Free Essay

Evidence Based Practise in Nursing

In: Science

Submitted By marielamereles
Words 1068
Pages 5
Hand hygiene is a practise of evidence-based medicine and the number one way to prevent health-care associated infections (Garbutt, 2011). The term of hand hygiene applies to adequate hand washing, antiseptic hand-wash, antiseptic hand-rub, or surgical hand antisepsis (Garbutt, 2011). Evidence-based practices have been put into place to prevent such infections from occurring.
The present paper will examine ways in which health professionals use the five steps of evidence based practices (EBP) to locate, appraise and apply the best available research evidence. In this case, the five steps of EBP will be assessed in conjunction to the practise of good hand hygiene.

Liamputtong (2013, p.267) has explained evidence-based practise (EBP) as the use of the best research evidence, clinical expertise, available resources, and patient preferences in respect to clinical decision-making. EBP is taught and practised using five steps to reduce inconsistency and increase efficiency and effectiveness of health care (Liamputtong, 2013, p.267).
According to Liamputtong (2013, p.267) the first step of EBP is to ask an answerable question stating the population, intervention, comparison and outcome of the question (PICO). Next, acquire the best available evidence using research strategies (Liamputtong, 2013, p.267). This evidence is then appraised to determine its quality and relevance (Liamputtong, 2013, p.267). The fourth step it to apply the evidence integrated with clinical expertise and patient preference (Liamputtong, 2013, p.267). Finally, the process is to be accessed, reflecting on steps one to four and identifying ways to improve efficacy (Liamputtong, 2013, p.267).

The five-step approach to EBP is essential in the field of nursing as it ensures high-quality patient care to fit the patient’s needs (Beyea & Slattery, 2006, p.8). This minimizes potential risks to the patient, with benefits outweighing harm (Beyea & Slattery, 2006, p.9). EBP provides nurses with the skills and knowledge to evaluate healthcare literature, increasing their confidence in decision-making (Beyea & Slattery, 2006, p.9).
The Centre for Evidence Based Medicine and the National Health and Medical research Council have developed a hierarchy of evidence to reflect various types of biomedical research, with a ranking according to its validity (Davidson & Iles, 2013). This hierarchy is known to inform and guide health professionals with clinical decision-making.

Mariela Mereles S00107898
The top three levels provide the best quality of evidence as very rigorous procedures (formal methods) have been used to conduct such studies (Davidson & Iles, 2013). Systematic reviews have been found to provide excellent effectiveness, appropriateness and feasibility in research evidence, and thus are located at the top of the hierarchy (Evans, 2003).
This type of research provides scientific summary of literature on a specified topic (Liamputtong, 2013, p.463). Systematic reviews are classified as level I evidence. This type of evidence is best found using the Cochrane Library database, as it is a source of high-quality systematic reviews (Davidson & Iles, 2013).

Level II evidence includes randomized-controlled trails with research evidence providing a good level of effectiveness, appropriateness and feasibility (Evans, 2003). This type of research tests the effectiveness of medical interventions within a patient population (Liamputtong, 2013, p.461). Randomized-controlled trials may be found using PubMed or PsychINFO database.
The following three levels of the hierarchy includes non-research based evidence and have been conducted using less rigorous procedures (informal sources) (Davidson & Iles, 2013). Such research includes cohort studies, case series and reports found to have poor effectiveness, appropriateness and feasibility of research (Evans, 2003).

Healthcare professionals must refer to the 5-step approach to connect EBP with clinical decision-making. Firstly, an answerable question must be asked and for the purpose of this paper, the question will be: ‘For health professionals is alcohol-based hand agents or hand washing more effective in reducing the spread of infection’.
In respect to this question, research suggests the transmission of microorganisms spread due to contamination from health care personnel after patient contact (Allegranzi & Pittet, 2009). However, adherence to hand hygiene remains low (Hass & Larson, 2008).
Pratt et al. (2001) suggested that liquid soap and water could effectively decontaminate hands. Further research suggested that hand washing using antiseptic soap or waterless hand disinfectants, are more effective in reducing bacteria on hands and the spread of infection (Lucet et al., 2002; Stone, 2001; Voss & Widmer, 1997).

