Evidence Based Practice Poster Presenter: ______________________ Date: ___________ PICO Question: _________________________ Total Points: ___ Category 4 3 2 1 Significance/Backgrou nd to the Problem PICO Question Identification In-depth coverage of topic, topic is relevant to nursing practice research-based information, outstanding clarity, PICO question complete Good coverage of topic, topic is appropriate to nursing practice basis in sound, research-based information, PICO question complete Minimal coverage of topic, topic is appropriate to nursing practice, PICO question complete Minimal to no coverage of topic, topic is not relevant to nursing practice, not based on research-based information, PICO incomplete/ or not included Literature Appraisal (Appendix G) Minimum of 10 peer-reviewed full text articles written in last 5 years or less. All articles are relevant to EBP problem and provides clear evidenced based recommendation s. Minimum of 10 peer-reviewed full texted articles written in 5 years or less. 8-9 articles relevant to EBP problem and provides clear evidenced based recommendation s. Minimum of 10 peer-reviewed articles, full texted articles, articles written in more than 5 years. 7-8 articles relevant to EBP problem and provides clear evidenced based recommendation s. Less than 10 peer reviewed full texted articles written in 5 years or less. Less than 7 articles relevant to EBP problem and provides clear evidenced based recommendation s. Project Recommendations Clear and concise summary of evidenced based recommendation from appraisal of articles. Two recommendation s to answer PICO question. Clear and concise summary of evidenced based recommendation from appraisal of articles. One recommendation to answer PICO question. Recommendatio ns lacks concision or may be irrelevant to PICO question. One recommendation to answer PICO question. Recommendatio n lacks relevance to PICO question, or none given. References (Submitted with Appendix G) Reference page in Word document typed in 12 font, APA format for each article. Reference page in Word document typed in 12 font, APA format for each article. Missing references. Reference page in Word document, typed in 12 font, APA format incorrect. Missing references. Reference page not included. Slide (Poster) Appearance Attractive, easy to interpret, pleasing colors with high contrast, slide presentation well-organized, excellent use of bullets, and graphics which enhance the presentation of the content Attractive, easy to interpret, pleasing colors with good contrast, slide presentation organ ...

1. Evidence Based Practice Poster
Presenter: ______________________ Date: ___________
PICO Question: _________________________ Total Points:
___
Category 4 3 2 1
Significance/Backgrou
nd to the Problem
PICO Question
Identification
In-depth
coverage of
topic, topic is
relevant to
nursing practice
research-based

2. information,
outstanding
clarity, PICO
question
complete
Good coverage
of topic, topic is
appropriate to
nursing practice
basis in sound,
research-based
information,
PICO question
complete
Minimal
coverage of
topic, topic is
appropriate to

3. nursing practice,
PICO question
complete
Minimal to no
coverage of
topic, topic is
not relevant to
nursing practice,
not based on
research-based
information,
PICO
incomplete/ or
not included
Literature Appraisal
(Appendix G)
Minimum of 10
peer-reviewed

4. full text articles
written in last 5
years or less. All
articles are
relevant to EBP
problem and
provides clear
evidenced based
recommendation
s.
Minimum of 10
peer-reviewed
full texted
articles written
in 5 years or
less. 8-9 articles

5. relevant to EBP
problem and
provides clear
evidenced based
recommendation
s.
Minimum of 10
peer-reviewed
articles, full
texted articles,
articles written
in more than 5
years. 7-8
articles relevant
to EBP problem
and provides
clear evidenced

6. based
recommendation
s.
Less than 10
peer reviewed
full texted
articles written
in 5 years or
less. Less than 7
articles relevant
to EBP problem
and provides
clear evidenced
based
recommendation
s.

7. Project
Recommendations
Clear and
concise
summary of
evidenced based
recommendation
from appraisal
of articles. Two
recommendation
s to answer
PICO question.
Clear and
concise
summary of
evidenced based

8. recommendation
from appraisal of
articles. One
recommendation
to answer PICO
question.
Recommendatio
ns lacks
concision or may
be irrelevant to
PICO question.
One
recommendation
to answer PICO
question.

