Determining the Credibility of Evidence and Resources

Determining the Credibility of Evidence and Resources

Quality or Safety Issue

The chosen quality issue is a new nurse on a medical-surgical unit assigned to a middle-aged man suffering from a spinal injury. The newly trained nurse identified the risk of developing pressure ulcers as the patient is immobilized and made a nursing diagnosis of the risk of impaired skin integrity. After initial guidance and personal research, the nurse still experiences difficulties determining the credibility of the online medical sources. Maintaining skin integrity among hospitalized patients is a critical goal in nursing care. Interventions aim to prevent and restore skin integrity and are a multidisciplinary convergence of expertise and critical thinking skills. Ensuring high-quality and safe plans in the hospital relies on current best evidence. Therefore, developing an evidence-based practice culture on comprehensive skin integrity programs would prevent at-risk patients from developing them. Although they are treatable, nurses using evidence-based best practices would be able to implement appropriate measures such as repositioning techniques, monitoring, and other continuous care strategies to manage and prevent pressure ulcers (Mitchell, 2018).

Criteria for Determining Credibility of Resources

Nurses are continually challenged to identify, locate, and use credible and reliable information that informs their decision-making in evidence-based practice (EBP). Advances in technology and the growth of the internet world have resulted in more sophisticated search engines and robust databases. These factors modify the breadth of online information and change how nurses arrive at clinical information. Determining the credibility of a source involves a systematic approach that considers different aspects. The first step is to check whether the article is relevant to the risk of impairment of skin integrity. It is important to understand and detect alternative terms used interchangeably, such as pressure injuries, sores, or decubitus ulcers. The criteria ensure that only sources relevant to the patient or the diagnosis are accessed and reviewed. Other measures to be considered include the timeliness of the article, the authority commanded by the institution or author of the article on the topic, the intended audience, and the general perspective of the article.

Nursing is a science, and nurse scientists address health barriers, generate new information, and translate evidence to practice (Chesak et al., 2022). Their training and technical expertise help nurses to make the initial exclusion or inclusion criteria for the different sources. The addresses of different websites help to determine the credibility of a source. Domain suffixes give a clue about the purpose of the website and the article on it. Commercial sites have .com suffixes that usually serve a specific purpose in product promotion. The information may not be misleading, but it usually does not offer the complete picture. Educational institutions use .edu, and government domains have .gov .org are typically owned by non-profit organizations such as the Red Cross. The latter three websites tend to have increasingly credible information than commercial websites. Openly biased URL names, absent author names, and the presence of advertisement pop-ups that may cover content and outdated content suggest that the source is not credible. However, seemingly credible sources such as peer-reviewed articles may not be credible.

Some articles the nurse may encounter could pass as credible, evidence-based sources. However, it is important to differentiate between randomized control studies (RCTs) and systematic reviews. High-quality RCTs provide the most credible and reliable evidence. Systematic reviews summarize many high-quality primary studies to answer a specific question. Therefore, the nurse should be able to differentiate between case studies, controlled trials, and systematic reviews. The knowledge will help them understand the type and quality of information to expect from the different types of articles. Systematic reviews offer the most credible source, followed by evidence synthesis papers and critically appraised individual articles. These contain carefully filtered information. Expert reports from professional organizations or government agencies are the least credible sources. However, they can still offer good insights into managing and preventing the nursing diagnosis of impaired skin integrity and equip the nurse with technical know-how for quality nursing care to the patient.

Analyzing the Credibility and Relevance of the Evidence within the Context of the Issue

The nurse arrived at multiple online websites and articles that they reported reviewing to understand more about preventing pressure ulcers and ensuring maintenance of skin integrity for the patient. Sources identified from the nurse’s search history showed that they arrived at moderately credible sources. The first article was from MedicalNews Today, whereby the author had submitted their excerpt to be reviewed by a medical officer. However, it did not comprehensively review the subject topic, and the depth of knowledge was relatively shallow, suggesting that it was targeted at the general public. Additionally, there were plenty of advertisements on the website.

An article from Mayo Clinic and Medscape were found to be credible sources. Their website addresses ended with .org. Medscape provides references, and the content is cited throughout. These two websites had limited advertisements and were powered by credible organizations that command authority in medicine. Other sources in the organization’s online library were mostly credible. The articles were peer-reviewed, current, relevant, and unbiased. These included unfiltered sources such as randomized control studies and filtered information like systematic reviews. The sources adequately covered the topic and provided evidence-based insights toward informed nursing care for patients at risk of impaired skin integrity (“Evidence-based practice for nursing: Evaluating the evidence”, n.d.).

