American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing

Essential III:  Scholarship for Evidence Based Practice: “Professional nursing practice is grounded in the translation of current evidence into one’s practice”

 

  • Foundations of Professional Nursing 1 (NURS 307, currently enrolled at Virginia Commonwealth University): This course has introduced essential skills for understanding evidence-based practice, such as developing PICO questions, performing a literature review, and comprehensive database searching.
    • Sample PICO question:Background question: What different types of nonpharmacological treatments or therapies are used to decrease anxiety and pain in patients with burn injuries?Foreground question: How does aromatherapy affect pain and anxiety in patients with burn injuries?PICO Question:In patients with burn injuries (P), how does using aromatherapy as an adjunct to pharmacological treatment (I), compared with pharmacological treatments alone (C), affect patients’ pain and anxiety (O) within the length of their hospital admission (T)?
    • Sample Rapid Critical Appraisal of a source from a literature review:Rapid Critical Appraisal (MeInyck & Fineout-Overholt, 2018):
      • Date: 2016
      • Park, S., Jeong, I., Kim, K., Park, K. Jung, M., Jun, S. (2016). The effect of intravenous infiltration
      • management program for hospitalized children. Journal of Pediatric Nursing 31, 172-178. https//dx.doi.org/10.1016/j.pedn.2015.10.013 0882-5963
      • PICO question: In hospitalized pediatric patients (P), how will the implementation of a peripheral intravenous (PIV) infiltration management program (I) compared with standard nursing care for PIVs (C) affect PIV infiltration rates (O)?
      • Purpose of study: The researchers want to know if implementing a PIV infiltration management program, above and beyond standard PIV care, will have an impact on PIV infiltration rate
      • Study design: Quasi-experimental
      • Study description: The study participants included 2,894 pediatric patients (age zero to 19) in a hospital in Korea who had a PIV inserted. The control group was historical, and included pediatric patients admitted from August 1 to October 31, 2011 who received standard care. Standard care included educational posters, educating the patient’s parents about assessing the site for abnormalities, and documenting the IV site upon insertion. The experimental group were pediatric patients admitted to the same hospital and unit from November 1, 2011 to February 28, 2012. The experimental group received standard care, plus the PIV infiltration management program, which asked nurses to assess vein size and quality before attempting an IV. Nurses were also asked to monitor the PIV insertion site, and document findings each shift.
      • Hypothesis: Implementing a PIV infiltration management program will decrease the PIV infiltration rate in hospitalized pediatric patients.
      • Study aims: Show decreased PIV infiltration rates after implementing the PIV management program.
      • Sampling technique: Convenience sampling, as the study participants were all inpatient in one particular hospital in Korea. N = 2,894
      • Dependent variable: PIV infiltration, as measured by the standard scale of the Infusion Nurses Society. This scale is an appropriate measurement of this variable.
      • Data analysis: Chi-square test used to evaluate differences in IV infiltration rates. Two-tailed test with significance level of 0.05 also performed.
      • Validity: The study participants are similar between the control and experimental groups. The intervention is clearly identified. There is a control group. The experimental group received reasonable care. Follow-up is clearly stated. Statistical analysis is appropriate. Outcomes are measured with the same instrument for all participants, and that instrument is valid and reliable.
      • Results: The results are of importance because it indicates that the simple additional techniques used in the experimental group did decrease infiltration rate. Precision is unclear as the confidence interval is not published.
      • Applicability: The results are applicable to the patient population I work with, because I do have pediatric patients on the burn unit. The results are useful for assuring patients and their parents. I would use these study results, because it indicates that initial insertion site selection can play a big role in IV infiltration rates. Whenever possible, it makes sense to avoid joints, areas of curvature, and to consider the child’s mobility and thumb-sucking habits to avoid an area that will be frequently bent.

       

      MeIncky, B. & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice.  Wolters Kluwer Health.

  • Nursing Informatics (NURS 310, currently enrolled at Virginia Commonwealth University): This course is teaching essentials of evidence-based practice with a focus on information management and information literacy. Lectures have included multiple webinars on MeSH terms for performing a search in PubMed, and skill building for database searching more generally. One major assignment was the Evidence Based Search Paper, in which the quality of Internet search results were compared to the quality of database search results.Sample of my own writing from the Evidence Based Search Paper:“When comparing the results of the Google search with the PubMed database search, the Google search generated many more sources, even after filters were applied. The Google search resulted in 159 sources, whereas the PubMed search resulted in 21 sources. The quality of the PubMed results was significantly higher than the Google search. The highest quality of evidence available “is derived from meta-analysis of randomized controlled studies (RCTs) and… systematic reviews of RCTs” (Sewell, 2019). 50% (5 out of 10) of the PubMed sources were systematic reviews and meta-analyses, while only 1 out of 30 of the Google sources were systematic reviews. Following systematic reviews, the next highest level of evidence is evidenced derived from a randomized controlled study (Sewell, 2019). 40% (4 out of 10) of the PubMed sources were randomized controlled studies, while the Google search did not produce any randomized controlled studies. Thus, 90% of the PubMed sources were in the top 2 tiers on the hierarchy of evidence, compared to 3.3% in the Google search. All of the PubMed sources were relevant to my interest in treating anxiety in burn patients, compared to only 27% of the Google search. Additionally, all of the PubMed sources came from a peer-reviewed journal, while 50% of the Google sources were peer-reviewed. The Google search also resulted in various problems that I did not encounter during the PubMed search, including duplicate sources, non-English publications, and sources one could not access without paying a subscription fee.”Sewell, J. (2019). Informatics and nursing: Opportunities and challenges. Wolters Kluwer.