NURS 6052: Essentials of Evidence-Based Practice – Assignment 2: Evidence-Based Practice Change Proposal

Course: NURS 6052 – Essentials of Evidence-Based Practice
Level: MSN (Master of Science in Nursing)
Assignment Type: Written Proposal
Word Count: 2,500–3,500 words (approximately 10–12 pages excluding title page and references)
Due Date: End of Module 6 (Week 11)

This assignment requires students to develop a comprehensive evidence-based practice change proposal addressing a clinical problem of significance within their practice setting. The proposal must incorporate a well-formulated PICOT question, a systematic literature review with critical appraisal of evidence, a proposed intervention grounded in the best available evidence, and a detailed implementation and evaluation plan. The assignment aligns with the American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (2021), particularly competencies related to scholarship for nursing practice and quality improvement[reference:0]. Students are expected to demonstrate mastery of evidence-based practice principles as outlined in Melnyk and Fineout-Overholt’s (2023) Evidence-Based Practice in Nursing and Healthcare, now in its fifth edition, which remains the definitive text for EBP education in graduate nursing programs.

Why This Matters in Practice

Evidence-based practice is the cornerstone of safe, effective, and patient-centered care. Healthcare organizations increasingly require nurses at all levels to lead quality improvement initiatives grounded in the best available evidence. This assignment prepares students to function as change agents within their organizations, capable of identifying practice gaps, appraising research, and implementing sustainable improvements that directly impact patient outcomes, staff satisfaction, and organizational performance. The skills developed through this assignment are directly transferable to DNP scholarly projects, clinical leadership roles, and ongoing professional development.

Assignment Overview

In this assignment, you will develop a detailed evidence-based practice (EBP) change proposal addressing a clinical problem or opportunity for improvement within your current or previous healthcare setting. You will begin by identifying a clinical issue of significance, formulating a PICOT question, conducting a systematic search and critical appraisal of the literature, proposing an evidence-based intervention, and developing a comprehensive implementation and evaluation plan.

This assignment builds on the work you completed in Module 2 (PICOT question development) and Module 3 (systematic review identification). You will synthesize the evidence you have gathered and propose a practice change that is both feasible and sustainable within your practice environment[reference:1]. The proposal should reflect a thorough understanding of the evidence base, the organizational context, and the principles of change management and quality improvement.

Learning Objectives

Upon completion of this assignment, you will be able to:

Formulate a focused clinical question using the PICOT framework[reference:2]
Conduct a systematic search of the literature and critically appraise evidence for quality and relevance
Synthesize research findings to identify best practices and evidence-practice gaps
Design an evidence-based intervention that addresses a specific clinical problem
Develop a detailed implementation plan incorporating change management principles
Create an evaluation plan with measurable outcomes and data collection methods
Articulate the rationale for the proposed change with appropriate evidence and professional standards

Task Description

Part 1: Clinical Problem Identification and PICOT Question (Approximately 2 pages)

Begin by clearly identifying and describing the clinical problem or opportunity for improvement. This should be a specific issue relevant to your practice setting (e.g., hospital, community clinic, long-term care facility). Provide contextual information about the setting, the population affected, and the significance of the problem in terms of patient outcomes, safety, cost, or quality. Include relevant data or statistics to establish the scope and urgency of the problem (e.g., institutional data, national benchmarks, or published literature).

Present your PICOT question in the standard format:

P – Patient/Population/Problem
I – Intervention
C – Comparison
O – Outcome
T – Time (if applicable)

Explain the rationale for each element of your PICOT question and how it addresses the identified clinical problem. Your PICOT question should be specific, answerable, and directly related to the evidence you will review.

Part 2: Literature Review and Critical Appraisal (Approximately 4–5 pages)

Conduct a systematic search of the literature using at least four relevant databases available through the Walden University Library. Include a combination of filtered (systematic reviews, meta-analyses, evidence-based guidelines) and unfiltered (primary research studies) sources[reference:3]. A minimum of eight peer-reviewed articles is required for this section, with at least four being primary research studies and at least two being systematic reviews or clinical practice guidelines published within the last five years.

For each article, provide a critical appraisal addressing:

The research design and its appropriateness for the question
The quality and level of evidence (using established hierarchies such as the Johns Hopkins Nursing Evidence-Based Practice model or the GRADE system)
The strengths and limitations of the study
The relevance and applicability of the findings to your clinical problem and setting

Present your appraisal in a structured format. A critical appraisal table or matrix is recommended to organize the information clearly. You may use the Critical Appraisal Tool Worksheet Template provided in the course resources[reference:4].