Incorporating Credible Evidence into EBP models

EBP models were developed to provide a framework for nurses interested in adopting EBP toward optimizing patient care. These models guide approaches to EBP through directing strategic implementation, proper evaluation, and appropriate resource use. Therefore, nursing and medical research evidence are continually adopted into evidence-based decision-making in nursing care. An example of an EBP model is the Johns Hopkins Nursing Evidence-Based Practice Model. The model is clinician-focused and allows the timely and suitable adoption of current knowledge and best practices into patient care. The model has three steps: identification of the EBP question, sourcing and reviewing the available evidence, and translating feasible evidence into consideration. The research question in the identified case scenario is the need to conduct a driven program toward preventing and managing the risk of impaired skin integrity of the immobilized spinal injury patient. Adoption of the PICO question format can be implemented in the evidence-reviewing phase to ensure that the key articles relating to pressure ulcer incidence, risk factors, comparison of nursing interventions, best practices, and their safety are accessed (Anicoche, 2021).

Evidence revealed from reviewed sources through the Johns Hopkins EBP model will offer suitable interventions to prevent or manage the identified nursing diagnosis for spinal injury patients. Possible prevention interventions include developing an optimal patient repositioning schedule, risk and skin assessment, appropriate bed positioning to prevent shear, and padding and pillows to reduce pressure. Treatment interventions include appropriate wound dressings, nutritional assessment, wound debridement, and the use of biological agents (Atkinson & Cullum, 2018). Findings from the exercise should be suitably communicated to all members of the unit through a continuous medical education activity to increase the competence of the entire team in risk assessment and beginning nursing interventions for patients at risk of impaired skin integrity.

Conclusion

The inclusion of EBP in nursing practice helps to incorporate current, real-time, and data-based insights toward decision-making in nursing care. Nurses who adopt EBP stay updated about medical protocols for care, evaluate research, and make nursing decisions that uphold practice core principles of medical practice: autonomy, beneficence, non-maleficence, and justice. Scientific evidence shows that immobilized patients, like those with spinal cord injuries, have the highest risk of altered skin integrity and the development of pressure sores. These skin changes contribute to the risk of iatrogenic infections and reduced range of movement and function. Interventions to ensure skin integrity and prevent pressure ulcers require understanding evidence-based best practices to promote positive outcomes. Evidence-based practice models are instrumental in providing a framework for conceptualizing evidence into practice. The Johns Hopkins EBP model is one such model implemented to the effect.

References

Anicoche, M. L. (2021). The Johns Hopkins Evidence-Based Practice (EBP) Model: Weinberg Perianesthesia Interventions for a Healing Environment. Journal of PeriAnesthesia Nursing, 36(4), e21.

Atkinson, R. A., & Cullum, N. A. (2018). Interventions for pressure ulcers: a summary of evidence for prevention and treatment. Spinal Cord, 56(3), 186-198.

Chesak, S. S., Rhudy, L. M., Tofthagen, C., & Chlan, L. L. (2022). A practice‐based model to guide nursing science and improve the health and well‐being of patients and caregivers. Journal of Clinical Nursing, 31(3-4), 445-453.

Evidence-based practice for nursing: Evaluating the evidence. (2021). Research Guides at East Carolina University Libraries. https://libguides.ecu.edu/c.php?g=17486&p=97640

LibGuides: Nursing resources: What is credible? (2021) https://libguides.starkstate.edu/c.php?g=501100&p=3431970

Mitchell, A. (2018). Adult pressure area care: preventing pressure ulcers. British Journal of Nursing, 27(18), 1050-1052.

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Assessment 2 Instructions: Determining the Credibility of Evidence and Resources

• Develop a 2-4 page scholarly paper in which you describe a quality or safety issue or a chosen diagnosis, and then identify and analyze credible evidence that could be used as the basis for applying EBP to the issue.

