NR 439 Discussion Applying and Sharing Evidence to Practice

After the data have been analyzed, conclusions are made regarding what the findings mean. Then, this information must be shared with your healthcare team.

Choose one of the articles from the RRL assignment, and discuss the findings. Would you apply the evidence found to your practice? Explain your answer, please.

Translating research into practice is the final and most important step in the research process. Review information you found in your Week 3 Assignment, and explain ways in which you would share the research-based evidence with your peers.

You may begin posting in this TD on Sunday for credit

As you evaluate results reported in the articles, consider using the 4 rules that we discussed last week. It is very important to identify the purpose of the study before moving forward with the evaluation of the results. If the study has an intervention or treatment, then it is likely that there will be dependent and independent variables (Chamberlain College of Nursing, 2017). The next step focuses on identification of data collection methods and how investigators measured these variables. Furthermore, discussion and conclusion sections of the report offer an interpretation of study results and may even incorporate investigators’ opinions or speculations regarding the findings (Chamberlain College of Nursing, 2017).

A well-written research report contains strengths and limitations. Concerns with study limitations are especially important when investigators report results from a pilot study. Pilot studies are often designed to preliminary test the intervention to identify potential benefits; however, as we acknowledged, results from such a study are very hard to generalize to a greater population. Pay special attention to the sample selection for the study and resources needed to implement the proposed change. Last week we discovered that even though some results appear to be statistically significant, they may not have any clinical significance. Think about other barriers or challenges you might encounter while implementing a change and how you would overcome those challenges. Thank you, Dr Joy

Reference

Chamberlain College of Nursing. (2017). NR439 Week 7: Reading research literature, credibility, and significance [Online Lesson]. Downers Grove, IL: DeVry Education Group.

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The week 5 RRL article I will be discussing on is quantitative balance and gait measurement in patients with Frontotemporal dementia and Alzheimer diseases. A pilot study. Fall is one of the leading cause of injury morbidity and mortality in older adults. People with history of falling may limit their activities because of fear of falling. Frontotemporal dementia and Alzheimer’s disease are neuro-generative dementia with a wide prevalence of fall. The purpose of the study was to identify the relationship which gait, balance, and ambulation have with falls in normal aging versus patients with AD and FTD. Identifying the patterns of gait and balance in these patients helps to put in place appropriate interventions to prevent falls in these individuals. According to the study, balance and gait problems exist in normal elderly as well as patients with AD and FTD during dual tasking indicating the role of divided attention.

The study states that patients with FTD have a tendency to tilt forward, while patients with AD have a tendency to tilt backward. These indicates the different patterns of gait and balance in patients with FTD and AD. Differentiating gait and balance in these patients will help in formulating an individualized care plan for preventing falls. Working in long term care, I encounter many patients with dementia. Often times, it is very difficult to distinguish between patients with FTD and AD. There is no distinction between the types of dementia. The two main diagnoses of dementia that is common are unspecified dementia with behavioral disturbances and unspecified dementia without behavioral disturbances. Before applying the evidence in my practice, it must be a multidisciplinary approach involving every member of the healthcare team. The physician must first diagnose the patient with FTD or AD, and the interdisciplinary team will determine which intervention is appropriate for the patient by applying evidence from the study.

Translating research into practice is the final and most important step in the research process. Review information you found your nursing clinical issue and explain ways in which you would share the research-based evidence with your peers.

Evidence based research is very important in nursing. Research and evidence based practice go hand in hand with each other. Research leads to new knowledge and nurses use research findings as evidence during their practice. I will share the research based evidence with my peers by conducting meetings and in-services. Publishing the results of the research findings in the organization’s bulletin board, newsletters, and websites. I can also use statistical analysis such as tables, graphs, and pie charts when presenting research based evidence. Our week 7 lesson states that the research process is terminated by disseminating or communicating information about the research study through publications. An example of a clinical issue is the implementation of an evidence based clinical practice guideline to reduce the number of center acquired pressure ulcers on wheelchair and bed bound patients. Using a quantitative question in the research also provide a stronger level of evidence when sharing research based evidence with my peers. Quantitative research seeks to make conclusions about the effectiveness of an intervention. They can be broken down into PICO elements (population, intervention, comparison, and outcome) for easy understanding (Houser, 2017).

References.

CCN,( 2017). NR 439 week 7 lesson: Reading research literature, credibility, and significance. Online lesson. Downers Grove, IL: Devry Education Group.

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Sudbury, MA: Jones & Bartlett.

Velayutham, S. G., Chandra, S. R., Bharath, S., & Shankar, R. G. (2017). Quantitative balance and gait measurement in patients with frontotemporal dementia and Alzheimer diseases: A pilot study. Indian Journal Of Psychological Medicine, 39(2), 176-182. doi:10.4103/0253-7176.203132. http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=122248443&site=eds-live&scope=sitLinks to an external site.

Thanks for reading my post and thanks for the question. In response to your questions:

How can a nurse evaluate whether the practice change that is implemented based on research was effective?

The nurse can do this by using quantitative and qualitative research studies and by using the SMART acronym.

