Clinical Question
The clinical questions which guided this paper were related to the problem of utilization of traditional practices by nurses instead of using practices that are established to be best by evidence. The clinical question guiding a search for a qualitative article was: What are some of the traditional practices that are inconsistent with the evidence, but are often utilized by nurses in clinics? The clinical question guiding a search for a quantitative article was: Do nurses often employ traditional practices which are inconsistent with evidence? The asked questions, therefore, are mainly Therapy questions.
The search was conducted over a number of databases, such as Ovid, PubMed, Sage Publications, and EBSCOhost. The key words utilized in the search were “evidence,” “practice,” “traditional practice,” and “nursing” in different combinations.
Description of the Problem
The problem that this paper is concerned with is the opposition between the evidence-based nursing practice and the nursing practices that are carried out traditionally, regardless of what research and evidence show to be the best approach. The traditional practices usually take place due to the fact that nurses have always acted in these or similar ways, and thus act in accordance with the habits or traditions. For instance, a nurse practitioner might prompt their preoperative adult patients to be nil per oral after midnight because it is traditionally believed that this reduces the likelihood of aspiration, whereas evidence shows that other, less strict fasting measures should be enough in order to reduce the aspiration risk (Miller, Hayes, & Carey, 2015, p. 52).
Significance of the Problem
The status-quo practices, which are in some cases dubbed “sacred cows” of nursing (Miller et al., 2015), are caused by a multitude of factors, such as the dearth of evidence-based education and skills among the nursing personnel, the culture in a particular hospital or ward, and so on. The main problem pertaining to these practices is that they may adversely influence patient outcomes; another problem is that traditional but ineffective routines may increase the amount of work a nurse does, thus decreasing their efficiency and, again, negatively influencing patient outcomes. The consequences of status quo practices that are inconsistent with evidence are as follows (Makic, Martin, Burns, Philbrick, & Rauen, 2013):
- Inaccurate measurements of vitals and other indicators;
- Confused cause-effect connections;
- Inadequate interventions which result in complications;
- The jeopardized safety of both patients and nurses.
For instance, it is generally accepted safe to use a large catheter (gauge 18-20) for PRBC infusions to avoid cells hemolysis. Research has established that there is no positive association between smaller catheters and hemolysis, while the insertion of large catheters into narrower veins (e.g., in pre-adolescent or elderly clients) can cause discomfort (Makic et al., 2013).
Thus, basing the practice on beliefs and tradition is capable of worsening the clients’ medical experiences and endangering their health further, which bespeaks for the significance of the issue.
Purpose of the Paper
The purpose of this paper is, therefore, to find out what traditional practices that are inconsistent with evidence are used by nurses, and how often. In order to do this, two research articles which may be instrumental in shedding light on this issue were selected from the medical databases.
Description of Findings
Makic, M. F., Martin, S. A., Burns, S., Philbrick, D., & Rauen, C. (2013). Putting evidence into nursing practice: Four traditional practices not supported by the evidence. Critical Care Nurse, 33(2), 28-44. doi:10.4037/ccn2013787
- Purpose: To determine the ways nursing practice can incorporate research; evaluate existing beliefs, and validate guidelines to eliminate status quo practice.
- Study Design – Qualitative: Empirical descriptive study.
- Sample, Size & Selection: A sample of 4 practice issues and a systematic review of literature on each of them.
- Data Collection Methods: Systematic review
- Major Findings: The necessity to replace the status quo practices of:
- non-invasive BP measurement in pre-adolescents;
- usage of oxygen in COPD clients;
- catheter size administration;
- infection control measures with evidence-based practices.
Miller, J., Hayes, D. D., & Carey, K. W. (2015). 20 questions: Evidence-based practice or sacred cow? Nursing, 45(8), 46-55. doi:10.1097/01.NURSE.0000469234.84277.95
- Purpose: To determine the ways nursing practice can incorporate research; evaluate existing beliefs, and validate guidelines to eliminate status quo practice.
- Variables:
- Dependent Variables: Ambiguity of evidence;
- Independent Variables: The respondents’ SES and demographics
- Study Design – Quantitative: nationwide survey.
- Sample, Size & Selection: There were a total of 2,356 participants, a strata of nurses.
- Data Collection Methods: Survey.
- Major Findings: The numbers of incorrect responses vary from 19% to 70% and higher. The persistence of “sacred cow” practices is established among younger nurses with education no higher than BSN. LPNs/LVNs were more likely to answer correctly, as were those at the age greater than 40.
Concepts
The studies explore the concepts of status quo (“sacred cow”) practices as opposed to the evidence-based ones. The significance of evidence-based practice, it appears, has not been realized until relatively recently, which explains the lack of higher quality research (e.g., clinical trials) pertaining to the subject.
Methods
The authors employ the methods of systematic reviews and observation in the first study and a survey in the second one. The evidence can be deemed relevant because of the considerable body of literature reviewed in (1) and a heterogeneous sample of a large size in (2).
Participants
A sample is present in article (2): the participants were nursing practitioners, N = 2,356. The nurses varied in their SES and demographics, e.g., age, gender, education, and place of residence. The article (1) is based on a literature review.
Instruments
The first study is based on a literature review, and does not employ specific instruments; it can only be noted that most of the sources utilized in the research are, not unexpectedly, scholarly articles. Simultaneously, the second study employs a questionnaire which was presented online and in a journal, and consisted of 20 questions to which respondents were asked to answer either “yes” or “no.” The questions were related to some concrete elements of nursing practice for which it is probable that the traditional understanding is different from what evidence shows to be best.
The reliability of the study (2) is determined by the stratified sample size and the design. The authors do not mention any limitations. As for study (1), its nature implies that the study cannot be used to predict causality.
Answer to “Purpose” Question
The evidence which is supplied in the articles suggests that there may sometimes be a considerable discrepancy between the needs of the patients and the interventions that they are provided with. Article (1) demonstrates that the traditional practices are based on beliefs and other factors and can prove insufficient and dangerous.
Study (2) shows that younger nurses are more likely to follow traditions in such areas as intensive, home, and emergency care (Miller et al., 2015). The high percentage of incorrect beliefs might worsen patient outcomes, although more specific research is needed in order to focus on particular areas of practice and establish this correlation.
Questions for Group
- What are common beliefs/generally accepted ways of practice related to our particular area of expertise?
- Can we estimate their relevance and associate them with positive/negative client outcomes?
Conclusion
The reviewed articles demonstrate that there is a problem of outdated traditional practices in the nursing profession. This problem is pressing, and its causal correlation with adverse patient outcomes appears to be likely to exist due to the erroneous nature of such practices. In order to determine whether there is such a causal correlation and what its scope is, carrying out additional research is required.