DIFFERENTIATING EBP, QI AND RESEARCH 8
DifferentiatingEBP, QI and Research
DifferentiatingEBP, QI, and Research
Thenursing profession is one in which practitioners cannot compromisequality. The superiority of patient care is the most crucialdeterminant factor for recovery from disease, medical conditions, andpreconditions (Dearholt& Dang, 2012).As part of professionalism, evidence-based practice (EBP) techniques,continuous nursing research, and quality improvement (QI) arecritical. These practices are instrumental in identifying mechanismsfor promoting professional practice in the clinical setting. Fornurses in advanced practice, nursing research plays a key role indiscovering the best practices for ensuring excellence in theprofession. Discovering the best practices comes from the developmentof new knowledge for improving clinical decision making.Evidence-based practice translates available evidence gathered fromempirical and experiential research into decisions based onverification that has previously brought results that have improvedpatient care. Quality improvement is a continuous process that aimsat transforming the delivery of services to patients in differentclinical settings. This paper seeks to differentiate evidence-basedpractice, research, and QI.
EBPrefers to the methodical integration and use of current clinicalknowledge, research, and clinical expertise in which evidence isavailable on their efficacy in improving patient care in a broadrange of clinical settings.
EBPgives nurses the opportunity to apply evidence-based methods ofproviding patient care (Dearholt& Dang, 2012).According to Dearholtand Dang(2012), it is through evidence-based practices in the clinicalsetting that nurses are able to identify and apply appropriatemethods of care that meet the needs of individual patients. As partof evidence-based practice, nurses can apply their personal expertisein clinical practice together with cutting-edge research from resultsobtained in other clinical settings by nurses who take an active rolein the study. The most recent ways of providing care that haveyielded results that practitioners can account for also form thebasis of evidence-based nursing.
Evidencecomes from expert opinion developed through research and clinicalknowledge and experiences. Dearholt& Dang(2012) established that EBP has certain steps that result in evidencethat practitioners can use in many settings. The first step in EBP ispromoting a culture of enquiry. An inquisitive culture amongprofessional nurses enables them to question existing standards andmethods of practice. Notably, this is essential in identifyingpossible enhancements that can improve clinical judgments in varioussettings (Gwen & Barnsteiner, 2011). The second step in EBP isasking a relevant PICO (T) question that can be applied in a clinicalenvironment. These clinical questions are useful in formalizing theresults that nurses experience in their practice. Besidescutting-edge research, these anecdotal experiences are constructingevidence that other practitioners can apply in professional nursingpractice in different locations. Furthermore, formalizing PICO (T)questions is crucial in the analysis of evidence that makes theoutcomes of such analyses quite open and straightforward. The thirdstep in evidence-based practice is the collection of the bestapplicable substantiation of facts. According to Gwen and Barnsteiner(2011), this may take the form of publications from peer-reviewedjournals. Once evidence is available, the fourth step is appraisingthe verification critically. After the critical appraisal, othersteps include incorporating evidence into the clinical settingwhereby nurses can see results, evaluate changes that take place, anddisseminate information.
BriefDescription of a Clinical Problem
Therehave been incidences of an increase in ventilator-associatedpneumonia (VAP) in infants in the recent years. The development inneonatal care has prompted medical practitioners to explore publishedevidence on this topic. As part of enquiry, nurses have also reliedon experiential experiences of practitioners who have handled VAP inadult and infant populations during their practice.Althoughthe focus is on the infant population, nurses’ clinical experiencesin providing care to adult patients are significant in examining thetrend of the disease. Such an examination is also useful indeveloping evidence-based interventions for the neo-natal population.Therefore, this has been a crucial process of identifying suitablemeans of addressing this pertinent health issue. Klompaset al.(2014) described ventilator-associated pneumonia as a type of diseasethat occurs approximately two days after the use of mechanicalventilation interventions administered using endotracheal tubes.
P:Infant patients on a mechanical ventilator
I:Reasons that influence VAP prevention on the positive side
C:Factors that influence VAP prevention on the negative side
O:Decreased or negligible incidence of ventilator-associated pneumonia
Question:What factors may positively (I) affect the incidence ofventilator-associated pneumonia (O) among neonatal patients (P)compared to those that might affect the incidence of VAP negatively(C)?
