NUR 590 Benchmark EBP Project PICOT Paper Essay -

NUR 590 Benchmark EBP Project PICOT Paper Essay

Sample Answer for NUR 590 Benchmark EBP Project PICOT Paper Essay Included After Question

Description:

Refer to the PICOT you developed for your evidence-based practice project proposal. If your PICOT required revision, include those revisions in this assignment. You will use your PICOT paper for all subsequent assignments you develop as part of your evidence-based practice project proposal in this course and in NUR-590, during which you will synthesize all of the sections into a final written paper detailing your evidence-based practice project proposal.

Write a 750-1,000-word paper that describes your PICOT.

Describe the population’s demographics and health concerns.
2. Describe the proposed evidence-based intervention and explain how your proposed intervention incorporates health policies and goals that support health care equity for the population of focus.
3. Compare your intervention to previous practice or research.4. Explain what the expected outcome is for the intervention.
5. Describe the time for implementing the intervention and evaluating the outcome.
6. Explain how nursing science, social determinants of health, and epidemiologic, genomic, and genetic data are applied or synthesized to support population health management for the selected population.
7. Create an Appendix for your paper and attach the PICOT. Be sure to review feedback from your previous submission and revise your PICOT accordingly.
8. Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper.

NUR 590 Benchmark EBP Project PICOT Paper Essay

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Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based

practice project proposal assignments.

You are required to cite at least four to six peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

BA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

MS Nursing: Public Health MS Nursing: Education
MS Nursing: Acute Care Nurse Practitioner MS Nursing: Family Nurse Practitioner
MS Nursing: Health Care Quality and Patient Safety

4.1: Synthesize nursing science, determinants of health, and epidemiologic, genomic, and genetic data in the management of population health.

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

Your response needs to be a minimum of 150 words (not including your list of references)
There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
Include in-text citations in your response
Do not include quotes—instead summarize and paraphrase the information
Follow APA-7th edition
Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

A minimum of 6 responses per week, on at least 3 days of the week.
Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
Each response needs to be at least 75 words in length (does not include your list of references)
Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
Follow APA 7th edition
Points will be deducted if the above is not followed
Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
Here are some helpful links
Student paper example
Citing Sources
The Writing Center is a great resource

A Sample Answer For the Assignment: NUR 590 Benchmark EBP Project PICOT Paper Essay

Title: NUR 590 Benchmark EBP Project PICOT Paper Essay

Evidence-Based Practice Project

Abstract

Fundamentally, the focus of this project is evidence-based practice (EBP). In many instances, EBP is characterized by the potential of patient-centered care provision, cost effectiveness of care, and improved expertise of the health care providers. Due to these benefits, EBP is associated with the highest quality of care and positive patient outcomes. In particular, the focus of EBP in this project is the comparison of the best intervention between the use of hemodialysis and peritoneal dialysis in reduction of incidences of mortalities caused by end-stage renal diseases. Before the initiation of the project, the organizational readiness to embrace the project was determined. Based on the evaluation, the organization showed moderate preparedness for the integration of evidence-based practice in the organization. The proposed solution for determining the best intervention between hemodialysis treatment and peritoneal dialysis treatment was determined through a retrospective study. The Trans-Theoretical Model of behavioral change was utilized to facilitate the adoption of change in the organization. This model helped in facilitating the communication with stakeholders since provides information in a manner that prompts individuals to make decisions to change their behaviors. Consequently, an implementation plan was developed. The project allocated a period of nine months for patients follow-up to determine the clinical outcomes. Specifying the timeframe also helped in defining resources needed for the implementation of the project.

Section A: Organizational Culture and Readiness Assessment

The survey tool that was used in this research was obtained from the book authored by Melnyk and Fineout-Overholt (2011). The tool provides insights into the readiness of an organization in integrating evidence-based practice into its systems. It consists of 19 survey questions that explore various organizational issues that are critical for successful integration of evidence-based practice. The questions are rated from one to five. The lowest rate represents none at all response while the highest rate represents very much response. The score for my survey was 75%, which shows that there is moderate preparedness for the integration of evidence-based practice in the organization. The highest survey scores included those of the questions that focused on whether the mission reflects evidence-based practice, commitment of the nursing staff to evidence-based practice, and championing level of the healthcare providers. The survey questions with the lowest scores included those concerning the readiness of the physicians and availability of fiscal resources to support evidence-based practice. The overall survey result shows that evidence-based practice can be successfully introduced in the firm. The success can be seen in its current practices that align with the requirements of successful integration of evidence-based practice in an organization.

