NURS 8114 WEEK 4 BLOG: OBSERVATION OF EVIDENCE-BASED PRACTICE

Sample Answer for NURS 8114 WEEK 4 BLOG: OBSERVATION OF EVIDENCE-BASED PRACTICE Included After Question

BY DAY 3 OF WEEK 4

Post a blog on the topic of evidence-based practice in the health care organization where you practice. Drawing on your understanding of EBP and your firsthand observations within your organization, include the following content in your blog:

  • Briefly describe one specific example of evidence-based practice that produced/is producing significant patient outcomes. Or, if you are lacking examples, describe a recent patient experience that might have been improved through application of evidence-based practice. Explain your reasoning. Note: To maintain confidentiality, do not refer to individuals by name or with identifying details.
  • Evaluate the overall application of evidence-based practice within your health care organization, including conditions that support it or roadblocks to overcome. Explain your reasoning, including how you have arrived at your conclusions.
  • Describe how you can advocate for application of evidence-based practice within your health care organization.

Read a selection of your colleagues’ blogs.

A Sample Answer For the Assignment: NURS 8114 WEEK 4 BLOG: OBSERVATION OF EVIDENCE-BASED PRACTICE

Title: NURS 8114 WEEK 4 BLOG: OBSERVATION OF EVIDENCE-BASED PRACTICE

Evidence based practice (EBP) is the use of current best evidence in making decisions about patient care. It is a problem-solving approach that members of the healthcare system such as DNPs use to improve clinical practice. This approach integrates a systematic search for the most relevant evidence to answer a clinical question, our own clinical expertise and it also takes into consideration patient`s preferences and values. All together allows us to provide the best patient care and improve health outcomes. 

In the hospital setting, we have point of care testing blood sugar for Diabetics, EBP shows that hyperglycemia and hypoglycemia episodes during hospitalizations are associated with poorer outcomes such as increased morbidity, mortality and increased length of stay. POCT offers a fast, affordable test results that can easily tell the health care team members if the patient needs insulin before meals or at bedtime, if needs insulin adjustment or if the patient is having a hypoglycemic episode and needs to be corrected. In my experience as a bedside nurse in the diabetes unit, I have learned that POCT before meals and at bedtime has decreased the number of rapid responses calls due to severe hypoglycemia as we check blood sugars at least every 4-6 hours allowing us to catch it before it gets dangerously low.

Moreover, being able to check blood sugars and obtain the results within seconds allows us to decide how much insulin a patient may need and if medication adjustment is needed, this provides better care for the patient as it avoids hyperglycemic and hypoglycemic episodes. In the study “Management of Diabetes and Hyperglycemia in Hospitalized Patients” found that the prevalence of hyperglycemia and diabetes ranging from 38% to 40% in hospitalized patients, which was determined by using POCT. 

References 

Dhatariya K, Corsino L, Umpierrez GE. Management of Diabetes and Hyperglycemia in Hospitalized Patients. [Updated 2020 Dec 30]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. South Dartmouth (MA): MDText.com, Inc.; 2000-.  https://www.ncbi.nlm.nih.gov/books/NBK279093/

Nichols JH. Utilizing Point-of-Care Testing to Optimize Patient Care. EJIFCC. 2021 Jun 29;32(2):140-144. PMID: 34421482; PMCID: PMC8343046.

Titler MG. The Evidence for Evidence-Based Practice Implementation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 7. https://www.ncbi.nlm.nih.gov/books/NBK2659/Links to an external site.

A Sample Answer 2 For the Assignment: NURS 8114 WEEK 4 BLOG: OBSERVATION OF EVIDENCE-BASED PRACTICE

Title: NURS 8114 WEEK 4 BLOG: OBSERVATION OF EVIDENCE-BASED PRACTICE

Great discussion on the impact that Point of Care Testing (POCT) for glucose has on patient outcomes and safety. The management of the hospitalized diabetic patient is an important focus. There is a lot of work happening within healthcare to promote a better awareness of glucose management, the care of the diabetic patient, and improving glycemic control (Oba, Barry, Gordon, & Chutipanyanporn, 2020).

Nursing plays a critical role in preventing poor diabetic outcomes related to insulin management and glucose monitoring (Kadrija & Karabollaj, 2021). There is a lot of literature out there that showcases the differing multidisciplinary approaches to diabetic patient care; however, the use of POC remains a constant benefit to decreasing morbidity, mortality, and length of stay.

This had me thinking more about your evidence-based practice on hyperglycemia and POCT. POCT supports evidence-based practice and a patient-centered approach to addressing the needs of acutely unwell patients with diabetes that are “susceptible to hyperglycemia, hypoglycemia and ketosis due to acute illness, stress, dehydration, inactivity, diet, changes in nutrition status and medication-related issues, including errors” (Knee, Hussain, Alkharaiji, Sugunendran, & Idris, 2020).

