Evidence-Based Practice Paper

Evidence-Based PracticeAlexis IrwinDelta CollegeMarch 11, 2019Evidence-Based PracticeThe American Association of Critical-Care Nurses (AACN) define Evidence-Based Practice, or EBP, as a problem-solving approach in practice that involves the conscientious use of current best evidence in making decisions about patient care and incorporates a systematic search for critical appraisal of relevant evidence to answer a clinical question (Munro & Hope, 2019). The foundation for EBP includes the involvement of researchers who collect the evidence, as well as the clinical professionals who apply their knowledge of said evidence to make clinical decisions based on the necessities of their patient(s). It provides insight into evidence-backed methods for direct patient care, workflow matters, infection control, charting, etc. The best evidence is a product of multiple well-designed clinical trials that test the same health issues. In settings that involve critical care, it is particularly difficult to design and conduct a clinical trial that will inform practice. Clinical care must always be paramount, even if it compromises a study. Patients care must always come first, and the trial second. Evidence-Based research trials need to account for the patient’s current pathology, as well as underlying issues (severity included), age, gender, and ethnicity (Munro & Hope, 2019).Evidence-Based Practice Relevancy to Nursing PracticeThe purpose of EBP is to provide the best possible care and to improve patient outcomes. It allows healthcare professionals to access dependable research (with results) and clinical guidelines appropriate to patients receiving their care. Not only is it essential for nurses to understand the importance of the evidence, it is equally important that they know how to analyze and transform the evidence into practice. Although there are many forms of evidence available, healthcare professionals are required to understand and identify the best methods to provide the best patient outcome. Deficits in the most recent knowledge related to EBP creates problems, as professionals may be unable to provide the basis on which they apply their clinical decisions. Evidence-Based Practice might prompt nurses to alter their methods if the evidence contradicts what they learned in school or even if something has been standard practice for years.Nurses must be open to understanding the research process, as well as demonstrating the skills and knowledge required to transform the evidence into their care. Staying current on research allows nurses to demonstrate the ability to obtain new knowledge and adapt their practices to reflect that knowledge. If healthcare professionals, especially nurses, can realize the importance of research and apply this to EBP, it will indirectly improve the quality of patient’s care. Aside from the nurse’s responsibilities, facilities also need to provide resources and support to implement Evidence-Based Practices.Evidence-Based Practice ChangesThe following examples explain changes in healthcare over the past few years: Evidence-Based Infection Control Policies are in place to aid nurses in preventing unexpected illness or infection. Implementing infection prevention measures is necessary to protect not only the patients, but the staff as well, and to control the spread of infection. This includes correct and consistent hand hygiene, keeping the environment clean, and following isolation protocols. The concept of infection control is more frequently referred to today as infection prevention, but implementation is much the same. A noticeable difference is that in addition to the Joint Commission’s standards and goals, the CDC has established “never events,” in which HCAI’s may result in lack of reimbursement for hospitalizations. Evidence-Based principles of infection prevention have 4 primary tenets: (1) hand hygiene; (2) barrier precautions; (3) decontamination of environment, items, & equipment; and (4) antibiotic stewardship (Makic, Martin, Burns, Philbrick, & Pallen, 2013). While nurses have numerous responsibilities, one of the most important is to consistently implement practices to prevent infection.Another example is oxygen use in patients with COPD. The belief used to be that providing O2 with a COPD exacerbation could induce hypercarbia and/or acidosis, and that the risk would outweigh the benefit. Recent research has proven that the practice of applying oxygen can help prevent hypoxia and organ failure, as well as enhance the patient’s quality of life. Withholding oxygen as an attempt to prevent adverse outcomes is dangerous and unwarranted in most