about how to evaluate and rank evidence in the literature. Below is an excerpt from the C301 Course of Study that can be found as a file attachment at the end of the Taskstream Instructions. You will create a table like the one below to list and critique the evidence that defends your recommended practice change.
Don’t confuse the table below with the Critical Appraisal Tool, designed to help you with the analysis of your articles. To ensure your practice change is supported by the most current evidence, be sure every article is less than 5 years old, from a peer-reviewed journal, and provides direct support for the change you are proposing. It is also critical that each source is cited in correct APA format using the 6th Edition of the APA manual. It is advisable that you manually insert each correctly formatted source in the table and not rely on electronic programs, as they are often incorrect. The Writing Center has resources to help with APA formatting.
Please refer to the information in the C301 course to understand how to identify the strength and how to rank the evidence. For assistance making decisions about the level and hierarchy of the evidence, download the C301Evidence Leveling Navigation Tool with Directions and Table. The Evidence Leveling Navigation Tool and its related hierarchy table is an interactive decision algorithm.
For more detailed information on common research design refer to the videos included in the asynchronous material (21 & Done Plan) and chapters 7 and 9 in your Schmidt & Brown (2015) textbook. Although you may encounter a variety of models available for ranking evidence in your textbooks, on the web, and even in your practice, it is important that you use ONLY the system and resources provided to you in this course, as this is the system is used to assess your competency.
Have confidence…if you follow the directions of the leveling tool, you will arrive at the accurate level and hierarchy of your sources.
|Full APA citation for 5 sources. Include doi or url.||Evidence Strength (I-VII) andEvidence Hierarchy|
|Chan, H. Y., Dai, Y. T., & Hou, C. (2016). Evaluation of a tablet-based instruction of breathing technique in patients with COPD. International Journal of Medical Informatics, 94, 263-270. https://doi-org.wgu.idm.oclc.org/10.1016/j.ijmedinf.2016.06.018||Level II, RCT|
|Piamjariyakul, U., Werkowitch, M., Wick, J., Russell, C., Vacek, J. L., & Smith, C. E. (2015). Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans. Heart & Lung – The Journal of Acute and Critical Care, 44(6), 466-473. Retrieved from:http://www.sciencedirect.com.wgu.idm.oclc.org/science/article/pii/S0147956315001843||Level II, RCT|
|Strength of Evidence Level Table to be used for Part C of TaskThis information is also found in your Course of Study and on the Navigation ToolOnly the ‘yellowed’ columns are what goes into your paper!|
|Strength of Evidence||Hierarchy||Types of Studies|
|Level I||Systematic Review||Systematic Review|
|Level I||National Practice Guidelines||National Practice Guidelines|
|Level I||Integrative Review||Integrative Review|
|Level II||Randomized Control Trial||Randomized Control Trials|
|Level III||Quasi-Experimental||Quasi-Experimental studies|
|Level IV||Non-experimental||RetrospectiveCase controlledCross-sectionalCohort-comparisonProspectiveDescriptiveCorrelational|
|Level VI||Qualitative||Qualitative Studies|
|Level VII||Expert Opinions||Narrative ReviewsQuality Improvement ProjectsCase StudiesReports from expert committeesOpinions from expertsSpecialists opinionsEditorials|
Distilling the Evidence: Please refer to the Developing the Evidence Summary section in the course of study.
An important part of managing the evidence is identifying the content of the article that will specifically link the evidence to practice. This is one of the preliminary steps for translation of the evidence from the theoretical to the practical.
For each source, consider the following questions:
Be mindful of proper APA formatting, referring to the article by author name. For example: ‘The study by Jones and Groans (2016) explored nurses attitudes about hourly rounding in a non-experimental design using a Likert-type survey’.
The final step in the process of distilling the literature is identifying the practice supported by all five pieces of evidence. What practice is it that all of the articles agree upon. The idea is that evidence-based practice results from many studies, from many parts of the world, using a variety of methods yet coming to the same conclusions regarding the appropriate recommendations to change practice.
How to Make Change
The purpose of using a model to make change is to ensure change occurs in an orderly and meaningful way that results in lasting change. Frequently students find this to be a new idea, but using a model/method to approach change is not a new idea. Nursing theory is rooted in models.
The C301 course offers you several excellent resources to increase your knowledge about the background and types of Change Models:
Chapter 16 in your Schmidt & Brown (2015) text
Schaffer, Sandau & Dietrick (2013) article and
When choosing a model to implement your recommended practice change, be sure to critically evaluate the model. Identify key features and aspects of the model that make it a good fit for your particular change in your particular organization. Using each step of the chosen change model primarily serves as your action plan for how you will actually change practice in your setting.
Who is Involved and what is their role in implementing a practice change?
Change cannot happen without the cooperation of key people in your organization. Think about and identify who has a vested interest in this practice area? Who is needed to move the change forward and who can obstruct acceptance of the change? What is their role in ensuring change is implemented and what will they need to do to make change successful? Refer to the information in the C301 course for more information about the importance of key stakeholders and their roles in implementing change.
Stakeholders can either be supporters or barriers. Besides the stakeholders, there are other potential barriers that will need consideration. Read pages 445-449 in chapter 16 of Schmidt and Brown (2015) and think about the problems and barriers that might be encountered during the implementation of your practice change. You do not have to come up with the solutions, although in the “real world” the barriers would have a bearing on whether you moved forward with the change or not.
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