evidence based practice

Ariesbsn · May 2, 2007

Just for the fun of it, I am going to use the enumeration feature to see how many reasons I can quickly come up with.

We practice with many other professionals, some of whom are in the position to help or hinder the adaptation of what nurses want to do based on research.
- Research shows that by and large feeding patients is a good thing. However, I have taken care of vented patients in ICU who have gone over a month without some form of nutrition. Since they were being sedated with whopping quantities of Propofol (to the tune of 7700 calories a day according to pharmacy), they weren't losing weight. Over all, our docs have gotten better at responding to the daily reminders requesting some form of nutrition for the pts, but there is generally a 2 week lag time before pts that are vented and sedated for respiratory issues get some form of nutrition.

[*]People are resistant to change in general

"By gumm we have done it this way for the last 26.3 years, and not too many people have died so why should we change?"

[*]It might mean lower profit margins so administrators aren't so keen to make the change happen.

How much research has been done that shows under-staffing of nurses increases the risk of negative patient outcomes? Still though, many institutions are regularly understaffed.
I've posted this before and I'm posting it again. In our ICU, we have been told that we are not allowed to refuse to take a patient "just because" we don't have the nurses available to care for them.

[*]The desire for good Press Ganey scores by management takes precedent over research.

Research has shown that there is a positive relationship between the number of times a nurse is interrupted and medication errors. However, open visitation is being embraced and at least in the hospital where I work family members are allowed to interrupt the nurses for their own wants. I am being paid to care for the vented person on multiple drips and CRRT, not to go down to the cafeteria and get the visitor a hamburger because they forgot to ask their son to go get them one and their son went home (less than 5 minutes ago). They couldn't have been that hungry, if they forgot to ask. In the first 4 hours, this visitor put the call light on 11 times for personal wants (a different selection of magazines, another blanket, turn the thermostat up 3 degrees, now turn it down 1 degree). The charge nurse said part of nursing was taking care of family too and I had to learn to deal with those kinds of things.

[*]Nursing research, what's that?

Nursing students and nurses know that it exists, but who else does?

[*]Nurses may not believe the research findings and chose not to implement them.

My OB text had a section in it about allowing women in labor to eat. According to the text, nursing research indicated that women in labor tended to eat light foods and not a lot of it as labor progressed, and being able to eat resulted in a more positive patient experience. My OB instructor said she didn't care "what the research indicated" that when we were doing our clinicals we were to only allow ice chips and not too many of those.

I had a few more, but I can't remember them.

mauxtav8r · May 2, 2007

Great post Ariesbsn. I know just about everyone has a tale, but here's mine. As a school clinic volunteer in 2003 I was instructed that the proper way to care for a nosebleed was to have the child to lean over forward, allowing the blood to leave the body onto a tissue or into a basin. I was told this was found to produce less nausea.

Fast forward to nursing school, peds lecture, 2007. (bear in mind the research was so old as to have been disseminated to the "village idiot clinic volunteer" - ME - years and years before). My instructor, who is really good at her job in most respects, states "I think the book is wrong on this. In the real world the child's head is tilted back like this" (demonstrates).

Pass the duct tape, I think my head is going to explode.

mauxtav8r · May 2, 2007

Great post Ariesbsn. I know just about everyone has a tale, but here's mine. As a school clinic volunteer in 2003 I was instructed that the proper way to care for a nosebleed was to have the child to lean over forward, allowing the blood to leave the body onto a tissue or into a basin. I was told this was found to produce less nausea.

Fast forward to nursing school, peds lecture, 2007. (bear in mind the research was so old as to have been disseminated to the "village idiot clinic volunteer" - ME - years and years before). My instructor, who is really good at her job in most respects, states "I think the book is wrong on this. In the real world the child's head is tilted back like this" (demonstrates).

Pass the duct tape, I think my head is going to explode.

JaneyW · May 2, 2007

Terrific insight, Ariesbsn. This is a big reason for all of the moral and ethical dilemmas of nursing. We have the knowledge, but we do not have the power or autonomy to put that knowledge into play--not even at the so-called Magnet facilities. We are a profession that has no power in the workplace. This makes it difficult for evidence-based practice to take hold and thrive.

Elvish, BSN, DNP, RN, NP · May 2, 2007

:twocents: 1) People are afraid to change, especially if they feel they have no vested interest in it. This includes nurses, MDs, anyone.

2) A field like OB is so fraught with lawsuits, many OBs are afraid that if they don't cater to what the patients want (social induction or scheduled c/s at 37 weeks, for example) they'll be sued.

3) Field that have little to do with nursing have some say over what nurses can & can't do. Example: Anesthesia wants to keep laboring women NPO just in case they have to have a c/s so they don't risk aspirating under general anesthesia. So nurses have to follow the physician's order to keep them NPO. Forget the fact that women tend to self-regulate their intake in labor, and have more strength when they've been allowed to eat. Forget the fact that a whomping majority of c/s use epidurals or spinals, not general. Forget the fact that someone could very easily come to triage in with a prolapsed cord needing a crash c/s, at which point you better be doing it without diddling & worrying about if she's eaten anything in the last 8 hours.

