Evidence-Based Practice And Clinical Decision-Making

Introduction It is fundamentally important for nurses to develop and appreciate the process of integrating evidence and research conclusions into their clinical decision-making. Evidence-based practice (EBP) is one reliable process that assists in efficient clinical decision-making (Wong & Myers, 2015). This process has emerged as a means of improving clinical practice from a culture of nursing guidelines derived from authoritarian traditions, to practice developed upon the current evidence-based research (Aitken et al., 2011). EBP has five systematic steps which enable nurses to make clinical decisions; devising an answerable clinical question, detect the relevant evidence to answer the clinical question, critically appraise the evidence, …show more content…
In relevance to the indicated answerable clinical question from the case study, several articles present strong arguments supporting changing IVC’s to when clinically indicated versus routinely. Although current guidelines recommend the routine change of IVC’s within the clinical setting, this is not supported by recent data. According to Webster et al., (2010), no evidence of reduced infection rates amongst patients was observed when cannula changes were regularly changed versus as clinically indicated. However, the authors did establish that intravenous cannulas in patients should be inspected at each shift change for infection. Similarly, Webster et al., (2015) studied a total of 4895 patients over seven trials and concluded that there was no evidence to suggest lower infection rates in patients when cannulas where changed 48-72 hours (routinely) compared to when clinically indicated. Rickard, McCann, Munnings, and McGrail (2010), recommend that current evidence suggests current policy for routine IVC’s is ineffective and should be replaced with an ‘as clinically indicated ' policy. Furthermore this is supported by their study where IVC infection rates in patients were observed; half the patients had IVC’s changed routinely (48-72 hours) and half changed when clinically indicated. In the routine replacement of IVC’s 7% developed …show more content…
To assist in the EBP process, developing a well-built clinical question is the first step in the EBP process and the PICO framework assists in shaping this question. When locating evidence, systematic studies produce high-level evidence and nurses need to have an awareness of the various methods that predict validity in research such as data collection style, sample size and ethical transparency. Appraising current available evidence allows nurses to integrate high-level knowledge into their clinical decision making. Modern evidence recommends the current policy for routine replacement of IVC’s within the 48-72 hour timeframe is ineffective and should be replaced with an ‘as clinically indicated’ policy. It is vital that nursing staff monitor IVC’s daily, with cessation as soon as possible. Research also demonstrates that routine IVC change involves staff procedural time and increased hospital costs. In relation to the case study, the large quantity of existing research that supports an ‘on clinical indication’ IVC replacement policy. This research also confirms that healthcare facilities should be encouraged to ensure their guidelines replicate contemporary evidence-based

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