For your final paper you will be selecting a clinical problem that both interests you and is relevant to your nursing practice.

For your final paper you will be selecting a clinical problem that both interests you and is
relevant to your nursing practice. You will then be seeking a best practice, clinical
guideline, or practice bundle that has been established to address this concern. For
example, perhaps you are interested in the reduction of patient falls in your health care
facility and you wish to implement the best interventions supported by research to
prevent falls. After you identified this concern, you would then seek a clinical guideline
to guide you in the implementation of the evidence based change you would like to
make. You might use the Falls prevention clinical guideline developed by the RNAO. Or
perhaps you are interested in the clinical problem of catheter associated UTI’s and you
wish to implement the CAUTI prevention bundle. You will then develop a paper that
addresses the clinical concern, discusses the guideline you chose, and critically analyzes
three (3) research studies that support the change in practice. Following this you will
present the clinical setting and discuss how you might implement the guideline within
that setting. You are not required to implement, just formulate a plan.
Steps toDevelop the Paper:
1. Select a Clinical Problem for the Focus of Evidence-Based Practice Paper
Review recent research literature and select a clinical concern that is of interest to you
and nurses in your current practice area. A way to identify an area of interest may be to
ask yourself or colleagues questions such as: Is there a better way of doing
something? Would another intervention be more effective and improve patient
outcomes? What research-based intervention exists to improve current care in terms of
patient, provider, and health care agency outcomes? Look in the literature for
answers. Try to identify something for which you really want an answer. Be certain
that it is a clinical concern that you feel would improve patient outcomes in your clinical
area and most importantly, be certain it is a clinical concern that is addressed through
NURSING interventions.
Review a variety of web sites such as:
Agency for Healthcare Research and Quality
National Guideline Clearinghouse
Clinical Practice Guidelines
Best Practice Guidelines
RCN Clinical Guidelines
Nursing Best
Look for guidelines that will provide the solution and evidence based interventions for
your identified clinical concern and that will provide the support for the development of
your evidence-based paper. The important deciding factor is whether the intervention is
something registered nurses have decisional control over. Be careful NOT to choose an
intervention that is a medical intervention that is simply carried out by nurses. You need
to find a guideline that supports nursing actions and nursing sensitive outcomes.
1. Establish the Research Support
Using the existing protocol, clinical guideline, or best practice that you chose for your
evidence-based practice paper, identify at least three (3) research articles from
references of the protocol, clinical guideline, or best practice. Look for meta-analyses,
integrative reviews of research, clinical trials, and quasi-experimental studies related to
your topic.
Once you find the research studies, you will examine EACH study and describe the
will be quite easy to do as it should be clearly identified in the study. Fill this in the
Then note the levels of evidence for each study. The table follows. USE THIS TABLE
Rating System for the Hierarchy of Evidence/Levels of Evidence
Level I
Evidence for a systematic review or meta-analysis of all
relevant RCTs or evidence-based clinical practice guidelines
based on systematic reviews of RCTs.
Level II Evidence obtained from at least one well-designed RCT
Level III Evidence obtained from one well-designed controlled trials
without Randomization
Level IV Evidence from well-designed case-control and cohort studies
Level V Evidence from systematic reviews of descriptive or qualitative
Level VI Evidence from single DESCRIPTIVE or QUALITATIVE study
Level VII Evidence from the opinion of authorities and/or reports of
expert committees
* Table from Melnyk, Bernadette Mazurek and Ellen Fineout-Overholt. Evidence-based
practice in nursing and healthcare. Philadelphia: Lippincott Williams & Wilkins, 2005:10.
Note that when you determine the LEVEL OF EVIDENCE, YOU MUST JUSTIFY WHY YOU
CHOSE THAT LEVEL. Please do this carefully as this will reflect your understanding of
levels of evidence. Following the completion of the review of the three articles, you will
complete this assignment by writing a narrative summary of the levels of evidence of
the studies. This represents the “body of evidence” supporting your proposed clinical
change. Summarize how strong you feel the evidence is to support your proposed
change. Thus, you will submit three completed forms, a brief explanation at the end of
each signifying the strength of the evidence, and ONE paragraph at the end
summarizing the BODY OF EVIDENCE supporting your proposed change. These three
forms are to be included in the body of the paper and should NOT be submitted
Application of the Guideline, Protocol, or Best Practice to the Clinical Setting
During this section of the paper you will describe the clinical setting in which you
propose to implement the guideline and you will address how you will accomplish this
taking into consideration the agency, administration, staff, and desired outcomes of the
intervention. You will specify how you will plan this change and utilize a specific theory
of change (Lewin works best for this) to support your plan.
Synthesize the content of the paper with a full summary of the paper and provide at
least four significant summary points.
End the paper with a thoughtful reflection on the experience of seeking the evidence for
a change in clinical practice and the planning it takes to implement this change. Has
this experience broadened and strengthened your understanding of evidence based
nursing practice? How do you see yourself moving forward and using the understanding
and skills you developed through this assignment? Note that this is the only section of
the paper where you will use personal pronouns.
Provide full APA formatted references for all research studies and be sure that you have
provided citations for all the sources in your paper as well as full references for these
citations. It is expected that the content of the paper will be well supported with
support from credible and scholarly nursing sources.
Criteria for Paper:
APA format to include title page and reference page