There exist possible barriers that might hinder the adoption of evidence-based practice in our organization. One of them is the low level of commitment from the physicians towards the adoption of evidence-based practice. Efforts need to be embraced to ensure that all the healthcare providers support to use of evidence-based practice in the provision of healthcare. The other potential barrier is the limited fiscal resources needed to support evidence-based practice in the organization. Healthcare organizations are supposed to support the adoption of evidence-based practice in their settings. The support could be in the form of providing learning materials and organizing training for the healthcare providers. This challenge can be addressed by raising the level of awareness of the management and leadership of the organization on the importance of evidence-based practice.

Section B: Proposal/Problem Statement and Literature Review

Background of the Topic

End stage renal disease is one of the health problems that affect a significant proportion of the world’s population. It is estimated that 750, 000 patients are diagnosed with end stage renal disease in the US on an annual basis. About 2 million people are also affected by the disease globally (University of California San Francisco, n.d.). The World Health Organization reports that about 1.2 million people lost their lives to end stage renal disease in 2015. The rate represented an increase by 32% when compared to the statistics of the year 2005. Globally, approximately 5-10 million people die annually due to chronic diseases of the kidney (Luyckx, Tonelli,&Stanifer, 2018). The prevalence of end-stage kidney disease is high in women than in men. There is disproportionate prevalence of the disease across races. For instance, it is more common in individuals with non-Hispanic blacks when compare to non-Hispanic white and non-Hispanic Asians (CDC, 2019).

End stage renal disease is characterized by the loss of kidney function and represents glomerular filtration rate below 13 ml/min (Bujanget al., 2017). The disease is associated with risk factors that include diabetes, infections such as HIV/AIDS, malaria, and hypertension (Luyckxet al., 2018). The management of end-stage renal disease relies mainly on the use of peritoneal dialysis and hemodialysis. These methods of management are effective in preventing mortalities caused by uremia. The selection of a method of treatment depends on a wide range of factors such as patient’s preferences, logistical considerations of the existing treatment facilities, comorbidities, and timing or acuity of uremia (Zhou et al., 2019).

The duration of survival and mortality rates among end-stage renal disease patients on hemodialysis and peritoneal dialysis has been an issue of concern to patients and healthcare providers. Controversy exists as to whether there is survival advantage between peritoneal dialysis and hemodialysis (Xueet al., 2019). The findings reported in observational studies on the survival rates between the two treatment approaches have been inconsistent. Some observational studies have shown that there is an initial survival advantage with the use of peritoneal dialysis within the first 2 years of diagnosis with end stage renal disease. The mortality risk increases significantly after this period. Other studies have shown the lack of clear mortality between the two treatments, thereby, attributing the mortalities to residual confounding factors (Zhou et al., 2019).

Studies conducted in the past can provide insights into the mortalities associated with hemodialysis and peritoneal dialysis in patients suffering from end-stage renal disease. A meta-analysis conducted by Xueet al. (2019) showed that there was no statistical difference in mortalities in end-stage kidney disease patients on hemodialysis and peritoneal dialysis. Instead, the analysis revealed that the benefits of these treatment methods outweigh their potential risks. The study by Yang et al. (2015) revealed that hemodialysis was associated with better survival results when compared to those started in hemodialysis. However, there was no significant difference in mortalities reported among young as well as healthier patients. The findings reported by these scholars cannot be relied upon wholly as the research was confounded by selection bias. A study by Wong et al., (2018) showed that there were no differences in mortalities among patients on hemodialysis and peritoneal dialysis. Rufinoet al. (2011) argue that while peritoneal dialysis might be associated with better survival outcomes, its beneficial effects are short-lived and cannot be the basis for its adoption over hemodialysis. Therefore, it makes it evident that further studies exploring the mortalities associated with these treatment modalities are conducted, hence, the need for this proposed research.

PICOT

Purpose of the Project and Significance to Nursing

The purpose of this proposed project is to investigate whether the use of hemodialysis will result in incidence of mortalities caused by end stage renal disease within nine months when compared to the use of peritoneal dialysis. On the other hand, the use of evidence-based practice data has gained significant need in the modern practice of nursing. As a result, this project will act as a source of evidence-based data on the effectiveness of the two treatment approaches in end stage renal disease. The proposal will raise the level of knowledge among the nurses on the type of management that is appropriate to the patients with end stage renal disease they serve on a regular basis. The research will also inform policy changes in healthcare organizations. The results might shift the focus of management of end stage renal disease in the institution. Lastly, it can stimulate more researches into the topic among the nurses. The results of the study might act as a basis for future researches conducted by the nurses to explore the survival benefits between the two treatment methods of end stage renal disease.

