NR 439 Discussion Introduction to Evidence-based Practice 

NR 439 Discussion Introduction to Evidence-based Practice 

NR 439 Discussion Introduction to Evidence-based Practice 

Thanks for sending me the link. I have watched many Unit 731 documentaries. It is very difficult for me to watch these dreadful events had happened in Unit 731: The Japanese researchers studied STDs. They forced prisoners who were infected with syphilis to have sex with healthy ones to see how it spread. They carried out a vivisection, a dissection of a live human without anesthetics, to see blood loss. They infected the prisoners with diseases, then removed the prisoner’s organs while they were alive, so that the researchers could study the effects of the disease before the decomposition could start (Avani, 2018). They conducted an experiment on prisoners, frozen their arms stiff with ice, then put the frozen stiff arms into a vat of hot water. The flesh wound would be stripped off the bones, but the prisoner still alive. Women were raped and injected with disease to study transfer to fetus. A shocking photo found in archives show a Chinese woman was cut open from throat to pelvis, exposing a fully-grown baby in her belly……

Despite thousands of victims, the Japanese government denied the existence of the Unit 731 until 1998. The U.S. used double standard in the postwar responses to the experiments upon different nationalities. The Unit 731 scientists were given immunity from prosecution, and their dehumanized acts were coved-up in exchange for exclusive access to their finding (Brody, et al., 2015).  

I still need to have a deeper understanding of the atrocities. But one thing I firmly believe that all humans are born free and equal in dignity and rights. We ought to respect this moral principle at all the time (Human Rights).  

Reference

Avani, S., (2018) Unit 731: Japan’s Biological warfare project. https://www.atomicheritage.org/history/unit-731Links to an external site.

Brody, H., Leonard, S. E., & Weindling, P., (2015). United Stated responses to Japanese wartime inhuman experimentation after World War II: National security and wartime exigency. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487829/Links to an external site.

Human Rights. https://www.un.org/en/sections/issues-depth/human-rights/Links to an external site.

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Thank you, Fiorenzo, for your post and for sharing the discussion question. I agree with you that nursing research’s evolution since the Nightingale era has necessitated advancements in the nursing practice and profession for better services to patients. Accordingly, through the systematic process of inquiry that employs rigorous guidelines to produce unbiased answers to nursing practice questions, research remains a critical aspect of effective care delivery. Over 150 years ago, Nightingale pioneered nursing research to understand the effects of the Crimean War on the mortality and morbidity of soldiers at the time (Grove & Gray, 2018). The data gathered by Nightingale transformed nursing research as it led to the development of interest by professionals in practice. Nightingale succeeded in impacting fundamental nursing practice changes and care as it is known today and public health in general. 

NR 439 Discussion Introduction to Evidence-based Practice 
NR 439 Discussion Introduction to Evidence-based Practice 

With time, nursing research transformed because of different factors that included increased understanding to focus on the patient. Early researchers looked at ways to improve quality care delivery amidst lack of access to vital technology at disposal today. Research in nursing would pick in the 1950s, where efforts to apply science in nursing were advanced for better outcomes. Nursing education did not exist, and in most cases, nurse practitioners learned through apprenticeship programs. However, due to increased nursing education research, the need to train nurses as professionals led to the establishment of nursing schools in different parts of the country (Grove & Gray, 2018). Present research in nursing focuses on enhancing patient-centred care approaches using evidence-based practice. Nurses now can specialize in research through terminal degrees like a doctor of philosophy in nursing (PhD). The implication is that research in nursing is critical in providing quality care. 

Reference

Grove, S. K., & Gray, J. R. (2018). Understanding Nursing Research E-Book: Building an 

Evidence-Based Practice. Elsevier Health Sciences.

I was skeptical about the vaccine as well….and in truth, I am still skeptical even though I am fully vaccinated (I had the first shot at the end of December and the 2nd shot mid January).  I have been tested several times over (both swab and antibody tests) and by the Good Graces, I have not contracted the virus.  However, I still chose to get the vaccine anyway because my 75yr old mother lives with me and my brother is severely immunocompromised – and I’m around both of them ALL THE TIME.  With my potential exposure to covid positive patients at the hospital, I would feel so guilty if I was one of those asymptomatic people that unknowingly contracted the virus and then passed it on to my loved ones. 

