NUR 681 Integration of Evidence for Advanced Practice
NUR 681 Integration of Evidence for Advanced Practice
NUR 681
Integration of Evidence for Advanced Practice
3 credit hours
Verse of the Year
“If we walk in the light as he is in the light, we have fellowship with one another.”
– I John 1:7 (NIV)
Spring Arbor University Concept
“Spring Arbor University is a community of learners distinguished by our lifelong involvement in the study and application of the liberal arts, total commitment to Jesus Christ as the perspective for learning, and critical participation in the contemporary world.” NUR 681 Integration of Evidence for Advanced Practice
Table of Contents
NUR 681: Integration of Evidence for Advanced Practice 3
Course Description 3
Course Overview 3
Learning Outcomes 3
Professional Skills 4
Critical Reasoning 4
Theory Application 4
Evidence-Based Practice 4
Resources 5
Required Texts 5
Repeating Textbooks 5
Supplemental Resources on Blackboard 5
Grading Guidelines 6
Course Schedule 7
Week 1 8
Week 2 12
Week 3 15
Week 4 18
Week 5 20
Week 6 23
Week 7 26
Course Expectations 29
Academic Integrity 30
SAU-MSN Academic Integrity (SafeAssign) 30
Accommodation for Students with Disabilities 31
Attendance and Financial Aid 32
Attendance and Participation Policy 32
Blackboard Netiquette 32
Course Evaluation 34
Discussion Boards (DB) 34
Faculty Interaction 35
Faith and Learning 35
Inclusivity Statement 35
Late Submission of Assignments 36
Late Point Deductions by Calendar Day 36
Naming Convention 36
Prayer Requests, Chapel, and Break Room 37
Quiz/Examination Settings 37
Rounding Policy 37
Technical Support 38
Writing Standard 38
Right to Modify 38
Rubrics 39
Discussion Board Assignments Rubric 40
Section A: (Week 1) Organizational Culture and Readiness Assessment Rubric 41
Section B: (Week 2) Problem Description Rubric 43
Section C: (Week 3) Literature Support Rubric 45
Section D: (Week 4) Solution Description Rubric 47
Section E: (Week 5) Change Model 50
Section F: (Week 6) Implementation Plan Rubric 52
(Week 7) EBP Proposal Final Paper Rubric 54
(Week 7) Presentation Discussion Board Rubric 56
Revised October 2020
Syllabus Disclaimer: This syllabus is intended as a set of guidelines for NUR 681. Spring Arbor University and your instructor reserve the right to make modifications in content, schedule, and requirements as necessary to promote the best education possible within prevailing conditions affecting this course NUR 681 Integration of Evidence for Advanced Practice.
NUR 681: Integration of Evidence for Advanced Practice
Course Description
Students will examine the evidence base for resolving a current health problem, design and evaluate a project specific to their practice setting. Students will utilize evidence-based practice skills learned earlier in the program.
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Course Overview
This course provides an opportunity for students to develop an evidence-based practice project proposal that addresses a problem, issue, or concern in professional practice. Students identify a problem amenable to research-based intervention; search literature; propose a solution; and develop a plan to implement the solution, evaluate its outcome(s), and disseminate the findings. Problems identified are those that are appropriate to students’ specialty tracks: adult – gerontology primary care nurse practitioner, and family nurse practitioner.
Learning Outcomes
Each course in the MSN curriculum follows the Christ-centered mission of the SAU Nursing Department, which is to develop and empower advanced practice professional nurses. For SAU, the mission of graduate nursing education is devoted to integrating our faith and learning exemplified by the SAU Concept. This integration starts with the conviction that God is already in us and in the classroom, and we are engaged in blending or uniting our Christian beliefs with our intellectual pursuits of knowledge to interpret and inform our nursing practice NUR 681 Integration of Evidence for Advanced Practice.
