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.docxgerardkortney
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.
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.
Original ArticleThe Establishment of Evidence-BasedPract.docxgerardkortney
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.
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.
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.
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) 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.
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.
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.
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.
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 ...
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.
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.
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.
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 overview and introduction to evidence-based decision making (EBDM) for dental professionals. It defines key terms like evidence-based practice and discusses the need for EBDM to improve patient care and address variations in practice. The document outlines the 5 steps of EBDM and emphasizes that evidence alone is not sufficient, and a hierarchy of evidence exists. It also discusses forming answerable clinical questions as the first step using the PICO framework.
There are differences between research, evidence-based practice (EBP), and quality improvement (QI) but they all aim to improve quality of care. Research develops new knowledge while EBP translates existing evidence into clinical decisions using the best available research and expertise. QI focuses on maintaining and improving quality, safety, and adherence to regulations through monitoring clinical, management, and risk practices. Together, research, EBP, and QI close gaps between research and practice and drive organizational changes to generate knowledge and advance care.
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.
1) The document discusses using the Stetler model of evidence-based practice to guide a quality improvement intervention aimed at addressing provider behavior related to guidelines for treating community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections.
2) The intervention included an educational program for providers to raise awareness about appropriately prescribing antibiotics according to clinical guidelines.
3) Evaluation found the education increased provider knowledge and improved guideline-concordant prescribing for 43% of patients, showing the Stetler model provided an effective framework for integrating research into practice.
1. Primary sources2. Secondary sources3. La Malinche4. Bacon’s.docxvannagoforth
1. Primary sources
2. Secondary sources
3. La Malinche
4. Bacon’s rebellion
5. Robert Carter III
6. Mesoamerica
7. Middle Passage
8. Indentured servitude
9. The Jefferson-Hemings Controversy
10. Triangular trade
11. Saint Dominique Revolt
12. Syncretism
13. Olaudah Equiano
14. Christopher Columbus
15. Columbian Moment
16. Hernan Cortes
17. Florentine Codex
18. Master Narrative of American History
19. Reconquista
20. The Paradox of Slavery
21. Indian Removal Act 1830
22. Trail of Tears
23. Treaty of Guadalupe Hidalgo
24. Niños Heroes (Heroic Children)
25. Antonio López de Santa Anna y Pérez de Lebrón
26. The Royal Africa Company
27. John Locke
28. St. Patrick’s Battalion
29. Chilam Balam
30. Popol Vuh
31. El requerimiento (The Requirement)
32. Manifest Destiny
33. Moses and Stephen F. Austin
34. Colonialism
35. Colonial Legacy
.
1. Prepare an outline, an introduction, and a summary.docxvannagoforth
The document instructs the reader to prepare a 4 page double spaced report on an attached article, including an outline, introduction, and summary, and to prepare 4 PowerPoint slides summarizing the report.
More Related Content
Similar to Original ArticleThe Establishment of Evidence-BasedPract.docx
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.
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) 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.
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.
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.
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.
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 ...
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.
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.
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.
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 overview and introduction to evidence-based decision making (EBDM) for dental professionals. It defines key terms like evidence-based practice and discusses the need for EBDM to improve patient care and address variations in practice. The document outlines the 5 steps of EBDM and emphasizes that evidence alone is not sufficient, and a hierarchy of evidence exists. It also discusses forming answerable clinical questions as the first step using the PICO framework.
There are differences between research, evidence-based practice (EBP), and quality improvement (QI) but they all aim to improve quality of care. Research develops new knowledge while EBP translates existing evidence into clinical decisions using the best available research and expertise. QI focuses on maintaining and improving quality, safety, and adherence to regulations through monitoring clinical, management, and risk practices. Together, research, EBP, and QI close gaps between research and practice and drive organizational changes to generate knowledge and advance care.
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.
1) The document discusses using the Stetler model of evidence-based practice to guide a quality improvement intervention aimed at addressing provider behavior related to guidelines for treating community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections.
