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Article emphasizes need for evidence-based practice in ICUs

Friday April 11, 2014
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The rationale behind common nursing interventions often is based solely on tradition and not research or other evidence-based practice guidelines, according to a newly published critical care nursing article.

The article, published in the April issue of the journal Critical Care Nurse, encourages nurses to critically evaluate and apply evidence to their daily practice to improve patient outcomes and to stop using practice interventions that are based solely on tradition.

Current reviews of clinical practice suggest fewer than 15% of clinicians consistently implement evidence-based care, while original research might not be put into routine clinical practice for up to two decades, according to the article.

Lead author Mary Beth Flynn Makic, RN, PhD, CNS, CCNS, is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora.

“It is important for nurses to continually evaluate their practice to ensure that current best evidence is guiding practice interventions, rather than providing care based on tradition alone,” Makic said, according to a news release. “As research and new evidence evolve, nurses are often the frontline catalysts for translating them into practice.”

The article examines the evidence associated with four common clinical practices that are within the realm of nursing: turning critically ill patients, promoting sleep in the ICU, preventing venothromboembolism and managing feeding tubes in infants and children.

Among the questions the article answers with recommendations based on current research:

• Should patients be repositioned at least once every two hours? “Turning patients every two hours is essential to prevent poor outcomes,” the authors write. “In fact, some patients may need to be turned more often, depending on the severity of the illness.”

• How can nurse-driven protocols promote sleep in critically ill patients? “Nurses should question unit practices that encourage bathing patients during optimal sleep times, consider clustering care, limit unnecessary conversations at the bedside and manage alarms.”

• What is the best way to verify correct placement of a feeding tube in infants and children? “Radiography remains the only single method by which feeding tube placement can be reliably determined; otherwise, multiple methods should be used.”

• How can nurses help prevent patients from developing deep vein thrombosis and other venothromboembolism-related complications? "Prevention of venothromboembolism starts with the nurse assessing all patients upon admission to the ICU for risk factors and anticipating orders for prophylaxis based on that risk assessment."

For each intervention, the authors examine current practice, critique the current best evidence and offer implications for practice.

Critical Care Nurse is a journal of the American Association of Critical-Care Nurses. Study: http://ccn.aacnjournals.org/content/34/2/28.full


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