Nursing Assignment Sample

Executive Summary

The research report is based on focusing on analysing the information sources for evidence-based practices. This is important in understanding the rules and duty of care. Research reasons and objectives are stated in the report. The gathered information can be analysed based on credibility, objectivity or bias, and accuracy. The comparison for the appropriate resources has been done too. The issues have been discussed for the possible gaps and recommendations. Training, aligning with education of future nurses and interdisciplinary aspects are important for the research topic. This report has allowed understanding the need for EBP in research and clinical practice for nurses.

Table of Contents

Step 1: Research and Evidence-Based Practice (EBP) 4

1.1 Rules of Evidence. 4

1.2 Evidence-based Practice. 4

1.3 Research and Continuous Improvement 4

1.4 Research Methods. 5

1.5 Duty of Care Requirements. 7

1.6 Research Reasons. 7

Step 2: Plan the Information. 8

2.1 Issue Statement 8

2.2 Objectives and Trends of Issues. 8

2.3 Research Data Sources. 9

Step 3: Gather the Information. 10

3.1 Information-gathering Strategy. 10

3.2 Systematic Information Summary. 10

Step 4: Analyse the Information. 10

4.1 Information Validity. 10

4.2 Cultural and Ethical Considerations. 12

4.3 Information Analysis Processes. 12

4.4 Information Comparison. 13

Step 5: Use Information in Practice. 16

5.1 Use of Information in Practice. 16

5.2 Gaps in Information. 16

5.3 Actions and Recommendations. 17

References. 19

Step 1: Research and Evidence-Based Practice (EBP)

1.1 Rules of Evidence

“Rules of evidence” in EBP states that a piece of evidence needs to be the “best available evidence” and provide a “problem-solving approach”; one needs to be aware about its limitations. It needs to cater for patient values and allow decision-making for appropriate outcomes (cebma.org, 2020).

1.2 Evidence-based Practice

An evidence-based practice is integrative of high-quality research evidence that reflect guided clinical expertise, patient characteristics, values and are the best of the available ones (Greenhalgh, 2017). It is used to make clinical decisions for the patient and evaluate health care decisions by considering empirical evidence.

1.3 Research and Continuous Improvement

Research and CQI differ from EBP in terms of “developing new knowledge” and “improvement of processes or patient outcomes” respectively (Haut, 2018). These are used to enrich databases with answers of different phenomena and in using accurate evidence to make overall improvements for patients.

1.4 Research Methods

Diagram of EBP, typical research process and continuous quality improvement methods are being used to improve quality of EBP.

Figure 1: “Diagram of EBP”

(Source: Haut, 2018)

Figure 2: A “typical research process”

(Source: Greenhalgh, 2017)

Figure 3: Continuous Quality Improvement

(Source: healthit.gov, 2020)

1.5 Duty of Care Requirements

“Duty of care requirements in EBP” reflect the need for anticipating “legal, professional, organisational, community and personal” aspects of risk (health.gov.au, 2020). It empowers young people and protects them from harm.

1.6 Research Reasons

  • Comparison: Comparison allows including information from multiple sources into the research. Thus, enhancing the depth of knowledge for research.
  • Hypothesis testing: This allows in accepting or rejecting pre-developed notions, so that findings could add to existing information bases (Christenbery, 2017)
  • Trend identification: Trends give insights into existing patterns, commonly followed practices and general acceptability.
  • Own knowledge extension: Multiple sources are scanned and searched to improve personal knowledge and its future applicability in arriving at results (Bäck et al. 2020)
  • Strengthen quality of own practice: Professional standing in health research requires improvement in practice along with changing scenarios.

Step 2: Plan the Information

2.1 Issue Statement

The first issue is “Maintaining professional capabilities”. This is important in maintaining the professional standards for health care services.

The second issue is “Adhering to scope of practice expectations”. This is vital in upholding clinical standards and undertaking best possible decisions.

