NURS 6150 week 6 Discussion Essay
Evidence-Based Practice Implementation
As the role of nursing and nurses continue to evolve, keeping the patient safe from harm requires the use of evidence to practice. According to Gray et al. (2017), the professional nurse provides quality care that improves patient outcome by the used of evidence-based practices. The use of evidence to provide quality care such as disease prevention with hand hygiene is one such instance that came from research back by the evidence put into practice. An evidence-based practice, according to (Titler 2008), is using current best practice conscientiously and judiciously along with clinical expertise as a guide for healthcare decision for patient outcome.
NURS 6150 week 6 Discussion Essay Throughout the practice, nurses and healthcare workers use the excuse, such as not touching anything as to why there is no need for hand hygiene before entering or leaving patient rooms. Hand hygiene with soap and water or an alcohol-based rub, when done for 15-20 second, correctly decrease the risk of disease transmission. CDC (2019). According to Titler (2008), the nurse must put into practice what is research for it to be effective in improving patient outcome. This course has thought about the importance of how research is used to improve quality outcomes for patients — learning the difference between qualitative and quantitative research and the effectiveness of these research methods.
The goal of all medical research and nursing care is to use new knowledge generated to optimize patient outcome by maintaining their rights and interests (Izet et al. 2014). Nursing is the alleviation of suffering through the restoration of health and the prevention of illness and injury. It encompasses the advocating for and the protection of the patient from undue harm, and as a scholar-practitioner, this class will help guide the care provided by being up to date with the current best practices.
Reference;
Center for Disease Control and Prevention: Hand hygiene in the healthcare setting retrieved July 3rd, 2019 https://www.cdc.gov/
Gray, Groves, & Sutherland (2017) state “Nurse researchers need to implement the most effective research methodologies to develop a unique body of knowledge that is core to the discipline of nursing” (p. 1).
Izet, M., Ajila, H., & Smaila, M. (2014, September). Ethics in Medical Research and Publication. International Journal of Preventative Medicine, 5(9). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192767/
The aim of this essay is to explore the relationship between the research process and evidence based practice. The author of this essay intends to explore and illustrate an understanding of the various types of evidence used within nursing practice. There are barriers to implementing research into practice, the author intends to give explanation to these barriers and detail strategies/organizations that assist to putting research into nurse’s everyday practice. Two journal articles will be critiqued within this essay; the aim of this is to indicate which evidence has been used, to assess the strengths and weaknesses in the research process and to evaluate its usefulness in practice.
Principles of Evidence Based Practice
Research can be described as a method of investigating a chosen area to illicit new information on the topic or to build on previous knowledge. In nursing research the aim of this research is to provide clients, their carers and their families with the best possible care in all aspects of their treatment to promote well being (Burns and Grove 2001).NURS 6150 week 6 Discussion Essay
“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external evidence from systematic research.” (Sackett et al 1996;72)
Nurses are at the front line of healthcare and have most one to one contact time with clients; therefore it is essential that the foundation of their practice be formed from reliable evidence (Parahoo 2006). Evidence based practice sets out to integrate the best possible evidence, nursing knowledge and patient views into practice. It is vital that nursing staff be knowledgeable of the latest findings in nursing research and are able to access and opt for the most suitable evidence to inform and implement into their practice. (Gerrish 2006) suggest that evidence based practice consists of research, patient experience and clinical expertise.
It is important to address which research findings nurses should consult to inform their clinical practice in order for them to deliver adequate care to their patients. There are many different types of evidence available to practitioners; Gray Muir (1997) as cited in Gerrish (2006) outlines a hierarchy of evidence and indicates which types are more superior. Placed at the top of the hierarchy are systematic reviews and multiple randomized controlled trials (RCTs). A systematic review is essentially a study done on prior research; this is then deemed as secondary research (Parahoo 2006). The aim of this type of review is to carry out an extensive and thorough search of material already available on this topic. The most fitting material in relation to the topic is chosen, this is then evaluated, the findings are then collaborated and summarized to answer the original question. This process should be performed in a clear manner so that it would be possible for others to carry out this research. In second place on the hierarchy is randomized controlled trials, third; non-randomized controlled trials, fourth; non-experimental studies and fifth; descriptive studies/expert committees. This hierarchy is more suited to quantitative research and is deemed inappropriate if outcomes are not measurable (Gerrish 2006).
There are many organizations that provide information on research and guidance to how it should be implemented into clinical practice. The National Institute for Health and Clinical Excellence (NICE) offer clinicians guidelines and criteria to follow with the aim of developing nursing care to the benefit of the clients health (NICE). The Cochran e Collaboration supply research material which is available to everyone. Their aim as an organization is to provide health care workers, clients and their carers with information on the most current and reliable evidence used within health care settings.NURS 6150 week 6 Discussion Essay
There are several different barriers to implementing evidence into clinical practice; Gerrish (2006) suggests that these barriers can be set into four categories; the nature of the evidence, communication of the evidence, knowledge and skill of the nurse and organizational barriers. Barriers with regard to the nature of the evidence may include research questions unsuitable to clinical practice. In relation to communication of evidence the language used in the research may be deemed as inaccessible due to complex terminology. It has been identified that barriers concerning the nurses skill include troubles identifying or appraising evidence and also lack of confidence of the individual in using resources to access the research. Organizational barriers seem to indicate that lack of support from senior staff in providing information and time to implement changes are the main cause for concern.
