Methods for Detecting Evidence in Tracheostomy - Research Paper Example

An Evaluation of a Best Practice Guideline: The Joanna Briggs Institute for Evidence Based Nursing and Midwifery (2000). Tracheal Suctioning of Adults with an Artificial Airway A. Determine the quality of the guideline and whether nursing knowledge is increased as a result of it. Based on the review conducted for the selected Best Practice Guideline by Joanna Briggs Institute about Tracheal Suctioning of Adults with an Artificial Airway, the quality of the paper is asserted to be above-average as it effectively illustrated the important information about the topic. Though there are some weaknesses which have been depicted such as the absence of clear and accurate clinical question(s), absence of procedure for updating the guideline, and difficulty to trace the key recommendations presented by the paper, nonetheless, it is still gauged as acceptable and recommendable for further learning of nurses and other health care providers. The paper can provide increased knowledge about tracheal suctioning and how it should be managed by the health care professional as based on many practical pieces of evidence. B. Apply your clinical experience and relevant literature to discuss the feasibility of implementation as evidenced-based practice. The Best Practice Guideline by Joanna Briggs Institute is gauged to be feasible for implementation as evidence-based practice in a clinical setting. Tracheostomy is described as a “long-established, routine procedure”, a widely used clinical intervention for patients suffering from airway obstruction or needing mechanical ventilation due to acute or chronic respiratory failure (Gilony et al, 2005). Despite its recognizable extensive application, nonetheless, it is also worth noting that such a procedure entails much more psychological and physically traumatic experience for patients (Sherlock et al, 2009). In this regard, tracheostomy care is highly regarded by clinicians and other health care providers. Whether as a permanent measure or temporary therapy, the goal of tracheostomy care is the same and this encompasses the assurance of airway patency through keeping the tube free from any mucus buildup; maintaining mucous membrane and skin integrity, and most especially is to prevent the acquisition of infection (Williams and Wilkins, 2007 p. 359). In this connection, the recommendations provided by the guideline are explicitly connected with supporting evidence. Likewise, as stressed by Elliott et al ( 2007, p. 58), the value of evidence-based nursing is in its identification of specific nursing practice that ought to enhance and evaluate current evidence which will imply the formulation of recommendations for improvement. Given this perspective, the guideline which was developed by the Joanna Briggs Institute has done its part in a very commendable manner. Using the thorough procedure of critically analyzing all existing papers related to tracheostomy, significant insights were are found vital for the enhancement of knowledge and skills of health care providers instead of tracheostomy management. C. Discuss the application of the Best Practice Guideline relating to potential organizational barriers and cost to an organization at a unit level. The guidelines set forth by the paper are considered applicable though it also suggests a little cost for the organization to provide better training of the staff by the proper management of tracheal suctioning of patients. It is gauged very important that the proper techniques are followed to ensure the effective management of patients with such a condition. The potential barrier in the application is for organizations that are deemed to be unable to adjust their routine instead of the guidelines provided by the paper. D. Domain and Aspects for critical reflection I. Scope and Purpose i. The overall objective of the guideline is specifically described       The overall aim or objective of the guideline is to provide evidence-based practice information sheets for health professionals about Tracheal Suctioning of Adults with Artificial Airway. Based on this aim it is clearly presented to the readers that the primary purpose of the guideline is to serve as an important source of information for nurses and other health care providers as regards the different types and effect of suctioning to patients and therefore derive knowledge and understanding about the important practices (based on evidences) which need to be performed in line with tracheal suctioning and its implications. The objective of the guideline is necessary as it answers the many comments of authors about the lack of sufficient knowledge (Choate et al, 2003, cited in Ward and Agiius, 2008, p. 265), confidence (Lewis and Oliver, 2005, cited in Ward and Agius, p. 265) and training (Heafield et al, 1999, cited in Ward and Agius, 2008, p. 265) of health care professionals in relation to management of complex clinical needs of patients with a tracheostomy tube. ii. The clinical questions covered by the guideline is specifically described In addition to this, it may also be noticed that practices and knowledge levels vary widely amongst health care professionals who are aligned with taking care of clients who underwent a tracheostomy. Nonetheless, no clinical question(s) is/are presented in the guideline which could provide a more specific direction for the study. On the other hand, the guideline covers some of the important concepts which could help in the learning process of nurses and other health care providers instead of tracheal suctioning of adults. These include the effects of suctioning, different suctioning techniques, oxygenation, suctioning patient subgroups, a summary of evidence and recommendations. iii. The patients to whom the guideline is meant to apply are specifically described. Instead of patients, the target population includes adult patients (>15 years) within the acute care hospital setting, with either an endotracheal tube or a tracheostomy tube in situ. The studies included both spontaneously breathing and/or artificially ventilated participants. The description given for the scope of covered concepts of the guideline as well as its targeted population is deemed clear and provided adequate information for the health care professionals. Rigour of Development iv. Systematic methods were used to search for the evidence.       