Evidence based practice in registered nurse and critical care (Part-2)

Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence.

In an observation of Swedish Researchers, it has been found that the country needs old age critical care under RNs with EBP. The RNs working in the care of older people are not only accountable for planning the care of the older person, they are also expected to provide leadership for nurse aides and promote quality improvement and EBP.

The importance of EBP in RN earned utmost recognition in Japan though it has not been applied and  expanded accordingly. Chiyo Matsuoka, PhD Department of Nursing, Bukkyo University, Kyoto, and her team of Nursing leaders and scientists, explores knowledge and strategy to promote and implement EBP. An initiative developed with the goal of applying EBP models and resources to fit health care and nursing care in Japan. The Iowa Model was selected as the framework. The EBP Implementation Guide and book with resources and tools provided direction for application. An approach that can be beneficial is developing strategic partnerships among practice and academics.

The partnership built upon existing expertise to expand application of EBP in academic and practice settings across Japan. Educational programs focused on application in both academia and practice settings. Program reach built upon recognized experts among the Japanese nursing community. Discussions built a collaboration that could function through open sharing of resources. A key deliverable is development of a Japanese translation of resources for application of EBP (Chiyo Mutsuoka et al ; 2017) This process is on going  is on-going and next steps include the implementation and evaluation of the intervention study which adopted the EBP process in clinical nursing research for the chief nurses and staff nurses.

Connection between health professionals’ implementation of EBP and beliefs about the value of EBP and their confidence in implementing EBP into practice, organizational culture, group cohesion and job satisfaction in a community hospital system in the US has been scrutinized by Melnyk and her team. Supportive leadership is identified as being strongly associated with EBP practice in several studies.

In the United States, the National Institute of Nursing Research (NINR) at NIH is a major source of supporting clinical and basic research necessary to approach scientific clinical practice; the prevention of disease and disability; the management and elimination of symptoms caused by illness, and the enhancement of end-of-life and palliative care. Increasingly, the engagement of patients as active participants in their own health and health care provides a significant opportunity for nurses in preventing the development of chronic diseases. NINR’s research agenda targets the special needs of at-risk, vulnerable, and underserved populations with particular emphasis on eliminating health disparities and promoting health equity.

Regarding the point of linking the evidence to action in EBP, and Melnyk and her team pointed exactly what we need to tell about EBP: “There is a tremendous need to enhance nurses’ skills so that they achieve competency in EBP in order to ensure the highest quality of care and best population health outcomes. Academic programs should ensure competency in EBP in students by the time of graduation and healthcare systems should set it as an expectation and standard for all clinicians”.

The barriers can be addressed as bellow in general.

Time limitation,

Insufficient training

Limited Knowledge on the subject

Insufficient scope and ability of research

Lack of international environment training

Underestimation from society

Underestimation from Doctors, hospital management

Lack of family support and economic barrier.

Discussion  

It has been proved in many ways that EBP in nursing improves the patient care quality and outcomes. Unfortunately it has been found from the records that this practice has not been well distributes and involved in patient care systems worldwide. There are countries in variation applying this method to the healthcare system.

The developed countries are being strongly tried by their nursing leaders, expertise and scientists to apply EBP as much as possible and they have opened broad research gates to welcome the scientific and practical method to expand EBP.

For the developing countries, the nurses are struggling with their hospital management, social stigma, family plights, economic barrier, ‘too many patients -few nurses ratio, their own healthcare settings, time constrains, underestimations from doctors, and poor scopes for research.  It has been said that, ‘how nurses rate their own skills in finding, assessing and using evidence seems to be an important factor to consider in implementing evidence-based practice’.

The Internet has become an important tool for gathering information. There are many many documents, research articles, Nursing databases, journals and discussion in the workshops, seminars and conferences, which can be a titanic source of nursing research.

Winning Over the Barriers:

Overcoming the identified barriers asserts most effective evidence based practice for the registered professional nurses.  

 Pragmatic and experimental evidence determines kind of information that obtained through overall observation and experimentation, originating from research and professional nursing practice. The RN can practice this profusely; these evidences are sufficiently found in published documents with background information, methods, findings, and discussion and explanations of how the results may be used in practice. ‘The use of technology to promote EBP through mobile devices, simulation, and the web is on the rise and web-based educational platforms have been demonstrated as an effective and desirable mechanism to deliver educational content to health professionals.’

