NURS 6052 Assignment: EBP And The Quadruple Aim

Introduction to Evidence-Based Practice and Research Program Transcript

NARRATOR: Research evidence and nursing practice.

MARIANNE SHAUGHNESSY: Well, nursing is an art and a science. And research really relates to the science component, because looking at clinical issues through the lens of strong scientific research allows us to provide the best care possible for our patients. according to NURS 6052 Assignment: EBP And The Quadruple Aim, at the end of the day, it’s incumbent upon all of us to stay current with what’s being published.

NARRATOR: Creating new knowledge to improve patient care at the bedside.

JANET BROWN: Well, research is the creation of new knowledge. And evidence- based practice is finding a way to address a clinical problem. There are commonalities, but evidence-based practice is looking at outcomes directly related to that clinical question that one is grappling with in practice.

NARRATOR: Using evidence-based practice to inform clinical decisions.

NOLA SCHMIDT: Imagine if you had an ill family member, would you want the healthcare providers, the physicians, the nurses to say, well, let me consult the eight ball and take a guess about how we should treat your loved one? Or should we actually base our decisions for care on what we know is best practice, or what the evidence tells us will get us the best outcomes? So I think evidence-based practice is critical for providing patients the care they deserve.

MARIANNE SHAUGHNESSY: Nursing research takes a closer look at the phenomena that surround the human experience of health and illness and takes a rigorous scientific approach to looking at that experience, to either describe it or define and identify ways to influence the outcome of that experience. And as the questions arise from clinical practice, theoretical frameworks give us a way to contextualize or look at the problem. And research is the systematic process that we use to identify solutions to the problem or generate conclusions as stated in NURS 6052 Assignment: EBP And The Quadruple Aim.

There’s constant knowledge coming out every day. And you don’t have to look any farther than the multitude of medical and nursing journals published every month to the health section of the New York Times. And it’s very important for all of us to stay current on what the best practices are. As new research is published and new knowledge is identified, it’s important that we all apply that to our clinical practices, because it’s what we as nurses do.

Well, all of nursing practice should be built on evidence. But our evidence comes from a lot of different sources. Sometimes it’s tradition, sometimes it’s authority, and sometimes it’s a journal article. But it’s incumbent upon us to stay current with what’s coming out, because once new information is published and new

knowledge is generated, as nurses, we have to stay on top and let our practice be guided by the evidence.

In many facilities, they’ve begun to develop evidence-based practice committees that work hand in hand with policy and procedure committees, which makes perfect sense when you think about the fact that policies and procedures do need to be updated periodically. And it provides a wonderful opportunity for those nurses who are working on policies and procedures to combine efforts with nurses who want to bring their practice up to the current state of the science, so that the nurses who are working on the evidence-based practice committee can collect the information, summarize it, and then design a policy or procedure for the facility that is defined by the evidence.

There are many, many different ways nursing research has changed nursing practice. I can pull an example for you from my discipline in gerontology. Nurses used to be taught that for patients who were unsafe ambulating on their own, that it was wise to use vest restraints to restrain them in bed. And particularly, we used that strategy often with older adults, who might have been unsafe ambulating independently around their hospital rooms or to the bathroom. So for years, we tied patients into beds with the belief that we were keeping them safe.

And there were two nurse researchers at the University of Pennsylvania School of Nursing, Doctors Neville Strumpf and Lois Evans, who took on this nursing research question and published some very, very significant evidence in the 1980s that showed that once these patients were restrained in the beds, they were not only at just as much risk for injury because of trying to release themselves from restraints, but they were also then subjected to all of the hazards of immobility, such as pressure ulcers, pneumonia, urinary tract infection, and other problems that we know result from keeping patients mobile in bed. So when that piece of literature came out, the result of that has been the fact that most nursing homes and many hospitals are now either restraint free or have very distinct and time-limited procedures for using restraints.

So that’s one obvious example. There are multitudes of others, because nursing research has really guided best practices in doing everything from IV dressing changes to trach care. A lot of the tasks that nurses do every day have been addressed through nursing research.

JANET BROWN: Evidence-based practice is essentially important because finally, we have a model in nursing that will move research to the bedside. And the process of evidence-based practice is a process that practicing nurses can get their arms around and embrace and bring forward, finally. For years, we tried to talk about research utilization, and the process was just too complex to be able to move into any sort of change. And the evidence-based practice movement has really propelled the use of research at the bedside for practicing nurses, and that’s why it’s so important.

It is essential that patient care be based on evidence. For as long as nursing has been around, we have based our practice on many different models of knowledge– tradition, authority, trial and error, and we can’t do that anymore.

There is no way that we will have all of practice be based on evidence immediately, but we have to move toward that model. And having practicing nurses engaged in implementation of best practice is the only way that this change will happen.

And as we look at practice and best practice, we must rely on a pyramid of evidence in making decisions about what research is ready to be implemented. So we have to have good research in order to have evidence-based practice.

Students get confused, because as we go through the evidence-based practice model, they see that when we’re doing an evidence-based practice project, there will be steps that are recognized, the same steps as in the research model. And so those processes are very much the same. And students get confused when they’re doing evidence-based practice, thinking that they’re essentially doing research.

according to NURS 6052 Assignment: EBP And The Quadruple Aim, Practicing nurses have to keep clear what their objectives are. Practicing nurses, staff nurses are charged with answering clinical questions and making certain that they are doing practice that is yielding good outcome. And that’s what evidence-based practice is.

Research is one of the scariest words in the English language for a baccalaureate student and certainly a new graduate.

NOLA SCHMIDT: Well, I think the key to evidence-based practice is remembering that it involves three components. as sated in NURS 6052 Assignment: EBP And The Quadruple Aim, It involves what is best evidence, what is the clinician’s judgment, and what is the patient preference. So we have to look at what’s worked for us in the past as a clinician, what has been our practice. And we also have to inquire about what the patient perceives would be best for them. Just because it works for everyone doesn’t mean that it will work for the patient that you’re taking care of. I think these decisions aren’t made in a vacuum. You consult with your team, other nurses, other physicians, the pharmacist, other healthcare providers, in making decisions about what should be the plan of care.

When I was a clinical nurse specialist, we were working on an adult med-surg and pediatric unit. And at that time, the peds and adult unit had merged. And so the nurses were using patient-controlled analgesia, PCA pumps, on the adults, but we weren’t using them on the kids. And so the nurses wanted to start using the PCA pumps on the children.

So one of the nurses sort of spearheaded this, and she went out and she got some articles. She shared them with the physicians and with the pharmacist, and we came up with a protocol that allowed us to begin allowing children to use the

PCAs. And that really, in the end, improved our parent satisfaction ratings with the care. And really, we saw a difference in how children were healing and getting better quicker.

And so we were one of the first community hospitals that was using the PCA with children. It had pretty much at that time been limited to children’s hospitals. And so that was a nice piece of work by a nurse who had a burning question and wanted to find out the answer and change practice in her area.

JANET BROWN: according to NURS 6052 Assignment: EBP And The Quadruple Aim, the purpose of evidence-based practice, the reason we need to have evidence-based practice in place, is that our goal is to increase good outcomes. And that is the whole purpose of nursing care.

NOLA SCHMIDT: I think that evidence-based practice is critical now. All you have to do is look at ANA social policy or the mandates from the Joint Commission on what are the key nursing problems. Those all are areas rich for doing evidence-based work, research, and changing practice.

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