Nursing Evidence-Based Practice Quiz

Evidence-Based Practice in Nursing

• Evidence-Based Practice (EBP) integrates clinical expertise, current best evidence, and patient values to provide high-quality care.
• EBP is essential for improving patient safety and outcomes, encouraging up-to-date knowledge, supporting professional development, and bridging the research-practice gap.
• Florence Nightingale's use of data during the Crimean War is considered an early example of EBP practice.
• The evolution of EBP in nursing began in the 1970s, emphasizing research-based practices.

Nursing Knowledge

• Knowledge is awareness of reality acquired through learning and investigation.
• Individuals build a knowledge base by collecting, organizing, and arranging facts relevant to their personal experiences.
• Traditional knowledge is passed down through generations, often practiced without a specific, researched rationale, however nurses describe it as "we've always done it this way."
• Authoritative knowledge comes from experts based on their perceived expertise, such as a senior nurse teaching a procedure.
• Scientific knowledge derives from the scientific method and research, testing new ideas with objective criteria.

Steps of Evidence-Based Practice

• 1. Ask a clinical question: Clinical questions should reflect patient care and identify areas needing clarification. Specific questions, such as "how long have you had pain?", are valuable.
• 2. Collect the best evidence: EBP involves searching for evidence in various databases like AHRO, CINAHL, MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, National Guidelines Clearinghouse, PubMed, and Worldviews on Evidence-Based Nursing. Google Scholar is also a helpful resource.
• 3. Critically appraise the evidence: Nurses need to ensure the evidence collected is accurate, reliable and applicable. Appraising the evidence critically means asking questions like “is this information accurate?” "Is this information reliable?" and "will this information work for my patient?"
• 4. Integrate the evidence: This involves incorporating research findings into patient care plans. This is commonly done by considering a standard nursing process steps such as assessment, diagnosis, planning, implementation and evaluation.
• 5. Evaluate the practice decision or change: The impact of using new or revised evidence-based practices needs to be assessed. Measuring the impact allows for feedback and adjustments to the plan of care.
• 6. Share the outcomes of EBP changes with others: Sharing outcomes improves nursing practice by disseminating successful practice changes and fostering collaboration.

Barriers to Evidence-Based Practice in Nursing

• Lack of EBP skills and knowledge
• Misperceptions or negative attitudes toward research and EBP
• Lack of belief that EBP improves patient outcomes
• Overwhelming amount of information available
• Lack of time or resources to appraise evidence
• Overwhelming patient loads, or increased demands of practice
• Organizational constraints and lack of administrative support
• Lack of mentorship and resources
• Demands placed on nurses related to specific types of patient care.

Overcoming Barriers to EBP

• Provide EBP training programs
• Ensure administrative support
• Encourage a culture of continuous improvement

Future of EBP in Nursing

• Integration of Artificial Intelligence (AI) in evidence appraisal
• Focus on global health challenges
• Enhance patient participation in decision-making

Conclusion

• Evidence-Based Practice (EBP) is essential for improving patient care, advancing nursing practice, and ensuring healthcare sustainability.

Case: Managing a Feverish Child

• Patient: An 8-year-old boy with fever, fatigue, and loss of appetite.
• Situation: Manage the fever using best methods. Currently recommendations are plenty of fluids and cool compresses.
• Simple Discussion Questions: Discuss priorities for intervention, benefits and limitations of using cool compresses, and additional fever-reducing methods aside from paracetamol.

Benefits and Limitations of Using Cold Compresses

• Benefits: Reduce fever by increasing heat loss; reduce pain related to inflammation; reduce swelling. Easy and affordable.
• Limitations: Temporary effect, risk of incorrect application (leading to damage or hypothermia), ineffective against the underlying cause of fever, and can be uncomfortable for individuals with sensitive skin.

Alternative Methods to Reduce Fever

• Lukewarm Bath or Wiping
• Maintaining a Cool Environment
• Ensuring Hydration
• Light Clothing
• Cold Compress or Damp Cloth
• Proper Rest in the Right Position
• Herbal Remedies (consult a doctor)
• Seeking medical advice if fever is above 39°C or persists.

EBP Case example

• Population: Adult inpatients at risk for pressure ulcers.
• Intervention: Air-fluidized mattress
• Comparison: Foam-mattress overlays
• Outcome: Pressure ulcer rates
• Time: Short term (months)
• PICO Question: Is air-fluidized mattress use related to fewer pressure ulcers than foam-mattress overlays?
• Finding (from research): Level I systematic review findings suggest no evidence that air-fluidized mattresses are better than foam overlays for preventing pressure ulcers.
• Recommendation: Do not purchase air-fluidized mattresses.