Determining the Credibility of Evidence and Resources Essay

Determining the Credibility of Evidence and Resources Essay

To guarantee that the information you are using is trustworthy and accurate and to help you make informed decisions, it is crucial to critically assess the evidence and resources’ reliability. My safety issue from assignment 1 was sepsis diagnosis. Early diagnosis of sepsis can promote better treatment outcomes. This paper aims to describe this safety issue, propose evidence-based criteria that would be used to assess the credibility of evidence sources, assess the credibility of chosen sources, and use an evidence-based model to justify the importance of incorporating credible evidence into the model.

Safety Issue

A new nurse has been hired to work in a medical-surgical unit of a healthcare facility and has been assigned to care for a patient with sepsis on their first day. The patient is experiencing borderline low blood pressure, slightly elevated heart rate, and confusion. The nurse is unsure how to proceed due to a lack of knowledge and experience with managing sepsis and limited time to perform a full physical examination. In this situation, it is important for the nurse to seek guidance and support from the unit’s nurse manager or other experienced nurses, utilize available resources such as computers and internet access to research appropriate protocols and nursing diagnoses, and communicate with the healthcare team to ensure that the patient’s condition is being closely monitored and necessary interventions are implemented. The nurse should also continue to educate themselves on sepsis management and seek out additional support as needed because it would improve her anxiety and EBP knowledge and skill competencies (Larsen et al., 2019). To make an accurate diagnosis and plan evinced based interventions for this patient, the nurse would rely on evidence-based practice to seek evidence-based information in this case.

Criteria for Determining the Credibility of the Sources

Various criteria have been used to determine the trustworthiness of online bases sources of information, but there is no conventional method that has been set to achieve a uniform assessment of credibility. Various models, such as the CRAAP model, have been used to assess source credibility. This model has its benefits and drawbacks. Various alternatives have been in various settings to teach EBP and promote the use of credible sources. The CCOW model is one alternative to the CRAAP model that would be easy and efficient in determining the credibility of sources in finding evidence for making clinical decisions by the nurse in the above scenario. According to Tardiff (2022), the CCOW model is a criterion that encourages an investigative approach to appraising the sources and thus offers a convenient way to ensure that trainees and practitioners use trustworthy sources. CCOW model is an acronym for credentials, claims, objectives, and worldview.

This criterion requires that firstly the user assess whether the source was published by an expert or reputable organization in the relevant field. The user then assesses whether the claims are accurate or unreliable. Thirdly, the user of the information assesses the objectives to assess whether the information was intended at informing, convincing, or selling ideas to the user (Tardiff, 2022). Lastly, the worldview criterion promotes the user of the information to assess whether the information is biased or neutral so that the decision they make using it would not harm the patient. An example of using this criterion is when searching for a piece of information on the internet. The user will need to decide if the website is from a reputable organization or just a blog if the information was meant for medical reasons and thus purposeful, and if the information contained conforms with worldviews or is age-old.

Sources

The following sources will provide evidence-based information to make an early diagnosis of sepsis and improve patient safety and care quality. The sources have been annotated and their credibility assessed.

American Association of Critical-Care Nurses. (n.d.). Sepsis Guidelines for Nurses – AACN. Aacn.org. Retrieved January 3, 2023, from https://www.aacn.org/clinical-resources/sepsis

This is a credible source because it was published by the American Association of Critical-Care Nurses, an organization of experts in nursing and critical care. This source was published to educate nurses on the best guidelines to follow when diagnosing and treating a patient with sepsis. The information contained in this area represents reviewed information from various studies and research evidence from more than one study.

Husabø, G., Nilsen, R. M., Flaatten, H., Solligård, E., Frich, J. C., Bondevik, G. T., Braut, G. S., Walshe, K., Harthug, S., & Hovlid, E. (2020). Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study. PloS One, 15(1), e0227652. https://doi.org/10.1371/journal.pone.0227652

Husabø and colleagues are health experts in various medical and nursing fields in hospitals in Norway. Their study aimed to establish associations between diagnostic procedures, time to treatment, and mortality outcomes. The findings of this study are defended by statistical analyses. Therefore, this source is credible per the CCOW model.

