NURS 8114 Blog Observation of Evidence-Based Practice Walden

NURS 8114 Blog Observation of Evidence-Based Practice Walden
RE: Week Four Blog
EBP is the integration of the best research and patient values ( Chien, 2019). In health care, we primarily focus on how we care for our patients through the use of EBP, as well as methods to improve their overall outcome. Infection control was a clinical issue addressed by EBP in my organization. As we all fight this war against COVID, we as medical professionals forget that there are other health issues that must be addressed. One thing that had been happening this past year at a hospital where I was working on a part-time basis was an increase in hospital-wide IV catheter site infections.
The IV catheter itself can be involved in four different pathogenic pathways, including skin flora colonization of the catheter tip and cutaneous tract, contamination of the catheter lumen, hematogenous seeding of the catheter from another infected site, and contamination of the catheter lumen (Marsh, Webster, Mihala, & Richard, 2018).
During the spring of 2021, at the height of the pandemic, everyone at my facility was focused on the overwhelming cases of COVID in our hospital that patients were not only suffering from respiratory issues related to COVID, but we were also beginning to see an increase in phlebitis due to peripheral vascular catheter (PVC) site infections.
Due to oversights and a lack of nursing staff to monitor IV site changes, PVC sites were exceeding the 72-hour policy that had been implemented.
The Centers for Disease Control and Prevention (CDC) guidelines for 2019 state that replacing IV catheters in adults no more than every 72 to 96 hours is not necessary, but the CDC does not specify when the catheters should be replaced.
According to the guidelines, the recommendation that a catheter be replaced only for clinical indications is a “unresolved issue” for adult patients.
The CDC recommends replacement for children only when clinically indicated.
Many hospitals have protocols requiring IV catheter replacement every 72 to 96 hours, regardless of clinical indication (CDC, 2019).
Our facility’s policy is to change sites every 72 hours, and it had been working well until focus was lost.
Patients had kept PVC for up to 14 days if there was visible redness, swelling, or infiltration at the site.
EBP is important to follow in this situation because it demonstrated that our organization had not had a case of PVC site infection in over 5 years, then we suddenly had 18 cases in a 3 month span.
When the organization realized that the number of PVC site infections had significantly increased due to the overwhelming circumstances, it was a wake-up call to everyone that, despite the overwhelming cases of COVID, it was critical to continue monitoring and performing quality control measures.
As a DNP prepared nurse, it is critical to practice using EBP in order to educate other health care professionals about the importance of maintaining quality control measures and focusing on providing safe and quality care.
Policy implementation and infection control prevention are critical to minimizing issues such as PVC site infections.
To ensure that these methods are used consistently in daily practice, it is necessary to work collaboratively with other health care professionals and facility management.
References
Centers for Disease Control and Prevention. 2019 guidlines for the prevention of intravasular catheter-related infections. Available at:
https://www.cdc.gov/hicpac/BSI/references-BSI-guidelines-2019.html. Accessed September 20, 2021. [Google Scholar].
Chien, L. Y. (2019). Evidence-Based Practice and Nursing Research. The Journal of Nursing Research: JNR, 27(4),e29.https://doi.org/10.1097/jnr.00000000000346
Marsh, N., Webster, J., Mihala, G., & Richard, C. M. (2018). Devices and dressings to secure peripheral venous catheters to prevent complications.
As a DNP, you will have a significant voice in your health care setting to . Understanding how evidence can inform better nursing care and patient outcomes is fundamental to successful advocacy, as are examples of where, why, and how evidence-based practice is needed.
Photo Credit: steheap / Adobe Stock
For this activity, you will essentially observe for evidence to . You will write and post a blog in which you identify examples of evidence-based practice in your health care organization and/or examples of need for application of evidence-based practice. Although the blog functions like a Discussion Board, the aim is to be somewhat more informal in sharing your perspectives. Colleagues will respond to your blog, as you will respond to theirs.
To prepare:
Review the Learning Resources, particularly the chapter on evidence-based practice from McEwen and Wills, and readings in the White, Dudley-Brown, and Terhaar text.
With your understanding of evidence-based practice in mind, observe for examples of evidence-based practice (EBP) in the health care organization where you practice, and/or examples of nursing practice that are tradition bound and lack an evidence base.
Consider conditions that support within health care organizations and recommendations for application of EBP.
With these thoughts in mind …
By Day 3 of Week 4
Post a blog on the topic of. Drawing on your understanding of EBP and your firsthand observations within your organization, include the following content in your blog:
Briefly describe one specific example of evidence-based practice that produced/is producing significant patient outcomes. Or, if
NURS 8114 Blog Observation of Evidence-Based Practice Walden
you are lacking examples, describe a recent patient experience that might have been improved through application of evidence-based practice. Explain your reasoning. Note: To maintain confidentiality, do not refer to individuals by name or with identifying details.
