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Database Relevant to Evidence Based Practice: Chronic Obstructive Pulmonary Disease

Adaeze Egbuaba

Capella University

Course Code: NURS-FPX4030

Professor: Lisa Hessheimer

Date: Nov 15, 2023

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Database Relevant to Evidence Based Practice: Chronic Obstructive Pulmonary Disease

Evidence-based practice (EBP) has become a critical aspect nursing practice. According

to Tlili et al. (2022), the growth in popularity of EBP is due to understanding and appreciation of

effective and justifiable decisions. Scholarly evidence indicates that EBP can reduce healthcare

costs, improve patient safety, and promote positive clinical outcomes (Tlili et al., 2022).

Evidence-based practice can be helpful in the management and treatment of various diseases,

including chronic obstructive pulmonary disease (COPD). COPD is considered a clinical and

economic burden to health systems (Vega-Olivo et al., 2022). Statistics from the World Health

Organization (WHO; 2023) indicate that COPD is among the leading source of mortality and

morbidity globally. This paper will explore the use of EBP to manage COPD based on one of the

nurses’ unfamiliarity with the diagnosis. In particular, this paper will focus on communication

and collaboration strategies to encourage the nurse to research COPD. Additionally, the paper

proposes several places to complete the study and sources for evidence for the clinical diagnosis.

Communication and Collaborative Strategies

Communication and collaboration are critical for promoting acceptance and adherence to

EBP. According to Li et al. (2018), communication impacts the implementation of EBP in a

healthcare setting. The new nurse can be encouraged to research more about the clinical

diagnosis through different communication and collaborative strategies. This paper proposes two

strategies: Communication channels and the nature of communication. First, the communication

should entail using credible or reliable channels. According to Dadich and Hosseinzadeh (2016),

communication channels shape how healthcare professionals engage and use EBP. Healthcare

professionals embrace information delivered through credible channels (Dadich & Hosseinzadeh,

2016). Some of the credible channels for encouraging the nurse to research the condition include

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official memos, calls or messages using office devices, scheduled meetings, emails, and

debriefing (Li et al., 2018).

Maintaining open and transparent communication with the nurse would also encourage

research into the diagnose. Sommerbakk et al. (2016) consider trustworthy and transparent

communication as a facilitator for the utilization of EBP in healthcare. Open and transparent

communication would encourage the nurse and other members to share their research findings

and findings (Kwame & Petrucka, 2021). Additionally, an open communication would enable

the nurse to seek for clarification on some of the findings. By sharing the research findings and

seeking clarification, the nurse will be collaborating with others in using EBP.

Best Places for Research

Evidence-based practice relies on obtaining reliable and credible information. According

to the American Nurses Association (2023), nurses need to obtain the best evidence to inform

their decisions and practice by exploring relevant publications or articles. From this

understanding, sources for EBP have to be filtered. Presently, there are several places to

complete the research. The first place to complete this research is medical/nursing databases.

Some notable databases are CINAHL Plus, Embase, Clinical Key, Clinicalkey Nursing, Pubmed,

and Cochrane Library (Seal, 2020). According to Seal (2020), these medical/nursing databases

contain credible resources for EBP. Another place to complete the research is in healthcare/

nursing journals. According to Rallison (2015), journals define and refine information. From this

understanding, journals ensure that only credible and reliable information is published. Some

notable nursing journals are the American Journal of Nursing, BMC Nursing, Journal of Clinical

Nursing, Evidence-based Nursing, Journal of Research in Nursing, The Journal of Nurse

Practitioners, and Clinical Nursing Research. Other places to complete the research are resources

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from professional associations and organizations, books, government health agencies, and school

libraries.

Complete research requires the use of various resources. The first resource to seek is

peer-reviewed medical journals and articles. Medical journals publish important resources for

research, including clinical trials, case reports, and studies related to healthcare issues.

Additionally, the research will seek literature reviews and meta-analyses from medical databases

such as PubMed or Embase. Other resources to seek during the research include textbooks and

reference materials, clinical practice guidelines, healthcare protocols and policies, conference

and symposium proceedings, and government health agencies and reports.

