NR 500 Discussion Evidence-Based Practice
NR 500 Discussion Evidence-Based Practice
Evidenced-based practice (EBP) combines evidenced-based research, values of the patient and expertise of the clinician to provide the best care and most beneficial outcomes to patients. EBP is implemented into nursing care daily and is an expected intervention provided by today’s nurses. Our lesson states that the profession of nursing has evolved, and the expectation is that the professional nurse has a scientific foundation to support the care that is provided (CCN, 2018). My specialty track is family nurse practitioner. I chose family nurse practitioner to be able to help and provide care for people that are sick or in need of health prevention and promotion. Family nurse practitioners are able to see patients of all ages. The diversity of patient population is also something that interested me and helped with my decision of choosing the family nurse practitioner route. Each patient you see is different and I love being able to communicate with patients and family members to identify their healthcare needs as well as incorporate their beliefs into their healthcare plan. Family nurse practitioners are involved in many facets of healthcare such as treating healthcare issues, promoting healthcare by prevention and preventing healthcare issues. An area of interest that I have been interested in/passionate about is vaccinations for adults and children.
Family nurse practitioners are in a unique position to educate and teach patients/family members about vaccinations and their importance. They can also educate patients who shouldn’t take the vaccinations and why such as contraindications. The family nurse practitioner is in a leadership position to give a unbiased approach to patients about vaccinations and listen to their beliefs. A systemic review was done that reviewed evidence of the effectiveness of standing order protocols for adult vaccinations coverage rates. It was found in the study that implementation of standing orders programs alone or combined with other effective interventions can help improve vaccination coverage by institutional providers (“Use of Standing Order”, 2000). Family nurse practitioners can help implement this evidence-based practice in institutions to increase the number of vaccinations received by patients.
Chamberlain College of Nursing. (2018). NR-500 Week 5: Scholarship and Evidence-Based Practice: A Process for Change. [Online lesson]. Downers Grove, IL: DeVry Education Group.
Use of Standing Orders Programs to Increase Adult Vaccination Rates: Recommendations of the Advisory Committee on Immunization Practices. (2000). MMWR: Morbidity & Mortality Weekly Report, 49(11), 21-26.
Evidenced-based practice (EBP) is a crucial component to the science of nursing. It is the clinical solution to a problem based on research and evidential proof. Over the last 20 years EBP has brought about positive change to the healthcare and nursing community. With the public’s demand for improved healthcare and the evidence of scientific based research that can provide potentially life-saving benefits, EBP should be of upmost consideration to all care providers (Spruce, 2014). Evidenced-based practice combines clinical expertise, research evidence, patient values, and preferences into the process of decision making for the improved care of patients (Howe & Close, 2016). It is through continued implementation of EBP into the practice of nursing that will benefit those within our care.
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My specialty is track is that of nurse educator. I chose this track to fulfill the interest I have in educating, encouraging, and mentoring those new to nursing practice or a particular nursing specialty. This interest in education has evolved over my years in nursing practice as well as from motherhood. Since 2012, I have educated my children primarily at home. It has been through these experiences that sparked a desire in me to pursue the education path in nursing. Seeing someone learn something new, master a skill, and grow in knowledge gives me great joy.
As an operating room nurse, I have been witness to evidenced-based practice and the impact it can have on surgical patients. One topic that interests me greatly is the prevention of surgical site infections. Surgical site infections (SSIs) are the most common infection that is healthcare associated in surgical patients (Schub & Smith, 2016). SSIs can delay healing and increase morbidity and mortality. Increased hospital stays and readmissions are a huge contributor to rising costs in healthcare. The prevention of SSIs is an evidence based practice focus in nursing care. As a perioperative educator in a hospital based setting, I can contribute to educating nursing staff on proven, preventable measures that can be implemented in surgical patients. Educators in individual care settings can work to review the evidence and work closely with healthcare providers to improve practice and increase safety for patients (Spruce, 2014). One example of an educator’s implementation to improve SSIs would be holding pre-procedure huddles with the OR team to improve communication, quality of care, and to empower other nurses to advocate for their patients and speak up when necessary. The following of surgical safety checklists, surgical skin antisepsis, hand hygiene, minimizing OR traffic, team training, speaking up whenever a break in sterile technique is observed, and timely prophylactic antibiotics are just a few methods that have been researched and proven effective in the prevention of SSIs (Spruce, 2014). Nurse educators will play a crucial role in educating nurses in the academic and clinical setting in improving care based upon evidence based practice.
Howe, C., & Close, S. (2016). Be an expert: Take action with evidence-based practice. Journal of Pediatric Nursing, 31(3), 360-362. doi: 10.1016/j.pedn.2016.02.01
Schub, T. & Smith, N. (2016, June). Infections, surgical site: Prevention. CINAHL Nursing Guide. Retrieved from: http://eds.b.ebscohost.com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=4&sid=46d7bc80-e559-482e-80f7-aa7dff360b99%40sessionmgr103
Spruce, L. (2014). Back to basics: Preventing surgical site infections. AORN Journal, 99(5), 600-611. doi: 10.1016/j.aorn.2014.02.002
Huddles have become a popular concept in healthcare settings today. The concept actually comes from football, where the team members come together for about 25 seconds before a game to discuss strategy and execution of their plays. Similarly, a pre-shift or pre-procedure huddle can be an effective way to gather the healthcare team together to discuss safety concerns, staffing plans for the shift, and the promotion of education geared towards improving patient safety and care. Criscitelli (2015) considers huddles as a micro meeting that has structure and focuses upon communication and safe patient care.