2.2 Objectives and Trends of Issues

Research topic 1

  • To investigate the professional requirements of nurses and needed improvements for providing health services; to understand difficulties in nursing decision-making.
  • Melnyk et al. (2017) found certain deficits in “professional practices, quality of healthcare and outcomes for patients”; there is a need for improving personal competencies. Christenbery (2017) studied the roles and skills for decision-making; it is an issue so that patient outcomes and concerned decisions could be improved.
  • Watters (2019) stated that the need for professional improvement in nursing services could be witnessed in evidence-based outcomes and practices for the patient. Melnyk et al. (2017) upholds decision-making in nursing practices for arriving at best possible clinical decisions.
  • Professional standards are managed by following guidelines and codes of professional ethics for the nurses; standards and compliance policies are developed by respective organisations to maintain the same. Decision-making in nursing is guided by clinical reasoning; using data from EBP aids in implementing best possible evidence for patients.

Research topic 2

  • To improve practice expectations in the absence of clear evidence and take suitable decisions; to follow set clinical standards and fulfil professional expectations
  • Watters (2019) explored that EBP could help in patient safety as well as improvement in quality of health services, thus, adequate decisions could be taken by exploring organisational opinion if best evidence are hard to find. Cashin et al. (2017) had mentioned that stagnated practices could lead to outdated outcomes for the patients, thus it needs to be improved for making best-suited decisions.
  • Australian nursing settings use practices for registered nurses (Cashin et al. 2017); Improvement in standards is seen in organisations and health clinics (Back et al. 2020).
  • Clinical setting and senior professionals use experience in absence of clear evidence; training is done for nurses to achieve the professional expectations. Australian government’s guidelines manage the nursing ethics; codes for physicians and nurses are managed by using needed implementation processes.

2.3 Research Data Sources

Resource nameResource typeResource website or link
Bäck, A., von Thiele Schwarz, U., Hasson, H., & Richter, A. (2020). Aligning perspectives?—Comparison of top and middle-level managers’ views on how organization influences implementation of evidence-based practice.Journal articlehttps://academic.oup.com/bjsw/article-abstract/50/4/1126/5528524
Melnyk, B. M., Gallagher-Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2017). The First U.S. Study on Nurses’ Evidence-Based Practice Competencies Indicates Major Deficits That Threaten Healthcare Quality, Safety, and Patient Outcomes.Journal articlehttps://doi.org/10.1111/wvn.12269
Cathy Haut, D. N. P., & CPNP-AC, P. C. (2018). Differentiating Between EBP/QI/Research: Introduction to Evidence Based Practice.  Journal articlehttps://cpb-us-w2.wpmucdn.com/sites.udel.edu/dist/3/3406/files/2015/09/Differentiating-bettwen-EBP_QI_RESEARCH-Research-Haut-Compatibility-Mode-1s0phsy.pdf
Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., … & Fisher, M. (2017). Standards for practice for registered nurses in Australia.Journal articlehttps://www.sciencedirect.com/science/article/pii/S1322769616300038
Watters, R. (2019). Translation of evidence-based practice: quality improvement and patient safety.Journal articlehttps://doi.org/10.1016/j.cnur.2018.10.006
health.gov.au (2020), Duty of care issuesGovernment websitehttps://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front11-wk-toc~drugtreat-pubs-front11-wk-secb~drugtreat-pubs-front11-wk-secb-6~drugtreat-pubs-front11-wk-secb-6-1#:~:text=The%20principle%20of%20duty%20of,prevent%20them%20coming%20to%20harm
Greenhalgh, T. (2017). How to implement evidence-based healthcare. United States: John Wiley & Sons.Bookhttps://books.google.com/books?hl=en&lr=&id=ySgnDwAAQBAJ&oi=fnd&pg=PR3&dq=Greenhalgh,+T.+(2017).+How+to+implement+evidence-based+healthcare.+United+States:+John+Wiley+%26+Sons.&ots=tkdADS7O8Z&sig=FqM1keM173CuuCI-4ya3A58QKjE
Christenbery, T. L. (2017). Evidence-Based Practice in Nursing: Foundations, Skills, and Roles. Springer Publishing Company.  Bookhttps://books.google.com/books?hl=en&lr=&id=8RAzDwAAQBAJ&oi=fnd&pg=PP1&dq=Christenbery,+T.+L.+(2017).+Evidence-Based+Practice+in+Nursing:+Foundations,+Skills,+and+Roles.&ots=lg9ROFdMkC&sig=6uIqWahlsjH7gz6roo0mXd821Dk

