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Evidence-Based Practice Analysis

Sara Yoder

NSG 462: Issues in Contemporary Nursing

Professor Garman

October 6, 2023
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Evidence-Based Practice Analysis

Evidence-based practice is fundamental in the nursing field because it can be ever

evolving as new research is developed on patient care, equipment and methods of procedures.

The goal is to provide quality care established according to the most up-to-date research rather

than historical methods or subjective beliefs (ANA, 2023). By implementing evidence-based

practice into nursing care there will be better patient outcomes, more cost effective healthcare

and growth of the nursing field.

A minor change but effective change in our ICU over the last few years has been our

compliance with oral care on ventilated patients. When I started working there, we used

chlorhexidine every 4 hours on a patient, while scanning the medication to help prevent

Ventilator Acquired Pneumonia. We transitioned to now using chlorhexidine twice a day, while

still doing basic oral care every 4 hours without the need for chlorhexidine (AACN, 2017). This

change was initiated by our ICU EBP Committee and has remained in place.

As we are becoming more progressive with technology, a tool being utilized more

includes telemedicine. In the last 3 years, the ICU I've been working has continued to have ICU

Intensivists at the bedside during night shift but we have also transitioned to a night shift

telemedicine-based practice. This included a physician off-site while still addressing the needs

of the patients this physician is assigned to. This was developed in my facility after the COVID

crisis because we were in a lack of physicians and mid-levels to help provide care for the

amount and acuity of patients we acquired. Some research has come to light that tele-ICU

physicians have increased best-practice processes, including prophylaxis for ventilator-

associated pneumonia, catheter-acquired infection and pressure ulcers (Udeh, 2018). There

has been a range of improvements and changes throughout the process, because as evidence

based research is, this is always changing based on the statistics of positives and negatives

that arise.
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Feeding tube placement is a common bedside procedure, however, improper placement

can cause serious complications like aspiration or infection and increase the risk of death. There

is minimal research on standards of care that have developed a policy for accurate feeding tube

placement. In a national survey, it was reported that greater than 75% of nurses only use one

verification tool to confirm feeding tube placement and the majority bedside nurse method is

auscultation which is said to be less than 45% accurate (Bourgault, 2020). Feeding tube

placement needs to be verified with radiographic interpretation (Lyman, 2018). By using

radiology to evaluate placement, a more accurate assessment of anatomical landmarks is

increased while bedside misjudgment is decreased.

After seeing multiple instances in my nursing career where bedside feeding tube

placement was misjudged and inaccurate even after using multiple bedside evaluation tools, the

ultimate goal in our hospital unit is to get xray verification post placement. This is a safer tool for

feeding tube placement and has been the most accurate and decreases chances of aspiration,

pneumothorax or infection. Although it is not currently protocol, it is something we are looking

forward to adding as a standard of care in the future.

Throughout this module, a consistent barrier in evidence-based practice is the lack of

high quality studies, lack of skilled researchers and minimal time to implement and trial

evidence-based practices (Zimmerman, 2017). Implementing Evidence-based practice works

well with thorough policies, researchers and management to facilitate. Another institution barrier

could be the cost of continuous education needed to prior staff with up to date processes and

practice methods. However, the positive research that comes from using evidence-based

practices at the bedside is important and meaningful in benefits for patients and their care inside

facilities and when discharged.

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References

ANA. (2023). What is Evidence-Based Practice Nursing? https://www.nursingworld.org/practice-

policy/nursing-excellence/evidence-based-practice-in-nursing/

Bourgault, A. M., Powers, J., Aguirre, L., Hines, R. B., Sebastian, A. T., & Upvall, M. J. (2020).
National Survey of Feeding Tube Verification Practices: An Urgent Call for Auscultation
Deimplementation. Dimensions of critical care nursing : DCCN, 39(6), 329–338.
https://doi.org/10.1097/DCC.0000000000000440

Lyman, B., Peyton, C., Healey, F. (2018). Reducing nasogastric tube misplacement through
evidence-based practice. https://www.myamericannurse.com/reducing-nasogastric-tube-
misplacement/

Vollman, K., Sole, M., & Quinn, B. (2017). Endotracheal Tube Care and Oral Care Practices for
Ventilated and Non-Ventilated Patients. https://www.aacn.org/docs/Photos/Procedure-04-
dab15t1l.pdf

Udeh, C., Udeh, B., Rahman, N., Canfield, C., Campbell, J., & Hata, J. S. (2018).
Telemedicine/Virtual ICU: Where Are We and Where Are We Going?. Methodist DeBakey
cardiovascular journal, 14(2), 126–133. https://doi.org/10.14797/mdcj-14-2-126

Zimmerman, K. (2017). Essentials of evidence based practice. International Journal of

Childbirth Education, 32(2), 37-43