| Introduction 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
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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”. When this is done effectively, nursed begin to question whether there is a better way to deliver patient care and a “culture of inquiring is born” (Halm, 2010 p. 377). Nursing leaders need to be a role model and collaborate with their staff regarding implementation of Evidence-Based Practice. If we remain “inside (the box) looking in”, evolution of the nursing profession will be hindered and patient outcomes will be jeopardized (Halm, 2010 p. 77). Evidence-Based Care for Pressure Ulcers Prevention and treatment of pressure ulcers are major nursing priorities. There is evidence that a program of prevention guided by risk assessment can simultaneously reduce the institutional incidence of pressure ulcers by as much as 60%, and bring down the cost of prevention at the same time (Potter and Perry 2004) Evidence-Based Practice shows that lack of documentation of patients at risk demonstrates the need for hospitals to increase the strategies for predictability and prevention.
Therefore implementation of a risk scale can provide triggers to plan care to decrease risk factors. Evidence-Based Practice also shows that extended stays over 7 days increase the risk of pressure ulcer development. Therefore, nurses need to be vigilant in the prevention of pressure ulcers in patients with longer hospital stays. Evidence-Based practice also shows the use of daily skin assessments, use of pressure-relief surfaces and objective risk assessment measure such as the Braden scale have reduced evidence of pressure ulcer development (Lyder, et al, 2001).
Nursing intervention based on Evidence-Based Practice will help with the care of, reduction of, and prevention of pressure ulcers. Conclusion Because the nation is encountering a healthcare shift, we must alter the way in which we practice nursing to meet the needs of society and health care delivery. Teaching methods and responsibilities of our nursing leaders to implement Evidence-Based Practice were explored. The Pros and Cons of Evidence-Based Practice were discussed as well. Finally how Evidence-Based Practice can help predict, prevent and resolve pressure ulcers were reviewed. References:
Broeder J. L. , Donze A. , Smith J. R. , Sonze A (2010. The Role of the Qualitative Research in Evidence-Based Practice. Neonatal Network, 2010 May-Jun: 29 (3): Suppl: 197-202 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. American journal of Critical Care, 2010 Jul: 19:49 (7): 387-92) Bryan-Brown, C. W. , 2006, Evidence-Based Practice is Wonderful Sort Of, American Journal of Critical Care Kozier, B. nd Erb, G. 2004 Fundamentals of Nursing: Concepts Process and Practice 7th Edition Pearson Education Inc. Lyder, C. H. , J. Pererson, et al 2001. Quality of care for hospitalized medical risk for pressure ulcers. Arch intern Med. 161(12): 1549-54 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. Journal of Midwifery ; Womens Helath,(46), 137-145 Ferguson,L. , ; Day, R. A. (2005). Evidence-based nursing education: Myth or reality? Journal of Nursing Education, (44) 107-115.