Section C: Solution Description

Proposed Solution

The PICOT question for this research is; In patients with chronic kidney disease, will the use of hemodialysis as compared to peritoneal dialysis reduce incidences of mortalities cause by end stage renal disease within a period of 9 months? Therefore, the proposed intervention for this research would be a retrospective study that will be conducted in our unit. Patients suffering from end-stage renal failure will be assigned to either hemodialysis treatment or peritoneal dialysis treatment. The participants will then be followed for a period of nine months to determine the clinical outcomes. The outcome of focus would be the mortality rate reported in the two groups of patients.

The above-proposed solution aligns with previous studies conducted on the topic. Wang et al. (2018) conducted a study to compare the survival rate between patients with end-stage renal disease on hemodialysis and peritoneal dialysis in the era of icodextrin treatment. The outcomes showed that icodextrin has the ability of attenuating the survival advantage among patients on peritoneal dialysis unlike in hemodialysis. Another study by Zhou et al., (2019) compared early mortality rates among patients on hemodialysis and peritoneal dialysis who were transitioned with an optimal start at the outpatient clinic. The outcomes showed that there were no differences in early mortality rate among patients on hemodialysis and peritoneal dialysis.

Gonçalves et al. (2015) also conducted a study that aimed at comparing the quality of life of patients with chronic kidney disease on either peritoneal dialysis or hemodialysis. The results showed that peritoneal dialysis was associated with better quality of life when compared to hemodialysis. Therefore, these studies show that the proposed intervention in this research can provide a better understanding of the topic.

The intervention is realistic for our setting. It has a large number of patients seeking hemodialysis and peritoneal dialysis care. Therefore, it is expected that an adequate number of participants will be obtained for the research. The adequacy will also imply that the conclusions that will be reached will support evidence-based practice in the management of end-stage renal disease.

Organizational Culture

The proposed solution is consistent with the culture and resources of our organization. Vanderbloemen (2018) has defined culture as the manner in which organizational tasks and decisions are undertaken. Our organization recognizes the fact that evidence-based practice is an important aspect that enhances the quality of care. As a result, it has invested its resources in initiatives that will promote evidence-based practice. This includes supporting studies that explore the use of different treatment approaches to case management in our institution. The healthcare providers are also trained on evidence-based practice. They constantly appraise evidence on the use of various clinical interventions to improve the health outcomes of their patients. Therefore, it is believed that the supportive culture in the organization will enhance the adoption of the proposed intervention.

Expected Outcomes

It is expected that this proposed intervention will provide insight into the effectiveness of hemodialysis and peritoneal dialysis in reducing the mortality rate among patients suffering from end-stage renal failure. The intervention will enable clinicians to determine the most effective treatment approach for these patients, with the aim of optimizing their health outcomes. Through this research, it is expected that the outcomes will agree or contradict with those reported in other studies. Therefore, it will inform the clinical practice in relation to the management of end-stage renal failure.

Method to Achieve the Outcomes

The participants in this study will be followed throughout the study period. Their response to the treatment will be examined using the symptoms and adverse reactions they report to the healthcare team. By the end of the study period, statistics on the survival rate among the patients on hemodialysis and peritoneal dialysis will be computed to provide insights into their efficacy and safety. Some of the barriers that might be experienced include low adherence to the prescribed treatment among the patients and their lack of willingness to utilize a treatment approach from the two methods. These barriers will be eliminated through active follow-up of the patients and informing them on the two treatment approaches for them to make informed decisions. One of the assumptions made in this intervention is that any mortality that will be reported during the study period will be due to complications of hemodialysis or peritoneal dialysis alone.

Outcome Impact

The results from this intervention will inform clinical practice. They will inform the decision on whether patients suffering from end-stage renal disease should be placed on hemodialysis or peritoneal dialysis. The results will also form a basis of other studies into the topic as clinicians try to examine additional ways of optimizing the care given to patients suffering from end-stage renal disease. The intervention will also promote the provision of safe and quality care to these patients since the most effective treatment approach will be utilized in managing their conditions.

Section D: Change Model

Selected Model and its Applicability to My Project

The selected model for my evidence-based proposal is Trans-theoretical Model of behavioral change. Prochaska and DiClemente developed it in the 1970s. The model provides information on the manner in which individuals make decisions to change their behaviors. It assumes that behavioral change does not occur in a faster rate but continuously through incremental improvement of behaviors (Glanz, Rimer & Viswanath, 2015). This model is relevant to my project because it recognizes the fact that change occurs in a sequential process and not a drastic event. The introduction of my project requires sequential interventions in the organization. The staffs have to be made aware about the need for the change, behaviors that they should adopt, and ways of sustaining the desired success. Therefore, the increased focus of the model of stimulating behavior change among the adopters make it an important framework for my project as it mainly relies on the change in behavior among nurses working in the renal unit.