Step 3: Gather the Information

3.1 Information-gathering Strategy

In this assignment, the search strategies included using key and relevant terms or synonyms for gathering suitable resources. Additionally, the databases were searched for the last five years by limiting the search setting. This helped to collect recent information and findings from those sources. Sources like textbooks, journals, articles, and publications from relevant public bodies were explored. The relevance of that information was determined by scanning through main points of the content and reading the abstract. Terms like evidence-based practices, nursing practices, professional standards/expectations, clinical decision-making, continuous improvement and others were entered while searching the database. Certain resources were left out because they did not give required information around the topic but were centred on particular nursing care settings and decision-making for aged care or paediatric care. Some were also focused on particular populations like children or women.

3.2 Systematic Information Summary

Research ObjectiveResource APA ReferenceResource LinkMethod used to searchType of resource
“Investigate professional requirements of nurses and improvements for providing health services”“Christenbery, T. L. (2017). Evidence-Based Practice in Nursing: Foundations, Skills, and Roles.” Retrieved from: https://books.google.com/books?hl=en&lr=&id=8RAzDwAAQBAJ&oi=fnd&pg=PP1&dq=Christenbery,+T.+L.+(2017).+Evidence-Based+Practice+in+Nursing:+Foundations,+Skills,+and+Roles.&ots=lg9ROFdMkC&sig=6uIqWahlsjH7gz6roo0mXd821Dk From google scholarBook
“Melnyk et al. (2017). The First U.S. Study on Nurses’ Evidence-Based Practice Competencies Indicates Major Deficits That Threaten Healthcare Quality, Safety, and Patient Outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16–25.”Retrieved from: https://doi.org/10.1111/wvn.12269  SAGEJournal article
“Watters, R. (2019). Translation of evidence-based practice: quality improvement and patient safety. Nursing Clinics, 54(1), 1-20. ”Retrieved from: https://doi.org/10.1016/j.cnur.2018.10.006 SAGEJournal article
Understand difficulties in nursing decision-making“Watters, R. (2019). Translation of evidence-based practice: quality improvement and patient safety. Nursing Clinics, 54(1), 1-20. ”Retrieved from: https://doi.org/10.1016/j.cnur.2018.10.006 SAGEJournal article
“Christenbery, T. L. (2017). Evidence-Based Practice in Nursing: Foundations, Skills, and Roles.” Retrieved from: https://books.google.com/books?hl=en&lr=&id=8RAzDwAAQBAJ&oi=fnd&pg=PP1&dq=Christenbery,+T.+L.+(2017).+Evidence-Based+Practice+in+Nursing:+Foundations,+Skills,+and+Roles.&ots=lg9ROFdMkC&sig=6uIqWahlsjH7gz6roo0mXd821Dk From google scholarBook
“Melnyk et al. (2017). The First U.S. Study on Nurses’ Evidence-Based Practice Competencies Indicates Major Deficits That Threaten Healthcare Quality, Safety, and Patient Outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16–25.”Retrieved from: https://doi.org/10.1111/wvn.12269  SAGEJournal article
 “To improve practice expectations in the absence of clear evidence”“Bäck et al. (2020). Aligning perspectives?—Comparison of top and middle-level managers’ views on how organization influences implementation of evidence-based practice. The British Journal of Social Work, 50(4), 1126-1145.” Retrieved from: https://academic.oup.com/bjsw/article-abstract/50/4/1126/5528524 British Journal of Social Work Journal article
“Cashin et al. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.” Retrieved from: https://www.sciencedirect.com/science/article/pii/S1322769616300038 Database search from “Collegian: The Australian Journal of Nursing Practice, Scholarship and Research” Journal article 
“Watters, R. (2019). Translation of evidence-based practice: quality improvement and patient safety. Nursing Clinics, 54(1), 1-20.”Retrieved from: https://doi.org/10.1016/j.cnur.2018.10.006 SAGEJournal article
“To follow set clinical standards and fulfil professional expectations”“Watters, R. (2019). Translation of evidence-based practice: quality improvement and patient safety. Nursing Clinics, 54(1), 1-20.”Retrieved from: https://doi.org/10.1016/j.cnur.2018.10.006 SAGEJournal article
“Cashin et al. (2017). Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.” Retrieved from: https://www.sciencedirect.com/science/article/pii/S1322769616300038 Database search from “Collegian: The Australian Journal of Nursing Practice, Scholarship and Research” Journal article 
“Bäck et al. (2020). Aligning perspectives?—Comparison of top and middle-level managers’ views on how organization influences implementation of evidence-based practice. The British Journal of Social Work, 50(4), 1126-1145.” Retrieved from: https://academic.oup.com/bjsw/article-abstract/50/4/1126/5528524 British Journal of Social Work Journal article

