Evidence-Based Practice Project Final Paper

Evidence-Based Practice Project Final Paper

Evidence-Based Practice Project Final Paper

Pregnant women, in some cases, face health challenges throughout the nine months that need careful attention and management for better patient outcomes. One of such health concerns is hypertension. Hypertension has been shown to be common among pregnant women, as up to 10% of pregnant women are affected by hypertension (Antza et al., 2018). The condition can result in various negative impacts for both the mother and the unborn child or the baby.  While it can lead to low birth weights and premature births among babies, the condition can lead to preeclampsia, which can possibly kill the mother (Antza et al., 2018). Even though medication protocols exist for controlling hypertension, it’s key that pregnant women know well about the risk and symptoms so that they can seek immediate medical attention in case such symptoms develop.

Perinatal hypertension can result from various causes, one of them a history of high blood pressure and other factors such as obesity, stress, smoking, and carrying more than one child (Agrawal& Wenger, 2018). Various treatment strategies exist for tor the perinatal women experiencing hypertension. However, such options may vary from case to case. In most cases, the health care professional may recommend that the patient lifestyle intervention such as an integration of increased physical activity and dietary modifications and hypertension management medications (Agrawal& Wenger, 2018). The implication is that physicians have to work closely with the patients to help formulate effective individual-specific plans.

Currently, there are various standardized hypertension medications for perinatal women. For example, beta-blockers are vital in lowering the patient’s blood pressure as they block the hormone adrenaline (Agrawal& Wenger, 2018). Another set of medications used in relaxing the muscles around the blood vessels to improve the blood flow is the calcium channel blockers. In addition, ACE inhibitors have also been widely used since they are key in protecting patients from kidney damage that is caused by high blood pressure. Therefore, the purpose of this paper is to propose an evidence-based project for managing the hypertension crisis in perinatal women.

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The PICOT Statement

In efforts to guide the project, a PICOT statement was formulated. In the perinatal women (P), will the treatment of a hypertension crisis with the recommended medication within 60 min (I), compared to current standardized practices (C), improve maternal outcomes/prevent complications (O) within 6 months (T).

The hypertension crisis event requires that a patient seeks medical attention timeously, where the healthcare professionals, in most cases, prescribe medications that can help in lowering the blood pressure. While short-term medications can be useful in stabilizing blood pressure during a crisis, long-term medications can be used to control blood pressure for extended periods of time (Braunthal& Brateanu, 2019). However, medication adherence is key. It is important to note that this condition is still prevalent even with the current strategies, and there is a need to explore more evidence-based practices. Therefore, this project seeks to explore the treatment of hypertension crisis with the known and recommended drugs within 60 minutes in comparison to the current standard practice. The strategy will be studied to find out if it improves outcomes or helps in the prevention of other complications among the perinatal women within six months.

It is important to take the current research guidelines into consideration. For example, the management and treatment of pregnant women need to be done regarding the patient’s autonomy and informed consent. In addition, such a research effort should be carried out in such a way that it does not expose the woman and the unborn baby to any risk. It is hoped that treating the hypertension crisis using the recommended medications will have more impact in comparison to the current practice.

Problem Statement

From the Center for Disease Control and Prevention (CDC) data, hypertension is one of the most common public health concerns in the U.S since it affects about twenty-five percent of all adults. The condition particularly poses danger to pregnant women since it has several adverse effects such as stillbirth, low childbirth weight, and premature birth. Among the maternal mortalities in the country approximately 11% result from hypertension (Petersen et al., 2018). Based on such evidence, it is key to understand the risk factors and causes of the condition for better prevention and treatment. Various factors have been shown to cause hypertension, including the use of particular medications for various diseases such as kidney disease, diabetes, and obesity. African Americans are also associated with a higher risk for developing hypertension during pregnancy compared to other racial groups.

Hypertension has known adverse impacts on pregnant women and is among the top causes of maternal deaths in the US. However, the determination of the exact magnitude of the hypertension crisis among pregnant women is complex. Nonetheless, the condition stands out to be serious and should be addressed (Petersen et al., 2018). Since the effect may vary from one woman to another, it is important that the pregnant women discuss the condition with the healthcare providers to enable them to have individualized plans that can effectively help control and manage high blood pressure during pregnancy. Even though there are current treatment protocols for hypertension among these women, there is a gap that needs to be addressed. Due to pregnancy, the hypertension medications for managing them are currently limited as the existing ones can negatively impact both the child and the mother.