Mariela Mereles S00107898
Additionally, barriers of noncompliance for good hand hygiene practices have been identified and corrective actions proposed. Lack of time and the imbalance between workload and staffing has led to little attention of hand hygiene (Parett et al., 2001; Bittner, Rich, Turner, & Arnold, 2002). Immediate access to hygiene facilitators, such as alcohol-based rubs, will improve compliance as little time is required to apply this and is fast actioned (Voss & Widmer, 1997). Skin sensitivity and irritation to such agents have been found, yet providing access to hand lotions or creams will minimize this effect (Kampf & Löffler, 2007)
Lack of knowledge has also presented a barrier to regular hand washing (Dalheim, Harthug, Nilsen & Nortvedt, 2012). Education and motivation is critical in teaching of basic hygiene practises to reduce the spread of pathogens (Stone, 2001).

Evidence-based practise has shown to have limitations as well. This may include focussing treatment on groups rather than individuals (Beyea & Slattery, 2006). In such case, the evidence will provide a guideline as to how individuals within a group should be treated and not the individual themselves. Additionally, if evidence is misinterpreted, EBP may be problematic. This may be when evidence is generalized to a wider group than they should be (Beyea & Slattery, 2006).

In conclusion, research has shown hands to be the main pathway of pathogen transmission during health care (Alleganzi & Pittet, 2009). Hence, good hand hygiene is highly important to prevent the spread of infections (Alleganzi & Pittet, 2009).
Alcohol-based agents, including antiseptic soaps and sanitizers are more effective in eliminating pathogens in comparison to hand washing with soap and water (Lucet et al., 2002; Stone, 2001; Voss & Widmer, 1997).
Lack of time, knowledge and access to hygiene facilitators has been identified as barriers restricting good hand hygiene to be actioned (Parett et al., 2001; Bittner, Rich, Turner, & Arnold, 2002). Additionally, health professionals must be aware of the risks involved, when failing to practise good hand hygiene while treating patients.

Mariela Mereles S00107898

Similar Documents

Premium Essay


...• National competency standards for registered nurses were first adopted by the Australian Nursing and Midwifery Council (ANMC) in the early 1990s. The ANMC was a peak national and midwifery organisation established in 1992 to develop a national approach to nursing and midwifery regulation. The ANMC worked in conjunction with the state and territory nursing and midwifery authorities (NMRAs) to produce national standards – an integral component of the regulatory framework – to help nurses and midwives deliver safe and competent care. educated overseas seeking to work in Australia involved in professional conduct matters. The National Board may also apply the competency standards in order to communicate to consumers the standards that they can expect from nurses. Universities also use the standards when developing nursing curricula, and to assess student and new graduate performance. The ANMC officially became the Australian Nursing and Midwifery Accreditation Council (ANMAC) on 24 November 2010. The name change reflected ANMC’s appointment as the independent accrediting authority for the nursing and midwifery professions under the new National Registration and Accreditation Scheme (the National Scheme) that came into effect on 1 July 2010 (18 October 2010 in Western Australia). These are YOUR standards — developed using the best possible evidence, and using information and feedback provided by nurses in a variety of settings. Included......

Words: 5094 - Pages: 21

Premium Essay

Future of Nursing

...THE FUTURE OF NURSING: LEADING CHANGE, ADVANCING HEALTH Introduction Studies show that the nursing profession cover most of the workforce in the health sector, and they are mainly served with the responsibility of acting as patients’ advocates as well as defining the care that is to be provided to ailing patients (Hamric, Spross and Hanson 21). Nurses mainly work on the frontline of patient care, and they tend to play a significant role in realizing the objectives formulated in the in the 2010 Affordable Care Act and the Robert Wood Johnson Foundation Initiative (RWJFI) in collaboration with the Institute of Medicine (IOM), which define the need to change and advance healthcare (Initiative on the Future of Nursing n.d). Therefore, as much as there is a need to restructure the current healthcare, it is important to first address issues that interfere with the provision of quality and evidenced healthcare. To promote changes and advance health, the IOM report recommends nurses to practice to the full extent of their education, achieve higher levels of education and training through improved education process, and nurse to be involved in decision making processes touching on healthcare (Institute of Medicine n.d). The Future of Nursing: Leading Change, Advancing Health The impact of the IOM report on nursing education The primary goals of nursing education is mainly to prepare nurses to meet the ever increasing patients’ needs, function as leaders, and......

