Evidence-Based-Practice Proposal

HLT 490V Selecting the Problem, Purpose, and Question Introduction

Advancing an original point of view either in a written or oral format (often a combination of both) as a result of research done at a master's level is called a thesis; completed at a doctoral level, it is called a dissertation. For the professional capstone project proposal, however, students do not conduct original research; they prepare an evidence-based practice plan for a project whose focus is the resolution of an issue or clinical problem significant to improving patient care.

Project Overview

Capstone projects, or professional project proposals, serve to demonstrate and integrate what students have learned over the course of their curriculum. The final challenge is for students to analyze and resolve a managerial, clinical, health care issue or patient problem.

Students will develop a proposal that may include an intervention, a policy change, or other type of solution. In an evidence-based project, the student becomes familiar not only with the problem but with all of the pros and cons of the solution through their reading, analyzing, and synthesizing of relevant literature. The goal is to articulate recommendations, in a written format, for practice based on existing research findings.

Knowing what and knowing how, with regard to leadership and management theories, will be inherent parts of the project. Students will want to ensure that they discuss social, economic, and political environments, as well as how their project is affected by, or affects, those environments.

Decisions in practice are made from a position of experience, authority, and solid evidence. Students' critical thinking skills also will be demonstrated by the development of this project.

Capstone projects offer students the opportunity to demonstrate their ability to synthesize, integrate, and apply the best clinical evidence. It also gives them an opportunity to demonstrate newly acquired communication skills and to explain how those communication skills can be used for disseminating the findings of the project.

The project proposal should reflect a synthesis and integration of program content and professional practice. To demonstrate integration of many concepts, consider how the values and perceptions of patients influence health; a clinician may wish to relate short stories to demonstrate how he/she employed the clinical process in the spiritual care of adults, for example. Regardless of your idea, the entire project proposal should revolve around evidence-based practice.

Selecting a Problem

Clinical problems are often derived from practice or from theory. For this project, the problem selected should address an issue related to patient care quality. The problem statement should be stated clearly and with enough contextual detail to establish why it is important. Just as in clinical research, which is a systematic gathering of information (Macnee, 2004), the project should be a summary of what the evidence says.

Problems in clinical situations promote the development of clinical questions. The problem is that one question usually leads to ten more, making it more difficult to narrow the question. Finding the answer to the problem is finding and asking the right clinical question. Questions can be answered generally in four ways.

1) Consulting an authority to answer the question.

2) Using intuition and subjective judgment to answer the question.

3) Turning to experience to answer the question

4) Reading clinical research to find an answer to the question (Macnee, 2004, p. 4)

Describing the Purpose

The purpose statement is exactly as it sounds, it is a statement about what the researcher will be accomplishing through the implementation of his/her project. This statement is closely aligned with the problem statement, but worded in such a way that it guides readers to understand the issue to be resolved.

The PICO question is usually buried in the purpose statement, because the purpose statement usually includes the population, and the dependent and independent variables. For instance, one problem may be the rising cost of heart failure. It is significant to clinical practice because providing ways to keep patients who are diagnosed with heart failure out of the hospital decreases direct and indirect costs. The purpose of this study may be to evaluate if telephonic programs are cost effective. My PICO question may read as follows:

P	Patients diagnosed with heart failure
I	Telephonic programs
C	Heart failure clinics
O	Decrease readmission rates

How to Ask the Question

Bridging the gap from research to clinical practice can be accomplished by multiple means, but the first step is knowing how to ask the question.

It is no longer acceptable for clinicians to simply surf the Internet or pull out old teaching material when questions are being asked by peers, patients, and families. Relying on knowledge that does not come from current, valid research is no longer acceptable. The public expects clinicians to know how to clinically appraise the evidence used in clinical practice (Melnyk and Fineout-Overholt, 2004).

Remember the seven levels of evidence? These can guide the search:

Level 1 – From a systematic review or meta-analysis of all RCT or EB clinical practice guidelines based on systematic reviews of RCT

Level 2 – From at least one well designed RCT

Level 3 – From at least one well designed controlled trial without randomization

Level 4 – From a well-designed case control and cohort studies

Level 5 – From a systematic review of descriptive and qualitative studies

Level 6 – From a single descriptive or qualitative study

Level 7 – From the opinion of authorities and/or reports of expert committees

Answering Questions

According to Macnee (2004, p. 4), four commonly used approaches to answering questions posed by patients include:

1) Consulting an authority to answer the question

2) Using intuition and subjective judgment to answer the question

3) Turning to experience to answer the question

4) Reading nursing research to find an answer to the question

"Knowledge is what is understood and recognized about a subject" (Macnee, 2004, p.7), and finding the answer to certain questions to increase our knowledge can be a difficult task. Figuring out what the question is can be an even harder task.

Finding answers to questions can be very time consuming. How often have you searched the Internet or databases for something specific yet still could not find what you were looking for? How many research papers have been read, only to discover that they were not about what it was thought they were?

According to Melnyk and Fineout-Overholt (2004), there are two types of questions: background questions and foreground questions. Background questions ask for general information about a clinical issue, and foreground questions are those that can be answered from scientific evidence. Melnyk and Fineout-Overholt give the following examples:

Background question: How does acetaminophen work to affect fever?

Foreground question: Which is more effective in reducing fevers in children, acetaminophen or ibuprofen?

CONCLUSION:

The key to a successful evidence based project is to ensure that each step of the process is done well. As each step of the process builds off each other, if one step is not completed thoroughly, then following steps will be completed from poor work. Remember the term, garbage in, garbage out. Having a complete understanding of the problem will allow the student to create a strong purpose statement and question.

REFERENCES:

Macnee, C. (2004). Understanding nursing research: reading and using research in practice. Philadelphia: Lippincott Williams & Wilkins.

Melnyk, B. & Fineout-Overholt, E. (2004). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.