Evidence Based Practice Essay

Evidence-based practice (EBP) is a system of incorporating research findings into nursing practice so as to improve the therapeutic outcomes. (Polit, F. D & Beck, T. C, 2010). “The evidence based practice places particular emphasis on the use of evidence, in particular research findings, in clinical decision making”. (Parahoo, K, 2006). During past clinical exposures, the issues regarding post natal depression were found as a less explored one because of the complex involvement of both mental health nursing and maternal and child health nursing. “Postpartum psychosis is a manifestation of a life time vulnerability to affective disorders with child birth as the precipitating factor” (Spinelli, M. G, 2009).The focused clinical question discussed here, which is an important element in an evidence based practice is as follows; How effective is the education of nurses about postpartum depression in helping to identify and reduce postpartum depression among new mothers in a maternal ward or community?. According to the PICOT strategy for formulating EBP questions, here, the population is ‘new mothers’, the intervention is education of nurses about postpartum depression and outcome is ‘identify and reduce postpartum depression’.

The clinical settings chosen for this focused clinical question is maternal ward in a hospital as well as community settings. It is based on the general assumption that initial care will be given in a Hospital maternal ward followed by contact care given in community settings. Having a baby is a joyous moment, but for some women it also brings worries as well as stress. Many recent study reports highlight alarming rates of occurrence of post natal depression. About 10% of new mothers suffer from the most severe form of post natal depression.(Science Daily, 2010). It is evident that, being the closest aid of a post natal delivered woman, maternal and child health nurse can do a lot in identifying and reducing post natal depression. Here, an attempt is made to explore and analyse the educational aspect of nurses in alleviating the said problem. The online databases chosen for this assignment is CINAHL (Cumulative Index to Nursing and Allied Health Literature) . A systematic search strategy has been carried out using key words such as postnatal depression, postnatal emotional disturbance, puerperal depression, perinatal depression, psychosis, nursing care, nurse knowledge, nursing care, and education. More than 700 results were yielded initially when postnatal depression used as the key words.

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The results were narrowed by choosing the publication dates between January 2000 and December 2010. Results were further sorted by re arranging them in a date descending order and a suitable article titled ‘Detection, treatment and referral of perinatal depression and anxiety by obstetrical providers'(Goodman ,J,H, Tyer-Viola, L, 2010) obtained. Key words were combined by using Boolean operator ‘AND’. The combination of key words postnatal depression and nursing interventions generated 4 results, and among them, two results with titles, ‘Improving the postnatal outcomes of new mothers’ (Morse C, Durkin S, Buist A, and Milgrom J, 2004) and Comparison of effects of nursing care to problem solving training on levels of depressive symptoms in post partum women’ (Tezel, A and Gozum, S, 2006) were found relevant for the focused clinical question.

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Evidence Based Practice Essay

This question reminded me about the famous and probably one of the most important inventors in the world, Thomas Edison. When he was trying to create his filament for his light bulb, it took him more than a thousand tries to do so. Likewise in a hospital, all the procedures and treatments that nurses do while on the job has been practiced and experimented on so the patient can receive first-class quality care from the nurses.

Evidence-based nursing is a process founded on the collection, interpretation, and integration of valid, important, and applicable research. An example of this can be when a new technique or procedure has been discovered to help cure new diseases. After extensive amounts of research, the technique will be experimented on. They will perform the new technique on patients to see if the patients feel better, and like the procedure done to them.

Evidence-based practice will help you explore the process of making solid clinical decisions that you must make in the hospital. New problems will arise daily, and with evidence-based practice, you are able to solve those problems in a systematic way. I believe that to do evidence-based practice needs to be done with a group or a team. Efficiency and accuracy is needed when doing evidence-based practice because in the end, the patients are the ones that need to be satisfied with the care that they are receiving.

An example of the evidence based practice is as a chemo nurse, patients admitted for chemotherapy are offered pre-treatment assessment and physical and emotional support. Also, we provide a low-stress setting that helps patients and families to receive fully absorb the information and educate themselves about their disease and its treatments. As an effect to evidence-based nursing, we can now be more confident about the procedures that we do on our patients, because they have been thoroughly checked over.There is a need for health services stipulation to apply the best evidence instead of applying the customary methods (Stevens et al, 2001). However, this is only possible if practitioners, researchers, scholars, politicians, managers and public in general conducted a high quality research. Different methods of researches that are evident-based tend to have lack support from most users. This is because those researches are lack of proper referencing which the reviewer could not access.

This module has requisite us to articulate the definition of evidence based practice, analyzing different forms of evidence and reflect on possible tactics utilized in the implementation of evidence based practice. To aid me in achieving those outcomes, I have use resources from database like ebscohost, books, researches, journals and search engine like Google.

The paper I choose focuses on a descriptive-correlation method of research based on operating room nurse’s knowledge and practice of sterile technique. This research is vital due to several cases of surgical infection taking place in operating room. The aim of the study is to determine the information and extent of applying sterile technique among operating room nurses in four selected hospitals in Samar, Philippines.

Globalization comes with a large number of professional developments and policies especially in the nursing sector. Working in a government hospital in the Middle East, and attached to operating department is tough because research carried out on operating room nurse’s knowledge and practice of sterile techniques clearly shows a clear association between knowledge and practice (Luo et al,2010). This study was conducted on four hospitals in Philippines. Inclusion standards were set for this study is participation among nurses are nurses with permanent employment, nurses who agreed to participate on this study and nurses working in the identified hospitals.

The research concludes that knowledge has a positive effect on the extent of practice by the nurses. Different International bodies as Commission for health improvement prove that evidence based practice is researched on daily basis by different scholars. Evidence based practice (EBP) requires the nurse to be able to apply his/her knowledge in operations without necessarily consulting. EBP

Sackett et al (2000) denote evidence-based practice is a popular discipline that applies in clinical practices since 1992, and started with the medicine sector as Evidence Based Medicine (EBM). It later spread out to other fields like nursing, education, dentistry, psychology, and library among others. EBP demands that these practical decisions need to come from confirmed research studies, and they should interpret according to particular EBP norms. EBP is the incorporation of the best research evidence with clinical expertise and patient values. This explanation emphasizes on the patient’s situations, goals, available evidence and the practitioner’s expertise. However, there are some patients who reject the administration based on their different culture and values. Besides that, the practitioner might understand underlying hindrances like finances that may halt the application of EBP.

Evidence Based Practice in nursing includes the major decisions made by the professionals, which in my area includes the surgeries. Some of these decisions include appraising, accessing, and integrating research evidence with their professional judgment and with their clinical decision-making (Department of Health, 2002). The research on operating room nurse’s knowledge and practice of sterile techniques intention is to identify the extent of nurses applying their knowledge in practice pertaining sterile technique. There are several factors on why nurses are reluctant to apply EBP in their daily work. Evidence based practice include making decisions by combining any knowledge acquired from the nursing practice, patients inclination, and applying research evidence.

It means that the nurses have a variety of options including sitting back and watching, or taking action based on their experience. Nevertheless, the decision made is crucial hence it need brainwave. A clinical question is essential before making evidence-based decision. So, it is important to search for a suitable EBP to help in making the right decision at the particular situation. Lastly, the nurse evaluates the different effects of the action taken.

Strengths of EBP

Since the early years of Florence Nightingale, research became popular till the first nursing journal published in United States in 1952 which began considering evidence based practice. Nightingale is famous for her systematic thinking and applied religious faith that favored systematic approach. According to Keith (1988), Nightingale had a good access to governmental information and other material making her work knowledge based. She applied graphical presentation in form of pie and bar charts unlike others who used tables. The health ministry requested Royal College of Nursing in 1966 to examine the effectiveness of nursing. From then onwards, various research programs came up including Information provision and wound care.

Anyhow, Rodgers (2000) noted that the progress of EBP is slow but it is successful as the years go. Utilization of evidence-based knowledge broadens the relationship between the nurses and the management like the clinicians. Another major strength in evidence-based practice includes a research carried out around 1990’s on the physical constraint normally applied on older frail generation. The result showed harmful and prolonged routines thus it made a change in the national policy within acute care hospices and long-term care settings (Evans et al, 2006). These changes presented a drop in constrained home care residents from 1980s 75% to 2004s 8%. Nurses applied excessive pressure on the elderly without realizing of the psychological torture involved.

Weaknesses of Evidence Based Research

Today, science has expanded and advance compare to those years during Nightingale years. In spite of this progressive development, there is still a gap on contemporary knowledge and the extensive adoption to improve the health sector. Bass (2010) stated EBP appliance in nursing profession is similar in all fields or disciplines. The major challenge is the readiness to apply these evidence-based researches due to different drawbacks that include lack of understanding, inclusion, and lack of necessary education programs. To further strengthen this argument, Pravikov et al (2005) mention most nurses have two years degree program which does not accommodate evidence based practice. Moreover, EBP weakness also includes accessing of vital information on the research done.

The information gathered in research is publishing in various resources like database, journals, health magazines, newspapers, books and online. Therefore, users find it difficult to access especially in work place. In nursing, the clinical specialists and the doctors who own higher skills in recognizing problems, analyzing, and translating are far from reach. Hence, they are hesitated to apply EBP in their practice.

Usefulness of Evidence Based Practice in my clinical Practice

Perioperative nurse must be knowledgeable on sterilized technique. Reflecting on my experience being a perioperative nurse for five years now, to enhance better understanding on the importance of sterile technique and the consequences of not applying sterile technique, EBP is the best tactic. For instance, EBP is based on studies done on sterile technique and they show result for not applying sterile technique may lead to surgical infection. EBP make perioperative nurses like me acknowledge importance of sterile technique and we are accountable for patient’s safety. Hereafter, nurses could make decision-making on evidence-based in their practice. It is crucial for nurses to be familiar with different decisions they partake and consider the consequences associated with the decision made. It is also important for nurses to be given the necessary skills required to enable them construct the vital questions and efficiently and effectively look for the available study evidence that best applies to these questions.