Within my organization, we utilize a harm scoreboard which focuses on several high-level issues that the Clinical Nurse Leader team has identified as problem areas; these include reportable state events, such as falls resulting in moderate or major injury, hospital-acquired infections (C.Diff or VAP), or Pressure Injuries that developed during the hospital stay. We also monitor process improvement work around sepsis and timeliness to treat, as well as, repeat hypoglycemic episodes. I have found the hypoglycemic work very interesting! To your point, POCT offers fast and reliable testing at the bedside that guides the nurse to manage the patient care needs.

The quality initiative on hypoglycemic events really highlighted the need for nursing to use their critical thinking skills and use interdisciplinary communication around these events to improve outcomes. The patient harm scoreboard focuses on the second hypoglyemic event for that patient. The first hypoglycemic event during the hospital stay is considered a “warning sign” and a trigger to call a huddle with interdisciplinary team members to discuss the patient’s plan of care. This is particularly important for patients that are admitted to the hospital on their home dose insulin and become hypoglycemic following that dose.

The POCT glucose test plays an essential role in the timeliness of intervention and ability to decrease patient cost, length of stay, and potential harm. Patients using insulin as part of their diabetes management were more likely to benefit from this intervention (Knee, Hussain, Alkharaiji, Sugunendran, & Idris, 2020). My learning through this process improvement was the opportunities that exist with implementing and evaluating the effectiveness of the patient care by creating nurse-led multidisciplinary teams, timeliness of glucose checks, insulin administration, and patient presentation.  

Thank you for sharing this evidence-based practice with us!

References:

Kadrija, M. & Karabollaj, F. (2021). Level of knowledge and nursing practices on diabetic foot management. International Journal of Ecosystems & Ecology Sciences. Nov2021-Jan2022, Vol. 12 Issue 1, p101-106. 6p

Knee, M., Hussain, Z., Alkharaiji, Z., Sugunendran, S., & Idris, I. (2020). Diabetes specialist nurse point-of-care review service: improving clinical outcomes for people with diabetes on emergency wards. Practical Diabetes; 37(2): 50–54

Oba, N., Barry, C., Gordon, S., Chutipanyaporn, N. (2020). Development of a Nurse-led Multidisciplinary Based Program to Improve Glycemic Control for People with Uncontrolled Diabetes Mellitus in a Community Hospital, Thailand. Pacific Rim International Journal of Nursing Research; 24(3) 349-362

Briefly describe one specific example of evidence-based practice that produced/is producing significant patient outcomes.

Evidence-based practice (EBP) is using proven evidence from research and knowledge gained from everyday life experiences to make excellent clinical decisions ((Stewart, Chambless, & Stirman, 2018). The leaders of my organization put a policy in place to aid in reducing hospital-acquired pressure injuries (HAPI) due to many patients getting pressure injuries. HAPI is preventable with implemented interventions, but when they occur, they are costly (Polancich et al., 2023). The plan is that when a patient first arrives in a hospital unit to get admitted, their assigned nurse and a fellow nurse must perform a head-to-toe skin assessment of the patient. The name of the policy is “4-eyes” because two nurses use all their eyes, two from each, to perform the evaluation. Any observed wound or injury gets immediately documented in our electronic records, alerting the wound care team to act quickly. I am proud to say that since we started this policy five years ago, no patient on my unit has gotten any HAPI due to the hard work of my fellow nurses, and this is a perfect example of how EBP improves patients’ care.

Evaluate the overall application of evidence-based practice within your healthcare organization.

The overall application of EBP in my organization shows that patient safety is among our leaders’ top priorities. A perfect example that supports this is that many patients are no longer acquiring HAPIs as much as they did since implementing the “4-eyes” policy. We also have guidelines on hand hygiene, hourly rounding to prevent patients from falling, and other policies that protect patients’ safety and improve their care. The hand hygiene policy involves:

  • Having signs posted to gel-in and gel-out with hand sanitizers when going in and out of patients’ rooms.
  • Washing our hands with soap and water when visibly soiled.
  • Correcting one another when anyone forgets to follow the policy.

Surveyors with hidden identities score our compliance and report it to management for follow-up. EBP is successful at my organization due to the zero HAPIs in my unit, decreased spread of infection due to good hand hygiene by nurses, and prevention of patients from falling.

Describe how you can advocate for applying evidence-based practice within your healthcare organization.

I can advocate for EBP in my organization by reminding my coworkers to gel-in and gel-out when entering and leaving patients’ rooms and for them to wash their hands with soap and water when soiled. I will bring up issues that need looking over that can improve patients’ care and experience to the leadership team. I can also advocate for the application of EBP by joining committees in my organization, so I will be among the individuals who help put policies in place. I will implement all of the policies my organization has in place that utilize EBP when caring for patients and educate my coworkers to do the same.

