NR505NP Week 1 Assignment: Spirit of Inquiry
NR505NP Week 1 Assignment: Spirit of Inquiry
Have you ever wondered if there is a better way to approach a situation you’ve encountered in practice? Perhaps you’ve even sought evidence to support a change in practice. According to the National League for Nursing (NLN, 2017), a spirit of inquiry is “a persistent sense of curiosity that informs both learning and practice. A nurse infused by a spirit of inquiry will raise questions, challenge traditional and existing practices, and seek creative approaches to problem-solving. A spirit of inquiry in nursing engenders innovative thinking and extends possibilities for discovering novel solutions in both predictable and unpredictable situations” (p. 8). For professional nurses, a spirit of inquiry must always be present. A spirit of inquiry motivates nurses to pursue research to support evidence-based, holistic, person-centered care and promotes professional excellence.
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The Spirit of Inquiry
Listen to the following podcast which examines a humble style of inquiry and may help achieve the next big breakthrough.
The Spirit of InquiryLinks to an external site.
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Week 1: Research, Evidence-based Practice, and Quality Improvement
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Week 1: Research, Evidence-based Practice, and Quality Improvement
Week 1Research, Evidence-based Practice, and Quality Improvement
Evidence
Nursing practice in all settings is based on a body of knowledge. The body of knowledge that supports practice may be referred to as evidence. When determining what evidence should be used to guide nursing practice, the nurse needs to examine the quality and volume of the available evidence.
Research
Where do we get the evidence to support nursing practice? Research.
Research is a process by which we discover new knowledge. The research process begins with the spirit of inquiry, which leads to the development of a question to be answered. The next step of the process involves gathering evidence to answer the question through systematic investigation. Research results are communicated to others in the nursing profession to help inform practice and to provide the basis of future inquiry.
Florence Nightingale
Changing the Field of Nursing – Fast Facts | History
Nightingale employed statistical methods to show that better food, hygiene, and sanitation could reduce morbidity and mortality among the soldiers (Houser, 2018; Nieswiadomy & Bailey, 2018). Nightingale is recognized as one of the first nurses to utilize evidence as a basis for her practice (Nieswiadomy & Bailey, 2018; Polit & Beck, 2018). A glimpse into the past~ Nightingale’s Coxcomb chart demonstrates statistics being used early in the beginning stages of the nursing profession. According to McDonald (2014), Nightingale tracked and documented data using statistical methods to highlight the death toll from the number of battle and non-battle related death rates of soldiers.
(McDonald, 2014)
Image Description
Several decades passed before nursing would create a significant body of research. Today, we have many reputable, respectable organizations and professional groups and societies that conduct and promote research. One example is the National Institute of Nursing Research (NINR) which promotes the health of all Americans through nursing research funding and training (NINR, n.d). Take some time to explore the NINR website!
Expanding Nursing Knowledge through Research
From a historical perspective, nursing research served a vital role in expanding the knowledge base to support professional practice. From the early efforts of Florence Nightingale to reduce morbidity and mortality from battlefield injuries to more recent efforts to reduce risk and promote outcomes at the population level, research continues to contribute to a growing body of knowledge to validate the credibility and accountability of the nursing profession (Nieswiadomy & Bailey, 2018).
Evidence-based Practice
Evidence-based practice (EBP) involves the application of evidence obtained through research, the nurse’s clinical expertise, and the patient’s values and preferences to nursing practice (Melnyk & Fineout-Overholt, 2018). EBP is the most effective way to impact patient care because it uses the best available evidence to inform nursing interventions to improve healthcare outcomes (Academy of Medical-Surgical Nurses, 2019). Evidence provides direction for the creation of nursing practices that support holistic, person-centered care. Evidence also supports the need for nurses to integrate self-care, personal responsibility, spirituality, and reflection into their own lives. Holistic approaches to person-centered care lead to better patient outcomes and improved nurse satisfaction. Finding evidence to support practice involves a systemic approach and a critical examination of the evidence for quality and relevance.
