What is the order of evidence based practice that a nurse should follow while caring for a client?

Nursing best practices are crucial to excellence in healthcare. Nurses with a Bachelor of Science in Nursing are able to apply their evidence-based education with healthcare best practices. The evidence-based curriculum combines research, science, clinical experience and the opinions of experts. These lessons equip nurses with the tools they need to work in the challenging and evolving healthcare industry.

Throughout their daily routines, nurses need to use best practices. The following are examples of nursing best practices in these three areas:

1. Nurse-to-nurse shift change.
2. Prevention of infection.
3. Patient care and discharge.

In a clinical setting, the term “shift change” may be used interchangeably with any of the following:

• Handoff.
• Handover.
• Sign-out.
• Cross-coverage.
• Shift report.

The most important element in nursing best practices is communication — especially during a shift change. During a shift change, nurses record and transfer important patient information, and it is imperative that the information is accurate and complete.

There is a greater risk of patient care mistakes during a nurse-to-nurse shift change. Problems exist due to the complex nature of specialized health systems. Incomprehensive handoffs can result in gaps in patient care — incorrect medications, surgery mistakes and even fatalities. Improper handoffs happen because of a breakdown in communication and the omission of crucial patient information on sign-out sheets.

A successful handoff happens without interruption to a patient’s care. Regulatory agencies such as the Agency for Healthcare Research & Quality, The Joint Commission and the National Quality Forum have established protocols for handoffs. Details of a patient’s care should not have any omissions regarding medication regimen or treatments, and the new attending nurse should know about any patient restrictions or physical needs. During a shift change, there should be full staff coverage so nurses are free from distractions. The shift change handoff should include the submission of accurate and up-to-date patient documentation and the opportunity to ask questions. The on-duty nurse should verify patient information by reading it back to the end-of-shift nurse.

According to an article in Critical Care Nurse, hospital patients contract an infection at a rate of 4.5 out of 1,000. A patient who develops an infection is at risk for a prolonged hospital stay, serious illness or death. The transmission of bacteria in hospitals can cause infections at the surgical site, in the urinary tract or other sites as well. Bacteria can also cause central catheter bloodstream infections. One of the concerns about infections is due to the prevalence of multidrug-resistant organisms like Staphylococcus aureus, vancomycin-resistant enterococcus and gram-negative bacilli.

The Joint Commission’s National Patient Safety Goals, the World Health Organization and the Centers for Disease Control and Prevention provide guidelines for the prevention of infections. The evidence-based practice for combating the spread of infection consists of these standard care procedures:

• Hand hygiene.
• Barrier protection.
• Decontamination.
• Antibiotic stewardship.

A nurse should conduct hand hygiene after every interaction with a patient and when entering and exiting a patient’s room. Barrier protection includes wearing gloves, gowns, masks and goggles. Decontamination of the room and equipment is necessary in reducing and preventing the spread of infection. Antibiotic stewardship is critical to stopping the overuse of the treatment. Antibiotics should only be used when other methods fail and the therapy should be closely monitored. In extreme cases, patients with an active infection may have to be isolated.

Hospitals are implementing best practices for patient care follow-up and discharge instruction. Care rounding is used to reduce the need for the patient’s call light. Typically, patients push the call button to notify nurses that they need urgent care. Nurses who institute a care-rounding schedule are more accessible to patients. This procedure reduces the number of times patients use the call light to summon a nurse for a non-emergency reason.

When patients are ready for discharge, they are often impatient and unable to retain a nurse’s instructions about medications or home care. Care calls allow nurses to check up on discharged patients and answer any questions. Generally, a nurse will make a care call 48 to 72 hours after a patient is discharged. Care calls build relationships between nurses and patients and improve patients’ satisfaction regarding their healthcare experience.

Some hospitals are including both care rounding and care calls as part of their best practices. By adding technology, nurses can streamline the discharge process. They can upload instructions to a patient’s phone or computer and send patients the following items:

• Links to healthcare resources.
• Insurance information.
• Reminders about healthcare instructions.

When patients understand their discharge information, their chances for an emergency room visit or hospital re-admittance drop by 30 percent, according to a study published on National Center for Biotechnology Information's website.

Registered nurses can earn a Bachelor of Science in Nursing at the University of Rhode Island either on campus or through the online RN to BSN program and learn more about nursing best practices. Instructors for URI’s online program are well-respected in their fields of expertise. Many students are able to finish the program in as few as 15 months.

The URI online RN to BSN program prepares nurses for a career in healthcare. In the evidence-based courses, nurses will learn how integrate their practical knowledge, clinical experiences, and science- and research-based academics.

Learn more about the URI online RN to BSN program.

Sources:

Critical Care Nurse: Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence

National Center for Biotechnology Information: Patient Safety and Quality: An Evidence-Based Handbook for Nurses — Handoffs: Implications for Nurses

The Joint Commission: Joint Commission Center for Transforming Healthcare Releases Targeted Solutions Tool for Hand-Off Communications

Jack, B. W., Chetty, V. K., Anthony, D., Greenwald, J. L., Sanchez, G. M., Johnson, A. E., … Culpepper, L. (2009). A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial. Annals of Internal Medicine, 150(3), 178–187.

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One of the key principles in medicine today is evidence-based practice in nursing (EBP). This is the practice of medicine based on solid research, and it adheres to standards for high quality and safety, all while focusing on patients’ needs. This is also why EBP is typically part of RN to BSN program curriculum.

There are many examples of EBP in the daily practice of nursing.

1. Infection Control

The last thing a patient wants when going to a hospital for treatment is a hospital-acquired infection. Nurses play a key role in helping to prevent illness before it happens by adhering to evidence-based infection-control policies. This includes keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions and practicing correct handwashing. Although nurses are busy with many responsibilities, the time it takes to control infection is well worth the effort.

2. Oxygen Use in Patients with COPD

For patient health and safety, it is essential that nurses follow evidence-based practice in nursing when it comes to giving oxygen to patients with COPD. Despite the belief by some that providing oxygen to these patients can create serious issues such as hypercarbia, acidosis or even death, the evidence-based protocol is to provide oxygen to COPD patients. This practice can help prevent hypoxia and organ failure. Giving oxygen, which is the correct treatment based on the evidence, can enhance COPD patients’ quality of life and help them live longer.

3. Measuring Blood Pressure Noninvasively in Children

Nurses should measure blood pressure according to evidence-based practice because accurate measurements are an essential part of effective treatment. Measuring blood pressure in children is a different procedure than it is for adults. Measuring children’s blood pressure involves the auscultatory method, then comparing the measurement against data gathered with the oscillometric method.

4. Intravenous Catheter Size and Blood Administration

Nurses should follow EBP when using intravenous catheters to administer blood for packed red blood cell transfusions (PRBC). The protocol indicates that nurses should use a smaller-gauge catheter, which increases patient comfort.

Although nurses are using more evidence-based practice, there is still some room for improvement. The following are some areas where nurses could better adhere to EBP:

• Communication involving changes in a patient’s status.
• Soft skills that improve patient interaction.
• Training and onboarding new nurses.
• Shift scheduling and the effect on care.

Because new research and evidence become available on an ongoing basis, EBP must adapt to the latest evidence. Often, old practices may need to change if new research overturns the principles behind them.

Evidence-based practice in nursing has advanced a great deal in recent years, and it will continue to do so.

Learn more about the A-State online RN to BSN program.

Sources:

CriticalCareNurse: Putting Evidence Into Nursing Practice

NCBI: The Evidence for Evidence-Based Practice Implementation

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