4-Evidence based practice research has changed the field of nursing in many ways. It is one of the key principles in medicine today adhering to standards for high quality and safety, all while focusing on patients’ needs. Old practices may not work and need to change, evidence-based practice provides the latest research in improving these practices.

In emergency nursing, evidence-based practice is used daily. One very common practice is infection control. “This includes keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions and practicing correct handwashing” (Arkansas State University, 2016). Even though the emergency is very fast paced, nurses in my facility are very aware of infection control and make efforts to improve their infection control practices daily. Another evidence-based practice used frequently in the ED, is oxygen use in patients with COPD. “Despite the belief by some that providing oxygen to these patients can create serious issues such as hypercarbia, acidosis or even death, the evidence-based protocol is to provide oxygen to COPD patients. This practice can help prevent hypoxia and organ failure. Giving oxygen, which is the correct treatment based on the evidence, can enhance COPD patients’ quality of life and help them live longer” (Arkansas State University, 2016). It is very important that nurses know that giving to much oxygen can increase their respiratory drive, causing more distress, but some oxygen is key to helping improve the patients’ status.

Reference:

Arkansas State University (2016, December 20). 4 Examples of Evidence-Based Practice in

Nursing. Retrieved from https://degree.astate.edu/articles/nursing/examples-of-evidence-based-practice-in-nursing.aspx

 

5-Evidence-based practice is something that is embedded into our minds. During my first quarter of nursing school we were required to write down interventions for all nursing diagnoses and were required to cite evidence as to why we do the nursing interventions that we do. As nurses it is important to know the WHY as to why we do what we do. Evidence-based practice changes everyday because science and studies are frequently changing.

As nurses, we practice numerous nursing interventions daily. For bedridden patients who cannot move on their own, we are required to turn them at least every 2 hours because research shows that by turning these patients, the chances of developing bed sores are greatly decreased. We had a patient on our unit for about 6 months who was not able to move on his own and he did not develop a single bed sore because frequent turning was practiced. Other common evidence-based practice interventions include scrubbing the IV and central line hubs with alcohol for 10-15 seconds to prevent CLABSI. Washing your hands with soap and water before and after entering a patient’s room is the number one method of preventing the transmission of disease. We practice evidence-based interventions numerous times a day and we probably do not even realize that we are doing it because it becomes second nature to us such as something as simple as raising the head of the bed, picking out the correct blood pressure cuff, or grabbing some ice to apply to our patient’s knee, etc.

Arkansas State University states that nurses have room for improvement when it comes to EBP. They state the follo wing are some areas where nurses could better adhere to EBP:

• Communication      involving changes in a patient’s status.
• Soft      skills that improve patient interaction.
• Training      and onboarding new nurses.
• Shift      scheduling and the effect on care.

References:

Arkansas States University. 2018. Evidence-Based Practice in Nursing. Retrieved from https://degree.astate.edu/articles/nursing/examples-of-evidence-based-practice-in-nursing.aspx

 
 

6-From the perspective of a nurse, research or
evidence based practices are of vital importance when it comes to determining
the best course of action to take with clients, and determining which route to
take with an intervention plan. For instance, when examining an individual’s
symptoms or ailment, using evidence based practices can show the best steps to
take in order to provide the patient with the most in depth and intensive
treatment options which can be afforded to them (Melnyk & Fineout-Overholt,
2011).

           When
treating a patient with a number of symptoms which do not have an immediately
known cause, using evidence based practices can assist in determining which
specific ailment the patient is suffering from. By using research that
highlights similar symptoms the specific condition can be examined in more
detail which could lead to new treatment methods being devised (Koehn &
Lehman, 2008).

           The
benefits of evidence based practice are not limited only to the treatment of
patients, but can also be utilized in how to properly communicate and interact
with patients, and can prove vital in establishing connections with them as
well (Melnyk & Fineout-Overholt, 2011). For instance, when handling a
patient who is being difficult in their treatment methods, using the best
evidence based practices can give insight into ways to interact with the client
that can lead to more positive breakthroughs in their recovery (Koehn &
Lehman, 2008).

           Overall,
evidence and research based practices give nurses the ability to utilize a wide
range of resources to determine which course of action is the correct step to
take in ensuring that their patients receive the best cares possible (Koehn
& Lehman, 2008).

‘

References

Koehn, M. L., & Lehman, K. (2008). Nurses’ perceptions
of evidence-based nursing practice. Journal of Advanced Nursing, 62(2).
Retrieved from
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2648.2007.04589.x

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based
practice in nursing &        healthcare:
A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams             & Wilkins.

