The nursing career consists of evidence-based practices, research studies, and experience from expert and experienced nurses. These components of the career provide the nurse and the patient with the best experience in the hospital. The way that healthcare is handled around the world is important to know because nurses should always be updated on current issues going on such as a breakout of chickenpox in Europe. It is good to know how the nurses and healthcare workers in Europe practice nursing. It is also interesting to see if they practice certain interventions the same way the United States does the interventions.
Evidence-based practice is the implementation of the finest evidence when deciding on different techniques in taking care of patients. Different types of evidence include results from research studies, experience in the clinical setting, and a skillful person’s judgement. Evidence-based practice provides patients with the best care they can receive. The combination of extensive research and rules on how to approach specific situations in the healthcare setting results in evidence-based practice (Brown, 2018, page 10). The set of steps and rules also known as the protocol does not work the same for everyone. There are always unexpected situations in the healthcare field and health professionals can use alternative ways to solve a patient’s problem (Brown, 2018, page 10). For example, administering oxycodone for pain control after surgery might work for one patient, but it may not work for other patients.
The field of nursing follows strict evidence-based practice in healthcare settings such as hospitals or clinics. Evidence-based practice allows nurses to complete clinical skills the right way and the most effective way. Evidence-based practice is important in nursing because if every nurse did clinical skills the way they would want to do it, there would be many negative consequences towards both the nurse and the patient. Safety is one of the most important parts of nursing. If nurses do not follow evidence-based practice, then there would be a high safety risk in hospitals. It would increase infection rates and injury among nurses and patients. For example, there are maximum dosages of opioids that can be taken by patients. If the patient takes more than they need, then they will be at a high risk of respiratory depression or even death. This puts the patient and the nurse at a safety risk because the patient might not survive and the nurse may be sued if they gave a higher dosage then needed.
According to Perry (2018), a “no-lift policy” is a policy that advises nurses to use the lifting equipment instead of lifting the patient themselves. This evidence-based practice is based on previous incidents where nurses developed pain in their lower back as a result of bending forward or lifting patients and having the patient’s weight beared on them (Ovayolu et., al 2014). This is important for nurses who assist in ambulation for patients who came out of surgery. Over the years, there has also been an increasing number of nurses who retire earlier than the recommended time or who do not work productively due to their lower back pain (Ovayolu et., al 2014). It is important to keep the nurse’s well-being good and to keep the patient safe.
Evidence-based practice improves patient outcomes because it prevents complications for patients and healthcare workers. It is important to follow evidence-based practice interventions because complications that arise can place a patient in a life or death situation. For example, if a nurse is assisting an older adult to ambulate after surgery, it is good to utilize a gait belt to prevent falls that may result in more complications for the patient. According to Perry (2018), using different equipment is beneficial to the patient and the nurse’s health.
The nursing research process has four steps. These four steps are assessment, planning, intervention, and evaluation (Winsett et., al 2007). The assessment phase of the research process is where the clinical problem is identified, written works are researched, and variables are established. These variables include independent and dependent variables. The independent variable is the variable that is changed during research studies to see how it affects the dependent variable. The planning phase is where a question about the research is developed and the method to measure the variables is formulated (Youngblut et., al 2001). The intervention phase is where data about the clinical problem is gathered. The evaluation phase of the nursing research process is where the data that was gathered is interpreted and examined. This is also where the researcher can decide whether the study was successful or not. If the intervention that was tested in the research study worked, then the researcher would share their findings with others (Arslanian, n.d). Evidence-based practice is a solution to clinical issues in healthcare settings. The nursing research process leads to an evidence-based practice. One needs to understand the research process to implement an evidence-based intervention because they need to identify clinical issues in the real world and have the knowledge on how to approach them. If they understand the steps of the research process, then it would be easier for them to solve issues. For example, if a patient is deteriorating fast from opioid-induced respiratory depression, the nurse needs to quickly identify the issue and observe the variables causing the issue. The nurse will attempt at saving the patient by implementing evidence-based interventions such as administering specific medications or oxygen per the healthcare provider’s orders. If the medications do not improve the condition of the patient, the nurse should develop a question such as “What if cardiopulmonary resuscitation will work better with this patient?” or “What if intubating the patient will increase the oxygen in their lungs?”. The nurse will then attempt doing CPR or getting an order for intubation on the patient and evaluate whether it was successful or not.
Quality improvement projects and nursing research differ in many ways. Quality improvement projects consist of different activities and interventions implemented in order to improve the quality of healthcare in the hospital. This includes staff education classes or even placing more hospital rooms on each floor. The education classes apply knowledge to the staff nurses and healthcare workers. Nursing research is when people of expertise conduct and test specific ideas or problems. It is adding more knowledge to the population. The entire purpose of nursing research is to test whether a solution is available to a scientific nursing question.
