10
EBP: EVIDENCE TO PRACTICE Evidence Into Practice: Publishing an Evidence-Based Practice Project Susan Adams, PhD, RN, Michele Farrington, BSN, RN, CPHON, Laura Cullen, MA, RN, FAAN THE FINAL AND perhaps most intimidating step in the evidence-based practice (EBP) process is dis- semination. Dissemination is critical as it is the method by which the body of nursing knowledge expands. An EBP project is not complete until the information learned and outcomes achieved are shared in a public forum, both internally and externally, whether via a poster presentation, oral presentation, journal article, or a combination of these methods. 1 Multiple benefits result from dissemination of EBP projects, not only for the nursing staff but also for former, current, and future patients. Participating in the dissemination process promotes professional growth and development as nurses write and speak about what they have learned and outcomes that have been achieved. Sharing EBP projects has the potential to improve patient safety and outcomes as other health care professionals learn about EBP changes being implemented in diverse settings and are stimulated to consider the need to imple- ment similar changes to impact their own practice. Little is known about what strategies work for imple- menting change with various topics in different set- tings and with different practitioners. Access to information on projects implemented in other insti- tutions may provide practitioners with ideas on how best to proceed and what potential land mines to avoid when implementing change in their own insti- tution or unit(s). And finally, sharing experiences with other nurses reduces duplication of effort as health care professionals across sites ask the same questions and search for evidence to guide their own clinical decision making. Building on the work of others when appropriate is especially pru- dent given the time and resource limitations present in the current health care environment. Published journal articles on EBP projects have the advantage of reaching a larger audience than most conference presentations and create a permanent resource for others to access, both nationally and internationally. However, many clinicians express anxiety at the overwhelming prospect of prepar- ing a manuscript for publication. This article pro- vides a systematic approach to write and publish an article, and hopefully will encourage first-time authors to submit an article for publication. Obtaining Approval There remains a great deal of confusion among clini- cians regarding related concepts such as conduct of research, research utilization, EBP, quality im- provement, quality management, quality assurance, and performance improvement, just to name a few. 2 The lack of clarity regarding what constitutes con- duct of research and use of research in practice, and subsequently, what actually needs to be ap- proved by an organizational oversight committee (commonly referred to as an Institutional Review Board or IRB), 3 can be a stumbling block for clini- cians. Although clinicians may understand who might need to approve a project to implement changes in practice on their unit, they may be less clear if, when, or by whom, approval should be Susan Adams, PhD, RN, Investigator, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System (152), Iowa City, IA; Michele Far- rington, BSN, RN, CPHON, Staff Nurse, Department of Nursing Services and Patient Care, University of Iowa Children’s Hos- pital, Iowa City, IA; and Laura Cullen, MA, RN, FAAN, Evidence-Based Practice Coordinator, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Conflict of interest: None to report. Address correspondence to Susan Adams, Comprehensive Access and Delivery Research and Evaluation (CADRE) Cen- ter, Iowa City VA Health Care System (152), 601 Highway 6 West, Iowa City, IA 52246-2208; e-mail address: susan- [email protected]. Ó 2012 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 doi:10.1016/j.jopan.2012.03.004 Journal of PeriAnesthesia Nursing, Vol 27, No 3 (June), 2012: pp 193-202 193

Evidence Into Practice: Publishing an Evidence-Based Practice Project

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EBP: EVIDENCE TO PRACTICE

Evidence Into Practice: Publishingan Evidence-Based Practice Project

Susan Adams, PhD, RN, Michele Farrington, BSN, RN, CPHON,

Laura Cullen, MA, RN, FAAN

THE FINAL AND perhaps most intimidating stepin the evidence-based practice (EBP) process is dis-

semination. Dissemination is critical as it is the

method by which the body of nursing knowledge

expands. An EBP project is not complete until

the information learned and outcomes achieved

are shared in a public forum, both internally and

externally, whether via a poster presentation,

oral presentation, journal article, or a combinationof these methods.1

Multiple benefits result from dissemination of EBP

projects, not only for the nursing staff but also for

former, current, and future patients. Participating

in the dissemination process promotes professional

growth and development as nurses write and speak

about what they have learned and outcomes thathave been achieved. Sharing EBP projects has the

potential to improve patient safety and outcomes

as other health care professionals learn about EBP

changes being implemented in diverse settings

and are stimulated to consider the need to imple-

ment similar changes to impact their own practice.

