Critical Illness Evidence-Based Nutrition Practice Guideline - Essay Example

Evaluation of Guideline and Literature Review Analysis Blesson Varghese Jacksonville Evaluation of Guideline and Literature Review Analysis The guideline being evaluated at this instance was developed by the Academy of Nutrition and Dietetics and is titled ‘Critical Illness Evidence Based Nutrition Practice Guideline’ (Academy of Nutrition and Dietetics, 2012). The existence of this guideline is very important to nursing and Evidence Based Practices because it is useful in extending information in the field. In the writing of this guideline, there were specific objectives in mind that aimed at satisfying knowledge needs of evidence based practices in nursing while at the same time bridging gaps between evidence based practices in nursing and nursing practitioners. On the other hand, this guideline is important due to the general objectives that it posed. Among the objectives include helping practicing nurses to make informed decisions when it comes to trying and testing evidence based practices and to offer guidelines through which the nurses and nursing as a profession can develop values and professional practices that depend on this aspect (Academy of Nutrition and Dietetics, 2012). In this analysis, an evaluation guideline in addition to the reviewing of literature concerning evidence based practices has been done and through the paper, it can be observed that evidence based practice is supported by most people in organizations and how evidence based practices can be implemented is analogous. Literature Review One of the theories that relates to the nursing practice and evidence based practices is Carper’s four fundamental patterns of knowing (Schmidt, Nelson & Godfrey, 2003). In nursing, these patterns of knowing include empirical, ethical, personal and aesthetic factors (Schmidt, Nelson & Godfrey, 2003). In evidence-based practices in nursing, these patterns are essential because they assist nurses and other professionals in healthcare to engage evidence based care in the right manner and to the right extents. One of the ways in which personal factors on Carper’s fundamental patterns of knowing is personal factors and the role it plays in evidence based practice (Schmidt, Nelson & Godfrey, 2003). In these practices, the personalities of nurses and their various experiences in their profession relate to evidence based practices as it determines how they will embrace the practices (Dalheim et al., 2012). Secondly, the ethical factor is also related to the reviewed literature because in evidence based practices, personal and professional factors which are ethical play an important role in the success of the practices (Mashiach-Eizenberg, 2010). This theory can be applied to evidence based practices in nursing to see their successful adoption and implementation. The four patterns of knowing which include empirical, ethical, personal and aesthetic factors can shape the moral development of the nurses and make them less resistant to evidence based practices (Schmidt, Nelson & Godfrey, 2003). Ethics go hand in hand with the professional performance of an individual. As thus, if nurses tend to shape their personal and professional ethical factors to align to the ethical systems in their organizations, there is a very high possibility that they will be better aligned to receive evidence based practices. On the other hand, aesthetics are also influential in evidence based practices. One of the aesthetic factors that impacts a nurse’s work performance is their culture (Schmidt, Nelson & Godfrey, 2003). When in a work situation and faced with a work scenario, a nurse usually relates the scenario to their culture and gauges it on whether it can be accepted or not. If the response is negative, they may perceive the practice as wrong, but if it is positive they will be better placed to embrace them (Schmidt, Nelson & Godfrey, 2003). Empirical factors, which are the factors that are observed rather than those which are theorized act as important constituents in ensuring that evidence based practice either fails or succeeds (Schmidt, Nelson & Godfrey, 2003). This is because whatever that the eye sees and the mind observes sticks (Schmidt, Nelson & Godfrey, 2003). When a positive experience is observed by the mind and seen by the eye, it will be satisfactory to be repeated again but a negative experience will always be avoided. As thus, nurses need to engage with suggested evidence based practices and see the results that are yielded so as to gauge them on their own. On the other hand, the personality of a nurse should also be important in evidence based practice. This means that nurses should be ready to learn and to accommodate situations that mean good to their organizations as a whole. If this is possible, it will be easier for them to embrace the practices of evidence based management. Factors that impact Evidence Based Practice in Nursing One of the research journal articles reviewed is titled ‘A review of evidence‐based practice, nursing research and reflection: levelling the hierarchy’ by Mantzoukas (2008). In his journal, he was interested in studying evidence based practice and its relationship to reflective practices (Mantzoukas, 2008). In his study, he was able to realize that evidence based practices are more of benefit to an organization as compared to other similar practices (Mantzoukas, 2008). This was after hierarchical forms of practice were