A group of researchers of the Ohio State University  contemplates that  competencies for RNs range from questioning clinical practices for the purpose of improving quality of care, critically appraising published research, and collecting and tracking outcomes data that can support the continued use of newly adopted practices.

Nurses have the ability to influence patient-care outcomes by using their nursing knowledge and skills, their individual understanding of ethical principles, the nurse-patient and nurse-healthcare team relationships they establish, and good communication skills. An understanding of ethical principles, such as autonomy, beneficence, and justice, is used by nurses in all aspects of caring; respect and honesty established within the nurse-patient relationship positively influence the actions and behaviors of others.

The individual experiences of caring the patient can determine the interpersonal relationship of nursing. The relationship may be short or long that should be based on enhancing healing capacity of the patient. Knowing about Patients’ behavior and life history encompasses Aesthetic knowledge and that can be used by the RNs to heal the patient in right way.

 

The society and state should support RN professional and the Nursing Education by solving the identified problem in association with the social, economic perspective in relation to the nursing profession.

In addition, to win over the barriers we have to focus on:

Providing care on the basis of the best available evidence or best practice

Acquiring knowledge and skills for safe and effective practice

Trying to work within the limit of one’s capacity or ability

Work within the limits of one’s knowledge

Continuing studies and research to grab the last updated information

 Associating oneself in appropriate learning and practice activities in order to that maintain and develop performance

Involving oneself for the best EBP nursing care: literature review, knowledge of research, ability to reflect on practice and critical appraisal skills, quick decision making on critical time

Conclusion

  Evidence-based practice in nursing, approaches to high quality patient care with a combined use of clinical research and clinical experience, and understanding patient distinguishable disease feature and implementation of EBP. The Nurses are the best important community in the earth and an indispensable part of the health profession. They deal with care giving. Evidence Based Practice in nursing and critical care nursing adds values to the profession immensely. There are many obstacles worldwide for the RNs to Practice Evidence Based Nursing due to many systematic healthcare and own setting system of the hospitals, poor scopes research, socio-economic conditions of the nurses.

A professional registered nurse wants the same many things of what a patient and the relatives of the patient want from a nurse. The society and we all should receive nurses and their loftiest duties with more love and generosity; it will encourage the mind of a nurse for further education and applying that practically. It will support them in peace to apply all their knowledge in proper way and in proper situation in relation to patient care. The society must love nurses because they are doing the best part for the mankind and civilization.  (Concluded)

 

Evidence based practice in registered nurse and critical care (Part-2)

Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurses age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. In an observation of Swedish Researchers, it has been found that the country needs old age critical care under RNs with EBP. The RNs working in the care of older people are not only accountable for planning the care of the older person, they are also expected to provide leadership for nurse aides and promote quality improvement and EBP. The importance of EBP in RN earned utmost recognition in Japan though it has not been applied and expanded accordingly. Chiyo Matsuoka, PhD Department of Nursing, Bukkyo University, Kyoto, and her team of Nursing leaders and scientists, explores knowledge and strategy to promote and implement EBP. An initiative developed with the goal of applying EBP models and resources to fit health care and nursing care in Japan. The Iowa Model was selected as the framework. The EBP Implementation Guide and book with resources and tools provided direction for application. An approach that can be beneficial is developing strategic partnerships among practice and academics. The partnership built upon existing expertise to expand application of EBP in academic and practice settings across Japan. Educational programs focused on application in both academia and practice settings. Program reach built upon recognized experts among the Japanese nursing community. Discussions built a collaboration that could function through open sharing of resources. A key deliverable is development of a Japanese translation of resources for application of EBP (Chiyo Mutsuoka et al ; 2017) This process is on going is on-going and next steps include the implementation and evaluation of the intervention study which adopted the EBP process in clinical nursing research for the chief nurses and staff nurses. Connection between health professionals implementation of EBP and beliefs about the value of EBP and their confidence in implementing EBP into practice, organizational culture, group cohesion and job satisfaction in a community hospital system in the US has been scrutinized by Melnyk and her team. Supportive leadership is identified as being strongly associated with EBP practice in several studies. In the United States, the National Institute of Nursing Research (NINR) at NIH is a major source of supporting clinical and basic research necessary to approach scientific clinical practice; the prevention of disease and disability; the management and elimination of symptoms caused by illness, and the enhancement of end-of-life and palliative care. Increasingly, the engagement of patients as active participants in their own health and health care provides a significant opportunity for nurses in preventing the development of chronic diseases. NINRs research agenda targets the special needs of at-risk, vulnerable, and underserved populations with particular emphasis on eliminating health disparities and promoting health equity. Regarding the point of linking the evidence to action in EBP, and Melnyk and her team pointed exactly what we need to tell about EBP: There is a tremendous need to enhance nurses skills so that they achieve competency in EBP in order to ensure the highest quality of care and best population health outcomes. Academic programs should ensure competency in EBP in students by the time of graduation and healthcare systems should set it as an expectation and standard for all clinicians. The barriers can be addressed as bellow in general. Time limitation, Insufficient training Limited Knowledge on the subject Insufficient scope and ability of research Lack of international environment training Underestimation from society Underestimation from Doctors, hospital management Lack of family support and economic barrier. Discussion It has been proved in many ways that EBP in nursing improves the patient care quality and outcomes. Unfortunately it has been found from the records that this practice has not been well distributes and involved in patient care systems worldwide. There are countries in variation applying this method to the healthcare system. The developed countries are being strongly tried by their nursing leaders, expertise and scientists to apply EBP as much as possible and they have opened broad research gates to welcome the scientific and practical method to expand EBP. For the developing countries, the nurses are struggling with their hospital management, social stigma, family plights, economic barrier, too many patients -few nurses ratio, their own healthcare settings, time constrains, underestimations from doctors, and poor scopes for research. It has been said that, how nurses rate their own skills in finding, assessing and using evidence seems to be an important factor to consider in implementing evidence-based practice. The Internet has become an important tool for gathering information. There are many many documents, research articles, Nursing databases, journals and discussion in the workshops, seminars and conferences, which can be a titanic source of nursing research. Winning Over the Barriers: Overcoming the identified barriers asserts most effective evidence based practice for the registered professional nurses. Pragmatic and experimental evidence determines kind of information that obtained through overall observation and experimentation, originating from research and professional nursing practice. The RN can practice this profusely; these evidences are sufficiently found in published documents with background information, methods, findings, and discussion and explanations of how the results may be used in practice. The use of technology to promote EBP through mobile devices, simulation, and the web is on the rise and web-based educational platforms have been demonstrated as an effective and desirable mechanism to deliver educational content to health professionals. A group of researchers of the Ohio State University contemplates that competencies for RNs range from questioning clinical practices for the purpose of improving quality of care, critically appraising published research, and collecting and tracking outcomes data that can support the continued use of newly adopted practices. Nurses have the ability to influence patient-care outcomes by using their nursing knowledge and skills, their individual understanding of ethical principles, the nurse-patient and nurse-healthcare team relationships they establish, and good communication skills. An understanding of ethical principles, such as autonomy, beneficence, and justice, is used by nurses in all aspects of caring; respect and honesty established within the nurse-patient relationship positively influence the actions and behaviors of others. The individual experiences of caring the patient can determine the interpersonal relationship of nursing. The relationship may be short or long that should be based on enhancing healing capacity of the patient. Knowing about Patients behavior and life history encompasses Aesthetic knowledge and that can be used by the RNs to heal the patient in right way. The society and state should support RN professional and the Nursing Education by solving the identified problem in association with the social, economic perspective in relation to the nursing profession. In addition, to win over the barriers we have to focus on: Providing care on the basis of the best available evidence or best practice Acquiring knowledge and skills for safe and effective practice Trying to work within the limit of ones capacity or ability Work within the limits of ones knowledge Continuing studies and research to grab the last updated information Associating oneself in appropriate learning and practice activities in order to that maintain and develop performance Involving oneself for the best EBP nursing care: literature review, knowledge of research, ability to reflect on practice and critical appraisal skills, quick decision making on critical time Conclusion Evidence-based practice in nursing, approaches to high quality patient care with a combined use of clinical research and clinical experience, and understanding patient distinguishable disease feature and implementation of EBP. The Nurses are the best important community in the earth and an indispensable part of the health profession. They deal with care giving. Evidence Based Practice in nursing and critical care nursing adds values to the profession immensely. There are many obstacles worldwide for the RNs to Practice Evidence Based Nursing due to many systematic healthcare and own setting system of the hospitals, poor scopes research, socio-economic conditions of the nurses. A professional registered nurse wants the same many things of what a patient and the relatives of the patient want from a nurse. The society and we all should receive nurses and their loftiest duties with more love and generosity; it will encourage the mind of a nurse for further education and applying that practically. It will support them in peace to apply all their knowledge in proper way and in proper situation in relation to patient care. The society must love nurses because they are doing the best part for the mankind and civilization. (Concluded)