At the conclusion of this chapter, the learner will be able to
1. Synthesize key components from evidence-based nursing practice andresearch utilization to drive the provision of quality nursing care
2. Demonstrate proficiency in evidence-based practice using the princi-ples of the research process
➤ Evidence-based practice ➤ Research use
➤ Integrative reviews ➤ Systematic reviews
➤ Meta-analysis
Application ofEvidence-BasedNursing Practice
with Research
Sharon Cannon and Carol Boswell
Chapter Objectives
14Chapter
Key Terms
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Introduction
In Chapter 1, evidence-based practice (EBP) was defined as a research-based,decision-making process that is used to guide the delivery of holisticcare by nurses.The recent need for and acceptance of EBP is apparentin the literature. In a 2006 survey conducted by Sigma Theta TauInternational (STTI 2006), results suggested that a majority of thenurses needed evidence on a weekly basis to guide practice. About 90%of the participants indicated a moderate to high level of confidence inEBP. The results of this survey again support the premise that EBP is adriving force for the use of scientific data in the decision-makingprocess in the provision of nursing care.
Understanding the research process is the first step in using evi-dence in everyday nursing practice. Following initial historic back-ground regarding research in nursing, the other chapters of this bookhave focused on the research process. Examples of evidence-based prac-tice have been given to demonstrate how EBP is applied in specificcomponents of the research process.
Difficulty analyzing the evidence has been identified as a major ob-stacle to research use. The preceding chapters have provided informationto assist in the analysis of research findings in the application to nurs-ing care.This chapter is designed to “pull the pieces together” with apractical approach for research utilization in evidence-based nursingpractice.
Process for Evidence-Based Practice
318 | Chapter 14 Application of Evidence-Based Nursing Practice with Research
?Frequently, a laboring patient receives an epidural for painmanagement. A potential side effect of this procedure and thelaboring process is difficulty with urination. As a result, the pa-tient habitually receives catheterization to address this prob-lem. Depending on several factors, either a straight (in and out)catheter or a retention Foley catheter is used. Both methodsfor managing urinary retention include pros and cons.
• Based on the evidence, which way is best to manage thishealth challenge for the laboring client?
• List PICOT questions that could be generated from thisscenario.
• What ethical considerations would need to be addressedprior to a research study?
• How would you incorporate patient preferences into theevidence-based practice?
Think Outsidethe Box
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According to Myers and Meccariello (2006), “outdated practices arebarriers to decreased length of stay, favorable patient outcomes, andlowered costs” (p. 24). To move evidence-based nursing practice for-ward, a realistic approach for allowing bedside nurses to actively engagein the process must be determined and used. At each stage of provid-ing holistic care, nurses have to be confident in asking the questions andseeking the best practices to advance the provision of effective nursingcare. Omery and Williams (1999) set forth the initiative to ensure thatcareful and practical best evidence is used to propel health care deci-sions. Nurses must seek the best evidence to make sure that the care pro-vided represents the optimal health care available for the treatment planBy determining a functional method for documenting an EBP search,nurses can then gain confidence in conducting and implementing EBP.
The process for EBP determination is different from the process forresearch utilization. Research utilization is depicted in Chapter 13,which reflects how to complete an assessment of a single research re-port.The process for research utilization carefully examines a distinctstudy to determine the strengths and limitations assumed within thatone study. Research utilization becomes a key aspect within the over-all process of EBP, but it is only one piece. For a nurse to be able to ef-fectively utilize EBP, he or she does have to be able to conduct researchcritiques. Jolley (2002) supported this idea by emphasizing the needfor all nurses to be able to use research, but not everyone has to nec-essarily be able to conduct research. Bedside nurses need to understandhow to recognize the aspects within a research process that eitherstrengthen or limit the use of the results. By having this understandingabout the applicability of the results to practice, a nurse can then de-termine which studies can be used to sustain best practices in EBP. Asa result, nurses do need to appreciate the intricacies of the researchprocess. Bedside nurses should be able to identify the justifications thata researcher provides for selecting a specific method of sampling, datacollection, research design, and data analysis. If a researcher has a validexplanation for the choices employed within a study, the results can bevalued and incorporated into practice. Having begun the work withresearch critiques discussed in Chapter 13, the nurse can then move tothe next step of development to use those skills within the EBP process.
