NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
5 steps of Evidence Based Practice – Overview
- Ask a question
Converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc) into an answerable question
- Find information/evidence to answer question
Tracking down the best evidence with which to answer that question
- Critically appraise the information/evidence
Critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice) NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
- Integrate appraised evidence with own clinical expertise and patient’s preferences
Integrating the critical appraisal with our clinical expertise and with our patient’s unique biology, values and circumstances
Evaluating our effectiveness and efficiency in executing Steps 1-4 and seeking ways to improve them both for next time
Nurses Benefit from Evidence-Based Practice
EBP is now considered essential to the delivery of quality nursing care and has been utilized in everything from hand hygiene to dress code. It connects clinical decision-making to the best current evidence, clinical expertise and patient preference. The purpose of EBP is to reduce variations in practice and standardize healthcare. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
As healthcare continues to shift from volume-based to value-based, EBP is becoming even more critical. Baccalaureate-trained nurses are expected to know more than ever about problem-solving and best practices to support patient safety and healthy outcomes.
“Nurses arguably spend more time with the patient than anyone else in healthcare,” said Chief Nursing Officer Christina Dempsey for the patient satisfaction consulting firm Press Ganey. “As such, they are not only the gatekeepers, they are the ‘thin white line’ between patient safety and both the patient experience and sub optimal outcomes — much like police officers are the thin blue line between anarchy and order.” NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
The Institute of Medicine (IOM) set a goal of 90 percent of all healthcare practice to be evidence-based by 2020. As the United States moves toward the goal, nurses are at the forefront of implementing this evidence-based practice in healthcare. Key to this effort are registered nurses (RNs) who earn Bachelor of Science in Nursing (BSN) degrees and work in direct patient care. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Origins of Evidence-Based Practice
Historians have linked the earliest use of evidence-based practice to Florence Nightingale and her treatment of sick and injured soldiers during the Crimean War in the 1850s. Among her important insights were connecting poor sanitary conditions and the death rate of wounded soldiers.
In the 1970s, British researcher Archie Cochran e published Effectiveness and Efficiency: Random Reflections on Health Services, which criticized the lack of credible evidence behind many commonly accepted healthcare interventions. Cochran e became widely known as the father of EBP. In the 1990s, Dr. Gordon Guyatt, an internal medicine specialist, coined the term evidence-based medicine. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Models of EBP
In the past two decades, researchers have created dozens of EBP theoretical models and frameworks to help educators and clinicians advance the science behind EBP and facilitate changes. In general, all of the models follow the same basic structure:
- Identify the problem
- Review and analyze research that addresses the problem
- Evaluate the need for change and potential barriers
- Consult with stakeholders who will support the practice change NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
- Implement the change
- Evaluate outcomes
Because no single model meets the needs of all healthcare settings, several are commonly used in nurse-led research for quality improvements to healthcare. The most commonly used models are adaptable to a variety of environments:
ACE Star Model of Knowledge Transformation (ACE)
The ACE Star Model is a five-step process that has been used in both educational and clinical practice. ACE is used because it provides a simple yet comprehensive approach:
- Discovery of key research
- Summarizing and review of the research studies
- Translating the studies into clinical application
- Integrating changes into practice
- Evaluating the effectiveness of the change
Advancing Research and Clinical Practice through Close Collaboration (ARCC)
The ARCC model focuses on providing healthcare systems with ways to implement and sustain EBP for improved patient outcomes. ARCC contains five steps: NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
- Assess organization culture for change readiness
- Identify barriers to change
- Identify EBP mentors
- Implement EBP into practice
- Evaluate outcomes
The Iowa Model is intended to provide nurses and other clinicians with guidance while making decisions about day-to-day practice. Frequently used in clinical research, the model encourages clinicians to identify problems or “triggers” and solutions through seven steps:
- Select topic
- Form research team
- Retrieve and develop evidence
- Grade the evidence NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
- Develop an EBP to address the topic
- Implement the EBP
- Evaluate outcomes
Benefits of EBP in BSN Nursing
The role of EBP in nursing begins in nursing school, where BSN students are expected to apply critical-thinking skills, professional accountability and clinical knowledge to bedside care. The use of EBP benefits BSN nursing because it provides tangible proof of healthcare successes. Some EBP-based studies have been implemented into practice today:
- Hand Hygiene
Evidence that hand washing reduces the incidence of disease and infection dates to the 1890s when researchers recognized a connection between patient mortality and providers who handled cadavers. After Dr. Ignaz Edelweiss implemented hand washing with chlorine, the rate of patient deaths decreased. His research and subsequent practice launched what has become an essential public health tool.
