Best PRACTICE IN ADULT NURSING
Best PRACTICE IN ADULT NURSING
Guidelines for assignment
Examine the Evidence supporting a clinical topic and appraise the evidence underpinning this. Discuss the process of translating this evidence into clinical practice demonstrating an awareness of the factors that may inhibit the implementation of the best practice.
1 Chose a topic wisely. Make sure that it is clear and of a sensible size; in reality not too big. It is also helpful, but not obligatory, to use a topic from your eight week placement so that your work is really grounded in practice.
2 You can look at an area of hospital policy and evaluate its evidence base: this could be a care pathway, a hospital policy, a computerised care plan.
Or: you could look at a more general topic of nursing care, for example injection technique, and look at the evidence behind it.
It may be helpful to use the PICO formulation to clearly define an issue.
(PICO is: population; which patient group you will be looking at: gender or age, community or hospital settings etc.
Intervention: what test or treatment you are going to look at: medication, risk assessment tool etc. This could be a lot of different actions.
Comparison; Possibly an optional part of your PICO. If you want to compare a new intervention with the current standard practice for example.
Outcome: How you are going to measure how successful the intervention is: this could be in terms of morbidity or mortality rates, number of pressure sores etc.). Use PICO to help your identify a clear problem, but do not be ruled by it.
3 You need to look at the evidence base for your chosen topic. This will require good literature searching skills and a clear account of the search strategy you used. This will involve a discussion of the volume of research or writing about the topic, the time frame of this body of evidence and the kind of research: qualitative or quantitative.
4 You will need to address the quality of the research. This will involve a discussion of the hierarchy of evidence. If there is a good systematic review on the topic, this would normally count as very persuasive evidence in terms of influencing practice and would need to be a central part of your account… At the other end of the spectrum the body of evidence might consist primarily of expert opinion then there might be more doubt over how trustworthy the findings are. Chronology is important too. Research is iterative. This means it builds on previous work. Your account must take this into account. Often you will find the evidence is ambiguous and does not give us a clear roadmap.
There needs to be some discussion of context and risk. If you are planning to change a practice which might slightly improve care and not put lives at risk (nursing handover practice for example), you might accept different evidence than if changing practice which might have dramatic effects on mortality or morbidity (for instance a major new anti-cancer drug).Your account must include a discussion of these issues.
5 You will need to address the quality of the research articles you have found. But this requires some flexibility. If the research base is very small, you will be able to talk about the articles in some depth and assess their quality. If you have a large research base, then you will need a broader discussion of the nature of this evidence base as a whole as there will not be enough space to look at each article in depth. But both approaches might be appropriate and a spectrum of approaches in between.
6 The last quarter (roughly) of the assignment) will look at issues of implementation. What might be preventing change from taking place; attitudes, lack of clarity in the evidence base, finance or education: there might be more… You might chose to use tools like SWOT or Force field analyses but certainly draw on the literature on implementing good practice. If you feel that the practice has been implemented successfully, you certainly can write about why it was successful.
7 A brief conclusion bringing the key ideas together.
10 RESEARCH PAPERS TO SUPPORT THE TOPIC