1. Rate yourself according to your confidence level performing the

1. Rate yourself according to your confidence level performing
the skills identified in the Clinical Skills Self-Assessment
Form. 
2. Based on your ratings, summarize your strengths and
opportunities for improvement.  
3. Based on your self-assessment and theory of nursing practice,
develop four (4) measurable goals and objectives for
a practicum experience. 
4. Include them on the designated area of the form.
Self-Assessment Form
Desired Clinical Skills for Students to Achieve
Confident (Can complete independently)
Mostly confident (Can complete with supervision)
Beginning (Have performed with supervision or needs
supervision to feel confident)
New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric
illness across the lifespan
X
Differentiating between pathophysiological and
psychopathological conditions
X
Performing and interpreting a comprehensive and/or interval
history and physical examination (including laboratory and
diagnostic studies)

X
Performing and interpreting a mental status examination
X
Performing and interpreting a psychosocial assessment and
family psychiatric history
X
Performing and interpreting a functional assessment (activities
of daily living, occupational, social, leisure, educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
X
Formulating diagnoses according to DSM 5 based on assessment
data

X
Differentiating between normal/abnormal age-related
physiological and psychological symptoms/changes
X
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice
guidelines for medication plan (e.g., risk/benefit, patient
preference, developmental considerations, financial, the process
of informed consent, symptom management)
X
Evaluating patient response and modify plan as necessary
X
Documenting (e.g., adverse reaction, the patient response,
changes to the plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the

lifespan
X
Selecting appropriate evidence based clinical practice
guidelines for psychotherapeutic plan (e.g., risk/benefit, patient
preference, developmental considerations, financial, the process
of informed consent, symptom management, modality
appropriate for situation)
X
Applies age appropriate psychotherapeutic counseling
techniques with individuals and/or any caregivers
X
Develop an age appropriate individualized plan of care
X
Provide psychoeducation to individuals and/or any caregivers
X
Promote health and disease prevention techniques

X
Self-assessment skill:
Develop SMART goals for practicum experiences
X
Evaluating outcomes of practicum goals and modify plan as
necessary
X
Documenting and reflecting on learning experiences
X
Professional skills:
Maintains professional boundaries and therapeutic relationship
with clients and staff
X
Collaborate with multi-disciplinary teams to improve clinical
practice in mental health settings
X
Identifies ethical and legal dilemmas with possible resolutions

X
Demonstrates non-judgmental practice approach and empathy
X
Practices within scope of practice
Selecting and implementing appropriate screening
instrument(s), interpreting results, and making
recommendations and referrals:
Demonstrates selecting the correct screening instrument
appropriate for the clinical situation
X
Implements the screening instrument efficiently and effectively
with the clients
X
Interprets results for screening instruments accurately
Develops an appropriate plan of care based upon screening
instruments response

X
Identifies the need to refer to another specialty provider w hen
applicable
X
Accurately documents recommendations for psychiatric
consultations when applicable
X
Summary of strengths:
Opportunities for growth:

write four (4) possible goals and objectives for this practicum
experience. Ensure that they follow the SMART Strategy, as
described
SMART STRATEGY:
Goals
• Is it specific?
• Is it measurable?
• Is it achievable?
• Is it relevant?
• Is it timely?
1. Goal:
a. Objective:
b. Objective:
c. Objective:
2. Goal:
a. Objective:
b. Objective:
c. Objective:
3. Goal:
a. Objective:
b. Objective:
c. Objective:
4. Goal:
a. Objective:
b. Objective:
c. Objective:

Chapter 5
Evidence-Based Practice
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams
& Wilkins
Copyright © 2020 Wolters Kluwer • All Rights Reserved
Definitions #1
Variety of definitions, interpretations
Definition according to David Sackett
Definition by Sigma Theta Tau International
Use of the term best practice by industries
Association with “benchmarking”
Now, one of the less scientific forms of evidence used
Definitions #2
Goal: provide optimal patient care
Enhancement of nursing practice
Improvement of patient or system outcomes

Use of Evidence-Based Practice #1
Why?
Control of health care costs: early stimulus
Provision of highest quality patient care: selection of optimal
interventions for patients
Patient satisfaction
When and Where?
Priority across nursing specialties (see Table 5.1)
Valued across nursing roles and responsibilities
Preparation of nurse leaders and administrators
Refinement of nursing curricula
Expectation of staff nurses to participate in or lead initiatives
Around the World
Worldwide commitment
Australia (the Joanna Briggs Institute)
Canada (Registered Nurses’ Association of Ontario)
United Kingdom
Nursing Knowledge International (NKI): international
clearinghouse, facilitator

Question #1
Is the following statement true or false?
The term evidence-based practice was first defined during the
time of Florence Nightingale.
Answer to Question #1
False
Evidence-based practice emerged as a term in response to the
ongoing expansion and demanding changes in health care.
It evolved when discussions of evidence-based medicine were
expanded to include an interdisciplinary audience.
David Sackett, one of the leaders of the movement, defined
evidence-based medicine.
Sigma Theta Tau expanded the definition to address nursing.
Determination of Evidence-Based Practice
Questions arising in practice settings
Nurses empowered to ask critical questions (see Box 5.1)
Questions leading to decision making to affect outcomes
Best answers, decisions from informed, evidence-based analysis
of each situation

Sources of Evidence #1
Tradition based
Consultation with more experienced, educated, higher-
authority-level nurse
Institutional standards, procedure manuals
Coworkers, other health care providers
Sources of Evidence #2
Evidence based
Research
Randomized controlled trial (RCT): considered the gold
standard of clinical evidence
Integrative review
Meta-analysis
Additional Sources of Evidence
Benchmarking data
Clinical expertise
Cost-effectiveness analyses
Infection control data
Medical record review data
National standards of care
Pathophysiologic data
Quality improvement data
Patient and family preferences

Question #2
Is the following statement true or false?
Institutional standards are considered evidence based.
False
Institutional standards and procedure manuals are typically
considered sources for tradition-based evidence rather than
evidence-based information.
Support Mechanisms for Best Evidence
Garner administrative support
Collaborate with research mentor (see Box 5.3)
Seek assistance from professional librarians
Search already reviewed or summarized research (journals,
Cochrane Collaboration, AHRQ)
Access resources from professional organizations (AACN,
AWHONN, AORN, ONS)
Benchmark with high-performing teams, units, institutions

Mechanisms for Incorporation Into Practice
Development, refinement of research-based policies, procedures
Protocols, algorithms, decision trees, standards of care, critical
pathways, care maps, institutional clinical practice guidelines
Consensus of interdisciplinary team
Patient, family support
Challenges to Implementation #1
Accessibility of research findings
Anticipated outcomes of using research
Support from others
Lack of organizational support (Funk et al., 1991)
Spiva and colleagues (2017) used this instrument in the
implementation of a mentoring program to promote evidence-
based practice
Challenges to Implementation #2
Practicing nurses often feel overwhelmed by the volume of
research on their topics of interest
Practicing nurses often lack the time and experience to be able
to efficiently read and synthesize the literature
Practicing nurses struggle with the political challenges of
attempting to change long-standing policies and procedures in
their clinical settings
See Box 5.4

Question #3
Which of the following would a nurse most likely need to
address as the greatest obstacle when planning to implement
evidence-based practice?
A. Accessibility of research findings
B. Support from others
C. Setting
D. Organizational support
D
On the basis of research about barriers to implementing
evidence-based practice, lack of organizational support was
perceived to be the most significant limitation.
End of Presentation

1. Rate yourself according to your confidence level performing the

1. Rate yourself according to your confidence level performing the

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