Improving the Use of Evidence-Based Practice and Research Utilization Through the Identification of Barriers to Implementation in a Critical Access Hospital

Respond to discussion

Include citations/Use in text citation where needed

All sources must be 5 years old or newer

Only needs to be about a paragraph long

More like a discussion rather than a paper

Please add to the discussion in your peer responses with informative responses, instead of posts similar to “great idea! I really agree with you.”

Each response needs to have a citation

 

 

POST 1(Judy)

Evidence -based nursing practice involves finding a patient problem and determining ways to solve it through nursing research (DiCenso, Guyatt and Ciliska, 2014, p. 4).  Evidence-based practice is utilized in many ways throughout the nursing profession whether it is realized or not. For example.  Just over a year ago, there was a discussion in my facility with the interdisciplinary team, which includes, nursing, physicians, social services, recreation, dietary and environmental, regarding best practices to prevent falls. It was noted that there had been an increase of falls with major injuries, particularly hip fractures.  When the data was analyzed, it was found that about 50-60% of the hip fractures occurred with patients who had all four side rails up while in bed. This data sparked a conversation that resulted in several different possible solutions.

The principle that was utilized to conduct the study involved the experience of the clinicians involved as well as the patients’/legal guardians’ values (Rice, 2011, p. 446). It was evident when studying why we were utilizing all four side rails, that many of the patient’s/legal guardians’ requested the use of the side rails mainly for safety concerns.  It was discussed with the alert patients and the legal guardians that this method of “safety” was found to be more hazardous and the facility was looking to test several other options: leaving only two side rails up and placing cushioned mats on the floor on both sides of the bed; utilizing a concave mattress; or using a weighted blanket that has been found to reduce anxiety and give the patient a sense of security, therefore, better sleep and the likelihood they would not attempt to get out of bed on their own.  Of these three options, and taking into consideration input from the patients and guardians, the solution was to utilize two side rails and place cushioned mats on the floor beside the bed.

The choice to utilize clinical expertise along with patient values was simply due to a time constraint. To conduct proper research takes time and consideration. The goal in this situation was to come to a safe resolution as quickly as possible, while involving the patients and guardians in the process which is a vital part of practice. It would have been appropriate to conduct a more thorough research study if the facility was simply looking for improved ways of preventing falls with injuries – without having the data showing our current practice was causing more harm than good. We did, however, ensure to obtain informed consent from all patients and guardians, with proper explanation of our potential resolutions as well as encouraging them to give their own input. It was an multi-disciplinary effort that we continue to use to this day. Since its implementation, there has been a significant decrease in injuries from falls.

References:

Dicenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-based nursing e – book: A guide to clinical practice. Elsevier Health Sciences. Retrieved from

https://books.google.com/books?id=bHqjBQAAQBAJ&dq=principles+of+evidence+based+practice+in+nursing&lr=&source=gbs_navlinks_s

 

Rice, M. (2011). Evidence-based practice principles: Using the highest level when evidence is limited. Journal of the American Psychiatric Nurses Association.

Retrieved from https://www.researchgate.net/publication/51854103

 

 

POST 2 (Beth)

Principals of Evidence Based Practice

As nurses, we have the moral obligation to use the best available evidence based research in our everyday practice. The quality of our decisions or care will improve the more we make use of trustworthy evidence. The principal of evidence-based practice (EBP) is first noticing a problem and realizing there is a better way to do it, next an understanding of why this practice exists; and finally, research appropriate literature to see if there are viable alternatives. (An Overview of Evidence-Based Practice) Three components are incorporated to improve outcomes; research, clinical expertise and patient preferences. (Stavor, Zedreck-Gonzalez, & Hoffmann, 2017)

I am a psychiatric nurse in a detox and inpatient rehab facility. Our social workers and therapists use Cognitive Behavioral Therapy (CBT) in their treatment session, which is one of the most noted EBPs in mental health. CBT has been effective in treating a wide variety of mental health disorders including addiction and substance abuse by helping the patient discover the relationships that exists between self-destructive behaviors and negative thoughts and feelings. (Evidence-Based Treatment Practices. 2020)

Many of our detox patients do not stay and complete the inpatient rehab program resulting in repeat admission as they fall back into old habits. We already know that detox is the first step to recovering addicts, but the key to stay clean of addiction is the aftercare. We had identified the problem: repeat admissions, and researched why aftercare is not being completed. Many factors contributed to this; too expensive, unable to miss work for 28 or more days, no transportation or live too far away to attend group sessions. Being unable to combat these barriers for our patients, our facility nursing and social work management felt that as the nurses and psych techs have first point of contact with the patients, that CBT treatment can start at point of admission.

Currently, we psych nurses and our techs are completing training in CBT to implement in our everyday interactions with our patients. The hope is that something will stick with the patients who can not stay in treatment to battle their addiction in the real world, and by more in sync and collaborative in cares across the board from nursing staff to social work staff and physicians.

 

References

An Overview of Evidence-Based Practice. (n.d.). Retrieved from

https://media.pearsoncmg.com/pls/us/edaff/1323465561/nur400_lps/nur400_rebpn_01_splash.html

 

Evidence-Based Treatment Practices. (2020). Retrieved from https://dualdiagnosis.org/treatment-

therapies-for-dual-diagnosis-patients/evidence-based-treatment-practices/

 

Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the Use of Evidence-Based

Practice and Research Utilization Through the Identification of Barriers to Implementation in a Critical Access Hospital. JONA: The Journal of Nursing Administration, 47(1), 56–61. doi: 10.1097/nna.0000000000000437