Assignment cover sheet

Note: (1) The attention of students is drawn to: the Academic Regulations, the Academic Honesty Policy and the Assessment Policy, all of which are accessible viahttp://students.acu.edu.au/309246 (2) A de-identified copy of your assignment may be retained for University quality (audit) processes, benchmarking or moderation.

|Student ID Number/s: |Student Surname/s: |Given name/s: |
|S00158530 |Patel |Purvi |
| | | |
|Course:Bachelor of nursing |School:Australian catholic University |
|Unit code:HLSC122 |Unit title:Inquiry in Healthcare |
|Due date:30/03/2014 |Date submitted:30/03/2014 |
|Lecturer-in-Charge: Joe Perry |Tutorial Group/Tutor: T, 06 |
|Assignment Title and/or number: Assignment 1 |

DECLARATION OF ORIGINALITY

By submitting this assignment for assessment, I acknowledge and agree that: 1. this assignment is submitted in accordance with the University’s Academic Regulations, Assessment Policy and Academic Honesty Policy. I also understand the serious nature of academic dishonesty (such as plagiarism) and the penalties attached to being found guilty of committing such offences. 2. no part of this assignment has been copied from any other source without acknowledgement of the source. 3. no part of this assignment has been written by any other person, except to the extent of collaboration and/or group work as defined in the unit outline. 4. this assignment has not been recycled, using work substantially the same as work I have completed previously and which has been counted towards satisfactory completion of another unit of study or credited towards another qualification, unless the Lecturer in Charge has granted prior written consent to do so. 5. a copy of the original assignment is retained by me and that I may be required to submit the original assignment to the Lecturer in Charge upon request. 6. the Lecturer-in-Charge may, for the purpose of assessing this assignment: 1. reproduce this assignment; 2. authorise the reproduction of this assignment; 3. provide a copy of this assignment to another member of the University; and/or 4. communicate, or authorise communication of, a copy of this assignment to a plagiarism checking service, such as the “Turnitin” service operated by iParadigms LLC (or such other service utilised by the University at its absolute discretion). I acknowledge that a plagiarism checking service provider may then retain a copy of this assignment on its database for the purpose of future plagiarism checking.
Signature of student(s): ___________________________________________ Date: 30/03/2014
Question:
Describe Evidence Based Practices.

Nurses are constantly challenged to stay tuned with new information to provide the highest quality of patient care. Nurses are challenged to expand their “comfort zone” by offering creative approaches to old and new health problems, as well as creating new and innovative programs that make a difference in the health status of citizens. This challenge can best achieved by integrating rapidly expanding research and evidence based on health into the care of patients and their families (Schneider, Whitehead, LoBiondo-Wood & Haber, 2013). This essay will describe what is and how to use Evidence Based Practices in the field of nursing. EBP is the use of best research evidence, along with clinical expertise, available resources and patient’s preferences to determine the optimal assessment, treatment or management option into a specific situation (Liamputtong, 2013, p.286). The EBP activities include five steps: 1. Ask an answerable clinical question: The first step in research utilization is identifying areas of practice that have scope for improvement via reflection and observation of the process of care. When the problem has been identified, an EBP question is formulated. The useful method for creating the question is PICO (P=Patient type or Population, I=Intervention of interest / idea, C=Comparison or option, O=Outcome) (Borbasi & Jackson, 2012, p.197). 2. Acquire the best available evidence: It is one of the most important activity. This may involve research papers summarized in the form of a systematic review. One can also search it on Google Scholar, Pubmed, Cochrane library or PEDro search. As part of the systemic review process the quality of the research is appraised and the evidence is ranked according to its reliability. The Centre for Evidence Based Medicine (CEBM) and National Health and Medical Research Council (NHMRC) provide hierarchy (levels) of evidence showing the relationship between the research design and the level of confidence that research design conveys. The higher the level of evidence, the grater the confidence. Following table shows the hierarchy of evidence.

|Level of evidence|Research Question |
| |Therapy effectiveness |Diagnosis effectiveness |Prognosis |
|I |Systematic review of level II |Systematic review of level II |Systematic review of level II |
| |studies |studies |studies |
|II |Randomised controlled trial |Study of samples of consecutive |Prospective cohort study |
| | |patients; independent, blind, | |
| | |comparison with reference | |
| | |standard | |
|III-1 |Pseudo-randomised Controlled |Study of samples of |Representative case series; all or|
| |trial (Allocation not random) |non-consecutive patients; |none of the people with the risk |
| | |independent, blind, comparison |factor have the outcome of |
| | |with reference standard |interest. |
|III=2 |Comparative study with |Study that does not meet Level |Analysis of prognostic factors |
| |concurrent controls (e.g. cohort|II or III -1 evidence |among participants within a |
| |study, case control study, | |randomised control trials |
| |interrupted time series) | | |
|III-3 |Comparative study without |Diagnostic case-control study |Retrospective cohort study |
| |concurrent controls (e.g. |(Includes people with and | |
| |historical control) |without the condition) | |
|IV |Case series (With post-test or |Diagnostic study (no reference |Case series or cohort study with |
| |pre-post test outcome) |standard) |persons not at same stage of |
| | | |disease. |