Words: 1547 - Pages: 7

Premium Essay

Medication Errors

...Abstract Healthcare unlike many high-risk industries has made slow progress in improving patient’s safety. The role of nursing in improving medication safety has been largely underestimated. Much of the research undertaken to date in relation to adverse medication events has neglected the impact that nurses have or could have in improving patient safety. In examining literature regarding adverse medication events one can see the urgent need for significant improvement in medication practices and processes. In addition that this health care issue will only improve with the participation of all disciplines working towards a common goal of improving the safety of those in our care. Introduction Medications play a key role in healthcare but can also be a significant key cause of medical error and of adverse patient outcomes. Nurses by the nature of their roles in medication administration can be the last line of defense in eliminating or reducing adverse medication events. The administration of medication is a common and almost routine activity in a nurse’s daily work, yet it is fraught with complexity and risk for both the patient and nurse. As a student nurse working in partnership with a registered nurse I have observed a variety of practices in medication administration that have varied from what I have been taught in class. On reflecting on these practices and questioning nurses why such practice has been adopted has illustrated to me both the flawed processes and......

Words: 2857 - Pages: 12

Premium Essay


...Communication is a key skill for any health care professional, but for nurses, we ‘are in an occupation that has interpersonal communication at its core. Virtually all nursing work revolves around the need for nurses to be effective communicators, whether relating to colleagues or with service users. (Morrall 2001). This essay seeks to discuss an evidence based experience learnt in clinical practice. For the purpose of this essay the author has chosen communication skills, since it is the basis for which verbal, non verbal and written ideas are conferred among the nursing staff. Some key policies and evidence taken from (research evidence or from this essay) will be identified and discussed. It also seeks to conclude with a general analysis from the overall main findings of this essay. The National Midwifery Council (NMC) (2008) state that nurses must take part in appropriate learning and practice activities that maintain and develop their competence and performance. As a nurse in training, I had been given the opportunity to complete a four weeks placement in a rehabilitation unit. The services provided included the admission of patients requiring rehabilitation therapy and specialist nursing attention. I was elected by my mentor to sit in their weekly review meeting consisting of the Multidisciplinary Team (MDT) in order to facilitate my learning objectives. As a student my role was to observe how the MDT addressed, planned and implemented patient care. This was......

Words: 880 - Pages: 4

Premium Essay

Health Science

...1 Introduction Te Kaunihera Tapuhi o Aotearoa/The Nursing Council of New Zealand (‘the Council’) under the Health Practitioners Competence Assurance Act 2003 (‘the Act’) is the responsible authority that governs the practice of nurses. The principle purpose of the Act is to protect the health and safety of members of the public by providing mechanisms to ensure health practitioners are competent and fit to practise their professions. The Council sets and monitors standards in the interests of the public and the profession. The Council’s primary concern is public safety. This Code outlines the standards of ethical conduct set by the Council under section 118(i) of the Act. This Code complements the legal obligations that nurses have under the Act, the Health and Disability Commissioner (Code of Health and Disability Services Nursing Council of New Zealand, PO Box 9644, Wellington 6011 Published June 2012 The Code of Conduct for nurses has been revised and rewritten. This document replaces the previous Code of Conduct for nurses published by the Nursing Council of New Zealand between 1995 and 2011. © Consumers’ Rights) Regulations 1996 and the Health Information Privacy Code 1994. The Act and Code of Rights can be found at The Code of Conduct for nurses is a set of standards defined by the Council describing the behaviour or conduct that nurses are expected to uphold. The Code of Conduct provides guidance on......

