Evidence-Based Practice Application

Nurses spend most of their time analyzing and evaluating the quality of patient treatment. Nurses work in a temporal environment because the patient’s circumstance constantly evolves. Nurses must keep up with the progress in medicines, treatment, and new literature. The method deployed to assess and evaluate recent advances as practices and literature to establish state-of-the-art inpatient care is determined by Evidence-Based Practice (EBP). 

NURS FPX 5005 Assessment 3 Evidence-Based Practice Application

EBP drives external evidence, clinical expertise, patient values, and critique. Any novel and relevant method in practice as a nurse is evaluated based on external evidence, personal experience, and patient feedback. External evidence relates to clinically proven and state-of-the-art literature, while personal experience relates to the clinical expertise of individuals based on patient care.

Analysis of Criteria and Process for Implementing EBP

During day-to-day activities, nurses are exposed to repeated problems that their prior experience can solve. Still, they are sometimes exposed to novel issues that may require research. For this purpose, Evidence-Based Practice (EBP) serves as a Four step process which is given below:

1. Examination of the patient’s clinical problem
2. Searching the related and trustworthy literature
3. Assessment of articles
4. Execution and dissemination of information

First, nurses record and gather information based on the initial interview or diagnosis and form a clinical problem statement. Using that statement, they use a database and search for relevant studies, journal articles, and related literature. They analyze the validity of reports based on relevance and credibility because, in this progressing world, there can be outdated tests and procedures that affect treatment viability. Based on this intensive literature review, nurses report and execute the treatment (Alatawi et al., 2020).

According to Alatawi et al. (2020), the barriers associated with EBP are individual and organizational. The individual barrier is related to the professional competence of individuals, like experience and attitude. Sometimes nurses work with patients who cannot explain their problems, which makes nurses’ understanding and communication relevant. Organizational barriers are related to facilities and budgets available in the institute where nurses work. It relates to how far an organization is willing to go to provide the best care for the patient. Any change in practice inside the organization involves budget concerns, access to databases, tests, and other logistic issues.

Importance of Scholarship for EBP Research

Solving a problem requires individuals’ time and resources, which the nurses may not bear, so programs like Magnet® support evidence-based nursing practice and research (Wentland & Hinderer, 2020). Clinical nurses are distinctive in implementing new problem-driven research and scholarship to help capacities and staff development (Whalen et al., 2020). 

Inclusion and exclusion criteria for conducting evidence-based nursing practice from Saunders et al. (2019) include the following points:

1. The nurses who are conducting EBP research must take care of any biases during the selection of literature
2. Evaluation and viability of methodological quality must be considered.
3. The focus must be more than one outcome

Clinical Questions Related to Evidence-Based Practice

Speroni et al. (2020) conducted a survey encompassing respondents of 127 out of 181 research nursing leads from different Magnet-recognized hospitals across the US. Magnet-recognized hospitals are evaluated based on nursing leaders’ implementation of strategic nursing goals. The study showed that over 90% use the EBP model. The study indicates most used model in hospitals is the Iowa Model of Evidence-based-practice. EBP has improved patient care and the work environment for nurses.

Clinical Question: Which Interventions along with Patient Care Technologies Control Fever Based on EBP in ICU?

Iowa Model of Evidence-based Practice is one of the EBP strategies implemented in the ICU of Kamuzu Central Hospital (KCH) presented by Chiwaula et al. (2021). In the ICU, fever monitoring is a significant concern because patients in ICU are very vulnerable, requiring intervention as there are discrepancies in the fever management protocol. The study highlights the importance of using a temperature monitoring device with connected sensors (patient care technology) for fever monitoring in the ICU. This technique has empowered frontline nurses in the systematic management of the ICU for efficient, competent, and optimal care of patients. The purpose of the model is to generate a guideline for routine practice. Data was collected and analyzed using STATA 12.0 software for applying statistical tools like paired t-tests and to correlate the patient’s condition (temperature change) with clinical interventions spearman correlation was used. A study by Liu et al. (2020) evaluated the use of AI technology in a wearable wireless device iThermonitor WT705. This device helped in continuous temperature monitoring for patients admitted to the surgical wards.  The device aided in the continuous temperature measurements during the perioperative period. The study demonstrated that this device can capture more fevers as compared to intermittent observations. The precision of the device can be improved by adding advanced algorithm training and development.  

NURS FPX 5005 Assessment 3 Evidence-Based Practice Application

Knowledge Gap in Study

The consent of patients could not collect which they cannot give because patients mostly in ICU are unconscious and permission was sought from the caretakers of patients. This is the main area of uncertainty because EBP is based on patient critique and participation (Chiwaula et al., 2021).