(Source based on Table 1, NHMRC 2008a, p.6 cited in Liamputtong, 2013, p.288) The above evidence hierarchy allows you to use a ‘top-down’ approach to the evidence. If you can locate a relevant, well-conducted and reasonably recent systematic review you may not need to search any further. If no systematic review available on the topic, the level of evidence should be sought to answer the question. In the case of therapy efficacy, this would be to examine relevant Randomised Controlled Trials. If this level of evidence is not available, the next highest is sought and so on. 3. Appraise the evidence: Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results, and relevance to your own practice. As all published research papers are not of good quality, hence the reason research is appraised. This appraisal aim to determine if the findings of the research are relatively free from error or bias. (Borbasi & Jackson, 2012, p.198). A few basic questions to consider before appraising any research paper are: What are the findings? Are the findings are valid? Are the findings reliable? Can you apply the findings? It should contain title, abstract, keywords, introduction or background, methodology, results, discussion and reference (Borbasi & Jackson, 2012, p. 177). Check the context of publication, type and quality of the journal or book to decide quality of the paper (Borbasi & Jackson, 2012, p. 179). Check the author, his position, and qualification? What are their affiliations? (Borbasi & Jackson, 2012, p. 171). Check the reference list. 4. Apply the evidence: when the evidence has been searched and appraised, the next ste is to implement it into practice. There are many barriers to utilize and implement the evidence. These barriers include insufficient time to read research , lack of authority to effect change, lack of research skills and inability to access and engage with research findings (Borbasi & Jackson, 2012, p. 196). Before applying the evidence, check that feasibility of intervention and think about patient and alternative evidences. 5. Access the process: The final step of EBP is evaluation of process care to ensure that best practice was followed. The outcome of care are evaluated to ensure they have improved following the implementation of the research evidence (Borbasi & Jackson, 2012, p. 199). The clinical audit can be done to check the best practice, what the current practice is and comparing the findings to the identified best practice, and then, if necessary implementing change to improve practice. The audit cycle may start again later to evaluate the impact of the change (Borbasi & Jackson, 2012, p. 199).

Example: We consider which handwashing agent is most appropriate to kill microorganism on hands as an example of EBP. Ask an answerable clinical question: Question: Nurses who are working in clinics with patients and equipments, is handwashing with Chlorhexidine Gluconate Solution more effective against microbial count compare to Isopropylalcohol. Acquire the best available evidence: I have first search different research papers on internet. Found one paper named “Surgical hand antisepsis to reduce surgical site infection” (Tanner, Swarbrook, Stuart (2008)). The objective of this review is to determine the effects of surgical hand antisepsis on the number of surgical site infections (SSIs) in patients. The secondary objective is to determine the effects of surgical hand antisepsis on the numbers of colony-forming units (CFUs) of bacteria on the hands of the surgical team. Evidence from four studies suggests that chlorhexidine-based aqueous scrubs are significantly more effective than povidone-iodine-based scrubs in terms of the reduction in the number of CFUs on the hands both immediately after scrubbing, two hours after scrubbing and at the end of the surgical procedure. In the absence of information regarding the clinical impact of CFUs on SSI, it is tentatively suggested that aqueous scrub solutions of chlorhexidine should be used in preference to aqueous povidone-iodine scrubs for surgical hand antisepsis. Another paper also found named “Comparative Study on the Antimicrobial Effect of 0.5% Chlorhexidine Gluconate and 70% Isopropyl Alcohol on the Normal Flora of Hands” (Aly & Maibach,1979) which also states Chlorhexidine gluconate better than Isopropylalcohol. Appraise the evidence: As first paper found on Cochrane review, it is authentic. Both the paper contains all the contents necessary. Have also checked the authors qualification and journel. Apply the evidence: The evidence states that Chlorhexidine Gluconate is better to remove bacterias from hand, so it is now implemented with Isopropylalcohol solution in clinic for handwashing. Access the process: The outcome after implementation of use Chlorhexidine Gluconate as handwashing is monitered.

Conclusion: In conclusion EBP make available the most current and rigorous evidence to assist nurses and midwives in guiding individualised and contextualised research-based care decisions. Using these 5-steps, a nurse will have easier to apply current quality evidences from research in clinical and healthcare decisions.

Word count: 1300

References:

Aly, R., & Maibach, H., (1979). comparative study on the antimicrobial effect of 0.5% chlorhexidine gluconate and 70% isopropyl alcohol on the normal flora of hands. journal of applied and environmental microbiology,37(3),610-613. Borbasi, S., & Jackson, D. (Eds.). (2012). Navigating the maze of research: enhancing nursing and midwifery practice. (3rd ed.). Sydney: Mosby Elsevier. Liamputtong, P. (Ed.). (2013). Research methods in health: foundations for evidence-based practice. South Melbourne: Oxford University Press. Schneider, Z., Whitehead, D., LoBiondo-Wood, G., & Haber, J. (2013). Nursing and Midwifery research methods and appraisal for evidenced based practices (4th ed.). Mosby Elsevier. Tanner, J., Swarbrook, S., & Stuart, J.,(2008). surgical hand antisepsis to reduce surgical site infection. cohrane database of systemic reviews,(1).doi:10.1002/14651858.CD004288