Image Description
It is important to note that the term practice does not refer solely to patient care. EBP applies to all the diverse areas in healthcare in which nurses may be found. Nursing practice includes, but is not limited to, clinical practice, education, management, informatics, healthcare policy, and quality improvement.
While the concept of EBP may be somewhat new, nursing has long been aware of a gap between research and practice. For decades, nurse leaders have noted that nursing research is being published, but the time it takes to translate the evidence generated by research to practice is lengthy. Evidence-based practice seeks to correct the research-practice gap; however, barriers to evidence-based practice need to be removed. Some barriers include:
- lack of time
- lack of knowledge or experience with EBP and its steps
- lack of knowledge or confidence in reviewing research articles or statistics
- resistance to change within the culture of the organization
- peer pressure to continue with practices because “this is the way we have always done it”
Barriers to Evidence-Based Practice
In your current practice, have you experienced a barrier to evidence-based practice? Were you able to overcome this barrier? What action(s) did you take to remove the barrier?
Quality Improvement
One additional term that is often associated with professional nursing and producing evidence to guide practice is a quality improvement. Quality improvement (QI) uses a systematic process to improve patient outcomes within an institution. Commonly, an institution decides to improve a process, service or practice method/intervention related to patient care. For example, improving the process associated with discharge planning or decreasing the wait time in outpatient surgery would be examples of services provided by a hospital that may benefit from the change. While on the surface, this may sound very similar to research or EBP, the focus is more limited—often limited to one institution. In other words, the findings are used for internal improvement within an organization. While the results of quality improvement projects may be shared with other institutions, it is the responsibility of each institution or organization to determine if the suggested change would be of benefit within their own organization.
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Week 1: Evidence-based Models
Week 1Evidence-based Models
Overview
As noted in NR500NP, the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model is a powerful problem-solving approach to clinical decision-making and is accompanied by user-friendly tools to guide individual or group use. It is designed specifically to meet the needs of the practicing nurse and uses a three-step process called PET: practice question, evidence, and translation. The goal of the model is to ensure that the latest research findings and best practices are quickly and appropriately incorporated into patient care.
The PET Model is frequently demonstrated as a linear process. Click each plus sign to learn more about the steps involved in each section.
Transcript
Practice Question
Step 1: Recruit interprofessional team
Step 2: Define the problem
Step 3: Develop and refine the EBP question
Step 4: Define the scope of the EPB question and identify stakeholders
Step 5: Determine responsibility for project leadership
Step 6: Schedule team meetings
Evidence
Step 7: Conduct internal and external search for evidence
Step 8: Appraise the level and quality of each piece of evidence
Step 9: Summarize the individual evidence
Step 10: Synthesize overall strength and quality of evidence
Step 11: Develop recommendations for change based on evidence synthesis
Translation
Step 12: Determine fit, feasibility, and appropriateness of recommendation(s) for translation path
Step 13: Create action plan
Step 14: Secure support and resources to implement action plan
Step 15: Implement action plan
Step 16: Evaluate outcomes
Step 17: Report outcomes to stakeholders
Step 18: Identify next steps
Step 19: Disseminate findings
Another evidence-based practice model is the Advancing Research and Clinical Practice through Close Collaboration (ARCC) model (Melnyk & Fineout-Overholt, 2018). The focus of this model is to provide healthcare institutions and clinical settings with a framework for implementing system-wide change. The ARCC model also provides steps to help ensure the sustainability of change.
The Promoting Action on Research Implementation in Health Sciences (PARIHS) is a model that presents the interplay of factors involved in the successful implementation of evidence-based practice in clinical settings (Kitson & Harvey, 2016). This model is based on the promotion of behavioral change in individuals, teams, and entire organizations.
Other evidence-based practice models include the Iowa Model of Evidence-Based Practice, Stetler Model, and the ACE Star Model. Please explore more about these models below.
Transcript
Iowa Model of Evidence-Based Practice
As part of an initiative from the University of Iowa Hospitals and clinics, the Iowa Model was developed by a collaborative team to serve as a guide to implement research findings to foster patient care outcomes. This model has been used extensively and was revised in 2015. This model is very useful to implement EBP within an organization.