The treatment gap results from various reasons, such as limited resources, inadequate knowledge about the condition, and limited access to care. Such management strategies should be able to help protect them and the unborn child from health complications related to hypertension. In most cases, the standardized hypertension treatment options used among other populations are ineffective among pregnant women and may result in adverse complications for both baby and the mother (Webster et al., 2019). As such, there is a need for treatment approaches that consider the status of this population as most of the current ones have the potential of leading to effects like birth defects, among others. Pregnant women can either experience gestational or chronic hypertension. Even before experiencing gestational hypertension during pregnancy, some women could be having chronic hypertension, putting them at more risk.

As earlier highlighted, antihypertensive therapy has been applied as a standard treatment for hypertension in pregnant women, and even though they may help lower blood pressure, they can also lead to various adverse impacts such as birth defects. Therefore, it is essential to weigh the benefits and risks of medications to be administered to pregnant women experiencing high blood pressure (Webster et al., 2019). As such, evidence-based practice strategies have been used key in treating the hypertension crisis by applying the recommended medication. This project explores the use of the recommended medication within the first sixty minutes. The expectation is that the use of this protocol as compared to the standard practice will reduce complications or improve maternal outcomes.

Organizational Culture and Readiness

Various factors impact the success of an EBP implementation. Among the factors are organizational culture and readiness. Indeed, organizations that exhibit support to EBP implementation usually offer a good ground for the successful implementation of the EBP. As such, it is important for the EBP implementers to assess organizational culture and readiness (Melnyk & Fineout-Overholt, 2018). Therefore, the readiness of the organization and its prevailing culture will dictate how successful the project will be in controlling hypertension among pregnant women and improving their health outcomes.

Upon carrying out an assessment of the organizational culture and readiness, it was noted that the organization exhibits various desirable qualities. Forexample, the organization has an innovative mindset, positive values that support evidence-based practice, collaboration, stakeholder support culture, and effective leadership. Therefore, it is expected that the project will be creatively implemented. The stakeholders are an integral part of the successful implementation of the project (Melnyk & Fineout-Overholt, 2018). Therefore, it is key to obtain their buy-in, and the collaboration quality observed in the organization will be key in this respect. The implication is that there is every chance that every stakeholder will be willing to pull in the same direction and work towards a common goal of improving outcomes.

The project will be accomplished in a healthcare facility that offers hypertension care, management, and treatment as part of the plan. It is key to ensure that the healthcare facility chosen specializes in hypertension treatment and prevention. Even though the research intends to have research subjects, only medical records will be used, and the records will be obtained on a monthly basis. As earlier discussed, the stakeholders will be key in the implementation of the evidence-based practice project, with the key stakeholders being the leadership, frontline personnel, and doctors. The plan is to formulate a committee responsible for drafting the strategy. The committee members will have to collaborate and cooperate for successful strategy planning and implementation (Melnyk & Fineout-Overholt, 2018).

The Literature Review

Hypertension as a medical condition is often referred to as high blood pressure. While it can result in negative health for every individual, pregnant women can be more impacted as both the mother and the baby may develop complications. During pregnancy, various strategies applied in managing the condition include close monitoring by the healthcare experts, having bed rest, and medication. Depending on the severity of the condition, C-section delivery or early induction can be the preferred means to ensure that the mother and the baby are safe (Webster et al., 2019). Nonetheless, under proper care, the majority of pregnant women experiencing hypertension go on have healthy pregnancies and deliver healthy babies. In efforts to look for evidence that supports the proposed project, a comprehensive literature review was conducted. Therefore, the relevant articles have been reviewed, and the results are discussed in this section.

Christenson et al. (2021) conducted a study to explore the standardized treatment approaches for pregnant women with hypertension. The study recruited a total of eighty prenatal women. The participants were divided into two groups, a placebo group and the intervention group, which was offered a low-dose aspirin. Data analysis revealed that the participants given the low-dose aspirin presented with a substantially lower risk of developing postpartum hypertension as compared to those in the placebo group. Even though further research is required to support the findings of this study, low-dose aspirin can be useful in the prevention of postpartum hypertension. The importance of these findings is that healthcare professionals can use them to have a better understanding of the treatment of hypertension among this group of patients.

