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NUR 550 Evidence-Based Practice Project Proposal Identification of Nursing Practice Problem Assignment

NUR 550 Evidence-Based Practice Project Proposal Identification of Nursing Practice Problem Assignment

PICOT Draft

Name_____________________________________
Part 1: Propose a relevant nursing practice problem for an evidence-based practice project. Explain why you selected this topic and how it is relevant to advance nursing practice. Include one research article that demonstrates support for the nursing practice problem.

To provide optimal health care, nurses should work without being overwhelmed and always ready to serve all populations. However, the number of patients visiting health care facilities because of obesity and related complications has surged in the last decade. Some of the most at-risk population segments are school-age children and adolescents. My nursing practice problem for an evidence-based practice project is obesity among school-age children. Robinson et al. (2017) found that vulnerability to obesity has increased among children due to unhealthy lifestyles associated with sedentary living, such as watching television and gaming for a long time. I selected this topic since obesity is among the health care issues increasing mortality and morbidity rates in children as its prevalence increases. Being at risk of obesity implies that school-age children will be more exposed to chronic illnesses, such as heart disease and diabetes, and reduced quality of life (Che et al., 2018; De Lorenzo et al., 2019). Such adverse health outcomes increase illness burden in health care organizations, families, and society and increase nurses’ workload. In response, nurses should explore health care issues affecting population health and directly impacting their work and provide evidence-based interventions. I found the article by Stiglic and Viner (2019) to be relevant to the issue and directly supporting the nursing practice problem. Stiglic and Viner (2019) confirmed that obesity hampers children’s well-being, and interventions such as reducing screen time effectively reduce obesity rates. To improve health outcomes, nurses can also help patients and families to understand the risks of obesity and educate them on the recommended amount of screen time for children while encouraging parents to regulate the time that children spend on the screens.

Part II: In the table below, describe the population and the intervention. (You will continue drafting the PICOT, completing the shaded areas in Topic 3.)
PICOT Question
P Population School-age children with obesity
Obesity among school-age children has reached epidemic levels in the United States. De Lorenzo et al. (2019) described obesity as significant public health concern since it affects the physical, psychological, and cardiovascular health of the affected populations. Data from 2015-2016 shows that 1 in 5 children in the United States aged 6 to 19 years has obesity, and the rate has tripled since the 1970s (Centers for Disease Control and Prevention, 2018). Risk factors include poor eating habits, lack of physical activity, genetics, and negative childhood events. Therefore, immediate, evidence-based, and population-driven interventions are necessary to reduce the surging rates.
I Intervention Reducing screen time
Increased screen time is among the unhealthy lifestyles reducing the level of physical activity among school-age children. According to Robinson et al. (2017), screen media exposure increases obesity levels by encouraging more eating while viewing, reducing sleep duration, and increasing the possibility of taking sugary and low-nutrient foods. In addition, more screen time also exposes children to marketing that influences their eating habits and preferences. As a result, reducing screen time is a perfect intervention to keep children from these dangers to reduce obesity incidence.

NUR 550 Evidence-Based Practice Project Proposal Identification of Nursing Practice Problem Assignment

Learners will select a valid nursing practice problem for an evidence-based practice project proposal. The project will be completed in sections, beginning in NUR-550 and culminating in a final written paper detailing the evidence-based practice proposal in NUR-590.

The purpose of this assignment is to select a relevant nursing practice problem for your evidence-based practice project proposal. To identify a relevant problem, consider problems generally faced in nursing practice (coordination of health care, assessment, education, patient support, trauma prevention, recovery, health screenings, etc.).  Use the “PICOT Draft” template to complete this assignment.

