tyle=”text-align: justify;”>Evidence Based Nursing
In the summative assessment the student will submit an assignment focused on understanding the importance of research and evidence based nursing in informing their clinical practice and will include a critique of a research paper using a critiquing tool.
a An essay of 3000 words in which the importance of evidenced based nursing and research will be discussed. Then the student will pick one original research article relevant to nursing and critique it using an established tool or framework.
b) Areas to be addressed could include;
A description of Evidence based nursing.
The history and recent origins of evidenced based practice and evidence based nursing.
The benefits and potential drawbacks of EBN.
The article chosen should be an original research article and not a literature review or opinion iece or editorial. The research should be relevant to nursing. There are a large number of research critique frameworks. Choose one and use this to critique your article.
In the article you need to focus on understanding the importance of research and evidence based nursing in informing their clinical practice and will include a critique of a research paper using a critiquing tool.
a An essay of 3000 words in which the importance of evidenced based nursing and research will be discussed. Then the student will pick one original research article relevant to nursing and critique it using an established tool or framework.
b) Areas to be addressed could include;
A description of Evidence based nursing.
The history and recent origins of evidenced based practice and evidence based nursing.
The benefits and potential drawbacks of EBN.
The article chosen should be an original research article and not a literature review or opinion iece or editorial. The research should be relevant to nursing. There are a large number of research critique frameworks. Choose one and use this to critique your article.
Please include theses points in the article
1. Write about the evidence based practice (EPB) history especially for nursing
2. How can we spread the information for EPB to the medical felid
3. What is good or bad about EBP for people and the complication of it
4. How company use research and how they use it for their own good
5. Write about research and what is it and the different kind of research and how important is it for nursing
6. The complication of research and the barriers for some research like ethic
7. Write about 1000 word for the above points.
For referencing http://www.ukessays.com/tools/harvard-referencing/
The following should be used to guide the presentation of your work:
• You must ensure that the length of your project conforms to the word limit, +/ – 10%
• Your project should be typed, using Ariel Size 12 font, double spaced with at least 2.5cm margins
• The work should appear as a continuous piece of prose, subheadings should not be used
• The reference list should appear starting on a separate page, immediately after the assignment. Any appendices should be included at the end.
• Referencing must follow the Harvard System. There are a number of software products that can organize your sources automatically (Endnote, Endnote Plus and Papyrus).
• On the title page you must include the following elements:
26 AJN ? June 2011 ? Vol. 111, No. 6 ajnonline.com
Tragedy into Policy: A Quantitative Study of Nurses’ Attitudes Toward Patient Advocacy Activities
The study findings lead to new legal protections for Nevada whistleblowers.
Continuing Education
3
hours
original research
By Lisa M. Black, PhD, RN, CNE
Although the Centers for Disease Control and Prevention (CDC) reports that an estimated 3.2 million Americans are living with chronic hepatitis C, in southern Nevada fewer than four cases of acute hepatitis C are confirmed annually.1, 2 So when six people who had recently undergone endoscopic procedures were diagnosed with acute hepatitis C within a six-month period (July 2007 to December 2007), alarms were sounded.1 Ultimately, more than 62,000 patients who had undergone endoscopic procedures at either of two southern Nevada endoscopy clinics would be notified that they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.3 In total, seven patients would be confirmed as having clinic-associated HCV infections that were genetically linked to source patients; two more had clinic-associated HCV infections that could not be so genetically linked; and an additional 106 patients were presumptively diagnosed with “possible clinic-associated HCV infection.”3, 4 This appears to be the largest nosocomial patient exposure to a bloodborne pathogen in the United States ever documented in the literature.
BACKGROUND
In January 2008, the CDC, the Nevada State Health Division, and the Southern Nevada Health District began a joint epidemiologic investigation. The investigators found multiple breaches of infection control and record-keeping protocols at the two Las Vegas–area clinics, including the reuse of syringes, medication vials,
ABSABSABS
TRACRACRACT
Background: In 2007 and 2008, 115 patients were found to be either certainly or presumptively infected with the hepatitis C virus through the reuse of contaminated medication vials at two southern Nevada endoscopy clinics. A subsequent joint investigation by federal and state agencies found multiple breaches of infection control protocols. There was also strong anecdotal evidence that among clinic staff, unsafe patient care conditions often went unreported because of a general fear of retaliation. At the request of the Nevada legislature’s Legislative Committee on Health Care, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. This article presents the study findings and reviews how one public health tragedy led to the creation of effective health care policy.
