This essay will show the importance of understanding by nurses their great role in utilization of evidence-based practices. They can improve their working process, provide more effective and efficient treatment to patients, participate in development of new treatment methodologies, and challenge the effectiveness of the existing ones. Much attention is devoted to the necessity of understanding different research methods of evidence-based practices. Several examples of successful implementation of these practices in different countries are described in this essay too.
Application of evidence-based practices is considered as a use of the existing evidences for making decisions and realizing these decisions in health care providing. Health care providers perform systematic investigations of different clinical challenges and issues. Much attention is focused on supporting the existing theories or developing new ones, which are more effective and efficient. Evidence-based practices provide assessment of performed investigations and obtained outcomes together with development and successful implementation of gained knowledge (Koschel, 2013).
Evidence-based practices help nurses eliminate unnecessary procedures, successfully implement their knowledge for increasing effectiveness of patients’ treatment, and improve their understanding of health care providing procedures. These practices also provide additional skills and competence in increasing quality and safety of treatment. Continuous improvement of competence is strengthening . collaboration among health care providers and their awareness. Implementation of evidence-based practices helps nurses to clearly formulate questions concerning health care providing; use different ways for searching answers to these questions; thoroughly analyze obtained information, by using several sources of information, previous knowledge, and personal experience; and determine the most suitable time and way of implementing new findings into their working process. Evidence-based practices help nurses eliminate possibility of medical mistakes and negative outcomes of patients’ treatment. Reduction of variation in nursing care leads to improvement of health care providing and decrease in time of treatment.
Nurses widely participate in different medical researches and procedures, in assessment of effectiveness and efficiency of new and the existing treatment methodologies. The knowledge concerning treatment of patients and prevention of diseases should be constantly updated and improved, especially in case of curative medicine, in order to regularly enhance quality of health care providing. Also, it should be noted that constant assessment of previous evidences “may shoe that treatments generally recognized as useful are not or may even be dangerous and so should no longer be used” (Carter, 2000).
They bring up important treatment questions, which restrain successful patients’ treatment, and use treatment evidences as backgrounds of their practices. Nurses share their experience with colleagues and other members of health care teams. So, they need to have strong knowledge, superior skills, wide experience, and understanding of utilized evidence-based practices.
Necessity of Understanding of Research Methods in Implementation of Evidence-Based Practices
Health care providers perform randomized controlled trials, a great variety of experiments in scientific laboratories, epidemiological researches, quantitative and qualitative assessment investigations, clinical trials, and inductive reasoning. The most relevant outcomes are obtained by applying different research methods simultaneously, i.e. outcomes achieved after application of one method are confirmed by outcomes achieved after application of the other method. Nurses should clearly understand different research methods to correctly perform valid investigations and reasonable assessment of obtained outcomes.
Evidence-based practice is based on application of the following two methods: a qualitative method and quantitative method. Nurses should clearly understand and be able to perform quantitative summary and assessment of obtained statistical information, and to compare it with outcomes of previous investigations. According to the Carter,
these actions include the use of relative and absolute risk in studies of causation and adverse effects, calculation of the incremental benefit of additional diagnostic tests and estimation of the number needed to be treated to secure one more favorable outcome in reviews of therapy. (Carter, 2000).
If nurses do not get enough knowledge and skills for carrying out the above mentioned actions, they will be unable to make a quantitative analysis and obtain relevant results. So, their actions can be useless and even harmful as they may lead to obtaining wrong outcomes.
Additionally, nurses should know how to use and apply the qualitative method of evidence-based practice. This method is applied to entities that cannot be measured or calculated. The qualitative method is performed though questionnaires, discussions, and interviews of patients, which enable investigation of patients’ feelings and experiences related to health care providing. Nurses should be aware of ways to perform interviews and questionnaires: what questions should be asked, how they should be asked, how to stipulate patients’ pliability etc. Any obtained information should be documented in a proper way in order to save it for future analysis. Nurses should also mention time, gender, age, and physical conditions of interviewed patients because this information can be crucial for the performed investigation.
Utilization of Evidence-Based Practices in Different Countries All Over the World
This essay will provide description of successful implementation of evidence-based practices for different purposes in different health care providing institutions all over the world.
