NURS 8114 Blog Observation of Evidence-Based Practice

NURS 8114 Blog Observation of Evidence-Based Practice

NURS 8114 Blog Observation of Evidence-Based Practice

Interdisciplinary Collaboration in Healthcare

Interdisciplinary collaboration in clinical practice reduces fragmentation and improves the quality of patient care—this outcome prompted the Institute of Medicine to include interdisciplinary collaborative patient care as one of ten tenets for redesigning and promoting better health care (Bender et al., 2013). Hospital-acquired infections (HAI) are globally recognized as a persistent health problem primarily because patients acquire them during the treatment process, resulting in unwanted expenditure (Lewis et al., 2013). Therefore, the role of a multidisciplinary team is essential towards identifying underlying patient problems that may lead to contracted infection. The proposed interdisciplinary team will consist of the DNP, a clinical nurse specialist, infection preventionist, epidemiologist, dietician, physiotherapist, and clinical pharmacist.

The role of the DNP in addressing HAI incidences in the hospital setting is crucial towards enhancing patient care outcomes. The nurse is generally considered the first point of contact with the patient and their family members (Fattirolli et al., 2018). The specific task of the nurse, in this case, will be to identify and intercept underlying risk factors, intervene in co-occurring patient conditions, and facilitate adherence to therapy. According to a study by Snowdon et al. (2014), preoperative interventions for cardiovascular patients reduce the risk of postoperative complications such as respiratory infection or failure. The emergent role of the Clinical Nurse Specialist Perioperative Certification (CNS-CP) ensures proper care for the patient before, during, and after cardiovascular surgery.

One of the most critical healthcare specialists addressing patient infections is the infection preventionist (IP), whose role is to maintain working knowledge about the core function of rapid interventions and the knowledge they offer. The IP will also determine the best technology needed to meet the demands posed by the HAI prevention program. Additionally, the IP assumes the role of early detection of infections, close surveillance of bacteremia and multidrug-resistant organisms (MDROs) and monitoring changes in antibiograms for emergent bacterial resistance (Edmiston et al., 2018). In a case where the patient is an infant or newborn, the contributions of a podiatrist would be most constructive towards establishing a pattern for infection. Similarly, a geriatrist would provide valuable insights in the event of the patient being an older adult.

The IP also closely collaborates with the healthcare epidemiologist (HE) in conducting Antimicrobial Stewardship (AS), which refers to the optimal, informed, and judicious administration of antimicrobial drugs for patients across the entire healthcare continuum—that is, from acute to long-term patient care. Moody et al. (2012) noted that the expertise and knowledge availed by highly-skilled HEs and IPs in a hospital’s AS program accelerate patient progress towards preventing MDROs. With the emergence of MDRO being associated with increased risk of HAIs, the role of AS programs promotes the discovery of infection causes whereby both the IP and HE perform surveillance activities targeting syndromes of interest, propose interventions for evidence-based practice and provide translational insights concerning infection data to administrative personnel, healthcare workers, and nurses.

Among the functional interventions afforded through postoperative care to cardiovascular patients is the need for specialized nutrition. Waitzberg et al. (2006) reported that IMPACT specialized nutrition support resulted in significantly reduced infectious complications and hospital length of stay. The study also recommended supplementing a patient’s diet with IMPACT over a period of between 5 to 7 days prior to surgery. These results thus emphasize the role of a dietician in reducing HAI incidence and preventing reoccurrence among cardiovascular patients. The dietician designs and implements a patient care regimen informed by an assessment, dietary diagnosis, a clinically informed intervention, and a scheduled reassessment ((Fattirolli et al., 2018). Conducting preoperative and postoperative dietary assessments thus provides essential insights into the importance of dietician inputs.

Another postoperative intervention for cardiovascular patients relates to physiotherapy, which serves to provide optimum regain of functional capacity and patient autonomy within the expected time. An initial assessment conducted by the physiotherapist offers information about the functional requirements, dysfunctional features, and care needs of a patient. The final assessment then verifies the initial assessment results and offers insights into factors such as patient stability, autonomy level, and perceived fatigue. Depending on the reported levels of severity and patient immobility, a number of inferences can be made in this regard. Possible interventions to promote better patient outcomes include controlled breathing exercises, strengthening the upper and lower limb muscles, reeducating patient gait, active-assisted mobility, postural gymnastics, verification of patient ability to self-manage physical exercising in the home environment, incremental aerobic training, and trained independent walking (Fattirolli et al., 2018). Physiotherapy forms part of the recovery process, which allows for faster patient discharge.

