NR 351 Week 5 Discussion – Using Evidence-Based Practice to Improve Patient Care
A challenge for nurses that I witnessed during clinical regarding patient care was related to medical device-related pressure injuries (MDRPI). The charge nurse for the floor (ICU stepdown) would start every morning, reminding the team of their usual daily goals, including frequent skin-integrity assessments and patient turning q 2 hours. However, each patient is different and simple turning is not enough, especially if they have a medical device(s). “The Joint Commission’s Quick Safety issue on managing medical device-related pressure injuries (MDRPIs) points out that nearly all hospital patients require at least one medical device for care and treatment, putting them at risk for injury” (Rio, 2018, p. 50). Each patient, whether catheterized, on a nasal cannula or had a trach tube placed (just to mention a few), all are at risk for pressure injuries due to the contact of the medical device with their skin. Sometimes these were inevitable, but it is the nurse that can take steps to minimize these MDRPIs by knowing the risks of each device and patient situation, customizing care based on the required medical device(s), effectively communicating with all team members the plan of care, as well as frequently assessing for any changes (Rio, 2018). I recall two patients from the floor that rotation: one who had a BiPAP mask and the other a triplegic with a PEG Tube and Tracheostomy. The patient with a BiPAP mask started to form erythema around his face, where the mask and bands were coming into contact with the patient’s skin. After my instructor discussed the situation with the main nurse, they started to incorporate more frequent skin assessments with the application of dressing to the points of contact between the device and the skin. The second patient already had an unstageable ulcer in the coccyx region that we would perform scheduled dressing changes for and q 2 hours turns, but was starting to form visible skin irritation on her medial thigh, believed to be a combination of the tape to secure her catheter, shearing/friction when adducting her legs when turning/cleaning and the catheter itself, lack of sensation due to paralysis, and also age/compromised skin integrity (as she was elderly). Further, consult with the nurses and the wound management team implemented more frequent skin assessments along with intermittent catheterization to remove the prolonged use (and irritation) of the catheter. Utilizing the standard question-format PICO acronym, my challenge would be: when caring for post-operative patients who have a medical device(s), does turning the patient q 2 hours (or as per facility protocol) meet safety and quality standards in reducing pressure injuries, or does additional care specific to a medical device(s) increase success in reducing pressure injuries for the duration of care?
The utilization of Evidence-Base Practice (EBP) is “a means to solve clinical practical problems by making the best possible decisions related to care based on client reports, clinician observations, and research data” (Hood, 2018, p. 259). By reviewing EBP scholarly articles, we, as nurses, are able to incorporate methods proven to have better patient outcomes.
NR 351 Week 5 Discussion – Using Evidence-Based Practice to Improve Patient Care
CINAHL Complete is a database full of credible health and nursing literature that includes scholarly articles, journals, and full texts. When searching for evidence/literature on a certain subject, I navigate to the CINAHL Complete search engine, where search fields allow you to enter research terms. CINAHL Complete allows you to incorporate modifiers (Boolean) when using multiple research terminology. You can also apply further filters (Advanced Search)
Allowing you to narrow your search: Publication Date, Scholarly (Peer Reviewed) Journals, etc. If your initial search results are too broad, you can continue to add more filters or more specific search terms/search restrictors.
NR 351 Week 5 Discussion – Using Evidence-Based Practice to Improve Patient Care
Specifically, for my search, I entered into the search field “pressure injury prevention” with the Boolean modifier “AND” followed by “evidence-based practice” in the next search field. My results were too broad, so I clicked Advance Search and chose the following filters: Scholarly (Peer Reviewed) Journals, Evidence-Based Practice, English Language, Publication Date 2014 to 2019 (as current scholarly articles should be within the last five years). Then I started browsing the articles and their titles to see which applied to my original research evidence/literature.
References
Hood, L. J. (2018). Leddy & Pepper’s professional nursing (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Rio, G. C.-D. (2018). Evidence-based practice: Medical device-related pressure injury prevention. American Nurse Today, 13(10), 50–52.
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Question 
Select a challenging nursing care issue (examples include falls, medication errors, pressure ulcers, and other clinical issues that can be improved by evidence in nursing). Do not select a medical issue (disease, medical treatment). Do not select a workforce issue (staffing, call-offs, nurse-to-patient ratios). Explain the following for the selected clinical issue. State the issue.
Explain the process you would use to search CINAHL for evidence. Include your search terms.