reply1

In clinical research and in implementation of EBP projects, results that are statistically significant are many a times often interpreted, and wrongly so, as being clinically significant or important. Clinical significance, unlike statistical significance which indicates the reliability of the study results, reflects the impact of such results into clinical practice (Leung, 2017). The results may be reliable but impactful in terms of practice. This means that most times, clinical data is often analysed with traditional statistical probability with the result that the study results may be difficult to interpret clinically. The results do not give clinicians enough information to make clinical decisions. Clinical significance of data ensures that it provides information on the magnitude or direction of the results. Inclusion of more clinically relevant information such as confidence intervals and effect sizes is essential (Page, 2014). This way, clinical significance is important as it helps support the intended project outcomes by making them ore clinically relevant. Evidence based practice is meant to affect clinical decision making. However, if interpreting the research results is either difficult or impeded by the presentation of such results, this intention can hardly be achieved (Page, 2014). Clinical interpretation of research on treatment outcomes in important because of its influence in decision making. It imparts or confers confidence that the results are a true and reliable presentation of findings.

Source: Leung, W. (2017). Balancing statistical and clinical significance in evaluating treatment effects. BMJ Quality and Safety, 77(905), 73-81. doi:10.1136/pmj.77.905.201

Page, P. (2014). Beyond statistical significance: Clinical intepretation of rehabilitation research literature. International Journal of Sports Physical Therapy, 9(5), 726-736. Retrieved March 31, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197528/#__ffn_sectitle

reply2

One of the barriers that I foresee preventing my EBP change proposal from continuing would be staff participation. I would need ER nurses to assess the patient and implement the checklist on admission. The ER nurses are very busy and often have 10 patients at the same time. Initiating a new project during a pandemic, and adding more work to the nurses already heavy workload is probably not the best way to ensure that the project is continued. Another barrier would be the patient’s health acuity at that time may not permit for the nurse to talk to the patient at length about their health literacy, support system and financial status. To overcome these barriers, I would ask that the checklist be completed at some point during the admission process, perhaps when the patient is in their room and stable. Having management and administrative support from the beginning will be a key factor in the success of the project. They will be able to inform me on similar projects that were implemented and techniques that were used to ensure continuation. Frequent audits of charts by nurse leaders would also ensure that the checklist has been started and education is being documented. If the checklist becomes part of the patient’s permanent record, there would be proof of task completion. Having this information in the patient’s medical records will help with clinical auditing results and changes can be made to the checklist as needed to improve quality of care.

Esposito, P., & Dal Canton, A. (2014). Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World journal of nephrology, 3(4), 249–255. https://doi.org/10.5527/wjn.v3.i4.249

Ginex, P. (2018) Overcome Barriers to Applying Evidence Based Process for Practice Change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change