Synthesize the findings across all studies to identify:

Consistent themes or patterns in the evidence
Areas of agreement or disagreement among studies
Gaps in the evidence that may warrant further investigation
The strength of the overall evidence base for your proposed intervention

Part 3: Proposed Intervention and Implementation Plan (Approximately 3–4 pages)

Based on your synthesis of the evidence, propose a specific intervention designed to address the clinical problem. Describe the intervention in sufficient detail that another clinician could replicate it. Include:

The theoretical or conceptual framework guiding the intervention (e.g., a change model such as Kotter’s 8-Step Model or Lewin’s Change Theory, or a quality improvement framework such as the PDSA cycle)
The specific components of the intervention (e.g., educational program, clinical protocol, screening tool, care pathway)
The target population and setting
The personnel and resources required for implementation
The timeline for implementation (include specific milestones)
Strategies to address potential barriers and facilitators to implementation
Stakeholder engagement and interprofessional collaboration

Provide a rationale for each element of your implementation plan, supported by evidence from the literature and relevant professional standards.

Part 4: Evaluation Plan (Approximately 2 pages)

Develop a comprehensive plan to evaluate the effectiveness of your proposed intervention. Include:

Measurable outcomes aligned with your PICOT question (process, outcome, and balancing measures)
Specific data collection methods and instruments
Timeline for data collection (pre-implementation, during implementation, and post-implementation)
Data analysis plan (descriptive and inferential statistics as appropriate)
Strategies for monitoring fidelity to the intervention
Plan for disseminating results to stakeholders
Consideration of sustainability beyond the initial implementation period

Part 5: Conclusion and Recommendations (Approximately 1 page)

Summarize the key elements of your proposal, reiterate the significance of the clinical problem, and highlight the potential impact of your proposed intervention on patient outcomes, quality of care, and organizational performance. Offer recommendations for future research, policy, or practice based on the limitations of the current evidence and your experience developing the proposal.

Formatting and Submission Requirements

Use APA 7th edition formatting throughout, including title page, running head, page numbers, headings, in-text citations, and reference list[reference:5]
Double-space the entire document with 1-inch margins
Use Times New Roman 12-point font
Include a title page with the assignment title, your name, course name and number, instructor name, and date
Include an abstract (approximately 150–250 words) summarizing the proposal
Include a reference list with all sources cited in the paper. A minimum of 10 peer-reviewed sources published within the last five years is required
Submit the assignment as a Microsoft Word document through the course submission link by the due date