9. Recommendatio
n lacks
relevance to
PICO question,
or none given.
References
(Submitted with
Appendix G)
Reference page
in Word
document typed
in 12 font, APA
format for each
article.
Reference page

10. in Word
document typed
in 12 font, APA
format for each
article. Missing
references.
Reference page
in Word
document, typed
in 12 font, APA
format incorrect.
Missing
references.
Reference page
not included.

11. Slide (Poster)
Appearance
Attractive, easy
to interpret,
pleasing colors
with high
contrast, slide
presentation
well-organized,
excellent use of
bullets, and
graphics which
enhance the
presentation of
the content
Attractive, easy
to interpret,

12. pleasing colors
with good
contrast, slide
presentation
organized, good
use of bullets,
and graphics
which enhance
the presentation
of the content
Attractive,
difficult to
interpret,
pleasing colors
with high
contrast, slide
presentation
disorganized,

13. bullets, and
graphics detract
from the content
Unattractive,
difficult to
interpret, poor
color choice and
slide contrast,
slide
presentation
unorganized,
bullets, and
graphics detract
from the content
Grading Scale:
20 points = 100%
19 points = 98%

14. 18 points = 96%
17 points = 93%
16 points= 90%
15 points = 87%
14 points = 84%
13 points = 81%
12 points = 79%
11 points = 77%
10 points = 75%
09 points = 73%
08 points = 70%
07 points = 68%
06 points = 66%
05 points = 64%
1. What is the problem?
Many elderly patients often complain of back ache and are put
on steroid epidural injections. Clinicians have the number of
these epidural injections limited. The main problem that led to
this study is the increased immobility among the patients who
are put on long term epidural steroids.2. Why is the problem
important and relevant? What would happen if it were not

15. addressed?
It is important to focus on the wholeness of the patient.
Considering the possible outcomes of the therapy. If left
unaddressed, some patients are left immobile many of which are
the bread winners and this leaves the family in great loss and
the burden of taking care of their patient.3. What is the current
practice?
Currently, clinicians prescribe limited doses for patients with
back pain. This temporarily reduces the pain and inflammation
and promotes patient’s comfort. In some instances, patients may
be placed on long term use of these steroids.
4. How was the problem identified? (Check all that apply)
(x)Safety and risk-management concerns
(x)Quality concerns (efficiency, effectiveness, timeliness,
equity, patient-centeredness)
(x)Unsatisfactory patient, staff, or organizational outcomes
· Variations in practice within the setting
(x)Variations in practice compared to community standard
· Current practice that has not been validated
· Financial concerns5. What are the PICO components?
P – (Patient, population, or problem). The problem is common
in patients who are elderly and have back pain. These patients
have history of manual work during their lifetime that have to
led to the chronic back pain.
I – (Intervention) administration of alternative drugs for the
management of back pain, for instance NSAIDS.
C – (Comparison with other interventions, if foreground
question). The use of NSAID is far much safer to patient
compared to the epidural steroids for back pain since it does not
have serious complications like the steroids.
O – (Outcomes are qualitative or quantitative measures to
determine the success of change). Increasing mobility in patient
who have back pain and prevent further damage of the spine
bones.6. Initial EBP question ❑Background ❑Foreground
The continuous use of epidural steroids.

16. JohnsHopkinsNursingEvidence-BasedPractice
AppendixB:QuestionDevelopmentTool
JohnsHopkinsNursingEvidence-BasedPracticeAppendix B
Question Development Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University
School of Nursing
7. List possible search terms, databases to search, and search
strategies.
Epidural steroids
Steroids for back pain
8. What evidence must be gathered? (Check all that apply)
( x) Publications (e.g., EBSCOHost, PubMed, CINAHL,
Embase)
(x)Standards (regulatory, professional, community)
Guidelines
· (x)Organizational data (e.g., QI, financial data, local clinical
expertise, patient/family preferences)
· Position statements9. Revised EBP question
(Revisions in the EBP question may not be evident until after
the initial evidence review; the revision can be in the
background question or a change from the background to a
foregroundquestion)
10. Outcome measurement plan
What will we measure?
(structure, process, outcome measure)
How will we measure it?
(metrics are expressed as rate or percent)
How often will we measure it?
(frequency)