Just my :twocents: .

nurse79 · May 2, 2007

i was just curious bc i interviewed Rns on my unit,,and yes the vast majority of reasons were people are reluctant to change. Including the MDs..esp the OLD OLD schoolers. But with respect to nursing, alot of nurses do not take the time out there to see what is in the current literature and stay abreast of recent information ( i too am guilty of that). Nursing research and evidence based practice should def. be a foundation of why we adopt practices,.. not 'just because'.

Does anyone out there have any good strategies that i could implement on my nursing unit to bring about increased use of nursing research???

Thanks!!

Suninmyheart · May 3, 2007

i was just curious bc i interviewed Rns on my unit,,and yes the vast majority of reasons were people are reluctant to change. Including the MDs..esp the OLD OLD schoolers. But with respect to nursing, alot of nurses do not take the time out there to see what is in the current literature and stay abreast of recent information ( i too am guilty of that). Nursing research and evidence based practice should def. be a foundation of why we adopt practices,.. not 'just because'.
Does anyone out there have any good strategies that i could implement on my nursing unit to bring about increased use of nursing research???
Thanks!!

I have heard of Nursing Research Journal Clubs involving monthly meetings to discuss how the latest evidence-based research can be incorporated (or not) into practice. I am new - just graduating and will take NCLEX this summer - and am hoping the hospital I end up working at has something like this established. Has anyone been involved in this type of professional club?

2curlygirls · May 3, 2007

Not in L&D but we have a committee for evidence based nursing practice. Meets once a month.

Our MD's have Journal Club every month.

NPinWCH · May 4, 2007

My list of why we don't use EBP.

1. Resistance to change by nurses.

2. Resistance to change by docs (some who feel unless the study was done by MD/DOs at some great teaching hospital it isn't worth doing).

3. Laziness/lack of desire by nurses to read/interpret and apply the research to their own practice. Many nurses view their job as a job, and the boss will tell them how to do that job.

4. Lack of confidence in way too many nurses to read/interpret and apply the research. Many nurses I know feel intimidated by research and tend to say things like, "but I can't understand those things...they just don't make any sense."

In my small unit, I can count on 3 fingers the # of nurses who read the studies, consider the implications and attempt to apply it to their practice. Today for example, a fellow RN asked me if I cath suctioned the newborn she was getting ready to admit to the nursery. I said no, apgars were 9/9 and her lungs cleared up quickly with crying. "Besides, the newest info says that deep suctioning interferes with breast feeding." She looked at me like I had 2 heads and said, "Where do you get this stuff? You read TOO MUCH, I don't know where you find the time and beside all babies should be suctioned so they don't spit up."

Well, I make the time...consider the implications and choose to apply what I can, and since suctioning after delivery is my call, why not.

SmilingBluEyes · May 4, 2007

You left out the stupid POLICIES most nurses are bound by (mandates from federal agencies, no less) that go against the best-evidence practices-----policies that make our practices/interventions either counter-intuitive or plain stupid, but nonetheless, forced upon us to follow!

crissrn27, RN · May 5, 2007

My list of why we don't use EBP.
1. Resistance to change by nurses.
2. Resistance to change by docs (some who feel unless the study was done by MD/DOs at some great teaching hospital it isn't worth doing).
3. Laziness/lack of desire by nurses to read/interpret and apply the research to their own practice. Many nurses view their job as a job, and the boss will tell them how to do that job.
4. Lack of confidence in way too many nurses to read/interpret and apply the research. Many nurses I know feel intimidated by research and tend to say things like, "but I can't understand those things...they just don't make any sense."
In my small unit, I can count on 3 fingers the # of nurses who read the studies, consider the implications and attempt to apply it to their practice. Today for example, a fellow RN asked me if I cath suctioned the newborn she was getting ready to admit to the nursery. I said no, apgars were 9/9 and her lungs cleared up quickly with crying. "Besides, the newest info says that deep suctioning interferes with breast feeding." She looked at me like I had 2 heads and said, "Where do you get this stuff? You read TOO MUCH, I don't know where you find the time and beside all babies should be suctioned so they don't spit up."
Well, I make the time...consider the implications and choose to apply what I can, and since suctioning after delivery is my call, why not.

We also have several nurses that deep suction every baby, period. They really don't care about oral aversions or the latest study out there. We also do lots of things that were routinely done back in 1960 that evidenced based practice now says are not needed, or are actually harmful to baby or mom. They top reasons why are 1. scared of lawsuits 2. this is the way they have done it forever, why change? 3. lack of interest and wanting to do the "easiest" thing

This from an informal poll I have had going on since I started there 3 years ago. And yes some of them have actually said, "I don't care, I just do whatever is easiest"