NR 439 Week 1 Discussion: Introduction to Evidence-based Practice (graded)

Sample Answer for NR 439 Week 1 Discussion: Introduction to Evidence-based Practice (graded) Included After Question

• Explain how research has evolved since the Florence Nightingale era.

The practice of evidence-based nursing care began with Florence Nightingale in the mid-1850’s. Florence Nightingale kept detailed reports of medical and nursing practices during the Crimean War (Stolley et al., 2000). She is “recognized as one of the first nurses to utilize evidence as a base for her practice” by using statistical methods to prove that better food, sanitation, and hygiene reduced the morbidity and mortality of the soldiers in her care (Lesson 1, 2020). From this point in history, EBP has evolved into what it is today. Training schools for nurses began because of Florence Nightingale’s research. Today we use evidence-based practice (EBP) daily to improve the outcomes of our patients.

• Discuss how research and EBP are different; include how you believe research supports EBP for nursing.

Evidence-based practice cannot exist without good research, as the two go hand in hand. Continuing education for nurses is necessary to improve their practice. Having the most up-to-date information is so important to provide these patients with the best care possible. Research is a scientific investigation. Evidence-based practice is research-informed clinical decision-making. The nursing process is a form of the scientific method: assessing, diagnosing, planning, implementing and evaluating. With the nursing process, we research methods such as when we implement frequent handwashing, we find that we spread less infection or viruses. When research evolves, evidence-based practice evolves. Consider the Homan’s sign, which was once thought to be the main indicator of deep vein thrombosis. Research studies now suggest that Homan’s sign is unreliable in diagnosing DVT, so nursing programs now teach that ultrasound is the best tool for diagnosis. The evidence-based practice encourages nurses to stay current on research in order to improve patient outcomes.

• Describe one past/historical unethical breach of research conduct; then, share how you would ensure the care of a study participant using one ethical or legal research consideration (guideline/principle).

To prevent an unethical breach of research conduct patients participating in research studies must give their informed consent, be made aware of their diagnosis, and be allowed to quit whenever they wish. Historically, research has not always been this way. An example of a historical breach of research conduct is the “Tuskegee Study of Untreated Syphilis in the Negro Male” (CDC). This study was originally projected to last 6 months, instead, it went on for 40 years from 1932 to 1972. A group of 600 low-income African American men took part in this research study that was designed to record the natural history of syphilis. The men were not given informed consent and were told they were being treated for “bad blood,” this was a local term “used to describe several ailments, including syphilis, anemia, and fatigue” (CDC). The men were not treated for syphilis even though in 1947 penicillin became the drug of choice to treat it. Among many other ethical breaches, the men were not told if they were found to have syphilis, nor were they told that the researchers had no intention to treat them. In fact, the men were told they would receive treatment for the “bad blood,” free medical exams, free meals, and burial insurance in exchange for taking part in the study. This is why the men agreed to take part in the invasive, painful procedures associated with the study, such as scheduled blood draws and spinal taps. A class-action lawsuit was filed and an out-of-court $10 million-dollar settlement was reached (CDC). They received lifetime medical benefits and burial services and in 1975 the wives and offspring were added to this program. Currently, there are 11 living offspring receiving medical and health benefits. In this scenario, I would have made sure the participants had informed consent and knew that they could quit at any time. I would use the principle of autonomy, which is the right of competent adults to make informed decisions about their medical care. 

                                                                          References:

Houser, J. (2018) Nursing Research: Reading, using and creating evidence. (4th Ed. Jones and Bartlett learning.

Stolley, J. M., Buckwalter, K. C., & Garand, L. (2000). The Evolution of Nursing Research. Journal of the neuromusculoskeletal system : JNMS : a journal of the American Chiropractic Association, Inc, 8(1), 10–15.

“Tuskegee Study – Timeline – CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 2 Mar. 2020, www.cdc.gov/tuskegee/timeline.htm. 

