Evidence-based Practice in Nursing and Patient Safety

Introduction

Nursing is an important profession in the health sector. This is because nurses are the ones who take care of patients during their recovery and administer medication as directed by the doctors. The nurses play an important role in the recovery of patients because they can advise patients on how to live better lifestyles to prevent recurrence of illnesses and prevent the development of new illnesses. There are many roles that nurses play in the hospitals. They are the first to receive a patient who has an emergency and they are the same people to nurse them back to health. In ensuring that the safety of patients is well organized in hospitals, the nurses are the people to consult. They assist in running the hospitals on a day to day basis. This is an indication that the nurses have to be well equipped with skills, training and educational qualifications. This makes nurses very responsible and important stake holders in making plans for any type of changes in the hospital setting.

Identify a nursing practice

The nursing practice in the hospitals on the care of patients who need to be moved from one care unit to another has been challenging to the nurses, who have to strive to ensure the patients’ safety is well done. The nursing practice of moving patients, and ensuring their records are well updated and the flow of information is important in the nursing practice. As such, there is need for evidence-based nursing practises to be put in place to ensure such transfers do not expose both the patient’s and nurses to accidents within the hospitals premises. Nursing practice on patient safety is the most effective when the nurses and patients work together to identify the short comings of the existing care models. It is also important to understand the existing practice in nursing to ensure that when improvements are being made, it is not done blindly. There are many operations that come into play when evaluating the level of care that the nurses can afford to give to the patients and at the same time look out for their safety.

Description of the nursing practice

This is whereby the nurses would transfer patients between wards as their conditions changed and assume that the nurses on the other end would understand and take the appropriate action in caring for the patients. Some patients suffering from highly contagious diseases require extra precaution on the part of nurses so that they prevent themselves from contracting the disease. Without proper transfer information, the nurses may endanger each other and other patients as well. This has been the practise for the longest time ever because nursing has always been considered as the care giver’s position. With that assumption, the nurses were only expected to do what the doctors told them and indicated that they should do. Nursing was a profession that was considered less important compared to doctors’ professions. The nursing practice of caring for patients in the various care levels required was all the nurses had to do to earn their pay check and for some, satisfy their sense of duty. The nursing profession faced challenges in patient care when the patient ration to the nurses increased to extreme levels and personal care could not be accorded to any patient. It is important to understand that in this type of practice, safety of both the nurses and patients is greatly compromised. The conclusion, therefore, is that nursing and patient care practises have not been keen on the safety of patients and nurses as well.

Why there is need for change

The nursing practice needs to change to a more informed nursing practise. This is the type that ensures patients’ information is well recorded and the nursing units prepare for their work loads. For instance; transferring patients from the outpatient to in patient should be an easy task with adequate preparation. This involves the nurse in charge being aware of the patient’s condition and the type of care that they need. The nurse in charge will then be in a position to monitor and ensure that the nurses on duty are doing the right thing. The change from the traditional practice to evidence practice is necessary for ensuring that patients in the hands of nurses are safe from additional harm due to lack of knowledge, proper attention and wrong care due to misinformation. The nurses also need to be informed so that they are also safe while working. There are a lot of dangers that the hospital environment poses for both the patients and the care givers because it is a hospitals setting. There are mentally, physically and socially incapacitated patients in the hospital setting, under the care of nurses. This is an environment in which nurses cannot predict the actions of patients yet they have to ensure they are well cared for. 

There is need for change to ensure that the nurses are not harmed by a mentally challenged patient. This can only be done with proper training and good hospital monitoring procedures. This can be done by having surveillance cameras in the ward corridors and ensuring proper lighting throughout the hospitals. Good hospital infrastructure will assist the nurses to take good and timely care of the patients and be safe while at work. There have been rumoured cases of nurses being assaulted by patients but because of lack of evidence, nothing is done for the patients. This is wrong because the nurses deserve to be comfortable in their work places so that they offer the best possible care to patients. Comfortable nurses will also be keen to ensure that patients do not get accidents while in the hospitals or get wrong medication which is a safety hazard. For instance; when patient records are mixed up and two diabetic patients with type 1 and 2 respectively are given wrong medication, fatalities could ensue. To prevent such an incident from occurring and many other of the same kind, the nursing practice has to go through an over-haul on all levels from the curriculum to the training and even the hospital organizations on nursing rotations.

