EBP Project Proposal Part II: Lit Review

A comprehensive literature review using the PICO question described in the last post will help to reveal if the chosen intervention is beneficial based on the best available evidence (Everett & Titler, 2006; Hall & Roussel, 2014). This is a vital step prior to trialing the chosen intervention on a pilot unit (Everett & Titler, 2006; Hall & Roussel, 2014). Using a team approach to allow for division of labor will help tremendously by distributing the research burden but also removes potential selection bias caused by an individual completing the literature review alone.

When completing a literature review, the team must identify databases that may contain research relevant to the EBP project; examples include CINAHL, MEDLINE, PubMed Clinical Queries, National Guideline Clearinghouse, Scopus, the Cochrane Library, Joanna Briggs Institute, National Academies, and Agency for Healthcare Research and Quality (Hall & Roussel, 2014). Meeting with a research librarian who specializes in healthcare, nursing, medicine or a field related to the project may also reveal other relevant resources. Seeking advice from an EBP expert will also be helpful to identify potential resources.

Once several databases have been chosen, the research team needs to identify appropriate search terms and date range (Hall & Roussel, 2014). Starting the search in PubMed is helpful because it allows researchers to identify Medical Subject Headings (MeSH®), which is the “National Library of Medicine's controlled vocabulary thesaurus” (National Library of Medicine [NLM], 2015). Using MeSH® Terms will most likely generate the most comprehensive search results because it identifies terms related to the topic (e.g. vitamin C, ascorbic acid) (NLM, 2015). PubMed also offers tutorials that describe how to best utilize the database (NLM, 2016).

Many databases allow the search to be narrowed to a specific date range. This allows researchers to keep the body of evidence needing review to a manageable level as well as ensures data used is up-to-date. In general, the team should choose evidence published in the last five to ten years, depending on the nature of the project and number of available studies (Hall & Roussel, 2014).

Finally, there are special considerations for scholarly EBP projects. First, it is important to choose a phenomenon of interest that gets you excited. Combing a problem or knowledge focused trigger with a personal passion is vital to carry you through the arduous process of scholarly writing and research (Everett & Titler, 2006). Secondly, once you have browsed the literature, write an outline and a concept map, which will help reveal relationships between concepts (Moran et al., 2014). Setting achievable goals with deadlines is also paramount for completing the project on time (Moran et al., 2014; Zaccagnini & White, 2017).

Finally, find an EBP champion to mentor you through the process; hopefully this person can be your scholarly project chair. Make a conscious effort to communicate regularly with your project chair. Experience writing an undergraduate honors thesis taught me to give myself extra time to complete a project to allow for unforeseen barriers that come up along the way. Lastly, do not give up. Expect detours; that way when they come you have already mentally visualized yourself successfully navigating through them. YOU CAN do it! 

References

Everett, L. Q., & Titler, M. G. (2006). Making EBP part of clinical practice: The Iowa Model. In Teaching Evidence-Based Practice in Nursing (pp. 295-324). New York: Springer Publishing Company.

Hall, H. R., & Roussel, L. (2014). Evidence-based practice: An integrative approach to research, administration, and practice. Burlington, MA: Jones & Bartlett Learning.

Moran, K. J., Burson, R., & Conrad, D. (2014). The Doctor of Nursing Practice scholarly project: A framework for success. Burlington, Mass: Jones & Bartlett Learning.

National Library of Medicine. (2015). Fact sheet: Medical Subject Headings (MeSH®). Retrieved from https://www.nlm.nih.gov/pubs/factsheets/mesh.html

National Library of Medicine. (2016). PubMed Tutorial. Retrieved from https://www.nlm.nih.gov/bsd/disted/pubmedtutorial/cover.html

Zaccagnini, M. E., & White, K. W. (2017). The doctor of nursing practice essentials: A new model for advanced practice nursing (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

EBP Project Part I: Using PICO

This last semester I had the opportunity to write the first draft of my evidence-based practice (EBP) scholarly project proposal for my Doctor of Nursing Practice (DNP) program. This experience has given me new insights into the processes of EBP and proposal writing. Using a conceptual framework is important to guide the EBP process because it helps guide the EBP process by providing an outline for the steps that need to be taken (Hall & Roussel, 2014; Moran, Burson, & Conrad, 2014). While many models exist, I will be using the Iowa Model of EBP since it has been noted to be a useful in nursing EBP projects and is the model endorsed by my DNP program (Everett & Titler, 2006; Hall & Roussel, 2014).  

In the Iowa Model, the EBP project is stimulated by triggers that can be knowledge or problem focused (Everett & Titler, 2006). An example of a knowledge focused trigger would be new research that shows a need for change in clinical practice (Everett & Titler, 2006). In this day and age, every hospital is stacked up against other facilities of comparable size who offer similar services; quality metrics from an institution are compared to metrics of other facilities in a process called benchmarking (U.S. Centers for Medicare & Medicaid Services [CMS], n.d.). A quality indicator, such as surgical site infection rates, would be an example of benchmarking data that could be a problem focused trigger for an EBP project (Everett & Titler, 2006).