Little is knownaboutwhat strategieswork for imple-

Susan Adams, PhD, RN, Investigator, Comprehensive Access

and Delivery Research and Evaluation (CADRE) Center, Iowa

City VA Health Care System (152), Iowa City, IA; Michele Far-

rington, BSN, RN, CPHON, Staff Nurse, Department of Nursing

Services and Patient Care, University of Iowa Children’s Hos-

pital, Iowa City, IA; and Laura Cullen, MA, RN, FAAN,

Evidence-Based Practice Coordinator, Department of Nursing

Services and Patient Care, University of Iowa Hospitals and

Clinics, Iowa City, IA.

The views expressed in this article are those of the authors

and do not necessarily reflect the position or policy of the

Department of Veterans Affairs.

Conflict of interest: None to report.

Address correspondence to Susan Adams, Comprehensive

Access and Delivery Research and Evaluation (CADRE) Cen-

ter, Iowa City VA Health Care System (152), 601 Highway 6

West, Iowa City, IA 52246-2208; e-mail address: susan-

[email protected].

� 2012 by American Society of PeriAnesthesia Nurses

1089-9472/$36.00

doi:10.1016/j.jopan.2012.03.004

Journal of PeriAnesthesia Nursing, Vol 27, No 3 (June), 2012: pp 193-202

menting change with various topics in different set-tings and with different practitioners. Access to

information on projects implemented in other insti-

tutionsmayprovidepractitionerswith ideas onhow

best to proceed and what potential land mines to

avoidwhen implementing change in their own insti-

tution or unit(s). And finally, sharing experiences

with other nurses reduces duplication of effort as

health care professionals across sites ask the samequestions and search for evidence to guide their

own clinical decision making. Building on the

work of others when appropriate is especially pru-

dent given the time and resource limitations present

in the current health care environment.

Published journal articles on EBP projects have the

advantage of reaching a larger audience than mostconference presentations and create a permanent

resource for others to access, both nationally and

internationally. However, many clinicians express

anxiety at the overwhelming prospect of prepar-

ing a manuscript for publication. This article pro-

vides a systematic approach to write and publish

an article, and hopefully will encourage first-time

authors to submit an article for publication.

Obtaining Approval

There remains a great deal of confusion among clini-cians regarding related concepts such as conduct

of research, research utilization, EBP, quality im-

provement, quality management, quality assurance,

and performance improvement, just to name a few.2

The lack of clarity regarding what constitutes con-

duct of research and use of research in practice,

and subsequently, what actually needs to be ap-

proved by an organizational oversight committee(commonly referred to as an Institutional Review

Board or IRB),3 can be a stumbling block for clini-

cians. Although clinicians may understand who

might need to approve a project to implement

changes in practice on their unit, they may be less

clear if, when, or by whom, approval should be

193

194 ADAMS, FARRINGTON, AND CULLEN

obtained to submit an article for publication on

the same project. The confusion arises not just

among practicing nurses, but among researchers

and IRBs as well.4-10 According to the US

Department of Health and Human Services (2011),‘‘The intent to publish is an insufficient criterion

for determining whether a quality improvement

activity involves research. Planning to publish an

account of a quality improvement project does not

necessarily mean that the project fits the definition

of research; people seek to publish descriptions of

nonresearch activities for a variety of reasons, if

they believe others may be interested in learningabout those activities.’’11 Be sure to follow organiza-

tional policies regarding review and approval for

publication. The departments’ nursing research or

EBP committee should be able to provide guidance.

It is always recommended that before implementing

a practice change, the project director go to the

nursing committee that oversees EBP projects in

the organization. When publishing, this is anothertime to seek the counsel of this committee. EBP is

a form of quality improvement and is usually not

considered to be human subjects research.12 The

US Department of Health and Human Services,

Office for Human Research Protection, states that

if the purpose is to improve quality of patient care

andpatient or provider data are collected for clinical

or administrative purposes, it is not research.12

Wanting to publish an EBP project does not change

the requirements for IRB. However, some organiza-

tionsmaywantEBPprojects tohave adetermination

of human subjects research from the IRB prior to

publication. The nursing EBP committee and clini-

cal chair of the IRB can be helpful, as organizations

have differing policies.