Kim, H. I., & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6–14. https://doi.org/10.4046/trd.2018.0041

Kim and Park are also experts in critical care. In their review article, they have provided an in-depth discussion on screening for sepsis, the most current definitions, evidence-based medical and nursing interventions, and efforts to decrease mortality. The claims in this article are research evidence-based and reflect key worldviews in sepsis treatment. The purpose of this article was to educate nurses and other healthcare professionals on the current best treatment strategies and the need for early diagnosis.

In the above three sources, the first and the last source are more credible because they are authoritative, current, purposeful, and represent valid worldviews per the CCOW criteria. However, the first source (American Association of Critical-Care Nurses., n.d.) remains the most credible; the authors are reputable critical care experts and nurses, to be specific. The website contains information that is regularly updated to keep nurses with the best evidence-based interventions for sepsis diagnosis and treatment.

Evidence-based Practice Model

The above evidence-based practice has been based on Stetler’s model. This is an EBP model best for individual-level evaluation clinical practice. The emphasis of this model is at the level of the individual nurse thus, it is appropriate for the safety issue described earlier.  The six steps of Stetler’s model, preparation, validation, comparative evaluation, decision-making, application, and evaluation, have been considered. The first three steps have been completed regarding the safety issue of sepsis. It is important to incorporate credible evidence into Stetler’s model because the quality of the terminal stages, decision-making and evaluation, relies on the quality of this information. Also, this will ensure that the interventions made by the nurse in treating sepsis are the best available in the current practice. The risk of harmful or less effective interventions will be lower because the effectiveness and efficacy are evaluated by credible sources that meet the credibility criteria.

Conclusion

To improve patient care, the nurse should seek guidance from experienced colleagues, utilize available resources to research appropriate protocols and nursing diagnoses, and communicate with the healthcare team to monitor the patient’s condition closely. The CCOW model (credentials, claims, objectives, worldview) can be used to determine the credibility of evidence sources. This model requires the user to assess the source’s expert credentials, the accuracy of the claims made, the objectives of the information, and whether the information is biased or neutral. The selected sources for this safety issue include guidelines from the Centers for Disease Control and Prevention and the World Health Organization, as well as research articles from reputable journals. Using credible evidence in Stetler’s model helps to ensure the effectiveness of interventions and practices, minimize the risk of implementing ineffective or harmful interventions, and improve the efficiency of the healthcare system.

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References

American Association of Critical-Care Nurses. (n.d.). Sepsis Guidelines for Nurses – AACN. Aacn.org. Retrieved January 6, 2023, from https://www.aacn.org/clinical-resources/sepsis

Husabø, G., Nilsen, R. M., Flaatten, H., Solligård, E., Frich, J. C., Bondevik, G. T., Braut, G. S., Walshe, K., Harthug, S., & Hovlid, E. (2020). Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study. PloS One, 15(1), e0227652. https://doi.org/10.1371/journal.pone.0227652

Kim, H. I., & Park, S. (2019). Sepsis: Early recognition and optimized treatment. Tuberculosis and Respiratory Diseases, 82(1), 6–14. https://doi.org/10.4046/trd.2018.0041

Larsen, C. M., Terkelsen, A. S., Carlsen, A.-M. F., & Kristensen, H. K. (2019). Methods for teaching evidence-based practice: a scoping review. BMC Medical Education, 19(1), 259. https://doi.org/10.1186/s12909-019-1681-0

Tardiff, A. B. (2022). Have a CCOW: A CRAAP alternative for the internet age. Journal of Information Literacy, 16(1), 119. https://doi.org/10.11645/16.1.3092

Evidence-Based Practice in Nursing

Foundations, Skills, and Roles

Appendix: Evidence-Based Practice Models

Nurses and other healthcare professionals have developed several evidence-based practice (EBP) models that aid in the implementation of EBP. These models serve as organizing guides that integrate the most current research to create best patient care practices. In addition to helping nurses integrate credible evidence into practice, EBP models help assure complete implementation of EBP projects and optimize the use of nurses’ time and healthcare resources. No single EBP model can meet the needs of every organization and every patient situation. Therefore, we are providing model definitions, essential steps, salient points, and information resources for the models to help readers identify the EBP model that best fits their current, specific EBP needs.