The revised Iowa Model as noted below:
The IOWA Model Revised: Evidence-Based Practice to Promote Excellence in Health Care
Identifying Triggering Issues/Opportunities
- Clinical or patient identified issue
- Organization, state, or national initiative
- Data/New Evidence
- Accrediting agency requirements / Regulations
- Philosophy of care
State the Question or Purpose
Is this topic a Priority?
- No: Consider another issue/opportunity
- Yes: Form a Team
Assemble, Appraise, and Synthesize Body of Evidence
- Conduct systematic research
- Weigh quality, quantity, consistency, and risk
Is there sufficient evidence?
- No: Conduct research/Reassemble
- Yes
Design and Pilot the Practice Change
- Engage patients and verify preferences
- Consider resources, constraints, and approval
- Develop localized protocol
- Create an evaluation plan
- Collect baseline data
- Develop an implementation plan
- Prepare clinicians and materials
- Promote adoption
- Collect and report post-pilot data
Is change appropriate for adoption in practice?
No: Consider alternatives
Yes
Integrate and Sustain the Practice Change
- Identify and engage key personnel
- Hardwire change into system
- Minitor key indicators through quality improvement
- Reinfuse as needed
Disseminate results
Source: Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. doi:10.1111/wvn.12223
Used/reprinted with permission from the University of Iowa Hospitals and Clinics, copyright 2015. For permission to use or reproduce, please contact the University of Iowa Hospitals and Clinics at 319-384-9098.
Stetler Model
The Stetler model was developed to provide a pathway for advanced practice nurses to examine the best available evidence and then determine if can be applied within a practice setting. This model identifies that while research and EBP are not the same, the relationship between the two can foster improved patient outcomes by implementing research evidence.
Stetler Model
Phase 1: Preparation
Phase 2: Validation
Phase 3: Comparative Evaluation/Decision Making
Phase 4: Translation/Application
Phase 5: Evaluation
Source: McMaster University. (n.d.). Stetler model of evidence-based practice. https://www.nccmt.ca/knowledge-repositories/search/83.
Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model
The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model was developed by Dr. Melnyk and Fineout-Overholt who are identified to be leaders within the field of evidence-based practice. While this model seems complex when reviewed, it has a unique element that is noted to be the sustainability of the evidence-based practice. This sustainability is partly due to the detail present within the model itself with an emphasis on changing an organization. By first considering these core steps, a user of this model can then branch out to the additional areas to identify a comprehensive path to implementing evidence for EBP.
The core steps of the model would be noted as:
Step One: Assessment of organizational culture and readiness for EBP
Step Two: Identification of strengths and major barriers to EBP
Step Three: Development and use of EBP mentors
Step Four: EBP Implementation
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ACE Star Model of Knowledge Transformation
Developed by Dr. Kathleen Stevens, the ACE Star Model of Knowledge Transformation is a formula that is designed to transfer evidence present in the research literature into professional nursing practice. An individual or organization using the ACE Star model would conduct an extensive review of the research evidence regarding a concern. From this evidence, identify a change or appropriate action and then seek to implement the change into practice. The model also identifies the importance of evaluation of the change to determine the impact upon healthcare outcomes.
The ACE Star Model is frequently referred to as “star’ because the 5 steps can be presented as points on a star.
The following graphic presents the steps of the ACE Star Model.
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Week 1: References
Week 1References
Academy of Medical-Surgical Nurses. (2019). Evidence-based practice. https://www.amsn.org/practice-resources/evidence-based-practice
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett.
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-based Nursing. 14(3), 175-182.
Johns Hopkins Medicine. (n.d.). John Hopkins Nursing Evidence-Based Practice Model (JHNEBP). https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html
Kitson, A. L., & Harvey, G. (2016). Methods to succeed in effective knowledge translation in clinical practice. Journal of Nursing Scholarship, 48(3), 294-302.
