Evidence Based Practice Impact Of Nurses Nursing Essay

Evidence Based Practice Impact Of Nurses Nursing Essay Evidence-based practice (EBP) is widely recognised within the role of nursing. Its implementation and purpose in the delivery of care is seen as an important driver for nursing practice and clinical outcomes (Cullen Adams 2010). It has been defined as the: conscientious integration of best research evidence with clinical expertise and patients values and needs in the delivery of high-quality, cost effective health care (Burns Grove. 2007, p.4). EBP provides opportunity for nurses to ensure that clinical interventions and decisions making processes are safe and suitable for every patient group and enabling effectiveness in patient advocacy (Parahoo, 2006). An important part of practice and nursing culture, EBP should not be seen as an extra aspect to daily workload. Knowledge-base gained from pre-registration educational programmes and clinical experience should be the basis for the development of EBP (Cleary-Holdforth Leufer 2008). Nurses critically reflect daily in clinical practice with the implementation and evaluation of care and it is important to understand that this forms the foundation in research for evidence. Quick reference for guidance does not necessarily need to be a lengthy process with accessibility to intranet and local policies, protocols and best practice statements. However, the self-recognition of base knowledge and skill should be continually developed (Parahoo, 2006). Nurses require time to strive fo r answers to clinical questions, expanding clinical expertise in locating research evidence. Using critique frameworks as suggested in Burns Grove (2007), articles should be critically appraised with time spent deciding how they might apply to clinical practice. By taking a rigorous approach to appraisal, making an informed decision about the reliability and validity of sources of evidence, nurses can really look the effects in clinical practice and how the evidence can be delivered (Cleary-Holdforth Leufer 2008). Nurses working in clinical settings should really think about dilemmas or problems that come up frequently in their clinical practice that they would like to know further research and evidence for. It is expected that registered nurses should be comfortable and competent with the components of EBP such as forming clinical questions, literature searching skills, including accessing appropriate literature and showing enthusiasm in its development. Nurses need to have good resources and support from employers through providing access to library facilities containing major on-line databases such as EBSCO; Cochrane library database; Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the British Nursing Index (BNI). Through the use of databases, a comprehensive literature review should be conducted to generate understanding of what is known and not known about the particular clinical problem (Cleary-Holdforth Leufer 2008). The review can allow the nurse to decide whether adequate knowledge exists allowing for change in clinical practice or whether further research is required. From this initial thought may follow development of clinical question creating ethical consideration and understanding of beliefs and values of patients and colleagues. Nurses should being with searching highest level of evidence such as systematic reviews involving the compilation and ranking of evidence according to its methodological origin (Whiting. 2009). Systematic reviews summarise the results of high quality studies, often reviews of randomised controlled trials (RCTs). Described and the gold standard to research, they identify which interventions work, those which are not as effective and where further research should be carried out. In this way, bias is reduced and the effects of treatments studied are not overestimated. By using such evidence, time will be reduced in the need for critical appraisal (Whiting. 2009). It is important to note that as nurses move forward having more autonomy in decision making and its emphasis of patient centred care there still remains lack of appreciation in best evidence for patient response in emotional, psychological and holistic understanding and focus lies within scientific interventionism. Cleary-Holdforth Leufer (2008) criticise that the described highest level of evidence fails to acknowledge research based on patient experience and perception and aspect fundamental to nursing practice. This can be viewed in clinical guidelines developed by Scottish Intercollegiate Guidelines Network (SIGN), derived from systematic reviews of scientific literature all guidelines have levels of evidence statements with the highest level of evidence being meta-analyses, systematic reviews or RCTs (SIGN 2010). 640 words To apply evidence into practice it is vital for nurses to have role models that respect EBP, rather than relying on clinical expertise alone (Cleary-Holdforth Leufer 2008). They must value ideas and effectively support the process if clinical questions arise. Role models need to be enthusiastic about EBP and having positive vision about the opportunities EBP can provide when integrated into day-to-day practice. Nurses need be able to view the benefits of applying best current evidence to their practice and therefore creating a positive motivation for EBP. At all levels, nurses need to be interested in using the EBP and adopt certain practices and attitudes. These include devotion, professional pride, positiveness, courage and willingness to carry out change and commitment to continuous learning (Cleary-Holdforth Leufer 2008). The nurse will not only see maturity in professional self but also development of personal achievement and identity. Decision makers and new found knowledge needs to not only be distributed but fully utilised and the nurse must ensure that colleagues receive, read, understand and appreciate the value of and actually utilise it in their own decision-making processes and, where appropriate, alter their behaviour. As with any clinical intervention, evaluation of its effectiveness is essential and nurses must discuss with colleagues and participants Further to this assignment will be appraisal and evaluation of two papers providing critique and discussion. Each will be assessed for the appropriateness for evidence-based practice. Gethin, G. Cowman, S. (2008) Manuka honey vs. hydrogel a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. Journal of Clinical Nursing. 