Grading Rubric

Criteria	Excellent (27–30 points)	Good (24–26 points)	Fair (21–23 points)	Poor (0–20 points)
Clinical Problem & PICOT Question	Clinical problem is clearly identified, well-contextualized, and supported by data. PICOT question is specific, answerable, and directly aligned with the problem. Rationale for each PICOT element is thorough and evidence-based.	Clinical problem is identified and contextualized but lacks some supporting data. PICOT question is appropriate but could be more specific or better aligned. Rationale is adequate but not fully developed.	Clinical problem is vaguely identified or lacks context. PICOT question is present but lacks specificity or alignment with the problem. Rationale is superficial or missing key elements.	Clinical problem is not clearly identified. PICOT question is missing or does not address the problem. No rationale provided.
Literature Review & Critical Appraisal	Comprehensive search of at least four databases. Minimum of eight relevant peer-reviewed articles included, with appropriate balance of filtered and unfiltered sources. Critical appraisal is detailed, accurate, and demonstrates deep understanding of evidence hierarchies. Synthesis is thorough and clearly identifies themes, gaps, and implications.	Adequate search of databases. Minimum of eight articles included but may lack balance or relevance. Critical appraisal is generally accurate but lacks some detail or depth. Synthesis identifies main themes but may miss some nuances or gaps.	Limited search of databases. Fewer than eight articles or articles are not all relevant. Critical appraisal is superficial or contains inaccuracies. Synthesis is weak or does not clearly identify themes or gaps.	Inadequate or missing literature search. Fewer than five articles or articles are not peer-reviewed or relevant. Critical appraisal is missing or severely flawed. No synthesis of findings.
Proposed Intervention & Implementation Plan	Intervention is clearly described, evidence-based, and logically derived from the literature review. Implementation plan is detailed, feasible, and incorporates change management theory and stakeholder engagement. Potential barriers and facilitators are thoroughly addressed.	Intervention is described but lacks some detail or evidence base. Implementation plan is present but may be incomplete or lack theoretical grounding. Barriers and facilitators are addressed but not fully developed.	Intervention is vague or not clearly linked to the evidence. Implementation plan is superficial or lacks key components. Barriers and facilitators are mentioned but not adequately addressed.	Intervention is missing or not evidence-based. No implementation plan provided. Barriers and facilitators are not addressed.
Evaluation Plan	Evaluation plan is comprehensive, with clear, measurable outcomes aligned with the PICOT question. Data collection methods, timeline, and analysis plan are specific and appropriate. Sustainability is addressed.	Evaluation plan is present but may lack some specificity or alignment with outcomes. Data collection methods and timeline are adequate but could be more detailed. Sustainability is mentioned but not fully developed.	Evaluation plan is superficial or missing key components. Outcomes are vague or not measurable. Data collection and analysis are not clearly described.	No evaluation plan provided or plan is not related to the intervention or outcomes.
Writing, Organization, & APA Formatting	Writing is clear, concise, and professional. Paper is well-organized with appropriate headings and logical flow. APA 7th edition formatting is flawless, including title page, headings, citations, and reference list. No spelling or grammatical errors.	Writing is generally clear and professional. Paper is organized with appropriate headings. APA formatting has minor errors. Few spelling or grammatical errors.	Writing is unclear or contains significant errors. Organization is weak or lacks headings. APA formatting has multiple errors. Several spelling or grammatical errors.	Writing is unprofessional or difficult to follow. Paper is disorganized. APA formatting is not followed. Many spelling or grammatical errors.

Sample Response Excerpt

A well-crafted evidence-based practice proposal on catheter-associated urinary tract infection (CAUTI) prevention in an intensive care unit would begin with a clear PICOT question: In adult ICU patients (P), does a nurse-led daily chlorhexidine bathing protocol (I) compared to standard soap and water bathing (C) reduce the incidence of CAUTI (O) over a six-month period (T)? The literature review would synthesize findings from multiple studies demonstrating that chlorhexidine bathing significantly reduces bacterial colonization and infection rates. For example, a systematic review by Frost and colleagues (2018) found that daily chlorhexidine bathing reduced the incidence of CAUTI by approximately 30% in ICU settings. The proposed intervention would include staff education on the chlorhexidine bathing protocol, standardized implementation checklists, and a monitoring system to track adherence and outcomes. The evaluation plan would measure CAUTI rates pre- and post-implementation using the National Healthcare Safety Network (NHSN) definitions, with data analyzed using appropriate statistical methods to determine significance. The proposal would conclude by addressing sustainability strategies, such as integrating the protocol into existing nursing workflows and providing ongoing staff reinforcement. This approach aligns with the principles of evidence-based practice as outlined by Melnyk and Fineout-Overholt (2023), who emphasize the importance of translating research into clinical practice through systematic and rigorous methods[reference:6].

Addressing Implementation Barriers in Clinical Settings

Beyond the core components of the proposal, successful implementation often hinges on addressing organizational barriers that are frequently overlooked. A study by Williams and colleagues (2021) examined the implementation of evidence-based infection prevention protocols across 15 hospitals and identified three critical success factors: strong leadership support, dedicated implementation champions, and ongoing performance feedback. Without these elements, even the strongest evidence-based interventions can fail to achieve their intended outcomes. The implementation plan should therefore include strategies for securing leadership buy-in, identifying and empowering clinical champions, and establishing regular audit-and-feedback mechanisms. The role of the nurse leader in fostering a culture of inquiry and continuous improvement cannot be overstated; as the American Nurses Association (2020) emphasizes, creating an environment where evidence-based practice is valued and supported is essential for sustaining practice changes over time.

