Background Information for the assignment:
Health care policies are developed and implemented based on EBP. Advanced practice nurses (APNs) serve a critical role in this implementation process: evaluating and critiquing EBP to inform, create and change the delivery of health care while guiding policy formation. Since policies promote the care of patients, they are often governed by other agencies or organizations. For example, the World Health Organization describes health policy as actions that have been instituted by local, state and national government entities to influence health care outcomes. Even the International Council of Nurses feels that EBP is a problem-solving approach that influences decision making in the clinical setting (Hall & Roussel, 2017, p. 248-249).
However, just because you find a guideline or position statement does not mean that it will work for your facility, your group of patients, and so forth. To determine whether the recommendations in that guideline or position statement fit the needs of your facility, population, problem, APNs must determine the strength of the recommendations to regulate whether policy changes are warranted. Through this process the APN may begin with the development of a clinical question and a thorough search of the literature on the proposed changes needed. This question is typically presented in a PICO framework, which shapes how the question is searched, the outcomes intended, and timing of those outcomes (Hall & Roussel, 2017, Ch. 14). Sometimes as you uncover more research on the problem, the question can become revised, but nonetheless, any problem starts with a typical question that needs to be answered. This assignment will start by taking your POI and PICO clinical question and determine if the guideline or position statement should be implemented into practice by completing a thorough appraisal of it. Then you will determine who will be needed for implementation to occur, what barriers may be present, and ultimately why should it be done.
Step 1: Introduction
A good introduction should be no more than 1 paragraph grabbing the reader’s attention providing insight to the POI, guideline, and significance to the APN’s role. End with a strong thesis or purpose statement. Note: the thesis should be condensed to 1 brief purpose statement. The introduction should be one paragraph in length.
Step 2: Tool Completion
While this is the next step on the rubric, you will not be writing anything directly in the paper for this section. However, it must be completed as the next step because this is where you will appraise the guideline or position statement. Therefore, you will need to submit a copy of your completed tool to the assignment area. When you submitted your POI topic you also submitted a guideline/position statement for approval. You should be using your approved guideline/position statement to complete the tool for this section. If for some reason you were unsuccessful in gaining approval for your guideline/position statement, you still must complete this section by finding a guideline/position statement, but the opportunity to have that pre-approved is now past the deadline.
To provide an overview of the guideline OR position statement use the tool below. You will need to address each question in the corresponding guideline/practice recommendation section of the tool; missing information may cause you to lose points. You must submit the completed tool with the assignment. Please attach the completed tool separately to the assignment area. Faculty need to see your analysis of the guideline for full credit. Use the link below to complete. You can save the document as a pdf, use the edit function to fill in or handwrite and scan back into the assignment area. The tool has multiple parts that apply to other types of resources. You are expected to complete the sections that apply to the appraisal of the guideline or position statement. Read the directions on the tool.
Evaluation Tool for Guideline OR Position Statement Word Document
EXAMPLE ONLY Guideline or Position Statement.pdf Download EXAMPLE ONLY Guideline or Position Statement.pdf do not use this document for your appraisal but as a guide only
Important Note: At this point, some students feel like they chose a guideline/position statement that perhaps was not the best fit for various reasons (settings may be too different, low quality, etc.). It is important that you understand that is ok. This assignment allows you the opportunity to determine if you should implement the recommendations and explain why or why not. Likewise, you also have the opportunity to explain the quality rating which may have led you to determine that it was not a good fit after all. Regardless that is the point of the appraisal process. If you were going to implement this in real time, you may have to search for a different guideline that is a better fit, but for the purposes of this course, time does not permit us that luxury. So be sure that you explain your rationales thoroughly in the paper.
Step 3: Guideline or Position Statement
This section will not have any written text in the paper but serves as a reminder to submit the proper documents to the assignment. Please submit the guideline or position statement to the assignment area. If your guideline has been updated or revised, you need to submit the original and updated versions to the assignment area. Do not submit a link as links often do not open or require a login. Faculty need to see your document so they can refer back to it and add any comments directly on the document as needed for clarification. Guidelines/position statements should be current, within 5 years.
Step 4: Appraisal of the Guideline/Position Statement
Appraise the guideline or position statement by providing a robust discussion of the following criterions.
Summarize the purpose of the guideline and who the guideline impacts. (1 paragraph)
Explain who developed the guidelines and their significance to practice. Do not give names, instead provide the groups of nationally recognized experts by group, organization, or expertise in the field. What makes the developers experts? Explain your answer. (1 paragraph).
