Conscientious integration

Comment 1

  Evidence-based practice is the conscientious integration of best research, evidence with clinical expertise and patients’ values and needs in the delivery of high-quality, and cost-effective healthcare (University of Illinois at Chicago, 2015).

Evidence-based practice (EBP) promotes quality, safe, and cost-effective outcomes for patients, families, healthcare providers, and the healthcare system. It evolves from the integration of the best research evidence with clinical expertise and patients’ needs and values (Grove, Gray & Burns, 2015. 6th ed).

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        The treatment for acute muscle strain has changed over the years.  In the past, nurses learned to ice certain injuries for the first 24 hours and then apply heat to increase blood flow. Presently, evidence-based practice shows that only heat is beneficial (The university of New Mexico, 2016, Nov.30).

       Evidence-based practice has been developed to prevent healthcare–associated intravascular device–related bloodstream infections with the use of I-Care and the acronym stands for:

  • I—IV device management
  • C—Cleaning of hands
  • A—Access: Use of alcoholic chlorhexidine to prepare the insertion site, and use of sterile alcohol swabs to clean the injection port before accessing.
  • R—Reviewing the need for the IV device on a daily basis and remove when no longer required
  • E—Education about I-Care given to: staff, patients, and other care-givers (The Joint Commission, 2013, Nov.20).

       I work in prison facility and we had several cases of flu infection during this last episode. Hand washing with soap and water and contact precaution was evidence-based practice used to prevent the spread, also screen and testing others in the same dorm help to control spread of infection.

Comment 2

Evidence-based practice (EBP) is the combination of using research and clinical expertise, and include the patients’ values when making decisions about the care of individualized patients (Rauen, Chulay, Bridges, Vollman, & Arbour, 2008). Research findings are a group of facts and they become evidence when the findings are relevant and useful in particular patient situations. One example of EBP is collecting an accurate measurement of blood pressure, and it starts with picking the correct cuff size according to the circumference of the patient’s arm. Positioning the arm is also important and that should be based on how the patient is positioned. The study also found that using an automatic cuff to measure blood pressure in patients with atrial fibrillation was interchangeable with checking the blood pressure manually (Rauen, Chulay, Bridges, Vollman, & Arbour, 2008).  

Another EBP used when assessing pain is to intervene appropriately in patients that are non-verbal or have dementia. Assess for pain and intervene with non-verbal and/or demented patients when they have conditions that typically cause pain (Flynn Makic, n.d.). Assess for facial expression, verbalizations, a change in activity, and rubbing of certain parts of the body. The nurse can also evaluate for restlessness, agitation, and combativeness. Nurses should use a valid, reliable tool for assessing pain and re-evaluate frequently (Flynn Makic, n.d.).

The first EBP on accurately measuring blood pressure is widely used in all settings of health care including home health where I work. We manually check blood pressure and are instructed on choosing the proper cuff size and proper positioning of the patient for the most accurate results. The EBP for pain assessment we use the Numeric Pain Rating Scale as well as the Wong-Baker Faces Rating Scale. The numeric scale can tell us the intensity of pain which can help guide the nurse’s choice for pain medication and for the non-verbal, limited cognitive ability, and/or patient with mild to moderate dementia we use the scale with pictures (Wong-Baker). Patients with advanced dementia will need behavioral observation to determine the presence of pain (Wells, Pasero, & McCaffery, n.d., Chapter 17)

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