Week 2 The Clinical Question77 unread replies.2525 replies..docx

Week 2: The Clinical Question
77 unread replies.2525 replies.
Your capstone change project begins this week when you
identify a practice issue that you believe needs to change. The
practice issue must pertain to a systematic review that you must
choose from a List of Approved Systematic Reviews (Links to
an external site.)Links to an external site. for the capstone
project.
· Choose a systematic review from the list of approved
reviews based on your interests or your practice situation.
· Formulate a significant clinical question related to the
topic of the systematic review that will be the basis for your
capstone change project.
· Relate how you developed the question.
· Describe the importance of this question to your clinical
practice previously, currently, or in the future.
· Describe what a research-practice gap is.
· Collapse Subdiscussion
Julie White
Julie White
SundayOct 29 at 9:39am

Manage Discussion Entry
Opening Post_Julie
On a daily basis, healthcare providers are faced with an array of
clinical decisions to be made in an efficient and timely manner.
Translating evidence into best practices is one way to achieve
this. Without current best evidence, practice is rapidly outdated,
often to the detriment of the patient. Evidence based practice is
the conscientious use of current best practice in making
decisions about patient care (Sackett, Richardson, Rosenberg, &
Hayes, 2000). It is important for health care professionals to ask
questions about their current clinical practice. In this week’s
threaded discussion you will ask that burning question that you
ask in your daily care of your patients.
You’ll need to focus on asking the right questions, narrowing
the questions to one that is nurse driven and the need for change
is evident. The question that you formulate will be the question
for your Capstone Project.
The process of reviewing scholarly articles for a change in
practice is an important part of the development of any type of
research project that can lead to a change in practice. As you
are appraising the systematic review and other scholarly articles
for your change project, think about areas of the article such as
sample size, the population, type of study, discussion and
limitations. Critiquing a research article will allow you to
evaluate the scientific merit of the study and decide how the
results may be useful in practice.
ReplyReply to Comment
·

Collapse Subdiscussion
Adele Allen
Adele Allen
SundayOct 29 at 12:58pm
Hello Professor and Classmates,
Nurses are called to rely on current research to guide
evidence-based practice. The research on a topic can be vast and
contradictory. Traditional reviews of the evidence are no longer
appropriate. The information sifting called for with the wealth
of information available is too great a task. The reviewer needs
guidelines to ensure bias is minimized and the literature is
reviewed in such a way that questions are answered reliably. It
is easy to produce evidence to prove a point. Systematic reviews
follow a framework with clear objectives, clear questions,
criteria for inclusion , quality of evaluation, analysis of data for
significance, and transparent reporting of the method used to
conduct the review. The Cochrane Collaboration is a group
which synthesizes data to answer questions related to
interventions (Aromataris & Pearson, 2014).
The PICO format provides a framework to pose a
question in a manner which assists in the search for evidence to
answer that same question. Searchable key terms can be
identified which lead to relevant evidence (CCON, 2016). I
chose the systematic review: “Health-Associated Infections”
(HAI) from the approved list. Using the PICO framework I
broke down the study in the following manner:
P: surgical patients

I: preoperative bathing and showering with antiseptics of
preventing hospital acquired surgical site infections.
C: preoperative bathing and showering with non-antiseptic
preparations for preventing hospital acquired surgical site
infections.
O: incidence of surgical site infections.
The decrease of HAIs from clinical practice is of the
utmost importance. Elimination of HAIs is always a goal of
care. HAIs increase the length of hospital stay and increases
morbidity and mortality rates. Reimbursement of care is tied to
ensuring patients do not become subject to these complications.
There was a time in my practice when complications of
hospitalization were not recorded, analyzed and reported to the
general public. Currently transparency is expected by the public
and hospitals are required to report infection rates. This has led
to rigorous efforts to develop protocols and standards which
eliminate the occurrences of HAIs. This benefits patients,
reduces costs and ultimately drives nursing care in a positive
direction which raises standards and calls for innovation.
The research practice gap occurs when there is a large
body of knowledge and research pointing toward practice
changes that are not implemented. Implementation of a new
practice requires systematic review of the research. Many
nurses are not adequately prepared to undertake EBP initiatives.
The bedside nurse is in a key role to recognize where
improvements need to occur but are often not supported in being
change agents. Hospitals administrations need to provide the
financial resources and academic support to assist staff nurses
to the next level. Conner (2014), describes barriers to nurses
using research such as lack of knowledge, lack of confidence in
the process. Conner (2014), describes how the administration