Evaluate the overall application of within your health care organization, including conditions that support it or roadblocks to overcome. Explain your reasoning, including how you have arrived at your conclusions.
Describe how you can advocate for application of evidence-based practice within your health care organization.
Read a selection of your colleagues’ blogs.
By Day 6 of Week 4
Respond to at least two of your colleagues on 2 different days. Compare their observations and evaluations of EBP in their health care organizations with your own and offer recommendations for advancing EBP or identify suggestions you will apply in your own practice setting.
Week 4: Evidence-Based Practice, Quality Improvement, and Implementation Science: Interrelationships
From your experience as a registered nurse or APRN, how does change occur in a health care setting? How do outdated protocols get updated or the actual root cause of a persistent problem get uncovered and resolved?
You may have answers that speak to the commitment of health care organizations to continually improve. You may also have examples that demonstrate the inherent challenges in any change initiative. If only change were as clear and quick as striking a key. Rather, it requires a whole series of figurative keystrokes and, depending on the setting, may seem as though the whole world needs to be onboard.
This week you will explore a particular set of keys to quality improvement in health care. It involves reliance on science for evidence to inform nursing practice and implementation that makes sense to practitioners and patients. Your getting-started activities will include observing for and blogging about evidence-based practice, and looking for health care settings in your locale for investigating needs and acceptance of practice change.
Learning Objectives
Students will:
Evaluate application of evidence-based practice in health care organizations
Analyze approaches to advocacy of evidence-based practice in health care organizations
Compare health care settings for quality improvement projects
Justify practice problems for quality improvement
Analyze site and stakeholder requirements for quality improvement projects in nursing practice settings
Compare stakeholder requirements for quality improvement projects across nursing practice settings
Apply implementation science frameworks/models for evidence-based practice quality improvement projects
Learning Resources
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare (3rd ed.). Springer.
Chapter 1, “Evidence-Based Practice” (pp. 3–25); for reading about the PET model, focus on pp.14–16
Chapter 2, “The Science of Translation and Major Frameworks” (pp. 27–58)
Chapter 8, “Methods for Translation” (pp. 185–187 Quality Improvement and RCPI)
Chapter 9, “Project Management for Translation” (pp. 199–228)
Dang, D., & Dearholt, S. L. (Eds.). (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International.
Chapter 5, “Searching for Evidence” (pp. 79–96)
Note: The survey findings can be used to explore relationships between nursing attitudes concerning QI and other organizational characteristics such as QI environment.
Walden University. (2011). An evidence-based practice model [Video]. Author.
Translation text lead author Kathleen White discusses the PET model.
Accessible player
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Points Range: 5 (8.33%) – 5 (8.33%)
Written clearly and concisely.
Contains no grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
Points Range: 4 (6.67%) – 4 (6.67%)
Written concisely.
May contain one to two grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
Points Range: 3 (5%) – 3 (5%)
Written somewhat concisely.
May contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
Points Range: 0 (0%) – 2 (3.33%)
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Posting:
Timely and full participation
Points Range: 9 (15%) – 10 (16.67%)
Meets requirements for timely, full, and active participation.
Posts main Blog post by due date.
Points Range: 8 (13.33%) – 8 (13.33%)
Posts main Discussion by due date.
Meets requirements for full participation.
Points Range: 7 (11.67%) – 7 (11.67%)
Posts main Blog post by due date.
Points Range: 0 (0%) – 6 (10%)
Does not meet requirements for full participation.
Does not post main Blog post by due date.
First Response:
Post to colleague’s main post that is reflective.
Points Range: 9 (15%) – 9 (15%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
Points Range: 8 (13.33%) – 8 (13.33%)
Response has some depth and may exhibit critical thinking or application to practice setting.
Points Range: 7 (11.67%) – 7 (11.67%)
Response is on topic and may have some depth.
Points Range: 0 (0%) – 6 (10%)
Response may not be on topic and lacks depth.
First Response:
Writing
Points Range: 6 (10%) – 6 (10%)
Communication is professional and respectful to colleagues.
Response fully answers faculty questions, if posed.
Provides clear, concise opinions and ideas.
Response is effectively written in standard, edited English.
Points Range: 5 (8.33%) – 5 (8.33%)
Communication is mostly professional and respectful to colleagues.
Response mostly answers faculty questions, if posed.
Provides opinions and ideas.
Response is written in standard, edited English.
Points Range: 4 (6.67%) – 4 (6.67%)
Response posed in the Blog may lack effective professional communication.
