Evidence Informed Nursing Practice

Summary of Evidence and Recommendations

According to Chang et al. (2016), the use of non-pharmacological interventions such as yoga for 80 patients suffering from lower back pain is highly used, who are facing issues with the use of pharmacological interventions. Non-pharmacological interventions never offer any complications or side-effects to the patient. It is found that patients with lower back pain often suffer from issues like anxiety, depression, and reduced quality of life. All these factors are focused on the use of yoga. The patients are found to have ensured the effective mental and physical health of the patients. It also helps in concentration, posture improvement, sleeping patterns, and breathing. Yoga is found to have effective results in chronic lower back pain (Chang et al., 2016). Moreover, the patient should be checked for medical history, frequent laboratory tests, physical examinations, and psychological risk factors. As per the conditions in the facility, there should be the maintenance of standard 4 medication safety, in which the patient’s condition and health outcomes after the medication should be documented and evaluated for effective pain management (Australian Commission on Safety and Quality in Health Care, 2012). There should be a comprehensive assessment of the identification of the risks. The recommendations include recording and frequent monitoring of the patient and ensuring that his/her needs are fulfilled. If there are risks or chances of pressure injuries then they should be addressed and effective implementation of a monitoring plan should be prepared especially in the case of older patients. This will ensure standard 8 of managing and preventing pressure injuries (Australian Commission on Safety and Quality in Health Care, 2012). In the case of older patients, due to muscle weakness and lower back pain, the risks of pressure injury are also increased. Therefore, the nurses should ensure the use of supportive aids to the patient’s comfort. There should be a monitoring of patient outcomes with various medical cares. If the patient is provided with pharmacological interventions then it is recommended that he/she should be monitored and evaluated for the vital signs, functions of the cardiovascular system, depression, vomiting, nausea, and other complications if any. However, if the patient is provided with non-pharmacological interventions such as yoga or tai-chi, then it is recommended that he/she should be monitored for the rate of recovery, cardiovascular function improvement, and change of frequency as per patient’s improvement. Moreover, it is recommended that there should be the implementation of effective guidelines in the facility to ensure standard 1 of NSQHS of governance of quality and safety in health care. This will also be ensured if patient feedback is recorded or if the patient is informed about his/her decisions and medical care plan, thereby ensuring standards 2 of partnership with consumers. 

Ethical Considerations

In nursing care, there are 4 ethical principles are considered to be ensured in every facility, these are as follows: autonomy, justice, non-maleficence, and beneficence. At present, it is found that the facility has no standard and fixed guidelines for the management of patient that are suffering from chronic back pain, by using some complementary or alternative pain reliving therapies or approaches. As it results in varying levels of outcomes in a different patient, for example, some are getting relief from the use of pharmacological interventions, whereas some are feeling discomfort and sick feelings due to the use of such interventions or approaches for pain management. This shows that the ethical principle of justice is not maintained as there is no delivery of fair treatment. It was also found that the facility did not support the idea of patient decision-making for their care. The use of yoga is very useful in pain management and it has no side effects (Rae et al., 2020). According to Dove et al. (2017), it is found that the facility with clinical guidelines helps in ensuring the autonomy of the patient. The care decisions are focused to attain the patient’s well-being and promote her/his good health. The clinical guidelines ensure the quality of care as the information provided by the patient for his/her needs to be targeted so that informed care and a patient-centered approach is used. As per the principle of non- maleficence, no harm should be caused to the patient while delivery care services.

According to Nicholas (2019), pharmacological interventions such as panadeine and others are found to offer some side effects such as sweating, nausea, constipation, vomiting, stomach pain, and some others. The patients in the facility are also found to have feelings of illness, due to the use of such medicinal interventions. The principle of beneficence states that the actions or services should ensure that the actions or interventions should good of the patient. According to Kua et al. (2019), yoga and pharmacological interventions are varied effects on the patient’s health outcomes. The patient in the facility suggested yoga or other interventions because she faced some complications due to the use of medicines. With the help of such ethical principles, there is the maintenance of evidence-based practices and professional delivery of care services. The implementation of the clinical guidelines with ethical principles ensures patient-centered care, patient safety, and delivery of quality care services.

