see below

 

is is part 4 of your evidence-based practice project (EBP). 

In this assignment, you will refer back to assignment you completed in previous weeks, as this assignment will build upon it. You’ll be providing a solution to a clinical problem using the EBP process.

For this assignment, you will create a 13-16 slide PowerPoint, excluding the title and reference slides, covering the items below. This should be a high-level overview of what you’ve already discussed in your papers. Be sure to summarize your information (do not simply copy and paste).

· Describe the select EBP problem-

· List the created PICOT question-In a hospice facility how does lowering nurse to patient to 1to4 compare to having nurse to patient ratio 1-5 help improve pain management and comfort measures in a 6 month period 

· Provide a high-level overview of the articles you found, organizing them by design (i.e.; qualitative, quantitative, mixed methods)

· Summarize the search strategy you used to locate the articles.

· Discuss what changes could be made as a result of these findings

· Describe strategies and resources you would use to implement a change based on these findings

· Describe areas of opportunity for future research and EBP related to your topic

· Provide a conclusion and discussion of next steps

This should be a high-level overview of what you’ve already discussed in your papers. Be sure to summarize your information (do not simply copy and paste from previous papers). Your PowerPoint slides should be bullet points and/or images and not paragraphs of text. Descriptions and explanations will be written in the “speaker notes” section of the PowerPoint slides. In other words, use the “notes” section to write out what you would say if you were presenting the slides to a live audience.

You will be graded on presentation and layout. Be sure to not overcrowd your slides (follow the 7×7 Rule- No more than 7 bullet points per slide and no more than 7 words per bullet point). Finally, your background should be consistent throughout, and ensure your slides are readable. Do not use too many graphics either.

In addition, you must follow APA guidelines, providing a title slide, reference slide, and in-text citations.

Please review the rubric to ensure that your assignment meets criteria.

Supporting Materials:

· Gray, J. R., Grove, S. K. & Sutherland, S.  (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Elsevier Saunders. ISBN 978-0-323-37758-4

· Chapters 1,2, 3

· National Council of State Boards of Nursing, Inc. (2020).

NCSBN regulatory guidelines and evidence-based quality indicators for nursing education programs (Links to an external site.)

. https://www.ncsbn.org/NCSBN-Regulatory-Guidelines-and-Evidence-Based-Quality-Indicators

· Please view NCSBN document on Evidence-Based Nursing education. Consider the integration of clinical evidence and best practices in nursing education. Review topics of interest regarding best practices in areas of nursing education. 

Nursing Paper 1

Nursing Paper Unit 5 Assignment

Janet Johnson

Herzing University

8/14/2022

Stephanie Scovill PhD
109940000000041771
What is the practice problem? There is no problem statement or thesis statement.

Nursing Paper 2

The research design of the study

The research article by Dechawatanapaisal (2018) utilized a survey research design

method. This is a design method in which the primary source of data is a survey. The researcher

makes use of the survey to have a better understanding of the individuals or group of individuals

being studied relative to the topic or the concept of interest. In line with this article, the survey

method ensured that the participants engaged in self-reporting with the help of questionnaires so

that they better understand the impact of the highlighted factors. Kurnat-Thoma et al (2017) on

the other hand employed the evidence-based turnover analysis research design to undertake the

study. The main participants who were involved in the study included the nurses. The third

article by Stalpers et al (2015) employed the correlational research design method in which

relevant literature review studies were reviewed and relevant information collected.

Threats to external/internal validity

Internal validity refers to the extent or degree to which the relationship being tested is

trustworthy. The potential internal threats established from the articles include but are not limited

to; social interaction. The interaction that people have from different groups has a significant

impact on the outcome. For instance, the nurses who are working based on fixed hours are

resentful of the nurses who are working with flexible hours. This significantly impacts the job

satisfaction that employees go through. Another potential internal threat is regression towards the

mean. Employees, and nurses in this case who tend to score very low in the first survey many

times show a better and higher score in the next survey. This is in comparison with employees

who score averagely in the first score.

Stephanie Scovill PhD
109940000000041771
Remember to support your statements with in-text citations.

Nursing Paper 3

External threats to validity, on the other hand, refer to the degree to which study results

can be applied in real-life situations or even to a group of events. The common threat to external

validity is sampling bias. There can be situations in which the sample selected is not the actual

representation of the population to be studied. In this case, for example, the nurses who have

been interviewed might be having pre-determined minds about how they feel about the situation.