compared to evidence based practices(Mantzoukas, 2008). In the findings, it was realized that there are some factors in organizations that are responsible for impacting evidence based practices in nursing (Mantzoukas, 2008). One of the factors that has been observed to impact these practices is political ideologies (Mantzoukas, 2008). This is because when politics are given space in organizations, there is likelihood that the people in organizations will be manipulated and in the process, they may end up following political ideologies and abandon evidence based practices that can be functional (Mantzoukas, 2008). Ideological limitations have also been theorized as to impact the benefits that come with evidence based practices and in the process, counter such practices from being implemented (Mantzoukas, 2008). Ideologies are representations of people’s perceptions and the extent to which they believe in some aspects and hold disbeliefs ion others (Mantzoukas, 2008). As thus, a nursing leader can overlook evidence based practices and instead, choose to go with what they feel is best for them (Mantzoukas, 2008). As this happens, such ideologies take the front seat while evidence based practices are largely overlooked (Mantzoukas, 2008). Dalheim et al. (2012) has also discussed other factors that impact evidence based practice in nursing in their research journal known as ‘Factors influencing the development of evidence-based practice among nurses: a self-report survey’. Experience as noted by the authors of this research journal impacts evidence based practices greatly as nurses are involved in their day to day activities in their work settings, they take note of their practice routines, observe what works in certain situations, what does not usually work and the common factors that work across most practices, if not all (Dalheim et al., 2012). As thus, nurses that have a vast deal of experience are better placed to work better when it comes to evidence based practices as compared to those that do not have experience or are just fresh in the nursing profession (Dalheim et al., 2012). On the other hand, the extent of knowledge that a nurse is also responsible for checking on the manner and extent to which a nurse will be able to embrace evidence based practice in nursing (Dalheim et al., 2012). When the number of years before a nurse obtained any professional nursing certificate are many, there is a likelihood that such a nurse will have lee knowledge concerning evidence based practices and the crucial role they can play in an institution of health (Dalheim et al., 2012). Experience comes with age (Dalheim et al., 2012). As a nurse work more in the profession, their number of years in the service increases and in the process, they become more experienced. Thus, such a nurse gets to test and experience most of the evidence based practices in nursing, and understands those that work best and where (Dalheim et al., 2012). This means that age is another factor that impacts evidence based practices and that the aged a nurse becomes, the more they are able to embrace evidence based practices and encourage them on their peers . Through this, it was observed that the acquisition of skill is a good way in which evidence based practices can be implemented easily in a health institution (Dalheim et al., 2012). How to effectively adopt evidence based practices in Nursing In the studies that were conducted by Majid et al. (2011) known as ‘Adopting evidence-based practice in clinical decision making: nurses perceptions, knowledge, and barriers’ in 2011, it was observed that most of the nurses in the nursing profession do not have an issue with evidence based practices. In fact, 64% of nurses in Australia expressed their support for this practice (Majid et al., 2011). However, they cited some factors which make evidence based practices not to go down well with them as if they embrace it; they will be on the losing end. One of the factors that undermine embracing of evidence based practices is heavy workloads (Majid et al., 2011). This is because evidence based practices need some time for them to be implemented and when they are being introduced in an organization they may cause the nurses to see them as ways in which their workload will be increased causing them to work more than the current shifts. With this in mind, there is a need for leaders in health care settings to ensure that the introduction of evidence based practices and aspects come hand in hand with sufficient information on how they will be implemented. Inability to understand statistical forms acts as a major barrier to the proper implementation of evidence based practices (Majid et al., 2011). With evidence based practices, there comes some statistical data that accompanies the information and that are used to explain how and why the practices work. However, when nurses do not understand these statistics, they will see them as a total waste of time and in the process, they will develop some form of resistance to the practices that are about to be introduced (Majid et al., 2011). At this point, there is a need for the statistics to be explained in a clear and vivid manner to the people that they will impact so that the resistance that they may develop or that they may be having within them about evidence based practices is dealt some blows. Majid et al. (2011) also identified one other reason as to why evidence based practices in the nursing profession face stiff opposition