Ebp Evidence Based Practiced

Running head: EVIDENCE BASED PRACTICE1 Evidence Based Practice San K. So Nevada State College EVIDENCE BASED PRACTICE2 Abstract Evidence based practice is an important aspect of nursing and many other disciplines. It is needed to build upon and/or modify current practices. Evidence based practice has made hospitals and medical facilities nationwide use policies and procedures that closely match the guidelines suggested by certain research. For example, the use of foley catheters and the regulations for the use has been greatly modified due to research based data.The guidelines are used to prevent catheter-associated urinary tract infections. Evidence based practice also has influenced the use of certain treatments for premature babies and how nursing orientation is done. This article will touch upon many aspects that research and evidence based data has changed and/or improved, so patient care is maintained safely and effectively. Keywords: EBP (evidence based practice), CAUTI (cathe ter-associated urinary tract infections), JACHO (The Joint Commission), WHO (World Health Organization).SBAR (The Situation, Background, Assessment, and Recommendation) bronchopulmonary dysplasia (BPD). EVIDENCE BASED PRACTICE 3 Evidence based practice (EBP) is an approach to healthcare wherein health professionals use the best evidence possible to make clinical decisions (Blais and Hayes, 2011). It involves complex and conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences.Evidence based practice involves many steps along the way and have influence hospital policies and procedures. For example, the use and maintenance of in-dwelling foley catheters has been research upon and new practices are suggested. The new research and data had many purposes, like increase patient safety; decrease catheter-associated urinary tract infections, and how nursing will maintain the catheters. In this paper we will exami ne the use of evidence-based practice in regards to catheter-associated urinary tract infections.In the hospital, there are appropriate indications for indwelling urethral catheter and if those indications are not present then the physician needs to prescribe alternative methods of urinary drainage. Some indications per hospital policy is patient requiring prolong immobilization, perioperative use for urologic surgery, anticipated prolong surgery and the need to monitor urine output during surgery, critically ill patients that require strict input and output monitoring, patients with urinary retention and to improve comfort at end of life care.Indwelling catheters are not to be used for convenience for the medical staff. Once an indwelling catheter is indicated, then there are guidelines to maintaining the catheter. Sterile technique needs to be use while inserting the catheter to prevent infection. EVIDENCE BASED PRACTICE 4 As per policy nursing staff need to perform catheter care at least once a shift and as needed. The continuation reassessment of the indication needs to be done also. The catheter needs to be secured to the patient and the collection bag needs to be lower than bladder level.The collecting tube needs to be free of kinks and dependent loops. The collection bag should be emptied routinely. If the catheter has been in for three days or longer, the nurse should provide daily reminders to the physician recommending the removal of the foley catheter, unless it is still indicated. The nursing staff and medical team need to provide education to the patient and the family during the duration of the catheter. These guidelines closely match the recommendations noted on the National Guideline Clearinghouse website. The hospital nursing staff tries to follow these guidelines closely.Our hospital has a self-made monitoring sheet that helps the nurse and the charge nurse to monitor the indwelling catheter and ensure daily care and reassessments are done. T he sheet allows the charge nurse and on-coming nursing staff to closely monitor if the patient is at risk for CAUTI. If a patient does develop a fever and has an indwelling catheter, then urine samples are obtain to rule out infection related to the catheter. The guidelines closely match our current hospital policy, but re-analyzing the guideline would help fine tune many other aspects of the policy (Allen and Donohue and Gilmore, 2010).Along with Guideline for prevention of catheter-associated urinary tract infections, I also use other evidence-based techniques in my practice as a pediatric nurse. EBP shapes how we give report at the end of the shift. The Situation, Background, Assessment and Recommendation communication was developed from research, like the EVIDENCE BASED PRACTICE 5 one done in a northern Arizona hospital on the pediatrics/perinatal service department. The research was explained in the article, Collaborative Communication: Integrating SBAR to Improve Quality/Patie nt Safety Outcomes.Cynthia Beckett and Gayle Kipnis wrote the article explaining the importance and research supporting the use of SBAR during hand-off communication. This study surveyed nursing staff and physicians during and after the research. The integration of SBAR format helped this study achieve their two goals: increase effective communication and improvement of staff and patient satisfaction in care. As with the article, SBAR has made hand off communication to other nurses, physicians, and other discipline staff effective.The SBAR format paints a better picture of how the patient is doing and what is his current status. It also helps with further educating the staff. For example, when I am receiving report from