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Running head: E-FOLIO 1

E-Folio: Essential III

Margaret Anyiam
Frostburg State University


E-Folio: Essential III and the Case
Essential III: Scholarship for Evidence Based Practice states with references to the
nursing practice that scholarship for the baccalaureate graduate involves identification of
practice issues Appraisal and integration of evidence And evaluation of outcomes (American
Association of Colleges of Nursing, 2008, p. 15). It is important for a nurse to find the credible
information which is necessary for the work, to evaluate the evidences appropriately, and to
integrate the data into practice because the nursing practice should be evidence based, and it
should be supported with significant scholarship background (Bell, 2001; Meister et al., 2002;
Oermann, 2002).
Exemplar to be used is a project in which the evidence was ranked according to the
GRADE system. This is an effective example to demonstrate the importance of Essential III.
Thus, it was necessary for the project to choose the grading system, to provide the practice
recommendation, evaluate the strength of the recommendation and the quality of the evidence.
From this point, the development of the project can be discussed as an example of the necessity,
to learn how to evaluate evidence in order to continue research and make effective conclusions
appropriate for the nursing practice (Schmidt & Brown, 2012). The overall number of the
recommendations provided was three. This created the opportunity to evaluate the evidence in
relation to three different recommendations in order to improve skills in conducting the research
and evaluating the information. The ability to rank or classify the evidence according to definite
criteria is important to promote evidence based practice with references to scholarship skills
(Majid, 2011, p. 229).


The role of the project has been analyzed for the purpose of learning and career with
references to the principles stated in the Essential III. Thus, it is mentioned in the essential that
nurses should integrate reliable evidence from multiple ways of knowing to inform practice and
make clinical judgments (American Association of Colleges of Nursing, 2008, p. 16). Through
working on the project, one could improve skills in conducting the necessary research,
evaluating the resources, choosing the most appropriate material, and providing effective
conclusions. From this point, the project was effective enough to improve skills and abilities in
activities which are closely connected with the evidence-based practice (American Psychological
Association, 2010). Today, I understand the principles of the evidence-based practice clearly and
can use them with references to scholarship and work with information, data, and evidences.


American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education
for professional nursing practice. Retrieved from
American Psychological Association. (2010). Publication manual of the American Psychological
Association. Washington DC: American Psychological Association.
Bell, S. (2001). Professional nurses portfolio. Nursing Administration Quarterly, 25(2), 69-73.
Majid, S. (2011). Adopting evidence-based practice in clinical decision making: Nurses'
perceptions, knowledge, and barriers. JMLA, 99(3), 229236.
Meister, L., Heath, J., Andrews, J., & Tingen, M. (2002). Professional nursing portfolios: A
global perspective. MEDSURG Nursing, 11(4), 177-182.
Oermann, M. (2002). Developing a professional portfolio in nursing. Orthopedic Nursing, 21(2),
Schmidt, N. A. & Brown, J. M. (2012). Evidence-based practice for nurses: Appraisal and
application of Research. Boston: Jones and Bartlett Publishers.


Overview of the Grading System (Exemplar)
The GRADE approach will be utilized to gauge the value and likely effectiveness of the
recommendations made. The system allows for the classification of recommendations as either
strong or weak, based on the balance achieved between risks, benefits, cost and burden, as well
as the degree of confidence that can be inferred from the estimates of benefits, burdens and risks
provided. Furthermore, the system classifies evidence provided as high, moderate or low (Grades
A, B, and C respectively), depending on the consistency of the results, the precision of estimates,
the risk of bias and the directness of the evidence provided (Schmidt & Brown, 2009/2012).
Based on the findings, when a trade-off between the risks and benefits is made, a
recommendation can then be considered for implementation as an intervention.
Practice Recommendation #1
The first practice recommendation, would be to try and strengthen the quality of
relationships between the elderly and their spouses as well as with their children, in cases where
either or both exist. In most cases, the elderly normally find themselves abandoned, neglected, or
simply become lonely after their children move away, a factor that greatly contributes to their
loneliness. This is especially true for elderly persons who also happen to be widows or widowers
(Fiorillo & Sabatini, 2008; WRVS, 2011).
Strength of recommendation
The recommendation is quite strong, because the risks involved are quite minimal, while
the costs are negligible. In addition, helping to rekindle family relationships can lead to the
creation of lifelong relationships and support systems.


Strength and quality of evidence
The evidence can be classified as high due to the high number of studies that identify the
loss of a spouse or the moving away of children as causes of loneliness (Fiorillo & Sabatini,
2008; WRVS, 2011).
Practice Recommendation #2
The second recommendation would be to enhance social networking, either through the
establishment of support groups that can easily offer the required level of companionship. As an
alternative, or to augment the support group approach, activities that encourage socializing and
interaction between the elderly can be organized by the nursing homes or by the hospitals to
reduce loneliness (Windle, Francis, & Coomber, 2011).
Strength of recommendation
The recommendation is strong because the benefits will certainly outweigh the risks and
costs. For instance, by eliminating the risk of loneliness amongst the elderly, the system will also
reduce the number of senior citizens in need of medical attention due to conditions that co-occur
with loneliness. Furthermore, social networking events or support groups would cost
considerably less to organize compared to any medical costs (Windle, Francis, & Coomber,
Strength and quality of evidence
The evidence can be graded as low, because there are few studies that explore the effect
of social networking on loneliness, especially amongst the elderly; the evidence can be graded as


Practice Recommendation #3
In order to ensure constant monitoring of the wellbeing of the elderly, a community based
health worker can be tasked with making regular home visits to select vulnerable individuals.
Such visits, in addition to allowing for the assessment of their state of mind, would also allow for
the assessment of the quality of relationships such individuals are engaged in (Sahlen, Lofgren,
Helllner, &. Lindholm, 2008).
Strength of recommendation
The recommendation is strong, more so because it falls well within the concept of holistic
care and encourages the adoption of a proactive approach. The potential benefits of such an
approach would certainly outweigh the risks and costs. Furthermore, research findings on the
cost effectiveness of such visits is quite encouraging (Sahlen, Lofgren, Helllner, &. Lindholm,
Strength and quality of the evidence
The evidence provided can be graded as moderate, especially due to the risk of bias in
such studies.


Fiorillo, D., & Sabatini, F. (2011). Quality and quantity: the role of social interactions in
individual health. Social Science and Medicine, 73, 1644-1652.
Sahlen, K., Lofgren, B., Helllner, M., &. Lindholm, L. (2008). Preventive home visits to older
people are cost-effective. Scandinavian Journal of Public Health, 36(3), 265-271.
Schmidt, N. A. & Brown, J. M. (2009/2012). Evidence-based practice for nurses: Appraisal and
application of research. Boston: Jones and Bartlett Publishers.
Windle, K., Francis, J., & Coomber, C. (2011). Preventing loneliness and social isolation:
interventions and outcomes. Research Briefing 39. Retrieved from
WRVS (2011). Loneliness amongst older people and the impact of family connections .
Retrieved from