Steps of Change in the Model

According to the theory, behavioral change occurs in a series of steps. They include precontemplation, contemplation, preparation, action, maintenance, and termination. Precontemplation is the first stage in the Trans-theoretical Model of behavioral change. In this stage, those to be affected by the change agent do not have any intentions to embrace actions in their near future. They do not perceive their behaviors as being problematic or having undesired consequences to them or others. Therefore, they underestimate any need for behavioral change in their organizations (Sharma, 2017). Contemplation is the second phase of the Trans-theoretical Model of behavioral change. The stage is characterized by people showing intentions to embrace healthy behaviors in their near future. They have recognized that their behaviors are problematic and have undesired outcomes to them and others (Glanz et al., 2015). Despite this awareness, they are still ambivalent on the need to change their behaviors.

Preparation is the third stage in the Trans-theoretical Model of behavioral change. The people are ready to embrace change within a period of one month in this stage. They begin exploring small incremental steps that will enable them to achieve their desired behavioral change. The main reason for embracing change interventions is that they perceive the change to have healthier outcomes in their lives. The fourth phase is action stage. This stage is characterized by people who have recently adopted change behaviors planning to sustain the behavior change. They modify their behaviors as a way of promoting continuous change and improvement in their healthy behaviors (Sharma, 2017). The fifth stage is maintenance stage. The adopters in this stage have sustained the desired behaviors for a period and are willing to continue with the behavioral change going further. They focus on adopting interventions that would prevent or reduce incidences of relapse of the earlier behaviors. The last stage in the model is termination. The people in this stage are characterized by lacking any desire to return to their previously held unhealthy behaviors. They strongly believe that they will not experience relapse of their unhealthy behaviors (Glanz et al., 2015). Therefore, these people are ready to explore other ways in which extra benefits of the behavioral change can be achieved.

Application of Each Stage on Project Implementation

Each of the above stages of the Trans-theoretical Model is applicable to my change project. In precontemplation stage, the nurses do not plan to take any action related to the evaluation of the survival rate between patients on hemodialysis and peritoneal dialysis. They do not understand that these treatment methods might have undesired effect on the survival rate of patients suffering from end-stage renal disease. The nurses in contemplation stage begin to understand the need for examining the survival rate among end-stage renal disease patients on peritoneal dialysis and hemodialysis. They see the need to engage in research on this area in their near future. However, they are still skeptical on embracing the change (Hayden, 2019). The nurses in the preparation stage are ready to engage in research exploring the above treatment methods. They start small actions such as critical appraisal of studies on the issue. They then move to the next step of the model, action stage where they intend to keep exploring the issue by undertaking research on the topic. The nurses in the maintenance stage are willing to focus on future clinical researches on the topic to increase its relevance in the clinical practice. They implement their research findings in the clinical practice and explore their efficacy on a regular basis. Termination is characterized by the nurses implementing the study findings in clinical practice and sustaining the culture of evidence-based practice in providing care to patients suffering from renal conditions.

Section E: Implementation Plan

Setting and Access to Potential Subjects

The PICOT question that will guide the intervention is;in patients with chronic kidney disease, will the use of hemodialysis as compared to peritoneal dialysis reduce incidences of mortalities cause by end stage renal disease within a period of 9 months? The proposed intervention will be undertaken in the renal unit in our hospital. The unit is the largest in the region and serves approximately 300 patients on a weekly basis. The potential subjects for this intervention will be patients with chronic kidney disease who are to be initiated on either hemodialysis or peritoneal dialysis. These patients are considered part of the vulnerable population due to their health status. Therefore, it would be important to implement the intervention with a consideration of the research ethics. One of the most critical ethics that would be considered is seeking informed consent from the study participants. Informed consent is important in any clinical research since it creates awareness among the research participants on the potential benefits as well as risks of the interventions (Blease, Kelley & Trachsel, 2018). The potential subjects will be informed that their participation in the study is voluntary and have the right to decline to take part in it.

Timeline for Project

The projected time for this intervention will be at least nine months. The patients will be initiated on either hemodialysis or peritoneal dialysis and followed up for nine months. The measures of the study will include survival rates, complications, and the general wellbeing of the patients on each of these treatments. The project is expected to commence on January 2020 up to September 2020. The analysis of data will begin in October, completion of report writing in November, and communication of the findings by December.