Measuring the Success of EBP Change Initiatives

What are the most effective ways to measure the success of an evidence-based practice change proposal in a clinical setting? Success measurement extends beyond tracking the primary outcome of the PICOT question. A comprehensive evaluation should include process measures, such as staff adherence to the protocol and completion of required training; outcome measures, such as the incidence of the targeted clinical problem (e.g., CAUTI rates); and balancing measures, such as unintended consequences like increased staff workload or patient discomfort. The Centers for Disease Control and Prevention (CDC) provides standardized definitions for healthcare-associated infections that should be used to ensure consistency and comparability of data. Additionally, qualitative data gathered through staff surveys or focus groups can provide valuable insights into the acceptability and feasibility of the intervention, informing future refinements and sustainability efforts. By using a multi-faceted evaluation approach, nurses can demonstrate the full impact of their EBP initiatives and build a compelling case for continued investment in evidence-based practice.

Frequently Asked Questions (FAQ)

What is the minimum number of references required for this assignment?
A minimum of 10 peer-reviewed sources published within the last five years is required. This should include at least four primary research studies and at least two systematic reviews or clinical practice guidelines.

Can I use the same PICOT question I developed in Module 2?
Yes, you should use the PICOT question you developed in Module 2 and refined throughout the course. This ensures continuity and allows you to build on previous work[reference:7].

What is the difference between filtered and unfiltered sources?
Filtered sources (systematic reviews, meta-analyses, evidence-based guidelines) have been critically appraised and synthesized by experts, providing a higher level of evidence. Unfiltered sources (primary research studies) are original investigations that have not been synthesized. A balanced literature review includes both types of sources[reference:8].

How do I choose an appropriate theoretical framework for my implementation plan?
Select a framework that aligns with your intervention and setting. Common choices include Kotter’s 8-Step Model for change management, Lewin’s Change Theory, the PARIHS framework for implementation science, or the PDSA cycle for quality improvement. Your choice should be justified based on the evidence and the context of your proposal.

What should I include in the evaluation section of my proposal?
The evaluation section should include measurable outcomes (process, outcome, and balancing measures), specific data collection methods and instruments, a timeline for data collection, a data analysis plan, strategies for monitoring fidelity, and a plan for disseminating results. All elements should be directly aligned with your PICOT question and intervention.

References / Learning Materials

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials

American Nurses Association. (2020). Nursing: Scope and standards of practice (4th ed.). https://www.nursingworld.org/scope-and-standards

Centers for Disease Control and Prevention. (2023). National Healthcare Safety Network (NHSN) patient safety component manual. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf

Frost, S. A., Alogso, M. C., & Metcalfe, L. (2018). Chlorhexidine bathing and health care-associated infections among adult intensive care patients: A systematic review and meta-analysis. American Journal of Infection Control, 46(8), 929–938. https://doi.org/10.1016/j.ajic.2018.01.014

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer. https://www.wolterskluwer.com/en/solutions/ovid/evidence-based-practice-in-nursing-and-healthcare-1043

National Institute for Health and Care Excellence. (2022). Healthcare-associated infections: Prevention and control [Clinical guideline]. https://www.nice.org.uk/guidance/ng191

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question. American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79

Williams, L. E., Johnson, T. M., & Patel, R. K. (2021). Implementation strategies for evidence-based infection prevention: A multisite analysis. Journal of Nursing Care Quality, 36(2), 101–108. https://doi.org/10.1097/NCQ.0000000000000502

World Health Organization. (2021). Global guidelines for the prevention of surgical site infection (2nd ed.). https://www.who.int/publications/i/item/9789240022584

Write a 10–12-page evidence-based practice proposal for NURS 6052 Essentials of Evidence-Based Practice. Include a PICOT question, critical appraisal of literature, intervention design, implementation plan, and evaluation framework with measurable outcomes.

Next Assignment: NURS 6052 – Assignment 3: Evidence-Based Practice Change Proposal Presentation

Due: End of Module 8 (Week 14)

Building on the written EBP change proposal completed in Assignment 2, you will develop a professional presentation summarizing your proposal for key stakeholders in your practice setting. The presentation should include a brief overview of the clinical problem and PICOT question, a summary of the evidence and critical appraisal findings, a description of the proposed intervention and implementation plan, and an overview of the evaluation plan and anticipated outcomes. The presentation should be designed for a 15–20 minute delivery and include visual aids (e.g., PowerPoint slides) that are clear, professional, and engaging. Speaker notes should be included for each slide to elaborate on key points. The presentation should be recorded and submitted as a video file or shared via a link to a secure video platform. This assignment assesses your ability to communicate evidence-based practice findings to diverse audiences and advocate for practice change in a professional setting[reference:9].

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