Compare the types of information found in the articles from different levels and the value of the information from each level

Finding Sources of Evidence

An important step in the EBP process is reviewing the current body of literature to better understand the subject or topic in which you are interested. By conducting a review of the literature, you are building foundational knowledge about the topic; later, you can use this background to build new insights. Developing a strong grasp of a topic can only be garnered by taking the time to thoroughly search for relevant information and resources.

For this Discussion, you will practice searching the literature to find evidence on a specific topic.

To prepare:

Choose a simple search term(s) relating to a topic of your PICOT question.

Review the information on the evidence hierarchy discussed in Chapter 2 of the course text, in the article, “Facilitating Access to Pre-Processed Research Evidence in Public Health,” and in the multimedia presentation “Hierarchy of Evidence Pyramid,” found in this week’s Learning Resources.

Review the information on the Walden Library’s website, “Levels of evidence.” Take a few minutes to explore the different types of databases available for each level of evidence and focus on the meaning of filtered and non-filtered resources.

Conduct a literature search in the Walden Library on your selected topic using the databases that you reviewed. Use at least one database for each of the three levels of filtered information and at least one unfiltered database. Record the number of hits that you find at each level of the hierarchy of evidence.

Select one article from the results at each level of the hierarchy. Compare the articles based on the quality and depth of information. What would be the value of each resource if you were determining an evidence-based practice?

Post a summary of your search. Describe what topic you selected, the search term(s) that you used, and the number of results found at each level of the hierarchy. Compare the types of information found in the articles from different levels and the value of the information from each level. Highlight a useful tip that you could share with your colleagues about conducting an effective literature search.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.

Required Readings

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice” (Review pages 14–31)

Chapter 5, “Literature Reviews: Finding and Critiquing Evidence”

In this chapter, you focus on conducting a literature review. Topics include how to identify the relevant literature on a given topic and then how to critique the strengths and weaknesses of the literature that you have found. Finally, the chapter examines how to synthesize the research findings into a written literature review.

Houde, S. C. (2009). The systematic review of literature: A tool for evidence-based policy. Journal of Gerontological Nursing, 35(9), 9–12.

Retrieved from the Walden Library databases.

This article emphasizes the importance of systematic reviews of literature. The authors present an overview of resources that may assist in conducting systematic reviews.

Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195.

Retrieved from the Walden Library databases.

This article reviews the features of the TREAD Evidence-Based Practice Model. In particular, the authors of this article stress how the model emphasizes the use of standardized critical appraisal tools and Level I evidence.

Robeson, P., Dobbins, M., DeCorby, K., & Tirilis, D. (2010). Facilitating access to pre-processed research evidence in public health. BMC Public Health, 10, 95.

Retrieved from the Walden Library databases.

This article describes a hierarchy of pre-processed evidence and how it is adapted to the public health setting. The authors identify a range of resources with relevant public health content.

Walden Student Center for Success. (2012). Clinical Question Anatomy. Retrieved July 9, 2014, from http://academicguides.waldenu.edu/content.php?pid=183871&sid=2950360

Barker, J. (n.d.) Basic search tips and advanced Boolean explained. Retrieved August 3, 2012, from http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Boolean.pdf

This resource provides a graphical representation of different approaches to research and gives examples of each.

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

This article reviews the frameworks commonly used to assist in generating answerable research questions. The author recommends considering the individual elements of the frameworks as interchangeable (depending upon the situation), rather than trying to fit a situation to a specific framework.

Walden University Library. (2012). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=523225

This guide provides a listing of evidence-based clinical resources, including systematic reviews and meta-analyses, critically appraised topics, background information and expert opinions, and unfiltered resources.

Indiana State University. (n.d.). Database search strategies. Retrieved July 6, 2012, from http://libguides.indstate.edu/content.php?pid=118904&sid=1065428

In this resource, the most common types of database searches are highlighted. It includes topics such as nesting searches, phrase searches, and using synonyms of key words in the search.