If the EBP project director needs to seek determina-

tion of human subjects research by the IRB, follow

these tips. It is important to use correct terminology

to assist the committee in understanding the intent

and scope of the project. Remember, EBP projects

are not studies. Projects involve patients, not sub-

jects, and the intent is to align care for the specified

patient population with current best evidence toimprove patient outcomes. It can be helpful to use

quality improvement terms (eg, project director,

purpose, evaluation plan, etc.) and avoid using re-

search terminology (eg, study, sample, subjects,

and investigators). Plan ahead and limit evaluation

to essential data only and avoid collecting patient

identifiers or sensitive data when possible. The

goal of improving quality care and maintaining

confidentiality supports timely deidentification of

data after pre- and postgroup data analysis.

All organizations are different, and this precludesgiving specific instructions on this aspect of the

writing process. Approval, if needed, can be

obtained after implementation in most cases. The

approval process, although it may seem intimidat-

ing, should not discourage clinicians from sharing

the results of their projects, any more than it

should discourage clinicians from implementing

projects to improve patient outcomes. Seek assis-tance from a nursing leader who has been through

the process. Remember to keep copies of all meet-

ing minutes and recommendations from any com-

mittee or board that reviews the project for later

reference and contact information.

Before Writing Begins

Writing a manuscript for consideration in a profes-

sional journal can seem overwhelming when it has

not been done before, no matter what the educa-

tional and practice level of the nurse. However,

writing about a practice change does not have tobe done by just one person. Consider working

with the team who implemented and worked on

the practice change.

Ifmore than one personwill write themanuscript, it

is important to have a discussion regarding author-

ship at thebeginning to clarifywhowill be identified

as authors on the article and the order in which thenames will appear. This will help solidify account-

ability for writing, meeting deadlines, completing

the revisionprocess, andmost importantly, identifies

whowill be taking leadership of thewritingprocess.

And, if somemembers of the teamareunable tocom-

mit to writing the article or the team is too large,

thesemembersmay still be included in the acknowl-

edgment section available through most journals.

To organize the work, the author(s) must decide

on the major sections to be included. Working

on a draft of one section at a time makes the pro-

cess seem much more manageable. Authors can

work together on each section or individuals can

be assigned a section to complete and then the

overall style and content of the entire article canbe reviewed and revised by the lead author to en-

sure a congruent format. To decide on the sections

EVIDENCE-BASED PRACTICE PROJECT REPORTS 195

and format, it is helpful to take a close look at sev-

eral recent issues of the journal to which you

would like to submit the manuscript.

To select a journal, first reflect on who would bemost interested in hearing about your project

(eg, general practice nurses, specialty nurses, ad-

ministration, or physicians) and then consider

the journal audience or readership of a variety of

journals. This will ensure that the information

you will be sharing meets the needs of the audi-

ence whowill be reading the journal and increases

your chances of the manuscript being accepted forpublication. Having a journal in mind when begin-

ning the writing process also determines the

writing style required, which will eliminate refor-

matting work later in the process. The author

guidelines should then be obtained and followed

closely when dividing the work and writing.

At this time, there is no recognized standard formatfor presenting EBP projects for publication, and

many of the details will depend on the nature of

the project and the requirements of the specific

journal towhich you are submitting. It is not recom-

mended that EBP projects submitted for either

conference presentations or journal submission

be forced into a research format. For example, con-

ference submission guidelines for poster or oralpresentationsmay call for EBPprojects to be submit-

ted,but thenuse research terminologysuchas study,

subjects, and investigator in their suggestedheaders.

Even author guidelines and author reviewer guide-

lines may use research terminology, confusing nov-

ice and experienced authors and reviewers alike.

Research section headings canbematched to appro-

priate EBP section headings (Table 1). It is better touse the appropriate format and explain your choice

in a cover letter if necessary than to inaccurately de-

scribe the components of the project.

Table 1. Evidence-Based PracticeVersus Research Headings

EBP Headings Research Headings

Title/author/institution Title/author/institution

Purpose/rationale Research question or aim

Synthesis of evidence Background

Practice change Sample

Implementation Methods

Evaluation Results

Implications for practice Implications for practice

How to Start Writing

Some of the basic steps essential for manuscript

preparation include: keeping track of project work

electronically while the EBP project is being done,

arranging your schedule to create blocks of writing

time, having a designated place to work and think,

and beginning with an outline to help organize

your thoughts. Ifyouhavealreadywrittenasummary

of your project for other purposes, use it as a startingpoint for the article. This will jump start the writing

process and will help avoid having a blank sheet of

paper, which can be very discouraging.