The SAU Model of Graduate Nursing Education incorporates Professional Skills, Critical Reasoning, Theory Application, and Evidence-Based Practice through application of the American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing. The Essentials include: I. Background for Practice from Sciences and Humanities, II. Organizational and Systems Leadership, III. Quality Improvement and Safety, IV. Translating and Integrating Scholarship into Practice, V. Informatics and Healthcare Technologies, VI. Health Policy and Advocacy, VII. Interprofessional Collaboration for Improving Patient and Population Health Outcomes, VIII. Clinical Prevention and Population Health for Improving Health, and IX. Master’s-Level Nursing Practice.
At the completion of NUR 681, the student will be able to meet the following learning objectives and AACN Essentials of Master’s Education in Nursing that align with the SAU Model of Graduate Nursing Education.
Professional Skills
Critically analyzes data and evidence for improving advanced nursing practice. Scientific Foundation – 1
Uses best available evidence to continuously improve quality of clinical practice. Quality – 1
Critical Reasoning
Develops new practice approaches based on the integration of research, theory, and practice knowledge. Scientific Foundation – 1
Advances practice through the development and implementation of innovations incorporating principles of change. Leadership – 5
Theory Application
Applies clinical investigative skills to improve health outcomes. Practice Inquiry – 1
Integrates knowledge from the humanities and sciences within the context of nursing science. Scientific Foundation – 2
Evidence-Based Practice
Translates research and other forms of knowledge to improve practice processes and outcomes. Scientific Foundation – 3
Disseminates evidence from inquiry to diverse audiences using multiple modalities x. Practice Inquiry – 5
NUR 681 Integration of Evidence for Advanced Practice
Resources
Required Texts
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health. ISBN-13: 978-1-4963-8453-9
Repeating Textbooks
American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000
Supplemental Resources on Blackboard
American Journal of Nursing. (2020, February 4). Evidence-based practice, step by step.
This web page is a collection of articles.
Bettany-Saltikov, J. (2012). How to do a systematic literature review in nursing: A step-by-step guide. Open University Press, McGraw-Hill Education.
Melnyk, B. M., Gallagher-Ford, L., & Fineout-Overholt, E. (2017). Implementing the evidence- based practice (EBP) competencies in healthcare: A practical guide for improving quality, safety, and outcomes. Sigma Theta Tau International.
Grading Guidelines
Assignment
Points Possible
Points Earned
Due
Discussion Boards (16 points x 7 discussions)
112 points
Weekly
Section A
28 points
Week 1
Section B
36 points
Week 2
Section C
36 points
Week 3
Section D
60 points
Week 4
Section E
32 points
Week 5
Section F
36 points
Week 6
EBP Proposal Final Paper
36 points
Week 7
Total NUR 681 Integration of Evidence for Advanced Practice
376 points
A 95-100%
A- 90-94%
B+ 87-89%
B 83-86%
B- 80-82%
C+ 77-79%
C 73-76%
C- 70-72%
D+ 67-69%
D 66%
U lower than 65%
I Incomplete
Overall Directions
Prepare all assignments according to APA (American Psychological Association) Style (2010). An abstract and Table of Contents are not required.
All assignments have a rubric. Please, review the rubric before beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit each paper assignment to SafeAssign and include the resulting report with the uploaded assignment. Refer to the directions in Blackboard.
Course Schedule
Week
Readings
Assignments
1
● Articles and Links (6)
● Section A: Organizational Culture and Readiness Assessment
● Discussion Board
2
● Melnyk & Fineout-Overholt (2019), Chapter 3
● Articles and Links (2)
● Section B: Problem Description
● Discussion Board
3
● Articles and Links (3)
● Section C: Literature Support
● Discussion Board
4
● Melnyk & Fineout-Overholt (2019), Chapters 7, 8
● Section D: Solution Description
● Discussion Board
5
● Melnyk & Fineout-Overholt (2019), Chapter 14
● Articles and Links (2)
● Section E: Change Model
● Discussion Board
6
● Melnyk & Fineout-Overholt (2019), Chapters 9, 10
● Section F: Implementation Plan
● Discussion Board
7
● Melnyk & Fineout-Overholt (2019), Chapter 20
● Article (1)
● EBP Proposal Final Paper
● Discussion Board
NUR 681 Integration of Evidence for Advanced Practice
Week 1
Topics
Evidence-Based Practice
Learning Objectives
Identify problems, issues, or concerns in the professional work setting that are amenable to a research-based intervention using the PICOT format (population, intervention, comparison, outcomes, and timeframe).