A systematic method was used to search for evidence. All studies were categorized according to the strength of evidence-based on the following classification system: Level 1 – evidence obtained from a systematic review of all relevant randomized controlled trials; Level II – evidence obtained from at least one properly designed randomized controlled trial; Level III.1. – Evidence obtained from well-designed controlled trials without randomization; Level III.2. – evidence obtained from well-designed cohort or case-control analytic studies preferably from more than one center or research group; Level III.3. – evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments; Level IV – Opinion of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. v. The criteria for selecting the evidence are clearly described. The criteria for selecting the evidence are clearly described using gauging on the strength and quality of evidence-based of the studies which have been investigated. Accordingly, 504 papers referred to suctioning artificial airways and 95 of these have met the required inclusion criteria. vi. The methods used for formulating the recommendations are clearly described. The process of classifying the evidence is deemed accurate and necessary as this provides a better assessment of the importance of each recommendation. The methodology is described in a manner that is clear and accurate topromote better understanding of how recommendations were developed. vii. The health benefits, side effects and risks have been considered in formulating the recommendations. Apart from this, the guideline also considered the health benefits, side effects, and risks in the formulation of recommendations. As such, it was recommended that suctioning should only be done when a thorough assessment of the patient has been established regarding the necessity of such a procedure. It also ascertained that nurses ought to be gentle and manifest great procedural skills in terms of suctioning to prevent any complications or hazards associated with a tracheostomy. This is very important as patient safety is deemed the highest priority for health care providers (Clair, 2005). Moreover, the guideline also suggested important techniques and practices that nurses ought to adhere to for the proper and effective management of tracheostomy among adult patients. viii. There is an explicit link between the recommendations and the supporting evidence It is indeed asserted that the guidelines are deemed interconnected with supporting evidence found in literature as regards tracheostomy and its effective management. Since the paper formulated its recommendation based on practical evidences observed in various clinical settings derived from all researches about tracheostomy. Therefore, it is also believed that all the recommendations are indeed applicable and can be recommended for integration into the clinical setting. ix. A procedure for updating the guideline is provided. On the other hand, part of the assessment of rigor development is the provision of procedures that will help update the guideline if necessary. However, based on the Best Practice Guidelines of Joanna Briggs, the paper has not provided any procedure to cater to this particular task. Nonetheless, what it has offered to the readers is a warning that only those who have appropriate expertise in tracheostomy are allowed to use the guideline and that application of any information should first establish prior reliance. Clarity and Presentation x. The recommendations are specific and unambiguous. In regards to the presented recommendation of the guideline, each statement is clear and straight to the point. All items have precisely targeted the main objective of the study which is to derive pertinent information about tracheal suctioning of patients with an artificial airway that is also congruent to obtaining a comprehensive understanding for effective management of such condition. xi. The different options for management of the condition are clearly presented. It also shows different options for management of the condition which provides nurses and other health care professionals with clear instructions on how to effectively manage such conditions. xii. Key recommendations are easily identifiable. Nonetheless, gauging what seemed to be the key recommendations may be difficult as the presentation entails a continued flow of instructions and no format for emphasis has been projected. xiii. The guideline is supported with tools for application Even though the paper lacks a presentation of key recommendations among its list, each statement has an indicator of the level of evidence that supports the recommendation. In this manner, the tools applied for the study is also linked to the formulation of recommendations.    Summary The Best Practice Guideline for tracheal suctioning of adults with artificial airway by the Joanna Briggs Institute (2000) is deemed commendable for clinical practice as it effectively gauged on a wide array of researches pertaining on tracheostomy and applied critical analysis on this dearth of studies in order to derive a meaningful classification of evidence according to strength and quality of studies gauged. The recommendations given are straight to the point and accurate as each depicts the potential risk or negative implication associated with the condition. Nurses and other health care providers will gain adequate knowledge and information about tracheostomy and other related concepts in this guideline. More importantly, the evidence that has been gauged by the study in ordtolate the recommendations has been evaluated according to strength and quality. Therefore, it is assured that the recommendations given are highly credible.                     References Clair, J. (2005). A new model of tracheostomy care: closing the research-practice gap. Advance in Patient Safety, 3. Elliott, D., Aitken, L. and Chaboyer, W. (2007). ACCCN’s Critical Care Nursing. Elsevier Australia. Sherlock, ZV, Wilson, JA, Exley, C. (2009). Tracheostomy in the acute setting: Patient experience an dinformation needs. Journal of Criitcal Care. Elsevier, 1 -7. Ward, E., Agius, E., Solley, M., et al. (2008). Preparation, clinical support, and confidence of speech-language pathologists. American Journal of Speech – Language Pathology, 17(3), 265. Williams, L., Wilkins, L. (2007). Best practice: evidence-based nursing procedures. (2nd Ed.,). Lippincott Williams and Wilkins.   Read More