The Stakeholders in the Nursing Practice Change

1. The nurses.

The nurses are the key stakeholders in the change of practice. They are human and there are some demands that are beyond any human ability to achieve. One such demand is personal care by nurses when the nursing department is understaffed and the hospital has many high risk patients. At this point, nursing is no longer work that can be done effectively because of the overly stretched resources in the form of nurses. For instance; a nurse cannot attend to thirty patients and afford personal care for each of them. In such an environment, patient safety is at high risk. The nurses have to be consulted when making changes to the practice. This means that the challenges they face in ensuring patient safety are taken into consideration. The nurses should have an input in changing their practice because they are better placed to point out what would work better for patient safety seeing that they are the primary care-givers in the hospital setting. The nurses’ input will also ensure that any suggestion for change that is not viable is not effected. This is because, effecting a change that will do little to improve patient safety in the nursing practice is detrimental to the strides that have been  made in ensuring the safety of the patients gets better every day. Having the nurses on board with the changes in their practice is the only way to ensure that the changes will be accepted and effected.

2. The hospital managements

The management body in any institution is very important. When changes are likely to take place in the hospital setting, the management has to be consulted and incorporated in the discussions for change. Therefore, when discussing the change in nursing practice from merely nursing practice to evidence-based nursing practice, the management has to be involved. Their involvement is necessary because in any change project, funds have to be used to effect the change. Additionally, when working with the nurses to develop the change project, the management is made aware of the things that are going wrong in the hospital and they also get to know the challenges that the nurses go through in their work. This will ensure that when the nurses ask for better lighting in the wards, the management will be the first to know and get the reasons as to why it is important. The management is also made aware of the needs of the nurses so that they can meet their objectives of caring for the patients and ensuring their safety in the process. The management is thus responsible for ensuring that the patient safety in the hospital is well insured.

The management is also a key stakeholder in changing the nursing practice to evidence-based nursing practice because they have the sole responsibility for the safety of patents. When a patient is injured while in their hospital, they may get sued and incur a lot of costs because they will eventually have to compensate the patient and pay the legal fees. The hospital management is additionally required to ensure that patients are aware of their conditions so that they know when the right care is being accorded or not. The hospital management is the most important when it comes to dealing with patient safety because it is the body that is held to account in case things go wrong and it is the same body that is required to act to prevent patient accidents and ensure the safety of the caregivers as well. The administration can easily frustrate the desire by the nurses to adapt better nursing practices when the board fails to allocate adequate budgetary allocations to facilitate these changes. 

The hospital administration is also responsible for overseeing the effects of the changes in the nursing practice and ensuring that the right infrastructure is in place to support the change. This includes designing the wards in ways that the nurses can easily perform their duties without facing health hazards like sprains when moving patients. At the same time, the administration should always consult with the workers on what should be made better to prevent an accident that took place as a result of faulty or misinformed designs of the wards and the general hospital construction plans. The administration plays a very important role in helping the nurses take care of the patients’ safety.

3. The patients

The patients are the most important stakeholders in any hospital decisions. They are the reason for the existence of hospitals because without patients, the nursing profession would not exist. Patients need assurance that being in hospital is equal to getting care. Patients do not expect to get injured or worsen in their conditions while in the hospitals. The hospital environment for the patients is supposed to aid recovery with nurses at hand. Therefore, patient safety is very important to the nurses and this makes the patents also key stakeholders. The patients can be involved in the discussion for the improvement of their safety by filling out some questionnaires at the end of their stay in the hospital. This means that the patient’s voice will be incorporated in the decision where the nursing practice is updated to evidence-based practice. The patients’ experiences can be eye openers in terms of nursing. Their perspective is important in ensuring that the nurses are supposed to understand what the patients feel and what they need. The patients cannot obstruct the acceptance of change in the evidence-based nursing practice because they do not have the expertise or voice to stop change.

Evidence Critique

The sources for this course are less than five years old. This means that the studies are recent and relevant to the needs of the switch up to evidence based nursing practice. The evidence selected is recent to ensure that outdated practices are not considered problems at this point yet they have been faced out. The nursing practice is constantly changing to adapt to the advanced technology and the evolving needs of the patients as well. The evidence for this study is critical to developing best practices because it is well updated and timely for improving patient safety amid all the challenges that face the nursing profession at the moment, the biggest problem being the issue of staffing shortages.

