Evidence base responds 5

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Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”

Objectives

  • Identify types of research questions to be studied with qualitative methods
  • Describe the steps in making a clinical decision based on evidence

References:

  • Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.

Words Limits

  • Response posts: Minimum 100 words excluding references.

Discussion 1

Evidence-based practice is an essential part of providing safe, quality patient care in nursing. It involves the collection, evaluation, and integration of valid research evidence, combined with clinical expertise and an understanding of patient and family values and preferences, to inform clinical decision making (LoBiondo-Wood & Haber, 2006). The purpose of this post is to discuss a situation in my current practice as a staff RN where evidence-based practice has been applied.

I currently work on a step-down neurosurgical unit that is comprised of 18 patient beds. Throughout my 2 years as a nurse, I have seen many different changes and new evidence-based practices implemented. One major new practice was that of bedside shift report. This practice calls for nurses to give their change of shift report to the on-coming RN at the patient’s bedside, rather than outside the room at the nurse’s server, at the nurse’s station, or in a conference room.

Nurse hand-off report is crucial in providing safe and quality patient care. Nurses often feel rushed and are distracted during traditional report. This can cause the outgoing RN to potentially leave out crucial information, cause the oncoming RN to get started on their shift late, and lengthens the time that patients are left unseen. Research has shown that sentinel events, call bell usage, and patient falls are all more frequent during this period of patient “alone” time (Labriole, MacAulay, Williams, Bunting, & Pettorini-D’Amico, 2018). The newly implemented bedside shift report is to not only preventing any of the previous incidences from occurring, but also allows for patient’s to be more involved in their care. This inclusion of the patient and family enhances communication between the patient and nurses as part of patient- and family-centered care (Labriole et al., 2018). By having a real-time conversation with the patient and family, the nurses can establish a trusting relationship that encourages the patient and family to feel more comfortable voicing their questions and concerns. This promotes a sense of security and empowerment among patients when they feel that they play an active role in maintaining the accuracy of the patient handoff.

There are countless evidence-based research studies that have been conducted to support bedside shift report. One such study conducted on a ten-bed rehabilitation unit over a 60-day period, showed significant improvement in not only patient satisfaction, but nurse satisfaction as well (Labriole et al., 2018). Nurse accountability, patient condition, communication with patient and family, nursing communication, and overall satisfaction all increased dramatically (Labriole et al., 2018). Shift report, as well as patient falls and call light usage all decreased over this period as well (Labriole et al., 2018).

The new implementation of the bedside shift report has been difficult for some nurses to get use to. There are some drawbacks that I have personally experience. It is hard to do bedside report when you have a difficult patient or family. Patients often times like to interrupt with side notes or requests to use the bathroom during report. These inconveniences are small however, compared to the improved outcomes that bedside report has brought. Bedside report allows for the outgoing nurse to be accountable, lets the two nurses assess the patient together, and communicate with the patient about what is going on in their care. I think that the new report provides for better patient care and safety and allows me to get a better start to my day.

In conclusion, evidence-based practice allows for nursing care to be the most safe, quality care that it can be. Practices, such as bedside shift report, are constantly being evaluated and implemented to improve patient care.

References

Labriole, J., MacAulay, C., Williams, K., Bunting, D. R., & Pettorini-D’Amico, S. (2018). Implementing bedside shift report: Walking the walk and talking the talk. Nursing 2018, 1-4. doi:DOI-10.1097/01.NURSE.0000529809.90912.30

LoBiondo-Wood, G., & Haber, J. (2006). Nursing research: Methods, critical appraisal, and utilization. St. Louis, MO: Elsevier Mosby.

Discussion 2

Evidence based practice is a very important practice that can provide safe and comfortable care to our patients. Our discussion board for this week is to work on a project related to patient care, that can be a study research in evidence-based practice.

The evidence-based project I would like to work on is, the management of gestational diabetes on laboring patients. Is fingerstick or capillary blood glucose checks, everyone hour, is a necessary during all phases of labor? Gestational diabetes is very frequent in our labor patients. At my work place, we are checking the blood sugar every 1 hour, when the patient is in, for delivery, even if the patient is not in active labor. It is very painful to patients with diabetes, all their fingers are sore. Beside having labor pain, patients are having fingers pain. Spacing out the fingerstick checks should be more comfortable to our laboring patient.

According to the National institutes of health, (2013), study shows that continuous monitoring of the capillary blood sugar, (fingerstick), during labor may improve the outcome of mother and baby; It can help prevent maternal hyperglycemia and neonatal hypoglycemia or fetal acidemia. But the National institutes of health, (2013), added that, monitoring blood sugar every two to four hours, during the latent phase, and one to two hours during the active phase should be done to maintain or correct any hyperglycemia during labor. They added, if the capillary blood sugar is controlled, checking it every four to six hours should be better. My workplace is doing the blood sugar checks everyone hour. Changes need to be done.

In conclusion, further research on the evidence-based practice on the diabetes management should be done in our workplace, to help improve our safe and comfortable patient care. Physiological measurement, self-reporting data, existing data, even observational data, will be very helpful on this research project. Because evidence-based practice involves, a series of action steps and a complex nonlinear process, according to LoBiondo and Haber, (2010), implementing a change will take a long time to be establish. Management and physician should be aboard with this research for a change of practice to take place.

References:

LoBiondo, G. W., Haber, J., (2010). Nursing research: methods and critical appraisal for evidence-based practice. 7th ed. Mosby Elsevier. St Louis, Missouri.

US national library of medicine, (NLM). National institute of health, (2013). Peripartum management of diabetes. Retrieved from https://www.ncbi.nlm.nih.gov

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