Category: Evidence based practice

Horntvedt, May-Elin, et al. “Strategies for Teaching Evidence-Based Practice in Nursing Education: A Thematic Literature Review.”BMC Medical Education, vol. 18, no. 172, 2018, pp. 1–11. Web.

The scholarly source published in a peer-reviewed journal, BMC Medical Education, in 2018, was created by Horntvedt et al., the experts in Nursing and Health Sciences, who investigate teaching/learning strategies related to evidence-based practice (EBP). The authors apply the method of database literature search and aim to respond to the research question related to the best EBP strategies for enhancing knowledge in undergraduate students and the potential barriers in education. The researchers argue that there are difficulties in nurses’ EBP application and use qualitative evidence from critical appraisal and thematic analysis for the purpose of understanding interactive methods, clinically integrated strategies, learning outcomes, and barriers. The article is a useful source of data for the audience of nursing students, professors, or researchers because it contributes valuable information on EBP strategies/barriers despite methodological limitations (small sample size, exclusion of non-English sources). The findings on the role of training for the development of skills for nursing students can be integrated into the research paper, as the article aligns with the reviewed sources in terms of EBP focus.

Labrague, Leodoro, and Janet Alexis de los Santos. “Fear of COVID-19, Psychological Distress, Work Satisfaction and Turnover Intention Among Frontline Nurses.”Journal of Nursing Management, vol. 29, no. 3, 2020, pp. 395–403. Web.

The article, published in the reputable Journal of Nursing Management in 2020, was written by the Doctors of Nursing Practice, Leodoro Labrague and Janet Alexis de los Santos, who studied the COVID-19 impact on nurses. The researchers employed a cross-sectional methodology and formulated the research question related to the pandemic’s role in order to determine the sources of phycological distress, job satisfaction, and turnover in nurses impacted by the pandemic. The samples obtained from the questionnaires were distributed among 300 qualifying participants and provide supportive evidence for the author’s argument on the influence of COVID-19-related fear on frontline nurses’ mental well-being and associated work outcomes. The study directly addresses its target audience (healthcare/nursing professionals and researchers), provides implications for the healthcare field, including pandemic-specific training, practice, and interventions, but involves limitations caused by the research design and varying contributing factors. The article can be used for the research paper, as it examines the challenges of the nursing career during the pandemic and expands the understanding of EBP from other sources reviewed in the annotated bibliography.

Simha, Aditya, and Jatin Pandey. “Trust, Ethical Climate and Nurses’ Turnover Intention.”Nursing Ethics, vol. 28, no. 5, 2020, pp. 714–722. Web.

The study examining nurses’ turnover intentions and the influence of ethical climate appeared in a peer-reviewed Nursing Ethics journal in 2020 and was conducted by the specialists in nursing management, Aditya Simha and Jatin Pandey. The article is based on a cross-sectional survey method allowing the authors to demonstrate turnover intention mechanisms and adequately address the research question related to the impact of trust and ethical climates on nursing turnover. The evidence was generated from the analysis of the results from 285 questionnaires to support the authors’ argument on the positive association of nurses’ perception of ethical climates with trust and prove indirect climate-turnover relationships. The article’s intended audience are nursing managers, but it may be beneficial for healthcare students and researchers due to the implications of the findings, addressing the critical importance of ethical climate, for the healthcare/nursing field. The study can be employed as a source of evidence for the research paper because it aligns with the findings of the previous article on nurses’ turnover intentions and contains recommendations for ethical climate management. Additionally, the study might be included in the research paper on nursing career to compare the diverse approaches to nursing turnover, trust, and job satisfaction.

Background, Differences, Challenges, and Barriers

Evidence-based practices (EBP) are the essential methods, which are frequently used. Thyer and McNeece (2014) define them as “treatment based on the best available science,” and it clearly outlines the current attitude toward their implementation (p. 8). The evidence-based practitioner shall consult the empirical literature for the most accurate choosing the appropriate interventions (SW Classes, 2016a). Moreover, the worker relies on the efficacy data and utilized hypothesis-testing, a systematic approach that sets clear goals, develops an individualized treatment plan, and assists in progress monitoring (Thyer & McNeece, 2014); (SW Classes, 2016b). EBP is based on different research methods: systematic reviews, randomized controlled trials (RCT), quasi-experimental studies, case-control and cohort studies, pre-experimental group studies, surveys, and qualitative studies (Thyer & McNeece, 2014, p. 10). In addition, distinct practices have their areas of focus, contexts, challenges, and implementation barriers. Instances of EBP are clinical, macro, community, administrative, and policy (Thyer & McNeece, 2014). The difficulty of their implementation depends on the mentioned methods.