18 (3) p.466-474. Gethin and Cowman (2008) clearly seek to measure the effective comparison of two healing agents on venous ulcers and use a quantitative paradigm with two views to methods of debridement, and indicate that an RCT was undertaken. In a quantitative research study there is focus measurement of the relationship between variables (Burns Grove, 2007). Being the area of interest in the study, the variables that change over time are subject to statistical analysis. A prospective design has been decided on and to the reader indicates a collection of variable data with one or more points in the future. Macnee (2008) adds that time is a defining factor in the design of a quantitative study. In this case the time points were at week 4 and week 12 from initial baseline. A reasonable amount of information has been provided in the design title and allows the reader to be aware of the approach used. It seems that the research hypothesis is best addressed by quantifiable approach being the appropriat e design methodology for investigation. Gethin and Cowman (2008), aimed to select adults presenting with venous leg ulcers having over 50 percent of the wound area covered in slough. Further to this, they followed substantial inclusion and exclusion criteria which was clearly stated and indicated in the research including tables that could be easily understood by the reader. There could however be potential problem with this as a more tightly controlled or restricted sample could lead to limitations to clinical meaningfulness (Parahoo, 2006). The researchers goal is to avoid bias which could potentially distort findings and making it difficult or impossible to interpret results (). There is inconsistency in the description of the members in the study that could indicate bias. The researchers use both the term subject, participant and patient and to the reader, this could be questioned as to how removed the researchers were from those in the sample (Macnee, 2008). Had sample been used consistently then the reader could inte rpret this as being a distance and impersonal approach. Reassuringly the researchers state that they removed themselves from selection process and used blinded randomisation by two persons independent of the study to eliminate personal bias. Blinding refers to the group allocation and the concealment from one or more individuals involved in the research process (Karanicolas, Farrokhyar Bhandari 2010). The larger the sample size in a quantitative study, the more likely the study will apply to clinical situations and aiming to make generalisations about the larger population based on findings (Parahoo, 2006). The study uses a sample size of 108 which seems small and perhaps is unlikely to produce results of statistical significance failing to disclose the actual effectiveness of the agent used. It may have been that Gethin and Cowman (2008) failed to get enough funding to support their study or an increase in sample size would have been too time consuming. Non-probability sampling was used with recruitment of subjects attending a clinic. This type of sampling limits the extent of generalisation of the results to the population outside the research (Burns Grove, 2007). Failure to enrol the predetermined number of subjects creates limitation and restricting what a reader may learn about the study. Further to this, Gethin and Cowman (2008) did not discuss During the data collection stage of the process, there are two important considerations: the potential impact on the reliability and validity of the study. Reliability refers to how reliable the data collection methods are, this is the extent to which the selected methods will collect the same data on repeated occasions. The more consistent this is, the more reliable the methods are (Macnee, 2008). Gethin and Cowman (2008) used local clinical investigators who took part in a pretrial inter-rater reliability (IRR) study determining the level of agreement between the three raters when assessing slough as a percentage within wound bed. As the assessment was split between three data collectors, the reader could query potential differences in subjective opinion in deciding the percentage of slough within the wound bed. Thus influencing the accuracy and consistency in measurement making the measure less reliable. Validity refers to the extent to which the methods used to collect and analyse the data accurately measures what the researchers intended it would measure (Macnee, 2008). They selected to use Visitrak Digital Planimetry a tool for wound measurement. Sugama et al. (2007) explores and concludes that this type for wound measurement device was a efficient reliable system applicable for use in clinical practice improving validity of the research. It must be noted however, that this is only valid if the users are fully competent in its use. An important methodology feature of RCTs is to minimise bias and maximise the validity of the results (Whiting 2009). Gethin and Cowman (2008) failed to blind participants and data collectors due to the obvious orange staining from the Manuka honey. For a reader this is a immense flaw in the research introducing bias. The data collected in quantitative research must either be numerical or converted to numerical data and entered into a database (Macnee, 2008). Gethin and Cowman (2008) selected to use a Statistical Package for the Social Sciences (SPSS) and further a statistician who was completely disconnected from the research in terms of collection and interaction with the subjects. This is a very positive aspect of the research and Gethin and Cowman (2008) failed to elaborate why participants pulled out from the study and a reader should be highly concerned as to what exactly happened to these subjects and question averse