Rebecca Clopp's Professional Nursing Portfolio | They may ...



Evidenced Based Practice: Fluid Balance in Oncology PatientsRebecca CloppArizona State UniversityEvidence Based Practice: Fluid Balance on Oncology PatientsIn the clinical setting it is not always easy to measure a patient’s intake and output. Nurses don’t always see exactly how much a patient drinks throughout the day, or if a patient has an accident in bed how to measure that incontinence as output. There is no guide for nurses to know how to document their patient’s intake and output accurately, and the variation among nurses leads to inconsistency. This inaccuracy becomes an issue when intake and output needs to be tightly monitored especially in oncology patients who are immunosuppressed. This paper explores an article that describes how a medical oncology nursing clinical practice committee used the Iowa Model for Evidence-Based Practice to establish a policy for fluid balance measurement (Alexander and Allan, n.d.). The definition of evidence may sometimes be skewed as it can refer to one’s own personal knowledge. In a clinical setting nurses may develop certain strategies or skills that they have gained from their experiences in the field, and these experiences become an opinionated guide to their practice. These generated hypotheses may be correct, but there validity may only be found through research. This is where ones opinion-based hypothesis shifts to an evidenced based hypothesis. In order to form this hypothesis there must first be interest in a subject. This inquiry begins when there is a question toward the norm, whether there may be a better way. After the question is first formed it needs to be turned into a searchable PICOT question taking into account the population, intervention, comparison, outcome, and time (Melnyk et al, 2010). Once a question has been developed clinically it is researched for the best evidence. This method narrows the results to articles pertinent to the clinical question (Melnyk et al, 2010). From there the studies are reviewed, critiqued, and synthesized to determine if they come to similar conclusions (Melnyk et al, 2010). After this outcomes are implemented in clinical practice to be tested for changes that need to be made. This is needed because each patient is different and the intervention may not always have a positive outcome on each patient. If outcomes of an EBP practice are significantly beneficial, it is important that the information is spread clinically whether through articles or presentations. In this way EBP advances people’s practice for better outcomes. Counting a patient’s intake and output seems so simple and basic, but in truth there are many barriers for a nurse to accurately document intake and output. The three most principle barriers identified were “Inconsistencies in practice, variability in reports from patients, and appropriateness of orders” (Alexander and Allan, n.d.). Because of the difficulty in documenting there was poor compliance among nurses in recording a patient’s intake and output. It was evident that there needed to be an improvement in lessoning the barriers, and a guide needed to increase the compliance of the nurse. So the Iowa Model for Evidenced Based Practice was used to implement a better way to record intake and output. The Iowa Model is used to “promote quality care, and provides a framework for nurses to make decisions about day to day practices that affect patient care outcomes” (Titler et al, 2001). The model encourages the nurse to spark inquiry from either a problem in practice or simply new knowledge. When a change in practice is questioned, a team of professionals involved by the change is formed to research and synthesize evidence to support or negate the possible shift in practice. In the article by Alexander and Allan (n.d.), the staff led a critical evaluation of problem or knowledge-focused triggers, and then focused their research on a process for change. If the evidence strongly supports the change, then a pilot is implemented into clinic practice to assess how feasible and effective the new practice is (Titler et al, 2001). In Alexander and Allan (n.d.), two 31-bed oncology units implemented a pilot of the fluid balance measurement policy. If the pilot goes well then it is integrated into the facilities clinical practice, and the outcomes are monitored. From there the information is reported and shared with outside organizations. Outcome data of the fluid balance measurement supportedsuccessful change in practice without medical compromise, as well as improvedstaff compliance and satisfaction (Alexander and Allan, n.d.). The findings were then reported as evidenced by the article’s publication. One of the largest disadvantages to this model is that many nurses do not know how to interpret the research, and therefore do not implement the change in their practice. The two most common barriers to the Iowa Model are insufficient authority to change patient care procedures and insufficient time to implement new ideas (Funk et al, 2002). The advantages to the Iowa model include the use of internal research to find the best practice so that an individual nurse or organization may have