Philosophies and Theories for Nursing Practice Identify the EBP and QI models used in “your” clinical practice area. If no model has been adopted by your agency, select an EBP and QI model from the readings that could be adopted by the agency. -Briefly define the EBP and QI model. -Write a clinical question for practice improvement in PICO form related to your case scenario (see below instructions) -Identify facilitators and barriers to using these models in practice in answering the clinical question. SCENARIO: Ms. Williams is a 36-year-old female with bipolar disorder resistant to lithium treatment who was admitted after a car accident. We know that she had multiple hospitalizations for mania in the past. She was tried on multiple antipsychotics and is now stable on a regimen that includes olanzapine for 2 years. She tells you that she has gained 40 pounds over the last 2 years since starting olanzapine and today is refusing her antipsychotics. She tells you “I would rather be crazy than overweight; none of my clothes look good on me”. Her BMI is 29. How do we deal with a patient refusing nursing care? HINT: A PICO (or PICOT) question addresses a practice issue in a patient population, not an individual patient. When using your case scenario for the discussion, you need to think beyond your individual patient to the patient population they are a part of. The problem you’re addressing must be one amenable to a practice improvement project. For example, what intervention can be implemented on your unit or in your clinic to improve some aspect of practice related to a specific issue/problem in your patient population? Also, you don’t always need to have a comparison intervention. When appropriate, the C (comparison) could be the absence of the intervention. For example, if the intervention is telephone follow-up by an APN after discharge, the comparison could be patients who don’t receive telephone follow-up.
