Based Practice into Professional Nursing Practice Sandra Sparks Chamberlain College of Nursing NR 351: Transitions to Professional Nursing Fall 2010 Introduction During the 1980’s, the term “evidence-based” medicine surfaced to describe the approach that used scientific evidence to determine the best practice. Evidence-based practice is a process that entails reviewing and instilling the most reliable and updated research in patient care. The goal of evidence-based practice is to provide the highest quality care while being most cost efficient.It is a process based on the accumulation, interpretation, and integration of derived evidence. This best available is applied to improve the quality of patient care. Consumers of health care are becoming more informed and ready to challenge authorities in health care, consequently, expectations of health care provisions continue to rise, as people are encouraged to take responsibility and become actively involved in health care decisions.
When intervention is needed, expectations are high, with the most appropriate and best treatment demanded (Berenholtz & Provosost, 2003). Review of Professional Nursing LiteratureThere are several stages that must be completed before evidence based practice can be incorporated into final practice. The first stage is generally known as the knowledge generating stage. In this stage, knowledge in discovered through traditional research and scientific inquiry. Summarizing the knowledge is done in stage two. At this point in the process the research is synthesized into meaningful and useful information. This information results from multiple studies which will give more credible results.
The third stage results in the transformation of this evidence into practice recommendations and then integrated into practice.The goal of transformation is to provide useful tools to support care. The fourth stage, also known as the integration stage is the most challenging. This is when the information is adopted and integrated into care usually into the form of policy and procedure. The final stage is the evaluation of the outcome. According to Long and Harrison (1997), (as cited by Nursing and Health Sciences, 2003), evidenced base nursing is the process of systemically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions.Nurses carry out a variety of activities to obtain, recover, and develop the patient’s health and well being.
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Evidence-based practice helps nurses provide high quality patient care based on research and knowledge rather than because “this is the way we have always done it,” or based on traditions, myths, hunches, or most commonly based on the advice of co-workers. The challenge for nurses is to implement the best intervention and practice informed care by the evidence. Evidence-based practice positions nurses to be a significant influence on health care decisions and a partner in improving quality care.Nursing interventions and processes informed by the best evidence are critical to realizing health-care improvements and cost savings. “Nurses are becoming more independent in their practice, so it is important for them to have evidence to support why they do what they do” (Joseph, 2008, p. 11). By adopting evidence-based practice, the nursing profession can develop a systemic well informed approach to quality patient care.
For nurses, the framework for decision making has traditionally been the nursing process. This process is the use of assessment evidence to guide the nurse in the plan of care.Evidence-based practice is a detailed formal approach to enhancing this process and its efficiency. Evidence-based practice facilitates the nursing process by meeting the needs of patients and delivering care that is effective, efficient, patient centered, and timely ("Institute of Medicine", 2001). Nurses are central to patient care and have a strong incentive to use evidence and collaboration to support their decisions. Nursing as a profession have made a strong contribution to the collective understanding of how best to support decision making based on the best available evidence.The very nature of nursing practice compels nurses to participate in an active role in advancing best practices inpatient care.
Nurses serve instrumental roles in ensuring and providing evidence-based practice. They must continually ask the questions, “What is the evidence for this intervention? ” or “How do we administer the best practice? ” and “Are these the best achievable outcomes for the patient, family, and nurse? ” Nurses are also well positioned to work with other members of the healthcare team to indentify clinical problems and use existing evidence to improve practice.Numerous opportunities are available for nurses to question current nursing practices and use evidence to make care more effective. The American Nurses Association significantly revised the Scope and Standards for Nursing practice in 2004, making substantive changes to references to the imperative for evidence in nursing practice. The revised standards created a significantly stronger role for nurses to create the environment and advocate for resources to support research (American Nurses Association, 2004). Application of Clinical ExampleA study was documented in a John Hopkins Nursing Evidence-Based Practice Model and Guideline (Newhouse, Dearholt, Poe, Pugh, & White, (2007), on the voiding or not voiding of post-operative patients before discharge from the ambulatory post-operative ambulatory care unit. The question being whether to discharge the patients before they void or make them wait, thus, increasing length of stay, delaying in returning to home, increasing costs, and possibly slowing the flow of traffic from the operating room to the post-anesthesia care unit.
A team was assembled to conduct an evidence-based project; this was done by conducting a broad literature search. After gathering all the evidence, the team then gathered and assembled their findings. They found there were three risk levels involved when discharging patients that had not voided post-operatively. After reviewing the risks and by rewriting policy and procedure to address the levels and risks, new guidelines were established which in turn, made an impact on post-operative patient care, thereby decreasing chances of any negative outcome for the patient. ConclusionEvidence based practice creates a culture of critical thinking and ongoing learning. Evidence based practice supports rational decision making that reduces inappropriate variations and makes it easier for nurses to do their job. More nurses need be made aware of and able to engage in the process associated with assembling evidence into practice and be proficient in confirming what constitutes appropriate evidence in the "Journal of Clinical Nursing" (2008).
Nurses make up the largest number of health professionals. Every person is likely to receive nursing care at some time in their life.Therefore, nurses are in a leading position to influence the type, quality, and cost of care provided to the patients. There is a compelling need for evidence-based practice in our health-care environments; however, any kind of organizational change requires proper planning, development, and commitment by all team players.
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