In the perioperative environment, the Joint Commission has reported that poor communication is the cause of over two-thirds adverse events (Criscitelli, 2015). I found that report quite humbling. For huddles to be effective, they should be mandatory, have an agenda and time limit, be consistent at the same times every day, and display a recognizable structure to all who participate (Criscitelli, 2015). In my department, our team of nurses and surgical techs huddle 5 minutes before every shift to address safety concerns, plans for the shift, staffing assignments, and sometimes a brief in-service is provided by our nurse educator. Typically, huddles are led by charge nurses or nurse managers. Huddles can improve communication and workflow and are more effective when they are interdisciplinary. Pre-procedure huddles have actually been shown to reduce errors and unintended events (Criscitelli, 2015). In regards to surgical site infections, huddling can improve patient outcomes by increasing timely prophylactic antibiotic administration (Criscitelli, 2015). Huddling helps perioperative team members address the surgical safety checklist, keeping the patients safe care as a forerunner in the plan for the day.
Safety huddles can reflect the nursing profession’s commitment to improving safe care and thus supports evidence-based practice. It is a very simple concept that carries great benefits by bringing team members together and can inevitably reduce patient harm (Foster, 2017). As a nurse educator, I plan to foster the concept of huddles in the classroom and clinical setting.
Criscitelli, T. (2015). Fostering a culture of safety: The OR huddle. AORN Journal, 102(6), 656-659. doi:10.1016/j.aorn.2015.10.002
Foster, S. (2017). Implementing safety huddles. British Journal of Medicine, 26(16), 953. doi:10.1298.bjon.2017.26.16.953
The last thing a patient wants when going to a hospital for treatment is a hospital-acquired infection or as you mention surgical site infection. Nurses play a key role in helping to prevent infection before it happens by adhering to evidence-based infection-control policies. This includes keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions and practicing correct handwashing. Although nurses are busy with many responsibilities, the time it takes to control infection is well worth the effort. Infection control measures can be as simple as hand washing and as sophisticated as high-level disinfection of surgical instruments. Implementing these measures can prevent transmission of disease in health care settings and the community. Most importantly foam in and foam out of patient room. U.S. Centers for Disease Control and Prevention, and every hospital have established guidelines to prevent the transmission of disease. Because if the flu this season, Grady hospital for example have stopped children 14 and under from visiting patients. There are signs instructing visitors not to enter if they are having flu symptoms.
The term evidence-based practice refers specifically to “the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients (Hanberg & Brown, 2006). The idea behind the use of Evidence-based practice is that it comes from the values and preferences of the patient, the clinical or clinical expertise, and the research evidence itself. The combination of these aspects is what leads to improved individualized patient outcomes, making evidence-based practice crucial to nursing practice itself.
The process of EBP starts the asking of burning clinical questions to improve patient care. The question is asked in PICOT format. Once a clinical question is generated, the next process will be. Search for and collect the most relevant best evidence. Entering key word from the PICOT question into the database that is being searched (e.g. Medline, CINAHL) and then combining the research words together to reveal the studies that may answer the question. Reliable sources to answer the PICOT questions include systematic reviews, pre-appraised literatures and studies from peer-reviewed journals. Critical appraisal of the studies from the research is conducted. Evidence is integrated with the clinician’s expertise and patient preferences and values to make a decision regarding whether a practice change should be made. Outcomes should be measured to determine positive outcomes of the change (Hanberg & Brown, 2006).
One of the advantages of implementing evidence-based practice by nurses is results in higher quality of care that leads to improved patient outcomes, since EBP incorporates the latest research evidence that are made available to healthcare providers at the point of care. Also, the current use of evidence in healthcare would result in increased patient outcome since EBP includes healthcare recommendations that would help nurses in addressing questions related to best client care. As well, the use of evidences in the healthcare setting would further increase the nurses’ confidence, improve skills, critical thinking and decision making since nurses have to constantly evaluate various research that would support and be beneficial in their practice (Hanberg & Brown, 2006). Evidence-based practice not only enhance the nurse’s clinical performance, but also lead to higher job satisfaction and better group cohesion which promote job retention in health care. Also, another benefit of using evidence-based practice is reducing cost in health care compared with the care that is based in tradition and outdated policies and practices (Saba & McCormick, 2011). Implementation of evidence-based practice would manage available resources, since it would be used efficiently and effectively instead of being wasted in the process of determining ways of providing competent client care (Hanberg & Brown, 2006).
My specialty track is family nurse practitioner. FNP will prepare me with the academic knowledge and clinical skills I need to be a leader in health promotion, disease prevention, assessment, and management of common acute and chronic illnesses. FNP fills a need for more accessible health care for families, since fewer physicians are entering that field. Autonomy. diagnose illnesses, treat patients, prescribe drugs, order diagnostic tests, gather medical histories, perform physical exams, and educate their patients. FNP route can provide you with responsibilities, yet also provide you with the ability to spend time with your patients.
One of the topic I have passion about is PSA screening recommendations for prostate cancer. As an FNP, I will provide educational materials addressing patient questions and concerns about the guidelines, evaluate patient perceptions about prostate cancer screening benefits, harms and recommendations against screening. Prostate-specific antigen (PSA) is a protein made by the prostate. The prostate is a walnut-sized gland in men that makes a fluid for semen. Most PSA is released into semen. Some of it is released into the blood. If there is a problem with the prostate, then the PSA level in the blood can become elevated (Parlikar, 2017).
Hanberg, A., & Brown, S. (2006). Bridging the theory–practice gap with evidence-based practice. Journal Of Continuing Education In Nursing, 37(6), 248-249. Retrieved from EBSCOHost.
Parlikar, U. (2017). Prostate-Specific Antigen (PSA) Test. Health Library: Evidence-Based Information.
Saba, V. K. & McCormick, K. A., (2011). Essentials of Nursing Informatics, (5th edition). McGraw-Hill Companies.