Evidence-Based Practice Project

Course Project: Introduction to Course Project Evidence-based practice involves a great deal more than simply reading nursing periodicals on a regular basis. Nurses can take a more proactive approach to evidence-based practice by identifying authentic problems and concerns, and then using that to guide their inquiries into current research.

In this way, nurses can connect the results of relevant research studies to their nursing practice. For the Course Project, you identify and apply relevant research to a specific nursing topic or problem.

 You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the Course Project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice. Before you begin, review the Course Project Overview document located in this week’s Learning Resources.

Note: This Course Project will serve as the Portfolio Assignment for the course. In addition to submitting portions of this Project in Weeks 2 and 5, you will turn in all three deliverables inWeek 10. Project: Course Project: Part 1�€”Identifying a Researchable Problem One of the most challenging aspects of EBP is to actually identify the answerable question.

 �€”Karen Sue Davies Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis.

 It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICO model�€”patient/population, intervention/issue, comparison, and outcome�€”outlined in the Learning Resources to design your questions.

To prepare: •     Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICO model for guiding the development of research questions.

•               Review the section beginning on page 75 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.

•             Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.

• Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.

•    Formulate a preliminary PICO question�€”one that is answerable�€”based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question? Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

•             Using the PICO variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question. To complete: Write a 3- to 4-page paper that includes the following:

•          A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

• The 5 questions you have generated and a description of how you analyzed them for feasibility

•             Your preliminary PICO question and a description of each PICO variable relevant to your question •         At least 10 possible keywords that could be used when conducting a literature search for your PICO question and a rationale for your selections

This Project Assignment is due by Day 7. It will also be a component of your Portfolio Assignment for this course, which is due by Day 7 of Week 10. Reference: Davies, K. S. (2011).

Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75�€”80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144 Required Resources Note:

To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Readings

•    Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

o             Chapter 3, “Key Concepts and Steps in Qualitative and Quantitative Research” (for review) o      Chapter 4, “Research Problems, Research Questions, and Hypotheses” This chapter focuses on the steps in planning a study to generate evidence. These include developing a research question, identifying variables, articulating a problem statement, and generating hypotheses.

o             Chapter 7, “Ethics in Nursing Research” In this chapter, the focus is on the ethical dilemmas that occur when planning and conducting research and the ethical principles that have been enacted for protecting study participants. • Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3�€”14. Retrieved from the Walden Library databases.

This article describes a literature review conducted to determine the most important ethical issues that nurses encounter when undertaking or participating in research. The authors detail the results of the review and make recommendations for solving some of the problems highlighted.

• Newcomb, P. (2010). Evolving fairness in research on human subjects. Journal of Child and Adolescent Psychiatric Nursing, 23(3), 123�€”124. Retrieved from the Walden Library databases.

In this article, the author describes some of the ethical controversies that may arise in conducting research in human subjects, especially with respect to ownership of genes. The author also stresses the importance of educating research subjects and their families about the ultimate purpose of research.

•        Yakov, G., Shilo, Y., & Shor, T. (2010). Nurses’ perceptions of ethical issues related to patients’ rights law. Nursing Ethics, 17(4), 501�€”510. Retrieved from the Walden Library databases. The authors of this article detail a study conducted to determine how nursing staff deal with ethical issues in relation to the law.

The article emphasizes the difficulty staff had in distinguishing between legal and ethical problems. The authors make several recommendations to deal with legal and ethical problems.

• Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks.Evidence Based Library and Information Practice, 6(2), 75�€”80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144 This article reviews the frameworks commonly used to assist in generating answerable research questions.

The author recommends considering the individual elements of the frameworks as interchangeable (depending upon the situation), rather than trying to fit a situation to a specific framework.

 Delwiche, F. (2008). Anatomy of a scholarly research article in the health sciences. Retrieved fromhttp://danaguides.uvm.edu/content.php?pid=41591&sid=3177873 This article highlights the primary components of scholarly research articles. The article details the distinguishing factors of scholarly journals, the peer-review process, and the definition of “primary literature.”

