Necrotizing enterocolitis (NEC) accounts for a great percentage of premature infant deaths in the United States of America. Despite intensive research on the disease, no major breakthrough has been achieved to combat NEC's spread. Thus, this article aims at describing how NICU nurses can increase their knowledge in recognizing early signs and symptoms of NEC in premature infants. Besides, the paper proposes a model that guides nurses through a systematic process for the change to evidence-based practice. Finally, after identifying the problem and possible solutions, the paper outlines key words used for the literature search in the paper.
¶ … PICOT & Literature Review Worksheet
NEC remains a challenge in the nursing world despite the major medical progress made in the medical sector. Given the varying clinical presentation of NEC among infants, clinicians have a challenge in diagnosing the disease at both the earliest and least severe stage of pathogenesis (Mulhall, 1998). To curb this problem, assigning disease severity based on staging criteria for NEC is vital for both the diagnosis and treatment. Therefore, properly educating nurses on Bell Staging; the standard in assigning severity of disease to NEC cases is likely to result in accurate and effective diagnosis.
Educating NICU Nurses
Nurses working in the nation's NICUs lack the basic knowledge in handling infants showing possible signs of NEC infection. Thus, to ensure efficient diagnosis and treatment of NEC, proper education of nurses on the diagnosis methods is necessary (Barnsteiner, 1996). The nurses are educated on Bell's three stages for easy recognition and diagnosis of NEC to patients. The nurses are inducted on Stage 1, for patients with mild symptoms, Stage 2 for those with suspected NEC diagnosis and Stage 3 which includes advanced NEC cases.
Research Question
How can NICU nurses increase their knowledge in recognizing early signs and symptoms of necrotizing enterocolitis (NEC) in premature infants?
Focus of the question
How to properly educate NICU nurses on early signs and symptoms associated with NEC.
PICOT Elements
P = Patients(s) or problem
Patient, patient population or presenting issue
The population is nursing staff in the Neonatal Intensive Care Units (NICUs).
I = Intervention under Consideration
Education regarding early signs and symptoms of NEC.
C = Comparison
What is the current practice you are comparing to "I"? (This element may be implied or missing)
None.
O = Outcome
What is the effect of the "I" on "P?" What is desired outcome?
Increased knowledge, improved ability to recognize the early signs and symptoms of NEC, decrease incidence of NEC, improved patient outcomes.
T = Time
Is there a need to limit the timeframe for the intervention?
During the hospital course of stay in the NICU for a premature infant.
Step 1: Assess the Need for Change in Practice
To increase nurses' knowledge in recognizing early symptoms of NEC, the first step involves the collection of internal data and comparing it with external data (Rogers, 1995). The internal data indicates the nurses lack sufficient information on diagnosing NEC among infants. On the other hand, the external data presents a model; Bell's sampling for nurses. From the collected data, nurse managers concerned about care of NEC patients diagnostic problems for NEC patients existed in the hospital, and devoted to developing an evidence-based change.
Step 2: Link the Problem, Interventions, and Outcomes
In Step 2 of the practice change for patients with NEC, the nurses linked the disease with the usage of Bell Staging for diagnosing infants. In addition, the team agreed to initiate further training of nurses on Bell Staging. In line with this, the nurses chose possible interventions and patient outcomes based on clinical judgment, system priorities as well as available resources.
Step 3: Synthesize the Best Evidence
In this stage, the nurse managers and researchers undertook a comprehensive literature review research focusing on NEC. They appraised six literatures and after synthesizing evidence from them, they were compared with clinical judgments as well as related data. Afterwards, they chose to initiate a preliminary trial easy for nursing staff to implement but offering high benefits and reduced casualty among patients (Rosswurm & Larrabee, 1999).
The three databases best addressing their research question are PubMed, CINAHAL, and the nursing reference center. The subject headings used to modify the search included NEC, Preventing NEC and Nursing-NEC. In synthesizing evidence, they used peer-reviewed journal limiter and publication filter to ensure their articles were relevant to the specific topic and date.
Article
Peer Reviewed
Description of Research
Type of Research
Study Outcomes
1
Relationship of neonatal treatments with the development of necrotizing enterocolitis in preterm infants.
Yes
This article discusses the understanding of potential effects that are important to decreasing the incidence of NEC (Carter, Holditch-Davis, Tanks, & Schwartz, 2012).
This article describes a retrospective cohort controlled study, using logistic regression and relationship with NEC. Besides, it provides a systematic review of the relationship with NEC and other pre-term characteristics.
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