2) The intervention included an educational program for providers to raise awareness about appropriately prescribing antibiotics according to clinical guidelines.
3) Evaluation found the education increased provider knowledge and improved guideline-concordant prescribing for 43% of patients, showing the Stetler model provided an effective framework for integrating research into practice.
Similar to Original ArticleThe Establishment of Evidence-BasedPract.docx (20)
1. Primary sources2. Secondary sources3. La Malinche4. Bacon’s.docxvannagoforth
1. Primary sources
2. Secondary sources
3. La Malinche
4. Bacon’s rebellion
5. Robert Carter III
6. Mesoamerica
7. Middle Passage
8. Indentured servitude
9. The Jefferson-Hemings Controversy
10. Triangular trade
11. Saint Dominique Revolt
12. Syncretism
13. Olaudah Equiano
14. Christopher Columbus
15. Columbian Moment
16. Hernan Cortes
17. Florentine Codex
18. Master Narrative of American History
19. Reconquista
20. The Paradox of Slavery
21. Indian Removal Act 1830
22. Trail of Tears
23. Treaty of Guadalupe Hidalgo
24. Niños Heroes (Heroic Children)
25. Antonio López de Santa Anna y Pérez de Lebrón
26. The Royal Africa Company
27. John Locke
28. St. Patrick’s Battalion
29. Chilam Balam
30. Popol Vuh
31. El requerimiento (The Requirement)
32. Manifest Destiny
33. Moses and Stephen F. Austin
34. Colonialism
35. Colonial Legacy
.
1. Prepare an outline, an introduction, and a summary.docxvannagoforth
The document instructs the reader to prepare a 4 page double spaced report on an attached article, including an outline, introduction, and summary, and to prepare 4 PowerPoint slides summarizing the report.
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2. Should have at least 10 annotated sources (copy article onto word, highlight main point, write a few sentences about how it'll help you in writing the paper at the bottom of page)
3
. Should have an INTRO, NARRATION, ARGUMENTS, REFUTATION, CONCUSION
4. Use in-text citations and have organized mla format works cited page
SAMPLE OUTLINE
Research Paper Outline
Title: Rebellious Libya
Thesis: The United States should not get involved with Libya’s conflicts.
I.
Introduction:
A.
Start with the question, what is war? Explain briefly.
B.
Talk about the wars of the United States.
C.
What were the outcomes of some of those wars?
II.
Narration:
A.
Give some background on Libya.
B.
Explain how Col. Muammar Gaddafi became the leader of Libya
C.
Talk about why the citizens of Libya want to overthrow Gaddafi.
D.
Explain why the people feel that the United States should get involved in Libya’s conflicts.
III.
Partition:
A.
Thesis: I believe that the United States should not get involve with Libya’s conflicts.
B.
Essay Map.
1.
Cost of war.
2.
Using money in other Departments other defense.
3.
Killing innocent civilians and soldiers.
4.
Helping unknown rebels
5.
Involvement of foreign wars
IV.
Arguments:
A.
The cost of war is rising by the minute. The Obama Administration proposed a budget of $553 billion dollars for the department.
B.
Instead of spending all that money on war, we should be investing that money on health care and education.
C.
This conflict has caused the lives of many innocent civilians. NATO openly admitted to have killed innocent civilians, due to misguidance.
D.
The rebels fighting against Gaddafi are in need of military supplies. I don’t think that it is a good idea to help unknown rebels. We helped the Afghanistan rebels when they were fighting Russia. After they were victorious, they later became the “Taliban” and used those weapons to attack the US.
E.
Getting involved in foreign wars is not a good idea. The US has been involved in many foreign wars lately. These wars have been in foreign countries where Islam is the prominent religion. Libya is one of these countries. The involvement of the US in these places, builds a bad reputation worldwide and among the Muslim community.
V.
Refutation:
A.
Gaddafi’s actions against the civilians of Libya are totally wrong. Killing your own people is bad and therefore, we should help the rebels overthrow him.
