Scholarly Paper #2- Evidence-Based Practice
Nurse leaders play a major role in establishing a culture in which nursing practice is guided by evidence. To do this, leaders must establish expectations supported by departmental policy that encourage clinical nurses to actively incorporate evidence into daily decision making. This can produce challenges for the often overburdened nurse leader who must overcome the frequently sited barriers to EBP implementation: lack of time, inadequate knowledge and skills, lack of EBP mentors, and resistance to change.
This assignment is to assist the baccalaureate nursing students in understanding the importance of evidence-based practice (EBP) by identifying clinical nursing problems observed in practice, searching the literature for evidence related to the problem and presenting it in a systematic and organized method.
Choose one of the areas listed below and conduct systematic research to determine the EBP guidelines for this issue. Provide supporting research when discussing the importance of EBP in this area and its correlation to patient safety and positive patient outcomes.
EBP Topics:
Communication involving changes in a patient’s status.
Soft skills that improve patient interaction.
Training and onboarding new nurses.
Shift scheduling and the effect on care.
Infection control practices
Recognizing alarm fatigue
Nurse-to-nurse shift change.
Patient care and discharge.
Utilize the five “A’s†of EBP in your paper:
Ask: Formulate answerable clinical questions about a patient, problem, intervention, or outcome.
Acquire: Search for relevant evidence to answer questions.
Appraise: Determine whether or not the evidence is high-quality and valuable.
Apply: Make clinical decisions utilizing the best available evidence.
Assess: Evaluate the outcome of applying the evidence to the patient’s situation.
All papers should be written using full APA style— in-text references and a final reference list. Papers are limited to a total of 5 pages (which include the title page, and full reference list). No less than 6 references are expected. All references must be from professional sources. The majority of all references must be primary source, research/data based (MSU library), original articles. Yoder-Wise course text must be included as one of the references in this assignment.
Scholarly Paper #2- Evidence-Based Practice
Choose one EBP Topic from the assigned list. Conducts systematic research to determine the EBP guidelines for this issue. Provides supporting research when discussing the importance of EBP in this area and its correlation to patient safety and positive patient outcomes.
40
Utilizes the five “A’s†of EBP:
1. Ask: Formulate answerable clinical questions about a patient, problem, intervention, or outcome.
2. Acquire: Search for relevant evidence to answer questions.
3. Appraise: Determine whether or not the evidence is high-quality and valuable.
4. Apply: Make clinical decisions utilizing the best available evidence.
5. Assess: Evaluate the outcome of applying the evidence to the patient’s situation.
40
APA style—, in-text references and a final reference list. Papers are limited to a total of 5 pages (which include the title page, and full reference list)
10
Minimum of 6 references. All references must be from professional sources. The majority of all references must be primary source, research/data based (MSU library), original articles. Yoder-Wise course text must be included as one of the references in this assignment.
10
Total points
100
Scholarly Paper
Student’s Name
Institutional Affiliations
Scholarly Paper
Nurse leaders are charged with the responsibility of ensuring that nurses who are deployed in their units provide evidence-based care to patients. This requires that they have a comprehensive understanding of evidence-based clinical practice guidelines specific to clinical nursing problems that are commonly observed in practice (Li et al., 2019). In this respect, it is imperative that nursing students understand the importance of evidence-based practice (EBP) early enough in their careers. The purpose of this paper is to utilize the four ‘As’ of EBP (Ask, Acquire, Appraise, Apply, and Assess) to conduct systematic research to determine the EBP guidelines for discharge planning for patients with diabetes. The EBP topic associated with the chosen issue is ‘patient care and discharge.’ The application of EBP in discharge planning for patients with diabetes promotes patient safety and enhances the realization of positive patient outcomes.
Ask
Diabetes is a chronic condition whose outcomes are influenced by the health literacy levels of patients and their caregivers. This explains why it is important to educate the patient about self-care management in relation to blood glucose management and other health determinants. The emergency readmission rates of diabetic patients still remain high despite the fact that hospitalized patients are usually discharged when they are in a positive direction towards recovery (Rubin et al., 2022). According to Pinkhasova et al. (2021), limited knowledge regarding diabetes self-care management negatively affects patient outcomes at home and increases emergency readmission risks. Interventions that increase a patient’s self-care management at home can promote safety and generate positive health outcomes for patients with diabetes. Nurses’ actions to implement interventions such as patient education at the time of discharge must be informed by research (Li et al., 2019). The following clinical question can direct nurses to gather evidence that supports the effectiveness of patient education at the time of discharge in improving patient outcomes at home and reducing rates of emergency readmissions;
“In hospitalized diabetes patients (P), does patient education at the time of discharge (I) compared with lack of patient education (C) reduce rates of emergency readmissions (O)?”
Hospitalized diabetes patients are the patient population being targeted. The proposed intervention is providing patient education at the time of discharge and the comparison is the lack of patient education. The expected outcome is a reduction in rates of emergency readmissions after discharge.