Melnyk and Fineout-Overholt (2005) delineated the process ofEBP as involving five critical steps.These five steps are
■ Raising the urgent clinical question using a format that pro-vides the key aspects of the issue
■ Assembling the most appropriate evidence that addresses theissue identified
■ Evaluating the evidence critically to determine the validity,relevance, and applicability
Process for Evidence-Based Practice | 319
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■ Assimilating the evidence into clinical practice■ Assessing the changes resulting from the use of the best
evidence
Each of these steps must be carefully completed to come to a determi-nation of best practices for a nursing setting. If an EBP process doesnot include all of the five steps, the result does not take into consider-ation all of the available evidence related to the clinical question.
320 | Chapter 14 Application of Evidence-Based Nursing Practice with Research
?Over recent years, more and more parents are seeking alterna-tive birthing options. Some individuals elect to deliver at homedue to health care costs. Some make this decision from a de-sire to have a more natural birthing process. When complica-tions occur during the birthing process, the baby may have tobe admitted to an acute care setting. For newborn infants, thestandard initial treatment process includes erythromycin eyeointment, triple dye to the cord, and a vitamin K injection. If theparents voice concerns about these procedures, what stepswould a nurse need to take to provide evidence-based infor-mation concerning these procedures?
• List PICOT questions that could be generated from thisscenario.
• What ethical considerations would need to be addressedprior to a research study?
• What key words would be used for a literature search tolocate evidence related to this EBP question?
• What type of research project could be developed tofurther study this concern?
• How would you incorporate patient preferences into theevidence-based practice?
Think Outsidethe Box
Although many models for EBP are currently being evaluated andmodified, Table 14-1 is provided as a quick and easy organizational de-sign. Within this format, the initial step is to refine the question con-fronting the nurse. Careful time and attention should be given toclarifying the five aspects driving the EBP question. As discussed pre-viously, the question should consider the following five aspects (PICOT):
■ P—Population of interest■ I—Intervention of interest■ C—Condition of interest■ O—Outcome of interest■ T—Time
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Tab
le 1
4-1
Form
at fo
r D
ocum
entin
g E
vid
ence
-Bas
ed P
ract
ice
Asp
ects
Qu
esti
on
to
be
con
sid
ered
wit
hin
th
e ev
iden
ce-b
ased
pra
ctic
e p
roce
ss:
P(P
opul
atio
n of
Inte
rest
): _
____
____
____
____
____
____
____
____
____
____
____
____
__
I (In
terv
entio
n of
Inte
rest
): _
____
____
____
____
____
____
____
____
____
____
____
____
__
C (
Com
paris
on o
f Int
eres
t): _
____
____
____
____
____
____
____
____
____
____
____
____
_
O (
Out
com
e of
Inte
rest
): _
____
____
____
____
____
____
____
____
____
____
____
____
___
T(T
ime)
: ___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
Wh
o
Wh
at
Wh
ere
Art
icle
sIn
volv
edO
ccu
rred
Co
mp
lete
dW
hen
W
hy
Ho
wC
on
sist
enci
esG
aps
Su
mm
ary
of
fin
din
gs:
Ap
plic
atio
n o
f fi
nd
ing
s to
evi
den
ce-b
ased
pra
ctic
e th
at v
alid
ates
/ch
ang
es p
olic
ies
and
pro
ced
ure
s:
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322 | Chapter 14 Application of Evidence-Based Nursing Practice with Research
Each of these characteristics for the clinical questions was discussed inChapters 1 and 4. The development of a clear and concise clinical ques-tion is of paramount importance, because the question directs the en-tire process.
Once the question is determined, the nurse needs to work with thelibrarian to determine key words and/or expressions to use in con-ducting the literature review. Having appropriate terms to use withinthe various search engines helps to ensure that the resulting articlesprovide the structure for the analysis of the best practices. Melynk(2003) stated, “evidence-based practice is a problem-solving approachto clinical decision making that incorporates a search for the best andlatest evidence, clinical expertise, and assessment, and patient preferenceand values within a context of caring” (p. 6 of 7).
