Evidence Based Reflection on Practice A Metacognitive Activity of

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					Evidence Based Reflection on
Practice: A Metacognitive
Activity of Clinical Inquiry

Cas Cahill, DNP, ARNP
  Essentials For Evidence Based
              Practice

 Information Literacy


 Critical Thinking




                         (Moch, S.D. and Cronje, R.J., (2010)
EBP Reflection Outcomes
 Nursing Process Didactic, Clinical &
  Laboratory Settings
  – Organizing Infrastructure
     • Therapeutic Communication
     • Elements of Physical Assessment
        – HPI
        – CC
Metacognitive Assignment
 Fundamentals- Semester One
   – Focus is on foreground and background
     question analysis
   – How to formulate a clinical question
   – Lower source material is used:
      • Text to evaluate nursing responses
      • PDA
EBP Fundamentals
1. Describe a clinical event that was
   significant.

2. Look up this clinical event in your text(s)
   and read about it. List what are
   identified as the foreground or most
   important nursing response and the
   background or less important clinical
   elements along with the text and page
   number below
EBP Fundamentals
   3.     What was the nursing response
    related to the event that was in the
    foreground at the time that you cared
    for the patient?

   4. What was the nursing response
    related to the event that was in the
    background at the time you care for
    the patient
EBP Fundamentals
 5. Do you feel as though your response
 to the patient was the best response
 based on what you read in your text?
 Why or why not?
                                   5                               4                         3                           2                           1



   Quality of                                            Identifies the clinical
                    Identifies the clinical situation                              Identifies the clinical      Identifies the clinical   Identifies the clinical
                                                          situation with some
   Problem           with all related nursing and
                                                          related nursing and         situation with all     situation with either some      situation without
 Identification      medical aspects delineated                                      related nursing or           related nursing or       related nursing and
                                                            medical aspects
                                                                                      medical aspects              medical aspects           medical aspects
                                                               delineated
                                                                                         delineated                   delineated                delineated


                    Evidence based references
                     from a literature search are References from text and References from text or
                                                                                    PDA included in                                       Lacks references in
                        included in narrative.        PDA are included in                                       Lacks references in
   Resource/                                                                    narrative. References                                     narrative.
                      References completed per       narrative. References                                    narrative or references
                                                                                not completed per APA                                     References not
   Document         APA format, and are related       completed per APA                                      not related or connected
                                                                                                                                          related or connected
                    and connected to the clinical format and references are           format and/or             to the clinical issue
   Reference                                                                       references are not                                     to the clinical issue
                        issue identified in the    related and connected to                                    identified in the entry
                                                  the clinical issue identified      related and/or                                       identified in the entry.
                           journaling entry
                                                    in the journaling entry.        connected to the
                                                                                clinical issue identified
                                                                                       in the entry


                       Correctly discriminates                                     Incorrectly                                             Is unable to correctly
                                                   Correctly discriminates
                      between foreground and                                discriminates between            Incorrectly discriminates discriminate between
                                                     between foreground
Critical Thinking   background data, completes                                  foreground and               between foreground and         foreground and
                                                    and background data,
and Reasoning       narrative relative to both and                             background data;                  background data;          background data,
                                                   completes narrative but
                      is inclusive of all clinical
                                                       narrative lacks     incomplete narrative or           incomplete narrative and narrative is incomplete
                           aspects thereof
                                                      essential clinical         narrative lacks              narrative lacks essential with clinical aspects not
                                                                                                                                                 present
                                                          aspects              essential clinical                 clinical aspects
                                                                                     aspects

                                                                                                              6= Unsatisfactory and      3= Unsatisfactory
                                                        12 = Very good; meets      9= unsatisfactory and      must resubmit a journal and must resubmit a
                       15= Excellent; meets                requirements of         must resubmit journal      entry on a new patient     journal entry on a
    Scoring
                    requirements of assignment               assignment            entry on a new patient    and submit a third journal new patient submit a
                                                                                                                       entry              third and fourth
                                                                                                                                            journal entry
Metacognitive Assignment
 Medical Surgical Nursing I- Semester Two
  – Evaluate foreground and background data
  – Develop the PICO
  – Research the literature data bases to evaluate
    nursing responses
EBP Medical Surgical Nursing I
1. Describe a clinical event that was
   significant. Include all related medical
   and nursing aspects of the event and
   the background information
EBP Medical Surgical Nursing I
   2. Form your question using the PICO
    format

   P

   I

   C

   O
EBP Medical Surgical Nursing I
   3. Write out the foreground question
    and the patient perspective/preference
   4. Look up this clinical event online
    accessing the Cochrane Data Base
    and review 2 level 1-3 evidence-based
    research articles that address your
    foreground question.
   5. List the articles in APA format
EBP Medical Surgical Nursing I
   Compare your findings with:
•   the prescribed-nursing interventions
        for the clinical event
•   those in your text and PDA.
•   the patient perspectives/ preference


