Applying an Evidence-Based Practice Model to Postoperative Hernia Repair

The evidence-based practice (EBP) has a central role in nursing in order to make a positive influence on the outcomes of services to patients by integrating optimal researched evidence, clinical experiences, and consume preferences. Surgical site infections (SSIs) and hernia recurrence are typically related complications of hernia repair surgery, particularly following ventral hernia operation. This can become a barrier to healing, raise the expenses of medical care, and it can even decrease the quality of life in patients. The EBP approach is vital when addressing these issues: Applying an Evidence-Based Practice Model to Postoperative Hernia Repair.

Johns Hopkins Nursing EBP Model provides a structured way of translating research into clinical practice. Under this model, nurses will be able to develop means of preventing SSIs and relapse, hence promoting patient care and recovery post-procedure. In the current paper, the Johns Hopkins EBP Model is adopted to solve the complication of postoperative hernia repair, the aim of which is to minimize complications and maximize outcomes of the recovery process.

Issue Associated with Postoperative Hernia Repair

Postoperative complications, such as surgical site infections and hernia recurrence, remain significant concerns for patients undergoing ventral hernia repair. SSIs occur in approximately 10-12% of patients after abdominal surgeries, resulting in increased hospital stays, readmissions, and healthcare costs (Hou et al., 2022). Hernia recurrence is also a challenge, with rates ranging from 3-10%, even with modern mesh placement. To improve patient recovery, it is necessary to address these complications on the basis of evidence.

The best available research-based interventions, including antibiotic prophylaxis, standardized wound care, and education of the patients about infection prevention, hold significant potential to decrease the incidence of SSIs and reduce the number of SSIs. The application of these evidence-based strategies has helped nurses manage postoperative care, decide on the occurrence of complications, and promote better patient outcomes.

EBP Model Selection

The Johns Hopkins Nursing EBP Model was chosen due to the fact that it provides an extensive process of incorporating research into practice. This model consists of five important steps: practice question, evidence collection, evidence appraisal, evidence correction action, and result measurement. It presents a structured, procedural means of addressing clinical problems, and the interventions rest on the basis of the finest evidence.

The use of a Johns Hopkins model in the given case is also especially appropriate since it enables collecting and evaluating evidence of various origins, such as clinical research, expert opinions, and patient preferences (Upstate Medical University, 2024). This holistic approach ensures that interventions are well-rounded, taking into account not only the best research but also practical clinical considerations and the patient’s needs.

Steps of the Johns Hopkins EBP Model

Practice Question

The initial process of implementing the Johns Hopkins EBP Model involves coming up with a clinical question. Regarding postoperative hernia repair, the aforementioned question may be stated as follows: In adults undergoing muscular hernia repair using mesh, does antibiotic prophylaxis, compared to no antibiotic prophylaxis, decrease the occurrence of wound infections and recurrence within 30 days of the surgery? This PICOT question presents a systematic paradigm through which the evidence can be sought and interventions evaluated to minimize complications.

Evidence Gathering

Relevant evidence should be obtained after drafting the clinical question. Databases like PubMed and CINAHL were searched to include articles in search of peer-reviewed articles, systematic reviews, and clinical guidelines. Bibliographic references found included a multi-institutional study of T-line mesh, a Cochrane review of infection prevention in surgical patients, and surgical guidelines on post-surgical care of hernia patients by SAGES. These materials can provide evidence regarding infection prevention, wound care, and recurrence prevention, which are all vital aspects of postoperative care of hernia patients.

Evidence Appraisal

The evidence should then be subjected to critical appraisal concerning its quality and usefulness. The T-line mesh study is a multi-centered, peer-reviewed research study that documents the recovery rate (3.5 percent) and SSIs after hernia mesh repair. The sample size is big enough, the method of the research is strong, and the research is approved by the IRB, which makes the study a reliable one.

Similarly, the Cochrane review on infection prevention provides good evidence for the use of antibiotic prophylaxis so as to minimize SSIs, and thus, it is of high relevance in postoperative care. The SAGES guideline is also evidence-based, thus making its implementation in clinical practice.

Integrating Evidence into Practice

Upon appraisal of the evidence, it should be incorporated into clinical practice. In postoperative hernia repair, the following are suggested: the use of a standardized care algorithm that incorporates the use of antibiotic prophylaxis during surgery to minimize SSIs, uniform response when it comes to wound care treatment in an attempt to avoid infection, and patient education when it comes to infection prevention and detection of recurrence. The evidence-based methods can be hard-coded into routine clinical practice so they maintain a more organized and efficient manner of dealing with postoperative recovery.

Evaluating Outcomes

The last component of the Johns Hopkins EBP Model is measuring the results of the applied interventions. With the introduction of new care regimes, patient outcomes should be monitored, and these include SSI rates, hernia recurrence, and patient satisfaction. To determine the adequacy of the interventions and identify what can be improved, one should gather data for several months. The assessment will enable the health workers to design their practice better and enable them to enhance care for patients.

Credibility and Relevance of Resources

The use of the resources needs to be credible and relevant to ensure that the most convincing, high-quality, dependable evidence supports interventions. Regarding postoperative hernia repair, all three of the major resources, the T-line mesh study, the Cochrane review, and the SAGES guideline, were chosen due to credibility, relevance, and applicability to clinical practice.

