Original Article
The Establishment of Evidence-Based
Practice Competencies for Practicing
Registered Nurses and Advanced Practice
Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality,
Reliability, Patient Outcomes, and Costs
Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAANP, FAAN •
Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC • Lisa English Long, RN, MSN, CNS •
Ellen Fineout-Overholt, RN, PhD, FAAN
Keywords
evidence-based
practice,
competencies,
healthcare quality
ABSTRACT
Background: Although it is widely known that evidence-based practice (EBP) improves healthcare
quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still
not the standard of care delivered by practicing clinicians across the globe. Adoption of specific
EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world
healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health
care.
Aim: The aim of this study was to develop a set of clear EBP competencies for both practicing
registered nurses and APNs in clinical settings that can be used by healthcare institutions in their
quest to achieve high performing systems that consistently implement and sustain EBP.
Methods: Seven national EBP leaders developed an initial set of competencies for practicing
registered nurses and APNs through a consensus building process. Next, a Delphi survey was
conducted with 80 EBP mentors across the United States to determine consensus and clarity
around the competencies.
Findings: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors,
resulting in a final set of 13 competencies for practicing registered nurses and 11 additional
competencies for APNs.
Linking Evidence to Action: Incorporation of these competencies into healthcare system ex-
pectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion
processes could drive higher quality, reliability, and consistency of healthcare as well as reduce
costs. Research is now needed to develop valid and reliable tools for assessing these competen-
cies as well as linking them to clinician and patient outcomes.
BACKGROUND
Evidence-based practice (EBP) is a life-long problem-solving
approach to the delivery of health care that integrates the best
evidence from well-designed studies (i.e., external evidence)
and integrates it with a patient’s preferences and values
and a clinician’s expertise, which includes internal evidence
gathered from patient data. When EBP is delivered in a context
of caring and a culture as well as an ecosystem or environment
that supports it, the best clinical decisions are made that
yield positive patient outcomes (see Figure 1; Melnyk &
Fineout-Overholt, 2011).
Research supports that EBP promotes high-value health
care, including enhancing the quality and reliability of health
care, improving health outcomes,.
Original ArticleThe Establishment of Evidence-BasedPract.docxhoney690131
Original Article
The Establishment of Evidence-Based
Practice Competencies for Practicing
Registered Nurses and Advanced Practice
Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality,
Reliability, Patient Outcomes, and Costs
Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAANP, FAAN •
Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC • Lisa English Long, RN, MSN, CNS •
Ellen Fineout-Overholt, RN, PhD, FAAN
Keywords
evidence-based
practice,
competencies,
healthcare quality
ABSTRACT
Background: Although it is widely known that evidence-based practice (EBP) improves healthcare
quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still
not the standard of care delivered by practicing clinicians across the globe. Adoption of specific
EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world
healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health
care.
Aim: The aim of this study was to develop a set of clear EBP competencies for both practicing
registered nurses and APNs in clinical settings that can be used by healthcare institutions in their
quest to achieve high performing systems that consistently implement and sustain EBP.
Methods: Seven national EBP leaders developed an initial set of competencies for practicing
registered nurses and APNs through a consensus building process. Next, a Delphi survey was
conducted with 80 EBP mentors across the United States to determine consensus and clarity
around the competencies.
Findings: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors,
resulting in a final set of 13 competencies for practicing registered nurses and 11 additional
competencies for APNs.
Linking Evidence to Action: Incorporation of these competencies into healthcare system ex-
pectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion
processes could drive higher quality, reliability, and consistency of healthcare as well as reduce
costs. Research is now needed to develop valid and reliable tools for assessing these competen-
cies as well as linking them to clinician and patient outcomes.
BACKGROUND
Evidence-based practice (EBP) is a life-long problem-solving
approach to the delivery of health care that integrates the best
evidence from well-designed studies (i.e., external evidence)
and integrates it with a patient’s preferences and values
and a clinician’s expertise, which includes internal evidence
gathered from patient data. When EBP is delivered in a context
of caring and a culture as well as an ecosystem or environment
that supports it, the best clinical decisions are made that
yield positive patient outcomes (see Figure 1; Melnyk &
Fineout-Overholt, 2011).
Research supports that EBP promotes high-value health
care, including enhancing the quality and reliability of health
care, improving health outcomes,.
Original ArticleThe Establishment of Evidence-BasedPract.docxvannagoforth
Original Article
The Establishment of Evidence-Based
Practice Competencies for Practicing
Registered Nurses and Advanced Practice
Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality,
Reliability, Patient Outcomes, and Costs
Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAANP, FAAN •
Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC • Lisa English Long, RN, MSN, CNS •
Ellen Fineout-Overholt, RN, PhD, FAAN
Keywords
evidence-based
practice,
competencies,
healthcare quality
ABSTRACT
Background: Although it is widely known that evidence-based practice (EBP) improves healthcare
quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still
not the standard of care delivered by practicing clinicians across the globe. Adoption of specific
EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world
healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health
care.
Aim: The aim of this study was to develop a set of clear EBP competencies for both practicing
registered nurses and APNs in clinical settings that can be used by healthcare institutions in their
quest to achieve high performing systems that consistently implement and sustain EBP.
Methods: Seven national EBP leaders developed an initial set of competencies for practicing
registered nurses and APNs through a consensus building process. Next, a Delphi survey was
conducted with 80 EBP mentors across the United States to determine consensus and clarity
around the competencies.
Findings: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors,
resulting in a final set of 13 competencies for practicing registered nurses and 11 additional
competencies for APNs.
Linking Evidence to Action: Incorporation of these competencies into healthcare system ex-
pectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion
processes could drive higher quality, reliability, and consistency of healthcare as well as reduce
costs. Research is now needed to develop valid and reliable tools for assessing these competen-
cies as well as linking them to clinician and patient outcomes.
BACKGROUND
Evidence-based practice (EBP) is a life-long problem-solving
approach to the delivery of health care that integrates the best
evidence from well-designed studies (i.e., external evidence)
and integrates it with a patient’s preferences and values
and a clinician’s expertise, which includes internal evidence
gathered from patient data. When EBP is delivered in a context
of caring and a culture as well as an ecosystem or environment
that supports it, the best clinical decisions are made that
yield positive patient outcomes (see Figure 1; Melnyk &
Fineout-Overholt, 2011).
Research supports that EBP promotes high-value health
care, including enhancing the quality and reliability of health
care, improving health outcomes, ...
This document discusses evidence-based practice (EBP) in nursing. It defines EBP as making clinical decisions based on the best available research evidence, clinical expertise, and patient values. The document outlines the steps of EBP, which include developing a focused question, finding evidence, evaluating the evidence, applying it, and evaluating outcomes. It discusses models for EBP implementation, including the Stetler, Iowa, and Rosswurm and Larrabee models. Barriers to EBP include lack of time, skills and support, while benefits include improved patient outcomes. Nurse leaders play a key role in facilitating EBP through training, resources and supportive cultures.
The document discusses evidence-based practice (EBP) for nurses, including definitions of EBP, the process and steps involved, aims and objectives of EBP, barriers to EBP, and models for implementing EBP such as the Stetler and Iowa models. It provides an overview of what EBP is and how nurse leaders can facilitate its use to improve patient outcomes through a supportive culture and learning opportunities regarding EBP. Barriers to EBP prevalence include a lack of support from colleagues, leaders, and managers as well as a lack of EBP knowledge and skills among some nurses.
The document discusses evidence-based practice (EBP) for nurses, including definitions of EBP, the process and steps involved, aims and objectives of EBP, barriers to EBP, and models for implementing EBP such as the Stetler and Iowa models. It provides an overview of what EBP is and how nurse leaders can facilitate its use to improve patient outcomes through a supportive culture and learning opportunities regarding EBP. Barriers to EBP prevalence include a lack of support from colleagues, leaders, and managers as well as a lack of EBP knowledge and skills among some nurses.
The document discusses evidence-based practice (EBP) in nursing, including definitions of EBP, the process of EBP, aims and objectives of EBP, barriers to EBP, and models for implementing EBP such as the Stetler model, Iowa model, and Rossworm and Larabee model. It provides an overview of EBP for nurses, highlighting the importance of using research evidence, clinical expertise, and patient preferences in clinical decision making. The document also outlines the steps involved in conducting EBP, from developing a focused clinical question to evaluating and applying the evidence.
This document discusses evidence-based practice (EBP) in nursing and healthcare. It defines EBP as using research-based evidence to guide holistic patient care. The benefits of EBP include improved patient outcomes, reduced costs, and enhanced nursing practice. EBP involves five steps: asking a clear clinical question, acquiring evidence, appraising the evidence, applying the evidence to practice, and assessing outcomes. Barriers to EBP include lack of time, resources, and skills to implement research into practice. Overall, the document emphasizes that properly applying EBP through all five steps can help strengthen nursing practice and improve patient care.
Original ArticleThe Establishment of Evidence-BasedPract.docxhoney690131
Original Article
The Establishment of Evidence-Based
Practice Competencies for Practicing
Registered Nurses and Advanced Practice
Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality,
Reliability, Patient Outcomes, and Costs
Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAANP, FAAN •
Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC • Lisa English Long, RN, MSN, CNS •
Ellen Fineout-Overholt, RN, PhD, FAAN
Keywords
evidence-based
practice,
competencies,
healthcare quality
ABSTRACT
Background: Although it is widely known that evidence-based practice (EBP) improves healthcare
quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still
not the standard of care delivered by practicing clinicians across the globe. Adoption of specific
EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world
healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health
care.
Aim: The aim of this study was to develop a set of clear EBP competencies for both practicing
registered nurses and APNs in clinical settings that can be used by healthcare institutions in their
quest to achieve high performing systems that consistently implement and sustain EBP.
Methods: Seven national EBP leaders developed an initial set of competencies for practicing
registered nurses and APNs through a consensus building process. Next, a Delphi survey was
conducted with 80 EBP mentors across the United States to determine consensus and clarity
around the competencies.
Findings: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors,
resulting in a final set of 13 competencies for practicing registered nurses and 11 additional
competencies for APNs.
Linking Evidence to Action: Incorporation of these competencies into healthcare system ex-
pectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion
processes could drive higher quality, reliability, and consistency of healthcare as well as reduce
costs. Research is now needed to develop valid and reliable tools for assessing these competen-
cies as well as linking them to clinician and patient outcomes.
BACKGROUND
Evidence-based practice (EBP) is a life-long problem-solving
approach to the delivery of health care that integrates the best
evidence from well-designed studies (i.e., external evidence)
and integrates it with a patient’s preferences and values
and a clinician’s expertise, which includes internal evidence
gathered from patient data. When EBP is delivered in a context
of caring and a culture as well as an ecosystem or environment
that supports it, the best clinical decisions are made that
yield positive patient outcomes (see Figure 1; Melnyk &
Fineout-Overholt, 2011).
Research supports that EBP promotes high-value health
care, including enhancing the quality and reliability of health
care, improving health outcomes,.
Original ArticleThe Establishment of Evidence-BasedPract.docxvannagoforth
Original Article
The Establishment of Evidence-Based
Practice Competencies for Practicing
Registered Nurses and Advanced Practice
Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality,
Reliability, Patient Outcomes, and Costs
Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAANP, FAAN •
Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC • Lisa English Long, RN, MSN, CNS •
Ellen Fineout-Overholt, RN, PhD, FAAN
Keywords
evidence-based
practice,
competencies,
healthcare quality
ABSTRACT
Background: Although it is widely known that evidence-based practice (EBP) improves healthcare
quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still
not the standard of care delivered by practicing clinicians across the globe. Adoption of specific
EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world
healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health
care.
Aim: The aim of this study was to develop a set of clear EBP competencies for both practicing
registered nurses and APNs in clinical settings that can be used by healthcare institutions in their
quest to achieve high performing systems that consistently implement and sustain EBP.
Methods: Seven national EBP leaders developed an initial set of competencies for practicing
registered nurses and APNs through a consensus building process. Next, a Delphi survey was
conducted with 80 EBP mentors across the United States to determine consensus and clarity
around the competencies.
Findings: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors,
resulting in a final set of 13 competencies for practicing registered nurses and 11 additional
competencies for APNs.
Linking Evidence to Action: Incorporation of these competencies into healthcare system ex-
pectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion
processes could drive higher quality, reliability, and consistency of healthcare as well as reduce
costs. Research is now needed to develop valid and reliable tools for assessing these competen-
cies as well as linking them to clinician and patient outcomes.
BACKGROUND
Evidence-based practice (EBP) is a life-long problem-solving
approach to the delivery of health care that integrates the best
evidence from well-designed studies (i.e., external evidence)
and integrates it with a patient’s preferences and values
and a clinician’s expertise, which includes internal evidence
gathered from patient data. When EBP is delivered in a context
of caring and a culture as well as an ecosystem or environment
that supports it, the best clinical decisions are made that
yield positive patient outcomes (see Figure 1; Melnyk &
Fineout-Overholt, 2011).
Research supports that EBP promotes high-value health
care, including enhancing the quality and reliability of health
care, improving health outcomes, ...
This document discusses evidence-based practice (EBP) in nursing. It defines EBP as making clinical decisions based on the best available research evidence, clinical expertise, and patient values. The document outlines the steps of EBP, which include developing a focused question, finding evidence, evaluating the evidence, applying it, and evaluating outcomes. It discusses models for EBP implementation, including the Stetler, Iowa, and Rosswurm and Larrabee models. Barriers to EBP include lack of time, skills and support, while benefits include improved patient outcomes. Nurse leaders play a key role in facilitating EBP through training, resources and supportive cultures.
The document discusses evidence-based practice (EBP) for nurses, including definitions of EBP, the process and steps involved, aims and objectives of EBP, barriers to EBP, and models for implementing EBP such as the Stetler and Iowa models. It provides an overview of what EBP is and how nurse leaders can facilitate its use to improve patient outcomes through a supportive culture and learning opportunities regarding EBP. Barriers to EBP prevalence include a lack of support from colleagues, leaders, and managers as well as a lack of EBP knowledge and skills among some nurses.
The document discusses evidence-based practice (EBP) for nurses, including definitions of EBP, the process and steps involved, aims and objectives of EBP, barriers to EBP, and models for implementing EBP such as the Stetler and Iowa models. It provides an overview of what EBP is and how nurse leaders can facilitate its use to improve patient outcomes through a supportive culture and learning opportunities regarding EBP. Barriers to EBP prevalence include a lack of support from colleagues, leaders, and managers as well as a lack of EBP knowledge and skills among some nurses.
