Evidence-Based Practice

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.

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.

According to Dr. David Sackett, 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 is a clinical decision-making process in which clinicians use theory-derived, research-based knowledge to inform their decisions about care delivery. Most importantly, consideration of individual needs, preference and resources must be included.

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.

According to Stevens (2013), the call to develop and implement evidence-based practice (EBP) within all healthcare disciplines is fueled by legislative demands for improvement in standard medical metrics such as mortality and morbidity. However, increasing demands by the public for evidence related to the metrics and outcomes of such concepts as quality of life illustrate what may be more important to the client (Stevens, 2013). This client-directed focus has resulted in patient-centered outcomes research (PCOR) (Stevens, 2013). "The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information

In healthcare, evidence based practice (EBP) has grown and become important in providing the best quality care possible to patients. There are numerous ways to collect and use the research in the nursing profession. Studies are constantly being done to help better nursing and all of the healthcare field in order to help patients live better and maintain their health. There are different types of research such as qualitative and quantitative. Qualitative uses the human experience or something that has been lived by someone and quantitative examines for meaning and goes more in depth to research things and strives to test a hypothesis or makes use of statistical data to answer research questions (LoBiondo-Wood

Applying evidenced-based practice has three steps. Step one is making sure the research is creditable. Going into detail about step one should model a social work practice. In a social work practice, you always want to make sure you are looking for clarity and in some cases it helps to paraphrase it or reword it differently. As a social worker you have to be non-judgmental and try to understand every perspective. You have to be unbiased when it comes to wording and how it affects the meaning of the conversation. Also, making sure the research on the surveys or interviews are fair and represent the entire population. The second step is when you match your outcome of the research in your own “practice wisdom." As a social worker you want to compare the research you made with prior experience. You want to have different perspective and information that help you understand the client better. Lastly, the last step is to ask questions to the clients about their significance of what they have accomplished by working with you. Just asking what the client has learned can help

Using evidenced based practice in nursing care has been found to improve nursing care and patient outcomes for that matter. Though nurses are gradually embracing the use of evidenced based practice, we still have more to do to achieve EBP across the board. Studies have shown increase in responsiveness and attitude to EBP but are still faced by significant barriers in employing it. Therefore what we think and believe is not what is practiced (Stevens, 2013).

The purpose of Chapter two is to establish the theoretical foundations of the Evidence-Based Practice (EBP) project, discuss the connection between the EBP model and the PICOT question, discuss the literature search and appraisal of evidence that supports the project, synthesize the findings into recommendations for best practice to form a model for the EBP Project. The PICOT question at the core of the project’s purpose asks: For elementary school staff does the use of a specific anti-bullying program training reduce the risk of bullying in the school compared with current anti-bullying practices? This chapter details the search strategy including databases, keywords, limiters, inclusion and exclusion criteria, and describes the method of

Evidenced based practice (EBP) defined as “clinical decision making based on the simultaneous use of the best evidence, clinical expertise, and the clients” values (p. 28-29). In nursing practice, following EBP will strengthen influences and guide the nurse’s ability and help them provide the best clinical care practice (ANA, 2013). Nurses follows best practice to improve the quality of care for every patient and will assist them in understanding a study that is not well explained or hard to understand for better patient outcome. My best practices on implementing the project presentation is following and incorporate the evidenced based practice for promoting health for my target audience.

1.The Organization that developed Prevention of VTE in Orthopedic Surgery Patients: Antithrombic Therapy and Prevention of Thrombosis is The American College of Chest Physicians-Medical Specialty Society.

The application of Evidence Based Practice (EBP) requires doctors, nurses and other healthcare staff to be proficient in conducting quality research of peer reviewed academic literature (Introduction to Evidence-Based Practice, 2016). This process enables them to obtain appropriate and relevant evidence to support medical decisions. For example, to support the medical management of preterm births within the Aboriginal and Torres Strait Islander community (“Health of Australia 's Aboriginal Peoples” 2016), health professionals must access numerous peer-reviewed journal articles by searching on databases such as Medline and CINAHL. The identification of quality research in this area can enable them to expand their knowledge as to why higher preterm birth rates are more prevalent among the Aboriginal Australian community than the non-Aboriginal community ("Health of Australia 's Aboriginal Peoples” 2016). This information can be used to make informed decisions to lower preterm birth rates and improve health in this at-risk population group.

The best nursing care is evidence based practice which is based on knowledge and experience (Richardson-Tench et al. 2014, p. 13). Both documents use evidence-based practice to support their procedures. Document two presented two case studies that provided examples of when clinical staff have been presented with an aggressive patient and they have de-escalated the situation through all the techniques offered in the guidelines (Sim, Wain & Khong 2011, p. 870). Document one contained a variety of other sources and policies to broaden and support the guidelines presented on how to manage aggression (NSW Ministry of health 2015, p. 11).

Evidence-based practice has been implemented throughout the years of healthcare practice, not only are innovations being used based on Evidence-Based Practice (EBP) but they are being used as interventions by the providers, nurses and other staff. EBP is becoming more and more popular over the use of past decisions and opinions, and it is providing better quality care for patients, the major key to any healthcare provider. “One major objective behind all these efforts is to help doctors, nurses, and medical technicians provide the best possible care and treatment to patients” (Majid, Foo & Mokhtar, 2011). Part of the nursing process is to come up with interventions and implement them to have better patient outcomes, EBP can help with this by interlocking previous experiences with any treatments used with patients, although, as nurses we must use different techniques for each specific patient, the base of any procedure used in the past can be used and even modified as care is provided. By means, EBP is a great tool to use in the healthcare field, but there are many barriers that can intervene with the usage of this, for example, the massive amounts of healthcare literature, limited information technology (IT) searching skills and lack of time. Finding ways to overcome the barriers to implementing EBP can help with better outcomes in any facility.