Preventing Frozen Shoulder Surgery

Professionalism in nursing has advanced greatly over the years. A cornerstone for change includes that of evidence based practice (EBP) as the drive of nursing intervention and patient care. According to the Quality and Safety Education for Nurses (QSEN), Evidence-based practice is described as the combination of the most recent evidence with clinical knowledge that includes the patient’s best interests in mind for greater patient outcomes (QSEN, 2017). The QSEN’s goal is to prepare nurses for improvement in quality and safety of patients (2017). Because of this goal, six competencies, including evidence-based practice, are listed for criteria of improvement in nursing practice (2017). I have been fortunate to have experience with implementing this practice and providing education in certain EBP protocols in my career. One EBP protocol in particular that our unit has been involved in since May of this year includes Enhanced Recovery After Surgery (ERAS) now referred to as Improving Surgical Care and Recovery (ISCR).

Evidence based practice, “involves integrating the best available research evidence with professional expertise while also taking account of patient preferences the patients state setting and circumstance and health care resources” (Gerrish, K. Lathlean, J, 2015). As the health care profession constantly changes, then it is vital that all evidence based practice is kept up to date with current information and research, relating to nursing practice. Always assuring that the patients need are taken into consideration (Sackett et al, 1996).

The purpose of nursing research is to use the scientific method to prove theories, and from those theories comes the improvement of patient care. It is important to use evidence-based practice because it will help nurses to provide excellent patient care. For example, our unit’s disturbing patient’s fall incidence last year. As nurses our role is to identify the contributing factors, making our own observation, implementing safety practices, and determining the effectiveness of the plan. Nurses must work hand and hand with the interdisciplinary team to be more effective. The performance improvement chairperson is also vital in educating staff and reviewing problems. We must use the recent evidence-based practice to guide our nursing practice in providing care for

The project began with the formulation of a PICO question in an area of interest to guide the literature search. The PICO (population, intervention, control, and outcomes) format was used as a strategy for framing a foreground evidenced-based question. Dissecting the question into its component parts and restructuring was an essential first step in the evidence-based practice project. After careful consideration of the clinical manifestations and practitioner professional experience, the PIO question emerged was, Does Kinesio taping decrease pain and improve engagement in functional tasks in patients with shoulder pathology? Fortunately, there was sufficient evidence within the literature to support the PIO question.

Demonstrates sound clinical evidence-based skills and knowledge in relevant setting and area of practice, describing elements of safety, effectiveness, and efficiency in nursing process.

I also used evidence base practice with patients who have respiratory issues due to lying in bed and not mobile after surgery. It has been proofing by evidence- based practice

Turing and repositioning will avoid pressure from being exerted on one spot for too long (Miles, Nowicki, and Fulbrook, 2013). The nurse will also implement safety measures to prevent falling such as keeping the bed in the lowest position and hourly rounding (Crawford and Harris, 2016). The last priority nursing intervention for this patient is to get a set of vital signs before and after physical activity and prevent orthostatic hypotension. The patient can prevent orthostatic hypotension by adequate fluid intake, slow position changes and dangling the feet off the side of the bed before standing up (L. Schimke, J. Schimke,

According to Houser (2012), evidence Based Practice Nursing is the application of evidence based findings by nurses to steer the nurse toward integration of clinical expert opinion and experience with an unbiased comprehensive analysis of the best scientific evidence professional nursing care literature can provide while integrating patient principles and preferences. When planning for sustaining evidenced based practice, it is vital to adopt a methodical critical thinking decision making method, directed by deliberately adopting Evidence Based Nursing model pathway that encompasses searching, appraising, synthesizing, adapting, implementing, with a continuous evaluation of outcomes (Houser, 2012). Consequently, in an attempt to create or sustain an evidence-based practice, the plan must be well thought out, assessed, implemented and evaluated for desired outcome. My current area of nursing practice is in a Med-Surge/Orthopedic unit of an acute health care setting. We are specialized in Total Joint replacements, with an occasional spillover of Medsurg cases, who are admitted to the floor due to lack room at the specific units. My plan to create and sustain an evidence-based practice, will be in regards to creating and instituting a required pre-surgical class for patients who have elected to undergo a joint replacement.

3. Instruct the patient to reposition herself frequently and supply extra pillows for bony prominences like heels and elbows

What structure passes through the region outlined by the yellow arrow and how does it contribute to the pain experienced in the anterior compartment of the arm by Bruce? (3 marks) The structure passing through the yellow arrow is the humerus. It contributes to the pain at the anterior compartment of the arm by the long head tendon of the biceps muscle grinding against the scapular muscle. This leads to the ongoing instability of the humerus giving Bruce a large chance of a subluxated humerus. The superior labrum will also grind up against his inflamed bursa which is why Bruce has decreased range of motion and lots of

Evidence-based practice is the process of searching research to gain knowledge in the quest to improve nursing intervention. It requires time, resources, teamwork, collaboration, and dedication, but it’s our calling and duty as nurses to ensure that patients receive the highest quality of care. For this paper, I will identify a new best practice to initiate, describe steps required to implement it, and give examples from literature that support the change in patient care.

Evidence-based practice includes the integration of best available research, clinical expertise, and patient/client values and circumstances related to patient/client management, practice management, and health care policy decision making (American Physical Therapy Association (APTA), 2015, para. 9). It is based upon the notion that clinicians will seek out and use scientific knowledge in the pursuit of best practice for their patient (Zidarov, Thomas, & Poissant, 2013, p. 1571). In our quest to further improve our practice and take our profession to the next level, it is our duty to serve our patients with the best available evidence. Evidence in physical therapy guides us to look at valid and reliable examination measures for precise diagnosis, evaluate prognostic and risk factors that influence and affect outcomes, assess treatment interventions’ credibility and effectiveness, and weigh its benefits versus harm, review predictive factors and analyze relevance to patient, clinical setting and available resources, and consider outcomes of episode of care.

Increase AROM in right shoulder flexion and abduction as compared to the left shoulder to improve ability to perform ADL’s and safely complete tasked associated cooking and gardening.

Wide resection was performed in 26 patients and intentional marginal resection in 8 patients with favorable response to chemotherapy to preserve the adjacent joint. In metaphyseal lesions, at least 20 mm of tumor free subchondral bone was essential for joint preservation. The tumor bearing bone was frozen using single cycle liquid nitrogen protocol by freezing in liquid nitrogen for 20 minutes, thawing at room temperature for 15 minutes, and then rinsing with 37∘C distilled water for 10-15minutes. There are two main kinds of freezing procedures. The first one is the “Free Freezing Procedure” (FFP) in which either two osteotomies or hemicortical resection should be done and the tumor bearing bone is totally immersed in liquid nitrogen after

According to Ori Safran “Should patient with frozen shoulder be screened for diabetes mellitus” He conducted a case series study with level of evidence in 2017. The purpose to compare the prevalence of diabetes mellitus and pre diabetes among patient diagnosed with idiopathic frozen shoulder who are not known to have either diabetes mellitus or pre diabetic conditions. Fifty patients completed the test. Four patients with idiopathic frozen shoulder (8%) were found to be pre diabetic. No patient was found to be diabetic. All 4 patients reported a history of diabetes in their parents or