Resources

The implementation of the intervention will demand a wide range of resources. As shown bySargeant et al., (2015), the healthcare providers are the most critical resources in the implementation of evidence-based practice. They need to embrace the desired behaviors, knowledge, and skills for successful implementation of the change agent. The other resource is financial support from the hospital. Healthcare providers should be trained on the intervention for its successful implementation. The management should also support the implementation process. They should act as role models of the intervention. The intervention will result in the approach to providing care to patients with chronic kidney disease. A focus will be placed on active follow-up and selection of the patients to be initiated in each of the treatment. The healthcare providers will also champion for the provision of safe, effective and appropriate care to patients in each category since it will affect the outcomes of the research.

Methods and Instruments

Methods for research should be chosen carefully to obtain data that answers the research aims. The methods should cover a wide range of issues related to topic, as it is important in providing different perspectives of the issue under investigation (Drake, Rancilio & Stafford, 2017). The proposed intervention will employ the use of questionnaires to obtain the needed data. The questionnaires will have both open and closed ended questions. The use of the combined question formats will allow for the acquisition of a broader range of data, hence, better understanding of the topic.

Process of Delivering the Intervention

The study participants will be selected based on their assessment findings. They will be assigned to either hemodialysis or peritoneal dialysis. Baseline data will be obtained at the beginning of each session, stored, and compared throughout the period of data collection. The selection of the subjects will be done randomly. The random selection will ensure the generalizability of the findings. Training will be provided to the healthcare providers on the delivery of the interventions and acquisition of the relevant data.

Data Collection Plan

Data will be collected using structured questionnaires. The questionnaires will be administered to the patients during and after their dialysis sessions. The healthcare providers will collect baseline data at each encounter with the patients. Patients will also be visited once a month in their homes to assess their functional abilities, complications, and adaptation to the treatment. The collected data will be kept in a secured locker in the hospital. The cabinet will only be accessed by the researcher. Descriptive statistics will be used to analyze the demographic data of the subjects. The analysis of the data will also be done using SPSS version 20. The analyzed data will be presented using tables, charts, and graphs. The statistics will provide insights into the comparative response of the patients in the two groups to the treatment.

Strategies to Barriers, Facilitators and Challenges

One of the barriers that might be experienced is the unwillingness of the subjects to participate in the research. The issue will be addressed by providing adequate information to the subjects on the aims of the research (Harvey & Kitson, 2015). The other barrier is the resistance from the staffs. The challenge will be addressed through training them on the intervention and involving them in the activities of the research (Sargeant et al., 2015). An example of a facilitator is support from the organization. This could be through providing financial incentives and training to the staffs on the intervention. The other facilitator is the awareness of the staff on the benefits of the study (Brehaut et al., 2019). The staffs will be ready to embrace the intervention if they are aware of its intended benefit to the promotion of evidence-based practice.

Feasibility of the Implementation

Successful implementation of the intervention will require a wide range of resources. One of them is personnel training. The healthcare providers should be trained on the provision of the two treatment methods to the selected study subjects. There is also the need for additional finances for following up the patients when they are not on dialysis sessions. The other resource that is needed is five computers that would be used for capturing and storing the data from the selected patients. Data analysts will be outsourced. Therefore, there is a need to set aside the financial resources for them. The hospital should also add two more dialysis machines in the unit to balance the needs of those taking part in the research and those not part of the process. The last resource is printing materials. The research will also need much of paperwork, hence, a need to purchase adequate materials for this use.

Plans to Maintain, Extend, Revise, and Discontinue the Solution

The intervention will be extended beyond the proposed time if the research participants are inadequate or withdraw from the research. It will be revised if the estimate metrics are not met within the given time. It will be discontinued if it predisposes the participants to any adverse outcomes. It will also be discontinued if more than 50% of the participants withdraw from the research.

Section F: Evaluation of Process

Methods Used in Collecting the Outcome Data

Quantitative data will be collected in this proposed intervention. The data will be numerical and can be computed mathematically. Self-administered questionnaires will be used to obtain the quantitative data for this research. The questionnaires will contain questions as well as prompts that a related to the intervention. The selection of this method of obtaining outcome data is the most effective because diverse questions on the research question can be asked. Unlike methods such as interviews, the use of questionnaires is cheap and easy to conduct. The self-administered nature of the questionnaires will make it faster and easy to obtain the data for the research. The questionnaires also provide quantifiable data that can be analyzed easily by the researcher. Therefore, it makes them the best method in which the data for the outcome measure can be obtained in this intervention.

