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NUR 590 EBP Evaluation of Process Sample Paper

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NUR 590 EBP Evaluation of Process Sample Paper

Evidence-Based Practice Proposal – Evaluation of Process Grand Canyon University, NUR590-0500

April 1, 2020 Danielle M. Carbonneau

In an attempt to decrease pharmacologic treatment, decrease costs and length of stay (LOS) it is imperative to evaluate a non pharmacological treatment of infants experiencing neonatal abstinence syndrome (NAS) symptoms. Rooming-in or non-separation of parent and infant may be an effective treatment plan. More maternal-infant interaction improves NAS outcomes but is difficult to obtain in the neonatal intensive care unit (NICU). Rooming-in care allows parents to be at the infant’s bedside 24-hours a day unless separation is indicated for medical reasons or safety reasons, (MacMillan, Rendon, Verma, Riblel, Washer, &Volpe Holmes, 2018).

Methods Used in Collecting the Outcome Data

The most appropriate way to collect the data for this EBP project is utilization of structured observation as well as physical assessment. The observation will be systematic and purposeful by utilizing forms to document specific observations and assessments at specific times. The first tracking form will be the Modified Finnegan Withdrawal Scale (MFWS), a tool used to assess and score NAS infants based on subjective and objective data, this form will be utilized every four hours.

The second will collect data on parent interactions, breastfeeding, NAS score, as well as transfer to NICU and discharge date. The third will collect demographic information and a unique identification number for each rooming-in pair to be completed when rooming-in begins. These structured observations and physical assessments can be coded and quantified for use in evaluation of the project, (Tappan, 2016).

Ways in Which the Outcome Measures Evaluate the Project Objectives

Typically when implementing a project the goal is to successfully achieve the project’s objective. “Senior executives use the general  term  project  success  to  both subjectively  describe  and  objectively   evaluate   the   achievements   of   their projects”, (Meredith, & Zwikael, 2019). In this project the outcome being measured is infant

LOS for infants that go directly to the NICU for treatment (the current standard of care) vs the LOS for infants rooming-in with parents (the intervention group). By comparing the LOS for the standard of care through chart reviews with logs kept by nurses on the rooming-in infants it can be determined if there is a decrease in LOS for the intervention group.

Outcome Measurement and Evaluation

As each family begins to room-in data will be collected in real time. Basic information will be collected on an EXCEL file that consists of:

  1. Infant Name
  2. Infant Medical Record Number (MRN)
  3. Infant Birthdate
  4. Parent’s name and contact information
  5. Unique Identification (ID) Number (A number specific to this project to utilize in data collection in order to protect participant confidentiality)

All other data collection will be recorded using the unique ID number. Bedside RNs will be utilizing a printed tracking form to collect the following data on each infant:

  1. Admission date
  2. Discharge date
  3. Transfer to NICU
  4. Administration of medications
  5. Feeding method
  6. NAS score every 4 hours
  7. Parental interventions every 4 hours

The best practice team will meet weekly to analyze data early and transfer into EXCEL files.

The team is already familiar with EXCEL and it is provided for use from the facility. Performing preliminary analysis of the data helps avoid a large amount of data to be processed at the end of the project, helps catch problems early, helps detect safety problems early, and helps check interrater reliability, (Tappan, 2016).

The actual analysis of data for this project is simple, the LOS of infants in the intervention group compared to LOS in infants who received the standard of care. The effect size will be determined by comparing the mean LOS of each group, (Melnyk & Fineout-Overholt, 2015). The test will be valid due to utilizing the same analysis for both groups and reliable because the same inclusion criteria will be used for both groups.

Strategies if Outcomes Do Not Provide Positive Results

“Quantitative studies are frequently conducted to find out if there is an important and identifiable difference between two groups”, (Melnyk & Fineout-Overholt, 2015). If there is not a statistical difference in the effect size it does not mean the project was a failure. After attempting to find reasons for the results not providing positive results it can be concluded that the standard of care is working and does not need to be changed.

Implications for Practice and Future Research

The results of this project will determine future care of infants experiencing NAS symptoms. If the effect size proves that rooming-in leads to a decrease in LOS then this should become the standard of care. By collecting additional data during this project further research can be done. The best practice team can evaluate if breastfeeding or certain comfort measures had a significant impact on the LOS of infants in the intervention group.

References

  • MacMillan K., Rendon C., Verma K., Riblet N., Washer D., Volpe Holmes A. Association of rooming-in with outcomes for neonatal abstinence syndrome: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(4):345–351. doi:10.1001/jamapediatrics.2017.5195 Retrieved from https://jamanetwork com.lopes.idm.oclc.org/journals/jamapediatrics/fullarticle/2672042
  • Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare (3rd ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN-13: 9781496306364 URL: http://gcumedia.com/digital-resources/wolters-kluwer/2014/evidence-based-practice-in-nursing-and-healthcare_a-guide-to-best-practice_ebook_3e.php
  • Meredith, J., & Zwikael, O. (2019). When is a Project Successful? IEEE Engineering Management Review, Engineering Management Review, IEEE, IEEE Eng. Manag. Rev, 47(3), 127–134. https://doi-org.lopes.idm.oclc.org/10.1109/EMR.2019.2928961
  • Tappan, R. M. (2016). Advanced nursing research: From theory to practice (2nd ed.).Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284048308 Retrieved from: www.gcumedia.com/digital-resources/jones-and-bartlett/2015/advanced-nursing-researcfrom-theory-to-practice_2e.php