Best Practices in Nursing Specialties

1A) Developing an Evidence-Based Practice (EBP) Project Question)

Consider issues related to your nursing practice. What stands out to you about your specialty area? What questions or concerns do you think are especially in need of attention? Why? How would you most like to contribute to the knowledge base of your profession?

The EBP Project provides a significant opportunity for furthering the nursing profession. Formulating a specific, applicable question is a necessary first step for developing your project. The question defines the focus of the EBP Project and guides your selection of research methods and tools. Think about aspects of your specialty area, and begin to formulate a question that relates to your nursing practice.

The primary purpose of this Discussion is to provide a forum in which you and your colleagues can support each other in cultivating a practice-related question.

To prepare:
• Develop your EBP Project question using the PICO (patient group, issue or intervention, comparison, outcome) method as described in Chapter 2 of Clinical Research for the Doctor of Nursing Practice (p. 22) and other resources. Depending on your specialty area, you may modify the PICO method as necessary to be appropriate for your target population.

• Begin to complete the “Literature Review Matrix,” reviewing at least four to six research articles relevant to your specialty area and your EBP Project question. Note any areas of difficulty that you encounter, as well as any strategies or insights that might be beneficial to others.

• Reflect on the information presented in the McCurry, Revell, and Roy article listed in the Learning Resources.

• What questions or concerns, if any, do you have about how to develop your project question and/or expand your expertise in your specialty area?
By Day 3, post a cohesive scholarly response that addresses the following:
• Share your project question, as you have developed it thus far.

• Discuss salient elements that inform your project question: theory, current research, nursing practice, and specialty knowledge.

• Pose any questions or concerns you may have related to developing your project question or literature review. You may also include any other issues related to expanding your expertise within your specialty area.
Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
• Course Text: Terry, A. J. (2015). Clinical research for the doctor of nursing practice. (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

o Chapter 2, “Developing the Researchable Problem”

This chapter describes considerations for developing a sound practice (research) question, noting that the practice-oriented doctorate incorporates elements of multiple fields of study, such as management, finance, and technology. It also outlines the PICO method, which may be useful for developing your DNP Project practice question. (Note: You may modify the PICO framework as necessary to be appropriate to your specialty area as you develop your practice question.)
• Article: McCurry, M. K., Revell, S. M. H., & Roy, C. (2009). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.
Retrieved from the Walden Library using the Academic Search Complete database.

According to the authors, “Nursing as a profession has a social mandate to contribute to the good of society through knowledge-based practice” (p. 42). This article addresses the intersections of philosophy, disciplinary goals, theory, and practice and how the resulting synthesis can promote achievement of this social mandate.

• Article: Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice.American Journal of Nursing, 110(3), 58–61.
Retrieved from the Walden Library using the Ovid database.

This article is part of a series that is intended to help promote the implementation of evidence-based practice. This particular article in the series asserts that a well-developed question is an essential step in this process: “Formulating a clinical question in a systematic way makes it possible to find an answer more quickly and efficiently, leading to improved processes and patient outcomes” (p. 58). Note that for the purposes of this course, the DNP Project practice question does not have to be a “clinical” question depending on your area of specialty.

• Handout: Literature Review Matrix [Microsoft Word .doc]

• Handout: NURS 8410 Practicum Journal Template [Microsoft Word .doc]
Optional Resources
• Article: Winsett, R. P., & Cashion, A. K. (2007). The nursing research process. Nephrology Nursing Journal, 34(6), 635–643.
Retrieved from the Walden Library using the CINAHL Plus database.
1B) Reasoning in a Specialty Area

Bring to mind an important practice-related decision you have made recently. How did you approach this decision? What aspects of your specialty expertise informed your decision-making?

Evaluate your decision now in light of the principles of clinical reasoning presented in the Learning Resources this week. What new insights arise about your decision making as you look at it through this lens? What questions emerge as you reflect how you use reasoning in your practice?

In this Discussion, you and your colleagues examine the application of reasoning strategies in your specialty area of practice, particularly as it is connected to your EBP Project question.

To prepare:
• Consider the definition of clinical reasoning and how it is distinguished from other terms in the Simmons article.

• Bring to mind key characteristics of your specialty area. Is the concept of clinical reasoning relevant and sufficient to describe the process you utilize as you make decisions and solve problems in your area of specialization? Why or why not? If not, what terminology would be more useful for defining or characterizing this process?

• Review the literature to identify at least two specific examples of reasoning strategies used in your specialty area. These may be part of your literature review related to your EBP Project question(s).