It is helpful to ask a peer (or coauthor) to read the

manuscript early in the process to provide com-

ments and suggestions to keep your writing clear

and focused. It may also be to your advantage tohave a colleague who is unfamiliar with the project

read the article for clarity. This colleague will be

able to identify areas that are not clear far more eas-

ily than someone who is familiar with the project.

The following section highlights the main headings

that should be used for manuscript preparation

when reporting an EBP project. The Appendix con-tains sample directions from various journals and in-

cludes recommended articles that illustrate how to

write the specific manuscript section. It is

important to remember that many of the articles

have sections that are not in the recommended style,

for example, some use research terminology or do

not have the suggested headings. Unfortunately,

this is because there has been no standard formatfor reporting EBP work over the last several years.

We suggest accessing at least one article from each

section to get ideas on how to structure your own

manuscript, using the example to structure only

that piece of your manuscript. For example, in the

Appendix, we recommend reviewing an article by

Stebral & Steelman13 to see a well-written

description of a project that began with a problem-focused trigger.

Title

Deciding on a title for your article is an important

step. The title should be concise but it needs to pro-

vide enough information regarding the content to

be captured when an electronic search is donefor EBP work. Readers should get an idea of what

the article is about at a first and fast glance. It is

196 ADAMS, FARRINGTON, AND CULLEN

helpful if the title includes words that indicate the

patient population, the project focus (or topic), the

specialty, if applicable, and indication that it is an

EBP project. Use simple and straightforward lan-

guage. Examples of well-constructed titles include:

� Assessment of Oral Mucositis in Adult and Pe-

diatric Oncology Patients: An Evidence-Based

Approach14

� Double Gloving for Surgical Procedures: AnEBP Project13

� Implementation of an Evidence-Based Feed-

ing Protocol and Aspiration Risk Reduction

Algorithm15

� Listening to Bowel Sounds: An EBP Project16

Abstract

Almost all journals require that authors provide an

abstract. The abstract is important because it may

be the only part of the article people will see and

read. Readers often make a decision on whetheror not to acquire and read a full article based on

the information contained in the abstract. Depend-

ing on the journal you choose for submission, you

may be required to use a structured or an unstruc-

tured format for the article abstract. A structured

format would include specific headings that are

required or recommended; however, as men-

tioned earlier, it is important to be aware that head-ings typically used for research articles may not be

appropriate for an EBP project. Project informa-

tion should not be reported under inappropriate

subject headings just to meet the criteria listed in

the author guidelines. A cover letter may accom-

pany the manuscript when it is submitted for pub-

lication regarding why different subject headings

were used based on the desire to publish an EBPproject rather than a research study. Or, a query let-

ter or e-mail may be sent to the editor of the journal

you are considering before writing begins to see if

they will accept manuscripts that are not research

focused.

An abstract in an unstructured format does not have

specific headings that must be included. However,being familiar with headings used in structured

abstracts will enable you to write in a concise and

coherent format. Check the author guidelines for

the target journal for other details, such as word

count, font specifics, and spacing, just to name

a few. Most abstracts do not include citations.

Key Words

Journals may request that the author provide key

words, the exact number needed is journal specific.These are words that would be helpful in locating

your article during a database search. Try to include

themain clinical subject of the article, population of

interest, and indicate that thework is anEBPproject,

just as this same information is reflected in the title of

the article. Some journals require the use of Medical

Subject Headings (MeSH) when choosing key

words. These headings are part of a controlled vo-cabulary that standardizes search terms. Formore in-

formation on using the MeSH terms, visit http://

www.nlm.nih.gov/mesh/meshhome.html.

Body of the Article

If the body of the article is separated into sections ofthe EBP process, it is easier for the reader to follow

the project timeline and progression. The following

sections represent headers that reflect the various

steps in the EBP process.

Purpose/Rationale

In this section, youwillmake thecase forwhy itwas

important that you did this project. A good article

depicting the case for why a project was started af-

ter a problemwas recognizedon theunit is ‘‘Double

Gloving for Surgical Procedures: AnEvidence-BasedPractice Project.’’13 The authors identified the cur-

rent problem: ‘‘Needlestick and sharps injuries are

a serious hazard exposing health care workers to

bloodborne pathogens and deadly viruses’’ (p.