Observation of Evidence-Based Practice

Evidence-based practice (EBP) is the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. (McEwen & Wills, 2019). It is the recognized and desired standard for international transdisciplinary healthcare providers and is supported by national, international, and professional healthcare organizations and regulatory agencies. EBP involves integrating the best available evidence with clinical knowledge and expertise while considering patients’ needs and preferences. The goal is to quickly incorporate the best available research, along with clinical experience and patient preference, into clinical practice so that nurses can make informed patient-care decisions.

EBP in nursing may be even more crucial for mental health nurse practitioners. Mental and behavioral health disorders are complex; patients may suffer from two or more diagnoses. Additionally, patients may be homeless or incarcerated, making treatment even more difficult. As a Psychiatric Mental Health Nurse Practitioner (PMHNP), I commit to integrating evidence-based practice to solve different mental health issues. Schizophrenia and other related psychoses are fatal mental illnesses that affect millions of people across the globe (Liu et al., 2018). From my experience, a patient once presented to my health facility seeking a psychiatric assessment and diagnosis. Although she lacked insight into the problem, the psychiatric team subjected her to several assessments to determine the primary cause, which, in the end, was diagnosed with schizophrenia. This mental health condition is a chronic-severe disorder; different prescription formulations can be administered to such patients.

Distortions characterize schizophrenia, and patients have challenges interacting with other people. Adopting EBP mental health treatments acknowledges that patients may have other basic needs besides therapeutic care, such as loss of housing and money. In mental health services, EBP often combines psychiatric and therapeutic treatment with services that include helping patients find housing, employment, and other support. Evidence-based decision-making aims to reduce variations in practice, enhance the quality of care, improve patient outcomes, and reduce costs. The providers worked with the patient in providing the medical and social support needed in the quality management of her disease condition. Moreover, the EBP also helped optimize internal and external support, improving the patient care outcome.

For decades, nurse practitioners have embraced EBP in solving different healthcare issues. In my organization, evidence-based practice is applied in almost every department. The psychiatric department considers EBP as a solution to unknown mental challenges. Several factors support the success of the EBP. Firstly, the leadership of the hospital understands the importance of evolution. Leadership encourages the integration of modern and traditional methods of treatment to enhance patient outcomes. This leadership does not only support EBP but also encourages registered nurses to implement it in patients. The implementation process enhances critical thinking and research knowledge, which is essential in patient care (Chien, 2019). Sufficient resources, technology, clinical expertise, and workshops have an extensive impact on the application of EBP. As a PMHNP, I have witnessed the great effort in providing resources to nurses to enhance their services. For example, technology helps nurses to identify efficient diagnostic formulations for a patient, which optimizes patient care. Additionally, workshops boost research knowledge, increasing confidence in nurse practitioners. The EBP support systems have significantly elevated the hospital’s success and improved the quality-of-service delivery and patient care.

Evidence-based practice is established as a proven intervention. Once care is based on evidence, the nurse looks at practice differently, realizing that measurable outcomes drive every decision. Measurable outcomes empower nurses to advocate for the best possible care for their patients. This approach also allows the nurse to use measurable outcomes (evidence) to change policy in their own unit, hospital, or even nationally. Advocacy science indulges in consultation and conclusions based on expertise or technical knowledge. The first step will involve the choice of audience. Identifying the target audience will help reach many people (Portney, 2020). The target includes the community and policymakers. Essentially, policymakers and the community have a significant influence in implementing healthcare practices. For instance, the issue of discrimination and stigmatization for patients with mental complications can be eliminated right from the neighborhood. Helping people understand the importance of social support to the patients will improve the outcomes, hence the success of EBP in my healthcare organization. Collaborating with other clinicians is also another step (Portney, 2020). EBP is research-based and knowledge-diverse; therefore, it is important to be true to the science by engaging other medical experts. It is the ultimate way of creating a strong advocacy system in psychiatric practicum.

References

Chien, L. (2019). Evidence-Based Practice and Nursing Research. Journal of Nursing Research27(4), e29. Doi: 10.1097/jnr.0000000000000346

Liu, Y., Tang, C., Hung, T., Tsai, P., & Lin, M. (2018). The Efficacy of Metacognitive Training for Delusions in Patients with Schizophrenia: A Meta‐Analysis of Randomized Controlled Trials Informs Evidence‐Based Practice. Worldviews On Evidence-Based Nursing15(2), 130-139.doi: 10.1111/wvn.12282

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.

Portney, L. (2020). Foundations of clinical research: applications to evidence-based practice.