The research on operating room nurse’s knowledge and practice evidently show that many nurses have not applied their knowledge in practice. Helpful information that I picked in this study is the importance of sterilizing the operating instrument. This study based on surgical sites infections that are common in most operating rooms. Globally, studies shows that, 2-5% of the patients undergoing operation suffer from surgically related infections. This definitely raises most hospital concern and wants more research to be carried out in order to identify where the problem lies. Surgical site infection causes many deaths during the operations, and that is the reason why different strategies like sterilizing technology came up.

Many patients have died because of infected surgical wound and this calls for an evidence based study to resolve the prevailing problem. EBP faces major emphasis from American Psychological Association (APA), American Nurses Association, Occupational Therapy Association, and American Physical Theory association. In psychiatry, rehabilitation, medicine, psychology, and other professional bodies, loose bodies of knowledge apply, and this is a major drawback on their performances. Evidence based practice begins with a profiling research which informs the professionals and their clients what works best for them. Easy access to EBP information enhances both clients and the practitioners to identify their helpful treatment before intervention starts.

Methodology tool

The article that I will critic is on operating room nurse’s knowledge and practice of sterile technique by Leodoro et al (2012)(Appendix 1).I have choose this article as it has link with my profession and it is very knowledgeable for me being a perioperative nurse. The critic tool that I have chosen is step by step guidelines in critiquing a quantitative research study by Coughlan et al (2007)(Appendix 2). The methodology tool applied in this study was descriptive-correlation research method. The descriptive method describes the knowledge and the extent of which the nurses applied the sterilization technique in practice. In addition, the correlation method is dissimilar relationships among the different variables used.

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This study was conducted in four hospitals in Philippines and the results are based on answers by nurses with permanent employment, nurses who agreed to participate on this study and nurses working in the identified hospitals. There are three-part questionnaire consisted of demographics profiles of the participants. This part carries 10 multiple-choice questions and 10 general questions with an expected score of 20, and intended to measure the nurse’s knowledge scope using sterilized instruments. Questionnaire 11 includes a checklist whereby the participants rated out of 5 points with 1 being lowest rate. The data analyzed through inferential and descriptive statistics consisting of frequency, standard deviation, percentage and mean. Critiquing Descriptive-correlation Tool

Analyzing research studies require suitable tool looking at the methodology used. Tanner (2003) suggests these tools normally bear questions that aid the analyzer in determining the different steps followed in this research. It is notable that some steps are more vital than others. Descriptive-correlation tool applied in this study is credible based on many factors. The researcher uses simple language that is easy to understand without consultation. This means there are no scientific jargons that sometimes pose a threat to the readers. The authors seem to understand the subject matter clearly according to the list of questions in their questionnaire. The questionnaire cover most elements related to the operating room’s practice.

For instance, hand washing, scrubbing, intraoperative phase and circulator role. The purpose of this study is vital due to several incidents that related to surgical wound infection. In the article abstract, they mention the overview of their study, including the research problem which is in prevention of surgical site infection and contamination, sterile technique need to be implemented. They also remark the sample, methodology, finding and recommendations which is mention earlier in the need for the nurses to control and protect the patients from surgical site infections. The grammar used in this study is straightforward, easy to understand and systematically arranged. Usually, a reader like me demands an interesting research that motivates us to continue analyzing, and this presents well in the above-mentioned analysis. There are certain factors that strengthen this research, which includes the identification of the research problem. The hypothesis used is that most nurses have the knowledge on sterile techniques but due to some reasons, they fail to apply it in practice.

Some nurses bear the knowledge but they lack the confidence to put this evidence-based research into practice. There are four major reasons that limit the nurses from using EBP. Retsas (2008) stated research reports similar to the above-mentioned are normally complex, statistical, academic and nurses find it difficult to interpret or work with the research products. The research article on operating room nurse’s knowledge and practice of sterile technique is a study that is markedly academic and statistical. This may cause confusion to nurses during interpretation. The results are graphical and the nurse might have problems understanding it. This particular research is consistent and any nurse whether a graduate or a trainee can easily relate to it except of the graphical result. Beginning from the introduction, methodology, participants, instrument analysis, results and conclusion, the study is systematic with a great flow of intense knowledge. The researcher clearly links each step to the other with the objective of the study, which follows with a literature review.

In their literature review, the research is rather shallow compared to other great researches. It is lacked of specific details on the occasions where nurses have failed to apply the technology and the consequences that follow. The literature failed to analyze the different surgical tools applied in the operating rooms by the nurses. However, they identified the hospital and the need for the research. The literature should include the history of evidence-based practice including when it began and why. The hypothetical structure lacks in this study, which is necessary for reader who needs to understand and analyze the research. The researchers did not go in depth into the subject matter although the introduction had a good review of the search information. In terms of theoretical framework, which is a necessity in most researches (Basset & Basset 2003), the author failed to identify a conceptual model that would assist the reader as guidance.

The research paper is lacked of proper relationship between different concepts in its literature. However, most theoretical frameworks work best in experimental and quasi-experimental researches unlike in descriptive studies similar to the above mentioned. According to Dale (2005) in every research, it is vital to identify the main question and this was not seen in this research. For example, the researcher should have asked how competent the management of the operating room is in educating their staffs on sterile technique. This would assist the researches in analyzing the situation because the failure to practice sterile technique could be perioperative nurses not sent for continuous education leading to lack of competency. These questions are likely to come from patients or the nurses themselves. The questions may derive from the customary practices or from different literature. The sample in this study, for me the size is relatively small compared to the many operating rooms in Philippines.

Anyhow, the choice of participants in regards to age group, and gender is great. In terms of experience, the researcher should have picked people with longer experience in the job. Most of the participants are below five years’ experience in this research. The attendance for educational training of these participants is equally poor so it could not provide a conclusive result. The distribution of the sample is also inadequate because female participants are 73% compared to their male counterparts who are at 23%. A bigger sampling in all categories would have provided a better data analysis. This study was carried out in hospitals and chances for the nurses were conversant with the subject at hand. However, the participants were from only one-region hospitals and different issues may have limited their voluntary information.

At times, the participants are not sure of their confidentiality, despite them signing confidentiality forms; they still have the fear of being exposed. The nurses could fear intimidation from the superiors, and this drives them to give false information in favor of the organization. The researcher got the approval from the ethics committee at Samar Provincial hospital, and the other hospitals before they began conducting their research. No participants were forced or harm during the survey. Neither there was any bias because the respondents were not selected purposively. In the operational definitions, the researcher ensured that the reader fully comprehended the study by applying simple concepts and terms in the research (Parahoo, 2006). The researchers have used clear and simple understanding terms to carry out this study.

The research design used in the research on operating room nurses’ knowledge and practice of sterile techniques is a descriptive-correlation method, which is a recent method of study that is very effective. This is because it integrates the description of the nurses’ knowledge and the extent at which they practice the use of sterile technique together with a correlation analysis showing the relationship between the two variables. However, most of these studies relate because the objective regards patterns in group behaviors, tendencies, averages, and properties (Robson 2002). There is a possibility of mentality to take place as most of the researches done clinical credibility because these research products are not conclusive. This is a major drawback for nurses to agree in applying the results (recommendation) which also decrease the confidence in the products used for the survey like the questionnaire and the sample. In my opinion, the study did not succeed to offer a proper clinical direction and so the nurses prefer not to use them. Most nurses prefer a research that is more prescriptive and clinical concerning their work place.

The data collection is similar to a quantitative methodology of research whereby different data that includes questionnaires, interviews, and observation tools used. These tools are appropriate with the study aim. Then again, questionnaires are prevalent with different sets of closed questions and few with multiple choices and others with direct answers. The overall reliability and validity was discussed in the weakness and strength of the study done. It was describe as good but not perfect. Its validity, which is its ability to measure the content (Wood et al, 2006), is downcast due to the number of samples were insufficient (21 participants) and also from one region only. For the tool’s reliability, Wood et al (2006) stated reliability is to accurately measure and consistently measure the theory which being studied which was done in this research. The researchers have always emphasized on the extent of sterile technique practice throughout the study.

This study had a pilot study, which assisted the researcher in making some adjustments in their research. The researcher’s data analysis is a well-analyzed methodology since it is not complex and daunting. The ratings are clear and easy to understand. For instance, they used descriptive statistics that include the percentage, frequency, standard deviation and mean. The interpretation of the results included 0-7 as “needed improvement”, 8-10 as “fair”, 11-13 as “good”, 14-16 as “very good”, and 14-16 as “excellent”. This is quite an easy interpretation and anyone is able to analyze and understand. These are inferential tests and it helps the researcher in identifying the relationship among variables. The researcher discussed the findings in simple and clear terms. The researcher has a logical flow of information and the hypothesis is clearly supported by these findings. This study bears significance in its findings as per Russell (2002), and the researcher specifies every result without generalizing it.

They reported each section independently whether it could be gender, age, experience and number of training attended. As mention earlier, the perioperative nurses have knowledge of using sterile techniques but rarely apply them in practice (Luo et al 2010). The research also concluded that half of the nurses had the knowledge on sterile technique. In Goiana hospital, 75.6% seemed to understand the standard precautionary measures on surgical site infection (Melo et al 2006). Most researched documents have no references, which makes them less favorable.

There are known perspectives on accessibility of information and they include the humanistic ideology which involves the notion that human resource is most accessible. There is also a strong belief that local information derived from locally developed technologies is more accessible. The latest technologies information can be retrieve from internet easily accessible. However, the researcher did not mention much on recommendation for nurses to apply sterile technique in practice which is vital in guiding the readers.