Another research by Amanak et al. (2019) aimed at examining the impact of prenatal education on pregnancy, adaption to pregnancy, and gestational hypertension. The research mainly focused on the conventional treatment strategies for pregnant women with hypertension. The researchers used the Roy adaptation model as the framework. The researchers recruited a total of two hundred and four women into the study. The data analysis indicates that the educational intervention led to better pregnancy outcomes, reduction in weight, and increased physical activity among pregnant women. The findings from this study are key in understanding the problems encountered when treating pregnant women with hypertension.

Xu et al. (2017) focused on various non-medical approaches in the management of pregnant women with hypertension. From the study, various observations were made related to hypertension in pregnant women. For example, owning a pet in the perinatal period was connected to optimal blood pressure level and reduced hypertension. The study sample was composed of over six thousand adults. Mothers who lived with pets during pregnancy were observed to have reduced hypertension and lower systolic blood pressure. In addition, a similar relationship was also observed during the postnatal period, as mothers who had pet exposure for at least a year after childbirth experienced reduced hypertension and lower diastolic blood pressure.

Sharma et al. (2017) compared the efficacy of using nifedipine and hydralazine in managing hypertension in pregnant women. In a double-blind, randomized controlled trial, a total of sixty patients were enrolled in this study, with women experiencing at least 160 mm Hg of systolic blood pressure or at least 110 mm Hg of diastolic pressure. While the intervention group was given varying doses of hydralazine, the other group was offered a placebo while another group was given a saline injection. The analysis of the data showed that the use of both oral nifedipine and intravenous hydralazine are effective in lowering blood pressure in the management of hypertension during pregnancy.

Another study was conducted by Salama et al. (2019) to assess the fetal and maternal outcomes among women with hypertension and use either nifedipine or methyldopa medications compared to no medication. The researchers used a multicentre randomized clinical trial with a total of 490 pregnant women recruited in the study. A total of one hundred and sixty-six women were randomized into the methyldopa group, while one hundred and sixty were randomized into the nifedipine group. The rest were randomized into the no medication or control group. The analysis of the data showed that the women recruited in the control group showed a higher tendency to develop repeated hospital admissions, renal impairment, preeclampsia, and severe hypertension. The women in the treatment groups who used nifedipine and methyldopa had better outcomes. Therefore, methyldopa and nifedipine are promising medication options that can be applied in the treatment and management of hypertension among pregnant women.

The Change Model

Change models or frameworks are key in the implementation of the nursing intervention. Their importance emanates from the fact that they offer a foundation upon which various parts of the proposed intervention can be based during the implementation process (Melnyk & Fineout-Overholt, 2018). As such, there are various theoretical frameworks or models that exist today and are helpful in the EBP implementation process, and the choice depends on the nature of the project to be implemented. Therefore, the chosen change model that has been chosen to guide this project is Kurt Lewin’s change model. This model is one of the most common models, and it has been widely applied in change implementation and management.

According to the theory, change management happens in three phases or three-step. The first phase of change management is the unfreezing phase, which entails identifying and understanding the contributing factors to the existing situation that needs change (Hussain et al., 2018). The next phase is the change phase which entails making the desired change as an action to ensure that the current situation changes to the desired state. The final phase, the refreezing stage, entails making the changes made to part of the organizational culture or making the change more permanent. This change theory or model is key for the proposed evidence-based practice project since it gives a framework that the change implementers can use to understand how the treatment process can be changed to ensure that the pregnant women having hypertension have better patient outcomes (Hussain et al., 2018). In addition, the model also supports engagement with the stakeholders and participatory research to effect change and underlines the importance of the cyclical adjustment and assessment process for optimized outcomes.

Lewin’s change model can effectively be used to successfully manage change and guide evidence-based practice project implementation through its three phases. As such, it is key that the change leaders understand every concept in the model so that they implement the change effectively. This change theory has the major benefit of helping lower the risk of undertaking change initiatives that may be unsuccessful and change efforts that could cause harm to the patients. The application of data instead of intuition instills confidence in the healthcare professionals that the choices they are making are the best for the patients (Hussain et al., 2018). While the diagram representation of the model is shown below, the concept map has been included in the appendix section.

