Patient Care and Nursing

¶ … Evidenced-Based Practice (EBP) The objective of this study is to review an article titled "Evidence-Based Practice Habits: Transforming Research into Bedside Practice" (Rauen, Flynn, Bridges 2009 p 46). The authors point out that nursing practice in the United States is more focused on the traditional-based practice than evidence-based practice. Many practices in critical nursing care are still continuing despite that the researchers contradicting the practices. The study believes that insufficient administrative support, lack of time, limited access to information are the barriers in the clinical-based practice three decades ago still exist today.

While the benefits of evidence-based practice are well understood, nevertheless, there is a still a barrier in transforming the research findings into practice. To eliminate the problems, the accreditation bodies that evaluate and mandate the EBP (evidence-based practice) assist in moving the research forward. The authors suggest that it is critical to developing a culture of inquiry that will help nurses developing the current evidence into practice, and the culture of inquiry will assist in improving the clinical outcomes and patient care.

Steps taken by Nursing to Implement and Develop an EBP The evidenced-based practice is the judicious, explicit, and conscientious use of the available best practice and evidence to make effective decisions about patient care. The implementation of the EPB is to integrate the clinical evidence and clinical expertise using the systematic research and sound methodology to make decisions. Nursing practitioners are required to develop skills, which include literature searching as well as the application of evidence and formal rule in evaluating the clinical literature. According to Rauen, et al.

(2009), the clinical question or problem starts from the patient care, and it is critical to developing well-built clinical questions as well as selecting appropriate resources to conduct research. Rauen, et al. (2009) focuses on areas of critical care practice that include monitoring hemodynamic parameters for patients. The study also investigates how low-dose dopamine can be used to treat or prevent renal dysfunction. The authors discuss "prevention of deep vein thrombosis." (Rauen, Flynn, Bridges, 2009 p 46).

While there are issues with regard to the physiology and facts of the fluid replacement, the authors identify the current bodies of evidence that can assist nursing professionals in transforming research into bedside practice. Application of the EPB Setting regarding the Implementation of an EBP Rauen, Flynn, Bridges (2009) discuss the strategy of using the EBP to prevent the Deep Vein Thrombosis. The venous thromboembolism is defined as the combination of pulmonary embolism and DVT (deep vein thrombosis).

A recent estimate reveals that over 90,000 patients are being diagnosed of venous thromboembolism annually with 500,000 cases of pulmonary embolism and 400,000 cases of DVT. However, 60% of the cases are fatal with a risk of developing post thrombotic syndrome leading to pain, edema, hyperpigmentation, paresthesia, and venous dilatation. The author argues that clinical interventions that nurses can employ in preventing the problem of venous thromboembolism are to use a combination of pharmacological therapies and mechanical therapies.

Despite the effectiveness of the therapeutic strategies one-third of thromboembolism patients receive the prophylactic therapy because of lack of knowledge of nurses. Prevention is an effective EBP that can assist in alleviating the problem of venous thromboembolism. The preventive action includes pharmacological interventions and mechanical intervention that include graduated compression stockings, and early ambulation. "Evidence suggests that thigh-high graduated compression stockings are most effective in providing mechanical prevention; however, knee-high stockings are also effective and often have fewer complications associated with constriction, wrinkles, and compliance with continuous wearing." (p 55).

Rauen, Flynn, Bridges (2009) also discusses different clinical practices that can be beneficial for nurses in the application of an evidence-based practice. One of the clinical practices is the positioning of patients for hemodynamic monitoring. The authors argue that one major challenge that nursing practitioners face during a clinical practice is to make a decision on how the patient should lie flat for the hemodynamic monitoring.

To address the problem, nurses needs to access series of references and research studies to find solutions to the patient's problems suffering from acute respiratory distress, heart failure, cardiac surgery and sepsis. There is also a need to make a research on the studies that discuss the hemodynamic parameters in backrest versus supine elevated position, prone position and lateral position.

The authors argue that the evidence-based practice can assist the nursing practitioner to observe the difference between CVP (central venous pressure) and PAP (pulmonary artery pressure) in patients in supine and flat position compared with the position that.