Nurse Patient Ratios

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 the 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). 

APNs must determine the strength of the recommendations and guidelines to regulate whether policy changes are warranted. Through this process the APN may begin with a clinical question in mind before searching 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). PICO stands for Patient or Population; Intervention; Comparison and Outcome.

Step 1: Introduction

A good introduction should be no more than 1 paragraph grabbing the readers attention providing insight to the POI 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.

Step 2: POI Significance:

Discuss why this POI is significant to your role as an APN. How will it change practice? Why did you select this topic? What expected structural, process OR outcome measures are you hoping to see with instituting a change in practice? To see a more thorough discussion on these measures, review the following information.

AHRQ Structural, Process or Outcome Measures- (Links to an external site.)this link provides an overview of process, structural and outcome measures. Be sure to specify the type of measure you would expect with your implementation of EBP into practice. You must show understanding of the measure itself in your discussion.

Step 3 PICO :

You will include a PICO framework AND the clinical question in this section. Follow these directions as specified.

Outline the PICO framework by listing (do not write in a paragraph format)  P-population or patients, I-intervention, C-comparison, and O-outcomes as it relates to your POI. Then develop the clinical question by including  all parts of the PICO framework in the question. Be as specific as possible in both the PICO framework development and clinical question and avoid phrases such as:  “compared to the standard practice” , or “compared to the current practice” because faculty do not know what the normal practice or standard practice is at your facility.

EXAMPLE: Be sure to include a heading for this section i.e. PICO/Clinical Question.

PICO -center this heading p. 48-49 APA book

P: children in the acute care setting that are between 3 and 18 years of age, not including non-verbal children

I: implementation of non-pharmacologic pain interventions i.e. (art therapy, music, dim lights, etc.).

C: pharmacologic interventions (Tylenol, motrin, narcotics)

O: more effective at reducing pain as measured by decreased pain ratings on approved pain scales, stable vital signs, behavior

Clinical Question: In pediatric patients aged 3 years to 18 years (P) is the implementation of non-pharmacologic pain interventions (I) more effective (O) than pharmacologic interventions (C ) in reducing pain as evidence by: decreased pain ratings, stable vital signs, behavior assessments?

Step 4 Tool Completion:

To provide an overview of the guideline OR position statement use the tool below. You will need to address each question or section of the tool as it applies to the required information;  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.

Evaluation tool for Guideline OR Position statement PDF download

Evaluation Tool for Guideline OR Position Statement Word Document download

Step 5 Critique of Guideline/Position Statement:

Critique the guideline or position statement by discussing ALL of the following and including appropriate support from your guideline/statement selection:

(1) purpose/aim of the recommendation/postition statement-are they clear, current and relevant to your population?

(2) Recommendations or objectives of the guideline/statement

(3) Who (authors, groups, organizations) developed the guideline/position statement and what biases or funding did they receive? Did the authors, groups or organization have a valued interest in the guideline, why or why not? Remember to consider the author’s role professionally as part of your answer.

(4) Describe if they information is credible and justify your answer. What makes information credible? Is their truth in the data, interventions recommended, or studies used to support recommendations, how do you know?

(5)  What levels of evidence were used to support each recommendation statement-look at the studies and resources used to develop the guideline or position statement. What levels of evidence were these resoruces/studies? Are those individual studies/resources of strong or weak on the evidence hierarchy? How do you know and does it influence the overall recommentation or guideline?

(6) Based on the level of evidence used to support the recommendation statements, is the overall quality of that evidence high/low and how does that influence your decision to implement this recommendation or practice guideline into your practice? Fully support with evidence from the literature.

Step 6 Quality Improvement:

Explain how this guideline or position statement would impact uality improvement by addressing 2 of the bioethical principles: justice, autonomy, beneficience, or nonmalficence. Students must demonstrate full understanding of each principle discussed.

Step 7 Conclusion:

Conclude the entire paper by summarizing each section. Do not repeat what you did in the paper, but summarize the findings. Never include new findings in the conclusion.

Step 8 Guideline/Position Statement Link or Attachment:

Include a direct and working link to the guideline or Position Statement. after the conclusion.  Option: If you are having difficulty providing a direct link, you may provide a hard copy of the full guideline or position statement as an attachment or merged to the paper after the resources. Faculty must be able to have full and direct access to your guideline or position statement to determine if you selected and analyzed accordingly on your tool to receive full credit. See format example below:

Guideline/Position Statement Link center this heading p. 48-49 in the APA book

OR use the following info.:

Guideline/Position Statement Link center this heading p. 48-49 in the APA book

See guideline/position statement submitted with paper or merged to the paper

Step 9 Turnitin:

You are required to submit this paper to Turnitin. 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.

See Rubric for specific guidelines on scholarship deductions.

Page limit: 6 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.

References: you should include at least 2 additional peer reviewed references other than the guideline or position statement selected. The 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).

Upload as a Microsoft Word or Adobe PDF to the assignment area. Be sure you have also submitted the completed appraisal tool and a copy of the guideline or position statement if you did not provide a link.