 

The Implementation Plan

Implementation is one of the important phases of an EBP cycle. Therefore a comprehensive implementation plan needs to be formulated prior. Therefore, the implementation plan for this project will be in four steps. The four steps include evidence assessment, creating an implementation plan, putting the formulated plan into action, and an evaluation process of the achieved outcomes. During the assessment of the evidence base, existing literature and research are reviewed with the aim of identifying what is already known about a particular identified problem and possible gaps. The second step, which is the development of an implementation plan, entails a view into the translation of the evidence into practice (Melnyk & Fineout-Overholt, 2018). The next step of action involves the actual implementation of the planned problem followed by evaluating whether the obtained results have achieved the expected goals.

It is important to establish if there is a genuine problem or need to be addressed by applying evidence-based approaches. This can be done using various strategies such as conducting a comprehensive literature review of the existing research articles, making observations in the care environment, and noting down how the patients with the similar problem identified are offered help to overcome and consulting experts in the field (Melnyk & Fineout-Overholt, 2018). A literature search should follow a clear protocol to help find the best information. For example, the relevant search items should be identified to help narrow the search and make them more relevant to the research question. As part of the implementation planning, various aspects will also be considered, and they have been discussed below.

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The Setting and Accessing the Potential Subjects

The setting for carrying out an evidence-based project should be identified in time so that relevant documentation such as site approvals forms and relevant signatures are obtained(Melnyk & Fineout-Overholt, 2018). Therefore, the plan is to implement this research in a hypertension treatment center that deals with various patients with hypertension. Therefore, the facilities should be specific to those that offer general and specialized care to hypertensive patients. In addition, identifying the research subjects is important so that relevant documentation such as consent forms can be drafted and appropriately signed in time. Since medical history records will be used, the data will be acquired on a monthly basis, and pregnant women with hypertension symptoms will be included in this research.

The Project Timeline

Another important aspect of project implementation is the project timeline, as it guides the researchers to make appropriate efforts and complete the specific project phases within the required time frame(Melnyk & Fineout-Overholt, 2018). This project has been formulated to take six months. As part of the timeline plan, the project’s scope will be defined and a detailed plan created. A team of qualified personnel will be assembled to appropriately work together in resource allocation such as monetary resources and time. The team is also set to monitor the project’s progress and make adjustments as need be and ensure that the project remains on the designed path or track. The team is also to evaluate the results obtained. As such, it is key to include a timeline to enable task planning and execution. However, it is worth mentioning that it is a challenge to come up with a specific PICOT project completion date due to the several variables that could be at play to influence the overall time a project can take.

Budget and Resource List

Relevant resources are important for an evidence-based practice project implementation. Therefore, the resources should be timeously identified and listed to enable procurement. The cost of this project is projected to be between $10,000-$15,000. This money will be used to acquire various relevant items such as an echocardiogram, electrocardiogram, hypertension tools and training, hypertension patient education handouts, hypertension communication kits, printer, literature search process, computers with internet access, and software for data analysis.

The Research Design

This research will employ a quantitative design in data gathering as well as evaluation of the success of the program. The quantitative design is appropriate since the project data will majorly be numerical. One of the importance of the design is that it enables researchers to unbiasedly and precisely assess various study approaches (Hande et al., 2017).

Description of Instruments and Methods

            Various instruments and methods can be used in this project. Chart audits and interval tests will be used to enhance accuracy in data measurements. They are key in identifying the outliers in specific measurements, which might be due for a closer look. Carrying out interval audits and tests will be key in giving an idea about where the smooth processes could be interrupted.

The Evaluation Plan

            Evaluation is one of the last stages in an evidence-based practice process, and it helps in finding out how effective the intervention was. It also helps in finding out the effectiveness of strategies and processes employed. Therefore, this section explores various aspects of the evaluation plan.

The Expected Outcomes

It is important to timeously identify the expected outcomes so that the project goals can be aligned to best achieve them. Since the project majorly focuses on the treatment and management of hypertension crisis among pregnant women, one of the targeted outcomes is reduced cases or incidences of hypertension during this duration. The other targeted outcomes include lowered incidences of hospital visits caused by high blood pressure after discharge, lower incidences of stillbirth, reduced cases of mortality rates among pregnant women, and complications to their children (Braunthal & Brateanu, 2019). Central targeted outcomes are reduced incidences of hospital visits caused by hypertension crisis among pregnant mothers as such visits increase the cost of healthcare, which can be a burden to the patient who comes from low-economic backgrounds.