Parahoo (2006) suggests that there are four main components in the research process. Identification and formulation of the research question is the first stage in the process, this is where the researcher determines what is being researched and a question is created. Previous literature researched in the chosen field may be consulted by the researcher to help define concepts. The final question must be clearly set out. The second stage of the process is the collection of data, in this part of the process several decisions will have to be made before data is collected. The design of the study, methods used within it and sometimes piloting need to be decided upon. The population that will be participating needs to be defined at this point consent may need to be sought from ethical committees. Once these arrangements are in place the data can be collected. The third stage in this process is the analysis of data, at this stage the researcher would analyze, translate and display their findings. It is important to note that before the data was collected the researcher would have decided on how the analysis would be conducted. After analysis the researcher would typically translate findings, examine the limitations and make suggestion as to how to implement into practice. Recommendations may be made for additional research needed. The final stage in research process is the dissemination of findings. An organization that might be responsible for this area would be NICE, the barriers to the implementation of evidence are outlined above.NURS 6150 week 6 Discussion Essay
There are many ethical issues involved in the research process; the author of this essay intends to discuss some of these implications. Beneficence is an important ethical issue, it is essential that the study should be of the benefit of its participants and in the best interests of the overall public. Confidentiality is another ethical issue within the research process, any information gathered should be respected. Consultation to the participant’s wishes should be sought throughout the process and care must be taken by the researcher when publishing results so not to unintentionally expose the identity or information of its participants.
Conclusion
The author of this essay has explored the relationship between evidence and the clinical setting. Research, evidence based practice and the research process was considered. Barriers to implementing evidence based practice and the strategies/organizations used to avoid these barriers were discussed. Critiques of two research articles are included in this essay; these critiques aim to illustrate the author’s understanding of the research process and knowledge of the various types of research and the methods used.
The evidence based approach (EBP) to nursing practice provides nurses the ability to deliver quality health care services to a specific population. This kind of approach in the nursing practice is widely used because it reinforces the nurse’s ability to solve problems and overcome barriers using the best evidence available from research, patient references and clinical judgment (Schmidt & Brown, 2011 ). Orthopedic nursing involves the delivery of treatment and management of care to patients with musculoskeletal problems (Lippincott Williams & Wilkins, 2007) and this is one of the areas of clinical nursing practices that impose challenges and difficulties to a clinical nurse. Evidence based practice assists nurses to learn about how to respond to emergency procedures in the orthopedic ward but there are existing challenges and barriers that could prevent nurses from delivering optimal care to patients with musculoskeletal injuries. This paper aims to present these common barriers and challenges that nurses experience in the orthopedic ward based on evidence based approach perspectives while providing for the best strategies that would help overcome these difficulties.
An evidence based practice in nursing is primarily designed to integrate research evidences to a nurse’s clinical practice and the patient responses to their treatment and health care services that are made available for them. According to Malloch & O’Grady (2010), the keystones to evidence based practice involve clinical practice, clinical data and research, patients’ concerns and the identification of the best practices in the clinical setting. This helps the healthcare practitioners to exercise a sound judgment before any clinical situation laid down before them. Health professionals are becoming more engaged in involving patients in the decision making process with regards to the health care services received by them in consideration of their values and preferences (Hoffman, Bennett, and Del Mar, 2010).NURS 6150 week 6 Discussion Essay
In the orthopedic ward setting, a clinical nurse is often subjected to various difficulties and challenges. The nature of the condition of the patients in the orthopedic ward consists of musculoskeletal trauma that may be acute or chronic. Patients in the orthopedic ward also include the elderly population who require long term care of their condition or perhaps throughout their lifetime. According to Jester, Santy and Rogers (2011), orthopedic patients manifest major symptoms of pain, reduce mobility and function and deformity. Some of these patients may have existing medical conditions such as heart disease, pulmonary complications and diabetes making them high risk patients in the orthopedic ward. According to Nazarko (2004), choosing the right staff with the right skills is essential in the delivery of quality patient care. Considering how vulnerable patients in the orthopedic ward can become, nurses who are assigned in the orthopedic ward should be able to learn to identify the barriers that prevent them from becoming efficient nurses and to find the appropriate strategies in resolving them.
Nurses often experience difficulties when assisting the patient in their mobility where the risk of falls among elderly patients and those with high risk conditions may be high. Nurse related barriers usually involves the awkward handling of their patients during transfer and mobilizing them that may compromise patient safety and comfort (Nelson and Baptiste, 2004). Moreover, the lack of patient handling devices and equipment could also add to this problem encountered by nurses, which is essential in the delivery of quality patient care and safety. Some patients also feel extreme pain when receiving nursing care when mobilized especially during transfers and in the presence of their trauma wounds (Schoen, 2000).
