Discuss a clinical problem or issue in your area of practice that would be appropriate for an EBP project and formulate a researchable question using PICOT format. The discussion should not be too long about 2-3 paragraphs.

The initial posting (IP) and the response to peer  posting each (RTP) require one reference from an English titled, peer reviewed NURSING journal less than 5 y/o. The references must be from different journal articles.

IMPORTANT: The articles posted in each unit are to facilitate your understanding of the topic and help you meet the identified learning objectives. They are not to be used as references for any of your course work. 

However, FOR THIS WEEK ONLY:  I want you to use the articles in Unit 1 as your sources.

*The initial posting also requires a reference from the course textbook.

Professional, governmental, or educational organizations (.org, .gov, or .edu) 

may be used as supplemental references.

*The maximum number of references:  IP = 2, RTP = 2.

Postings with more than the maximum number of will be returned to the student.

APA format required. See grading criteria and rubric for discussion postings.

Please see the attached articles 

Please also use the following textbook:


Polit, D. E & Beck, C. T. (2018). Essentials of nursing research: Appraising    evidence for nursing practice(9th. ed.). Philadelphia, PA: Wolters Kluwer

ISBN: 978-1-4963-5129-6

esearch studies show that
evidence-based practice
(EBP) leads to higher qual-

ity care, improved patient out-
comes, reduced costs, and greater
nurse satisfaction than traditional
approaches to care.1-5 Despite
these favorable findings, many
nurses remain inconsistent in their
implementation of evidence-based
care. Moreover, some nurses,
whose education predates the in-
clusion of EBP in the nursing cur-
riculum, still lack the computer
and Internet search skills neces-
sary to implement these practices.
As a result, misconceptions about
EBP—that it’s too difficult or too
time-consuming—continue to

In the first article in this series
(“Igniting a Spirit of Inquiry: An
Essential Foundation for Evidence-
Based Practice,” November 2009),
we described EBP as a problem-
solving approach to the delivery
of health care that integrates the
best evidence from well-designed
studies and patient care data,
and combines it with patient

preferences and values and nurse
expertise. We also addressed the
contribution of EBP to improved
care and patient outcomes, de-
scribed barriers to EBP as well as
factors facilitating its implementa-
tion, and discussed strategies for
igniting a spirit of inquiry in clin-
ical practice, which is the founda-
tion of EBP, referred to as Step
Zero. (Editor’s note: although
EBP has seven steps, they are
numbered zero to six.) In this
article, we offer a brief overview
of the multistep EBP process.
Future articles will elaborate on
each of the EBP steps, using
the context provided by the

Case Scenario for EBP: Rapid
Response Teams.

Step Zero: Cultivate a spirit of
inquiry. If you’ve been following
this series, you may have already
started asking the kinds of ques-
tions that lay the groundwork
for EBP, for example: in patients
with head injuries, how does
supine positioning compared
with elevating the head of the
bed 30 degrees affect intracranial
pressure? Or, in patients with
supraventricular tachycardia,
how does administering the
β-blocker metoprolol (Lopressor,
Toprol-XL) compared with ad-
ministering no medicine affect

By Bernadette Mazurek Melnyk, PhD,
Ellen Fineout-Overholt, PhD, RN,

FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.

Williamson, PhD, RN

The Seven Steps of Evidence-Based Practice
Following this progressive, sequential approach will lead
to improved health care and patient outcomes.

This is the second article in a new series from the Arizona State University College of Nursing and Health Innova-
tion’s Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving
approach to the delivery of health care that integrates the best evidence from studies and patient care data with clini-
cian expertise and patient preferences and values. When delivered in a context of caring and in a supportive organi

Nephrology Nursing Journal January-February 2011 Vol. 38, No. 1 79

End-of-Life Issues and the Patient with Renal
Disease: An Evidence-Based Practice Project

n May 5, 2006, the Research/
Innovations Committee of St.
Joseph’s Hospital Health
Center (SJHHC) in Syracuse,

NY, sponsored one of several evi-
dence-based practice workshops for
staff nurses. Nurses attending the
workshop were taught how to use the
Iowa model of evidence-based prac-
tice. The Iowa model was developed
by Marita Titler and colleagues (2001)
“…to describe knowledge transforma-
tion and to guide implementation of
research into clinical practice” (p. 497).

