Refinement of Nursing Issue into Research

Refinement of Nursing Issue into Research

Evidence-based practice promotes change with evidence every day.  Once upon a time, practice was done using trial and error.  The evidence on an action’s effectiveness or ineffectiveness would therefore promote the use or discontinued use.

The role of research within evidence-based practice (EBP) is vital to the validity of the evidence.  Bourke and Loveridge (2013) explain that evidence-based practice requires obtaining the best available external clinical evidence and incorporating it for evaluation against systematic collections of data received from research.  Research is influenced by evidence-based practice so that the content has greater value. Refinement of Nursing Issue into Research.  This value comes from knowing that the information provided within the literature you view has been substantiated by other experts in the given field.  The researcher evaluates the findings provided in a study, qualifying the study as scholarly.  To qualify as scholarly, the author of the study will submit their credentials of how or why they should be considered as a qualified author on the subject.  In addition, the author will submit their written findings to other peers in the field for their review of the research material.  This is called a peer review study and after being reviewed and accepted by the author’s peers, this helps to ensure to the reader of the literature that other experts in the pertaining field have reviewed the study material and concur with what is written.  This is what allows the research to be considered evidence-based instead of conjecture or a hypothesis.


This paper addresses the issue of health care literacy.  According to MacLeod et al. (2017), research shows that inadequate health literacy impacts total patient-centered care; it affects compliance with healthcare, recommended preventative services, utilization of healthcare, medical expenditures and overall care.

The desperate need for increased exposure to health literacy is of grave importance.  Individuals with inadequate health literacy typically have poorer mental and physical health as well as being sicker in general (MacLeod et al., 2017).  This is because these individuals are lacking education on the importance of understanding how to identify evidence-based information and the importance of why and how this information can and will affect their overall health conditions.  Without the attention this issue deserves, the population of individuals with deficient health literacy will only continue to grow and more people will suffer from poor decision making and lack of action related to health care. Refinement of Nursing Issue into Research.

Application to Selected MSN Program Specialty Track

There is an expectation as an advance practice nurse to provide care based on the best possible evidence available.  Using the best available evidence is not enough to ensure confidence as a provider.  Master’s-prepared Family Nurse Practitioners must also demonstrate genuine concern regarding patients’ health and healthcare outcomes.  Establishing a connection with the patient and their ability to access and understand information and use of technology must also be accomplished (Harris, Thomas, & Fox, 2015).

The impact of resolving healthcare literacy would allow the Family Nurse Practitioner to connect with their patient at a greater level of comprehension.  The Master’s-prepared Family Nurse Practitioner must have greater confidence in the ability of the patient to stay compliant, and, when needed ask appropriate questions to be a more active partner in their own healthcare delivery.

The improvement of health literacy improves overall health conditions and reduces the cost of care.  Haun et al. (2015) provide extensive research stating that health literacy is a major contributor to the higher costs associated with medical care, and increased level of severity of both acute and chronic conditions. Refinement of Nursing Issue into Research.

Nursing Issue and Supportive Evidence Regarding the Issue

Media presents the general audience with all types of remedies through advertising from pharmaceutical manufacturers to products that are supposed to make someone healthier.  Whether the viewer is seeing advertisements on television, as a pop-up advertisement, or conducting a search on symptoms they may be experiencing, they are able to locate advertising to support what they are looking for.  With all the advancements in technology these days the consumer can obtain information from the internet simply by using hand-held devices such as cell phones and tablets, computers, and wireless two-way smart speakers, and now televisions even have internet capabilities built into them.  With information so accessible, it is critical to be able to decipher between credible and non-credible information.  Not having the right tools to do any job can be dangerous.  Not having the right tools to discriminate and recognize the best possible evidence, regarding healthcare can be lethal. Refinement of Nursing Issue into Research.

Patients frequently attempt to save time and money by looking up their physical ailments online to diagnose an issue they are experiencing.  Consumers then go to the store and purchase what they saw advertised or seek to buy it online.  The consumers believe they are saving money and feel good about caring for themselves.  Unfortunately, when the products consumers purchase fail to make them feel better or cure what they believe is their issue, they are then forced to either live with the condition hoping it goes away or seek attention from a health care provider.  This requires the patient to spend additional time and money, which could have been avoided had the consumer been knowledgeable about locating evidence-based information to help them help themselves.  Patients are not always forthcoming with notifying the provider of remedies attempted on their own.  Not notifying the provider of attempted remedies could cause the provider to miss pertinent data or information, improperly diagnose a condition, order additional unnecessary tests, and cost the patient a lot of extra money.