That being said, after receiving both vaccines, and seeing how I reacted to it vs. seeing how others have reacted to the vaccines or actual contraction of the virus (or a combination of the two), I wholeheartedly believe that I would have been one of those asymptomatic people.  I had absolutely no reaction to the vaccine whatsoever.  Some of my coworkers who never had covid had a bad reaction to the 2nd dose…and my coworkers that had covid and then received the first vaccine said they felt like they had covid all over again (they had no reaction with the 2nd shot).  So I truly believe I would have been one of those people “spreading the love” without knowing.  My family (husband, mom, brothers, sisters-in-law, and nieces) have said they will not receive the vaccine and I respect their wishes not to.  But for my peace of mind, I wanted to make sure I was doing my part to protect them from exposure despite my own reservations of the escalation for the research and the vaccine.     

I enjoyed your post very informative. I also wonder if there will be long term effects of the Covid-19 vaccine as it was released very fast. I myself have not received as am breast-feeding and the implications of the side effects on breastfeeding were not held. I do think their will be any long term effects, if anything history has shown us is that vaccines have helped the vast majority. Both the Pfizer and Moderna vaccinations are mRNA vaccines, which is nothing new scientist have been working how to modify mRNA. All viruses contain nucleic acids in the form of Deoxyribonucleic acid (DNA) or  Ribonucleic acid (RNA). DNA, RNA, and proteins are essential for existence. DNA carries all genetic information for cell growth and replication. RNA copies the DNA and thus regulates the expression of  genes in form of Messenger Ribonucleuic acid mRNA  which carries the genetic code from DNA from the cell’s nucleus to ribosomes where protein synthesis occurs. Proteins repair parts of the body and allows metabolic reactions to occur. Medications and vaccines that utilizes mRNA cause our cells to make a protein or specific piece of protein that triggers an immune response that creates antibodies and produces killer cells. So with this scientist just build on it based on the virus they are trying to target. 

https://www.health.harvard.edu/blog/why-are-mrna-vaccines-so-exciting-2020121021599

Explain how research has evolved since the Florence Nightingale era

When Florence Nightingale initiated change it was based on her collecting information and applying scientific data to it to show the benefit of the change. Unfortunately, in the years following there was not much scientific data being collected in nursing and that was probably because nurses went through apprenticeships and not formal education (Houser, 2018). Since then, nurses now have more formal education and nursing research is a key part of that. More nursing journals have been published that focus on nursing research and the National Institute of Nursing Research was formed (Houser, 2018).

Discuss how research and EBP are different; include how you believe research supports EBP for nursing.

Nursing research is a process to produce answers to questions about the nursing process, it integrates findings from multiple sources to develop a guide for best practice, finds solutions for existing issues, and tests our traditional approaches of patient care (Houser, 2018). Evidence-based practice (EBP) takes the best scientific research and integrates it with clinical experience and blends it with nursing care (Houser, 2018).  In my opinion, I believe that you cannot have EBP outcomes without having the research. The research is an integral part of developing practices that will promote effective and safe care of patients. You need to take the research results incorporated them into practice groups and present them to a panel of experts, and then evaluate the quality-of-life outcomes (Houser, 2018).

Describe one past/historical unethical breach of research conduct; then, share how you would ensure care of a study participant using one ethical or legal research consideration (guideline/principle).

One major unethical breach was during World War II with the Nazi’s brutal experiments. Their experiments concentrated on methods of killing but their results caused death, disfigurement, or permanent disabilities (Algahtani et al., 2018). At the end of the war, these crimes were tried and led to the Nuremberg Code of medical ethics (Algahtani et al., 2018). The Nuremberg Code established guidelines to be followed for research. Here are some of the guidelines: “consent is voluntary and informed for subjects who participate in medical experimentation, the knowledge gained is unobtainable by any other means, death or disability is not an expected outcome, and properly qualified scientists conduct the experiments” (Algahtani et al., 2018). In my research study, I would ensure respect for the participants by obtaining informed consent, explain the risks and benefits of the study, and explain my selection process.

