13 May NUR-4190 Evidence-Based Practice Intervention Planning Worksheet
Instructions: This worksheet is to be used for Written Assignment 5. Complete all sections of this worksheet to develop a comprehensive intervention plan. Your responses should be detailed enough that a colleague could implement your intervention in your absence. Use your textbook and the Tucker article listed in the Study Materials to guide your planning process.
Section 1: PICO/PIO Foundation
Primary intervention focus: Educational intervention
Section 2: Intervention Overview
Intervention title/name (should be the one identified in the PIO question):
Brief description (2-3 sentences):
Theoretical framework or model guiding your intervention:
Evidence supporting this intervention (cite 2-3 key sources):
Section 3: Target Population & Setting
Primary target population:
● Who (the RNs or the entire nursing staff etc?):
Implementation setting:
● Location(s):
● Physical space requirements:
● How will you communicate about this intervention to the participants and leadership:
Section 4: Educational Component
Learning objectives (minimum of 2 behavioral objectives): At the end of this educational session, participants will be able to:
1.
2.
3. (optional)
Teaching methods to be used:
Lecture/presentation
Demonstration
Hands-on practice
Case studies
Group discussion
Simulation
Online modules
Other (please specify):
Duration of educational session(s):
Materials/resources for learners:
How learning will be assessed/evaluated:
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