NR 351 Discussion Using Evidence-Based Practice to Improve Patient Care

NR 351 Discussion Using Evidence-Based Practice to Improve Patient Care

NR 351 Discussion Using Evidence-Based Practice to Improve Patient Care

According to Rowlands, incorrect surgical counts are a common occurrence after surgery.  In reviewing incident reports from six hospitals during a three-year period, researchers found that incorrect surgical counts (25%) were the most frequently reported event.  Despite the availability of AORN standards and recommended practices and hospital policies, this type of error continues to occur (2012).

Rowlands also states, “the OR is a highly complex, error-prone environment characterized by nonstop activity, specialization, and intricate interdisciplinary processes.  The complexity is manifested not only in the patient and his or her condition but also in the sophistication of instrumentation and technology, which may increase the risk for error”.  “From the stories of preoperative personnel involved in incorrect surgical counts, three distinct themes emerged: bad behavior, general chaos, and communication difficulties”.

Working in the OR first hand I deal with the three themes mentioned.  I find it difficult to have everyone participate in the correct sequence as well as visualizing each item counted.  When I correct someone, I receive “looks”, hissing and a feeling that I am being too strict while I feel that other are too lax and do not take into consideration that policies dictate our process.  The patient and their safety, following policies and maintaining my licensure are the core of my practice.  Recently, I had a surgical technologist berate me for correcting a new surgical technologist in the way they were performing the count.  I received attitude from the new employee and was berated by the preceptor during the procedure.  I structure my counting based on the policy and so I know that I am performing my count according to AORN standards.  

Moving forward in my practice, I will continue my counts as outlined in our policy.  I will continue to correct others when necessary and I will hold others accountable to follow the policy.  I do not play into unprofessionalism in my OR and I will address each situation as it arises.  When others disrupt the OR with unprofessionalism, I simply explain that we can discuss the situation at a later time.   

Researching in the Chamberlain Library for information regarding surgical counts, I began my search in the CINAHL complete tab, entered surgical counts on the first line and extended my search further with “risk factors associated with incorrect surgical counts”. I found a great journal article and used it along with my experience to complete my week 5 assignment.   


Hood, L. J. Leddy and Pepper’s Professional Nursing (9th ed.).  Philadelphia, PA Wolters Kluwer 

Rowlands, A. (2012). Risk Factors Associated with Incorrect Surgical Counts. to an external site. 

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That does not make me feel comfortable about having surgery knowing that the incorrect counts are so frequent! I am glad that you are following the policy. Have you taken this issue up with your supervisor? Perhaps some education is needed. Your article was good but try to find one that is more recent. Our goal is to find one that is within the last 5 years. That is not always possible. I found an interesting article from Dec 2019 from the ORNAC Journal called Factors affecting inaccurate surgical counts and system based prevention strategies. Great problem identification.

NR 351 Discussion Using Evidence-Based Practice to Improve Patient Care
NR 351 Discussion Using Evidence-Based Practice to Improve Patient Care

In your reference, you need to include the journal name along with volume and issue number and page numbers. Here is how your reference should look…..

Rowlands, A. (2012). Risk factors associated with incorrect surgical counts. AORN Journal, 96(3), 272-284. You may then include the https.   

A nursing care issue I would like to research is the management of pain in patients receiving acute cancer treatment. Since “asking a searchable, answerable question is a basic step in the EBP process” (Fineout-Overholt & Johnston, 2005, p. 160), and “the PICO(T) system helps us formulate a searchable clinical question” (Chamberlain College of Nursing, 2016), I will start by identifying my population, (P), which is hospitalized cancer patients. My intervention, (I), is scheduled pain assessments based on the next as needed, or pro re nata (PRN), pain medication. I will contrast this with my control, (C), the practice of relying on patient notification of increased pain levels. My outcome, (O) is the adequate management of pain through scheduled pain assessments and regular administration of oral analgesics without the use of intravenous medications for breakthrough pain. The timeframe, (T), is the length of hospital stay. A further application of this would be the adequate management of pain, with this patient population, in the outpatient setting. Thus, my formal PICOT question is, “Will patients receiving acute cancer treatment in the hospital setting who’s pain assessments are done in conjunction with the timing of PRN pain medications, as opposed to those who are relied upon to express elevated pain levels, experience better controlled pain levels through oral analgesics without the use of intravenous medications for highly elevated pain during their hospital admission.”

