Clinical guideline paper. #1
The focus of this paper is on evaluating care provided to a patient group using established standards or guidelines. All papers must be written in correct APA format (6th edition), including reference page. Points will be deducted for spelling errors and incorrect formatting. The paper should be at least 6 pages but no more than 8 pages, typed, double spaced, not including reference page.
Students are to select a common health problem and identify the standard of care for that problem. The standard/guideline should be from a national group, i.e., American Heart Association, American Diabetic Association, American Academy of Pediatrics, or protocols from the U.S. Preventative Task Force for Prevention of Health Problems.
Standards should include: Case finding/risk factors; usual presenting history; presenting signs and symptoms; laboratory/diagnostic studies typically performed; diagnostic criteria; management strategies; (pharmacological, educational, and otherwise); and follow up recommendations.
Once students have set the standard/guidelines for a given health problem, they must review a minimum of 10 charts from their practicum setting to determine to what extent the established norm is being met. Please do not include any identifying information such as patient name, DOB, initials, address or other data. Present the findings in a table format and discuss them. Was the standard met or not met and what are the implications for practice?
Example: A student selects the common problem of strep pharyngitis and uses an established practice guideline for management found in a book of clinical protocols. The student will include the guidelines in their paper and set up a table that lists those parameters. An example of this is shown here.
| Dx: strep pharyngitis | Chart 1 | Chart 2 | Chart 3 | Chart 4 | Chart 5 | Chart 6 | Chart 7 | Chart 8 | Chart 9 | Chart 10 |
| History:
–sore throat -T>101’ -Poor intake |
||||||||||
| Clinical findings:
-Pharynx erythematous -+exudate on tonsils -+Rapid strep =/or 48’ culture |
Develop a table to include all areas of the standard/protocol and look to see to what extent the students’ practicum setting reflects the standard.
Identify and discuss the findings i.e., “we have found that 60% of our patients do not have fever as high as that listed in the standard yet strep is documented to be present; while PenV K is recommended we have been using amoxicillin with good results; while salt water gargles are recommended no chart reflects this recommendation or any other self-care measures.”
Finally, draw some conclusions/make recommendations realizing that they are based on very limited findings i.e., “the standard does not consider looking at similar symptoms in other family members or work/school associates, we find this to be an important question and a good predictor of strep in our patients” OR “the standard suggests that association with others with similar symptoms must be considered, we don’t seem to be asking that question”, OR “we have had good success with amoxicillin, this should be considered an appropriate alternative treatment”, OR “it would appear that strep can be present without the high fever traditionally associate with it.”
Grading is as follows:
Established criteria 15%
Chart documentation 15%
Discussion of findings 35%
Conclusions/recommendations 35%
- Evidenced Based Practice Paper: 13% (4/10/2018)
Evidence-based practice (EBP) is the process by which nurse practitioners make clinical decisions using the best available research evidence. The goal of this assignment is to identify a clinical practice guideline based on evidence. All papers must be written in correct APA format, including reference page. Points will be deducted for spelling errors and incorrect formatting.
The following steps will help guide students with this process:
- Clearly describe a clinical issue or problem based on an actual patient(s) the student has or is caring for this semester
- Identify the specific clinical question about which the student is concerned. Use the PICOT format to write the clinical question.
- Search published and electronic databases for clinical research evidence about this question and the target population (The student may need the help of clinical and academic librarians to do this effectively)
- Evaluate the quality and strength of evidence according to these rating codes:
Code Specifications
I at least one properly designed randomized controlled trial
II well designed controlled trails without randomizations
III well designed cohort or case controlled analytic studies, preferably from more than one center or research group
IV multiple time series with or without an intervention
V opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
- Categorize interventions, practices and outcomes based on the evidence that are
- a. Beneficial: their effectiveness has been demonstrated based on RCT’s;
Evidence of harm is small compared with the benefits
- Likely to be beneficial: interventions for which effectiveness is less well documented than for those listed under beneficial
- Trade-off between benefits and harms: clinician and patients should weight the beneficial and harmful effects according to individual circumstances and priorities
- Unknown effectiveness: interventions for which there are insufficient data or data of inadequate quality
- Unlikely to be beneficial: interventions for which lack of effectiveness is less well established than for those listed under likely to be effective or harmful
- Likely to be ineffective or harmful: intervention for which ineffectiveness or harmfulness has been demonstrated by clear evidence
- Provide recommendations for the clinical practice situation that the student initially identified
Grading rubric:
- (10 %) PICOT question corrected formatted
- (15 %) clinical problem or issue is clearly identified and explained. The current state of knowledge and practice about the problem is made clear.
- (15 %) the population affected is identified and support provided as to why this is an issued for that group
- (10%) databases used in the search are listed along with descriptors used; the process of searching the literature is clearly spelled out
- (30 %) a listing of all research literature is provided with a chart developed showing: Title of study, author(s) publishing information, source of funding if pertinent, questions asked, sample size and characteristics, data analysis methods used if pertinent, tools/instruments used, conclusions, level of evidence provided according to grading system listed above
- (20 %) interventions for the identified problem are made clear and are supported by valid evidence