McDonald, L. (2014). Florence Nightingale, statistics and the Crimean war. Journal of the Royal Statistical Society: Series A (Statistics in Society), 177(3), 569-586.
McMaster University. (n.d.). Stetler model of evidence-based practice. https://www.nccmt.ca/knowledge-repositories/search/83.
Melnyk, B. M., & Fineout-Overholt, E, (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Lippincott Williams & Wilkins.
National Institute of Health. (n.d.) National Institution of Nursing Research. ninr.nih.gov
National League for Nursing. (2017). NLN program outcomes and competencies for graduate academic nurse educator preparation. http://www.nln.org/docs/default-source/professional-development-programs/program-outcomes-and-competencies2.pdf?sfvrsn=2
Nieswiadomy, R. M., & Bailey, C. (2017). Foundations of nursing research. Pearson.
Polit, D. F. & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Wolters Kluwer Health.
Raz, G. (Host). (2017, February 24). The spirit of inquiry. [Audio podcast episode]. In TED Radio Hour.
Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-based Practice. The University of Texas Health Science Center at San Antonio. http://nursing.uthscsa.edu/onrs/starmodel/institute/su08/starmodel.html
Course Outcomes
This assignment enables the student to meet the following course outcomes:
CO 1: Integrate evidence-based and research to support advancement of holistic nursing care in diverse healthcare settings. (PO 1,4)
CO 2: Integrate knowledge related to evidence-based practice and person-centered care to improve health outcome. (PO 1, 2)
CO 3: Demonstrate professional and personal growth through a spirit of inquiry, scholarship, and service in diverse healthcare settings. (PO 3, 4)
CO 4: Develop knowledge related to research and evidence-based practice as a basis for designing and critiquing research studies. (PO 1, 5)
CO 5: Analyze research findings and evidence-based practice to advance holistic care initiatives that promote positive healthcare outcomes. (PO 1, 2, 5)
Week 1: Area of Interest in NP
This is a graded discussion: 50 points possible
due Jul 16
Week 1: Area of Interest in NP
33 unread replies.33 replies.
Week 1Area of Interest in NP
Discussion
Purpose
Over the course of the next eight weeks, we will be examining concepts related to nursing research and the translation of evidence to practice. To help you better understand the process, you will be identifying a practice issue for nurse practitioners. You will develop a PICOT question associated with the issue, find evidence to support a change in practice, and present your recommendations for change to your peers. This week, we will work on helping you refine your area of interest so that you will be able to develop a concise question for next week’s assignment. You are encouraged to use the area of interest you chose for the project in NR500NP and/or NR501NP; however, you may choose a different area if you wish.
Select an issue in nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic. In 1-2 paragraphs, describe the scope and relevance of the issue and your recommended change. Provide reference support from at least two outside scholarly sources to support your ideas. Please pick something you can do as a NP in your practice that is patient focused. Your intervention needs to relate to a measurable patient health outcome. Please avoid anything that would require a policy or law change, such as full-practice authority. Burnout and satisfaction surveys also are not appropriate topics as they are not patient centered.
Review this 4-minute video to gain a better understanding of the requirements of a PICOT question. The PICOT question is not a research question, but a quality improvement issue that requires a practice change.
Due Date
A 5% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0 for any portion of the discussion not posted by that time).
NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Saturday.
A zero is the lowest score that a student can be assigned.
Faculty may submit any collaborative discussion posting to Turnitin in order to verify originality.
Total Points Possible: 50
Preparing the Assignment
Discussion Criteria
- Application of Course Knowledge: The student’s initial post contributes unique perspectives or insights gleaned from personal experience or examples from the healthcare field. The student must accurately and fully discuss the topic for the week in addition to providing personal or professional examples. The student must completely answer the entire initial question. Initial post must be posted by Wednesday at 11:59pm MT. Two resources must be used in your initial post. One from the weekly reading or lesson and one outside source.
- Engagement in Meaningful Dialogue:The student responds to a student peer and course faculty to further dialogue.