Suggestions for Facility to Incorporate Evidence-based Nursing Practice

After reviewing and researching the studies, evidence-based practices, and ethical principles. The 3 suggestions are staff education, diagnosis, patient interaction for feedback, and reviewing the implementation of these guidelines. The guidelines are used to reduce the chances of incorrect practices in nursing that might not ensure patient satisfaction. First, staff education, the staff should be educated about the importance of clinical guidelines in nursing and respecting the wishes of the patients. According to Gould et al. (2017), the guidelines ensure that there is informed decision making in patient care. The clinical guidelines ensure various benefits so, the staff should be trained and educated with the help of programs and meetings. Staff education ensures evidence-based practice and professional skills development. It also ensures a high improvement in performance, reducing the risks of clinical errors, and gaining the latest knowledge (Jun et al., 2016). Secondly, diagnosis, the patient should be monitored and frequently evaluated for the interventions or care plans delivered. This ensures more insights into the health of the patient. If the patient is benefitted by any alternate interventions then the patient should be provided with better care services. The facility should maintain the system for alerts or alarms for the patient so that effective care is ensured. The diagnosis also ensures the identification of related or associated complications of the patient. This reduces the stay at hospitals and the risk of other complications (Brunkert et al., 2019). Third, patient interaction for feedback, the facility should ensure that they effectively communicate with the patient so that they can get clear insights about the guidelines of the facility. If there is the use of effective communication by the health professionals then the patient will briefly describe the wishes, advantages, or limitations that are faced by the patient. The patient can provide various critics or other information about the guidelines, which ensures high-level facility management for patient care services (Jun et al., 2016). Fourth, reviewing the implementation of these guidelines, if there is the implementation of particular guidelines in the facility for pain management then the patient outcomes should be reviewed for effective and better results. Reviewing is beneficial not only for patient concerns but other factors should also be monitored with reviewing such as cost-effectiveness, reliability, clinical applicability, clarity, clinical flexibility, validity, and many others (Rababa et al., 2020). It should be ensured that the family members are also involved as they also observe the care delivered to the patient, so they can help in effective review comments for the guidelines so that in future effective actions can be taken for changes.

References for Pain Management in Nursing Home Residents

Australian Commission on Safety and Quality in Health Care. (2012). National Safety and Quality Health Service Standards. Retrieved from: https://www.safetyandquality.gov.au/sites/default/files/migrated/NSQHS-Standards-Sept-2012.pdf 

Brunkert, T., Simon, M., Ruppen, W., & Zúñiga, F. (2019). Pain management in nursing home residents: Findings from a pilot effectiveness‐implementation study. Journal of the American Geriatrics Society67(12), 2574-2580. https://doi.org/10.1111/jgs.16148

Chang, D. G., Holt, J. A., Sklar, M., & Groessl, E. J. (2016). Yoga as a treatment for chronic low back pain: A systematic review of the literature. Journal of Orthopedics & Rheumatology3(1), 1–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878447/

Dove, E. S., Kelly, S. E., Lucivero, F., Machirori, M., Dheensa, S., & Prainsack, B. (2017). Beyond individualism: Is there a place for relational autonomy in clinical practice and research?. Clinical Ethics12(3), 150-165. https://doi.org/10.1177%2F1477750917704156

Gould, D., Gaze, S., Drey, N., & Cooper, T. (2017). Implementing clinical guidelines to prevent catheter-associated urinary tract infections and improve catheter care in nursing homes: Systematic review.  Journal of Infection Control45(5), 471-476. https://doi.org/10.1016/j.ajic.2016.09.015

Jun, J., Kovner, C. T., & Stimpfel, A. W. (2016). Barriers and facilitators of nurses’ use of clinical practice guidelines: An integrative review. International Journal of Nursing Studies60, 54-68. https://doi.org/10.1016/j.ijnurstu.2016.03.006

Kua, C. H., Mak, V. S., & Lee, S. W. H. (2019). Health outcomes of deprescribing interventions among older residents in nursing homes: A systematic review and meta-analysis. Journal of the Medical Directors Association20(3), 362-372. https://doi.org/10.1016/j.jamda.2018.10.026

Nicholas, R. (2019). Pharmaceutical opioids in Australia: A double-edged sword. National Centre for Education and Training on Addiction (NCETA). Retrieved from: http://nceta.flinders.edu.au/files/2415/4960/5275/Pharmaceutical_opioids_in_Australia_A_double-edged_sword.pdf

Rababa, M., & Masha'al, D. (2020). Using branching path simulations in critical thinking of pain management among nursing students: Experimental study. Nurse Education Today86, 104323. https://doi.org/10.1016/j.nedt.2019.104323

Rae, L., Dougherty, P., & Evertz, N. (2020). Yoga vs stretching in veterans with chronic lower back pain and the role of mindfulness: A pilot randomized controlled trial. Journal of Chiropractic Medicine. https://doi.org/10.1016/j.jcm.2019.10.005

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