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Demicheli et al on critical thinking in evidence based pratice
Executive summary on pressure ulcers
Research studies on pressure ulcers
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Introduction
Skin is the major organ in the human body, that defend the body from foreign microorganisms, adjust body temperature and it is responsible for sensation. Any disruption of this layer will open the gate for the microbes to enter the body, so it is important to maintain the skin intact. The skin needs proper care to be healthy, this need increases as we become older, due to decrease the ability of elderly to reposition themselves, take care of their skin or taking care of their nutrition. As the result of these changes elderly are prone to have pressure ulcer more than others (Hampton, 2011). Decubitus ulcer, bed sore or pressure ulcer are Known as localized damage to the skin and/or it is surrounded, mainly over the bony prominence
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Elderly people, physical impairment, cognitive impairment and multiple comorbidities affect the skin integrity and the healing process (Chou, 2013). Evidence based practice (EBP) is a systematic process of making shared judgments between practitioners, clients and other important people to them based on current best available researches, client’s values and clinical practitioner’s expertise (Theofanidis, 2015). Integrating the nursing research and EBP in the clinical practice will help nurses to provide harmless, best, effective care and improve the client outcomes. Consequently, this integration can help in achieving the nursing privilege. Among the skills, information and processes required to support evidence based practice, critical thinking is vital. Nurses should develop a critical thinking skill which includes detecting the problem, choosing the best possible solution and determining the best way to resolve the problem. Critical thinkers made a reflection on the condition after implementing the plan to assess the effectiveness of the plan and if it can be done better (Tweed et al., 2016). This paper will answer the clinical question of “Does repositioning bed ridden patients are more effective in reducing pressure ulcer compared to the use of air
The Johns Hopkins Nursing Evidence-Based Practice Model provides nurses with a system to formulate a practice question, appraise both research and non-research evidence, and to develop recommendations for practice (Dearholt & Dang, 2012). This model guides nurses through the evidence-based research process with ease and minimal difficulty using a problem solving approach.
As a result of Lily’s extensive hospitalisation period, a grade 3 pressure ulcers developed on her buttocks. A pressure ulcer is a localised injury to the skin which is usually located over a bony area as a result of pressure or pressure combined with friction (Willock et al., 2007). According to Sibbald et al., (2003) excreted bodily fluids are often common factors which contribute to the breakdown of skin, especially as a consequence of urinary or faecal incontinence. There were many factors which contributed to the breaking down of Lily’s skin, such as infrequent nappy changes and lack of mobilisation. Ensuring the maintenance of skin integrator within the critical care setting has its challenges. Often, patients are attached to multiple
Evidence-based practice (EBP) entails the use of explicit, reliable, and judicious evidence to make effective decisions about the care of patients. This DNP student will introduce EBP with the IOWA model. The IOWA model applies to this DNP proposal. The IOWA model is an EBP applicable in healthcare setting and implemented to show the applicability of evidence in nursing to give the best outcome. Doody and Doody (2011) noted that the IOWA model focuses on problem-focused triggers and knowledge in undertaking quality improvement study. The steps involved include topic selection, team formation, evidence retrieval, grading evidence, developing an EBP evidence, implementation of EBP, and evaluation of the progress. These steps apply to this DNP proposal, showing best practices, guidelines, procedures, and policies
Pressure ulcers development occurs in every hospital and it remains a major worldwide health problem for many years. However, pressure ulcers have received minimal attention when we talk about it as a patient safety issue. It is a patient safety issue as it can lead to serious damage such as life-threatening infections and pain (Richardson & Barrow, 2015). On a med/surg unit, individuals may experience long or short hospital stays depending on the situation. For the short stays, the focus of care is often on regaining activities of daily living (Registered Nurses’ Association of Ontario, 2011). Therefore, assessment and education regarding pressure ulcers is often minimal or non-existent (RNAO, 2011). Every client who is at risk needs to be assessed and educated regarding pressure ulcers and the subsequent skin breakdown (Cooper, 2013). During the hospital stay, clients may have limited movement and pressure ulcers can extend into the muscle, tendon, and bone (RNAO, 2011). In many cases, clients do not notice the formation of an ulcer and as it may be in areas that are out of sight such as the coccyx. Often,
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