Critical to postoperative patient recovery is the type and dosage of pharmacological drugs recommended to patients at various levels of the healthcare continuum. In a study by Draxler et al. (2019), tranexamic acid (TXA) has antifibrinolytic properties, which prevent plasmin formation, thus reducing immunosuppressive outcomes. Administering TXA thus leads to a reduced frequency in the occurrence of postsurgical infections due to its supposed hemostatic properties. The role of a clinical pharmacist in establishing appropriate TXA doses, possible multi-dose options, and prescription periods. The clinical pharmacist engages in medical activities that facilitate optimized drug use and preventive interventions (Dunn et al., 2015). Through their training and experience, clinical pharmacists are capable of contributing critical pharmacy services that benefit both the interdisciplinary healthcare team and the patient.

This report was an investigation into the roles of various professionals within the interdisciplinary team towards identifying underlying causes for postsurgical cardiovascular patient infections. As the burden of intervention rests heavily on the DNP, the input of other professionals helps relieve this pressure and allows healthcare provision to be more patient-centered and informed. Integrating expertise from various professionals reduces fragmentation and allows patient care to be holistic and specialty-driven.

 

 

References

Bender, M., Connelly, C. D., & Brown, C. (2013). Interdisciplinary collaboration: The role of the clinical nurse leader. Journal of Nursing Management, 21(1), 165-174. https://doi.org/10.1111/j.1365-2834.2012.01385.x

Draxler, D. F., Yep, K., Hanafi, G., Winton, A., Daglas, M., Ho, H., Sashindranath, M., Wutzlhofer, L. M., Forbes, A., Goncalves, I., Tran, H. A., Wallace, S., Plebanski, M., Myles, P. S., & Medcalf, R. L. (2019). Tranexamic acid modulates the immune response and reduces postsurgical infection rates. Blood Advances, 3(10), 1598-1609. https://doi.org/10.1182/bloodadvances.2019000092

Dunn, S. P., Birtcher, K. K., Beavers, C. J., Baker, W. L., Brouse, S. D., Page, R. L., Bittner, V. & Walsh, M. N. (2015). The role of the clinical pharmacist in the care of patients with cardiovascular disease. Journal of the American College of Cardiology, 66(19), 2129-2139. https://www.jacc.org/doi/full/10.1016/j.jacc.2015.09.025

Edmiston, C. E., Garcia, R., Barnden, M., DeBaun, B., & Johnson, H. B. (2018). Rapid diagnostics for bloodstream infections: a primer for infection preventionists. American journal of infection control, 46(9), 1060-1068. https://doi.org/10.1016/j.ajic.2018.02.022

Fattirolli, F., Bettinardi, O., Angelino, E., da Vico, L., Ferrari, M., Pierobon, A., Temporelli, D., Agostini, S., Ambrosetti, M., Biffi, B., Borghi, S., Brazzo, S., Faggiano, P., Iannucci, M., Maffezzoni, B., Masini, M. L., Mazza, A., Pedretti, R., Sommaruga, M., Barro, S., Griffo, R., & Piepoli, M. (2018). What constitutes the ‘minimal care’ interventions of the nurse, physiotherapist, dietician and psychologist in cardiovascular rehabilitation and secondary prevention?: A position paper from the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology. European Journal of Preventive Cardiology, 25(17), 1799-1810. https://doi.org/10.1177/2047487318789497

Lewis, S. S., Moehring, R. W., Chen, L. F., Sexton, D. J., & Anderson, D. J. (2013). Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infection Control & Hospital Epidemiology, 34(11), 1229-1230. https://doi.org/10.1086/673443

Moody, J., Cosgrove, S. E., Olmsted, R., Septimus, E., Aureden, K., Oriola, S., … & Trivedi, K. K. (2012). Antimicrobial stewardship: a collaborative partnership between infection preventionists and healthcare epidemiologists. Infection Control & Hospital Epidemiology, 33(4), 328-330. https://www.jstor.org/stable/10.1086/665037

Snowdon, D., Haines, T. P., & Skinner, E. H. (2014). Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review. Journal of Physiotherapy, 60(2), 66-77. https://doi.org/10.1016/j.jphys.2014.04.002

Waitzberg, D. L., Saito, H., Plank, L. D., Jamieson, G. G., Jagannath, P., Hwang, T. L., Mijares,, J. M., & Bihari, D. (2006). Postsurgical infections are reduced with specialized nutrition support. World Journal of Surgery, 30(8), 1592-1604. https://doi.org/10.1007/s00268-005-0657-x

NURS 8114 Blog Observation of Evidence-Based Practice

As a DNP, you will have a significant voice in your health care setting to advocate for evidence-based nursing practice. 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 support evidence-based practice. 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 EBP 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 evidence-based practice in the health care organization where you practice. Drawing on your understanding of EBP and your firsthand observations within your organization, include the following content in your blog:

Week 4. Initial Post.

