Introduction to Transforming Evidence into Nursing Practice
Healthcare environment has been constantly changing in today's world, hence it is very important for all the healthcare professionals to ensure that the practices which are implemented in all health settings are providing best practices and services. Evidence practices have been recognised to a wider extent in nursing profession. The implementation and services which are provided to all the service users is considered as one of the most important drivers in nursing and clinical services. With the help of evidence based practices all nurses gets an opportunity to analyze that each and every clinical intervention which is provided to patients is safe and suitable. The process of EBP should not be considered as a work load and all the nurses should feel comfortable and competent enough to handle all the clinical forms of EBP in a proper manner.
In this part of essay, transforming evidence into nursing practice will mainly focus on managing quality within the healthcare settings so that better health services are provided to all the care users. It will also help in decision making process by considering patient's values and opinions. Different models will be applied which will help in determining wider perspectives for the chosen rationale.
Rationale and Background
For enabling effective decision making process in the nursing profession it is very important to implement evidence based practices so that decisions can be taken in proper manner. Although many studies have been conducted on nursing profession and evidence based practices but no studies have ever focussed collectively on transforming evidence into nursing practices. When theoretical perspectives change into practices it is very important to consider certain evidences which can improve and manage quality in a better way. Studies which have been conducted earlier and results drawn from them can be significantly used in nursing profession so that evidence is produced.
The models which are used in evidence based practices helps nursing process to accomplish assessment, diagnosis, proper planning, and integration of practice and evaluation of problem. For implementing evidence based practices it is necessary to consider following points which can improve the quality of patient's care in healthcare settings. On the initial level it is very necessary to identify problem that is existing in the profession. For justifying the problem it is important that empirical evidence and appraisal is collected. Summarising all the empirical and non empirical evidence will help in developing strategies that can integrate evidences into practices. Rationale of the study has been formed because there is a need to change various practices so that quality of services can be enhanced and improved.
Literature search strategy
There are various sources which help in selecting articles for the given topic. Database sources such as CINAHL, PubMed, Science direct, Google scholar, emerald insight and British library index are some of the common database sources that help in choosing articles that are relevant to the study. For the completion of ongoing study, articles and research papers were also selected from the same sources.
Critically evaluate the wider perspectives informing the rationale
There are three basic components of evidence based practices which should be implemented to improve the quality of services and practices in nursing and healthcare profession. The three components can be research, clinical guidelines and expertise and patience preference. Different ethical, legal and political aspects are also very necessary to be considered when implementing evidence based practice because it helps in justifying the change that is brought in the working of staff nurses and profession. Mitchell, 2013 has stated that evidence base practices cannot be justified only by using a single research paper it is very important to critically analyze all the research papers associated with the study so that study and findings can be linked together. It is also very necessary to add perspectives and judgements of different clinical personnel because it is imperative to true evidence based practices in nursing practices. In recent times evidence based practices have gained an impulse which is very helpful in implementing changes in nursing field. Basic research findings, clinical knowledge and opinions from clinical expertise are all considered among evidence which can be used in nursing. There are many aspects in healthcare where evidence practice is very necessary.
It can be for bringing change in education of the students and for working in a team for all the clinicians and researchers. It provides a wide opportunity for all the nurses to practice their work on individual basis. It is very important to consider ethical principles in health and medical field so that they are able to provide treatment to all the patients in proper manner. For implementing various practices it is necessary to ensure that particular outcome will be obtained. When certain modifications are made in nursing it should be made after considering ethical framework because there are equal chances that both positive as well as negative results can be obtained . If ethical considerations are not taken into account then it becomes very difficult to justify the changes that have been brought in the nursing profession. Changes can be at nursing level, healthcare organization level and patient’s level. Changes at nursing level can be improvement in the way a particular treatment is provided to a patient. It can also be used to improve the quality of services furnished to them. On the other hand, it can also be at organization level by identifying and managing risk in various conditions. If risk is identified it will help in resolving various types of issues which exists in healthcare organization.
