Nursing: Research and Evidence-based practice

Abstract 

The nursing profession depends on a multidisciplinary approach to account for care setting, patient preference, clinical interventions, proper judgement, and best practice. Nurses must justify their actions and demonstrate why they perform specific tasks to have autonomy in the profession. Evidence-based practice (EBP) entails integrating best research with nursing expertise and the patient’s values to provide quality and cost-effective healthcare. Making an informed decision in the best evidence requires nurses to ask questions, acquire information, appraise the best proof, apply the best knowledge and assess the outcomes. This paper discusses the best practices based on research evidence-based practice and the PICOT model. This paper also focuses on how nurses use evidence-based practice and the PICOT model to collect, analyze and implement clinical research findings to improve nursing and patient outcomes.

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PICOT: NURSING PRACTICES 

Research and Evidence-based practices 

Although they differ in purpose, research and evidence-based practice are systematic approaches in improving patient’s healthcare. Nursing research and evidence-based practice activities are interconnected and interdependent in implementing the best findings (Melnyk, 2017, pp. 147-149). Conducting the research helps add new information to the existing knowledge while utilizing the best evidence to translate evidence into best practices. Best outcomes evidence achievement from research must be matched with practical implementation. The ability to manage EBP requires special clinical applications based on the availability of up-to-date research findings. 

Identification of a foundation of information that reflects quality healthcare, there is a need to establish a research-centred platform to complement EBP (Tucker, 2017, pp. 87-89). The incorporation of EBP and research fortify and reinforce the evidence required to provide efficient healthcare in multiple settings. Research and practice as evidence confirmation are intertwined pieces of EBP as they generate scientific data which help in formulating more questions to be explored. Therefore, nurses must continuously explore new information and integrate it into nursing. Besides, it is important for nurses to understand the connection between research and practice to provide quality care. 

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Developing focused Clinical Questions

To meet the patient’s needs and improve clinicians, it is essential to ask directly relevant questions and correctly phrased them to help the nurse search for precise answers to the patient’s problems. Clinical items are grouped into background and foreground questions and narrowed into therapy, prognosis, etiological and diagnosis. PICO elements help develop focused clinical questions and turn them into searchable queries. Items commence with defining the characteristics of the patient. Patients’ problem questions must provide necessary information revealing the patient issues and history of previous prescriptions. Prognostic factor questions follow and help determine the best interventions and what clinical care to perform to the patient. After proposing the patient, various interventions, drugs and treatments are compared to decide which one fits the patient’s problem best. The process is accomplished by asking disease-oriented and patient-oriented questions to improve the outcome.

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The key elements of the PICOT Model

PICOT Model is a format used for formulating focused clinical questions to improve healthcare quality. The PICOT model’s critical elements are Patient, Population or Problem, which describes factors such as groups of patients with similar characteristics, age, health issues, and gender. The second element is the intervention to be considered for the patient, while the other feature compares various intervention alternatives about treatment, drug and therapy. The fourth element of the model describes the outcome and the extent to which the process is accomplished. The model includes the time taken to achieve the result and determine the duration to observe the patient. The formula helps in developing researchable questions, ease the process of assessing findings and evaluating evidence.  

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Components of PICOT model in research 

Agus et al. describe the coronary artery bypass grafting in a 105-year-old patient to improve life expectancy (Ogus et al., 2010, pp. Pp 1-3). The article employs the PICOT model to question to provide the best healthcare to the patient. Patient as an element of PICOT is relevantly used to determine the patient’s health status and age. The nurses can demarcate treatment offered to patients over the age of 90, where the patient falls. On the intervention factors, the model provided guidance on medical imaging procedures, Coronary angiography to view the patient’s blood vessels. Other interventions include physical examination, blood pressure, percutaneous transluminal coronary angioplasty intervention and blood analysis. 

The patient was taken through the Intensive Care Unit and neurological tests to give a broader range of treatment considerations. No neurological events were recorded after the post-operation procedures. The outcome indicates that the nurses achieved cardiopulmonary bypass grafting.  Proximal anastomosis took about 3 minutes, 92 minutes for cardiopulmonary bypass and the patient went home on the 18th day after post-operations. However, the postoperative hospital stay of 18 days may be considered longer as compared to a young patient undergoing cardiac surgery. 

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Focused Clinical Question using each element of PICOT

The patient and problem clinical question, in this case, would ask, what are the cardiopulmonary concerns for a 105-year-old patient? The intervention question would be, would regulating the arterial blood pressure, and proximal anastomosis flow improve the patient’s health issues? Comparing the intervention required answering questions such as, would major imperceptive branch sequential with vein grafts under ventricular fibrillation without cross-clamping? Again, will the intervention result in fewer complications and less morbidity? Would the expected outcome put the patient in danger due to neurocognitive impairment associated with old age? What are the risks of grafting to minimize respiratory complications and take shorter operations? What modifications are necessary for surgical procedures for the aged group as compared to young patients?

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Importance of EBP 

Evidence-based practice is vital to enable health care providers to give up-to-date health care interventions to address patients’ health problems. EBP improves patient outcomes and supports the implementation of changes from nursing research. It also helps to describe the patients’ problem, compare the intervention of interest and consider possible outcomes from interventions. EBP brings forth chances for nursing to be customized, effective, corrected, and dynamic, and to increase the impacts of nursing judgment. EBP enable nurses to remain knowledgeable about current medical policies for patient care. By looking for recorded intervention situations, their patients’ profiles, nurses can increase their outcome for recovery. Comparisonnterventopportunities ion reduces the chances of complications, enhances quality health care and make it affordable. Incorporating EBP makes patients a proactive role in their healthcare to share their values and preference, thus determining the patient’s time to recover. Besides, EBP eliminates unnecessary practices, supplies, equipment, and products no longer useful for specific procedures. 

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References 

Melnyk, M. (2017). Finding and appraising systematic reviews of clinical interventions: Critical skills for evidence-based practice. Journal of paediatric nursing, pp 147-149.

Ogus, T., Erdim, F., Selimoglu, O., Tekiner, F., & Ugurlucan, M. (2010). Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass. Case Reports in Medicine, 3 pages. Retrieved from https://doi.org/10.1155/2010/725173

Tucker, S. (2017). People, Practices, and Places: Realities That Influence Evidence-Based Practice Uptake. Worldviews on Evidence-Based Nursing, 87-89.