•             American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf This website provides the code of ethics for nurses to be used in carrying out their responsibilities. There is also a detailed explanation of each provision.

 •            Document: Course Project Overview (Word document) Note: You will use this document to complete the Project throughout this course. Media • Laureate Education, Inc. (Executive Producer). (2012a). Anatomy of a research study. Baltimore, MD: Author.

This multimedia piece explains the “anatomy” of both quantitative and qualitative research studies. In addition, there is a brief quiz at the end of the tutorial to measure knowledge about research articles.

•             Laureate Education, Inc. (Executive Producer). (2012d). Evidence-based practice and research.Baltimore, MD: Author. In this video, Dr. Marianne Chulay talks about the significance of evidence-based practice and research in nursing. She explains how nurses should apply research findings to health care decisions to improve outcomes.

•             Laureate Education, Inc. (Executive Producer). (2012h). Overview of evidence-based practice.Baltimore, MD: Author. In this video, Dr. Kristen Mauk explains evidence-based practice and its importance to nursing. She also provides a brief overview of the process of conducting original research. Optional Resources

• National Institutes of Health Office of Extramural Research. (2011).  Protecting human research participants. Retrieved from http://phrp.nihtraining.com/users/login.php This website provides a course on ethical research for those involved in research in human subjects. The course supplies basic concepts, principles, and issues relevant to protecting research participants. • University of Oxford. (2005). PICO: Formulating an answerable question.

 Retrieved from http://learntech.physiol.ox.ac.uk/cochrane_tutorial/cochlibd0e84.php Please proceed to the Discussion. Return to top Evidence Based Library and Information Practice Commentary Formulating the Evidence Based Practice Question: A Review of the Frameworks Karen Sue DaviesAssistant Professor, School of Information Studies University of Wisconsin�€”MilwaukeeMilwaukee, Wisconsin, United States of America Email: daviesk@uwm.edu Received: 17 Jan. 2011 Accepted: 04 Apr. 2011 2011 Davies.

This is an Open Access article distributed under the terms of the Creative Commons-Attribution- Noncommercial-Share Alike License 2.5 Canada (org/licenses/by-nc-sa/2.5/ca/”>http://creativecommons.org/licenses/by-nc-sa/2.5/ca/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly attributed, not used for commercial purposes, and, if transformed, the resulting work is redistributed under the same or similar license to this one.

Evidence Based Library and Information Practice 2011, 6.2 Introduction Questions are the driving force behind evidence based practice (EBP) (Eldredge, 2000). If there were no questions, EBP would be unnecessary. Evidence based practice questions focus on practical real-world problems and issues. The more urgent the question, the greater the need to place it in an EBP context.

One of the most challenging aspects of EBP is to actually identify the answerable question. This ability to identify the question is fundamental to then locating relevant information to answer the question.

An unstructured collection of keywords can retrieve irrelevant literature, which wastes time and effort eliminating inappropriate information. Successfully retrieving relevant information begins with a clearly defined, well-structured question. A standardized format or framework for asking questions helps focus on the key elements.

Question generation also enables a period of reflection. Is this the information I am really looking for? Why I am looking for this information? Is there another option to pursue first?

This paper writing introduces the first published framework, PICO (Richardson, Wilson, Nishikawa and Hayward, 1995) and some of its later variations including ECLIPSE (Wildridge and Bell, 2002) and SPICE (Booth, 2004). Sample library and information science (LIS) questions are provided to illustrate the use of these frameworks to answer questions in disciplines other than medicine.

Booth (2006) published a broad overview of developing answerable research questions which also considered whether variations to the original PICO framework were justifiable and worthwhile.

This paper will expand on that work. 75 Question Frameworks in Practice PICO The concept of PICO was introduced in 1995 by Richardson et al. to break down clinical questions into searchable keywords. This mnemonic helps address these questions:

P – Patient or Problem: Who is the patient? What are the most important characteristics of the patient? What is the primary problem, disease, or co-existing condition?I �€” Intervention: What is the main intervention being considered?C �€”

Comparison: What is the main comparison intervention?O – Outcome: What are the anticipated measures, improvements, or affects? Medical Scenario and Question: An overweight woman in her forties has never travelled by airplane before.