References

Algahtani, H., Bajunaid, M., & Shirah, B. (2018). Unethical human research in the field of neuroscience: a historical review. Neurological Sciences39(5), 829–834. https://doi.org/10.1007/s10072-018-3245-1Links to an external site.

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones & Bartlett Learning.

Explain how research has evolved since the Florence Nightingale era.

Nursing has evolved since the Nightingale era. A product of this evolution are the advancements in nursing research. According to Houser (2016) Nursing research, by definition, is a systematic process of inquiry that uses rigorous guidelines to produce unbiased, trustworthy answers to questions specific to nursing practice. Florence Nightingale introduced this concept over 150 years ago. Nightingale collected data that affected soldier mortality and morbidity during the Crimean War of the 1850’s. The scientific data she collected was able to induce change in nursing practice. Her work in this field led to an honorable induction to the Statistical Society of London. 

For quite some time, leading into the 1950s, there was little effort in the application of science to the nursing profession. As time progressed, so did the evolution of nursing education. Traditionally, nursing education was mostly accomplished through apprenticeship. As universities began to take on the role of Nursing Education, along followed the growth of nursing research as we see it in today’s world. 

Global initiatives in Nursing research became prominent. Nursing journals and research publications were established. This led to the dissemination of science/evidence-based findings throughout the nursing profession.

In the mid 1980s, The National Institutes of Health (NIH) was critical in the development of nursing research. The NIH recognized the importance of science in nursing and granted full institute status as the National Institute of Nursing Research (NINR). This federal agency is responsible for the support of nursing research by providing a framework that incorporates training that is supported by research awards and financial grants.

During the Crimean War, Florence Nightingale gathered information about factors that affected a soldier’s mortality and morbidity (Houser, 2018).  Since then, nursing research has evolved to publications of journals in the 70s and 80s, to the creation of the National Institute of Nursing Research (NINR) in 1986.  The ultimate goal of NINR is to improve the health of individuals, families, communities, and populations through evidence-based practices [EBP] (Houser, 2018).

EBP differs from research in the sense that research may base changes in practice on the results of one study, whereas EBP seeks to make clinical changes as a result of collaborating with other disciplines (Godshall, 2010).  That being said, nursing research can be considered one aspect of EBP data.  Information from other disciplines, such as data obtained from the lab, pharmacy, physical therapy/occupational/speech therapy, etc. would need to be gathered in order to be considered an effective EBP study.

One past unethical breach of research was former British physician Andrew Wakefield’s claim that vaccines caused autism.  His research was based on invalid tests that were performed in laboratories that he owned (Lindsay, 2020).  His claim caused a major firestorm and a resurgence of diseases thought to be eradicated in certain parts of the world (i.e. – Polio).  In this case, to really find out if there is a link between vaccines and autism, the Institutional Review Board (IRB) should be involved.  The IRB requires that research institutions meet all federal regulation criteria, including ethical standards (Houser, 2018).  Of the 8 required elements an IRB researcher must follow, the one principle guideline I would focus on would be #3: Risks to the participants, particularly if drugs or treatments are used.  This would clearly explain to the participant why the research is being conducted, the risks vs. benefits, and most importantly, it would make the parents of a child decide for themselves if they truly want to vaccinate their child…rather than looking in retrospect and arbitrarily declare that vaccines caused the autism. 

References:

Godshall, M. (2010). Fast Facts for Evidence-Based Practice: Implementing EBP in a Nutshell. New York: Springer Publishing Company. https://eds-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=3&sid=d7dcba5c-84cb-49c6-abe9-2c17fcf355f4%40sessionmgr4008&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=307460&db=nlebkLinks to an external site.

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones & Bartlett.       

Lindsay, P. (2020). Books: long read: The Doctor Who Fooled the World. Andrew Wakefield’s War on Vaccines: I looked on Immunisation as an Example of Modern Living and Progress…and Then Came Andrew Wakefield. Royal College of General Practitioners. https://www.doi.org/10.3399/bjgp21X714557Links to an external site.

