PICOT and EBP Assignment: Finding the Research Evidence Continuing on with step one of the Impact Model is the need to search for the studies to support your project. There are different classes of evidence that can guide changes in clinical practice. To prepare for this Assignment, review the following: Write a 2-page paper (exclusing title page and reference page) to address the following: • For the evidence-based problem that you identified in Week 1 for your project, locate two different articles/sources representing two different types of evidence from the following categories: (a) systematic review, (b) national clinical guidelines and/or (c) peer-reviewed quantitative / qualitative studies. PICOT and EBP Assignment: Finding the Research Evidence.

 Evidence-Based Practice Paper Guide

 Impact Model

(Source:  Brown, S. (2014). Evidence-based nursing: The research practice connection.  Burlington, MA:  Jones and Bartlett Learning.) PICOT and EBP Assignment: Finding the Research Evidence.

 

Step 1                  Ask and Search

 	
ASK– identify evidence-based practice (EBP) question

Write in PICO format

P –  patient population

I  –  intervention/issue

C – comparison intervention

O – outcome(s)

 

For example, in patients with acute myocardial infarction, does ambulation within the first 24 hours as compared to those who remain on bed rest for the first 48 hours result in increased participation in cardiac rehabilitation following discharge from the hospital?

 

Be sure to have your project approved by your Instructor before continuing with the steps.

 

Assignment Week 1:  Submit the completed Evidence-Based Problem and Question Template to the Week 1 Assignment link. (Refer to the grading rubric in Course Information for assignment details.)

 

 

 	
SEARCH

Identify search terms and search engines.  Find a minimum of five EBP articles that have been published within the last 5 years.  Be sure to look at the systematic reviews and the national clinical practice guidelines. PICOT and EBP Assignment: Finding the Research Evidence.

 

Assignment Week 2:  Submit a 1- to 2-page paper describing two sources
of evidence you have found, where they fit in the hierarchy of evidence, and the value of these sources in better understanding your evidence-based practice problem.  Summarize the findings in the literature that you retrieved. Submit to the Week 2 assignment link. (Refer to the grading rubric in Course Information for assignment details.)

 

Step 2                        Appraise the literature

 

Critique each article using the appropriate Appraisal Guide provided in Week 4 Resources. In the final paper, a critique of at least five of the articles used for your project will need to be submitted.

 

PICOT and EBP Assignment: Finding the Research Evidence Assignment Week 4:  Submit critiques of two of the articles using the appropriate Appraisal Guide provided to the Week 4 Resources. (Refer to the grading rubric in Course Information for assignment details.)

 

 

Step 3                         Design the project

 

Describe each step of the project clearly and completely.  Clearly explain the recommended evidence-based change including the setting, health care consumers affected, and the rationale for the change.

 

Assignment Week 5:  Submit a 2- to 3-page paper discussing your EBP plan.  Include the PICO clinical question, recommended change in practice, and the evidence to support the plan. (Refer to the grading rubric in Course Information for assignment details.)

 

 

Step 4                          EBP

 

The final step is to discuss how the outcomes from the plan will be evaluated.  Identify the criteria that will be used to measure the effectiveness of the change.  For example, how many individuals following an acute myocardial infarction are participating in or have participated in the cardiac rehabilitation program? The final EBP plan needs to be developed into a power point for posting in the classroom. PICOT and EBP Assignment: Finding the Research Evidence.

 

Assignment Week 6: Develop a voice over PowerPoint presentation.

Post the presentation in the Week 6 Discussion board by Day 3. Use the week 6 submission link to submit the final copy of the PowerPoint to your Instructor for grading. (Refer to the grading rubric in Course Information for assignment details.)