B.
Gaddafi has been in power for many years. In fact, he holds the record for most years in power in a single country. This type of power can potentially lead to corruption and mistreatment of civilians.
C.
The people of Libya deserve to have democracy. They should have the right to elect their own leader.
D.
If Al Qaeda is threatening NATO and Libyan mercenaries then we should help them fight terrorism.
VI.
Conclusion:
A.
Summarize my arguments.
B.
State why we should not get involve with Libya’s conf.
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c. speciation.
d. the biological species concept.
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c. habitat
d. incompatible reproductive structures
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c. A horse and a donkey can mate and produce offspring.
d. Two donkeys can mate and produce fertile offspring.
e. Two horses can mate and produce fertile offspring.
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b. reproductive isolation.
c. adaptation of existing structures to new functions.
d. inheritance of acquired characteristics.
e. the biological species concept.
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b. insects preserved in amber
c. petrified plant remains
d. animal bones
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7. The mass extinctions that included the dinosaurs took place during which period?
a. Cambrian (543–510 million years ago)
b. Devonian (409–363 million years ago)
c. Carboniferous (363–290 million years ago)
d. Jurassic (206–144 million years ago)
e. Cretaceous (144–65 million years ago)
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a. refinement of existing adaptations.
b. reproductive isolation.
c. adaptation of existing structures to new functions.
d. inheritance of acquired characteristics.
e. the biological species concept.
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b. Carbon-14 has a half-life of 5,730 years.
c. Uranium-238 has a very short half-life.
d. Uranium-238 is present in all organisms.
e. Carbon-12 is not found in living plants.
10. Which of the following provides the best explanation for why Australia has so many organisms unique to that continent?
a. punctuated equilibrium
b. the biological species concept
c. convergent evolution
d. continental drift
e. cladistics
11. Scientists think that a meteor that fell in ____________________ may have led to the extinction of the dinosaurs.
a. Australia
b. the Yucatán peninsula
c. The Galápagos Islands
d. Pangaea
e. India
12. The great diversit.
1. Of the three chemical bonds discussed in class, which of them is .docxvannagoforth
1. Of the three chemical bonds discussed in class, which of them is simultaneously the weakest and most important for life on this planet as we know it?
2.Carbohydrates are very important sources of energy for life. Plants and arthropods also use carbohydrates as components of structures that are very important for their existence. Provide the names of the two most important carbohydrate based structures (one for plants and one for arthropods) and the carbohydrate components that are used to form them.
3._____________ _____________ are joined by ______________ bonds to form proteins.
4.Proteins can be used for several functions. Provide examples of structural and metabolic functions of proteins.
5.Describe the phosholipid bilayer of the plasma membrane. Why is this bilayer important for the formation of cells and the sequestration of chemical reactions within the cell?
.
1. Look at your diagrams for hydrogen, lithium, and sodium. What do .docxvannagoforth
1. Look at your diagrams for hydrogen, lithium, and sodium. What do they all have in common? What group are these elements in on the periodic table?
2. Look at your diagrams for fluorine and chlorine. What do they have in common?
Picture is in the link. Put answers on the word document and re-submit
.
1. Name the following molecules2. Sketch the following molecules.docxvannagoforth
1. Name the following molecules:
2. Sketch the following molecules:
3-cyclohexenone
4-ethyl 2,2,5-trimethyl 3-hexanone
ethyl butyrate
pentanoic acid
2-chloro 4-methyl 2,5-heptadienal
3,4-dichloro 4-ethyl octanal
p-chloro phenol
3-bromo 2-chloro 4-methyl hexane
3-cyclopropyl 1,2-cyclopentanediol
methyl phenyl ether
3,5-dimethyl 2-heptene-4,5-diol
3. Give two different uses for ethanol.
4. Name two categories of organic compounds (alkanes, aldehydes…) that have very strong characteristic odours.
.