Sourcesof Evidence and references:
Thescholarly sources for research were obtained from three electronicdatabases. These are AltHealth Watch,AHRQ, and MEDLINE. These databases have useful sources that haverelevant information on EBP, QI, and research. Specifically, thesedatabases have several publications about prevention ofventilator-associated pneumonia using the VAP bundle. Although thenumbers of publications about ventilator-associated pneumonia inadults are considerably higher than those written about infantpatients, the available journals are useful in deriving evidence forEBP. During the initial search, 40 publications were seen as useful.Out of the 40 publications, 23 used longitudinal designs while 17utilized cross-sectional blueprints. A study by Klompaset al. (2014) established that VAP can become life-threatening if nothandled properly. Critically, ill neonatal patients also have anincreased chance of developing a nosocomial infection. Klompas et al.(2014) articulate that the deterioration of health in VAP patients isdue to the invasion of lung parenchyma in the entire respiratorytract. The invasion is as a result of the actions of pathogenicmicro-organisms that breed in the lower part of the respiratorytract. Also, intubation limits the trachea hence, allowing bothgastric and oral chemicals to gain access to the lower respiratorytract. Klompas et al. (2014) also indicated that infants who haveupper respiratory tract infections have often shown signs ofdeteriorating health. Therefore, this compels caregivers to usemechanical intervention using the endotracheal tube to save theirdeteriorating health. However, there have been incidences of VAP 48hours after intubation. Independent studies by Hamid, Malik, Masood,Zia, and Ahmad (2012), as well as Cooper and Haut (2013) have shownthat careful monitoring and staff education are important inempowering nursing practitioners to reduce the incidence of VAP amonginfants. According to these studies, prevention is crucial,especially since prophylactic treatment of ventilator-associatedsyndrome using antibiotics could have serious side effects topatients in the neonatal care setting. Immediate strategies thatcould go a long way in the prevention of VAP include proper handhygiene among practitioners, daily sedation breaks, and regularbreathing trials for identifying possible staphylococcusaureusinfections that create the perfect breeding ground for pneumoniabefore the onset of VAP (Hamid,Malik, Masood, Zia & Ahmad, 2012).
CriticalAppraisal of Evidence
JohnsHopkins University’s Nursing Evidence-based criteria for appraisalwere used to critically appraise each of the publications. Theavailable research on VAP in children is limited compared toliterature about ventilator-associated pneumonia in adult patients.For this reason, nursing practitioners need to have a comprehensiveunderstanding of VAP in adults to be in a good position of usingevidence-based nursing practices on the infant and neonatal categoryof patients. The publication by Hamid,Malik, Masood, Zia, and Ahmad (2012) gives a systematic method ofpreventing ventilator-associatedpneumonia in infants.
Theinfant population is a delicate one this is attributable to theirweak immune system. For babies in neonatal care units, high safetystandards are a must in the prevention of ventilator-associatedpneumonia. For this reason, preventing VAP usingventilator-associated pneumonia bundles is useful in providing thecare needed in neonatal care. VAP bundles form part of crucial EBPinterventions for intubated infant patients. Nurses should implementthis form of intervention carefully this is only possible ifpractitioners have adequate knowledge about the use of VAP bundles inneonatal patients. Nurse administrators can facilitate the process ofVAP implementation if they audit VAP bundle checklist for workers ona regular basis. Should issues of non-compliance arise, nurses shouldreceive the necessary on-the-job education to empower them tounderstand the strategies for VAP prevention.
Disseminationof information about evidence-based practices can take two majorforms. These are internal and external dissemination. Internally,information is disseminated through circulars, notices, departmentalmeetings of nursing units, newsletters, and through online portalswhere members can log in their portals using organizationalinformation systems. External dissemination of information could takethe form of publications in peer-reviewed academic journals andpresentations into organizational nursing conventions andconferences.
Innursing, a quality improvement is a logical approach to raising thequality standards of patient care using scientifically proventechniques. Stausmire (2014) has articulated that QI can influencethe outcomes of the nursing profession considerably. Therefore, thisimplies that quality and performance are inseparable. For thisreason, patient care and the health care system, in general, canbenefit from quality improvement initiatives.
Maintainingexcellence in the nursing profession is only possible through qualityimprovement this is mainly because there are various factors thatcan result in a decreased degree of quality. For instance, nurses whohave low work morale may not offer the best quality of patient care.According to Stausmire (2014), poor quality can be detrimental,especially to hospice and palliative care nurses. Notably, this isattributable to the reason that these nurses provide critical care toa unique set of patients who suffer from terminal illnesses andchances are high that these ill people may lose their lives ifpractitioners fail to accord them the highest quality of care.
Qualityimprovement happens through a wide array of QI initiatives. Accordingto Stausmire (2014), quality assurance is critical in the entireprocess of QI. In quality assurance, nurses check to ascertainwhether the current practices in their clinical settings meet therecommended standards of excellence. Therefore, this forms animportant basis for defining the direction the quality process shouldtake. Quality assurance takes place across all nursing units of aparticular health care facility. However, no part of the qualityimprovement process interferes with how nurses provide care topatients at all levels of the clinical setting. As a fact, QI takesplace in the background. Any measurable quality improvement processmust be sustainable. According to Stausmire (2014), this takes theform of a Plan-Do-Study-Act methodology.
Checkingcompliance to VAP bundle among intubated babies in a particularclinical setting.
Anursing team involved in collaborative care will audit the conditionsof care accorded to intubated babies using a VAP bundle checklist.
API team will comprehensively analyze empirical data obtained fromaudits that the chosen nursing team have done. Subsequently, theresults of the analysis will then be handed to the administration.Nurses in charge of the teams will lead this process in its entirety.