She is planning an anniversary holiday with her husband including several long flights. She is concerned about the risk of deep vein thrombosis. She would like to know if compression stockings are effective in preventing this condition or whether a few exercises during the flight would be enough. P �€” Patient / Problem: Female, middle-aged, overweight
I �€” Intervention: Compression stockings
C �€” Comparison: In-flight exercises
O �€” Outcome: Prevent deep vein thrombosis

The PICO framework and its variations were developed to answer health-related questions. With a slight modification, this framework can structure questions related to LIS.

The P in PICO refers to patient, but substituting population for patient provides a question format for all areas of librarianship. The population may be children, teens, seniors, those from a specific ethnic group, those with a common goal (e.g., job-seekers), or those with a common interest (such as a gardening club).

 The intervention is the new concept being considered, such as longer opening hours, a reading club, after-school activity, resources in a particular language, or the introduction of wi-fi. LIS Scenario and Question: Art history master’s students submit theses with more bibliography errors than those from students of other faculties.

The Dean of art history raised this issue with the head librarian. The head librarian suggested that database training could help.P �€” Population: Art History master’s students I �€” Intervention: database searching training C �€” Comparison: students with no training or students from other FacultiesO �€”

Outcome: Improved bibliographic quality Table 1 illustrates the different components introduced in several PICO framework variations. Fineout-Overholt and Johnson (2005) considered the questioning behavior of nurses.

They suggested a five-component scheme for evidence based practice questions using the acronym PICOT, with T representing timeframe. This refers to one or more time-related variables such as the length of time the treatment should be prescribed or the point at which the outcome is measured. A PICOT question in the LIS field is:

In a specialist library, does posting the monthly library bulletin on the Website instead of only having printed newsletters available result in increased usage of the library and the new resources mentioned in the bulletin?

In this question, the timeframe refers to a month. Petticrew and Roberts (2005) suggested PICOC as an alternative ending to PICOT, with C representing context. For example, what is the context for intervention delivery? In LIS, context could be a public library, academic library, or health library. A variation similar to PICOT is PICOTT.

In this instance, neither T relates to timeframe. The Ts refer to the type of question and the best type of study design to answer that particular question (Schardt, Adams, Owens, Keitz, and Fontelo, 2007). An example LIS question is: In a specialist library, does instant messaging or e-mail messaging result in the greatest customer satisfaction with a virtual reference service?

This type of question is user analysis, and a relevant type of study design is Evidence Based Library and Information Practice 2011, 6.2 76 Evidence Based Library and Information Practice 2011, 6.2 Table 1
 Components of the Different PICO-based Frameworks Richardson et al., 1995 Fineout- Overholt & Johnson, 2005 Petticrew & Roberts, 2005 Schardt et al., 2007 ADAPTE Collaboration, 2009 Dawes et al., 2007
Schlosser & O’Neil-Pirozzi, 2006 DiCenso, Guyatt, & Ciliska, 2005 a questionnaire. The PICOTT framework may be too restrictive when searching. If you are searching for effective Websites then transaction log analysis would be a reasonable type of study design.

By limiting to that study type you would miss user observation studies, focus groups, and controlled experiments. These frameworks should focus the search strategy, while not excluding potentially useful and relevant information. Specifically developed for building and adapting oncology guidelines is PIPOH (ADAPTE Collaboration, 2009).

The second P refers to professionals (to whom the guideline will be targeted) and H stands for health care setting and context (in which the adapted guideline will be used). An example of this in the LIS setting would be:What is appropriate training for fieldwork students working on the library’s issue or circulation desk?P �€”

Population: Library usersI �€” Intervention: TrainingP �€” Professionals: Fieldwork studentsO �€” Outcome:S �€” Setting: Issue or circulation desk Dawes et al. (2007) developed PECODR and undertook a pilot study to determine whether this structure existed in medical journal abstracts.