Outcome Measures

The outcome measures for the proposed intervention will be varied. They will include the improvement in the clinical condition or indication for the management, reduction in adverse reactions to the treatment, survival rate, and patient’s ability to undertake in the activities of the daily living, and their sense of wellbeing with the treatment modality. The patient’s wellbeing will be measured based on aspects such as pain, anxiety, depression, and functional impairment with the treatment (Surendra et al., 2019). The outcomes measures will aid in the determination of the extent to which the objectives of the interventions are being achieved. The overall outcome of the intervention will be the survival rate among patients with chronic kidney disease on either peritoneal dialysis or hemodialysis. Therefore, indicators such as improvement in the clinical state of the patient, reduction in adverse events with the treatment, enhanced patient’s ability to engage in the activities of the daily living, and patient’s sense of wellbeing will translate into the objectives of the intervention being achieved.

Measuring of Outcomes

The outcomes of the proposed intervention will be measured in various methods. The overall quality of life of patients on either peritoneal dialysis or hemodialysis will be determined using Persian correlation. This measuring will aid in the evaluation of the determinants of quality of life such as physical functioning, engagement in the activities of the daily living, and mental wellbeing (Atapour et al., 2016). Symptoms of the treatment will be measured with the use of POS-S renal scale while IIRS tool will be used to measure the impact of the treatment on the life of the patient. Anxiety and depression among the patients will be measured with the use of HADS tool (Iyasere et al., 2018). Lastly, Pearson correlation will be done to determine whether a relationship exists between the treatment and the experiences of the patients with chronic kidney disease. Validity of the intervention will be promoted using randomization in the selection of the participants and pre-testing the measurement techniques as a way of improving its accuracy. The reliability of the intervention will be promoted by ensuring that human raters are used, ensuring familiarity of the participants with the intervention, and exposing them to similar environments. Scientific methods of research that promote rigor will be used to enhance applicability of the evidence.

Strategies in case of Negative Results

The intervention outcomes will be reported irrespective of the results. Negative results will imply that the interventions do not promote the well-being of the patients using them. Therefore, it will increase the need for re-evaluation of the methods that were used and their accuracy. It will also increase the need for additional researches to be conducted elsewhere to determine whether there will be duplication of the findings. Consequently, negative outcomes will form the basis of future studies into the topic.

Implications to Practice and Future Research

The proposed intervention will have significant implications to practice as well as research. It will inform the utilization of either peritoneal dialysis or hemodialysis in treating chronic kidney disease. It will also act as a source of evidence-based practice on the efficacy of these interventions in patients with chronic kidney disease. The intervention will also raise the interest of the healthcare providers to explore additional aspects influencing the health of patients with kidney disease. The intervention will act as the basis for future research. It will pinpoint areas of research that should be explored for the provision of optimum care to patients with kidney disease.

References

Atapour, A., Nasr, S., Boroujeni, A. M., Taheri, D., & Dolatkhah, S. (2016). A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis. Saudi Journal of Kidney Diseases and Transplantation, 27(2), 270.

Blease, C., Kelley, J. M., & Trachsel, M. (2018). Informed consent in psychotherapy: Implications of evidence-based practice. Journal of Contemporary Psychotherapy, 48(2), 69-78.

Brehaut, J. C., Colquhoun, H. L., Eva, K. W., Carroll, K., Sales, A., Michie, S., … & Grimshaw, J. M. (2016). Practice feedback interventions: 15 suggestions for optimizing effectiveness. Annals of internal medicine, 164(6), 435-441.

Bujang, M. A., Adnan, T. H., Hashim, N. H., Mohan, K., Kim Liong, A., Ahmad, G., … &Haniff, J. (2017). Forecasting the incidence and prevalence of patients with end-stage renal disease in Malaysia up to the year 2040. International journal of nephrology, 2017.

CDC. (2019). Chronic Kidney Diseases in the United States, 2019. Retrieved on 24th Sept. 2019 from https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html

Drake, B. F., Rancilio, D. M., & Stafford, J. D. (2017). Research methods. In Public Health Research Methods for Partnerships and Practice (pp. 174-187). Routledge.

Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health behavior: Theory, research, and practice. San Francisco, CA : Jossey-Bass.

Gonçalves, F. A., Dalosso, I. F., Borba, J. M. C., Bucaneve, J., Valerio, N. M. P., Okamoto, C. T., & Bucharles, S. G. E. (2015). Quality of life in chronic renal patients on hemodialysis or peritoneal dialysis: A comparative study in a referral service of Curitiba-PR. Brazilian Journal of Nephrology, 37(4), 467-474.

Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.

Hayden, J. (2019). Introduction to health behavior theory. Burlington, MA: Jones & Bartlett Learning.