reactions to the chosen product. A nurse having found this during a literature review would suggest there are too many weaknesses in the research to apply this to clinical practice and decision making. A main concern is the safety of patients and I would decline to use this product until further research was carried out considering all the available evidence potentially utilising a systematic review approach. Until then, it would not influence decision making in relation to methods of debridement. This intervention applied in everyday clinical practice could potentially have adverse consequences that outweigh the potential benefits. The cost was not reported and it may be that the Manuka honey treatment is very expensive providing only small health benefits and failing to make good use of reso urces. It may have been beneficial for the researchers to provide a rough idea of the cost of producing one unit of benefit. An aspect fundamental to nursing practice is to incorporate understanding of the participants perspective about their experiences (Leufer Cleary-Holdforth 2009). This is not something that was not explored, had funding been available qualitative research, which will be explored in the next paper could have been incorporating using two design methods. 1305 words Hancock, H. C. Easen, P. R. (2006) The decision-making processes of nurses when extubating patients following cardiac surgery: An ethnographic study. International Journal of Nursing Studies. [Online] 43 (6) p.693-705.

How do you define environmental science? Essay

Environmental science is an interdisciplinary field that combines information from many disciplines, such as biology, geography, chemistry, geology, physics, economics, sociology (particularly demography, the study of populations), cultural anthropology, natural resource management, agriculture, engineering, law, politics, and ethics. Ecology, the discipline of biology that studies the interrelationships between organisms and their environment, is a basic tool of environmental science. Atmospheric science is a branch of environmental science that includes the study of weather and climate, greenhouse gases, and other airborne pollutants. Environmental chemistry examines chemicals in the environment, including soil and water pollution. Geosciences—for example, environmental geology and physical geography—study a wide range of environmental topics, such as soil erosion, groundwater use, ocean pollution, and climate. Scientists in these sub-disciplines not only evaluate environmental quality but they also develop ways to restore damaged environments. Environmental science is an interdisciplinary academic field that integrates physical and biological sciences, (including but not limited to Ecology, Physics, Chemistry, Biology, Soil Science, Geology, Atmospheric Science and Geography) to the study of the environment, and the solution of environmental problems. Environmental science provides an integrated, quantitative, and interdisciplinary approach to the study of environmental systems.[1] Related areas of study include environmental studies and environmental engineering. Environmental studies incorporates more of the social sciences for understanding human relationships, perceptions and policies towards the environment. Environmental engineering focuses on design and technology for improving environmental quality. Environmental scientists work on subjects like the understanding of earth processes, evaluating alternative energy systems, pollution control and mitigation, natural resource management, and the effects of global climate change. Environmental issues almost always include an interaction of physical,  chemical, and biological processes. Environmental scientists bring a systems approach to the analysis of environmental problems. Key elements of an effective environmental scientist include the ability to relate space, and time relationships as well as quantitative analysis. Environmental science came alive as a substantive, active field of scientific investigation in the 1960s and 1970s driven by (a) the need for a multi-disciplinary approach to analyze complex environmental problems, (b) the arrival of substantive environmental laws requiring specific environmental protocols of investigation and (c) the growing public awareness of a need for action in addressing environmental problems. Events that spurred this development included the publication of Rachael Carson’s landmark environmental book Silent Spring[2] along with major environmental issues becoming very public, such as the 1969 Santa Barbara oil spill, and the Cuyahoga River of Cleveland, Ohio, â€Å"catching fire† (also in 1969), and helped increase the visibility of environmental issues and create this new field of study. * How does the relationship between science and technology affect   environmental problems and solutions in today’s society? It usually goes like this: Someone uses the power of SCIENCE to make a Really Cool Thingâ„ ¢ that causes unintended environmental problems (e.g. the car). If enough people care about the problems, then someone, again using the power of SCIENCE, makes something to fix or reduce the problem (e.g. the catalytic converter, hybrid car, etc.). If not enough people care about the problem, then they continue using the Really Cool Thingâ„ ¢ until the problem becomes such that it cannot be ignored (e.g. air pollution in California), whereupon people are compelled to make or enact something in an effort to fix or reduce the problem. Read more: How does the relationship between science and technology affect environmental problems and solutions in today’s society? | Answerbag http://www.answerbag.com/q_view/2679770#ixzz2HM50PYt6 * Why is the concept of environmental sustainability important, and why should it be studied? What are the historical patterns surrounding sustainable and unsustainable human interactions with the environment? * In general, how do human values affect sustainability given current challenges facing society? * After reviewing the research on the environment, how do environmental hazards affect human health? Provide at least two examples.