Malloch and Porter-O’Grady (2006) classified these investiga-tions of best practices as meta-analyses, systematic reviews, or integra-tive reviews. The combining of these different study types identifiedwithin the literature review and search engine inquiry provide thefoundation for determining whether there is a need to change prac-tice patterns. Meta-analysis incorporates a statistical technique to deter-mine the rigorousness of the findings from multiple studies on afocused question. A systematic review is the summarization of all evi-dence found correlated to an identifiable research or clinical issue em-ploying a rigorous format to ensure completeness of the assessment.An integrative review also summarizes prior research studies on a selectedtopic but, in addition, draws conclusions from the summary concern-ing the studies examined.
?Evidence-based practice should cause the nursing professionto question most of our normal activities. A simple skill such ascatheterizing an individual can result in an EBP question suchas: How much urine should a nurse drain off the bladder at onetime following a catheterization of a client?
• List PICOT questions that could be generated from thisscenario.
• What ethical considerations would need to be addressedprior to a research study?
• What key words would be used for a literature search tolocate evidence related to this EBP question?
• What type of research project could be developed tofurther study this concern?
• How would you incorporate patient preferences into theevidence-based practice?
Think Outsidethe Box
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Process for Evidence-Based Practice | 323
The format provided in Table 14-1 allows for either a systematicreview or an integrative review. Once the PICOT question has been de-termined and the literature review has been completed, each of theidentified articles/studies is carefully assessed. For each article, the whoinvolved (sample), what occurred (research design), where completed,when,why,and how (statistical/data analysis) are determined and documented.Asthese aspects of a research critique are completed on the different stud-ies, consistencies and/or gaps within the different studies begin tosurface.The identification of consistencies within the different studiesprovides support for potential changes in practice or confirmation ofbest practices currently being used. The detection of gaps within thestudies presents the need for further and/or more in-depth research en-deavors on the topic under consideration.The idea of identifying con-sistencies and gaps within the different articles/research reports isrelated to the concept of similarities and the omissions that may be pres-ent. Associations established from the results of the various studiesneed to be collected to add strength to the rationale for making anychanges in policies and procedures related to the selected clinical ques-tion. If several studies all reflect the equivalent results, then nursingpractice should embrace the behavior as supported by evidence. On theother hand, if multiple studies all reflect a gap in knowledge relatedto the selected clinical question, then further research should be di-rected toward the identified segment of nursing practice. Accordingto Pravikoff,Tanner, and Pierce (2005), “the finding that a lack of valuefor research in practice was the most frequently selected barrier to the useof research in practice is of greatest concern” (p. 13 of 17). Whenpracticing nurses cannot or do not use research results to strengthenand sustain holistic nursing practice, the implementation of EBP atthe bedside becomes incomplete.
After completing the grid portion of Table 14-1, time must begiven to summarizing the findings. The nurse should pay careful atten-tion to and critically consider the meaning ensuing from the consis-tencies and gaps identified. This painstaking contemplation of thediscovered omissions and similarities focuses the next steps within theprocess. By taking the time and energy to summarize and synthesizethe information collected, the nurse becomes well versed in the cur-rent state of the clinical problem. Obtaining this clearer viewpoint re-lated to the clinical problem allows the nurse to make an informeddecision as to what is needed next in this challenge
The final section of this table relates to the application aspect. Aftercompleting each of these prior steps, the nurse has a base on which tomake recommendations for maintaining or changing a policy or pro-cedure.The time taken to complete this exercise allows for any recom-mendations to be based on sound, factual data.The suggestions can thenbe effectively supported by a wealth of tested research endeavors.
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Conclusion
Yoder (2005) stated, “both EBP and QI initiatives require ongoing eval-uation of the practice environment, the appropriate use of data collec-tion and evaluation, and the dissemination of the information learnedthrough excellent communication process both from the top downand the bottom up” (p. 3 of 3). Resources are available to aid the nurseto strengthen EBP foundations and activities (see Table 14-2). The cur-
324 | Chapter 14 Application of Evidence-Based Nursing Practice with Research
?Frequently, an insulin drip protocol will seek to maintain aserum blood sugar result between 70 to 110 mg/dl. At onehealth care agency, a pilot research project revealed a meanblood sugar for patients dismissed from a cardiac intensivecare unit after three months was 148. The nurses questionedthe protocol ranges as a result of this pilot study result.
• List PICOT questions that could be generated from thisscenario.
• What ethical considerations would need to be addressedprior to a research study?
• What key words would be used for a literature search tolocate evidence related to this EBP question?
• What type of research project could be developed tofurther study this concern?