1. List the horizontal and vertical levels of systems that exist in .docxvannagoforth
1. List the horizontal and vertical levels of systems that exist in organizations.
2.
Describe at least five steps involved in systems integration
3.
What is the role of ERP systems in system integration?
4. Why do you think functional silos are not appropriate for today's organization? Discuss your answer from organizational and technical perspectives.
5. Pick an organization that you know of or where you are/were working and provide examples of logical and physical integration issues that were faced by the organization when they broke the functional silos and moved to integrated systems.
.
1. Kemal Ataturk carried out policies that distanced the new Turkish.docxvannagoforth
1. Kemal Ataturk carried out policies that distanced the new Turkish republic of the 1920s from the Ottoman past. Why? What specific policies did Ataturk pursue? 2. Why many Arabs felt betrayed by the British (and the French) after the First World War? 3. Discuss at least three features of patrimonial leadership. List three or more Middle Eastern states where such type of political leadership persists 4. Describe the key processes (both internal and external) that initiated political and economic disintegration of the Ottoman Empire in the nineteenth century. 5. European military superiority in the late eighteenth century prompted Ottoman rulers to respond with what specific political measures? 6. The Zionist political movement originated in Europe rather than in the Middle East. Explain why and how. 7. After the Second World War, several Arab countries went through the process of transition from constitutional monarchies to republics. Identify three such countries and describe the course of events that brought about this transition. 8. How is religious Zionism different from secular Zionism? What is the relevance of this difference for the creation of the state of Israel? Has the relative influence of the two remained stable since the creation of the Israeli state? 9. What was the principle source of political legitimacy of the Ottoman Empire? 10. While most Ottoman European provinces, riding the tide of the nineteenth century nationalism, sought and won independence from Istanbul, Ottoman Arab provinces maintained their political loyalty to the Ottomans. What explains this difference between Arab and European provinces? 11. Social and political forces in favor of a constitutional reform in Iran (1905-1911) were markedly different from the groups that promoted constitutional limitations on executive powers of the sultan in the Ottoman Empire prior to the First World War? Explain this difference. 12. What are some of the key features of Arab socialisms? Which Arab leaders adopted socialist ideology? Which Arab leaders were opposed to it? 13. After the First World War, the new Middle Eastern protectorates (e.g., Syria, Lebanon, Iraq) were expected to develop into modern secular states. What specific policies did France and Britain try to implement? How successful have theses policies been? 14. The 1967 war was a watershed event for all major actors in the Middle East. Explain the consequences of the war for domestic politics in Israel and Egypt respectively.
.
1. If we consider a gallon of gas as having 100 units of energy, and.docxvannagoforth
1. If we consider a gallon of gas as having 100 units of energy, and 25 of those units are used to move the car, what law of thermodynamics accounts for the other 75 units of energy? (Points : 2)
the first law
the second law
2. Which of these is not a component of a molecule of adenosine triphosphate (ATP)? (Points : 3)
adenosine
phosphate
deoxyribose sugar
ribose sugar
3. Glycolysis is a sequence of ______ chemical reactions. (Points : 3)
nine
six
five
ten
4. Exergonic reactions produce products with a ___ energy level than that of the initial reactants. (Points : 3)
lower
higher
the same
5. When chemical X is reduced, which of these expressions would be an accurate representation of its reduced state? (Points : 3)
XO
XH
X
HX
6. Most enzymes are which kind of organic compound? (Points : 3)
carbohydrates
lipids
proteins
none of the above
7. The area on an enzyme where the substrate attaches is called the: (Points : 3)
active site
allosteric site
anabolic site
inactive site
8. Which of the following creatures would not be an autotroph? (Points : 3)
cactus
cyanobacteria
fish
palm tree
9. The process by which most of the world's autotrophs make their food is known as: (Points : 3)
glycolysis