Acquire
Published evidence supports the effectiveness of patient education at the time of discharge on rates of emergency readmissions among diabetes patients. For example, the Endocrine Society’s Clinical Practice Guidelines recommend that healthcare providers should provide pre-discharge diabetes self-management education to patients because it is associated with positive health outcomes and reduce the likelihood of readmission (Endocrine Society, 2022). The American Diabetes Association’s (ADA’s) Clinical Practice Guidelines recommend that there should be a structured discharge plan for patients with diabetes right from the time of admission. At the time of discharge, the healthcare provider should provide the patient with appropriate equipment and medication, including detailed education regarding their use, to prevent readmissions (ADA, 2022). In two separate systematic reviews, Black and Duval (2019) and Hussain et al. (2020) reported the effectiveness of inpatient education offered at the time of discharge on readmission rate reduction in patients with diabetes. A randomized controlled trial conducted by Rubin et al. (2022) revealed that patient-centered discharged education, which is a component of the Diabetes Transition of Hospital Care (DiaTOHC), reduces risks of readmission among adult diabetic patients.
Appraise
The evidence that has been gathered in support of the proposed intervention is of high-quality and valuable. The evidence is a mixture of two evidence-based practice guidelines (ADA, 2022; Endocrine Society, 2022;), two systematic reviews (Black & Duval, 2019; Hussain et al., 2020), and a randomized controlled trial (Rubin et al., 2022). Systematic reviews and EBP guidelines contain the highest quality evidence because they are developed after analyzing results from different types of studies. Randomized controlled trials also contain high-quality evidence with consistent results that can be generalized to other settings (The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Healthcare professionals can use the gathered evidence to inform clinical practice with diabetic patients.
Apply
Available evidence supports the effectiveness of patient education offered at the time of discharge in reducing emergency readmission rates among patients with diabetes. Nurses should apply this evidence in clinical practice by educating patients about self-care management at home at the time of discharge (ADA, 2022). Patient education should cover medication use and other health promotion approaches that promote safety and improve patient outcomes.
Assess
It is important to evaluate the intervention to determine whether it produces the desired outcomes. During the evaluation, the healthcare professional should establish whether rates of emergency readmissions among patients with diabetes will reduce after the implementation of patient education at the time of discharge (Hussain et al., 2022). The healthcare provider should work closely with the patient and the healthcare team to ensure success.
Conclusion
This paper has utilized the four ‘As’ of EBP to conduct systematic research to determine the EBP guidelines for discharge planning for patients with diabetes. Published evidence supports the effectiveness of providing patient education at the time of discharge in reducing rates of emergency readmissions among patients with diabetes. Guided by this evidence, nurse leaders should ensure that nurses apply this evidence to enhance self-care management at home, promote safety, and improve health outcomes.
References
American Diabetes Association (ADA). (2022). Standards of Medical Care in Diabetes—2022: Abridged for Primary Care Providers. Clinical Diabetes, 40(1), 10-38. https://doi.org/10.2337/cd22-as01.
Black, R. L., & Duval, C. (2019). Diabetes Discharge planning and transitions of care: A focused review. Current Diabetes Reviews, 15(2), 111–117. https://doi.org/10.2174/1573399814666180711120830
Endocrine Society. (2022). Endocrine Society’s Clinical Practice Guideline offers recommendations for hospitalized patients with diabetes. https://www.endocrine.org/news-and-advocacy/news-room/2022/endocrine-societys-clinical-practice-guideline-offers-recommendations
Hussain, Z., Alkharaiji, M., & Idris, I. (2020). Evaluating the effect of inpatient diabetes education on length of stay, readmission rates and mortality rates: A systematic review. The British Journal of Diabetes, 20(2). doi:https://doi.org/10.15277/bjd.2020.256.
Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine, 98(39), e17209. https://doi.org/10.1097/MD.0000000000017209
Pinkhasova, D., Swami, J. B., Patel, N., Karslioglu-French, E., Hlasnik, D. S., Delisi, K. J., Donihi, A. C., Rubin, D. J., Siminerio, L. S., Wang, L., & Korytkowski, M. T. (2021). Patient understanding of discharge instructions for home diabetes self-management and risk for hospital readmission and emergency department visits. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 27(6), 561–566. https://doi.org/10.1016/j.eprac.2021.03.013
Rubin, D. J., Gogineni, P., Deak, A., Vaz, C., Watts, S., Recco, D., Dillard, F., Wu, J., Karunakaran, A., Kondamuri, N., Zhao, H., Naylor, M. D., Golden, S. H., & Allen, S. (2022). The Diabetes Transition of Hospital Care (DiaTOHC) Pilot Study: A randomized controlled trial of an intervention designed to reduce readmission risk of adults with diabetes. Journal of clinical medicine, 11(6), 1471. https://doi.org/10.3390/jcm11061471
The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide. https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf