Running head: EVIDENCE BASED NURSING AND MY PRACTICE

Evidence Based Nursing and My Practice Tamara Putney Ferris State University

EVIDENCE BASED NURSING AND MY PRACTICE Abstract Understanding the importance of integrating evidenced based practice and nursing research into everyday nursing practice is imperative for personal and professional growth, as well as

promoting optimal patient outcomes. Advancement of the nursing profession and how theory and research are related is also very important. Additionally, all nurses should realize the importance of adhering to strict American Nurses Association [ANA] Standards of Professional Performance (2010) to grow the nursing profession and improve care for the world we serve. keywords: research, nursing, evidence, patient safety, outcomes, theory, ANA standards

EVIDENCE BASED NURSING AND MY PRACTICE Evidence Based Nursing and My Practice Generalist Nursing Practice

The purpose of this paper is to discuss my nursing practice and the integration of nursing research and evidenced based practice into my daily work, all the while abiding by strict ANA standards. Because research and evidenced based nursing practice has been proven to produce better patient outcomes and promote patient safety, we should all strive to base our practice on proven research and teach others along the way (Burns and Grove, 2012). Nursing theory and the use of research, as related to advancement and development of the nursing profession, will also be explored. After a short stint in the United States Air Force, I attended nursing school at Northwestern Michigan College. I graduated with an ADN in 2001 have worked as a critical care nurse in the Intensive Care Unit since then. Hired directly into the critical care unit as a new graduate was great, but it did not allow me to experience other areas of nursing care. As my career progressed, I realized I liked the hospital I worked for, but I wanted more experience. To alleviate this problem and promote my personal and professional growth, I left for two consecutive winters, starting in 2008, and worked at a large trauma facility. I took a travel nurse job at an inner city Level 1 neurosurgical trauma center. Not only did I take care of the very acutely ill patient, I was required to float to many other units, including the general medical floors and the transplant unit. It was a culture shock and definitely out of my personal comfort zone, but the experience has been unparalleled. It gave me the life confidence and worldview my military training missed. It was this experience that sparked my interest for exploring more ways to deliver better nursing care based on evidence. It was very rewarding to see what others are doing; to this day I still pull ideas from that experience.

EVIDENCE BASED NURSING AND MY PRACTICE I enjoy critical care nursing, it is very rewarding in so many ways, but over the last year my work as a nurse has taken a turn. I still work in the intensive care unit, but only one day a week. The balance of my week is spent helping bridge the patient-nurse clinical world with the

information technology world (Information Systems Department). Every nurse knows that being the best bedside nurse possible is difficult if forces around the practice are not congruent, intuitive, safe, efficient and effective. The role I play is part nurse informaticist and part performance improvement/process redesign project specialist. This role basically entails making sure many of the processes that are carried out for the patient that include the Provider Order Entry (POE) and electronic order entry components of the computer system mesh, both for the provider and the nurse. Working with information systems to make the computer entry, and management of orders, more safe and effective has proven imperative to bedside nursing practice and workflow, which directly affects patient outcomes. I take identified patient care and outcome problems, in any department, and critically analyze the process and suggest a new process and plan to ensure the error or problem does not repeat itself. The most important thing in the world of healthcare is the safe care of the patient; I use many resources in an attempt to ensure that! I am not a manager, but working for the performance services department, in this very unique role, I have a lot of freedom for the direction of my practice. My primary responsibility in this role is to ensure safety of the patient by promoting smooth, efficient workflow at the bedside and beyond. Often I am required to work with nurse managers to research and find ways to implement best practice or the delivery of nursing care. I love my job, but my desire is to return to the bedside clinical world until my education has progressed enough to allow me to move into an educator or management role.

EVIDENCE BASED NURSING AND MY PRACTICE I am currently enrolled as an RN to BSN student at Ferris State University. I have a few more classes to complete then I plan to apply to the RN to MSN Bridge Program. I hope to obtain my Masters in Nursing in 2015, and would like to manage a critical care service line somewhere in the United States. My ultimate goal is to end my career as an educator at a university. Health Care Environment I understand the importance and strive to incorporate research and evidenced based care into my everyday nursing practice, both at the bedside, and in my performance improvement role. I constantly think about how to make care better and safer for patients. Every nurse is exposed to the American Nurses Association Standards [ANA] of Professional Performance

while in nursing school. Unfortunately, not every nurse, especially the associate prepared nurse, seeks to build on the practice of these standards. I realize I have an inordinate amount to learn about research and the utilization and integration of evidence into my practice. Realizing this and the fact that learning about the application of research and theory is a life long process; I attempt to utilize all the resources around me, including advanced practice nurses and literature. My unique role allows me to interact with all care providers and use nursing research to leverage the computer system to promote safer patient care by making the job the nurse has to do at the bedside, more clear, concise and efficient. As technology advances, it seems nurses are being pulled more to the computer and away from the patient. Through my work, I am attempting to reverse or halt that trend. Although we are not required to read nursing journals, we are expected to advance our knowledge, and at least one of our goals on our annual review at work has to be about furthering our professional practice. I read nursing research, both qualitative and quantitative, and recently

EVIDENCE BASED NURSING AND MY PRACTICE had a membership to the American Association of Critical Care Nurses (AACN) and the American Nursing Informatics Association (ANIA). I do read online journals frequently as part of my work and am very thankful for the statistics class I was required to take as part of the Ferris State University RN to BSN program. It is very important to understand what is working for others in order to improve our practice and ourselves! The facility I work for is a Magnet Hospital and is very engaged in research and promoting evidence based nursing practice. At my current job I have the ability, and am encouraged, to participate in many committees. I am a member of the Evidence Based Practice Committee, Shared Governance Informatics Group, Nursing Informatics Advisory Group, Regional Sepsis Committee, and the POE Optimization Group, as well as many others. The

functions of these specific groups are to address clinical nursing and or care problems and review evidence to improve process and patient outcomes. These committees are far from groups of official researchers, but there are many advanced degree nurses in these groups who act as leaders. For example, the Evidenced Based Practice Committee is pivotal in producing change in clinical practice. There are regular meetings to review research and subgroups are developed to analyze and investigate ways to influence practice and outcomes. We participate in nurse driven evidence based projects on trial units and if the research and evidence is successful in producing the desired change and, if deemed feasible, the practice is educated on then implemented. Some of the recent evidenced based projects I have been involved in are: using evidence to show a need for the use of disposable electrocardiogram leads to help prevent central line infections, development and implementation of a new evidence based nurse screening sepsis protocol, the impact of family presence at the bedside during resuscitation, and the initiation of nurse driven sedation awakening trials in ICU patients. Currently, I am working with a group to

EVIDENCE BASED NURSING AND MY PRACTICE improve the care and outcomes of the alcohol and drug withdrawal patient population. The interesting part of all the work that I do is that both of my jobs are very focused on evidencebased practice. Some projects involve formal research; some involve merely investigating what

has been tried and true and implementing that practice in our hospital. I am excited to gain more knowledge about nursing research. I want to understand how to do critical appraisals of research, utilize and apply that research to produce and influence change, not only in our hospital, but also for our affiliates. We do great things at our hospital and deliver great care, but we fall short at making all nurses realize how important each and every persons role is in the delivery of care to the patient! There are many ANA standards nurses must adhere to. Most importantly, as related to research is ANA Standard 9: Evidenced Based Practice and Resources (2010). The ANAs Scope and Standards of Practice (2010) states that nurses must, integrate evidence and research findings into practice (p. 51). I have participated in many formal committees to accomplish this. Also, informally I integrate evidence into my everyday practice and share that evidence with my colleagues whenever possible. All ANA Standards of Professional Performance (2010) relate to patient care and promote best practice and safety for optimal outcomes. Besides the evidence based and quality standards, some of the most important standards to me are: being ethical in practice and life (ANA Standard 7), continuing my education to remain capable, competent and provide great patient care (ANA Standard 8), developing my communication skills (ANA Standard 11), being a leader both in my profession and in the community (ANA Standard 12), always being aware and open to the importance of a cohesive collaborative team (ANA Standard 13), always evaluating myself and my practice (ANA Standard 14), utilizing all possible resources (ANA

EVIDENCE BASED NURSING AND MY PRACTICE Standard 15) and always promoting environmental health, which is ANA Standard 16 (ANA,

2010). The ultimate ANA Standard that relates directly to research is ANA Standard 10: Quality of Practice (ANA, 2010). To follow this ANA standard I must be proficient at understanding and utilizing research of all kinds. As suggested by the ANA (2010), I must encourage change to improve nursing practice (p.52). In my opinion, the only way to truly be accurate, efficient, and thorough in producing the very best outcomes for the patient is to understand and utilize research and theory. As a BSN nurse and with more knowledge of how to use research and evidence I can lead change and influence others to improve practice. Professionalism Nurses should care about research and evidenced base practice because, Through nursing research, empirical knowledge can be developed to improve nursing care, patient outcomes, and the healthcare delivery system (Burns and Grove, 2011, p.6). All nurses should embrace learning how to appraise, understand, and utilize research to advance our profession, our personal practice, as well as for personal growth. Based on my professional nursing experience and how I have used nursing research up to this point, I see the need for nursing research utilization more imperative than ever before. The advancement of the nursing profession depends on quality performance and outcomes. Quality performance and outcomes depends on knowledge. One of the ways quality knowledge is gained is through recognition of quality nursing research; the only way to recognize this quality is to have the ability to appraise and understand what credible work looks like (Burns and Grove, 2011). After learning how to not only efficiently find, but also critically appraise research I will be able to more effectively assess what changes are realistic and feasible for my practice and nursing practice as a whole. As my development and understanding of research evolves I will be