For instance, RCT may not contain enough information about the potential for bias, which ethnic group the participants belong to, and the legitimate random conduct. There is a necessity to ensure the client does not know that they receive less credible intervention than regular ones, as the placebo is used for control (Thyer & McNeece, 2014). Therefore, it might be challenging to implement such a practice in social work treatment. Pre-experimental research is even less credible and complicated for a practitioner to utilize because of the absence of control groups and evaluating only the client’s well-being after receiving treatment (Thyer & McNeece, 2014); (SW Classes, 2016a). Moreover, all the retrospectively designed studies’ results can be questioned, as not appropriately proven ones, which also make such EBP more complicated to utilize than outcome studies.

The Role of Culture In Evidence-Based Practice Implementation

It is vital to consider the role of culture in EBP, especially for persons who have severe and persistent mental illnesses, as it might influence the treatment outcomes. Cultural competence that enables one to take the role of culture into account and act appropriately is vital for a practitioner. Gonzalez (n.d.) defines this term as “the ability to engage in action or create conditions that maximize the optimal development of the client and client systems” (p. 71). EBP in mental health service shall be based on considering the cultural factors to ensure competent clinical care for patients with mentioned above illnesses.

From a historical perspective, the specificities and features of the client’s ethnicity can impact the treatment positively if shared values, common rituals, and other particular characteristics are considered to make the process of care more convenient (Gonzalez, n.d.). In current day perspectives, it might be vital for competent clinical care with the use of EBP to provide mental health treatment concerning socio-cultural-economic forces, such as race, gender, and class (Gonzalez, n.d.). Therefore, there is a necessity to consider the impact of culture on the treatment of persons with mental illnesses to ensure appropriate and competent, individualistic clinical care.

Ethical Implications and Circumstances Under Which Practices Shall not be Used

Consideration of ethical concerns and particular circumstances that limit the use of EBP is due to ensure the safety of their utilization. For instance, some types of knowledge are not included in such practices, according to Allmark (2015), “experience and intuition can point in directions counter to those suggested by EBP” (p. 2). It also implies that sometimes it is better to leave a patient on an old treatment instead of utilizing the new one. The other concern is that EBP runs counter to patient-centered care, which might lead to the situation when patients or practitioners lose choice, and in similar cases, such practices shall not be used. Moreover, EBP might be neglected in case trials produce unethical results, as Allmark (2015) claims that “Testable by RCT” is not the same as “most effective” (p. 3). Therefore, there is a necessity for ethical consideration, and in some situations, EBP shall not be implemented.

References

Allmark, Peter (2015). Ethics and evidence-based practice. In: M. Lipscomb (Ed.), Exploring evidence-based practice: debates and challenges in nursing. Routledge key themes in health and society. (pp. 180-194). Routledge.

Gonzalez, B. J. (n.d.). Evidence-Based Practice With Ethnically Diverse Clients. Web.

SW Classes. (2016a). Overview of Evidence-Based Practice. YouTube. Web.

SW Classes. (2016b). Overview of Evidence Based Practice Part 2. YouTube. Web.

Thyer, B. A., & McNeece, A. C. (2004). Evidence-based practice and social work. Journal of Evidence-Based Social Work, 1(1), 7–25. Web.

The job description of registered case manager nurses is explicitly correlated with the soft skill of finding a unique approach to the patient in order to secure long-term and efficient treatment. For this reason, prior to making any treatment decision, the nurses are to carefully consider every option regarding the patient’s case. The notion of evidence-based practice, which stands for integrating the relevant scholarly research, patient values, and professional expertise, is, thus, highly efficient in choosing an appropriate intervention (LoBiondo-Wood et al., 2018). One of the most common critiques of evidence-based practice concerns the fact that finding scholarly proof is a time-consuming endeavor, whereas time is a priceless commodity in clinical expertise. However, as far as the RN case managers are concerned, the planning of the long-term individual treatment may require additional research prior to submitting the most beneficial option. For this reason, it is advisable RN case managers address relevant research and patients’ perception of treatment in order to reach a consensus.