The document discusses evidence-based practice (EBP) in nursing, including definitions of EBP, the process of EBP, aims and objectives of EBP, barriers to EBP, and models for implementing EBP such as the Stetler model, Iowa model, and Rossworm and Larabee model. It provides an overview of EBP for nurses, highlighting the importance of using research evidence, clinical expertise, and patient preferences in clinical decision making. The document also outlines the steps involved in conducting EBP, from developing a focused clinical question to evaluating and applying the evidence.
This document discusses evidence-based practice (EBP) in nursing and healthcare. It defines EBP as using research-based evidence to guide holistic patient care. The benefits of EBP include improved patient outcomes, reduced costs, and enhanced nursing practice. EBP involves five steps: asking a clear clinical question, acquiring evidence, appraising the evidence, applying the evidence to practice, and assessing outcomes. Barriers to EBP include lack of time, resources, and skills to implement research into practice. Overall, the document emphasizes that properly applying EBP through all five steps can help strengthen nursing practice and improve patient care.
How does your facility incorporate EBP in a clinical setting to prom.docxfideladallimore
How does your facility incorporate EBP in a clinical setting to promote patient outcomes? Do you have recommendations on how your facility can improve its use of EBP?
My facility incorporates evidence-based practice in the clinical setting in a resourceful manner in order to promote patient outcomes. The institution integrates clinical expertise, the best research evidence and patient values in the decision making process to foster the implementation of evidence based practice. In this endeavor, the facility also encourages patients to bring their personal preferences, unique concerns, values and expectations in order to ensure that the clinicians have a heighted understanding of their pertinent medical issues and provide patient-centered care that meets the distinct needs of the patients.
According to
Polit & Beck (2011),
through the practice of EBP, the healthcare facility can be in a better position to ascertain the effects of therapy, the prognosis of diseases, the utility of diagnostic tests as well as the etiology of disorders. It is worth mentioning that my facility follows various steps in implementing the EBP practices. These steps include assessing the patient, asking clinical questions derived from the patient’s case, acquiring the evidence through searching appropriate resources and then appraising the evidence for its applicability and validity. The other steps usually include integrating the evidence with patient preferences, clinical expertise and applying it to practice. The institution also encourages all practitioners to evaluate their performance with the patient as a yardstick for determining the effectiveness of the EBP process.
Although the facility has registered notable success in its EBP initiatives, various recommendations can help it to improve on these processes. One of such proposals is to aim at creating and sustaining strong nurse-client relationships
(Majid, Foo, & Luyt, 2011)
. This can enable the practitioners to have a better understanding of the patient’s unique values and preferences, all of which are fundamental components of EBP practice. The leaders of the facility should also serve as positive role models through advocating, embracing and communicating the benefits of EBP to other employees in the organization. Ultimately, this will help to create a culture that supports the adoption and implementation of evidence-based practice across the entire healthcare establishment
(Polit & Beck, 2011)
.
References
Majid, S., Foo, S., & Luyt, B. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.
Journal of the Medical Library Association, 99
(3), 229–236. Retrieved June 10, 2015, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901/
Polit, D., & Beck, C. (2011).
Nursing Research: Generating and Assessing Evidence for Nursing Practice
(9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Discussion Question 2
Ho.
NONPF - 1NURSE PRACTITIONER CORE COMPETENCIES April 201.docxkendalfarrier
NONPF - 1
NURSE PRACTITIONER CORE COMPETENCIES
April 2011
Amended 2012*
Task Force Members
Anne C. Thomas, PhD, ANP-BC, GNP - Chair
M. Katherine Crabtree, DNSc, FAAN, APRN-BC
Kathleen R. Delaney, PhD, PMH-NP
Mary Anne Dumas, PhD, RN, FNP-BC, FAANP
Ruth Kleinpell, PhD, RN, FAAN, FCCM
M. Cynthia Logsdon, PhD, WHNP-BC, FAAN
Julie Marfell, DNP, FNP-BC, FAANP
Donna G. Nativio, PhD, CRNP, FAAN
Note: Terms in bold are defined within the glossary found at the end of the competencies.
Preamble
In August 2008, NONPF endorsed the evolution of the Doctorate of Nursing Practice (DNP) as the entry
level for nurse practitioner (NP) practice (NONPF, 2008a). Nurse practitioner education, which is based
upon the NONPF competencies, recognizes that the student’s ability to show successful achievement of
the NONPF competencies for NP education is of greater value than the number of clinical hours the
student has performed (NONPF, 2008b).
The Nurse Practitioner Core Competencies (NP Core Competencies) integrate and build upon existing
Master’s and DNP core competencies and are guidelines for educational programs preparing NPs to
implement the full scope of practice as a licensed independent practitioner. The competencies are
essential behaviors of all NPs. These competencies are demonstrated upon graduation regardless of the
population focus of the program and are necessary for NPs to meet the complex challenges of translating
rapidly expanding knowledge into practice and function in a changing health care environment.
Nurse Practitioner graduates have knowledge, skills, and abilities that are essential to independent
clinical practice. The NP Core Competencies are acquired through mentored patient care experiences
with emphasis on independent and interprofessional practice; analytic skills for evaluating and
providing evidence-based, patient centered care across settings; and advanced knowledge of the
health care delivery system. Doctorally-prepared NPs apply knowledge of scientific foundations in
practice for quality care. They are able to apply skills in technology and information literacy, and engage
in practice inquiry to improve health outcomes, policy, and healthcare delivery. Areas of increased
knowledge, skills, and expertise include advanced communication skills, collaboration, complex decision
making, leadership, and the business of health care. The competencies elaborated here build upon
previous work that identified knowledge and skills essential to DNP competencies (AACN 1996; AACN,
2006; NONPF & National Panel, 2006) and are consistent with the recommendations of the Institute of
Medicine’s report, The Future of Nursing (IOM, 2011).
At completion of the NP program, the NP graduate possesses the nine (9) core competencies regardless
of population focus.
* Amended as result of additional validation through the 2011-2012 Population-Focused Competencies Task Force.
Competencies 7, 6, & 7 .
Evidence-based practice (EBP) uses scientific evidence to determine the best practices. EBP emerged in the 1980s and started in England in the early 1990s. EBP involves using the best current evidence from research, clinical expertise, and patient preferences to make decisions about patient care. Implementing EBP requires finding and applying effective interventions through a systematic process. Barriers to EBP include lack of time, support, and research knowledge, but EBP can improve outcomes, consistency of care, and decision-making. Common models for EBP include the John Hopkins, Iowa, and Stetler models.
The document discusses evidence-based practice (EBP) in nursing. It defines EBP as using the best available research evidence, clinical expertise, and patient values to make decisions about patient care. The document outlines the steps of EBP, which include asking questions, finding evidence, appraising evidence, applying it to practice, and assessing outcomes. It also discusses popular EBP models like the Johns Hopkins Nursing EBP model and the Iowa model. Barriers to EBP and its advantages are summarized as well.
At the end of this presentation you will be able to:
Define evidence-based practice
Describe process & outline steps of EBP
Understand PICO elements & search strategy
Identify resources to support EBP
The focus of this presentation is nursing practice, although it is still of value to physicians and other health care professionals.
This document provides an overview of evidence-based practice (EBP) in healthcare. It defines EBP as integrating the best research evidence, clinical expertise, and patient values and preferences. The key elements of EBP are outlined, including formulating answerable clinical questions using the PICOT format, searching for and appraising evidence, applying evidence to individual patients, and evaluating outcomes. The steps of the EBP process and strategies to bridge the research-practice gap are also summarized. Overall, the document emphasizes that EBP aims to improve clinical decision-making and patient outcomes by basing practices on rigorous research evidence rather than tradition alone.
This document provides an overview of evidence-based practice (EBP) presented by Amritanshu Chanchal at Subharti Nursing College in Meerut. It defines EBP, discusses its components and key steps. The presentation covers asking questions using PICOT format, searching for evidence, critically appraising evidence, integrating evidence with clinical expertise and patient preferences, evaluating outcomes, and disseminating results. Models for EBP are also introduced, including the Iowa Model which outlines identifying triggers for change, determining organizational priority, and forming an interdisciplinary team to develop, evaluate and implement EBP changes.
Do you ever wonder whynurses engage in practicesthat areDustiBuckner14
D
o you ever wonder why
nurses engage in practices
that aren’t supported by
evidence, while not implementing
practices substantiated by a lot
of evidence? In the past, nurses
changed hospitalized patients’ IV
dressings daily, even though no
solid evidence supported this prac-
tice. When clinical trials finally
explored how often to change IV
dressings, results indicated that
daily changes led to higher rates
of phlebitis than did less frequent
changes.1 In many hospital EDs
across the country, children with
asthma are treated with albuterol
delivered with a nebulizer, even
though substantial evidence shows
that when albuterol is delivered
with a metered-dose inhaler plus
a spacer, children spend less time
in the ED and have fewer adverse
effects.2 Nurses even disrupt
patients’ sleep, which is important
for restorative healing, to docu-
ment blood pressure and pulse
rate because it’s hospital policy to
take vital signs every two or four
hours, even though no evidence
supports that doing so improves
the identification of potential
complications. In fact, clinicians
often follow outdated policies and
procedures without questioning
their current relevance or accu-
racy, or the evidence for them.
When a spirit of inquiry—an
ongoing curiosity about the best
evidence to guide clinical decision
making—and a culture that sup-
ports it are lacking, clinicians are
unlikely to embrace evidence-based
practice (EBP). Every day, nurses
across the care continuum perform
a multitude of interventions (for
example, administering medica-
tion, positioning, suctioning)
that should stimulate questions
about the evidence supporting
their use. When a nurse possesses
a spirit of inquiry within a sup-
portive EBP culture, she or he
can routinely ask questions about
clinical practice while care is being
delivered. For example, in patients
with endotracheal tubes, how
does use of saline with suctioning
compared with suctioning without
saline affect oxygen saturation?
[email protected] AJN � November 2009 � Vol. 109, No. 11 49
By Bernadette Mazurek Melnyk, PhD,
RN, CPNP/PMHNP, FNAP, FAAN,
Ellen Fineout-Overholt, PhD, RN,
FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.
Williamson, PhD, RN
Igniting a Spirit of Inquiry: An Essential Foundation for
Evidence-Based Practice
How nurses can build the knowledge and skills they need to
implement EBP.
Every day, nurses perform interventions (for
example, administering medication, positioning,
suctioning) that should stimulate questions
about the evidence supporting their use.
This is the first article in a new series from the Arizona State University College of Nursing and Health Innovation’s
Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach
to the delivery of health care that integrates the best evidence from studies and patient care data with clinician
expertise and patient preferences and values. When delivered in a context of caring a ...
Scope and significance of evidence based research in nursing practice27 5-20Mallika Vhora
1) Evidence-based research in nursing is important to ensure quality patient care based on the best available research evidence. It has led to improved outcomes for patients, providers, and healthcare systems.
2) Future directions of evidence-based nursing research include conducting higher quality studies using various methodologies, synthesizing findings, translating research into practice, and examining outcomes. There will also be a focus on cultural competence and patient input.
3) Nurse researchers are likely to study health promotion, disease prevention, social determinants of health, evidence-based practice implementation, and vulnerable populations. Collaboration between nurses and researchers will expand to address fundamental healthcare issues.
The standard delineation of Evidence-Based Practice (EBP) originates from Dr. David Sackett, referring to an explicit and conscientious problem-solving approach useful in clinical practice. EBP integrates individual clinical expertise with the best available research evidence and patient values and circumstances. The ultimate goal of EBP is to enhance healthcare quality and outcomes, reduce costs, and strengthen clinicians, referred to as the quadruple healthcare aims. While the United States has developed infrastructure and culture to realize these aims through EBP, challenges remain like medical errors and lack of clinicians. EBP is presented as the best strategy to achieve the quadruple aims through improved understanding and application of evidence in clinical decision making.
1. A U.S. study found that nurses reported low competency in evidence-based practice skills and identified factors like education level, EBP beliefs and mentorship as influencing competency.
2. A qualitative study found that patients accepted a pressure ulcer prevention care bundle when it encouraged participation through positive interactions with nurses and easy to understand information.
3. Interviews with hospital staff identified creating a supportive organization, maintaining awareness of prevention, and focusing on patient benefits as key factors for successful pressure ulcer prevention.
This document provides an introduction to evidence-based practice (EBP) for nurses. It defines EBP as incorporating the best available scientific evidence, clinical expertise, and patient preferences. The document notes that while EBP is crucial for improving quality of care, only 15% of current nursing practice is scientifically validated. Barriers to EBP include limited time and lack of skills/confidence to implement it. The document recommends regular education programs to teach nurses how to find, evaluate, and apply research evidence through the five steps of EBP. Implementing EBP can empower nurses and improve patient outcomes, clinical excellence, and job satisfaction.
1) Evidence based practice is a process through which scientific evidence is identified, appraised and applied in health care interventions to provide the best patient care.
2) It involves forming a team to develop, implement and evaluate an evidence based plan, searching databases to retrieve evidence, grading the strength of evidence, and developing standards for practice.
3) Barriers to evidence based practice include lack of time, administrative support, and difficulty changing practice habits, but it can improve patient and organizational outcomes when implemented successfully.
Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.
Nurses can expand their knowledge and improve their clinical practice experience by collecting, processing, and implementing research findings. Evidence-based practice focuses on what's at the heart of nursing — your patient. Learn what evidence-based practice in nursing is, why it's essential, and how to incorporate it into your daily patient care.
- American Nurses Association
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
Evidence Base Practice (EBP)-Define, Benefits,Resource, steps PPTsonal patel
Evidence based practice (EBP) involves integrating the best available research evidence with clinical expertise and patient values to provide optimal care. EBP aims to move away from relying on "tried and true" practices and instead make decisions based on high-quality clinical research. The key steps of EBP include asking answerable clinical questions, searching for relevant evidence, appraising the evidence quality and applicability, integrating the evidence with expertise and context, and evaluating outcomes. EBP has benefits like improved patient outcomes, more efficient care, and keeping nursing practice current with the latest research findings.
This document discusses the importance of evidence-based practice in nursing. It begins by explaining how evidence-based practices have reverberated across nursing practice, education, and science. The need for improved healthcare calls for evidence-based practices to be incorporated into health systems to increase effectiveness, safety, and efficiency. New practice approaches should be evidence-based to help move healthcare in the desired direction. The document also provides an example of how one facility successfully reduced hospital-acquired pressure ulcers through implementing evidence-based skin assessment and wound care protocols. It concludes by stating the importance of evidence-based practices in tackling issues like hospital-acquired pressure ulcers.
