Evidence Based Practice Report

This evidence based practice report discusses the importance of health education and the effectiveness of wearing gloves and handwashing in minimizing infection transmission in hospitals. It provides recommendations for implementing evidence based practice and overcoming barriers.

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Evidence-based Practice Report.
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Evidence search.
Practicing being a nurse have opened my eyes to see what I could not see before. I could
not be able to see the issues that affected the nursing sector as clear as now. Therefore, the
clinical nursing problem that has been concerned to me is health education. This is where the
patients and their families are not well educated on what is required of them to help in the
recovery of the patient. The issue of health education is of greater essence as it helps in ensuring
that the treatment provided by the doctors are apprehended. Moreover, health education acts as a
preventive measure that ensures that minimal casualties are experienced. It helps the society to
live responsibly being aware of their health (Katz, at al.2015). It mainly helps patients and the
public with the needed behaviors to observe in order to live healthy lives. For this assignment the
article used as a systematic review is “Scurlock-Evans, L., Upton, P., & Upton, D. (2014).
Evidence-based practice in physiotherapy: a systematic review of barriers, enablers, and
interventions. Physiotherapy, 100(3), 208-219.”
Failure to address the issue of health education may lead to more casualties even after the
patients have been discharged (Brown. 2015). Taking a scenario of a patient with high blood
pressure, they need to be taught how to measure their themselves often. They also need to be
shown the lifestyle to live to control the condition. Failure to provide relevant education to a
nursing mother may lead to them neglecting some key clinical appointments and hence
endangering the life of her child. Therefore, it becomes an issue that is too simple but cannot be
ignored for it provides the foundations of good health care.
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One of the patient care dilemmas that I did experience in my clinical experience was
informed consent. As a nurse, the patient wanted to know some health information that had not
been made clear to him by the doctor. The patient had not been fully informed of the prognosis
hence he felt free to ask. It was a tricky situation because it was the thing to be done but on the
other hand, I could not release the information without the doctor’s permission. Therefore, I
choose to conduct this activity using the evidence-based approach as it favors both the patient
and the nurses. It personalizes patient care and equips the nurse taking care of the patient.
Clinical Question.
P The problem at hand. Infection transmission.
I Intervention made for solutions
to be seen
Wearing gloves
C Comparison of the interventions Hand washing and
O Outcomes desired Reduce infection
The health industries have different domains of operation and in this scenario; I choose
to focus on the domain of disease prevention in the hospital. This domain is very important as it
ensures the safety of all the people in the hospital hence it is advisable to come up with a clinical
question that will aid in acquiring solutions for the challenges faced in it (Dang& Dearholt,
2017 ). Therefore, is wearing gloves or handwashing and effective way of minimizing infection
transmission in the hospital?
Search strategy.
Evidence-based practice.
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Evidence-Based Practice is a strategy used by nurses to help them to improve the
healthcare care services they are providing to the patients. The strategy uses available evidence
to assist the nurses in making informed decision hence acting as a guide to nursing care
(LoBiondo-Wood & Haber, 2017). This choice of strategy is significant us it improves the
standard of care offered to the patients by the nurses. This is made possible by including the
patient's preference in the decision-making process, ensuring that there is a reduction in the stay
period of the patient and providing and assurance on the safety of the patient. It ensures that the
nurse is empowered leading to job satisfaction. Therefore, the strategy leads to better outputs
with reduced cost and hence assuring consistency and competence in development.
Key stages.
The following stages create a cycle used in nursing which includes asking, acquiring,
appraising, applying and finally assessing.
Asking.
This is the initial stage where one has to formulate a clinical question as carried out
above. This question is precise and forms the basis of the report. It shows the answers that nurses
have been seeking. The question in this case being, is wearing gloves or handwashing and
effective way of minimizing infection transmission in the hospital?
Acquiring Evidence.
In this, stage one search for the evidence that will back up the answer to the clinical
question in the first process. In order to have strong evident scholar evidence must be there. In
this case, an article that is going to provide the evidence.
Appraising and Applying the evidence.
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In this stage, one has to critically look at the literature material gathered to ensure that
they are valid in the first place (LoBiondo-Wood& Haber, 2017). It would be an error to apply a
piece of evidence in research and it has not been validated for its applicability. This stag ensures
that the evidence gathered will truly help in getting the solution when applied.
