Discussion: Where in the World Is Evidence-Based Practice?

Searching for articles to answer PICO(T) questions can be rigorous and time-consuming. Techniques used can be different in several ways depending on the database used, terms, keywords, and Boolean operators. To search the databases, one must classify the elements of the PICO(T) question.  According to Stillwell, Fineout-Overholt, Melnyk, and Williamson (2010, p. 1), “PICOT is an acronym for the elements of the clinical question: patient population (P), intervention (I), comparison of intervention or issue of interest (C),  outcome(s) of interest (O), and time it takes for the intervention to achieve the outcomes (T).” Below is an example of a PICO(T) question for this discussion:

PICOT QUESTION: Are Aricept effective in reducing signs and symptoms of Alzheimer’s Disease compared to Namenda on the geriatric population 65+ years old after 3 years?

P – geriatric population 65+ with Alzheimer’s disease

I –   Aricept medication

C-   Namenda

O- reduced signs and symptoms of Alzheimer’s disease

T – in 3 years

Two Databases

1. Cochrane Database of Systematic Reviews

The number of articles shown on the first attempt showed 3,691 articles using the words:

Alzheimer’s

OR Donepezil or Aricept

OR Namenda or memantine

OR Effectiveness

Number of articles returned on the second attempt search with different Boolean operators: 27 articles

Search terms used: main box: Alzheimer’s disease OR dementia

Second search box: AND Aricept or donepezil

Third search box: OR Namenda or memantine

Fourth search box: AND effectiveness OR efficacy OR effective

1. Database of Abstracts of Reviews of Effects (DARE)

Search terms used: main box: Alzheimer’s disease AND

Second search box: medication AND

Third search box: effective OR

Number of articles on original Search: 2

Second attempt: Main search box: Alzheimer’s disease or dementia

Second search box: medication OR

Third search box: effective OR

Number of articles shown: 35

Using different Boolean operators and terms can change the number of articles returned on the second attempt compared to the first attempt. Furthermore, there are strategies to make to increase the rigor and effectiveness of database research on the PICO(T) question. According to New York University Libraries (2020), there are strategies includes “translating the natural language terms to subject descriptors, Medical Subject Headings (MeSH) terms, or descriptors”. According to Baumann (2016, para. 5), MeSH terms are “labels assigned to each article in Medline in order to describe what the article is all about. They are also official words or phrases selected to represent particular biomedical concepts.” One can start on the (P) and the (I) only to begin to search and keep initial search results broad.

Changing terms, keywords, Boolean terms can make a big difference in the research outcome. By using PICO(T) in a clinical inquiry, with the right strategies, nurses will gain knowledge and skills in gathering evidence one step at a time. Locating evidence can be time-consuming but with constant practice, it can be a breeze.

References

Baumann, N. (2016, January 13). How to use medical subject headings (MeSH). The International Journal of Medical Practice, 70(2), 171-174. http://dx.doi.org/ https://doi.org/10.1111/ijcp.12767

New York University Libraries. (2020). Health (Nursing, Medicine, Allied Health): Search strategies: Framing the question (PICO). Retrieved from https://guides.nyu.edu/c.php?g=276561&p=1847897

Stillwell, S., Fineout-Overholt, E., Melnyk, B. M., & Willliamson, K. (2010, March). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58-61. http://dx.doi.org/doi: 10.1097/01.NAJ.0000368959.11129.79

Health organizations deliver health care and promote quality care to a population. To provide quality care, health organizations based their decisions on research, and implement this information using evidence-based practice.

The healthcare organization named the Center for Disease Control and Prevention (CDC). CDC is “one of the divisions of the United States Department of Health and Human Services and the highest governmental health organization in the United States” (Forrest, 2019). The mission of the CDC is to “promote health and improve quality of life by preventing and controlling disease, injury, and disability” (Forrest, 2019, para.1). The organization is also “charged with protecting the public health by providing leadership and direction in the prevention and control of disease and other preventable conditions” (Forrest, 2019, para.1).

CDC’s mission is to protect the US population. To accomplish these, CDC “conducts critical science and provides health information to prevent expensively and dangerous health threats, and responds when this arises” (CDC.gov, 2019, para.2). One of the CDC’s pledge to the American people is to “base all public health decisions on the highest quality data that is derived openly and objectively” (CDC.gov, 2019).

CDC’s work is grounded on evidence-based practice (EBP), as they have stated on their website, all their decisions are based on scientific quality data. According to Melnyk, Fineout-Overholt, Stillwell, and Williamson (2010), the evidence-based practice uses seven steps: cultivate a spirit of inquiry, ask clinical questions, search for the best evidence, critically appraise the evidence, integrate the evidence with critical expertise, and patient preferences and values, evaluate the outcomes of practice decisions or changes based on evidence, and lastly, disseminate EBP results. These steps were all apparent in their mission statement.

The information gathered from their website has changed my perception of the organization as they provide information that is not biased, not based on opinion but facts. For example, they have a specific link to a journal that addresses chronic diseases entitled “Preventing Chronic Diseases.” This link also stated public health research, practice, and policy. According to the CDC (2019), the journal is a:

“peer-reviewed public health journal sponsored by Centers for Disease Control and Prevention authored by experts worldwide. Their mission is to promote dialogue among researchers, practitioners, and policymakers worldwide on the integration and application of research findings and practical experience to improve population health. The journal’s vision is to serve as an influential journal in the dissemination of the proven and promising peer-reviewed public health findings, innovations, and practices with editorial content respected for its integrity and relevance to chronic disease prevention”.

