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Evidence-based practice is the standard that guides clinical practices

Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

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    Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

    Validate an idea with your own experience and additional sources.

    Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

    Expand on your colleagues’ postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.

                                                          INITIAL POST

            Evidence-based practice is the standard that guides clinical practices within the nursing profession. Adams (2010) asserts that evidence-based practice “is defined as the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (Adams, 2010, p. 274). Polit and Beck (2017) maintain that there is no consensus about what does or does not constitute evidence. There are, however, agreed upon sources of evidence which exist within a hierarchy. Systematic reviews are at the pinnacle because information is derived from multiple sources.  Randomized controlled trials are next, followed by cohort studies, single case-control studies, cross-sectional studies, qualitative studies, and finally expert opinion reports. Knowledge translation is the process of using evidence to evoke systemic change within the clinical practice (Polit & Beck, 2017).

Managing Delirium

While working on a busy surgical floor, I was caring for a confused, combative, elderly patient with a urinary tract infection who had fallen and broken her hip. During report, the night shift nurse told me that she gave the patient multiple doses of haloperidol and lorazepam which were ineffective. The patient continued to be confused and agitated, and because she was a danger to herself by continually trying to get out of bed, the night shift nurse obtained an order for soft restraints. Springer (2015) contends that the nurse should determine if the utilization of restraints is appropriate based on the patient’s current behavior, and should only be used when all other options such as distraction and de-escalation are exhausted (Springer, 2015). Because I was not there, I must assume that the nurse used evidence-based practice to decide that the restraints were necessary.

When I went in to assess the patient, she was sleeping; and in my professional opinion, the restraints were no longer appropriate. I removed the soft restraints and put the patient on one to one observation with a nursing assistant. Not long into the shift, the light for that room came on, and I heard staff in the patient’s room yelling. I walked in to find the patient screaming and striking the nursing assistant as he was attempting to change the patient. It was clear that the patient was still experiencing acute delirium. However, the television was on, the blinds were open, and every light in the room was on. Instead of using a chemical or physical restraint, I turned off the television, lights, and closed the blinds. I sat down beside the patient, spoke softly and attempted to reorient her. Although she was still confused, she was calm.

Bull (2015) asserts that nursing interventions to manage delirium include providing a therapeutic environment, frequent re-orientation, anticipating the patient’s needs, ensuring sensory assistance devices such as glasses or hearing aids are in use, observing the patient’s response, and proceeding accordingly. Non-invasive interventions should be exhausted prior to restraining a patient chemically or physically (Bull, 2015). In this case, the patient responded to non-invasive interventions. I continued to use the one to one observation to ensure safety throughout the shift but did not need to escalate to using chemical or physical restraints. By implementing evidence-based practice, I kept the patient safe without using restraints.

Background and PICOT Question

    Background questions are broad, generalized questions that focus on a clinical issue (Polit & Beck, 2017). In this case, my background questions would be: what is delirium? And, what causes delirium? The acronym PICOT (population, intervention, comparison, outcome, and time) is a format used to create a research question with the subsequent goal of finding evidence-based solutions to implement into clinical practice (Polit & Beck, 2017). My PICOT question is: in delirious patients (population), what are the effects of non-invasive management techniques (intervention), compared to restraints (comparative intervention), on patient experience (outcome) and does either intervention increase or decrease the recovery period (time)?

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