Collaborative Learning Community EBP Development Guidelines and Implementation Plan

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Collaborative Learning Community: EBP Development Guidelines and Implementation Plan

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Abstract

This paper presents a discussion on Collaborative Community Learning and EBP in nursing and clinical setting. It begins by a brief description of EBP and CLC in the nursing next context before highlighting some merits associated with teamwork in learning. Besides, the paper uses a comprehensive literature review on the selected EBP identification question to develop EBP clinical guidelines and implementation plan. Finally, the paper utilizes three tables: EBP synthesis table, table of evidence and EBP evaluation table to synthesize and evaluate EBP among nurses. The information presented in the tables is based on multiple research studies and other sources from different authors and researchers in the field of nursing.

Keywords: Collaborative Learning Community, EBP Synthesis and Evaluation, EBP implementation plan

Introduction

Evidence Based Practice refers to conscientious and explicit attempt by nurses to find the most effective research evidence to enable them make best decisions for their patients (Sackett, Rosenberg and Gray, 1996). It has an objective of promoting efficient nursing interventions, improving outcomes for patients, providing the best evidence for effective educational and clinical decision-making. Nursing interventions informed by effective evidence is vital in the current dynamic and complex patient-care setting to improve health care services and save on medical costs.

Collaborative learning involves working as team toward a common goal. It entails teachers teaching students, students teaching each other or the students teaching their teacher. This implies that, Collaborative learning requires learners to be responsible for the learning of their colleagues and their own through negotiation and debate. Totten, Sills, Digby and Russ (1989) suggest that, students became critical thinkers through discussion within their groups and responsibility for their own learning. Besides, students taught in groups learn faster and can retain the taught information for long (Beckman, 1990; Chickering & Gamson, 1991; Goodsell, et al, 1992).

Advantages and disadvantages of working in a team environment

Working in a team environment enables the team members to share and exchange ideas by contributing the pros and cons of a certain approach to an idea. Teamwork also increases the efficiency by reducing the time taken to complete a certain task of a project. Increased efficiency consequently saves on time and cost involved in project implementation. Team environment also helps group members to showcase their strengths in various aspects of the faculty and compensates for areas of weaknesses through exchange of ideas. Finally, team environment improves relationships among the team members and enables them to support each other during and after the project. However, team environment may encourage among other team members and lead to unequal participation in project implementation. This may lead to false perception of team members since all members will be appraised according to the team performance. Teamwork also involves many processes like selection and approval of members that takes longer time and may delay project implementation.

CLC: EBP Agreement

All the group members will take part in literature of the selected clinical question. Each member will review and present at least five information sources of which two should be relevant scholarly articles. There will be weekly group meeting in which members will raise questions and ideas concerned with the tasks allocated to them. Members who fail to attend the meetings due to valid reasons will send their questions to the group head through the group email. The group chairperson will conduct a biweekly assessment of the EBP implementation plan and submit the final copy to the instructor. The group secretary and the assistant chair will record the group’s proceedings in CLC forum.

CLC: EBP Identification of Clinical Question

There have been several cases reported where patients are presenting to health facilities are given wrong prescriptions due to inadequate diagnosis knowledge among the nurses. This wrong indication may trigger development of other diseases to the patient especially the terminal diseases and further complicate the treatment plan. Our clinical question is meant to help nurses diagnose the likelihood of depression in patients using the two-question case finding.

Owing to the above description, our clinical question, our group’s clinical question stated in from of a foreground question and problem statement is “is a two-question case finding device accurate in determining depression in suspected patients compared to the six instruments validated previously?”

CLC: EBP Literature Search/Appraisal of Evidence

Group members exhibited a positive coordination in reviewing relevant literature on to obtain more information on the selected clinical question. The surveyed literature and their levels of evidence are embedded in the evidence tables at the end of the article.