A healthcare organization that uses evidence-based practice to provide quality care follows a format that forms an inquiry, search, synthesize, implement, and evaluate the outcomes of the implemented principles.

References

Centers for Disease Control and Prevention. (2019). Preventing Chronic Diseases. Retrieved from https://www.cdc.gov/pcd/about_the_journal/index.htm

Centers for Disease Control and Prevention. (2019). Mission, Role, and Pledge. Retrieved from https://www.cdc.gov/about/organization/mission.htm

Forrest, K. Y.Z. (2019). Centers for Disease Control and Prevention (CDC). Magil’s Medical Guide (Online Edition). Retrieved from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=4&sid=22b2cb3a-38ae-447a-bf2a-59d719e86629%40sdc-v-sessmgr02&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=89093368&db=ers

Discussion: Where in the World Is Evidence-Based Practice?

March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.

In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.

To Prepare:

• Review the Resources and reflect on the definition and goal of EBP.
• Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
• Explore the website to determine where and to what extent EBP is evident.

By Day 3 of Week 1

Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.

By Day 6 of Week 1

Respond to at least two of your colleagues on two different days by visiting the websites they shared and offering additional examples of EBP or alternative views/interpretations to those shared in your colleagues’ posts.

Submission and Grading Information

The healthcare organization website reviewed for this discussion was, The Joint Commission’s (TJC) website. TJC was Founded in 1951, as an independent, not-for-profit organization and is the nation’s oldest standards-setting and accrediting body in health care (TJC, 2020). TJC is the largest accrediting body in the United States, evaluating and accrediting over 22,000 health care organizations and programs throughout the country (TJC, 2020). TJC was created with the intent of continuously improving health care for the public by evaluating health care organizations and driving them to excel in providing safe and effective care of the highest quality (TJC, 2020).

The term evidence-based practice does not appear in TJC’s mission or vision statement; however, it can be found in the, “Health Services Research” section under, “Resources”. According to Brown (2018) evidence-based practice is the utilization of care practices that have been recommended by an agency because the available evidence indicates they are effective. This description is reinforced by Melnyk and Fineout-Overholt (2018) who express that evidence-based practice is a lifelong problem-solving approach to clinical decision making that involves the use of the best available evidence combined with acquired experience and or  expertise along with patient preference to improve outcomes.

Based on the previous descriptions of evidence-based practice, The Joint Commission’s work in the development of standards meet this criterion. According to TJC (2020) standards are developed with input from health care professionals and are informed by current scientific literature, expert consensus, must relate to patient safety or quality of care, and have a positive impact on health outcomes. After conducting research, the information provided on TJC’s website has changed my perception of the healthcare organization. Prior to being informed I assumed TJC’s role was to survey and penalize healthcare organizations for infractions. I did not fully comprehend that TJC conducted research and surveyed healthcare organizations to ensure best practice guidelines were being followed in order to achieve high quality care and improved outcomes across a variety of settings.

References

Brown, S. J. (2018). Evidence-Based Nursing: The Research-Practice Connection. Burlington: Jones and Bartlett Learning.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

The Joint Commission. (2020). History of The Joint Commission. Retrieved from https://www.jointcommission.org/about-us/facts-about-the-joint-commission/history-of-the-joint-commission/

The Joint Commission. (2020). Standards Development Process. Retrieved from https://www.jointcommission.org/standards/about-our-standards/

response

In addition to your post, in the “Resources” link, one can also click on the “Research” drop-down menu, and it will show Operations Support Research, Evaluation Research, and Health Services Research on The Joint Commission website.

The Operation Support Research analyzes and interprets data to inform and support Joint Commission programs and services. It uses “quantitative and qualitative research methods to ensure that decision making across the organization is informed by reliable information” (The Joint Commission, 2020a, para.1)

In the Evaluation Research, which uses “qualitative and quantitative methods to carry out research activities such as systematically assessing outcomes of a specific intervention or the impact of a product, program, or service on an organization, or its stakeholders” (The Joint Commission, 2020b, para.1)

In the Health Services Research, it supports customers with evidenced-based quality improvement and safety interventions (The Joint Commission, 2020c, para.1). According to the United States Agency for Healthcare Research and Quality (AHRQ), as cited by The Joint Commission (2020c), is a “multidisciplinary field of scientific investigation that studies how the social, economic and health technologies and personal behavior affect access to health care, the quality and cost of health care, and ultimately our health and well-being” (para.3).

This website uses evidence-based practice to provide quality, effective methods of health care delivery serving the United States population.

References

The Joint Commission. (2020a). Operations support research. Retrieved from https://www.jointcommission.org/resources/research/operations-support-research/

The Joint Commission. (2020b). Evaluation Research. Retrieved from https://www.jointcommission.org/resources/research/evaluation-research/

The Joint Commission. (2020c). Health Services Research. Retrieved from https://www.jointcommission.org/resources/research/health-services-research/