Recent orders
Role DNP in Evidence-Based Practice (EBP)
Evidence Based Practice Model to use : IOWA Model Evidence based Practice
Practice Problem: VAP (Ventilator Associated Pneumonia)
Student: Wilmot-Carter, Sherian
Introduction to Evidenced Based Practice
Evidenced Based Practice (EBP) is defined as the use of scientific evidence as a guide for decision making that will evoke change in any organizational system (Hall & Roussel, 2017). This concept is continuously applied in nursing as it creates a medium for facilities to use best evidence to develop strategies that counter a particular clinical problem (Polit & Beck, 2017). This paper will discuss the Stetler Model of Research Utilization, the Advanced Practice Registered Nurse’s (APRN) role in each step and the steps of the model as it relates to managing catheter associated urinary tract infections (CAUTI).
The Stetler Model of Research Utilization
Since the introduction of EBP, researchers have developed and used numerous research models to guide their pursuit of problem solving. One such model that has been used for decades is the Stetler Model of Research Utilization. The Stetler Model is a tool that is used to transform research and best evidenced into clinical practice (Stetler, 2001). There are five steps to the Stetler Model, which all play and integral role in the process of problem solving. Each step enables critical thinking, alleviate some human errors made in decision making and uses evidence in daily practice (National Collaborating Centre for Methods and Tools, 2011).
- Preparation: This step describes the purpose for consulting evidence and the needs to consider all other contextual factors that will influence the process. The APRN is necessary to facilitates this step. This is where the APRN will ensure that all aspect of the problem is considered, and the best and most effective evidence is chosen to complement the process.
- Validation: This step is all about the credibility and applicability of each research finding. The APRN is very important in this step as this is where expertise and knowledge of level of evidence is needed to critique and evaluate the research choses.
- Comparative Evaluation/Decision Making, Synthesis and Decisions/Recommendations per Criteria of Applicability: In this step the APRN will organized the choses research based on their similarities and differences. The APRN will determine if there is substantial evidence that is suited for the practice setting and targeted population. Based on this comparison the APRN will decide which research evidence to use and the ones to reject.
- Translation/Application, Operational Definition of Use/Actions for Change: This is where the APRN will use the evidence gathered to put into action. This step represents the implementation of a plan of action.
- Evaluation: In this step the APRN will assess the implemented plan of action in terms of goals and potential outcomes that needed to be achieved.
The Stetler Model as it relates to CAUTI Prevention
CAUTIs have been a leading cause of infection in healthcare facilities, simply because healthcare workers are poorly educated on the need for a catheter (Carr, 2017). This results in higher healthcare cost for patients, longer hospital stays and increased mortality rates (Ferguson, 2018), therefore prevention is key. The Stetler Model can be used as a tool to address CAUTIs and to implement a solution.
Using the first step of the Model, relevant evidence was gathered as it relates to CAUTIs in a hospital setting. It was important to consider all areas in the hospital that catheters are used as each department had a different reason.
Applying the second step of the model, literature was analyzed and validated to determine its efficacy as it related to CAUTIs. The credibility of these articles was determined by their level of evidence, whether they were experimental or non-experimental and whether the research yielded positive results or not.
In third step of the process a decision was made to use the research that provided the best results for the patient population and setting being examined. A number of the articles reviewed were literature reviews and non-experimental. After reviewing and choosing the best evident, a choice was made for a solution to the problem. In order to address this issue, the most feasible solutions that would be most cost effective in preventing CAUTIs in the hospital setting would be an algorithm that determines if a catheter is warranted and an alternative method if its use is not justified. This plan of action was used in multiple research study with positive results.
The fourth step of the model would allow for plan implementation, which would begin as soon as patients are admitted to the hospital. The algorithm would be place on each patient’s chart so it is available should there be a consideration for a catheter. The patients that qualify for a catheter will still be limited on the number of days they can have the catheter, along with strict guidelines for maintenance. Patients who do not qualify for a foley catheter would benefit from alternatives such as female external catheter or a male condom catheter as it applies per gender and scheduled toileting. Although these methods are less invasive than a foley catheter they still pose a risk for infection and require adequate management.