Huang, Chen & Chiang, 2016 have stated that if nurses at various levels are not able to identify risk and danger in the profession then with the help of evidence based practices they can identify them effectively. Providing best and effective quality care services to all the patients is one of the main duties and responsibilities of nurses in nursing profession. With the help of evidence based practice nurses can incorporate all the practices which have been included in randomised control trials, care studies related to the patients and data of patient derived from compilation of different interventions. If evidence based practices are considered then patients will not suffer from any major health problems and healthy outcomes of nursing profession will be developed. Evidence based practice should not be confused with any primary or secondary research because it does not aim at conducting new research in order to implement new findings and sources, rather it utilises latest evidence from research which can act as a guidelines in deriving possible outcomes of evidence based practice.
Importance of evidence based practice has been increased in recent years. One of the major advantages of EBP is that it helps in improving the quality of services which are provided to patient. It can also result in improved outcomes of the patient due to the incorporation of new evidence based practices. In nursing profession all the nurses should inform patients about the treatment and medical interventions so that they are able to make their own choices based on law and ethical considerations. The code of ethics also states that all the patients in healthcare settings are liable to be treated equally which can eliminate the factor of discrimination and inequality. In healthcare there are certain decisions that should be taken collectively with the help of doctors and family members of the patients. In such cases evidence based practices is very beneficial. Through evidence one can support that following clinical or medical intervention will result in proposed outcome rather than relying on different types of assumptions. Different ethics and codes can be considered in four categories.
The four categories can be use of drugs in different forms, management strategies, provision of services and various intervention that are incorporated to treat diseases and illness . In a research based evidence a study was conducted and it was revealed that before prescribing drugs to any patient, their body weight, diet and lifestyle should be known. By developing evidences, the population can be prescribed of various medications so that they are treated for their diseases. Based on ethical considerations there are evidence for management strategies that justify the importance of adequate nutrition and immune system required to sustain any type of medication in the body. Evidence from randomised control trial has been obtained where more than 81 subjects were selected above the age of 65 years. They suffered from chest infection and. As it was a randomised study they received 500 ml of supplement ensure during the treatment and no supplement at the time of discharge. Based on research evidence it was stated that the group which received supplements showed significant health improvement with increased functional ability as compared to the group which did not receive any treatment . Service provision was also based on evidence-based practice which was obtained from retrospective cohort study analysis. It was reported that individuals who received structured care for diabetes presented low body weight mean arterial pressure of blood, fasting of blood glucose and increased use of ACE inhibitor.
It is very important to know that ethical considerations and evidence based practices have influenced the clinical and nursing practices in many ways . Due to the presence of evidence it is ensured that all the patients receive equal treatment for same condition. Efforts are incorporated so that equal quality of care is incorporated so that there are no limitations but there are certain aspects were limitations have been reported. The use of therapy in cardiovascular diseases, replacement therapy and therapy for chronic heart failures are some of the rationing occurs as limitation of resources.
Utilise national and local policies and guidelines and current literature
At national and local level there are different set of policies which are adopted in order to improve the quality of the services which provided to patients. In this context, there are several policies so as to shape the care policies. Main focus is to disentangle policies in order to make sense at different roles which are played by organizations to develop them. However, following are the frame work which is followed in national and local level...
National policy framework
In resourcing health and social care, National policies have high impact. However, they also set up different types of evaluation and indicator criteria. For instance, if for every patient, there is one criterion for evaluation. Then they should be named nurse. This highly affects to manage or to organize work or it may also affect the way one welcomes a patient. On the other hand, if performance indicators which are developed or set by national government which aims at measuring patients throughput, then one would find it difficult or under pressure to discharge patient them others.
National service framework
It was in the year 1998 since government of England started to develop NSFs (National Service Framworks). They aimed at providing proper care to all the people within the country and it also included elderly people. In this context, they aimed at understanding different types of researches which has been done in order to make the practice more effective. They conduced evidence based practice which enabled to develop trust and confidence with the help of which proper policies has been developed or created. However, they fine it difficulty in developing it into a policy.
Policies at organizational level
All the organizations have their own policies which they must be following. Regarding procedures and practices, they are very specific policies. These policies can be compared to as guidelines which are very helpful for the organization and the employees in it. It is not easy to trace their origins as they may not be local. There are many cases in which they get lost in the mists of time. In this context, there are many records regarding the committees and groups who developed these policies. However, the evidence which is related to the policies is very helpful and they enable to improve the policies in an effective manner.
