Overview of Selected Evidenced-based Practice Project
Evidence based practice and research are two different yet almost similar concepts. While EBP is more practice oriented, research is from a more theoretical perspective. The two are related in the sense that research provides a background for EBP. Research is about the development of new knowledge and validation of existing knowledge. The new knowledge and the validation results are shared to the public through publications, which can then be used to inform even EPB. On the other hand, EBP is about translating the evidence provided by research and practice into clinical decision making. EBP has the purpose of improving patient-care decisions through use of the best available evidence. Most of the evidence used for clinical decision making under EBP are obtained through research. In EBP, evidence is divided into distinctive hierarchies with the highest hierarchy assigned to evidence that stems from systematic reviews and meta-analyses (Black et al., 2015). The second hierarchy (second most important evidence) stems from randomized controlled trials. Both the first and the second levels of evidence, as well as the lower evidence levels are directly drawn from research, indicating the importance of research in EBP.
While EPB applies a lot of research findings and knowledge from research practice, it goes beyond mere application of research findings to include clinical expertise, patient values and patient preferences. It takes into consideration of the evidence from opinion leaders and experts where there is no definitive knowledge existing from research (Black et al., 2015). Best clinical practice is used to inform EBP related decisions unlike in research where there is dependence on both practice experience and past research as a driver of research need. Additionally, research is conducted based on a specific methodology, which can be either qualitative or quantitative. Research also comprises of several parts. One of the most important parts of research is the literature review, in which past studies are explored (Stevens, 2013). The past findings are used to guide the formulation of study hypotheses and the research questions. In EBP, practice related challenges are the best indicator of need.
EBP has contributed extensively to professional nursing practice. For instance, Stevens (2013) posits that EBP has been a key player in nursing transformation and in quality improvement towards the development of healthcare systems with greater quality, safety and efficiency. Evidence based practice has increasingly unified clinical expertise with research findings to come up with individualized care in which patient preferences are included. On practice, EBP has resulted in the exposure of nurses to new knowledge that is useful for clinical decision making, change support and transformational leadership. In this way, professional nurses can use EBP to motivate organizational cultural change, inter-professional collaboration and also knowledge exchange among teams. There have also been significant impacts on clinical research in that EBP has resulted in the development of various thematic areas under which clinical research can be conducted. Various models of knowledge transformation have also been developed through the integration of EBP into nursing practice (Black et al., 2013). These models provide simple and comprehensive strategies for the conversion of evidence into practice.
One of the areas of professional nursing that have been impacted by EBP is the Family Nurse Practitioner role. The family nurse practitioner role involves caring for medically stable patients across all population ages. Some of these nurses select the specific populations to which they deliver healthcare, while others collaborate with other specialties in helping specific patient populations (Nurse Journal, 2019). Through its impacts on nursing practice and research, EBP promotes change even in the context of family nurse practitioner practice. The ability to provide continuous and comprehensive care to all patient populations is affected by research and the application of current clinical practice transformations. This is promoted by EBP.
Identification of the Nursing Concern to be improved
One of the nursing concerns commonly experienced during practice as a family nurse practitioner us the need for the prevention of STDs and unwanted pregnancies among young adults in South Florida. According to CDC (2017), STDs and unwanted pregnancies have increased in prevalence in the recent years. Young adults aged between 20 and 24 years are involved in more than 57% of unwanted pregnancies. More than 47% of abortions conducted in the United States alone are done by young adults. This indicates the prevalence of unprotected sex among that population (CDC, 2017). With unprotected sex also come sexually transmitted infections such as HIV, syphilis and gonorrhea. In South Florida, the need for preventing such outcomes is high as in all other areas. Family nurse practitioners are faced with the need to help young adults and adolescents in the promotion of behavior change through practices such as family therapy. Since the nursing specialty deals with people with all conditions across all population ages, the concern about unwanted pregnancies and STDs is an inevitable outcome.