of Medical University Hospital in South Carolina noticed this
problem and decided to tackle it. A shared governance model
was initiated. The nurse’s knowledge was assessed, staff were
educated, and a one year nurse fellowship program was
developed where five nurses were mentored in conducting
research.
References:
Aromataris, E. & Pearson, A. (2014). The systematic review: An
overview. AJN, 114(3), 53-58. Retrieved from
https://chamberlainuniversity.idm.oclc.org/login?url=http://ovid
sp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=ful
ltext&AN=00000446-201403000-00028&LSLINK=80&D=ovft
(Links to an external site.)Links to an external site. (Links to an
external site.)Links to an external site.
Chamberlain College of Nursing (2016). NR-439. RN Evidence
Based Practice: Weekly Lessons 3. Downers Grove, IL: Online
Publication.
Conner, B.T. (2014). Bridging the gap between academia and
clinical practice How to build foundations for translating
research and evidence-based practice to the bedside. American
Nurse Today, 9(5), 40-43.

o
Julie White
Julie White
TuesdayOct 31 at 7:10pm
Hi Adele.
Well done post; many things in healthcare have change over the
years such as collecting and analyzing data related to infections.
This had led to many improvements in care which we need to
continue with to see quality outcomes. Your PICO question
looks good with the appropriate elements in place; consider
making your population more specific such as certain type of
surgery and make your outcome measurable-what do you want
to see with your intervention?
Julie
Jessica Stuckert

Jessica Stuckert
MondayOct 30 at 3:59pm
Professor and Class,
For this discussion post, I chose to read â€œSystematic Review
and Meta-Analysis of Comprehensive Behavioral Family
Lifestyle Interventions Addressing Pediatric Obesityâ€
(Janicke, et al., 2014). I am a bedside nurse in a large pediatric
hospital, and I see many children who are clinically obese.
Several of them are admitted for issues related to their weight,
such as diabetes, but many are not. Additionally, many are
admitted for tonsil and adenoid removal due to obstructive sleep
apnea, but in talking with them and their families, it seems that
the role their weight plays in their OSA has either not been
discussed or barely discussed. Some of these hospitalized
children are referred to our outpatient weight-management
program, Center for Obesity and its Consequences in Health
(COACH), but many are not. Currently, we have no way of
knowing whether those who are referred ever follow up. After
reading the systematic review and considering my current scope
of practice, I developed the following question: can providing
hospitalized, clinically obese pediatric patients and their parents
with an information packet about the health risks of obesity and
general information about our outpatient weight-loss program
increase the likelihood that they will follow up in the COACH
clinic? I developed this question by thinking about what I, as a
nurse who only sees a patient for one or two shifts, can do to
help obese patients to adopt a healthier lifestyle. Weight is a
sensitive subject for patients and their families, and many
nurses and physicians are uncomfortable discussing it,
especially when the patient has been hospitalized for something
unrelated. In my experience, in-patient physicians might

mention the fact a childâ€™s weight is a risk factor for health
issues and tell the parents they are referring them to the
COACH clinic, but that is the extent of it. Â Once a patient is
discharged and returns to their normal routine, it is easy to
forget about the referral. This may be especially true for
patients with overweight, sedentary parents, because the parents
feel that the referral shines a negative light on their family.
However, as healthcare providers, we know how detrimental
obesity can be to physical and mental health. By not being
proactive with our obese patients, we are complicit in their
future negative health outcomes.
An article in Open Journal of Nursing (2014) posits that
â€œapplying research findings in nursing practice is perhaps the
greatest challenge facing the nursing profession todayâ€ (C.
Agbedia, I. Okoronkwo, E. Onokayeigho,&Â M.A. Agbo). A
research-practice gap occurs when there is peer-reviewed
evidence for improved ways of doing things that are not adopted
in nursing practice. Several factors can influence this
phenomenon, including organizational culture, lack of technical
support, and lack of education (C. Agbedia, I. Okoronkwo, E.
Onokayeigho,&Â M.A. Agbo , 2014). To ensure that nurses
adopt evidence-based practices, organizations must create a
research culture where nurses are given the time to seek out new
practices. They must also ensure that they provide adequate
education of new processes, and after education nurse managers
must follow up to ensure that these evidence-based practices are
being consistently employed. Change can be frightening,
especially when we are asked to change the way we have been
doing something for a long time. For myself, I have come to see
nursing as a constantly changing profession, and am therefore
not bothered when I am asked to change my practice, so long as
there is evidence to support that change. I think adopting this
attitude helps me accept changes with less fear and annoyance.
References