The fifth step of the model would allow for and evaluation of the process and whether it has generated positive results. Failure of the intervention does not mean it was an inappropriate option. Therefore, during the process of evaluation all aspect of the process would be critiqued to determine what areas can be improved.
References
Carr, A. N. (2017). CAUTI prevention: Streaming quality care in a progressive care unit. MEDSURG Nursing, 26(5), 306–323. https://search-ebscohost-com.libproxy.usouthal.edu/login.aspx?direct=true&db=a9h&AN=125833258&site=ehost-live
Ferguson, A. (2018). Implementing a CAUTI prevention program in an acute care hospital setting. Urologic Nursing, 38(6), 273–302. https://doi-org.libproxy.usouthal.edu/10.7257/1053-816X.2018.38.6.273
Hall, H. R., & Roussel, L. A. (2017). Evidenced-based practice, an integrated approach to research, administration and practice (2nd ed.). Burlington, MA: Jones and Bartlett Learning.
National Collaborating Centre for Methods and Tools (2011). Stetler model of evidence-based practice. Hamilton, ON: McMaster University. (Updated 18 September, 2017) http://www.nccmt.ca/resources/search/83.
Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Stetler, C. (2001). Updating the Stetler model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49, 272-279. DOI: 10.1067/mno.2001.120517
Biomedical Ethics in the Christian Narrative
This assignment will incorporate a common practical tool in helping clinicians begin to ethically
analyze a case. Organizing the data in this way will help you apply the four principles of
principlism.
Based on the “Case Study: Healing and Autonomy” and other required topic study materials, you
will complete the “Applying the Four Principles: Case Study” document that includes the
following:
Part 1: Chart
This chart will formalize principlism and the four-boxes approach by organizing the data from the
case study according to the relevant principles of biomedical ethics: autonomy, beneficence,
nonmaleficence, and justice.
Part 2: Evaluation
This part includes questions, to be answered in a total of 500 words, that describe how
principalism would be applied according to the Christian worldview.
Remember to support your responses with the topic study materials.
APA style is not required, but solid academic writing is expected.
Quality Healthcare: Measuring NP Performance
How do you measure NP performance in quality management (1,100 words). Which metrics will you use.
Purpose
The purpose of this assignment is to have students research the measurement tools of NP performance. Through the use of quality patient outcomes, student will list and discuss three different patient interventions and how they would specifically measure the outcomes and how these primary care interventions result in improved patient outcomes and cost savings for the practice. In addition, students will discuss how these interventions result in improved patient ratings.
Requirements:
The National Committee for Quality Assurance (NCQA) was formed to ensure quality of patient care and measurement of patient outcomes with set standards.
Healthcare Effectiveness Data and Information Set (HEDIS) is a performance measurement tool used by millions of health insurance plans. There are 6 domains of care:
- Effectiveness of Care.
- Access/Availability of Care.
- Experience of Care.
- Utilization and Risk Adjusted Utilization.
- Health Plan Descriptive Information.
- Measures Collected Using Electronic Clinical Data Systems
You may access the 6 domains of care by clicking this link:
(NCQA, n.d. https://www.ncqa.org/hedis/ (Links to an external site.))
As an APN, productivity will be an important measurement for the practice to determine reimbursement and salary. Fee-for-service practices will require a set number of patients per day to maintain productivity. A capitated practice will require the APN to have a large panel of patients but also will focus on controlling costs. This can be accomplished through effective primary care that is accessible, convenient for the patients and has a method of measuring quality of care.
Write a formal paper in APA format with title page, introduction, the three required elements below, conclusion and reference page.
You are now employed as an FNP in primary care. Choose one performance measure from one of the six domains of care, i.e. Adult BMI Assessment, Prenatal and Postpartum care, etc.
Develop three different patient interventions for that one performance measure and how you would specifically implement the intervention and measure the outcomes for that particular performance measure in clinical practice.
How would these primary care interventions result in improved patient outcomes and cost savings for the practice?
How can these interventions result in improved NP patient ratings?