Patients who have a low health literacy may purchase over-the-counter supplements in hopes to help improve memory, fatigue, or stamina.  Not notifying the nurse or provider of these over-the-counter supplements could be the cause of an issue the patient is having.  Many individuals with low health literacy do not realize that over-the-counter supplements may be available without a prescription, but they still should not be taken without consultation from a health care provider.  The fact that supplements are available over-the-counter without a prescription does not make them safe for everyone.

In every health care setting it is the nurse’s responsibility to educate the patient. This becomes a difficult task when the patient is not responsive to learning and believes they can just go online and learn all they need to know. The prevalence of low health care literacy in society is at the highest level of all time (Johnson, 2014).  This may be because the largest growing population are older adults.  According to MacLeod et al. (2017), the number of people age 65 and over in the United States is over 46 million, and anticipated to more than double in the next 30 years.  Therefore, the mismatch between the health provider’s communication and the low health literacy of the patient adversely affect health outcomes daily (Johnson, 2014).

The proposed solution to help bridge the gap with health literacy in the community is to have nurses and medical librarians hold educational seminars free of charge.  Inviting the public to attend these seminars at local libraries, park-districts, and community centers will help educate consumers on the importance of health literacy.  Additionally, public service announcements would prove instrumental in explaining to consumers why the need to be educated on health literacy is so important.  Millican (2014) identifies creative ways in which collaborating with medical librarians and health organizations can minimize health literacy barriers.  This is because evidence-based practice originated with medical librarians teaching the importance of locating the best possible evidence to support health care delivery and how to identify which evidence qualified as the best possible evidence available.

Additional solutions for helping bridge the gap with health literacy include one-on-one consultations with patients in the health care clinic, or inviting patients to join group discussions regarding the importance of learning more about evidence-based health care.  Another potential option would be providing an online forum for patients to log into to read about questions other people are having that might affect them or their loved ones.  It is important to make available in generalized terms to the consumers that health care is delivered to them by health care providers who have done investigating into clinical trials and documented research, so that the health care practices that they give to the patient are done so by using the results of the research to make the best decisions on how to treat the patient the safest with the most optimal outcome.

The stakeholders impacted by low health literacy issues are the patients, patients’ loved ones, and health care providers.  MacLeod et al. (2017) recognized the individuals having inadequate health literacy are people of lower income levels, lesser education, minorities, and older males.  Empirical evidence explains individuals with low health literacy are at greater risk for making inappropriate decisions regarding their own personal health in addition to decisions for their loved ones (Engelke, 2016).  Inappropriate decision making can severely affect the stakeholder’s current and future health condition, by not getting health care attention soon enough, by not being compliant with directions given by the nurse or provider, and not understanding the ramifications of what might result in a chosen action.

By implementing this evidence-based practice project expected outcomes are to be improved compliance with provider direction, increased and improved patient satisfaction, and a greater sense of comfort for the patient. Refinement of Nursing Issue into Research. By improving patient health literacy, it allows patients to make educated decisions for themselves and their loved ones.  Educated decision making in lieu of arbitrary decisions based on advertisement coercion or lack of evidence to support the decision-making process improves patient care by allowing or seeking the best possible interventions made for the patient.  This in turn saves the patient time, money and gives them a greater sense of autonomy, strengthening the patient both mentally and physically.  Additionally, the Master’s-prepared Family Nurse Practitioner, in combining efforts along with health science librarians, will strengthen their ability to continue to provide evidence-based practice to their patients.  As Eldredge (2016) states, the use of the best evidence allows health science librarians to advance evidence-based practice along with healthcare providers. This keeps the health care providers on top of new or recent changes to evidence and sourcing of reliable data.  Having the ability to gather the best evidence available keeps patients safer and better cared for, making it possible to decrease health care costs and time providers need to spend with each patient.  If providers are not having to spend extensive time with patients, more patients can be seen, and a larger population cared for.