Sources

1. Evidence Strength and Evidence Hierarchy Critique

Level I	Integrative	Huang, C.-H., & Lee, Y.-C. (2018). The Perceptions of Patient Safety Culture: A difference between physicians and nurses in Taiwan. Applied Nursing Research, https://doi.org/10.1016/j.apnr.2017.12.010.
Level II	Randomized Control Trials	Hoben, M., Norton, P. G., & Estabrooks, C. A. (2017). Improving Nursing Home Care Through Feedback on Performance Data (INFORM): Protocol for a Cluster- Randomized Trial. BioMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223357/#!po=57.9755.
Level III	Quasi-Experimental	Moore , K. J., Candy, B., & Sampson, E. (2017). Implementating the Compassion Intervention, a Model for Integrated Care for People with Advanced Dementia Towards the End of Life in Nursing Homes: a Naturalistic feasesibility study. BMJ Open, www.ncbi.nlm.nih.gov/pmc/articles/PMC5541605/#!po=78.8462. Yazici, G. R., & Bulut, H. (2018). Efficacy of a care bundle to prevent multiple infections in the intensive care unit: A quasi-experimental pretest-posttest design study. Applied Nursing Research, http://doi.org/10.1016/j.apnr.2017.10.009.
Level VI	Qualitative	Lambooij, M. S., Drewes, H. W., & Koster, F. (2017). Use of Electronic Medical Records and Quality of Patient Data: Different Reaction Patterns of Doctors and Nurses to the Hospital Organization. BMC Medical Informatics and Decision Making, www.ncbi.nlm.nih.gov/pmc/articles/PMC5303309/.

Evidence Summary

Patient safety is important in all the nursing facilities. This includes hospitals and nursing homes. In hospitals, the nurses are trained and equipped to help patients in their journey to recovery. In nursing homes, the nurses are supposed to take care of all the needs of their clients who are often old people. The nursing homes have high chances of accidents because old people may have challenges with movement which may result in falls on slippery and uneven floors. They are also more likely to injure themselves when trying to do things on their own. This means that nurses in these home have to be very alert to prevent accidents to their clients. In hospitals, accidents can come from all corners. The doctor could accidentally cut a vessel, a nurse could accidentally dress a wound wrongly, medication can be switched as can records, patients can injured while being moved between units and so many other origins of accidents. It is for this reason that the research by Hoben, Norton and Estabrooks was conducted to evaluate the effectiveness of care by nurse’s form the patients (Hoben, Norton, & Estabrooks, 2017). This is an important move in getting the perspective of the patients when working out ways of improving patient care by nurses.

Nurses have a better perspective on the safety of their patients. This means that nurses can be most instrumental in advising the administration on the steps to take in improving the safety standards in the hospitals. Nurses can also be credited with being the ones who deal with the patients on a day to day basis and for the longest period of time during their admission. As such, nurses are able to see what the patients need the most. This is in contrast to the doctors, whose main objective to diagnose, write a prescription and delegate the care duties to nurses. Therefore, the doctors can offer some insight into patient safety but the nurses can be more exhaustive in this cases. This is because even in the theatre cases, the nurses are the ones to ensure that all items that were used are accounted for before the stitching is done. This is to ensure that no items are stitched up in the patient’s body. The study by Huang & Lee, indicates that the perspectives of all the people who deal with patients is well taken into consideration (Huang & Lee, 2018). All this is in an effort to ensure that the administration is well aware of the challenges in the wards.

Record keeping of patient data is an important factor of patient safety. This is because patient safety starts from getting the right diagnosis, medication and care. This can be compromised when the patient records are kept careless or in the open where malicious people can interfere. Interference with medical records can be fatal in the cases where patients have serious illnesses and their medication is not correct. The record keeping department in the hospital settings is supposed to be put in a way that only the cleared medical personnel can access them and their access should be prompt and accurate. This can only be achieved when the process is upgraded to use technology. It is for this reason that the research by Koster, Lambooij &Drewes was conducted to determine how the doctors and nurses relate to the administration in record keeping (Lambooij, Drewes, & Koster, 2017). The nurses require correct documentation so that they are able to offer safe care for their patients. 

There are people with different health challenges like dementia. These people require extra care given that their physical needs may not be as demanding as their mental needs. Caring for such patients is difficult because of their memory state. The nurses have to be vigilant to ensure that they do not endanger themselves by walking out of the hospital and into the streets where they could get hit by vehicles or even trip and fall. Additionally, when caring for such patients, nurses cannot afford to leave them unsupervised because they can get into all sorts of accidents and harm given their state of mind. All mental illnesses in the society are a challenge to the care givers that is the nurses and their relatives and family (Moore , Candy, & Sampson, 2017). Taking care of mentally unsound people could be a risky affair especially to those with episodes of violence and have the ability to harm nurses, other patients and themselves. These are the patients who need round the clock monitoring. It is also a situation where a nurse cannot take on a load of patients that is too big to give adequate attention promptly. This can be resolved by the administration of the hospitals ensuring that there are enough nurses and enough security assigned to this units. This will ensure that both the patients and the care givers are safe at all times.