A common example of employing evidence-based practice in the decision-making process is the choice of treatment options for patients with collateral chronic health conditions. In such cases that happen quite frequently in one’s practice, it is vital to conduct preliminary research and estimate whether the treatment plan would not interfere with the patient’s health state in the long-term perspective. Moreover, thorough consideration of evidence-based nursing intervention may potentially lead to quality improvement endeavors aiming at altering the overall approach to treatment and practice in a specific setting (LoBiondo-Wood et al., 2018). Hence, it may be concluded that the consideration of evidence-based treatment implications is of paramount importance for the formation of the RN case managers’ individualistic approach to the patients’ cases.

Reference

LoBiondo-Wood, G., Haber, J., & Titler, M. G. (2018). Evidence-based practice for nursing and healthcare quality improvement. Elsevier Health Sciences.

Organizational Readiness for Change

Before conceiving an evidence-based practice (EBP) intervention to address a current problem, one has to evaluate the medical organization’s readiness for change. In this project, the framework for the evaluation is borrowed from Vaishnavi and Syresh (2020). Based on the criteria provided by the authors, the organization has culture appreciative of change and an acute awareness of mission and goals. At the same time, personnel is not necessarily aware of the new trends in healthcare as it pertains to preventing hospital-acquired pressure ulcers specifically, hence the room for change. Finally, acquiring the necessary financial resources can also prove problematic in the chosen setting and reduce the organization’s overall readiness for change in this respect.

Opportunity for Change: Hospital-Acquired Pressure Ulcers (HAPUs)

An opportunity for change is the prevalence of hospital-acquired pressure ulcers (HAPUs) in clinical settings. First of all, these are a statistically common complication the percentage of which can reach double figures (Beal & Smith, 2016). Moreover, it demonstrates an increased incidence in older patients due to the thinning of epidermis, thus posing additional risks to a vulnerable population group (Fremmelevholm & Soegaard, 2019). Apart from that, there is currently no specific program for HAPU reduction and prevention in place in the chosen setting. Based on these factors, an EBP intervention designed to reduce the incidence of HAPUs in patients addresses an acute and current problem.

Evidence-Based Idea for Change

The evidence-based idea for change in this respect includes two phases. The first phase should involve a careful literature review and the analysis of EBPs used to reduce HAPU incidence so far. The development of organizational guidelines for the prevention of HAPUs should proceed based on this analysis and the identification of best practices (Beal & Smith, 2016). Second phase should include the establishment of a specialist nurse position and the dissemination of developed guidelines (Fremmelevholm & Soegaard, 2019). A transition to air mattresses as opposed to standard hospital surfaces is also a part of this phase (Shi, Dumville, & Cullum, 2018).

Knowledge Transfer Plan

Knowledge is to be created through the afore-mentioned literature review and EBP analysis. Dissemination of said knowledge should primarily happen through the distribution of the developed HAPU prevention guidelines among the staff (Beal & Smith, 2016). Additionally, a publication in a peer-reviewed journal should cover the intervention results. As for the implementation, it would happen through two primary avenues at the same time. First of all, nurse orientation should cover HAPU prevention, and, secondly, the appointed specialist nurse should act as a consultant in HAPU-related matters (Fremmelevholm & Soegaard, 2019).

Dissemination Strategies

The two main dissemination strategies chosen to distribute the knowledge developed and acquired through the intervention are organizational guidelines and a publication in a peer-reviewed journal. The obvious advantage of organizational guidelines as a strategy is their practice-oriented nature ensuring they would be a concise and straight-to-the-point source of information on the matter. Their applicability in practice is also a crucial advantage in this respect (Beal & Smith, 2016). A publication in a peer-reviewed journal, on the other hand, has the advantage of disseminating knowledge to a larger community of practitioners and help addressing the problem on a greater scale.

Measureable Outcomes

There are four measurable outcomes associated with the proposed EBP change. The first is the overall HAPU prevalence in patients, measured as a percentage to evaluate the effect of the proposed intervention, as used by Fremmelevholm and Soegaard (2019). The second outcome is the prevalence of the most severe 3&4 stage HAPUs, as used in Beal and Smith (2016). The third one is HAPU prevalence in patients using air mattresses. It is meant to be compared to HAPU prevalence in patients using standard hospital surfaces to test the findings of Shi, Dumville, and Cullum (2018).