After identifying the question, I will utilize the CINAHL database to conduct my research. Important keywords in my search will include “cancer treatment,” “pain assessment” and “management.” From there, I will narrow my results based on quality of evidence, with preference given to systematic reviews and meta-analysis because those, being the highest level of evidence, present themes common to multiple studies (Chamberlain College of Nursing, 2016). After identifying and reviewing relevant high-quality studies, I will decide if the information is pertinent to my practice and something I should share with my colleagues, because “dissemination is a critical element of scholarly practice” (American Association of Colleges of Nursing, 2008, p. 16).


American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. to an external site.

Chamberlain College of Nursing. (2016). NR351 Transitions in professional nursing: Week 5 lesson: Patient-centered care and evidence-based practice. Downers Grove, IL:Online Publication.

Fineout-Overholt, E., & Johnston, L. (2005). Teaching EBP: Asking searchable, answerable clinical questions. Worldviews on Evidence-Based Nursing 2(3), 157-160.

I must consider skin integrity of my patients as one issue of great importance. I have mentioned in previous discussions, I work in an acute rehab unit which means my patients stay on our unit for as long as a month or more. This prolonged stay adds to their risk of skin breakdown. “Pressure ulcers are serious clinical complications that can lead to increased length of stay, pain, infection, and death.” (Armour-Burton, 2013). To establish best practice regarding the issue of pressure ulcers and their prevention I would utilize research of the subject to expand my knowledge.

To formulate my research question I would employ the PICOT (population, intervention, comparison, outcome, and optimal timing) acronym (Melnyk and Fineout-Overholt, 2011, 2015, as cited in Hood, 2018). population is acute rehabilitation patients intervention is providing EBP care to prevent the breakdown of patient skin during hospitalization comparison would be not providing interventions prior to skin breakdown outcome would be the skin condition of patients at discharge

T..timing would be the period of time the patient is hospitalized

In searching CINAHL for information I would begin with terms such as “pressure ulcers during long term hospitalization”, “EBP regarding pressure ulcer prevention” and “the use of skin assessments in preventing pressure ulcers”. This search could be expanded with additional terms to obtain adequate material to address the subject if necessary.

Armour-Burton T., Fields W., Outlaw L., Deleon E. (2013). The health skin project: Changing nursing

practice to prevent and treat hospital-aquired pressure ulcers. Critical Care Nurse, 33(3), 32-40.

Melnyk, B., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to

best practice (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to

best practice (3rd ed.). Philadelphia, PA: Wolters-Kluwer.

Good problem identification. You will find an impressive amount of research when looking at pressure injuries. You will have to sort it out and see what is reliable.  I read a recent 2019 study that stated that 40% of pressure injuries are unavoidable due to co-morbidities (Pittman et al., 2019). While another recent study stated that 70% of pressure injuries are preventable with proper measures (Schrub & Karakashian, 2018).  You need to check the research and be sure it was a reliable study and that all variables were accounted for. 

Good use of your outside resources. When referencing a book, the name of the book belongs in italics. Good effort. 

Pittman, J., Beeson, T., Dillon, J., Yang, Z., & Cuddigan, J. (2019). Hospital-acquired pressure injuries in critical and progressive care: Avoidable versus unavoidable. American Journal of Critical Care, 28(5), 338–350. to an external site.

Schub, T. B., & Karakashian, A. R. B. (2018). Pressure injuries: facts and figures. CINAHL Nursing Guide. Retrieved from

There are many challenging nursing care issues in the medical field today. There are also solutions to many of these problems that can be found through researching evidence-based practice. One of the nursing care issues I would like to see improvement in is the lack of patient education. Patient education is extremely important to the health care field for many reasons. According to DeMarco (2011), “Health care consumers educated about a health condition are more likely to adhere to the health professional’s guidelines for disease management, treatment plan, and care at home for themselves or a loved one after being discharged from the hospital” (p. 23).

To research different ways to improve patient education I would start with the PICOT process. According to Hood (2018), PICOT stands for population, intervention, comparison, outcome, and optional timing. In order to accomplish effective research, I would have to come up with a question that involved those areas. The question I would insert into CINAHL is; In patients 30 years and older, does patient education compared to no education influence positive outcomes in their care throughout their lifetime? PICOT questions need to be extremely specific, so I’d have to refine it a few times to find the best evidence-based practice (EBP). After finding enough EBP, I’d incorporate it into my own experiences and determine whether my intervention of patient education affects patient care the way I believe it does.


Hood, L. J. (2018). Leddy & Pepper’s professional nursing (9th ed.). Philadelphia, PA: Wolters Kluwer.

Nystrom, M., Demarco, J., & Salvatore, K. (2011). The importance of patient education throughout the continuum of health care. Journal of Consumer Health on the Internet, 15(1), 22-31.