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Discussion

The study’s hypothesis that majority of the operating room nurses have the knowledge on implementing sterile technique, but seldom apply it in practice have been achieved as end result of the study. The findings confirmed that the nurses held a strong knowledge of the use of sterile technique according to the table 6 that showed the correlation between knowledge and the extent of use of sterile technique by the participating nurses. The discussion is clear and well elaborated in simple terms. The researcher explains the underlying causes on why nurses rarely apply the knowledge into practice. The issue of occupational culture where questioning is unpopular should be contested, and the nurses should ask any questions in the event of uncertainty. The information on sterile technique and importance of it should be taught to nurses by sending them for educational trainings or emphasize it at all times in work place. This information should be accessible especially the evidence-based literature in order for the evidence-based practice to be implemented.

For instance, books related to operating room and patient’s safety should be kept in operating department where nurses can access them anytime when needed. The researchers also discuss on the strength and limitation of their study which is appropriate as it helps the reader determine the reliability of the study and also the choice to implement it or not. The strength of the study is to ensure there was no selection bias; the respondents were inclusive of the entire population of operating room nurses in four identified hospitals for the investigation. Nevertheless, a wider variety of hospitals would have added this strength. Furthermore, the research shows that the investigation is from one province only, which weakens its strength. The discussion also noted the weakness in the questionnaire method of research because it lacked some details like. It is also clear that some participants fear telling the truth despite their secrecy assurance.

However, the research discussion is clear on its demerits, and although it does not offer any suggestion on a further research, it is vital to have a more detailed study on the same issue. Most researchers offer recommendation because their researches are not conclusive which this particular researcher failed to apply. The referencing in this study is very accurate especially on the in text citation. Most researches fail to offer the in text citation and leaves the readers struggling on locating the referencing. The higher number of references, the stronger the research perceives. Different methods of researches that are evident-based tend to have lack support from most readers.

This research had 18 references, which is the average number, required for any research. However, more references would have strengthened the research. This study has much merit but the method requires evaluation. The sampling requires a larger demographic region in order to accommodate more representatives of the participants. It is crucial for perioperative nurses to apply their knowledge on sterile technique in practice. If sterile technique is not applied during surgery it may lead to surgical infection which will harm the vulnerable patients which may also cause death if not treated well.

Conclusion

The study on operating room nurse’s knowledge and practice of sterile technique is a vital research globally and it was fairly conducted. Further research is recommended because this problem continues due to frequent changes in technology and management. The nurses should implement a more basic role in services through application of their skills while addressing questions from outside clinical range. This would in return increase their service demands from the environs. For skills development, the nurses should complement their hands-on function within the department. These nurses should be able to apply their developmental products effectively in order to prove everyone else wrong. People have failed to recognize the efforts applied by the nurses. The management and the clinical experts need to recognize and appreciate the nurses’ efforts through understanding their skills. After all, the management should ensure the nurses knowledge, resources, and skills are readily available in order to assist implementation. This only happens if the research information is excellent, with clarity and enough strength to hinder any doubts from reviewers.

References

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Haynes, R. Richardson, W. (1996). Evidencebased medicine: what it is and what it isn’t. British Medical Journal, 312, 71-72. http://cebm.jr2.ox.ac.uk/ebmisisnt.html Sackett, D., Richardson, W., Rosenberg, W., & Haynes, R. (1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingstone. Simpson, G., Segall, A., & Williams, J. (2007). Social work education and clinical learning: Reply to Goldstein and Thyer. Clinical Social Work Journal, (35), 33-36. Smith, S., Daunic, A., & taylor, G. (2007). Treatment fidelity in applied educational research: Expanding the adoption and application of measures to ensure evidence-based practice. Education & Treatment of Children, 30(4), pp. 121-134. Stevens K.R. & Ledbetter C.A. (2000) Basics of evidence-based practice. Part 1: the nature of the evidence. Semin Periopeative Nursing 9(3), 91–97. Stout, C., & Hayes, R. (Eds.). (2005). The evidence-based practice: Methods, models, and tools for mental health professionals. Hoboken, NJ: Wiley. Stuart, R., & Lilienfeld, S. (2007). The evidence missing from evidence-based practice. American Psychologist, 62(6), pp. 615-616. Trinder, L., & Reynolds, S. (2000). Evidence-based practice: A critical appraisal. New York: Blackwell. Wampold, B. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62(8), pp. 857-873. Wood M., Ferlie E. & FitzGerald L. (1998b) Achieving Clinical Behavioural Change: A Case of Becoming Interderminate. Social Science and Medicine, 47, 1729–1738

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Evidence Based Practice Essay

Implementation of Evidence Based Practice

Rosemary Garcia

Implementation of Evidence Based Practice

Evidence Based Practice Nursing is the utilization by nurses of Evidence Based Research findings that, according to Houser (2012), steer the nurse toward integration of clinical expert opinion and experience with an unbiased exhaustive review of the best scientific evidence professional nursing care literature can provide while incorporating patient values and preferences. Evidence Based Practice Nursing entails adopting a systematic critical thinking decision making process guided by a deliberate and defined chosen Evidence Based Nursing model path that involves searching, appraising, synthesizing, adapting, implementing, and continually evaluating the Evidence Based Research findings implemented. Among these models are the Conduct and Utilization of Research in Nursing (CURN) project, the Stetler Model of Research Utilization, and the Iowa Model for Research in Practice.

The purpose of this paper is to explore the impact of Evidence Based Research on nursing practice by defining Evidence Based Practice Nursing, directing attention to the importance of Evidence Based Research, briefly reviewing examples of qualitative and quantitative research and finally identifying some ways to overcome barriers that prevent nurse participation and utilization of Evidence Based Research. Importance of Evidence Based Research

Evidence Based Research is important because it provides nurses with “actual knowledge of elements of practice that have been known to work” according to R. Simpson (2004). Evidence Based Practice Nursing is based on a disciplined methodological decision making process in which nurses continually ask for Evidence Based Research to support their actions and consistently weigh the validity and reliability of activities of each day. The Evidence Based Practice Nurse also plans for change according to Rosswurm and Larrabee (1999). Evidence Based Research findings come through two proven methods, namely qualitative and quantitative research. Systematic reviews summarize and succinctly abstract findings from multiple studies and compile them into useable condensed formats for quicker study and review. A systematic review that includes a meta-analysis draws findings from multiple studies, recalculates the results to arrive at a new finding thus compounding its validity and reliability. The utilization of Evidence Based Research directly and positively improves nursing practice when the findings are implemented. Research Examples

The following two examples of Evidence Based Research show how implementation impacts nursing practice. Nursing homes promote their quality of care using analyses and marketing strategies to influence public perception and attract business. How a nursing home addresses the phenomena of palliative care and the prevalence of pressure ulcers affects that perception. A nursing home may presume to have high quality of care because of high score on the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator and promote such a score. Similarly, how a nurse responds to a resident in palliative care also reflects on quality of care. Evidence Based Research of these two phenomena helps improve nursing practice in this arena. A nurse in a long term care facility that provides palliative care may be called upon to respond to a resident who may be struggling with issues of regret for life events and feel a need for forgiveness.

A retrospective study by Ferrel, Otis-Green, Baird, and Garcia, (2013) through a convenience sample of 339 nurses attending palliative care educational courses throughout the U.S. and Belize, India, the Philippines and Romania sought to assess nurses’ responses to this issue. Since the purpose was to document the viewpoints and feelings, a descriptive qualitative research design using the phenomenology method was appropriate. The data was examined using content analysis and themes were identified. By focusing on nurses from a broad geographical base who were attending palliative care classes, the researches maximized the potential for gathering relevant data and enhanced transferability and validity through this convenience sample. They also minimized inherent cultural bias that could have potentially arisen if the sample had been solely from one country or region. The conclusion was that nurses would benefit from additional education regarding how best to address these concerns. Implementing these Evidence Based Research findings helps improve nursing practice.

As noted earlier, the prevalence of pressure ulcers, their prevention and treatment is a common dilemma in a long term setting and nursing homes want to demonstrate success in this area as part of the quality of care. One method used to identify and monitor pressure ulcers is the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator. Bates-Jensen et al (2003) in a quantitative research descriptive study sought to determine whether the minimum data sheet pressure ulcer indicator of a high or low score reflected differences in processes related to pressure ulcer prevention and treatment. The convenience sample consisted of 321 residents from 16 different nursing homes. The resident had to be at risk for pressure ulcer development using the PU Residential Assessment Protocol of the MDS to meet the criteria for inclusion.

This was a quantitative study designed to collect numerical data by measuring 16 care process quality indicators (10 related to PU care processes, five related to nutrition and one related to incontinence management) using medical record data, direct human observation, interviews and data from wireless thigh movement monitors. The statistical data results revealed that the MDS PU indicator was not a useful indicator of quality of care and could be misinterpreted if not explained. Family members who are considering long term care benefit from this research and in a facility that might have mistakenly interpreted the meaning of the MDS PU indicator, Evidence Based Practice Nursing would implement corrective measures regarding future use of the scores and thus bring about an improved change. Barriers Preventing Research Utilization

Nursing improves when Evidence Based Research findings can be utilized and implemented by nurses in their daily practice. J. Dracup (2006) stated what some nurses had identified as barriers to Evidence Based Research, namely: “accessibility of research findings, anticipated outcomes of using research, organizational support to use research, and support from others to use research.” Dracup believed that “evidence-based practice must include an assessment of the available resources” since the cost of implementation is yet another barrier and “will not be adopted if resources are insufficient to incorporate them into the daily routine” nursing care. G. Mitchell (1999) raised ” the lack of sufficient meaningful research” as an additional barrier. A multidisciplinary effort by researchers and educators of all fields will be required to work toward the removal of these barriers. Collaborate to provide a more efficient system of information dissemination must take place. Systematic reviews, sometimes combined with meta-analysis, already advance the cause of having multiple sources of research data condensed to a useable quickly reviewable format.

One possible way that nurses could gain access to Evidence Based Research through the Cochrane Library, for example, is by way of grants to school districts and local libraries allowing free or low cost subsidized access. After obtaining this access and recognizing nurses’ research time restraints, the formation of high school clubs like “Cochrane Library Scholars” would allow nurses to pose Research Questions to the club who would in turn compile relevant research articles for the nurse. Similar clubs could be “AHRQ Research Scholars” and “Campbell Library Scholars.” Since addressing the barrier of cost of Evidence Based Research implementation is equally important., to purposefully draw community leaders’ attention to the Evidence Based Research available at their local library, create a logo such as “LIBR[LIBRARY]ARY” with the slogan “A Library within A Library.”