There are many systems which are adopted by organizations and agencies in developing dissemination policies. Some of the policies many is structure and formal. In formal committees the policies which are developed can be read as they are made available in many sources. On the other hand, there are organizations in which the process is not that free or not easily accessible. In this context, the first type of policy has the advantage of transparency. Any of the person who want to access it can do it and could also get the outcomes. However, there are cases in which it takes time to respond do it. Second set of policies are more flexible but people within the organization are not clear about it.
Dignity on the ward campaign
This enables to understand how campaign help in making the policies change. There are many cases in which elderly people are not provided proper care without respect and dignity. Sometimes, it causes due to lack of resources, effective communication process and negative behaviour of staff members and caring roles. In addition to this, health care experts and caring roles requires to respect the culture of service users without doing any type of discrimination with them. The caring roles of care organization require maintaining the privacy of service users in respect to their personal information, identification and medical reports.
Lewins Change Management model
In order to adopt change, there are different type of models which can be adopted. Among these models Lewins Change Management mode is very effective. There are three stages which are involved in this model which are Unfreezing, changing and refreezing. Following are the different stages involved in Lewins Change Management...
This model is generally known as change management model which identifies different areas which needs change and improvement. At initial level, it identifies the area where some alteration is required. After identification of change, rectification should be incorporated so that functioning and structure of organization can be altered. At last, after the change has been incorporated, it is refreezing so that the change is not reverted back to its original position.
Implementation of the change
Before adopting any change, it is important that the change which has to be adopted should be clearly defined. Proper steps should be prepared so that they will be able to achieve the desired goals and objectives. Further, the organization should be able to analyze the situation and understand positive as well as negative impact when the change is been adopted. In addition to this, it is important that the changes which has top be made should be conveyed to employees so that they may not find issues related to it. This way the policy can be implemented effectively and efficiently.
Second stage is adopting the policy which has to be adopted. It is important that the organization take proper step or precaution through which they will be able to implement the change effectively. Further, monitoring should be done so that they will be able to identify the whether the change which has been made is helping the firm to grow or not. In this way, firm can also make changes in the policy which they are willing to adopt. In addition to this, suggestions should be taken from employees as they will be able to provide better ideas they will be practically adopt the change.
It is the final stage of freezing because this leads to implementation and reinforcement of practices after the change. The norms, practices and all the changes that are made in nursing profession are accepted but there are many cases where all the nurses and other medical staff do not comply with the changes readily. In the refreezing process it is very necessary to ensure that all the nurses and other staff nurses do not revert back to old ideas and changes that were implemented earlier. Refreezing should not show revert back mechanism because if it is not accepted by all the nurses in evidence based practices then the change will be lost from the organization framework.
The overall report is based on transforming evidence into nursing practice. In this report it has been discussed that how different types of researches help in developing strategies and evidence for the implementation of practices in nursing profession. In the first part of the report a critical analysis was done by considering all the ethical, legal and political aspects of evidence based practice in nursing. It is important to consider all the ethical and legal considerations in nursing because when different practices are innovated in health and care organization it is very necessary to justify them with the help of evidence so that it is not proved wrong. Without ethical and legal consideration it cannot be implemented in nursing or any other medical profession. In another part of the report various national and local policies were discussed which further helps in implementation of various evidence based practices. A model was also designed which could help in providing a better understanding of different types of research studies in nursing profession. That model has helped in comparing the change that has been brought in nursing profession before and after evidence based practices.
Through evidence based practice I have learned that how studies from different research such as randomised controlled trials and prospective cohort studies can be used to understand the concept of EBP in nursing profession. It is very important to justify all the practices in healthcare to ensure that proper practice is conducted in nursing. Through this report I have learned that it is very necessary to bring about changes in working of nurse in order to improve the quality of work and practices in nursing.
- Burman, M. E., Robinson, B., & Hart, A. M. (2013). Linking evidence-based nursing practice and patient-centered care through patient preferences. Nursing administration quarterly.
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- Cowen, P. S., & Moorhead, S. (2014). Current issues in nursing. Elsevier Health Sciences.