Evidence-Based Nursing Research: Oxygen Therapy in Palliative Care

This report examines evidence-based nursing research, focusing on oxygen therapy for palliative care patients experiencing breathlessness. The study references research by Higginson (2010) and Abernethy et al., highlighting concerns about the effectiveness of oxygen therapy compared to room air or medical air. The report discusses the Grol and Wensing's 10-step model for implementing practice changes, including addressing barriers like lack of awareness and financial constraints, and incentives for adopting new evidence. It emphasizes the importance of educating healthcare workers, particularly nurses, about appropriate oxygen therapy protocols and the potential benefits of alternative interventions like high-speed fans. The conclusion stresses the challenges of implementing changes in palliative care, while emphasizing the need for proper incentives, education, and financial support to ensure successful adoption of innovative practices. The report also includes references to support the findings and recommendations.

Running head: EVIDENCE BASED NURSING RESEARCH
EVIDENCE BASED NURSING RESEARCH
Name of the Student
Name of the university
Author’s note

1EVIDENCE BASED NURSING RESEARCH
Palliative Care students
Breathlessness can be a frightening and a devastating syndrome that affects the palliative
care patients with terminal illness. Oxygen therapy in patients with advanced illness, but a paper
by Higginson, (2010), had raised concern against the effectiveness of oxygen therapy and has
compared their efficiency with the room air. After the conduction of the double blind randomised
control trial, it was found that both oxygen therapy and medical air have had some effects in
decreasing the breathlessness. It was found that the oxygen therapy had a profound influence in
the morning breathlessness and medical air has been found to be effective in case of evening
breathlessness (Higginson,2010),. It was also found that holding a high speed fan directed
towards the face have positive effects in decreasing the breathlessness. Abernethy and colleagues
have also demonstrated that oxygen therapy did not provide any additional benefits over room air
provided by nasal cannula in the terminally ill non hypoxic patients.
These readings provides with the rationale that conventional approaches of the oxygen
therapy should be changed as that might cause adverse effects in the terminally ill patients like
bloody nose or skin irritation, dry mouth. Other side effects of endotracheal oxygen therapy
include infection slipping of the tube. In order to bring about a change in the practice and to
bridge the gap between the scientific evidence and patient care it is required to have an in depth
understanding of the barriers and the incentives for achieving the changes in the practice.
According to Grol and Wensing’s 10 step model in order to bring about a change in the practice
some steps should be kept on mind- Orientation, Insight, Acceptance, change and the
maintenance. Initially it is necessary to keep the patients aware of the innovation, such as the

2EVIDENCE BASED NURSING RESEARCH
provision of high speed fan for the non-hypoxic patients than artificial oxygen therapy.
According to LeBlanc & Abernethy, (2014), room air has been found to have a positive effect on
the palliative care patients as seen from the self rated dyspnea scores.
In order to inform about the pros and the cons of oxygen therapy it is necessary to create
an understanding among the health care workers which can be done by suitable education. The
nurses should be educated the oxygen therapy is a must for the hypoxemia and not breathlessness
except for severe cases. Oxygen therapy should only be applied in case the oxygen saturation
level fall by 3 percent (LeBlanc, & Abernethy, 2014). Nurses can be educated by the registered
nurses accompanied by a physician. It is necessary to develop a positive attitude towards to the
change about oxygen therapy and initiating medical air via nasal cannula.
Barriers to change
The barriers to the change in practice are lack of awareness and knowledge, lack of
motivation, individual acceptance and the beliefs, lack of skills and the lack of practicalities.
There are certain barriers that are beyond our control such as the political and the financial
environment. Our organization had payment issues for binging about the new interventions
(Grol, & Wensing, 2013). Practical barriers to evidence based practice in our health care
involved lack of proper medical equipments for the implementation of the change. Furthermore,
in order to induce the change it is needed for the individuals about the change or what could be
done for the change (Grol, & Wensing, 2013). Some of the health care worker lacked proper
knowledge. Health care workers should have appropriate knowledge regarding the side effects of
oxygen therapy and the dosages and the range of the oxygen saturation, for which it should be

3EVIDENCE BASED NURSING RESEARCH
given. According to O'Driscoll et al., (2013), regulation and the national target setting brings
about modifications in health care.
Incentives
The incentive structure or the mechanism to drive changes in health care department
might not be aligned with what is required for implementing the changes. Financial incentive is
the most important and effective incentive to bring about a change in the organization (Grol et
al., 2013). The health professionals should be provided with extra financial support to those
palliative care students adopting the new evidence against oxygen therapy. Monitoring of the
evidence based practice should be done in order to monitor the performances (Grol et al., 2013).
In conclusion it can be said that implementation of a sudden changes in palliative care
can be challenging as the department deals with terminally ill patients and a slight mistake can
bring about mortality. However, proper incentives, education and the financial support for the
innovative implementation can bring about positive changes successfully.

4EVIDENCE BASED NURSING RESEARCH
References
Grol, R., & Wensing, M. (2013). Implementation of change in healthcare: A complex
problem. Improving patient care: The implementation of change in health care, 1-17.
Grol, R., Wensing, M., Bosch, M., Hulscher, M., & Eccles, M. (2013). Theories on
implementation of change in healthcare. Improving patient care: The implementation of
change in health care, 18-39.
Higginson, I. J. (2010). Refractory breathlessness: oxygen or room air?. The Lancet, 376(9743),
746-748.
LeBlanc, T. W., & Abernethy, A. P. (2014). Building the palliative care evidence base: lessons
from a randomized controlled trial of oxygen vs room air for refractory dyspnea. Journal
of the National Comprehensive Cancer Network, 12(7), 989-992.
O'Driscoll, B. R., Howard, L. S., Earis, J., & Mak, V. (2017). British Thoracic Society Guideline
for oxygen use in adults in healthcare and emergency settings. BMJ open respiratory
research, 4(1), e000170.