Clinical protocol and the implementation plan

Grand Canyon UniversitySubject: CLC: EBP Development Guidelines and Implementation PlanEffective Date: 05/01/2015Revised Date: 03/06/2015Approval Date: 17/06/2011Approved By: Henry Smith, Group ChairPolicy Statement:Evidence-based practice is the process of making clinical decisions about effective patient care basing on relevant and appraised research findings. EBP aids nurses and clinical assistants in decision-making and enables patients to obtain better health care services. Appropriate EBP requires effective guidelines and protocols, which forms a sound scientific foundation from which nurses can draw expert consensus and clinical literature. By using these EBP guidelines and protocols, our team will determine how these guidelines affect the results diagnosis and treatment plans. Depression exhibits a higher prevalence in the society and is usually recognized in the primary treatment plan. Therefore, appropriate guidelines should be available to ensure effective treatment.Responsibility:The group members have an ultimate responsibility to develop an appropriate EBP plan to help nurses diagnose depression in patients during earlier stages. The group will accomplish this by examining the effectiveness of a two-question case-finding tool in determining depression in their patients. The project chair Henry will allocate various tasks to different members during the EBP implementation. Implementation:The group will begin to implement the EBP immediately after identifying a relevant clinical question that affects a considerable population in the society. The EBP implementation project will take at least six months of which there will be weekly meetings with the group chair and biweekly briefs from the project instructor. Each member will research at least five resources and present their findings for further analysis to determine their relevance. The group secretary will compile and document information and hand it to the chairperson who will present it to the project instructor. Monitoring:The group will keep track of its progress by conducting weekly meeting whose venues and time will be communicated to the members via the email. The group will analyze the tasks assigned to each member for correctness before allowing them to proceed. Besides, the project instructor will meet with the group biweekly to assess their progress.Clinical practice guidelines:During the EBP implementation plan, the group suggested that the best clinical practice for nurses when diagnosing depression patients should involve:Risk assessment for the patientAssessment of the duration, severity, subtypes of the depression. Assessment of the patient’s lifestyle like use of alcohol and drugsAssessing the patient’s family and personal history and determining if the patient has had any history of mental retardation or illness.The group recommended that nurses should use the following tables to determine the evidence of their activities.Table 1: Criteria for the evidence levelLevel Criteria 1 Adequate sample sizes with 2 RCTs or more, meta-analysis having narrow intervals of confidence is preferred21 RCT or more with enough sample size or meta-analysis having wide intervals of evidence. 3Non-randomized, quality retrospective, case series studies, or precise prospective evidence.4Consensus and opinion from expertsTable 2: Standards treatment linesTreatment line Criteria FirstEvidence of Level 1 or 2, and clinical supportSecondEvidence of Level 3 or higher, and clinical supportThird clinical support and either Level 4 evidence or higher

Table 3: EBP Synthesis Table of depression among adolescent patients

  Carrigan 2001 Meade 1999 Johnson 2005 Smith 2008
Levels of Evidence II III II I
Study Design R Q Q R
Mean age of sample 15 55 280 1400
Type of intervention Yoga Music Relaxation Visual imagery and music
Effect of intervention on depression among adolescents Reduces the Risk of depression Reduces the Risk of depression Has no effect on depression Increases the risk of depression

Q= quasi-experimental study; R= randomized controlled trial. The studies were analyzed using Beck Depression Scale.

Table 4: Evidence Table on how nurses can improve their awareness and implementation of EBP

  Study 1 Study 2 Study 3 Study 4 Study 5
Author Dykes etal, 2010 Huang etal, 2011 Barker etal, 2009 Mollon et al,2012 Levin et al,2011
Study title Practice guidelines and measurement: state of the science. Evaluation of PICO as a knowledge representationfor clinical questions. Short-term effects of a combination product night-time therapeutic regimen on breath malodor. Staff practice, attitudes, andknowledge/skills regarding evidence-based practice before and after an educational intervention Appraising evidence and teaching EBP innursing
Research Questions How can nurses improve their EBP implementation? How can nurses enhance their awareness of EBP in clinical practice? What interventions are necessary to equip nurses with the best EBP? What is the implication of interventional education on improving EBP among nurses? What are the appropriate teachings methods to ensure that nurses have the required knowledge in EBP?
Design ClusterRCT RCT Before/After Pre-posttestQuasiExperiment Two-grouprandomizedcontrol
Setting 8 urban medical units in U.S 8 acute care medicalWards in Singapore A single Small acute care in Australia A hospital with 488 nurses and 121 health professionals in California An urban hospital with 26 new graduate nurses
Sample All patients transferred or admitted to the units within a6 monthstudy period 1822patients 271,095Patients 283 patients 54 patients
Level of evidence I I II II I
Analysis Relativerisk OR Frequency Relative ratio OR
Key findings Considerablyfewer falls Considerablyfewer falls Considerablyfewerinjuries no significance posttest changes inknowledge experience and skills 8-week follow up scores on knowledge skills and better posttest changes
Recommendations Interventional training enables nurses improve their awareness on EBP PICO is an effective solution to most clinical questions. Nurses to undergo additional interventional education through collaboration and team work inadequate knowledgetesting as the study involved onehospital Generalization of findings was limited to home care context. Possibility of bias since PI was amentor to the study group.