Library of Congress Online Catalog. (2008). Boolean searching. Retrieved from http://catalog.loc.gov/help/boolean.htm

This web page provides a basic overview of Boolean searches and provides simple examples of key search terms.

Walden University. (n.d.b.). Searching and retrieving materials in the research databases. Retrieved August 10, 2012, from http://academicguides.waldenu.edu/foundationscoursedocs/SearchingRetrieving

This resource provides tips for searching in the Walden Library. It includes a guide to keyword searches, an explanation of Boolean searches, and tips on locating specific journals or articles.

Document: Course Project Overview (Word document)

Note: You will use this document to complete the Project throughout this course.

Media

Laureate Education (Producer). (2012e). Finding resources for EBP. Baltimore, MD: Author.

Note: The approximate length of this media piece is 6 minutes.

In this video, Dr. Marianne Chulay identifies sources where nurses can find evidence to support their practices. She provides several examples of resources that provide specific information about best practices in health care.

Accessible player

Laureate Education (Producer). (2012f). Finding sources of evidence. Baltimore, MD: Author.

Note: The approximate length of this media piece is 9 minutes.

Dr. Kristen Mauk explains the process of performing a literature review in this video. She provides advice for nursing students in browsing databases and analyzing sources of evidence.

Accessible player

Laureate Education (Producer). (2012g). Hierarchy of evidence pyramid. Baltimore, MD: Author.

This multimedia piece explains the hierarchy of evidence pyramid. The piece offers definitions and key information for each level of the pyramid.

How might role conflict and/or ambiguity have contributed to the situation?

Discussion: Group Management for Just Culture
The concept of a fair and just culture refers to the way an organization handles safety issues. Humans are fallible; they make mistakes. In a just culture, ‘hazardous’ human behavior such as staff errors, near–misses and risky actions are identified and discussed openly in hopes of finding ways to improve processes and systems—not to identify and punish the individual.
—Pepe & Caltado, 2011

This Discussion examines the opportunities of managers in working with groups to promote change that facilitates the delivery of safe, high–quality care.
To Prepare

Review the information on just culture presented in the Learning Resources.
For this discussion, you will use the Regulatory Decision Pathway found in Russell, K. A. & Radtke, B. K. (2014).
Examine an adverse event at the unit level in your organization or one with which you are familiar and apply the Regulatory Decision Pathway.
Compare the findings of the Regulatory Decision Pathway to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?
Think about how a nurse leader–manager may use just culture as a framework to create or maintain a focus on accountability and outcomes throughout a group. What actions could be taken if a systems–related error was made or if an error resulted from risky behavior?
How might role conflict and/or ambiguity have contributed to the situation?

Post a description of an adverse event in your organization and your analysis of the issue using the Regulatory Decision Pathway. Explain how role conflict or ambiguity might have influenced this situation. Apply the principles of just culture as you explain how you, as the group’s manager, would handle the situation.

http://sidneydekker.com/wp-content/uploads/2013/01/JustCultureCritique.pdf

http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

**************Below is a paper to use as reference!!!!!!!!!

PLEASE USE THIS AS A REFERENCE ONLY.