Nursing and patient safety is a delicate balance in cases where the patient is in intensive care unit. At this stage the body requires delicate care and any accident whatsoever can be fatal. As such, the nurses in the intensive care unit in the hospital cannot afford to let these mishaps happen. The care of patients in the intensive care unit has proven to be a challenge more so because the patients in many cases cannot communicate their discomfort. They suffer in silence till they recover well enough to talk about their discomfort or pain while some die and the nurses will never know about their struggles. This makes it difficult to adjust the nursing practices because of lack of information. The designs of many hospitals are similar and there is little that the nurses can do in the areas where the patients do not speak. Therefore, the nurses have to act on observation and communicate openly with the hospital administration to ensure the changes that they recommend are taken seriously. The patient safety in the intensive care unit includes being well cared for to prevent the most common infections that patients contract while in the intensive care unit. A research was conducted to evaluate the efficiency of the care bundles that the nurses utilize when dealing with patients in the intensive care units. The research was conducted on patients before and after their time in the intensive care unit (Yazici & Bulut, 2018). The nurses were trained separately on care for the patients in the ICU and the results observed in the recovery of the patients compared. The safety of the patients differed in terms of infections depending on the type of care bundle they were given. With care bundles that were more compatible after following the evidence based guidelines, the rate of infections in the intensive care unit reduced significantly.

Recommend Best Practice

In a hospital environment, patient safety is mainly the responsibility of the nurses. However, they cannot do it alone and require support from the hospital administration and input form the patients on how best to improve their nursing practice. This means that the patients will be required to give their input as to where they felt that the nurses could do better. The nurses on the other hand need to take the criticisms, suggestions and views form patients positively. This will ensure that when they get down to developing better nursing practices, they have something to work on. The nurses can also take the improvement opportunities to develop their skills and become better care givers. In nursing, the best practices are patient centred. This means treating all the patients with respect and maintaining their dignity while at it. The nurses are also required to inform the patients on what to do to avoid getting injured especially where they have medical equipment attached to their bodies for treatment like tubes and syringes.  Nurses should always ensure that they can effectively attend to the number of patients that they have been assigned. When the load is too much to handle, prompt communication to the department should be done. This is to ensure that the administration is aware of the situation and employers more nurses. In the current economy the salary issues mean that the few employed nurses are underpaid and over worked; a situation that is already dangerous to the patients under the care of these nurses. When the nurses suffer burn outs every so often, it is difficult for them to deal with patient safety because they are already incapacitated to handle their own safety. This is the situation where the nurses are involved in cases of negligence; not because they do not care enough but because their concentration is not as sharp as it should be.

Practice Change Model

A test of the Advancing Research and Clinical Practice Through Close Collaboration, ARCC, Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes. This model of change works best when the patient views, research results and medical knowledge is put together to determine the viability of the change being proposed (Melnyk, Fineout-Overholt, & Giggleman, 2016). This model ensures that perspectives are examined and the appropriate action is taken to effect the changes. It is important to the practice to effect changes that have been advised by research and extensive studies. This will make the change in practice effective and the patients will receive better care from informed nurses. It is also important that the hospital administration supports the changes in the nursing practices by availing better equipment for the same. This includes ensuring that the medical records are digitalised and well updated. The patient labelling should always be done with precision to avoid endangering the patients due to miss-matched records. This model of change is the best placed to change the practice in the care for patients. This is especially because the input of the patient is sought before any changes are designed and effected. It is a show of commitment by the nursing body to improve the quality of care for patients and most especially, to ensure the safety of patients while in hospitals is top notch.

Model Justification

The model is most appropriate for this type of change given its broad scope of collecting data. This is seen in the event where the views of the patients are taken positively by the body tasked with overseeing the changes. The views of the patients take the centre stage when designing this change model. It means that the model implementation is more effective than those which do not consult the patients. They are blindly developed by guessing the shortcomings of their own systems without a third party’s perspective. It is important that nurses in the hospital environment plan their changes in practice using this model given its level of efficiency. In improving the safety of patients, it is important to ensure that all the measures taken re patient centred. It is for this reason that the ARRC model of change is most effective in developing and implementing the desired improvement in patients’ safety within the hospital environments. 