- Dress Code
A Richmond, VA-based hospital changed the nursing staff dress code based on research that found a positive correlation between standardized attire and the identification of staff and the appearance of professionalism. The group recommended nurses wear discipline-specific scrubs (For example, RNs wear solid ciel blue, solid white or a combination and nurse practitioners wear solid teal, solid white or a combination). Based on EBP recommendations, nurses were also issued gold and black tags that identified their professional titles. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
- Oxygen for chronic obstructive pulmonary disease (COPD) patients
Researchers found COPD patients must be provided ancillary oxygen despite the previous practice of withholding oxygen. In the past, providers thought ancillary oxygen could cause illness or death in COPD patients. However, EBP has proven oxygen can prevent hypoxia and organ failure.
- Nurse education
In 2003, the IOM published its Health Professions Education: A Bridge to Quality report that stated healthcare providers, including nurses, were not receiving adequate training and education. The IOM included EBP as one of the core competencies for all providers. Since then, nursing education programs have put a significant emphasis on teaching EBPs and methods.
EBP has impacted all realms of healthcare practice, so providers must be prepared to implement new standards based on facts and evidence. Approaches that have been used for decades but have no evidentiary value are on the way out. The top nursing schools, including Duquesne University, use evidence-based practice in nursing and healthcare education. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Patient safety and quality outcomes are major issues in the health care industry. Many national organizations have pushed these issues to the forefront of health care, demanding that health care professionals, especially nurses, play a vital role and be vigilant in these endeavors. Nurse educators, using The Essentials of Baccalaureate Education for Professional Nursing Practice, are in a unique position to impact health care systems and patient care by educating and training nursing students in the skills necessary to promote safety and quality outcomes. This article describes a creative, authentic learning experience that is currently being used in a Bachelor of Science in Nursing (BSN) program. The learning experience is a shared partnership between the clinical agency, the faculty, and the health science librarian to assist senior nursing students in the last semester of their baccalaureate degree program to synthesize and use the knowledge, skills, and attitudes that promote patient safety and optimal outcomes. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper It is a teaching strategy that incorporates many of the outcomes from the BSN Essentials and aids students to actively seek and deliver care using evidence-based practice.
Doctor of nursing practice (DNP) education is heavily focused on innovative and evidence-based practices (EBPs) that reflect the ability to translate research findings to practice settings. Unlike the PhD-prepared nurse who generates external evidence through rigorous research, the DNP-prepared nurse generates internal evidence through quality improvement, outcomes management, and EBP change projects. The practice-focused programs generally require the student to carry out a capstone project as the terminal work of the DNP. The capstone exemplar describes how a DNP student was guided to design and implement an EBP capstone project from beginning clinical inquiry to dissemination of the results of the completed project. This DNP capstone project used the seven steps of EBP and selected Essentials to implement an EBP change, resulting in improved outcomes for depressed teens treated at a rural community-based mental health clinic. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Nursing has deeply rooted traditions. As far back as Florence Nightingale in the 19th century, nurses prided themselves on patient advocacy, infection control (before germ theory), and physical care of the entire body, not limiting the focus to management of disease or signs and symptoms.1 These early roots established the philosophy of nursing. Nurses labeled what they do as caring or the art of nursing. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Critical care nurses find themselves in a unique situation. We have our feet deeply rooted in the art of nursing. Yet our hands and minds reach for the scientific basis that our highly technical, physiological, and pharmacological specialty requires. To base our practice on science, we must use research to answer questions, establish protocols, and promote critical thinking and decision making at the bedside. Doing so requires us to be willing and able to change practices, regardless of the tradition and commonly held beliefs, if validated, reliable, and useful evidence leads to such change. Nurses are at the forefront of evidence-based approaches.2 NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