Understand how to determine organizational readiness for change.
Determine feasibility of specific change projects.
Reading Due
Read
(n.d.). Evidence based practice toolkit for nursing.
Eberhart, A. E. (2014). Quality improvement needs assessment for evidence-based practice readiness in primary care [Unpublished doctoral dissertation]. Graduate School of The Ohio State University.
Example of a finished project.
Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PloS one, 14(12), e0226742. https://doi.org/10.1371/journal.pone.0226742
Duke University. (n.d.). Model one: Intro to EBP.
This website is a good review of EBP that you had in NUR551. It may be helpful as a guide for this course.
S. Department of Health and Human Services. (n.d.). Readiness assessment & developing project aims.
Agency for Healthcare Research and Quality. (2015, August). Readiness Assessment.
Review
Organizational culture and system wide interrogation of EBP survey, EBP beliefs, and EBP implementation scale in Appendix K of Melnyk & Fineout-Overholt (2019).
Examples of EBP Topics for Project
AAFP
North Dakota center for Nursing: Please choose from Family Practice or Geriatric/Long-Term care topics.
Assignments Due
Acknowledgment Quiz
Points Possible: Ungraded
Due: Wednesday, 11:59 p.m. EST/EDT
After reviewing the Textbooks & Information area, the student will complete a short quiz to acknowledge that he or she reviewed the syllabus, grading rubrics, and SAU’s Policy on Academic Integrity. Completion of the quiz counts for attendance in Week 1 of the course. By clicking Yes, you acknowledge that you completed and understood the required tasks NUR 681 Integration of Evidence for Advanced Practice.
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2. Evidence-Based Proposal – Introduction
This is the beginning of the Evidence-Based Practice Proposal, which will be completed by writing a section each week and editing the document with feedback from the professor each week. The final product is due in Week 7 and is the culmination of the course. Each week the section due will be graded and returned with suggestions for improvement. Students need to make the suggested changes and/or add to the document for the final grading process.
3. Section A: Organizational Culture and Readiness Assessment
Points Possible: 28 points
Due: Sunday, 11:59 p.m. EST/EDT
Before making a case for an evidence-based project, it is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation.
Complete an assessment of your clinical practice site using questions from the samples in the Week 1 Bb folder, “Organizational Culture and Readiness for System-Wide Integration of EBP Survey,” “EBP Beliefs,” and “EBP Implementation Scale.” Use as many questions from these samples to accurately assess readiness for change in your organization. You will use personal reflection of your experience in the clinical setting. The setting may be your job site or a student clinical placement.
Develop an analysis summary of at least 250 words from the results of your questions addressing your organization’s readiness level, possible project barriers and facilitators, as well as how to integrate clinical inquiry. Make sure to include the rationale for your answers on the questionnaire, incorporating details and examples. Also, explain how to integrate more clinical inquiry into the organization, providing strategies that strengthen the organization’s weaker areas. The actual questionnaire results do not need to be included.
The grading guidelines for this assignment are in the rubric section of this syllabus. Upon receiving feedback from the instructor, revise Section A: Organizational Culture and Readiness Assessment for your final paper submission. This will be a continuous process throughout the course for each section.
