Running Head: Evidence Based Practice and Applied Nursing Research Essay

Running Head: Evidence Based Practice and Applied Nursing Research Essay

The purpose of this paper is to explore the impact of Evidence Based Research (EBR) on nursing practice. Included in the review will be research examples as related to the author’s field of practice in occupational health, both qualitative and quantitative. Also reviewed will be a brief discussion on barriers to the use of EBR and possible interventions to overcome those barriers. Importance of Evidenced Based Research

In 2002 Brown gave a definition of Evidence Based Practice (EBP) as “professional understanding and action that is based on the thoughtful use of knowledge and information from available, reliable, and dependent sources.” In 2008 Houser gave a further definition to EBP as the balance of clinical experience, proven evidence from scientific studies with patient input. This input from patients will incorporate their values, preferences, and systems influence. Evidence Based Practice is a fluent process that requires nursing professionals to be current and correct on information as it pertains to their daily practice. Regardless of who defines EBP, the intent is to ultimately improve quality of the care that is delivered to the client. Today’s consumers of health care have increased access to information via public sources. This increased knowledge, whether it is correct or incorrect, is a motivating factor for nursing professionals to have current and correct information available when working with clients in making health care decisions. The consumer’s increased information access in conjunction with the increasing demand for quality cost effective health care from third party pay sources are some driving forces for the promotion of EBP (Salmond, 2007). Healthcare professionals, especially nurses are the touch point of health care…

Evidence Based Practice And Applied Nursing Research

Evidence based practice and applied nursing research encompasses selecting a perioperative procedure such as routine shaving of a surgical site which is something you would commonly find on a surgical floor. The process of shaving a perioperative site includes cleansing and shaving the site that is to be operated on. Clipping the surgical site of hair is more appropriate because it would decrease the likelihood of surgical site infection. Gregory P Nowinski noted in his article the following:

“ An alternative to using razors is powered surgical clippers. Clippers mechanically trim the hair close to the skin, effectively removing it from the field, and avoid the skin trauma caused by the sharp blade of a razor. A study of open heart surgery patients showed a significant decrease in deep infections in individuals whose hair was removed by clippers compared to those whose hair removal was done with a razor” (Nowinski,2008).

Doctor’s and hospital administration determined the best practice for removing the hair from the surgical site. This would remove the hair completely and all the germs contained in the hair in the hopes it would lead to less infection for the surgery. The rationale for making the decision was based on the knowledge that hair carries a number of germs that could easily infect the site. It also increased visibility of the surgical site making the surgical procedure a smoother adverse free operation. The clinical implications of shaving rather than clipping the site after review of the literature shows that shaving often leads to open areas and ingrown hair which causes surgical site infections. Clipping the hair however does not damage the skin opening it up for infection and also allows the removal of the hair so that germs from the hair do not enter the surgical site as well as giving the surgeon a better view of the site unobstructed by hair. There are specific guidelines when performing a preoperative procedure checklist including a protocol written by the foot and ankle center: “ Do not shave the surgical area for a minimum of 3 days prior to surgery. Shaving can cause nicks, cuts and abrasions in the skin, allowing bacteria to enter, increasing the risk of infection.”(Foot & Ankle Center,2012)

The best method of preparing a surgical site for pre operative procedure is to clip the hair rather than shave it. In an article written by David E. Reichman MD and James A. Greenberg MD posted on the internet, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812878/ “Studies have shown that shaving the skin as compared with clipping results in a statistically significant increase in the rate of surgical site infection. Shaving results in microscopic cuts and abrasions, thus acting as a disruption of the skin’s barrier defense against microorganism colonization. Clippers, when used correctly, should not cut into the patient’s skin, potentially explaining the differences in infection” (Greenberg & Reichman, 2009) It is more cost effective because the tools used for clipping could be sterilized and reused while the shaving equipment must be thrown away and also requires cream or moisturizer of some type while shaving does not.