NR 439 Week 1 Discussion: Introduction to Evidence-based Practice (graded)

NR 439 Week 1 Discussion: Introduction to Evidence-based Practice (graded)

This discussion has 3 questions.  I encourage you to not wait until the last minute to post your discussion…Frequently I will respond with a reminder that you didn’t answer part of the question, or that you answered part of the question incorrectly, and I want you to be able to take advantage of that feedback.

Also, remember that to earn maximum points, you have to integrate an outside scholarly source into at least one of your 2 discussion posts for the week.  The optional readings are NOT considered an outside source.

For the third question, you need to “Describe one past/historical unethical breach of research conduct”  Please be sure this is related to research conduct, not potential unethical conduct in a clinical situation.  Also, you need to “share how you would ensure care of a study participant using one ethical or legal research consideration”.  Again – this is related to research situations, not clinical situations.  You need to describe how you would ensure care of a study participant, not a patient.

I’m looking forward to reading your first discussions this week!  You may post for credit beginning Sunday, February 28.

A Sample Answer For the Assignment: NR 439 Week 1 Discussion: Introduction to Evidence-based Practice (graded)

Title: NR 439 Week 1 Discussion: Introduction to Evidence-based Practice (graded)

Thanks for sending me the link. I have watched many Unit 731 documentaries. It is very difficult for me to watch these dreadful events had happened in Unit 731: The Japanese researchers studied STDs. They forced prisoners who were infected with syphilis to have sex with healthy ones to see how it spread. They carried out a vivisection, a dissection of a live human without anesthetics, to see blood loss. They infected the prisoners with diseases, then removed the prisoner’s organs while they were alive, so that the researchers could study the effects of the disease before the decomposition could start (Avani, 2018). They conducted an experiment on prisoners, frozen their arms stiff with ice, then put the frozen stiff arms into a vat of hot water. The flesh wound would be stripped off the bones, but the prisoner still alive. Women were raped and injected with disease to study transfer to fetus. A shocking photo found in archives show a Chinese woman was cut open from throat to pelvis, exposing a fully-grown baby in her belly……

Despite thousands of victims, the Japanese government denied the existence of the Unit 731 until 1998. The U.S. used double standard in the postwar responses to the experiments upon different nationalities. The Unit 731 scientists were given immunity from prosecution, and their dehumanized acts were coved-up in exchange for exclusive access to their finding (Brody, et al., 2015).  

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I still need to have a deeper understanding of the atrocities. But one thing I firmly believe that all humans are born free and equal in dignity and rights. We ought to respect this moral principle at all the time (Human Rights).  

Reference

Avani, S., (2018) Unit 731: Japan’s Biological warfare project. https://www.atomicheritage.org/history/unit-731Links to an external site.

Brody, H., Leonard, S. E., & Weindling, P., (2015). United Stated responses to Japanese wartime inhuman experimentation after World War II: National security and wartime exigency. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487829/Links to an external site.

Human Rights. https://www.un.org/en/sections/issues-depth/human-rights/Links to an external site.

Thank you, Fiorenzo, for your post and for sharing the discussion question. I agree with you that nursing research’s evolution since the Nightingale era has necessitated advancements in the nursing practice and profession for better services to patients. Accordingly, through the systematic process of inquiry that employs rigorous guidelines to produce unbiased answers to nursing practice questions, research remains a critical aspect of effective care delivery. Over 150 years ago, Nightingale pioneered nursing research to understand the effects of the Crimean War on the mortality and morbidity of soldiers at the time (Grove & Gray, 2018). The data gathered by Nightingale transformed nursing research as it led to the development of interest by professionals in practice. Nightingale succeeded in impacting fundamental nursing practice changes and care as it is known today and public health in general. 