Janicke, D. M., Steele, R. G., Gayes, L. A., Lim, C. S., Clifford,
L. M., Schneider, E. M., & ... Westen, S. (2014). Systematic
review and meta-analysis of comprehensive behavioral family
lifestyle interventions addressing pediatric obesity. Journal of
Pediatric Psychology, 39(8), 809-825.
Agbedia, C., Okoronkwo, I. , Agbo, M.A. (2014). Nursesâ€™
perspective of the research-practice gap in nursing. Open
Journal of Nursing. 4(2). DOI:10.4236/ojn.2014.42013 (Links to
an external site.)Links to an external site.
o
Anna Campomanes
Anna Campomanes
Jessica,
You do have a very good understanding of childhood obesity
and your patients’ and their families’ need for additional
teaching about its significance. It’s when nurses can identify the
reasons for their patient’s hesitance that we identify areas of
concern others might have missed. I like how you made out your
clinical question as it is very nursing-driven. You also

explained how and when a research gap occurs. It’s enlightening
to hear someone else say that nursing is constantly evolving and
changing. I too try to keep an open-mind to new ideas our
hospital’s education department might introduce. After all, I
don’t know everything, and I can certainly benefit by learning
from those who know more than me. I enjoyed your post, thanks
for sharing.
·
Erin Knevels
Erin Knevels
Professor and class,
As nurses, it is our responsibility to advocate for our patients
safety and well being. Sometimes as nurses we need to make
decisions that will be better for our patients safety, even though
it is not something they approve of or understand. We need to
educate our patients on the reasons we do things a certain way
and how it can better their outcome. Evidence based practice
plays a large role in healthcare, with nurses being some who are
most affected. We see practice changing almost daily as new
research comes out showing that changing the way we practice
can be more beneficial for our patients and ourselves.

The systematic review that most closely relates to what I do is
that of health acquired infections. This speaks specifically to
pre-op patients and how to decrease their risk of infection. One
way to pose a question is to use the PICO template- population,
intervention, comparison, outcome. In this case, we are
monitoring surgical patients to see if using an antiseptic wash
prior to surgery decreases the rate of infections. Decreasing the
post op infection rate would tremendously improve patient
outcomes, decrease death rates, decrease length of stay, and
decrease cost for the hospital and the patient.
Research practice gap is what happens when research shows that
a specific practice is what is best, but the clinical areas are not
using that practice yet. This can be caused by a number of
things including practicality and misunderstanding. According
to jnd.org, sometimes clinicians believe that the research was
too pristine and doesn't actual show a real world use.
Eventually practices change and health care providers must
change, too. Getting stuck in your ways will inevitably cause
poor outcomes for your patients.
https://guides.nyu.edu/c.php?g=276561&p=1847897 (Links to
an external site.)Links to an external site.
Norman, D. (n.d.). The Reseach-Practice Gap. Retrieved
October 31, 2017, from
http://www.jnd.org/dn.mss/the_research-practic.html
·