Grantham University Wk 11 Evidence Based Nursing Practice Discussion Question...write4
The document discusses evidence-based practice and the importance of integrating different types of evidence beyond just scientific research. It argues that evidence-based practice requires the expert judgment and knowledge of experienced clinicians, not just research evidence. True evidence-based practice considers both research findings as well as clinical expertise and patient preferences. The Iowa Model of evidence-based practice is presented as a framework to guide the implementation of evidence into clinical practice through identifying problems or knowledge triggers, forming teams, reviewing and critiquing research, and piloting changes.
· Describe strategies to build rapport with inmates and offenders .docxgerardkortney
· Describe strategies to build rapport with inmates and offenders in a correctional treatment or supervision program.
· Describe the effect of group dynamics on facilitating programs.
· Describe techniques for establishing a therapeutic environment.
Generalist Case Management
Woodside and McClam
https://phoenix.vitalsource.com/books/9781483342047/pageid/44
https://phoenix.vitalsource.com/#/books/9781323128800
https://phoenix.vitalsource.com/#/books/9781483342047
https://phoenix.vitalsource.com/#/books/9781133795247
https://phoenix.vitalsource.com/#/books/1259760413
Use book and two outside sources.
At least 100 words per question
THANKS
1 The Role of the Correctional Counselor CHAPTER OBJECTIVES After reading this chapter, you will be able to: 1. Identify the functions and parameters of the counseling process. 2. Discuss the competing interests between security and counseling in the correctional counseling process. 3. Know common terms and concerns associated with custodial corrections. 4. Understand the role of the counselor as facilitator. 5. Identify the various personal characteristics associated with effective counselors. 6. Be aware of the impact that burnout can have on a counselor’s professional performance. 7. Identify the various means of training and supervision associated with counseling. PART ONE: A BRIEF INTRODUCTION TO COUNSELING AND CORRECTIONS There are many myths concerning the concept of counseling. Although the image of the counseling field has changed dramatically over the past two or three decades, much of society still views counseling and therapy as a mystic process reserved for those who lack the ability to handle life issues effectively. While the concept of counseling is often misunderstood, the problem is exacerbated when attempting to introduce the idea of correctional counseling. Therefore, the primary goal of this chapter is to provide a working definition of correctional counseling that includes descriptions of how and when it is carried out. In order to understand the concept of correctional counseling, however, the two words that derive the concept must first be defined: “corrections” and “counseling.” In addition, a concerted effort is made to identify the myriad of legal and ethical issues that pertain to counselors working with offenders. It is very difficult to identify a single starting point for the counseling profession. In essence, there were various movements occurring simultaneously that later evolved into what we now describe as counseling. One of the earliest connections to the origins of counseling took place in Europe during the Middle Ages (Brown & Srebalus, 2003). The primary objective was assisting individuals with career choices. This type of counseling service is usually described by the concept of “guidance.” In the late 1800s Wilhelm Wundt and G. Stanley Hall created two of the first known psychological laboratories aimed at studying and treating individuals with psychological and e.
· Debates continue regarding what constitutes an appropriate rol.docxgerardkortney
· Debates continue regarding what constitutes an appropriate role for the judiciary. Some argue that federal judges have become too powerful and that judges “legislate from the bench.”
1. What does it mean for a judge to be an activist?
2. What does it mean for a judge to be a restrainist?
· Although conservatives had long complained about the activism of liberal justices and judges, in recent years conservative judges and justices have been likely to overturn precedents and question the power of elected institutions of government.
3. When is judicial activism appropriate? Explain.
· To defenders of the right to privacy, it is implicitly embodied in the Constitution in the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. To opponents, it is judge-made law because there is no explicit reference to it under the Constitution. The right to privacy dates back to at least 1890, when Boston attorneys Samuel Warren and Louis Brandeis equated it with the right to be left alone from journalists who engaged in yellow journalism.
4. In short, do you believe a right to privacy exists in the federal Constitution. Why or why not?
.
More Related Content
Similar to Original ArticleThe Establishment of Evidence-BasedPract.docx
How does your facility incorporate EBP in a clinical setting to prom.docxfideladallimore
How does your facility incorporate EBP in a clinical setting to promote patient outcomes? Do you have recommendations on how your facility can improve its use of EBP?
My facility incorporates evidence-based practice in the clinical setting in a resourceful manner in order to promote patient outcomes. The institution integrates clinical expertise, the best research evidence and patient values in the decision making process to foster the implementation of evidence based practice. In this endeavor, the facility also encourages patients to bring their personal preferences, unique concerns, values and expectations in order to ensure that the clinicians have a heighted understanding of their pertinent medical issues and provide patient-centered care that meets the distinct needs of the patients.
According to
Polit & Beck (2011),
through the practice of EBP, the healthcare facility can be in a better position to ascertain the effects of therapy, the prognosis of diseases, the utility of diagnostic tests as well as the etiology of disorders. It is worth mentioning that my facility follows various steps in implementing the EBP practices. These steps include assessing the patient, asking clinical questions derived from the patient’s case, acquiring the evidence through searching appropriate resources and then appraising the evidence for its applicability and validity. The other steps usually include integrating the evidence with patient preferences, clinical expertise and applying it to practice. The institution also encourages all practitioners to evaluate their performance with the patient as a yardstick for determining the effectiveness of the EBP process.
Although the facility has registered notable success in its EBP initiatives, various recommendations can help it to improve on these processes. One of such proposals is to aim at creating and sustaining strong nurse-client relationships
(Majid, Foo, & Luyt, 2011)
. This can enable the practitioners to have a better understanding of the patient’s unique values and preferences, all of which are fundamental components of EBP practice. The leaders of the facility should also serve as positive role models through advocating, embracing and communicating the benefits of EBP to other employees in the organization. Ultimately, this will help to create a culture that supports the adoption and implementation of evidence-based practice across the entire healthcare establishment
(Polit & Beck, 2011)
.
References
Majid, S., Foo, S., & Luyt, B. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.
Journal of the Medical Library Association, 99
(3), 229–236. Retrieved June 10, 2015, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901/
Polit, D., & Beck, C. (2011).
Nursing Research: Generating and Assessing Evidence for Nursing Practice
(9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Discussion Question 2
Ho.
NONPF - 1NURSE PRACTITIONER CORE COMPETENCIES April 201.docxkendalfarrier
NONPF - 1
NURSE PRACTITIONER CORE COMPETENCIES
April 2011
Amended 2012*
Task Force Members
Anne C. Thomas, PhD, ANP-BC, GNP - Chair
M. Katherine Crabtree, DNSc, FAAN, APRN-BC
Kathleen R. Delaney, PhD, PMH-NP
Mary Anne Dumas, PhD, RN, FNP-BC, FAANP
Ruth Kleinpell, PhD, RN, FAAN, FCCM
M. Cynthia Logsdon, PhD, WHNP-BC, FAAN
Julie Marfell, DNP, FNP-BC, FAANP
Donna G. Nativio, PhD, CRNP, FAAN
Note: Terms in bold are defined within the glossary found at the end of the competencies.
Preamble
In August 2008, NONPF endorsed the evolution of the Doctorate of Nursing Practice (DNP) as the entry
level for nurse practitioner (NP) practice (NONPF, 2008a). Nurse practitioner education, which is based
upon the NONPF competencies, recognizes that the student’s ability to show successful achievement of
the NONPF competencies for NP education is of greater value than the number of clinical hours the
student has performed (NONPF, 2008b).
The Nurse Practitioner Core Competencies (NP Core Competencies) integrate and build upon existing
Master’s and DNP core competencies and are guidelines for educational programs preparing NPs to
implement the full scope of practice as a licensed independent practitioner. The competencies are
essential behaviors of all NPs. These competencies are demonstrated upon graduation regardless of the
population focus of the program and are necessary for NPs to meet the complex challenges of translating
rapidly expanding knowledge into practice and function in a changing health care environment.
Nurse Practitioner graduates have knowledge, skills, and abilities that are essential to independent
clinical practice. The NP Core Competencies are acquired through mentored patient care experiences
with emphasis on independent and interprofessional practice; analytic skills for evaluating and
providing evidence-based, patient centered care across settings; and advanced knowledge of the
health care delivery system. Doctorally-prepared NPs apply knowledge of scientific foundations in
practice for quality care. They are able to apply skills in technology and information literacy, and engage
in practice inquiry to improve health outcomes, policy, and healthcare delivery. Areas of increased
knowledge, skills, and expertise include advanced communication skills, collaboration, complex decision
making, leadership, and the business of health care. The competencies elaborated here build upon
previous work that identified knowledge and skills essential to DNP competencies (AACN 1996; AACN,
2006; NONPF & National Panel, 2006) and are consistent with the recommendations of the Institute of
Medicine’s report, The Future of Nursing (IOM, 2011).
At completion of the NP program, the NP graduate possesses the nine (9) core competencies regardless
of population focus.
* Amended as result of additional validation through the 2011-2012 Population-Focused Competencies Task Force.
Competencies 7, 6, & 7 .
Evidence-based practice (EBP) uses scientific evidence to determine the best practices. EBP emerged in the 1980s and started in England in the early 1990s. EBP involves using the best current evidence from research, clinical expertise, and patient preferences to make decisions about patient care. Implementing EBP requires finding and applying effective interventions through a systematic process. Barriers to EBP include lack of time, support, and research knowledge, but EBP can improve outcomes, consistency of care, and decision-making. Common models for EBP include the John Hopkins, Iowa, and Stetler models.
The document discusses evidence-based practice (EBP) in nursing. It defines EBP as using the best available research evidence, clinical expertise, and patient values to make decisions about patient care. The document outlines the steps of EBP, which include asking questions, finding evidence, appraising evidence, applying it to practice, and assessing outcomes. It also discusses popular EBP models like the Johns Hopkins Nursing EBP model and the Iowa model. Barriers to EBP and its advantages are summarized as well.
At the end of this presentation you will be able to:
Define evidence-based practice
Describe process & outline steps of EBP
Understand PICO elements & search strategy
Identify resources to support EBP
The focus of this presentation is nursing practice, although it is still of value to physicians and other health care professionals.
This document provides an overview of evidence-based practice (EBP) in healthcare. It defines EBP as integrating the best research evidence, clinical expertise, and patient values and preferences. The key elements of EBP are outlined, including formulating answerable clinical questions using the PICOT format, searching for and appraising evidence, applying evidence to individual patients, and evaluating outcomes. The steps of the EBP process and strategies to bridge the research-practice gap are also summarized. Overall, the document emphasizes that EBP aims to improve clinical decision-making and patient outcomes by basing practices on rigorous research evidence rather than tradition alone.
This document provides an overview of evidence-based practice (EBP) presented by Amritanshu Chanchal at Subharti Nursing College in Meerut. It defines EBP, discusses its components and key steps. The presentation covers asking questions using PICOT format, searching for evidence, critically appraising evidence, integrating evidence with clinical expertise and patient preferences, evaluating outcomes, and disseminating results. Models for EBP are also introduced, including the Iowa Model which outlines identifying triggers for change, determining organizational priority, and forming an interdisciplinary team to develop, evaluate and implement EBP changes.
Do you ever wonder whynurses engage in practicesthat areDustiBuckner14
D
o you ever wonder why
nurses engage in practices
that aren’t supported by
evidence, while not implementing
practices substantiated by a lot
of evidence? In the past, nurses
changed hospitalized patients’ IV
dressings daily, even though no
solid evidence supported this prac-
tice. When clinical trials finally
explored how often to change IV
dressings, results indicated that
daily changes led to higher rates
of phlebitis than did less frequent
changes.1 In many hospital EDs
across the country, children with
asthma are treated with albuterol
delivered with a nebulizer, even
though substantial evidence shows
that when albuterol is delivered
with a metered-dose inhaler plus
a spacer, children spend less time
in the ED and have fewer adverse
effects.2 Nurses even disrupt
patients’ sleep, which is important
for restorative healing, to docu-
ment blood pressure and pulse
rate because it’s hospital policy to
take vital signs every two or four
hours, even though no evidence
supports that doing so improves
the identification of potential
complications. In fact, clinicians
often follow outdated policies and
procedures without questioning
their current relevance or accu-
racy, or the evidence for them.
When a spirit of inquiry—an
ongoing curiosity about the best
evidence to guide clinical decision
making—and a culture that sup-
ports it are lacking, clinicians are
unlikely to embrace evidence-based
practice (EBP). Every day, nurses
across the care continuum perform
a multitude of interventions (for
example, administering medica-
tion, positioning, suctioning)
that should stimulate questions
about the evidence supporting
their use. When a nurse possesses
a spirit of inquiry within a sup-
portive EBP culture, she or he
can routinely ask questions about
clinical practice while care is being
delivered. For example, in patients
with endotracheal tubes, how
does use of saline with suctioning
compared with suctioning without
saline affect oxygen saturation?
[email protected] AJN � November 2009 � Vol. 109, No. 11 49
By Bernadette Mazurek Melnyk, PhD,
RN, CPNP/PMHNP, FNAP, FAAN,
Ellen Fineout-Overholt, PhD, RN,
FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.
Williamson, PhD, RN
Igniting a Spirit of Inquiry: An Essential Foundation for
Evidence-Based Practice
How nurses can build the knowledge and skills they need to
implement EBP.
Every day, nurses perform interventions (for
example, administering medication, positioning,
suctioning) that should stimulate questions
about the evidence supporting their use.
This is the first article in a new series from the Arizona State University College of Nursing and Health Innovation’s
Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach
to the delivery of health care that integrates the best evidence from studies and patient care data with clinician
expertise and patient preferences and values. When delivered in a context of caring a ...
Scope and significance of evidence based research in nursing practice27 5-20Mallika Vhora
1) Evidence-based research in nursing is important to ensure quality patient care based on the best available research evidence. It has led to improved outcomes for patients, providers, and healthcare systems.
2) Future directions of evidence-based nursing research include conducting higher quality studies using various methodologies, synthesizing findings, translating research into practice, and examining outcomes. There will also be a focus on cultural competence and patient input.
3) Nurse researchers are likely to study health promotion, disease prevention, social determinants of health, evidence-based practice implementation, and vulnerable populations. Collaboration between nurses and researchers will expand to address fundamental healthcare issues.
The standard delineation of Evidence-Based Practice (EBP) originates from Dr. David Sackett, referring to an explicit and conscientious problem-solving approach useful in clinical practice. EBP integrates individual clinical expertise with the best available research evidence and patient values and circumstances. The ultimate goal of EBP is to enhance healthcare quality and outcomes, reduce costs, and strengthen clinicians, referred to as the quadruple healthcare aims. While the United States has developed infrastructure and culture to realize these aims through EBP, challenges remain like medical errors and lack of clinicians. EBP is presented as the best strategy to achieve the quadruple aims through improved understanding and application of evidence in clinical decision making.
