Refinement of a Nursing Concern into an Evidence-based Practice Proposal Using the Research Process
Overview
Research is mainly used to generate new knowledge or for the validation of existing knowledge based on a theory. Evidenced-based practice (EBP) is the translation of evidence and applying the evidence to clinical decision-making. Most of the evidence used in EBP stems from research. However, EBP will go beyond the use of research and it will include clinical expertise together with patient preference and values. EBP will make use of the evidence developed or knowledge discovered using research to determine the best evidence that can be used or implemented in clinical practice. Research and EBP go hand in hand in that while one will generate new knowledge, the other will make practical use of the knowledge and make use of the knowledge by implementing it into clinical practice. EBP is supported by research since any new clinical practice has to be backed up by information and data that is discovered using research.
Unlike research, EBP is not concerned with the development of new knowledge or the validation of existing knowledge. The main purpose of EBP is to make use of the best evidence available in order to make patient care decisions. There is also consideration given by EBP that the best evidence is not always based on research results. The opinion of leaders and experts can also be
used in EBP. EBP encourages the nurses to be asking questions on how they can improve healthcare delivery.
EBP has assisted the nursing profession in numerous ways. Nursing education has been changed because of EBP and colleges and universities have had to change their BSN program in order to incorporate EBP. The programs encourage critical thinking skills and nursing students are encouraged to consider clinical, religious, cultural, and socioeconomic backgrounds of the patients as well as using the relevant scientific research available. EBP has led to an increased interest in and emphasis on nursing research. EBP has also improved patient outcomes in that nurses can now use current research to assist them in minimizing complications that are associated with chronic illness and prevent additional disease or illness.
I am the Cardiovascular Services Educator for CVICU and CVSD at my facility and my MSN program specialty track is Education. I have chosen as my area of interest and nursing concern: Mandatory education and in-services for critical care nurses who provide care to patients with central venous catheter lines (CVLs) in order to help decrease the rate of infections. I feel that using current evidence-based practice will support not only my current position as an educator but also my future position as a mastered prepared nurse educator. When educating nurses an interdisciplinary targeted educational approach can be selected utilizing an education program centered on EBP. These education programs should include central-line insertion and maintenance bundles, teamwork, and optimizing patient safety through supplies and hand hygiene. By doing this, these practices have great potential for decreasing the incidence of CLABSIs in the acute care hospital setting (Raup, Putnam, & Cantu, 2013).
Since EBP aims at hardwiring current knowledge into common care decisions it will improve the care process and patient outcomes within our practice setting. EBP is backed by research and there is evidence to support that implementing a change will result in improved outcomes for patients. This makes it easy for other nursing staff to embrace the proposed change since there is supporting evidence that making the change will be beneficial to the patient.
Nursing Concern to be Improved
The nursing concern selected is the care of central venous catheter lines in Intensive Care Unit. For critically ill patients, Central Venous Catheters (CVC) play a vital role in their treatment. Therefore, there is a need for the nurses to be well educated on the care and use of central venous catheter lines, especially in the ICU. Patients who are hospitalized in the ICU require critical care and nurses who offer this care need to be well educated on how best to offer the care needed by the patients. Implementing mandatory education for nurses on how to care for central venous catheter lines has been shown to improve patient outcomes and reduce the incidences of infections. In the United States, it is estimated that between 250,000 to 500,000 cases of central line-associated bloodstream infections (CLABSI) occur every year, which results in a mortality rate of between 10% to 30% (Perin, Erdmann, Higashi, & Sasso, 2016). The incidence of primary bloodstream infection is reported to be about 1.52/1,000 catheters-day and this CVC utilization rate is 0.80. Based on this there has been concern over the risk of infections that patients are exposed and the prevalence of CLABSI. CLABSI has been identified as the primary complication of CVC.
Critical care workers, nurses, patients, and hospital management are the main stakeholders who are impacted by this health concern. However, the nurses who work in the ICU and the critical care workers are directly impacted by this healthcare concern. Considering that they are the ones who will be charged with caring for the CVC lines. Therefore, there is need to ensure that they are well educated on the risks that are associated with lack of proper care for the central venous catheter lines. Mandatory education will ensure that nurses who work in the ICU receive the required knowledge and training on the best practice for handling and caring for central venous catheter lines, which will ultimately result in reduced incidences of infection and improve patient outcomes (Scatliffe et al., 2015). CLABSIs also result in increased mortality rates and they might lead to higher healthcare costs for the patients. When a patient is infected, they will likely spend more days in hospital than would have been required, which translates to increased costs for healthcare (Shimoyama et al., 2017).
Research has shown that with increased education on the proper use and care of CVC nurse increase their knowledge on the handling of the patient CVC, which in turn reduces patient mortality (Salama, Jamal, Al Mousa, & Rotimi, 2016). There is a growing lack of education on how to care for central venous catheter lines and implementing mandatory education will ensure that nurses receive the education they need. Education will involve proper hygiene, best methods for handling the lines, and proper care to ensure there will be no infection to the patient. The purpose statement for this EBP proposal is to determine the effectiveness of mandatory education for the care of central venous catheter lines in ICU patients as compared to no mandatory education.
PICOT Question and Literature Search Process
The PICOT question is “Among critical care nurses, how does mandatory education and/or in-services for the care of central venous catheter lines in Intensive Care Unit (ICU) patients compared to no mandatory education and/or in-services affect the incidence of infection during a four-week period?”