The Institute of Medicine defines evidence-based practice (EBP) as “the integration of best research, clinical expertise, and patient values in making decisions about the care of individualized patients.”3 Research findings are a collection of facts. They become evidence when the findings are relevant and useful in particular clinical circumstances.4 Using research to guide clinical decision making is a shift in culture from basing decisions on opinion, past experiences, and precedents to basing decisions on science, research, and evidence.5 The Agency for Healthcare Research and Quality published Making Health Care Safer: A Critical Analysis of Patient Safety Practices.6 This document outlines 79 evidence-based practices and targets related to patient safety. The 11 recommendations with the strongest research support have a direct connection to critical care practice (Table 1⇓). NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Evidence-based practice (EBP) is the process of collecting, processing, and implementing research findings to improve clinical practice, the work environment, or patient outcomes. According to the American Nurses Association (ANA), nursing interventions should be practical, methodical decisions based on EBP research studies. Utilizing the EBP approach to nursing practice helps us provide the highest quality and most cost-efficient patient care possible. Here we’ll discuss the key characteristics of EBP relating to nursing research. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Involving all disciplines, EBP is an approach to clinical practice that’s been gaining ground since its formal introduction in 1992. Starting in medicine, it then spread to other fields, such as nursing, psychology, and education. Currently, 55% of all nursing practices are based on research findings. The ANA predicts that by 2020, 90% of all nursing practice will be based on EBP research findings.
When you incorporate up-to-date information from new EBP research, you’ll be able to question current practices. You may ask questions such as, “Are my current nursing interventions the most effective or safest for my patients?” or “Could we utilize these new EBP interventions in my work area?” Nurses committed to EBP will compare current professional and clinical practices with new research facts and outcomes as they emerge. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
To meet the 2020 goal, nurses must become proficient in evaluating various types of EBP research because they provide effective, proven rationales for nursing actions (see Learn the lingo!). As you incorporate this new knowledge into your clinical practice and work areas, you become a role model and a positive change agent. Share these discoveries with your healthcare team to improve the essential components of your role and work environment.
Knowing where to look
Nurses can find EBP research published in scholarly single-blind or double-blind peer-reviewed journals. Many state and national nursing organizations, such as the ANA, conduct nursing research. The National Institute of Nursing Research is well-known for comprehensive research studies that build the scientific foundation of our nursing practices; enhance hospice and palliative care; and help guide the prevention, treatment, and innovative management of diseases. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Many universities, colleges, and formal nursing programs also conduct and publish research findings in their newsletters or scholarly journals, or on their websites. Remember to look for the latest research findings relevant to your job role.
Consider obtaining appropriate institutional approval and conducting a formal research project of your own if you identify areas for improvement within your job role or work environment (see Caution: permission required). EBP research can be conducted in any area of nursing, including hospice care, geriatric or long-term care settings, in-patient hospital units, home care, substance abuse programs, and risk management. Besides improving patient outcomes and the work environment, research can help you evaluate social interactions, improve patient safety, resolve environmental issues affecting health, enhance quality of life, develop theories, explore healthcare economic issues, and address bench marking needs or barriers. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Four key elements
When evaluating EBP nursing research studies, focus on these four criteria:
- validity—the legitimacy, accuracy, and soundness of all aspects of the study
- reliability—the extent to which a measurement’s result is consistent
- relevance—the logical connection between two ideas, tasks, or events
- outcome—the conclusions reached through the process of research.
If a study’s outcome doesn’t demonstrate validity, reliability, or relevance, using it to make a change in current practices that have a proven history of effectiveness, efficiency, and positive outcomes may not be justified. But if the study’s outcome is valid, reliable, and relevant to your work environment or patient population, you should consider incorporating the new information into current clinical practice. Failure to utilize EBP to guide nursing care increases the risk of poor outcomes. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Examples of EBP in Nursing
There are many examples of EBP in the daily practice of nursing.