E refers to exposure, replacing 77 Patient / Population Intervention Comparison Outcome Timeframe Context Type of Question Type of Study Design Professionals Health Care Setting Exposure Duration Results Environment Stakeholders Situation intervention to allow the inclusion of different study types such as case control studies and cohort studies.

The D stands for duration, either the length of time of the exposure or until the outcome is assessed. The R refers to results. Here is a sample LIS question: Does teaching database searching skills to postgraduate students in a hands-on workshop compared to a lecture result in effective skills to utilize throughout two or more years of study?

Duration would be the length of the postgraduate course (2+ years), and results could be defined as effective searching skills. Schlosser and O’Neil-Pirozzi (2006) proposed PESICO which applied to the field of fluency disorders and speech language pathology. E refers to the environment or the context in which the problem occurs, and S stands for stakeholders. Stakeholders are an important consideration in certain library settings.

LIS Scenario and Question:

Each year, library staff accompany new university students on an introductory library tour. The tour is time- consuming and may not be appropriate for new students who have much information to absorb in their first few days.

Library staff and student instructors suggested that staff post a virtual library tour on the Website. It can be accessed at a time and place to suit the student,andmay improvetheir understanding of library services. P �€”

Population: New university students E �€” Environment: LibraryS �€” Stakeholders: Library staff and student instructorsI �€” Intervention: Virtual library tourC �€” Comparison: Physical library tourO �€”

Outcome: Improved understanding of library services Many of the adapted PICO frameworks introduce terms worth consideration depending on the subject, area, topic, or question.

The elements which are additions to the original PICO framework could serve as filters to be reviewed after gathering the initial PICO search results. They can help determine the relevance of initial search results.

For example, consider filtering on context when determining if the results from a rural public library service are directly applicable to a large endowed university library. DiCenso, Guyatt, and Ciliska (2005) suggested that questions which can best be answered with qualitative information require just two components.

Such questions may focus on the meaning of an experience or problem. P �€” Population: The characteristics of individuals, families, groups, or communities S �€” Situation: An understanding of the condition, experiences, circumstances, or situation This framework focuses on these two key elements of the question.

An LIS example is: In a public library, should all library staff who have face-to-face, telephone, or e-mail contact with users attend a customer awareness course?
P – Population: Library staff with user contact S – Situation: Customer awareness course ECLIPSE PICO and its variations were all developed to answer clinical questions. Within the medical field there are other types of questions which need to be answered. ECLIPSE was developed to address questions from the health policy and management area (Wildridge and Bell, 2002). E �€”

 Expectation: Why does the user want the information?C – Client Group: For whom is the service intended? L �€” Location: Where is the service physically sited?I �€” Impact: What is the service change being evaluated? What would represent success? How is this measured? This component is similar to outcomes of the PICO framework. P �€” Professionals: Who provides or improves the service? SE �€” Service: What type of service is under consideration?

Evidence Based Library and Information Practice 2011, 6.2 78 LIS Scenario and Question: There have been user complaints about the current Interlibrary Loan (ILL) service. What alternatives might improve customer satisfaction? E �€” Expectation: Improve customer satisfaction C – Client group: Library users who request ILLsL �€” Location: Library I �€” Impact: Improve the ILL service P �€”

Professionals: ILL staffSE �€” Service: ILL SPICE The previous frameworks can all be adapted to answer LIS questions. One framework, SPICE, was developed specifically to answer questions in this field (Booth, 2004): S �€” Setting: What is the context for the question?

The research evidence should reflect the context or the research findings may not be transferable.
P �€” Perspective: Who are the users, potential users, or stakeholders of the service?
I �€” Intervention: What is being done for the users, potential users, or stakeholders?
C �€” Comparison: What are the alternatives? An alternative might maintain the status quo and change nothing.
E �€” Evaluation: What measurement will determine the intervention’s success? In other words, what is the result?