 

NUR 550 Evidence-Based Practice Project Proposal Identification of Nursing Practice Problem Assignment

Use a national, state or local population health care database to research indicators of disparity. Choose a mortality/morbidity indicator to identify a clinical problem or issue that you want to explore pertaining to a population of focus. Use this indicator to begin to formulate a PICOT statement.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite one peer-reviewed source to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

RUBRIC

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NUR-550 Course Objectives

Description:

In this course, the student will:

  1. Explore research articles, nursing and related theories, applying levels of evidence, and theoretical frameworks to identify quality research studies.
    2. Demonstrate understanding of scientific inquiry, knowledge generation, utilization, and dissemination in advanced nursing practice.
    3. Evaluate the evidence for potential solutions/innovations that can potentially solve a health care issue and improve patient outcomes.
    4. Identify gaps in nursing knowledge and evidence-based practice that can potentially be resolved by planning and implementing a practice change project.
    5. Formulate a clinically researchable question amenable to an innovative evidence-based practice change proposal.
    6. Write a scholarly literature review that supports a clinically researchable question amenable to an innovative evidence-based practice change proposal.
    7. Evaluate health policy and advocacy issues for the purpose of improving health care outcomes.
    8. Engage in scientific inquiry into the state of health care delivery, patient-centered care, and ethical principles related to health beliefs, health promotion, and risk reduction of diverse populations.
    9. Propose quality improvement initiatives that advance the delivery of safe, high-quality health care.
    10. Use principles from epidemiology, biostatistics, genetics, genomics, and cultural competence to guide comparisons of various patient populations.

You are not required to submit this assignment to LopesWrite. t

PICOT Draft

Name_____________________________________

Part 1: Propose a relevant nursing practice problem for an evidence-based practice project. Explain why you selected this topic and how it is relevant to advance nursing practice. Include one research article that demonstrates support for the nursing practice problem.

Part II: In the table below, describe the population and the intervention. (You will continue drafting the PICOT, completing the shaded areas in Topic 3.)
PICOT Question
P Population
I Intervention
C Comparison
O Outcome
T Timeframe
PICOT

Problem Statement

Course Code Class Code Assignment Title Total Points
NUR-550 NUR-550-O503 Evidence-Based Practice Project Proposal: Identification of Nursing Practice Problem 10.0

Optional: ThinkingStorm

Description:

For additional information, the following is recommended:

ThinkingStorm is an online tutoring resource that provides flexible support to supplement traditional educational environments. The tutoring center is remotely accessible to GCU learners with a computer and an Internet connection and offers convenient hours for learners with busy schedules. ThinkingStorm tutoring includes a writing center that offers 24/7 submission-based writing support, as well as live writing support across the curriculum.

If you are interested in utilizing ThinkingStorm’s writing support, submit your documents chapter by chapter, rather than as a full manuscript.

To assist learners with their success at the university, GCU will pay for the first 10 hours of a learner’s annual ThinkingStorm activity. Learners are responsible for usage charges after the first 10 hours.

To access ThinkingStorm, click on the link provided and select the yellow “Go to ThinkingStorm” button.

Optional: Grammarly

Description:

For additional information, the following is recommended:

Grammarly is an online writing assistance application that reviews written submissions and suggests context-specific corrections for grammar, spelling, word usage, wordiness, style, punctuation, and plagiarism. The reasoning for each suggested correction is provided, allowing users to make informed decisions about how to correct writing issues.

Grammarly can be installed as free browser extension, though Grammarly Premium requires an annual subscription. This subscription is not a GCU-required purchase.

NUR-550 Course Objectives

Description:

In this course, the student will:

  1. Explore research articles, nursing and related theories, applying levels of evidence, and theoretical frameworks to identify quality research studies.
    2. Demonstrate understanding of scientific inquiry, knowledge generation, utilization, and dissemination in advanced nursing practice.
    3. Evaluate the evidence for potential solutions/innovations that can potentially solve a health care issue and improve patient outcomes.
    4. Identify gaps in nursing knowledge and evidence-based practice that can potentially be resolved by planning and implementing a practice change project.
    5. Formulate a clinically researchable question amenable to an innovative evidence-based practice change proposal.
    6. Write a scholarly literature review that supports a clinically researchable question amenable to an innovative evidence-based practice change proposal.
    7. Evaluate health policy and advocacy issues for the purpose of improving health care outcomes.
    8. Engage in scientific inquiry into the state of health care delivery, patient-centered care, and ethical principles related to health beliefs, health promotion, and risk reduction of diverse populations.
    9. Propose quality improvement initiatives that advance the delivery of safe, high-quality health care.
    10. Use principles from epidemiology, biostatistics, genetics, genomics, and cultural competence to guide comparisons of various patient populations.

