Literature review to search for the best available evidence: Once the topic is selected ,the research relevant to the topic must be reviewed. It is important that clinical studies , integrative literature reviewes , meta analysis, and well known and reliable existing evidence based practices guidelines are accessed in the literature retrieval process.
The article can be loaded with optionated nd or biased statements that would clearly taint the findings, thus lowering the credibility and quality of article.
Time management is crucial to information retrieval. To maintain high standards for evidence based practice implementation, education in research review is necessary to distinguish good research from poorly conducted research. Once the literature is located, it is helpful to classify the articles either conceptual or data-based. Before reading and critiquing the research ,it is useful to read theoretical and clinical articles to have a broad view of the nature of the topic and related concepts , and to then review existing evidence based practice guidelines.
Evaluating and analyzing the strengths and weakness of that evidence in terms of validity and generalisability: Use of rating systems to determine the quality of the research is crucial to the development of evidence based practice. Once you have found some potentially useful evidence it must be critically appraised to determine its validity and find out whether it will indeed answer your question. When appraising the evidence the main questions to ask, therefore, are: Can the evidence e.
What does the evidence mean? Different appraisal and interpreting skills must be used depending on the kind of evidence being considered. Additionally, guidance and training on appraising different types of evidence are available from some of the websites listed on the Useful Internet Resources.
Implimenting useful findings in clinical practice based on valid evidence: After determining the internal and external validity of the study ,a decisions is arrived at whether the information gathered does apply to your initial question.
It is important to address questions related to diagnosis ,therpy ,harm, and prognosis. Once you have concluded that the evidence is of sound quality, you will need to draw on your own expertise, experience and knowledge of your unique patient and clinical setting.
This will help you to decide whether the evidence should be incorporated into your clinical practice. You must consider both the benefits and risks of implementing the change, as well as the benefits and risks of excluding any alternatives.
This decision should be made in collaboration with your patient, and in consultation with your manager or multidisciplinary team where appropriate. The information gathered should be interpreted according to many criteria and should always be shared with other nurses.
Evaluating efficacy and performance of evidences through a process of self reflection ,audit , or peer assessment: Finally after implementation of the useful findings for the clinical practices;efficacy and performance is evaluated through process of self reflection ,internal or external audit or peer assessment.
Part of the evaluation process involves following upto determine if your actions or decisions achieved the desired outcome. Start with the patient — a clinical problem or question arises from the care of the patient ASK the question 2.
Appraise that evidence for its validity closeness to the truth and applicability usefulness in clinical practice APPLY: Return to the patient — integrate that evidence with clinical expertise, patient preferences and apply it to practice Self-evaluation 6. Evaluate your performance with this patient. There are many barriers to promoting evidence based practices such as: Lack of professional ability to critically appraise research.
Lack of time workload pressure ,and competing priorities of patient care can impede use of evidence based practice. Lack of knowledge of research methods. Lack of support from the professional colleges and organizations , and lack of confidence nd authority in the research area Practice environment can be resistant to changing tried and true conventional methods of practice. It is important to show nurses who may be resistant to changes the nursing practice the benefits that nurses, their patients and their institutions can reap from the implementation of evidence base nursing practices which is to provide better nursing care.
Values ,resources and evidence are the three factors that influence decision making with regard to health care. In adition the nurses need to be more aware of how to assess the information and determine its applicability to the practice. Lack of continuing educational programs. Practices donot give have the means to provide workshops to teach new skills due to lack of funding, staff and time ;therefore research may be tossed dismissed. Another barrier is introducing newly learned method for improving the treatments or patients.
New nurses might feel it is not their place to suggest oreven tell a superior nurse that newer , more efficient methods and practices are available. The perceived threat to clinical freedom offered by evidence — based practice is neither logical nor surprising. When we make decisions based upon good quality information we are inconsistent and biased. A number of different models and theories of evidence based practice has been developed and are important resources.
These models offer frameworks for understanding the evidence based practice process and for implementing an evidence based practice project in a practice setting. Models that offer a framework for guiding an evidence based practice include the following: Advancing research and clinical practice through close collaboration ARCC model [Melynk and fineout-overholt ,] Diffusion of innovations theory [Rogers , ].
Framework for adopting an evidence —based innovation [DiCenso et. Although each model offers different perspectives on how to translate research findings into practice. It provides an overview of key activities and processes in evidence based practice efforts ,based on a a distillation of common elements from the various models. The most prominent models are Stetler model of research utilization and Iowa model of research in practice.
Stetler model of research utilization:. The Stetler model of evidence-based practice would help individual public health practitioners to use evidence in daily practice to inform program planning and implementation. The Stetler model of research utilization helps practitioners assess how research findings and other relevent evidence can be applied in practice.
This model examines how to use evidence to create formal change within organizations, as well how individual practitioners can use research on an informal basis as part of critical thinking and reflective practice.
