Nursing Practice: an Evidence-Based Clinical Management - Essay Example

?Nursing Practice: An Evidence-Based Clinical Management Introduction The increasing consumer awareness and participation of public citizens in health-related topics raise accountability that health care professionals need to uphold. With these, enhanced availability of large amounts of clinical information and resources due to liberal research ventures assure that professional practices are anchored by sufficient proof of efficacy and efficiency. As explained by Malone, et al. (2003, p.83), collections of evidence provided by research studies, especially in quantitative form, occupy top level ranks in providing strong and solid answers that substantiate clinical actions and procedures. Yet, such ironclad research data are dispensable, and are liable to change through time, as recent updates replace older studies--depending on their validity and efficacy in health settings. Bearing these in mind, the significance of evidence-based practice is highly valuable in proving that health practices are safe for the public and cost-effective. In this paper, barriers and possible resolution of gaps between nursing research and their application are tackled, as well as their utilization through standardized clinical guidelines in relevantly managing smoke cessation in clinical settings. Discrepancies in Evidence-Based Practice Despite the long emergence of concepts in evidenced-based practice in health care sectors, success in fully translating research outcomes into care practices seemed lagging in progress. At large, four main sectors contextually represent the barriers to research employment: “health-care professional related, organizational-related, research related, and presentation-related” (Chau, Lopez, & Thompson, 2008, p.640). Each division indicates specific areas of clinical problems that probably weaken health professionals in fully responding to the positive sides brought about by solid research results. Health-care associated factors may range from personal demographics (educational level, social and economic status), personal characteristics and values, such as knowledge seeking behaviors to further one’s practice. With organizational barriers, these comprise viewpoints of affiliated institutions on its commitment to research adaptation and dissemination, facility maintenance, hierarchical culture and authority for change, administrative support, and lack of opportunities to develop and acquire research resources. As of research-related interference and presentation, types and comprehensiveness of research contents affect professional perceptions, including comparison of previous and present research for results and conflicting thoughts. As such, there is increased tendency to reject research composition and presentation should data fail to meet practical health needs of clinical personnel that research teams aim at satisfying. In more ways, the concerted results of practical nursing barriers create disparities that may unintentionally provide nurses with concrete excuses not to change their old ways. Common among perceived nursing barriers to full research application are said to be generated from organizational, and professionally-related factors. Funk, Tornquist and Champagne (1995, p.397) emphasized “insufficient authority to (clinical practice) change...and insufficient time to implement new ideas” as primary sources of research to practice discrepancies. The prevailing culture of inflexible organizational structures in most clinical institutions restricts the attitude of change and resource availability in such settings. Elaborately, it also affects sufficiency of time required to search, read, and substantially absorb relevant information from research journals and related materials. To top these off, Cummings, et al. (2007, p.S33) revealed the nature of occupation nurses suffers, where most of the time, exhaustion in both physical and emotional aspects reduce their quality of professional care. There is difficulty, then, to acquire suitable skills in search for relevant studies due to their hectic work schedules. Malloch and Porter-O’Grady (2009, p.108) added the danger of consorting with researches of inappropriate procedures and results. The doubts generated by irrelevant studies add to barriers with lack of discerning skills in for research utilization. Hence, the combination of professional and environmental hindrances appeared to create problems in converting research studies to practical nursing applications. Evidence in Clinical Settings In remedy, there are a number of strategies known to specifically meet the needs of nurses in professional and organizational level. The primary roles that institutional organization must assume are highlighted by several experts. To foster the attitude of change in nursing personnel, modifications in organizational priorities should be initiated. Both nurses and administrators should accept the need for practical application of clinical knowledge first, before proceeding to construct ways in practically achieving them. Specifically, institutional organizations are in strategic position to select evidence-based nursing data and promote its wide application for nurses. The evolution towards computer literacy indicates that hospitals should provide for enhanced “electronic access to information, time to seek information, and opportunities to computer and search skills” (Tanner, Pierce, & Pravikoff, 2004, p.939). In relevance, nurses need to be updated in current technological status for better research access and information integration. For the most part, organizational structure should be flexible enough to incorporate research-based information in a variety of institutional ways. Gerrish and Clayton (2007, p.121) discovered that large amounts of knowledge in nursing practice are drawn from procedural manuals and actual clinical experience; hence, it is important for organizations to take active responsibilities in incorporating research-based data sets in manuals and during developmental skills training for enhanced nursing practices. Professional values could be significantly influenced by such organizational stance, as environmental settings encourage nurses to develop necessary skills and proof-based values. The culture of constructive change initiated at top organizational level, thereby, translates a cultural commitment towards research utilization for better nursing practices. In several frameworks for research utilization in nursing practices, the involvement of key participants, organizations, their nursing personnel and clinical researchers, are substantial to develop relevant procedures in resolving gaps in research and application. The need for assistance, in social, financial, and technical areas, are necessary to continue the initiatives in the culture of research-based clinical services (Nieva, et al., 2003, p.449). Giving nurses professional and financial incentives are prudent ways to keep nurses satisfied in the highly stressful settings. Other than such strategies, Walter, Nutley, and Davies (2003, pp.4-6) compiled several mechanisms that may aid in resolving research to application difficulties. Initially, dissemination and education practices should be tailored according professional needs. Each nurse requires individualized learning needs and capacities, hence, explicit educational resources for clinical practice, as well as customized distribution of information, can be attempted by committed organizations. Other than these, direct communication patterns need to be established by researchers and information recipients. As such, research procedural outcomes need to be validly