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Evidence-Based Practice and Applied Nursing

Introduction

The dynamic nature of the nursing practice has occasioned the integration of sophisticated and better interventions in offering patient care regardless of the medical department. Evidence-based nursing endeavors to utilize the best research findings in informing practice in all health care facilities. Its application into nursing practice is usually interested in improving the quality of patient care particularly in sensitive departments such as the surgical and wards units (Brown, 2009, p. 38).

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The desire to improve the safety of the patients while ensuring the care providers are protected from infections has occasioned several studies on the best nursing practices that will result in a better prognosis for surgical patients. This essay will describe a perioperative procedure carried out in the surgical process with a particular interest in assessing its worthiness and relation to the evidence-based practice. In addition, discussion of the perioperative procedures in combination with a critical appraisal of the methods will also occur.

Main text

Shaving before surgery has been a traditional procedure that is practiced in many healthcare facilities. Although its usefulness has been emphasized in a variety of research literature, it became imperative to review its usage in the face of increasing infections in the surgical departments. Several decades ago saw the introduction of shaving into surgical procedures to provide a conducive environment that will be free of microbe multiplication. However, the emergence of many diseases associated with blood and body fluids meant that better innovative methods had to be devised to address the shortcoming.

Shaving occurred in a very unhygienic environment despite the practice receiving much acceptance due to myths. In believing that the hair shaving would result in faster healing of the wounds, the physician and nurses continued with the procedure oblivious of the potential danger in terms of post-operation infections. Shaving follows a systematic process where the care provider usually prepares the skin surface in anticipation of the cut. Application of creams and liquids on the surface is important before shaving is started. During the shaving process, the shave should be carried out in the direction of the growth mainly because hairs usually grow at 45-degree angles instead of the assumed 90 degrees. More importantly, shaving must be finished with a cut against the grain of the hairs. After ensuring that no hairpieces are left on the surface, the skin is overly rinsed with the help of clean water followed by a pat instead of the usual rubbing. Injuries to the skin surface are common during shaving (Fischer et al, 2006, p. 12)

Taking into account the presence of various contaminants and other surgical fluids, the cuts provide a large avenue upon which contamination and infection can occur. The fact that the immune system of the patient is compromised may result in complications and sometimes death. Moreover, empirical findings have denoted that the timing of the shaving itself has a great impact on the occurrence of infection around the wound. The report denotes that removal of hair after the operation has proved useful in lowering infection rates compared to shaving hours before the surgery. Given the above, it becomes imperative to find better ways to address the situation (Fischer et al, 2006, p. 45).

According to the hospital personnel, the hospital administration had the upper hand in deciding the procedures and was therefore adamant to change from the traditional ways. The decision to have the shaving was based on the cost implications to the patient and the hospital thereby making them reluctant to adopt better methods such as laser shaving. The insistence on the traditional way was based on cost-effectiveness rather than its efficacy in averting infection to the patient and the medical personnel.

Literature review

Several studies have denoted the importance of shaving in surgery. A systematic review of studies dealing with hair removal denoted that there was substantial evidence to show that hair removal was essential during surgery. Moreover, the utilization of methods such as depilatory or to a large extent the electric clipping should be carried out immediately before any surgical procedure is initiated (Kjonniksen et al, 2002, p. 928). The avoidance of shaving particularly for intracranial procedures is highly stressed since it was found that the rate of wound infection was not influenced by shaving or the lack. Shaving has been blamed for increasing wound infection particularly in abdominal surgical procedures unlike when other procedures are utilized (Fischer et al, 2006, p. 56). The fact that shaving has been implicated in decreasing patient safety and response to treatment has made several hospitals apply other methods that ensure no bodily injury to the skin surface. (Duffy, Fisher & Munroe, 2008, p. 23).

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Clinical implications

According to the empirical findings on shaving, the clinicians and many health facilities have been forced to the drawing board to decide on the best practices to be adopted. Given the above, it becomes essential for the concerned stakeholders to consider embracing other procedures that do not bring about incisions in the patient’s body. Suat and Kara (2007, p. 1576) asserted the need to adopt nonincisive methods to reduce the morbidity and mortality occasioned by shaving immediately before the inception of surgery. The use of electric clipping is believed as a prevention measure taking into account the large numbers of postoperative infections associated with shaving.

