The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [29]
Implementing evidence in practice
The implementation of evidence in practice in an organization, be that at a local level in a ward, throughout a hospital or in the community, can be demanding and requires planning, determination and time and the participation of individuals, teams and the organization to effect this change. It is beyond the scope of this chapter to cover the process in detail but some key factors to consider in the successful implementation of EBP are the evidence which has been explored in detail in this chapter, the context and facilitation (Rycroft-Malone et al. 2002, Scott and McSherry 2009). It can be useful to consider questions such as: how appropriate is the research to your group of patients/families/staff? Will the proposed research answer the issues you have? Is it transferable and is it justified to implement it? Did the design meet the stated research question and was the design appropriate? Was it methodologically rigorous?
Implementation of evidence in practice is most likely to occur when evidence is robust and inclusive, the context is receptive to change and the process is facilitated by someone who has the skills to effect change. Practice development teams in organizations are well placed to assist with the implementation of evidence in practice but the onus is also in the individual nurse who has a professional, moral and ethical duty to ensure that their practice is up to date, and who needs to willingly engage and apply evidence to practice.
Conclusion
This chapter has discussed the current context of healthcare, identifying the issues that influence the use and development of nursing procedures in the delivery of patient-centred care. The procedures in this book affect the whole person. They range from those that are observational and physically non-invasive to those involving intrusion into both the physical body and the psychological persona. The intent also varies; some are diagnostic, others therapeutic and some are supportive with the aim of increasing well-being. This chapter seeks to remind you of the importance of seeing procedures not just as tasks but as part of the whole for the patient.
It is important to remember that even if a procedure is very familiar to us and we are very confident in carrying it out, it may be new to the patient, so time must be taken to explain it and gain consent, even if this is only verbal consent. The diverse range of technical procedures that patients may be subjected to should act as a reminder not to lose sight of the unique person undergoing such procedures and the importance of individualized patient assessment in achieving this.
When a nurse
Encounters another
What occurs is never a neutral event
A pulse taken
Words exchanged
A touch
A healing moment
Two persons
Are never the same.
(Anon in Dossey et al. 2005)
Nurses have a central role to play in helping patients to manage the demands of the procedures described in this manual. It must not be forgotten that for the patient, the clinical procedure is part of a larger picture, which encompasses an appreciation of the unique experience of illness. Alongside this we need to be mindful of the evidence upon which we are basing the care we deliver. We hope that through increasing the clarity with which the evidence for the procedures in this edition is presented, you will be better able to underpin the care you deliver to your patients in your day-to-day practice.
Website
http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/COI_NHSConstitutionWEB2010.pdf.
References
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J. and Silber, J.H. (2002) Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction. JAMA, 288 (16), 1987–1993.
Arthur, D., Pang, S. and Wong, T. (2001) The effect of technology