Evidence Based Practice: A Case Study

Proper collection of blood cultures are necessary and the most direct method of determining whether or not a patient is septic. The purpose of obtaining blood cultures is to identify and isolate the bacteria that are causing an illness and then determine the best course of treatment based on the sensitivity of the bacteria to particular antibiotics. One of the most frustrating problems plaguing hospitals is the increased rate at which blood culture results are being returned as contaminated specimens. These results can lead to a significant increase in cost to the hospital and patient as well as an increased length in hospital

In the past few decades, many nursing practices were relied on state regulation, cost, or insurance policy. However, evidence based practice (EBP) are increasingly recognized and emphasized to change in nursing practice. For many clinical settings, there are thousands of resources available today. Not only most of nursing practice are made based on a pilot study but also implied to bring most benefits of the care.

According to Dr. David Sackett (1996) Evidence Based Practice (EBP) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

In this essay, I am going to consider how evidence-based practice can be used to support, justify, legitimate and/or improve clinical practice. I am also going to explore and discuss primary and secondary research evidences about how nursing interventions can potentially improve the quality of life of patients in the community suffering from heart failure. I will gather these evidences using a literature search which I will include an account of. Using a critiquing framework for support, I will appraise both primary and secondary evidences that I have chosen. I will also look at potential non-evidential factors that can influence evidence utilisation in practice. Finally, a conclusion will be drawn.

4) Significance: This research shows that there is a gap in the evidence, but that the primary concern for nursing staff is to ensure that catheters are removed as soon as it is possible to do so.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

Pressure ulcers occur over bony prominences when skin is compressed for long periods of time, affecting the blood supply to certain areas, leading to ischaemia development (Waugh and Grant, 2001). Compression of skin is caused by pressure, shearing and friction, but can also occur due to pressure exerted by medical equipment (Randle, Coffey and Bradbury, 2009). NICE (2014) states that the prevalence of pressure ulcers in different healthcare settings in December 2013 was 4.7%, taken from data available for 186,000 patients. The cost of treating ulcers can vary depending on severity from £43 up to £374 (NICE, 2014). Evidence based practice skills are essential in nursing as it allows the best available evidence to be used to improve practice and patient care, while improving decision-making (Holland and Rees, 2010). I will be critiquing two research papers; qualitative and quantitative, using a framework set out by Holland and Rees (2010), and will explore the impact on practice. Using a framework provides a standardised method of assessing quality and reduces subjectivity.

This paper will demonstrate that mental health social workers should employ evidence based practice. To do this I will discuss Advantages of evidence based practice, Ethics and Values and Educated Clients.

The findings from good, current, reliable, valid or trustworthy research are the basis for maintaining high standards of care and all nurses must practice based on the most up to date evidence (NMC 2008). It is now an important part of nursing to actively participate in research and evidence based practice in order to continually improve the standard of the health care system. This process ensures that nurses are kept up to date with relevant information needed to provide the most effective care for patients.

The goal of healthcare organization and nursing staff is improving patient safety. Patient safety is the number reason healthcare administrators need to support nurses taking the next step in their career to become certified. The American Board of Nursing Specialties (as cited in Falker, 2014) defines certification as the formal recognition of specialized knowledge, skills, and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes (p.10). The Iowa Model of evidence-based practice is the model I will use to shine a light on a problem-focused trigger, which is to encourage nurses to become certified in their specialty. Research proves that specialty nurse certification is

When it comes to finding all-around optical care in the greater Lexington, KY area, locals turn to the dedicated practice of optometrist and eye physician, James W. Matthew, M.D. At the core of it, the professionals at this practice aim to do whatever is necessary to ensure that patients’ eyes are in good health. This means that the staff here performs everything from routine examinations, glaucoma tests and treatments to more specialized work in optical surgery, all with an eye towards patient comfort and satisfaction.

The damage on the tissue is determined by the type of medication and the strength of the medication plus the quantity that has extravasated into the tissue (Farrell & Dempsey, 2014, p 154). Nursing management for extravasation includes stopping the IV therapy immediately and notifying the Doctor. Depending on the work place policy procedures for extravasation may include treating the tissue with antidotes for the medication used, assessment as to if the IV is to be removed and resited before or after treatment of antidotes, a warm or cold compress to applied and regular neurovascular assessments on the affected limb (Farrell & Dempsey, 2014, p 154). Prevention strategies for nursing staff to avoid infiltration and extravasation could include educating the patient on the IV insertion site, such as being careful not to knock the site in the bed or shower. Regular monitoring of the insertion site by nursing staff to prevent and detect infiltration and extravasation in the early

A good blood flow is essential for UF treatment; therefore, a central line is usually needed. A continuous heparin infusion titrated to a nomogram is necessary in order to prevent clotting of the UF filter. The patient must be monitored for hypotension and hypovolemia; therefore, frequent vital signs and accurate urinary output measurement is essential (Wick & Bakhai, 2012). The most commonly reported adverse events associated with UF are clotting of the filter, transient hypotension, and pain or infection at the catheter site. There is some evidence that the risk of adverse events is higher when the fluid removal rate is too high. Selection of candidates for UF is controversial at present, and a clinical selection tool would be beneficial (Wick & Bakhai, 2012).

What is not understood, however, is that once patency has been confirmed, experts agree (Infusion Nursing Standards of Practice, Standard 45. Flushing and Locking, Practice Criteria H.) that a smaller diameter syringe can be used to administer a medication. In addition, a few respondents reported diluting medications for which the manufacturer specifically warns against dilution (e.g., darbepoetin alfa). Several respondents also reported the practice of simply hanging a piggyback of normal saline to administer concurrently with an IV push medication to circumvent the need to dilute a medication—a practice that may not be appropriate without a prescriber’s order. When possible, require pharmacy to prepare any IV push medications that must be diluted according to the manufacturer’s guidelines or hospital policy. The syringe of diluted medication should be labeled for each patient with the patient’s name, drug name, strength, dose, directions for administration (e.g., slow IV push over 2 minutes), and expiration. The dilutions cover the range from 1/2 to 1/100

Patients will be allocated to the intervention and control group by block randomization with permuted blocks of four. Allocations will be placed on sealed envelopes by a teammate unrelated to the study. The envelopes for treatment will be opened in sequence by eligible participants after signing informed consent. As mentioned above the primary outcome that will be measured is the incidence rate of catheter-related dysfunction (thrombotic occlusions) and bacteremia. A cost comparison between the uses of Tego connectors with NS flushes versus using citrate locking solution with catheter caps will be recorded for further analysis. This proposed research will be conducted upon approval from the DaVita Clinical Research (DCR) team, committed to advancement in knowledge and practice of kidney care (Brunelli et al., 2014). In addition to the DCR team, direct patient care providers such as clinical managers, nurses, infection control managers, and patient care technicians will also be actively involved in data collection and analysis.