Instrumental use refers to the concrete, direct application of knowledge. The Stetler model of evidence-based practice based on the following assumptions 1. Research and evaluation provide probabilistic information, not absolutes. Lack of knowledge and skills pertaining to research use and evidence-informed practice can inhibit appropriate and effective use Phase I: Preparation—Purpose, Context and Sources of Research Evidence Identify the purpose of consulting evidence and relevant related sources.
Recognize the need to consider important contextual factors that could influence implementation. Note that the reasons for using evidence will also identify measurable outcomes for Phase V Evaluation.
Assess each source of the evidence for its level of overall credibility, applicability and operational details, with the assumption. Determine whether a given source has no credibility or fit and thus whether to accept or reject it for synthesis with other evidence. A summary of findings should: Determine whether it is desirable or feasible to apply these summarized findings in practice others involved. Based on the comparative evaluation, the user makes one of four choices: Decide to use the research findings by putting knowledge into effect Consider use by gathering additional internal information before acting broadly on the evidence.
Delay use since more research is required which you may decide to conduct based on local need Reject or not use. Write generalizations that logically take research findings and form action terms Identify type of research use cognitive, symbolic and instrumental. Identify level of use individual, group, organization.
Consider the need for appropriate, reasoned variation in certain cases. This means there are no scientific jargons that sometimes pose a threat to the readers. The authors seem to understand the subject matter clearly according to the list of questions in their questionnaire. For instance, hand washing, scrubbing, intraoperative phase and circulator role.
The purpose of this study is vital due to several incidents that related to surgical wound infection. In the article abstract, they mention the overview of their study, including the research problem which is in prevention of surgical site infection and contamination, sterile technique need to be implemented.
They also remark the sample, methodology, finding and recommendations which is mention earlier in the need for the nurses to control and protect the patients from surgical site infections.
The grammar used in this study is straightforward, easy to understand and systematically arranged. Usually, a reader like me demands an interesting research that motivates us to continue analyzing, and this presents well in the above-mentioned analysis.
There are certain factors that strengthen this research, which includes the identification of the research problem. The hypothesis used is that most nurses have the knowledge on sterile techniques but due to some reasons, they fail to apply it in practice.
Some nurses bear the knowledge but they lack the confidence to put this evidence-based research into practice. There are four major reasons that limit the nurses from using EBP.
Retsas stated research reports similar to the above-mentioned are normally complex, statistical, academic and nurses find it difficult to interpret or work with the research products.
This may cause confusion to nurses during interpretation. The results are graphical and the nurse might have problems understanding it. This particular research is consistent and any nurse whether a graduate or a trainee can easily relate to it except of the graphical result. The researcher clearly links each step to the other with the objective of the study, which follows with a literature review.
In their literature review, the research is rather shallow compared to other great researches. It is lacked of specific details on the occasions where nurses have failed to apply the technology and the consequences that follow. The literature failed to analyze the different surgical tools applied in the operating rooms by the nurses.
However, they identified the hospital and the need for the research. The literature should include the history of evidence-based practice including when it began and why. The hypothetical structure lacks in this study, which is necessary for reader who needs to understand and analyze the research. The researchers did not go in depth into the subject matter although the introduction had a good review of the search information.
The research paper is lacked of proper relationship between different concepts in its literature. However, most theoretical frameworks work best in experimental and quasi-experimental researches unlike in descriptive studies similar to the above mentioned.
According to Dale in every research, it is vital to identify the main question and this was not seen in this research. For example, the researcher should have asked how competent the management of the operating room is in educating their staffs on sterile technique. This would assist the researches in analyzing the situation because the failure to practice sterile technique could be perioperative nurses not sent for continuous education leading to lack of competency.
These questions are likely to come from patients or the nurses themselves. The questions may derive from the customary practices or from different literature. The sample in this study, for me the size is relatively small compared to the many operating rooms in Philippines.
Anyhow, the choice of participants in regards to age group, and gender is great. In terms of experience, the researcher should have picked people with longer experience in the job. The attendance for educational training of these participants is equally poor so it could not provide a conclusive result. A bigger sampling in all categories would have provided a better data analysis. This study was carried out in hospitals and chances for the nurses were conversant with the subject at hand.
However, the participants were from only one-region hospitals and different issues may have limited their voluntary information. At times, the participants are not sure of their confidentiality, despite them signing confidentiality forms; they still have the fear of being exposed. The nurses could fear intimidation from the superiors, and this drives them to give false information in favor of the organization.
The researcher got the approval from the ethics committee at Samar Provincial hospital, and the other hospitals before they began conducting their research.
No participants were forced or harm during the survey. Neither there was any bias because the respondents were not selected purposively. In the operational definitions, the researcher ensured that the reader fully comprehended the study by applying simple concepts and terms in the research Parahoo, The researchers have used clear and simple understanding terms to carry out this study. However, most of these studies relate because the objective regards patterns in group behaviors, tendencies, averages, and properties Robson There is a possibility of mentality to take place as most of the researches done clinical credibility because these research products are not conclusive.