Attendees developed several ques-
tions using this model. Nurses who
cared for patients with end stage renal
disease (ESRD) and who attended the
workshop asked the question, “How
can we assist our patients with ESRD
with end-of-life issues?” The project
described in this article was initiated
to answer that question and has since
evolved into an evidence-based prac-
tice project. The question was found
to be a problem-focused trigger, and
more specifically, the identification of

a clinical problem. Following the
Iowa model, a second question was
raised: “Is this topic a priority for the
organization?” The group agreed that
it was a priority for the organization.

The Evidence-Based Practice Renal
Project Team

The next task was to form a team.
The Evidence-Based Practice (EBP)
Renal Project Team was composed of
eight nurses who care for patients
with renal disease (from acute care
hospital and outpatient settings) and
several clinical nurse specialists with
varied end-of-life care experience. As
the project took shape, a physician
champion (the nephrology medical
director) was added to the team.

Pre-Assessment and

Participants were asked to com-
plete a survey before and after the ses-
sion. The survey was a component of
the American Nephrology Nurses’
Association (ANNA) Advanced Care
Planning (ACP) Module – 1: End-of- Life
Decision Making and the Role of the
Nephrology Nurse (ANNA, 2004). The
pre-assessment survey posed eight
questions. The first four questions were
true/false questions and asked about
the nurses’ knowledge related to end-
of-life. The last four questions asked
about nurses’ experience and comfort
level with end-of-life discussions.

Deborah J. Hopkins, MS, RN-BC, ACNS-BC, is
a Staff Educator, St. Joseph’s Hospital Health Center,
Syracuse, NY, and an Assistant Professor, St. Joseph’s
College of Nursing, Syracuse, NY. She a member of
ANNA’s Central New York Chapter and can be con-
tacted via e-mail at [email protected]

Mary Rose Kott, MS, RN, ANP/CNS, CNN, is
an Adult Clinical Nurse Specialist, Medical Services,
and a Nurse Practi

The Impact of Evidence-Based
Practice in Nursing and the Next Big


that nurses lead
teams in improving
delivery systems
and care brings to
the fore the
necessity for new
practice, that are
requisite as nurses

Kathleen R. Stevens, EdD, RN, ANEF, FAAN

The impact of evidence-based practice (EBP) has echoed across nursing practice, education, and
science. The call for evidence-based quality improvement and healthcare transformation
underscores the need for redesigning care that is effective, safe, and efficient. In line with multiple
direction-setting recommendations from national experts, nurses have responded to launch
initiatives that maximize the valuable contributions that nurses have made, can make, and will
make, to fully deliver on the promise of EBP. Such initiatives include practice adoption; education
and curricular realignment; model and theory development; scientific engagement in the new fields
of research; and development of a national research network to study improvement. This article
briefly describes the EBP movement and considers some of the impact of EBP on nursing practice,
models and frameworks, education, and research. The article concludes with discussion of the next
big ideas in EBP, based on two federal initiatives, and considers opportunities and challenges as EBP
continues to support other exciting new thinking in healthcare.

Citation: Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas”
OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4.

DOI: 10.3912/OJIN.Vol18No02Man04

Key words: EBP, quality improvement, education, research network, translational science, Institute of Medicine

Over the past decade, nurses have been part of a movement that reflects perhaps more change than any two
decades combined. Directions in nursing education in the 1960s established
nursing as an applied science. This was the entry of our profession into the age of
knowledge. Only in the mid-1990s did it become clear that producing new
knowledge was not enough. To affect better patient outcomes, new knowledge
must be transformed into clinically useful forms, effectively implemented across
the entire care team within a systems context, and measured in terms of
meaningful impact on performance and health outcomes. The recently-articulated
vision for the future of nursing in the Future of Nursing report (IOM, 2011a)
focuses on the convergence of knowledge, quality, and new functions in nursing.
The recommendation that nurses lead interprofessional teams in improving
delivery systems and care brings to the fore the necessity for new competencies,
beyond evidence-based practice (EBP), that are requisite as nurses transform
healthcare. These competencies focus