251). The authors then gave an assessment of the

current situation in the clinical practice area, the

operating room, in this case: ‘‘Between September

1, 2004 and August 31, 2005, there were 63 re-ported sharps injuries in the operating room, occur-

ringwhen thepersonwaswearing gloves’’ (p. 253).

Be clear on the purpose of the project. Do not

make the readers search for this, but rather use

the words ‘‘the purpose of this project.’’ This

can be placed before or after the rationale, but it

should be early in the article to give readers a frameof reference as they begin to read the article.

Synthesis of the Evidence

The article should include a synthesis of the evi-

dence indicating that the author(s) performed

EVIDENCE-BASED PRACTICE PROJECT REPORTS 197

a thorough literature search and evaluated the

available evidence before determining what the

practice change would look like. EBP projects usu-

ally evolve over many months, or years in some

cases, so it may be necessary to perform anotherliterature search when you get to the point of pub-

lication to make sure all of the latest evidence is in-

cluded. Citations must be included in this section,

and the format for the citations will be determined

by the author guidelines of the journal.

Practice Change

This section should include a concise description of

what changes were made based on the evidence

available, such as policy development, policy revi-

sions, or protocol development. Tables work well

to highlight the key concepts in this area. Informa-

tion should be clear in this section so that practi-

tioners at another institution could implement the

same practice change. This section should also in-clude a discussion of how and when the practice

change was piloted and a general description of

the unit(s), types of patients, hospital setting, etc.

Implementation Strategies

Information in this section of the manuscript

should include how practitioners on the unit orwithin the institution were made aware of the

practice change(s) and what strategies were used

to facilitate the change.17 For example, were edu-

cation sessions held, and if so, how were they con-

ducted? Were change champions or opinion

leaders used to assist in rolling out the change or

for problem solving? Were reminders, practice

prompts, new documentation, logos, or sloganscreated? Be specific regarding any barriers that

arose, and how they were overcome.

Evaluation

Implementation of all EBP projects needs to include

how theprojectwas evaluated, both before and after

the practice change occurred. Evaluation compo-nents may include staff questionnaires assessing

knowledge, attitudes, and practices18; patient ques-

tionnaires; electronic health record data; core mea-

sures from publicly reported data (eg, Hospital

Consumer Assessment of Healthcare Providers and

Systems scores)19; and measures reported for value-

based purchasing.20,21 Evaluation of an EBP project

does not require an intense statistical analysis of

the data; the impact of the project can be shared

through the use of mean scores and percentages

depending on the type of data gathered for the

project. Use of these simple descriptive statisticscan facilitate interpretation and trending of data22

for integration of the practice change.

Implications for Practice

Readers want to know what the practice change

means and how it will impact future patients. For

example, will there be financial savings for the in-

stitution; increased patient safety; improved nurse,

patient, or family satisfaction; or ability for the pro-

ject to impact other patient populations? This sec-tion may also include a discussion regarding next

steps, such as continued audits for assessment of

compliance with the practice change. This section

provides the rationale for other practitioners to

consider doing a similar EBP project, as well as

making the case to the journal reviewer on why

it is important for this EBP project to be published.

Conclusion

The end of the article should include a conclusion

section that will tie everything together for the

reader. It is important to again highlight why the

project was initiated and what impact has been

shown to date.

Tables/Figures

Depending on the type of EBP project conducted,

tables and figures may be used within the narrative

portion of the manuscript to highlight some of thekey practice changes, select information from a pol-

icy that was created, an algorithm developed, or

project timeline. Provide information in the format

of a table or figure that you think the readerwill find

helpful when attempting this project in their own

institution or clinical practice area.When preparing

the manuscript, the tables and figures should be

placed on separate pages after the reference sectionor as directed by the author guidelines of the jour-

nal. After the manuscript is accepted for publica-

tion, the article will be laid out by the copy

editors for review by the author before publication,

and at this time, the tables and figureswill be placed

with the corresponding text.

198 ADAMS, FARRINGTON, AND CULLEN

References

Themanuscript is not complete until the references

have been included. All evidence previously pub-lished that is referenced within the narrative (or

text) portion of the articlemust beplaced on the ref-

erence list at the end of the article. It is important to

read the instructions from the target journal toknow

how to format your references. Each journal has its

own preferred method, and there are many online

resources tohelp format references invarious styles.