17. Where will we obtain the data?
Who will collect the data?
To whom will we report the data?
The degree of immobility in patients receiving epidural steroid,
especially the elderly.
The number of patient s who have become immobile after a
long-term administration of epidural steroids, divided by the
total number of patients receiving epidural steroids multiplied
by one hundred.
Measurement can be taken after every 18 months (1.5 years)
From hospital and rehabilitation centers.
Researchers.
The research leader.
References
Epstein N. E. (2013). The risks of epidural and transforaminal
steroid injections in the Spine: Commentary and a
comprehensive review of the literature. Surgical neurology
international, 4(Suppl 2), S74–S93.
https://doi.org/10.4103/2152-7806.109446
Mayo Clinic. 2021. Steroid Injections for Back Pain: Why
Limited Dosing? [online] Available at:
<https://www.mayoclinic.org/diseases-conditions/back-
pain/expert-answers/epidural-steroid-injections/faq-20058277>

18. [Accessed 8 January 2021].
Directions for Use of the Question Development ToolPurpose
This for

19. misusedtodevelopananswerableEBPquestionandtoguidetheteam
intheevidencesearchprocess.Thequestion,searchterms,searchstrat
egy,and
sourcesofevidencecanberevisedastheEBPteamrefinestheEBPques
tion.
What is the problem, and why is it important?
Indicate why the project was undertaken. What led the team to
seek evidence? Ensure that the problem statement defines the
actual problem and does not
includeasolution.Wheneverpossible,quantifytheextentoftheprobl
em.Validate the final problem description with practicing staff.
It is important for the inter-
professionalteamtotakethetimetogethertoreflect,gatherinformatio
n,observe
currentpractice,listentoclinicians,visualizehowtheprocesscanbed
ifferentor
improved,andprobetheproblemdescriptioninordertodevelopashar
edunderstandingoftheproblem.
What is the current practice?
Definethecurrentpracticeasitrelatestotheproblem.Thinkaboutcurr
entpoliciesandprocedures.Observepractices.Whatdoyousee?
How was the problem identified?
Check all the statements that apply.
What are the PICO components?
P(patient,population,problem)e.g.,age,sex,setting,ethnicity,cond
ition,disease,
typeofpatient,orpopulation
I(intervention)e.g.,treatment,medication,education,diagnostictes
t,orbest practice(s)
C (comparison with other interventions or current practice for
foreground questions; is not applicable for background
questions, which identify best practice)
O (outcomes) stated in measurable terms; may be a structure, a
process, or an outcome measure based on the desired change
(e.g., decrease in falls, decrease in length of stay, increase in
patient satisfaction)

20. Initial EBP question
A starting question (usually a background question) that is often
refined and adjusted as the team searches through the literature:
· Background questions are broad and are used when the team
has little knowledge, experience, or expertise in the area of
interest. Background questions are often used to identify best
practices.
· Foreground questions are focused, with specific comparisons
of two or more ideas or interventions. Foreground questions
provide specific bodies of evidence related to the EBP question.
Foreground questions often flow from an initial background
question and literature review.
List possible search terms, databases to search, and search
strategies.
Using PICO components and the initial EBP question, list
search terms. Terms can be added or adjusted throughout the
evidence search. Document the search terms, search strategy,
and databases queried in sufficient detail forreplication.What
evidence must be gathered?
Check the types of evidence the team will gather based on the
PICO and initial EBP question.
Revised EBP question
Often, the question that you start with may not be the final EBP
question. Back- ground questions can be refined or changed to a
foreground question based on the evidence review. Foreground
questions are focused questions that include specific
comparisons and produce a narrower range of evidence.
Measurement plan
Measurescanbeaddedorchangedasthereviewoftheliteratureisc omp
leted andthetranslationplanningbegins:
· A measure is an amount or a degree of something, such as
number of falls with injury. Each measure must be converted to
a metric, which is calculated before and after implementing the
change.

