Evidence-Based Practice and Applied Nursing Research

Introduction

The main focus of nursing is to give patients professional care so as to assist them to maintain good health, recover their health optimally, and improve on the quality of their lives. Nursing is different from other aspects of health care in that their scope and approach to offering health care is different. Traditionally, nurses provided health care under the guidance of doctors. However, in some cases, they are permitted to offer health care independent of doctors. This is dependent on the nurses’ level of qualification and the circumstances under which the administration of health care arises (Barker, 2009).

According to the American Nurses Association (ANA), nurses are mandated to protect, promote, and optimize abilities and health, prevent injuries and illnesses, alleviate suffering by diagnosing and treating, and advocate for the care of populations, communities, families and individuals. This paper attempts to review the role of nurses in the delivery of evidence based care, especially in perioperative procedures (Barker, 2009).

Evidence based care/nursing is an approach to providing health care that uses a problem solving technique. It encompasses best evidence that comes from studies carried out and the patient care data. Evidence based nursing leads to better decisions and improved outcomes of patients. Evidence based care also takes into account the preferences of the patients. As outlined in the Honor Society of Nursing, Sigma Theta Tau International (STTI), nurses ought to ensure that they have all the relevant information before attempting to offer health care (Vanov & Blue, 2007).

Objectives

  1. To identify strategies for overcoming barriers to adopting an evidence-based practice for a given nursing situation.
  2. To identify methods of application of evidence-based research to guide implementation of a given quality improvement process.
  3. To identify barriers to evidence-based practice in a given process or situation.
  4. To identify why a systematic review can provide a strong evidential foundation for clinical decision making in a given situation.
  5. To identify the difficulties of translating from research to practice.
  6. To investigate how to involve key stakeholders in obtaining staff compliance with an evidence-based practice change in a given situation.

Perioperative Procedure of Shaving the Surgical Site

Since this paper shall deal with perioperative procedures, it is important to identify what perioperative nursing is. It can be defined as the processes that are administered to a patient who is about to undergo operative procedures or other invasive procedures. The processes are applied by a registered nurse. Perioperative nurses work hand in hand with the surgeons. To be able to carry out perioperative procedures effectively, the nurse should be aware of the physical assessment of the patient. This includes the patients’ history, laboratory tests carried out, and the procedure to be carried out on them. This paper focuses on the perioperative procedure of routine shaving of the surgical site (Simmers, Simmers-Nartker & Simmers-Kobelak, 2009).

Procedure of Shaving the Surgical Site

Routine shaving of the surgical site is a procedure that happens prior to a surgery. It involves removal of all hair that is present at the surgical site. Traditionally, it is believed to decrease the risk of infections at the surgical site commonly known as Surgical Site Infections (SSI). This involves the use of a surgical blade or razor to remove the hair. This procedure needs to be changed because previous studies have indicated that removal of hair does not reduce the risk of SSIs. The method of shaving has also been documented to have some side effects as shaving is done close to the skin and thus interferes with the environment around the skin. It may also cause cuts and bruises that may indeed lead to infections. Surgical site contaminations may lead to the death of victims. It is for this reason that this procedure has been chosen as an area that needs change (Simmers, Simmers-Nartker & Simmers-Kobelak, 2009).

Rationale behind Shaving the Surgical Site

The rationale behind the procedure of shaving the surgical site is cleaning the area before surgery so as to eliminate any germs and bacteria that may lead to the surgical site infections. It is a practice that has been carried out over centuries. Shaving of the surgical site is also done to minimize the risk of potential post operational infections of the wound or surgical site. When shaving the surgical site, factors to be considered include the amount of hair to be removed and the place where the incision is to happen among others. Shaving of the surgical site is carried out by skilled personnel like the perioperative nurses. It is also done according to the doctors’ instructions and in a way that ensures the skin integrity is kept intact. Shaving the skin when wet is preferable, and it is done just before the surgery. This reduces the amount of time bacteria and other microorganisms have to colonize the surgical site again. The skin preparation procedure is always documented in the patients’ file (Altman, Kerestzes, Wcisel, & Altman, 2010).

For a long period, this procedure has been done in this way due to lack of adequate research and evidence based practice. It has been a common belief that, during any surgical procedure, the hair at the surgical site had to be removed to get rid of bacteria and microorganisms. Surgeons also believed that shaving made access to the surgical site easier. These beliefs are retrogressive and not based on adequate evidence (Radford, County & Oakley, 2004).