Data Collection Tools and Methods

The major source of data for this study will be the patient’s electronic health records. This source of data will be key as the data obtained will be used in evaluating how effective the intervention has been in managing the hypertension crisis during pregnancy (Hong et al., 2019). The importance of health records emanates from the fact that it captures patient information more accurately, making them an important research tool in this study (Lund et al., 2021). It will help to get data that can be analyzed to find out if there is any significant difference between the use of medications within the first sixty minutes and the standard procedure of blood monitoring strategies. Chart audits will also be key in activity measurements and in supporting the facility to achieve the major objectives that can be useful in evaluating the care quality offered by the professionals.

The Statistical Tests

One of the tests that will be applied in this project is the interval test. The interval tests will be key in assisting the implementers in arriving at a correct conclusion. The statistical tests will be key in determining the difference in the efficacy of the two methods, allowing a comparison between the proposed intervention and the standard practice protocols in managing the hypertension crisis. In addition, the outcomes after the intervention will be compared with the observations made before the intervention. The statistical tests and interval tests are compatible (Melnyk & Fineout-Overholt, 2018).

The Remediation Strategies

            Evidence-based practice projects are meant to bring positive outcomes for a particular group of patients. However, in some cases, the outcomes turn out to be negative or bring unexpected results. As such, it is necessary to plan for remediation strategies. One of such methods is research method analysis to find out if there was any bias so that it can be corrected (Lund et al., 2021). Besides,  a comparison analysis with research findings of other studies can be performed to make an informed decision on the need to modify the intervention or not. Another strategy is to engage every stakeholder to participate in a review process where the implementation process will be evaluated for potential errors and corrected (Melnyk & Fine-Overholt, 2018).

Plans to Maintain and Extend the Proposed Solution

An evidence-based practice project does not end with evaluation, and therefore as part of the process, there should be a plan in place to maintain and extend the solution. In case the project is successful, it will be maintained through the engagement of the healthcare practitioners and other staff members who are key drivers of change (Sharplin et al., 2019). The implication is that these individuals have to be supported and motivated to sustain the change by showing them the data that indicates that the intervention has had positive impacts on the health outcomes of pregnant women with hypertension. To support the sustenance, pamphlets and posters with the recommended medication protocol will be used as they will be central in reminding the staff of the need to use the new protocol for sustained and improved healthcare outcomes.

Conclusion

One of the most prevalent health complications during pregnancy is hypertension. Hypertension affects up to 10% percent of pregnant women leading to various adverse outcomes such as preeclampsia which can be dangerous for the mother and the child. The implication is that pregnant women should seek medical attention immediately the first symptoms of hypertension appear. While short-term strategies can be used in stabilizing the patient’s blood pressure, long-term options are available for sustained management. Various management options exist, including bed rest, close monitoring by the medical staff, and the use of recommended medication. However, the medications used for hypertension during pregnancy are limited since most of them can adversely affect the unborn child hence a need to pursue better strategies. Therefore, this project has proposed the treatment of hypertension within the first sixty minutes to help prevent complications or improve patient outcomes in the management and treatment of hypertension among pregnant women.

 References

Agrawal, A., & Wenger, N. K. (2020). Hypertension during pregnancy. Current Hypertension Reports, 22(9), 1-9. https://doi.org/10.1007/s11906-020-01070-0

Antza, C., Cifkova, R., & Kotsis, V. (2018). Hypertensive complications of pregnancy: a clinical overview. Metabolism, 86, 102-111. https://doi.org/10.1016/j.metabol.2017.11.011.

Braunthal, S., & Brateanu, A. (2019). Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Medicine, 7, 2050312119843700. https://doi.org/10.1177%2F2050312119843700.

Hande, K., Williams, C. T., Robbins, H. M., Kennedy, B. B., &Christenbery, T. (2017). Leveling evidence-based practice across the nursing curriculum. The Journal for Nurse Practitioners, 13(1), e17-e22.https://doi.org/10.1016/j.nurpra.2016.09.015.

Hong, Q., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M.-C., & Vedel, I. (2019). Improving the content validity of the mixed methods appraisal tool: A modified e-delphi study. Journal of Clinical Epidemiology, 111, 49–59.e1. https://doi.org/10.1016/j.jclinepi.2019.03.008

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002.

