C10122v11 Bachelor Of Nursing
Question:
Assessment: Using evidence to inform clinical decision-making
Intent
In this assessment, you demonstrate that you can provide an evidence-based conclusion to an uncertain clinical situation. It requires you to search for relevant research, understand levels of evidence, consider the quality of evidence, present the summary of each article, interpret their findings, and reach a conclusion based on your reviewed evidence.
Task:
You have been provided with three clinical scenarios. Each scenario indicates an area of clinical uncertainty. Select a scenario that interests you and using your evidenced based practice skills answer the question that follows.
” level of the evidence, quality of the evidence, relevance ” is to use good search strategies, articles that are based on RCT or Systametic Review ” an excellent understanding of evidence” this means that the paper should contain the understanding and good explanation of confidence intervals from the article (this has the most marks) Also focus on the outcomes of your PICO question .
Scenario 1:
In the course of your clinical placement in a surgical ward, you noted inconsistency in wound care. While some nurses use a sterile technique, others employ a clean dressing change technique.
Is clean wound dressing a safe option for dressing of surgical wounds?
Scenario 2:
You are working on a hospital ward where you encounter stroke patients. You notice that some doctors order compression stockings for prevention of deep venous thrombosis while others not.
Should antithrombotic stockings be routinely used for patients with stroke or not?
Scenario 3:
You are working as an RN in an emergency department. A 10-year-old child has been admitted to the department with a diagnosis of exacerbation of asthma secondary to bronchitis. The patient has been prescribed salbutamol.
What is the more effective method of delivery- a nebuliser or a spacer?
Answer:
Introduction
Wound dressing, post a surgery or a traumatic injury and in the cases of development of chronic injuries is a very important area of wound care that is critical to stabilize the condition of the patient (Hegarty et al. 2019). Wound care and management is a critical area that should be addressed and managed by the nurse, by development the right and appropriate strategies, in order to prevent any chances of infection that can be posed in the scenario (Djavid et al. 2020). The risks of the hospital acquired infections and in the incidences of the cross contamination are very high in the wards, where the patients are clinically managed. Sepsis can occur due to lack of evidence based nursing care (Conley et al. 2017). Sepsis can lead to the development of complex adverse clinical events and in order to reduce the chances of risks presentations, the aseptic techniques are very much incorporated in the evidence based wound care and management, as per the guidelines given by World Health Organization and the National guidelines to wound and dressing. Performing the PICO (Patient Intervention comparison outcome) analysis, the research question that was developed is – In the surgical ward, does a sterile technique used by the nurses is more effective as compared to the clean dressing change technique, in wound care. Based on the level of evidence, the qualitative and the quantitative researches performed in the same area of wound care will be searched, in relevance to the above mentioned research question. As for search strategy, an electronic search was performed across, the databases such as PubMed and Sciencedirect to find the right articles. As for the inclusion criteria, only the researches published in 5 years and are in English and peer–reviewed were chosen. As for exclusion criteria, the articles which were not published in the last 5 years, not in English language and which are not peer reviewed were not chosen at all. In order to present the novelistic findings and the scholarly evidence in a very organized manner, a systematic literature review will be undertaken. This will ensure the quality of the research and help identify, the major themes in which, the changes are to be made, in increase safety technique compliance. It is important to be noted that lack of knowledge in the new graduate nurses, the sterile wound care technique is not incorporated into practice. In order to study this, article 1 is chosen and 2 is chosen. Lack of patient care protocols cause the difference in the application of wound care techniques and to study this, article 3 has been chosen. Lack of positive perception and positive attitude in new graduate nurses are the psychosocial issues that led to wound care discrepancies (Boga 2019). There are various types of sterilization techniques are available and they are all generally are expected to provide a safe care to the patient, which in reality, is not the case. Certain sterile techniques are very effective from the other and lack of understanding to differentiate between the varieties can lead to safety complications (Ding et al. 2017) and to study this, article 4 is chosen. All the studies chosen are either systematic review or random control trials, thus adding to quality of research.
Systematic review
|
Article name |
Authors and date of publication |
Method |
Findings |
|
A systematic review of the literature addressing asepsis in wound management. |
Haesler, E., Thomas, L., Morey, P. and Barker, J., 2016 |
Systematic Review |
The researchers of the study finds out the confusion presented by the nurses and the other clinicians over the application of the different techniques that are used in the safety protocols that lead to the wound care risks and complications, with respect to the patients, in the post-surgical scenario. The researchers of the study performed 20 quantitative studies in order to understand the differences the perceptions and the attitudes of the nurses in the application of the wpound care techniques and it was found that very less nurses actually complied with the aseptic techniques, with complete knowledge and understanding about the sterile techniques. Most of the nurses on the other hand, demonstrated their preference to clean dressing method because of its simplicity and as the same was very much easier to undertake as a nurse, in the post-surgical conditions. The confusion in the nurses was actually created due to the lack of knowledge about the sterile technique that involved more steps than the clean dressing technique and hence, was generally perceived as complex and difficult by the new nurses. The researchers of the study also points to the complex and high paced, highly demanding work environment of the post-operative departments and that is why, the lack of psychological safety in the new graduate nurses and lack of effective therapeutic communication with the supervisors and the seniors, lead to the non-compliance with the wound care safety techniques in the clinical scenario, which led to the risk and hazards with respect to the patient condition. It was also found that in the primary health care frameworks, where there is lack of infrastructure and sources – it is i9ncreasingly difficult to maintain the wound management, following the complete asepsis guidelines and that is why some of the nurses has to take up the sterility technique and other nurses had to take with the clean wound dressing techniques and there was presented an increased disparity between their clinical practices. |