 

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Model Definition	Essential Steps	Salient Points to Consider
Iowa Model of EBP (Titler et al., 2001). The Iowa Model focuses on the entire healthcare system (e.g., patient, practitioner, infrastructure) to implement and	1.  Identify either a “problem- focused trigger” or “knowledge-focused trigger” that will generate the need for a practice change. 2.  Determine whether the “trigger” is a healthcare organization priority.	•     Recommended for use at organizational systems level •     Uses pragmatic problem-solving approach to EBP implementation •     Detailed flowchart (see Chapter 1 1) guides decision-making process •     Clearly identified decision points and feedback loops throughout the model •     Emphasizes necessity of pilot project before initiating system-wide project •     Designed for interprofessional collaboration •     Has sustained test of time
guide practice decisions based on best available research and evidence.	3. Reflect a team’s topic of interest and include interested stakeholders. The team will search, appraise, and synthesize literature related to
	the topic.
	4. Evaluate the availability and merit (e.g., level of evidence, quality of evidence) of evidence. If evidence availability and merit are lacking, conduct research.
	5. If credible and reliable evidence is available, pilot the practice change.
	6. Appraise pilot for level of success. If pilot is successful, disseminate findings within the organization and implement recommended change into practice.

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Model Definition Essential Steps Salient Points to Consider   Stetler Model (Ciliska et al., 201 1; Steps in this model are referred to as phases. •     Designed to encourage critical thinking about the integration of research findings •     Promotes use of best evidence as an ongoing practice •     Helps lessen errors in critical decision-making activity •     Allows for categorization of evidence as external (e.g., research) or internal (e.g., organization outcome data) •     Emphasizes use by single practitioner but may include groups of practitioners or other stakeholders p 3s Stetler, 2001). The     Stetler Model Phase I. Preparation: Identify a   enables practitioners priority need. Identify the purpose   to assess how of the EBP project, context in which   research findings the project will occur, and relevant   and other pertinent sources of evidence.   evidence are     implemented in Phase II. la//dar/on:Assess sources   clinical practice. The of evidence for level and overall   model examines how quality. Determine whether source   to use evidence to has merit and goodness of fit and   create change that whether to accept or reject the   fosters patient- evidence in relation to project   centered care. purpose.     Phase III. Comparative     Evaluation/Decision Making:     Evidence findings are logically     summarized and similarities and     differences among sources of     evidence are evaluated. Determine     whether it is acceptable and     feasible to apply summation of     findings to practice.     Phase IV. Translation7Application.’     Develop the “how to’s” for     implementation of summarized     findings. Identify practice     implications that justify application     of findings for change.

expected outcomes of the project

and determine whether the goals of EBP were successfully achieved.

 

	Essential Steps		Salient Points to Consider
(Graham & Logan, 2004 Graham et al., 2006). The Ottawa Model is an interactive model that depicts research as a dynamic process of interconnected decisions made and actions taken by stakeholders.	The model is composed of three phases: (a) Assess barriers and supports. (b) Monitor intervention and extent of use. (c) Evaluate outcomes. Subsumed under the three phases are six designated primary elements that must be considered when integrating research into practice: I. Assess barriers and supports: 1. Evidence-based innovation: Clearly identify what the innovation is and what the implementation will involve.		•     Patients are central to the model’s process and their health outcomes are the primary focus. •     The model focuses on the unit-level environment instead of the entire healthcare organization. •     The prescriptive aim of the model is to assess, monitor, and evaluate.
	2. Potential adopters: Identify potential adopters with characteristics that could influence the adoption of the innovation (see Rogers’ Change Theory in Chapter 7).
	3. The practice environment: Identify leaders, formal and informal, who can inspire change. Assess environment for needed resources.				35
	II. Monitor intervention and extent of use:
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Model Definition	Essential Steps	Salient Points to Consider
	implementation and provide necessary education and training for conducting the implementation. 2. Adoption of innovation: Determine the extent of adoption of implementation. III. Evaluate outcomes: 1. Evaluate the impact of innovation on patients, practitioners, stakeholders, and healthcare organization.