                                      5                                4                             3                               2                                1



    Quality of     Identifies the clinical event with        Identifies the clinical       Identifies the clinical
     Problem       all related nursing and medical           event with all related        event with all related                                     Does not identify the
                                                                                                                        Either does not identify the
Identification and aspects, complete background              nursing and medical           nursing and medical                                          clinical event, all
                                                                                                                            clinical event and all
  Formulation of    data and correctly completes             aspects, incomplete           aspects, incomplete                                        related nursing and
                                                                                                                            related nursing and
                                 PICO                        background data and          background data and                                          medical aspects,
Clinical Question                                                                                                        medical aspects, and/or
                                                                                                                                                       and/or incomplete
                                                              correctly completes         incorrectly completes         complete background data
                                                                      PICO                          PICO                                             background data and
                                                                                                                              and/or incorrectly
                                                                                                                                                     incorrectly completes
                                                                                                                               completes PICO
                                                                                                                                                              PICO
                           2 Level 1-3 evidence based                                                                                               Lacks level 1-3
                          references from a Cochrane   2 Level 1-3 evidence based                                                                   references from
                                                                                          I level 1-3 evidence based    Lacks level 1-3 references
                         literature search. References  references from Cochrane           reference from Cochrane
                                                                                                                                                    Cochrane literature
                                                                                                                         from Cochrane literature
                                                              literature search.                                                                    search. References
Resource/Docu           are completed per APA format,
                                                        References not completed
                                                                                                literature search.      search and/ or references
                        and are related and connected                                     References not completed                                  not related or
ment Reference                                           per APA format and are                                         not related or connected to
                           to the foreground question                                        per APA format and/or                                  connected to the
                                                         related and connected to                                        the foreground question
                            developed through PICO                                         references are not related                               foreground question
                                                          the foreground question           and/or connected to the
                                                                                                                         developed through PICO
                                                                                                                                                    developed through
                                                            developed through PICO            foreground question                                   PICO
                                                                                            developed through PICO




                            Correctly discriminates       Correctly discriminates
                                                                                                                           Incorrectly discriminates
                         between foreground question        between foreground          Incorrectly discriminates       between foreground question        Incorrectly discriminates
                             and background data.        question and background          between foreground              and background data and            between foreground
                                                                    data.
Critical Thinking          Compares research with
                                                        Completes three of the four
                                                                                      question and background            completes three of the four      question and background
                              prescribed/nursing                                        data and completes the           research comparisons with         data and completes 2/4
and Reasoning                                           research comparisons with four research comparisons                                              research comparisons with
                       interventions, nursing text ,PDA                                                                       prescribed/nursing
                                                             prescribed/nursing          with prescribed/nursing                                              prescribed/nursing
                               data and patient                                                                          interventions, nursing text ,
                                                        interventions, nursing text , interventions, nursing text ,                                      interventions, nursing text ,
                                                                                                                             PDA data and patient
                            perspective/preference         PDA data and patient           PDA data and patient
                                                                                                                                                             PDA data and patient
                                                             perspective/preference.                                        perspective/preference         perspective/preference.
                                                                                          perspective/preference



                                                                                                                                                         3= Unsatisfactory and
                                                                                                                          6= Unsatisfactory and
                                                            12 = Very good; meets         9= Unsatisfactory and                                             must resubmit a
                                                                                                                         must resubmit a journal
                           15= Excellent; meets all          most requirements of         must resubmit journal                                          journal entry on a new
      Scoring                                                                                                           entry on a new patient and
                         requirements of assignment              assignment               entry on a new patient                                          patient submit a third
                                                                                                                        submit a third journal entry
                                                                                                                                                           and fourth journal
                                                                                                                                                                   entry
Metacognitive Assignment
 Medical Surgical Nursing 2- Semester 3
  – Evaluate foreground and background data
  – Develop the PICO
  – Research the literature data bases to evaluate
    nursing responses
  – Research National Guidelines/Standards to
    evaluate data and nursing responses
EBP Reflection Outcomes
 Information Literacy :
   – Foundation Established in the Didactic Setting
      • Searching the data bases
      • Identification of higher level evidence
EBP Reflection Outcomes
 Information Literacy
   – Reinforced in the clinical setting with
     applications of data gleaned and evaluated
   – Use of PDA’s at the bedside




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EBP Reflection Outcomes
 Critical Thinking
  – Application of Didactic and Clinical Concepts
  – Analysis of Current Practices
  – Synthesis of research through clinical
    applications of higher level evidence through
    Nursing Research
A Final Thought.....
  – Nursing Research and Evidence Based
    Practice are not synonymous and may even be
    mutually exclusive




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EBP Reflection
 Questions?