Submit work to the assignment link in Blackboard. Use the naming convention:
NUR681_LastName_FirstInitial_EBPSectionA1.docx
4. Discussion Board
Points Possible: 16 points
Due: Initial post by Thursday, 11:59 p.m. EST. Two responses by Sunday, 11:59 p.m. EST.
Review the “Rapid Critical Appraisal Checklists” Appendix B in your course text. You should save this tool and use it throughout the development of the PICOT question, problem description, and literature review. Begin the development of your PICOT question using the following resource: Melnyk & Fineout-Overholt, Appendix A: Template for Asking Clinical Questions.
Formulate your PICOT question and post it to the Week 1 Discussion Board. Respond to at least two other statements, providing feedback on their clinical questions regarding relevance to primary care practice. Review the statements to see if the clinical issue is clearly defined and that all aspects are identified. Also, refer to the “PICOT: Components of an Answerable, Searchable Question” Table 2.2 in your text, p. 40. If one PICOT statement has at least three feedback posts, move to another statement. You will be using the feedback to make revisions to your PICOT question before using it in your Section B of Final Proposal: Problem Description assignment.
Respond to at least 2 other statements, providing feedback on their clinical questions regarding relevance to primary care practice. Review the statements to see if the clinical issue is clearly defined and that all aspects are identified NUR 681 Integration of Evidence for Advanced Practice.
See the Discussion Boards and Blackboard Netiquette policies in the Course Expectations of this syllabus. Include required readings and outside references for your Discussion Board post. Respond to at least two of your peers’ posts. Your responses should be substantive and supported by cited sources.
Week 2
Topics
Making the Case for Evidence-Based Practice
Learning Objectives
Analyze practice versus research to recognize a change.
Assess stakeholders, team roles, and leadership skills needed to bring about change.
Create EBP objectives that are aligned to measurable outcomes.
Reading Due
Melnyk & Fineout-Overholt (2019):
Chapter 3: Finding relevant evidence to answer clinical questions: Tools for Finding the Needle in the Haystack, pp. 55-92.
(n.d.). Topics.
This resource has topics that may give you specific information on change projects. It also has research reports, sources of data and tools useful to translating evidence into practice.
Stevens, K., Marcley, S., DeGrazia, M., & Schuler, E. (2019, July 12). The Stevens Star Model of Knowledge Transformation to improve care and outcomes [Video]. OPENPediatrics.
Assignments Due
1. Section B: Problem Description
Points Possible: 36 points
Due: Sunday, 11:59 p.m. EST/EDT
Write a paper of 500-750 words (not including the title page and reference page) on your proposed problem description for your EBP project. The paper should address the following:
Describe the background of the problem. Tell the story of the issue and why it deserves attention. Identify the stakeholders/change agents and who or what organizations are concerned, may benefit from, or are affected by this proposal. List the interested parties, patients, students, agencies, Joint Commission, etc. Use the feedback from this week’s (Week 2) Discussion Board post, and refine your PICOT question for the final proposal. Make sure that the question fits with your graduate degree specialization.
State the purpose or goal and project objectives in specific, realistic, and measurable terms. The objective should address what is to be gained. This is a restatement of the question, providing focus on how to answer the question.
Provide supportive rationale that the problem or issue is an important one for nursing to resolve; use relevant professional literature sources.
Develop an initial reference list to assure that there is adequate literature to support your evidence-based practice project. The majority of references should be research articles. However, national sources such as Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Department of Health and Human Resources (HHS), or the Agency for Healthcare Research and Quality (AHRQ), and others may be used when you are gathering statistics to provide the rationale for the problem.
Once you get into the literature, you may find there is very little research to support your topic and you will have to start all over again. Remember, in order for this to be an evidence-based project, you must have enough evidence to introduce this as a desired practice change. If you find that you do not have enough supporting evidence to change a practice, further research would need to be conducted NUR 681 Integration of Evidence for Advanced Practice.
The grading guidelines for this assignment are in the rubric section of this syllabus. Upon receiving feedback from the instructor, refine Section B: Problem Description for your final submission. This is a continuous process throughout the course for each section.