 

Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (80.00%) Satisfactory (88.00%) Good (92.00%) Excellent (100.00%)
Content 100.0%

Population 25.0% The population is not described. The description for the population is incomplete, or the information for the population is inaccurate. A summary of the population is presented. More information is needed. Revision is required. The population is described. Minor detail is needed for clarity or accuracy. Minor revision is needed. The population is thoroughly and accurately described. No revision is needed.

Nursing Practice Problem (relevant to nursing practice, appropriate for an evidence-based practice project proposal, supported by current research) 35.0% A problem was not submitted. A proposed problem is presented but is not relevant to nursing practice. The nursing practice problem lacks support from current research. A new nursing practice problem must be selected. A relevant nursing practice problem for an EBP project proposal is presented and is generally supported by a current research article. Some information or revision is required. The explanation for why the topic is selected and its relevance to advance nursing practice is somewhat unclear. The nursing practice problem is conditionally approved; final approval is contingent upon revision. A relevant nursing practice problem for an EBP project proposal is presented and is adequately supported by a current research article. Minor revision is needed for the nursing practice problem. An explanation for why the topic is selected and its relevance to advance nursing practice is presented. The nursing practice problem is conditionally approved; final approval is contingent upon revision. The proposed problem is highly relevant to nursing practice, strongly supported by a current research article, and excellent for an evidence-based practice project. A clear explanation for why the topic is selected and relevant to advance nursing practice is presented. The nursing practice problem is approved. No revision is needed. 

Intervention 25.0% The proposed intervention is not described. The proposed intervention is incomplete, or the proposed intervention is not relevant to the population or problem. The proposed intervention is generally described and adequate to the nursing practice problem and the population. More information needed. Revision is required. The proposed intervention is described and adequate to the nursing practice problem and the population. Minor detail is needed for clarity. Minor revision is needed. The proposed intervention is clearly described and relevant to the nursing practice problem and the population. No revision is needed.

Required Sources 5.0% Sources are not included. Number of required sources is only partially met. Number of required sources is met, but sources are outdated or inappropriate. Number of required sources is met. Sources are current, but not all sources are appropriate for the assignment criteria and nursing content. Number of required resources is met. Sources are current and appropriate for the assignment criteria and nursing content. NUR 550 Evidence-Based Practice Project Proposal Identification of Nursing Practice Problem Assignment

Mechanics of Writing (includes spelling, punctuation, grammar, and language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is employed. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. The writer is clearly in command of standard, written, academic English. NUR 550 Evidence-Based Practice Project Proposal Identification of Nursing Practice Problem Assignment

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 5.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. “The writer is clearly in command of standard, written, academic English.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.”

Re: Topic 1 DQ 1

Evidence-based practice (EBP) is the process of combining evidence from studies, clinical expertise and patient values and preferences to come to a conclusion to promote the best patient-centered care (Nurse.com, 2021). However, it has been noted that much evidence-based practice takes time to be implemented into practice, and often does not progress past being published in a professional journal (Weiss et al., 2018). According to Titler (2018), there is a gap between EBP recommendations and the actual implementation of said recommendations to help improve patient care. Given this, translational research is utilized. Translational research is the process by which evidence-based interventions are incorporated into real-life, clinical settings (Melnyk & Fineout-Overholt, 2019). The process of translational research falls under the umbrella of translational science, in which EBP interventions are utilized and put into place to help improve patient care and outcomes, as well as the health of the overall population (Titler, 2018).