This is a major drawback for nurses to agree in applying the results recommendation which also decrease the confidence in the products used for the survey like the questionnaire and the sample.
In my opinion, the study did not succeed to offer a proper clinical direction and so the nurses prefer not to use them. Most nurses prefer a research that is more prescriptive and clinical concerning their work place. The data collection is similar to a quantitative methodology of research whereby different data that includes questionnaires, interviews, and observation tools used.
These tools are appropriate with the study aim. The overall reliability and validity was discussed in the weakness and strength of the study done. It was describe as good but not perfect. Its validity, which is its ability to measure the content Wood et al, , is downcast due to the number of samples were insufficient 21 participants and also from one region only.
The researchers have always emphasized on the extent of sterile technique practice throughout the study. This study had a pilot study, which assisted the researcher in making some adjustments in their research. The ratings are clear and easy to understand. For instance, they used descriptive statistics that include the percentage, frequency, standard deviation and mean.
This is quite an easy interpretation and anyone is able to analyze and understand. These are inferential tests and it helps the researcher in identifying the relationship among variables. The researcher discussed the findings in simple and clear terms. The researcher has a logical flow of information and the hypothesis is clearly supported by these findings. This study bears significance in its findings as per Russell , and the researcher specifies every result without generalizing it.
They reported each section independently whether it could be gender, age, experience and number of training attended. As mention earlier, the perioperative nurses have knowledge of using sterile techniques but rarely apply them in practice Luo et al The research also concluded that half of the nurses had the knowledge on sterile technique. In Goiana hospital, Most researched documents have no references, which makes them less favorable.
There are known perspectives on accessibility of information and they include the humanistic ideology which involves the notion that human resource is most accessible. The latest technologies information can be retrieve from internet easily accessible. However, the researcher did not mention much on recommendation for nurses to apply sterile technique in practice which is vital in guiding the readers. The findings confirmed that the nurses held a strong knowledge of the use of sterile technique according to the table 6 that showed the correlation between knowledge and the extent of use of sterile technique by the participating nurses.
The discussion is clear and well elaborated in simple terms. The researcher explains the underlying causes on why nurses rarely apply the knowledge into practice. The issue of occupational culture where questioning is unpopular should be contested, and the nurses should ask any questions in the event of uncertainty. The information on sterile technique and importance of it should be taught to nurses by sending them for educational trainings or emphasize it at all times in work place.
This information should be accessible especially the evidence-based literature in order for the evidence-based practice to be implemented. The researchers also discuss on the strength and limitation of their study which is appropriate as it helps the reader determine the reliability of the study and also the choice to implement it or not.
The strength of the study is to ensure there was no selection bias; the respondents were inclusive of the entire population of operating room nurses in four identified hospitals for the investigation. Nevertheless, a wider variety of hospitals would have added this strength. Furthermore, the research shows that the investigation is from one province only, which weakens its strength. The discussion also noted the weakness in the questionnaire method of research because it lacked some details like.
It is also clear that some participants fear telling the truth despite their secrecy assurance. Most researchers offer recommendation because their researches are not conclusive which this particular researcher failed to apply.
The referencing in this study is very accurate especially on the in text citation. Most researches fail to offer the in text citation and leaves the readers struggling on locating the referencing. The higher number of references, the stronger the research perceives. Different methods of researches that are evident-based tend to have lack support from most readers. This research had 18 references, which is the average number, required for any research.
However, more references would have strengthened the research. This study has much merit but the method requires evaluation. The sampling requires a larger demographic region in order to accommodate more representatives of the participants. It is crucial for perioperative nurses to apply their knowledge on sterile technique in practice.
If sterile technique is not applied during surgery it may lead to surgical infection which will harm the vulnerable patients which may also cause death if not treated well. Further research is recommended because this problem continues due to frequent changes in technology and management.
The nurses should implement a more basic role in services through application of their skills while addressing questions from outside clinical range. This would in return increase their service demands from the environs. For skills development, the nurses should complement their hands-on function within the department. These nurses should be able to apply their developmental products effectively in order to prove everyone else wrong.
People have failed to recognize the efforts applied by the nurses. After all, the management should ensure the nurses knowledge, resources, and skills are readily available in order to assist implementation. This only happens if the research information is excellent, with clarity and enough strength to hinder any doubts from reviewers.
References American Psychological Association. APA presidential task force on evidence based practice. International Journal of Nursing Studies 37, — Journal of Advanced Nursing 43 3 , — Best practice in professional psychology. Evidence-based practice in clinical social work. Critical appraisal of epidemiological studies and clinical trials 3rd ed.
Oxford University Press Gambrill, E. Implications for knowledge development and use in social work. Evidence-based practice for the helping professions. The four cornerstones of qualitative research. Qualitative Health Research, 16 3 ,
Evidence based practice is a complex experience that requires synthesizing study findings to establish the best research evidence and correlate ideas to form a body of empirical knowledge (Burns & Grove ). There are many definitions but the most commonly used is Sackett et al ().
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