Assessing the evidence.
It is the last stage where one look to see if the work done above brought any fruit. In the
case of the clinical question, one would assess to see if the real gloves and the washing of hands
prevented the spread of disease in the hospital. The effectiveness will be seen with the
comparison of two scenarios, one with the use of gloves while another without.
Hierarchy of evidence.
Of the two hierarchy of evidence model, JBI and NHMRC, I do consider using the JBI
model as the best level of evidence to my clinical question due to its uniqueness (Katz, at al.
2017). In the domain of disease prevention which lies in effectiveness area. The five sources
were selected due to their adaptability to the JBI hierarchy of evidence. Their study design fitted
the five levels in the strategies hence they are suitable for the evidence search. The sources
provide a descriptive experimental design that helps to show one how to carry out an effective
resource. Another source partially talks about the clinical question hence featuring in the second
level. The source of health welfare provides an observational design that can fit appropriately
with the third level. This entire source does fit and provides a valid response to the answer for
the clinical question.
Synthesis of best evidence.
 Handwashing.
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The evidence shows that handwashing among the patients is the most effective and economical
way of preventing infection transmission. This is not only made possible by ensuring safe
contacts among the patients, but it also helps in keeping the surface environment clean. This way
even visitors in the hospital or the staffs may not contact infection.
• Protective gloves.
On the other hand, another article shows that gloves worn by nurses prevent up to almost 100%
infection transmission. This way it is mandatory for every health care worker to implement the
personal protective equipment policy (Mudedla, at al 2014). This policy ensures that no nurse or
any other worker should handle a patient with proper safety equipment.
 Pressurization.
The evidence also shows that airborne infections can be prevented by using an air-pressure
control system. The process of pressurization ensures that infection from a particular does not
cross to another room due to the difference in pressure gradients (O’Brien, et al .2014).
Therefore, the process of air filtration is also applied. Even with all this handwashing and
wearing protective gloves remains to be the most effective and friendly way to minimize
infection in the hospital.
 Reliability of results.
Therefore, I can confidently affirm that the findings of the evidence are totally reliable.
The results are reliable in that, they are based on experimental design. this is where a study was
conducted among the patients how in the hospital often were not infected by any other diseases
and those that were infected in their period of stay in the hospital. The once that remained health
from infection said that they did observe their personal hygiene very much. This included the
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washing of hands before eating and after visiting the toilet. On the contrary, they that were
regularly infected showed that they often missed applying the principle on hand washing. The
evidence also shows that the nurses who valued and implemented the policy of personal
preventive equipment remained free from infections no matter the environment posted.
 Applications.
These results can be useful when only applied to patients. Therefore, the need for health
education among patients and their families. As I nurse, I can ensure that my patients know the
importance of a simple hand wash. This can be done by regularly sensitizing the matter to them
to ensure they understand it. I can also make a commitment that at all time I will be wearing
protective cloths to prevent infection transmission while handling the patients.
Therefore, this brief synthesis answers the original clinical question in that, it affirms that
truly putting on gloves and applying the principle of handwashing to help in minimizing the
infection rate in the hospital. It provides practical evidence that shows the benefits brought by the
simple concepts of infection protection. This way sensitizing on an intentional commitment to
every nurse and patient to ensure they do apply the finds for their health safety. For these
reasons, I would suggest the following recommendations to ensure that the safety of both the
patients and heath works is achieved.
Recommendations.
It is not always easy and straightforward to change a practice that had been adapted as a
routine therefore; there are barriers that need to be faced in order to properly implement the
change. These barriers include:
Barriers by Organization.
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The management organization also acts as a barrier to effective implementation of the evidence-
based practice in the following way.
 Limited human resources.
The hospital may want to put into practice the findings but in the centrally find a
challenge due to the available workforce. Most of the findings requires an increase in
human resource which may be a burden to the organization. The shortage of nurse is a
barrier that is being experienced in all the health organization amounting to 78.3%.
 Workload.
70% of the hospital experience heavy workload in their daily activities. This way the
limited human resource available becomes exploited. This way additional evidence from
the research adds to the workload hence making it difficult to be implemented.
Barriers by Individuals.
In the implementation of the evidence-based practice the individual barriers constitute the largest
percentage which is 57% (Scurlock-Evans, Upton & Upton, 2014). These factors are lack of time
and the high level of computer illiteracy as discussed below.
 lack of time.