The vast advancement in technology has allowed the Nursing Profession to evolve immensely since the Florence Nightingale era. According to this week’s lesson, “Nightingale employed statistical methods to show that better food, hygiene, and sanitation could reduce morbidity and mortality among the soldiers”. (Houser, 2018; Nieswiadomy, & Bailey, 2018). What I gathered from the lesson was that Nightingale was the nurse who ignited the fire for research and utilizing evidence as a base for her practice. Going back into the beginning days of the nursing profession, Nightingale created her own statistical research using her own Coxcomb chart, where she used statistical methods to track and document on the death toll between nonbattle deaths and battle deaths rates of soldiers. We still see her statistical methods used in todays practice. 200 years later after the anniversary of Nightingale’s birth, Nightingale’s relevance has only increased and her work regarding public health, sanitation, and standard mortality data has been highlighted during this Pandemic, on Nightingale’s 200th Anniversary (2020). Nightingale used the chart to track the spread of disease, and today the WHO has worked effortlessly in tracking the spread of the Covid19, and preventing the spread at the same time, encouraging Nightingale’s theory of hygiene and sanitation and public health. Today, technology only helps us keep logs of contact tracing and communicate internationally about disease spreading and prevention. The lesson this week states, “research is more readily available for dissemination and use; thereby, communication of best practices has been able to advance more rapidly into practice than before the days of the Internet.” (Houser, 2018).

I believe that research significantly supports EBP, however the two are different. According to this week’s lesson, “EBP incorporates science, patient preferences, and clinical expertise (Houser, 2018). However, research is the sound structure upon which to build a practice firmly supported on valid, reliable, trust-worthy evidence.” (Houser, 2018). EBP is the implementation of the research conducted and concluded. Research is conducted in response to a question to generate knowledge or validate existing knowledge based on a theory (Conner et al., 2019). Nursing research examples are those such as CAUTI and CLABSI systematic reviews on how to prevent such infections. This is where EBP comes in, and here we are not generating new knowledge or clarifying known theories but are using the best evidence available to make patient care decisions and apply that evidence to clinical decision making (Conner et al., 2019).  

An example of a time in nursing where there was a breach in research from 1932 to 1972, known as  the Tuskegee Syphilis Study, where the US conducted a study on the progression of untreated syphilis in poor black men in Alabama. The participants were tricked into thinking the government was providing them free health care. The participants were not informed the by the government that they would be infected with syphilis and then left untreated and were unaware that the transmission process would be through sexual intercourse; they were clueless. Ironic how the participants thought this was free health care. It makes me wonder, exactly how tricked were they? According to the article, “Instead, they were told that they suffered from “bad blood,” a local term used to refer to a range of ills.” (Tikkanen). Initially, the study was to last only up to six months, and patients were being treated, but then after seeing that there were no positive outcomes with treatments, they halted the treatments and just followed the participants to their death. The estimated death toll for this disaster of an experiment was more than 100 participants, out of the 399 infected (Tikkanen).

To ensure care in a study participant I would validate that informed consent is signed by the participant prior to the study, and if the participant is unable to sign, I would warrant the proper next of kin or guardian to obtain informed consent. I cannot believe that in the 20th century, the US conducted such a risky experiment without proper signed informed consent. I cold never imagine sending a patient to surgery or a test without them knowing the full truth of what is going to happen and their approval. It is not our decision to make for others, and if others cannot make their own decisions there are legal guidelines in place to help us obtain approval.

References-

Conner, B. T. (2019, October 31). Differentiating research, evidence-based practice, and quality improvement. Retrieved March 03, 2021, from https://www.myamericannurse.com/differentiating-research-evidence-based-practice-and-quality-improvement/Links to an external site.

“Data not CHATTA:” Florence Nightingale’s Nursing and… : Advances in Skin & wound care. (2020, May). Retrieved March 03, 2021, from https://journals.lww.com/aswcjournal/Fulltext/2020/05000/_Data_Not_Chatta___Florence_Nightingale_s_Nursing.1.aspxLinks to an external site.

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett. Tikkanen, A. (n.d.). Tuskegee syphilis study. Retrieved March 03, 2021, from https://www.britannica.com/event/Tuskegee-syphilis-studyLinks to an external site.