Order Description
You can work with my draft included below (my topic was Nursing assessment of Pain in a skilled nursing facility) or choose any other topic you are most comfortable with. (Setting can be in skilled nursing facility, a primary care or community clinic)

Introduction:

One of the key roles of the master’s-prepared nurse is to lead practice change across the full spectrum of healthcare settings. Master’s-prepared nurses must be able to translate the existing body of knowledge around a phenomenon of interest (accessible through published research studies) to inform decision making related to nursing practice.

Requirements:
A. Identify a current nursing practice within your healthcare setting that requires change.
1. Describe the current nursing practice.
2. Discuss why the current nursing practice needs to be changed.
B. Identify the key stakeholders within your healthcare setting who are part of the current nursing practice.
1. Describe the role each identified key stakeholder will play to support the proposed practice change.

C. Create an evidence critique table (see “Sample Evidence Critique Table”).
1. Identify five sources from scholarly peer-reviewed journals, which adhere to the following standards:
a. Each source must be published within the past five years.
b. Each source must relate to the change identified in part A.
c. Each source must be listed in the table using APA format.
2. Identify the evidence strength of each chosen source, using the Strength of Evidence Table in the study plan.
3. Identify the evidence hierarchy of each chosen source, using the Evidence Hierarchy Table in the study plan.
D. Develop an evidence summary based on the findings from part C that includes each of the five sources used (suggested length of 1–2 pages for all sources).
E. Recommend a specific best practice based on the evidence summary developed in part D.
F. Identify a practice change model that is appropriate to apply to the proposed practice change.
1. Justify why you chose the practice change model.
2. Explain how to apply the identified model to guide the implementation of the proposed practice change.
G. Discuss possible barriers to successful implementation of the proposed practice change.
H. Discuss any possible ethical implications that may arise while planning or implementing the proposed practice change.
I. When you use sources, include all in-text citations and references in APA format.
Below is my rough draft for the answers I had started answering
A. Identify a current nursing practice within your healthcare setting that requires change.
1. Describe the current nursing practice.
Pain is a sensation that hurts caused by an illness or injury leading to discomfort or distress.
Nursing assessment of pain in a skilled nursing setting is one of the most common and yet most complex nursing assessments in this setting. Nursing assessment is one of the five systematic steps in the nursing process which focuses on identifying the potential or actual alteration in an individual, community or population’s health.
Pain is subjective. It is what the patient says it is. Unfortunately, some patients are unable to provide a self-report of pain verbally, in writing, or by other expressive means, such as finger movement (Merkel, 2002) or blinking their eyes to answer yes or no questions (Pasero & McCaffery, 2011).
I provide on call nursing care at several skilled nursing facilities and they all utilize the PQRST method of assessing residents’ pain. PQRST is a 5-part set of questions, P-Provocation of pain, Q-Quality of the pain, R-Region of the pain, S-Severity and T-Timing of the pain including the start and how long it lasts.
The population at the skilled nursing facilities is a mixture of young and old unconscious patients who have tracheostomies and are on ventilators, older adults with advanced dementia and patients at the end of life. Each of these populations may be unable to self-report pain due to cognitive and physiological limitations making it difficult to adequately assess their pain.
The PQSRT method therefore, is not comprehensive enough to utilize for patients who are unable to provide a self-report of pain verbally, in writing, or by other expressive means.
B. Identify the key stakeholders within your healthcare setting who are part of the current nursing practice.

1. Describe the role each identified key stakeholder will play to support the proposed practice change.
Providers who include Physicians and ARNPs, nurses, rehabilitation staff who include, speech, physical and occupational therapists, respiratory technicians, administrators, certified nursing assistants, patients and their families are all stakeholders in assessing patient’s pain at any point of their stay in the facility.
There are no objective tests to measure pain but the pathophysiology of pain may result in vital signs changes such as elevating respiration rate, pulse rate, blood pressure and temperature.
Providers are especially trained to ….
Family members may able to help provide helpful information about the patient’s baseline behaviors and symptoms
C. Create an evidence critique table (see “Sample Evidence Critique Table”). – See my draft below in a table to answer this question. Only the last 2 columns are really important.
1. Identify five sources from scholarly peer-reviewed journals, which adhere to the following standards:
a. Each source must be published within the past five years.
b. Each source must relate to the change identified in part A.
c. Each source must be listed in the table using APA format.
2. Identify the evidence strength of each chosen source, using the Strength of Evidence Table in the study plan.
https://www.journals.elsevier.com/pain-management-nursing/most-cited-articles/
3. Identify the evidence hierarchy of each chosen source, using the Evidence Hierarchy Table in the study plan.
Sample Evidence Critique Table:
Full APA citation for at least 5 sources Evidence Strength (1-7) and Evidence Hierarchy
1. Tricco, A. C., Cogo, E., Holroyd-Leduc, J., et al. (2013). Efficacy of falls prevention interventions: Protocol for a systemic review and network meta-analysis. Systematic Reviews, 2, 38. doi: 10.1186/2046-4053-2-38 1 and Systematic review
2.
3.
4.
5.

