Evidence Based Practice

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.

Evidence-based practice (EBP) in nursing has been widely adopted in many advanced countries. Although EBP has been introduced to Hong Kong for over 20 years, it is still quite indistinct for many nurses and nursing students. For me, a local nursing student, I thought EBP was merely equivalent to the direct use of research findings to guide specific nursing interventions and decision making in nursing care. However, I found that EBP is broader and deeper than what I thought recently.

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

Research, quality improvement (QI), and evidence-based practice (EBP) all play an important role in the field of healthcare and are essential for the delivery of quality patient care. While each involves teamwork, critical thinking, and creativity there are distinct differences between them.

As mentioned before, my chosen policy priority is childhood obesity, an epidemic with many health issues associated with it. According to Burns, Grove, and Gray (2011), research used as evidence- based practice (EBP) has been implemented in the clinical practice to achieve quality care, efficiency, and positive outcome for patients and healthcare organizations. Furthermore, when EBP is applied to clinical practice it provides description, explanation, prediction and the control of phenomena. To this, Saviñon, Taylor, Canty-Mitchell, and Blood-Siegfried (2012) suggested that nurses can advocate for the children by encouraging parents to provide children with a variety of foods in adequate amounts to support growth and energy play. Furthermore,

While there are many people that think that evidence based practice and practice based evidence should stay the way that they are. If you took both of these and used them together it could provide the appropriate treatments and meet the needs of the patients. Evidence based practice and practice based evidence play a big part in the treatment of a patient and their mental health. Evidence based treatment would be a lot better if the research was focused on each patient and what their needs are. There a many mental disorders that require different treatments and most of them are evidence based, but this does not look at each patient individually, and there a many people with health problems that could use both of the research and evidence to help them get better.

In our research, we have compared three very different tools for ranking evidence based practice methods. Each of these tools could be effectively utilized in any healthcare facility or healthcare organization.

Nurses have many responsibilities. Providing safety and the highest quality client care is one of the top priorities. The collective goal for the Quality and Safety Education for Nurses (QSEN) is to educate nurses and future nurses to constantly refine their knowledge, skills and attitude to provide the highest safety and quality to their patients (Cronenwett et al., 2009). Evidenced-based Practice is one of competencies written by QSEN. This is a process which involves the healthcare provider to efficiently and effectively collect appropriate data and research activities to provide optimal healthcare to the patients (Cronenwett et al., 2009).

Utilizing evidence based practice in nursing is paramount today in the always evolving field of nursing. Having the clinical expertise and knowledge of a nurse is just the first step in making decisions for the treatment of a client. Adding the most recent and up to date evidence alongside with the client’s values and preferences is ideal to guiding the process of healthcare (Kelly & Tazbir, 2010). When evidence based guidelines are set forth in the plan of care for a client, the clinician has an abundant of amount of data to make sound decisions on. This allows the nurse to make the best decision or develop the best strategy to deliver care. Evidence based practice also allows

The purpose of this essay will be to discuss evidence based practise and its use in nursing, I will be discussing, the types of research and various forms of data, including the principles of evidence based practise and research. Evidence Based practice is finding the most effective, research proven, evidence to make decisions regarding the service users individual needs and the best decisions for them. As David Sackett quotes, "evidence based practise is the integration of best research evidence with clinical expertise and patient values." (Sackett D, et al 1996, p.71) Evidence based practice is good practice, assist practitioners, avoiding information overload and applying the most useful information.

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).

Evidence based practice (EBP) in dietetics is combining research evidence which has been appraised for its validity, with clinical experience, to make an informed decision about the nutritional care plan which is put in place. Employing EBP within my practice is beneficial as it provides a strong rationale for the decisions I make in designing a nutritional care plan for a patient. However the negatives of following EBP exclusively is that it does not allow for adjustment of care plans for individuals. I believe that it is of utmost importance to consider the patient at the centre of my decision making and therefore it may not be possible to always adhere to EBP.

For the UMC skin prevalence on June 4, 2015 I was assigned to conduct skin checks for all the patients on 5 North and South (MEDSURG) and the cardiac floor. The team I worked with consisted of 3 RNs, Brandy in our clinical group, and myself. Our instructions were to introduce ourselves to the patients and ask them if we could check their skin for pressure ulcers. After we checked the skin we had to note any pressure ulcers and the patients score on the Braden scale. The RN in charge demonstrated how to conduct the check on the first few patients, so we could eventually do it by ourselves. At first, I was very nervous and felt like I did not know what I was doing. After watching the RN a few times and how she was checking each patient, we broke up into teams. The team consisted of a Pediatric