NR 351 Week 3 Discussion Integration of Evidence-Based Practice Into Professional Nursing Practice

NR 351 Week 3 Discussion Integration of Evidence-Based Practice Into Professional Nursing Practice

NR 351 Week 3 Discussion Integration of Evidence-Based Practice Into Professional Nursing Practice

Integration of Evidence-Based Practice Into Professional Nursing Practice

As the professional nurse, you realize that your nursing care area often sees patients with the same particularly challenging nursing care issue (NOT medical care issue). Include allof the following in your answer to this discussion:
Identify the nursing care issue or problem and justify why it is a nursing care issue in need of implementation of evidence. Remember, this should not be a medical issue.
Explain how you would search the nursing literature for evidence on this topic (including search terms you would use) and how you would critically appraise the evidence found in your search. NOTE: You do not need to perform the search and provide an article for this discussion, but you may do so if you like.

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Nursing as a health care science focuses on serving the needs of humans as a biophychosocial and spiritual being.  Its practice requires not only scientific knowledge, but also interpersonal, intellectual and technical abilities and skills.  This means a composition of knowledge, clinical work and interpersonal communication.  Communication is a vital element in nursing in all areas of activity and in all its interventions such as prevention, treatment, therapy, rehabilitation, education and health promotion.  Good Communication also improves the quality of care provided  to patients, which is observed in the results.  Additionally, it is considered an inalienable right and a prerequisite for building a genuine and meaningful relationship between patients and nurses and other health professionals.  Kourkouta (2014). Effective communication between nurses and physicians is extremely important to patient safety.  The Joint Commission reports that communication errors contribute to the majority of sentinel events reported.  Thomas (2009)

I would like to share an experience I had recently involving poor communication, teamwork and collaboration.  It involved a scheduled procedure on a patient’s left hand.  This patient was evaluated and diagnosed by her surgeon, seen by him the morning of the procedure, completed all the pre-operative assessments and was ready to be transported to the operating room.

While performing my assessment and interview, I noticed a bangle bracelet on her left wrist, the operative limb.  I kindly asked her to remove the bracelet.  Patient stated that the bracelet has been on for the past 20 years and she was physically unable to remove it.  She became emotional and tears begin to flow.  She shared with me how special the bracelet was to her and if it must be removed she would not proceed with her surgery.  By taking the time to listen and sympathize with my patient, I recommended that she reconsider her decision.  I pointed out that she had mentally and physically prepared for the procedure.  She would still have the pain and problems that she had previously. Upon further dialogue, it was discovered that the bracelet was actually made of glass and therefore, could not be removed safely in the hospital setting. I explained that we would try to figure out a solution together.

I contact the surgeon and he said he would not perform the procedure if the bracelet was not removed.  At this point, I communicated the situation to my supervisor.  My supervisor consulted the surgeon and explained the predicament.  At this point, he decided to perform the procedure with the bracelet left in place but secured and kept out of the sterile field.  

Again, I returned to the patient and explained what the plan was moving forward. She was to immediately seek treatment in the emergency department should swelling occur because the bracelet could cause harm and increase the risk for potential loss of hand/limb.  She understood and agreed to use ice and elevation to minimize the swelling.  I also spoke to the husband and explained the events, the delay and the importance of monitoring for swelling. 

My patient was relieved, the procedure safely performed and her bracelet remained in place.  The roles assumed by nurses require that they have a repertoire of clinical, cognitive and communication skills.  Adaptation to situations is necessary as nurses often encounter complicated patient situations.  Hood ( 2018). This event included communication, teamwork and collaboration, safety, patient centered care, quality improvement, leadership and professionalism on my part as a nurse.  These core competencies came together to allow me to provide excellent patient care.

References

Hood, L. J. Leddy and Pepper’s Professional Nursing (9th ed.).  Philadelphia, PA Wolters Kluwer 

Kourkouta, L. Communication in Nursing Practice (February 2014).  https://www.ncbi.nlm/nih.gov/pmc/articles/PMC3990376/

Collaboration is an important factor in any career field. It is especially so for the health care field to provide patients with the best care possible. I thought that collaboration and communication were the same things but, they are different yet codependent. According to Wells (2017), “Collaboration is the action of working with someone to produce or create something. Communication is the imparting or exchanging of information or news.” This is something that nurses and all other members of the health care team do daily to provide the best care for their patients.