Although both EBP and translational research are related, they are not to be used interchangeably (Titler, 2018). According to Titler (2018), EBP is the application of evidence while translational research is the implementation of the evidence into practice. This includes executing knowledge, research designs and methods into real-life in practice, communities and public health settings. Translational research focuses on applying these EBP interventions to help improve patient outcomes, and to determine what strategies work for whom, why they work, and in what environment they work in (Titler, 2018).

There are five phases of translational research, which are known as “bedside to community” (Titler, 2018). The first phase, T0, refers to basic science research which includes preclinical and animal studies. After this, a phase 1 clinical trial must be done, to test the safety in a small group of humans, which is known as the T1 phase. The next phase of translational research, T3, includes both phase 2 and 3 clinical trials which tests the safety in a larger group of people and allows for comparison of common treatments. Phase four, or T4, includes phase 4 clinical trials and outcomes research which can be applied into practice. Lastly, phase five (T5) consists of a translation to the community, in which the larger population outcomes research is obtained (Titler, 2018). Translational research can be seen with the implementation of vaccinations. After evidence and research is conducted in regard to the particular disease and vaccine components, the application of the scientific evidence can be applied in trials to see how the product of the research can be used effectively in practice (Centers for Disease Control and Prevention, 2020).

References

Centers for Disease Control and Prevention. (2020, December 17). Topic area 5: Translational

          research. https://www.cdc.gov/niosh/programs/review/ecb/topic5.html

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing &

          healthcare: A guide to best practice. Wolters Kluwer.

Nurse.com. (2021). Evidence-based practice. https://www.nurse.com/evidence-based-practice

Titler, M. G. (2018). Translation Research in Practice: An Introduction. Online Journal of Issues

in Nursing, 23(2), 1. https://doi-org.lopes.idm.oclc.org/10.3912/OJIN.Vol23No02Man01

Weiss, M. E., Bobay, K. L., Johantgen, M., & Shirey, M. R. (2018). Aligning Evidence-Based

Practice With Translational Research: Opportunities for Clinical Practice Research.

JONA: The Journal of Nursing Administration, 48(9), 425–431.

https://doi-org.lopes.idm.oclc.org/10.1097/NNA.0000000000000644

https://doi-org.lopes.idm.oclc.org/10.1097/NNA.0000000000000644

https://doi-org.lopes.idm.oclc.org/10.1097/NNA.0000000000000644

The type of translational research conducted in this study was T1. T1 translational research involves the development of treatments and interventions (Vukotich, 2016). In this study, a multidisciplinary approach was employed to improve nutrition in preterm neonates. Although approved nutritional guidelines were in place, routine chart audits revealed noncompliance (Page et al., 2017). Therefore, an evidence–practice gap existed. The researchers’ goal was to identify barriers to the timely delivery of the appropriate nutrition in a tertiary‐level Neonatal Critical Care Unit through the development of an implementation project to ensure best practices (Page et al., 2017). Information was obtained via individual interviews with medical and nursing staff and digitally recorded with informed consent of the participants (Page et al., 2017). After analysis of the interview questions, the data highlighted inconsistent practice and a lack of adherence to guidelines regarding nutritional support as a barrier to achieving optimal early nutrition (Page et al., 2017). As a result of this study, appropriate and specific interventions were developed, implemented, and evaluated (Page et al., 2017).

T1 translational research was conducted because interventions were needed to increase compliance with following nutritional guidelines in the treatment of preterm neonates. New knowledge was gained to enhance patient care and improve patient outcomes. Furthermore, the interventions developed were intended to change behaviors and bridge the evidence–practice gap.