21. · Metrics let you know whether the change was successful. They
have a numerator and a denominator and are typically expressed
as rates or percent. For example, a metric for the measure falls -
with-injury would be the number of falls with injury
(numerator) divided by 1,000 patient days (denominator). Other
examples of metrics include the number of direct care RNs
(numerator) on a unit divided by the total number of direct care
staff (denominator); the number of medication errors divided by
1,000 orders.
Running head: EVIDENCE-BASED PRACTICE 1
EVIDENCE-BASED PRACTICE 2
Evidence-Based Practice: Level and Quality of Research Article
Evidence-Based Practice: Level and Quality of Research Article
The article selected was Epidural Steroid Injection Therapy for
Low Back Pain: a meta-analysis by Choi, Hahn, Kim, Jang,
Park, Lee, Chung, and Park (2013). The article aimed at
systematically assessing the long-term advantages of injections
of epidural steroid for low-back pain patients. The article is a
Level I article because it is an experimental study with
randomized control trials. The article also embodies explanatory
mixed method designs that contain only Level I quantitative

22. study. The article includes systematic reviews of Randomized
Controlled Trials with meta-analysis, which is characteristic of
Level I articles.
The article is a high quality article. This is because it conveys
its formation in a greatly structured manner. It’s title succinctly
reflects the content of the study and it provides five important
keywords used in the study. The article also gives a clear
background of information about the study as well as the aims
of the study. The gap in literature is well conveyed which
justifies the need for the study. The article is consistent and the
materials and methods used in the study are clearly defined. The
information provided is specified and it clearly demonstrates
how the study is planning on achieving its aims. This is one of
the most important characteristics of a high quality article
according to Guyatt et al. (2018).
Additionally, the article is high quality because it uses
sufficient sample size for the study design and provides
generalizable results (John Hopkins Nursing Evidence-Based
Practice, 2017). The results are well-analyzed and presented in
a manner that any average reader would comprehend. The
discussion provided in the article shows insights into the
meaning and importance of the research findings. The article
offers definitive conclusions which are clearly stated and can be
validated by the study. The article also uses comprehensive
literature review to provide its recommendations which makes
them consistent. All these characteristics justify the article as
high quality.

23. References
Choi, H. J., Hahn, S., Kim, C. H., Jang, B. H., Park, S., Lee, S.
M., ... & Park, B. J. (2013). Epidural steroid injection therapy
for low back pain: a meta-analysis. International journal of
technology assessment in health care, 29(3), 244-253.
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter,
Y., Alonso-Coello, P., & Schünemann, H. J. (2018). GRADE: an
emerging consensus on rating quality of evidence and strength
of recommendations. Bmj, 336(7650), 924-926.
John Hopkins Nursing Evidence-Based Practice. (2017).
Appendix D: Evidence Level and Quality Guide. John Hopkins
University School of Nursing.
Date: 25 January, 2021.
EBP Question: The Use of Steroids Injections for Chronic or
Acute Pain
Article Number
Author and Date
Evidence Type
Sample, Sample Size, Setting
Findings That Help Answer the EBP Question
Observable Measures
Limitations

24. Evidence Level, Quality
1.
Choi, H. J., Hahn, S., Kim, C. H., Jang, B. H., Park, S., Lee, S.
M., ... & Park, B. J. (2013).
Systematic review of RCTs, with meta- analysis
29 articles of randomized control trials of database searches
· Epidural steroid injection did not provide improvement of
back pain disability more other methods.
· Epidural steroid injection failed to decrease the number of
patients that attended subsequent surgery.
· Weight mean difference.
· Number of months.
· Percent confidence interval.
The article did not provide evidence-based recommendations for
the results.
Level I
High Quality
2.
El Abd, O., Amadera, J., Pimentel, D. C., & Gomba, L. (2015).
Explanatory mixed method design that includes only a level I
quantitative study
150 consecutive patients receiving TFSI.
Setting is a spine center associated with a rehabilitation
hospital.
· Transforaminal Epidural Steroid Injections with
dexamethasone offers minor self-limited transient adverse
effects which can be managed easily.
· Adverse effects in a period if two weeks.