a seasoned nurse and she recommends certain interventions, I am able to ask the needed questions to understand her recommendations; it provides an opportunity for a new nurse to learn the reasons behind certain interventions. EBP can be also applied to certain treatm ents over others. An example of such application is inhaled nitric oxide in preterm infants.A study done at John Hopkins University Evidence-based Practice Center in 2010 was an attempt to review the evidence on the use of nitric oxide on infants born at or before thirty-four weeks gestation age and need to receive respiratory support. Treatment for acute respiratory failure usually contributes to the development of bronchopulmonary dysplasia (BPD) or pulmonary hypertension. The purpose of this evidence report is to address if nitric oxide increase survival and/or reduce the occurrence of brochopulmonary dysplasia, are there short term EVIDENCE BASED PRACTICE 6 r long term risk in the therapy and if the effects of inhaled nitric oxide therapy on BPD. The data collected and information was based on medical research, like certain clinical trials and other researches on Medline, EMBASE, the Cochrane Central Register of Controlled Studies, and PsycInfo databases. The information extract ed from these databases range from 2009 to 2010. The data collected was analyzed and the applied to the questions listed above. The results show that infants treated with nitric oxide did not decrease or increase the mortality rate in infants in the neonatal intensive care.There is inconclusive data regarding the short and long-term effects of inhaled nitric oxide. The research report does indicate there is no evidence that supports the use of inhaled nitric oxide in preterm infants with BPD. This research report is significant for nursing because it provides further education of the nursing staff. If a nurse is well versed in current treatment and their effectiveness, then they can assist the care for the patient along with the physicians and respiratory therapist (Beckett and KIpnis, 2009). Another aspect of nursing that EBP can be applied, is on management level.We discussed how it is applied on skills and treatments, but now we are going to see how EBP can improve the management of the nursing profession. In What Is the Latest Evidence on Nursing Orientation, written by Mary Krugman, the author examines the idea of nursing orientation. Is there a magic number of hours that is most effective to convey information to the new hires and also keep the cost for the hospital within reasonable limits. The article reviewed literature on this topic written in the past five years, spanning from 2006 to 2011. They selected twenty-nine articles to review.The selected articles they were organized and summarized by graduate nurse orientation and EVIDENCE BASED PRACTICE 7 general orientation. The results showed that there was a gap in the general orientation versus graduate nurse orientation. There are many suggestion that professional development specialist should modify the traditional way of framing an orientation. There are studies that suggest that critical care nurse orientation should be provided to all levels of nursing. It becomes hard to challenge and keep the n ew hire engaged when all hospital orientation go over the same nursing concepts.The research implies that one must know your audience and modify the orientation as the day progresses. This article was not a study, but an implementation project. The ideas in the article would help the management and education team redesign how they orientate new hires. Sitting in a room and watching videos may not be the most effective way to organize nursing orientation. Integrating more hands on during orientation would better prepare new hires and new graduate nurses with the transition to the career. This idea would help make my hospital orientation become more interesting and engaging.The traditional way of orientation lack hands on and physically being on the unit. This would not really cost more than the classroom form of orientation. EVIDENCE BASED PRACTICE 8 Summary Implementing evidence-based practice is a vital part of nursing and other professions. The application of the data from researc h and data collect help improve and modify all nursing aspects. It can shape certain practices done in the clinical setting, like how we maintain central venous lines, how we prevent catheter acquired urinary tract infections and as basic as hand hygiene.EBP also influence treatment options. Clinical data and or trials help provide new information on standard of care compared to new innovative treatment, as seen in the use of nitric oxide in preterm infants. We are able to compare the effectiveness treatment options to better serve the patient. EBP can also be used to improve nursing management. EVIDENCE BASED PRACTICE 9 References Allen MC, Donohue P, Gilmore M, et al. Inhaled Nitric Oxide in Preterm Infants. Rockville (MD): Agency for Healthcare Research and Quality; 2010 Oct. Evidence Reports/Technology Assessments, No. 195. ) Available from: http://www. ncbi. nlm. nih. gov/books/NBK56325/ Beckett, C. , & Kipnis, G. , (2009). Collaborative Communication: Integrating SBAR to Impro ve Quality/Patient Safety Outcomes. Journal for Healthcare Quaility. 5(31), 19-28. Blais, K. , & Hayes, J. S. (2011). Professional nursing practice, concepts and perspectives. (6 ed. , p. 184-185). Upper Saddle River, NJ: Pearson. Krugman, M. , (2011). What is the latest evidence on nursing orientation. Journal For Nurses in Staff Development. 27(6). 310-312.

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