If you write articles frequently, there are also pro-grams available that format citations automatically,

for example, RefWorks or EndNote. Your institution

may provide secretarial assistance to format or sub-

mit an article. It is very important that your refer-

ences are cited completely and correctly.

Journal reviewers do pay attention to details. Ref-

erence sections that are well done make the man-uscript appear more professional and suggest that

you have paid close attention to detail. Tables and

figures, if not your original work, must be refer-

enced, and permission for their use in your article

must be obtained from the original journal or pub-

lication. The journal to which you are submitting

the article will most likely need some type of con-

firmation that this permission was obtained.

Final Steps

The next step is, of course, submitting the manu-

script to the journal you have chosen. Be very care-ful to have several people proofread the article.

Spelling errors or typographical errors will nega-

tively impact your chances of receiving a good re-

view. You do not want the reviewers distracted

from the content of your article. Follow the direc-

tions for submission carefully, then sit back andwait. The wait can vary, but it is often several

months before you hear anything from the journal.

Most manuscripts, even if accepted, will need

revisions before the final article is published.

Follow the suggested revisions carefully. If you dis-

agree or cannot make a suggested change, politely

let the editor know your reasoning in a cover letterthat accompanies the revised manuscript. Most ed-

itors are open to this if you explain your reasoning.

If your article is rejected, look carefully at the re-

viewer critiques and decide if you can revise

your article tomake it stronger. If so, consider a sec-

ond journal you would like to submit the article to,

revise it, and send it in. Another journal may bea better fit, and your revised article will be stronger

as a result of the comments from the first journal.

By following the steps in this article, you have

a very good chance of seeing your article in print

and having the satisfaction of knowing that other

practitioners and patients will be able to benefit

from your hard work.

Acknowledgment

The authors would like to thank Kim Jordan for her assistance

with the manuscript preparation.

References

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inpatient value-based purchasing program. Final rule. Fed

Regist. 2011;76:26490-26547.

21. Agency for Healthcare Research and Quality. Evaluating

the Impact of Value-Based Purchasing: A Guide for Pur-

chasers. Rockville, MD: Agency for Healthcare Research and

Quality, AHRQ Publication No. 02–0029; 2002.

22. Carey R, Lloyd R. Measuring Quality Improvement in

Healthcare: A Guide to Statistical Process Control Applica-

tions. Milwaukee, WI: ASQ Quality Press; 2001.

23. Farrington M, Lang S, Cullen L, Stewart S. Nasogastric

tube placement verification in pediatric and neonatal patients.

Pediatr Nurs. 2009;35:17-24.

24. Cullen L, Titler MG. Promoting evidence-base practice:

An internship for staff nurses. Worldviews Evid Based Nurs.

2004;1:215-223.

25. HydenR, FieldsW. Improving the acutemyocardial infarc-

tion rapid rule out process. J Nurs Care Qual. 2010;25:313-319.

26. Hanrahan KS, LofgrenM. Evidence-based practice: Exam-

ining the risk of toys in the microenvironment of infants in the

neonatal intensive care unit. Adv Neonatal Care. 2004;4:

184-201. quiz 202–205.

27. Van Waning NR, Kleiber C, Freyenberger B. Develop-

ment and implementation of a protocol for transfers out of

the pediatric intensive care unit.Crit Care Nurs. 2005;25:50-55.

28. Yackel EE, McKennan MS, Fox-Deise A. A nurse-

facilitated depression screening program in an army primary

care clinic: An evidence-based practice. Nurs Res. 2010;59:

S58-S65.

Appendix. Tips and Examples

Manuscript Sections Practical Tips Direction Examples Article Examples

Title � Include patient population, project focus or

topic, specialty (if applicable), and indication

of an EBP project

Bowman et al15 (2005)

Farrington et al14 (2010)

Madsen et al16 (2005)

Stebral and Steelman13 (2006)

Abstract � Clear and concise

� Engage readers so they will obtain the entire

article

� Journal of Nursing Care Quality (unstruc-

tured abstract): ‘‘Include an abstract of 50 to

75 words that stimulates readers’ interest in

the topic and states what they will learn from

reading the article.’’

� Worldviews on Evidence-Based Nursing

(structured abstract): ‘‘Manuscripts should

include a structured abstract of up to 300

words. The following headings could be used

when appropriate: background and/or

rationale; aims; methods; results/findings;

discussion; implication(s) for practice,

research, policy, management, and/or

education (depending on the focus of the

manuscript); and conclusions. Where

manuscripts are theoretical or debate pieces,

a structured abstract should still be used but

headings adapted accordingly.’’

