NR 393 Discussion Evidence-Based Practice Changes 

NR 393 Discussion Evidence-Based Practice Changes 

NR 393 Discussion Evidence-Based Practice Changes 

Nursing during the earliest decades of the 20th century changed dramatically from the vocation that it had been during the latter part of the 19th century. Many aspects of nursing today are influenced by these events and the promotion of new opportunities for all women. The observations and recommendations of nurses who worked relentlessly to promote nursing as an honest and worthy endeavor changed medical care dramatically. There were many medical advances, a world war, two epidemics, changes in nursing education, creation of nursing organizations, expansion of public health or community nursing, promotion of women’s rights nationally, acknowledgment of women’s health concerns, greater recognition of childhood issues, and promotion of hospitals as a better way to provide medical care. Many of the principal nurses of these decades influenced nursing while acting as political and social reformers as well. As the public’s perception of nursing and the importance of nurses’ roles in the lives of the American people became evident, nurses gained a more positive image and nursing was perceived as a profession rather than a job”(Judd and Sitzman el, at. 2020. P143)

As per the weekly reading “The middle of the 20th century was a time of great growth in healthcare knowledge and technology. By the 1960s, with the development of coronary care and intensive care units, nurses began to play a prominent role in the care of critically ill adults and children. The first coronary care units were established in a few American cities in the early 1960s. Continuous monitoring of cardiac rhythms coupled with specialized care from nurses skilled in cardiac nursing resulted in evidence of improved patient outcomes. Soon, coronary care units were developed at most large hospitals”

The field of nursing continues to grow to meet the ever changes that are facing society. As we face COVID -19 and the effects of this disease we will see more specialties emerging to meet the complexities of this disease. Nursing as a profession will continue to evolve to meet the ever-changing demography of our society.

 Judd, D., Sitzman, K., (2014) A History of American Nursing Trends and Eras (2nd ed.) North Carolina, Jones & Bartlett Learning 9781284044324.

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As in our chapter readings, nursing research and education is discussed throughout the years.  “An almost endless effort . . . has changed nursing practice and provided the body of knowledge to support evidence-based practice. . .” (Judd & Sitzman, 2014).  Nursing research and education will always continue, so that nurses can improve patient care.

In the 20th century, and in the very beginning years of the 21st century, nurses were trained according to evidence-based practice, to aspirate intramuscular injections.  Not long into the beginning years of the 21st century, evidence-based practice states that this procedure is no longer necessary. 

NR 393 Discussion Evidence-Based Practice Changes 
NR 393 Discussion Evidence-Based Practice Changes 

Nurses were originally trained to aspirate intramuscular injections, to verify that the injection was in the muscle and not in a vein.  If blood aspirated into the syringe, this meant that the injection was placed in a vein, and then the syringe with the blood and medicine would need to be discarded, and the medicine drawn up again.  The act of aspirating was to be done over a five to ten second period. 

“More recently, evidence-based guidelines do not advocate aspiration. . .”  (Do you need to aspirate, 2016).  Aspirating intramuscular injections today is no longer necessary.  The rationales for this new procedure are that the sites that intramuscular injections are given in do not contain major blood vessels, there is no evidence that aspiration without or with blood eliminates the chance of being in a blood vessel, not aspirating reduces the time of the injection, there is less waste of medications, less pain, and most nurses do not wait and aspirate over the recommended five to ten second period.  (Evidence-based Injection Practice, n.d.).

However, if using the dorsal gluteal area, aspiration is needed, because you must be careful of the sciatic nerve and blood vessels.  Therefore, it is not recommended to use this area.  (Evidence-based Injection Practice, n.d.). 

Nursing gives many drugs intramuscularly, so it is necessary to keep up on medication education.  For example, one intramuscular medication that I have given many times is Haldol, to calm down patients.  As stated above, some advantages to no longer having to aspirate intramuscular injections is less pain and reducing the time of the injection.  If having to give Haldol, usually it is needed to be given quickly, and less pain is beneficial for the patient.  So far, the changes to this evidence-based practice has proved to be successful in my practice.


Do you need to aspirate when giving intramuscular (IM) injections? (December 11, 2016).  Retrieved from to an external site.

Evidence-based Injection Practice:  To Aspirate or Not.  (n.d.).  Retrieved from to an external site. aspiration poster 9 25 12 for iowa.pdf

Judd, D., & Sitzman, K.  (2014).  A history of American nursing:  Trends and eras.  (2nd ed.).  Jones & Bartlett

In our chapter readings, some leaders and events had greatly changed the practices in nursing but it is not removed yet it was improved to cater the needs and practice for nurses. With these, nurses will gain more knowledge and deeper understanding regarding their specialization. Yes, education and practices for nurses would continue to provide patient care but in former ages nurse registration was an organized list of educated nurses in a state. Moreover, most of the nurses thought that aside from nurse registration license would elevate their standards as well as their profession. Thus, practices in any field including nursing is a must.