With time, nursing research transformed because of different factors that included increased understanding to focus on the patient. Early researchers looked at ways to improve quality care delivery amidst lack of access to vital technology at disposal today. Research in nursing would pick in the 1950s, where efforts to apply science in nursing were advanced for better outcomes. Nursing education did not exist, and in most cases, nurse practitioners learned through apprenticeship programs. However, due to increased nursing education research, the need to train nurses as professionals led to the establishment of nursing schools in different parts of the country (Grove & Gray, 2018). Present research in nursing focuses on enhancing patient-centred care approaches using evidence-based practice. Nurses now can specialize in research through terminal degrees like a doctor of philosophy in nursing (PhD). The implication is that research in nursing is critical in providing quality care. 

Reference

Grove, S. K., & Gray, J. R. (2018). Understanding Nursing Research E-Book: Building an 

Evidence-Based Practice. Elsevier Health Sciences.

I was skeptical about the vaccine as well….and in truth, I am still skeptical even though I am fully vaccinated (I had the first shot at the end of December and the 2nd shot mid January).  I have been tested several times over (both swab and antibody tests) and by the Good Graces, I have not contracted the virus.  However, I still chose to get the vaccine anyway because my 75yr old mother lives with me and my brother is severely immunocompromised – and I’m around both of them ALL THE TIME.  With my potential exposure to covid positive patients at the hospital, I would feel so guilty if I was one of those asymptomatic people that unknowingly contracted the virus and then passed it on to my loved ones. 

That being said, after receiving both vaccines, and seeing how I reacted to it vs. seeing how others have reacted to the vaccines or actual contraction of the virus (or a combination of the two), I wholeheartedly believe that I would have been one of those asymptomatic people.  I had absolutely no reaction to the vaccine whatsoever.  Some of my coworkers who never had covid had a bad reaction to the 2nd dose…and my coworkers that had covid and then received the first vaccine said they felt like they had covid all over again (they had no reaction with the 2nd shot).  So I truly believe I would have been one of those people “spreading the love” without knowing. 

My family (husband, mom, brothers, sisters-in-law, and nieces) have said they will not receive the vaccine and I respect their wishes not to.  But for my peace of mind, I wanted to make sure I was doing my part to protect them from exposure despite my own reservations of the escalation for the research and the vaccine.     

I enjoyed your post very informative. I also wonder if there will be long term effects of the Covid-19 vaccine as it was released very fast. I myself have not received as am breast-feeding and the implications of the side effects on breastfeeding were not held. I do think their will be any long term effects, if anything history has shown us is that vaccines have helped the vast majority. Both the Pfizer and Moderna vaccinations are mRNA vaccines, which is nothing new scientist have been working how to modify mRNA. All viruses contain nucleic acids in the form of Deoxyribonucleic acid (DNA) or  Ribonucleic acid (RNA). DNA, RNA, and proteins are essential for existence. DNA carries all genetic information for cell growth and replication. RNA copies the DNA and thus regulates the expression of  genes in form of Messenger Ribonucleuic acid mRNA  which carries the genetic code from DNA from the cell’s nucleus to ribosomes where protein synthesis occurs. Proteins repair parts of the body and allows metabolic reactions to occur. Medications and vaccines that utilizes mRNA cause our cells to make a protein or specific piece of protein that triggers an immune response that creates antibodies and produces killer cells. So with this scientist just build on it based on the virus they are trying to target. 

https://www.health.harvard.edu/blog/why-are-mrna-vaccines-so-exciting-2020121021599

Explain how research has evolved since the Florence Nightingale era

When Florence Nightingale initiated change it was based on her collecting information and applying scientific data to it to show the benefit of the change. Unfortunately, in the years following there was not much scientific data being collected in nursing and that was probably because nurses went through apprenticeships and not formal education (Houser, 2018). Since then, nurses now have more formal education and nursing research is a key part of that. More nursing journals have been published that focus on nursing research and the National Institute of Nursing Research was formed (Houser, 2018).

Discuss how research and EBP are different; include how you believe research supports EBP for nursing.