Sources and Rationale

The five sources of online information for locating evidence for clinical diagnosis of

COPD include PubMed, International Journal of Chronic Obstructive Pulmonary Disease, BMJ

Best Practice, World Health Organization (WHO) website, and Centers of Disease Control and

Prevention (CDC) website. The rationale for selecting these sources is because they provide

reliable and credible information. Accordingly, Pubmed, International Journal of COPD, and

BMJ Best Practice are peer-reviewed journals. As peer-reviewed, articles in these journals under

rigorous filtering to ensure that the information are of high quality of information. The CDC and

WHO websites are credible due to their openness and focus on applying scientific standards

(CDC, 2019).

Conclusion

The new nurse should be encouraged to embrace and deploy EBP in managing and

treating COPB. Evidence-based practice can reduce healthcare costs of managing and treating

COPB, which improves patient safety and positive clinical outcomes (Tlili et al., 2022). The new

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nurse needs to be encouraged to use EBP by using credible or reliable communication channels

and maintaining open and transparent communication. The best places to complete the research

include medical/nursing databases, healthcare/nursing journals, professional associations and

organizations, books, government health agencies, and school libraries. These platforms provide

resources for the research, including peer-reviewed medical journals and articles, literature

reviews and meta-analyses, textbooks and reference materials, clinical practice guidelines,

healthcare protocols and policies, conference and symposium proceedings, and government

health agencies and reports. By using these resources, the new nurse can implement EBP in

managing and treating COPD.

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References

American Nurses Association. (2023). What is evidence-based practice in nursing? Nursingworld.org.

https://www.nursingworld.org/practice-policy/nursing-excellence/evidence-based-practice-in-

nursing/

Centers of Disease Control and Prevention. (2019, November 21). CDC – Info Quality Support –

Guidelines – FAQs – Science Support – Science Quality – OSQ – OS. Www.cdc.gov.

https://www.cdc.gov/os/quality/support/info-qual.htm

Dadich, A., & Hosseinzadeh, H. (2016). Communication channels to promote evidence-based practice: a

survey of primary care clinicians to determine perceived effects. Health Research Policy and

Systems, 14(1). https://doi.org/10.1186/s12961-016-0134-z

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and

communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC

Nursing, 20(158), 1–10. https://doi.org/10.1186/s12912-021-00684-2

Li, S.-A., Jeffs, L., Barwick, M., & Stevens, B. (2018). Organizational contextual features that influence

the implementation of evidence-based practices across healthcare settings: a systematic

integrative review. Systematic Reviews, 7(1), 1–19. https://doi.org/10.1186/s13643-018-0734-5

Rallison, S. P. (2015). What are Journals for? The Annals of the Royal College of Surgeons of England.

https://doi.org/10.1308%2F003588414X14055925061397

Seal, S. (2020). Welch Medical Library Guides: Nursing Resources: Bibliographic Literature

Databases. Browse.welch.jhmi.edu. https://browse.welch.jhmi.edu/nursing_resources/databases-

clinical-tools

Sommerbakk, R., Haugen, D. F., Tjora, A., Kaasa, S., & Hjermstad, M. J. (2016). Barriers to and

facilitators for implementing quality improvements in palliative care – results from a qualitative

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interview study in Norway. BMC Palliative Care, 15(1). https://doi.org/10.1186/s12904-016-

0132-5

Tlili, M. A., Aouicha, W., Tarchoune, S., Sahli, J., Ben Dhiab, M., Chelbi, S., Mtiraoui, A., Ajmi, T.,

Ben Rejeb, M., & Mallouli, M. (2022). Predictors of evidence-based practice competency among

Tunisian nursing students. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-

03487-4

Vega-Olivo, M., Halpin, D. M. G., Han, M. K., Hanania, N. A., Kalhan, R., Lipson, D. A., MacIntyre,

N., Midwinter, D., Stiegler, M., Young, C., Martinez, F. J., & Criner, G. J. (2022). Best Practice

Management of Patients with Chronic Obstructive Pulmonary Disease: A Case-Based Review.