• How would you incorporate patient preferences into theevidence-based practice?
Think Outsidethe Box
Table 14-2
Suggested Resources to Support the Retrieval and Appraisal of Evidence
• Oncology Nursing Society (ONS) EBP Online Resource Center “Evidence Search” section: http://onsopcontent.ons.org/toolkits/ebp/process_model/evidence_search.htm
• National Library of Medicine Web site, which allows free searches of MEDLINE through PubMed:www.ncbi.nlm.nih.gov/entrez/query.fcgi
• National Guidelines Clearinghouse: www.guideline.gov
• National Comprehensive Cancer Network: www.nccn.org
• Agency for Healthcare Research and Quality: www.ahrq.gov
• Cochrane Database of Systematic Reviews: www.updates-software.com/conchrane/abstract.htm
• University of Alberta – EB Medicine Tool Kit: www.ualberta.ca/ebm/ebm.htm
• RNAO Best Practice Guidelines: www.rnao.org
• Centre for Evidence-Based Nursing (York, UK):www.york.ac.uk/healthsciences/centres/evidence/cebn.htm
• Joanna Briggs Institute: www.joannabriggs.edu.au
• ScHARR Netting the Evidence: www.shef.ac.uk/scharr/ir/netting
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rent health care community requires nurses and other health careproviders to be diligent in the determination and provision of holistichealth care. The different treatments and plans of care put forth forclients must be based on factual, tested data. Each nurse must take re-sponsibility for ensuring that the care provided is based on firm, accu-rate research data. This research data is then used to provideindividualized health care to clients based on factual data, patient pref-erences, and nursing expertise.
Conclusion | 325
?Gather at least three of your peers and form a journal club.Select a topic of your choice and identify a PICOT question.Conduct an integrative review for the selected topic. Whatconclusion can you draw from the review? How will thischange your practice?
Think Outsidethe Box
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Summary Points
1. Evidence-based practice (EBP) was defined as a research-based, decision-making process used to guide the delivery of holistic care by nurses.
2. Understanding the research process is the first step in using evidence ineveryday nursing practice.
3. To move evidence-based nursing practice forward, a realistic approach forallowing bedside nurses to actively engage in the process must be deter-mined and used.
4. The process for research use carefully examines a distinct study to deter-mine the strengths and limitations assumed within that one study.
5. By having an understanding of the applicability of the results to practice,a nurse can then determine which studies can be used to sustain bestpractices in EBP.
6. The development of a clear and concise clinical question is of paramountimportance, because the question directs the entire process.
7. Meta-analysis incorporates a statistical technique to determine the rigor-ousness of the findings from multiple studies on a focused question.
8. A systematic review is the summarization of all evidence found correlatedto an identifiable research or clinical issue employing a rigorous formatto ensure completeness of the assessment.
9. An integrative review also summaries prior research studies on a selectedtopic but, in addition, draws conclusions from the summary concerningthe studies examined.
10. For each article, the who involved (sample), what occurred (research design),where completed,when,why, and how (statistical/data analysis) are determinedand documented.
11. The identification of consistencies within the different studies providessupport for potential changes in practice or confirmation of best practicescurrently being used.
12. The detection of gaps within the studies presents the need for furtherand/or more in-depth research endeavors on the topic under consideration.
13. Obtaining this clearer viewpoint related to the clinical problem allows thenurse to make an informed decision as to what is needed next in thischallenge.
326 | Chapter 14 Application of Evidence-Based Nursing Practice with Research
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Red Flags | 327
RED FLAGS
• Research utilization and evidence-based practice are not one and the same.
• The recommendation for changing nursing practice must be based on sound
evidence not a single study.
