You are a NP in a leadership role on an Inpatient Adult/Gero psychiatric unit.  In the past 4 months you have noticed a pattern of elderly female patients falling and injuring themselves in the middle of the night.  Using the 3 major components of Evidence Based Practice (Melnyk & Fineout-Overholt, 2011, page 4 figure 1.1)  Discuss the following in relation to your decision to make a practice change on the Unit:
  1. Identify the best type of evidence to use to solve this patient care issue
  2. Name the level of the evidence,
  3. Briefly discuss Why you would use that particular type of Research Evidence.
  4. Name and describe how you would use the other 2 Components essential for Evidence-based   Clinical decision making and describe what changes you might institute on this unit.
example of how the answer should look:
I am a PMHNP in a leadership role on an inpatient adult/gero psychiatric unit.  In the past four months I have noticed a pattern of elderly female patients falling and injuring themselves in the middle of the night.  This is unacceptable.  My goal is to improve the falls rate on the unit and to accomplish this I will utilize evidenced based practice (EBP).  Evidenced based practice is 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 (Melnyk et al., 2010). Evidenced based practice is aimed at hardwiring current knowledge into common care decisions to improve care processes and patient outcomes and holds great promise for producing the intended health outcome (Stevens, 2013).
The first step in integrating the best evidence and the patient data is to search for the best evidence (Fineout-Overholt et al., 2010). The search for evidence to inform clinical practice is tremendously streamlined when questions are asked in PICOT format.  Inquiries in this format take into account the patient population of interest (P), intervention or area of interest (I), comparison intervention or group (C), outcome (O), and time (T). Once articles are selected for review, they must be rapidly appraised to determine which are most relevant, valid, reliable, and applicable to the clinical question. Rapid critical appraisal uses three important questions to evaluate a study’s worth: 1) are the results of the study valid (level of evidence),  2) what are the results and are they important (how well was the study conducted), and 3) will the results help me care for my patients (how useful it is to practice)?

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