The Journal for Nurse Practitioners, 18(7), 730–735.

https://doi.org/10.1016/j.nurpra.2022.03.010

World Health Organization. (2023). Chronic obstructive pulmonary disease (COPD). World Health

Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-

pulmonary-disease-(copd)

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Assessment 01 – Locating Credible Databases and Research

Create a 2-4 page resource that will describe databases that are relevant to EBP around one of the diagnoses below and could be used to help a new hire nurse better engage in EBP.

Before you complete the instructions detailed in the courseroom, first select one of the diagnoses below. You will use this diagnosis in Assessments #2 and #3.

• Chronic Obstructive Pulmonary Disease (COPD): A chronic inflammatory lung disease that causes obstructed airflow from the lungs.

o Interventions: Bronchodilators, corticosteroids, pulmonary rehabilitation, oxygen therapy, and smoking cessation.

o Keywords: Emphysema, chronic bronchitis, spirometry, respiratory failure, inhalers.

• Acute Myocardial Infarction (AMI): Commonly known as a heart attack, it occurs when blood flow to a part of the heart is blocked.

o Interventions: Oxygen therapy, nitroglycerin, aspirin, beta-blockers, angioplasty, and patient education on lifestyle modifications.

o Keywords: Heart attack, coronary artery disease, EKG changes, troponin levels, cardiac catheterization.

• Stroke: A condition where blood flow to a part of the brain is cut off, leading to brain cell death.

o Interventions: Thrombolytic therapy, anticoagulants, physical therapy, speech therapy, and swallow evaluation.

o Keywords: Ischemic stroke, hemorrhagic stroke, transient ischemic attack, aphasia, neurologic deficits.

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Selecting a Model for Evidence-Based Practice Changes A Practical Approach

AACN Advanced Critical Care

Volume 19, Number 3, pp.291–300

© 2008, AACN

Anna Gawlinski, DNSc, RN, FAAN

Dana Rutledge, PhD, RN

Evidence-based practice models have been

developed to help nurses move evidence into

practice. Use of these models leads to an organ-

ized approach to evidence-based practice, pre-

vents incomplete implementation, and can

maximize use of nursing time and resources.

No one model of evidence-based practice is

present that meets the needs of all nursing envi-

ronments. This article outlines a systematic

process that can be used by organizations to

select an evidence-based practice model that

best meets the needs of their institution.

Keywords: evidence-based practice models,

evidence-based practice, models

A B S T R A C T

Factors related to patient safety, quality, and evidence-based practice (EBP) are driving

changes in healthcare. Nurses are interested in how to move good evidence into practice to optimize patients’ outcomes; thus, nurses may benefit from understanding more about EBP models. These models have been developed to help nurses conceptualize moving evidence into practice. They can assist nurses in focusing efforts derived either from clinical problems or from “good ideas” toward actual implementa- tion in a specific practice setting. Use of EBP models leads to systematic approaches to EBP, prevents incomplete implementation, promotes timely evaluation, and maximizes use of time and resources.

This article describes a systematic process for organizations to use as a template for choosing an EBP nursing model. Strategies for involving staff nurses and clinical and administrative leaders are discussed. Finally, a summary of key EBP nursing models is presented.

Creating Structures or Forums for Discussions The first step in selecting a model is to estab- lish a structure or a forum in which presenta-

Anna Gawlinski is Director, Evidence-Based Practice, and

Adjunct Professor, Ronald Reagan University of California, Los

Angeles Medical Center & University of California, Los Angeles

School of Nursing, 757 Westwood Plaza, Los Angeles, CA

90095 ([email protected]).

Dana Rutledge is Professor, Department of Nursing, California

State University Fullerton; and Nursing Research Facilitator,

Saint Joseph Hospital, Irvine, California.

tions and discussions can occur about various EBP models, their advantages and disadvan- tages, and their applicability to organizational needs. Several possible strategies include:

• use of an existing nursing research commit- tee in which selection of an EBP model is added to annual goals and activities;

• formation of an EBP council, with an initial task of selecting an EBP model;

• appointment of a task force charged with selecting an EBP model;

• use of an educational event to increase knowledge about EBP models while facili- tating the selection of a model appropriate for the organization; and

• use of a focus group process to select an EBP model consistent with the philosophy, vision, and mission of the organization.1

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Any of these strategies could help “set the stage” for an organization to choose an EBP model. For example, the authors used an existing nursing research committee/council to begin the process of selecting an EBP model in 2 different settings. In a third hospital, a multidisciplinary EBP council took on the task of selecting an EBP model. Regardless of the structure or the forum used, a thoughtful and systematic process is helpful.