While the common goal is to provide the best care possible, there are sometimes barriers. In order to overcome these barriers, nurses can use a variety of collaboration strategies. According to Hood (2018), using SBAR, verifying orders, and using I PASS the BATON are all collaboration strategies for effective communication. SBAR is a template that is used by nurses to communicate with other members of the health care team to explain the situation, background, assessment and recommendations or requests are for the patient. While I communicate this information every shift, I PASS the BATON is a strategy that I haven’t heard of before. Introduction, patient, assessment, situation, safety, background, actions, timing, ownership, and next are all crucial information needed to give in the report to the next shift, (Hood, 2018).

One strategy that I use daily at work is what we call huddle. Around 10 am, Monday-Friday, the nurse, case management, and our manager all meet in the backroom to discuss a plan of care for each patient that we are assigned to. We also discuss what needs to happen to carry out the plan of care for each patient. This includes which doctors need to be contacted, if the case managers need to set up an ambulance ride home or to a facility and making sure they have been approved to go to the facility. This helps make a complex plan more achievable.

References:

Hood, L. J. (2018). Leddy & Pepper’s professional nursing (9th ed.). Philadelphia, PA: Wolters Kluwer.

Wells, K. (2017, November 29). Collaboration vs. Communication: Why the Difference Matters. Retrieved March 10, 2020, from Field Service Digital website: https://fsd.servicemax.com/2017/11/29/collaboration-vs-communication-the-difference-matters/

OK…I think I get it now.  Here’s take two!

In the article, CMSRNs’ continuing competence methods and perceived value of certification: A descriptive study, by Boyle & Thompson (2020), one of the studies that researched the value of a nursing specialty certification was done by Whitehead and colleagues in 2019.  The research included a review of 41 articles published between 2000-2018.  The review findings contained several categories for valuing certifications.  These included: 1) personal and professional incentives, 2) knowledge and skills, 3) job satisfaction, 4) organizational commitment, 5) empowerment, and 6) confidence.  Under the category of personal and professional incentive, the Perceived Value of Certification Tool (PVCT) was used and determined the value was based on two different factors: intrinsic and extrinsic rewards (Boyle & Thompson, 2020). 

The top 3 intrinsic rewards for nursing specialty certification:

• enhanced feelings of personal accomplishment (98.45%)
• personal satisfaction (97.93%)
• validation of specialized knowledge (97.13%)

The top 3 extrinsic rewards for nursing specialty certifications:

• promotes recognition from peers (85.96%)
• promotes recognition from other health professionals (78.68%)
• promotes recognition from employers (84.45%)

The findings from the research study by Whitehead and colleagues support Boyle & Thompson’s purpose of determining the value of nursing specialty certification by having the PVCT included within their research.  The fact that the value for obtaining certification was more intrinsic than extrinsic is something that I found interesting.  From the personal experience of having obtained a certification myself, I can understand how it brings about self-fulfillment, however, the encouragement to pursue the certification came from extrinsic forces (i.e. – my manager and charge nurse). 

In regards to a strategy that would help create a strong literature review/search, our textbook mentions to select resources from a comprehensive clinical database (Houser, 2018).  While Whitehead and colleagues’ research was thorough and comprehensive, one could argue that the sample size for the base of their research was small (only 41 articles utilized).  Using a comprehensive database, such as CINAHL, which has access to thousands of scholarly articles, books, journals, and research papers, one could go delve more into the value of a nursing specialty certification.  The importance for a thorough review of the literature is to remember that despite all the evidence presented, it is still an article of opinion.  Therefore, providing as much evidence as possible to defend and convince others of one’s hypothesis could only be enhanced by greater numbers. 

References:

Boyle, D. K. & Thompson, S. A. (2020). CMSRNs’ continuing competence methods and perceived value of certification: A descriptive study. MEDSURG Nursing, 29(4), 229-254. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=145282314&site=eds-live&scope=siteLinks to an external site.

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones & Bartlett.