Model Guide to Implementation

Implementation processes for this model is supposed to be systematic for maximum efficiency. It is important that the first step is to find out what challenges the nurses face in keeping the patients safe. This is what the body in charge of effecting the change is supposed to use to determine where the changes will begin taking place. Additionally, when the problems and challenges have been pointed out from the bottom, then the solutions will have a place to begin. The second step in the implementation of this change process is to involve the nurses and the hospital administration in discussions whereby the data collected is evaluated and appropriate responses are created for each. At this point, the solutions will be tailor made to respond to each problem individually yet exhaustively. At this stage of implementation, the care- packages are developed for each type of patient needs. There are the high dependency and intensive care unit sections which require extra care and other wards that require well informed nurses to be operational. It is important that after the practice changes constant evaluation is conducted to determine whether the improvements that have been developed are effective (Melnyk, Fineout-Overholt, & Giggleman, 2016). The implementation of the ARRC model of evidence-based nursing practice should be done systematically to ensure no problems are left without solutions. 

Barriers to Implementation

There are many barriers to the implementation of changes in nursing. The most common barrier to change is rigidity of the administration of the hospitals. The board of directors in hospitals may be hesitant to effect changes due to shortages in funds. Lack of adequate funding is the biggest barrier to the implementation of any changes too an organization. On top of lack of funds, the management of a hospital may not understand the gravity of the mater when the nurses come up with an idea for change that should make their work easier when caring for patients. Ultimately, the management of a hospital can be a barrier to change in any hospital practices.

The nurses may hinder changes from taking effect when it requires that they advance their studies. This is mainly because they may see it as an extra cost on their already small pay checks. It will be more difficult to effect changes when the nurses being required to further their studies have already been overworked and they do not find their pay enough to cater for their needs. The nurses could also reject the changes if their opinions are not well taken into consideration. Additionally, nurses also need to be made safe and when the changes being proposed disregard the safety of the nurses while they work, they will reject any changed about safety in the hospitals. Nurses are also victims of assault by patients but little is heard of it because the hospital administrations tend to cover up for the same. 

The change ideas developed may be incompatible with the hospital where they are expected to be implemented. This can happened when the management does not consult with their staff on matters of change in the nursing practice. At the end of the day, the nurses will find the changes ineffective and they may also feel ambushed by their employers. Consultation and sensitization has to be done extensively to ensure that the nurses accept, understand look forward to implementing the changes that make them more efficient. Failure to go through all the necessary implementation steps could easily result in a plan for change being rejected.

Ethical Implications

There are many ethical implications when effecting changes in the nursing practice. The nurses are supposed to save lives all the time. This may be compromised during the transition period in case there is an oversight during the creation of the model for change. There are ethics that all hospitals must abide by, this is saving lives, patient confidentiality, consent for nay treatment and the patient has to be made aware of their condition as it is. When creating better care models for patients, the nurses have to be made to understand that at all times the ethics must be upheld. The changes in care models should not interfere with the profession’s ethics.

Conclusion

Evidence-based nursing practice is the best in caring for patients on whatever level. This is because patients are the major clients a hospital has and their safety has to be guaranteed. The nursing practice is undergoing changes gradually to adapt to the changes in medical needs of the patients. It is important that the medical field is well adjusted in caring for patients in all ways. It is necessary to talk about safety in hospitals because both the medical staff and the patients face risks in terms of safety. They can all be endangered when there is a patient with a highly contagious illness and even risks caused by technical faults like electrocution or even falls. A hospital is supposed to minimize accidents that are avoidable so that the response to the other accidents is prompt and through. Infections acquired when in the hospital is an indication that the patient’s safety is compromised. 

References

Hoben, M., Norton, P. G., & Estabrooks, C. A. (2017). Improving Nursing Home Care Through Feedback on Performance Data (INFORM): Protocol for a Cluster- Randomized Trial. BioMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223357/#!po=57.9755.

Huang, C.-H., & Lee, Y.-C. (2018). The Perceptions of Patient Safety Culture: A difference between physicians and nurses in Taiwan. Applied Nursing Research, https://doi.org/10.1016/j.apnr.2017.12.010.

Lambooij, M. S., Drewes, H. W., & Koster, F. (2017). Use of Electronic Medical Records and Quality of Patient Data: Different Reaction Patterns of Doctors and Nurses to the Hospital Organization. BMC Medical Informatics and Decision Making, www.ncbi.nlm.nih.gov/pmc/articles/PMC5303309/.

Moore , K. J., Candy, B., & Sampson, E. (2017). Implementating the Compassion Intervention, a Model for Integrated Care for People with Advanced Dementia Towards the End of Life in Nursing Homes: a Naturalistic feasesibility study. BMJ Open, www.ncbi.nlm.nih.gov/pmc/articles/PMC5541605/#!po=78.8462.

Yazici, G. R., & Bulut, H. (2018). Efficacy of a care bundle to prevent multiple infections in the intensive care unit: A quasi-experimental pretest-posttest design study. Applied Nursing Research, http://doi.org/10.1016/j.apnr.2017.10.009.