 

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   4- Sampling is process where certain number of people are selected from the population, these selected people will represent the whole targeted population and the theory concerning sampling process is known as sampling theory (Grove, Gary, & Burns, 2015).

    The sampling theory is commonly used to gather information related to population in medical, social, business, psychological sector. The sampling is done as it is not possible to do research on everyone thus, they are selected based on the topic or area of research (Ullah, 2018). For example, a research is to be conducted on “average age of marriage of women in Nepal.” Here, sampling can be done by selecting 10 families from each state, that includes 10 different states, from the whole country, this makes the data collection easier as it includes 100 families and is unbiased as number is equally distributed.

    Generalizability is the effectiveness of the research, as effective and successful research is known to have good Generalizability. It is essential in Nursing research as our research are mainly related to health of people or health related problems of them.

References:

Grove, S. K., Gray, J., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice. St. Louis, MO: Elsevier.

Ullah, M. I. (2018, November 02). Sampling theory, Introduction and Reasons to Sample. Retrieved from http://itfeature.com/statistics/sampling-theory-introduction-and-reasons-to-sample

 

 
 

    5-   Sampling theory is the field of statistics that is involved with the collection, analysis and interpretation of data gathered from random samples of a population under study.  In the application of the sampling theory, it is concerned with the proper selection of observations from the population that will constitute the random sample, the use of probability theory, along with prior knowledge about the population parameters, to analyze the data from the random sample and develop conclusions from the analysis. The normal distribution, along with related probability distributions, is most heavily utilized in developing the theoretical background for sampling theory (Sampling Theory, n.d.). For example, finding out the percentage of damaged tools produced during a given 5-day week in a specific factory by examining 30 tools daily at a specific time. All the tools produced in this case during the week represents the population, while the 150 selected tools during 5-days constitute a sample.

     Generalization is the act of reasoning that involves drawing broad inferences from particular observations, it is widely-acknowledged as a quality standard in quantitative research but is more controversial in qualitative research (Polit & Beck 1970). It is important in nursing research as it provides the ability to generalize results allows researchers to interpret and apply findings in a broader context, making the finding relevant and meaningful.

References

Key Issues in Quantitative Research – Center for … (n.d.). Retrieved from https://cirt.gcu.edu/research/developmentresources/research_ready/quantresearch/keyissues

Polit, D. F., & Beck, C. T. (1970, January 01). Generalization in quantitative and qualitative research: Myths and strategies. – Semantic Scholar. Retrieved from https://www.semanticscholar.org/paper/Generalization-in-quantitative-and-qualitative-and-Polit-Beck/a2018b430beae56c41d4c293a051aded822a2f19

sampling Theory (n.d.). Retrieved from https://course-notes.org/statistics/sampling_theory

 

6-Sampling theory is a study of relationships existing between a population and samples drawn from the population. Sampling theory is applicable only to  random  samples . For this  purpose  the population or a universe may be defined as an aggregate of items possessing a common trait or traits.  

Example:  We may wish to draw conclusions about the percentage of defective bolts produced in a factory during a given 6-day week by examining 20 bolts each day produced at various times during the day. Note that all bolts produced in this case during the week comprise the population, while the 120 selected bolts during 6-days constitute a sample.  

Generalizability refers to the extension of a research finding as well as conclusions from the study conducted on sample population to the large population.  

Example:   W hen a person wants to find out the percentage of people who smoke in a certain country. A sample would be taken in order to represent the entire population as well as findings taken to represent the general population.    

References  

Burns, N., Grove, S. (2011).  Understanding Nursing Research, 5th Edition. [ Pageburstl ]. Retrieved from https://pageburstls.elsevier.com/#/books/978-1-4377-0750-2/ 

 

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4-Continuous Quality Improvement (CQI) is defined by the American Society for Quality (ASQ) as “a philosophy and attitude for analyzing capabilities and processes and improving them repeatedly to achieve customer satisfaction”. (Huber 292) CQI is something that is relevant to all nurses as we all need to be responsible for continual improvement at work. As professionals we should always have this as a top priority. There are many challenges in the workplace, and by looking for ways to improve, we are constantly learning and growing as a profession, this is a large piece of evidence-based practice, which is something we all hold as a standard in healthcare today.

An example of how I would apply CQI in my current position working as a nurse circulator in the operating room, is to ensure that the time out procedure is followed every single case I circulate. This is important as we often get complacent in rules and regulations, as do surgeons that we are trying to keep happy as they are customers just as much as our patients are.