clear for nurses, specifically targeting their practicable needs, and with study presentation that are readable for busy nurses. The strategies in limiting constraints in research utilization are multifaceted in function, and should address areas in social, financial, organization, and professional factors for higher success potentials in bridging nursing practice gaps. Strategies to Clinical Accountability The direct contact nurses have with hospitalized patients place them in strategic positions in influencing care recipients towards better health care values and well-beings. The increasing health care trends that primarily target health promotion schemes and disease prevention relegate nurses with roles ranging from health educators to reliable informants of health-related information and resources (Nagle, Schofield, & Redman, 1999, p.133). Hence, the burden of converting the health beliefs of the public into constructive ones markedly falls on nurses as care advocates. In application, they are obligated to present treatment options preferable to clients, collaboratively reinforcing risks and benefits data with available therapeutic interventions, in accordance with recommended clinical guidance. In application is the rampant case of nicotine addiction through excessive cigarette smoking focused in health promotions and disease prevention. A number of cessations interventions had been indicated in clinical guidelines, in a variety of strategic modes (traditional, behavioral, and pharmacological), that can be individually or collectively done to assist smokers out of their destructive habit. Significantly, the Nicotine Replacement Therapy (NRT) employs nicotine-based materials (gums, skin patches, nasal inhalers, and digestive tablets) to gradually lower cravings for nicotine in cigarette smokers. Compared to other pharmacological treatment, such as opioid agents and antidepressants, NRT possesses higher success rates if combined with individual or group counseling therapies, as projected in Smoking and Cessation Intervention (The Joanna Briggs Institute, 2008, p.3). The combination of pharmacological strategies and behavioral counseling appears to ensure higher efficacy in assuring long-term cessation in smoking. At this point, supportive assistance from nurses is significantly required, not only in safe administration of medication agents, but as reinforcement figures with clinical guidance against smoking habits. Nurses serve as clinical managers and health advocates, where they organize individualized care needed by every patient and consistently drill them on the importance of healthy lifestyle in preventing serious infirmities. Trained nurses are well-oriented with identifying health care needs, the right treatments required, and how to manage resistance and related difficulties, if there is any (Katz, et al., 2004, p.601). It is important to note that accurate assessment of perceived needs can serve as basis on how to proceed with treatment, and nurses assume dynamic supportive roles, presenting credible health options for clients to adjust with difficulties accompanying temporary and permanent cessation from smoking habits. Applicable Guidelines to Practice The enlisted clinical treatment modalities in solving unrestrained dilemmas of smoking cigarettes are only partially addressed in clinical guidelines indicated for health care practitioners. In choosing reliable clinical guidelines in targeting specific health event, a number of things should be considered. For one, guidelines for health practices should not significantly contradict existing clinical values of intended user, and not overly tax the efforts of target groups during adjustment phase of implementing changes in guideline. Furthermore, success depends on the amount of interference it produces on clinical routine of health personnel, as well as constructive patient response (Grol, et al., 1998, p.860). The cultural change in clinical settings elicited by new clinical guidelines, then, plays a major role on its adaptability in some institutions. Yet, applicability of clinical guidelines, even radical ones, can be resolved by highly supported research evidences. Thus, organizations are motivated by clinical guidelines if they are based from well-supported database that are both explicit and clinically measurable (Curry, 2008, p.42S). The need for evidence-based commendations is profound in increased institutional resistance to environmental change. One of the well-accepted health guidelines created to increase awareness on smoking risks is “Clinical Practice Guideline,” legitimately created by the Agency for Healthcare Research and Quality (AHRQ). As multi-disciplinary guide to practice, this evidence-based parameter to nursing practice incorporates general roles of nurses as health advocates and support resources, while specifically leading appropriate directions nurses must adhere in better practice execution. Summarily, AHRQ constructed researched-based proposal for smoking cessation, where treatment modalities are promoted after accurate needs assessment are performed. As there is higher success outcome with prolonged treatment, the organization suggested utilization of three intervention schemes: “NRT, social support...(behavioral) skills training/problem solving” attitudes and values in healthier lifestyle (Fiore, 1996, no pag.). Basing from such guideline elements, these recommendations fit the functional roles already occupied by nurses in clinical settings. As discussed earlier, nurses need to project a dynamic nature as educators and care managers. In doing so, nurses provide physical and psychological support to patients who need to stop their smoking habit, whether in mild or chronic health cases. As they are trained to safely administer prescribed medications, their skills in counseling and supportive emotional services are competently guided through smoking cessation guidelines, presenting intervention modalities that had been well-studied to provide the best possible health results for patients. The series of health promotion strategies render nurses more capable in their field of work, and they are more confident in the supportive roles they assume, as their clinical actions and practices are best guided by standardized smoking cessation clinical guidelines--conducted in evidence-based manner. Conclusion All in all, the trend in evidence-based health services in every health care delivery is a motivational approach to enhance compliance in both health care providers and care recipients. In clinical settings, the utilization of research-based practice is highly expected, yet, a number of barriers are seen to hinder its full application. The commitment of institutional organizations and professional willingness to participate in practical endeavors are part of the keys in resolving gaps in research utilization. Organizations need to promote an environment of increased research awareness, where nurses are given opportunities for sufficient time and energy to devote in journal reading and clinical application. Motivated to do so, research utilization is enhanced. A number of strategies are developed to ensure such events, including reinforcements on aspects in financial, social and technical areas in research studies. As nurses are dynamic in roles, they can adapt to diverse clinical guidelines in their health practices. Through health promotion, nurses can advocate smoking cessation with direct contact with patients, where the latter are given enough treatment options to suit their preferences. In every procedural step, nurses are consistently involved to foster supportive services. 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