Lubomira Kotowska
Lubomira Kotowska
Professor, and Classmates,
For the past ten years of my nursing career, I have been
employed in the sub-acute vent unit. It consists of a mixed
population of patients with a common denominator. All of the
patients have tracheostomies, some are dependent upon
mechanical ventilator support, others rely on oxygen delivered
via tracheostomy masks. In most cases, these patients are non-
ambulatory and incontinent of bowel and bladder. In addition to
their respiratory status being compromised, they also have
neurological deficits, poor circulation, and other comorbidities
such as diabetes. Some patients are admitted to our facility with
multiple pressure ulcers at different stages and receiving
treatment. Others come with skin intact. According to NPUAP
(2001), 95% of pressure ulcers could be prevented. Bruno Costa
the author of article “ Pressure Ulcers: assessment and
Prevention in The Early Stages” supports the idea that
prevention begins with assessment. Not only an assessment of
the individual’s risk for development of pressure ulcers such as
nutritional status, mobility, comorbidities but also skin
assessment which should be performed Costa, B. (2013)
“continuously from admission” (p.260). Our facility has a
Pressure Ulcer Prevention Protocol, which includes a use of
Low Air Loss Mattresses, nutritional support, turning and
repositioning schedule and weekly skin assessment. Despite all
efforts and interventions to prevent the occurrence of new
pressure ulcers on weekly wound rounds lead by a Dr. K. wound
specialist hired by our facility, new pressure ulcers are

frequently identified. When does that happen? From intact skin,
how does a patient develop a stage II, or DTI pressure ulcer?
Apparently, our protocol is not carried out successfully.
Hence I would like to focus on systemic review on a subject
pertinent to wound care. It would be great to have a designated
wound care team, but since my intervention needs to be nurse-
driven and show the need for change I will ask the following
clinical question;
”Could increase in the frequency of skin assessment from
weekly to every shift decrease the occurrence of new pressure
ulcers?”
According to the (Moore, Z. E. H., Webster, J., & Samuriwo, J.
(2015), the wound care team consists of healthcare professional
who works closely to supervise prevention and manage wound
care. As indicated by authors the team may have a simple
strategy such as increased frequency of skin assessment, turning
and repositioning schedule, or more complex including dietary
interventions, mobilization, and education.
Increased incidence of new pressure ulcers indicates poor
practice for nurses and healthcare facilities. In addition,
treatment is more expensive than prevention. Most of all,
pressure ulcers cause pain and decrease the quality of life for
our patients. According to Lyder, CH.(2008) “Preventing
pressure ulcers can be nursing intensive. The challenge is more
difficult when there is nursing staff turnover and shortages.
Studies have suggested that pressure ulcer development can be
directly affected by the number of registered nurses and time
spent at the bedside”.
The research-practice gap occurs when despite an accumulating
body of knowledge about the effectiveness of some nursing
interventions, the gap forms between what is known and what is

practiced. According to (Thomson, M.A, 2015)’ “The problem
of implementing valid research results in nursing practice is
well known”, however, the problem involves many systems, and
it is not merely the consequence of nurses failing to keep up to
date.
References;
Closing the gap between nursing research and practice
Mary Ann Thomson, BHSc (PT),
MHS,http://dx.doi.org/10.1136/ebn.1.1.7 (Links to an external
site.)Links to an external site.
Costa, B. (2013). Pressure ulcers: assessment and prevention in
the early stages. Nursing & Residential Care, 15(5), 258-262.
Moore, Z. E. H., Webster, J., & Samuriwo, J. (2015). Wound-
care teams for preventing and treating pressure ulcers. Cochrane
Database of Systematic Reviews 2015, Issue 9. Art. No.:
CD011011. doi:10.1002/14651858.CD011011.pub2.
http://onlinelibrary.wiley.com.chamberlainuniversity.idm.oclc.o
rg/doi/10.1002/14651858.CD011011.pub2/full (Links to an
Lyder CH, Ayello EA. Pressure Ulcers: A Patient Safety Issue.
Agency for Healthcare Research and Quality (US); 2008 Apr.
Chapter 12. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK2650/

o
Anna Campomanes
Anna Campomanes
Lubomira,
I agree about how the prevention of pressure ulcers is less
costly than its treatment. The medical-surgical units in our
hospital employ similar interventions to yours. I work in NICU
now, but my former colleagues from the medical units told me
that there still is a high incidence of hospital acquired pressure
ulcers. And it is a cause of concern because it significantly
affects our reimbursement rates. This seems to be an example of
a research gap. Your clinical question sounds valid and
promising, I hope to hear more about what you find out.
o
Jessica Stuckert