Words: 5823 - Pages: 24

Premium Essay

Discussion on How Theory and Research in Health Psychology Has Been Helpful or Unhelpful in Addressing Human Problems and disease outcomes studies would be done. To support this essay on how theory and research in health psychology has been helpful or unhelpful in addressing human problems Studies by Belloc and Breslow (1972) and Breslow and Enstrom (1980) was in support the study looked at the relationship between health behaviour and life expectancy in a population. Results showed individuals that leaved a healthy lifestyle had better health status and a higher life expectancy than those of an unhealthy lifestyle. As mentioned above that smoking is one of the growing influences in diseases and deaths, According to Eysenck (1982) the most important role is personality trait and that people require psychological stimulation. However in contrast the evidence was weak, so the stimulation hypothesis would not help as smoking contains stimulus drug nicotine that people get addicted to. However if nicotine crewing gun and behavioural therapy is combined it showed positive result. To help maintain and adapt to behaviour, social learning theory and positive social support showed to be important, Bandura (1977). According to Albert and Muafo, (2008) the bio-medical model states the human mind does not influence physically as the mind and body are separate systems. Showing body physical changes from viruses and germs that cause Illness however illness and diseases showed a Psychological independence. Therefore the bio-medical model showed a huge support in the studies of health and illness......

Words: 1854 - Pages: 8

Premium Essay

Motivational Interviewing the Nurse’s Role in Helping Motivation for Change in Client with Alcohol Dependence

...INTRODUCTION This work will discuss about motivational interviewing (MI) the nurse’s role in helping motivation for change in client with alcohol dependence. For clarity purpose, key terms like MI and alcohol dependence shall be defined. The evidence of effectiveness of MI as a psychosocial intervention for alcohol dependence and policies underpinning the use as well as the strengths and weaknesses and ethical issues. This work will evaluate nurse’s role in providing care and treatment including health education and promotion by helping patients/client’s motivation for change. Through reflection on practise, the writer’s clinical placement practise experiences of working with alcohol dependent clients in the community shall be use for illustration. Name and place will not be mentioned due to patient’s confidentiality (NMC, 2008). In conclusion, recommendations will be made to improve practice. The aim of this work is to critically evaluate the effectiveness of MI as a psychosocial intervention in alcohol dependence. The rational and motivation for choosing to explore this topic is because of a particular interest in substance misuse nursing and experiences from using MI in the care and treatment of alcohol dependent clients. Alcohol dependence represents a major burden to the National Health Service (NHS) and the wider health and social care systems (alcohol concern, 2009, Cabinet Office, 2003). The Department of Health (2004) estimates that nationally, six percent of......

Words: 2888 - Pages: 12

Free Essay

Roles and Responsibilities of a Midwife

...need to gain a degree from an approved midwifery course that then leads to registration with the Nursing & Midwifery Council (NMC). Most programmes are usually three years in length and are full-time. Qualified nurses can complete a shortened programme, which lasts 78 weeks full-time. A small number of universities offer a part-time option. Both of these routes are known as pre-registration programmes. Applicants must have a minimum of five GCSEs (or equivalent) and at least two A-levels (or equivalent) for degree programmes. Course entry is also possible through recognised access programmes, or in England, foundation degrees in healthcare or related subjects. Applications for degrees and diplomas in England and Scotland are made through the Universities and Colleges Admissions Service (UCAS). Information on degrees in Wales is available from Health in Wales and applications should be made through UCAS. Acceptance on a course will be subject to satisfactory health clearance and a disclosure and barring service (DBS) check. Some medical conditions can exclude entry. Courses cover applied psychology and sociology as well as biological sciences and professional practice. Most modules are continually assessed. Gaining a place on a direct entry course to midwifery is highly competitive, so you should aim to apply early. Skills To become a midwife an applicant will need to show evidence of the following: * An intuitive, caring, objective and flexible approach; *......

