You will provided with a topic and 2 responses to the topic. please comment to each response. please provide reference to each response.
Any clinical example made should be reference to emergency department
Topic: Evidence-based practice (EBP) is an important topic in healthcare organizations. How could you apply EBP in your current nursing practice? Please provide examples.
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Response 1: Herman
The application of evidence-based practices (EBP) is the use of research evidence in guiding practices. Many nurses are encouraged to use EBP in their clinical practices because of the benefits the practice has. Application of EBP has many advantages in healthcare including helping in making quality clinical decisions. However, Belowska et al. (2018) identify that there is still a difference in the nurses’ knowledge, behaviors and attitudes regarding EBP. Also, although there is still an increase in the trends and use of EBP in nursing, there still exist barriers that prevent the correct implementation of EBP.
Arsenault Knudsen et al. (2021) identified that nurses need to be ideally positioned to improve patient outcomes by changing their practice to align it with research evidence and organizational initiatives. In my practice, I can attest to the use of EBP. For instance, the research articles help in providing workable ideas that could be used in primary healthcare to make various clinical decisions. The most important thing to understand about EBP is to know what research works best to solve a certain clinical problems and ones that do not meet the supposedly quality research. For instance, I have used EBP in my current nursing practice to understand more about the importance of engaging patient in their healthcare. That is because it helps the patient to understand more about their care needs and practices, and also enhances patient adherence.
Response 2: Samantha
My current nursing practice entails working as a labor and delivery nurse at a local county hospital in Southern California. King & Pinger mention that there are often actions taken in regard to laboring patients that are not all backed by sound evidence, but are perhaps done because that is how they’ve always been done. Discussing evidence-based practice (EBP) at work always reminds me of a situation where one of our OB fellows wanted to change our practice of vaginal preps for all cesarean sections, regardless of if they had been laboring or not. Normally a vaginal prep is only performed prior to cesarean section only if the patient had rupture of membranes or if they had been laboring, but in this situation the OB fellow had read a paper that reported a lower infection rate when vaginal preps were done on all patients. There was some pushback to this change, but there was also support from some of the providers. Being that this was only one paper, only one study that was supporting this change to our practice, many of us were hesitant. In addition, many of us were concerned about altering the natural flora unnecessarily. The ask for change was not long lasting, and our floor has returned to our original practice – but this situation always comes to mind when discussing EBP.
King & Pinger bring forward important statistics and input regarding the topic of TOLAC (trial of labor after cesarean) versus elective repeat cesarean. Risks of uterine rupture typically cause a lot of fear for patients and some institutions don’t offer TOLACs due to risks, but one way to support patients is by use of the latest data in regard to TOLAC and the risks associated vs. the alternatives to the plan of care. “TOLAC carries an overall risk of uterine rupture of less than 1%” (King & Pinger, 2014, p. 582). Ultimately, the actual risks of uterine rupture are low. In addition, there are success calculators that can help providers to predict the chances of a successful vaginal delivery. The studies and data help to provide information to educate patients so that they are able to make informed decisions regarding their plan of care, in addition to supporting providers as they make their recommendations.
Another way that EBP can be implemented and supported at my work is by consulting some of the big organizations in the field. Both ACOG (American College of Obstetricians and Gynecologists) and AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) provide guidelines and interventions for those in this field based on scientific evidence.
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Hello, thank you for the opportunity to respond to your post. I appreciate you taking the time to contribute to the discussion. I agree with your views, and therefore, I will only add a few points to your post. Your work is well structured with good comprehension and grammatically sentences. Evidence-based practice requires a consistent implementation to enhance quality care, improve patient outcomes, and reduce hospital costs. Therefore, it is upon healthcare organizations to work around the various barriers that might be affecting the effective implementation of EBP.
Effective implementation of EBP can be enhanced if there is enough knowledge and skills that will change the nurses’ behaviors, attitudes and perceptions. The misperceptions and cultural traditions on EBP, such as following the organization’s way of doing things even if it is not right, will reduce in the long run (Mathieson et al., 2019). Therefore, all health practitioners must understand the basics of EBP before applying its concepts in their practice or solving a problem, especially that which involves patient care.
I appreciate your consideration to participate in this discussion. I would like to add that, due to the frequent changes in the nursing profession, clinical interventions keep changing as well. Therefore, nurses should apply the most recent studies in their care. This will help limit medical errors and educate patients on the effective interventions that will help improve their well-being. The current health studies entail statistical data that can help solve the clinical problems at my work, especially in this case of various actions being taken on laboring patients with no sound evidence. This shows a tremendous need to improve nurses’ skills and knowledge on EBP to solve the problem and implement medically proven interventions that will improve the patients’ outcomes and promote the safe delivery of their choice (Melnyk et al., 2018).
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/74D8FB3E7561129C8CBBF01207837BCC/S1463423618000488a.pdf/strategies-facilitators-and-barriers-to-implementation-of-evidence-based-practice-in-community-nursing-a-systematic-mixed-studies-review-and-qualitative-synthesis.pdf
Melnyk, B. M., Gallagher‐Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first US study on nurses’ evidence‐based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence‐Based Nursing, 15(1), 16-25. https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/wvn.12269?casa_token=mwM6orFuP_QAAAAA:pWblGeBbE4AbnajVhKABYgf798cIgne4cG7R5B33EAyTDCEDy4QG6KccgeLrL7jWwMR3HQB64tawMg
ns being taken on laboring patients with no sound evidence.f an help us in applying the most recent studies in their care.