Prevention of STDs and unwanted pregnancies is a concern for the general population as well as the healthcare providers due to the impacts of such conditions on the productivity and quality of life of the affected individuals and others (Bearak, Popinchalk, Alkema, & Sedgh, 2018). The key stakeholders in this concern include parents of young adults, government organizations and healthcare providers. The patients are affected by the concern due to the social and economic impacts of unwanted pregnancy and STDs on households. Victims have to be taken care of, which results in reduced economic productivity of their parents/ caregivers and themselves. Some victims undergo prolonged hospitalization, which results in additional healthcare costs for governments, insurance agencies and their parents. Healthcare providers also have to be actively involved in caring for patients, especially in the case of chronic STIs (Bearak et al., 2018). As such, entire communities have to be involved in the prevention of unwanted pregnancy and STDs among young adults through awareness creation, promotion of safe sexual practice and encouragement of abstinence among others.
Preventing unwanted pregnancies and STDs is a concern for the general population because of the impacts of these outcomes on the populations. Yazdkhasti, Pourezza, Pirak, and Abdi (2015) point out some of the commonly experienced consequences of this concern. One of the mentioned consequences is the increase in financial burden as a result of the conditions. STDs drive the need for medical support, which requires financial intervention. Similarly, unwanted pregnancies impose an economic, moral and social burden to the communities. Pregnant young adults have to be taken care of through antenatal healthcare provision; in case they decide to have abortions, the economic impacts of such activities will be felt by the parents. The doctors, caregivers and the young adults themselves are also faced with the moral dilemma as to whether it is ethical to end the life of a fetus. If they decide to have children from unwanted pregnancies, the children impose an ever existing economic burden to the parents of the young adults (Yazdkhasti et al., 2015). Socially, taking care of the sick and young adults can be draining and can result in the loss of quality of life among the caregivers as well.
Because of the consequences of unwanted pregnancies and STDs among adults, the proposed solution is awareness creation among the general population in South Florida. There is need for the involvement of healthcare practitioners, parents and community based organizations in enhancing the awareness of youths from a young age about unwanted pregnancies and STDs. The youths have to know the consequences of reckless sexual behaviors across the entire population. This can only be achieved through community based forums that promote information sharing and provide alternative activities through which youths can spend their leisure time. For this reason, this EBP proposal proposes a community based model of youth involvement through which the youths would be integrated in various activities during which information regarding STDs and unwanted pregnancy prevention will be shared.
PICOT/PICo question and Literature Search Process
To achieve the objective of the proposed EBP, a qualitative approach to research has been selected. The research question in this case will be: How can the family nurse practitioner work with community based organizations to promote the prevention of unwanted pregnancies and STDs among young adults in South Florida? The question has been formulated in the PICo format, in which the target population comprises of the young adults. The interest is the prevention of unwanted pregnancies and STDs while the context is in South Florida. To answer the research question, a literature search and review will be conducted to provide a background to the research question and to provide a framework for the management of the actual research.
From the proposed EBP, the findings are expected to result in a framework that can be used by family nurse practitioners to promote the prevention of outcomes such as unwanted pregnancy and STDs. These findings will be essential in my future practice setting as such outcomes are commonly handled by family nurse practitioners in all healthcare contexts. The nurse practitioner has to address the outcomes associated with unwanted pregnancies and STDs in both physical and emotional health contexts. In this setting, the nurse has to understand the implications of unwanted pregnancies and STDs among the young adults and advise them accordingly. This complicates the work of the nurse as they have to either practice as counselors as well as clinical nurses or engage an inter-professional collaboration model to ensure that the affected individuals obtain more holistic care (Bungay, Masaro & Gilbert, 2014). Additionally, nurses working as family nurse practitioners often interact with youths who are yet to be victims of unwanted pregnancy and/ or STDs. Such youths can be counseled as a preventive measure for these concerns.
While working on the proposed EBP, finding effective and sustainable solutions will depend on the background developed for the study. Conducting a literature review is an essential part of building the required background. Maggio, Sewell and Artino Jr (2016) also emphasize the role of effective literature review in building quality clinical research projects. Conducting a literature review begins with the clarification of the EBP question and purpose. This will be followed by conducting a search for relevant literatures, abstraction of information from those literatures and synthesizing that information into specific themes that can be used for report generation. Peer reviewed journals are preferred for this kind of study. Databases such as the Cochrane Library, PubMed (MEDLINE), EMBASE, CINAHL Complete and Web Science among others would offer an exceptional reference point for the EBP. To obtain the required information, key search terms will include: Unwanted Pregnancy Prevention; STDs among youths; Prevention of STDs; and Family Nurse Practitioner roles. The additional search terms will include teen pregnancy and contraception. Additionally, an organization such as the National Campaign to Prevent Teen and Unplanned Pregnancy, can be an essential resource for data, specifically on prevalence rates of the concern in question.
