NUR 590 When reviewing the literature for your evaluation plan and different types of evidence for your project, what gaps in the findings did you encounter?

Evaluation is one of the most important aspects of evidence-based practice as it helps the project team to explore the extent of the success of an implemented project. It is important to perform an appropriate and comprehensive literature review that can offer insights on how to evaluate the effectiveness of the implemented intervention. A comprehensive literature review also helps in the identification of gaps which can then form the basis of future research (LoBiondo-Wood & Haber, 2021). For instance, research involving quality improvement in patient care settings can lead to new quality improvement initiatives as identified from the gaps. Therefore, a literature review was carried out regarding the evaluation plan for the proposed evidence-based practice. As such, various gaps were identified.

Among the gaps identified during the literature review for the evaluation plan is the lack of homogeneity regarding the educational approaches used when promoting vaccine intake. The education approaches found ranged from the use of videos, text messages, calls, and education workshops. In addition, some of the education interventions used more than one strategy (Argote et al.,2021). The implication is that it is hard to draw substantive comparisons when making a conclusion on the right approach to use based on evaluation results.

The other gap identified in the evaluation is that the articles used different evaluation approaches. For example, while some of the articles used willingness to take vaccines as a way of evaluating the effectiveness of education programs, other research efforts used willingness to influence close friends and relatives to take vaccines. In addition, other research reports also used the changes in vaccine uptakes among populations (Jensen et al.,2022). Such gaps can have a substantial influence on other researchers. For example, the researchers may need to go for educational approaches which lead to the best results in terms of increasing the willingness to take the Covid-19 vaccine. In addition, some researchers may opt for combining different education approaches.

References

Argote, P., Barham, E., Daly, S. Z., Gerez, J. E., Marshall, J., & Pocasangre, O. (2021). The shot, the message, and the messenger: COVID-19 vaccine acceptance in Latin America. NPJ Vaccines, 6(1), 118. https://doi.org/10.1038/s41541-021-00380-x

ensen, U. T., Ayers, S., & Koskan, A. M. (2022). Video-based messages to reduce COVID-19 vaccine hesitancy and nudge vaccination intentions. PloS One, 17(4), e0265736. https://doi.org/10.1371/journal.pone.0265736

LoBiondo-Wood, G., & Haber, J. (2021). Nursing research E-book: Methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.

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Wouldn’t you say that the different educational approaches are due to the learners ability to retain information and not necessarily providing a gap? Me personally I’m a vey hands on person and learn by doing. Auditory and visual learners may prefer the visual auditory learning strategies presented by vaccine hesitancy literature. If the literature used the same learning strategy its a possibility that they wouldn’t be able to reach and educate a substantial amount of people.

U. T., Ayers, S., & Koskan, A. M. (2022). Video-based messages to reduce COVID-19 vaccine hesitancy and nudge vaccination intentions. PloS One, 17(4), e0265736. https://doi.org/10.1371/journal.pone.0265736

Since my EBP proposal is also based on education and behaviors/beliefs both before and after, I have experienced some of the same gaps in findings. Since educating adults is a challenging and fluid approach to change implementation, it is difficult to derive solid data from this approach. I feel that, in these types of circumstances, larger test groups and broader results are more telling than individual or small group responses.

While preparing for my evidence based project (EBP) it was immediately apparent there was little research on outcomes themselves but it did acknowledge the lack of resources and supported the need for changes. This gap in evidence reinforces the need for change and improvement not only at organizational levels but also at legislative levels. “There is a need for stronger standardized policies and guidelines to ensure optimal transitional care to adult mental health services (AMHS)” (Leavey, et al., 2019).

The gaps support the need for research to be conducted. However, more importantly it supports the need to implement changes and research the outcomes of the changes and patient response. These changes may lead to further EBP’s being conducted and ultimately improving patient care and outcomes.

Leavey, G., McGrellis, S., Forbes, T., Thampi, A., Davidson, G., Rosato, M., Bunting, B., Divin, N., Hughes, L., Toal, A., Paul, M., & Singh, S. P. (2019). Improving mental health pathways and care for adolescents in transition to adult services (impact): A retrospective case note review of social and clinical determinants of transition. Social Psychiatry and Psychiatric Epidemiology, 54(8), 955–963. https://doi.org/10.1007/s00127-019-01684-z

I could not agree with you more on the need for change from national legislation down for the referral process and the funding of mental health services. I live in Texas which is one of the most underfunded states for mental health needs and seeing these results day after day in the ER or in the ICU where I work is truly heartbreaking. The massive influx of people presenting for signs and symptoms of a mental health condition or emergency since the start of the pandemic has only emphasized the downfall in our mental health care system.

Manning et al., (2023) have a great article on the barriers to mental health services for persons with disabilities (PWD) since the pandemic. They report PWD accounts for about 25% of the population however studies into these barriers has been limited. Reporting stigmas towards mental healthcare as well as towards PWD, and less accessible services to be amongst the top barriers for PWD to access quality mental healthcare.

Reference:

Manning, R. B., Cipollina, R., Lowe, S. R., Bogart, K. R., Ostrove, J. M., Adler, J. M., Nario-Redmond, M. R., & Wang, K. (2023). Barriers to mental health service use among people with disabilities during the COVID-19 pandemic. Rehabilitation Psychology. https://doi.org/10.1037/rep0000512

What a great motivating factor for you with your EBP proposal. I can imagine that the lack of research can be challenging, however it leaves an exciting opportunity for you to add much needed information on this extremely important topic. With the mental health crisis and rising deaths related to opioid misuse, the mental health of our young population is in need of some over-due attention and revision. Thank you for your efforts in improving this area of health care.

When reviewing the literature for my evaluation plan and different types of evidence I noticed there were inconsistencies on how sepsis is reported for different types of patients. For example, their are a variety of measures and tool to identify sepsis for the neonate, pediatric, and geriatric patient. Each tool is different and measure different factors to determine sepsis. Factors such as altered mental status which can be a late sign in sepsis, is considered an early sign in some tools and can be the main factor in implementing sepsis protocols.

Researchers can be influenced by this when they develop EBP in the future by noticing these inconsistencies as well and advocating for a universal protocol. “Many people who develop sepsis have underlying medical conditions, and a significant proportion are frail or approaching the end of natural life”. What is a chronic condition for a patient such as dementia cannot be considered sepsis and shouldn’t play a factor. Granted there are outliers such as not knowing the patients baseline, prior medical history, etc. Nevertheless a universal protocol for the specific patient type i.e (neonate, pedicatic, geriatric) should be established.

Nazarko L. Tool to improve communication and enable rapid identification of sepsis. Journal of Community Nursing. 2023;37(2):63-66. Accessed July 23, 2023. https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=163311113&site=eds-live&scope=site

NUR 590 When reviewing the literature for your evaluation plan and different types of evidence for your project, what gaps in the findings did you encounter?