By raising awareness of the benefits of Evidence Based Research of public and private pivotal decision makers, these individuals could prove instrumental in helping to identify and acquire the resources needed to implement Evidence Based Research within their sphere of influence. By opening avenues to Evidence Based Research findings through local libraries, engaging students as researchers and raising community awareness, more nurses could gain knowledge that translates into Evidence Based Practice Nursing. Participants would be engaged in raising the quality of care within their own communities. Raising widespread awareness of the importance and value of Evidence Based Research could be the catalyst that propels groups to collectively seek resources for implementation of Evidence Based Practice in communities across the nation. Conclusion

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Evidence Based Research impacts Evidence Based Practice Nursing if it is utilized. A deliberate effort to promote the understanding of its importance combined with taking measures to remove barriers that prevent nurses from using Evidence Based Research findings will impact, improve, and ensure the best possible nursing practice.

References

Bates-Jensen, B.M., Cadogan, M., Osterwell D., Levy-Storms L, Jorge, J., Alsamarrai, N., Grbic, V. & Schnelle, J.F. (2003) The Minimum Data Set Pressure Ulcer Indicator: Does It Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes? Journal of American Geriatric Society, 51(9). DOI: 10.1046/j.1532-5415.2003.51403.x Dracup, J. (2006). Evidence-Based Practice is Wonderful … Sort Of, American Journal of

Critical Care. 15(4)

Ferrel, B., Otis-Green, S, Baird, R.P., & Garcia, A. (2013). Nurses’ Responses to Requests for

Forgiveness at the End of Life. Journal of Pain System Management,

DOI: 10.1016/j.jpainsymman.2013.05.009

Houser, J. (2012). Nursing Research: reading, using, and creating evidence. (2nd ed.). Salisbury,

MA: Jones & Barlett Publishing

Mitchell, G. (1999). Evidence-based practice: Critique and alternative view. Nursing Science Quarterly, 12(1), 30-35. Retsas A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31:599-606. Rosswurm, M. A., & Larrabee, J. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322.

Implementation of Evidence Based Practice

Rosemary Garcia

Submitted to Karen Rhoades, MS, RN in partial fulfillment of NR460R Evidence Based Practice

August 10, 2013

Implementation of Evidence Based Practice

Evidence Based Practice Nursing is the utilization by nurses of Evidence Based Research findings that, according to Houser (2012), steer the nurse toward integration of clinical expert opinion and experience with an unbiased exhaustive review of the best scientific evidence professional nursing care literature can provide while incorporating patient values and preferences. Evidence Based Practice Nursing entails adopting a systematic critical thinking decision making process guided by a deliberate and defined chosen Evidence Based Nursing model path that involves searching, appraising, synthesizing, adapting, implementing, and continually evaluating the Evidence Based Research findings implemented. Among these models are the Conduct and Utilization of Research in Nursing (CURN) project, the Stetler Model of Research Utilization, and the Iowa Model for Research in Practice.

The purpose of this paper is to explore the impact of Evidence Based Research on nursing practice by defining Evidence Based Practice Nursing, directing attention to the importance of Evidence Based Research, briefly reviewing examples of qualitative and quantitative research and finally identifying some ways to overcome barriers that prevent nurse participation and utilization of Evidence Based Research. Importance of Evidence Based Research

Evidence Based Research is important because it provides nurses with “actual knowledge of elements of practice that have been known to work” according to R. Simpson (2004). Evidence Based Practice Nursing is based on a disciplined methodological decision making process in which nurses continually ask for Evidence Based Research to support their actions and consistently weigh the validity and reliability of activities of each day. The Evidence Based Practice Nurse also plans for change according to Rosswurm and Larrabee (1999). Evidence Based Research findings come through two proven methods, namely qualitative and quantitative research. Systematic reviews summarize and succinctly abstract findings from multiple studies and compile them into useable condensed formats for quicker study and review.

A systematic review that includes a meta-analysis draws findings from multiple studies, recalculates the results to arrive at a new finding thus compounding its validity and reliability. The utilization of Evidence Based Research directly and positively improves nursing practice when the findings are implemented. Research Examples

The following two examples of Evidence Based Research show how implementation impacts nursing practice. Nursing homes promote their quality of care using analyses and marketing strategies to influence public perception and attract business. How a nursing home addresses the phenomena of palliative care and the prevalence of pressure ulcers affects that perception. A nursing home may presume to have high quality of care because of high score on the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator and promote such a score. Similarly, how a nurse responds to a resident in palliative care also reflects on quality of care. Evidence Based Research of these two phenomena helps improve nursing practice in this arena. A nurse in a long term care facility that provides palliative care may be called upon to respond to a resident who may be struggling with issues of regret for life events and feel a need for forgiveness.

A retrospective study by Ferrel, Otis-Green, Baird, and Garcia, (2013) through a convenience sample of 339 nurses attending palliative care educational courses throughout the U.S. and Belize, India, the Philippines and Romania sought to assess nurses’ responses to this issue. Since the purpose was to document the viewpoints and feelings, a descriptive qualitative research design using the phenomenology method was appropriate. The data was examined using content analysis and themes were identified. By focusing on nurses from a broad geographical base who were attending palliative care classes, the researches maximized the potential for gathering relevant data and enhanced transferability and validity through this convenience sample. They also minimized inherent cultural bias that could have potentially arisen if the sample had been solely from one country or region.

The conclusion was that nurses would benefit from additional education regarding how best to address these concerns. Implementing these Evidence Based Research findings helps improve nursing practice. As noted earlier, the prevalence of pressure ulcers, their prevention and treatment is a common dilemma in a long term setting and nursing homes want to demonstrate success in this area as part of the quality of care. One method used to identify and monitor pressure ulcers is the Minimum Data Sheet (MDS) prevalence ulcer (PU) indicator. Bates-Jensen et al (2003) in a quantitative research descriptive study sought to determine whether the minimum data sheet pressure ulcer indicator of a high or low score reflected differences in processes related to pressure ulcer prevention and treatment. The convenience sample consisted of 321 residents from 16 different nursing homes. The resident had to be at risk for pressure ulcer development using the PU Residential Assessment Protocol of the MDS to meet the criteria for inclusion.

This was a quantitative study designed to collect numerical data by measuring 16 care process quality indicators (10 related to PU care processes, five related to nutrition and one related to incontinence management) using medical record data, direct human observation, interviews and data from wireless thigh movement monitors. The statistical data results revealed that the MDS PU indicator was not a useful indicator of quality of care and could be misinterpreted if not explained. Family members who are considering long term care benefit from this research and in a facility that might have mistakenly interpreted the meaning of the MDS PU indicator, Evidence Based Practice Nursing would implement corrective measures regarding future use of the scores and thus bring about an improved change. Barriers Preventing Research Utilization

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Nursing improves when Evidence Based Research findings can be utilized and implemented by nurses in their daily practice. J. Dracup (2006) stated what some nurses had identified as barriers to Evidence Based Research, namely: “accessibility of research findings, anticipated outcomes of using research, organizational support to use research, and support from others to use research.” Dracup believed that “evidence-based practice must include an assessment of the available resources” since the cost of implementation is yet another barrier and “will not be adopted if resources are insufficient to incorporate them into the daily routine” nursing care. G. Mitchell (1999) raised ” the lack of sufficient meaningful research” as an additional barrier. A multidisciplinary effort by researchers and educators of all fields will be required to work toward the removal of these barriers. Collaborate to provide a more efficient system of information dissemination must take place. Systematic reviews, sometimes combined with meta-analysis, already advance the cause of having multiple sources of research data condensed to a useable quickly reviewable format. One possible way that nurses could gain access to Evidence Based Research through the Cochrane Library, for example, is by way of grants to school districts and local libraries allowing free or low cost subsidized access.

After obtaining this access and recognizing nurses’ research time restraints, the formation of high school clubs like “Cochrane Library Scholars” would allow nurses to pose Research Questions to the club who would in turn compile relevant research articles for the nurse. Similar clubs could be “AHRQ Research Scholars” and “Campbell Library Scholars.” Since addressing the barrier of cost of Evidence Based Research implementation is equally important., to purposefully draw community leaders’ attention to the Evidence Based Research available at their local library, create a logo such as “LIBR[LIBRARY]ARY” with the slogan “A Library within A Library.”

By raising awareness of the benefits of Evidence Based Research of public and private pivotal decision makers, these individuals could prove instrumental in helping to identify and acquire the resources needed to implement Evidence Based Research within their sphere of influence. By opening avenues to Evidence Based Research findings through local libraries, engaging students as researchers and raising community awareness, more nurses could gain knowledge that translates into Evidence Based Practice Nursing. Participants would be engaged in raising the quality of care within their own communities. Raising widespread awareness of the importance and value of Evidence Based Research could be the catalyst that propels groups to collectively seek resources for implementation of Evidence Based Practice in communities across the nation. Conclusion

Evidence Based Research impacts Evidence Based Practice Nursing if it is utilized. A deliberate effort to promote the understanding of its importance combined with taking measures to remove barriers that prevent nurses from using Evidence Based Research findings will impact, improve, and ensure the best possible nursing practice.