The nursing profession evolved greatly in the 20th century. Two catapults that greatly changed the nursing profession were both world wars. Evidenced-based practice and the rapid increase in technology contributed to many changes in the way nursing was performed. One area that I found interesting and is a great contrast to how our practice works today was the concept of Public Health Nursing. The ideas that kept changing in the early 20th century, such as clean water, sanitation, and the use of vaccines began to start during this time period. “Advancing knowledge about germ theories from the mid-1800s to the mid-1900s focused medical evolution on “hygiene and sanitation . . . the forefront of the struggle against illness and disease,” and work done in these two areas “resulted in unprecedented longevity, concomitant with markedly improved quality of life in the last century and a half” (Judd 2014).  These ideas go back to Nightingale’s original theories of cleanliness, fresh air, and sanitation, but now in the 20th century have been scientifically identified and the advances in knowledge lead to the eventual understanding of germ theories and epidemiology. ” During the 1920s, vaccines for diphtheria, pertussis, tuberculosis, and tetanus were introduced. The result was an increase in life expectancy from 59.7 years to 74.9 years over the next 30 years.” (Judd, 2014) Increasing life expectancy like this was revolutionary and nurses advocated for public health measures. Sanitation and vaccines were new and public education was a task that nursing took on in order to continue this cause. 

I thought reading about this history right now while answering questions on vaccines and during a pandemic were very timely as we as nurses are once again educating the public on health measures and sanitation guidelines. Nursing has always been about education for the patient, and in the 20th century, the nursing profession began to greatly increase its role as public health advocates and educators. 


Judd, D., & Sitzman, K.  (2014).  A history of American nursing:  Trends and eras.  (2nd ed.).  Jones & Bartlett

There is a a lot of false information going around holding people back from getting vaccines. During this time, “The National Vaccine Plan (NVP) is intended to be a comprehensive framework that guides national efforts of federal, state, local, multinational, and non-governmental partners to improve access to and increase uptake of vaccines, as well as continued development of new and improved vaccines”(Shen 2019). A culture of vaccine hesitancy threatens to undermine public health and the value of vaccines.  Since this issue has been validated by the recent measles outbreak 2019, the World Health Organization recognized vaccine hesitancy as one of the top 10 threats to global health. The biggest platforms for this misinformation is social media and online sources. The 2020 vaccine plan will offer guidance on addressing the spread of this misinformation. They plan to implement this by building partnerships with social media platforms, leveraging provider- patient encounters to advance informed decision making, and messaging the value of vaccines through targeted strategies across digital and print media platforms. (Shen 2019). The CCDH warned that the anti- vaccine movement could undermine the vaccine against COVID- 19. As nurses it’s our job to educate and put out accurate information. Much of the reasoning and information anti-vaxxers have against vaccines have been proven to be myths. We are required to ask everybody leaving the hospital if they want the flu shot. I always do small education on why the flu shot is important before letting them make their decision. As for vaccines being mandatory, I think that certain vaccines should be mandatory like the childhood vaccines, because we have seen how people not getting the MMR vaccine has brought back measles. But, as for the flu vaccine I do not think at this point it should be mandatory.  


Shen, A. (2019). Shaping the 2020 national vaccine plan. Health Affairs: Leading Publication Of Health Policy Research & Insight. (Links to an external site.)

Burki, T. (2020).

We as nurses are a health education resource for the public. We are first-line educators to prevent further disease progress, prevent transition, and care for current conditions. This is a timely discussion of what role we will play in the very near future. Nursing historically has played such a large role in administering and educating about the benefits of vaccines. As nurses and health care professionals I believe our role is shifting from simply providing basic education, but now sadly, dispelling misinformation about vaccines and side effects. When I started my nursing career, vaccines were generally accepted as part of routine care. Now, especially with having two young children and vaccinating them myself, I find the education has been reoriented to dispelling misinformation, providing education on benefits versus risks, and seeking appropriate sources of information.  The false information that is out there really makes our job as nurses more difficult. It’s my fear that this will continue despite national efforts to provide the right information.

Your post is so relevant today. Looking back on Florence Nightingale’s body of work where it relates to hygiene and sanitation it remains the same today. As the COVID-19 pandemic affect the world hand hygiene and sanitation of one’s surroundings has shown a decrease in transmission of this virus. The implementation of vaccines and other medications such as antibiotics as stop the spread of disease and viruses centuries ago and are the things to defeat this virus today. For us, in nursing, today vaccinations are a preventative measure for us. for example, the flu vaccine is mandatory in many health care institutions. In order for the healthcare providers, not infection the patients and promote good and safe care.