According to Melnyk and Overholt (2011), there are different factors that affect the nurses’ ability to use evidence based practice in their profession. Among these barriers include their misconception and negative attitudes about research and evidence-based care, overwhelming patient loads, lack of resources to make a research, resistance to change, organizational constraints such as lack of administrative support and incentives as among others. Moreover, work beliefs and attitude of nurses also affect the way they perceive the effectiveness of evidence based practice or they lack the knowledge with no EBP mentors to help them apply the EBP concepts in the orthopedic ward (Godshall, 2009). Because of the lack of understanding about the EBP principle, orthopedic nurses often fail to consider the patient’s own difficulties and pain and deliver care that is only oriented according to their own usual care of practice without regard to consider the patient as the core of the nursing care service.
According to Courtney and McCutcheon (2010), evidence based practice help nurses to learn how to communicate with patients and the health care team the rationale of their decision making process and health care plans. With the lack of knowledge of using EBP in clinical practices, nurses lack the skills to practice their initiative of attending to their patient needs accordingly. Moreover, the inadequate availability of research materials (that are often outdated already) serves as a barrier for nurses to improve their skills in applying evidence based practice in the health care settings (DiCenso, Guyatt and Ciliska, 2005).NURS 6150 week 6 Discussion Essay Another gap identified by Ball (2011) is the nurse’s inability to access, identify and evaluate EBP resources. Apparently, about 58% of nurses do not use research and journals and 82% do not utilize the use of the hospital library.
Organizational cultural barriers also affect the infusion of EBP in the orthopedic ward. There is the absence of institutional promotion of the EBP in various hospital departments. Many health organizations support the principle of EBP but they do not necessarily provide support to their staff in terms of resources, time and guidance (Polit and Beck, 2008) for its implementation. Thus, strong organizational leadership is expected for the effective implementation of EBP in hospital settings because their role in the implementation of EBP and in developing a culture that fosters the practice of evidence based patient care is essential in sustaining the same in the delivery of health care services. Nurses are also constrained to exercise their own initiative in performing nursing care that is based on research findings (Gerrish and Lacey, 2010) owing to inflexible organizational health practice policies.
Numerous guiding principles have been provided in literatures to help overcome the barriers to the implementation of EBP. A paradigm principle of EBP in the orthopedic setting usually involves the corroborative efforts between the health care team, case management nurses and outcome measurements monitoring to ensure a functional outcome of treatment. Flarey and Blancett (1996) emphasized that organizational barrier is overcome by providing facilities and promoting a cultural environment for case nurses to practice research efficiently in order to understand which treatment approach is best to deliver to individual patients. This will strengthen the outcome measurement of the patient’s response to the delivery of care received by them. The transfer and mobility difficulties that are commonly encountered in the clinical setting is attributed to the lack of skills of a nurse as well as the lack of corroborative efforts with the other staff present in the ward. This experience can be used as guiding principle in improving a nurse’s skill on transfer and mobility care for patients with musculoskeletal injuries (Hally, 2009) and may be strengthened by research on the best EBP treatment approach to this specific patient population.
The Cochrane Collaboration is a non-profit organization that aims to deliver to the global health care communities updated research data that would improve the quality of patient care through a systematic review on health care practice and policy (The Cochrane Collaboration). Hospital management should be able to obtain sources that will help them foster an effective organizational culture and policies that will promote the practice of evidence based patient care. Another organization, the Joanna Briggs Institute (JBI) also offers a good implementing guidelines on how to adopt strategies that will effectively implement the research data available for EBP and how to disseminate the same to the health care providers. Using the Best Practice Information Sheet designed by the institute, nurses will be guided in their practice of delivering evidence based nursing care services. The institute has a wide database of systematic reviews and implementation reports (Joanna Briggs Institute Library) that should be accessible electronically to practicing nurses and nursing students as well without a cost for health care professionals to use.NURS 6150 week 6 Discussion Essay
In conclusion, the nursing profession is a practice based profession where improvement in the quality of services usually emanates from evidence based practice that improves the nurses’ ability to exercise an efficient decision making process. Individual and organizational barriers are common but there are guiding principles that could help overcome these barriers with the availability of the wide research data base and implementing guidelines on EBP that can be adopted in the healthcare setting. Evidence based practice is only effective when its principles are implemented in the health care organizations that need to foster a supportive environment that will encourage nurses to perform research for professional development and in improving their delivery of evidence based oriented nursing care services. Orthopedic ward patients need appropriate nursing care services which can be best addressed through the delivery of an effective evidence based patient care services that can be optimized through research and fostering the implementation of evidence based practice culture within the orthopedic ward section.NURS 6150 week 6 Discussion Essay