Lessons Learned: Critical Appraisal

Speaking of the lessons learned from the critical appraisal of the articles studies for this project, two stand out as the most important. First of all, this assignment was a valuable experience for the identification of an inexplicit conceptual framework. It is an important skill because, in certain articles, authors do not explicitly proclaim the theoretical framework used for the study. In such cases, the readers have to deduce this information by themselves (Fremmelevholm & Soegaard, 2019; Beal & Smith, 2016). Another valuable lesson was a better understanding of the network meta-analysis methodology on the example of Shi, Dumville, and Cullum (2018).

Lessons Learned: Evaluation Table

As for the lessons learned from the evaluation table part of the assignment, the first of those was the development of the skill of identifying qualitative or quantitative study design. Articles studied for this assignment were all identified as either qualitative or quantitative, with no mixed-methods studies (Shi, Dumville, & Cullum, 2018; Beal & Smith, 2016; Fremmelevholm & Soegaard, 2019). Among other things, the important lesson learned from the study by Fremmelevholm and Soegaard (2019) specifically was the crucial importable of managerial support for the successful implementation of evidence-based changes in a given clinical setting.

References

Beal. M. E., & Smith, K. (2016). Inpatient pressure ulcer prevalence in an acute care hospital using evidence-based practice.Worldviews on Evidence-Based Nursing, 13(2), 112-117. Web.

Fremmelevholmm A., & Soegaard , K. (2019). Pressure ulcer prevention in hospitals: A successful nurse-led clinical quality improvement intervention.British Journal of Nursing, 28(6), S6-S11. Web.

Shi, C., Dumville, J. C., & Cullum, N. (2018). PLOS One, 13(2), e0192707. Web.

Vaishnavi. V., & Syresh, M. (2020). Assessment of healthcare organizational readiness for change: A fuzzy logic approach.Journal of King Saud University – Engineering Sciences, in print. Web.

Introduction

To date, evidence-based nursing practice is an actively developing area in nursing, which aims to improve the efficiency and quality of nurses’ work. This direction can be successfully integrated with other modern principles of nursing care, such as the nursing diagnosis or the nursing process as a whole. The evidence-based nursing practice involves making decisions based on individual experience combined with the best available clinical evidence from other specialists. This paper is devoted to the article Evidence-Based Practice Beliefs and Implementation in Doctor of Nursing Practice Students authored by Singleton, its summary, and the most critical aspect in the research material.

Summary of the Article

The main objective of this study was to evaluate the impact of the curriculum on the beliefs and implementation of EBP in medical students. This study sought to solve the following tasks:

• What are the evidence-based beliefs and intended evidence-based practical implementation of DNP-FNP-trained masters students at the beginning of the curriculum (Singleton, 2017)?
• Are there any successes in the evidence-based beliefs of DNP-FNP undergraduates and the perception of evidence-based practice implementation between the start and completion of the curriculum (Singleton, 2017)?

The critical point of this article is the presence of an EBP mentor, a best practice nurse who helps nurses and other doctors hone their EBP knowledge and skills and implement EBP projects to improve patient care and outcomes. A mentor can help overcome various existing barriers that hinder implementing behaviors and achieving goals (Singleton, 2017). The DNP curriculum evaluated in this study was based on the work of educators who transferred the Master’s degree curriculum in several specialized programs to the EBP curriculum.

A constant researcher carried out administration and collection of research tools. Students were asked initial questions at each data collection point, but using a unique code allowed them to remain anonymous (Singleton, 2017). The research tools included a demographic questionnaire, an Evidence-based Belief Tool (EBP-B), and an Evidence-based Implementation Tool (EBP-I) (Singleton, 2017). This study concludes that nursing teachers play a crucial role in bridging the gap in quality. To achieve this goal, teachers should receive support in research on educational outcomes at the local, professional and national levels.

The Most Important Aspects of This Study

The most important aspect of this study is to draw attention to the development of evidence-based nursing practice. To date, some circumstances create difficulties in developing evidence-based nursing practice. Firstly, nurses often lack the knowledge and skills to use medical sources available on the Internet actively (Portney, 2020). Secondly, it is necessary to solve organizational issues related to nurses’ access to electronic medical resources. It is advisable to create resource centers for evidence-based nursing practice in various country regions.