References

Bates-Jensen, B.M., Cadogan, M., Osterwell D., Levy-Storms L, Jorge, J., Alsamarrai, N., Grbic, V. & Schnelle, J.F. (2003) The Minimum Data Set Pressure Ulcer Indicator: Does It Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes? Journal of American Geriatric Society, 51(9). DOI:

10.1046/j.1532-5415.2003.51403.x Dracup, J. (2006). Evidence-Based Practice is Wonderful … Sort Of, American Journal of

Critical Care. 15(4)

Ferrel, B., Otis-Green, S, Baird, R.P., & Garcia, A. (2013). Nurses’ Responses to Requests for

Forgiveness at the End of Life. Journal of Pain System Management,

DOI: 10.1016/j.jpainsymman.2013.05.009

Houser, J. (2012). Nursing Research: reading, using, and creating evidence. (2nd ed.). Salisbury,

MA: Jones & Barlett Publishing

Mitchell, G. (1999). Evidence-based practice: Critique and alternative view. Nursing Science Quarterly, 12(1), 30-35. Retsas A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31:599-606. Rosswurm, M. A., & Larrabee, J. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322.

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Evidence Based Practice Essay

INTRODUCTION:

Evidence-Based Practice (EBP) is a thoughtful integration of the best available evidence, coupled with clinical expertise. As such it enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past research, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings.

UNIT BACKGROUND:

Evidence based practices was founded by Dr.Ardice Cochrane , a British epidemiologist.Cochrane was a strong proponent using evidence from randomized clinical trials because he believed that this was the strongest evidence on which clinical practice division is to be based.Evidence based health care practices are available for a number of conditions such as asthma,smoking cessation,heart failure and others.However these practices are not be implemented in care delivery and variation of practices[CMS,2008;Institute of medicine ,2001].Recent findings in the united states and Netherlands suggest that 30% to 40 % of patients are not receiving evidence based care,and 20% to30% of patients are receiving unneeded or potentially harmful care.

DEFINITION:

The most common definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996) Muir Gray suggests that evidence based health care is:

“an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best”(Muir Gray, 1997)

PURPOSES

1. Evidence based practice is an approach which tries to specify the way in which professionals or other decision mkers should make decisions by identifying such evidence that there may be for a practice and rating it according to how scientifically sound it may be. 2. Its goal is to eliminate unsound or excessively risky practices in favour of those that have better outcomes. 3. Evidence based practices has contributed a lot towards better patient outcomes. 4. The ultimate goal of evidenced based nursing is to provide the highest quality and most cost-efficient nursing care possible. 5. The purpose of evidence based practice in nursing is mainly to improve the quality of nursing care.

For example: If you are caring for a child who was in a motor vehicle accident and sustained a severe head injury, would you want to know and use the effective ,empirically supported treatment established from randomized controlled trials to decrease his or her intracranial pressure?

If the answer is “yes”,the empirical evidences are essentially very important in most of the clinical decision-making situations. The goal of EBP is the integration of: (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver values to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve. Conceptually, the trilateral principles forming the bases for EBP can be represented through a simple figure:

STEPS OF EVIDENCED BASED PRACTICE :

Evidence based practice process involves 5 steps as:

1. Formulating a clear question based on a clinical problem 2. Literture review to search for the best available evidences 3. Evaluating and analyzing the strengths and weaknessof that evidence in terms of validity and genelisability 4. Implementing useful findings in clinical practice based lon valid evidence 5. Evaluating efficacy and performance of evidences through a process of self reflection , audit, or peer aseessment 1.Formulating a clear question based on a clinical problem:[ ASK the question ] The first step is to formulate a clear question based on clinical problems.Ideas come from different sources but are categorized in two areas: Problem focused triggers and Knowledgee focused triggers. Problem focused triggers are identified by healthcare staff through quality improvement,risk surveillance,benchmarking data,financial data, or recurrent clinical problems.Problem focused triggers could be clinical problems,or risk management issues.

Example:Increased incidence of deep vein thrombosis and pulmonary emboli in trauma and neurosurgical patients.Diagnosis and proper treatment of a DVT is a very important task for health care professionals and is meant to prevent pulmonary embolism.This is an example of an important re tht more research can be conducted to add into evidence –based practice. Knowledge focused triggers are created when health care staff read research, listen to scientific papers at research conferences.Knowledge based triggers could be new research findings that further enhance nursing ,or new practice guidelines. Example: Pain management .,prevention of skin breakdown , assessing placement of nasogastric tubes, and use of saline to maintain patency of arterial lines.

When selecting a question ,nurses should formulate questions that are likely to gain support from people within the organization.The priority of the question should be considered as well as the sevearity of the problem.Nurses should consider whether the topic would apply to many or few clinical areas.Also,the availability of the solid evidence should be considered.This will increase the staff willingness to implement into nursing practice.

When forming a clinical question the following should be considered:the disorder or disease of the patient, the intervention or finding being reviewed, possibly a comparison intervention and the outcome.An acronym used to remember this is called the PICO model.:

P-Who is the patient population?

I-What is the potential intervention or area of interest?

C-Is there a a comparison intervention or control group?

O-What is the desired outcome?

2.Literature review to search for the best available evidence :[ ACQUIRE the evidence ]

Once the topic is selected ,the research relevant to the topic must be reviewed . It is important that clinical studies , integrative literature reviewes , meta analysis, and well known and reliable existing evidence based practices guidelines are accessed in the literature retrieval process .The article can be loaded with optionated nd or biased statements that would clearly taint the findings, thus lowering the credibility and quality of article.Time management is crucial to information retrieval.To maintain high standards for evidence based practice implementation, education in research review is necessary to distinguish good research from poorly conducted research.it is important to review the current materials.Once the literature is located, it is helpful to classify the articles either conceptual or data-based.Before reading and critiquing the research ,it is useful to read theoretical and clinical articles to have a broad view of the nature of the topic and related concepts , and to then review existing evidence based practice guidelines. 3. Evaluating and analyzing the strengths and weakness of that evidence in terms of validity and generalisability: [APPRAISE the evidence]

Use of rating systems to determine the quality of the research is crucial to the development of evidence based practice. Once you have found some potentially useful evidence it must be critically appraised to determine its validity and find out whether it will indeed answer your question. When appraising the evidence the main questions to ask, therefore, are: Can the evidence (e.g. the results of the research study) be trusted? What does the evidence mean?

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Does this answer my question?

Is it relevant to my practice?

Different appraisal and interpreting skills must be used depending on the kind of evidence being considered. Additionally, guidance and training on appraising different types of evidence are available from some of the websites listed on the Useful Internet Resources. 4.Implimenting useful findings in clinical practice based on valid evidence :Evidence is used alongside clinical expertise and the patient’s perspectives to plan care:[ APPLY:talk with the patient ]

After determining the internal and external validity of the study ,a decisions is arrived at whether the information gathered does apply to your initial question.It is important to address questions related to diagnosis ,therpy ,harm, and prognosis. Once you have concluded that the evidence is of sound quality, you will need to draw on your own expertise, experience and knowledge of your unique patient and clinical setting. This will help you to decide whether the evidence should be incorporated into your clinical practice.

You must consider both the benefits and risks of implementing the change, as well as the benefits and risks of excluding any alternatives. This decision should be made in collaboration with your patient, and in consultation with your manager or multidisciplinary team where appropriate.The information gathered should be interpreted according to many criteria and should always be shared with other nurses . 5.Evaluating efficacy and performance of evidences through a process of self reflection ,audit , or peer assessment: [self-evaluation ]

Finally after implementation of the useful findings for the clinical practices;efficacy and performance is evaluated through process of self reflection ,internal or external audit or peer assessment.Part of the evaluation process involves following upto determine if your actions or decisions achieved the desired outcome.

The Steps in the EBP Process:

ASSESS

the patient

1. Start with the patient — a clinical problem or question arises from the care of the patient ASK

the question

2. Construct a well built clinical question derived from the case ACQUIRE

the evidence

3. Select the appropriate resource(s) and conduct a search

APPRAISE

the evidence

4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) APPLY:

talk with the patient

5. Return to the patient — integrate that evidence with clinical expertise, patient preferences and apply it to practice Self-evaluation

6. Evaluate your performance with this patient

BARRIERS IN EVIDENCE BASED PRACTICE

There are many barriers to promoting evidence based practices such as: Lack of professional ability to critically appraise research.this includes having a considerable amount of research evaluation skills ,access to journals ,nd hospital support to spend time are limited to the nurses. Lack of time workload pressure ,and competing priorities of patient care can impede use of evidence based practice. Lack of knowledge of research methods

Lack of support from the professional colleges and organizations , and lack of confidence nd authority in the research area Practice environment can be resistant to changing tried and true conventional methods of practice.It is important to show nurses who may be resistant to changes the nursing practice the benefits that nurses, their patients and their institutions can reap from the implementation of evidence base nursing practices which is to provide better nursing care. Values ,resources and evidence are the three factors that influence decision making with regard to health care.In adition the nurses need to be more aware of how to assess the information and determine its applicability to the practice.

Lack of continuing educational programs . Practices donot give have the means to provide workshops to teach new skills due to lack of funding, staff and time ;therefore research may be tossed dismissed.if this will occur valuable treatment may never be utilized in the practice. Another barrier is introducing newly learned method for improving the treatments or patients.New nurses might feel it is not their place to suggest oreven tell a superior nurse that newer , more efficient methods and practices are available. The perceived threat to clinical freedom offered by evidence – based practice is neither logical nor surprising.When we make decisions based upon good quality information we are inconsistent and biased.

MODELS OF THE EVIDENCE – BASED PRACTICE PROCESS

A number of different models and theories of evidence based practice has been developed and are important resources.These models offer frameworks for understanding the evidence based practice process and for implementing an evidence based practice project in a practice setting.Models that offer a framework for guiding an evidence based practice include the following : Advancing research and clinical practice through close collaboration(ARCC) model [Melynk and fineout-overholt ,2005] Diffusion of innovations theory [Rogers , 1995]

Framework for adopting an evidence –based innovation [DiCenso et.al.,2005] Iowa model of research in practice [titler et al ,2001]

Johns Hopkins nursing evidence based practice models [Newhouse et.al, 2005] Ottawa model of research use [Logan and Graham ,1998]

Promoting action on research implementation in health services (PARIHS] model-,[Rycroft – Malone et.al2002 ,2007] Stetler model of research utilization.[Stetler ,2001]

Although each model offers different perspectives on how to translate research findings into practice .It provides an overview of key activities and processes in evidence based practice efforts ,based on a a distillation of common elements from the various models.The most prominent models are Stetler model of research utilization and Iowa model of research in practice. Stetler model of research utilization:

The Stetler model of evidence-based practice would help individual public health practitioners to use evidence in daily practice to inform program planning and implementation. The Stetler model of research utilization helps practitioners assess how research findings and other relevent evidence can be applied in practice. This model examines how to use evidence to create formal change within organizations, as well how individual practitioners can use research on an informal basis as part of critical thinking and reflective practice.

