DNP PROJECT FOR YOUR ORGANIZATION Individual Evidence Summary Table Synthesis Process and Recommendations Tool DNP.EvidenceSynthesisandRecommendationForm.pdfIndividualevidenceresources

DNP PROJECT FOR YOUR ORGANIZATION

Individual Evidence Summary Table
Synthesis Process and Recommendations Tool

DNP.EvidenceSynthesisandRecommendationForm.pdf

Individualevidenceresources.docx

DNP.IndividualEvidenceTool.docx

Synthesis Process and Recommendations Tool

Key Points:

• Evidence synthesis is best done through group discussion. All team members share

their perspectives, and the team uses critical thinking to arrive at a judgment based

on consensus during the synthesis process. The synthesis process involves both

subjective and objective reasoning by the full EBP team. Through reasoning, the

team:

▪ Reviews the quality appraisal of the individual pieces of evidence

▪ Assesses and assimilates consistencies in findings

▪ Evaluates the meaning and relevance of the findings

▪ Merges findings that may either enhance the team’s knowledge or

generate new insights, perspectives, and understandings

▪ Highlights inconsistencies in findings

▪ Makes recommendations based on the synthesis process

• When evidence includes multiple studies of Level I and Level II evidence, there is

a similar population or setting of interest, and there is consistency across findings,

EBP teams can have greater confidence in recommending a practice change.

However, with a majority of Level II and Level III evidence, the team should

proceed cautiously in making practice changes. In this instance,

recommendation(s) typically include completing a pilot before deciding to

implement a full-scale change.

• Generally, practice changes are not made on Level IV or Level V evidence alone.

Nonetheless, teams have a variety of options for actions that include, but are not

limited to: creating awareness campaigns, conducting informational and educational

updates, monitoring evidence sources for new information, and designing research

studies.

• The quality rating (see Appendix D) is used to appraise both individual quality of

evidence and overall quality of evidence.

Date:

EBP Question:

Article

Number

Author and Date

Evidence Type

Sample, Sample

Size, Setting

Findings That

Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level,

Quality

Johns Hopkins Nursing Evidence-Based Practice

Appendix H Synthesis Process and Recommendations Tool

EBP Question:

Category (Level Type) Total Number of Sources/Level

Overall Quality Rating

Synthesis of Findings Evidence That Answers the EBP Question

Level I

▪ Experimental study ▪ Randomized controlled trial (RCT)

▪ Systematic review of RCTs with or without meta-analysis

▪ Explanatory mixed method design that includes only a Level I quaNtitative study

Level II

▪ Quasi-experimental studies

▪ Systematic review of a combination of RCTs and quasi-experimental studies, or quasi- experimental studies only, with or without meta-analysis

▪ Explanatory mixed method design that includes only a Level II quaNtitative study

Level III

▪ Nonexperimental study ▪ Systematic review of a combination of RCTs,

quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta- analysis

▪ QuaLitative study or meta- synthesis

▪ Exploratory, convergent, or multiphasic mixed-methods studies

▪ Explanatory mixed method design that includes only a level III QuaNtitative study

Johns Hopkins Nursing Evidence-Based Practice

Appendix H Synthesis Process and Recommendations Tool

Category (Level Type) Total Number of Sources/Level

Overall Quality Rating

Synthesis of Findings

Evidence That Answers the EBP Question

Level IV

▪ Opinions of respected authorities and/or reports of nationally recognized expert committees or consensus panels based on scientific evidence

Level V

▪ Evidence obtained from literature or integrative reviews, quality improvement, program evaluation, financial evaluation, or case reports

▪ Opinion of nationally recognized expert(s) based on experiential evidence

Johns Hopkins Nursing Evidence-Based Practice

Appendix H Synthesis Process and Recommendations Tool

Based on your synthesis, which of the following four pathways to translation represents the overall strength of the evidence?

❑Strong, compelling evidence, consistent results: Solid indication for a practice change is indicated.

❑Good and consistent evidence: Consider pilot of change or further investigation.

❑Good but conflicting evidence: No indication for practice change; consider further investigation for new evidence or develop a research study.

❑Little or no evidence: No indication for practice change; consider further investigation for new evidence, develop a research study, or discontinue project.

If you selected either the first option or the second option, continue. If not, STOP , translation is not indicated.

Recommendations based on evidence synthesis and selected translation pathway

Consider the following as you examine fit:

Are the recommendations:

▪ Compatible with the unit/departmental/organizational cultural values or norms?

▪ Consistent with unit/departmental/organizational assumptions, structures, attitudes, beliefs, and/or

practices?

▪ Consistent with the unit/departmental/organizational priorities?

Consider the following as you examine feasibility:

▪ Can we do what they did in our work environment?

▪ Are the following supports available?

• Resources

• Funding

• Approval from administration and clinical leaders

• Stakeholder support

• Is it likely that the recommendations can be implemented within the unit/department/organization?

Johns Hopkins Nursing Evidence-Based Practice

Appendix H Synthesis Process and Recommendations Tool

Directions for Use of This Form

Purpose of form

Use this form to compile the results of the individual evidence appraisal to answer the EBP question. The

pertinent findings for each level of evidence are synthesized, and a quality rating is assigned to each level.