References

Page, D., Gilroy, M., Hurrion, E., Clark, L., & Wilkinson, S. (2017). Optimising early neonatal nutrition using translational research methodology. Nutrition & Dietetics74(5), 460–470. https://doi-org.lopes.idm.oclc.org/10.1111/1747-0080.12333

Vukotich, C. J., Jr. (2016). Challenges of T3 and T4 translational research. Journal of Research Practice12(2). Retrieved from http://jrp.icaap.org/index.php/jrp/article/view/552/454

Topic 1 DQ 2

Using the GCU Library (notably the GCU Library: Nursing and Health Sciences Research Guide), find a database, journal, or other collection of resources that focuses on translational research. Select a population health problem or issue of interest from the available studies. What type of translational research is used for the study? Provide rationale as to why this is the best.

Re: Topic 1 DQ 2

Incidences of stroke in the U.S. have declined in the past few years for the first time in history. However, stroke incidence among older adults has always been higher than younger adults, especially older women (Portz et al., 2018). Older adults of 80 years and above make about 17% of all stroke patients and are at high risk of mortality and prolonged hospital stays (Portz et al., 2018). This journal is in phase T4 type of translational research, where the information obtained in the previous stages is disseminated and implemented. This translational research aimed to investigate the impact of physical fitness and exercises for older adults with chronic stroke. A large body of literature has examined the correlation between self-management intervention such as physical fitness and exercise and chronic stroke. For instance, Schmid et al. (2014) observed that patients with chronic stroke showed physical improvements like body balance after enrolling in a yoga program that involved physical activities such as walking.

Based on the previous literature, Portz et al. (2018) used the information to investigate whether physical fitness and exercise would be used as a clinical intervention for managing chronic stroke. After implementing the information, Portz et al. (2018) found that it is essential for health care professionals to incorporate self-management interventions such as physical fitness and exercise in managing chronic stroke among older adults. This will improve their quality of life, strength, and endurance by incorporating yoga practice. Furthermore, this kind of research will encourage more health care researchers to conduct translational research to reach phase 4 (T4), where yoga practice can be used as an evidence-based intervention for chronic stroke.

References

Portz, J. D., Waddington, E., Atler, K. E., Van Puymbroeck, M., & Schmid, A. A. (2018). Self-management and yoga for older adults with chronic stroke: A mixed-methods study of physical fitness and physical activity. Clinical Gerontologist, 41(4), 374–381. https://doi-org.lopes.idm.oclc.org/10.1080/07317115.2016.1252453

Schmid, A. A., Miller, K. K., Van Puymbroeck, M., & DeBaun-Sprague, E. (2014). Yoga leads to multiple physical improvements after stroke, a pilot study. Complementary Therapies in Medicine, 22(6), 994–1000. https://doiorg.lopes.idm.oclc.org10.1016/j.ctim.2014.09.005

Topic 1 DQ 1

Identify the different levels of translational research. Explain how translational research is different from evidence-based practice and discuss application to population health management.

Re: Topic 1 DQ 1
Melnyk and Fineout-Overholt (2019) state translational research is often confused with evidence-based practice (EBP). The EBP process involves a critical appraisal of multiple bodies of evidence to make recommendations about patient care. EBP takes clinician expertise and combines it with multiple studies, patient/family preferences and values, to enhance health care quality, improve patient outcomes, reduce costs, and empower clinicians. Translational research, in comparison, studies how EBP interventions translate into real-world clinical settings. Also known as implementation science, translation science focuses on testing implementation interventions to improve the use of evidence to improve patient outcomes and population health (Titler, 2018). It also clarifies what implementation strategies work for whom, in what settings, and why. EBP is the actual application of evidence into practice, or the “doing of” where translational science is research steps to take discoveries “from the bench to the bedside and back again” (Fort et al., 2017).Although the concept of translational research has been widely used and applied in the scientific literature for more than a decade, and there is little agreement between definitions, five phases (T0-T4) remain as an emerging consensus (Fort et al., 2017).5 Phases of Translational Research

  • T1 involves processes that bring ideas from basic research through early testing in humans.
  • T2 involves the establishment of the effectiveness of an intervention in humans and particularly the establishment of clinical guidelines
  • T3 primarily focuses on the implementation and dissemination of research
  • T4 focuses on outcomes and effectiveness in populations
  • T0 phase is relatively rare but involves steps to close the research cycle, wrapping back around to basic research to T1

One reason governments fund research is for the value it provides to society at large (Luke et al., 2017). Benefits to translational research cover four domains: clinical and medical, community and public health, economic benefits, and policy/legislative.