Words: 3579 - Pages: 15

Free Essay


...the enrolled nurse Introduction Description of Enrolled Nurse National Competency Standards Assessing Competence Glossary of Terms Introduction The Australian Nursing and Midwifery Council (ANMC) is a peak national nursing and midwifery organisation established in 1992 with the purpose of developing a national approach to nursing and midwifery regulation. The ANMC works in conjunction with the state and territory nursing and midwifery regulatory authorities (NMRAs) to produce national standards which are an integral component of the regulatory framework to assist nurses and midwives to deliver safe and competent care. The standards include the national competency standards for enrolled nurses which were first adopted by the ANMC in the early 1990s. These have been reviewed and revised regularly since then. Other standards developed by the ANMC for implementation by the NMRAs include the competency standards for registered nurses, midwives and nurse practitioners, codes of professional conduct and ethics, and a range of position statements and guidelines. The full list of standards, position papers and guidelines produced by the ANMC can be viewed on the website. The national competency standards for the enrolled nurse are scheduled for review in 2007. This review will be undertaken by a team of expert nursing consultants and will include extensive consultation with nurses around Australia. The purpose underpinning the review will be to contemporise the standards to......

Words: 4755 - Pages: 20

Premium Essay

Reflection on My Role as Student Nurse and Future Healthcare Practitioner

...the experience.” As a future learning disability Nurse, I will be looking at the essential skills that are required for me to advance and pass my course as set out by the NMC (2007) Standard for Pre-Registration Nursing Education. These required essential skills have been identified as reading and research skills, numeracy skills (counting and calculations), writing, oral communication, working with others, critical and analytical thinking, document use, IT and digital technology.This skills I have found in my few months of study at the university to be of great challenge to most student of which I am no exemption. I also will be looking into the challenges faced during the studies and what the challenges are, the impact and the benefits of the skills gained during the studies will be used to evaluate where I am as a student and the areas of improvement will be noted especially in my first year of study. This essay will be concluded based on my progress so far and concentrating more on the areas needed for improvement in order to be able to achieve my qualification. In my present training at the University, the essential skills course was one of the most challenging course that I encountered at the beginning of the term. The task to score myself based on my present knowledge of the required skills as well as to undergo some training and development by myself on areas that I was lacking behind in was not a very easy one as I have to critically examine what the......

Words: 1513 - Pages: 7

Premium Essay

Critical Incident Analysis

...result of the framework under which you operate being a continuously transforming environment. Healthcare and our understanding and application thereof is constantly changing and for that reason self-reflective attitudes of healthcare professionals is favourable. (Hendricks, et al., 1996) At one period in my educational background the year was met with many constraints, namely limited time, limited resources and an inexperienced, unqualified lecturer. In the very few contact sessions made available with the lecturer it was important to get through large masses of the workload, particularly the practical sessions as they are rather complex to self-study. The most viable method of getting through all this work in the allotted time was to practise the simulations in a behaviourist method which “concentrates on observable behaviour without considering motivation or other mental processes” (O'Neill, et al., 2005). This involved going through scenarios and memorizing key words as triggers to administer the appropriate drug. This behaviourist method of teaching and learning was passable as it helped the lecturer work through a sufficient volume of the required topics with the class in the short amount of time available. I managed to excel in the practical evaluation, achieving a relatively good grade. My grade was a true reflection of the ability of this particular approach to produce results exponentially due to its focus on “conditioned, convergent reflexes on a single task”......

Words: 880 - Pages: 4

Premium Essay

Role of the Mentor

...professions (Gopee, 2011) as too have the requirements for mentors within the health profession. The current definition from the Nursing and Midwifery Council (NMC, 2008a) states that “A mentor is a registrant who has met the outcomes (of a mentor preparation course) and who facilitates learning, supervises and assesses students in a practice setting” (NMC, 2008a). The role of a clinical nurse mentor is described as someone who supervises, teaches and assesses student nurses in a practice setting (Jokelainen et al, 2011, Ousey, 2009), although the role is more complex in that a clinical nurse mentor needs to process the ability to select and support learning opportunities, they have a responsibility to manage diversity and equality, be accountable and ensure standards are maintained (NMC, 2008a). This is supported by Jokelainen et al (2011) who describes mentoring as being complex due to contextual, collegial, pedagogical and clinical teaching. Student nurses are supernumerary in the practice placement, meaning they are there as learners even though they must make an active contribution to the work of the practice area (RCN, 2007). Their active contribution is additionally supported by Morgan (2002) who emphasises that students may feel surplus to requirements through their supernumerary status. Standards relating to mentoring nursing students are set by the Nursing and Midwifery Council (2008a). They include; establishing effective working relationship through placement......