Lund, H., Juhl, C. B., Nørgaard, B., Draborg, E., Henriksen, M., Andreasen, J., Christensen, R., Nasser, M., Ciliska, D., Clarke, M., Tugwell, P., Martin, J., Blaine, C., Brunnhuber, K., & Robinson, K. A. (2021). Evidence-based research series-paper 2 : Using an evidence-based research approach before a new study is conducted to ensure value. Journal of Clinical Epidemiology, 129, 158–166. https://doi.org/10.1016/j.jclinepi.2020.07.019

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.

Petersen, E. E., Davis, N. L., Goodman, D., Cox, S., Mayes, N., Johnston, E., … & Barfield, W. (2019). Vital signs: pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017. Morbidity and Mortality Weekly Report, 68(18), 423. https://dx.doi.org/10.15585%2Fmmwr.mm6818e1

Salama, M., Rezk, M., Gaber, W., Hamza, H., Marawan, H., Gamal, A., & Abdallah, S. (2019). Methyldopa versus nifedipine or no medication for treatment of chronic hypertension during pregnancy: A multicenter randomized clinical trial. Pregnancy Hypertension, 17, 54-58. https://doi.org/10.1016/j.preghy.2019.05.009

Sharma, C., Soni, A., Gupta, A., Verma, A., & Verma, S. (2017). Hydralazine vs nifedipine for acute hypertensive emergency in pregnancy: a randomized controlled trial. American Journal of Obstetrics and Gynecology, 217(6), 687-e1. https://doi.org/10.1016/j.ajog.2017.08.018.

Sharplin, G., Adelson, P., Kennedy, K., Williams, N., Hewlett, R., Wood, J., Bonner, R., Dabars, E., & Eckert, M. (2019). Establishing and sustaining a culture of evidence-based practice: An evaluation of barriers and facilitators to implementing the best practice spotlight organization program in the australian healthcare context. Healthcare, 7(4), 142. https://doi.org/10.3390/healthcare7040142

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Appendices

Appendix A: Timeline

No.	Activity	Time (Months)
1	Defining the problem or question	1
2	Collection and analysis of data	2
3	Developing a plan for how the question or the problem will be addressed	1
4	Testing and modifying of the plan	1
5	Implementing the plan and gathering more data to see if it has had the desired effect	1

 Appendix B: Budget and Resource List

No.	Item	Cost ($)
1.	Computer with internet access	1000
2.	Software for data analysis (SPSS, RStudio)	1500
3.	Literature search databases (e.g. PubMed, Web of Science)	1000
4.	Printer/copier	2000
5.	healthcare personnel	3000
6.	Hypertension Communications Kit	2000
7.	Hypertension Patient Education Handouts	1000
8.	Hypertension Tools And Training	1000
9.	Electrocardiogram,	1000
10.	Echocardiogram	1000
11.	TOTAL	13,500

 Appendix C: Chart Audits

Appendix D: Lewin’s Change Model

Appendix E: Resource List

Microsoft Teams available	Patient educational material
Laptop computer	Frontline staff educational materials
Poster boards to show education	Data collection nurse
Staff nurses	RN driving QI project
Information technology	Room for in person meeting
Healthstream education system	Nurse champions
Printer/copier	Laminator
Physician liaison	Snacks for meeting attendees

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For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.
To writer: the project for Nur 550 was different, see current project for this class
EBP project: In the perinatal women (P), will the treatment of a hypertension crisis with the recommended medication within 60 min (I), compared to current standardized practices (C) improve maternal outcomes/prevent complications (O) within 6 months (T).
To W: Please use the research that you have been doing with the previous work for this same EBP project. Thank you

Final Paper
The final paper should:
1. Incorporate all necessary revisions and corrections suggested by your instructors.
2. Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
3. Contain supporting research for the evidence-based practice project proposal.
Main Body of the Paper
The main body of your paper should include the following sections:
1. Problem Statement
2. Organizational Culture and Readiness
3. Literature Review
4. Change Model, or Framework
5. Implementation Plan
6. Evaluation Plan
Appendices
The appendices at the end of your paper should include the following:
1. All final changes or revisions for the drafts that will be included in the appendices of your paper.
2. Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.
General Requirements
You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.