Methods: A study questionnaire was developed and tested for reliability and validity. Questionnaires were then sent to an initial sample of 1,725 Nevada RNs, representing 10% of all RNs in the Nevada State Board of Nursing database with active licenses and current Nevada addresses.
Results: The response rate was modest at 33% (564 respondents). Of those who responded, 34% indicated that they’d been aware of a patient care condition that could have caused harm to a patient, yet hadn’t reported it. The most common reasons given for nonreporting included fears of workplace retaliation (44%) and a belief that nothing would come of reports that were made (38%).
Conclusions: The study findings underscore the need for a shift in organizational culture toward one that encourages clear and open communication when patient safety may be in jeopardy. These findings were ultimately used to support the passage of whistleblower protection legislation in Nevada.
Keywords: Las Vegas hepatitis C outbreak, patient advocacy, whistleblower.
ajn@wolterskluwer.com AJN ? June 2011 ? Vol. 111, No. 6 27
bite blocks (devices placed in the mouth during upper endoscopies), and other equipment intended for single use.4, 5 At one clinic, the staff reported that “the rule was to reuse single-use equipment three times if possible.”5 The clinic staff also reported that they were “only allowed to use four bite blocks per day per procedure room,” regardless of the number of procedures performed, and were “directed to reuse syringes”; purchasing records supported both statements. The investigators themselves observed “the reuse of ‘single-use’ [medication] vials for multiple patients.”
It bears emphasizing that single-use items aren’t designed for reuse on another patient. The Society of Gastroenterology Nurses and Associates has stated that “critical medical devices” (devices introduced into the bloodstream or other sterile areas of the body) that are intended for single use should not be reused.6 They note that original equipment manufacturers must conduct rigorous testing to verify that a reusable item can be reliably cleaned and if necessary sterilized; and that the Food and Drug Administration requires equipment reprocessors to demonstrate that a reprocessed device is “substantially equivalent” to a newly manufactured device.6, 7
The investigators concluded that the Las Vegas–area nosocomial hepatitis C outbreak likely resulted from the use of contaminated syringes to reaccess single-use medication vials; the syringes were then used to administer procedural sedation to subsequent patients.4
The specific failures in this situation didn’t seem to stem from a lack of knowledge about proper infection control practices. On the contrary, one RN reported to the investigators that he had observed the reuse of contaminated syringes on multiple occasions and had complained to clinic management about the practice.5 Another RN reported quitting after one day of work because of concerns about equipment reuse.5 She stated that when she voiced complaints about this and faulty record-keeping practices at the clinic to other staff members, she was told that was “how things were done there.”
Nurses who were employed at the clinics told the executive director of the Nevada Hepatitis C Task Force that they feared being “fired, mistreated, or blackballed” if they were to report unsafe practices.8 Because the events at the clinics remain the subject of ongoing civil, administrative, and criminal proceedings, many details aren’t publicly available; whether direct retaliatory activities were taking place at the clinics cannot yet be verified. That said, there’s strong anecdotal evidence that a general fear of retaliation existed such that unsafe practices were not reported.8
WHAT THE LITERATURE REVEALS
While several government reports have urged the open reporting of concerns about the quality and safety of patient care,9-11 underreporting of quality problems and adverse events is common.12-17 The antecedents and consequences of whistleblowing, as well as the beliefs and values of whistleblowers, haven’t been well described in the literature. Nor is there a single accepted definition of whistleblowing. Bolsin and colleagues offer this: “the attempt, in good faith and in the public interest, to disclose and resolve in a reasonable and non–vexatious manner, but in the face of significant institutional or professional opposition, a significant deficiency in the quality or safety of health care.”13
McDonald and Ahern noted in 2000 that the bulk of nursing research specific to whistleblowing has been theoretical in nature rather than empirical,18 and that has remained true over the past decade. Still, there are some valuable findings. McDonald and Ahern’s survey of nurses in western Australia found numerous negative professional consequences of whistleblowing, including demotion, pressure to resign, and referral to mental health providers.18 A study by Attree, conducted with British RNs, identified fear of repercussions, an unsupportive organizational climate, labeling, and blame as barriers to nurses’ reporting both actual and potential threats to patient safety.12 Nurses also risk what’s been termed “moral compromise” when there’s a conflict between their duty to advocate patient safety and real or perceived pressure from an employer to do otherwise in order to remain employed.12, 19 Studies also indicate that nurses have not reported patient safety threats because they believed their concerns would be ignored.20 And Ray attributed an instance of external whistleblowing to the organization’s failure to meet its ethical obligations, and argued for an organizational infrastructure that fosters ethical and effective policymaking.21
Nurses risk “moral compromise” when there’s a conflict between their duty to advocate patient safety and real or perceived pressure from an employer to do otherwise.