 

Evidence_based_practice

T
he idea of sharing clinical experiences to improve patient care is not new to
nurses. Florence Nightingale published her observations on cleanliness, nutrition,
and fresh air in Notes on Nursing1 in 1860. Her work was the start of evidence-based
nursing practice. More than 150 years and thousands of research studies later, the
use of evidence to guide nursing practice is the expected standard of practice for both
individual nurses and health care organizations. Scope and Standards of Practice2 and Code of Ethics3
of the American Nurses Association both call for nurses to incorporate research evidence into
clinical practice. Schools of nursing have added content on evidence-based practice to their curricula.4 Despite these efforts, barriers inhibit implementation of changes based on published evidence
into bedside patient care. Overall, the barriers involve the characteristics of the nursing profession,
organizational dynamics, and the nature of the research.5,6 Studies7,8 have consistently indicated
that a nurse’s inability to both determine what evidence is ready for implementation into practice
and then successfully develop processes to sustain an evidence-based practice change is a barrier.
Choosing the Best PICOT and EBP Assignment: Finding the Research Evidence
Evidence to Guide Clinical
Practice: Application of
AACN Levels of Evidence
MARY H. PETERSON, RN, DNP, MSN, NEA-BC
SUSAN BARNASON, RN, PhD, APRN-CNS, CEN, CCRN
BILL DONNELLY, RN, PMBA, BS, CCRN
KATHLEEN HILL, RN, MSN, CCNS
HELEN MILEY, RN, PhD, AG-ACNP, CCRN
LISA RIGGS, RN, MSN, APRN, CCRN
KIMBERLY WHITEMAN, RN, DNP, CCRN
©2014 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ccn2014411
Evidence-Based Practice
Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its
use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of
practice for nurses and health care organizations, but numerous barriers exist that create a gap between new
knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts
and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the
strength of research studies, assess the findings, and evaluate the evidence for potential implementation into
best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in
practice. (Critical Care Nurse. 2014;34[2]:58-68)
58 CriticalCareNurse Vol 34, No. 2, APRIL 2014 www.ccnonline.org
In this article, we provide a brief history of the involvement of the American Association of Critical-Care
Nurses (AACN) in evidence-based practice, explain the
recent clarifications added to the 2009 AACN levels of
evidence, and provide examples of how to change bedside practice in the clinical setting.
History of AACN Involvement in
Evidence-Based Practice
Currently, AACN is the largest specialty nursing
organization and a leader in the movement to improve
patient care by applying the best scientific evidence. In
1995, AACN began to publish Protocols for Practice, an
evidence-based resource for clinical nurses. Each protocol provides a guide for appropriate selection of patients,
use and application of management principles, initial
and ongoing monitoring, discontinuation of therapies
or interventions, and selected aspects of quality control.
The protocols have covered topics such as hemodynamic
monitoring and care for patients treated with mechanical
ventilation. Subsequently, a volunteer workgroup was
formed to connect clinicians with research to improve
care of critically ill patients. The original research workgroup, known since 2007 as the Evidence-Based Practice
Resources Workgroup (EBPRWG), focused on developing resources that synthesized current research. Resources
were made readily available and in an easy-to-use format
for use in care decisions at the bedside (eg, laminated
pocket-sized cards for clinicians). The work of this group
has continued for more than 2 decades. Current products available to AACN members include protocols for
practice; practice alerts with tool kits, PowerPoint presentations, and audit tools; pocket card references; and
defined levels of evidence for clinical nursing practice.
Evolution of AACN Levels of Evidence
The amount and availability of research supporting
evidence-based practice can be both useful and overwhelming for critical care clinicians. Therefore, clinicians
must critically evaluate research before attempting to put
the findings into practice. Evaluation of research generally occurs on 2 levels: rating or grading the evidence by
using a formal level-of-evidence system and individually
critiquing the
quality of the
study. Determining the
level of evidence is a key
component of
appraising the evidence.5,9,10 Levels or hierarchies of evidence are used to evaluate and grade evidence. The purpose of determining the level of evidence and then
critiquing the study is to ensure that the evidence is credible (eg, reliable and valid) and appropriate for inclusion