Research use occurs in three forms

Instrumental use refers to the concrete, direct application of knowledge. Conceptual use occurs when using research changes the understanding or the way one thinks about an issue. Symbolic use or political/strategic use happens when information is used to justify or legitimate a policy or decision, or otherwise influence the thinking and behaviour of others.

The Stetler model of evidence-based practice based on the following assumptions 1. The formal organization may or may not be involved in an individual’s use of research or other evidence. 2. Use may be instrumental, conceptual and/or symbolic/strategic. 3. Other types of evidence and/or non-research-related information are likely to be combined with research findings to facilitate decision making or problem solving. 4. Internal or external factors can influence an individual’s or group’s review and use of evidence. 5. Research and evaluation provide probabilistic information, not absolutes.

6. Lack of knowledge and skills pertaining to research use and evidence-informed practice can inhibit appropriate and effective use Phase I: Preparation—Purpose, Context and Sources of Research Evidence Identify the purpose of consulting evidence and relevant related sources. Recognize the need to consider important contextual factors that could influence implementation. Note that the reasons for using evidence will also identify measurable outcomes for Phase V (Evaluation).

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Phase II: Validation—Credibility of Findings and Potential for/Detailed Qualifiers of Application

Assess each source of the evidence for its level of overall credibility, applicability and operational details, with the assumption .Determine whether a given source has no credibility or fit and thus whether to accept or reject it for synthesis with other evidence .Summarize relevant details regarding each source in an ‘applicable statement of findings’ to look at the implications for practice in Phase III. A summary of findings should: reflect the meaning of study findings

reflect studied variables or relationships in ways that could be practically used Phase III: Comparative Evaluation/Decision Making—Synthesis and Decisions/Recommendations per Criteria of Applicability

Logically organize and display the summarized findings from across all validated sources in terms of their similarities and differences. Determine whether it is desirable or feasible to apply these summarized findings in practice others involved). Based on the comparative evaluation, the user makes one of four choices: Decide to use the research findings by putting knowledge into effect Consider use by gathering additional internal information before acting broadly on the evidence. Delay use since more research is required which you may decide to conduct based on local need Reject or not use .

Phase IV: Translation/Application—Operational Definition of Use/Actions for Change

Write generalizations that logically take research findings and form action terms Identify type of research use (cognitive, symbolic and instrumental). Identify method of use (informal/formal, direct/indirect).

Identify level of use (individual, group, organization).

Assess whether translation or use goes beyond actual findings/evidence. Consider the need for appropriate, reasoned variation in certain cases. Plan formal dissemination and change strategies.

Phase V: Evaluation

Clarify expected outcomes relative to purpose of seeking evidence Differentiate formal and informal evaluation of applying findings in practice. Consider cost-benefit of various evaluation efforts.

Use Research Utilization as a process to enhance the credibility of evaluation data. Include two types of evaluation data: formative and outcome

CONCLUSION

Evidence based practices as using the best evidence available to guide clinical decision making.Evidence based practice in nursing is a pocess of locating ,appraising and applying the best evidence from the nursing and medical literature to improve the quality of clinical nursing practices. Evidence-Based Practice (EBP) is a thoughtful integration of the best available evidence, coupled with clinical expertise. As such it enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past research, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings.Evidence based practice involves making clinical division on the basis of the best possible evidence ,usually best evidence come from the rigrous research.

REFERENCE

1. Anne M Barker. Advanced Practice Nursing-Essentials of knowledge for the profession. United States of America: Jons and Batlett publishers; 2009. P.337-338 . 2. Suresh k Sharma. Nursing research and statistics. Haryana: Elsevier; 2011. P. 22-27. 3. Dennise F Polit ,Cheryl Tatano Beck. Essentials of nursing research-Appraising evidence for nursing practice. 7th ed. Noida: Lippincot Willaims and Wilkins; 2009. P. 25-47. 4. Potter Perry. Basic Nursing. 7th ed. Haryana: Rajkamal Electric Press; 2009. P. 54-57. 5. Dr.R.Bincy. Nursing Research-Building Evidence for Practice. NewDelhi: Viva Books; 2013. P. 286-297. 6. Judith Habour. Nursing Research. 5th ed. United States of America: Mosby Elsevier; 2010. P. 386-427. 7. Neelam Makhija. A practice based on evidence based practice. Nightingale Nursing Times-A window for health. 2007 September; Vol 3: 18-21. 8. Models of evidence based practice. www.nccmt.ca/registry/view/eng/83-html. Accesed october 15, 2013.

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Evidence Based Practice Essay

The following ssion of this assignment attempts to critically appraise the venUS III randomised control trial (RTC) published in the British Medical Journal. As a student/healthcare worker who is new to critical appraisal I am aware that I do not fully understand some of the calculations involved in reporting of findings, however Greenhalgh (2006) argued, ‘all you really need to know is what the best test is to apply in given circumstances, what it does and what might affect its validity/appropriateness’.

When caring for patients it is essential that Healthcare Professionals are using current best practice. To determine what this is they must be able to read research, as not all research is of the same quality or standard therefore Healthcare Professionals should not simply take research at face value simply because it has been published (Cullum and Droogan, 1999; Rolit and Beck, 2006). I am completing this assignment to cultivate the skills at enable me to effectively assess the validity of research that may shape my practice.

There are numerous tools available to help reviewers to critique research studies (Tanner 2003). I have elected to use the Critical Appraisal Skills Programme (CASP) tool. I chose CASP as it is simple, directive and appropriate to quantitative research. The research article had a clear concise and easily understandable title and abstract. Titles should be 10/15 words long and should clearly identify for the reader the purpose of the study (Connell Meehan, 1999). Titles that are too long or too short can be confusing or misleading (Parahoo, 2006).

From the abstract the reader should be able to determine if the study is of interest and whether or not to continue reading (Parahoo, 2006). The author(s’) qualifications and job can be a useful indicator into the researcher(s’) knowledge of the area under investigation and ability to ask the appropriate questions (Conkin Dale, 2005). The authors of the venUS III trial were from a range of academic and clinical backgrounds and are considered experts in their fields.

The VenUS III RTC clearly set out its objective to consider the clinical effectiveness of weekly high frequency ultrasound on hard to heal venous leg ulcers, (hard to heal was defined). In cases where participants had more than one venous leg ulcer the largest ulcer would be tracked if ultrasound treatment was allocated this site received the treatment. Outcomes to be considered where clearly outlined and method of measurement/collection defined. The study screened 1488 people with leg ulcers and 337 people became participants (22. %) Participants were randomised and evenly distributed, 168 to ultrasound therapy (dependant variable) plus standard care (experimental group) and 169 to standard care only (control group) This is reported as being the largest trial undertaken on the subject of therapeutic ultrasound for wound healing and earlier studies are referenced in support this statement. The study was cross-sectional, its population was taken from both community and district nurse led services as well as hospital outpatient clinics.

The 12 care settings used where taken from both rural and urban settings. A “good” sample is one that is representative of the population from which it was selected (Gay 1996) Venous leg ulcers rates rise sharply with age with an estimated 1 in 50 people over the age of 80 developing venous leg ulcers (NHS choices 2012). The age of the participants in the study ranged from 20-98 years old, however the median age overall was 71. 85 and the mean age was 69. 44 years old across the study, well below the age range where venous leg ulcers are most seen.

The assignment of participant’s treatment was equally randomised: treatment was blindly allocated: 168 to ultrasound therapy plus standard care and 169 to standard care only. Randomisation was conducted by an independent agency (York trials Unit) The lack of attrition bias was a strong positive for the venUS III trial, it had a low loss to follow up rate. The nurses providing treatment where not blind to which treatment had been allocated, this may impact on construct validity as in some cases it is suggested that control subjects are compensated in some way by healthcare staff or family for not receiving research intervention (Barker 2010).

Nurses who were blinded were employed to trace the ulcers. Participating patients were not blind to the treatment/s. As one of the measured outcomes was patients perceptions of health, assessed by a questionnaire (SF-12) it is reasonable to conceive that this assessment may have been influenced by the patients awareness of the treatment type they were receiving thus creating the possibility for assessment bias. Construct validity may also be impacted on peoples behaviours as a response to being observed or to the treatment because they believe it will have a positive effect. Barker 2010) Healing date was assessed remotely by independent assessors who where blind to the treatment allocation this guards against assessment bias. Overall both treatment groups were equal in size. Both treatment groups had an almost equal average age of study participants, this is important because inequality in age between the groups would represent a heterogeneous population (Barker 2010). Venous leg ulceration is more common in woman than men in those below 85 year of age (Moffat 2004) the trial participants had a female majority.

Probably the weakest element of the study was the probability of performance bias. Standard care comprised of low adherent dressings and four-layer bandaging that was high compression, reduced compression or no compression depending upon the participant’s tolerance. Any changes to the regime where recorded and where made at the discretion of the treating clinician. Standard care was practiced in accordance with local protocol and could have varied between locations the quality of standard care given may be considered to be a confounding variable.

Surveys of reported practice of leg ulcer care by nurses have demonstrated that knowledge often falls far short of that which is ideal (Bell 1994, Moffat 2004, Roe 1994) and that there is a wide variation in the nursing management of people with leg ulcers in the United Kingdom (UK) (Elliot 1996, Moffat 2004, Roe 1994). Large variation in healing rates according to trial centre is a further indicator that standard care is so variable that it potentially affects the reliability of results.