Submit work to the assignment link in Blackboard. Use the naming convention:
NUR681_LastName_FirstInitial_EBPSectionB2.docx
2. Discussion Board
Points Possible: 16 points
Due: Initial post by Thursday, 11:59 p.m. EST. Two responses by Sunday, 11:59 p.m. EST.
Answer this question in a minimum 250-word post in the Week 2 Discussion Board: What strategies will you use in your new practice as an APN to review and critique literature pertinent to your practice? Respond to at least two others.
See the Discussion Boards and Blackboard Netiquette policies in the Course Expectations of this syllabus. Include required readings and outside references for your Discussion Board post. Respond to at least two of your peers’ posts. Your responses should be substantive and supported by cited sources.
Week 3
Topics
Critical Appraisal of the Evidence
Learning Objectives
Formulate research support.
Critically appraise the best available evidence for the proposed solution.
Recognize the validity and reliability of clinical recommendations for practice.
Reading Due
Bramer et al. Systematic Reviews (2016) 5:39.
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. AJN The American Journal of Nursing, 110(7), 47-52.
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Critical Appraisal of the Evidence: Part II: Digging deeper—examining the “keeper” studies. AJN The American Journal of Nursing, 110(9), 41-48.
Assignments Due
1. Section C: Literature Support
Points Possible: 36 pints
Due: Sunday, 11:59 p.m. EST/EDT
To begin, work through the reference list you created in Section B: Problem Description. Appraise each resource using the one of the “Rapid Critical Appraisal Checklists” located in Appendix B, pp. 708-722 of the Melnyk & Fineout-Overholt text in the course materials or other literature review tools such as the ones used in NUR 551 in the Johns Hopkins Model. The specific checklist you use will be determined by the type of evidence within the resource (i.e., case-control studies, or cohort studies, etc.).
Develop an “Evidence Synthesis” table to organize and summarize the research studies. Using a summary table allows you to be more concise in your narrative description. Only research studies used to support your intervention are summarized in this table. Refer to the “Evaluation and Synthesis Tables” templates in Appendix C, pp. 723-727 of the Melnyk & Fineout-Overholt text, or you may use this table that uses the PICO to summarize the research studies:
Author, title,
journal
Population
Intervention
Comparison
Outcome
Validity
Write a narrative of 750-1,000 words (not including the title page and reference list) that presents the research support for the project’s problem and proposed solution. Make sure to do the following:
Include a description of the search method (e.g., databases, keywords, criteria for inclusion and exclusion, and number of studies that fit your criteria).
Summarize all of the research studies used as evidence. The essential components of each study need to be described so that readers can evaluate its scientific merit, including study strengths and limitations.
Incorporate a description of the validity of the internal and external research.
It is essential to make sure that the research support for the proposed solution is sufficient, compelling, relevant, and from peer-reviewed professional journal articles. Please, submit the checklist information and the evaluation table you design for the instructor as well as the narrative that summarizes the information.
The grading guidelines for this assignment are in the rubric section of this syllabus. Upon receiving feedback from the instructor, refine Section C: Literature Support for your final submission. This will be a continuous process throughout the course for each section.
Submit work to the assignment link in Blackboard. Use the naming convention:
NUR681_LastName_FirstInitial_EBPSectionC3.docx
2. Discussion Board
Points Possible: 16 points
Due: Initial post by Thursday, 11:59 p.m. EST. Two responses by Sunday, 11:59 p.m. EST.
What factors must be assessed when critically appraising quantitative studies? Which is the most important? Why? Submit answers in a 250-word post and respond to two peers.
See the Discussion Boards and Blackboard Netiquette policies in the Course Expectations of this syllabus. Include required readings and outside references for your Discussion Board post. Respond to at least two of your peers’ posts. Your responses should be substantive and supported by cited sources NUR 681 Integration of Evidence for Advanced Practice.