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328 | Chapter 14 Application of Evidence-Based Nursing Practice with Research
A Hispanic woman presents to the Emergency Room complaining of epigas-tric pain in atypical form, nausea, diaphoretic, and complaining of neck pain.The initial assessment reveals a 60-year-old, Hispanic female with a history ofdiabetes and hypertension. She has a granddaughter attending nursing schoolat the local community college.The client reports being a smoker with a fam-ily history of cardiac problems. She is 5 feet 3 inches tall and weighs 185pounds. She is a homemaker with no outside employment. For the most part,she reports a sedentary life style and denies alcohol consumption. The ERphysician orders an EKG and cardiac panel to rule out an acute myocardial in-farction. Other tests ordered include a chest X-ray, urinalysis, and standardchemistry (CBC, troponins, creatinine protein). The tests revealed elevatedtroponin and EKG changes with an elevation in the ST segment.The client isdiagnosed with a full-blown myocardial infarction.The ER physician mobilizesthe cath lab team and orders a cardiology consultation. The client is trans-ported to the cath lab for an angiogram, which reveals two blocked cardiac ves-sels. After a double angioplasty is performed, the client is transferred to theCardiac Care Unit. After she arrives in the unit, the nursing staff assessed theclient and determines that the angioplasty versus manual compression wascompleted with Perclose. The use of this closure for angioplasty has been asource of discussion in the CCU. As a result of this case and others, the nurs-ing staff elects to engage in an evidence-based practice activity to determineif the policies and procedures currently used on the unit reflect the best prac-tices for this type of client and medical treatment plan.The following PICOTquestion was identified (see Table 14-3). The EBP process was initiated.
As can be seen from the case study analysis, there are gaps in the literature inthe lack of actual research projects on the use of Perclose versus manual pres-sure.All of the literature reviewed were case studies with reference to recom-mendations from the manufacturer. If the nurses wished to continue furtherexploring Perclose, they could use the Gap Table (Table 5.4) in Chapter 5.However, the case study illustrates how EBP and research can lead to specificactions to improve nursing care.Thus, patient outcomes can be improved.
Case Scenario
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References
Tab
le 1
4-3
Form
at fo
r D
ocum
entin
g E
vid
ence
-bas
ed P
ract
ice
Asp
ects
Qu
esti
on
to
co
nsi
der
wit
hin
th
e ev
iden
ce-b
ased
pra
ctic
e p
roce
ss:
P(P
opul
atio
n of
Inte
rest
): _
___
His
pani
c ad
ult 5
0 ye
ars
or o
lder
I (In
terv
entio
n of
Inte
rest
): _
___
Per
clos
e us
age
C (
Com
paris
on o
f Int
eres
t): _
___
Man
ual p
ress
ure
O (
Out
com
e of
Inte
rest
): _
___
decr
ease
d le
ngth
of s
tay,
dec
reas
ed h
emat
oma,
dec
reas
ed d
isco
mfo
rt, d
ecre
ased
infe
ctio
n ra
te
T(T
ime)
: ___
_ w
ithin
2 w
eeks
from
dis
char
ge
Wh
o
Wh
at
Wh
ere
Art
icle
sIn
volv
edO
ccu
rred
Co
mp
lete
dW
hen
W
hy
Ho
wC
on
sist
enci
esG
aps
Gea
ry, L
ande
rs, F
iore
, &R
iggs
. (20
02).
Man
agem
ent o
f inf
ecte
dfe
mor
al c
losu
re d
evic
es,
Car
diov
ascu
lar
Sur
gery
,10
(2),
161
–163
.
Hec
k, M
uldo
wne
y, &
McP
hers
on. (
2002
).In
fect
ious
com
plic
atio
nsof
Per
clos
e fo
r cl
osur
e of
fem
oral
art
ery
punc
ture
s,JV
IR,4
27–4
31.
Joha
nnin
g, F
ranl
in,
Elm
ore,
& H
an. (
2001
).F
emor
al a
rter
y in
fect
ions
asso
ciat
ed w
ith p
ercu
ta-
neou
s ar
teria
l clo
sure
de-
vice
s, J
ourn
al o
f Vas
cula
rS
urge
ry, 3
4(6)
, 983
–985
.
Infe
ctio
n
Infe
ctio
n
Infe
ctio
ns
2002
2002
2001
Cas
est
udie
s
Cas
est
udie
s
Cas
est
udie
s
4 m
ales
, 1 fe
mal
eag
e ra
nge
63–7
3
2 fe
mal
es, 1
mal
e,ag
e ra
nge
40–7
6
2 m
ales
, age
rang
e 50
–56
NY,
Acu
te c
are
unit,
out
patie
nt,
gene
ral h
ospi
tal
Thr
ee d
iffer
ent
inst
itutio
ns
Eas
tern
Sta
te
Exa
min
ed P
ercl
ose,
no
in-
dica
tion
of p
roph
ylac
tic a
nti-
biot
ic u
se, s
taph
yloc
occu
sin
fect
ions
Rep
ort o
f cas
es, 3
day
spo
st o
p.