Total number of sources per level

Record the number of sources of evidence for each level.

Overall quality rating

Summarize the overall quality of evidence for each level. Use Appendix D to rate the quality of evidence.

Synthesis of findings: evidence that answers the EBP question

• Include only findings from evidence of A or B quality.

• Include only statements that directly answer the EBP question.

• Summarize findings within each level of evidence.

• Record article number(s) from individual evidence summary in parentheses next to each statement

so that the source of the finding is easy to identify.

Develop recommendations based on evidence synthesis and the selected translation pathway

Review the synthesis of findings and determine which of the following four pathways to translation

represents the overall strength of the evidence:

• Strong, compelling evidence, consistent results: Solid indication for a practice change.

• Good and consistent evidence: Consider pilot of change or further investigation.

• Good but conflicting evidence: No indication for practice change; consider further investigation for

new evidence or develop a research study.

• Little or no evidence: No indication for practice change; consider further investigation for new

evidence, develop a research study, or discontinue the project.

Fit and feasibility

Even when evidence is strong and of high quality, it may not be appropriate to implement a change in

practice. It is crucial to examine feasibility that considers the resources available, the readiness for

change, and the balance between risk and benefit. Fit refers to the compatibility of the proposed change

with the organization’s mission, goals, objectives, and priorities. A change that does not fit within the

organizational priorities will be less likely to receive leadership and financial support, making success

difficult. Implementing processes with a low likelihood of success wastes valuable time and resources on

efforts that produce negligible benefits.

Johns Hopkins Nursing Evidence-Based Practice

Appendix H Synthesis Process and Recommendations Tool

References

Individual evidence resources

The title for the planned DNP project is ‘Tangible Virtual Treatment’ and the setting will be at the private practice Virtual Consult MD in Norcross, Georgia, USA. The private practice offers telepsychiatry to individuals across the lifespan. Physical monitoring before recommending and prescribing medication for various mental health conditions is not required. This quality improvement practice gap is an issue in my organization. For instance, research indicates that less than 50% of patients on prescription drugs in mental care settings undergo critical monitoring when they seek care in England (Ayre, Lewis, and Keers, 2023). Physical monitoring of vital signs and other areas such as weight and blood level for illicit drugs is critical for mental health patients. Furthermore, it guides the characteristics of the health condition and the patient’s body’s ability to acclimate to the resulting stress on the well-being of their various physiological components (Sapra, Malik, and Bhandari, 2020).

The proposed type of project is a quality improvement initiative. This initiative is in line with the practice gap in my healthcare organization. A quality improvement initiative seeks to improve the identified practice gaps in an organization by implementing the related interventions. For instance, a quality improvement initiative for medication administration without consideration for patient monitoring will also educate staff within the organizational setting. Therefore, reiterating the basics tenants of patient care promotes -evidence-based practice in healthcare organizations while closing practice gaps.

References

Ayre, M. J., Lewis, P. J., & Keers, R. N. (2023). Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review. BMC Psychiatry, 23(1), 1-17. clinical services (No. WHO/CDS/HIV/19.17). World Health Organization.

Sapra, A., Malik, A., & Bhandari, P. (2020). Vital sign assessment.

· The practice gap, in this case, is the administration of medication without prior physical monitoring of vital signs, weights, and blood levels for illicit drugs. The lack of such assessments negatively impacts nurses’ responsiveness to critical solutions. Research carried out on 48,864 patients admitted in general wards between 2015 and 2018 reveals that early warning scores assessments such as vital signs were undermined in one-quarter of measurements (Elliott and Endacott, 2022). Clinical deterioration goes undetected when protocols like physical monitoring before medicine administration have low compliance rates in organization settings including mental health care organizations. This lack of compliance is persistent in health care provision, with the assessment of vital signs being often neglected in clinical practice despite them being a critical part of care provision. According to Eddahchouri, et al. (2021), the factors contributing to negligence in vital signs assessment include the nurse’s experience, the absence of formal guidelines, and the idea that vital signs assessment is neglectable in low-risk patients. The lack of physical patient monitoring is a problem in nursing and healthcare in general as it undermines the lives of patients resulting in avoidable deaths.

References

· Eddahchouri, Y., Koeneman, M., Plokker, M., Brouwer, E., van de Belt, T. H., van Goor, H., & Bredie, S. J. (2021). Low compliance to a vital sign safety protocol on general hospital wards: a retrospective cohort study. International Journal of Nursing Studies, 115, 103849.

· Elliott, M., & Endacott, R. (2022). The Clinical Neglect of vital signs’ assessment: an emerging patient safety issue?. Contemporary Nurse, 58(4), 249-252.

Date:

EBP Question: Will the physical monitoring of vital signs before recommending and prescribing psychiatric medications promote -evidence-based healthcare practice?

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

❑N/A

Attach a reference list w ith full citations of articles review ed for this EBP question.

Johns Hopkins Nursing Evidence-Based Practice

Appendix G

Individual Evidence Summary Tool

Date:

EBP Question:

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

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