28 AJN ? June 2011 ? Vol. 111, No. 6 ajnonline.com
Fears of reprisal are frequently described in the literature that discusses professional consequences of whistleblowing18, 22 and explores nurses’ reasons both for reporting poor practice and for failing to so report.20, 23, 24 Such fears may be further fueled by media coverage of nurses who have been persecuted and even prosecuted for reporting practices and situations potentially dangerous to patients. One striking recent example was the case of Texas whistleblowers Vicki Galle and Anne Mitchell, two RNs who were criminally prosecuted in 2009 for “misuse of official information,” a felony, after they reported a physician to the Texas Medical Board out of concern that his practices were below the acceptable standard of care. Although the charges against Vicki Galle were dismissed one week before the February 8, 2010, trial date, and although Anne Mitchell was swiftly acquitted, they told the New York Times that the case had “derailed” their careers and “stained their reputations and drained their savings.”25 The expenses they incurred and the damages to their reputations and employment prospects understandably give other nurses reason to be wary when making similar reports. (For details of the case and its aftermath, see Winkler County Nurses Update at http://bit.ly/hIy9kE.)
The American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements calls on nurses to be accountable professionals; yet it fails to acknowledge that few protections exist for those who report unsafe patient care conditions.26 Indeed, although the Texas case marks the first time that nurses have been criminally prosecuted for reporting patient care concerns, cases in which nurses have been sanctioned, fired, or otherwise retaliated against have been commonly reported.12, 18 Such reports notwithstanding, nurses remain under mandate to protect patients from threats of which they are aware. Failure to do so is often considered to be unprofessional conduct by state boards of nursing.27
A catch-22. While nurses have a legal and moral imperative to protect patients from harm, they may also face the very real threat of employment loss for reporting unsafe practices. This is particularly true in states like Nevada where employment is “at will.” Under the employment-at-will doctrine, employment is noncontractual and of indefinite duration; employees can be terminated for “good cause, bad cause, or no cause at all.”28 Such terms place nurses who witness unsafe practices in a difficult catch-22: if they report unsafe practices, they risk losing their jobs; if they don’t, they risk losing their licenses. Nurses can find themselves forced to gamble with patient safety in order to keep their jobs and reputations, especially when they lack confidence in their facility’s reporting system.12
The findings of the joint investigation into the Las Vegas hepatitis C outbreak strongly suggest that many nurses were aware of unsafe practices that hadn’t been reported.1, 5 Ultimately, 22 RNs and LPNs were investigated in connection with the outbreak; several are still under investigation by the Nevada State Board of Nursing (NSBN) for alleged violations that included failure to safeguard a patient, failure to properly document care, falsification of documentation, and failure to conform to customary standards of practice (Debra Scott, NSBN executive director, e-mail communication, September 7, 2010). At least two certified registered nurse anesthetists were also found to have actively engaged in unsafe practices.3 Nurses who knowingly failed to safeguard patients from the “incompetent, abusive or illegal practice of any person” were in violation of the Nevada Nurse Practice Act’s Unprofessional Conduct Regulation,29 and were subject to licensure sanction by the NSBN. It remains unclear exactly how
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