This renders them unfit to represent a population sample. Another external threat is the

Hawthorne effect. This is a threat in which the participants selected for the study tend to change

their behaviors after realizing that they are being studied. For instance, the participants might

decide to avoid anxiety-inducing situations because they are conscious of what is being studied.

Potential legal/ethical issues within the article

The potential ethical issues include informed consent. In nursing and health-related

articles, informed consent is a common battle for nurses. Dilemma situations emerge in cases

where the patients together with their children have not been informed fully about the treatment

that they are supposed to go through. There are also issues pointing out that patients are not free

to ask questions yet they are not aware of the implication of the fear of the services they are

about to receive. The second ethical issue is inadequate staffing and resources. This is evident in

the articles that have been presented. The cost of healthcare has been on the rising daily. Patients

and nurses themselves are at great risk when the resources are not enough. This demands a

formulation of very hard decisions.

Stephanie Scovill PhD
109940000000041771
Remember to support your statements with in-text citations.

Stephanie Scovill PhD
109940000000041771
Remember to support your statements with in-text citations.

Stephanie Scovill PhD
109940000000041771

Nursing Paper 4

Data analysis (be sure to elaborate on this more from your paper in week 4, providing

specifics about the results)

The research article by Dechawatanapaisal (2018) established that there three major

contributors to nursing turnover rates are lead exchange quality, organizational identification,

and job embeddedness. According to the results obtained, if these three can be taken good care of

in the organization, then it is evident that turnover rates will be taken good care of. These causes

are majorly engineered by the nature of the management of a facility. Kurnat-Thoma et al (2017)

on the other hand realized that the implementation of an onboarding program can significantly

reduce nurse turnover rates. According to the article, this can be attained through having quality

standards and procedures employees follow to join an organization. If the steps followed are the

right ones, then it is evident that turnover rates will be at their minimum. The third article

revealed that there exists a sensitive relationship between nurses and patients, which plays a role

in employee turnover. The environment that relationship between these two people creates a

robust environment in which other activities in the organization go on very well with minimum

disturbances.

Implications for evidence-based practice and how this article could be used to make an

evidence-based change

Evidence-Based Change (EBP) is a typical process that commences with a simple clinical

question and later goes ahead to finding critically appraising evidence. The article has played an

essential role in establishing a practice change that ought to be changed. The information that has

been provided by the articles gives a solid foundation for the follow up steps, that is integrating

evidence in the clinical expertise as well as patients preferences. Through the article, relevant

Stephanie Scovill PhD
109940000000041771

Stephanie Scovill PhD
109940000000041771

Nursing Paper 5

organizations and bodies are well positioned to implement decisions that will address the

turnover rates. This will collectively bring change. The articles have enhanced the understanding

of internal and external threats as well as possible legal implications which might emerge.

Conclusion/summary of the evidence

In summary, there exists several factors influencing the working nature of the nurses as

well as their relationship with the patients whom they are meant to handle. Other inadequacies

that patients meet in town do not solely come from inadequate staffing of the nurses and their

high turnover rates. However, if the staffing issues can be addressed, many challenges faced by

patients would have been addressed. This is because the higher the number of nurses in place, the

better the services that are being offered since patients have more and enough time with the

patients.

Stephanie Scovill PhD
109940000000041771
Remember to support your statements with in-text citations.

Nursing Paper 6

References

Dechawatanapaisal, D. (2018). Nurses’ turnover intention: The impact of leader-member

exchange, organizational identification and job embeddedness. Journal of Advanced

Nursing, 74(6), 1380-1391. Nurses’ turnover intention: The impact of leader‐member

exchange, organizational identification, and job embeddedness

Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and

registered nurse staff turnover—a 10-element onboarding program intervention. SAGE

Open Nursing, 3, 2377960817697712.

