Integration of Evidence-Based Practice Into Professional Nursing Practice Essay

In this paper we will discuss the integration of evidence based practice into professional nursing practice. Scott & McSherry (2008) define evidence based practice as the combination of individual, clinical, or professional expertise with the best available external evidence to produce practice that is most likely to lead to positive outcomes for a patient. Despite literature surrounding what evidence based nursing is and isn’t, nurses struggle to get evidence into practice. Many reasons have been reported including a lack of understanding about evidence based nursing means. Scott & McSherry (2008) also define evidence based nursing is a process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient outcomes. We will also discuss nursing’s simultaneous reliance on and critique of EBP in the context of critical reasoning. There will also be discussion of a study done that examined the effects of integrating evidence based practice into clinical practicum among RN-BSN students and the limitations of evidence based practice and an alternate view of decision making. Lastly we will discuss evidence that challenges the traditional practice regarding injection sites (Cocoman & Murray 2010). According to Guem et al. (2010) evidenced based practice is a problem solving approach to clinical care that incorporates the conscious us of the current best available evidence, a clinician’s expertise, and the patient values. Evidence for evidence based practice does not always rely on research findings. Sources used can include research findings, clinical experience, quality improvement data, logical reasoning, recognized authority, and client satisfaction, situation, experience, and value (Leddy & Pepper 2008 p. 66). On the contrary evidence based nursing is essential because of its potential to save time and money and improve patient outcomes by decreasing costs, through standardizing and streamlining costs (Scott & McSherry 2008). It is important o understand the difference between evidence based practice and evidence based nursing because at times they are used interchangeably. Scott & McSherry (2008) state that the nursing practice has welcomed EBP but when it comes to EBN, it is still yet to come reality because the concept is much unsophisticated and can lead to problems associated with its use and misuse. EBN is merely a construct and has yet to be successfully implemented (Scott & McSherry 2008). In essence the dilemma with EBN is that we don’t really know the definition of nursing. Although there are problems with the definition we know that clinical judgment is one of the major concepts used in nursing thus it reinforces the notion of EBP and ultimately EBP. To advance the profession and ensure solid standards of practice, we should look beyond evidence based practice, while useful in implementation it is just one of many other component parts (Jutel 2008). Evidence based practice is like the new black in nursing practice and already occupies a prominent position, several international nursing organizations support its use as a strategic action in the advancement of the profession. Despite the emphasis on EBP, there is also a strong opposition to it, not with the actual use of EBP being a problem but with the fundamentals on which it stands. These arguments complain of the veracity of the criteria used in EBP which simultaneously undermines and cannot support EBP (Jutel 2008). If it had not been for the cultural turn which recognized that things are not always as they seem or that power, society, and culture contribute as much as science to generating knowledge, the debate about EBP would have never surfaced (Jutel 2008). Although nurses argue against EBP, they lack important tools necessary to replace EBP. â€Å"Nursing education places high value on authority and adherence to clinical protocols, rather than on skills† (Jutel, 2008. P. 419). Opponents of EBP suggests that development of clinical practice guidelines, critical care pathways, and protocols may actually interfere and entice practitioners to develop somewhat of a cookbook recipe attitude to client care (Leddy & Pepper 2010). With quality improvement being rooted in industrial production, perhaps standardization may not be as desirable because patients have unique needs and characteristics the may be overlooked when adhering to strict clinical practice guidelines. Nursing adopts a devoted and somewhat naive trust when assessing information, we are quick to accept the truths of a peer reviewed article, drug company propaganda, and quick to accept an argument on inconsistencies of EBP. The tools EBP claims to own, are incredibly useful, however, are not tools of EBP; they are critical skills of information appraisal. As evidence based practice rapidly replaces the traditional paradigm of healthcare decision making, health care members have an obligation to access knowledge, apply it in practice, and lead others to use it appropriately (Geum et al. 010 p. 387). For example RN-BSN programs; these are adult students who have clinical knowledge and skill, structured background and educational preparation and employment experience but have not taken a formal research course, thus they show less confidence to include evidence based practice in their practices because these are courses that are not common outside a baccalaureate curriculum. To examine the effectiveness of the integration of EBP into a clinical practicum a study was done among Korean RN-BSN students. The main goals were to enhance students’ competencies for EBP knowledge skills and attitudes and to expose students to opportunities that would encourage the use of best evidence (Geum et al. 2008). Each student was instructed to define patients nursing problems for their individually assigned patient and to formulate nursing problems using the EBP question format, PICO, which we discussed earlier in the semester, to select the nursing intervention for the problems posed. Before the EBP practicum, the overall and individual scores for EBP efficacy among RN-BSN students indicated that students were â€Å"a little confident† regarding the EBP process (Geum et al. 2008, p. 389). Results of this study indicate that integration of EBP into an RN-BSN clinical practicum had a positive effect on EBP efficacy and decreased barriers to research utilization among students in Korea, which also corroborates with studies conducted in other countries. Evidence based practice is a learned set of skills thus critical thinking is vital in developing evidence based nursing practice (Geum et al. 2008). Regardless if the evidence on complications, nurses in clinical settings still continue to use and instruct nursing students on the use of dorsogluteal injection sites as the site of choice for intramuscular injections (Cocoman & Murray 2010). So, where should an intramuscular (IM) injection be given? Nurses have traditionally used the dorsogluteal, but recent literature has advocated the ventrogluteal site. Choosing sites has been a matter of personal preference, rather than the results of evidence based practice. Slow uptake of medications, major nerves and blood vessels present make this site problematic. A British study suggests â€Å"as previous studies have shown the low efficacy of gluteal intramuscular injections, this route should be avoided for most drugs† (Cocoman & Murray, 2010. P. 1171). As the sciatic nerve lies only a few centimeters from the injection site, injuries pose a significant threat, making the need for accurately identifying landmarks especially important. An alternative site is the ventrogluteal, seen by many as the preferred site. This site provides the greatest thickness of gluteal muscle and is free from penetrating nerves and blood vessels (Cocoman & Murray 2010). Despite evidence favoring the ventrogluteal site, nurses are slow to use it, relying on the much taught and used dorsogluteal site. â€Å"Studies show that only 12% of American nursing staff uses the ventrogluteal site† (Cocoman & Murray 2010. P. 1172). Studies suggest that some reasons the site is not used is because of nurses’ unfamiliarity in locating the site and potential needle stick injury. Unfortunately, nurses have not come to realize that when using the V method, the non injecting hand is to be removed, as it’s only used for visual land marking (Cocoman & Murray 2010). Throughout this paper we have discussed the integration of evidence based practice into nursing from various articles. In the various articles the authors talked about evidence based practice compared to evidence based nursing, the integration of evidence based practice in RN-BSN programs. We also discussed the article on a clinical example which suggested that the ventrogluteal intramuscular injection site over the dorsogluteal site is preferred when it comes to positive patient outcomes.