NR 505 Week 8: Future Use of Evidence-Based Practice

Sample Answer for NR 505 Week 8: Future Use of Evidence-Based Practice Included After Question

NR 505 Week 8: Future Use of Evidence-Based Practice

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The lesson for Week 8 asks you to objectively reflect on your current use of evidence-
based practice. Throughout this course you have worked hard and created a template
for an EBP project proposal. Rather than look to the past, this discussion asks you to
look to the future—your future as an MSN-prepared advanced practice nurse!
You are a nurse leader in your future advanced practice track-based setting. You notice
that although nurses say they use evidence-based practice (EBP), you find very few
examples of this. As the leader, you decide to develop an environment that fosters EBP.
Please respond to each of the following topics.
 How would you role model EBP in your future advanced practice setting? Be specific!
 How would you foster an organizational culture that promotes EBP? How would you promote
EBP throughout the entire organization?
 You have one staff member who constantly says, "We have never done it this way—why
change?" What actions would you take to change him or her from a distracter to a promoter of
EBP?
Scholarly references to support your response are required.

Deisi Yasmin Guerrero
Jun 17, 2018Jun 17 at 3:34am
Manage Discussion Entry
Instructor Question

What are your thoughts about integration a pilot to test ebp in your workplace?

A Sample Answer For the Assignment: NR 505 Week 8: Future Use of Evidence-Based Practice

Title: NR 505 Week 8: Future Use of Evidence-Based Practice

Dr. Linda

I work in the emergency room and during my shifts I come across at least one
person whose chief complain is related to chronic pain. For the most part, the
primary care providers provide them with some sort of analgesic in order to manage
their pain. We definitely have our regulars who come in at least once a week
demanding morphine or dilaudid. PCP’s have a constant pressure to maintain high
patient satisfaction scores and feel the need to negotiate the plan of care with these
patients. However, many are reluctant to order or prescribe opioids or controlled
substances even though because they don’t see it as appropriate to chronic pain
management. Nonetheless, if these patients don’t get the drugs they seek, one
knows they will be unsatisfied with their care. As mentioned by Henson and Jeffrey
(2016), pilot studies can provide a better insight of the developing research, they
assess sample size, data collection and clarify many questions before the
implementation process. Pilot studies tend to foretell what one must expect from the
actual study, therefore providing one with the opportunity to alter and adjust one’s
methods. Implementing a pilot study in the ER will be challenging for me. For the
most part the ER consist of pharmacological intervention and in this fast phase
setting it would be difficult to implement nonpharmacological interventions. Currently,
in my ER we divide our patients in two sections. One section is for our acute patients
whom need to be seen by a PCP as soon as possible or whom will require
numerous resources such as blood draw, xray, radiology, etc. The other section is
our “fast track”, this portion of the ER sees nonemergent cases or those whom will
require one to two resources such as those whom need small sutures or medication
refill. Many time, some of the patients whom are complaining of chronic pain will go
to the fast track section, medication will be provided, and they will be discharged.
Given this setting is less acute and patients are more stable, I believe I could
integrate nonpharmacological teaching and interventions. Nonetheless, in order to
intergrade a pilot study, one must take many things into consideration.

Deisi

Henson, A., & Jeffrey, C. (2016). Turning a clinical question into nursing research:
the benefits of a pilot study. Renal Society of Australasia Journal, 12(3),99-105.

Jaziel Chavira
Jaziel Chavira
Jun 19, 2018Jun 19 at 7:26am
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Hello Deisi,
Thank you for the great post as always. I have enjoyed reading your posts this class
as you always provide great insight on the discussions. I also work in the
emergency setting and see many of the same issues as you. We have a similar set
up in our ER including a fast track area. It works well moving non-acute patients
quickly. I like your idea regarding implementing non-pharmacological interventions
for patients with chronic pain. Last week, there were discussion posts explaining the
value of physical therapy for those with chronic pain. This is one of my favorite
interventions to discuss with patients with chronic pain as it has the capacity to
alleviate pain as well as provide overall health benefits. The pressure on providers
to prescribe narcotic pain medications is a huge issue and very unfortunate. I can
see why many feel pressured to give out medications for fear of being negatively
criticized. We have had many discussions in our ER regarding this issue and found
that through working together as a group and being consistent, our level of pain
medication disbursement has gone down significantly. It began with our medical
director speaking to all physicians on our new goal and continued with nursing
managers and staff providing constant education to the public that things were
changing and why they were changing. Overtime, we saw many patients who
frequented our ER seeking pain medications for chronic issues had less visits thus

lowering our overall disbursements of narcotics. Thank you again and good luck in
your studies!
thanks
jazi
o

James Gold
James Gold
Jun 21, 2018Jun 21 at 7:28am
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Hi Deisi,
Again, another great post. In this current state of healthcare, it is sad to see the
realization that doctors are basically being blackmailed to receive good patient
satisfaction scores. This is the issue with pay for performance in my opinion.
Because every area in the US is not like another. In one ER they may have more
resources or patient population, which if they receive a couple of negative scores, it
does not hurt their reimbursement. Now, look to the converse of this situation. You
work in a rural community ER and people are coming in for chronic pain or drug
seeking behavior, you refuse their request for meds, then your facility receives a bad
review. So, your performance is lower; therefore, you do no receive reimbursement
as readily. I do believe there are people out there with chronic pain, but resources
for the ER should not be used for refilling chronic pain or pain seeking behaviors.
Sadly, drug seekers are very manipulative and realize what they are doing and the
impact they play. Chronic pain patients are different, but as well, they know when
their prescriptions are due to be filled. coming to the ER for a refill is in my humble
opinion ridiculous. This would totally make me as a PCP or nurse have huge issues
with this practice.
o

Amy Bardon
Amy Bardon

Jun 22, 2018Jun 22 at 6:12am
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NR505 Week 8 Peer Response
Deisi,
Like James has noted, I too have enjoyed reading your posts and perspective
throughout our course. Your topic, like many others in our current healthcare
environment, is so multifaceted and complex. Patients seeking pain management
options in the ED is the result, in my opinion, of an overall fail of their health
management. I continuously hear our senior leaders talk about primary care and
primary prevention; as well as care across the continuum. As I read your post, I stop
and think about how the many opportunities we have at every point of care a patient
may receive.
There are some patients that do not have chronic health care needs, do not see a
primary care provider for a health condition, and are the ones seeking medications
like you described above. I agree with James's thoughts; and your response as to
how difficult a pilot would be in the ED regarding the expectations around pay for

performance with this patient population. It is unrealistic to achieve high patient
satisfaction scores in an ED with this population when the expectation and
regulations on the clinicians and providers is to NOT prescribe narcotics. The
narcotics are what the patient came to the ED for; another issue that we have all
identified. I feel that until there is a true collaborative effort with all points of care
patients may touch across their healthcare journey; and a solid plan to connect
these patients with the additional care they may need post ED visit to address their
pain, and in most cases their drug dependency, we will continue to see these
opportunities and struggle to meet the goals that are set for us (pay for performance,
customer satisfaction, and throughput to name a few).
Great thoughts in your post. Best of luck in future courses.
Amy

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Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

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