Stalpers, D., de Brouwer, B., Kaljouw, M., & Schuurmans, M. (2015). Associations between

characteristics of the nurse work environment and five nurse-sensitive patient outcomes in

hospitals: A systematic review of the literature. International Journal of Nursing Studies,

52(4), 817-835. https://doi.org/10.1016/j.ijnurstu.2015.01.005

https://doi.org/10.1016/j.ijnurstu.2015.01.005

Nursing Paper 7

Appendix

Article/Reference (in APA
format)

Purpos
e of the
Article/
Study
Questi
on

Variabl
es (i.e.;
Indepen
dent vs.
Depend
ent)

Study
Desig
n

Sampl
ing

Metho
ds

Instru
ment

Findings/
Results

Dechawatanapaisal, D.
(2018). Nurses’ turnover
intention: The impact of
leader-member exchange,
organizational
identification and job
embeddedness. Journal of
Advanced Nursing, 74(6),
1380-1391. Nurses’
turnover intention: The
impact of leader‐member
exchange, organizational
identification, and job
embeddedness

The
purpos
e of
this
researc
h was
to look
into the
ways in
which
leader-
membe
r
interch
ange
quality,
organiz
ational
identity
, and
job
embed
dednes
s all
affect
people’
s
propen
sity to
leave
an
organiz
ation.
The
availab

Depend
ent
variable
–
Nurses’
turnove
r
intentio
n
Indepen
dent
variable
:
leader-
membe
r
exchan
ge,
organiz
ational
identifi
cation,
and job
embedd
edness.

Cross
–
sectio
nal
surve
y

Conve
nience
sampli
ng

Cross-
sectio
nal
survey
metho
d

Self-
report
questi
onnair
e

The
quality
of
exchange
s
between
leaders
and
followers
and job
embeddi
ng were
found to
be
directly
related.
The
impact of
leader-
member
interchan
ge
quality
on work
embedde
dness
was
partially
mediated
by
individua
ls’ levels
of
identifica
tion with

Nursing Paper 8

le
literatu
re does
not
provide
enough
inform
ation
about
this
topic.

their
respectiv
e
organizat
ions. The
analysis
also
backed
the idea
that job
embedde
dness
acted as
a
mediator
between
organizat
ional
identity
and
turnover
intent.

Kurnat-Thoma, E.,
Ganger, M., Peterson, K.,
& Channell, L. (2017).
Reducing annual hospital
and registered nurse staff
turnover—a 10-element
onboarding program
intervention. SAGE Open
Nursing, 3,
2377960817697712.

What
are the
relevan
t ways
of
reducin
g the
nurse
staff
turnove
r rate
in the
hospita
l
setting
annuall
y?

Depend
ent
variable
– nurse
staff
turnove
r.

Indepen
dent
variable
– 10
element
s
onboar
ding
progra
m
interve
ntion.

Evide
nce-
based
turno
ver
analy
sis
appro
ach

Source
s
strateg
ically
sampl
ed

Standa
rdized
exit
survey
and
review
of
record
s.

Standa
rdized
exit
survey
.

The
study
findings
showed
an
abnormal
ly high
turnover
rate
among
new
hires,
that we
needed a
new
onboardi
ng
program
to better
support
new
hires,
and that

Nursing Paper 9

we
needed
to work
more
closely
with
hospital/
unit
directors
and
superviso
rs to
enhance
the
experien
ce of
new
hires. To
lower
yearly
hospital
and RN
staff
turnover,
we
designed
and
impleme
nted a
10-
element
program
interventi
on with a
heavy
emphasis
on
supportin
g newly-
hired
employe
es. The
outcome
was a
reduction

Nursing Paper 10

of staff
turnover
by 14
percent
overall
and 20
percent
among
new
hires,
both of
which
are
statistical
ly
significa
nt
accompli
shments.

Stalpers, D., de Brouwer,
B., Kaljouw, M., &
Schuurmans, M. (2015).
Associations between
characteristics of the nurse
work environment and
five nurse-sensitive patient
outcomes in hospitals: A
systematic review of the
literature. International
Journal of Nursing
Studies, 52(4), 817-
835. https://doi.org/10.101
6/j.ijnurstu.2015.01.005

The
purpos
e of
this
study
was to
conduc
t a
system
atic
literatu
re
review
on the
associa
tions
betwee
n the
workin
g
conditi
ons of
nurses
and
five

Depend
ent
variable
–
patient
sensitiv
e
outcom
e.

Indepen
dent
variable
– nurse
work
environ
ment
charact
eristics.

Syste
matic
revie
w
desig
n.

Target
ed
sampli
ng.