What different levels of evidence (classes/grades of evidence) were used to develop the recommendations? To complete this step you must look at the studies/references used that support the recommendations or position statements. You must use levels as indicated on the level of evidence hierarchy as described in your book or resource in the Readings/Resources section of the course page to support your answer. You may also include any specific rating system the guideline or position statement referenced as well. How many levels of evidence were used? What is the difference between the various levels? Support your answers by explaining why these various levels of evidence matter when assessing the strength of the guideline. (2-3 paragraphs).
Review the levels of evidence discussed in #3 to support the recommendations to explain the following: 1. were the resources consistent, well-designed studies? 2. were the majority of the studies used to form recommendations primarily high level or low level studies? 3. Should the authors consider using more studies, different types of studies? 4. Is the guideline current or do you feel there are any gaps in the guideline/position statement that should have been addressed, but wasn’t? Support your statements with peer reviewed resources and thorough rationales to explain your answers (2-3 paragraphs). You may want to revisit the level of evidence hierarchy to assist you in answering this question.
Based on your answers in #3-4, how does this impact your decision to use this guideline in practice or to disregard the recommendation. Explain your answer with fully supported information from the guideline or position statement, and other resources as necessary. (2-3 paragraphs)
Discussions should be detailed and robust demonstrating full understanding of the content. No simple yes/no answers permitted. This section is your longest section and worth the most points, so the depth of answers should be noted in your responses. It would be expected to have 1-2 pages of information related to the appraisal in this section. Use the resources provided to you on the readings/resources page. There are several that discuss levels of evidence. It is expected that you can differentiate among the various levels used.
Step 5: Institute of Medicine Aims
In this section, you will be discussing the Institute of Medicine Aims. While there are 6 aims in total, you are only expected to discuss 3. Therefore, you should identify the selected 3 aims and provide a robust understanding of the aim, then how that aim relates to the POI, and finally how your APN role will further influence the aim. This section should be well supported by peer reviewed references and also serves as an area where the depth of the discussion is expected. Support with proper resources (1/2 to 1 page).
Step 6: Barriers to Implementation
In each project, you should expect to come across barriers. These barriers will impact your implementation and may include personnel, individuals, groups, administrators, etc.; financial, structural, process (inadequate planning), time, etc. As the project lead, you must anticipate and plan for barriers. What will you do to overcome them, can you prevent them, or will you have to create an idea to simply work around the barrier? Whatever the case, you will need to consider these barriers for your project and describe 2 that will directly impact implementation. You need to incorporate your original outcome as specified in your PICO Clinical Question and determine what those barriers are, how will you resolve these barriers so that implementation can move forward? This section should be well supported by peer reviewed references and also serves as an area where the depth of the discussion is expected. Support with proper documentation. (1/2 to 1 page).
Team 7: Stakeholders
This section will be written in a shorter format. Include the heading: Stakeholders, then simply list your stakeholders by including a short description of their role. Keep in mind that this list will likely expand upon who is listed on your guideline/position statement itself as that only applies to who is using the guideline. You are including all those impacted by the implementation of the guideline, so the list will be much broader.
Here is the expected format:
Stakeholders
Nurse Educator: provides education to day/night shift workers as needed on policy changes
Computer/Tech Personnel: updates Electronic Health Record to support new additions to assessments
Step 8: Conclusion
Conclude the entire paper by summarizing each section. Do not simply tell me a summary of what you wrote (i.e. avoid “First I discussed”, Next, I wrote…” statements in the paper), instead summarize the essential or main points for the various sections. Never include new findings in the conclusion. (1 paragraph)
Step 9: Turnitin:
You are required to submit this paper to Turnitin by visiting https://www.turnitin.com/. Review the originality report and change any phrases or sentences that you need to. You can re-submit the assignment if needed. Failure to submit to Turnitin by the due date will result in a late penalty deduction. Faculty will view your similarity report upon submission.
See Rubric for specific guidelines on scholarship deductions.
Page limit: 8 max pages excluding title page, references and any attachments included. Students should write in third person only for all sections of this paper. First person pronouns are not permitted. Paper should be submitted to the Assignment area.
References: you should include at least 2 additional peer reviewed references in addition to text books and the guideline or position statement selected. All references and guideline/position statement should be current, no older than 5 yrs. unless that guideline or position statement remains the gold standard (support with evidence). You must get any guideline or position statement approved if it older than 5 years. Minimum number of references: 1-2 textbooks, 2 peer reviewed resources, guideline/position statement= 4 MINIMUM
To see the rubric, go the next section of the Module and click on the Rubric link.