Note: Evidence Strength will range from level 7 (lowest) to level 1 (highest). Evidence Hierarchy will reflect the research methodology (Expert Opinion [lowest] to Meta-Analysis [highest]).
A guide to answer question C. Create an evidence critique table (see “Sample Evidence Critique Table”). Only the last 2 columns are really important.

Level Hierarchy Examples Explanation My Full APA citation for at least 5 sources Evidence Strength (1-7) and Evidence Hierarchy
Level I Meta-analysis, Systematic Reviews, Integrative Reviews, National Practice guidelines This level includes; research designs of Meta-Analyses, Systematic Reviews, Integrative Reviews, and EBP Guidelines which are developed from systematic reviews and housed in national repositories Meneses Oliveira, R., Sales da Silva, L. M., Aires de Freitas, C. H., Paz de Oliveira, S. K., Monteiro Pereira, M., & de Arruda Leitão, I. T. (2014). MEASUREMENT OF PAIN IN CLINICAL NURSING PRACTICE: INTEGRATIVE REVIEW. Journal Of Nursing UFPE / Revista De Enfermagem UFPE, 8(8), 2872-2882 11p. doi:10.5205/reuol.6081-52328-1-SM.0808201439
1 and systematic/Integrative review
Crosta, Q. R., Ward, T. M., Walker, A. J., & Peters, L. M. (2014). A review of pain measures for hospitalized children with cognitive impairment.Journal For Specialists In Pediatric Nursing, 19(2), 109-118 10p. doi:10.1111/jspn.12069 1 and Systematic review
Level II Randomized Controlled Trial (RCT) and Experimental This level represents evidence from studies using a true experimental design
Level III Quasi-Experimental This level represents evidence obtained from experimental studies without randomization.
Level IV Hierarchy: Non-experimental This level represents evidence from well-designed nonexperimental designs such as retrospective, case-control, cross-sectional, cohort-comparison, prospective, descriptive and correlational single studies. Chan, J. C., & Hamamura, T. (2015). Nursing students’ assessment of pain and decision of triage for different ethnic groups: An experimental study. Nurse Education Today, 35(8), 921-925 5p. doi:10.1016/j.nedt.2015.04.004

4 and cross-sectional quantitative design
VALIDITY AND SENSITIVITY OF 6 PAIN SCALES IN CRITICALLY ILL, INTUBATED ADULTS. (2015). American Journal of Critical Care, 24(6), 514-524 11p. doi:10.4037/ajcc2015832 Am not so sure of this one.
(Methods: Fifty communicative and 100 noncommunicative patients receiving mechanical ventilation were observed before and during routine physical examination and endotracheal tube suctioning.)
Level V Meta-Synthesis This level represents evidence from systematic reviews of studies using qualitative methods. Liu, J. Y. (2014). Exploring nursing assistants’ roles in the process of pain management for cognitively impaired nursing home residents: a qualitative study. Journal Of Advanced Nursing, 70(5), 1065-1077 13p. doi:10.1111/jan.12259 5 and a qualitative study.
Level VI Single Qualitative Study This level represents single studies using a qualitative research method
Level VII Expert Opinions This level represents materials from a variety of non-research based evidence and generally consists of reports of expert committees and/or opinions of authorities on the subject. The evidence from this level includes; specialists’ opinions, case studies, practice guidelines, narrative reviews, editorials, regulations, legislation, and program outcome data/QI projects Malcolm, C. (2015). Acute pain management in the older person. Journal Of Perioperative Practice, 25(7/8), 134-139 6p.

Nissen, S., & Dunford, C. (2014). Assessment of pain in children with brain injury: moving to best practice. British Journal Of Nursing, 23(17), 930-934 5p. doi:10.12968/bjon.2014.23.17.930 These are low level to consider but with good info.

D. Develop an evidence summary based on the findings from part C that includes each of the five sources used (suggested length of 1–2 pages for all sources).
Current best evidence suggests that when providing care to patients who can’t self-report pain, clinicians should assess pain frequently using a behavioral pain scale and information obtained from surrogates, assess for subtle changes in observed behaviors, and initiate an analgesic trial.
F. Identify a practice change model that is appropriate to apply to the proposed practice change.
1. Justify why you chose the practice change model.
Consider impact of pain on sleep, mood, appetite, activity, usual functioning in self-care and job, and role in family and community