Introduction

The goal of using evidence-based research findings is to enhance safety and quality of patient care and ensure optimal outcomes are achieved. It is not uncommon to hear a nurse say, “why change it as we’ve always done it this way.” However, this is no longer acceptable in today’s practice environment. The profession of nursing has evolved, and the expectation is that the professional nurse has a scientific foundation to support the care that is provided. As the profession of nursing continues to evolve and engage in health care transformation, baccalaureate-prepared nurses are expanding taking on leadership roles that include incorporating EBPs. To be able to do this, the nurse needs to understand the criteria and makes a resource credible, as this is crucial when deciding if the research is valid and reliable for implementation into health care settings. The nurse will need to incorporate the use of evidence-based practice models. EBP models are designed to assist the nurse in developing a plan to gather evidence to answer a practice problem or question. It is a systematic approach to direct the user to incorporate scholarly findings into current practice. These EBP models lead the nurse through the decision-making process of evaluating the literature to determine the best practice evidence for the practice issue or question.
It would be an excellent choice to complete the Vila Health Determining the Credibility of Evidence activity prior to developing the report. The activity is a media simulation that offers an opportunity to review a scenario and work on determining the credibility of presented evidence. These skills will be necessary to complete Assessment 2 successfully. This media simulation is one potential source of context on which to base your assessment submission. This will take just a few minutes of your time and is not graded.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.
Scenario
For this assessment, you may choose from the following options as the context for the quality or safety issue or chosen diagnosis/health issue for researching and completing this assessment:
• The specific diagnosis/health issue you identified in your previous assessment.
• The simulation Vila Health: Determining the Credibility of Evidence.
• A personal practice experience in which a sentinel event occurred.
Instructions
The purpose of this analysis is to better understand what constitutes credibility of journal articles as well as websites. The role of the baccalaureate-prepared nurse in incorporating evidence-based research continues to growth in clinical practice. As quality improvement (QI) measures to reduce safety risks continue to be emphasized, the need for evidence-based models and evidence-based templates is growing. This type of systematic approach to incorporating evidence-based findings allows nurses to make clinical and operational decisions based upon the best available evidence. When the most up-to-date evidence-based findings are utilized, patient-centered care improves outcomes and enhances the patient experience.
Below is a quick review table of several well-known Evidence-Based Practice Models used to guide exploration:
Evidence-Based Practice Models
Iowa Model of Evidence-Based Practice
Stetler Model
Ottawa Model
PARiHS (Promoting Action on Research Implementation in Health Services) Model
ACE (Academic Center for Evidence-Based Practice) Star Model
ARCC (Advancing Research and Clinical Practice Through Close Collaboration) Mode
John Hopkins Model
KTA (Knowledge-to-Action) Model

For this assessment:
• Explain the criteria that should be used when determining the credibility of journal articles as well as websites.
• Support your explanations with references to the literature or research articles that describe criteria that should be used to determine credibility.
• Your identification and determination of credibility should be done within the context of your chosen scenario for this assessment. For example, if you choose to use the provided Vila Health scenario, your initial identification of resources should be of resources that will best help address the presented issue. However, if you are locating resources to help provide evidence-based care for the diagnosis/health care issue you identified in the first assessment, you may want to begin your literature and evidence search from the databases that were identified. Any of the three scenario options are acceptable. So, pick the one that most interests you.
•
Be sure to address the following in this assessment, which correspond to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you will know what is needed for a distinguished score.
• Describe a quality or safety issue, or a chosen diagnosis, that could benefit from an evidence-based approach.
• Explain criteria that should be considered when determining credibility of resources such as journal articles and websites.
• Analyze the credibility and relevance of evidence and resources within the context of a quality or safety issue, or a chosen diagnosis.
• This is where you are selecting the specific resources to help address the issue in your chosen scenario.
• Identify the Evidence-Based Practice model and explain the importance of incorporating credible evidence into the EBP model used to address a quality or safety issue, or a chosen diagnosis/health care issue. Review the literature below and choose the appropriate model for your diagnosis/health care issue.
• Selecting a model for evidence-based practice changes. [PDF] and Evidence-Based Practice Models help explain the various evidence-based nursing models.
• Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.
Additional Requirements
Your assessment should meet the following requirements:
• Length of submission: 2-4-page scholarly paper, this does not include the APA-formatted title page and reference list.
• Number of references: Cite 3-5 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than five years old.
• APA formatting: References and citations are formatted according to current APA style.
Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
• Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
• Explain criteria that should be considered when determining credibility of resources such as journal articles and websites.
• Analyze the credibility and relevance of evidence and resources within the context of a quality or safety issue, or a chosen diagnosis.
• Competency 3: Apply an evidence-based practice model to address a practice issue.
• Identify an evidence-based practice model (such as Iowa, Stetler, John Hopkins, etc.) and explain the importance of incorporating credible evidence into an EBP model used to address a quality or safety issue, or a chosen diagnosis/health care issue.
• Competency 4: Plan care based on the best available evidence.
• Describe a quality or safety issue, or a chosen diagnosis, that could benefit from an evidence-based approach.
• Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
• Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
• Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA form