NR 393 Evidence-Based Practice Changes

NR 393 Evidence-Based Practice Changes

NR 393 Evidence-Based Practice Changes

As in our chapter readings, nursing research and education is discussed throughout the years.  “An almost endless effort . . . has changed nursing practice and provided the body of knowledge to support evidence-based practice. . .” (Judd & Sitzman, 2014).  Nursing research and education will always continue, so that nurses can improve patient care.

In the 20th century, and in the very beginning years of the 21st century, nurses were trained according to evidence-based practice, to aspirate intramuscular injections.  Not long into the beginning years of the 21st century, evidence-based practice states that this procedure is no longer necessary.

Nurses were originally trained to aspirate intramuscular injections, to verify that the injection was in the muscle and not in a vein.  If blood aspirated into the syringe, this meant that the injection was placed in a vein, and then the syringe with the blood and medicine would need to be discarded, and the medicine drawn up again.  The act of aspirating was to be done over a five to ten second period.

“More recently, evidence-based guidelines do not advocate aspiration. . .”  (Do you need to aspirate, 2016).  Aspirating intramuscular injections today is no longer necessary.  The rationales for this new procedure are that the sites that intramuscular injections are given in do not contain major blood vessels, there is no evidence that aspiration without or with blood eliminates the chance of being in a blood vessel, not aspirating reduces the time of the injection, there is less waste of medications, less pain, and most nurses do not wait and aspirate over the recommended five to ten second period.  (Evidence-based Injection Practice, n.d.).

However, if using the dorsal gluteal area, aspiration is needed, because you must be careful of the sciatic nerve and blood vessels.  Therefore, it is not recommended to use this area.  (Evidence-based Injection Practice, n.d.).

Nursing gives many drugs intramuscularly, so it is necessary to keep up on medication education.  For example, one intramuscular medication that I have given many times is Haldol, to calm down patients.  As stated above, some advantages to no longer having to aspirate intramuscular injections is less pain and reducing the time of the injection.  If having to give Haldol, usually it is needed to be given quickly, and less pain is beneficial for the patient.  So far, the changes to this evidence-based practice has proved to be successful in my practice.

 

References

Do you need to aspirate when giving intramuscular (IM) injections? (December 11, 2016).  Retrieved from https://ed-areyouprepared.com/wp-content/uploads/2018/12/Do-you-need-to-aspirate-when-giving-intramuscular.pdfLinks to an external site.

Evidence-based Injection Practice:  To Aspirate or Not.  (n.d.).  Retrieved from www.nnpnetwork.org/Uploads/EBPLinks to an external site. aspiration poster 9 25 12 for iowa.pdf

Judd, D., & Sitzman, K.  (2014).  A history of American nursing:  Trends and eras.  (2nd ed.).  Jones & Bartlett

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In our chapter readings, some leaders and events had greatly changed the practices in nursing but it is not removed

NR 393 Evidence-Based Practice Changes
NR 393 Evidence-Based Practice Changes

yet it was improved to cater the needs and practice for nurses. With these, nurses will gain more knowledge and deeper understanding regarding their specialization. Yes, education and practices for nurses would continue to provide patient care but in former ages nurse registration was an organized list of educated nurses in a state. Moreover, most of the nurses thought that aside from nurse registration license would elevate their standards as well as their profession. Thus, practices in any field including nursing is a must.

The nursing profession evolved greatly in the 20th century. Two catapults that greatly changed the nursing profession were both world wars. Evidenced-based practice and the rapid increase in technology contributed to many changes in the way nursing was performed. One area that I found interesting and is a great contrast to how our practice works today was the concept of Public Health Nursing. The ideas that kept changing in the early 20th century, such as clean water, sanitation, and the use of vaccines began to start during this time period. “Advancing knowledge about germ theories from the mid-1800s to the mid-1900s focused medical evolution on “hygiene and sanitation . . . the forefront of the struggle against illness and disease,” and work done in these two areas “resulted in unprecedented longevity, concomitant with markedly improved quality of life in the last century and a half” (Judd 2014).  These ideas go back to Nightingale’s original theories of cleanliness, fresh air, and sanitation, but now in the 20th century have been scientifically identified and the advances in knowledge lead to the eventual understanding of germ theories and epidemiology. ” During the 1920s, vaccines for diphtheria, pertussis, tuberculosis, and tetanus were introduced. The result was an increase in life expectancy from 59.7 years to 74.9 years over the next 30 years.” (Judd, 2014) Increasing life expectancy like this was revolutionary and nurses advocated for public health measures. Sanitation and vaccines were new and public education was a task that nursing took on in order to continue this cause.

I thought reading about this history right now while answering questions on vaccines and during a pandemic were very timely as we as nurses are once again educating the public on health measures and sanitation guidelines. Nursing has always been about education for the patient, and in the 20th century, the nursing profession began to greatly increase its role as public health advocates and educators.

 

References:

Judd, D., & Sitzman, K.  (2014).  A history of American nursing:  Trends and eras.  (2nd ed.).  Jones & Bartlett

https://www.nursing.upenn.edu/nhhc/american-nursing-an-introduction-to-the-past/

There is a a lot of false information going around holding people back from getting vaccines. During this time, “The National Vaccine Plan (NVP) is intended to be a comprehensive framework that guides national efforts of federal, state, local, multinational, and non-governmental partners to improve access to and increase uptake of vaccines, as well as continued development of new and improved vaccines”(Shen 2019). A culture of vaccine hesitancy threatens to undermine public health and the value of vaccines.  Since this issue has been validated by the recent measles outbreak 2019, the World Health Organization recognized vaccine hesitancy as one of the top 10 threats to global health. The biggest platforms for this misinformation is social media and online sources. The 2020 vaccine plan will offer guidance on addressing the spread of this misinformation. They plan to implement this by building partnerships with social media platforms, leveraging provider- patient encounters to advance informed decision making, and messaging the value of vaccines through targeted strategies across digital and print media platforms. (Shen 2019). The CCDH warned that the anti- vaccine movement could undermine the vaccine against COVID- 19. As nurses it’s our job to educate and put out accurate information. Much of the reasoning and information anti-vaxxers have against vaccines have been proven to be myths. We are required to ask everybody leaving the hospital if they want the flu shot. I always do small education on why the flu shot is important before letting them make their decision. As for vaccines being mandatory, I think that certain vaccines should be mandatory like the childhood vaccines, because we have seen how people not getting the MMR vaccine has brought back measles. But, as for the flu vaccine I do not think at this point it should be mandatory.

ISGlobal. https://www.isglobal.org/en/healthisglobal/-/custom-blog-portlet/como-desmontar-cientificamente-los-4-principales-argumentos-antivacunas/3098670/0

Shen, A. (2019). Shaping the 2020 national vaccine plan. Health Affairs: Leading Publication Of Health Policy Research & Insight. https://www.healthaffairs.org/do/10.1377/hblog20191212.484779/full/ (Links to an external site.)

Burki, T. (2020). https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30227-2/fulltext