Establishing if there is a difference in patient outcomes will assist in future practice as the organization will better understand the impact of mandatory education especially for critical care workers. We expect that with mandatory education there will be improved patient outcomes. The nurses will have updated knowledge on how to care for central venous catheter lines, which will reduce hospital stays for patients, improve patient outcomes, and reduce mortality rates. Education is beneficial as it will also empower the nurses to use their critical skills and increase their knowledge by questioning what they are learning as compared to their current nursing practice.
A literature review is considered to be an evaluative report of information that has been found within the literature relating to the selected area of study. Conducting a literature review will demonstrate the knowledge of the author on a particular study. Knowledge of the key terminologies that are used within the particular field will also be demonstrated. Literature reviews will also inform the author of the influential researchers and research groups within the field of study. A literature review should offer a theoretical base for research and assist the author to establish the nature of the research. To the reader, a literature review will convey the knowledge and ideas that have been established regarding the topic. The strengths and weaknesses of the ideas are also established in the literature review. In order for one to justify their research or EBP, there is need to have supporting information, which would be offered by the literature review. For our proposed EBP proposal, the literature review will determine where our study fits in the existing body of knowledge. Understanding what has been covered in the past regarding our topic of interest will also assist in showing the benefits of implementing the proposed EBP proposal.
Search for literature was conducted using these databases CINAHL, Cochrane, EBSCOhost, and MEDLINE. Our key search terminologies and phrases were derived from out PICOT question and they were aimed at uncovering information and past research covering our topic area. Our search was restricted to articles and research published in the past five years. This was to ensure that we are only using current research and articles, especially considering that nursing practice is regularly advancing and changing. The search terms used were central venous catheter lines, care for CVC, ICU care for patients with CVC, mandatory education for CVC care, and reducing the incidence of infection for CVC. Additional search terms and phrases included CLABSI incidences in ICU, critical care nursing, and best practices for ICU patient care. The American Association of Critical-Care Nurses (AACN) is the specialty organization that is directly related to the EBP proposal that we have selected. This being an organization for critical-care nurses it is directly related to nursing in the ICU.
Theoretical Framework
The IOWA Model of EBP has been selected as the theoretical framework to be used in this EBP proposal. This model highlights the importance of considering the whole healthcare system from the patient to the provider, to the infrastructure by using research to guide practice decisions (Brown, 2014). Considering that our identified problem is a knowledge-focused trigger, this model would be highly suited for use in implementing our EBP proposal. Knowledge-focused triggers refer to new practice guidelines. Our EBP proposal aims at implementing new practice changes in order to ensure that nurses working in the ICU have the requisite and up-to-date information in regards to the care of central venous catheter lines. This has been identified as a leading cause of infections in the ICU for patients and nurses have been shown to not have the adequate education on how to care for the CVC lines. Making use of the steps that are outlined in the IOWA Model of EBP, it would be easy to demonstrate the lack of knowledge and how increasing the nurses’ knowledge would result in improved patient outcomes and reduce the incidence of infections.
The IOWA Model of EBP would first be implemented by identifying the kind of problem that exists, which in our case would be a knowledge-focused trigger. The issue is then analyzed and it is determined if it is a priority problem for the organization. Once it is determined to be a priority the relevant literature should be reviewed and critiqued to determine if there is enough evidence to support the proposed practice change. With all the available information supporting the need for education for critical care nurses on how to care for CVC in the ICU, this model offers support for out EBP proposal. The third step for this model is identifying the research evidence that is in support for the proposed change in clinical practice. The final step would be to implement the proposed change and monitor the outcomes of the change (Brown, 2014).
Having established the need for education in the critical care setting for CVC. It is vital to ensure that the EBP proposal is supported by relevant knowledge and research on the topic. Using the IOWA Model of EBP, we would first determine the issue and document its prevalence in our hospital setting. This will be aimed at determining the prevalence of knowledge that is lacking within the care facility. Having already determined that the EBP proposal is dealing with a knowledge-focused trigger, we would go ahead and analyze the available research on the topic. This will be aimed at establishing how effective our proposed solution would be and the outcomes to be expected once implemented. Critique would also be provided for the literature obtained in order to justify the implementation of the proposed solution. Once it is determined that there is enough evidence to support our proposed change then we shall go ahead and identify the research evidence that supports the change in a clinical setting. This is aimed at ensuring that the identified research does indeed offer support for the change. Finally, we shall implement the change within our practice and it is vital that we monitor its outcomes. This will inform us of the impact that the change has had in the clinical practice and its results.
References
Brown, C. G. (2014). The Iowa Model of Evidence-Based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing. Clinical journal of oncology nursing, 18(2).
Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Revista latino-americana de enfermagem, 24.
Raup, G. H., Putnam, J., & Cantu, K. (2013). Can an education program reduce CLABSIs? Nursing management, 44(5), 20-22.
Salama, M. F., Jamal, W., Al Mousa, H., & Rotimi, V. (2016). Implementation of central venous catheter bundle in an intensive
care unit in Kuwait: Effect on central line-associated bloodstream infections. Journal of infection and public health, 9(1), 34-41.
Scatliffe, K., Davis, A., Wang-Kocik, C., Villanueva, N. M., Espiritu-fuller, M., Larang, R., . . . Murillo, J. (2015). The Reduction of Catheter-Related Blood Stream Infections through the Implementation of an Interdisciplinary Healthcare Team. Journal of Critical Care Medicine, 2015.
Shimoyama, Y., Umegaki, O., Agui, T., Kadono, N., Komasawa, N., & Minami, T. (2017). An educational program for decreasing catheter-related bloodstream infections in intensive care units: a pre-and post-intervention observational study. JA Clinical Reports, 3(1), 23.
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