In an effort to involve key stakeholders in the decision to change this procedure or comply with the proposed change a meeting could be held. A report could be drafted showing the evidence based research that clipping causes less infection. But research suggests that shaving a patient’s skin before surgery may raise the risk of an infection. In an article written by Kelly M Pyrek it is stated:

“ A recent OR Manager survey revealed more than half of the respondents said surgeons at their hospitals are still using razors for preoperative hair removal, despite a growing body of research proving that it is unnecessary and perhaps even…

A Better Understanding of the Integration of Evidence-Based Practice in Nursing

On a daily basis health care professionals are confronted with difficult questions and situations while caring for patients. They want to know how to interpret diagnostic test accurately, how to predict the prognosis of a patient, and how to compare the effectiveness of therapeutic intervention. As health care professional we are challenged to stay familiar with any new information regarding health. This allows us to give our patients the highest quality health care available. This is where Evidence-Based Practice is important. It is defined as the integration of the best systematic research evidence with clinical expertise and patient values.

The intent of this presentation is to look at the pros and cons of Evidenced-Based Practice, how nursing schools need to teach it to their students, how nursing management can incorporate it to their employees and how it can work for patients with pressure ulcers.

PROS AND CONS OF EVIDENCE-BASED PRACTICE

Evidence-Based Practice is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of patients, (1) It involves integrating the individual clinical expertise of the physician or nurse with the best available external clinical evidence for systematic research and individual patient preferences, (2) Research shows that patients’ outcomes are at least 28% better when clinical care is based on evidence rather than the tradition common sense (Bryan-Brown, 2006).

Opponents of Evidence-Based practice argue that the use of it can potentially nurses to be less autonomous and it is “responsible for the suppression of the innovation and creativity” (Walsh, 2010 p.27)

There have been barriers to Evidence-Based Practice implementation identified as the time it takes to research evidence, limited team cooperation, and staffing levels. Also, for nurses in rural areas, they are less likely to hear about new research for evidence based practice. Often it is the nurses in the larger medical centers that participate in the research or have the information easily obtainable.

Fortunately, the research on the benefits of Evidence-Based Practice are abound. Data is collected over a period of time targeting a particular audience. Quantitative and qualitative research is gathered by research groups. There are two mnemonics to remember when conduction quantitative and qualitative research: For quantitative research, PICO stands for: 1. Patient population, 2. Intervention, 3. Comparison group and 4.Outcome.

Alternatively, the mnemonic SPICE stands for: 1. Setting, 2. Perspective, 3. Intervention. 4. Comparison group and 5.Evaluation.
Ideally, once qualitative and quantitative integration occurs, qualitative metasynthesis takes place and more definitive interpretations of the study can be incorporated (Broeder & Donze, 2010 p.199).

TEACHING EVIDENCE-BASED PRACTICE

Ferguson and Day (2005) emphasized that nursing faculty are incorporating Evidence-Based Practice by helping students increase their skills in accessing and analyzing the most relevant evidence to support their beginning nursing practice. Nursing faculty can help students recognize the importance of current research evidence.

Erikson-Owes and Kennedy (2001) emphasized that an evidence based nursing approach is a learned skill for both the student and the clinical educators that requires intellectual curiosity to explore beyond “the way it has always been done” (p.137).

Students need to be able to enhance their evidence-based knowledge through guided research questions, systematic searches, reading and critiquing the strength of the evidence, synthesizing the evidence and preparing the evidence based on recommendations.

Leadership Responsibilities

The phrase, “Knowledge of Power” applies to the responsibility nursing leaders have to empower their staff. Leaders need to have their staff, “think outside the box”….

References: Broeder J. L., Donze A., Smith J.R., Sonze A (2010. The Role of the Qualitative Research in
Evidence-Based Practice
Walsh N. (2010). Dissemination of Evidence into Practice: Opportunities and Threats. Primary
Health care, 2010 Apr: 20:20 (3): 26-3
Halm M.A. (2010). “Inside Looking In” or “Inside Looking Out?” How Leaders Shape Cultures
Equipped for Evidence-Based
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Bryan-Brown, C.W., 2006, Evidence-Based Practice is Wonderful Sort Of, American Journal of
Potter, P. and Perry, A. 2004. Fundamentals of Nursing. Mosby.
Erickson-Owens D.A., & Kennedy, H.P. (2001) Fostering evidence-based care in clinical teaching.

Running Head: Evidence Based Practice and Applied Nursing Research Essay