The following outline follows the 7 steps of EBP and serves as the expected sections for each DNP student’s final project. Please note the entire project once completed should range from 20-30 pages at the maximum plus references and appendices.
Section 1a: Problem Identification (EBP Step 0 – Cultivate a spirit of inquiry)
|Statement of the Problem/Issue||Provide concise statement identifying the problem/issue, why this problem/issue is important to address, and how this aligns with the strategic priorities of the organization where the project will be executed. Include specific information such as:
|Organizational assessment of the problem/issue||Discuss the current impact of the issue on the organization, setting and/or population.
Provide internal evidence such as:
· Quality data to support the problem/issue exists within a given organization, setting and/or population
· Current policies and/or practices around the issue
· Financial impact of the current state
· Anecdotal reports related to the problem/issue
· Data already being collected within the organization around this problem issue
· Identify who owns that data
· Identify process for accessing that data
· Identify existing processes for practice change and approvals needed within the organization/setting
|Section 1b: PICOT (EBP Step 1 – Ask clinical questions in PICOT format)|
|Background and significance of the problem/issue
PICOT (Problem/population; intervention of concern; comparison treatment or group, outcomes, and timeframe (if applicable)
|Summarize what the literature says about the history and state of the problem/issue.
Identify the significance and how it relates to the given organization, setting, and/or population.
PICOT question— Provide searchable question in PICOT format, highlighting the key words within the sentence. (utilize PICOT templates in existing resources such as the Melnyk & Fineout-Overholt 4th ed textbook)
|Section 1c: Search Strategy (EBP Step 2 – Search for the best evidence)|
|Search Strategy||Outline sources of literature (electronic databases utilized, sources where clinical practice guidelines are housed, point-of-care resources (i.e. Clinical Key and Up-To-Date), gray literature, etc.)
Search strategies used (key words, MeSH, Subject heading, title searching, etc.)
· Modified PRISMA diagram to identify and map out their search history
|Section 1d: Critical Appraisal of the Literature (EBP Step 3 – Critically appraise the evidence)|
|Critical appraisal methodology
|Identify the levels of evidence hierarchy used to evaluate the literature within the body of evidence
Identify critical appraisal tools used to appraise the evidence (i.e. Hopkins, Joanna Briggs Institute, Fuld Institute critical appraisal tools, etc.)
|Narrative of the appraisal and synthesis of the body of literature (keeper studies)
Narrative should include:
· Written description of the characteristics of the body of evidence, (e.g. number of articles at various levels and quality ratings)
· A synthesis of findings with references to the following tables that should be included as appendices:
|Recommendations||Based on both internal and external evidence, state the recommended practice change (if a change is indicated).
If organization is already engaging best practices according to the literature, then identify best practice is already in place.
|NOTE: If the organization is already engaging in best practice, then utilize QI processes/methodologies to evaluate processes and structures around engagement of best practice to explore whether processes and structures are preventing attainment of best outcomes.|
|Section 2: Project Planning (EBP Step 4 – Integrate the evidence with clinical expertise and patient preferences and values)|
|State purpose of project (one to two sentences)
State intended, realistic goals/outcomes of project using established method (e.g. SMART* criteria (Specific, Measurable, Attainable, Relevant, Timely).
|Framework||Identify framework/model and strategies to guide implementation based on findings from organizational assessment with rationale (e.g. EBP model, QI framework, Implementation model/strategies, Change model)
NOTE: use models/strategies already being utilized by the organization (when and where applicable). Graphics of the model(s) utilized may be included.
|Context||Describe project participants or population, setting, and any other elements that are central to where the change will such as current organizational climate, readiness for change, leadership support/engagement, administrative support, access to needed resources, etc.)|
|Identify agencies, departments, committees, units, and/or individuals needed to complete the project and/or affected by project, and strategies to gain buy-in and sustainability.
Describe plan for involving patient/family engagement and preferences (if applicable)
Practice change process
|Consider clinician experiences and necessary education/training clinicians will need
Describe what implementation strategies (aligned with EBP* model/framework) you will use to implement the practice change (if practice change is recommended).