Clinical Implications of Shaving the Surgical Site

The clinical implications of shaving surgical sites are tremendous. First the belief that it reduces surgical site infections has been documented to be untrue. In fact, shaving according to some trials carried out has been shown to increase the risk of infection. First, shaving can scar the skin or cause abrasions, which act as entry areas for bacteria and make the skin more sensitive to contamination. In addition, shaving that is done the night prior to the procedure may induce more contamination as the area is left fragile for a long period (Kingsnorth & Bowley, 2011).

Literature review shows that there is a relation between perioperative hair removal and the risk of surgical site infections. This means that not shaving or removing hair reduces the risk that an infection will occur. It is for these reasons that this report seeks alternative ways of carrying out this procedure or alternative measures to be taken (Kingsnorth & Bowley, 2011).

Recommendations

First, hair removal should only be done when it is necessary to do so. One of the circumstances that may necessitate hair removal is when the surgeons’ view of the surgical area is interfered with due to the presence of hair. Another instance is when adhesives need to be applied at the surgical area before the procedure is carried out. One of the things that can be done when hair removal is necessary is removing hair in a different way apart from shaving. Shaving has been shown to be harsh on the skin and can lead to cuts and abrasions. Other methods that can be used include clipping of hair and using depilatory creams. Use of depilatory creams is a milder procedure. However, tests need to be carried out on the skin to determine compatibility of the skin to a certain cream. In addition, surgical site infections are lower in patients that have had their hair removed by depilatory creams than those that have had it removed by shaving. Clippers are also a preferred method of hair removal as the method does not tamper much with the skin flora at the surgical site nor does it cause abrasions or cuts (Altman, Kerestzes, Wcisel, & Altman, 2010).

Furthermore, hair removal should be done closer to the time of the surgical procedure, preferably less than two hours before. This is due to literature review that indicates that removing hair closer to the time of surgery reduces the risk of infection at the surgical site. The process of hair removal could also be improved upon by having a protocol that defines the procedure to be followed (Altman, Kerestzes, Wcisel, & Altman, 2010).

Stakeholders Involved

The stakeholders involved should be involved so that change is implemented effectively and efficiently. The stakeholders in this case all the health care professionals and the support staff. For changes in the perioperative, procedure of shaving hair at the surgical site to manifest support is needed from all the stakeholders. Support could be monetary support from the administration because using depilatory creams and clippers is more costly than using razors. Support from the nurses and doctors is needed in terms of cooperation and implementation of the new procedures. One way of gaining this support is through sensitizing and educating the stakeholders concerning the need for change. Carrying out extensive training programs for the stakeholders based on evidence collected would help in convincing them of the need to embrace the change (Radford, County & Oakley, 2004).

Challenges of Implementing Recommendations and Strategies to Counter Them

There are many challenges that may be incurred in trying to implement this change. They include convincing the surgeons and nurses that the tradition of shaving the surgical site does not reduce infections and can indeed do more harm than good. Changing their long held perception would take a long time and would require solid evidence, facts and rationale. Translating theoretical findings into practice is thus another challenge to deal with especially where a long existing culture exists. Miscommunication is another challenge that may be encountered. This may lead to wrong interpretation of data (Kingsnorth & Bowley, 2011).

The strategies that can be used to counter these challenges are adequate training of the stakeholders and especially the perioperative nurses. Training acts as a tool of changing how people perceive things and effectively passing on new information and skills. Another strategy is setting in place good communication networks. This will prevent misinterpretation and enable effective implementation (Kingsnorth & Bowley, 2011).

Conclusion

The findings in this study can be used as a case study. This can be presented to the stakeholders and administration so as to gain their support for implementing the change that is needed. The findings can also be used to train the medical staff on the disadvantages that are linked to the shaving of the surgical site. From the literature review and findings in this study, it is evident that change with regard to the perioperative procedure of shaving the surgical site needs to be implemented.

References

Altman, G., Kerestzes, P., Wcisel, M.A., & Altman, G. (2010). Fundamental & advanced nursing skills. Clifton Park, NY: Delmar Cengage Learning.

Barker, J. H. (2009). Evidence-based practice for nurses. London: SAGE.

Kingsnorth, A.N., & Bowley, D. (2011). Fundamentals of surgical practice: A preparation guide for the intercollegiate MRCS examination. Cambridge: Cambridge University Press.

Radford, M., County, B. & Oakley, M. (2004). Advancing perioperative practice. Cheltenham, U.K: Nelson Thornes.

Simmers, L., Simmers-Nartker, K. & Simmers-Kobelak, S. (2009). Diversified health occupations. Clifton Park, NY: Delmar Cengage Learning.

Vanov, L.L., & Blue, C.L. (2007). Public health nursing: Leadership, policy, & practice. Australia: Delmar Cengage Delmar.