EVIDENCE BASED NURSING AND MY PRACTICE able to participate more in identifying areas of change, as well as implementing that change and communicating to those around me how important research is for the nursing profession. Sharing what we know is essential to growing.

Because our changing economic times, the healthcare industry is struggling. Utilizing the best research evidence and implementing the very best, feasible practices will have an overall positive impact on our nations healthcare system and national budget. Better care leads to better outcomes, and a decreased length of stay, which decreases cost for everyone involved. Research, evidence and experience are imperative to the advancement of the nursing profession and the improvement of patient outcomes. Now, more than ever, advancements in the quality of healthcare are drastically needed. As nursing research and the use of evidenced based practice is utilized, the nursing role in improving patient outcomes, lowering healthcare costs, reducing lengths of stay and preventing readmission is pivotal. I think the profession of nursing will advance using research because as new practice based on evidence evolves, nurses are validating and quantifying the profession, increasing the respect and authority, as well as improving and creating more opportunities for autonomy. Many people see nurses as just at the bedside carrying out doctors orders. We must show that what we do independently of the written doctors order is imperative to the patient outcome. Nursing standards of care have a tremendous impact on the patient as a whole. Also, nurses have the ability through evidence to actually influence and induce change in other professions such as medical and pharmacy. Influencing change in other professions, especially in the light of so much rapid technological advancement, will validate the nursing profession as a needed vital part of achieving optimal health in this nation. The use of more evidence based

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nursing practice will advance the profession in a way that will create more jobs for nurses, make nurses more valuable, and make healthcare systems more efficient and effective. Theoretical Base for Practice Theories have been developed in nursing to explain phenomena important to clinical practice, (Burns and Grove, 2011, p.227). Nursing is a practice-based profession. Everything we do for our patients is based on best practice and improving standards of care to produce the best outcome possible. Researching needed changes are the best way to determine what that best practice is. Theory and research are interrelated. Most nurses really want to provide the best possible care for their patients, they are just very busy or they do not understand how to utilize research to initiate the needed changes in the profession. Theories are developed to explain what nurses do, and how patients act and react. This is where theory related to research comes in. Research is directly related to developing a theory. The profession of nursing is evolving into a more researched and evidenced based practice with the increasing use of technology, and as dissemination of information is more widespread. Also, it seems as pay for performance and meaningful use guidelines become mandated, research will become essential and more hospitals will embrace it to improve nursing practice and improve patient outcomes (U.S. Department of Health and Human Services, 2012). This in turn, will most likely result in the development of more nursing theories and frameworks to guide our practice. As the nursing profession gains more credibility due to performance, the profession will grow and demand will increase. Nurses are the backbone of the healthcare system, and all the people of the world are our patients. When people get sick we must nurse them back to optimal health if at all possible, or enable them to leave this world in the most humane and comfortable way possible. To do this in the safest, most efficient, most cost effect manner, extremely high standards must be maintained

EVIDENCE BASED NURSING AND MY PRACTICE and best practice must be followed. The only way to develop the very best practice possible is through tireless research and application of that research.

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EVIDENCE BASED NURSING AND MY PRACTICE References American Association of Critical Care Nurses [AACN] (n.d.). About AACN. Retrieved from http://www.aacn.org/wd/mainpages/content/aboutus.pcms?menu=aboutus American Nurses Association [ANA] (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.

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American Nursing Informatics Association [ANIA]. (n.d.). Nursing informatics. Retrieved from http://www.ania-caring.org/mc/page.do?sitePageId=101673&orgId=car Burns, N., & Grove, S.K. (2011). Understanding nursing research: Building and evidencedbased practice (5th ed.). Maryland Heights, MO: Elsevier Saunders. U.S. Department of Health and Human Services. (2012). The office of the national coordinator for health information technology: Electronic health records for meaningful use. Retrieved from http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2

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Instructor Comments: Author: Denise Hoisington Date: January 30, 2012 9:48 AM Great paper. APA looked good. Great thought and I love the informatics part as that is a love of mine too. 100/100