the ability to make a change in the clinical setting. It also involves different loopholes to make sure the change in practice creates significantly better outcomes. Implementation of this EBP model provided within a context of caring, leads to the best clinical decision making as well as outcomes for patients and their families, because it is completed with evaluation of outcomes and continues with dissemination of findings (Overholt, 2005). Another EBP model that could have been used for the fluid balance management study is the ACE star model. It incorporates 5 stages including discovery, evidence summary, translation, integration, and evaluation (Stevens, 2004). The inquiry of how to better measure fluid balance would be the discovery stage, and the evidence summary step would be the research of the PICOT question and narrowing of the articles. The translation step would relate to the evaluation of the evidence and comparison of the outcomes. The integration would have been the implantation of the change in the clinical setting, and the evaluation would relate to the outcomes of the change in practice. The major disadvantage to using this system is it ignores patient’s values and preferences (Spector, n.d.). The advantage to the ACE model, just as the Iowa model, is that it allows changes in practice to take place at the individual or organizational level. Paul Ellwood provided the framework of outcome measurements, and described the use of outcomes as “a technology of patient experience designed to help patients, payers, and providers make rational medical care-related choices based on better insight into the effect of these choices on patient life” (p. 1549). In evidenced based practice, research is done, and new studies are conducted in order to find positive or negative outcomes of current practices. These studies allow for development in different procedures, and provide the patient with the highest quality of care, which in turn improves their outcomes. By using a model of evidence there is an accumulation of reliable research to back up universal healthcare practices, rather than an assumed outcome, there is a proven outcome. Evidence based practice integrates current scientific knowledge with clinical practice, and allows the practitioner to use the research to “correctly identify the clinical problem, apply the most high-quality intervention, and re-evaluate the outcome for future improvement” (NIH staff, 2009). If health care institutions implement EBP, there employees can be confident in their practice leading to better outcomes. If institutions are able to maintain innovation in their environment, they can contribute to advances in practice, and become more prestigious by providing the most advanced care. Evidenced based practice is so important because it provides for treatment that works, and effective treatment promotes adherence. It is the foreground to quality care, as it utilizes the best information in research, and the ability for clinical questions to be addressed. As a provider it helps to keep personal knowledge current, gives support in clinical judgment, can save time, and improve care. In the Alexander and Allan (n.d.) article, evidenced based practice improved adherence and accuracy in fluid balance measurement. With an established policy, better quality care was provided, and provider satisfaction was improved. In all, evidenced based practice leads to advancements in healthcare that provide better outcomes for all. ReferencesAlexander, L. & Allen, D. (n.d.). Establishing an evidence-based inpatient medical oncology fluid balance measurement policy. Clinical Journal of Oncology Nursing 15(1) 23-25. DOI: 10.1188/11.CJON.23-25Funk, S., Tornquist, E., Champagne, M. (2002). Barriers and Facilitators of Research Utilization. University of North Carolina. 30. 395-404.Melnyk, M., Fineout-Overholt, E., Stillwell, S., Williamson, K. (2010). The Seven Steps of Evidenced-Based Practice. American Journal of Nursing 110(1) 51-53. Melnyk, M., Fineout-Overholt, E., Stillwell, S., Williamson, K. (2010). Asking the Clinical Question: A Key Step in Evidence-Based Practice. American Journal of Nursing 110(3) 58-61.NIH staff. (2009). Health Services Research Definitions. National Institutes of Health. Retrieved from , M.G., Kleiber, C., Steelman, V., Rakel, B.A., Budreau, G., Everett, L.Q., Goode, T. (2001). The Iowa model of evidence-based practice to promote quality care.Critical Care Nursing Clinics of North America, 13, 497-509.Overholt, E., Melnyk, B., Schultz, A. (2005). Transforming Health Care from the InsideOut: Advancing Evidence-Based Practice in the 21st Century. Journal of Professional Nursing. 21. 335-344. Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for?Evidence-based Practice; The University of Texas Health Science Center at San Antonio. Retrieved from acestar.uthscsa.eduSpector, N. (n.d.). Evidence-Based Health Care in Nursing Regulation. National Councilof State Boards of Nursing. Retrieved from , M.G., Kleiber, C., Steelman, V., Rakel, B.A., Budreau, G., Everett, L.Q., Goode, T. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America 13 497-509. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download