The SPICE framework specifically includes stakeholders under P for perspective and is therefore similar to the PESICO framework. LIS Question: In presentations to library benefactors, does the use of outcome-based library service evaluations improve their perceptions of the importance and value of library services? S �€” Setting: Library presentation to funders P �€” Perspective: Library benefactors
I �€” Intervention: Outcome-based evaluations of library services
C �€” Comparison: Other evaluations
E �€”

Evaluation: Improved perception of the importance and value of library services Some of these additional concepts are related. Context, environment, and setting have similar connotations, and duration is similar to timeframe.

This suggests that the options for constructing well-defined questions are not as numerous as Table 1 suggests. Combining comparable and related terms would provide the following concepts:P �€” Population or problemI �€”

Intervention or exposure C �€” Comparison
O �€” Outcome
C �€” Context or environment or setting
P �€” Professionals
R �€” Research �€” incorporating type of question and type of study design R �€” Results
S �€” Stakeholder or perspective or potential users
T �€” Timeframe or duration Conclusion These frameworks are tools to guide the search strategy formation.

 A minor adaption to the medical question frameworks, usually something as simple as changing patient to population, enables the structuring of questions from all the library and information science domains. Rather than consider all of these frameworks as essentially different, it is useful to examine the different elements: timeframe, duration, context, (health care) setting, environment, type of question, type of study design, professionals, exposure, results, stakeholders, and situation.

These can be used interchangeably when required. Maintaining an awareness of the different options for structuring searches broadens the potential uses of the frameworks. Detailed knowledge of the frameworks also enables the searcher to refine strategies to suit each particular situation rather than trying to fit a search situation to a framework. Evidence Based Library and Information Practice 2011, 6.2 79


 The ADAPTE Collaboration. (2009). The ADAPTE process: Resource toolkit for guideline adaption (version 2). Retrieved from http://www.g-i- n.net/document-store/adapte- resource-toolkit-guideline-adaptation- version-2 Booth, A. (2004). Formulating answerable questions. In A. Booth & A. Brice (Eds.), Evidence based practice for information professionals: A handbook (pp.61-70). London: Facet Publishing. Booth, A. (2006). Clear and present questions: Formulating questions for evidence based practice. Library Hi Tech, 24(3), 355-68. doi:10.1108/07378830610692127

Dawes, M., Pluye, P., Shea, L., Grad, R., Greenberg, A., & Nie, J.Y. (2007). The identification of clinically important elements within medical journal abstracts: Patient population problem, exposure intervention, comparison, outcome, duration and results (PECODR). Informatics in Primary Care, 15(1), 9-16. DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St Louis, MO: Elsevier

Mosby. Eldredge, J. D. (2000). Evidence-based librarianship: An overview. Bulletin of the Medical Library Association, 88(4), 289-302. Fineout-Overholt, E., & Johnson, L. (2005). Teaching EBP: Asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing, 2(3), 157-60. doi: 10.1111/j.1741- 6787.2005.00032.x

 Nollan, R., Fineout-Overholt, E., & Stephenson, P. (2005). Asking compelling clinical questions. In B. M. Melnyk & E. Fineout-Overholt (Eds.). Evidence-based practice in nursing and healthcare: A guide to best practice (pp.25-37). Philadelphia: Lippincott, Williams & Wilkins. Evidence Based Library and Information Practice 2011, 6.2

Petticrew M., & Roberts, H. (2005). Systematic reviews in the social sciences: A practical guide. Malden, MA: Blackwell Publishing. Richardson, W. S., Wilson, M. C., Nishikawa, J., & Hayward, R. S. A. (1995). The well-built clinical question: A key to evidence-based decisions. ACP Journal Club, 123, A12-13. Schardt, C., Adams, M. B., Owens, T., Keitz, S., & Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics and Decision Making, 7, 16. doi:10.1186/1472-6947-7-16

Schlosser, R. W., & O’Neil-Pirozzi, T. (Spring, 2006). Problem formulation in evidence-based practice and systematic reviews. Contemporary Issues in Communication Sciences and Disorders, 33, 5-10. Wildridge, V., & Bell, L. (2002). How CLIP became ECLIPSE: A mnemonic to assist in searching for health policy/management information. Health Information and Libraries Journal, 19(2), 113-115. doi: 10.1046/j.1471- 1842.2002.00378.x 80

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