Week 4
Topics
Analyzing Evidence-Based Practice Outcomes
Learning Objectives
Critique measurements for expected outcomes (validity and reliability).
Describe the obstacles or barriers to implementing evidence-based practice.
Explain why patient values and clinical judgment must be considered before applying the evidence in clinical decision making for an individual patient.
Reading Due
Melnyk & Fineout-Overholt (2019):
Chapter 7: Integration of Patient Preferences and Values and Clinician Expertise into Evidence-Based Decision-Making, pp. 219-232.
Chapter 8: Advancing Optimal Care with Clinical Practice Guidelines and Evidence based Recommendations, pp. 233-256.
Assignments Due
1. Section D: Solution Description
Points Possible: 60 points
Due: Sunday, 11:59 p.m. EST/EDT
Write a paper of 500-750 words (not including the title page and reference list) for your proposed evidence-based practice project solution. Address the following criteria:
Proposed Solution:
Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention.
Consider if the intervention may be unrealistic in your setting, too costly, or there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your PICOT before continuing.
Organization Culture: Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.
Expected Outcomes: Explain the expected outcomes of the project. The outcomes should flow from the PICOT.
Method/s to Achieve Outcomes: Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations that may need to be addressed.
Outcome Impact: Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient-centered quality care, efficiency of processes, environmental changes, and/or professional expertise.
The grading guidelines for this assignment are in the rubric section of this syllabus. Upon receiving feedback from the instructor, refine Section D: Solution Description for your final submission. This will be a continuous process throughout the course for each section.
Submit work to the assignment link in Blackboard. Use the naming convention:
NUR681_LastName_FirstInitial_EBPSectionD4.docx
2. Discussion Board
Points Possible: 16 points
Due: Initial post by Thursday, 11:59 p.m. EST. Two responses by Sunday, 11:59 p.m. EST.
Conducting research projects while ensuring the protection of human subjects is necessary. What are some methods to protect personal rights of someone in one of the groups that is labeled as vulnerable? Justify your rationale. Post your 250-word initial post and respond to two classmates.
See the Discussion Boards and Blackboard Netiquette policies in the Course Expectations of this syllabus. Include required readings and outside references for your Discussion Board post. Respond to at least two of your peers’ posts. Your responses should be substantive and supported by cited sources.
Week 5
Topics
Evidence-Based Practice Implementation Model
Learning Objectives
Analyze the components associated with implementing evidence-based practice.
Differentiate between the following models for applying evidence-based practice: Stetler model, Iowa model, and the ARCC model NUR 681 Integration of Evidence for Advanced Practice.
Reading Due
Melnyk & Fineout-Overholt (2019):
Chapter 14: Models to guide implementation and sustainability of evidence-based practice, pp. 378-427.
Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(53), 1-13.
Open Access
Sigma Global Nursing Excellence. (2017, September 17). Iowa model of evidence-
based practice: Revisions and validation Worldviews on Evidence-Based Nursing.
https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12223
Assignments Due
1. Section E: Change Model
Points Possible: 32 points
Due: Sunday, 11:59 p.m. EST/EDT
In 500-750 words (not including the title page and reference page), critique change models for feasibility for your practice problem.
Review the resources that describe the following change implementation models:
Stetler model of evidence-based practice
Advancing Research and Clinical Practice through Close Collaboration model (ARCC)
Iowa model of evidence-based practice to promote quality care
You will use one of these models in the actual implementation plan for Week 6. For this Week 5 assignment, analyze the above models for suitability to use in your proposed practice change described in the previous sections of your proposal.
Include the following:
Assumptions of the model – “assumptions, aims and other characteristics, which have implications for their use” (Nilsen, 2015) must be recognized in order to determine the best model to follow.
Evidence that the model can be used for your type of project (i.e., primary care versus acute care).
Able to guide the process of implementation for your project. In other words, you can use the model to create objectives for the process of