Syste
matic
review
of
literat
ure.

Dutch
versio
n of
Cochr
ane’s
critical
apprai
sal
instru
ment.

There is
an
associati
on
between
the work
environm
ent and
the nurse
sensitive-
patient
outcomes
.

https://doi.org/10.1016/j.ijnurstu.2015.01.005

https://doi.org/10.1016/j.ijnurstu.2015.01.005

Nursing Paper 11

patient
outcom
es that
are
particul
arly
import
ant to
nurses.

Running head: EBP PROJECT 1

EBP PROJECT 10

EBP Project

Student Name

Institution Affiliation

EBP Project

Reducing patient suffering while providing medical care is a perennial concern for nurses. Although relieving patients’ physical and mental pain is undoubtedly a top priority for nurses, existing models of practice fail to account for the necessary precautions that must be taken to avoid causing more suffering to patients and their loved ones throughout the provision of care. The shortage of nurses, especially with a high ratio of a single nurse attending five patients at a time, makes it unbearable for patients needing immediate attention to relieve their pain. Increasing the number of nursing staff is a significant intervention that ensures that patients receive immediate attention in relieving their pain without much waiting. Assessing and treating pain are two areas where nurses frequently struggle. The research found that nurses’ inability to answer questions about pain treatment correctly was independent of their level of education, and more education and exposure makes them more competent in service delivery (Stalpers et al., 2015). Improving emergency room pain evaluation and management practices raises the bar for eradicating actual pain felt by patients. Having enough nurses in the hospital facility reduces the ratio and makes it possible for the nurses to cooperate in assisting the patients in patient management for quality care.

Article 1:

Dechawatanapaisal, D. (2018). Nurses’ turnover intention: The impact of leader-member exchange, organizational identification and job embeddedness. Journal of Advanced Nursing, 74(6), 1380-1391. Nurses’ turnover intention: The impact of leader‐member exchange, organizational identification, and job embeddedness

The article discusses about the challenge of turnover rate among the nurses in the healthcare setting. Three factors are highlighted as the main contributors to the turnover: lead-exchange quality, organization identification, and job embeddedness. The study adopts the cross-sectional survey method that facilitates the participants to engage in self-reporting through questionnaires to get to understand the impact that the three factors highlighted causes. The participants of the study are 1966 nurses that are drawn from private hospitals. Self-reporting questionnaire is the instrument used in sourcing the data and is practical in achieving the exercise. The instrument is reliable and valid because the questions are well designed in the questionnaire.

Article 2:

Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover—a 10-element onboarding program intervention. SAGE Open Nursing, 3, 2377960817697712.

The article targets reducing the annual nurse turnover rate recorded in hospitals by adopting the 10 element onboarding program intervention that targets strengthening and standardizing the way new employees are welcomed and accommodated. The evidence-based turnover analysis approach is the method used in sourcing data for the source in finding the impact of the 10 element onboarding intervention on the nurse staff. The participants in the reviewed sources and records are nurses, and the instrument used is the existing standardized survey and the review of records that gives detailed data that is reliable and valid to develop a conclusion.

Article 3:

Stalpers, D., de Brouwer, B., Kaljouw, M., & Schuurmans, M. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of the literature. International Journal of Nursing Studies, 52(4), 817-835. 

https://doi.org/10.1016/j.ijnurstu.2015.01.005

The article explains about the role that the nurse environment plays in offering quality healthcare services to the patients for a quality outcome. The article’s findings confirmed that there is an association between the work environment for the nurses and patient outcome sensitivity. A systematic literature review is adopted to get information and insight into the relations between the working conditions and patient outcomes. The participants in the study are nurses, and the instrument used is the reviewing of literature to get insight. The method and instruments used are reliable and valid in giving significant results.

Conclusion

The evidence has shown that the nurses’ treatment in the workplace matters in the services that they offer to the patients and also their retention and turnover rates (Stalpers et al., 2015). Employees that enjoy their workplaces remain there for a long and offer quality services to patients. Unfavorable work environment results in an increased turnover rate.

References

Dechawatanapaisal, D. (2018). Nurses’ turnover intention: The impact of leader-member exchange, organizational identification and job embeddedness. Journal of Advanced Nursing, 74(6), 1380-1391. Nurses’ turnover intention: The impact of leader‐member exchange, organizational identification, and job embeddedness
Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover—a 10-element onboarding program intervention. SAGE Open Nursing, 3, 2377960817697712.