1. Infection Control
The last thing a patient wants when going to a hospital for treatment is a hospital-acquired infection. Nurses play a key role in helping to prevent illness before it happens by adhering to evidence-based infection-control policies. This includes keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions and practicing correct hand washing. Although nurses are busy with many responsibilities, the time it takes to control infection is well worth the effort. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
2. Oxygen Use in Patients with COPD
For patient health and safety, it is essential that nurses follow evidence-based practice in nursing when it comes to giving oxygen to patients with COPD. Despite the belief by some that providing oxygen to these patients can create serious issues such as hypercritical, acidosis or even death, the evidence-based protocol is to provide oxygen to COPD patients. This practice can help prevent asphyxia and organ failure. Giving oxygen, which is the correct treatment based on the evidence, can enhance COPD patients’ quality of life and help them live longer. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
3. Measuring Blood Pressure Noninvasive in Children
Nurses should measure blood pressure according to evidence-based practice because accurate measurements are an essential part of effective treatment. Measuring blood pressure in children is a different procedure than it is for adults. Measuring children’s blood pressure involves the auscultate method, then comparing the measurement against data gathered with the oscilloscope method.
4. Intravenous Catheter Size and Blood Administration
Nurses should follow EBP when using intravenous catheters to administer blood for packed red blood cell transfusions (PRBC). The protocol indicates that nurses should use a smaller-gauge catheter, which increases patient comfort. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
Areas Where More EBP Is Necessary
Although nurses are using more evidence-based practice, there is still some room for improvement. The following are some areas where nurses could better adhere to EBP:
- Communication involving changes in a patient’s status.
- Soft skills that improve patient interaction.
- Training and on boarding new nurses.
- Shift scheduling and the effect on care.
Because new research and evidence become available on an ongoing basis, EBP must adapt to the latest evidence. Often, old practices may need to change if new research overturns the principles behind them.
Evidence-based practice in nursing has advanced a great deal in recent years, and it will continue to do so.
Evidence-based nursing (EBN) is an approach to making quality decisions and providing nursing care based upon personal clinical expertise in combination with the most current, relevant research available on the topic. This approach is using evidence-based practice (EBP) as a foundation. EBN implements the most up to date methods of providing care, which have been proven through appraisal of high quality studies and statistically significant research findings. The goal of EBN is to improve the health and safety of patients while also providing care in a cost-effective manner to improve the outcomes for both the patient and the healthcare system. EBN is a process founded on the collection, interpretation, appraisal, and integration of valid, clinically significant, and applicable research. NURS 5052 – Essentials of Evidence-Based Practice Essay PaperThe evidence used to change practice or make a clinical decision can be separated into seven levels of evidence that differ in type of study and level of quality. To properly implement EBN, the knowledge of the nurse, the patient’s preferences, and multiple studies of evidence must all be collaborated and utilized in order to produce an appropriate solution to the task at hand. These skills are taught in modern nursing education and also as a part of professional training.
Evidence-Based Teaching in Nursing: A Foundation for Educators, Second Edition focuses on providing potential and current nursing faculty with the tools and knowledge they need to achieve highly successful outcomes for teaching nursing students and staff. The Second Edition also concentrates on the full role of nursing faculty and not just the educational process.
This robust text provides concrete examples of best practices within nursing education and has been crafted in a manner to excite faculty members to create a learning environment grounded in best practices and evidence. Today’s healthcare environment demands that practice be based on evidence, so the educational process should also be based on best practice and evidence.
- Updated and revised content
- Coverage of social media and informatics
- Information on different types of classroom and student involvement
- Discussion of new innovations in online education
- Focus on simulation education NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
What do we mean by evidence-based?
The universally accepted definition: the integration of the best research with clinical expertise and patient values. Evidence-based nursing, therefore is a rigorous methodology where all the research data for a particular problem or issue are analyzed together, also accounting for values and expert consensus. Nurse educators incorporate evidence-based practice into their curricula and use evidence-based strategies to support their teaching strategies. Nurse regulators use evidence-based regulation in their regulation of nurses. NURS 5052 – Essentials of Evidence-Based Practice Essay Paper
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