Great post. As nurses, we all understand the true benefit of vaccines, and the diseases they have eradicated. It is interesting to see so many people becoming more interested in being anti-vaxers, due to the potential of vaccine injury. While that is always a risk, I personally believe that receiving some vaccines are crucial to not just our own health, but the health of others. The topic of cleanliness, and vaccines, is one near and dear to my heart, as my brother was severely compromised and was unable to get many vaccinations. My first experience with a 3-month-old with such severe whooping cough that we had to intubate them, I knew that there was major education that needed to happen for the family – as none of them had received the vaccine. Seeing their baby so sick changed their minds, and the family had a much better understanding of why vaccines aren’t just important for our own health. I am anxious to see where the Covid vaccine leads us, as it has been fast-track created, and from what it looks like, implemented. I personally believe in one’s right to choose whether they get the vaccine or not, however, it seems like our current government may make this a mandatory vaccine. Don’t know about you, but I would like to see some really good research into the vaccine before I get it, especially as I am immune compromised! 

Thank you for sharing this post regarding vaccines and its impact of improving life expectancy.   I believe as nurses we are advocates for our patients and it is our responsibility to educate them about the importance of vaccines and help answer any misconceptions people may have about them.  In respect to the Covid-19 vaccine there are so many questions and valid concerns people have which I understand being this is new and will be the first time administered to the general population. I myself have a few concerns and am not sure that I would like to be in the first round of people receiving it.  The Advisory Committee on Immunization Practices (ACIP) is a group of fifteen medical experts who review findings and discuss vaccine research and have updates and hold meetings where there is time slotted for the general public to share their comments and feedback.  They review recommendations and discuss evidence-based recommendations.

At the hospital I work, as we were discussing the covid vaccine and concerns about how it may be mandated for us to receive it, what will we do? One nurse said “No.” She did not want it and wanted to wait since she has gone this far without it. The other nurse said “YES! I want it. Give it to me!” She said she was not worried if anything happened to her because she is old and she wanted it.  She said she is willing to be the trial and first batch. 

As nurses, I think that evidence-based practice and research findings that support the vaccine’s effectiveness will encourage more people to want to receive the vaccine.  Mandating the flu shot has helped us at work, but there are people for religious reasons and beliefs that do not receive the vaccine who must provide documentation in order to continue to work.  I am curious to see what will be enforced about the covid vaccine once it is released.  Having people close to me that have lost their relatives and friends lost to covid I do know this vaccine is very important, but I can’t help but wonder myself about the different things I hear from social media and people about the vaccines and the virus.


Centers For Disease Control and Prevention; to an external site.

Wonderful discussion thread. This topic as you have mentioned is very relevant to what is occurring today with the COVID vaccine. In speaking to different people both professional healthcare providers and the general public, I hear so many mixed responses regarding the willingness to take the vaccine. As was emphasized throughout the discussion thread was the emphasis on our roles as nurses to educate. Also mentioned was the information that is easily accessible to everyone through the internet that continues to provide fragmented information without evidence to back up the claim. 

I personally have COVID antibodies and am curious as to how that will unfold as there is a lot of mixed information I am hearing regarding the protection or length of protection that the antibodies will provide and the recommendations for vaccination. 

Thanks for sharing everyone.

As we know from the text and lessons, Florence Nightingale feared licensure for nurses a few reasons, but we have come quite a ways since then (Judd and Sitzman, 2014). Florence feared not being respected as nursing’s own profession and the control of doctors and today although we utilize orders from doctors, we have become our own discipline with our own research (Judd and Sitzman, 2014). We even have instituted our own Commission on education of NLN Certified Nurse Educators (Nick, et al, 2013). “During the latter half of the 20th century, certification became a demonstrated standard of excellence in nursing “(Nick, et al, 2013). We have our RN licensure, differing levels of education, and during the 20th century while certification became the norm, nursing education itself was recognized as a specific discipline (Nick, et al., 2013).

My unit has oncology and hospice certification eligibility. I am chemotherapy certified currently, but would enjoy getting additional certifications in my future. Nursing education is something that also very much interests me in my near future.


Judd, D., & Sitzman, K. (2014). A history of American nursing: Trends and eras (2nd ed.). Jones & Bartlett.

Nick, J. M., Sharts-Hopko, N. C., Leners, D. W. (2013). From Committee to Commission: The history of the NLN’s academic certified nurse educator program. Nursing Education Perspectives 34 (5): 298-302.