Developing a Patient Population, Intervention, Comparison, and Outcome (PICO) question is really helpful when completing a literature review because it narrows the focus to a particular issue (Hall & Roussel, 2014). In the Iowa Model, the problem portion of the PICO question is derived from the knowledge and problem focused triggers (Everett & Titler, 2006; Hall & Roussel, 2014). After identifying a trigger, one must consider the organization’s priorities; this is the second step in the Iowa Model and shows the necessity to weigh the potential benefits that can be gained from an EBP project against competing issues and needs (Everett & Titler, 2006). If the knowledge or problem focused trigger is an organizational priority, an interdisciplinary EBP team can be formed of key stakeholders and those with EBP expertise (Everett & Titler, 2006; Hall & Roussel, 2014).

Developing a succinct and focused PICO question helps to generate a search that is neither too broad nor too narrow (Hall & Roussel, 2014). After identifying a problem, the next step is to consider potential solutions. The “I” in PICO stands for “Intervention” (Hall & Roussel, 2014, p. 256). In the example of surgical site infection as the problem focused trigger, using chlorhexidine soap for baths pre-operatively could be the intervention the team chooses to investigate in the literature (Everett & Titler, 2006; Hall & Roussel, 2014). The PICO question could be, “Do preoperative chlorhexidine baths lower surgical site infections compared to standard antimicrobial soaps?”. In this question, surgical site infection rates are the outcome of interest, and bathing with the standard bar or liquid soap used in the hospital is the comparison intervention (Hall & Roussel, 2014). 

References

Everett, L. Q., & Titler, M. G. (2006). Making EBP part of clinical practice: The Iowa Model. In Teaching Evidence-Based Practice in Nursing (pp. 295-324). New York: Springer Publishing Company.

Hall, H. R., & Roussel, L. (2014). Evidence-based practice: An integrative approach to research, administration, and practice. Burlington, MA: Jones & Bartlett Learning.

Moran, K. J., Burson, R., & Conrad, D. (2014). The Doctor of Nursing Practice scholarly project: A framework for success. Burlington, Mass: Jones & Bartlett Learning.

U.S. Centers for Medicare & Medicaid Services. (n.d.). What is hospital compare? Retrieved from https://www.medicare.gov/hospitalcompare/About/What-Is-HOS.html

Building Your Portfolio

The process of building your portfolio can start when you are in nursing school. Participation in extracurricular service activities, especially when they are related to nursing, is one way to boost your marketability after graduation. Community service activities (CSER), for example, is a great opportunity to use your skills to benefit others as well as a great addition to your resume. When I was sophomore nursing student, I taught a class on the effects of drug addiction on the brain to a group of women recovering from various addictions at a local Teen Challenge. Other great opportunities to serve and simultaneously hone nursing skills and expand your knowledge base is volunteering in the nursing skills lab and tutoring student nurses in nursing courses, such as Patho, Med/Surg, and pharmacology. I did both of these when I was an upperclassman, and there is so much truth in the old adage that the teacher learns more than the student.

You also don't have to wait until you pass your boards to start attending continuing education (CE) activities such as professional conferences. There are usually plenty of offerings for local CE opportunities. Honors students might be interested in petitioning critical care as this involved attending a single critical care conference when I attended LUSON. See your instructor for current petitioning requirements.

Nursing Undergraduate Honors Thesis

Your Honors Thesis will likely be one of the more challenging writing projects of your undergraduate studies, but it can be very interesting and rewarding if you pick a topic that has the potential to contribute to the body of nursing knowledge and is something you are passionate about. Writing your Honors Thesis does not have to be a dry and dreary task, although it can be at times. For me it was a scholastic adventure that took me down a road I did not expect. I discovered pieces of evidence I was not looking for, and it took on a shape that I had not anticipated. But that is the wonder of nursing. God's creation is so complex we are continuously surprised and delighted by the mysteries of His handiwork. Our earthly bodies daily testify to the glory of our King and tell of His wondrous deeds (Psalm 78:4).

If you are a sophomore or a junior nursing student figuring out your thesis topic, I suggest looking in and looking around; look in to find what is really important to you or what interests you, and look around to find out what is going on in nursing and medicine. Once you pick a topic, find a mentor, this will usually be your thesis chair, to help you to find a searchable question to answer in your thesis. Formulating a question using Patient Intervention Comparison Outcome (PICO) can help you narrow down your search.

Using your resources is also important. Even though I used to work in the Library, I still sought input from the nursing librarian when I was writing my thesis. Another resource I wish I had used when I was an undergraduate was the residential writing center. As a grad student, I have used the graduate writing center multiple times and found their feedback very helpful and informative.

Finally, have the grit to stick with your thesis topic when you get tired and bored. If you pick a topic meaningful to nursing and yourself, the laborious process will be well worth the effort.