RCT=Randomized Controlled Trial; OR = Odds Ratio.

Table 5: EBP Evaluation of the influence of rapid response team on the number of cardiac arrests in a three months period compared to none rapid response team

Citation Major variables studied Design Subject/Setting Findings/ResultsIndependent VariableDependent Variable Implication for Practice Methods Data Analysis Level & Quality of Evidence
McGaughey J,et al. CochraneDatabase SystRev 2007;3:CD005529 IV: RRTDV1: HMR SR(Cochranereview)Aim: influence of RRT on HMR• Reviewed 6 data bases between 1990 and 2006Only 2 RCTs were considered valid Study involved two acute care settings in UK and AustraliaAttrition: NR Australian OR study revealed 0.98 (95% CI, 0.83–1.16)UK OR study indicated, 0.52 (95% CI, 0.32–0.85) Didn’t include enough evidence• Conflicts with other studies and the recommendation needs more research. Australian study involved HMR that revealed an overall mortality in hospital without DNR.Study in UK used SAPS (SimplifiedAcute PhysiologyScore ) II to estimate Death probability OR I
Chan PS, et al.Arch Intern Med 2010;170(1):18-26 IV: RRTDV1: HMR(excluded DNR in ICU DNR, There was no definition of HMR DV2: CR SR aim: influence ofRRT on CR and HMR,Reviewed 5Sources from1950 to 2008. Involved 18 out of a possible 143 studiesSetting was acute care facilities with 5 pediatrics and 13 adults.Mean no. beds = NRAttrition: NR 4/5 pediatric studies and 7/11 adult studies revealed considerable reduction in CRAdults exhibited 21%–48% CR reduction with CR; RR 0.66 of (95% CI, 0.54–0.80)Pediatrics showed a 38% CR reduction with CR; RR 0.62Of (95% CI, 0.46–0.84) Identified variation in the resulting definition and measurement, 10/15 studies involved deaths due to DNRs in their mortality measurement.Study was associated with weaknesses since search for Grey literature was restricted to medical meetings RRT involves use of MD. HMR was used to estimate the overall hospital deaths due to cardiac arrest. Frequency and Relative risk was used to analyze the data. I
Winters BD,et al. CritCare Med2007;35(5):1238-43 IV:RRTDV1:HMRDV2:CR SR aim: effect of RRT on CR and HMR. Study surveyed three literatures between 1990 and 2005 considering sources that had a control group. Involved 8 studiesMean number of beds was Average no. of beds was 500 and attrition was not reported. HMR using observational studies indicated a risk ratio forRRT on HMR of 0.87 (95% CI, 0.73– 1.04)RCTs, had ratio risk for RRT on HMR,0.76 (95% of CI, 0.39– 1.48).Using observations, risk ratio for RRT on CR, 0.72 (95%Was CI, 0.56– 0.92) Study provides comparison across studies for RRT initiation criteria. Support provided for RRT is not sufficient to recommend an effective standard of care HMR was used to estimate the overall death rate.CR was however used determine the number of cardiac arrest to hospitalized patients.. Data analyzed using Risk ratio. I

CR = Code Rates or Cardiopulmonary Arrest; CI = Confidence Interval; DV = Dependent Variable; DNR = Do Not Revive; HMR = Hospital-Wide Mortality Rates; ICU = Intensive Care Unit; IV = Independent Variable; MD = Medical Doctor; ICU = Intensive Care Unit; NR = Not Reported; RCT = Randomized Controlled Trial; OR = Odds Ratio; RR = Relative Risk; SR = Systematic Review; RRT = Rapid Response Team; UK = United Kingdom.

References

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Canadian Network for Mood and Anxiety Treatments (CANMAT, 2009. Guidelines for the management of depressive disorder in adults. Journal of Affective Disorders.

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Malhi, G.S., Adams, D., 2009. Are guidelines in need of CPR? The development of clinical practice recommendations (CPR). Acta Psychiatr. Scand. 119 (Suppl. 439), 5–7.




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