Table 1: Information summary

Step 4: Analyse the Information

4.1 Information Validity

The information gathered for the current assignment topic was selected from different databases by surfing through google. Appropriate citations were used for the resources and the summary of information was listed too (Haut, 2018). An external research analysis is important in such situations when the sources are taken from multiple sources. These help to evaluate the credibility of the sources, any objectivity or bias, the time or the accuracy. Here, the factor of time of gathered resources was kept within five years as a constant. This makes it a recent search for relevant information and thus, the said factor will be omitted.

  • Credibility of the resources

The research topic would use credible resources by utilising books and journals articles that are readily available. Moreover, the authors were persons with expertise in the subject matter. The book source was from a commercial publisher and the journal articles were scholarly and peer-reviewed in nature (researchguides.library.brocku.ca, 2020).

  • Any objectivity or bias in sources

The findings from the resources were not subjective; rather they were fact-based with research evidence. Some gave guidelines as well for the professional expectations from nurses. There were no biases found in the resources used (researchguides.library.brocku.ca, 2020

4.2 Cultural and Ethical Considerations

The ethical considerations for the research are as follows:

  • Ethical approval from the educational institution is very important for the research. This will help to clarify any ethical grounds that might affect the research.
  • Accessing information from organisations could be difficult and knowing about their establishment of professional standards might be a problem if the authorities do not agree to share information.

4.3 Information Analysis Processes

Comparing: This can be done by comparing information on some predefined criteria. It needs analysing of resources based on research skills and conduct (ori.hhs.gov, 2020).

Contrasting: Using research methods like content analysis could help in analysing the information from sources.

Challenging: It is done by presenting counter evidence for the existing information and put forward unbiased inferences (ori.hhs.gov, 2020).

Reflecting: Reflecting can be done by using “Gibbs Reflective Cycle”, “Kolb’s Reflective Cycle” or “Johns Model of Reflection”. These analysis processes are useful here.

Distinguishing relevant from irrelevant: Searching from keywords could help in finding and analysing information that are relevant for the research topic.

Drawing interdisciplinary connections: Interdisciplinary connections can be drawn by checking the norms for the field’ research.

4.4 Information Comparison

Research objectiveInformation author and yearSummary of what information suggestsHow feasible of practical is the informationBenefitRisk
“Investigate professional requirements of nurses and improvements for providing health services”“Melnyk et al. (2017)”Suggests that competencies in EBP shows deficits for patient outcomes and healthcare quality It might be difficult to undertake all the opinions in the hospital settings and thus, there could be chances of individual differencesMore competency could be achievedIt could be difficult for hospitals to ensure competency for each nurse
“Watters, R. (2019)” Suggested the need for including evidence-based practiceUsing evidence at each step to clinical setting might be difficult due to unclear evidenceStreamlined flow of information and beneficial outcomes are possibleThere might not be consensus in using clinical experience against EBP
Understand difficulties in nursing decision-making“Watters, R. (2019)”Suggested that decision-making needs to incorporate evidence and use it in practiceGathering credible evidence might take timeAppropriate decision is reachedIt could be time taking and require expertise
“Christenbery, T. L. (2017)”The skills and foundation of EBP in nursing is suggestedFollowing each code and professional standard requires years of practiceProfessional standard is enhancedRetaining staff could be difficult
“To improve practice expectations in the absence of clear evidence”“Bäck et al. (2020)”Suggests that practice expectations of organisations are differentAligning perspective within the hierarchy is difficultGuideline and norm for discipline is established by thisManagerial differences might be difficult to understand and document
“Cashin et al. (2017)”Suggests nursing practices for registered nurses in vitalSome practices might need to be modifiedThere is a standard protocol for meeting the scope and professional expectationsMaintaining the scope limits could be difficult
“To follow set clinical standards and fulfil professional expectations”  “Watters, R. (2019)”Suggests that professional scope requires making best suited decisions for the patientIt could be difficult to maintain adequate levels of expectationImprovement in quality of processes and outcomes is reachedProfessional capabilities could be hampered
“Cashin et al. (2017)”  Suggests that following guidelines provides a sense of professionalism in clinical settingsPractices might be outdated according to patient needsA clear procedure is important in reaching best evidence and outcomesIt could be difficult to fulfil patient needs and professional requirement simultaneously