Catheter Acquired Urinary Tract Infections (CAUTIs) has become to be classified as one among the leading infections which most individuals end up being susceptible to acquire while at the hospital. Healthcare-associated or acquired infections (HAIs) are a significant cause of illness, death, and more often than not, have resulted to cost the tax payers potentially high medical expenses in most health care settings. ("Agency for Healthcare Research and Quality," para. 1) Due to this, 1 out of every 20 patients will end up with CAUTI within the US hospitals and this has caused Agency for healthcare research and quality (AHRQ) to embark on nationwide plans to help in the eradication and control of CAUTI incidences. ("Agency
Thomas, D. R. (2001). Issues and dilemmas in the prevention and treatment of pressure ulcers: A
Licensed practical nurses (LPN 's) fill an important role in modern health care practices. Their primary job duty is to provide routine care, observe patients’ health, assist doctors and registered nurses, and communicate instructions to patients regarding medication, home-based care, and preventative lifestyle changes (Hill). A Licensed Practical Nurse has various of roles that they have to manage on a day to day basis, such as being an advocate for their patients, an educator, being a counselor, a consultant, researcher, collaborator, and even a manager depending on what kind of work exactly that you do and where. It is the nursing process and critical thinking that separate the LPN from the unlicensed assistive personnel. Judgments are based
Within this essay, evidence based practice will be identified and the significant effect it has on the nursing profession, barriers will also be explored in the implementation of evidence based practice. Individuals need specific care tailored to them, it is vitally important to have the correct professional and appropriate personal care. In order to receive this, we need to get the patient involved in the decision process, listen to their views and opinions and receive the relevant, accurate, professional and medical information. Once all the information is collated, a personal care package can be put into practice. Evidence Based Nursing, An introduction (2008, p. 1).
In social work evidence based practice is considered to be a decision making process and practitioners rely on the evidence when working with clients. According to Aveyard and Sharp (2013), evidence based practice is not easy to put into practice and there are many barriers to evidence based practice such as lack of time, lack of awareness of research, lack of support and cooperation, and lack of authority and inadequate facilities (p. 145). Although there are challenges to implementing evidence base practice this is still a doable task in the field of social work. Therefore, practitioners need to explore the motivation, knowledge and skills needed by the individual, the organizational motivation, learning
Over the last 10 years evidence-based practice (EBP) has grown substantially and is changing the nursing care delivered to patients along with the nursing work environment. Nurses are more involved in the decision making process, and are making clinical decisions with better patient outcomes (Good, Fink, Krugman, Oman, & Traditi, 2011). With technology growing at such a fast pace, new and more effective medicines, medical devices, and procedures are developed daily. Digestible sensors that monitor your bodily systems and 3D printing of embryonic stem cells, blood vessels, and sheets of cardiac tissue that actually beat like a real heart, are significantly impacting the future of healthcare (Honigman,
Evidence based practice (EBP) is a key component in delivering cost-effective, high quality health care. [1] However, only around half of the care providers in the United States utilized EBPs. Additionally, nearly a quarter of services delivered to American consumers are unnecessary and potentially harmful. Today, educators are teaching and promoting evidenced based health care to future nursing professionals. The Institute of Medicine (IOM) supports this action as a means to achieve the objective that 90 percent of all medical treatments have a foundation in evidence based practices by the year 2020.
One feature of evidence based practice is a problem-solving approach that draws on nurses’ experience to identify a problem or potential diagnosis. After a problem is identified, evidence based practice can be used to come up with interventions and possible risks involved with each intervention. Next, nurses will use the knowledge and theory to do clinical research and decide on the appropriate intervention. Lastly, evidence base practice allows the patients to have a voice in their own care. Each patient brings their own preferences and ideas on how their care should be handled and the expectations that they have (Fain, 2017, pg.
What is the central component of advanced practice nurses (APNs) direct clinical practice and patient/families?
Reflection Paper: Evidence-Based Management Evidence-based management (EBMgmt) uses a combination of critical thinking and best available evidence to make management decisions (Stichting Center for Evidence Based Managment, n.d.). Additionally, EBMgmt refers to the use of the “scientific method used to manage organizations” (White & Griffith, 2016, p. 29). EBMgmt relies greatly on performance measurement, best practice, facts and quantitative statistics (White & Griffith, 2016).