Evidence-based practice should consistently be implemented in healthcare settings to ensure a favorable patient outcome. Nursing knowledge of the said evidence is essential when using new evidence. Nevertheless, the application of current knowledge in clinical decision-making is hampered by a lack of support and obstacles to putting evidence-based knowledge into clinical practice. (Dagne & Beshah, 2021). Practices based on evidence encourage successful patient outcomes, lower medical expenses by averting problems, aid in the advancement of nursing science, and permit the use of modern technology in the delivery of healthcare.

In mental health/ addiction, a lot of the patients we see have issues with following their treatment plan, Medication compliance, and sobriety in general. The DNP nurse must equip themselves with evidence-based knowledge to ensure patient’s understanding of their diagnoses, treatment modalities, and coping skills to manage their symptoms and ensure their safety. Patient education and health-promoting interventions can help provide the necessary information the patient needs to stay informed and follow their treatment plan.

More than half of patients with mental health and substance use disorders experience total or partial non-adherence, which further reduces the effectiveness of drug treatments. For this reason, psychosocial rehabilitation is one of the most critical systematic efforts to support adults with psychiatric disabilities in achieving their individual goals. (Vita & Barlati, 2019).

An example of an evidence-based practice that has produced significant outcomes includes:

Cognitive-behavioral therapy (CBT) is a type of talk therapy that focuses on altering behaviors and questioning illogical thinking to help patients learn coping mechanisms for stressful circumstances.

The focus of dialectical behavior therapy (DBT) is acceptance and mindfulness.

ACT stands for Assertive and Commitment Therapy. ACT prioritizes tailored treatment plans and community involvement.

Psychotherapy is an evidence-based practice that has helped patients develop coping skills to manage mental health symptoms, abstain from substance use, and teach ways to navigate life’s stress without thoughts of hurting themselves or others.

Evaluate the overall application of evidence-based practice 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.

In the clinic where I work, we utilize effective communication to provide education to clients in a language they can understand, actively listen to the client’s concerns or dilemmas they might be facing and provide education on evidence-based interventions that help the client resolve their concerns. There are therapists in the building who are skilled in CBT, DBT, ACT, and even motivational interventions to help clients struggling with their mental health, even while on medication or sobriety.

Since many clients in recovery have cut ties with their families, the holidays can be challenging for them. During the holidays, we observe a significant risk of relapse, medication non-compliance, and even fentanyl overdose. It is advised that patients try to patch things up with their relatives. Family therapy is often established to aid in healing damaged relationships. In an effort to close the family gap over the holidays, clients whose relationships with their families are irreparably damaged are scheduled to attend Thanksgiving, Christmas, and New Year lunch and supper. Holiday lunches and dinners are intended to comfort patients throughout the holiday season as they continue their therapy sessions. Evidence-based psychotherapy has been beneficial in altering behaviors and questioning illogical thinking to help patients learn coping mechanisms for stressful circumstances. There have been improved outcomes in patient who utilize both pharmacological and psychotherapeutic treatment modalities in managing their mental health diagnoses.

Conditions that support evidence-based practice include the availability of

Information, clinical knowledge and skills and acceptance of the new evidence. (McEwen, & Wills, 2019).

Nurses favor innovative and enhanced patient care methods as long as it results in better patient outcomes. EBP can improve client outcomes, quality of care, and professional satisfaction. However, implementing EBP in client education can face common barriers, such as lack of time, resources, knowledge, skills, or support. By offering guidance and assistance in executing the novel approach, the nurse is enabled to welcome modifications. Patients who were content and willing to stick to their prescribed course of care were observed in our clinic. As the patient and family started to work on patching things up, the patient noted progress. The patient reported using the coping mechanisms they acquired in therapy in their day-to-day activities.

Describe how you can advocate for the application of evidence-based practice within your healthcare organization.

I can advocate for the application of evidence-based practice within my clinical setting by Understanding my patients’ needs and motivations.

I can provide accessible and pertinent evidence, involve other colleagues in the process, train and educate staff members on developing listening skills/abilities, track and assess the results, and Talk about the impact of the implemented intervention and the findings. (Dagne, & Beshah, 2021)

I can also advocate by researching evidence-based resources on the benefit of Psychotherapy to help meet our patients’ knowledge needs. I can ensure my patients receive the finest care possible by sending them to a skilled therapist who best suits their needs. A DNP may support a patient by providing information on medication adherence, symptoms, adverse effects, and indicators that the patient should report immediately.

In conclusion, a DNP-prepared nurse can support their patient’s mental health and safety by combining interventions that promote health, such as education, with evidence-based tools, such as psychotherapy, to ensure a positive health outcome.

• Briefly describe one specific example of evidence-based practice that produced/is producing significant patient outcomes. Or, if 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 evidence-based practice 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.