Stalpers, D., de Brouwer, B., Kaljouw, M., & Schuurmans, M. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of the literature. International Journal of Nursing Studies, 52(4), 817-835. https://doi.org/10.1016/j.ijnurstu.2015.01.005

Appendix

Stalpers, D., de Brouwer, B., Kaljouw, M., & Schuurmans, M. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of the literature. International Journal of Nursing Studies, 52(4), 817-835. https://doi.org/10.1016/j.ijnurstu.2015.01.005

Article/Reference (in APA format)	Purpose of the Article/Study Question	Variables (i.e.; Independent vs. Dependent)	Study Design	Sampling	Methods	Instrument	Findings/Results
Dechawatanapaisal, D. (2018). Nurses’ turnover intention: The impact of leader-member exchange, organizational identification and job embeddedness. Journal of Advanced Nursing, 74(6), 1380-1391. Nurses’ turnover intention: The impact of leader‐member exchange, organizational identification, and job embeddedness	The purpose of this research was to look into the ways in which leader-member interchange quality, organizational identity, and job embeddedness all affect people’s propensity to leave an organization. The available literature does not provide enough information about this topic.	Dependent variable- Nurses’ turnover intention Independent variable: leader-member exchange, organizational identification, and job embeddedness.	Cross-sectional survey	Convenience sampling	Cross-sectional survey method	Self-report questionnaire	The quality of exchanges between leaders and followers and job embedding were found to be directly related. The impact of leader-member interchange quality on work embeddedness was partially mediated by individuals’ levels of identification with their respective organizations. The analysis also backed the idea that job embeddedness acted as a mediator between organizational identity and turnover intent.
Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover—a 10-element onboarding program intervention. SAGE Open Nursing, 3, 2377960817697712.	What are the relevant ways of reducing the nurse staff turnover rate in the hospital setting annually?	Dependent variable- nurse staff turnover. Independent variable- 10 elements onboarding program intervention.	Evidence-based turnover analysis approach	Sources strategically sampled	Standardized exit survey and review of records.	Standardized exit survey.	The study findings showed an abnormally high turnover rate among new hires, that we needed a new onboarding program to better support new hires, and that we needed to work more closely with hospital/unit directors and supervisors to enhance the experience of new hires. To lower yearly hospital and RN staff turnover, we designed and implemented a 10-element program intervention with a heavy emphasis on supporting newly-hired employees. The outcome was a reduction of staff turnover by 14 percent overall and 20 percent among new hires, both of which are statistically significant accomplishments.
The purpose of this study was to conduct a systematic literature review on the associations between the working conditions of nurses and five patient outcomes that are particularly important to nurses.	Dependent variable- patient sensitive outcome. Independent variable- nurse work environment characteristics.	Systematic review design.	Targeted sampling.	Systematic review of literature.	Dutch version of Cochrane’s critical appraisal instrument.	There is an association between the work environment and the nurse sensitive-patient outcomes.

Topic I decided to pick the topic unsafe staffing levels and its impact on patient safety. During the pandemic shortages of staffing was a main concern for nurses. 

this is the topic you selected and identified in your unit 1 discussion).  After selecting a topic from the provided list, you will develop a PICOT question around your topic. Then, you will discuss the selected topic problem and significance of the problem, as well as your search strategy in locating three research articles that align to your selected topic.

For this assignment, be sure to include the following assignment criteria in your paper:

1. Discuss your selected evidence-based practice problem/topic.

2. Discuss the significance of the selected evidence-based practice problem.

3. Support your discussion in terms of statistics and evidence-based outcomes.

4. Describe your PICOT question created around the selected evidence-based practice problem.

5. Included the individual PICOT components, as well as a combine PICOT question, in sentence format.

6. Identify the three articles you selected that address the problem which is the focus of your PICOT question.

7. Describe the search strategy you used to locate these three articles, including terms used when search, the research databases, and how you refined your search to select the three articles.

8. Provide a conclusion to summarize your findings.

· Gray, J. R., Grove, S. K. & Sutherland, S.  (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.) . St. Louis, MO: Elsevier Saunders. ISBN 978-0-323-37758-4

· Chapters: 5 & 6