DNP PROJECT FOR YOUR ORGANIZATION
- Individual Evidence Summary Table
- Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Synthesis Process and Recommendations Tool
Key Points:
• Evidence synthesis is best done through group discussion. All team members share
their perspectives, and the team uses critical thinking to arrive at a judgment based
on consensus during the synthesis process. The synthesis process involves both
subjective and objective reasoning by the full EBP team. Through reasoning, the
team:
▪ Reviews the quality appraisal of the individual pieces of evidence
▪ Assesses and assimilates consistencies in findings
▪ Evaluates the meaning and relevance of the findings
▪ Merges findings that may either enhance the team’s knowledge or
generate new insights, perspectives, and understandings
▪ Highlights inconsistencies in findings
▪ Makes recommendations based on the synthesis process
• When evidence includes multiple studies of Level I and Level II evidence, there is
a similar population or setting of interest, and there is consistency across findings,
EBP teams can have greater confidence in recommending a practice change.
However, with a majority of Level II and Level III evidence, the team should
proceed cautiously in making practice changes. In this instance,
recommendation(s) typically include completing a pilot before deciding to
implement a full-scale change.
• Generally, practice changes are not made on Level IV or Level V evidence alone.
Nonetheless, teams have a variety of options for actions that include, but are not
limited to: creating awareness campaigns, conducting informational and educational
updates, monitoring evidence sources for new information, and designing research
studies.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
• The quality rating (see Appendix D) is used to appraise both individual quality of
evidence and overall quality of evidence.
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Date:
EBP Question:
Article
Number
Author and Date
Evidence Type
Sample, Sample
Size, Setting
Findings That
Help Answer the EBP Question
Observable Measures
Limitations
Evidence Level,
Quality
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Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
EBP Question:
Category (Level Type) Total Number of Sources/Level
Overall Quality Rating
Synthesis of Findings Evidence That Answers the EBP Question
Level I
▪ Experimental study ▪ Randomized controlled trial (RCT)
▪ Systematic review of RCTs with or without meta-analysis
▪ Explanatory mixed method design that includes only a Level I quaNtitative study
Level II
▪ Quasi-experimental studies
▪ Systematic review of a combination of RCTs and quasi-experimental studies, or quasi- experimental studies only, with or without meta-analysis
▪ Explanatory mixed method design that includes only a Level II quaNtitative study
Level III
▪ Nonexperimental study ▪ Systematic review of a combination of RCTs,
quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta- analysis
▪ QuaLitative study or meta- synthesis
▪ Exploratory, convergent, or multiphasic mixed-methods studies
▪ Explanatory mixed method design that includes only a level III QuaNtitative study
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Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Category (Level Type) Total Number of Sources/Level
Overall Quality Rating
Synthesis of Findings
Evidence That Answers the EBP Question
Level IV
▪ Opinions of respected authorities and/or reports of nationally recognized expert committees or consensus panels based on scientific evidence
Level V
▪ Evidence obtained from literature or integrative reviews, quality improvement, program evaluation, financial evaluation, or case reports
▪ Opinion of nationally recognized expert(s) based on experiential evidence
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Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Based on your synthesis, which of the following four pathways to translation represents the overall strength of the evidence?
❑Strong, compelling evidence, consistent results: Solid indication for a practice change is indicated.
❑Good and consistent evidence: Consider pilot of change or further investigation.
❑Good but conflicting evidence: No indication for practice change; consider further investigation for new evidence or develop a research study.
❑Little or no evidence: No indication for practice change; consider further investigation for new evidence, develop a research study, or discontinue project.
If you selected either the first option or the second option, continue. If not, STOP , translation is not indicated.
Recommendations based on evidence synthesis and selected translation pathway
Consider the following as you examine fit:
Are the recommendations:
▪ Compatible with the unit/departmental/organizational cultural values or norms?
▪ Consistent with unit/departmental/organizational assumptions, structures, attitudes, beliefs, and/or
practices?
▪ Consistent with the unit/departmental/organizational priorities?
Consider the following as you examine feasibility:
▪ Can we do what they did in our work environment?
▪ Are the following supports available?
• Resources
• Funding
• Approval from administration and clinical leaders
• Stakeholder support
• Is it likely that the recommendations can be implemented within the unit/department/organization?
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Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
Directions for Use of This Form
Purpose of form
Use this form to compile the results of the individual evidence appraisal to answer the EBP question. The
pertinent findings for each level of evidence are synthesized, and a quality rating is assigned to each level.
Total number of sources per level
Record the number of sources of evidence for each level.
Overall quality rating
Summarize the overall quality of evidence for each level. Use Appendix D to rate the quality of evidence.
Synthesis of findings: evidence that answers the EBP question
• Include only findings from evidence of A or B quality.
• Include only statements that directly answer the EBP question.
• Summarize findings within each level of evidence.
• Record article number(s) from individual evidence summary in parentheses next to each statement
so that the source of the finding is easy to identify.