1. A U.S. study found that nurses reported low competency in evidence-based practice skills and identified factors like education level, EBP beliefs and mentorship as influencing competency.
2. A qualitative study found that patients accepted a pressure ulcer prevention care bundle when it encouraged participation through positive interactions with nurses and easy to understand information.
3. Interviews with hospital staff identified creating a supportive organization, maintaining awareness of prevention, and focusing on patient benefits as key factors for successful pressure ulcer prevention.
This document provides an introduction to evidence-based practice (EBP) for nurses. It defines EBP as incorporating the best available scientific evidence, clinical expertise, and patient preferences. The document notes that while EBP is crucial for improving quality of care, only 15% of current nursing practice is scientifically validated. Barriers to EBP include limited time and lack of skills/confidence to implement it. The document recommends regular education programs to teach nurses how to find, evaluate, and apply research evidence through the five steps of EBP. Implementing EBP can empower nurses and improve patient outcomes, clinical excellence, and job satisfaction.
1) Evidence based practice is a process through which scientific evidence is identified, appraised and applied in health care interventions to provide the best patient care.
2) It involves forming a team to develop, implement and evaluate an evidence based plan, searching databases to retrieve evidence, grading the strength of evidence, and developing standards for practice.
3) Barriers to evidence based practice include lack of time, administrative support, and difficulty changing practice habits, but it can improve patient and organizational outcomes when implemented successfully.
Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.
Nurses can expand their knowledge and improve their clinical practice experience by collecting, processing, and implementing research findings. Evidence-based practice focuses on what's at the heart of nursing — your patient. Learn what evidence-based practice in nursing is, why it's essential, and how to incorporate it into your daily patient care.
- American Nurses Association
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
Evidence Base Practice (EBP)-Define, Benefits,Resource, steps PPTsonal patel
Evidence based practice (EBP) involves integrating the best available research evidence with clinical expertise and patient values to provide optimal care. EBP aims to move away from relying on "tried and true" practices and instead make decisions based on high-quality clinical research. The key steps of EBP include asking answerable clinical questions, searching for relevant evidence, appraising the evidence quality and applicability, integrating the evidence with expertise and context, and evaluating outcomes. EBP has benefits like improved patient outcomes, more efficient care, and keeping nursing practice current with the latest research findings.
This document discusses the importance of evidence-based practice in nursing. It begins by explaining how evidence-based practices have reverberated across nursing practice, education, and science. The need for improved healthcare calls for evidence-based practices to be incorporated into health systems to increase effectiveness, safety, and efficiency. New practice approaches should be evidence-based to help move healthcare in the desired direction. The document also provides an example of how one facility successfully reduced hospital-acquired pressure ulcers through implementing evidence-based skin assessment and wound care protocols. It concludes by stating the importance of evidence-based practices in tackling issues like hospital-acquired pressure ulcers.
Grantham University Wk 11 Evidence Based Nursing Practice Discussion Question...write4
The document discusses evidence-based practice and the importance of integrating different types of evidence beyond just scientific research. It argues that evidence-based practice requires the expert judgment and knowledge of experienced clinicians, not just research evidence. True evidence-based practice considers both research findings as well as clinical expertise and patient preferences. The Iowa Model of evidence-based practice is presented as a framework to guide the implementation of evidence into clinical practice through identifying problems or knowledge triggers, forming teams, reviewing and critiquing research, and piloting changes.
Similar to Original ArticleThe Establishment of Evidence-BasedPract.docx (20)
· Describe strategies to build rapport with inmates and offenders .docxgerardkortney
· Describe strategies to build rapport with inmates and offenders in a correctional treatment or supervision program.
· Describe the effect of group dynamics on facilitating programs.
· Describe techniques for establishing a therapeutic environment.
Generalist Case Management
Woodside and McClam
https://phoenix.vitalsource.com/books/9781483342047/pageid/44
https://phoenix.vitalsource.com/#/books/9781323128800
https://phoenix.vitalsource.com/#/books/9781483342047
https://phoenix.vitalsource.com/#/books/9781133795247
https://phoenix.vitalsource.com/#/books/1259760413
Use book and two outside sources.
At least 100 words per question
THANKS
1 The Role of the Correctional Counselor CHAPTER OBJECTIVES After reading this chapter, you will be able to: 1. Identify the functions and parameters of the counseling process. 2. Discuss the competing interests between security and counseling in the correctional counseling process. 3. Know common terms and concerns associated with custodial corrections. 4. Understand the role of the counselor as facilitator. 5. Identify the various personal characteristics associated with effective counselors. 6. Be aware of the impact that burnout can have on a counselor’s professional performance. 7. Identify the various means of training and supervision associated with counseling. PART ONE: A BRIEF INTRODUCTION TO COUNSELING AND CORRECTIONS There are many myths concerning the concept of counseling. Although the image of the counseling field has changed dramatically over the past two or three decades, much of society still views counseling and therapy as a mystic process reserved for those who lack the ability to handle life issues effectively. While the concept of counseling is often misunderstood, the problem is exacerbated when attempting to introduce the idea of correctional counseling. Therefore, the primary goal of this chapter is to provide a working definition of correctional counseling that includes descriptions of how and when it is carried out. In order to understand the concept of correctional counseling, however, the two words that derive the concept must first be defined: “corrections” and “counseling.” In addition, a concerted effort is made to identify the myriad of legal and ethical issues that pertain to counselors working with offenders. It is very difficult to identify a single starting point for the counseling profession. In essence, there were various movements occurring simultaneously that later evolved into what we now describe as counseling. One of the earliest connections to the origins of counseling took place in Europe during the Middle Ages (Brown & Srebalus, 2003). The primary objective was assisting individuals with career choices. This type of counseling service is usually described by the concept of “guidance.” In the late 1800s Wilhelm Wundt and G. Stanley Hall created two of the first known psychological laboratories aimed at studying and treating individuals with psychological and e.
· Debates continue regarding what constitutes an appropriate rol.docxgerardkortney
· Debates continue regarding what constitutes an appropriate role for the judiciary. Some argue that federal judges have become too powerful and that judges “legislate from the bench.”
1. What does it mean for a judge to be an activist?
2. What does it mean for a judge to be a restrainist?
· Although conservatives had long complained about the activism of liberal justices and judges, in recent years conservative judges and justices have been likely to overturn precedents and question the power of elected institutions of government.
3. When is judicial activism appropriate? Explain.
· To defenders of the right to privacy, it is implicitly embodied in the Constitution in the First, Fourth, Fifth, Ninth, and Fourteenth Amendments. To opponents, it is judge-made law because there is no explicit reference to it under the Constitution. The right to privacy dates back to at least 1890, when Boston attorneys Samuel Warren and Louis Brandeis equated it with the right to be left alone from journalists who engaged in yellow journalism.
4. In short, do you believe a right to privacy exists in the federal Constitution. Why or why not?
.
· Critical thinking paper · · · 1. A case study..docxgerardkortney
· Critical thinking paper
·
·
· 1.
A case study.
Deborah Shore, aged 45, works for a small corporation in the Research and Development department.
When she first became a member of the department 15 years ago, Deborah was an unusually creative and productive researcher; her efforts quickly resulted in raises and promotions within the department and earned her the respect of her colleagues. Now, Deborah finds herself less interested in doing research; she is no longer making creative contributions to her department, although she is making contributions to its administration.
She is still respected by the coworkers who have known her since she joined the firm, but not by her younger coworkers.
Analyze the case study from the psychoanalytic, learning, and contextual perspectives: how would a theorist from each perspective explain Deborah's development? Which perspective do you believe provides the most adequate explanation, and why?
2. Interview your mother (and grandmothers, if possible), asking about experiences with childbirth. Include your own experiences if you have had children. Write a paper summarizing these childbirth experiences and comparing them with the contemporary experiences described in the text.
3. Identify a "type" of parent (e.g., single parent, teenage parent, low-income parent, dual-career couple) who is most likely to be distressed because an infant has a "difficult" temperament. Explain why you believe that this type of parent would have particular problems with a difficult infant. Write an informational brochure for the selected type of parent. The brochure should include an explanation of temperament in general and of the difficult temperament in particular, and give suggestions for parents of difficult infants.
4. Plan an educational unit covering nutrition, health, and safety for use with preschoolers and kindergartners. Take into account young children's cognitive and linguistic characteristics. The project should include (1) an outline of the content of the unit; and (2) a description of how the content would be presented, given the intellectual abilities of preschoolers. For example, how long would each lesson be? What kinds of pictures or other audiovisual materials would be used? How would this content be integrated with the children's other activities in preschool or kindergarten?
5. Visit two day care centers and evaluate each center using the information from the text as a guide. Request a fee schedule from each center. Write a paper summarizing your evaluation of each center.
Note:
Unless you are an actual potential client of the center, contact the director beforehand to explain the actual purpose of the visit, obtain permission to visit, and schedule your visit so as to minimize disruption to the center's schedule.
6. Watch some children's television programs and advertising, examine some children's toys and their packaging, read some children's books, and listen to some children's recor.
· Coronel & Morris Chapter 7, Problems 1, 2 and 3
· Coronel & Morris Chapter 8, Problems 1 and 2
A People’s History of Modern Europe
“A fascinating journey across centuries towards the world as we experience it today. ... It is
the voice of the ordinary people, and women in particular, their ideas and actions, protests
and sufferings that have gone into the making of this alternative narrative.”
——Sobhanlal Datta Gupta, former Surendra Nath Banerjee
Professor of Political Science, University of Calcutta
“A history of Europe that doesn’t remove the Europeans. Here there are not only kings,
presidents and institutions but the pulse of the people and social organizations that shaped
Europe. A must-read.”
——Raquel Varela, Universidade Nova de Lisboa
“Lively and engaging. William A Pelz takes the reader through a thousand years of
European history from below. This is the not the story of lords, kings and rulers. It is the
story of the ordinary people of Europe and their struggles against those lords, kings and
rulers, from the Middle Ages to the present day. A fine introduction.”
——Francis King, editor, Socialist History
“This book is an exception to the rule that the winner takes all. It highlights the importance
of the commoners which often is only shown in the dark corners of mainstream history
books. From Hussites, Levellers and sans-culottes to the women who defended the Paris
Commune and the workers who occupied the shipyards during the Carnation revolution in
Portugal. The author gives them their deserved place in history just like Howard Zinn did
for the American people.”
——Sjaak van der Velden, International Institute of Social History, Amsterdam
“The author puts his focus on the lives and historical impact of those excluded from
power and wealth: peasants and serfs of the Middle Ages, workers during the Industrial
Revolution, women in a patriarchic order that transcended different eras. This focus not
only makes history relevant for contemporary debates on social justice, it also urges the
reader to develop a critical approach.”
——Ralf Hoffrogge, Ruhr-Universität Bochum
“An exciting story of generations of people struggling for better living conditions, and for
social and political rights. ... This story has to be considered now, when the very notions of
enlightenment, progress and social change are being questioned.”
——Boris Kagarlitsky, director of Institute for globalization studies and social
movements, Moscow, and author of From Empires to Imperialism
“A splendid antidote to the many European histories dominated by kings, businessmen
and generals. It should be on the shelves of both academics and activists ... A lively and
informative intellectual tour-de-force.”
——Marcel van der Linden, International Institute of Social History, Amsterdam
A People’s History
of Modern Europe
William A. Pelz
First published 2016 by Pluto Press
345 Archway Road, London N6 5AA
www.pluto.
· Complete the following problems from your textbook· Pages 378.docxgerardkortney
· Complete the following problems from your textbook:
· Pages 378–381: 10-1, 10-2, 10-16, and 10-20.
· Pages 443–444: 12-7 and 12-9.
· Page 469: 13-5.
· 10-1 How would each of the following scenarios affect a firm’s cost of debt, rd(1 − T); its cost of equity, rs; and its WACC? Indicate with a plus (+), a minus (−), or a zero (0) whether the factor would raise, lower, or have an indeterminate effect on the item in question. Assume for each answer that other things are held constant, even though in some instances this would probably not be true. Be prepared to justify your answer but recognize that several of the parts have no single correct answer. These questions are designed to stimulate thought and discussion.
Effect on
rd(1 − T)
rs
WACC
a. The corporate tax rate is lowered.
__
__
__
b. The Federal Reserve tightens credit.
__
__
__
c. The firm uses more debt; that is, it increases its debt ratio.
__
__
__
d. The dividend payout ratio is increased.
__
__
__
e. The firm doubles the amount of capital it raises during the year.
__
__
__
f. The firm expands into a risky new area.
__
__
__
g. The firm merges with another firm whose earnings are countercyclical both to those of the first firm and to the stock market.
__
__
__
h. The stock market falls drastically, and the firm’s stock price falls along with the rest.
__
__
__
i. Investors become more risk-averse.
__
__
__
j. The firm is an electric utility with a large investment in nuclear plants. Several states are considering a ban on nuclear power generation.
__
__
__
· 10-2 Assume that the risk-free rate increases, but the market risk premium
· 10-16COST OF COMMON EQUITY The Bouchard Company’s EPS was $6.50 in 2018, up from $4.42 in 2013. The company pays out 40% of its earnings as dividends, and its common stock sells for $36.00.
· a. Calculate the past growth rate in earnings. (Hint: This is a 5-year growth period.)
· b. The last dividend was D0 = 0.4($6.50) = $2.60. Calculate the next expected dividend, D1, assuming that the past growth rate continues.
· c. What is Bouchard’s cost of retained earnings, rs?
· 10-20WACC The following table gives Foust Company’s earnings per share for the last 10 years. The common stock, 7.8 million shares outstanding, is now (1/1/19) selling for $65.00 per share. The expected dividend at the end of the current year (12/31/19) is 55% of the 2018 EPS. Because investors expect past trends to continue, g may be based on the historical earnings growth rate. (Note that 9 years of growth are reflected in the 10 years of data.)
The current interest rate on new debt is 9%; Foust’s marginal tax rate is 40%, and its target capital structure is 40% debt and 60% equity.
· a. Calculate Foust’s after-tax cost of debt and common equity. Calculate the cost of equity as rs = D1/P0 + g.
· b. Find Foust’s WACC
· 12-7SCENARIO ANALYSIS Huang Industries is considering a proposed project whose estimated NPV is $12 million. This estimate assumes that economic conditions wi.
· Consider how different countries approach aging. As you consid.docxgerardkortney
· Consider how different countries approach aging. As you consider different countries, think about the following:
o Do older adults live with their children, or are they more likely to live in a nursing home?
o Are older adults seen as wise individuals to be respected and revered, or are they a burden to their family and to society?