photosynthesis
chemosynthesis
herbivory
10. Plants are the only organisms that use ATP for the transfer and storage of energy. (Points : 2)
True
False
11. The colors of light in the visible range (from longest wavelength to shortest) are: (Points : 3)
ROYGBIV
VIBGYOR
GRBIYV
ROYROGERS
12. Chlorophyll is a green pigment because it absorbs only the green part of the visible light spectrum. (Points : 2)
True
False
13. The photosynthetic pigment that is essential for the process to occur is: (Points : 3)
chlorophyll a
chlorophyll b
beta carotene
xanthocyanin
14. A photosystem is: (Points : 3)
a collection of hydrogen-pumping proteins
a series of electron-accepting proteins arranged in the thylakoid membrane
a collection of photosynthetic pigments arranged in a thylakoid membrane
found only in prokaryotic organisms
15. Which of these molecules is NOT a product of the Electron Transport System? (Points : 3)
ATP
Water
Pyruvate
NAD+
16. The dark reactions require all of these chemicals to proceed except: (Points : 3)
ATP
NADPH
carbon dioxide
oxygen
17. The structural unit of photosynthesis, where the photosystems are located, are called: (Points : 3)
chlorophylls
eukaryotes
stroma
thylakoids
18. Which of the following does NOT occur during the light independent process? (Points : 3)
CO2 is used to form carbohydrates
NADPH converts to NADP
ADP converts to ATP
ATP converts to ADP
19. The production of ATP that occurs in the presence of oxygen is called: (Points : 3)
aerobic respiration
anaerobic respiration
chemiosmosis
photosynthesis
20. The first stable chemical formed by the Calvin Cycle is: (Points :.
1. In 200-250 words, analyze the basic issues of human biology as th.docxvannagoforth
1. In 200-250 words, analyze the basic issues of human biology as they relate to chronic conditions and describe the interaction between disability, disease, and behavior. Examine and discuss the impact of biological health or illness on social, psychological, and physical problems from the micro, mezzo, and macro perspectives. Choose a chronic condition from those provided in your text and consider how you might feel, think, and behave differently if the condition were affecting you versus if the condition were affecting a stranger. How might you think differently about this chronic condition if it were affecting someone close to you, your neighbor, or someone in your community? Please include at least two supporting scholarly resources.
2.Our stage of life, intellectual/cognitive abilities, and sociocultural position in life, affect our perspectives and resultant behaviors about a number of conditions including cancer. Consider the information provided in the
“Introduction to the Miller Family”
document. Both Ella and Elías have been diagnosed with cancer. Ella has been fighting cancer with complementary and alternative methods with some success for many years. Elías, her grandson, is 10 years old and has recently been diagnosed with leukemia but has not yet begun treatment. Putting yourself in either Ella or Elías’s place, what might your perspective on your cancer be? Integrate how the stage of life, cognitive abilities, and sociocultural position of your chosen person impacts her/his perspective on his/her individual disease.
.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
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Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
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
Step0:Cultivate a spirit of inquiry alongwith anEBPculture
andenvironment
Step 1: Ask thePICO(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 orAfricanAmerican 2
NativeHawaiian or other Pacific
Islander
1
Asian 2
Ethnicity NotHispanic 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
Nursepractitioner 2
Clinical nurse specialist 12
Clinical nurse leader 0
Nurse educator 18
Nursemanager/administrator 8
Academic faculty 10
Academic administration 3
Other 22
Currently serving inan
EBPmentor 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.*Competency6wassplit into
twoseparatecompetencystatements
basedon 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. thequality of care.
2. Describes clinical problemsusing internal evidence.*
(internal evidence* = evidencegenerated internallywithin a
clinical
setting, suchaspatient assessment data, outcomesmanagement,
andquality improvement data)
3. Participates in the formulation of clinical questions
usingPICOT* format. (*PICOT = Patient population;
Intervention or areaof
interest; Comparison intervention or group;Outcome; Time).