The first example is application of evidence-based practice in Hamilton Health Sciences hospital in Ontario, Canada. This hospital contains 1100 beds and more than 2 million people receive health care providing services in this hospital (Mohide, 2003). Over 2800 nurses work there as full-time or part-time employees (Mohide, 2003). The Nursing Practice Committee of the hospital decided to implement evidence-based practice by direct care nurses. This evidence-based practice was based on the use of chlorhexidine that was considered to be “more effective skin antiseptic than 2 other cleansing agents in preventing probable peripheral intravenous catheter related infection” (Mohide, 2003). This information was thoroughly checked. The Nursing Practice Committee studied numerous researches, which confirmed the effectiveness of this medication. Additional investigations were performed by health care providers who worked in Hamilton Health Sciences hospital. A special questionnaire was developed and introduced to nurses. Over 300 nurses provided their responses to these questions. The investigation has shown that more than three quarter of nurses use chlorhexidine “for asepsis before intravenous initiation” and about 40 per cent of nurses use this medication for “asepsis before venipuncture (where alcohol was the prescribed aseptic agent)” (Mohide, 2003). This evidence-based practice was based on quantitative analysis of outcomes. This investigation leads to a wider use of chlorhexidine by direct care nurses and incorporation of information about high efficiency of this medication in health care providing educational process. Moreover, this investigation of chlorhexidine and obtained outcomes were presented on HHS nursing conference.
One more example of implementation of evidence-based practice in Ontario, Canada that relates to work of nurses concerns mobility of health care providers and cross principal registration. According to Regulated Health Professions Act, health professionals, including nurses, should develop and implement procedures directed at assuring high quality of health care providing and constantly increasing competency. That is why, the College of Nurses in Ontario has developed a program that enables more than 100,00 nurses to take part in a reflection process concerning clinical experience each year (Nurs, 1999). This program consists of the following procedures: nurses’ self-assessment, peer feedback about the quality of work, development of a learning plan, realization of this plan, assessment of learned information.
In Australian hospitals, evidence-based practice in nursing is used for improving venous thromboembolism prophylaxis treatment, also known as VTE treatment. Nurses are engaged in analysis of possibility of VTE risks. More than 15,000 patients are affected by VTE each year (Colins, 2010). It leads to more than 5,000 deaths annually (Colins, 2010). Morbidity among patients is reflected in chronic oedema, recurrent venous ulceration, and pain. It is notable that the possibility of VTE development can be reduced up to 80 per cent by timely “prophylaxis using anticoagulants and/or mechanical devices such as compression stockings or intermittent pneumatic compression” (Colins, 2010). So, effective and efficient development and timely implementation of evidence-based practice by Australian nurses can lead to elimination of VTF diseases in hundreds of patients.
The first step in developing evidence-based practices is investigation of the most susceptible patients. They are medical patients, like patients with active form of cancer, chronic lung disease, people over 60 years old, and etc, and surgical patients, for example, patients with major traumas and patients with surgery over 45 years old. Also, the risk of VTE can be increased by such factors as obesity, pregnancy, and advanced maternal age (Colins, 2010). Nurses should know that the above mentioned groups of patients have higher risk of VTE and require more serious attention and treatment.
The effective and timely VTE risk assessment by nurses is based on the following factors: paying attention to the patient’s clinical condition, probability of prophylaxis, and possible bleeding risk. Different pharmaceutical agents, like low molecular weight Heparin and Dabigatran, decrease VTE risk. Also, it can be lowered by use of different mechanical devices, for example, Graduated Compression Stockings. According to official investigations performed in the UK, this mechanical device decreases VTE risk on more than 50 per cent (Colins, 2010). These investigations lead to the development special VTE prevention guidelines for nurses to decrease VTE risks. These guidelines help nurses recognize high VTE risk patients and provide them with effective and efficient treatment
This essay provides description of the important role of nurses in developing and realizing evidence-based practices in health care providing. Nurses can improve the quality of provided treatment, increase the rate of successful prevention of numerous diseases, successfully participate in clinic investigations, and ameliorate the existing health care providing methodologies. Nurses should clearly understand both quantitative and qualitative research methods of evidence-based practice to successfully implement these methods and obtain relevant outcomes. This essay provides examples of realization of evidence-based practices in hospitals of Canada and Australia.