No treatment fidelity checks were undertaken and no observation regime beyond usual practice of the treating nurse’s practice was implemented despite nurses being new to ultrasound application. Nurses were deemed competent after one day of training, these nurses where then also considered competent to train other local nurses who would be providing treatment. The ultrasound treatment given during the venous III trial did not give any additional effect on ulcer healing or reoccurrence rate and it did not affect quality of life.

As the study only looked at one ultra sound regime extrapolation of the results was not possible, a between-subjects designed study may have provided data that was of further function. Treatment effect was measured precisely; the primary outcome measured was the time that the venous leg ulcer took to heal, this was measured in days and adjustments were made in order to account for baseline ulcer area (larger ulcer would be expected to take longer to heal than smaller ulcers).

A fully healed ulcer was clearly defined and the ulcers were photographed every four weeks, at the point of healing and seven days after full healing has occurred, assessment of the ulcer was completed by two blind independent assessors and where required a third assessor was used if outcome was inconclusive. In some cases no photographs were available for patients in this case the treating nurse assessed healing date, no explanation why photographs would not be available is given. 7. 8% of the sample were assessed by an unblinded nurse this presented some risk of assessment bias.

The trial also considered how many patients had fully healed ulcers within 12 months. Reduction in ulcer size was measured by area, by a blinded nurse who took acetate traces of the ulcers every four weeks the method of which was considered to be accurate and reliable and its provenance clearly referenced. Quality of life was also measured with a standardised questionnaire (SF-12) which looked at both physical and mental elements. As there is no evidence to support the use of ultrasound therapy in addition to standard treatment therefore no current change in practice is indicated and standard practice should continue.

The study reported significant heterogeneity in healing rates among the treatment centres. Centres that treated the most patients produced better healing overall, if there is a correlation between volume of patients treated and positive outcomes this hypothesis has the potential to impact upon the way care is delivered in the future. The trial considered not only medical outcomes but also considered changes in patient quality of life (both physical and mental). Beauchamp and Childress (2001) identify four fundamental moral principles: autonomy, non-maleficence, beneficence and justice.

Autonomy infers that an individual has the right to freely decide to participate in a research study without fear of coercion and with a full knowledge of what is being investigated. Participants gave written, informed consent and recruiting nurses were trained in consent procedures. Non- maleficence implies an intention of not harming and preventing harm occurring to participants both of a physical and psychological nature (Parahoo 2006). Patients who had a high probability of being harmed if they received the ultrasound where excluded from the trial, the exclusion criteria took into account contraindications.

Initially it was planned to exclude those unable to tolerate compression bandaging but after ethical consideration this was removed as these patients were identified as being particularly in need of the chance to benefit from ultrasound therapy. Beneficence is interpreted as the research benefiting the participant and society as a whole (Beauchamp and Childress, 2001). The annual cost to the NHS is estimated at ? 230-400 million (NHS Centre for Reviews and Dissemination, 1997; Bosanquet, 1992; Baker et al. 991) some individual health authorities are spending ? 0. 9m to ? 2. 1 million (Carr et al 1999). There are psychological implications to the patient in that the ulcer increases social isolation through limited mobility, uncontrolled exudate and odour, together with pain (Lindholm et al. 1993; Charles1995). Justice is concerned with all participants being treated as equals and no one group of individuals receiving preferential treatment (Parahoo, 2006). There is no evidence to suggest that any of the participants were discriminated against.

The following section attempts to discuss how evidence based health care enhances health care- looking at the evidence base within health care Evidence-based practice (EBP) is one of the most important developments in decades for the helping professions—including medicine, nursing, social work, psychology, public health, counselling, and all the other health and human service professions (Briggs & Rzepnicki, 2004; Brownson et al. , 2002; Dawes et al. , 1999; Dobson & Craig, 1998a, 1998b; Gilgun, 2005; Roberts & Yeager, 2004; Sackett et al. ,2000).

That is because evidence-based practice holds out the hope for practitioners that we can be at least as successful in helping our clients as the current available information on helping allows us to be. Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factorsExamine the ways that health professionals can use the five steps of evidence-based practice (EBP) as a practical framework to overcoming barriers to locating, appraising and applying best research evidence. Use an occupational health and safety practice as an example. Examples of occupational health and safety practices include:  Use of professional protective equipment (e.g. gloves)  Safety considerations when using equipment (e.g. sharps)  (or a topic you select yourself in negotiation with your LIC)

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Health professionals are very good at seeking information from their clients and their families and also from the settings in which they work but however they have not been as aware of the information that they can gain from research. Although they need information from many sources, evidence based practice shows how research can also play a role in informing clinical decisions, (Hoffmann ,2010). Health professionals use the five steps of evidence-based practice (EBP) as a structure to overcoming barriers and applying best research. Examples of this include use of professional protective equipment and safety considerations when using equipment.

Liamputtong (2010) states that evidence based practice is a “process that requires the practitioner to find empirical evidence about the effectiveness or efficacy of different treatment options and then determine the relevance of the evidence to a particular clients situation” (pp. 252). Sackett (1996, pp.71) states that “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external evidence from systematic research, and the more thoughtful identification and compassionate use of individual patients’ predicaments, rights and preferences.” The purpose of evidence-based practice is to assist in clinical decision-making. To make informed clinical decisions, we need to integrate lots of pieces of information, (Hoffmann ,2010). EBP reduces inconsistency in practice and increases efficiency and effectiveness, and therefor has been accepted by the government and funding bodies as essential to better health care. (Liamputtong, 2010).

Evidence based practice has 5 steps. The first step is to convert your information needs into an answerable clinical question. The process of EBP begins with the recognition that as a health professional, have clinical information need, these types of clinical information needs can be answered with assistance of research evidence. After converting your information into clinical questions, you then need to find the best evidence to answer your clinical question, and then upon finding the evidence, you will need to critically appraise it. This means you need to examine the evidence closely to determine whether its worthy of being used to inform your clinical practice. There are 3 main aspects of the evidence that need to be appraised; Internal validity – refers to whether the evidence is trustworthy, impact – health professionals need to determine the impact of the evidence and applicability – this means to evaluate whether you can apply the results of the study to your client. The fourth step is to integrate the evidence with clinical expertise, the clients values and circumstances, and information from the practice context. The final step consists of evaluating the effectiveness and efficiency with which steps 1-4 were carried out and think about ways to improve your performance of them next time. (Hoffmann ,2010, pp.4)

Evidence based practice is important because it aims to provide the most effective care that is available, with the aim of improving client outcomes. It is also important because when an individual seeks health care from a health professional, you would expect that they would provide you with most effective care and the most accurate health care information. It is also important because it reduces inconsistency in practice and increases efficiency and effectiveness. (Liamputtong ,2010, pp.253). Evidence based practice promotes an attitude of inquiry in health professionals and gets people thinking about things like ‘Why am I doing this in this way? , Is there evidence that can guide me to do this more effective way?. The most important role-played is that in ensuring that health resources are used wisely and that relevant evidence is considered when decisions are made about funding health services. Evidence-based practice provides a critical strategy to ensure that care is up to date and that it reflects the latest research evidence.

In summary, it is important because it results in better patient outcomes, it contributes to the science of nursing, it increases confidence in decision-making and policies and procedures are current and include the latest research. (Suzanne ,2006 pp. 8) Some safety considerations, prevention and control measures include hand hygiene; the health professionals checking that all their patients’ hands and fingernails are clean. Health professionals must always perform hand hygiene rules before and after each contact with client/patient or any contact with environmental surfaces near the client/patient. Another consideration is all personal protective equipment is to be removed/discarded before leaving the room of a patient who is suspected of having a infection. Health professionals know these health/safety measures are effective because of study and previous research. (Hoffman, 2010) They can firstly convert them into questions; for example – what equipment will best prevent myself from coming into contact with any infection?, from there research is done. Health professionals then apply this knowledge in the workplace and see whether it’s an effective method or not.

The barriers that prevent nurses from using research include; lack of value for research in practice, difficulty in changing practice, lack of administration support, lack of knowledgeable mentors, insufficient time to conduct research, lack of education about the research process, complexity of research reports and difficulty accessing research reports and articles. Another barrier is also the insufficient fund supply. (Suzanne , 2006 pp. 10)

A facilitating factor is that the organisation should support staff to practice evidence based practice by allocating time for individuals to pursue it. Newhouse (2007). Limitations consist of low response rate, health professionals passionate either positively or negatively more likely to respond and also the self reporting to assess knowledge, skills and attitudes may resulted in inflated or underestimated scores. “Systematic reviews may be of varying kinds, but all are based on rigorous protocols” (Liamputtong, 2010)

In conclusion health professionals seek information from patients/clients but they also turn a blind eye to the information that they can gain form research unintentionally. They do this by using the 5-step mechanism of evidence-based practice to overcome barriers and to find the most valid and reliable information. Examples of this consist of use of professional protective equipment and safety considerations such as disposing sharps after use.

Reference list

Liamputtong (2010). Research methods in health (2nd ed.) Australia: Oxford University

Hoffmann (2010). Evidence based practice. Australia: Sunalie Silva Suzanne (2006) Evidence based practice in nursing. Australia: Mary Jo

Newhouse (2007) Evidence based practice. Monash University : Gulzar Malik

Vernel, E. (2011, December 9). Developing evidence based practice among students. Retrieved from http://www.nursingtimes.net/developing-evidence-based-practice-among-students/5038920.article” The institute of Medicine has set a goal that by 2020, 90% of all health care decisions will be evidence based” (Mazurek et al. , 2009). On entering the words “Evidence Based Practice” into the Cumulative Index for Nursing and Allied Health Literature( CINAHL) database in December 2012, the amount of articles to be found by the author of this assignment was 5694. It could be said that this shows the importance of evidence based practice in today’s world of nursing. In 2012, the words accreditation, in private health care settings, Health Information and Quality Authority ( H. I. Q. A) standards, in the public sector and indeed Clinical Governance are spoken every day!