Most striking in this study is the effectiveness of the curriculum, which was reported by DNP-FNP students in connection with their achievements in EBPB and perceived EBPI. Of most significant interest are the curriculum data that report EBPB and perceived EBP-I in DNP students, which has not been previously observed in other similar studies (Singleton, 2017). In addition, attention is drawn to the information obtained in this study, according to which the DNP curriculum has demonstrated advantages over the curriculum in EBP and EBP students (Singleton, 2017). Also fascinating is that all the students who participated in the study had practical experience and were prepared for a master’s degree. DNP-FNP students who completed their current internship may have had formal continuing education and independent training, which gives the results of the study great weight and reliability.

Conclusion

Thus, this study focuses on several essential things, for example, the need to implement a high-quality educational program for DNP students who want to become EBP leaders. An important conclusion of this study is that EBPB and EBPI are valid and reliable indicators for evaluating achievements within the curriculum (Singleton, 2017). In addition, due to the learning outcomes, teachers can assess the desired student outcomes for EBP throughout the curriculum (Singleton, 2017). Finally, it will be possible to create an evidence base for the ongoing development of the curriculum.

References

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

Singleton, J. K. (2017). Evidence‐based practice beliefs and implementation in doctor of nursing practice students. Worldviews on Evidence‐Based Nursing, 14(5), 412-418. Web.

In a medical environment, the continued promotion of excellence and improvement is a necessity. As a field that directly deals with human wellness, its professionals are both personally and occupationally invested in promoting the best outcomes for their subjects; with the development in medical research and the constant introduction of new treatment methods, techniques and approaches, the state of healthcare as a profession changes rapidly. In the flow of new information, the use of the evidence-based practice, or EBP, becomes crucial. The ultimate goal of EBP is to ensure that both nurses and doctors are able to help their patients more effectively. By utilizing new data, better ways of promoting public health and wellness can be surmised. Furthermore, less effective or potentially harmful practices can be recognized on a structural level, leading to more positive outcomes for patients.

Medical researchers publish articles in specialized journals, which are then used to guide existing medical practitioners and move the field forward as a whole. Healthcare organizations use a variety of practices to promote better adherence to EBP, centered on cultivating the correct culture within their organizations and training staff. Research has shown that leaders also play a big role in the process, promoting the right attitudes and establishing an EBP-based work environment (Allen et al., 2018). In addition, specialized professionals and training can be used to help healthcare organizations implement evidence-based practice. Investigations into the current competencies of medical professionals alarmingly show that many are unable to implement principles of EBP into their work or lack sufficient knowledge about its importance (Melnyk et al., 2017). For many nurses and doctors, the skills to properly utilize medical data in their work are not present, which is a problem for the profession as a whole.

References

Allen, P., Jacob, R. R., Lakshman, M., Best, L. A., Bass, K., & Brownson, R. C. (2018). Lessons learned in promoting evidence-based public health: Perspectives from managers in State Public Health Departments.Journal of Community Health, 43(5), 856–863. Web.

Melnyk, B. M., Gallagher-Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2017). The first U.S. study on nurses’ evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16–25. Web.

The concept of nursing is closely associated with the idea of continuous improvement, as the trends of health care need to mirror the existing social trends to provide the best care possible. One way to secure such care is to refer to the latest scholarly findings to modify the approaches to care provision in the workplace. This process of implementing research-based findings in daily patient care is known as evidence-based practice (EBP) (Wilson & Austria, 2021). Currently, EBP is not used actively by nurses for several reasons.

First, the workload of most nurses discourages their desire to learn and embrace EBP. According to McArthur et al. (2021), a physical opportunity is a construct that contributes to the nurses’ ability to resort to EBM. Physical opportunity includes such barriers as “cost and lack of resources, compromised communication, staff turnover, and limited physical guidelines” (McArthur et al., 2021, p. 20). As a result, management promotes behavioral patterns that react to the environment rather than examine it in advance. The second massive barrier to EBP in the workplace is the lack of social opportunity embodied in the lack of organizational support and teamwork (McArthur et al., 2021). Since the aforementioned examples tackle only a minor part of the existing challenged, the need to intervene and facilitate EBP is evident.

The first commonly mentioned approach to facilitate the use of EBP is to establish a leadership that would encourage the practice by both setting an example and conducting training and workshops. Another crucial facilitator is to secure nurses’ access to relevant sources in the workplace, including relevant databases, steady Internet connection, and subscription to peer-reviewed publications. In such a way, the use of scholarly research will become more time-efficient and less stressful for nurses.