Evidence-based Practice Question

The PICOT format is used to address the question: In patients in the community center receiving care, does providing education on health literacy influence finding credible information regarding healthcare as compared to not receiving education on health literacy?  This question will be answered by surveying the people in the community health center, prior to the teaching intervention, and then again 6 months following the education intervention the same members of the community health center will be surveyed to give us our pretest and post-test data figures.  We use the optional (T) in the PICO because we are conducting a quantitative approach. Refinement of Nursing Issue into Research.

P:   Patients in the community center

I:    Providing literacy education one-on-one and/or in a group setting

C:   Patients with health literacy education compared to patients without health literacy education

O: The ability for patients to locate credible information with and without health literacy education.

T:   Surveying the population prior to the teaching intervention and 6 months after the teaching.


Health literacy is a major issue affecting the health and wellbeing of many Americans.  According to Rong et al. (2017), the ability to gather and comprehend basic information regarding health care and to make informed, educated decisions based on that comprehension describes health literacy.  Engelke (2016) teaches that consumers with a low health literacy are at greater risk for poor decision making related to healthcare options.

Interventions are available to help educate people on what information is credible and how to discern between credible evidence-based information and non-credible information.  Eldredge (2016) explains how evidence-based practice was created by medical scientific librarians who taught health care providers how to research and use the best possible evidence to direct patient centered care.  Logically, it then serves to reason that, the same professional body should be involved in educating the public on evidence-based practice and how to encompass it into improving health literacy.

In writing this assignment I learned that there are many factors that help to create and support low health literacy.  I had a preconceived idea or concept of what I felt health literacy encompassed.  In completing research on this topic, I have learned that there is far more than I ever imagined involved with health literacy.  One of the more surprising things that I learned was that the convergence to evidence-based practice into the clinical setting originated from the medical librarians, their creation of a system where the research and literature providing the evidence to learn and practice from allowed practitioners to learn and provide care based on that best available evidence.  Additionally, this assignment caused me to give extensive thought to the government, and their use of mass promotion on public safety issues such as the opioid crisis.   A major contributor to this crisis is evidenced by low health literacy.  Health literacy can address the senseless deaths opioid use is causing, by educating consumers on why so many over-doses are killing people.  I feel it’s very possible to reduce the number of deaths, by simply educating the public.  The old proverb “Knowledge is Power” speaks volumes to correcting and abolishing many health issues, as many are self-created due to low health literacy. Refinement of Nursing Issue into Research.



Bourke, R., & Loveridge, J. (2013). A scientist-practitioner model for inclusive education: Supporting graduate students to conduct systematic reviews for evidence-based practice. New Zealand Journal of Teachers’ Work10(1), 4-23.

Eldredge, J. D. (2016). Integrating research into practice. Journal of The Medical Library Association104(4), 333-337. doi:10.3163/1536-5050.104.4.017

Engelke, Z. M. (2016). Patient Education: Caring for patients with low health literacy. CINAHL Nursing Guide.

Harris, L., Thomas, V., & Fox, M. (2015). The influence of health care literacy on the use of PHRs among older adults. MEDSURG Nursing24(4), 283-285. Refinement of Nursing Issue into Research.

Haun, J. N., Patel, N. R., French, D. D., Campbell, R. R., Bradham, D. D., & Lapcevic, W. A. (2015). Association between health literacy and medical care costs in an integrated healthcare system: A regional population based study. BMC Health Services Research15(1), 1-11. doi:10.1186/s12913-015-0887-z

Johnson, A. (2014). Health literacy, does it make a difference? Australian Journal of Advanced Nursing31(3), 39-45.

MacLeod, S., Musich, S., Gulyas, S., Cheng, Y., Tkatch, R., Cempellin, D., & … Yeh, C. S. (2017). Feature article: The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatric Nursing38(4), 334-341. doi:10.1016/j.gerinurse.2016.12.003

Millican, K. (2014). How are medical librarians addressing health literacy barriers? Serials Librarian67(3), 260-275. doi:10.1080/0361526X.2014.915606

Rong, H., Cheng, X., Garcia, J. M., Zhang, L., Lu, L., Fang, J., & … Chen, J. (2017). Survey of health literacy level and related influencing factors in military college students in Chongqing, China: A cross-sectional analysis. Plos One12(5), e0177776. doi:10.1371/journal.pone.0177776. Refinement of Nursing Issue into Research.

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