Community and Public Health Specific Benefits

  • Health Promotion
    • Disease prevention/reduction
    • Life expectancy/quality of life
  • Characteristics of Health Care
    • Accessibility
    • Delivery
    • Quality
  • Health Activities and Products
    • Education resources
    • Community health services

Resources

Fort, D. G., Herr, T. M., Shaw, P. L., Gutzman, K. E., & Starren, J. B. (2017). Mapping the evolving definitions of translational research. Journal of Clinical and Translational Science1(1), 60–66. https://doi.org/10.1017/cts.2016.10

Luke, D. A., Sarli, C. C., Suiter, A. M., Carothers, B. J., Combs, T. B., Allen, J. L., Beers, C. E., & Evanoff, B. A. (2017). The translational science benefits model: A new framework for assessing the health and societal benefits of clinical and translational sciences. Clinical and Translational Science11(1), 77–84. https://doi.org/10.1111/cts.12495

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: a guide to best practice. Wolters Kluwer.

Titler, M. G. (2018). Translation Research in Practice: An Introduction. Online Journal of Issues in Nursing23(2), 1. https://doi.org/10.3912/OJIN.Vol23No02Man01

Topic 1 DQ 2

Using the GCU Library (notably the GCU Library: Nursing and Health Sciences Research Guide), find a database, journal, or other collection of resources that focuses on translational research. Select a population health problem or issue of interest from the available studies. What type of translational research is used for the study? Provide rationale as to why this is the best.

Re: Topic 1 DQ 2
According to the Centers for Disease Control (CDC), 34.2 million people in the United States have diabetes with 7.3 million people being undiagnosed with the highest percentage of 5.4 % being in individuals greater than or equal to 65 years of age (CDC, 2020). Of those that are undiagnosed, the highest percent of 4.6% is in the Asian and non-Hispanic population (CDC, 2020). When looking through the database I came across an article on Niclosamide ethanolamine salt (NEN) improving diabetes and diabetic kidney disease in mice. Diabetes is a problem worldwide and definitely leads to renal complications along with other challenges (Han et al., 2018). This study looked at the use of NEN and how it could improve diabetic symptoms in type 1 diabetes (T1D) as evidence has shown that it could improve diabetic symptoms in individuals with type 2 diabetes (T2D).In this study the use NEN was shown to increase serum insulin levels and slow the progression of diabetic kidney disease in T1D (Han et al., 2018). What I found interesting in this article was that the control mice showed high fasting blood glucose levels, hemoglobin A1c levels, and urine glucose levels and when treating other T1D mice with NEN for 8 weeks, the results showed that NEN significantly reduced the blood glucose levels in these mice (Han et al., 2018). This study could be promising for future treatment with T1D patients and slowing the progression of diabetic kidney disease. The testing in this study was performed on mice making this a T0 translational research study. This level/phase of translational research is best for this study so that no human subjects are harmed in the preclinical studies until the safety of the intervention has been determined.

References:

Centers for Disease Control and Prevention (CDC). (2020). Prevalence of both diagnosed and undiagnosed diabetes. https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed-diabetes.html

Han, P., Shao, M., Guo, L., Wang, W., Song, G., Yu, X., Zhang, C., Ge, N., Yi, T., Li, S., Du, H., & Sun, H. (2018). Niclosamide ethanolamine improves diabetes and diabetic kidney disease in mice. American Journal of Translational Research, 10(4), 1071-1084.

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