Alternative methods

Incorporation of electric clipping and application of creams offers improved patient safety and is cost-effective in the long term. Based on evidence-based practice, the paradigm shift to their application would not only save money and time but also ensure quick recovery for the patients. A total departure from hair removal should be embraced by hospitals unless in instances where there is interference with the anatomical sites of the wounds (Duffy, Fisher & Munroe, 2008, p. 3). However, in such instances, methods other than shaving should be applied. Increased awareness of the importance of depilatory agents is imperative to compel the nurses and the surgeons to abandon the traditional razor shave due to its associated adverse effects. Integration of research is therefore essential to the current crop of nurses thus resulting in the embracement of best perioperative procedures (Fischer et al, 2006, p. 56).

Involvement of stakeholders

To institute changes in the current perioperative procedures, the nursing professionals should compile relevant research evidence denoting the benefits accrued from the new methods. Evidence-based research is essential in informing policy changes at the institutional level (Melnyk & Fineout-Overholt, 2005, p. 54). The management and policymakers must be compelled to accept the new approach through the production of evidence denoting the efficacy and cost-effectiveness of the methods. In addition, it is imperative to base the argument on other facilities or countries enjoying the benefits of the paradigm shift to prove the applicability and sustainability of the new approach. Furthermore, the inclusion of the stakeholders as part of the task force reviewing the adoption of best nursing practices is an impetus since they feel like part of the change (Brown, 2009, p. 32).

The inception of the improvements

Nonetheless, the adoption of new approaches in nursing faces enormous challenges owing to the complexity of their working environment. Although the nurses carry out the shaving, the decision on the applied methods mainly rests on the surgeon. More importantly, the need for retraining and sensitization may provide a challenge to the effective adoption due to the reluctance of the working population to embrace professional development opportunities (Houser, 2008, p. 76). The tendency to have a synchronized program among all the stakeholders in terms of training, funding, and willingness to embrace the change has always played down the success of the evidence-based practice. Continuous involvement of the stakeholders and considerations of their opinions and concerns are important to the overall success of the program. Integration of the findings into the current surgical procedures at the hospital level must be done in stages to enhance the smooth shift. It is important to start from the simpler and less involving tasks before embarking on the more involving tasks. In this case, the improvements should be done on small scale starting from the minor operations before upscaling to cover all surgical operations within the facility. The improvements should be tied to a schedule to allow the concerned parties to have time to embrace and incorporate the changes in their normal daily activities (Houser, 2008, p. 36).

Conclusion

Evidence-based nursing has gained prominence due to its ability to offer better solutions taking into consideration the recent evidence in the field. Shaving has continually been applied in surgical procedures despite its adverse effects on the patients’ life. Ignorance and resistance to change have proved the main impediments to the embracement of new approaches. Involvement of the stakeholders in the planning and implementation is imperative to avoid facing barriers in the long term.

Reference list

Brown, S, J. (2009). Evidence-based nursing: The research-practice connection. Sudbury, MA: Jones & Bartlett.

Duffy, P., Fisher, C. & Munroe, D. (2008). Nursing knowledge, skill, and attitudes related to evidence based practice: Before or After Organizational Supports. Medical Surgical Nursing, 17 (1), 55–60.

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Fischer, J., Bland, K., Callery, M., Clagett, P. & Jones, D. (2006). Mastery of Surgery, 2 Volume Set. New Jersey: Lippincott Williams & Wilkins.

Houser, J. (2008). Nursing research: Reading using and creating evidence. Sudbury MA: Jones and Bartlett.

Kjønniksen, B.M., Andersen, M., Søndenaa, A., Segadal, M. (2002). Preoperative Hair Removal—a Systematic Literature Review. AORN, 75(5), 928.

Melnyk. B.M. & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. Philadelphia: Lippincott Williams & Wilkins.

Suat E. Ç. &Kara, A. (2007). Does Shaving the Incision Site Increase the Infection Rate After Spinal Surgery? Spine. 32(15), 1575-157.

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