Table 2: Information Comparison

Step 5: Use Information in Practice

5.1 Use of Information in Practice

Issue 1

The information for issues in “maintaining professional capability” suggests following the organisational codes of ethics and principles of professional nursing. These are important in the current context so that clinical guidelines from authorised bodies are followed, evidence is incorporated to keep the patient values intact as well as best possible evidence and outcomes are preferred. It also suggests managing “continuous quality improvement” (CQI) so that improvement in patient preferences, measuring the beneficial outcomes and maintaining values are not ignored (healthit.gov, 2020). These could help to rectify the issue.

5.2 Gaps in Information

Issue 2

The organisational factors play a big role in adhering to professional expectations. Thus, the differences in clinics and hospitals could be evaluated and scope of professionalism could be found. In addition, the need for “evidence-based decision-making” needs further research to know about its beneficial outcomes for nursing practices. Here, interdisciplinary concerns like managerial aspects and patient needs are to be taken into consideration. Cashin et al. (2017) stated that practices for registered nurses could help in improving the hospital scenario for the Australian healthcare setting.

5.3 Actions and RecommendationsIssue 1

Issue 2

  • Setting up exceptions for certain scenarios in patient treatment is important. This would help to make decisions when clear evidence is not available.
  • Professional nursing standards need to allow education and training to be made compulsory for adhering to the expectations.

References

Books

Christenbery, T. L. (2017). Evidence-Based Practice in Nursing: Foundations, Skills, and Roles. Retrieved from: Springer Publishing Company. https://books.google.co.in/books?hl=en&lr=&id=8RAzDwAAQBAJ&oi=fnd&pg=PP1&dq=Christenbery,+T.+L.+(2017).+Evidence-Based+Practice+in+Nursing:+Foundations,+Skills,+and+Roles.+Springer+Publishing+Company.+&ots=lg9RPF7DkJ&sig=1G7Ba-CkyWrnkHzkM5Y_UmLB1DQ&redir_esc=y#v=onepage&q=Christenbery%2C%20T.%20L.%20(2017).%20Evidence-Based%20Practice%20in%20Nursing%3A%20Foundations%2C%20Skills%2C%20and%20Roles.%20Springer%20Publishing%20Company.&f=false [16th November 2020]

Greenhalgh, T. (2017). How to implement evidence-based healthcare. United States: John Wiley & Sons. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=ySgnDwAAQBAJ&oi=fnd&pg=PR3&dq=Greenhalgh,+T.+(2017).+How+to+implement+evidence-based+healthcare.+United+States:+John+Wiley+%26+Sons.&ots=tkdAER3O7_&sig=pQbMpNzvcpcWR-2wdmWrlhak9Sk&redir_esc=y#v=onepage&q=Greenhalgh%2C%20T.%20(2017).%20How%20to%20implement%20evidence-based%20healthcare.%20United%20States%3A%20John%20Wiley%20%26%20Sons.&f=false [16th November 2020]

Bäck, A., von Thiele Schwarz, U., Hasson, H., & Richter, A. (2020). Aligning perspectives?—Comparison of top and middle-level managers’ views on how organization influences implementation of evidence-based practice. The British Journal of Social Work, 50(4), 1126-1145. Retrieved from: https://academic.oup.com/bjsw/article-abstract/50/4/1126/5528524 [16th November 2020]

Professional body publications

cebma.org (2020), Evidence-based management: The basic Principles, Retrieved from: https://cebma.org/wp-content/uploads/Evidence-Based-Practice-The-Basic-Principles-vs-Dec-2015.pdf [16th November 2020]

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