The findings show that most of the individuals lack time to read. Due to the busy
schedules of life, people do not get ample time to study such finding. By this, it becomes
hard to implement the outcome of the research as most of them are passed to the people
through the written materials.
 Computer illiteracy.
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On the other hand, the finds do show that most individuals, statistically,52.6% of those
how enrolled in computer courses did not pass. Therefore, most of the individuals acts as
a barrier to implement the finds as information technology as of key pillar in the
implementation.
Strategies.
Due to the barriers that are faced in the implementation face strategies have to be put in
place to allow effective change as per the findings. These strategies include.
 Training programs.
This strategy is aimed in equipping the organization and individuals with the required
information concerning the EBP. Therefore, a learning environment is created to clear all
the doubts that may arise. This way, experts may interact with the staffs to ensures that
they are properly equipped.
 Identifying barriers.
Here the team have to carefully see the barriers that may hinder the application stage. The
main aim being to overcome these barriers. Therefore, facilitating a smooth flow of the
EBP findings.
 Evaluation and monitoring.
This strategy is aimed to see that the implemented EBP is properly working among the
organization. It ensures the future of the EBP carried is relevantly applied and more
training done to the incoming medical staffs
The limitation that may hinder the implementation of the evidence may include,
- The cost needed to apply the personal protective equipment policy.
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-Moreover, the coming up of a policy that can be adapted by all in the hospital is another
limitation.
On the contrary, I do recommend the implementation of a hand wash policy. The policy
should be signed by every patient in the admission time at the hospital. Nurse, on the other hand,
should be provided with the necessary equipment to ensure their safety when handling the
patients in the hospital. In conclusion, I do support the consideration of the proposal by the
executive members in the hospital to ensure that every patient is entitled to safety.
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References.
Brown, A. M. (2015). Simulation in undergraduate mental health nursing education: A literature
review. Clinical Simulation in Nursing, 11(10), 445-449.
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and
guidelines. Sigma Theta Tau. Pico
Katz, D. F., Turakhia, M. P., Sauer, W. H., Tzou, W. S., Heath, R. R., Zipse, M. M., ... & Kao,
D. P. (2015). Safety of ventricular tachycardia ablation in clinical practice: findings from
9699 hospital discharge records. Circulation: Arrhythmia and Electrophysiology, 8(2),
362-370.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-E-book: methods and critical
appraisal for evidence-based practice. Elsevier Health Sciences.
Mudedla, S., Tej, W. L., Reddy, K. T., & Sowribala, M. (2014). A study on knowledge and
awareness of standard precautions among health care workers at Nizam's institute of
medical sciences Hyderabad. The Journal of National Accreditation Board for Hospitals
& Healthcare Providers, 1(2), 34.
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for
reporting qualitative research: a synthesis of recommendations. Academic Medicine,
89(9), 1245-1251.
Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses. Jones & Bartlett
Learning.
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Scurlock-Evans, L., Upton, P., & Upton, D. (2014). Evidence-based practice in physiotherapy: a
systematic review of barriers, enablers, and interventions. Physiotherapy, 100(3), 208-
219.
Appendices
Appendix A: links to five best evidence sources
https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/
overview
https://www.aihw.gov.au/reports-data/health-welfare-overview/australias-health/overview
https://www.safetyandquality.gov.au/national-priorities/
https://usqdirect.usq.edu.au/usq/file/e7cd483c-b9af-4fb3-a1b9-b80fa5466b0a/1/
Where_to_Start_with_Research_-_20160801_120233_6.html
https://www.evidentlycochrane.net/category/evidence-for-everyday-nursing/
Appendix B: evidence summary table.
Author (s)
(date)
Study
design
question
Domain
Key
information
Validity
check
Author’s
Results/
findings
Author’s
conclusions
Reviewer
Comments
(your
appraisal)
Evidence
source
27th
august,2019
Purpose:
Conduct a
research
Design:
EBP
Level:
JBI
Domain:
Disease
prevention
P: infection
transmission.
I:
handwashing.
C: protective
gloves.
O: patient
safety
Very
reliable.
70.23%
of the
patients
do not
clean
their
hands
often.
There is a
need for
mobilization
among
patients.
Excellent
findings and
data
collection.
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Appendix C: search history and results.
Appendix D: Critical appraisal of highest level of evidence
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