Jessica Stuckert
YesterdayNov 1 at 10:02am
Lubomira,
I think this is a great idea. We learned in nursing school that
pressure ulcers can form over a relatively short period of time,
so having daily assessments could help prevent ulcers and help
ensure that Stage I and II ulcers are properly treated so that they
do not progress. Of course this a big patient safety and
satisfaction issue, but it is also a financial one. When Stage III
and greater pressure ulcers form during a patient's stay, they
will require increased services and treatments. Also, I'm not
sure insurance companies will reimburse facilities for those
treatments if the ulcer forms during the patient's stay.
Jessica
·
Melissa Kirk
Melissa Kirk

Professor and Class,
Nurses use research on a daily basis in their line of work.
Nursing research is defined as “a systematic process of inquiry
that uses rigorous guidelines to produce unbiased, trustworthy
answers to questions about nursing practice” ( Houser, 2018).
Nursing research creates new knowledge for the nursing
practice. In order to conduct a systematic review, one must
have the knowledge of developing questions and conduct
literature searches (Houser,2018).
Based on the choices from the approved systematic reviews, I
feel that the topic of hospital acquired infections best fits my
current line of work. Being employed at a urology office, we
see many patients that decide on elective surgeries, or may even
need an urgent surgery. Occasionally, the patient will be
readmitted to the hospital for an infection, or will need an
urgent surgical procedure to clean up the infection (ex. I&D).
By reducing the risk of hospital acquired infections after
surgery increases patient satisfaction and allows the patient to
heal in a timely manner. Hospitals and/or facilities lose money
when a post-op patient returns with an infection. Initiating
evidence-based practices revolving around the preparation of
surgical patients could reduce the risk of HAIs.
A systematic review summarizes existing knowledge and
answers specific questions related to a topic (Acromataris &
Pearson, 2014). For the topic of hospital acquired infections,
the question I have created is: Does the use of antiseptic
cleansers for preoperative cleansing reduce the risk of hospital
acquired infections or surgical site infections in urology
patients?
P: Urology patients receiving surgical procedures

I: Use of antiseptics for pre-operative bathing
C: No use of antiseptics preoperatively
O: Decreased number of HAI of surgical sites of patient
receiving urological procedures
“Research gaps prevent systematic reviewers from making
conclusions and, ultimately, limit our ability to make informed
health care decisions” (Robinson et al., 2013). A research gap
indicates information is missing or incomplete; therefore, the
key question has not been answered.
Melissa Kirk
Aromataris, E. & Pearson, A. (2014). The systematic review: An
overview. AJN, 114(3), 53-58. Retrieved from
https://chamberlainuniversity.idm.oclc.org/login?url=http://ovid
sp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=ful
ltext&AN=00000446-201403000-00028&LSLINK=80&D=ovft
(Links to an external site.)Links to an external site. (Links to an
Houser, J. (2018). Nursing research: Reading, using, and
creating evidence (4th ed.). Sudbury, MA: Jones & Bartlett.
Robinson, K. A., Akinyeda, O., Dutta T., et al. (2013,
February). Framework for determining research gaps during
systematic review: Evaluation. Retrieved October 31, 2017,
from https://www.ncbi.nlm.nih.gov/books/NBK126708/
Webster, J., & Osborne, S. (2015). Preoperative bathing or
showering with skin antiseptics to prevent surgical site
infection. Cochrane Database of Systematic Reviews2015, Issue

2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5.
CS6191: Medical Decision Support Systems
(40%) -2500 words.
You have been requested to write a report that compares and
contrasts clinical decision support systems used to support an
area of healthcare of your choice. Your report should provide
(i) An overview of each system,
(ii) A summary of the type(s) of information and knowledge
used and how it is structured,
(iii) The reasoning method(s) use to select and order decision
options,
(iv) Standards utilised and
(v) Outline any limitations of these systems and make
suggestions for improvement.
You should discuss about three systems in the same area and
referencing is must.

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Week 2 The Clinical Question77 unread replies.2525 replies..docx