References

McArthur, C., Bai, Y., Hewston, P., Giangregorio, L., Straus, S., & Papaioannou, A. (2021). Barriers and facilitators to implementing evidence-based guidelines in long-term care: A qualitative evidence synthesis.Implementation Science, 16(1), 1-25. Web.

Wilson, B. & Austria, M. J. (2021). What is evidence-based practice?Health University of Utah. Web.

The topic of the project in question addresses the implications evidence-based practice (EBP) training among nurses can have on the scope of patient satisfaction with health care services. Essentially, the project seeks to meet five major objectives that tackle both the nurses’ and patients’ well-being in the hospital setting:

• The first objective of the project is to explore how nurses’ level of EBP knowledge and implementation affects the quality of services they provide to the patients. Since studies demonstrate that EBP implementation in the workplace contributes positively to the nurses’ sense of personal achievement, it is reasonable to assume that such an improvement will affect their motivation to perform work due diligence (Rodríguez-Nogueira et al., 2021). Hence, this project will help clinical specialists to explore the peculiarities of this connection.
• The second objective of the project is to improve the overall level of EBP knowledge and implementation among nurses in general hospitals. Even if the intervention of the project does not present the expected results in terms of correlation between patient satisfaction and EBP training, the latter is still an asset for the clinical setting. Indeed, the EBP implementation remains one of the objectives for many general hospitals.
• The third objective is to explore the connection between the EBP training programs and nurses’ job satisfaction. Job satisfaction and motivation are some of the pillars of meaningful and efficient nursing practice and community outreach. For this reason, this project seeks to identify the extent to which improving nurses’ level of expertise and self-awareness contributes to their mental well-being and dedication to the job.
• The fourth objective of the project is to develop and practice a comprehensive and time-efficient EBP introductory training for the nurses in general hospitals. One of the many reasons behind the lack of EBP implementation in the workplace is the nurses’ inability to find enough time for research and analysis. Thus, by presenting a three-day training program that takes nearly six hours to complete, the project may present insight into the patterns of meaningful EBP training in a busy hospital setting.
• The final objective of the project is to collect exhaustive feedback on the matter of patients’ satisfaction with the services provided by the nurses. Quality health care is one of the primary objectives of any clinical setting, so conducting a patient satisfaction survey is a beneficial way to gain insights into the existing strengths and weaknesses of the nursing staff. Thus, even if the hypothesis of the project is not justified, the facility will still obtain data on the areas for service improvement.

All the aforementioned objectives for the project are focused on the integrity of services provided to the patients. The right to receive quality health care is one of the fundamental aspects of social justice, as it presupposes equal access to high-quality nursing care regardless of the individuals’ personal beliefs and qualities and the nurses’ subjective attitude. Although many nurses realize the importance of pursuing social justice, excessive workload and lack of personal accomplishment sometimes let them extrapolate their fatigue and job dissatisfaction to the attitude towards the patients (Sultana et al., 2020). Moreover, burnout and lack of expertise among nurses affect patient autonomy or the patients’ right to participate in the decision-making process and treatment. In order to ensure autonomy, nurses are to pay attention to the patients’ concerns and non-medical factors. Since lack of EBP expertise and the prevalence of burnout contribute to poor interaction with patients, this project will help reinstate patient autonomy in the workplace. Hence, the present project seeks to explore the options to minimize the level of personal concerns and their potential effect on the socially equal and respectful treatment of the patients.

References

Rodríguez-Nogueira, Ó., Leirós-Rodríguez, R., Pinto-Carral, A., Álvarez-Álvarez, M., Morera-Balaguer, J., & Moreno-Poyato, A. R. (2021). Examining the association between evidence-based practice and burnout among Spanish physical therapists: A cross-sectional study. Journal of Personalized Medicine, 11(8), 805. Web.

Sultana, A., Sharma, R., Hossain, M. M., Bhattacharya, S., & Purohit, N. (2020). Burnout among healthcare providers during COVID-19: Challenges and evidence-based interventions. Indian Journal of Medical Ethics, 5(4), 308-11. Web.

