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