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Weekly Student Learning Objective #5 is addressed in this assignment.

How does a nurse, faced with a problem, begin the process of quality improvement? Hopp and Rittenmeyer (2021) indicate that armed with data, nurses use the best available literature to guide practice. 

Your assignment this week will spark your curiosity about how nurse leaders spur change. You are probably aware of problems at work that you would like to review. Nurse leaders drive quality improvement processes. This week, we are asking you to use an evidence-based approach to a problem.

The problem should be related to leadership and management concepts that we are studying in this course. You can focus on best practice quidelines, improving work environments, promoting safety, and/or system change. Some examples of issues that require system change may be medication errors among nurses who work 12 hour shifts on your unit, or increased re-admissions of cardiac surgery patients after discharge.  Other examples might be absenteeism among nurses on a particular care unit; or decreasing patient fall rates in the ICU; or improving change of shift reporting among nurses.  These are just a sample of the many types of problems that you might choose for this assignment.  Still, other examples or ideas may be found in Chapter 23 of your Marquis and Huston textbook.    

 

1. Identify a current problem within a health care work environment that requires a quality improvement initiative. 

2. Imagine you are asked to lead an evidence-based initiative that addresses the problem. You are asked to develop a PICO question to narrow and specify your problem. The PICO question will guide your search for the best available evidence. Here’s some helpful hints… 

**Please review the Presentation on EBP Questions and Search Strategy (29:00) and the information found under the ‘Evidence-based practice’ tab of the course Library Guide for additional information on PICO question writing and levels of evidence. The Worksheet to assist in creating a PICO question and search strategy does not have to be submitted. This is only for assistance in creating the PICO. 

The PICO elements needed for a good research question are:

P- population: be specific about that population. As an example, if you are interested in retention rates of nurses, be as specific as you can about the population. Perhaps you are interested in newly graduated nurses’ working on a medical-surgical unit. Think about how best to describe the population? 

I- intervention- be specific about the intervention your population receives. You will be searching for the highest level of evidence in the literature. Remember, you are not doing a research project. Instead, you are trying to find the best available evidence to support a change and/or quality improvement intervention.  Another thing to think about – is this a nurse specific intervention? Practice changes that involve other stakeholders (managers and/or inter-disciplinary team members) would also require them to be at the table.

C-comparison Who is your comparison group? Did half the group in the study receive the intervention and the other half did not? The literature will tell you the answer. In the example of newly graduated nurses, some interventions might be a formal orientation program, assignment of a mentor, or the establishment of a clinical ladder. Whereas, the comparison could be newly graduated nurses that did not receive the intervention.  

O- outcome what outcome do you want to measure? Ex. retention rates on the medical surgical unit with intervention versus without.  

Here is an example of a well-written PICO question addressing a hand hygiene practice initiative: What is the effectiveness of offering mandatory training sessions (I) compared to posting signs in the hospital (C) on improving adherence to the hospital hand hygiene protocol (O) among nurses in the ICU (P)?

Make sure to write your PICO question in the assignment. Label the parts of the question to receive all points. 

3. Search for a minimum of three (maximum of five) research (scholarly) articles published within the last 10 years that relate to the chosen problem. Note: Focus on higher levels of evidence whenever available.  Use APA format to reference each article at the end of your assignment. 

4. Summarize and synthesize the evidence as it relates to your question. 

a. Summarizing your article means that you are articulating general findings in your own words for each of the three (3) articles cited on your reference list.

b. Synthesizing is applying the findings to the problem you have identified in step 1. 

SCIENCE
HEALTH SCIENCE
NURSING