25. · Intensity and duration of side effects.
The sample size enrolled was too small to provide proper
evidence of the results.
Level I
Good quality
3.
Brose, S. W., Montfort, J., Gustafson, K. J., Mittebrun, I.,
Gauriloff, S., Mosher, M., & Bourbeau, D. J. (2017).
Opinion of respected authorities
1 Patient
70-year-old man with paraplegia suffering from multifocal
degenerative wrist pain.
· Corticosteroid injection of the pisotriquetral joint under
ultrasound guidance is effective in the management of wrist
pain stemming from that joint.
· Bleeding and bruising after injections.
· Pain resolution after the injections
The sample size is way too low to draw any evidence-based
conclusions.
Level IV
Good Quality.
4.
Kennedy, D. J., Plastaras, C., Casey, E., Visco, C. J.,
Rittenberg, J. D., Conrad, B., ... & Dreyfuss, P. (2014).
Randomized Control Test
78 subjects suffereing from acute uni-level disc herniation
leading to unilateral radicular pain.
· Transforaminal epidural corticosteroid injections are an
effective treatment for acute radicular pain due to disc
herniation
· only require 1 or 2 injections for symptomatic relief
· Dexamethasone displays possession of rationally parallel
effectiveness in comparison with triamcinolone.
· Surgical rates

26. · Injections received
· Categorical scores of pains
· Mean Oswestry Disability Index.
No recommendations were provided after the results.
Level I
Good Quality.
5.
Cohen, S. P., Hanling, S., Bicket, M. C., White, R. L., Veizi, E.,
Kurihara, C., ... & Pasquina, P. F. (2015).
Randomized Control Trial
· Military, Veteran, and civilian hospitals.
· 145 participants with lumbosacral radicular pain secondary to
herniated disc or spinal stenosis for less than four years.
· The patients had equal or more severe leg pain compared to
back pain.
· N/A
· The differences between epidural steroid injection and
gabapentin are modest and transient for most people.
· Average leg pain after the injection.
· The study did not have a true placebo group.
Level I
Good quality.
6.
Yürük, D., Yılmaz, A., Özgencil, G. E., & Aşık, İ. (2019).
Opinion of respected authorities
One 47-year-old patient.
· Epidural steroid injection leads to complications such as the
rhabdomyolysis.
· Patient status pre- and post-the steroid injection.
The sample size is too small to draw any evidence-based
conclusions.
Level IV

27. Good quality.
· N/A
Attach a reference list with full citations of articles r eviewed
for this EBP question.
Date:
EBP Question:
Article Number
Author and Date
Evidence Type
Sample, Sample Size, Setting
Findings That Help Answer the EBP Question
Observable Measures
Limitations
Evidence Level, Quality
7.
Cui, J. Z., Zhang, X. B., Zhu, P., Zhao, Z. B., Geng, Z. S.,
Zhang, Y. H., ... & Feng, J. Y. (2017).
Randomized Control Trial
93 participants with acute thoracic HZ.
· Repetitive intracutaneous injections with local anesthetics and
steroids together with standard treatment greatly decrease the
length of pain and herpetic eruption and incidence of PHN.
· Severity of pain
· Time of complete resolution
Lack of previous study on the effectiveness of intracutaneous

28. injections with local anesthetics and corticosteroids to support
the study.
Level I
High Quality
8.
Darrieutort-Laffite, C., Varin, S., Coiffier, G., Albert, J. D.,
Planche, L., Maugars, Y., ... & Le Goff, B. (2019).
Randomized controlled trial.
132 patients with 5mm symptomatic clarification.
· Steroids greatly improve VAS pain at rest and during
activities, and function at 7 days and 6 weeks.
· Steroids do not change the rate of calcification resorption.
· Mean difference of maximal pain
· Pain at rest
· Pain during activity
· radiological evolution of the calcification
No recommendations after the results were provided by the
study.
Level I
Good quality.
9.
Schreiber, A. L., McDonald, B. P., Kia, F., & Fried, G. W.
(2016).
A retrospective study.
1343 patients with acute spinal cord injuries.
· Increased use of interventional spine procedures to treat pain,
do not increase the proportion of cervical epidural -related SCI
admissions.
· characteristics of patients and proportion of SCI admissions to
cervical epidural injections injuries
The sample were from earlier years 2001 to 2008. There is need
for research in the span of recent years.
Level II
Good quality.
10.
Kennedy, D. J., Zheng, P. Z., Smuck, M., McCormick, Z. L.,