Quantitative studies provide strong evidence to support outcome measurement and evaluation (Houser, 2018). By using quantitative research study, the nurse is able to draw conclusions about the relationships between interventions and outcomes. Quantitative research study provides strong evidence about the effectiveness of the intervention. The focus is on the comparing of two groups such as an intervention group and a control group, a group with a risk factor and a matched group without that risk factor, or the same group at baseline and after the treatment. Quantitative studies provide strong evidence to support outcome measurement and evaluation, it allows the nurse to evaluate the expected outcome from a specific intervention.

Qualitative research is another way which the nurse can use to evaluate whether the practice change that is implemented based on research is effective. It helps the nurse to understand whether the intervention was beneficial to the patient or not. It helps the nurse to understand the response of the patient to the treatment and what affected the patient’s life in an adverse way. Qualitative research enables the nurse researcher to identify rich, interesting, and insightful information about the experiences of patients (Houser, 2018).

The SMART acronym is also another useful tool which the nurse can use to evaluate whether the practice change was effective or not. According to (nursingworld.org), once the nurse is certain about the change that he/she wants to make and how to go about the change, it is useful to set some objectives and outcome measures. The SMART acronym is a commonly used tool:

Specific – Objectives should refer to specific, detailed outcomes rather than vague or broad statement
- Measurable – It should be possible to monitor whether or not something has changed
  - Appropriate – The objectives set should be achievable and realistic
  - Relevant – The objectives should make sense in terms of the overall purpose of the project
  - Time-bound – The objectives should set clear time frames.

2. If your project findings showed a clinical significance how would you share these results with your organization?

I will share this result with my organization by graphically representing superimposing normative group information on a graph showing pretreatment and post-treatment data. This can be done through staff meetings, organization bulletins, and newsletters. This can also be shared through open discussions with staffs and stakeholders on evidenced-based practice. Membership in a nursing organization like the national nurses association is also very important because they’re well placed to disseminate information and key measures about evidence based practice to their members, nurse managers, educators and policy makers. Thanks,

Charles

References

Closing the Gap: From Evidence to Action. Retrieved from: https://nursingworld.org/…/ClosingLinks to an external site. -the-Gap-from-Evidence-to-Action.pdf. Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Sudbury, MA: Jones & Bartlett.

1. Finding from “Quantitative balance and gait measurement in patients with frontotemporal dementia and Alzheimer diseases: A pilot study.” This data was placed into the Shapiro-Wilkins test to make normal parameters, and this tested the mean age, BMI, and in years’ education of all 3 groups. Also, ANOVA was done to see the difference in all groups. Both diseases had problems with balance, gait, and dual tasks but so did the control group with the dual tasks. Frontotemporal dementia has balance problems were with overall balance, and front to back swaying, and had low scores with forward left direction. This disease had a reduced step cycle, length, and overall score. Alzheimer’s disease has balance problems with side to side swaying, and low scores with backward direction. This disease had a low score in the dual tasks, and no gait limits affected. Both disease have balance and gait issues than in control in both tasks, but Alzheimer’s disease patients have more problems with balance and limits of stability sections of balance.

This information could be used everywhere for the elderly community, from hospitals, doctor’s offices, nursing homes, and rehabilitation facilities. As rehab nurse, I could use this information with the care of my patients with dementia. It is helpful with the understanding of how they move, walk, and cannot multi-task. I will take this information and use it when I am transferring a patient with dementia to keep them from getting distracted, doing a single task at a time when it comes to gait, and balance, but also keep in mind if they are going to lose their balance then Alzheimer’s disease will tilt backwards, and Frontotemporal dementia will tilt forward. I will be passing this along to the therapists as well when they are training with these patients to come up with a program that is either specific for Alzheimer’s disease with postural stability training or Frontotemporal dementia with gait training.

2. PICOT question: For patients with bladder and bowel incontinence, how do staff members get every patient on a toileting program (I), compared to those with no alternative treatment (C) reduce or eliminate the number of incontinent episodes (O) every 1 to 2 hours daily (T).

According to our lecture Week 7: Reading Research Literature—Credibility and Significance, “The discussion and conclusion section brings the process full circle by referring back to the earlier steps. The conclusion addresses whether the research serves to help close the knowledge gap that was identified at the beginning of the process.”

I would set up bladder training with a toileting program, using a survey tool to evaluate the patient’s needs to the program, and help the nursing staff to participate in the interventions themselves. According to Lappen, Berall, Davignon, Lancovitz, and Karuza (2016), “This was a program evaluation initiative to assess the implementation of the prompted voiding intervention and understand the barriers and facilitators of introducing continence care guidelines. This evaluation demonstrated the need for Plan-Do-Study-Act cycles to ensure that optimum uptake of best practices is integrated with the clinical team’s processes in delivering patient care” (p. 29). I would explain to my peers that this toileting program could get patient to becoming continent, and it would take a load off all the staff if patients are not having to be cleared up after incontinent episode because they are continent.

References

Lappen, D., Berall, A., Davignon, A., Lancovitz, L., & Karuza, J. (2016). Evaluation of a Continence Implementation Program on a Geriatric Rehabilitation Unit. Perspectives: The Journal Of The Gerontological Nursing Association, 39(1), 24-30. Received from http://web.b.ebscohost.com.proxy.chamberlain.edu:8080/ehost/pdfviewer/pdfviewer?vid=15&sid=7aacec8a-c4df-472e-9e98-2fe44c1a776b%40sessionmgr102Links to an external site..

NR 439 Discussion Applying and Sharing Evidence to Practice