I had circulated a case with another nurse during orientation in which not all implants for a total knee replacement were in the room. I was not notified of this until after the case started, the patient was anesthetized, and time out had been completed though this requirement was not stated/asked. Later the rep for the implants then stated the implants were in route from another location. This is unacceptable, and I am glad that I was still in orientation at the time this occurred as it was a great learning experience for me. I learned how to write an incident report that day, and why the time out procedure is so important.

Resources

Huber, Diane. Leadership and Nursing Care Management, 5th Edition. Saunders, 10/2013. VitalBook file.

 

5-Health care delivery requires structure (staff, education, equipment, prospective data collection), and process (policies, procedure, protocols), which when integrated provide a system (programs, organizations, cultures) leading to outcomes (patient safety, quality, satisfaction). An effective health care system has all of these elements – structure, process, system, and patient outcomes in a framework of continuous quality improvement, or CQI (Kronich et al., 2015).

The purpose of QCI is to improve health care by identifying problems, implementing and monitoring corrective action and evaluating its effectiveness. Hospitals use a specific process to find areas in the health care delivery system that need improvement. When an area has been found, staff develop and implement strategies for improvement. General areas that are being studied include access to care, continuity of care, the intake process upon admission, emergency care, and adverse patient events, including all deaths (National Commission on Correctional Care, 2018).

In my previous position, working as a NICU RN, we initially did not use two RN’s to verify the content in the TPN-bags for each patient. Shortly after I started working at this facility, this change was implemented. The purpose was to catch medical errors from pharmacy that sadly was occurring more frequently. This new process of reading labels with another RN while verifying the content with the document from pharmacy, and then hanging the TPN required more time in the nurses’ day. In addition, all this was done toward the end of day-shift around 1730. This process resulted in stress among the RN’s and often overtime, which was not appreciated by management. Thankfully, a solution was found by changing the time of day TPN was delivered to the unit. By working together and brainstorming solutions, everyone was satisfied in the end; quality of care was improved, and the nurses were able to finish their duties in time.

References:

Continuous Quality Improvement. (2018).

Retrieved from https://www.ncchc.org/spotlight-on-the-standards-24-1

Kronich, L., Kurz, M., Lin, S., Edelson, D., Berg, R., Billi, J.,…Cabanas, J. (2015). System of Care and Continuous Quatity Improvement.

Retrieved from https://www.ahajournals.org/doi/abs/10.1161/cir.0000000000000258

 

6-I agree with your response about having a rapid response team because this helps identify patients at risk for cdoing before the event when you can give care to help prevent a code. I think rapid response teams are a must in facilities. according to patient safety primer .gov 

Rapid response teams represent an intuitively simple concept: When a patient demonstrates signs of imminent clinical deterioration, a team of providers is summoned to the bedside to immediately assess and treat the patient with the goal of preventing intensive care unit transfer, cardiac arrest, or death (psnet.ahrq.gov). I also agree with your staement about the lean technique that is in our text as a useful apporach to imrove efficincy in renedering care. When we are effective communicators and work as a team in our settings, we will definietly be more productive and work loads can be reduced, less stress in the workplace, etc. Team work is amazing when it is used the way it was intended to. Evryone working together to achieve a common goal is also important. If everyone is not on the same page, then this is where conflict can areise. Thank you for sharing, I enjoyed reading your post!

Reference

Retrieved from 

https://psnet.ahrq.gov/primers/primer/4/rapid-response-systems

 

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4-The four part of Christian Biblical Narrative are:
Creation- God created the Earth and everything on it intentionally. Nothing was created by accident.

Fall – Gods perfect order was broken. Sin, suffering, and death was introduced into the world.

Redemption- Jesus Christ died so that we can be forgiven and given the chance for salvation and a proper relationship with God.

Restoration- The ultimate goal of restoration of all creation. Has not yet occurred.

These ideas can provide comfort in times of sickness and disease. Disease and sickness did not occur until sin was introduced into the world. Often times, people lose faith in God when they are suffering and wonder why God put them in this position. It is during these times that our faith is tested. Healing occurs when faith is restored. The fact that God is present at all times and has plans for restoration of human kind should provide comfort.

 
 

5-In order to build a biblical-theological framework for understanding God’s mission, the church’s mission, and the church’s mission to the nations, one must first understand the unified biblical narrative, including its four major plot movements creation, The fall, redemption, and restoration. It is with this in mind that the contributors to Theology and Practice of Mission address some of the most compelling, practical, and crucial issues facing the global church today, issues such as justice, discipleship, community, and unreached people groups (Grand Canyon University, 2015).In the final days the story will not end with redemption. God has promised to renew the whole world, and the Bible gives us a peak into this glorious future. The restoration of all things will take place in two ways. Christ will return to judge sin and evil, and He will usher in righteousness and peace. God will purge this world of evil once and for all.

