evidence based nursing?

[ohbet]

I was in Borders about 2 hours ago,reading a nursing book "Best Practices: A guide to excellence in nusing care"

It all about evidenced based nursing,that is nusing based on scientific research.

The majority of the book is procedures,and the research that supports the procedures, lets say a procedure indicationg how to start an IV would be supported by research done by INS,or the CDC.

Then I started to wonder how much of my nursing care evidenced based? and how much is based on what everyone else does or "thats how its done here",or ways of doing things that have worked for me, or outdated information I learned in school but am still employing

I really couldnt answer the question in terms of percentages but I would hope that my care would be evidenced based as much as possible.

How about you? How much of your care is evidenced based nursing?,nursing which is backed by research,which would be the "best practice"

[joyrochelle]

I am a new Rn, so I am still very doe-eyed and attentive to how the veterans do procedures/ provide nursing care, but I am trying very hard to be evidence and practical.

I have found though, that however satisfying it is to know the how and why u are doing something, in modern OB practice it is sometimes a bit of a pickle to satisfy!

what types of things are you discovering?

[ohbet]

Lets take a hypothetical situation,purely hypothetical.

A nursing is straight cathing a female for a UA and there is difficulty location the meatus. The nurse inserts the sterile cath into what she thought was the meatus,but alas was not. Because the nurse is pressed for time, instead of discarding the contaminated catheter and obtaining another sterile one, she uses the original and contaminated cath ,makes another attempt,with success and obtains the urine.

Now in this purely hypothetical situation we have an example of a practice that is not evidenced bases nursing.

Another thought,if you saw a nurse practicing this way,would you say something to her? And if so,what would you say? or would you shine it on?

[Dr. Kate, BSN, RN]

To go back to your original question about evidence based nursing practice. While it would be nice if all nursing were evidence based, it still isn't. There are many reasons for this not the least of which is that nursing research is a relatively young area of nursing. (There is a difference between research based nursing practice and evidence based nursing practice, but you didn't ask about that. )

Evidence based practice is more that "How I fixed a patient problem good" which was the tone of the bulk of nursing literature on nursing care practice for most of the 20th century. Evidence based practice looks at the goals, actions, and outcomes of the care being delivered. It answers the question of "do we really know that what we're doing makes a difference?"

In your straight catheterization example, you're really looking at a practice issue: sterile versus nonsterile technique. The example I use with new grads, partly because it really freaks them out, is what we did in the good old days related to pressure ulcer care. When I was young in nursing we would use Maalox and sugar on stage II/III pressure ulcers. Why? Because someone had heard from someone, who knew someone who said that it worked, sometimes (how I fixed my patient good.) Now care is based on the stage, depth, and amount of drainage. Why? Because there is research and outcome evidence to support the treatment (evidence based practice.)

We've come a long way in validating what nurses do, and in showing that some of what we do is of no value. There is still a long way to go.

[nell]

Love that example Dr. Kate.

I remember Maalox and sugar on ulcers. I'll bet you're a wonderful instructor.

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

The nurse that cath'd someone and disregarded sterile technique put their pt in harm and should be talked to and reported. Use the chair of command in your hospital. Talk to her personally, next incident report to this person's mgr. Watch this nurse.

[Tookie]

Good explanation Dr Kate -

[ohbet]

Dr. Kate,please explain again the difference bet/ evidence based vs research based nursing practice. I thought they were much the same,like "I did this research and obtained this evidence to support this here hypothesis"

[jevans]

The RCN stated

"Evidence based practice is doing the right thing in the right way at the right time for the right patient"

But how do we know that what we are doing is right. Carper suggest that nursing draws knowledge from

Empirics[ Research],esthetics [art] ethics[moral] and personal experience. So this then supports another quote that evidence based practice is

"the conscientious and judicious use of current best evidence from clinical research to guide healthcare decissions"

But you do have to have the ability to critique the research

eg there was a study conducted which suggests that spinach has a higher iron content

however, there was an error of a decimal point. The research was still published.

Hope this helps a little

j

[ohbet]

Maybe evidenced based practice is following the the P and P,assuming its current etc.

[sjoe]

"Evidence-based nursing" The new buzzwords for now, I guess.

This will be replaced soon enough by another set, and then another--all pretending that nursing is, somehow, a science in a misguided attempt to achieve some measure of respectability (not to mention government "research" grants).

Psychology went through the same pointless exercises in the 1970s. A waste of time. IMHO.

[ohbet]

Ok,I did some reading. Evidence based practice is nursing practice built on information obtained from research.

Nursing doesnt claim to be a complete scientific practice,but it surely has large elements of science as its basis and nursing based on research will move us to excellence in Nursing Care.