Add
to d
ata,
sta
phyl
ococ
cal
arte
rial i
nfec
tion,
MR
SA
,bl
ood
seru
m a
t site
ser
ved
as b
acte
rial g
row
th m
ediu
m
All
had
infe
ctio
ns, s
utur
epl
acem
ent,
antib
iotic
s
2 ha
d st
aphy
loco
ccal
,on
e fr
om b
acte
rial,
con-
cern
s ab
out s
utur
epl
acem
ent
Sut
ure
plac
emen
t, pr
e-pr
oced
ure
antib
iotic
s
Littl
e re
sear
ch,
reco
mm
enda
-tio
ns c
ame
from
man
ufac
ture
r,no
indi
catio
n of
ethn
ic o
rigin
Ref
ers
to p
ub-
lishe
d tr
ials
Ref
ers
toM
AU
DE
, no
time
desi
gnat
ion
on th
ese
case
sas
to h
ow lo
ngbe
fore
iden
tific
a-tio
n of
infe
ctio
n
cont
inue
s
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Tab
le 1
4-3
co
nti
nu
ed
Form
at fo
r D
ocum
entin
g E
vid
ence
-bas
ed P
ract
ice
Asp
ects
Wh
o
Wh
at
Wh
ere
Art
icle
sIn
volv
edO
ccu
rred
Co
mp
lete
dW
hen
W
hy
Ho
wC
on
sist
enci
esG
aps
Ties
enha
usen
, Tom
ka,
Allm
ayer
, Bau
man
n,H
essi
nger
, Por
tuga
ller,
&M
ahle
r (2
004)
. Fem
oral
arte
ry in
fect
ion
asso
ciat
edw
ith a
per
cuta
neou
s ar
te-
rial s
utur
e de
vice
, VA
SA
,33
,83–
85.
Infe
ctio
nre
sulti
ng in
sept
ic d
eath
2004
Cas
est
udie
s77
-yea
r-ol
d m
ale
Aus
tria
A
dd to
dat
a, in
fect
ion
iden
-tif
ied
4 w
eeks
pos
t hos
pita
l-iz
atio
n, s
een
in E
R p
rior
tofin
al a
dmis
sion
to h
ospi
tal
with
sep
sis,
Per
clos
e ca
r-rie
s ris
k of
fem
oral
art
ery
infe
ctio
ns
Ste
rile
field
mus
t be
mai
ntai
ned,
sut
ure
plac
emen
t
Ref
ers
to r
e-se
arch
, not
of
His
pani
c or
igin
Su
mm
ary
of
fin
din
gs:
Per
clos
e ca
n re
duce
leng
th o
f sta
y; T
o im
prov
e ou
tcom
es –
pro
per
use
of P
ercl
ose
and
cons
ider
atio
n of
pro
phyl
actic
ant
ibio
tic th
erap
y sh
ould
be
utili
zed
in c
onju
nctio
n w
ith th
e us
eof
Per
clos
e; A
ll of
the
revi
ewed
art
icle
s w
ere
case
stu
dies
; No
quan
titat
ive
rese
arch
was
foun
d; N
o nu
rse-
dire
cted
res
earc
h w
as lo
cate
d, L
engt
h of
tim
e be
fore
infe
ctio
ns id
entif
ied
rang
ed fr
om 3
day
s to
4 w
eeks
; Ste
rile
tech
niqu
e du
ring
proc
edur
e is
par
amou
nt.
Ap
plic
atio
n o
f fi
nd
ing
s to
evi
den
ce-b
ased
pra
ctic
e th
at v
alid
ates
/ch
ang
es p
olic
ies
and
pro
ced
ure
s:
•A
ll ar
ticle
s su
gges
t pro
phyl
actic
ant
ibio
tic u
se a
nd s
tric
t adh
eren
ce to
man
ufac
ture
r’s r
ecom
men
datio
ns fo
r in
surin
g a
ster
ile s
urgi
cal s
ite.
•E
R d
epar
tmen
t sho
uld
revi
ew it
s po
licie
s co
ncer
ning
the
asse
ssm
ent o
f pos
t-an
giop
last
y cl
ient
s w
ho p
rese
nt w
ith v
ague
sym
ptom
s si
nce
the
infe
ctio
n m
ay b
e m
aske
d un
til it
de-
velo
ps in
to a
sep
sis
type
of i
nfec
tion
even
as
late
as
4 w
eeks
pos
tpro
cedu
re.