                                                                                  Reference:

Grand Canyon University.  (2015).  Lecture 3 PHI 413V.  Retrieved from https://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?currentTopicname=&viewPage=past&operation=innerPage&topicMaterialId=a788df13-3e3d-4f98-83d7-029c35f3f96c&contentId=7c6bddaa-839a-46a4-b020-48f1f8451ce9&

 

6-According to author Bruce Ashford’s “Theology and Practice of Mission” everything in the universe and was created according to God’s plan .”In order to build a biblical-theological framework for understanding God’s mission, the church’s mission, and the church’s mission to the nations, one must first understand the unified biblical narrative, including its four major plot movements–creation, fall, redemption, and restoration.”

There are 4 main themes that interconnect the history of the Judeo-Christian worldview. The first is creation. In the beginning, God created time and the universe by His power, turning nothing into something (ex-nihilo). He created the stars, galaxies, fish, cucumbers, trees, giraffes, and his greatest work of all, humankind. God placed the man Adam and his wife Eve in the Garden of Eden, a perfect environment, and gave them the responsibility to tend the garden and take care of the animals.

The Temptation or the Fall of man. This is the struggle between good and evil in all kinds hearts and it has its origins in the garden of Eden and the Snake (Lucifer) and the apple of temptation of Eve’s biting of the apple.

The redemption in the Old Testament is the story of God’s plan to bring redemption of man. The sacrificial system, the spotless lamb, the savior of the world, the one who would die for his own people’s sins.

The final theme is restoration. It is when Christ will return and make all things right. At the moment of his death, there was a great earthquake. Jesus’ body was taken from the cross, laid in a nearby tomb, and on the third day, Jesus’ tomb was discovered empty. Only to be restored to eternal life.

                                                                              References:

Grand Canyon University.  (2015).  Lecture 3 PHI 413V.  Retrieved from https://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatform/loudBooks/loudbooks.html?currentTopicname=&viewPage=past&operation=innerPage&topicMaterialId=a788df13-3e3d-4f98-83d7-029c35f3f96c&contentId=7c6bddaa-839a-46a4-b020-48f1f8451ce9&

Ashford, Bruce, R. Theology & Practice of Mission (Nashville: B&H, 2011).

 

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4-Clinical significance refers to that ability displayed by a treatment to enable a patient return to his or healthy state of body functioning. However, it differs from statistical significance in a sense that it is more objective i.e. it determines whether the prescribed treatment was able to achieve the intended purpose (Sedgwick, 2014). Statistical significance, though a determinant that was only used sometimes back is expressed as a variable meaning that it is never exact on whether the treatment recommended is going to restore a patient’s normality. It operates on the principle of probability.

The ultimate aim of the evidence-based practice project is to bring forth positive outcome. Incorporation of clinical significance can prove to be of great help in achieving this. Carrying out a clinical interpretation in the entire research process will be fundamental in ensuring that patient’s safety, as well as efficacy need, is put into consideration when it comes to decisions made. This will significantly enhance positive outcomes of the research work.

A critical evaluation of the research project by clinicians so as to qualify internal as well as external validity will trigger positive results. The employment of all these aspects of clinical significance will see to it that Evidence-based practice project becomes not only meaningful but also helpful to those seeking medical solutions to their unhealthy conditions.

References

Sedgwick, P. (2014). Clinical significance versus statistical significance. BMJ, 348, g2130-g2130. Retrieved from: http://dx.doi.org/10.1136/bmj.g2130

 

5-According to my memory about statistics, statistical significance is a result that is not attributed to chance. Meaning that the null hypothesis is true. Using p-value of less than 0.05 shows the rejection of the null hypothesis- a significant difference exists.

“Clinical significance is the practical importance of the treatment effect, whether it has a real, palpable, noticeable effect on daily life (Leyva De Los Rios, 2017).” It is the difference in patient care outcome.

We can use statistical significance in results for evidence-based practice. Then use the clinical significance to improve the patient care outcome. Collecting articles showing a significant difference in positive outcomes of care will be supporting evidence for the proposed project for a change of practice.

Leyva De Los Rios, C. (2017). Statistical significance vs. clinical significance. Retrieved from

https://www.students4bestevidence.net/statistical-significance-vs-clinical-significance/

 

 

6-understanding the statistics is very important in nursing. Learning how to measure outcomes in clinical practice is important. Collecting evidence-based practices is one thing, but collecting results from the outcomes is different. For example, evaluating how our practice affects pts is measured differently I think. We would have to create charts to show the improvement, right? Did your co-workers do a project like this yet? 

 

 

 

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