Quality improvement projects can benefit an entire hospital or it may not have a chance at improving certain issues, while nursing research is targeted towards benefiting individuals. Also, nursing research can take a while to benefit individuals in the hospital, while quality improvement projects are implemented and benefit the patient at a faster pace. Quality improvement projects and nursing research are similar because data is gathered in both studies and the intention for conducting a research design or a quality improvement project is the same. The intention is to identify issues in healthcare. This initial intention leads to conducting nursing research to investigate and evaluate data related to the clinical issue. It also leads to creating quality improvement projects based on the clinical issue in order to improve the problem. (Quality improvement, n.d.).
Opioid analgesics such as oxycodone, morphine, and fentanyl can be prescribed to surgical patients postoperatively. The dosage of these opioids depends on each individual patient and the needs of the patient. In some cases, a patient may take a higher dosage than needed and go into severe respiratory depression. In general, opioid analgesics cause respiratory depression in patients. This is why the nursing intervention of ambulating patients is put into practice for patients who come out of surgery. Patients need to walk around after surgery because it helps the blood in their body transport to different extremities (University of Wisconsin, n.d). Since blood is composed of oxygen, then oxygen flows throughout the body as well. Walking also prevents respiratory issues such as atelectasis which is the collapse of the lungs due to a decreased amount of oxygen located there.
Healthcare around the world differs greatly. The interventions may be similar or different in various countries. The nursing intervention of ambulating patients to improve the clinical issue of postoperative opioid-induced respiratory depression was researched in the United States and Japan. The first article, “Early Mobilization: Changing the Mindset” is about a level IV study conducted in the United States on changing the mindset and actions of surgical intensive care unit nurses towards the topic of implementing early postoperative ambulation. The study was conducted at the North Shore University hospital in New York. It consisted of fifty-six surgical intensive care unit nurses to which thirty-five of those nurses answered the survey provided. The nurses were chosen through stratified sampling where they were picked out of the nurse population in the whole hospital. The model used to improve postoperative ambulation was the plan-do-study-act model (Castro et., al 2015). This is where the nurses were given a survey to answer about the surgical patients and ambulation after two weeks, six months, and one year of implementation of early ambulation. The surveys showed that the surgical ICU nurses answered that early ambulation of patients on assisted-breathing devices resulted in decreased hospital stay and decreased pneumonia incidences (Castro et., al 2015).
The second article, “Effects of early morning care, named 'Comfort upon Rising' care, on postoperative orthopedic ambulation and morning activity.” was about a study conducted in Tokyo, Japan. It took place in an orthopedic unit. The study tested whether or not comfort interventions for the patients resulted in them having a good mood and ambulating. It consisted of eighty patients with forty patients in each group. The first group was the patients who received the ‘comfort upon rising’ care, while the second group did not receive it. This study was conducted from the morning of one’s surgery until three days after the surgery. A training session was provided to the nurses in order for them to have the knowledge to provide ‘comfort upon rising’. ‘Comfort upon Rising’ included many interventions such as greeting the patient, oral care, and checking the quality of pain the patient has (Ohashi et.,al 2014). Results showed that thirty-six out of forty patients in each group stayed throughout the study. The patients who had ‘comfort upon rising’ interventions in the morning showed a better mood overall based on a questionnaire given after their hospital stay.
Overall, the evidence based practice quality improvement projects do seem credible and effective. The first project that took place in the United States improved the clinical issue of early ambulation after surgery because the nurses in the study implemented early ambulation for one year. This study showed that ambulation plays an important role the respiratory status of the patient. A similar project to this one would be practical for the postoperative unit of surgical services because ambulation is a nursing intervention that needs to be done in the recovery room of surgery as soon as possible.
The second article that took place in Japan improved the patients’ mood after providing the patients with ‘comfort upon rising’ nursing interventions. This increased their readiness to ambulate. A similar project to this one would not be practical for the postoperative unit in South Florida due the time constraint and the duration of the study. The patients in the study were monitored over a three-day period. This is not possible because the patients in the recovery room usually do not stay there for three days. If a hospital was to ask which nursing technique and intervention is best at improving postoperative ambulation, the study conducted in the united states would be the best way of doing the task. The research done in this position paper emphasized the importance of implementing evidence-based practice and ambulation after surgery. Many complications are capable of arising in the postoperative recovery room such as heart dysrhythmias or a decreased respiratory rate and oxygen saturation. This is why one should always be one step ahead of the game by knowing the interventions and protocols that need to be done in order to save the patient.