|
Wound care evidence, knowledge and education amongst nurses: a semi?systematic literature review. |
Welsh, L. 2018 |
Systematic review |
The researchers of the study found out the importance of education, awareness and practical knowledge of the nurses to be a driving factor in day ti day compliance with wound dressing techniques in a sterile way. The strength of the study is that researched the pedagogical approaches used in the university levels and found out gaps in the pre-0registration courses that contextualized the use of aseptic wound care techniques over the other varieties of the wound dressings and that is why all the wound dressing techniques were wrongly perceived as equally safe. The researchers of the study recommends the application of the more focused and accurate wound management programs at pre-registration, post -graduation and at professional level to help the new graduate nurses understand the importance and the important implications of the sterility techniques that is used in the would care, after the surgery. |
|
Postoperative wound management with negative pressure wound therapy in knee and hip surgery: a randomised control trial. . |
Giannini, S., Mazzotti, A., Luciani, D., Lullini, G., Tedesco, G., Andreoli, I., Cadossi, M. and Faldini, C., 2018 |
Randomized control trial |
In this randomized control study, the researchers used the negative pressure wound therapy that is known as NPWT in the experimental group and the control group received the povidone-iodine gauze as the standard wound care after the surgeries of the knee and hip. The researchers of the study hypothesized more therapeutic value of the NPWT over the standard gauge and more score on ASEPSIS scale. However, there was no significant and substantial differences found between the two wound dressing techniques but the Negative pressure wound therapy was more efficient for the patients with higher chances of developing post-surgical infections in the clinical departments. |
|
Comparison of sterile polyacrylate wound dressing with activated carbon cloth and a standard non-adhesive hydrocellular foam dressing with silver: a randomised controlled trial protocol. |
Probst, S., Saini, C. and Skinner, M.B., 2019. |
Randomized control trial |
The researchers of the study focuses on the hard to heal wound and find out the efficiency of the sterile polyacrylate wound dressing over the use of the non-adhesive hydro cellular foam dressing but the cost effectiveness was a huge issue. The nurse can choose to use sterile technique, only when the infrastructure allowed them.
|
The reviewed studies shows compliance with the research hypothesis and the research questions and there are certain factors such as economy, cost effectiveness, resource and infrastructure that were initially not assumed to be a problem but was found out through the course of the undertaken systematic literature review (Templeton et al. 2018). However, awareness, education and knowledge were the cardinal issues as hypothesized.
Conclusion
There are several factors such as nursing education at pre-graduation, post-graduation and also during the daily profession life is lacking with respect to the aseptic wound care and that is why, this lead to lack of knowledge and understanding in the new graduate nurses about the use of the aseptic techniques. Lack of skills in regards with the accurate step by step method of asepsis was an issue and that is why, the same could be translated to the accurate and safe clinical practice. The nurses who are new and inexperienced, not only lacks from the lack of knowledge and skills but also from the lack of confidence and psychological safety that led to more confusion in relation to the wound dressing techniques that is to be used appropriately. The problem with the use of the sterile technique in dressing not only concerned the nurses but the other clinicians as well due to the same lack of knowledge about the technology and the method. Hence, even in a multidisciplinary, the right choice of the aseptic technique was not assisted with others. Moreover, lack of economy, lack of resources in the community and primary care frameworks were found to be responsible to crippled the daily safety practice of the nurses with the sterility technique, even if they were educated and skilled.
References
Boga, S. M. 2019. Nursing Practices in the Prevention of Post-Operative Wound Infection in Accordance with Evidence-Based Approach. International Journal of Caring Sciences, 12(2), 1228.
Conley, S. B., Buckley, P., Magarace, L., Hsieh, C., and Pedulla, L. V. 2017. Standardizing Best Nursing Practice for Implanted Ports. Journal of Infusion Nursing, 40(3), 165-174.
Ding, S., Lin, F., Marshall, A.P. and Gillespie, B.M., 2017. Nurses’ practice in preventing postoperative wound infections: an observational study. Journal of Wound Care, 26(1), pp.28-37.
Djavid, G. E., Tabaie, S. M., Tajali, S. B., Totounchi, M., Farhoud, A., Fateh, M., … and Taghizadeh, S. 2020. Application of a collagen matrix dressing on a neuropathic diabetic foot ulcer: a randomised control trial. Journal of Wound Care, 29(Sup3), S13-S18.
Giannini, S., Mazzotti, A., Luciani, D., Lullini, G., Tedesco, G., Andreoli, I., Cadossi, M. and Faldini, C., 2018. Postoperative wound management with negative pressure wound therapy in knee and hip surgery: a randomised control trial. Journal of wound care, 27(8), pp.520-525.
Haesler, E., Thomas, L., Morey, P. and Barker, J., 2016. A systematic review of the literature addressing asepsis in wound management. Wound Practice & Research, 24(4).
Hegarty, J., Howson, V., Wills, T., Creedon, S.A., Mc Cluskey, P., Lane, A., Connolly, A., Walshe, N., Noonan, B., Guidera, F. and Gallagher, A.G., 2019. Acute surgical wound?dressing procedure: Description of the steps involved in the development and validation of an observational metric. International wound journal, 16(3), pp.641-648.
Probst, S., Saini, C. and Skinner, M.B., 2019. Comparison of sterile polyacrylate wound dressing with activated carbon cloth and a standard non-adhesive hydrocellular foam dressing with silver: a randomised controlled trial protocol. Journal of wound care, 28(11), pp.722-728.
Templeton, S., Wong, C., Rando, T., Adamson, P., and Lynn, P. 2018. Microbial contamination of open?but?unused portions of wound dressings stored in home settings. International wound journal, 15(1), 106-113.
Welsh, L., 2018. Wound care evidence, knowledge and education amongst nurses: a semi?systematic literature review. International wound journal, 15(1), pp.53-61.
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