Motivation Theories Essay - 1149 Words

Motivation is defined as â€Å"the desire to achieve a goal or a certain performance level† (Bauer Erdogen, 2009, p.97). Motivation theories are useful tools that organizations can use to energize employees and foster a stimulating work environment. These theories are categorized as either content or process theories. Today, Bauer and Erdogen (2009) state that many organizations have applied motivation theories ,such as the goal setting theory and reinforcement theory, in order to modify their employees’ behavior in the workplace through goals and reward systems. According to the reinforcement theory, behavior that is rewarded is often repeated. As a result, many organizations have utilized this theory by tying rewards to performance (Bauer †¦show more content†¦Fallon and McConnell (2007) define a performance appraisal as a â€Å"structured event† in which employee performance is examined. Such reviews are normally based on documents such as the job de scription and a performance appraisal form. Bauer and Erdogen (2009) strongly believe that the organizational use of performance appraisals is beneficial for many reasons. â€Å"When employees have goals, they tend to be more motivated if they also receive feedback about their progress† (Bauer Erdogen, 2009, p.132).Both Nickols (2007) and Fallon and McConnell (2007) agree that performance appraisals are excellent tools that can be use to provide employees with feedback on their performance. â€Å"The goal of providing performance feedback is to help the rater solve performance problems to motivate the employee to change behavior† (Bauer Erdogen, 2009, p.134). Nickols (2007) also believes that such appraisals also provide the opportunity to identify training and performance options and for employees to establish their personal goals. Further, â€Å"performance appraisals afford the corporation legal protection against employee lawsuits for discrimination and wrongful termination† (Nickols, 2007, p.14) Bauer and Erdogen (2009) state that when a supervisor uses the performance appraisal interview to give employees constructive criti cism, encourage employee participation, and focus on the employee’s behavior , the employees tend to react positively. However,Show MoreRelatedTheories Of Motivation And Motivation Theories1493 Words   |  6 Pagesextent, needs of theories of motivation are still relevant to contemporary management practice. Theories of motivation are important as it helps managers to understand their employees’ needs of motivations, and to motivate their employees to perform and excel better. There are several motivation theories; this essay will briefly explain six major theories of motivation and discuss three of the theories in more detail. 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Fact, Fiction, And Perception Understanding Schizophrenia

Fact, Fiction, and Perception: Understanding Schizophrenia Tia M. Hunter Understanding Schizophrenia 1 Salem College Understanding Schizophrenia Schizophrenia is a disorder of varying symptoms, in fact until the current edition of the DSM-V this disorder was broken into subtypes such as catatonic, disorganized, paranoid, undifferentiated, and residual. There many facets of schizophrenia such as auditory hallucinations, delusions, social isolation, as well as intense suspicion or agitation, each of which contributed to the previous subtypes of schizophrenia. Today, individuals with schizophrenia are assessed severity of symptoms rather than by classification. How Do You Know Cain was a typical law student making his mark on the world. At twenty-four years old he was in his final year of law school, if he finished out his final stretch perfect there were already offers waiting for him. That was until Cain?s friends began to notice a change in him; over the course of the school year Cain began to change into someone they did not know. It began with Cain being a little more anxious than normal, his fellow classmates just wrote this off as stress of the last year (Bray, 2007), but his behavior soon began to escalate. Rather than participate in study groups or pull his share of the group work on cases, Cain became disorganized and paranoid (Castle Buckley, 2015). Cain wanted nothing to do with his friends, and felt that they were out to take his offers away. Rather thanShow MoreRelatedUnderstanding Schizophreni How Do You Know?1916 Words   |  8 PagesUnderstanding Schizophrenia 3 Understanding Schizophrenia Schizophrenia is a disorder of varying symptoms, in fact until the current edition of the DSM-V this disorder was broken into subtypes such as catatonic, disorganized, paranoid, undifferentiated, and residual. 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