•P
atie
nt e
duca
tion
shou
ld b
e ad
dres
sed
with
in p
olic
ies
to e
nsur
e th
at c
lient
s ar
e ta
ught
to m
aint
ain
a cl
ean
site
at t
he in
cisi
on a
rea,
to c
ompl
ete
all a
ntib
iotic
trea
tmen
t ord
ered
,an
d to
rep
ort v
ague
sym
ptom
s re
flect
ive
of in
fect
ions
eve
n up
to 4
wee
ks p
ostp
roce
dure
.
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Suggested Readings | 331
Suggested Readings
Suggested Readings | 331
Coopey, M., & Clancy, C. M. (2006, July/September). Translating researchinto evidence-based nursing practice and evaluating effectiveness. Journalof Nursing Care Quality, 21(3), 195–202.
Marchiondo, K. (2006, January/February). Planning and implementing anevidence-based project. Nurse Educator, 31(1), 4–6.
Newhouse, R. P. (2006, July/August). Examining the support for evidence-based nursing practice. Journal of Nursing Administration, 36(7-8),337–340.
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332 | Chapter 14 Application of Evidence-based Nursing Practice with Research
References
Jolley, S. (2002). Raising research awareness: A strategy for nurses. Nursing Standard,16(33), 33–39.
Malloch, K., & Porter-O’Grady, T. (2006). Introduction to evidence-based practice in nursing andhealth care. Boston: Jones and Bartlett Publishers.
Melnyk, B. M. (2003). Finding and appraising systematic reviews of clinical interven-tions: Critical skills for evidence-based practice. Journal of Pediatric Nursing, 29(2),125, 147–149.
Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare:A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.
Myers, G., & Meccariello, M. (2006). From pet rock to rock-solid: Implementing unit-based research. Nursing Management, 37, 24–29.
Omery, A., & Williams, R. P. (1999). An appraisal of research utilization across theUnited States. Journal of Nursing Administration, 29(12), 50–56.
Pravikoff, D. S,Tanner,A. B., & Pierce, S.T. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40–51.
Sigma Theta Tau International. (2006). Results of EBN survey. Retrieved from an e-maildated June 12, 2006 from Sigma Theta Tau International Honor Society ofNursing. NurseAdvanceTM: Knowledge Solutions.
Yoder, L. (2005). Evidence-based practice: The time is now! Medsurg Nursing, 14(2),91–92.
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Critical Thinking Exercise | 333
Critical Thinking Exercise
Multiple ideas related to potential clinical questions are provided foryour consideration. Select a situation to use in working through theprocess reflected in Table 14-1.The situations are presented in a briefmanner.Take the idea and develop the PICOT question to best meet theneeds at a selected health care agency of your choice. These ideas areprovided to stimulate thought and ideas.
■ A possible clinical question relates to whether a relationship be-tween adequate pain control and length of stay in a communityhospital setting could be determined.
■ Another clinical situation for investigation involves the determina-tion of any relationship between glucose control during the opera-tive period and length of stay in an acute care setting.
■ An alternative clinical circumstance relates to the effect of a one-on-one diabetic education course on the patient’s HbA1C.
■ In the occurrence of a medication error, the value of full disclosureto patients and/or family to build trust and restore confidence asopposed to nondisclosure, with a look at the impact on perceivedquality of care, could be investigated.
■ An additional idea involves determining whether the length of timeand frequency of visits to patient’s rooms by nursing staff affectsthe number of calls and the perception of quality of care by thepatient and/or family members.
■ Maternal/child nurses understand that certain treatments (prophy-laxis eye treatments, vitamin K injections, PKU tests) are providedfor all newborn children. What happens to children born outside ofan acute care setting (e.g., home births)? What rationales do wehave to support these treatments?
■ Childhood immunization is a state-directed process for all school-age children. Certain immunizations (MMR, polio, DPT) are desig-nated at key times prior to and during the school age years. Sowhat is happening with the growing number of home-schooledchildren? Are they getting the immunizations? What happenswhen these children come into acute care settings without havingreceived the expected childhood immunization series?
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