NOTE: Utilize models/frameworks already being utilized by the organization where the project is occurring.
|Summarize plan for evaluating the effectiveness of the practice change. Identify:
· applicable process and outcomes data to be collected/tracked
· owners of that data and how to access it
· tools/instruments selected to collect data.
· methods for analyzing/interpreting the data (e.g. statistical data control charts, Run Charts or Pareto Charts).
NOTE: When possible, use organizational data already being collected by the organization and tools/instruments and methods for analyzing/interpreting data already being used by the organization where the project is occurring.
Identify potential return on investment (ROI) and/or value on investment (VOI)
|Possible barriers to implementation
Standardization of policies/procedures/protocols
|Identify possible barriers and implementation strategies to mitigate these barriers.
Plan for standardization of policies/procedures/protocols
|Sustainment||Identify potential strategies to sustain the change.|
|Timeline||Establish a realistic timeline for project completion. Create a visual illustrating timeline.|
|Resources needed||Identify all resources (e.g. indirect and direct) needed to complete the project.|
|Review approvals needed||Identify and obtain the required review and approval needed for implementation (e.g. institution, community agency, IRB*).|
|Section 3: Implementation (EBP Step 4 continued – Integrate the evidence with clinical expertise and patient preferences and values)|
|Describe all project processes and procedures implemented and if any changed from what was planned||Secure or collect data pre-implementation so that it can be used to evaluate effectiveness of practice change.
Describe the practice change that was actually implemented, and the actual setting of implementation. Include any deviations from your project plan (Section 2).
Describe key stakeholders’ involvement, including any additions or changes to key stakeholders list identified in the project planning (Section 2).
Describe how clinical expertise was acknowledged and integrated into the project.
Describe how patient preferences and values were acknowledged and integrated into the project (if applicable).
Describe implementation strategies and processes actually utilized, including deviations from the original plan
|Track any adaptations/changes from the project plan (see Section 2) and discuss causes and necessary adjustment made in response to deviations
Collect/secure post implementation data.
|Section 4: Evaluation (EBP Step 5 – Evaluate the outcomes of the practice decisions or changes based on evidence)|
|Results/Interpretation||Report data around project outcomes utilizing methods/terms familiar to the organization.|
|Report evaluation of the effectiveness of the practice change and extent to which the desired outcome(s) were achieved.
Capture and report ROI* and/or VOI*
|Sustainment plan||Identify key personnel necessary to sustain implementation of change.
Hardwire the change into the system (e.g. EHR* modification, recommendations for organizational policies/procedure changes, resource allocation, etc.)
Suggest key indicators that should be monitored continuously.
Suggest auditing and feedback as a key evidence-based implementation strategy
|Section 5: Dissemination (EBP Step 6 – Disseminate the EBP results)|
|Traditional||Disseminate to the organization where the project was done in a manner meaningful to the organization (e.g., executive report, poster, presentation at a meeting, poster with QR code to access details of project, etc.)
Disseminate in the format recommended by the academic institution (i.e. poster, public presentation, etc.)
Prepare final project write-up using established reporting guidelines (e.g. EPQA*, SQUIRE*)
Submission to a local, state or national conference for either poster or podium presentation.
|Non-traditional||Develop a website to display project, use personal or program social media (e.g. Twitter, Facebook) to share project information.|
*DNP, doctor of nursing practice; PICO, Population, Intervention, Comparison, Outcome; CMS, Center for Medicaid and Medicare Services; NDNQI, National Dataset of Nursing Quality Indicators; AHRQ, Agency for Healthcare Research and Quality; SMART, specific, measurable, attainable, relevant, timely; IRB, Institutional Review Board; EHR, Electronic Health Record; ROI, Return on Investment; VOI, Value of Investment; EPQA, Evidence-Based Practice Process Quality Assessment Guidelines; SQUIRE, Standards for Quality Improvement Reporting Excellence;.
Adapted from Milner, K., Zonsius, M., Zellefrow, C., Alexander, C. and Randall,H. 2020. DNP project advisement: A roadmap for faculty and student success. Journal of Nursing Education. (publication pending: JNE-2019-364R2).