Evidence-Based Practice is a process used to review, analyze, and translate the scientific evidence. The goal is to quickly incorporate the best available research, along with clinical experience and patient preference, into clinical practice, so nurses can make informed patient-care decisions (Evidence-Based Practice, n.d.). One of the evidence-based practice that produced a significant and positive patient outcome is the amount of time treatment is activated for patients with sepsis. According to Rello and Rubulotta (2018), the Surviving Sepsis Campaign (SSC) Guidelines recommend that antibiotics be initiated within an hour as soon as sepsis or septic shock is recognized, and Institute Quality improvement recommends it to be done within three hours. At my facility we implemented that antibiotic and fluids should be administered to patients within 3 hours of sepsis or septic shock recognition. Labs should also be drawn within this time frame to start finding and treating the source.

Sepsis is the acute organ dysfunction caused by a dysregulated host response to infection, poses a serious public health burden. Current management includes early detection, initiation of antibiotics and fluids, and source control as necessary (Lewis et al., 2018). With evidence-based practice it was shown that antibiotic therapy and fluid resuscitation is very time sensitive and should be administered early in other to get a positive patient outcome. The facility formed a committee which I was one of the participants as a registered nurse to give my opinion about the practice at the bedside and how we can help educate and improve a better practice.

For the practice to be effective, nurses had to be educated on the process, we had to involve technology through the charting system to recognize suspected sepsis through the input of data, and to alert the providers in a timely manner to help aid the process. Once sepsis is identified a chain of command was implemented for patients’ immediate evaluation and assessment. There was also an order set created in the charting system that will give providers easy access to provide orders needed for the treatment in a timely manner.

Implementing changes in the healthcare can be very challenging, especially when there are multiple departments involved. We had to make sure that education was provided to all parties involved. This education had to start from patient’s entry, which is the emergency room to the time of discharge. The challenges were getting everyone on board with education and making sure the technology is working appropriately. The purpose of training and educating healthcare professionals is to ensure both individual understanding and a team approach with shared knowledge, skills, and attitudes towards the prevention (and management) of this condition (National Institute for Health and Care Excellence (NICE), 2014).

Implementing evidence-based safety practices are difficult and need strategies that address the complexity of system care, individual practitioners, senior leadership, and -ultimately- changing health care cultures to be evidence-based safety practice environment (Titler, 2008).  To advocate for application of evidence-based practice, I will continue to research the most reliable and relevant information. I’ll evaluate the evidence for its validity, reliability, and relevance to the issue researched. I will investigate the possible challenges that can affect the implementation and how to come up with the solutions. Afterwards, I’ll make sure to constantly proposed the benefit for evidence-based practice to my healthcare organization.

                                                                                            Reference

Evidence-Based practice. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/evidence-based-practiceLinks to an external site.

Rello, J., & Rubulotta, F. (2018). Best practice for sepsis. Journal of Thoracic Disease. https://doi.org/10.21037/jtd.2018.03.29

Lewis, A., Griepentrog, J. E., Zhang, X., Angus, D. C., Seymour, C. W., & Rosengart, M. R. (2018). Prompt administration of antibiotics and fluids in the treatment of sepsis: a Murine trial*. Critical Care Medicine, 46(5), e426–e434. https://doi.org/10.1097/ccm.0000000000003004

National Institute for Health and Care Excellence (NICE). (2014, April 1). Training and education of healthcare professionals. The Prevention and Management of Pressure Ulcers in Primary and Secondary Care – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK333168/Links to an external site.

Titler, M. G. (2008, April 1). The Evidence for Evidence-Based Practice Implementation. Patient Safety and Quality – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK2659/

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.

Evidence-Based Practice is a process used to review, analyze, and translate the scientific evidence. The goal is to quickly incorporate the best available research, along with clinical experience and patient preference, into clinical practice, so nurses can make informed patient-care decisions (Evidence-Based Practice, n.d.). One of the evidence-based practice that produced a significant and positive patient outcome is the amount of time treatment is activated for patients with sepsis. According to Rello and Rubulotta (2018), the Surviving Sepsis Campaign (SSC) Guidelines recommend that antibiotics be initiated within an hour as soon as sepsis or septic shock is recognized, and Institute Quality improvement recommends it to be done within three hours. At my facility we implemented that antibiotic and fluids should be administered to patients within 3 hours of sepsis or septic shock recognition. Labs should also be drawn within this time frame to start finding and treating the source.

Sepsis is the acute organ dysfunction caused by a dysregulated host response to infection, poses a serious public health burden. Current management includes early detection, initiation of antibiotics and fluids, and source control as necessary (Lewis et al., 2018). With evidence-based practice it was shown that antibiotic therapy and fluid resuscitation is very time sensitive and should be administered early in other to get a positive patient outcome. The facility formed a committee which I was one of the participants as a registered nurse to give my opinion about the practice at the bedside and how we can help educate and improve a better practice.

For the practice to be effective, nurses had to be educated on the process, we had to involve technology through the charting system to recognize suspected sepsis through the input o