Assignment 2: Due 10/30 (through Assignment Dropbox)
EBP Problem, Searching the Evidence, and Appraisal
Develop a EBP question guided by the Question Development Tool Appendix B, (Dearholt& Dang, 2012) and then using this question conduct a literature search to investigate the issue or problem. Gather a minimum of 5 research articles to address the practice question. Please upload the 5 articles. The assignment should be organized in the following 6 parts:
A. Title Page
B. Practice question
C. Develop and Implement a Search Strategy. Please work with a librarian to conduct a literature search. The literature search parameters should be saved and included.
D. Appraise (determine quality) 5 articles using Research Evidence Appraisal Tool ( Dearholt and Dang, 2012, pg 240).
E. Explanation of Reference Relevance to the practice question. For each article explain the relevance to the practice questions (3-4 sentences per article)
F. Reference list using APA format
It is anticipated article Appraisal and E.1-2 pages per article.
Assignment 3: Due 11/30 (through Turnitin folder in Assignment Dropbox)
Overall Evidence Appraisal and Translation
The assignment should be organized in the following 4 parts:
A. Title Page
B. Overall what is the strength of the evidence? (5 research articles from Assignment 2)
C. What does the evidence tell us should be done about the clinical issue, health problem, or service delivery issue? Please consider is the change feasible and:
• “Would this change improve clinical outcomes?
• Would this change improve patient or nurse satisfaction?
• Would this change reduce the cost of care for patients?
• Would this change improve unit operations ?” (Dearholt and Dang, 2012, pg 150).
D. Reference list using APA format
This assignment should be a maximum of 5 pages in length. Please use APA format and see Evaluation Writing Rubric

Evidence Based Practice in Nursing
Name Angel E Garcia Sousa
Transitional Research