Unstructured example:

Farrington et al23 (2009)

Structured example:

https://www.uihealthcare.org/

otherservices.aspx?id523011

Key words � Include subject of the article, population of

interest, and indicate EBP project

� Pediatrics: ‘‘Authors should provide keywords

on the title page and use Medical Subject

Headings (MeSH) terms as a guide. Visit: http://

www.nlm.nih.gov/mesh/meshhome.html’’

Cullen and Titler24 (2004)

Purpose and rationale � The purpose of this project was to (imple-

ment, improve, reduce, and so on)

� Do not be too broad

Farrington et al23 (2009)

Hyden and Fields25 (2010)

200

ADAMS,

FARRIN

GTON,AND

CULLEN

Synthesis of evidence � Include databases used/key words, number

of references located, number of articles

used, and were there any existing practice

recommendations or guidelines; if not,

summarize the evidence with your own

recommendations/practice changes based

on synthesis of the research

Hanrahan and Lofgren26 (2004)

Madsen et al16 (2005)

Stebral and Steelman13 (2006)

Practice change � Context (eg, type of unit/hospital)

� Stakeholders, team, clinicians, providers,

and so on

� Policy/protocol development/revision

� Piloting the intervention

� Adjustments made as a result of the pilot

Practice change:

Farrington et al23 (2009)

Van Waning et al27 (2005)

Yackel et al28 (2010)

Policy change:

Madsen et al16 (2005)

Piloting:

Stebral and Steelman13 (2006)

Implementation strategies � Education

� Change champions or opinion leaders

� Logos/slogans

� Reminders

� Audit and feedback

� Practice prompts

� Documentation changes

Hyden and Fields25 (2010)

Van Waning et al27 (2005)

Evaluation � Pre- and postimplementation metrics and

results

� Data analysis

� Discussion

Farrington et al23 (2009)

Yackel et al28 (2010)

Implications for practice � What does this project mean for the unit

and/or hospital?

� What are some of the next steps for moving

the project forward or sustaining the project?

Implications for practice:

Madsen et al16 (2005)

Next steps:

Farrington et al23 (2009)

Conclusion � Tie themain points of the article together and

reemphasize why the project was completed

and the impact shown

Bowman et al15 (2005)

(Continued)

EVID

ENCE-BASED

PRACTICE

PROJECT

REPORTS

201

Appendix. Continued

Manuscript Sections Practical Tips Direction Examples Article Examples

Tables and figures � The use, format, and placement of tables or

figures will be dictated by the journal to

which you are submitting the article

� American Journal of Nursing (AJN): ‘‘We

.encourage the use of diagrams, tables,

charts, illustrations, and photos.authors

should include these as attachments, as op-

posed to placing them in the body of the text.’’

� Worldviews on Evidence-Based Nursing:

‘‘Tables should be self-explanatory, and the

data they contain must not be duplicated in

the text or figures. Tables and figures should

be embedded in the text of the manuscript.’’

� Journal of Pediatric Oncology Nursing:

‘‘Each table should be typed on a separate

sheet at the end of the manuscript file. The

author should provide table titles on the same

sheet as the table.’’

Bowman et al15 (2005)

References � References begin on a separate page from

the text

� The format of the references and location

(before or after tables or figures) depends

on the specific journal

� If no recommended style of references or

citations is given, the author may choose

� Worldviews on Evidence-based Nursing:

‘‘References within the text should cite the

author’s name followed by the date of

publication, in chronological order.. Where

there are three or more authors, the first

author’s name followed by et al will suffice.but all authors should be cited in the

reference list.’’

� Pediatrics: ‘‘All aspects of the manuscript

(tables, illustrations, and references) should

be prepared according to the International

Committee of Medical Journal Editors re-

quirements. Citations should be numbered in

the order in which they appear in the

text.Reference style should follow that of

the AMA Manual of Style, 10th edition.

Abbreviated journal names should reflect the

style of Index Medicus.’’

Bowman et al15 (2005)

Farrington et al23 (2009)

Madsen et al16 (2005)

Stebral and Steelman13 (2006)

202

ADAMS,

FARRIN

GTON,AND

CULLEN