Nursing research is a process to produce answers to questions about the nursing process, it integrates findings from multiple sources to develop a guide for best practice, finds solutions for existing issues, and tests our traditional approaches of patient care (Houser, 2018). Evidence-based practice (EBP) takes the best scientific research and integrates it with clinical experience and blends it with nursing care (Houser, 2018).  In my opinion, I believe that you cannot have EBP outcomes without having the research. The research is an integral part of developing practices that will promote effective and safe care of patients. You need to take the research results incorporated them into practice groups and present them to a panel of experts, and then evaluate the quality-of-life outcomes (Houser, 2018).

Describe one past/historical unethical breach of research conduct; then, share how you would ensure care of a study participant using one ethical or legal research consideration (guideline/principle).

One major unethical breach was during World War II with the Nazi’s brutal experiments. Their experiments concentrated on methods of killing but their results caused death, disfigurement, or permanent disabilities (Algahtani et al., 2018). At the end of the war, these crimes were tried and led to the Nuremberg Code of medical ethics (Algahtani et al., 2018). The Nuremberg Code established guidelines to be followed for research. Here are some of the guidelines: “consent is voluntary and informed for subjects who participate in medical experimentation, the knowledge gained is unobtainable by any other means, death or disability is not an expected outcome, and properly qualified scientists conduct the experiments” (Algahtani et al., 2018). In my research study, I would ensure respect for the participants by obtaining informed consent, explain the risks and benefits of the study, and explain my selection process.

Joan Roselli

References

Algahtani, H., Bajunaid, M., & Shirah, B. (2018). Unethical human research in the field of neuroscience: a historical review. Neurological Sciences, 39(5), 829–834. https://doi.org/10.1007/s10072-018-3245-1Links to an external site.

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

5. Grading Rubric

Discussion Criteria	 A (100%) Outstanding or highest level of performance 	B (87%) Very good or high level of performance	C (76%) Competent or satisfactory level of performance	F (0) Poor or failing or unsatisfactory level of performance
Answers the initial graded threaded discussion question(s)/topic(s), demonstrating knowledge and understanding of concepts for the week. 16 points	Addresses all aspects of the initial discussion question(s) applying experiences, knowledge, and understanding regarding all weekly concepts.16 points	Addresses most aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of most of the weekly concepts.14 points	Addresses some aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of some of the weekly concepts.12 points	Minimally addresses the initial discussion question(s) or does not address the initial question(s).0 points
Integrates evidence to support discussion. Sources are credited.* ( APA format not required) 12 points	Integrates evidence to support your discussion from:assigned readings** OR online lessons, ANDat least one outside scholarly source.***Sources are credited.*12 points	Integrates evidence to support discussion from:assigned readings OR online lesson.Sources are credited.*10 points	Integrates evidence to support discussion only from an outside source with no mention of assigned reading or lesson.Sources are credited.*9 points	Does not integrate any evidence.0 points
Engages in meaningful dialogue with classmates or instructor before the end of the week. 14 points	Responds to a classmate and/or instructor’s post furthering the dialogue by providing more information and clarification, thereby adding much depth to the discussion.14 points	Responds to a classmate and/or instructor furthering the dialogue by adding some depth to the discussion.12 points	Responds to a classmate and/or instructor but does not further the discussion.10 points	No response post to another student or instructor.0 points
Communicates in a professional manner. 8 points	Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).8 points	Presents information in an organized manner (few errors in English grammar, spelling, syntax, and punctuation).7 points	Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).6 points	Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).0 points
PARTICIPATION: Response to initial question: Responds to initial discussion question(s) by Wednesday, 11:59 p.m. M.T.	0 points lostStudent posts an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.		-5 pointsStudent does not post an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.
PARTICIPATION Total posts: Participates in the discussion thread at least three times on at least two different days.	0 points lostPosts in the discussion at least three times AND on two different days.		-5 pointsPosts fewer than three times OR does not participate on at least two different days.