Number 1 peer post
“In undergraduate, they taught students that it is a scientific practice in nursing that determines how to conduct oneself in clinical setting. For example, it is evidence based practice that using sterile technique reduces infections when you emplace a foley. Also, it became evidence based practice to keep foleys in for longer such as thirty days instead of taking them out more as this intervention did cause more infections. Evidence based practice is dynamic, and always changes based on clinical and scientific studies.
The way in which it is defined academically is as follows: "Evidence-based practice (EBP) is an approach to healthcare that utilizes the most current research available in order to improve the health and safety of patients while reducing overall costs and variation in health outcomes" (Horntvedt, 2018). The evolution began with the mother of nursing Florence Nightingale who began to study how patients reacted with nursing care. She designed experiments with wound care, infection, and cleanliness keeping detailed record. She felt that no patient should get bed sores unless the care-giver was not performing care correctly. This continued to evolve with science as nurses in the 1960s began to codify their career with the expansion of advanced practice nursing. Nursing gained traction as its own independent profession. It started to develop its own theories and practices that were rooted in rigorous scientific education and training.
Barriers in evidence practice are the dynamism of the field. For instance, now in nursing school, we are taught not to clip toenails for diabetic patients due to increases in diabetic ulcers. However, many nurses trained even 15 years ago were taught how to do this task or that they were able to. Then skilled nursing facilities will make there own policies based on management and wanting to save money in not having a podiatrist to come into the facility. Some nurses will perform nail care, and others won't based on their comfort, but there is no conclusive evidence based practice in order to prevent amputations or hurting a patient in this instance thus creating a barrier.
A clinical question I would like to explore is if air mattresses can be used to prevent wounds from becoming stage 3 or stage 4, or to see if they will heal them more quickly. I am fascinated by wound care and wound care prevention as I think our skin is one of the most neglected areas in medicine. I would like to explore this topic more in depth. “
Number 2 peer post
“Evidence-based practice (EBP) is a clinical practice based on evidences within the discipline with the collaboration of clinical experience and patient preferences (Polit & Beck, 2018). EBP is widely used in health care setting, as EBP has multiple benefits. It improves the quality of health care, improves patient outcome, helps with cost reduction and empowers clinicians in decision making (Melnyk & Fineout-Overholt, 2019).
After a few decades, EBP has evolved from a simple definition-as a thorough use of evidence to make decision in clinical setting and it has expanded its scope to a permanent problem-solving approach to clinical practice (Melnyk & Fineout-Overholt, 2019). The three concepts within EBP are used as framework to attain an answer from clinical questions. The data from clinical evidences, clinical experiences, and patient references are used to accomplish a positive patient outcome.
I have experienced an initial deployment of an evidence-based practice when I was working as a junior nurse. The administration of Ketamine infusion for pain management was a new concept in military medicine around 2010. Our inpatient ward was among the first department that was appointment to start the use of Ketamine infusion for our post-operative patients. One of the barriers that was encountered during this deployment was the resistance from the staff members. To overcome this barrier, numerous trainings were mandated for the clinical staff to ensure the safe administration of the medication. Also, new processes were implemented to avoid confusion. An example was infusing the Ketamine separately from the patient’s IV fluids. The Alaris pump was also tagged with a red tape as an additional precaution. As we initiated this process, continuous data collection was performed by the staff with the guidance of the certified nurse specialists. After a few months of data collection, research and implementation, positive patient outcome from our post-operative patients that received Ketamine infusion were established. The facility continued the process with the practice and eventually was used by the other departments in the facility.
The clinical question that piques my interest is regarding pain tolerance and the use of pain medications. As a nurse, I do understand that pain should be taken subjectively. However, after patient assessment, patient education and exhaustion of all resources such as nursing and medical interventions, how can a nurse address the patient’s pain appropriately while keeping the patient satisfied and comfortable?
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