EBP has the potential to become a go-to guide for the patient with a specific condition, but the circumstances and symptoms of the patient can vary from patient to patient. EBP demands great care while implementing guidelines using EBP (Chiwaula et al., 2021). 

Evaluation of Ethical and Regulatory Concerns for EBP

Ethical concerns relating to patient-doctor confidentiality and the code of ethics demand that patients are briefed on the study and that health implications and permission must be sought while conducting investigations relating to the patient (Chiwaula et al., 2021). The ethical considerations for evidence-based practice ensure that all the ethical principles recommended by Belmont principles must be followed (Tu & Gao, 2021). Belmont’s ethical principles include respect for the autonomy of persons, beneficence, and justice. The regulatory considerations are that the evidence-based technology needs to fulfill all regulatory recommendations by FDA.  The Belmont principles and regulatory recommendations from FDA impacted the implementation of the wearable wireless technology device iThermonitor WT705 for continuous temperature monitoring in intensive care units of hospitals.

 Patient safety and privacy are concerns that sometimes can call for intervention as in the case of fever intervention in the ICU (Chiwaula et al., 2021). With intervention relating to serious procedures, patient safety becomes a major factor while implementing EBP. EBP always calls for structural changes in an organization and technology upgrades, which demands more funds and are linked to financing, which is another policy concern while implementing EBP (Chipps et al., 2020).

Conclusion

Evidence-Based Practice can solve novel problems in the healthcare sector if opportunities and scholarships are provided to nurses participating in these studies because they are contributing with time and effort. Nurses conducting evidence-Based Practice must consider strict evaluation criteria for literature and ensure methodological quality. While performing any EBP study, patient confidentiality concerns and patient anonymity must be maintained.

References

Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in nursing profession: A literature review. American Journal of Nursing Science, 9(1), 35. https://doi.org/10.11648/j.ajns.20200901.16 

Chipps, E., Tucker, S., Labardee, R., Thomas, B., Weber, M., Gallagher-Ford, L., & Melnyk, B. M. (2020). The impact of the electronic health record on moving new evidence-based nursing practices forward. Worldviews on Evidence-Based Nursing, 17(2). https://doi.org/10.1111/wvn.12435 

Chiwaula, C. H., Kanjakaya, P., Chipeta, D., Chikatipwa, A., Kalimbuka, T., Zyambo, L., Nkata, S., & Jere, D. L. (2021). Introducing evidence-based practice in nursing care delivery, utilizing the Iowa model in the intensive care unit at Kamuzu Central Hospital, Malawi. International Journal of Africa Nursing Sciences, 14, 100272. https://doi.org/10.1016/j.ijans.2020.100272 

Liu, Y., Liu, C., Gao, M., Wang, Y., Bai, Y., Xu, R., & Gong, R. (2020). Evaluation of a wearable wireless device with artificial intelligence, iThermonitor WT705, for continuous temperature monitoring for patients in surgical wards: A prospective comparative study. BMJ Open, 10(11), e039474. https://doi.org/10.1136/bmjopen-2020-039474 

Saunders, H., Gallagher‐Ford, L., Kvist, T., & Vehviläinen‐Julkunen, K. (2019). Practicing healthcare professionals’ evidence‐based practice competencies: An overview of systematic reviews. Worldviews on Evidence-Based Nursing, 16(3), 176–185. https://doi.org/10.1111/wvn.12363 

NURS FPX 5005 Assessment 3 Evidence-Based Practice Application

Speroni, K. G., McLaughlin, M. K., & Friesen, M. A. (2020). Use of evidence‐based practice models and research findings in magnet‐designated hospitals across the united states: National survey results. Worldviews on Evidence-Based Nursing, 17(2), 98–107. https://doi.org/10.1111/wvn.12428 

Tu, J., & Gao, W. (2021). Ethical considerations of wearable technologies in human research. Advanced Healthcare Materials, 10(17), 2100127. https://doi.org/10.1002/adhm.202100127 

Wentland, B. A., & Hinderer, K. A. (2020). A nursing research and evidence-based practice fellowship program in a magnet®-designated pediatric medical center. Applied Nursing Research, 151287. https://doi.org/10.1016/j.apnr.2020.151287 

Whalen, M., Baptiste, D.-L., & Maliszewski, B. (2020). Increasing Nursing Scholarship Through Dedicated Human Resources. JONA: The Journal of Nursing Administration, 50(2), 90–94. https://doi.org/10.1097/nna.0000000000000847