The T-line mesh study is published in a peer-reviewed journal and conducted in a variety of institutions, which makes it possible to apply the results to large patient groups. This study is valid because the sample size was large and an IRB had approved the research (Lu et al., 2024). The relevancy of the study to the clinical question, hernia repair using mesh, and the occurrence of SSIs and returns is important since the study directly relates to the problem of complications in this question.

The Cochrane review on infection prevention is a systematic review based on randomized control trials, which are considered the gold standard of clinical research. As the Cochrane Library has methodological rigor, it is highly credible, which makes this review reliable (Seidler et al., 2020). The results of the review suggest that the application of antibiotic prophylaxis in the prevention of the development of SSIs can be easily applied in postoperative hernia repair, where the prevention of infection is of the most importance.

Thirdly, the SAGES clinical guideline is a considerably acceptable source produced by a leading surgical committee. The guidelines also provide evidence-based information on what to do in post-surgical care, including wound care and prevention of infection (Daly et al., 2024). The particular interest in this resource can be attributed to its practical and evidence-based suggestions that can be adopted in clinical practice to positively impact the patients’ final results. It is certainly plausible because it has been formulated by sophisticated clinicians and screened to perfection.

All these resources were examined based on some criteria. First, they evaluated their credibility according to the review of peer-to-peer publications, investigation of the IRB, and systematic review procedure. Second, they possessed relevance in postoperative hernia repair that was in direct opposition to SSIs and recurrence. Finally, the applicability of the said resources was considered based on the ability to influence clinical practice and improve patient outcomes in postoperative clinical scenarios.

Conclusion

The Johns Hopkins Nursing EBP Model used on postoperative hernia repair is a systematic way to positively affect patient outcomes with postoperative hernia repair due to the complications that could arise, including SSIs and hernia recurrence. Nurses can learn how to conduct effective, evidence-based interventions focusing on limiting complications and speeding up recovery by adhering to the steps provided by the model, including formulating a clinical question, searching and assessing evidence, incorporating this evidence into practice, and evaluating outcomes.

The identified resources—the T-line mesh study, Cochrane review regarding infection prevention, and SAGES guideline—are credible, relevant, and clinically applicable; thus, the interventions to be introduced in the future are founded on the highest quality evidence. Implementing these evidence-based practices into postoperative care will allow nurses to improve the safety of patients, decrease complications and the period of recovery, and increase patient satisfaction. The system can also help develop and implement practices toward a system that will allow the maintenance of healthcare interventions that are current, effective, and patient-centered in the aspect of hernia repair. 

References

Daly, S., Kumar, S. S., Collings, A. T., Hanna, N. M., Pandya, Y. K., Kurtz, J., Kooragayala, K., Barber, M. W., Paranyak, M., Kurian, M., Chiu, J., Ansari, M. T., Slater, B. J., & Kohn, G. P. (2024). SAGES guidelines for the surgical treatment of hiatal hernias. Surgical Endoscopy, 38(9), 4765–4775. https://doi.org/10.1007/s00464-024-11092-3

Hou, Y., Collinsworth, A., Hasa, F., & Griffin, L. (2022). Incidence and impact of surgical site infections on length of stay and cost of care for patients undergoing open procedures. Surgery Open Science, 11(76), 1–18. https://doi.org/10.1016/j.sopen.2022.10.004

Lu, C., Cassidy, J., Embel, V., Ouellette, T., Arumugam, D., & Kipnis, S. (2024). Utilizing T-line mesh for periumbilical hernia repair: Evaluation of short-term outcomes. Plastic & Reconstructive Surgery Global Open, 12(11), e6287. https://doi.org/10.1097/gox.0000000000006287

Seidler, A. L., Hunter, K. E., Cheyne, S., Berlin, J. A., Ghersi, D., & Askie, L. M. (2020). Prospective meta-analyses and Cochrane’s role in embracing next-generation methodologies. Cochrane Database of Systematic Reviews, 10(10). https://doi.org/10.1002/14651858.ed000145

Upstate Medical University. (2024, November 15). Johns Hopkins Nursing evidence-based practice: Searching for the evidence. Upstate Medical University Health Sciences Library. https://guides.upstate.edu/c.php?g=1023176&p=7411259

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As the profession of nursing continues to evolve and engage in healthcare transformation, baccalaureate-prepared nurses are expanding, taking on leadership roles that include incorporating EBPs. To be able to do this, the nurse needs to understand the criteria that make a resource credible, as this is crucial when deciding if the research is valid and reliable for implementation into healthcare settings. The nurse will need to incorporate the use of EBP models.

EBP models are designed to assist the nurse in developing a plan to gather evidence to answer a practice problem or question. It is a systematic approach to direct the user to incorporate scholarly findings into current practice. These EBP models lead the nurse through the decision-making process of evaluating the literature to determine the best practice evidence for the practice issue or question.

Applying an Evidence-Based Practice Model to Postoperative Hernia Repair

Professional Context
As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, healthcare systems, and nursing practice outcomes are positively impacted.

Preparation
Review all resources for this assessment, as well as the scoring guide for details of how this assessment will be graded. You will use the specific diagnosis or health issue you selected for Assessment 1.