NURS 6052 Wk 4 Assignment: EBP Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
NURS 6052 Wk 4 Assignment: EBP Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
NURS 6052 Wk 4 Assignment EBP Part 2 Advanced Levels of Clinical Inquiry and Systematic Reviews
This presentation will discuss:
- Clinical issue of interest
- Process of developing PICOT question
- Research Databases
- Peer-reviewed articles
- Strengths of Systematic Reviews
Clinical Issue of Interest
}Issue of interest: Nursing shortage
}Cause d by: low job satisfaction
}Reduced quality of care & missed nursing care
}Causes poor patient outcomes
}Decreased patient satisfaction
}Increased nurses’ workload
My clinical issue of interest, for NURS 6052 Wk 4 Assignment EBP Part 2 Advanced Levels of Clinical Inquiry and Systematic Reviews assignment, is nursing shortage, which is an increasing concern in the health care systems in the U.S. Nursing shortage is associated with a detrimental impact to patients, nurses, and the healthcare organization (Johnson et al., 2016). It contributes to poor health outcomes due to reduced
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quality of care and missed nursing care. Common patient outcomes attributed to nursing shortage include increased patient falls, pressure ulcers, and medical errors (Johnson et al., 2016). This results in increased inpatient stays, morbidity rates, and patient costs. Besides, reduced quality of patient care results in decreased patient satisfaction.
Nursing shortage results in an increased workload for nurses; this contributes to reduced job satisfaction and motivation. Failure to adhere to the recommended nurse to patient ratios often leaves nurses exhausted and causes burnout, which is linked to high turnover rates (Johnson et al., 2016). A high nursing turnover rate results in a greater nursing shortage and further worsens the situation. Low job satisfaction has been considered the primary cause of nursing turnover, which causes nurses’ shortage (Johnson et al., 2016). Health organizations need to identify ways of increasing nurses’ job satisfaction to increase their retention and eventually reduce the nursing shortage.
References
Johnson, W. G., Butler, R., Harootunian, G., Wilson, B., & Linan, M. (2016). Registered nurses: The curious case of a persistent shortage. Journal of Nursing Scholarship, 48(4), 387-396. https://doi.org/10.1111/jnu.12218
Developing a PICOT Question
}Population of interest- Registered Nurses
}Intervention- increasing job satisfaction
}Comparison plan- no intervention
}Outcome- increase nursing retention
}Timeline- 12 months
vIn registered nurses, does increasing job satisfaction compared to no intervention increase nursing retention within 12 months?
I developed my PICOT question from the clinical issue of interest by first identifying the population of interest, registered nurses. Secondly, I identified an intervention that would help address the nursing shortage and a comparison plan. The identified intervention is, increasing job satisfaction and the comparison plan is no intervention. I also identified the intervention’s outcome, which is to increase nursing retention and a time frame of 12 months.
The final PICOT question is:
In registered nurses (P), does increasing job satisfaction (I) compared to no intervention (C) increase nursing retention (O) within 12 months (T)?
Research Databases
}Research Databases used to search for articles:
qPubMed
qScience Direct
qMEDLINE
qBMJ Journals
The research databases used to search the peer-reviewed articles on nursing shortage include:
PubMed
Science Direct
MEDLINE
BMJ Journals
Levels of Evidence
Bridges et al. (2019) used a Case series, Observational study. Case series are considered Level IV evidence since they have no comparison group.
Level IV refers to evidence from case series and case reports.
Jarrar et al. (2019) employed a Cross-sectional survey. This is Level III evidence since it involves making inferences about a population of interest at one point in time.
Nantsupawat et al. (2017) used a cross‐sectional survey. This is Level III evidence.
Perry et al. (2018) conducted a qualitative study using online surveys. The study is Level III evidence.
From a practice viewpoint, clinical issues represent the care aspects prioritized when performing clinical interventions. They are primarily the everyday events in health care delivery that adversely affect health outcomes. Clinical issues often inform research problems. In this case, they are the basis for evidence-based application in health practice where nurses and other care providers integrate scientific evidence with clinical expertise and patient preference to enhance health outcomes. This presentation describes the clinical issue of interest, PICOT development, and the databases used to conduct the search process. It also identifies the research databases used, APA citations for the peer-reviewed articles used, and levels of evidence. The last part is a detailed analysis of the strengths of systematic reviews as the highly recommended evidence type for clinical research.