• Reflect on your EBP Project question(s). Reexamine your project question(s) through this lens of clinical, or alternately termed, reasoning.

By Day 3, post a cohesive scholarly response that addresses the following:
• How are reasoning strategies most often applied in your specialty area? Provide at least two specific examples supported by the literature.

• How can you apply reasoning strategies to the refinement of your EBP Project question(s)?

Required Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources.
• Course Text: Terry, A. J. (2015). Clinical research for the doctor of nursing practice. (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

o Chapter 1, “The Importance of Research in the Doctor of Nursing Practice Degree”
Read pages 16-23 beginning with “The DNP Graduate With an Aggregate Focus”

In this section of Chapter 1, the author explains relationship between the DNP clinician, the research process, and developing an effective evidence-based practice. The author also discusses facilitating change in practice based on critically appraised and validated evidence. In addition, Carper’s four essential patterns of “knowing” in nursing and Rosswurm and Larrabee’s six-phase model for reviewing research are highlighted.

• Article: Banning, M. (2008). Clinical reasoning and its application to nursing: Concepts and research studies. Nurse Education in Practice, 8(3), 177-183.
Retrieved from the Walden Library using the ScienceDirect database.

In this article, Banning offers a definition of clinical reasoning as it applies to the field of nursing. She pays special attention to its application in evaluating available evidence in order to make professional judgments that affect the care of the individual patient. The author also discusses the use of patient-centered prototypes, protocol analysis, and the think aloud approach, and the advantages and disadvantages of these methods of clinical reasoning.

• Article: Simmons, B. (2010). Clinical reasoning: Concept analysis. Journal of Advanced Nursing, 66(5), 1151-1158.
Retrieved from the Walden Library using the Academic Search Complete database.

In this article, Simmons provides a concept analysis and definition of “clinical reasoning” and distinguishes it from other concepts. She opines that clinical reasoning is what separates professional nurses from ancillary health care providers and that clinical reasoning is a precursor to decision and action. Simmons also discusses several formal and informal strategies, including deliberation, heuristics, inference, metacognition, logic, information processing, intuition, and analysis.

Optional Resources
• Article: Price, B. (2011). Improving clinical reasoning in children’s nursing through narrative analysis. Nursing Children & Young People, 23(6), 28-34.
Retrieved from the Walden Library using the CINAHL Plus database.

• Article: Standing, M. (2008). Clinical judgement and decision-making in nursing – nine modes of practice in a revised cognitive continuum. Journal of Advanced Nursing, 62(1), 124-134.
Retrieved from the Walden Library using the CINAHL Plus database.

• Article: Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.
Retrieved from the Walden Library using the Education Research Complete database.

Evidence-Based Practice (EBP) Project

1) Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project (developed in Week 2)

In a 1- page paper, address the following:

• Provide a summary of the selected practice issue in which the outcome is different from what would be expected according to the research literature. (Note: The issue you select must be suitable for completing the entire EBP Project.)
2) Application 2: Laying the Foundation for New Approaches to Practice (developed in Weeks 4 and 5)

In a 4 page paper, include the following:

• A brief summary of the currency of the science underlying the practices used to address your EBP Project issue
• Possible causes of the difference in outcomes from what would be expected according to the research literature
• The effect the EBP Project issue is having in practice
• Current research evidence on new practices for addressing the EBP Project issue
• A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue
3) Application 3: Becoming a Leader in the Translation of Evidence to Practice (developed in Weeks 6 and 7)

Write a 3-page paper that synthesizes:

• Your vision of yourself as a leader—specifically:
o How you would continue to increase your knowledge and awareness of financial, economic, and other concerns related to new practice approaches
o How translating evidence would enable you to affect or strengthen health care delivery and nursing practice
o How you would advocate for the use of new evidence-based practice approaches through the policy arena

4) Application 4: Planning for Change, Implementing and Evaluating EBP Projects (developed in Weeks 8–10)

Write a 5-page paper that addresses the following:
Planning for Change

• Analyze the impact of implementing change in your practice environment, including the factors that need to be considered regarding stakeholders and end users.
• Summarize the methods you would use to ensure that those are adequately addressed.

Implementing EBP Projects

• Identify the desired outcomes of your EBP Project.
• Describe any macro or micro systems issues that may inhibit implementation and strategies for resolving those issues.
• Explain how resolving your EBP Project issue will improve quality and patient safety.

Evaluating EBP Projects

• Describe evaluation strategies.
• Formulate new practice guidelines based on the possible results of the evaluation of outcomes.
• Describe, if appropriate, new standards of care relevant to the new practice guidelines.