into practice.10 Critique questions and checklists are
available in most nursing research and evidence-based
practice texts to use as a starting point in evaluation.
The most common method used to classify or determine the level of evidence is to rate the evidence according to the methodological rigor or design of the research
study.10,11 The rigor of a study refers to the strict precision
or exactness of the design. In general, findings from
experimental research are considered stronger than findings from nonexperimental studies, and similar findings
from more than 1 study are considered stronger than
results of single studies. Systematic reviews of randomized controlled trials are considered the highest level of
evidence, despite the inability to provide answers to all
questions in clinical practice.11,12 For example, AACN
and other organizations have done extensive research
on healthy work environments. This topic would not be
examined in a randomized controlled trial because of
ethical and practical considerations. Randomly assigning nurses to work in various healthy or unhealthy work
Authors
Mary H. Peterson is an educator for Elsevier, Inc Live Review and
Testing, Houston, Texas and a cardiovascular clinical nurse specialist.
Susan Barnason is director of the DNP program at the University of
Nebraska Medical Center in Lincoln.
Bill Donnelly is a critical care staff nurse at Cooley Dickinson Hospital,
Northampton, Massachusetts.
Kathleen Hill is a clinical nurse specialist in the surgical intensive
care unit at Cleveland Clinic, Cleveland, Ohio.
Helen Miley is a specialty director adult-gero acute care nurse practitioner at Rutgers, The State University, Newark, New Jersey.
Lisa Riggs is director of cardiovascular quality at Saint Luke’s Hospital
of Kansas City, Kansas City, Missouri.
Kimberly Whiteman is codirector of the DNP program at Waynesburg
University, Waynesburg, Pennsylvania.
Corresponding author: Mary H. Peterson, 543 Westwood Road, Alexander City, AL
35010 (e-mail: petermh@uab.edu).
To purchase electronic or print reprints, contact the American Association of CriticalCare Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949)
362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org.
www.ccnonline.org CriticalCareNurse Vol 34, No. 2, APRIL 2014 59
The purpose of determining the level of
evidence and then critiquing the study is
to ensure that the evidence is credible
(eg, reliable and valid) and appropriate
for inclusion into practice.
environments could have an adverse effect on the quality
and safety of patients receiving care. Therefore, most of
the studies on healthy work environments have involved
descriptive or qualitative study designs. Although the less
rigorous design places descriptive and qualitative studies
at a lower level than that of randomized control trials on
the AACN rating system, the lower level is the highest
level of evidence that the information on healthy work
environments can ethically and practically provide.
AACN Evidence-Rating System
As interest in promoting evidence-based practice has
grown, many professional organizations have adopted
criteria to evaluate evidence and develop evidence-based
guidelines for their members.5,12 A task force formed by
AACN developed the organization’s original rating scale,
which used Roman numerals; lower numerals represented
lower levels
of evidence. In
1995, the
time of the
original AACN rating scale, only a few other organizations had published levels of evidence. Other professional
hierarchies used a reverse order, with lower Roman
numerals reflecting higher levels of evidence. This difference led to confusion among practitioners who were trying to use the original rating system in the clinical setting.13
In 2008, AACN challenged the EBPRWG to review the
rating system and make recommendations for improvement. The result was an alphabetical hierarchy in which
the highest form of evidence was ranked as A and included
meta-analyses and meta-syntheses of the results of controlled trials. Evidence from controlled trials was rated
B. Level C evidence included findings from studies with
a variety of research designs (Table 1). As in the previously published rating system, the 2008 system included
results of theory-based evidence, expert opinion, and
multiple case reports as level E evidence. Rapid
advances in technology resulted in many products being
used solely on the basis of the manufacturers’ recommendations. M was used to represent the body of practice recommendations provided by industry.14
When the 2008 hierarchy of evidence was published,
AACN welcomed feedback from its members about the
changes. Since then, members have asked for clarification on the hierarchy, particularly an explanation of the
rating of systematic reviews. Most rating systems rank