Iyasere, O., Brown, E. A., Johansson, L., Davenport, A., Farrington, K., Maxwell, A. P., … & Woodrow, G. (2018). Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clinical Kidney Journal, 12(2), 262-268.

Kueny, A., Shever, L. L., Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29.

Luyckx, V. A., Tonelli, M., &Stanifer, J. W. (2018). The global burden of kidney disease and the sustainable development goals. Bulletin of the World Health Organization, 96(6), 414.

Melnyk, B. M., &Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Rufino, J. M., Rufino, J. M., García, C., García, C., Vega, N., Vega, N., … & Rodríguez, A. (2011). Current peritoneal dialysis compared with haemodialysis: medium-term survival analysis of incident dialysis patients in the Canary Islands in recent years. Nefrología (English Edition), 31(2), 174-184.

Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., … & Power, M. (2015). Facilitated reflective performance feedback: developing an evidence-and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Academic Medicine, 90(12), 1698-1706.

Sharma, M. (2017). Theoretical foundations of health education and health promotion. Burlington, MA : Jones & Bartlett Learning.

Surendra, N. K., Manaf, M. R. A., Hooi, L. S., Bavanandan, S., Nor, F. S. M., Khan, S. S. F., … & Gafor, A. H. A. (2019). Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC nephrology, 20(1), 151.

University of California San Francisco. (n.d.). The Kidney Project. Retrieved on 24th Sept. 2019 from https://pharm.ucsf.edu/kidney/need/statistics

Vanderbloemen, W. (2018). Culture wins: The roadmap to an irresistible workplace. Los Gatos : Smashwords.

Wang, I. K., Lin, C. L., Yen, T. H., Lin, S. Y., & Sung, F. C. (2018). Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment. European journal of internal medicine, 50, 69-74.

Wong, B., Ravani, P., Oliver, M. J., Holroyd-Leduc, J., Venturato, L., Garg, A. X., & Quinn, R. R. (2018). Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities. American Journal of Kidney Diseases, 71(3), 344-351.

Xue, J., Li, H., Zhou, Q., Wen, S., Zhou, Q., & Chen, W. (2019). Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies. Renal Failure, 41(1), 521-531

Yang, F., Khin, L. W., Lau, T., Chua, H. R., Vathsala, A., Lee, E., & Luo, N. (2015). Hemodialysis versus peritoneal dialysis: a comparison of survival outcomes in South-East Asian patients with end-stage renal disease. PloS one, 10(10), e0140195.

Zhou, H., Sim, J. J., Bhandari, S. K., Shaw, S. F., Shi, J., Rasgon, S. A., … & Jacobsen, S. J. (2019). Early Mortality among Peritoneal Dialysis and Hemodialysis Patients Who Transitioned With an Optimal Outpatient Start. Kidney international reports, 4(2), 275-284.

Appendices

Appendix A: Conceptual Model of the Project

Appendix B: Data Evaluation and Collection Tools

Questionnaire

Please answer the questions to the best of your ability

What is your gender?

How old are you?

Which type of dialysis treatment are you currently using?

How many sessions of dialysis do you attend weekly?

How long does each dialysis session end?

Do you believe that the treatment has adversely affected your health? Tell us some of the ways

What health problems have you experienced with the treatment?

Appendix C: Project Budget

Item	Cost
Training	$5000
Patient followup	$2000
Five computers	$2000
Data analysts	$1500
Two dialysis machines	$5000
Printing materials	$800
Total	$16, 300

Appendix D: Project Timeline

	January	February-August	September	October	November	December
Recruiting subjects
Follow-up with data collection
Completion of follow-up and data collection
Data analysis
Completion of report writing
Communication of findings

Appendix E (a): Approval Forms (Informed Consent)

Hello, my name is Y. I am conducting a research in collaboration with our hospital to investigate the survival outcomes of patients with chronic kidney disease on hemodialysis or peritoneal dialysis. The focus of the research is to determine the mortalities and complications associated with these treatment methods after a period of nine months. Your participation in the study is voluntary. You will be allocated randomly to any of the two treatment methods and followed up closely for nine months. Your participation is highly important since it will provide evidence on the effectiveness of these treatment methods. Be informed that your participation will not cause you any health harm. The data will be kept private and confidential. Your identity will be kept anonymous.

Appendix E (b): Participant Consent

I have read and understood that my participation in the research is voluntary. I have also understood that my participation in the study will not subject me to any health risk. Therefore, I consent to participate in the research.