Develop recommendations based on evidence synthesis and the selected translation pathway
Review the synthesis of findings and determine which of the following four pathways to translation
represents the overall strength of the evidence:
• Strong, compelling evidence, consistent results: Solid indication for a practice change.
• Good and consistent evidence: Consider pilot of change or further investigation.
• Good but conflicting evidence: No indication for practice change; consider further investigation for
new evidence or develop a research study.
• Little or no evidence: No indication for practice change; consider further investigation for new
evidence, develop a research study, or discontinue the project.
Fit and feasibility
Even when evidence is strong and of high quality, it may not be appropriate to implement a change in
practice. It is crucial to examine feasibility that considers the resources available, the readiness for
change, and the balance between risk and benefit. Fit refers to the compatibility of the proposed change
with the organization’s mission, goals, objectives, and priorities. A change that does not fit within the
organizational priorities will be less likely to receive leadership and financial support, making success
difficult. Implementing processes with a low likelihood of success wastes valuable time and resources on
efforts that produce negligible benefits.
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Appendix H Synthesis Process and Recommendations Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
References
,
Individual evidence resources
The title for the planned DNP project is ‘Tangible Virtual Treatment’ and the setting will be at the private practice Virtual Consult MD in Norcross, Georgia, USA. The private practice offers telepsychiatry to individuals across the lifespan. Physical monitoring before recommending and prescribing medication for various mental health conditions is not required. This quality improvement practice gap is an issue in my organization. For instance, research indicates that less than 50% of patients on prescription drugs in mental care settings undergo critical monitoring when they seek care in England (Ayre, Lewis, and Keers, 2023). Physical monitoring of vital signs and other areas such as weight and blood level for illicit drugs is critical for mental health patients. Furthermore, it guides the characteristics of the health condition and the patient’s body's ability to acclimate to the resulting stress on the well-being of their various physiological components (Sapra, Malik, and Bhandari, 2020).
The proposed type of project is a quality improvement initiative. This initiative is in line with the practice gap in my healthcare organization. A quality improvement initiative seeks to improve the identified practice gaps in an organization by implementing the related interventions. For instance, a quality improvement initiative for medication administration without consideration for patient monitoring will also educate staff within the organizational setting. Therefore, reiterating the basics tenants of patient care promotes -evidence-based practice in healthcare organizations while closing practice gaps.
References
Ayre, M. J., Lewis, P. J., & Keers, R. N. (2023). Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review. BMC Psychiatry, 23(1), 1-17. clinical services (No. WHO/CDS/HIV/19.17). World Health Organization.
Sapra, A., Malik, A., & Bhandari, P. (2020). Vital sign assessment.
· The practice gap, in this case, is the administration of medication without prior physical monitoring of vital signs, weights, and blood levels for illicit drugs. The lack of such assessments negatively impacts nurses' responsiveness to critical solutions. Research carried out on 48,864 patients admitted in general wards between 2015 and 2018 reveals that early warning scores assessments such as vital signs were undermined in one-quarter of measurements (Elliott and Endacott, 2022). Clinical deterioration goes undetected when protocols like physical monitoring before medicine administration have low compliance rates in organization settings including mental health care organizations. This lack of compliance is persistent in health care provision, with the assessment of vital signs being often neglected in clinical practice despite them being a critical part of care provision. According to Eddahchouri, et al. (2021), the factors contributing to negligence in vital signs assessment include the nurse’s experience, the absence of formal guidelines, and the idea that vital signs assessment is neglectable in low-risk patients. The lack of physical patient monitoring is a problem in nursing and healthcare in general as it undermines the lives of patients resulting in avoidable deaths.
References
· Eddahchouri, Y., Koeneman, M., Plokker, M., Brouwer, E., van de Belt, T. H., van Goor, H., & Bredie, S. J. (2021). Low compliance to a vital sign safety protocol on general hospital wards: a retrospective cohort study. International Journal of Nursing Studies, 115, 103849.
· Elliott, M., & Endacott, R. (2022). The Clinical Neglect of vital signs’ assessment: an emerging patient safety issue?. Contemporary Nurse, 58(4), 249-252.
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Date: |
EBP Question: Will the physical monitoring of vital signs before recommending and prescribing psychiatric medications promote -evidence-based healthcare practice? |
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Article Number |
Author and Date |
Evidence Type |
Sample, Sample Size, Setting |
Findings That Help Answer the EBP Question |
Observable Measures |
Limitations |
Evidence Level, Quality |
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❑N/A |
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❑N/A |
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❑N/A |
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Attach a reference list w ith full citations of articles review ed for this EBP question.
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Appendix G
Individual Evidence Summary Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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Date: |
EBP Question: |
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Article Number |
Author and Date |
Evidence Type |
Sample, Sample Size, Setting |
Findings That Help Answer the EBP Question |
Observable Measures |
Limitations |
Evidence Level, Quality |