4. Searches for external evidence* to answer focusedclinical
questions. (external evidence* = evidencegenerated from
research)
5. Participates in critical appraisal of preappraised evidence
(suchas clinical practice guidelines, evidence-basedpolicies and
procedures, andevidence syntheses).
6.Participates in thecritical appraisal ofpublished
researchstudies todetermine their strengthandapplicability
toclinicalpractice.
7. Participates in the evaluation and synthesis of a bodyof
evidencegathered todetermine its strength andapplicability to
clinical
practice.
8. Collects practice data (e.g., individual patient data, quality
improvement data) systematically as internal evidence for
clinical
decisionmaking in the care of individuals, groups,
andpopulations.
9. Integrates evidencegathered fromexternal and internal
21. sources in order to plan evidence-basedpractice changes.
10. Implements practice changesbasedonevidenceandclinical
expertise andpatient preferences to improve careprocesses and
patient outcomes.
11. Evaluates outcomesof evidence-baseddecisions andpractice
changes for individuals, groups, andpopulations todetermine
best practices.
12. Disseminatesbest practices supportedby evidence to
improvequality of care andpatient outcomes.
13. Participates in strategies to sustain an evidence-
basedpractice culture.
Evidence-basedpractice competencies for practicing
advancedpractice nurses
All competencies of practicing registeredprofessional
nursesplus:
14. Systematically conducts anexhaustive search for external
evidence* toanswer clinical questions. (external evidence*:
evidence
generated from research)
15. Critically appraises relevant preappraised evidence (i.e.,
clinical guidelines, summaries, synopses, synthesesof relevant
external evidence) andprimary studies, including evaluation and
synthesis.
16. Integrates abodyof external evidence fromnursing and
relatedfieldswith internal evidence* inmakingdecisions about
patient
care. (internal evidence* = evidencegenerated internallywithin a
clinical setting, suchaspatient assessment data, outcomes
23. Table 8. Round 2 Registered Nurse (RN) Competen-
cies (N = 59)
CompetencyConsensusMean ± SDConsensusMet (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.
DISCUSSION
Competencies are a mechanism that supports health profes-
sionals in providing high-quality, safe care (Dunn et al., 2000).
24. 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-
tency of healthcare as well as reduce costs. Support
systems in healthcare institutions, including edu-
cational and skills building programs along with
26. Original Article
Table 9. Strategies for Integration of the EBP Competencies
Category Organizational Strategies Individual Strategies
Promote a culture and
context or environment
that supports EBP
• Assess theorganization’s andemployee’s
readiness for implementation of EBP
competencies prior to implementation to
promotedevelopmentof aneffective strategic
plan for their integration.
• Beanevidence-basedclinicianby integrating
EBPcompetencies into daily practice to
deliver thebest carepossible to patients and
families.
• IncludeEBPcompetency language in the
mission and vision statements for nursing as
well as sharedgovernance council charters.
• Bea rolemodel for othersbymakingdecisions
basedonevidence every day.
• Provide systemsand resources that support
the integration anduseof EBPcompetencies,
suchas a criticalmassof EBPmentors,
access to library services including a
dedicated librarian, andavailability of aPhD
preparednurse scientist.
27. • IncludeEBPcompetencies 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
theEBPcompetencies.
• Support thedevelopmentof EBPmentors,who
meet/exceed theEBPcompetencies to
support practicing nurses andAPNs in EBP
projects.
Establish EBPperformance
expectations for all nurse
leaders andclinicians:
• IncludeEBP-competency-relatedquestions in
interviewprocesses
• Expect evidence-baseddecisionmaking from
others to promote awork environmentwhere
thebest care is possible.
• Designonboarding/orientationprograms that
specifically alignwith EBPcompetencies
• Rewrite jobdescriptions to include theEBP
competencies
Sustain EBPactivities and
culture
• IncludeEBPcompetencies in performance
appraisals and clinical ladder programs
29. 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.
