In nursing practice, the provision of healthcare is based on evidence-based practice. By description, evidence-based practice (EBP) is a problem-solving strategy to deliver health care that incorporates the best evidence from studies and patient care data. Applying evidence-based practice (EBP) also considers the clinician’s expertise, patient preferences, and values. In my practice problem identified in the week one discussion, I have pointed out that pressure ulcers among those in assisted living facility workshops are a problem. The data indicates that over 3 million adults worldwide are affected by pressure ulcers (Guzman, McClanahan & Vaughn, 2018). There are various interventions have been proposed to help curb pressure ulcers. However, there is still a gap to support for the implementation of the proposed interventions. Consequently, the proposed solutions still need to be backed up by the sources of pieces of evidence. In this discussion, I will explore multiple sources of evidence for the above practice problem.
Sources of Evidence
To support the evidence of interventions to reduce pressure ulcers, I would employ several sources of evidence to support the practice. The first source I would use is peer-reviewed journal articles. Peer-reviewed journal articles are scholarly sources written by experts in a particular field and by several other experts before the article is published in the journal, thus ensuring the article’s quality (Neilson, 2021). The second source I would consider for the identified practice problem is journals that contain articles written by professionals and academics. Examples of such journals include the American Journal of Critical Care, the American Journal of Public Health, and the Journal of Hospice and Palliative Nursing.
The third source I would use is scientific and reputable databases such as PubMed, CINAHL, and Clinical Key. These databases provide indexing for consumer health, nursing, allied health, and biomedical journals. These databases also include standards of practice that would support the practice problem identified. The fourth source of evidence I would include is the organizations that produce practice guidelines. Example of these organizations is the National Institutes of Health (NIH) and the American College of Physicians are made up of several institutes that conduct and support medical research and thus, guarantee the quality of the evidence (Jones, Brennan & Davis, 2020).
The Impact of not Including Resources
Failure to include evidence from scholarly articles means that the evidence is less likely to be scientifically valid in terms of providing reasonable conclusions. Databases such as PubMed provide supportive resources, including biomedical and life sciences literature, with the key objective of improving health–both globally and personally. These databased provide huge, up to date, reliable and authoritative resources, and thus, failure to include resources would mean insufficient evidence to support the practice problem (Hickey & Giardino, 2021)
Overall, deciding which sources of evidence to use for a practice problem depends on various factors. These factors include accessibility of the resource, search, and time available. However, it is important to use reliable sources (Hickey & Giardino, 2021). Such sources are not limited to selected websites and databases, peer-reviewed journal articles, and organizations that publish guidelines.
References
Guzman, J. L., McClanahan, R., & Vaughn, S. (2018). Development of guidelines for pressure ulcer prevention. Wounds International, 9, 4, 34-38.
Hickey, J. V., & Giardino, E. R. (Eds.). (2021). Evaluation of quality in health care for DNPs (3rd ed.). Springer Publishing.
Jones, E. P., Brennan, E. A., & Davis, A. (2020). Evaluation of literature searching and article selection skills of an evidence-based practice team. Journal of the Medical Library Association, 108(3), 487–493.
Neilson, C. J. (2021). Adoption of peer review of literature search strategies in knowledge synthesis from 2009 to 2018: An overview. Health Information & Libraries Journal, 38, 3, 160-171.
I agree with you on the failure to include evidence from scholarly articles. Searching in a combination of databases has been shown to answer a higher proportion of questions (Bramer, M. L., Kleijnen, France, 2017). When searching for relevant references within systematic reviews, it is advisable to use multiple databases. However, searching databases is laborious and time-consuming, as the syntax of search strategies are database specific (Bramer, M. L., Kleijnen, France, 2017). A single database search is inadequate for systematic reviews as the non-inclusion of missed trials would influence the results of the meta-analysis (Ho, Liew, Ng, Hisham Shunmugam, & Glasziou, 2016). Restricting the search to one database would miss many papers and therefore affect the overall results retrieved. A study highlighted the importance of a combination of three databases to achieve a 90% retrieval of relevant literature on the subject areas (Ho, Liew, Ng, Hisham Shunmugam, & Glasziou, 2016). Each database has its unique search terms and architecture, making it challenging to retrieve relevant articles. This makes the process time-consuming, and a proper search would often require the skills of a medical librarian (Ho, Liew, Ng, Hisham Shunmugam, & Glasziou, 2016).
References
Bramer, W. M., Rethlefsen, M. L., Kleijnen, J., France, O. H., (2017). Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev 6, 245 (2017). https://doi.org/10.1186/s13643-017-0644-y
Ho, G. J., Liew, S. M., Ng, C. J., Hisham Shunmugam, R., & Glasziou, P. (2016). Development of a Search Strategy for an Evidence-Based Retrieval Service. PloS one, 11(12), e0167170. https://doi.org/10.1371/journal.pone.0167170
I did a stakeholder analysis and organizational readiness to change form for this practice problem. A unique way to gather evidence was through social media. On Facebook, I joined the doctoral peer mentoring group, and the posts I saw there led me to look at a repository of DNP projects. The doctoral project repository had a search bar that only showed one result on the topic I was looking at exploring, but it was a starting point for me. I believe that I do not have enough time in the day to reinvent the wheel, so I thought exploring completed projects would allow me to understand what was included in completing a project of this scope with the time I have available. Having a formula in place that has already been tested will guide me to complete the project.
Google scholar (2022) was another database that I had forgotten about but was reminded about in this course. I like google scholar because it has meta-analysis, peer-reviewed, scientific research that encompasses the content of many research areas. The fact that I could search for data that is up to date within the past few years was a bonus.
The last source of evidence I looked at was exploring the website for the American sleep association. The American sleep association (2022) has information on screening processes for specific sleep disorders. That will benefit the practice as I will be using relevant content that will hopefully enhance the learner’s experience and boost the learner’s confidence in independently implementing the screenings post-project.
Flaws of noninclusion
The impact of not including information from the national and social resources that are available could impact my research by providing irrelevant data or have me looking through overwhelming content. If I did not explore all the resources available, I might be missing out on an intervention that could make a difference in the educational change that I would like to pursue the practice problem. I look forward to reading classmates’ thought processes on how they collect evidence to grow as a scholar that is outside of the nursing journal realm.
References
American Sleep Association: Insomnia, Sleep Apnea & Snoring. (2022)
https://www.sleepassociation.org
Doctoral Project Repository- Doctors of Nursing Practice, Inc. and the DNP online community. http://www.doctorsofnursingpractice.org/project-repository/
Google Scholar.(2022) https://scholar.google.com
