Question

Healthcare is changing rapidly and ideas and methods that had value in the past need to be re-evaluated as we move towards healthcare reform, integrate evidence-based practice and/or best practices, and work towards achieving positive patient outcomes and educate nurses who will be prepared to practice in this ever changing health care environment.

• Recall a situation when you were asked to perform a specific intervention and/or practice idea based on authority or tradition.
• Describe the the intervention or practice.
• Based on your knowledge of evidence-based practice, does this practice still hold value now?  
• Use an Evidence-Based Guideline or nursing specialty organization Standard of Practice to support your answer.

Answer 1

Health care is developing rapidly.ongoing research is bringing out numerous changes which force us to change the traditional practice we followed till date.

EVIDENCED BASED PRACTICE is a conscientious use of current best evidence in making decisions about patient care

These practices help us to achieve positive patient outcomes

There are number of such traditional practices which were proven wrong.I would like to share one of my experiences in that regard

"CHANGING POSITION OF A BEDRIDDEN PATIENT EVERY TWO HOURS ONCE"

When i joined as a staff nurse in a geriatric ward,during my training period i was told that all the disabled patients needs to be changed every two hours once and even the hospital protocol also addressed the same thing.

I followed the same thing for about a year of my service and my documentation was also the same thing

Once i was sent to attend a training on "PATIENT SAFETY"....where the major concern was bedridden patients.I asked them "on what basis is it decided to change position every 2 hrs once" ....That is the point when i got my answer the trainer said it is not a rule and it is not same for all the patient....

MOTHER TERESA while treating hundreds of war victims,took 2 hours to come back to the first patient and that is how it was initially planned to change the position of disabled person every two hours....

After that it was again decided to change position every two hours because researchers explained that tissue tolerance was 2 hours and the patients are more probable to develop pressure ulcer after 2 hours

And we followed it for many years but yet there was research going on...

EVIDENCE BASED PRACTICE REGARDING POSITION CHANGE:

Current accepted guidelines for care is to turn patients every two hours

but it is not same for all the patients..frequency of turns should be individualised to each patient based on factors like

• patient's tissue tolerance
• level of activity
• general medical condition
• overall treatment objectives
• skin condition
• comfort

PATIENT'S TISSUE TOLERANCE

Testing tissue tolerance involves documenting the time it takes the skin to redden over body prominences

The test is a step by step process

Caregiver gradually increases the amount of time patient is left in the same position until reddened skin is detected

Once that time is established set the turn frequency to 30 minutes less than the time interval

for example if the patient was last turned at 4 pm and if he develops redness on bony prominence at 6pm (time interval here is 2 hrs) ,then his turn frequency will be 2 hours minus 30 min which is one and half hour

so this patient should be turned every 90 min once...similarly turn frequency for patients should be calculated and implemented

TECHNIQUE:

• when you reposition make sure that pressure is actually relieved or redistributed
• avoid positioning individual on bony prominences with existing non blanchable skin
• Two or more people are needed to perform this action
• LIft ---do not drag the patient when repositioning...this will reduce damage due to shear and friction
• count numbers like 1,2,3, and lift the patient at a time
• RULE OF 30 should be followed----

1. head should not be elevated at no more than 30 degrees from horizontal
2. body placed in 30 degrees laterally inclined position
3. patients hips and shoulders 30 degrees from supine
4. use pillows or wedge to keep patient positioned without pressure

Apart from all these his level of activity,his general condition, skin condition and comfort of the patient should also be considered

This practice is followed in the area i work and the old procedure is no more in existence.