· Next, select two different countries and compare and contrast their approaches to aging.
· Post and identify each of the countries you selected. Then, explain two similarities and two differences in how the countries approach aging. Be specific and provide examples. Use proper APA format and citation. LSW10
.
· Clarifying some things on the Revolution I am going to say som.docxgerardkortney
· Clarifying some things on the Revolution
I am going to say something, and I want you to hear me.
I am a scholar of the Revolution. That's the topic of my dissertation. Please believe me when I say that I know a lot about it.
I also happen to know--and this is well-supported by historians--that the Revolution was a civil war in which, for the first several years, Revolutionaries and Loyalists were evenly matched.
I will repeat that. Evenly matched. Loyalists were not merely too cowardly to fight, and they were not old fogies who hated the idea of freedom. Most had been in the Colonies for generations. Many of them took up arms for their King and their country. And when they lost, you confiscated their homes and they fled with the clothes on their back to Canada, England, and other places of the Empire. Both sides--both sides--committed unspeakable atrocities against civilians whom they disagreed with.
Now, a lot of you love to repeat some very fervent patriotic diatribe about how great the Revolution was. That's not history. That's propaganda. Know the difference.
History has shades of gray. History is complex and ambiguous. Washington, for instance, wore dentures made from the teeth of his slaves. Benjamin Franklin's son was the last royal governor of New Jersey. Did you know that the net tax rate for Americans--they always conveniently leave this out of the textbooks--was between 1.9 and 2.1%, depending on colony.? And that was if they had paid the extra taxes on tea and paper.
And, wait for it, people who support California independence use the same logic and arguments as they did in 1775. Did you know that the Los Angeles and Washington are only a few hundred miles closer than Boston and London? That many of the same issues, point by point, are repeating here in California? So put yourself in those shoes. How many of you would have sided with the Empire (whether American or British) based on the fact that you don't know how this will shake out? Would you call someone who supports Calexit a Patriot? Revolutionary? Nutcase? Who gets to own that word, anyway?
You can choose that you would have supported the revolutionaries--but think. Think about the other side. They matter, and their experiences got to be cleansed out of history to make you feel better about the way the revolutionaries behaved during the War. Acknowledge that they are there, and that their point of view has merit, even if you not agree with it.
· Clarifying Unit III's assignment
I have noticed a few consistent problems with the letter in the Unit III issue. Here are some pointers to make it better.
1. Read the clarifying note I wrote above. Note that the taxes aren't actually as high as you have been led to believe, but the point is that they should not be assigned at all without your consent.
2. Acknowledge that this is a debate, that a certain percentage are radicalized for independence, but there are is also a law-and-order group who find this horrific, and want .
· Chapter 9 – Review the section on Establishing a Security Cultur.docxgerardkortney
· Chapter 9 – Review the section on Establishing a Security Culture. Review the methods to reduce the chances of a cyber threat noted in the textbook. Research other peer-reviewed source and note additional methods to reduce cyber-attacks within an organization.
· Chapter 10 – Review the section on the IT leader in the digital transformation era. Note how IT professionals and especially leaders must transform their thinking to adapt to the constantly changing organizational climate. What are some methods or resources leaders can utilize to enhance their change attitude?
.
· Chapter 10 The Early Elementary Grades 1-3The primary grades.docxgerardkortney
· Chapter 10: The Early Elementary Grades: 1-3
The primary grades are grades 1-3.
Although educational reform has had an effect on all children, it is most apparent in the early elementary years. Reform and change comes from a number of sources and the chapter begins by reminding you of this. Let’s examine a few of these sources...
Diversity. There has been a rise in the number of racial and ethnic minority students enrolled in the nation's public schools; this number will (most likely) continue to rise. Teaching children from different cultures and backgrounds is an important piece to account for when planning curriculum.
Standards. Standards is a reason for reform. We've already looked at standards; these are something you must keep in mind when planning lessons.
Data-Driven Instruction may sound new, but it is not a new concept to you. We’ve done a great deal of discussing the outcomes of test-taking and assessments. You've probably all heard "teaching to the test."
Technology. Today’s students have had much experience with technology, therefore, it’s important to provide them with opportunities to learn with technology. It may take a while for you to be creative and think of ways to use it in your teaching (if you haven’ t been).
Health and Wellness. Obesity is a major concern in this country. Therefore, it is important to make sure that children have the opportunity to be active. Unfortunately, due to the pressure of academics, many schools have been taking physical education/activity time out of the curriculum.
Violence: One issue that I notice this new edition of the text has excluded is violence. However, I think that this topic is important; we need to keep children safe when they are at school. As a result of 9/11 (and, not to mention that many violent events have happened on school campuses in recent years), many school districts now have an emergency system in place that they can easily use if there is any type of incident in which the children’s safety is at risk.
WHAT ARE CHILDREN IN GRADES ONE TO THREE LIKE?
Your text explains that the best way to think of a child’s development during this time is: slow and steady. During this stage, there is not much difference between boys and girls when it comes to physical capabilities. Although it is always important to not stereotype based on one’s gender, it is especially important during these years. These children are also entering into their "tween" years, thus; being sensitive to the children's and parents' needs in regards to such changes is important.
It is important to remember that children in the primary grades are in the Concrete Operations Stage. This stage is children ages 7 to 12. The term operation refers to an action that can be carried out in thought as well as executed materially and that is mentally and physically reversible.
These children are at an age in which they can compare their abilities to their peers. And, therefore, children may develop learned helplessnes.
· Chap 2 and 3· what barriers are there in terms of the inter.docxgerardkortney
· Chap 2 and 3
· what barriers are there in terms of the interpersonal communication model?
Typically, communication breakdowns result from lack of understanding without clarification; often, there wasn't even an attempt at clarification. If barriers to interpersonal communication are not acknowledged and addressed, workplace productivity can suffer.
Language Differences
Interpersonal communication can go awry when the sender and receiver of the message speak a different language -- literally and figuratively. Not everyone in the workplace will understand slang, jargon, acronyms and industry terminology. Instead of seeking clarification, employees might guess at the meaning of the message and then act on mistaken assumptions. Also, misunderstandings may occur among workers who do not speak the same primary language. As a result, feelings may be hurt, based on misinterpretation of words or of body language.
Cultural Differences
Interpersonal communication may be adversely affected by lack of cultural understanding, mis-perception, bias and stereotypical beliefs. Workers may have limited skill or experience communicating with people from a different background. Many companies offer diversity training to help employees understand how to communicate more effectively across cultures and relate to those who may have different background experiences. Similarly, gender barriers can obstruct interpersonal communication if men and women are treated differently, and held to different standards, causing interpersonal conflicts in the workplace.
Personality Differences
Like any skill, some people are better at interpersonal communication than others. Personality traits also influence how well an individual interacts with subordinates, peers and supervisors. Extraversion can be an advantage when it comes to speaking out, sharing opinions and disseminating information. However, introverts may have the edge when it comes to listening, reflecting and remembering. Barriers to interpersonal communication may occur when employees lack self-awareness, sensitivity and flexibility. Such behavior undermines teamwork, which requires mutual respect, compromise and negotiation. Bullying, backstabbing and cut throat competition create a toxic workplace climate that will strain interpersonal relationships.
Generational Differences
Interpersonal communication can be complicated by generational differences in speech, dress, values, priorities and preferences. For instance, there may be a generational divide as to how team members prefer to communicate with one another. If younger workers sit in cubicles, using social networking as their primary channel of communication, it can alienate them from older workers who may prefer face-to-face communication. Broad generalizations and stereotypes can also cause interpersonal rifts when a worker from one generation feels superior to those who are younger or older. Biases against workers based on age can constitute a form of disc.
· Case Study 2 Improving E-Mail Marketing ResponseDue Week 8 an.docxgerardkortney
The document provides a case study and instructions for an assignment on improving the response rate of email marketing. Students are asked to: 1) conduct a design of experiment using the provided data to test cause-and-effect relationships, 2) determine an appropriate graphical display for the results and provide rationale, 3) recommend actions to increase email response rates with rationale, and 4) propose an overall strategy to develop a process model to increase response rates and obtain effective business processes with rationale. The assignment requires a 2-3 page paper following APA formatting guidelines.
· Briefly describe the technologies that are leading businesses in.docxgerardkortney
· Briefly describe the technologies that are leading businesses into the third wave of electronic commerce.
· In about 100 words, describe the function of the Internet Corporation for Assigned Names and Numbers. Include a discussion of the differences between gTLDs and sTLDs in your answer.
· In one or two paragraphs, describe how the Internet changed from a government research project into a technology for business users.
· In about 100 words, explain the difference between an extranet and an intranet. In your answer, describe when you might use a VPN in either.
· Define “channel conflict” and describe in one or two paragraphs how a company might deal with this issue.
· In two paragraphs, explain why a customer-centric Web site design is so important, yet is so difficult to accomplish.
· In about two paragraphs, distinguish between outsourcing and offshoring as they relate to business processes.
· In about 200 words, explain how the achieved trust level of a company’s communications using blogs and social media compare with similar communication efforts conducted using mass media and personal contact.
· Write a paragraph in which you distinguish between a virtual community and a social networking Web site
· Write two or three paragraphs in which you describe the role that culture plays in the development of a country’s laws and ethical standards.
QUESTION 1
Lakota peoples of the Great Plains are notably:
nomadic and followed the buffalo herds
Sedentary farmers, raising corn, northern beans, and potatoes
peaceful people who tried to live in harmony with neighboring tribes and the environment
religious and employed a variety of psychoactive plants during religious ceremonies
QUESTION 2
Tribal peoples of the Great Plains experienced greater ease at hunting and warfare after the introduction of:
Hotchkiss guns
smokeless gunpowder
horses
Intertribal powwows
all of the above
QUESTION 3
The Apaches and Navajos (Dine’) of the southwestern region of North America speak a language similar to their relatives of northern California and western Canada called:
Yuman
Uto-Aztecan
Tanoan
Athabaskan
Algonkian
QUESTION 4
The Navajo lived in six or eight-sided domed earth dwellings called:
wickiups
kivas
hogans
roadhouses
sweat lodge
QUESTION 5
Pueblo Indians, such as the Zuni and Hopi tribes, are descendants of the ancient people known as the:
Anasazi
Ashkenazi
Athabaskan
Aztecanotewa
Atlantean
2 points
QUESTION 6
1. Kachinas, or spirits of nature, were believed to:
Assist in the growth of crops and send rain
Help defend the Navajo against all foreign invaders
Provide medical assistance to the Hopi when doctors were not available
Combat evil spirits such as Skin-walkers or Diablitos
All of the above
2 points
QUESTION 7
1. The preferred dwellings among the Lakota Sioux were:
wickiups
adobe pueblos
pit houses
teepees
buffalo huts
2 points
QUESTION 8
1. Native Americansbenef.
· Assignment List· My Personality Theory Paper (Week Four)My.docxgerardkortney
· Assignment List
· My Personality Theory Paper (Week Four)
My Personality Theory Paper (Week Four)
DUE: May 31, 2020 11:55 PM
Grade Details
Grade
N/A
Gradebook Comments
None
Assignment Details
Open Date
May 4, 2020 12:05 AM
Graded?
Yes
Points Possible
100.0
Resubmissions Allowed?
No
Attachments checked for originality?
Yes
Top of Form
Assignment Instructions
My Personality Theory Paper
Instructions:
For this assignment, you will write a paper no less than 7 pages in length, not including required cover and Reference pages, describing a single personality theory from the course readings that best explains your own personality and life choices. You are free to select from among the several theories covered in the course to date but only one theory may be used.
Your task is to demonstrate your knowledge of the theory you choose via descriptions of its key concepts and use of them to explain how you developed your own personality. It is recommended that you revisit the material covered to date to refresh your knowledge of theory details. This is a "midterm" assignment and you should show in your work that you have studied and comprehended the first four weeks of course material. Your submission should be double-spaced with 1 inch margins on all sides of each page and should be free of spelling and grammar errors. It must include source crediting of any materials used in APA format, including source citations in the body of your paper and in a Reference list attached to the end. Easy to follow guides to APA formatting can be found on the tutorial section of the APUS Online Library.
Your paper will include three parts:
I. A brief description of the premise and key components of the theory you selected. You should be thorough and concise in this section and not spend the bulk of the paper detailing the theory, but rather just give enough of a summary of the key points so that an intelligent but uniformed reader would be able to understand its basics. If you pick a more complicated theory, you should expect explaining its premise and key components to take longer than explaining the same for one of the simpler theories but, in either case, focus on the basics and keep in mind that a paper that is almost all theory description and little use of the theory described to explain your own personality will receive a significant point deduction as will the reverse case of the paper being largely personal experience sharing with little linkage to clearly described key theory components.
II. A description of how your chosen theory explains your personality and life choices with supporting examples.
III. A description of the limitations of the theory in explaining your personality or anyone else’s.
NOTE: Although only your instructor will be reading your paper, you should still think about how much personal information you want to disclose. The purpose of this paper is not to get you to share private information, but rather to bring one .
· Assignment List
· Week 7 - Philosophical Essay
Week 7 - Philosophical Essay
DUE: Mar 22, 2020 11:55 PM
Grade Details
Grade
N/A
Gradebook Comments
None
Assignment Details
Open Date
Feb 3, 2020 12:05 AM
Graded?
Yes
Points Possible
100.0
Resubmissions Allowed?
No
Attachments checked for originality?
Yes
Top of Form
Assignment Instructions
Objective: Students will write a Philosophical Essay for week 7 based on the course concepts.
Course Objectives: 2, 3, & 4
Task:
This 4 - 5 full page (not to exceed 6 pages) Philosophical Essay you will be writing due Week 7 is designed to be a thoughtful, reflective work. The 4 - 5 full pages does not include a cover page or a works cited page. It will be your premier writing assignment focused on the integration and assessment relating to the course concepts. Your paper should be written based on the outline you submitted during week 4 combined with your additional thoughts and instructor feedback. You will use at least three scholarly/reliable resources with matching in-text citations and a Works Cited page. All essays are double spaced, 12 New Times Roman font, paper title, along with all paragraphs indented five spaces.
Details:
You will pick one of the following topics only to do your paper on:
· According to Socrates, must one heed popular opinion about moral matters? Does Socrates accept the fairness of the laws under which he was tried and convicted? Would Socrates have been wrong to escape?
· Consider the following philosophical puzzle: “If a tree falls in the forest and there's no one around to hear it, does it make a sound?” (1) How is this philosophical puzzle an epistemological problem? And (2) how would John Locke answer it?