 

 

Model Definition	Essential Steps	Salient Points to Consider
Promoting Action on Research Implementation in Health Services (PARiHS) Framework (Rycroft-Malone, 2004). The PARiHS Framework provides a method to implement research into practice by exploring the interactions among three key elements: (a) evidence, (b) context, and (c) facilitation.	1.  Evidence: Search for and identify the best available evidence from research, clinician experience, patient values, organization data, and information. 2.  Context: This is the local environment where the practice change will occur. Adoption of practice change is dependent on contextual features such as organizational culture and level of acceptance, leadership investment, and evaluation of desired outcomes. 3.  Facilitation: Organizational participants use their knowledge and skills to foster implementation of practice change.	•     Explicitly uses facilitation as a factor impacting integration of research findings into practice •     Does not address generation of new knowledge •     Focus is on unit settings more than system-wide environment •     Codified (e.g., research data) and noncodified (e.g., practitioner experience) sources of evidence used

 

Model Definition Essential Steps Salient Points to Consider   ACE (Academic Center for Evidence-Based Practice) Star Model of Knowledge Transformation (Kring, 2008; Stevens, 2004). As a framework, the ACE Star Model aids in systematically integrating best evidence into practice. The model has five major stages that depict forms of knowledge in relative sequence. Research moves through the cycles to combine with other forms of knowledge before integration into practice occurs. Five Stages: 1.  Discovery: This stage involves searching for new knowledge found in traditional quantitative and qualitative methodologies. 2.  Evidence Summary: The primary task is to synthesize the body of research knowledge into a meaningful statement of evidence for a given topic. This is a knowledge-generating stage, which occurs simultaneously with new findings that may arise from the synthesis. 3.  Translation: The aim of translation is to provide clinicians with a practice document (e.g., clinical practice guideline) derived from the synthesis and summation of research findings. •     Focus on promoting use of EBP for direct care nurses •      Includes use of qualitative evidence •     Primary goal of model is knowledge transformation •     Does not incorporate nonresearch evidence (patient values, practitioner’s experience) •      Identifies factors that impact adoption of innovation   35   4. Integration: Practitioner and healthcare organization practices are changed through formal and informal channels.       5. Evaluation: An array of EBP outcomes are evaluated on

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impact, qua ity, and

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Model Definition	Essential Steps	Salient Points to Consider
Advancing Research and Clinical Practice Through Close Collaboration (ARCC) (Melnyk & Fineout-Overholt, 2015).	1.  Assess the healthcare organization for readiness for change and implantation of EBP project. 2.  Identify potential and actual barriers to and facilitators of EBP project. 3.  Identify EBP champions to work with direct care nurses or specific clinical units. 4.  Implement evidence into practice. 5.  Evaluate EBP outcomes.	•     Promotes use of EBP among advanced practice nurses and direct care nurses •     Identifies a network of stakeholders who are supportive of the EBP FO eCt ’     j •     Cognitive behavioral theory underpinnings •      Emphasis on healthcare organizational readiness and identification of facilities and barriers •     Encompasses research, patient values, and clinical expertise as evidence.

 

 

Model Definition Essential Steps Salient Points to Consider johns Hopkins Nursing Evidence- Based Practice Model gHNEBP) (Newhouse, Dearholt, Poe, Pugh, & White, 2007). The jHNEBP Model applies a problem- solving approach to clinical decision making. The model is designed to meet the EBP needs of direct care nurses using an uncomplicated three-step process referred to as PET: (a)  Practice Question, (b)  Evidence, and (c) Translation. 1.  Practice Question: Using a team approach, the EBP question is identified. 2.  Evidence: The team searches, appraises, rates the strength of evidence, describes quality of evidence, and makes a practice recommendation on the strength of evidence. 3.  Translation: In this stage, feasibility is determined, an action plan is created, and change is implemented and evaluated. Findings are presented to the healthcare organization and broader nursing community. •     Emphasizes individual use •     Well-developed tool kit that provides nurses with guide for question development, evidence-rating scale, and appraisal guide for various forms of evidence

35

 

Model Definition	Essential Steps	Salient Points to Consider
Knowledge-to- Action (KTA) Process Framework (Graham et al., 2006). The KTA is a model of knowledge creation and knowledge integration.	Phases: 1.  Identify problems that need to be addressed and begin searching for evidence and research about the identified problem. 2.  Adapt the knowledge use to a local context. 3.  Identify barriers to use of knowledge. 4.  Select, adapt, and implement interventions.	•     Adapts well for use with individuals, teams, and healthcare organizations •     Is grounded in planned action theory, which makes the model adaptable to a variety of settings •     Breaks knowledge-to- action process into manageable sections.
	5. Monitor the use of implanted knowledge.
	6. Evaluate outcomes related to knowledge use.
	7. Sustain appropriate knowledge use.

 

REFERENCES

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