Words: 4445 - Pages: 18

Free Essay

Infextion Control

...control needs around the procedure as well as the professional and ethical practice of infection control. The patient I shall be referring to shall be known as Patient A, this is to meet the nursing and midwifery code of conduct to protect the patient’s identity and to maintain confidentiality (NMC 2008). (LO 1.8) Patient A is an elderly gentleman living within a residential home, doctors are unable to resolve his underlying medical conditions of Chronic Obstructive Pulmonary Disease (CoPD), Heart Failure and Malignancy, which together resulted in him suffering from recurrent Pleural effusion. A Pleural Effusion is an accumulation of fluid in the chest cavity (Rocket 2012) this area normally contains a small amount of Pleural fluid and aids for optimal function of the lungs during respiration (rocket, 2012). However, Patients A’s conditions interfere with the body’s natural ability to reabsorb the fluid, which results in a larger amount of fluid building up, which in turn made the patient have serve breathing difficulties. Doctors decided rather than submitting Patient A for repeated procedures they inserted an Indwelling Pleural Catheter (IPC) into his chest, which allowed medical staff to drain off excess Pleural fluid and eliminate his respiratory symptoms (Rocket 2012). As part of the Nursing Process (KYN107) my mentor, a registered nurse assessed that patient A was able to have his Pleural Catheter drained , it was also assessed that due to the high risk of......

Words: 1364 - Pages: 6

Premium Essay


...between different health professionals be it oral or written, also the conclusion of many health care quality improvement investigations state that there is a lack of Inter-professional communication and hence suggest to improve it (Berman, Kozier & Erb, 2012). This collaboration between the professionals forms an integral part of the healthcare setting because the whole process of the treatment is based on communication patterns and a level of understanding amongst the carers. However, the health outcomes may suffer to a great extent suffer of poor communication, misunderstanding others perspective, lack of interest and conflicts. (Zwarenstein, Goldman & Reeves, 2009). Hence it is evident that for quality health outcomes inter-professional practice is vital. At healthcare places for providing a supportive environment for everyone, each healthcare team member is responsible. In the case of nurses, their responsibilities include, providing evidence based nursing care to people of all ages and cultural groups including individuals, families and communities (Jarvis, 2012). “Nursing is the act of utilizing the environment of the patient to assist him in his recovery” (Nightingale, 1969). As stated by Berman & Kozier (2008) according to the aspects of the particular environment and roles required, nurses may act as a counsellor while providing physical care and teaching aspects of that care. A patient while in a hospital basically relies on the nurse for any kind of......

Words: 961 - Pages: 4

Premium Essay

Qualiative and Quantative Appraisal

...School of Health Nursing & Midwifery Assessment Title Page Title Page Information | Module Code | NURS09189 | Module Title | Research Evidence and Practice | Assessment wordage (if applicable) | 3,000 word assignment – no more than 3,300 words | Submission deadline (Date and Time)**The assessment must be submitted prior to this deadline to avoid penalty | Date: 11th December 2015Time: 9am(If the submission is via drop box, the time must be 9am) | To be completed by the student prior to submitting assessment | Assessment Title- please specify the question you have chosen | People experience distress in different ways and so attempting to measure it Is pointless | Banner ID number(this is an 8 digit number, preceded by the letter ‘B’, e.g. B00123456) | B00188060 | Have you been granted a formal extension? | YES Audrey Cund Revised submission deadline for extension: 18th DEC 15 | Contents page Page 2 Introduction Page 3 Literature search Page 5 Critical Appraisal of a Quantitative Study Page 8 Critical Appraisal of a Qualitative Research Study Page 10 Conclusion Page 12 Appendix 1 Page 15 Appendix 2 Page 18 Appendix 3 Page 21 References Critical Appraisal of Quantitative and Qualitative Nursing Research Introduction Contemporary nursing continues to not only strive for evidence based practice, which according to the Nursing and Midwifery Council (NMC) 2008 Code of Performance and Ethics should be part of nurse’s......

Words: 4972 - Pages: 20