To provide optimal patient care, nurses should always be in the right physical and mental health state. Unfortunately, clinical issues hamper nurses’ ability to provide quality and satisfactory care. Workplace incivility in nursing is among the common clinical issues profoundly affecting health outcomes. Typical among nurses, workplace incivility involves rude and disrespectful actions towards colleagues. Incivility shows disregard for others’ feelings and needs, often intending to harm or hurt them. The effects of incivility are far-reaching since it is positively correlated with anxiety and job burnout besides lowering nurses’ self-esteem (Shi et al., 2018). Other effects necessitating evidence-based interventions include the affected nurses negatively perceiving the nursing profession (Alshehry et al., 2019) and being highly vulnerable to medical errors (Abdollahzadeh et al., 2017). The outcomes are detrimental to the quality of patient care.
The PICOT approach is highly recommended in health practice when developing interventions for clinical problems. When creating the PICOT question, the problem or population in question is first identified. It should be vivid too. The issue of interest is workplace incivility among nurses. The other central components include the intervention and comparison. The intervention suggested to reduce workplace incivility is policy interventions and awareness programs compared to no intervention. From a practice viewpoint, the intervention should lead to a specific objective: reducing workplace incivility to promote a healthy working environment. The time frame defines the time it will take for an intervention to realize the desired outcome. In this case, six months.
To make informed decision about a clinical issue, nurses and other health care providers should search for evidence from the leading research databases. Since workplace incivility is a nursing issue, the search was limited to nursing research databases. As a reliable source of scholarly and peer-reviewed sources, CINAHL Plus with Full Text provides access to literature related to nursing and allied health. JAMAevidence has many nursing and health care articles. Trip Pro is largely a search engine that enables a nurse to access research evidence relevant to clinical practice. Systematic reviews and practice guidelines can be accessed via Trip Pro. Google Scholar facilitates search for peer-reviewed articles.
The full citations of the above articles have been provided in the reference list. As indicated, the articles focus on different research areas related to workplace incivility. The broadened focus enhances understanding of the topic to justify why evidenced-based interventions are necessary. The article by Kile et al. (2019) examined the effectiveness of education and cognitive rehearsal in managing workplace incivility. Both interventions enhance awareness of workplace incivility. Abdollahzadeh et al. (2017) examined how to prevent workplace incivility from a nurses’ perspective. Armstrong (2018) primarily focused on nursing workplace incivility prevention. The last article by Shi et al. (2018) examined the link between workplace incivility and job burnout.
Nurses should use the highest level of evidence to guide decision-making in health practice. Systematic reviews provide high-level evidence since they comprehensively search for evidence from multiple credible sources. Besides the high quality of evidence, systematic reviews narrowly focus on a clinical question. By synthesizing available evidence of a particular topic, systematic reviews help nurses and other health care providers to make more informed decisions regarding practice issues. Most systematic reviews identify research biases and flaws in the synthesized literature and propose areas that require further research based on the research gaps. As a result, they inform decision-making and guide future research.
This presentation primarily focused on workplace incivility as the clinical issue of interest. It deserves maximum attention due to its adverse impacts, including reducing nurses’ self-esteem, contributing to burnout and anxiety, and increasing the chances of nurses committing medication errors. Nursing and health care research should always be informed by the highest evidence level possible. As a result, systematic reviews are highly encouraged due to their high level of evidence and in-depth analysis of a clinical problem. Their use enhances understanding of a clinical problem and ensures that the evidence used to guide interventions is relevant to the reviewed issue.
References
Abdollahzadeh, F., Asghari, E., Ebrahimi, H., Rahmani, A., & Vahidi, M. (2017). How to prevent workplace incivility?: Nurses’ perspective. Iranian Journal of Nursing and Midwifery Research, 22(2), 157-163. https://doi.org/10.4103/1735-9066.205966
Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403-410. https://doi.org/10.1177%2F2165079918771106
Kile, D., Eaton, M., deValpine, M., & Gilbert, R. (2019). The effectiveness of education and cognitive rehearsal in managing nurse‐to‐nurse incivility: A pilot study. Journal of Nursing Management, 27(3), 543-552. https://doi.org/10.1111/jonm.12709
Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open, 8(4), e020461. doi:10.1136/ bmjopen-2017-020461