Composition of the Committee or the Group The second step to identifying an EBP model is to carefully consider appropriate members of the committee or the group. Administrative and clinical leaders such as nurse managers, clinical nurse specialists, and nurse educators should be represented, as should interested staff nurses. Staff nurses who are clinical resources in their units, share an interest in improving patient care, or are curious about research are likely members. The educational level of the committee members should reflect that of nurses within the department or the institution and will most commonly include nurses with associate, bachelor’s, and master’s degrees. In addition, members should repre- sent the various clinical units/departments or specialties within the institution.

Involvement of persons with special expert- ise in research or EBP, such as a nurse researcher or faculty member from a local unit, hospital, or school of nursing, may be especially helpful. These persons may be internal or external to the organization and have valuable expertise in EBP nursing models. They can function as active members or as consultants. A librarian member may also be useful in retrieving needed publications to evaluate selected models.

The evaluation process and the number of EBP models that are considered can influence the desirable number of committee members. For example, at one institution (a university academic hospital), the nursing research council selected 7 EBP nursing models for review and evaluation. Table 1 lists the mod- els and shows the criteria used to evaluate them. These 7 models were chosen for evalua- tion either because they were commonly men- tioned in publications about EBP nursing models or because they were identified by committee members. At another institution (a community hospital), the nursing research council selected 4 EBP nursing models to eval-

uate on the basis of council members’ knowl- edge of the models’ utility and potential fit with the organization.

Involvement of all committee members in the evaluation process is vital. Using a process where 2 or 3 persons volunteer to review and present 1 to 2 EBP nursing models can get all members involved. Staff nurses can be paired with administrative or clinical leaders in teams of 2 to 3 persons. All committee members can then participate in the process of evaluating models by attending presentations about each model and actively participating in discus- sions. By having small groups present each model, the workload is divided among group members. The more people involved in the process, the greater the need for coordination and oversight by the chairperson.

Organizing the First Meeting Once the group has been selected, the next step is to organize the first meeting so that clear communication about the roles and responsibilities of team members can occur. The chairperson or the leader can survey the group members to determine the optimal date, time, and comfortable location for this meet- ing. Because of the nature of the work involved in selecting a model, 2 hours is an optimal duration for meetings. An agenda should accompany the meeting invitations and initially will include items such as discussions of the purpose and goals of the committee and the roles and responsibilities of committee members (Table 2). Providing a brief reading assignment that gives an overview of EBP models and should be completed before the first meeting is advisable. The chairperson can request committee members who are already knowledgeable about EBP models to highlight parts of the reading assignment at the first meeting to promote discussion. The chairper- son should also collaborate with unit leaders to ensure that staff nurses have appropriate release time for meetings.

Roles and Responsibilities of Committee or Members At the first meeting, roles and responsibilities of the members for reviewing, presenting, and evaluating each EBP model should be addressed. Assignments and due dates are determined to ensure steady progress. For example, a member can elect to work in a small group to review the literature on an EBP

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Table 1: Evaluation Criteria and Scoring for 7 Models of Evidence-Based Practice Changesa

Evaluation Criteria for EBP Model

Purpose of Project: Evaluation and selection of an EBP model for the Nursing Department of Ronald

Reagan University of California, Los Angeles Medical Center.

1. Search, retrieve, and synthesize the current literature describing EBP models to help staff nurses use

EBP concepts and apply them in clinical practice.