Response somewhat answers faculty questions, if posed.
Points Range: 0 (0%) – 3 (5%)
Responses posted in the Blog lack effective communication.
Response to faculty questions is missing
First Response:
Timely and full participation
Points Range: 5 (8.33%) – 5 (8.33%)
Meets requirements for timely, full, and active participation.
Posts by due date.
Points Range: 4 (6.67%) – 4 (6.67%)
Meets requirements for full participation.
Posts by due date.
Points Range: 3 (5%) – 3 (5%)
Posts by due date.
Points Range: 0 (0%) – 2 (3.33%)
Does not meet requirements for full participation.
Does not post by due date.
Second Response:
Post to colleague’s main post that is reflective.
Points Range: 9 (15%) – 9 (15%)
Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty.
Points Range: 8 (13.33%) – 8 (13.33%)
Response has some depth and may exhibit critical thinking or application to practice setting.
Points Range: 7 (11.67%) – 7 (11.67%)
Response is on topic and may have some depth.
Points Range: 0 (0%) – 6 (10%)
Response may not be on topic and lacks depth.
Second Response:
Writing
Points Range: 6 (10%) – 6 (10%)
Communication is professional and respectful to colleagues.
Response fully answers faculty questions, if posed.
Provides clear, concise opinions and ideas.
Response is effectively written in standard, edited English.
Points Range: 5 (8.33%) – 5 (8.33%)
Communication is mostly professional and respectful to colleagues.
Response mostly answers faculty questions, if posed.
Provides opinions and ideas.
Response is written in standard, edited English.
Points Range: 4 (6.67%) – 4 (6.67%)
Response posed in the Blog may lack effective professional communication.
Response somewhat answers faculty questions, if posed.
Points Range: 0 (0%) – 3 (5%)
Responses posted in the Blog lack effective communication.
Response to faculty questions is missing.
Second Response:
Timely and full participation
Points Range: 5 (8.33%) – 5 (8.33%)
Meets requirements for timely, full, and active participation.
Posts by due date.
Points Range: 4 (6.67%) – 4 (6.67%)
Meets requirements for full participation.
Posts by due date.
Points Range: 3 (5%) – 3 (5%)
Posts by due date.
Points Range: 0 (0%) – 2 (3.33%)
Does not meet requirements for full participation.
Does not post by due date.
Total Points: 60
Name: NURS_8114_Week_4_Blog
I like reading your post and want to add to the prevention of catheter-associated urinary tract infection (CAUTI). Urinary tract infection attributed to an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities (Nicolle 2014). The single most important intervention to prevent CAUTI is to avoid the use of an indwelling urinary catheter. A patient who is acutely ill needs hourly monitoring of urine output (Nicolle 2014). In our hospital, in addition to output monitoring, intermittent catheterization is used if post-void residue (PVR) is more significant than 200 ml and the patient is unable to void. Post void residue (PVR) is done every 4 hours to check for retention. For incontinent patients and are bed-bound, a condom catheter is used to prevent skin breakdown in men. Nicolle (2014) also affirmed that alternate voiding management strategies such as intermittent catheterization or, for men, external condom catheters should be used when possible.
Other key interventions include conducting a daily assessment of an indwelling urinary catheter (Saint et al. 2016) and avoiding the use of an indwelling urinary catheter by considering alternative urine-collection methods, such as intermittent straight catheterization, emphasizing the importance of aseptic technique during insertion of a catheter and proper maintenance after insertion (Saint et al. 2016). However, each hospital unit could tailor these interventions to the specific circumstances of the unit (Saint et al., 2016). Additional recommended interventions include providing feedback to the units’ nurses and physicians on catheter use and catheter-associated UTI rates and providing training to address any identified gaps in knowledge about urinary management processes (Saint et al., 2016).
Infection control programs must develop, implement, and monitor policies and practices to minimize infections associated with the use of these devices (Nicolle 2014). Institutional policies should also minimize perioperative catheter use by promoting early post-procedure catheter removal and monitoring of bladder volume with ultrasound bladder scanners, where available, to limit catheter reinsertion for potential urinary retention. When a catheter is indicated, it should be removed once it is no longer required (Nicolle 2014).
References
Nicolle L. E. (2014). Catheter-associated urinary tract infections. Antimicrobial resistance and infection control, 3, 23. .
Saint, D., Krein, S., Roger, M., Ratz, D., Fowler, K., Greene, T., … & Edison, B., (2016). A Program to prevent catheter-associated urinary tract infection in acute care. New England Journal of Medicine, 374, 2111-2119. DOI: 10.1056/nejmoa1504906