· Evaluate the movie, The Matrix, in terms of the philosophical issues raised with (1) skepticism and (2) the mind-body problem. Explain how the movie raises questions similar to those found in Plato’s and Descartes’ philosophy. Do not give a plot summary of the movie – focus on the philosophical issues raised in the movie as they relate to Plato and Descartes.
· Socrates asks Euthyphro, “Are morally good acts willed by God because they are morally good, or are they morally good because they are willed by God?” (1) How does this question relate to the Divine Command Theory of morality? (2) What are the philosophical implications associated with each option here?
· Explain (1) the process by which Descartes uses skepticism to refute skepticism, and (2) what first principle does this lead him to? (3) Explain why this project was important for Descartes to accomplish.
Your paper will be written at a college level with an introduction, body paragraphs, a conclusion, along with in-text citations/Works Cited page in MLA formatting. Students will follow MLA format as the sole citation and formatting style used in written assignments submitted as part of coursework to the Humanities Department. Remember - any resource that is listed on the Works Cited page must .
· Assignment 3 Creating a Compelling VisionLeaders today must be .docxgerardkortney
· Assignment 3: Creating a Compelling Vision
Leaders today must be able to create a compelling vision for the organization. They also must be able to create an aligned strategy and then execute it. Visions have two parts, the envisioned future and the core values that support that vision of the future. The ability to create a compelling vision is the primary distinction between leadership and management. Leaders need to create a vision that will frame the decisions and behavior of the organization and keep it focused on the future while also delivering on the short-term goals.
To learn more about organizational vision statements, do an Internet search and review various vision statements.
In this assignment, you will consider yourself as a leader of an organization and write a vision statement and supporting values statement.
Select an organization of choice. This could be an organization that you are familiar with, or a fictitious organization. Then, respond to the following:
· Provide the name and description of the organization. In the description, be sure to include the purpose of the organization, the products or services it provides, and the description of its customer base.
· Describe the core values of the organization. Why are these specific values important to the organization?
· Describe the benefits and purpose for an organizational vision statement.
· Develop a vision statement for this organization. When developing a vision statement, be mindful of the module readings and lecture materials.
· In the vision statement, be sure to communicate the future goals and aspirations of the organization.
· Once you have developed the vision statement, describe how you would communicate the statement to the organizational stakeholders, that is, the owners, employees, vendors, and customers.
· How would you incorporate the communication of the vision into the new employee on-boarding and ongoing training?
Write your response in approximately 3–5 pages in Microsoft Word. Apply APA standards to citation of sources.
Use the following file naming convention: LastnameFirstInitial_M1_A3.doc. For example, if your name is John Smith, your document will be named SmithJ_M1_A3.doc.
By the due date assigned, deliver your assignment to the Submissions Area.
Assignment 3 Grading Criteria
Maximum Points
Chose and described the organization. The description included the purpose of the organization, the products or services the organization provides, and the description of its customer base.
16
Developed a vision statement for the organization. Ensured to accurately communicate the goals and aspirations of the organization in the vision statement.
24
Ensured that the incorporation and communication strategy for the vision statement is clear, detailed, well thought out and realistic.
28
Evaluated and explained which values are most important to the organization.
24
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate r.
· Assignment 4
· Week 4 – Assignment: Explain Theoretical Perspectives for Real-life Scenarios
Assignment
Updated
Top of Form
Bottom of Form
For each of the following three scenarios, use a chart format to assess how each traditional theoretical perspective would best explain the situation that a social worker would need to address. You may create your charts in Word or another software program of your choice. An example chart follows the three scenarios.
Scenario 1
You are a hospital social worker who is working with a family whose older adult relative is in end-stage renal failure. There are no advanced directives and the family is conflicted over what the next steps should be.
Scenario 2
You are a caseworker in a drug court. Your client has had three consecutive dirty urine analyses. She is unemployed and has violated her probation order.
Scenario 3
You are a school social worker. A teacher sends her 9-year-old student to you because he reports that he has not eaten in 2 days and there are no adults at home to take care of him.
Chart Example:
Your client, an 11-year-old girl, was removed from home because of parental substance abuse. She is acting out in her foster home, disobeying her foster parents and not following their rules.
Theory
Explanation for Scenario – please respond to the questions below in your explanation
Systems Theory
What systems need to be developed or put in place to support the child? Would Child Protective Services need to become involved? What other systems would support her and a successful outcome for being in foster care?
Generalist Theory
What is the best intervention or therapy to use based on this child’s situation? Given her circumstances, how could you best improve her functioning?
Behavioral Theory
What behaviors are being reinforced? What behaviors are being ignored or punished? What would you suggest to maintain this placement? Would this involve working with the foster parents?
Cognitive Theory
How would you help your client to examine her thinking, emotions, and behavior? What would this entail from a cognitive developmental framework?
Support your assignment with a minimum of three resources.
Length: 3 charts, not including title and reference pages
Your assignment should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards where appropriate. Be sure to adhere to Northcentral University's Academic Integrity Policy.
Assignement 3
State the function of each of the following musculoskeletal system structures: Describe the structures of the musculoskeletal system.
Skeletal muscle
Tendons
Ligaments
Bone
Cartilage
Describe each of the following types of joints:
Ball-and-socket
Hinge
Pivot
Gliding
Saddle
Condyloid
Newspaper Rubric
CATEGORY
4
3
2
1
Headline & Byline & images
16 points
Article has a .
· Assignment 2 Leader ProfileMany argue that the single largest v.docxgerardkortney
· Assignment 2: Leader Profile
Many argue that the single largest variable in organizational success is leadership. Effective leadership can transform an organization and create a positive environment for all stakeholders. In this assignment, you will have the chance to evaluate a leader and identify what makes him/her effective.
Consider all the leaders who have affected your life in some way. Think of people with whom you work—community leaders, a family member, or anyone who has had a direct impact on you.
· Choose one leader you consider to be effective. This can be a leader you are personally aware of, or someone you don’t know, but have observed to be an effective leader. Write a paper addressing the following:
· Explain how this leader has influenced you and why you think he or she is effective.
· Analyze what characteristics or qualities this person possesses that affected you most.
· Rate this leader by using a leadership scorecard. This can be a developed scorecard, or one you develop yourself. If you use a developed scorecard, please be sure to cite the sources of the scorecard. Once you have identified your scorecard, rate your leader. You decide what scores to include (for example, scale of 1–5, 5 being the highest) but be sure to assess the leader holistically across the critical leadership competencies you feel are most important (for example, visioning, empowering, strategy development and communication).
· Critique this individual’s skills against what you have learned about leadership so far in this course. Consider the following:
· How well does he/she meet the practices covered in your required readings?
· How well has he/she adapted to the challenges facing leaders today?
· If you could recommend changes to his/her leadership approach, philosophy, and style, what would you suggest? Why?
· Using the assigned readings, the Argosy University online library resources, and the Internet including general organizational sources like the Wall Street Journal, BusinessWeek, or Harvard Business Review, build a leadership profile of the leader you selected. Include information from personal experiences as well as general postings on the selected leader from Internet sources such as blogs. Be sure to include 2–3 additional resources not already included in the required readings in support of your leadership profile.
Write a 3–5-page paper in Word format. Apply APA standards to citation of sources. Use the following file naming convention: LastnameFirstInitial_M2_A2.doc.
By the due date assigned, deliver your assignment to the Submissions Area.
Assignment 2 Grading Criteria
Maximum Points
Explained how this leader has been influential and why you think the leader is effective showing analysis of the leader’s characteristics or qualities.
16
Analyzed the characteristics or qualities the leader possesses that have affected you most..
16
Rated your leader using a leadership scorecard and supported your rationale for your rating.
32
Criti.
· Assignment 1 Diversity Issues in Treating AddictionThe comple.docxgerardkortney
· Assignment 1: Diversity Issues in Treating Addiction
The complexities of working with diverse populations in treating disorders, such as addictions, require special considerations. Some approaches work better with some populations than with others. For example, Alcoholics Anonymous (AA) programs are spiritually based and focus on a higher power. Some populations have difficulty with these concepts and are averse to participating in such groups.
Select a population—for example, African Americans; Native Americans; or lesbians, gays, or bisexual individuals. Research your topic by using articles from the supplemental readings for this course or from other resources such as the Web, texts, experience, or other journal articles related to diversity issues and addictions.
Write a three- to five-page paper discussing the following:
· Some specific considerations for working with your chosen population in the area of addiction treatment
· Whether your research indicates that 12-step groups work with this population
· Any special problems associated with this population that make acknowledging the addiction and seeking treatment more difficult
· Any language or other barriers that this population faces when seeking treatment
Prepare your paper in Microsoft Word document format. Name your file M4_A1_LastName_Research.doc, and submit it to the Submissions Area by the due date assigned Follow APA guidelines for writing and citing text.
Assignment 1 Grading Criteria
Maximum Points
Discussed some specific considerations for working with your chosen population in the area of addiction.
8
Discussed whether your research indicates that 12-step groups work with your chosen population.
8
Discussed any special problems associated with this population that make acknowledging the addiction and seeking treatment more difficult .
8
Discussed any language or other barriers that this population faces when seeking treatment.
8
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.
4
Total:
36
· M4 Assignment 2 Discussion
Discussion Topic
Top of Form
Due February 9 at 11:59 PM
Bottom of Form
Assignment 2: Discussion Questions
Your facilitator will guide you in the selection of two of the three discussion questions. Submit your responses to these questions to the appropriate Discussion Area by the due date assigned. Through the end of the module, comment on the responses of others.
All written assignments and responses should follow APA rules for attributing sources.
You will be attempting two discussion questions in this module; each worth 28 points. The total number of points that can be earned for this assignment is 56.
Minority Groups
Many minority groups experience stress secondary to their social surroundings. For example, a family living in poverty may face frequent violence. Limited income makes meeting the day-to-day need.
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তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
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Original ArticleThe Establishment of Evidence-BasedPract.docx
1. Original Article
The Establishment of Evidence-Based
Practice Competencies for Practicing
Registered Nurses and Advanced Practice
Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality,
Reliability, Patient Outcomes, and Costs
Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FNAP,
FAANP, FAAN •
Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC • Lisa
English Long, RN, MSN, CNS •
Ellen Fineout-Overholt, RN, PhD, FAAN
Keywords
evidence-based
practice,
competencies,
healthcare quality
ABSTRACT
Background: Although it is widely known that evidence-based
practice (EBP) improves healthcare
quality, reliability, and patient outcomes as well as reduces
variations in care and costs, it is still
not the standard of care delivered by practicing clinicians across
the globe. Adoption of specific
EBP competencies for nurses and advanced practice nurses
(APNs) who practice in real-world
healthcare settings can assist institutions in achieving high-
2. value, low-cost evidence-based health
care.
Aim: The aim of this study was to develop a set of clear EBP
competencies for both practicing
registered nurses and APNs in clinical settings that can be used
by healthcare institutions in their
quest to achieve high performing systems that consistently
implement and sustain EBP.
Methods: Seven national EBP leaders developed an initial set of
competencies for practicing
registered nurses and APNs through a consensus building
process. Next, a Delphi survey was
conducted with 80 EBP mentors across the United States to
determine consensus and clarity
around the competencies.
Findings: Two rounds of the Delphi survey resulted in total
consensus by the EBP mentors,
resulting in a final set of 13 competencies for practicing
registered nurses and 11 additional
competencies for APNs.
Linking Evidence to Action: Incorporation of these
competencies into healthcare system ex-
pectations, orientations, job descriptions, performance
appraisals, and clinical ladder promotion
processes could drive higher quality, reliability, and
consistency of healthcare as well as reduce
costs. Research is now needed to develop valid and reliable
tools for assessing these competen-
cies as well as linking them to clinician and patient outcomes.
BACKGROUND
Evidence-based practice (EBP) is a life-long problem-solving
4. long lag times continue to exist between the generation of re-
search findings and their implementation in real-world clinical
settings to improve care and outcomes due to multiple barri-
ers, including: (a) misperceptions by clinicians that it takes
too much time, (b) inadequate EBP knowledge and skills, (c)
academic programs that continue to teach the rigorous pro-
cess of how to conduct research instead of an evidence-based
approach to care, (d) organizational cultures that do not sup-
port it, (e) lack of EBP mentors and appropriate resources, and
(f) resistance by colleagues, managers or leaders, and physi-
cians (Ely, Osheroff, Chambliss, Ebell, & Rosenbaum, 2005;
Estabrooks, O’Leary, Ricker, & Humphrey, 2003; Jennings &
Loan, 2001; Melnyk, Fineout-Overholt, Feinstein, et al., 2004;
Melnyk, Fineout-Overholt, et al., 2012; Titler, 2009).
The Seven-Step EBP Process and Facilitating
Factors
The seven steps of EBP start with cultivating a spirit of inquiry
and an EBP culture and environment as without these ele-
ments, clinicians will not routinely ask clinical questions about
their practices (see Table 1). After a clinician asks a clinical
question and searches for the best evidence, critical appraisal
of the evidence for validity, reliability, and applicability to
prac-
tice is essential for integrating that evidence with a clinician’s
expertise and patient preferences to determine whether a cur-
rent practice should be changed. Once a practice change is
made based on this process, evaluating the outcomes of that
Table 1. The Seven Steps of Evidence-Based Practice
Step 0: Cultivate a spirit of inquiry along with an EBP culture
and environment
Step 1: Ask the PICO(T) question
6. resources that facilitate EBP (Gerrish & Clayton, 2004; Mel-
nyk, Fineout-Overholt, et al., 2012; Pravikoff, Pierce, &
Tanner,
2005; Restas, 2000; Rycroft-Malone et al., 2004).
There are also factors that facilitate EBP, including: beliefs
in the value of EBP and the ability to implement it, EBP men-
tors who work with direct care clinicians to implement best
practices, supportive EBP contexts or environments and cul-
tures, administrative support, and assistance by librarians from
multifaceted education programs (Melnyk et al., 2004; Mel-
nyk & Fineout-Overholt, 2011; Melnyk, Fineout-Overholt, &
Mays, 2008; Newhouse, Dearholt, Poe, Pugh, & White, 2007;
Rycroft-Malone, 2004). The concept of healthcare context (i.e.,
the environment or setting in which people receive health-
care services), specifically organizational context, is becoming
an increasingly important factor in the implementation of ev-
idence at the point of care (Estabrooks, Squires, Cummings,
Birdsell, & Norton, 2009; Rycroft-Malone, 2004). Strategies
to enhance system-wide implementation and sustainability of
evidence-based care need to be multipronged and target: (a)
the enhancement of individual clinician and healthcare leader
EBP knowledge and skills; (b) cultivation of a context and cul-
ture that supports EBP, including the availability of resources
and EBP mentors; (c) development of healthcare leaders who
can spearhead teams that create an exciting vision, mission,
and strategic goals for system-wide implementation of EBP;
(d) sufficient time, resources, mentors, and tools for clinicians
to engage in EBP; (e) clear expectations of the role of clini-
cians and advanced practice nurses (APNs) in implementing
and sustaining evidence-based care; (f) facilitator characteris-
tics and approach; and (f) a recognition or reward system for
those who are fully engaged in the effort (Dogherty, Harri-
son, Graham, Vandyk, & Keeping-Burke, 2013; Melnyk, 2007;
Melnyk, Fineout-Overholt, et al., 2012).
