Evidence-based practice process implementation in nursing

¶ … nursing -- caring, empathy and ethics. The author (Lachman, 2012) uses numerous examples, each of which show the positive impacts of caring. Along with examples of ethical decisions that must be made, and with theories on caring and empathy put forward by scholars, the paper examines morality, competence, and the "reciprocal" relationships between nurses and their patients. That is, caring for a patient is reciprocal because if the needs of the patient are met, there is reciprocity -- the giving of care and the receiving and acknowledgement of that care giving.

Summary of Key Points

On page 113 Lachman references several leading theorists and scholars that have provided important research and results on nursing ethics and the caring concepts alluded to in the Introduction. Dr. Jean Watson has a caring theory (112) that has three main components: a) carative factors; b) the "transpersonal caring relationship"; and c) the "caring occasion/caring moment." As to the carative factors, Watson explains that this involves the development and sustainability of an "authentic…helping-trusting…caring relationship," which sounds very obvious but it should lead to a "connection with deeper spirit of self" involved in the relationship (Lachman, 112). In the second element of Watson's strategy, the transpersonal caring relationship, this entails a "moral commitment" the nurse must make to connect with the patient; and the third component, the "caring occasion/caring moment" is what it sounds like -- that space and time during which the nurse bonds with the patient and caring takes place (Lachman, 112).

Also, Joan C. Toronto, an author and recognized expert on nursing and the caring concepts, has a big role in this paper. In 1993 Toronto defined care -- an important point -- as a "species activity" that entails anything and everything that relates to maintaining, continuing and repairing the "world" around us, to include "…our bodies, ourselves and our environment" (Lachman, 113). In other words, for a nurse part of his or her environment is the patient, and the patient's body, which must be cared for.

Toronto's four phases of caring are important to this article: a) caring about; b) taking care of; c) caregiving; and d) care receiving (Lachman, 113). Those are redundant on the surface but she is talking about phases, not applications of caring. Perhaps more importantly in terms of key points, are Toronto's four elements of caring: a) attentiveness (a nurse steps away from his or her learning and "preference system" and steps into the patient's shoes, which is the true definition of empathy); b) responsibility (the Code of Ethics for Nurses -- according to the American Nurses Association -- asserts that all nurses are responsible for patients under their care so there can be "no ambiguity" at all in that regard); c) competence (this means managing patients based on skills learned -- being efficient and accurate in caregiving -- but it also means the nurse has a responsibility to "update competence continuously"); and d) "responsiveness of the care receiver" (this is where reciprocity enters into the picture; the nurse must receive a positive and healthy response from the patient in order to know if what the nurse did was effective in solving the health issue) (Lachman, 113-114).

Another worthy and key point in this article is Dr. Watson's emphasis on the fact that the patient should "never be uses as a means to an end of self-gratification" (Lachman, 114). The care that is given to a patient should occur "…within the framework of a relationship between the nurse and the patient," which closely resembles the meaning of reciprocity. A relationship does and should exist, not in the traditional definition of "relationship" of course but there should be an important and sincere "interchange" and it must be based on meeting the care needs of the patient and the patient's family as well (Lachman, 114).

A list of the Steps Taken by Nursing to Develop and Implement an EBP

A questioning approach is always recommended as nurses work towards the development of evidence-based practices. What works and what doesn't work - those are pragmatic questions that are taken into account during the development of a practice based on evidence, in other words, what works and is proven effective is evidence-based.

Once a nurse is fully educated in the most recent and relevant patient-centered approach to nursing, using the latest knowledge available in pain management, for example, is a way of providing protocols for evidence-based practices. The first step is education, which provides a strong background for the nurse in practices, procedures and protocols. That education the nurse receives must be updated frequently so she or he stays in the forefront of that knowledge.

The second step follows in the path of education is practice; the patient has needs that are to be met and implementing practices that solve health problems is evidence that those practices are valid. The practices were found to be valid and hence were put in place based on theory-based approaches that became proven problem-solving incidents -- that is, based on evidence from patient results that have contributed to the betterment of the patient.

Application of Learned Information