The study showed that bibliometric analysis of evidence gathered from integrative reviews and analytical studies had substantial implications for nurse-related and evidence based policy changes. Primarily, this is possible through the use of integrative reviews in designing new programs (Benton et al., 2020). The collective database of the synthesized studies as suggested by the authors of the study, can be utilized by nurses to be empowered through evidence-based materials in the formulation of changes in universal health coverage. As such, the applicability of this information has a number of benefits for working nurses, as they will be able to employ concise and trusted resources when advocating or implementing changes to policy. I think that nursing practice can be vastly improved with the use of well-managed databases that employ evidence-based research. This is because such a database will be able to illustrate gaps in knowledge of overarching issues as well as daily medical practices in the sphere of nursing (Houser, 2016). Similarly, it allows for insight into nurse-specific fields such as nurse education, care for the lederly, emergency care, and more.

Currently, accessibility to extensive and complete information that is formed through evidence-based research is limited due to a number of factors. In order to better provide such informative materials among working nurses it is essential to reduce bureaucratic processes and integrate technology into the process. Modern technology allows for low-cost and time-saving methods of information sharing, which will be largely beneficial for nursing. As mentioned prior, evidence-based research has the potential to reveal gaps in information in nurse-specific practices that would otherwise be unseen. I believe it is essential to make such knowledge accesibile and cohesive to promote better nursing care and work quality.

References

Benton, D. C., Watkins, M. J., Beasley, C. J., Ferguson, S. L., & Holloway, A. (2020). Evidence-based policy: nursing now and the importance of research synthesis. International Nursing Review, 67(1), 52-60. Web.

Houser, J. (2016). Nursing research: Reading, using and creating evidence (4th ed.). ‎ Jones & Bartlett Learning

Research is consistent that nurses must have the capacity to use relevant data sources to integrate research evidence with clinical expertise in what is commonly known as evidence-based practice (Fachiano & Snyder, 2012). This section reviews and summarizes the data sources that will be used to guide the proposed EBP intervention.

The article by Grap (2009) reviewed the findings of other primary research studies to demonstrate several evidence-based practices that could be used to reduce the risks associated with mechanical ventilation. Evidence from the article suggests that ventilator-associated pneumonia can be significantly reduced through the use of higher backrest elevations (30° to 45°), ensuring proper oral health practices to minimize the colonization of the oropharynx by pathogens (e.g., by using oral applications of chlorhexidine at the time of intubation), and following recommended practices in sedating critically ill patients.

The main strength of the article lies in its use of primary research sources and data to outline effective EBP interventions that could be used to reduce the risks associated with mechanical ventilation. However, the article’s findings are limited due to the use of a broad scope of the study (mechanical ventilation), leading to issues of generalizability in VAP contexts

The article by Gupta et al. (2016) detailed some of the best practices to prevent aspiration of oral colonization, which is a common cause of ventilator-associated pneumonia in intensive care settings. The recommended oral care interventions include (1) conducting an initial admission and daily assessment of the patient’s oral cavity to allow for early identification of oral hygiene problems, (2) using unit-specific protocols to not only minimize the development of mucositis, but also to help the patient in maintaining normal saliva production and oral tissue health, (3) keeping the head of the bed elevated to at least 30° to assist in preventing reflux and aspiration of gastric contents, and (4) routinely suctioning the patient’s oral and subglottic discharges to reduce aspiration of infected secretion into the lungs.

In strengths, the article relied on credible data sources and guidelines to discuss the relationship between the aspiration of oral colonization and VAP. Additionally, the article focused on ICU, hence reducing the challenges associated with data applicability. However, the recommended oral health care interventions are not supported by relevant literature as would be expected in EBP contexts.

The study by Kubbara et al. (2015) investigated the application and interpretation of CDC guidelines (VAC, IVAC, VAP) by diverse groups of healthcare providers in the assessment of ventilator-associated pneumonia. Evidence from the study suggests that the application of the CDC guidelines varies between different healthcare providers, hence the need to allow for the modification of the guidelines across settings based on clinical or professional judgment. In strengths, the study not only used validated CDC guidelines and appropriate methodological strategies but also recruited a diverse sample to identify attitudinal shifts in the application of the guidelines. A major limitation, though, lies in the fact that the authors failed to elaborate on how the application and interpretation of CDC guidelines influence VAP incidents in the ICU.

The study by Klompas et al. (2015) investigated the effectiveness of two clinical interventions (coordinated awakening and spontaneous breathing) in preventing the incidence of ventilator-associated events in intensive care settings. Evidence from the study suggests that coordinated awakening (e.g., by use of bedside alarms) and assisting patients to breathe impulsively without the use of sedation are positively associated with a reduction in duration of mechanical ventilation in the ICU and hospital length-of-stay. In strengths, this study used an appropriate research design to investigate the two interventions and is specific in its scope and applicability in the ICU. However, it is felt that the sample size used is not adequate to generalize the findings to larger contexts.