Cranston (2002) stated that for the organisation, clinical governance lies at the heart of quality assurance and that clinical governance is linked to clinical effectiveness which is the goal of evidence based practice. Inevitably as a result of this all health care professionals are required to use evidence based practice in their every day working lives. Thus promoting accountability and quality patient care. However we must ask ourselves is there a down side to all this evidence based practice?

What is wrong with the way we always did things? As already stated above it is a necessity for all health care professionals to use evidence based practice, however for the purpose of this assignment the author will concentrate on the nursing profession, looking at how the use of evidence based practice is important for the patient, the nurse and finally the organisation. On the other hand the author will also look at the barriers of evidence based practice for nurses. The methodology used is that of a literature review on evidence based practice in nursing.

In addition a S. W. O. T. analysis was undertaken by the author looking at the strengths, weaknesses, opportunities and also the threats to evidence based practice. At the outset it is important to firstly look at what evidence based practice is. It has been defined as ” the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett D. L, 1996) In addition it is further described as the “integration of best research evidence with clinical expertise and patient values” (Sackett, 2000).

On speaking about Professor Archie Cochrane, Barker ( 2010) stated that “he argued there was a need to ensure treatment was delivered in the most effective way and to ensure that available evidence was used” (p. 5). The dictionary definition of evidence is a “grounds for belief or disbelief; data on which to base proof or establish truth or falsehood” (Collins 1998) So where you may ask do we obtain this evidence? Well ” the range of different sources of evidence that can inform practice includes personal reflection, journal articles, policies, guidelines, reports and professional consensus, as well as research and audit.

However, the literature generally implies research is the strongest form of evidence” (Dale, 2005). So why is it important to use evidence based practice to the nursing profession? For this section the author has divided it into three; the patient, the nurse and finally the organisation. Improvement in the quality of care received by the patient. The Department of Health and Children (2001) stated that improving quality in the Irish Healthcare system requires the implementation of internationally recognised evidence based guidelines and protocols.

Furthermore Craig and Smyth (2007) stated that ” the main aim of evidence based practice is to obtain the best outcomes for patients by selecting interventions that have the greatest chance of success” cited by Leufer and Cleary-Holdforth (2009). Every working day a nurse carries out daily duties; a bed bath, medication administration, mobilising patients post joint replacement, and many more, the list is endless; but how does the nurse know that what he or she is doing is the best way to do it and indeed perhaps what he or she is doing may be impeding the healing for the patient.

Evidence based practice has been demonstrated to yield improved patient outcomes” ( Killeen and Barnfather, 2005). Recent research carried out on the use of anticoagulation therapy for the prevention of post operative development of deep vein thrombosis and pulmonary embolism following a total knee or total hip replacement surgery, showed the effect of the anticoagulants appears to be influenced by the time of initiation of coagulation more than the effect of the drug itself. (Salazar, et al. , 2011).

Therefore it can be said that the previous practice of commencing the anticoagulant post operatively is not the best for the patient. Indeed commencement pre operatively greatly reduces the risk of developing a deep venous thrombosis or a pulmonary embolism, thus improving the patient outcome. When evidence is used to define best practices rather than to support existing practices, nursing care keeps pace with the latest technological advances and takes advantage of new knowledge developments. ( Youngblut and Brooten 2001). Accountability and Ongoing Education for the nurse as a practicing professional.

In addition to the before mentioned benefit to patient outcomes another strength to evidence based practice is that to the nurse as a professional. The Code of Professional Conduct for Nurses in Ireland states that “each registered nurse is accountable for his or her own practice” An Bord Altranais ( 2000). In order for the practicing nurse to be accountable for his or her practice he or she must ” be able to substantiate the decisions they have made on a foundation of professional expertise which clearly includes using relevant evidence to inform practice” (McSherry, et al. 2006) Nurses and midwives form the bulk of the clinical health workforce and play a central role in all health service delivery (Buscher, et al. , 2009).

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Therefore it could be said that nurses can improve the quality of healthcare provided to their patients if they were to use the best evidence based practice. Moreover by carrying out evidence based practice the nurse is maintaining and improving his or her knowledge continuously. Therefore increasing his or her confidence while carrying out his or her daily nursing duties, as he or she is confident that the care he or she is administrating is based on researched findings.

Furthermore in their article on a Spirit of Inquiry Melnyk et al. stated that findings in some studies indicated that when nurses engage in evidence based practice, they experience greater autonomy in their practices and a higher level of job satisfaction. This is of huge importance in these difficult times of staff shortages, cost saving and unfortunately emigration. There is a need to retain the nurses that we have and indeed job satisfaction goes a long way to aid this retention. The Organisation:

Finally in this section the author looks at the organisation as a beneficiary of evidence based practice. Leufer et. al (2009) stated that evidence based practice is highly relevant in a social and healthcare environment that has to deal with consumerism, budget cuts, accountability, rapidly advancing technology, demands for ever-increasing knowledge and litigation. Furthermore in the USA there is a “system where health care follows a business model, it is imperative for organisations to provide the best care based on the best available evidence to ‘attract customers’. (Fitzsimmons & Cooper, 2012).

This indeed could also be said for the healthcare system in Ireland at present, with the increasing demands on health care facilities either public or private to show that they are compliant with strict standards of care. Furthermore some of the many health insurance providers in Ireland will not continue to provide cover to the private hospitals if they do not hold an accreditation award. Moreover as has been seen in recent years H. I. Q. A. ill without a doubt close down healthcare facilities if they do not show themselves to be compliant with the H. I. Q. A. standards. It could be said that the best way to ensure obtaining and retaining these standards is through the use of evidence based practice. As already mentioned in the introduction clinical governance is also of paramount importance in today’s hospitals; Sale 2005 stated that ” achieve clinical governance, organisations are expected to set and monitor standards that are evidence-based. ” as cited by Dale (2006).

In addition in these highly litigious times, an organisation that uses internationally approved evidence based practice could perhaps be less likely to attract litigation cases. However if such a case were to arise the organisation could successfully defend itself, again if it is providing care which is of international best practice standard. Finally in relation to the benefits of evidence based practice to the organisation it could perhaps be claimed that evidence based practice may lead to a change in practice; as a result of said change, indeed cost saving may occur.

For an example of this the author would again like to refer to the afore mentioned study on anticoagulants, if the use of the anticoagulant preoperatively is to reduce the risk of developing thrombosis, this in turn will lead to a reduction in hospital length of stay, when no thrombosis occurs, thus in the long term introducing a cost saving to the organisation. However, even with all the benefits of evidence based practiced as already discussed, throughout the literature review, it was difficult for the author not to discover the weaknesses, or indeed the pitfalls to the use of and the implementation of same.

Lack of understanding! Perhaps one of the main barriers to evidence based practice is indeed the very lack of understanding of what it is! ” Evidence based practice is a well known concept, yet practitioners appear to lack knowledge of the principles that underpin it” (Dale, 2006). It could be said that definitions of evidence in nursing are very broad, Is it literature review? Is it clinical expertise? Is it nursing knowledge? Is it nursing theory? Is it local?

Is it organisational? As evidence based practice is a relatively new phenomenon to the profession of nursing, only really being born in the 90’s, there are a lot of nurses trained before this time who do not understand the concept of evidence based practice. This in turn perhaps leads to another pitfall of evidence based practice! Conflict between professionals: There may indeed be a lack of team effort in implementing evidence based practice in the work place.

As previously mentioned the “old fashioned trained nurses” may not understand what evidence based practice is and may feel that ” I have always done it this way” or ” you’re only qualified what would you know” Resistance to change is very common in all areas of life. ” The extent to which different healthcare professionals work well together can affect the quality of the health care that they provide. If there are problems in how healthcare professionals communicate and interact with each other, then problems in patient care can occur. (Zwarenstein, et al. , 2009).

In addition there may interdisciplinary conflict as a result of nurses carrying out evidence based practice. As already mentioned above in the research carried out by Salazar, et al. in 2011, it is of more benefit to administer anticoagulant therapy pre total hip or total knee replacement; however the nurse does not prescribe these medications and perhaps he or she may not feel they have the autonomy or authority to propose this or indeed even show the consultant or the anaesethist these findings.

There could be a perceived lack of authority to change practice on reflection of research findings ” Medical disinterest is a significant barrier to evidence-based standards” (Sams, et al. , 2004) Unfortunately it would appear from the authors own experience that some surgeons still see the nurses as ” only nurses”. Therefore the nurse may feel this is a waste of time. Speaking of time this leads onto another pitfall in the use of evidence based practice.

Time Constraints: In these times of cost savings, high staff turn over, emmigration and staff shortages, there may be a perceived lack of time to carry out any research or data. It can be said that staff work hard and perhaps they feel as if research is not part of their job, as it is not spelt out in the their job description. However as discussed earlier it is the responsibility of every registered nurse is accountible for his or her own practice.

In addition it could be said that in this nday and age nurses feel that they do too much writing and have less time for hands on care therefore they feel that they really do not have the time for researching data. “Because we are so busy doing the “real” work of caring for patients in the operating room, it is hard to even contemplate activities that would result in more work! We often believe we don’t have the time, that our energies are better directed toward patient care, and that research is something to be conducted by academics;” (Knoll & Leifso, 2009).

If however the time was made available, another question to be asked is; Is there the library facilities available? Lack of study facilities or library facilities: Yes if perhaps the nurse works in a teaching hospital then it could perhaps be presumed that there would be very good library and research facilities to hand to aid in research. However in some organisations there may be a “lack of resources to support changing practice to reflect research findings” (Hewitt-Taylor, et al. , 2012).

However not all hospitals are teaching hospitals, so where does the information come from. In an ideal world the organisation would provide such facilities, however what if there is a: Lack of Organisational Support: Is there managerial support provided? Do management understand the process and the importance of the process for the organisation? Is there a cost involved to the organisation? If there is going to be a change in practice will it be cost effective. Is there organisational readiness to change?

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