7. Competencies for Nurses
Although there is a general expectation of healthcare systems
globally for nurses to engage in EBP, much uncertainty exists
about what exactly that level of engagement encompasses. Lack
of clarity about EBP expectations and specific EBP competen-
cies that nurses and APNs who practice in real-world healthcare
settings should meet impedes institutions from attaining high-
value, low-cost evidence-based health care. The development of
EBP competencies should be aligned with the EBP process in
continual evaluation across the span of the nurses’ practice, in-
cluding technical skills in searching and appraising literature,
clinical reasoning as patient and family preferences are con-
sidered in decision making, problem-solving skills in making
recommendations for practice changes, and the ability to adapt
to changing environments (Burns, 2009).
Competence is defined as the ability to do something well;
the quality or state of being competent (Merriam Webster Dic-
tionary, 2012). Competencies are a mechanism that supports
health professionals in providing high-quality, safe care. The
construct of nursing competency “attempts to capture the myr-
iad of personal characteristics or attributes that underlie com-
petent performance of a professional person.” Competencies
are holistic entities that are carried out within clinical contexts
and are composed of multiple attributes including knowledge,
psychomotor skills, and affective skills. Dunn and colleagues
contend that competency is not a “skill or task to be done, but
characteristics required in order to act effectively in the nurs-
ing setting.” Although a particular competency “cannot exist
without scientific knowledge, clinical skills, and humanistic
values” (Dunn et al., 2000, p. 341), the actual competency tran-
scends each of the individual components. The measurement
of nurses’ competencies related to various patient care activi-
ties is a standard ongoing activity in a multitude of healthcare
organizations across the globe, however, competencies related
to the critical issue of how practicing nurses approach decision
8. making (e.g., whether it is evidence-based vs. tradition-based)
is limited and needs further research.
Recently, work has been conducted to establish general
competencies for nursing by the Quality and Safety Educa-
tion for Nurses (QSEN) Project, which is a global nursing
initiative whose purpose was to develop competencies that
would “prepare future nurses who would have the knowl-
edge, skills, and attitudes (KSAs) necessary to continuously
improve the quality and safety of the healthcare systems
within which they work” (QSEN, 2013). This project has
developed competency recommendations that address the
following practice areas:
� Patient-centered care
� Teamwork and collaboration
� Evidence-based practice
� Quality improvement
� Safety
� Informatics
Further work in competency development has been spear-
headed by the Association of Critical Care Nurses, which de-
veloped the Synergy Model. The goal of the model was to assist
practicing nurses in decision making. An example of the model
in action would be the use of the model by charge nurses in
their decisions to match patients and nurses to achieve best
outcomes of evidence-based care processes promulgated by
the American Association of Critical Care Nurse (2013). Kring
(2008) wrote about how clinical nurse specialists, when com-
petent in EBP, can leverage their unique roles as expert prac-
10. METHODOLOGY
The first step in formulating the competencies involved seven
national experts from both clinical and academic settings across
the United States, who were identified and invited to participate
in developing EBP competencies through a consensus build-
ing process. These experts were chosen because they were rec-
ognized national experts in EBP, having influenced the field
or being widely published in the area. Through a consensus
building process, the EBP expert panel produced two lists of
essential EBP competencies, one set for practicing registered
nurses and one for APNs. For registered nurses, the experts
identified 12 essential EBP competencies. For APNs, there were
11 additional essential EBP competencies (23 total).
The next step in developing the competencies involved uti-
lizing the Delphi survey technique, which seeks to obtain con-
sensus on the opinions of experts through a series of struc-
tured rounds. The Delphi technique is an iterative multistage
process, designed to transform opinion into group consensus.
Studies employing the Delphi technique make use of individ-
uals who have knowledge of the topic being investigated who
are identified as “experts” selected for the purpose of applying
their knowledge to a particular issue or problem. The literature
reflects that an adequate number of rounds must be employed
in a Delphi study in order to find the balance between produc-
ing meaningful results without causing sample fatigue. Rec-
ommendations for Delphi technique suggest that two or three
rounds are preferred to achieve this balance (Hasson, Keeney,
& McKenna, 2000).
Inclusion Criteria
The expert participants for this Delphi survey of EBP compe-
tencies were individuals who attended an intensive continuing
education course or program in EBP at the first author’s aca-
demic institution within the last 7 years and who identified
11. themselves as EBP mentors. The EBP mentors were nurses
with in-depth knowledge and skills in EBP along with skills
in organizational and individual behavior change, who work
directly with clinicians to facilitate the rapid translation of re-
search findings into healthcare systems to improve healthcare
quality and patient outcomes. EBP mentors guide others to
consistently implement evidence-based care by educating and
role modeling the use of evidence in decision making and ad-
vancement of best practice (Melnyk, 2007).
An important design element of a Delphi study is that the
investigators must determine the definition of consensus in
relation to the study’s findings prior to the data collection
phase (Williams & Webb, 1994). Although there is no uni-
versal standard about the proportion of participant agreement
that equates with consensus, recommendations range from
51% to 80% agreement for the items on the survey (Green,
Jones, Hughes, & Williams, 2002; Sumsion, 1998). Data anal-
ysis involves management of both qualitative and quantitative
information gathered from the survey. Qualitative data from
the first round group similar items together in an attempt
to create a universal description. Subsequent rounds involve
quantitative data collected to ascertain collective opinion and
are reported using descriptive and inferential statistics.
In preparation for the Delphi survey of EBP mentors across
the United States, the study was submitted to the first author’s
institutional review board and was deemed exempt status. Prior
to the survey being disseminated electronically to the EBP men-
tors for review, the study team determined the parameters of
consensus. The EBP mentors were asked to rate each com-
petency for: (a) clarity of the written quality of the competency
and (b) how essential the competency was for practicing nurses
and APNs. The criterion for agreement set was that 70% of the
EBP mentor respondents would rate the EBP competency (e.g.,
“Questions clinical practices for the purpose of improving the
13. competencies for practicing APNs. The survey was open for 2
weeks from the first contact date. A reminder e-mail was sent
1 week following the first contact and a second reminder was
issued a day before the survey closed. Consent was obtained
by virtue of the participant completing the survey.
The EBP mentors were asked to respond to two questions
about each of the EBP competencies on the survey using a five-
point Likert scale with 1 = Not at all, 2 = A little, 3 =
Somewhat,
4 = Moderately so, and 5 = Very much so. The first question
was related to how essential the competency was for nurses
and APNs and was stated as “To what extent do you believe the
above EBP competency is essential for practicing registered
professional nurses.” The second question was focused on the
clarity of the competency and was stated as, “Is the competency
statement clearly written?” If participants answered “no” in
response to whether the statement was clearly written, they
were asked how they would rewrite it. Only the EBP mentors
who identified themselves as APNs were permitted to rate the
APN competencies.
FINDINGS
Of the 315 EBP mentors originally contacted to participate in
the survey, 80 responded indicating a 25% response rate. De-
mographic data collected reflected that all 80 participants were
female with a mean age of 52 years and an average of 26 years
in
clinical practice. Fifty of the 80 respondents were self-reported
as APNs and the average number of years as an EBP mentor
was reported as 3 (see Table 2). The majority of the partici-
pants had a Master’s or higher educational degree and was
currently serving in an EBP mentor role. The participants re-
ported holding both clinical positions and academic positions
(see Table 3). There was a relatively even distribution of partic-
ipants who worked in Magnet (n = 36; 45%) and non-Magnet
14. institutions (n = 44; 55%). The sample represented a variety of
primary work settings (see Table 4).
In the competency rating section of round 1 of the survey,
all of the practicing registered nurse and APN competencies
achieved consensus as an essential competency, based on the
preset criteria. However, in the clarity portion of the rating
section, there was feedback provided by participants regarding
refining the wording of four of the competencies. Each of these
Table 3. Race, Ethnicity, Education, and Role
(N = 80)
n
Race White 75
Black or African American 2
Native Hawaiian or other Pacific
Islander
1
Asian 2
Ethnicity Not Hispanic or Latino 79
Hispanic or Latino 1
Education Bachelor’s 9
Master’s 48
PhD 18
15. DNP 4
Other 1
Current position Staff nurse 5
Nurse practitioner 2
Clinical nurse specialist 12
Clinical nurse leader 0
Nurse educator 18
Nurse manager/administrator 8
Academic faculty 10
Academic administration 3
Other 22
Currently serving in an
EBP mentor role
Yes 63
No 17
four competencies was reworded and included in a second
round of the Delphi study. None of the competencies were
eliminated (see Tables 5 and 6).
Based on the feedback received from the participants in
round 1 related to the clarity of the competencies, the following
process was operationalized. In the single case where clarity
17. designated
institution
Yes 36
No 44
Table 5. Round 1 Registered Nurse (RN) Competen-
cies (N = 80)
Consensus Reword Revote
Competency Mean± SD (Yes–No) (Yes–No)
1 4.9± 0.3 No No
2 4.7± 0.5 No No
3 4.7± 0.5 Yes Yes
4 4.8± 0.4 No No
5 4.6± 0.5 Yes Yes
6 4.6± 0.5 Yes* Yes*
7 4.7± 0.5 No No
8 4.7± 0.5 No No
9 4.8± 0.4 No No
10 4.7± 0.4 No No
11 4.7± 0.5 No No
12 4.8± 0.4 No No
Note. *Competency 6 was split into two separate competency
statements
based on round 1 feedback.
2 for the reviewers to see that their feedback had been inte-
grated and they were asked to revote on the whether the revised
competency still rated as an essential EBP competency. Only
registered nurse competencies received feedback that required
revoting. All of the APNs competencies reached consensus
18. with only minor clarifications in terminology needed.
Table 6. Round 1 APN Competencies (N = 50)
Consensus Reword Revote
Competency Mean± SD (Yes–No) (Yes–No)
1 4.8± 0.4 No No
2 4.9± 0.3 No No
3 4.9± 0.3 No No
4 4.9± 0.3 No No
5 4.9± 0.2 No No
6 5.0± 0.2 No No
7 4.9± 0.3 No No
8 4.9± 0.3 No No
9 4.9± 0.3 No No
10 4.9± 0.2 No No
11 5.0± 0.2 No No
Three registered nurse competencies required rewriting
and revoting. Two competencies (#3, #5) required rewording
and one competency (#6) required splitting into two separate
competencies. Competency 3, formulates focused clinical ques-
tions in PICOT (i.e., Patient population; Intervention or area of
interest; Comparison intervention or group; Outcome; Time),
was
revised to be: participates in the formulation of clinical ques-
tions using PICOT* format (*PICOT = Patient population;
Intervention or area of interest; Comparison intervention or
group; Outcome; Time). Competency 5, conducts rapid critical
appraisal of preappraised evidence and clinical practice
guidelines
to determine their applicability to clinical practice, was revised
to
be: participates in critical appraisal of preappraised evidence
(such as clinical practice guidelines, evidence-based policies
20. quality of care.
2. Describes clinical problems using internal evidence.*
(internal evidence*= evidence generated internally within a
clinical
setting, such as patient assessment data, outcomes management,
and quality improvement data)
3. Participates in the formulation of clinical questions using
PICOT* format. (*PICOT= Patient population; Intervention or
area of
interest; Comparison intervention or group; Outcome; Time).
4. Searches for external evidence* to answer focused clinical
questions. (external evidence*= evidence generated from
research)
5. Participates in critical appraisal of preappraised evidence
(such as clinical practice guidelines, evidence-based policies
and
procedures, and evidence syntheses).
6. Participates in the critical appraisal of published research
studies to determine their strength and applicability to clinical
practice.
7. Participates in the evaluation and synthesis of a body of
evidence gathered to determine its strength and applicability to
clinical
practice.
8. Collects practice data (e.g., individual patient data, quality
improvement data) systematically as internal evidence for
clinical
decision making in the care of individuals, groups, and
populations.
21. 9. Integrates evidence gathered from external and internal
sources in order to plan evidence-based practice changes.
10. Implements practice changes based on evidence and clinical
expertise and patient preferences to improve care processes and
patient outcomes.
11. Evaluates outcomes of evidence-based decisions and
practice changes for individuals, groups, and populations to
determine
best practices.
12. Disseminates best practices supported by evidence to
improve quality of care and patient outcomes.
13. Participates in strategies to sustain an evidence-based
practice culture.
Evidence-based practice competencies for practicing advanced
practice nurses
All competencies of practicing registered professional nurses
plus:
14. Systematically conducts an exhaustive search for external
evidence* to answer clinical questions. (external evidence*:
evidence
generated from research)
15. Critically appraises relevant preappraised evidence (i.e.,
clinical guidelines, summaries, synopses, syntheses of relevant
external evidence) and primary studies, including evaluation
and synthesis.
16. Integrates a body of external evidence from nursing and
related fields with internal evidence* in making decisions about
patient
23. EBP Competencies for Practice
Table 8. Round 2 Registered Nurse (RN) Competen-
cies (N = 59)
Competency Consensus Mean± SD Consensus Met (Yes–No)
3 4.6± 0.5 Yes
5 4.6± 0.5 Yes
6 4.6± 0.5 Yes
7 4.5± 0.5 Yes
This process rendered a revised set of EBP competencies
that included 13 competencies for registered nurses and an
additional 11 EBP competencies (for a total of 24) for APNs
(see Table 7).
In October 2012, the second round of the Delphi study was
conducted. The revised set of EBP competencies was e-mailed
to the EBP mentors who responded in the first round of the
study in October 2012. The round 2 survey provided feedback to
the EBP mentors about the process that had been conducted by
the study team to render the revised competencies and asked
them to rate the three revised and the two new (split) EBP
competency statements using the same five-point Likert rank-
ing scale used in round 1. Fifty-nine of the 80 original EBP
mentors responded to the second round of the study (74%)
by the response deadline. In round 2 of the study, each of the
13 registered nurse competencies achieved consensus (based
on the preset criteria) as an essential EBP competency (see
Table 8). Throughout the process, none of the EBP mentors
articulated additional competencies, indicating a high level of
consensus about the completeness of the list of EBP compe-
tencies identified in the study. The final list of consensus-built
EBP competencies is included in Table 7.
