discussion post replies
Reply to at least two of your classmates. Review two of your peers’ posts and in your reply posts, what suggestions can you offer them? Share and describe an EBP article that may help them with their project.
Reply posts are expected to be at least 1–2 paragraphs in length and use at least 1–2 scholarly citations to support your statements to meet expectations.
Discussion 1:
Evidence-based practice (EBP) in nursing involves using the latest clinical knowledge, research findings, and patient preferences to improve patient safety and overall well-being (Connor et al., 2023; Dusin et al., 2023). EBP makes sure treatments are based on the best evidence, making them more likely to help patients. Instead of just going by personal experiences or intuition, healthcare providers use proven methods, leading to better care quality and reduced incidences of adverse outcomes. EBP starts through learning, for example, in nursing school, both bachelor’s and graduate programs, students don’t just learn theory; they also gain hands-on experience applying EBP in real-world settings. This could mean joining research projects, reviewing literature, and participating in clinical rotations.
At my workplace, I’ve observed a clinical gap in the continuity of care for psychiatric patients. Often, when patients are discharged, they should have planned accommodations, like a halfway house or a shelter, and their medications should be reconciled until they’re able to see their outside providers. However, patients are frequently discharged without proper planning. There have been incidents where their PT-1 transportation services have brought them back because the receiving halfway house wasn’t aware they were coming. In a study by Smith et al. (2023), it was observed that when inpatient psychiatric hospitals plan for a patient’s discharge before they leave, it increases the likelihood that they’ll continue to receive care once they’re out.
Another gap noticed is that we don’t fully provide patient-centered care. Besides the medications that are tailored to individual patients, other aspects like Cognitive Behavioral Therapy (CBT) self-help strategies and group sessions tend to be generalized. It is disappointing to note that sometimes we lack the time to meet patients one-on-one to truly understand their needs, largely due to inadequate staffing and bureaucratic obstacles. In my role as a unit nurse, I focus on discharge planning when I’m in charge. I make sure to remind the treatment team to gather everything the patient needs before discharge, aiming to help them transition to stable living outside, although it’s not always possible due to factors beyond our control. Additionally, during assessments, I try and take extra time to ask additional questions, ensuring I thoroughly check in on the patients’ mental well-being.
References
Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P., Hole, A., Moore, L. J., Brown, R., Melnyk, B. M., & Gallagher‐Ford, L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence-based Nursing, 20(1), 6–15. https://doi.org/10.1111/wvn.12621
Dusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting: a scoping review. BMJ Open, 13(5), e071188. https://doi.org/10.1136/bmjopen-2022-071188
Smith, T. E., Haselden, M., Corbeil, T., Wall, M. M., Tang, F., Essock, S. M., Frimpong, E., Goldman, M. L., Mascayano, F., Radigan, M., Schneider, M., Wang, R., Rodgers, I., Dixon, L. B., & Olfson, M. (2022). The effectiveness of discharge planning for psychiatric inpatients with varying levels of preadmission engagement in care. Psychiatric Services, 73(2), 149–157. https://doi.org/10.1176/appi.ps.202000863
Discussion 2:
The process of reviewing, interpreting, and analyzing the most recent scientific data is known as evidence-based practice (EBP). The objective is to swiftly apply the most up-to-date research to clinical practice while also taking patient preferences and clinical experience into account (John Hopkins Medicine, 2023).
Clinical practice gaps may come in multiple forms. There may be gaps in knowledge, competency, performance, or in patient outcomes (Explanation of Gaps, Needs, Objectives and Needs Sources, n.d.). Some examples from my workplace that come to mind is the interaction between staff and the Moroccan patients. Many staff do not know that the Moroccan dialect is only about 46% similar to traditional Arabic so when they call for an interpreter who does not speak the correct dialect, less than half of what is said is understood and the rest is lost in translation. I have been working with our interpreter services to differentiate on the patient’s chart which dialect they speak so that staff can call for the correct interpreter. They are also working to ensure that the interpreters that answer the call for a Moroccan Arabic interpreter are actually from that area and can speak and understand that dialect. Currently they have interpreters from the middle east whose dialect is still very different than the one our patients need. My observation of the patient’s frustration about not being understood and not being able to understand the interpreters or staff has lead to my interest in the project I will be focusing on for my dissertation, which is to help bridge the gap in care and knowledge between staff and the patients from the Moroccan community.
One gap in knowledge I personally experienced is when my patient who was on narcotics for decades was no longer able to achieve analgesia from her narcotics. This patient had also had multiple overdoses from her prescribed narcotics so we wanted to find a safer alternative. I discussed switching to Suboxone with them and they were in agreement to do so but being on narcotics currently and Tramadol, I didn’t know how to initiate Suboxone without having her go into withdrawals. The local pain clinic wouldn’t prescribe Suboxone for her and she couldn’t accept the diagnosis of substance abuse to be able to get it from our recovery center prescribers. I ended up doing a lot of research and summited for an electronic consult of a recovery and pain specialist through our EMR system in partnership with external vendor that provides these consults to ask for recommendations. They gave me a schedule of how much to taper off the narcotics, bridge Tramadol and initiate Suboxone in low doses and gradually increase that while also decreasing the other substances to prevent withdrawal or adverse events. This is called the Bernese Method (Menard & Jhawar, 2021).
There is a gap in the research focusing on Moroccan patients, so all the more reason I conduct this project. The only article I found was about Moroccan patients in a clinic in Spain and the nurse’s perception of these patients (Plaza et al, 2013). It does not discuss steps that could be taken to help bridge this gap, it does not discuss different dialects, and it does not provide guidelines for the medical staff in how to interact and better care for this population. However, I found a link from University of Vermont OT class where they had an immersive trip to Morocco and it helped cultivate their understanding of cultural humility and sensitivity (White, 2024) by incorporating their skillset in different settings like orphanages and schools and partook in other festivities like henna night, ate the cuisine and lived with the Moroccans as neighbors and peers to better understand them.
References:
Explanation of Gaps, Needs, Objectives and Needs Sources. (n.d.). UC Davis Health. https://health.ucdavis.edu/media-resources/cme/doc…
John Hopkins Medicine. (2023). Evidence-Based Practice. Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/nursing/center-nur…
Menard, S., & Jhawar, A. (2021). Microdose induction of buprenorphine-naloxone in a patient using high dose methadone: A case report. The mental health clinician, 11(6), 369–372. https://doi.org/10.9740/mhc.2021.11.369
Plaza Del Pino, F. J., Soriano, E., & Higginbottom, G. M. (2013). Sociocultural and linguistic boundaries influencing intercultural communication between nurses and Moroccan patients in southern Spain: a focused ethnography. BMC nursing, 12, 14. https://doi.org/10.1186/1472-6955-12-14
White, S. (2024, January 13). New Occupational Therapy Course Promotes Cultural Humility. The University of Vermont. https://www.uvm.edu/news/cnhs/new-occupational-the…
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