2. Recommend the adoption of a specific EBP model for use by UCLA nurses.

Scoring system: 0 � not present; �1 � present/yes; �2 � highly present/yes

Criteria Models

1. Concepts and organization of model are

clear and concise

2. Diagrammatic representation of the

model allows quick assimilation of

concepts and organizes the steps in the

process of EBP changes

3. The model is comprehensive from

beginning stages through implementation

and evaluation of outcomes

4. The model is easy to use when

concepts are applied to direct EBP

changes and practice issues in clinical

settings

5. The model is general and can be applied

to various populations of patients,

EBP projects, and department initiatives

and programs

6. The model can be easily applied to

typical practice issues as evidenced

with practice scenario or in published

literature

Total

Comments

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

a Used with permission from the Evidence-Based Practice Program, Nursing Department at Ronald Reagan University of California, Los

Angeles Medical Center, Los Angeles, California.

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model. Work teams should be assigned a pres- entation date to present details of the reviewed EBP model to committee members. Presenta- tions of each EBP model may take 30 to 45 minutes and might include information on the history and development of the EBP model (who, what, when, where, and how), revision of the model over time, overall concepts in the EBP model, the process and flow of the EBP model, and publications describing how the model guided EBP changes in other facilities.

Each presentation of an EBP model can be followed by 10 or 15 minutes for group mem- bers to raise questions and discuss specific aspects of the EBP model. After the presenta- tion and discussion, group members could review an example of how the EBP model might be applied in a realistic practice scenario that requires consideration of a practice change (Table 3). Group members could then use the EBP model under discussion to address the practice issue. Depending on the group’s size, this work can be done in small groups, with each small group slated to report back to the larger group its opinion about how the model “worked.” It is recommended that groups break into smaller groups of 2 or 3 persons to “rate” the models’ applicability on the basis of predetermined criteria (Table 4). Criteria for evaluating the applicability of the EBP model

should include clarity of the EBP model con- cepts and diagrammatic representation, appli- cability of the EBP model to clinical practice issues for diverse patient care situations in the institution, ease and user-friendliness of the EBP model, and the ability of the EBP model to pro- vide direction for all phases of the EBP process.

Table 1 shows an example of an evaluation tool that can be used by committee members when reviewing each EBP model. After the evaluation instrument is administered and scored, committee members can compare and contrast the ratings, strengths, and weaknesses for addressing the practice scenarios, and potential adoption by the institution for each model is reviewed.

The use of a structured process provides members with little or no background in evalu- ating an EBP model to learn about EBP models and have greater participation and support in the evaluation process. The link of the EBP model to practice is clear when the practice sce- nario is used. Members increase their knowl- edge and skills in using EBP models for practice changes and become champions for the adop- tion of a model within the organization.

Finally, the ongoing work of the committee should be communicated through forums such as mass e-mails, newsletters, posters, nursing grand rounds, and other continuing education programs. Such communication helps dissemi- nate the process used in selecting a model for the organization, while inviting others to par- ticipate via comments and feedback.

Summary of Selected EBP Nursing Models A number of EBP models have been devel- oped; many appear very different from each other. Some of these models are more useful in some contexts than others, and each has advantages and disadvantages. The following steps or phases are common to most models:

• Identification of a clinical problem or poten- tial problem

• Gathering of best evidence • Critical appraisal and evaluation of evi-

dence; when appropriate, determination of a potential change in practice

• Implementation of the practice change • Evaluation of practice change outcomes,

both in terms of adherence to processes and planned outcomes (eg, clinical, fiscal, administrative)

Table 2: Example of Agenda Items for the First Evidence-Based Practice Committee or Group Meeting

Welcome and introduce members

Review agenda

Discuss the goals of the committee

Discuss roles and responsibilities of committee

members

Select models for evaluation

Discuss the process for presenting and evaluating

evidence-based practice models

Make assignments and schedule

Identify resources and forms

Identify strategies to communicate ongoing

committee work to the department

Open discussion of other items

Plan for next meeting

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Table 3: Sample Practice Scenario for Evaluating Applicability of Models for Evidence- Based Practice Changesa

Scenario for Application of Evidence-Based Practice Nursing Models

Note: The following scenario includes selected literature on the subject for the purpose of providing a

clinical practice issue for use when applying EBP models. The following does not include an extensive or

integrated review of the literature on the subject.

Clinical Issue Suctioning patients who have endotracheal and tracheal tubes is a frequent and important nursing intervention.

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