Adverse Event
Adverse events are a part of the healthcare environment and how an event is dealt with can affect patient safety. The regulatory pathway and just culture are a means of improving the quality of care and safety culture (Russell & Radtke, 2014). Health care employees need to trust in their organization that an adverse event can be reported so that the organization and employee can learn from the event, and that it is not just a means to place blame.
An adverse event that took place in the cardiac catheterization lab was a procedure was done on the wrong patient. A patient that was to have a pacemaker instead ended up having a diagnostic catheterization. This event involved a patient identification issue by the nurse. The hospital’s patient identification policy and time out policy were not adhered to by the nurse and then the catheterization team. The incident was reported to the state, and there were several event meetings with the nurse and physician. As a result of the investigation, all staff in the catheterization lab were re-educated to the patient identification and time out policy. All staff had to sign an individual affidavit that they understood the policy. The nurse was given a written warning. This event would not have happened if the nurse and catheterization team had adhered to policy.
Regulatory Decision Pathway
Using the regulatory decision pathway, the nurse did not intend to harm the patient deliberately. The nurse asked the patient if she was Ms. X and the patient said yes. The identification policy is to check the patient’s identification band for name and medical record number against a second identifier. This was not done. There were no significant circumstances involving the system that led to the error. The nurse did not conceal the error or falsify the record. The nurse did not disregard or consciously take a substantial risk. She thought she had the correct patient. There were no similar or serious errors by this nurse. A reasonably prudent nurse would not have done the same in similar circumstances as the patient identification policy would have been adhered to. According to the regulatory decision pathway, this was at-risk behavior by the nurse (Russell & Radtke, 2014).
The catheterization team which included the physician, nurse, physician assistant, and technician contributed to this adverse event. The team did not follow the time out process policy where everything stops, and patient identification is reconfirmed with other parameters. Again, following the regulatory decision pathway, the catheterization team demonstrated at-risk behavior. At-risk behavior involves unsafe practice and carelessness which is shown by the nurse and catheterization team not adhering to policy (Russell & Radtke, 2014).
Role Conflict
The cardiac catheterization lab is very fast-paced, and the nurses can feel the stress of the workload. The procedure area and recovery room was very busy and crowded that day. Role conflict could have contributed to the situation as there is constant pressure to keep moving. Role conflict could have contributed in the time-out process not taking place in the procedure room. Nurses have to initiate the time out process when the physician arrives, and some physicians are not very cooperative in the process. Since the adverse event, patient identification and the time out policy are strictly adhered to.
Just Culture
Quality improvement and work environment improvement are a part of just culture (Lockhart, 2015). Just culture is safety issues, improving processes, and not about punishing individuals (Pepe & Cataldo, 2011). As the group’s manager using the principles of culture, I would have done firm counseling stressing the significance of the incident, but as this was the nurse’s first risky behavior, I would not have done a formal written warning with the threat of being fired if it happens again. Doing a staff meeting and re-educating the policies was appropriate. Patient identification and the time out process are now part of the cardiac catheterization lab’s monthly quality assurance surveys. All new employees are well educated in the two policies and must sign an attestation that they understand by the end of orientation. This adverse event led to improved processes in the cardiac catheterization lab which is the goal of just culture (Pepe & Cataldo, 2011).

References
Lockhart, L. (2015). Does your organization have a just culture? Retrieved from http://www.NursingMadeIncrediblyEasy.com doi-10.1097/01.NME.0000457286.16594.92
Pepe, J., & Cataldo, P. J. (2011). Manage risk, build a just culture. Health Progress. Retrieved from http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

Russell, K. A. & Radtke, B. K. (2014). An evidence-based tool for regulatory decision-making: regulatory decision pathway. Journal of Nursing Regulation, 5(2), 5-9. https://class.waldenu.edu/bbcswebdav/institution/USW1/201810_27/MS_NURS/NURS_6201/readings/USW1_NURS_6201_Russell.pdf

Describe a Nursing Home community of your choice.

Respond to each topic in two to three paragraphs
-Describe a Nursing Home community of your choice.
-Describe Health related concern
-Talk about Epidemiology in such environment
-Identify Epidemiology Risk Reactors
-Morbidity
-Incidence rate of specific diseases and injuries (compare a chosen Community with people of the same age group elsewhere.( City, County, State, or Nation)
-Prevalence rate of specific diseases and injuries (compare CA with same age group in the literature – City, County, State, or Nation)
Mortality
-Age specific death rates (compare CA with same age group in the literature – City, County, State, Nation)
-Leading cause of death of CA compared with same age group in the literature – City, County, State, or Nation
Identify levels of prevention & justify analysis for CA

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