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Luke Powell 

Initial post - Luke Powell

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Introduction

As nurses, we are guided by evidence-based practice to ensure that the care we deliver is safe and appropriate for our patients. During nursing school, we are encouraged to seek out scientific research to support why we do what we do and are taught to continue to do so even after we leave the classroom. We make decisions based from sources including coursework, our textbooks, and clinical experience (Polit & Beck, 2017). However, I have caught myself asking “what does the research say?” especially when completing cares. In particular, do sequential compression devices (SCD) actually contribute to the prevention of deep venous thrombosis (DVT). Nursing research is conducted to answer questions or solve problems (Polit & Beck, 2017). As I have began to ask my coworkers as to why we use SCDs, the answer is always that this is what we have always done. According to Polit and Beck (2017), this is described as unit culture, and these interventions are based on tradition rather than sound evidence.

PICOT Question

Many of the patients that I see in the intensive care unit (ICU) can expect to be there for at least three days. Most are too sick to be able to get out of bed and move around the room. This inactivity can potentially put them at risk for developing a DVT. To help prevent this from happening, knee high SCDs are utilized. However, the organization that I work for does not have the evidence they found listed anywhere to support the use of SCDs. In fact, when looking at unit council notes from years ago, the same question was brought up and it was noted that there is no evidence to support their use in the ICU.  When conducting research for evidence-based practice (EBP), it is important to create a clinical question that can be answered with research evidence (Polit & Beck, 2017). My PICOT question is “In patients admitted to the ICU, does the utilization of SCDs reduce the risk of DVTs as compared to the use of low dose subcutaneous heparin during a three day admission?” My background questions include: what is a DVT, and what is its pathophysiology? Using PICOT, I can turn this research question into search terms that help to prevent my search from being too broad (Walden Student Center for Success, 2012).

Adoption of Evidence-Based Practices

Overall, I do believe that my organization is willing to change processes or procedures, if the evidence is there to support such a change. The only problem that I can identify with making those changes is that they must be presented to a committee who reviews our current policies and procedures every two years. Unless there is a strong need to make changes, it could take some time before the specific policy or procedure is up for review. As for my coworkers, we are constantly reevaluating and questioning why we do what we do. It is not that we are trying to find faults within our organization rather that we are trying to ensure that we are providing the best and safest care for our patients. So if change, supported by EBP, does need to happen, our culture would quickly adopt and adhere to it.  

Barriers to Change

As with any change, there is some resistance to be expected. People are often resistant to change because they are either comfortable with the previous way of completing a task or they fear that they may not appear competent when trying to adhere to the new way. The barrier that I identified from the article that is most relevant for myself and the nurses that I work with is difficulty in finding time at the workplace to search for and read research articles and reports (Majid et. al, 2011). The ICU can be in a constant state of busy and often times I find it nearly impossible to sit down and try to conduct research. I know that the research is out there, however, I feel that it is sometimes impossible to take the time to find it. To help overcome this barrier, I believe that the use of a clinical resource nurse would be appropriate. He or she would be able to provide websites that we could access while at work to look at the current research available. They could also utilize our emails to send us facts that are relevant to the cares we provide in the ICU that could help us to begin asking the questions necessary to create change.

Resources

Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.-L., Chang, Y.-K., & Mokhtar, I. A. (2011).

Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal Of The Medical Library Association: JMLA,99(3), 229–236. https://doi-org.ezp.waldenulibrary.org/10.3163/1536-5050.99.3.010

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for

nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Walden Student Center for Success. (2012). Clinical Question Anatomy. Retrieved July 9, 2014,

from  https://academicguides.waldenu.edu/c.php?g=80240&p=523911