The study by Sedwick et al. (2012) aimed at investigating how the implementation of bundled practices in a hospital’s intensive care units affected the incidence of ventilator-associated pneumonia within the units. The bundled practices that were implemented in the units included elevation of head-of-bed (30° to 45°), prophylaxis for peptic ulcer disease, prophylaxis for deep-vein thrombosis, routine intermission of sedation, routine evaluation of readiness for extubation, daily oral care with chlorhexidine, protocols for mouth care and hand washing, head-of-bed alarms, and subglottic suctioning. Evidence from the study demonstrates that strict adherence to the bundled practices not only reduces pneumonia-associated mortality and morbidity of patients receiving mechanical ventilation but also shortens hospital stays and ensures that healthcare costs are kept at a minimum.

In strengths, the study’s scope is specific to VAP in intensive care contexts and the researchers used CDC guidelines on VAP to guide the research process. However, it is felt that the VAP bundle used in the study contains very many interventions that may be difficult to monitor in clinical contexts. Additionally, the study was carried out in one hospital, meaning that it may be difficult to generalize the findings to other contexts.

Lastly, the study by Azab et al. (2015) used the context of developing countries to evaluate the effectiveness of predesigned VAP bundled practices in reducing the incidence of ventilator-associated pneumonia in neonatal intensive care settings. The VAP prevention bundle used in the study consisted of head-of-bed elevation (30° to 45°), fortification of hand hygiene practices, sterile suction and handling of respiratory apparatus, intubation, re-intubation, and endotracheal tube (ETT) suction as stringently specified in the unit standards, changing ventilator circuit if noticeably dirty or mechanically faulty, implementing routine mouth care with normal saline and suctioning of oro-pharyngeal secretion, performing daily evaluations for readiness for extubation to nasal continuous air pressure (NCPAP) at morning round, as well as sedation vacation for sedated patients (Azab et al., 2015). Evidence from the study demonstrates that the implementation of a comprehensive infection control bundle consisting of the described clinical interventions leads to a significant reduction of VAP incidence and duration of stay in the intensive care unit.

This article is specific in scope as it studied VAP in neonatal intensive care settings. Additionally, the study used an appropriate research approach, design, and data collection techniques to gather data from the field. However, the main findings are limited to one hospital and the sample size used is not adequate in ensuring that findings can be generalized to other contexts.

References

Azab, S.F.A., Sherbiny, H.S., Saleh, S.H., Elsaeed, W.F., Elshafiery, M.M., Siam, A.G.,…Ghaith, T. (2015). Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP preventive bundle”: A cohort study.BMC Infectious Diseases, 15(1), 1-7. Web.

Fachiano, L., & Snyder, C.H. (2012). Evidence-based practice for the busy nurse practitioner: Part three: Critical appraisal process. Journal of the American Academy of Nurse Practitioners, 24, 704-715. Web.

Grap, M.J. (2009). Not-so-trivial pursuit: Mechanical ventilation risk reduction.American Journal of Critical Care, 18, 299-309. Web.

Gupta, A., Gupta, A., Singh, T.K., & Saxsena, A. (2016). Role of oral care to prevent VAP in mechanically ventilated intensive care unit patients. Saudi Journal of Anesthesia, 10(1), 95-97. Web.

Klompas, M., Anderson, D., Trick, W., Babcock, H., Kerlin, M.P., Sincowitz-Cochran, R.,…Pratt, R. (2015). The preventability of ventilator-associated events. The CDC prevention epicenters wake up and breathe collaborative.American Journal of Respiratory and Critical Care Medicine, 191, 292-301. Web.

Kubbara, A., Khan, A.R., Alreefi, F., Abdelkarim, A., Rehman, S., Hariri, A.,…Assaly, R. (2015). Applications of CDC ventilator associated pneumonia surveillance guideline to the real world. In C49: Refining quality and communication in the ICU (pp. A4545-A4545).New York, NY: American Thoracic Society.

Sedwick, M.B., Lance-Smith, M., Reeder, S.J., & Naardi, J. (2012). Using evidence-based practices to prevent ventilator-associated pneumonia. Critical Care Nurse, 34, 41-50. Web.