For every EBP, a theoretical model is an effective guidance towards effective problem solving. In the proposed EBP, the theoretical framework of choice will be the EBP competency framework. The proposed solution for the concern raised will only work if the nurses spearheading the implementation have the required competencies to manage the change process effectively. As such, identifying what nurses can do to help in preventing unwanted pregnancies and STDs among young adults would depend on what nurses are capable of doing within and outside their professional context. Leung, Trevana and Waters (2016) suggested the EBP competency framework as a strategy for evaluating nurse competency levels in translating evidence into practice. It is based on the measurement of the nurses skills and knowledge in different requirements for particular EBP interventions.
In the current proposal, this framework will be applied in the context of unwanted pregnancy and STDs prevention and management. Various competencies, knowledge and skills required by nurses in managing the concerns arising from unwanted pregnancies and STDs will be outlined. For instance, nurses require counseling skills, pharmacological skills and empathy as part of the practice requirements. These skills will be highlighted within the context of the proposed framework. Past research will then be reviewed to obtain information about the competencies of nurse practitioners in line with each of these skills. The competencies will be marked off on a skill matrix, which will be used to provide summaries on specific courses of action that nurses can take to promote the prevention of unwanted pregnancies and STDs. Leung et al. (2016) concluded that the EBP competency framework has incredible value in the facilitation of evidence based practice.
The findings from the evaluations conducted using the competency based framework should be sufficient to guide the EBP in the delineation of specific actions that nurses can take to promote the prevention of unwanted pregnancies and STDs. Nurses need to be aware of what they can do and the skills they have to transform healthcare towards the achievement of the EBP objectives. Moreover, nurses often act as the drivers of inter-professional collaboration and having them actively engaged in this concern can help to create a multidisciplinary approach to the prevention of unwanted pregnancies and STDs among young adults.
Bearak, J., Popinchalk, A., Alkema, L., & Sedgh, G. (2018). Global, regional and sub-regional trends in unintended pregnancy and its outcomes from 1990-2014: Estimates from a Bayesian hierarchical model. The Lancet, 6(4), PE380-PE389. Retrieved from www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30029-9/fulltext
Black, A.T., Balneaves, L.G., Garossino, C., Puyat, J.H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of Nursing Administration, 45(1), 14-20. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4263611/
Bungay, V., Masaro, C.L., & Gilbert, M. (2014). Examining the scope of public health nursing practice in sexually transmitted infection prevention and management: What do nurses do? Journal of Clinical Nursing, 23(21-22), 3274-85. Retrieved from www.ncbi.nlm.nih.gov/pubmed/24606574
CDC (2017). Sexually transmitted disease surveillance 2016. Atlanta: U.S. Department of Health and Human Services. Retrieved from www.cdc.gov/std/stats16/CDC_2016_STDS_Report-for508WebSep21_2017_1644.pdf
Leung, C., Trevana, L., & Waters, D. (2016). Development of a competency framework for evidence –based practice in nursing. Nurse Education Today, 39, 189- 196. Retrieved from www.sciencedirect.com/science/article/pii/S0260691716000538
Maggio, L.A., Sewell, J.L., & Artino Jr, A.R. (2016) The literature review: A foundation for high-quality medical education research. Journal of Graduate Medical Education, 8(3), 297-303. Retrieved from www.jgme.org/doi/full/10.4300/JGME-D-16-00175.1
Nurse Journal (2019). Role & scope of a family nurse practitioner. Nurse Journal. Retrieved from nursejournal.org/family-practice/role-scope-of-practice-of-a-family-nurse-practitioner/
Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2). Retrieved from ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html
Yazdkhasti, M., Pourezza, A., Pirak, A., & Abdi, F. (2015). Unintended pregnancy and its adverse social and economic consequences on health system: A narrative review article. Iranian Journal of Public Health, 44(1), 12-21. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4449999/