Evidence Based Practice

KYCNM · Apr 9, 2007

It would help if you included your area of practice, however, I will do my best to explain evidence based practice from my clinical perspective.

In the neonatal nursery, male infants are circumcised and it is a painful procedure. A number of research studies have explored interventions that reduce the infant's pain during the procedure. A review of the literature shows that things that reduce pain as evidenced by using the infant pain score scale to measure pain) include a penile block with xylocaine, EMLA cream applied 1 hour before the procedure, sucrose nipple and reducing noxious stimuli (restraining only the infants legs, performing the procedure in a warmer, using a gentle approach to the procedure). Therefore, armed with this information, in a setting where the procedure is performed in the usual medical manner (strap the baby in the restraining tray and hack away) I would make a recommendation to the staff that we work with the physicians to "humanize" the circumcision procedure.

Hope this helps.

Google evidence based nursing practice for additional examples. Good Luck!

TraumaICURN · Apr 9, 2007

Hello everyone...I am a first year nurse and at my job we keep portfolios which keep track of all and any awards we attain, accomplishments, inservices, etc. Well, we also have to do an Evidence Based Practice presentation. I'm not familiar with this type of presentation. What should be included in this? Where can I get information for this? HELP, HELP!!!!!!! This is MANDATORY and it will reflect how compliant I am with my job (also reflects my pay raise).

I see under your name that you're into neuro. One controvesial topic would be using nipple pinching/twisting to test a neuro pt's response to painful stimuli. I'm pretty sure you can find some evidence-based articles stating that nipple pinching is inhumane and unnecessary, and that other methods of testing for response to noxious stimuli should be used and are just as reliable.

Daytonite, BSN, RN · Apr 9, 2007

If you can find someone that has a copy of Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig, the authors include a little section on evidence-based practice in Section I of the book on page 9 and they list a 10-step process to do it. Basically, it goes something like this: you pose a question about some type of nursing care. For instance, years ago I was curious as to why some people's IV sites got red and started hurting faster than others even though they had the same IV solutions infusing. Then, you do a literature review. You look for as many research articles on the subject as you can find. You read up on anything you can find that pertains to the subject. Assemble all your data. Read and analyze it. (Basically, you can think of it as doing a term paper on your own except you may not writing anything down, at least not at this point.) And, then from the information you obtain you put together an answer that may or may not affect your nursing practice that you feel should be followed to make the practice better where you work. I can tell you, however, that when you do something like this and you find the solutions to a problem you've been having (I'm talking about an epiphany here) you want to shout it from the rooftops. You also actually put any possible solutions you find into action and evaluate whether or not they work better. You also will want to share what you have found with others either informally or through planned inservices. That's where the formal writing may or may not come in. Whether or not you carry it through to the next step which would be to get it into the nursing policy manual is up to you and the facility. That kind of action, however, usually bespeaks of someone who is headed toward management and leadership positions. This is how I was able to improve my nursing of patients with chest tubes and IVs over the years. I also ended up redesigning the report sheet we used at one facility because the one they had absolutely stunk and I made it a project to go out to other facilities and get copies of ones they used in order to put a better one together. The point is, no one twists your arm to do this. You do it because you see a problem that you are honestly trying to find a better solution to. Sometimes the search takes a while; sometimes with focused effort you can find the answers right away; sometimes you later discover someone else was doing the same thing. It's all part of being creative at your profession. It's actually a lot of fun and keeps you excited about your work. Most of the time the only one who is going to care about any evidence-based research and practice changes you make are going to be you, your boss and any other interested nurses who care to listen to what you have to say. That's OK because it's the patients they come into contact with who will benefit.

This is your facility's way of documenting the more outstanding performance of the more creative nurses on their staff. You won't find the whiners and complainers, the unmotivated, or people who see nursing as "just a job" going above and beyond to do these kinds of things. Their association with nursing textbooks and any nursing literature ended the day they graduated from nursing school. Those who are more willing to get involved in these kinds of "labors of love" do it because they love nursing and/or are headed upward on the career ladder as educators or administrators. [My little soapbox ranting.]

classicdame, MSN, EdD · Apr 9, 2007

What you are asking for is a crash course on EBP. That is difficult to manage. You need to consider a "problem" on your unit, find a few research articles on the topic then present the "bottom line". For instance, is it safe to give Vancomycin peripherally? What do the Infusion Nurse Society Standards say about it? Any other data??????