cases. Chronic hypoxemia causes the development of Cor Pulmonae in patients with COPD. The associated pulmonary hypertension adversely affects survival, not to mention additional consequences such as inadequate nutrition and decreased activity intolerance. Because these adverse outcomes are the result of tissue hypoxia, the provision of oxygen is necessary (Makic et al., 2013). Nurses have a duty to provide the best care possible, so applying this evidence may not only improve COPD patient’s acute symptoms, it may extend their lives.The size of an intravenous catheter was believed to influence the delivery of PRBC’s. The misconception was that it was necessary to insert the largest-bore catheter possible, as to avoid hemolysis of the cells during administration. (Makic, et al., 2013). Not only is it difficult to place a large-bore catheter in patients with superficial veins, e.g., the elderly population, it is likely to cause extreme pain. The American Association of Blood Bank’s guidelines advise that PRBC’s may be safely transfused through catheters ranging from 14 gauge to 22 gauge without incurring cell destruction, and that hemolysis is caused by high-pressure infusions, not the size of the catheter used (Makic et al.). A smaller gauge usually increases comfort for patients, as well as potentially preventing numerous needle sticks, phlebitis, and/or infiltration. It is the responsibility of the nurse to assess venous access, choose a site that has the best chance for success, and to minimize discomfort if possible.Cultural Diversity ConsiderationsIncluding culturally sensitive lines of inquiry into nursing’s base of evidence acknowledges the diversity of individuals, families, and communities. In turn, this reflects the knowledge, caring, and primary healthcare social justice agenda embraced by health professions. A 2015 report released by the US Census Bureau projects that by the year 2020, more than one half of the nation’s children will belong to a minority race (Sherman, 2018). Medical facilities open to and unbiased toward any culture is essential to maintain a positive reputation. Dr. Faisal Tawwab (a family practice specialist from Lake Mary, FL) stated “while it is medical skill that truly matters most, patients feel comfortable with doctors and/or nurses who appear similar to them at first” (Sherman, 2018, p.1). A vast part of nursing care is making the patient as comfortable as possible. The report also suggests that more than 20% of the US will be 65 or older. In addition to the requirement of extended treatment of chronic conditions (an increase in the issues listed above – COPD, increased risk for infection, and a potential increase in the need for transfusions), different age groups and cultures affect the nature of the illness, as well as morbidity and mortality.The Process of Cultural Competence in the Delivery of Healthcare Services Model encourages nurses to use the “ASKED” mnemonic (awareness of personal bias, skills to conduct a cultural assessment, knowledge of the patient’s worldview, encounters with patients from different cultures, and desire to be culturally competent) (Hussung, 2018). Providing high-quality nursing care to a continually aging and diversifying population is one of the most important responsibilities a nurse can have and it’s never too early or too late to learn the cultural diversifications of others, or the important of Evidence-Based Practice.References4 Examples of Evidence-Based Practice in Nursing | A-State. (2016, December 20). Retrieved March 10, 2019, from https://degree.astate.edu/articles/nursing/examples-of-evidence-based-practice-in-nursing.aspxEssays, UK. (November 2018). Evidence Based Practice In Nursing. Retrieved from https://www.ukessays.com/essays/nursing/evidence-based-practice-is-becoming-very-important-nursing-essay.phpMakic, M. B., Martin, S. A., Burns, S., Philbrick, D., & Rauen, C. (2013). Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence. Critical Care Nurse, 33(2), 28-42. doi:10.4037/ccn2013787Munro, C. L., & Hope, A. A. (2019). Conundrums in the Conscientious Use of Current Best Evidence. American Journal of Critical Care, 28(2), 93-95. doi:10.4037/ajcc2019686Sherman, J. (2018, April 06). Is a Lack of Cultural Diversity in Healthcare Harming Our Patients? [Web log post]. Retrieved March 14, 2019, from https://www.rasmussen.edu/degrees/nursing/blog/lack-of-cultural-diversity-in-healthcare/Hussung, T. (2018, October 02). How Changing Demographics Affect Nursing Practice. Retrieved March 18, 2019, from https://www.freshrn.com/2016/02/15/how-changing-demographics-affect-nursing-practice/

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