Address correspondence to Dr. Bernadette Mazurek Melnyk,
College of Nursing, The Ohio State University, 1585 Neil Av-
enue, Columbus, OH 43210, USA; [email protected]
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5 Adapt and Rejuvenate: Agile and Learning Organizations
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Learning Objectives
After reading this chapter, you should be able to do the
following:
1. Analyze key traits of successful change leaders.
2. Describe how agile organizations approach change compared
to traditional ones.
3. Examine the characteristics, levels, and principles of learning
organizations.
4. Explain the relationship between learning and change in
organizations, the process a company goes
through to become a learning organization, and the importance
of leadership.
5. Summarize the mind-set that both agile and learning
organizations must have in the 21st century.
38. entire industry and business market contribute to its specific
goals.
4. True/False: Learning organizations respond well to market
swings because they can
bring in outside marketing experts to advise them on how to
react.
5. True/False: In the 21st century, both agile and learning
organizations must accept
that change demands doing things differently.
6. True/False: Tension can actually be a source of energy and
renewal for a learning
organization.
Hyundai’s current successes may be surprising to those who
know its past. The Korean
automotive company has shed its former image of producing
low-quality, “me-too” vehicles—
and the experience of suffering a near collapse in sales in
1998—and replaced it with that of a
$66 billion company that controls 5% of the market today
(Holstein, 2013). The company’s cars
have vastly improved and are moving to the top of the list in
quality: J. D. Power and Associates
ranked Kia (owned by Hyundai) as number two, behind Porsche,
and Hyundai as number four,
behind Jaguar (Levin, 2015).
This change happened by design, not by chance. Hyundai’s
skills in design, product launch, and
consumer awareness are credited to its recently implemented
product management model. The
company’s overall success is attributed to the fact that it has
focused leadership; a dynamic
41. change can be diagnosed, planned, and implemented. In the
chapters that followed, strategies
and methods for sustaining change were presented. Here we
examine how organizations can
adapt to continuous change by emphasizing innovation,
creativity, agility, and learning, as is
the case with Hyundai.
Leading people is a crucial part of whether an organization
successfully adapts to continuous
change. Although leaders must facilitate and manage change by
articulating clear strategies
and creating flexible structures, they must also create a culture
that sustains not only the
“hard” dimensions of change (like strategies, structures, and
systems) but also its “soft”
dimensions, which involve motivating and developing people to
higher performance levels.
While transformational change happens rapidly and sometimes
dramatically, organizations
must also continue to make equally dramatic adjustments to
survive and succeed (Paton &
McCalman, 2000). At the same time, developing cultures that
attract high-quality talent
involves learning, innovation, and creativity.
Motorola’s 2011 restructuring exem-
plifies this type of continuous inno-
vation and creativity. The company
successfully split from a unified cor-
porate parent into Motorola Solu-
tions, which houses its businesses
that manufacture wireless devices
that are sold mainly to enterprises
and governments; and Motorola
Mobility, which sells cell phones and
42. set-top boxes to consumers. CEO
Greg Brown has helped engineer
the transformation from cell phone,
cable set-top box, wireless network,
automotive, and barcode scanner
divisions to a pure-play public-safety
LTE, a network technology that offers
high speeds and low lag times over
long distances. (Among other uses, it
provides first responders with valu-
able photos, video, and other infor-
mation via police radios equipped with specially designed
smartphones and other devices).
The turnaround involved trimming $500 million in annual
operating expenses in 3 years,
changing out 21 of 70 vice presidents, and adding 20% more
sales staff (Pletz, 2015).
Organizations that plan, implement, and strive to sustain change
must continually adapt
to unforeseen global competition, uneven economic shifts, new
technologies, and the rapid
increase of available data. Other challenges may be indirect and
less dramatic, such as learn-
ing how best to incorporate recent graduates into the workforce
when they may lack certain
skills because educational systems can’t keep pace with changes
in the workplace (Marquardt,
AP Photo/Richard Drew
CEO of Motorola
43. Solution
s Greg Brown helped Motor-
ola Inc. split into two successful companies, Motorola