29. Huynh, L., & Schneider, B. J. (2018).
Retrospective cohort study.
78 subjects
with single leg radicular pain rating ≥4/10 for less than 6
months' duration, with radiographic imaging demonstrating an
anatomically congruent single-level herniated nucleus pulposus.
· Lumbar disc herniation can be successfully treated in the
short-term by transforaminal epidural steroid injections
or surgery, but long-term recurrence rates are high regardless
of treatment received.
· Presence of recurrent or persistent pain
· current opioid use for radicular symptoms
· pain within the previous week
· spine injections for radicular pain, progression to surgery,
The study did not provide any recommendations for the results
it presented.
Level III
Good Quality
· N/A

30. · N/A
· N/A
Johns Hopkins Nursing Evidence-Based Practice
Appendix G
Individual Evidence Summary Tool
Johns Hopkins Nursing Evidence-Based Practice
Appendix G
Individual Evidence Summary Tool
©2017 The Johns Hopkins Hospital/ Johns Hopkins University
School of Nursing
References
Choi, H. J., Hahn, S., Kim, C. H., Jang, B. H., Park, S., Lee, S.
M., ... & Park, B. J. (2013). Epidural steroid injection therapy
for low back pain: a meta-analysis. Database of Abstracts of
Reviews of Effects (DARE): Quality-assessed Reviews
[Internet].

31. El Abd, O., Amadera, J., Pimentel, D. C., & Gomba, L. (2015).
Immediate and acute adverse effects following transforaminal
epidural steroid injections with dexamethasone. Pain
Physician, 18(3), 277-86.
Brose, S. W., Montfort, J., Gustafson, K. J., Mittebrun, I.,
Gauriloff, S., Mosher, M., & Bourbeau, D. J. (2017).
Ultrasound-Guided Steroid Injection of the Pisotriquetral Joint:
A Multidisciplinary Effort. American journal of physical
medicine & rehabilitation, 96(12), 904-907.
Kennedy, D. J., Plastaras, C., Casey, E., Visco, C. J.,
Rittenberg, J. D., Conrad, B., ... & Dreyfuss, P. (2014).
Comparative effectiveness of lumbar transforaminal epidural
steroid injections with particulate versus nonparticulate
corticosteroids for lumbar radicular pain due to intervertebral
disc herniation: a prospective, randomized, double-blind
trial. Pain Medicine, 15(4), 548-555.
Cohen, S. P., Hanling, S., Bicket, M. C., White, R. L., Veizi, E.,
Kurihara, C., ... & Pasquina, P. F. (2015). Epidural steroid
injections compared with gabapentin for lumbosacral radicular
pain: multicenter randomized double blind comparative efficacy
study. bmj, 350.
Yürük, D., Yılmaz, A., Özgencil, G. E., & Aşık, İ. (2019).
Acute rhabdomyolysis following epidural steroid injection: An
unusual complication in a patient with low back
pain. Agri, 31(3), 150-152.
Cui, J. Z., Zhang, X. B., Zhu, P., Zhao, Z. B., Geng, Z. S.,
Zhang, Y. H., ... & Feng, J. Y. (2017). Effect of repetitive
intracutaneous injections with local anesthetics and steroids for
acute thoracic herpes zoster and incidence of postherpetic
neuralgia. Pain Medicine, 18(8), 1566-1572.
Darrieutort-Laffite, C., Varin, S., Coiffier, G., Albert, J. D.,
Planche, L., Maugars, Y., ... & Le Goff, B. (2019). Are
corticosteroid injections needed after needling and lavage of
calcific tendinitis? Randomised, double-blind, non-inferiority

32. trial. Annals of the rheumatic diseases, 78(6), 837-843.
Schreiber, A. L., McDonald, B. P., Kia, F., & Fried, G. W.
(2016). Cervical epidural steroid injections and spinal cord
injuries. The Spine Journal, 16(10), 1163-1166.
Kennedy, D. J., Zheng, P. Z., Smuck, M., McCormick, Z. L.,
Huynh, L., & Schneider, B. J. (2018). A minimum of 5-year
follow-up after lumbar transforaminal epidural steroid
injections in patients with lumbar radicular pain due to
intervertebral disc herniation. The Spine Journal, 18(1), 29-35.