Evidence based practice assists healthcare practitioners to provide quality care on the basis of evidence and knowledge rather than based on customs, outdated texts or colleagues. The utilization of evidence-based practice can be attributed to a reply to a 2001 report by the Institute of Medicine depicting that many deficits in healthcare were causing preventable harm. This led to the introduction of a healthcare redesign proposal recommending that healthcare practitioners should implement and utilize evidence-based practices to increase the aspect of quality outcomes. However, in order to implement these practices healthcare providers have to come up with clinical questions and inquiries. Evidence based answers can only be obtained through the findings of a focused clinical question. The purpose of this article is to identify a clinical question through the utilization of PICO, identify the search parameters that facilitated the question and describe the articles retrieved in reference to their relevance to the question at hand.
The PICO question can assist in the formulation of clinical question. Evidence based practice model recommends that clinical questions should be framed in terms of population, comparison, intervention and outcome. Using the PICO formulae, I formulated this clinical question: Does the existence of a viable immediate environment have an influence on the nursing practice and provision of quality healthcare. The population is in terms of hospital settings, home based settings and neighborhood built environments. Interventions include the betterment of the physical and social environment around ailing persons. This question is largely based on the environmental theory by Florence Nightingale. The theory focuses on the alteration of a patient’s immediate environment to affect change in health. This derives the need for evidence-based practice to ascertain whether the theory can aid in the betterment of health care quality.
Evidence based practice models contribute to the conceptual implementation of varying nursing practices. Additional they assist in the organization and implementation of the evidence based practice, prevention of incomplete implementation, improve outcome evaluation and encourage the utilization of resources. One complementary model in the evidence based practice is the star model by the Academic Center of Evidence Based Practice that provides a framework for the comprehension of varying relations between knowledge transformation stages depicted as the conversion of finding from initial primary results through various forms and stages to impact health outcomes based on evidence based care. The model has five steps that are knowledge discovery, summarizing evidence, translating summary into practice recommendations, evaluation and practice integration. The end purpose of the model to act as a guidance and implementation tool of quality practice improvement. This brings us to the John Hopkins Nursing Evidence Based Practice Model.
The model allows translation of evidence for utilization by nurses in making clinical decisions in regards to care. The model contains three main stages that include the identification and development of a practice question, location and collection of evidence and the translation of the evidence into practice. It provides a user-friendly application to evaluate the practice question and guide users in the aspects of applying evidence based practice processes. Nursing students and practicing nurses can utilize this model to answer educational, administrative and clinical practice questions. In this case, the clinical question formulated has its roots in the prospects of the environmental theory by Florence Nightingale. The evidence-based practice seeks to analyze varying research that supports or disputes the theory and the effectiveness of its application. In order to find out varying researches that exist on the application of the environmental theory, I performed searches on the EBSCO database. In the search, I used the terms ‘environmental theory’ and ‘nursing practice’. This search yielded more than 200 results. Refining the search included the indication of articles to be less than 10 years old and the inclusion of the terminology ‘environmental health’ in the search results yielding to 19 hits. I carefully chose five relevant literatures (indicated in the reference section) for the paper in regard to their relevance to the clinical question at hand.
According to the literatures at hand, it is evident that the immediate physical and social environment around a patient has an impact on his well-being. Therefore, according to evidence based practice paradigm can imply that nurses and other health care providers have to incorporate the aspects of maintaining a viable environment around their patients to improve the quality of care provided. Zborowsky literature research indicates that nurses should be continuously engaged in research studies that facilitate the development of designed environments that aid in the healing of patients. The article maintains that the field is still lacking in this field as his statistics derived from 67 healthcare research articles from more than 20 nursing journals indicates that most practices tend to focus on progression of existing knowledge in care quality. Therefore, Zborowsky insists that education on Nightingale’s environmental theory should be encouraged to enhance knowledge development and that nurses are the best suited practitioners to assist in developing designed environments that will impact the healing process of patients (Zborowsky, 2014).
Hansen Ketchum, Marck and Reutter insist that interactions with nature have direct health benefits on patients. Their research is based on health research publications from as early as 1985. Their findings indicate that nurses and healthcare providers can utilize nature based health promotion concepts in their work to enhance reciprocal relationships in health promotion based on the interaction between humans and their environments (Hansen & Reutter, 2009). The data assumes that people who tend to interact with nature are more likely to engage themselves in physical activities and behaviors that improve their health. Additionally, these same individuals will be more active in protecting the health of the planet ensuring reciprocal benefits. Therefore, if nurses integrate the use of nature based health promotions then there will be beneficial aspects for both the humans and the environment. Tinker, Postma and Butterfield identify the various barriers and facilitators in environmental risk reduction. Therefore, the article already recognizes environmental health as a major component in nursing practice and quality of care. Through conducting one on one interviews with public health nurses, the article is able to come up with various challenges to environmental risk reduction (Tinker et al., 2010). These challenges include lack of training for nurses on environmental health, engaging the community and change in perception of relevance. Some facilitators include opportunities for building capacity, belief in imperativeness and personal interests. There conclusions depict the key to improving the practice is by providing adequate training and support for environmental risk reduction and that the nursing practice is in an excellent position to improve and facilitate the health of communities and families by incorporating the principles of environmental risk reduction into the nursing practice scope.
DeGuzman and Kulbok have a comprehensive publication on the aspects of nursing influence on built environments supplemented by the environmental theory by Florence Nightingale. The article depicts that nurses can have an impact on the health of communities by evaluating the environments they reside in and suggesting necessary changes. There is an urgent need for advancements in environment research in the nursing practice to ensure that nurses understand various ways of evaluating how built environments may be affecting patient’s health and test and come up with interventions (DeGuzman & Kulbok, 2012). Nurses are in a better place to provide insight into linking built environments with the well-being of patients and in turn providing evidence that may change the health prospects of even the healthy. Kangasniemi et al. insists that since nurses take the hugest share of healthcare staff they have an imperative role in addressing environmental health issues. Their findings indicate that the environmental issues awareness is leading to the utilization of more sustainable practices (Kangasniemi et al., 2014). Additionally, nurses are in the perfect position to develop and promote environmentally responsible healthcare since it will allow for the promotion of healthy environmental practices.
All these articles depict that there are varying relations between the environment, the nursing practice and provision of quality care. Nurses are in a position to promote the improvement of care quality by integrating environmental attributes into their practice. The articles provide evidence based researches that emphasize the fact that the environment is a crucial factor in the nursing practice and the provision of quality care. Additionally there is increased reference to Florence Nightingales environmental theory indicating that there is a need for continued knowledge development in this field. This calls for additional incorporation of environmental health in nursing programs and institutional support from all stakeholders.

Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. Health Environments Research & Design Journal, 7(4), 19–34.
DeGuzman, P. & Kulbok, P. (2012). Changing Health Outcomes of Vulnerable Populations Through Nursing’s Influence on Neighborhood Built Environment: A Framework for Nursing Research. Journal of Nursing Scholarship 44(4), 341-348.
Tinker, E., Postma, J. & Butterfield, P. (2010). Barriers and Facilitators in the Delivery of Environmental Risk Reduction by Public Health Nurses in the Home Setting. Journal of Public Health Nursing 28(1), 35-42
KANGASNIEMI, M., KALLIO, H. & PIETILA, A. (2014). Towards environmentally responsible nursing: a critical interpretive synthesis. Journal of Advanced
Nursing 70(7), 1465–1478. doi: 10.1111/jan.12347
HANSEN-KETCHUM P., MARCK P. & REUTTER L. (2009) Engaging with nature
to promote health: new directions for nursing research. Journal of Advance Nursing 65(7), 1527–1538 doi: 10.1111/j.1365-2648.2009.04989.x

please note assignment 3 is a continuation of assignment 2, I NEED TO UPLOAD THE ARTICLES,
The paper you did for assignment 3 does not follow or continue assignment 2.

assignment 3
Organization of healthcare delivery systems is important in the healthcare sector. There are different healthcare organization that seeks to promote their service to the patients and for this to be effective there needs to be a good plan (Burrit & Steckel, 2009). It is important to create themes that are related to be able to set a good organization for the healthcare delivery systems. Healthcare organizations need to integrate care models and performance in order to compile services across various disciplines and also to set care episodes for conditions such as cancer and diabetes.
There is the need to explore community-based care. This represents a different form of care delivery and it has its own merits and demerits. Community-based care includes community health programs and other characteristics of the neighborhood such as the environment and implications of public health (Burrit & Steckel, 2009). Is also includes the faith-based groups that are important in promoting care for the patients. Partnerships and interdisciplinary collaborations are also significant in the coordination of care. It helps to promote the extended functions of nurses and physicians who offer primary care. It also helps in uniting professionals from various departments who will collaborate and share ideas that leads to provision of evidence based care processes.
Provision of high quality care assists in improving the services offered to patients. High quality care can be improved by using new technologies to reach patients (Burrit & Steckel, 2009). Innovations such as e-consult can be able to help physicians and nurses to reach patients’ requests and needs without necessarily holding face to face conversations. This can encourage specialists to offer high quality healthcare at any time without many inconveniences.
Lastly, evaluation of performance and outcomes should also be done to determine the success of the system. This process requires an effective audit plan which includes the review of the organization’s performance. Operations that were less beneficial should be replaced with much improved ones. An in-depth survey should be done to the areas where a problem was identified to improve the care.
Assessing and evaluating a healthcare organization is important since it helps to provide improved care. Themes such as integrating care models, promoting community-based care, creating interdisciplinary collaborations, provision of high quality care and evaluating performance should be observed and adhered to. They help to promote and improve care.
Burrit, J., & Steckel, C. (2009). Supporting the learning curve for contemporary nursing practice. Journal of Nursing Administration, 39(11), 479–484.

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