24. DISCUSSION
Competencies are a mechanism that supports health profes-
sionals in providing high-quality, safe care (Dunn et al., 2000).
The issue of nursing competence in implementing EBP is im-
portant for individual nurses, APNs, nurse educators, nurse
executives, and healthcare organizations. Regardless of the sys-
tem, the culture and context or environment in which nurses
practice impact the success of engagement in and sustainabil-
ity of EBP. Therefore, it is imperative for nurse executives and
leaders to invest in creating a culture and environment to sup-
port EBP (Melnyk, Fineout-Overholt, et al., 2012). One action
toward investment in a culture of EBP is to provide a mecha-
nism for clarity in expectations for evidence-based care. Devel-
opment of evidence-based competencies provides a key mech-
anism for engagement in EBP and the delivery of high-quality
health care. Through a Delphi survey process, EBP competen-
cies were developed by EBP experts working in a variety of
settings, for registered professional nurses and APNs practic-
ing in real-world healthcare settings. These EBP competencies
can be used by healthcare systems to succinctly establish ex-
pectations regarding level of performance related to EBP by
registered professional nurses and APNs.
Multiple strategies can be used to incorporate competen-
cies into healthcare systems to improve healthcare quality, re-
liability, and patient outcomes as well as reduce variations in
care and costs. These strategies range from implementation of
competencies developed by the AACN, NLN, QSEN, and the
Institute of Medicine (IOM) from an organizational perspective
LINKING EVIDENCE TO ACTION
� Practice: Incorporation of EBP competencies into
healthcare system expectations and operations
can drive higher quality, reliability, and consis-
25. tency of healthcare as well as reduce costs. Support
systems in healthcare institutions, including edu-
cational and skills building programs along with
availability of EBP mentors, should be provided
to assist practicing nurses and APNs in achieving
the EBP competencies.
� Research is needed to develop valid and reliable
instruments for assessing these competencies. Al-
though the Fresno tool has been developed as
a valid and reliable tool for assessing EBP com-
petence in medicine (Ramos, Schafer, & Tracz,
2003), it has not been tested with nursing or al-
lied health professionals. Future research should
also determine the relationship between imple-
mentation of these EBP competencies with both
clinician and patient outcomes.
� Policy: Organizations that set standards for prac-
tice should embrace and endorse the EBP compe-
tencies as a tool to build and sustain acquisition of
EBP knowledge, development of EBP skills, and
incorporation of a positive attitude toward EBP to
promote best practices.
� Management: Nursing leaders should integrate
EBP competencies into multiple processes that
impact nurses across their clinical lifespan includ-
ing; interview questions, onboarding/orientation,
job descriptions, performance appraisals, and
clinical ladder promotion programs.
� Education: EBP competencies should be inte-
grated into both academic and clinical education
programs to establish and continuously reinforce
EBP as the foundation of practice.
27. access to library services including a
dedicated librarian, and availability of a PhD
prepared nurse scientist.
• Include EBP competencies in role expectations
of nurse leaders to support the
implementation of EBP in all aspects of care.
• Provide educational and skills building
programs to support clinicians’ attainment of
the EBP competencies.
• Support the development of EBP mentors, who
meet/exceed the EBP competencies to
support practicing nurses and APNs in EBP
projects.
Establish EBP performance
expectations for all nurse
leaders and clinicians:
• Include EBP-competency-related questions in
interview processes
• Expect evidence-based decision making from
others to promote a work environment where
the best care is possible.
• Design onboarding/orientation programs that
specifically align with EBP competencies
• Rewrite job descriptions to include the EBP
competencies
Sustain EBP activities and
culture
29. survey technique with individuals who had EBP mentorship
experience in real-world practice settings were strengths in the
development of this set of contemporary EBP competencies for
practicing and APNs.
SUMMARY
A national consensus process and Delphi study was conducted
to establish contemporary EBP competencies for practicing
registered nurses and APNs. Incorporation of these EBP com-
petencies into healthcare systems should lead to higher quality
of care, greater reliability, improved patient outcomes, and re-
duced costs.
ACKNOWLEDGMENTS
The authors would like to thank the following national expert
panel who participated in the first phase of achieving consensus
in the development of these EBP competencies: Dr. Karen Bal-
akas, Dr. Ellen Fineout-Overholt, Dr. Anna Gawlinski, Dr. Mar-
ilyn Hockenberry, Dr. Rona F. Levin, Dr. Bernadette Mazurek
Melnyk, and Dr. Teri Wurmser. WVN
Author information
Bernadette Mazurek Melnyk, Associate Vice President for
Health Promotion, University Chief Wellness Officer, Dean
and Professor, College of Nursing, Professor of Pediatrics and
Psychiatry, College of Medicine, The Ohio State University,
Columbus, OH; Lynn Gallagher-Ford, Clinical Associate Pro-
fessor and Director, Center for Transdisciplinary Evidence-
based Practice, College of Nursing, The Ohio State Univer-
sity, Columbus, OH; Lisa English Long, Expert Evidence-based
Practice Mentor, Clinical Instructor, College of Nursing, The
Ohio State University, Columbus, OH; Ellen Fineout-Overholt,
Dean and Professor, Groner School of Professional Studies,
Chair, Department of Nursing, East Texas Baptist University,
Marshall, TX.
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doi 10.1111/wvn.12021
WVN 2014;11:5–15
Worldviews on Evidence-Based Nursing, 2014; 11:1, 5–15. 15
37. care settings. Content includes
evidence-based projects and deci-
sion making, locating measurement
tools for quality improvement
and safety projects, using outcome
measures to evaluate quality, prac-
tice implications of administrative
research, and exemplars of proj-
ects that demonstrate innova-
tive approaches to organizational
problems.
In a recent evidence-based practice
(EBP) workshop, a nurse executive
asked: ‘‘What is the difference
between EBP and quality improve-
ment (QI) and benchmarking?’’ In
a different workshop, another
asked: ‘‘Do I need an institutional
review board approval for my
EBP project?’’ It becomes confus-
ing when organizational EBP, QI,
and research activities are all re-
ferred to as EBP. The issue is that
these activities often overlap.
This column assesses the unique
and overlapping relationships
among EBP, QI, and research. Defi-
nitions are provided in Figure 1.
Using an organizational problem
of increased pressure ulcer rates,
examples of each approach are
provided in Figure 2.
Research
38. Research is a systematic investiga-
tion, including research develop-
ment, testing, and evaluation
designed to develop or contribute
to generalizable knowledge.1 Be-
cause nursing research is under-
developed in a number of areas,
scientific evidence (research) is not
available to inform practice when
a problem emerges or questions
are raised about nursing processes
included in organizational policies.
The research process includes
identification of the problem,
selection of a conceptual frame-
work or theoretical model that
describes the relationships be-
tween study variables, generation
of hypotheses or research ques-
tions, and a plan for the study
design and method. The design
and method are based on the
state of knowledge of the prob-
lem and the gap in the evidence.
The design frames the appro-
priate research approach (experi-
mental, quasi-experimental, or
nonexperimental). The sample
consists of the number and type
of subjects needed to identify a
statistically significant difference
if one exists. The method includes
appropriate controls, including mea-
39. sures or instruments with adequate
estimates of reliability and valid-
ity. Standard research procedures
are established that include a plan
for interventions, measurement,
data collection, and statistical
analysis. Institutional review
board approval is obtained before
implementation of the research
protocol.
The design and methods of
research seek to control as many
variables as possible so that a link
is established between the inter-
vention (or concept of interest)
and effect (or outcome). Using a
well-planned and implemented
research approach to solve a clini-
cal, administrative, or education
432 JONA � Vol. 37, No. 10 � October 2007
Evidence and the
Executive
Author Affiliation: Associate Profes-
sor and Assistant Dean, Doctor of Nurs-
ing Practice, University of Maryland,
School of Nursing, Baltimore, Maryland.
Correspondence: University of Mary-
land, School of Nursing, 655 W. Lombard
Street, Room 516B, Baltimore, MD 21201-
1579 ([email protected]).
40. Copyright @ Lippincott Williams & Wilkins. Unauthorized
reproduction of this article is prohibited.
problem informs decisions in
healthcare organizations, extend-
ing beyond lessons learned in
one organization, to generalizable
knowledge that can be applied in
similar settings.
Quality Improvement
Quality improvement is a process
by which individuals work to-
gether to improve systems and
processes with the intention to
improve outcomes.2 An alterna-
tive definition is that QI is a data-
driven systematic approach to
improving care locally.3 The dis-
tinction between research and QI
has been recently reviewed, defined,
and debated.3-5
One familiar framework to
guide the QI process is plan-do-
study-act.6 Examples of ap-
proaches to data presentation
from QI efforts include control,
radar, Pareto charts, and cause-
and-effect diagrams.7 Although
approaches to QI have undergone
an evolution to improve the sys-
41. tematic approach, publications of
results are usually limited to les-
sons learned, instead of general-
izable results. In addition, there
has been an increase in investiga-
tors who conduct health services
research with their research activi-
ties focused on QI interventions.
These investigators intend to gen-
eralize results and approach the
organizational improvement inter-
vention as a research study.
Evidence-Based Practice
An often-cited landmark defini-
tion of EBP is: ‘‘Evidence-based
medicine is the conscientious,
explicit, and judicious use of
current best evidence in making
decisions about the care of indi-
vidual patients. The practice of
evidence-based medicine means
integrating individual clinical
expertise with the best available
external clinical evidence from
systematic research.’’8(p71)
This definition is appropriate
for nursing research utilization,
but insufficient for EBP because
the best evidence available to
address nursing problems is often
not research. In addition, nursing
practice is nested within organi-
42. zations, and appropriate organi-
zational infrastructure fosters
system and individual uptake
and use of evidence. The defini-
tion of EBP can be expanded to
the following: EBP is a problem-
solving approach to clinical deci-
sion making in a healthcare
organization that integrates the
best available scientific evidence
with the best available experien-
tial (patient and practitioner)
evidence, considers internal and
external influences on practice,
and encourages critical thinking
in the judicious application of
such evidence to care of the
individual patient, patient popu-
lation, or system.9 Note that this
approach uses the best available
evidence, not one source of evi-
dence that supports current prac-
tice. A rigorous search strategy is
used, followed by retrieval and
review of evidence that includes
grading the strength and quality,
and then applying the results
through implementation and
evaluation of the recommenda-
tions. This definition includes the
organization’s experience.
Experiential evidence ex-
tends beyond the individual pro-
vider or patient, to activities
such as QI, benchmarking, or
43. organizational or program out-
come monitoring. Rycroft-Malone
et al10 call this organizational
evidence ‘‘local context’’ and
suggest that far more work is
needed to understand how this
type of evidence is collected and
incorporated with other types
of evidence to inform healthcare
decisions.
Figure 1. Definitions.
JONA � Vol. 37, No. 10 � October 2007 433
Evidence and the Executive
Copyright @ Lippincott Williams & Wilkins. Unauthorized
reproduction of this article is prohibited.
The Overlapping Relationships
Research and QI (as a form of
experiential evidence) both in-
form EBP. Research provides a
higher level of evidence than QI
and is the major source of evi-
dence in the medical discipline.
Quality improvement provides
real-life experience and descrip-
tive data within the context of
the organization, making the
rapid cycle approach and evalua-
tion of outcomes very actionable.
44. However, there are 2 major
problems with using QI data as a
source of evidence.11 First, usu-
ally, the QI process does not meet
fundamental standards for the
conduct or publication of research.
Second, the interventions used in
QI processes often are not based
on theory that predicts their
success. These deficiencies in the
QI process produce results that
are not transferable to other
organizations (generalizable) and
do not measure variables or data
that are needed to explain the
results, designs that lack the ability
to draw causal inferences, and a
number of additional weaknesses
(threats to internal validity).
Research and EBP processes
both inform QI. When develop-
ing strategies to improve outcomes
in QI initiatives, research evidence
is reviewed, and an intervention or
interventions are selected to im-
prove the likelihood of success
for the change. Individual research
studies may be used to inform QI
action, as well as the recommen-
dations from an EBP evidence
review. The evidence review may
contain scientific (such as experi-
45. mental studies) or experiential
(such as consensus or expert opin-
ion) sources. Scientific evidence
(research) provides a higher level
of generalizability or application
to similar settings than experien-
tial evidence.
Evidence-based practice and
QI both inform opportunities
for research. As the team evalu-
ates the QI outcomes and les-
sons learned in their rapid cycle
Figure 2. Examples of research, QI, and EBP.
434 JONA � Vol. 37, No. 10 � October 2007
Evidence and the Executive
Copyright @ Lippincott Williams & Wilkins. Unauthorized
reproduction of this article is prohibited.
improvements, they may iden-
tify descriptive improvements in
areas where there are gaps in
the evidence to support the need
for research to test a new inter-
vention. Likewise, during the
evidence review and synthesis
phase of the EBP process, gaps
in knowledge are identified.
These gaps provide the opportu-
nity to generate research ques-
46. tions or hypothesis and design a
research study to measure the
association or differences between
variables.
Conclusion
Major forces drive the need for
nurses to demonstrate basic and
advanced competency in EBP,
QI, and research. These forces
include disparities and deficits in
quality of care for patients, in-
creasing evidence to support the
effectiveness of interventions,
national efforts to standardize
performance measures, and a
focus on improving the health-
care work environments.
Efforts to improve work
environments necessitate that we
apply evidence to healthcare de-
livery, align payment policies
with QI, and prepare the work-
force.12 Applying evidence to
practice requires that we apply
scientific knowledge systemati-
cally, building infrastructure to
support decision making, setting
goals for improvement, and de-
veloping measures to assess qual-
ity.12 Preparing the workforce
involves developing competencies
in QI, EBP, informatics, patient-
centered care, and interdisciplinary
47. collaboration.13
To advance quality, an inter-
disciplinary common vision, lan-
guage, and processes are required.
Research, QI, and EBP are tools
to identify and describe problems,
explain relationships between fac-
tors of interest, and implement
interventions or strategies with a
clear rationale. Nurse executives
have an important role in diffus-
ing the confusion between EBP,
QI, and research; building collabo-
rative relationships; and establish-
ing organizational infrastructure to
support continued improvements
in healthcare quality.14,15 A precur-
sor to leading is understanding the
distinct differences, yet overlap-
ping associations, between these
3 important activities.
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Evidence and the Executive