Afterthe checks have been conducted successfully, any non-compliance withstandards of EBP will be noted. The next step is to re-educate nursesduring departmental and board meetings, as well as throughpublications in journals. If non-compliance to the ventilatorassociated persists, a one-on-one coaching approach will be used.
Innursing, research is a process that seeks to produce evidence forimproving patient care in a broad range of settings. Nursingresearchers carry out their study in multiple settings (Parahoo,2014).Therefore, this means that nurses who specialize in research carryout their work in clinical settings and non-clinical environmentssuch as universities, as well as private and public health care studyinstitutions. Such research is crucial in ensuring every aspect ofnursing practice is up-to-date.
Anyform of research aims at transforming and developing new knowledge.According to Parahoo(2014), in nursing school, the curriculum places a unique emphasis onthe need for continuous research among practitioners at all levelsfor the sole purpose of promoting evidence-based care. As such,conducting continuous research facilitates evidence-based nursingpractices and patient care. Other than evidence-based care, nursingresearch empowers nurses to take a leading role in shaping healthcare policies (Parahoo,2014).Policies are only valid if backed up by research that shows theirrelevance in current health care. Therefore, research enables nursesto formulate health care policies that facilitate quality improvementand EBP.
Otherthan developing new knowledge, research also aims at validatingexisting sources of knowledge. The validation involves a systematicenquiry for answering certain research questions based onpredetermined testable hypotheses (Gwen & Barnsteiner, 2011).Investigating existing knowledge in nursing entails reviewing currentand past literature. Such investigation is of strategic importance toidentifying specific gaps in the theoretical underpinnings of theideologies in literature.
Accordingto Parahoo(2014), research in nursing can either be qualitative orquantitative. Quantitative research focuses on quantifiable outcomesthat can be seen through the application of statisticalmethodologies. On the other hand, qualitative research cannot bemeasured but is instead conducted by a broad set of case studies andinterviews in which researchers record results for analysis at laterstages of the study process. After the data collection process,nursing researchers carry out a comprehensive analysis of availabledata, which is crucial in pinpointing out potential applications ofthe research outcomes in enhancing evidence-based patient care. Also,disseminating research outcomes is important in ensuring nurses arewell-versed with the latest research findings for ensuring highstandards of professionalism in nursing.
ResearchQuestion: Are there ways of improving the clinical skills thatnursing practitioners who work in collaborative care settings have inusing ventilator-associated pneumonia bundle (VAP bundle)? Can theseskills be improved using electronic mechanisms of disseminatinginformation using computers?
Estimation of the sample size: The most appropriate technique that will be used is the power analysis method. This method is preferred since it has sufficient statistical power for analyzing both large and small numbers of participants.
Criteria for inclusion: Advanced care nurses, (Registered Nurses) RNs, Collaborative care, and Nurses working in palliative care settings who have experience in providing care to patients with ventilator-associated pneumonia (VAP).
Risks/Benefits:One of the expected risks is psychological trauma that could arisewhen nurses see the suffering VAP patients go through, especially atlate stages of the disease. However, the benefits are anticipated tosurpass the risks. For example, nurses will have a deep sense ofsatisfaction when they see patients successfully recover fromventilator-associated pneumonia due to the impact of cutting edgenursing research.
Theresearch team will focus on specific aspects of socio-demographicanalysis. These aspects include gender, race, and gender.
Thepreferred statistical method of analysis is the use of a measure ofcentral tendency for speedy statistical analysis. Software tools willbe useful at this stage.
Implicationsfor future practice/Results/Findings
Resultsof the study will be documented for future practice amongpractitioners. The sole aim of such documentation will be tofacilitate evidence-based practice.
Insummary, nursing research, QI, and EBP are distinct concepts that areoften confused. To some individuals, these terms can be usedinterchangeably without diluting the intended context of use. On thecontrary, nursing research, quality improvement, and evidence-basedpractice have different meanings and are distinct areas of thenursing profession. Nursing research seeks to develop new knowledgefor advancing the nursing practice. A new body of knowledge thatresults from cutting edge research is useful in ensuring all aspectsof nursing practice are up to the task and the expectations ofpatients and the universal objectives of health care in the globe. Onthe other hand, quality improvement seeks to use scientificallyproven mechanisms of raising the quality standards of patient care.For this to be a reality, all activities of quality improvement haveto utilize a systematic approach in which results of improvements donot take too long. According to Stausmire (2014), during the qualityimprovement process, nurse administrators have to take a leadingrole. For instance, during performance checks, individual nurses andthose in team-based settings have to examine how their conformity toquality standards under the leadership of administrators. Theseadministrators then use the data they obtain to improve particularaspects of patient care that seem to take a downward trend. On theend side, evidence-based practice seeks to incorporate knowledgegained from nursing research and experiential learning in makingclinical decisions that impact patient care. Evidence-based practicedoes not in any way seek to develop any form of knowledge in nursingpractice. Instead, EBP applies current knowledge and clinicalexpertise in clinical decisions. Also, EBP does not seek to improvethe quality standards but aims at ensuring patients are accordedproper care.
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