RNSG 1137 Exam 2 Blueprint. A+ Guide. Lone Star College.1. EBP- Best practice and standards- Prioritizations:
Evidence-based practice (EBP) in nursing is
... [Show More] a problem-solving approach to
making clinical decisions, using the best evidence available (considered “best”
because it is collected from sources such as published research, national
standards and guidelines, and reviews of targeted literature).
Makic & Rauen (2016) identify essential elements of EBP as (1) the integration of
best research and other forms of evidence to guide practice; (2) viewing clinical
expertise as a component in care effectiveness; and (3) considering patients’
preferences, values, and engagement in care decisions as essential to providing
optimal evidence-based care to patient and their families.
The steps of EBP are as follows:
Cultivate a spirit of inquiry.
Ask the burning clinical question in Population/Patient/Problem, Intervention,
Comparison, Outcome, and Time (PICOT) format.
Search for and collect the most relevant best evidence.
Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and
synthesis).
Integrate the best evidence with one’s clinical expertise and patient preferences
and values in making a practice decision or change.
Evaluate outcomes of the practice decision or change based on evidence.
Disseminate the outcomes of the EBP decision or change.
EBP blends both the science and the art of nursing so that the best patient outcomes
are achieved.
To practice EBP, nurses carry out the following five steps:
o Ask a question about a clinical area of interest or an intervention.
There are several different methods that can be used to ask clinical
questions. The most common method is the PICOT format
o Collect the most relevant and best evidence
o Critically appraise the evidence
o Integrate the evidence with clinical expertise, patient preferences, and
values in making a decision to change.
o Evaluate the practice decision or change
Pressure ulcers:
1. Conduct a pressure ulcer admission assessment for all patients
Ensure that risk assessment is done within 4 hours of admission
Include a visual cue on admission documentation record for skin/risk assessment
Agree on use of standard risk assessment tool
Use multiple methods to visually cue staff about patients at risk
Build shared pride in progress
2. Reassess risks daily
Adopt documentation tools to prompt daily risk assessment, findings and
prevention interventions
Educate all levels of staff regarding risk factors and prevention strategies
Use validated risk assessment tools
3. Inspect skin daily
Adapt documentation tools to prompt daily skin inspection
Educate all levels of staff to inspect skin any time they are assisting the
patient
4. Manage moisture: Keep the patient dry and skin moisturized
Design a process for periodic activities such as repositioning, assessing for
wet skin, applying barrier agents, offering toileting opportunity
Provide supplies at bedside for at risk patients
Provide under pads that pull moisture away from skin
5. Optimize nutrition and hydration
Assist patient with meals, snack and hydration
Document amount of nutritional intake, notify provider or dietician if intake
is inadequate
Offer water to every patient scheduled to be turned
6. Minimize pressure
Turn and reposition patient every 2 hours
Use pressure- redistribution surfaces
Preventing Central Line Associated Bloodstream Infections:
1. Hand hygiene
2. Maximal barrier precautions
3. Chlorhexidine skin antisepsis
4. Optimal catheter site selection with avoidance of using the femoral vein for
central venous access in adults
5. Daily review of line necessity, with prompt removal of unnecessary lines
Catheter Associated UTIs:
1. Use strict aseptic technique during insertion of smallest possible catheter
2. Secure catheter to prevent movement
3. Frequently inspect urine color, odor, and consistency
4. Performing meticulous daily perineal care with soap and water
5. Maintain a closed system
6. Follow a manufacturer’s instructions when using catheter port to obtain
urine specimen
Ventilator Associated Pneumonia:
1. Elevate head of bed
2. Daily sedative interruption and daily assessment of readiness to extubate
3. Peptic ulcer disease prophylaxis
4. DVT prophylaxis
5. Daily oral care with chlorhexidine [Show Less]