- Peer Response: The student responds substantively to at least one topic-related post by a student peer. A substantive post adds content or insights or asks a question that will add to the learning experience and/or generate discussion.
- A post of “I agree” with a repeat of the other student’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
- The peer response must occur on a separate day from the initial posting.
- The peer response must occur before Sunday, 11:59 p.m. MT.
- The peer response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.
- Faculty Response: The student responds substantively to at least one question by course faculty. The faculty question may be directed to the student, to another student, or to the entire class.
- A post of “I agree” with a repeat of the faculty’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
- The faculty response must occur on a separate day from the initial posting.
- Responses to the faculty member must occur by Sunday, 11:59 p.m. MT.
- This response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.
- Integration of Evidence:The student post provides support from a minimum of one scholarly in-text citation with a matching reference AND assigned readings OR online lessons, per discussion topic per week. Two resources total and to count must be an in-text citation in your initial post.
- What is a scholarly resource? A scholarly resource is one that comes from a professional, peer-reviewed publication (e.g., journals and government reports such as those from the FDA or CDC).
- Contains references for sources cited
- Written by a professional or scholar in the field and indicates credentials of the author(s)
- Is no more than 5 years old for clinical or research article
- What is not considered a scholarly resource?
- Newspaper articles and layperson literature (e.g., Readers Digest, Healthy Life Magazine, Food, and Fitness)
- Information from Wikipedia or any wiki
- Textbooks
- Website homepages
- The weekly lesson
- Articles in healthcare and nursing-oriented trade magazines, such as Nursing Made Incredibly Easy and RNMagazine (Source: What is a scholarly article.docx; Created 06/09 CK/CL Revised: 02/17/11, 09/02/11 nlh/clm)
- Can the lesson for the week be used as a scholarly source?
- Information from the weekly lesson can be cited in a posting; however, it is not to be the sole source used in the post.
- Are resources provided from CU acceptable sources (e.g., the readings for the week)?
- Not as a sole source within the post. The textbook and/or assigned (required) articles for the week can be used, but another outside source must be cited for full credit. Textbooks are not considered scholarly sources for the purpose of discussions.
- Are websites acceptable as scholarly resources for discussions?
- Yes, if they are documents or data cited from credible websites. Credible websites usually end in .gov or .edu; however, some .org sites that belong to professional associations (e.g., American Heart Association, National League for Nursing, American Diabetes Association) are also considered credible websites. Websites ending with .com are not to be used as scholarly resources
- Professionalism in Communication:The post presents information in logical, meaningful, and understandable sequence, and is clearly relevant to the discussion topic. Grammar, spelling, and/or punctuation are accurate.
- Wednesday Participation Requirement:The student provides a substantive response to the graded discussion question(s) or topic(s), posted by the course faculty (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.
- Total Participation Requirement:The student provides at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.
- What is a scholarly resource? A scholarly resource is one that comes from a professional, peer-reviewed publication (e.g., journals and government reports such as those from the FDA or CDC).
- Peer Response: The student responds substantively to at least one topic-related post by a student peer. A substantive post adds content or insights or asks a question that will add to the learning experience and/or generate discussion.
Discussion Rubric
| Category | Points | Description |
| Application of Course Knowledge | 15 | Answers the initial discussion question(s)/topic(s), demonstrating knowledge and understanding of the concepts for the week by Wednesday at 11:59pm MT. |
| Engagement in Meaningful Dialogue With Peers and Faculty | 10 | Responds to a student peer AND course faculty furthering the dialogue by providing more information and clarification, adding depth to the conversation |
| Integration of Evidence | 15 | Assigned readings OR online lesson AND at least one outside scholarly source are included. The scholarly source is: 1) evidence-based, 2) scholarly in nature, 3) published within the last 5 years |
| Total content points = 40 points | ||
| Grammar and Communication | 5 | Presents information using clear and concise language in an organized manner |
| Reference Citation | 5 | References have complete information as required by APA In-text citations included for all references AND references included for all in-text citation |
| Total format points = 10 points | ||
| Discussion total points = 50 points | ||
**To view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.
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