Name

Sign

Appendix F: List of Resources

Atapour, A., Nasr, S., Boroujeni, A. M., Taheri, D., & Dolatkhah, S. (2016). A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis. Saudi Journal of Kidney Diseases and Transplantation, 27(2), 270.
Blease, C., Kelley, J. M., & Trachsel, M. (2018). Informed consent in psychotherapy: Implications of evidence-based practice. Journal of Contemporary Psychotherapy, 48(2), 69-78.
Brehaut, J. C., Colquhoun, H. L., Eva, K. W., Carroll, K., Sales, A., Michie, S., … & Grimshaw, J. M. (2016). Practice feedback interventions: 15 suggestions for optimizing effectiveness. Annals of internal medicine, 164(6), 435-441.
Bujang, M. A., Adnan, T. H., Hashim, N. H., Mohan, K., Kim Liong, A., Ahmad, G., … &Haniff, J. (2017). Forecasting the incidence and prevalence of patients with end-stage renal disease in Malaysia up to the year 2040. International journal of nephrology, 2017.
CDC. (2019). Chronic Kidney Diseases in the United States, 2019. Retrieved on 24th Sept. 2019 from https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html
Drake, B. F., Rancilio, D. M., & Stafford, J. D. (2017). Research methods. In Public Health Research Methods for Partnerships and Practice (pp. 174-187). Routledge.
Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health behavior: Theory, research, and practice. San Francisco, CA : Jossey-Bass.
Gonçalves, F. A., Dalosso, I. F., Borba, J. M. C., Bucaneve, J., Valerio, N. M. P., Okamoto, C. T., & Bucharles, S. G. E. (2015). Quality of life in chronic renal patients on hemodialysis or peritoneal dialysis: A comparative study in a referral service of Curitiba-PR. Brazilian Journal of Nephrology, 37(4), 467-474.
Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.

Hayden, J. (2019). Introduction to health behavior theory. Burlington, MA: Jones & Bartlett Learning.
Iyasere, O., Brown, E. A., Johansson, L., Davenport, A., Farrington, K., Maxwell, A. P., & Woodrow, G. (2018). Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clinical Kidney Journal, 12(2), 262-268.
Kueny, A., Shever, L. L., Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29.
Luyckx, V. A., Tonelli, M., &Stanifer, J. W. (2018). The global burden of kidney disease and the sustainable development goals. Bulletin of the World Health Organization, 96(6), 414.
Melnyk, B. M., &Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Rufino, J. M., Rufino, J. M., García, C., García, C., Vega, N., Vega, N., … & Rodríguez, A. (2011). Current peritoneal dialysis compared with haemodialysis: medium-term survival analysis of incident dialysis patients in the Canary Islands in recent years. Nefrología (English Edition), 31(2), 174-184.
Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., … & Power, M. (2015). Facilitated reflective performance feedback: developing an evidence-and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Academic Medicine, 90(12), 1698-1706.
Sharma, M. (2017). Theoretical foundations of health education and health promotion. Burlington, MA : Jones & Bartlett Learning.
Surendra, N. K., Manaf, M. R. A., Hooi, L. S., Bavanandan, S., Nor, F. S. M., Khan, S. S. F., … & Gafor, A. H. A. (2019). Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC nephrology, 20(1), 151.
University of California San Francisco. (n.d.). The Kidney Project. Retrieved on 24th Sept. 2019 from https://pharm.ucsf.edu/kidney/need/statistics
Vanderbloemen, W. (2018). Culture wins: The roadmap to an irresistible workplace. Los Gatos : Smashwords.
Wang, I. K., Lin, C. L., Yen, T. H., Lin, S. Y., & Sung, F. C. (2018). Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment. European journal of internal medicine, 50, 69-74.
Wong, B., Ravani, P., Oliver, M. J., Holroyd-Leduc, J., Venturato, L., Garg, A. X., & Quinn, R. R. (2018). Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities. American Journal of Kidney Diseases, 71(3), 344-351.
Xue, J., Li, H., Zhou, Q., Wen, S., Zhou, Q., & Chen, W. (2019). Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies. Renal Failure, 41(1), 521-531
Yang, F., Khin, L. W., Lau, T., Chua, H. R., Vathsala, A., Lee, E., & Luo, N. (2015). Hemodialysis versus peritoneal dialysis: a comparison of survival outcomes in South-East Asian patients with end-stage renal disease. PloS one, 10(10), e0140195.
Zhou, H., Sim, J. J., Bhandari, S. K., Shaw, S. F., Shi, J., Rasgon, S. A., … & Jacobsen, S. J. (2019). Early Mortality among Peritoneal Dialysis and Hemodialysis Patients Who Transitioned With an Optimal Outpatient Start. Kidney international reports, 4(2), 275-284.