from practitioners. According to them, the jargon that is used by researchers in research articles about evidence based practices becomes pretty hard to understand (Majid et al., 2011). As this is so, a nurse poses a lesser understanding of which evidence based practices work and how they work. On the other hand, these journals seem to confuse nurses on evidence based practices even more. In the case that a health institution needs to check on this aspect and give clear information on the practices. Rycroft-Malone et al. (2004) have also extended information on the best practices in the successful implementation of evidence based practices. In their journal titled ‘An exploration of the factors that influence the implementation of evidence into practice’, they have identified some practical reasons and factors that contribute to failure to properly implement evidence based practices. The nature and role of evidence based practices deeply determines the success that can follow the introduction of evidence based practices in the nursing profession (Rycroft-Malone et al., 2004). When the role that is to be played by the evidence based practice that is to be introduced is clear and relevant, there is a possibility that this practice will be more embraced as compared to one that will be lacking the aspects. On the other hand, the relevance of an evidence based practice to the activities and roles of an organization is also vital (Rycroft-Malone et al., 2004). As the need for the practice can be seen during the day to day activities of an organization, the more the aspect will be embraced and allow the management and leadership of the organization easy transition. The resources that have been used in the evidence based practices also have a part to play in the success of the practice (Rycroft-Malone et al., 2004). The weaker the resources to support the practice, the more opposition that they will face from the people it is intended for, as thus, organizations in the healthcare sector need to use strong evidence and resources so that they can convince the nursing profession that the practices are truly effective and embracing them will bring in more benefits to the organization. In general, there is a need for a checklist that will oversee the successful implementation of evidence based practices Evidence Based Implementation of Evidence Based Practices Evidence based practices are a necessity in the nursing profession and in the healthcare sector as a whole. However, their implementation does not usually follow the recommended criteria and in the process, they face a lot of criticism and resistance. Van Archtenberg, Schoonhoven & Grol (2008) identified this gap and did a research to counter the issue and suggested some observations that need to be incorporated in the implementation of evidence based practices. In the research article title ‘Nursing Implementation Science: How Evidence Based Nursing Requires Evidence-Based Implementation’, they identified decision support as one of the ways in which implementation of evidence based practices can be effective (Van Archtenberg, Schoonhoven & Grol, 2008). In decision support, the members of an organization and in this case nurses should be informed on the decision that is about to be made and then ask for their support in deciding whether it is right to implement the practice or not. This will be an assurance that if the practice is supported at this stage, its implementation will be easier and smooth sailing. Another factor that was identified in this implementation is the use of rewards (Van Archtenberg, Schoonhoven & Grol, 2008). The use of rewards is a way in which employees or any other person can be motivated in order to do or embrace something. As thus, incorporating rewards in evidence based practices, their reception will be warm. An example of the way in which evidence based practices can be rewarding is a definition of how the implementation of the strategy will be of good use is through explaining how workload can be greatly reduced if a certain evidence based practice is adopted or the manner in which work will be made easier if at all the strategy is adopted. How Nurses can Improve their Perception of Evidence Based Practice Both personal and professional factors hinder evidence based practices and their perception of nurses. However, this observation provides some points of which can be used to establish how the nurses can enhance how they perceive these practices. In the journal by Eizenberg (2011) which is titled ‘Implementation of Evidence Based Practice: Nurses Personal and Professional Factors’, there are a host of factors that have been identified and which include accessing evidence based practices research journals in libraries so as to extend their knowledge, searching and reading professional literature, interacting with colleagues on the importance and relevance of the practices to their organizations and enhancing their professional value by enrolling in classes of advanced learning (Eizenberg, 2011). All these factors need to be observed in the right proportions so that they can be able to help the organization in the successful implementation of these practices. Recommendations From the selected articles, it can be argued that they support the used guideline because the findings that are presented in the articles all have a reflection that is reflected in the guideline. The guideline is on point and if there are changes that need to be implemented in it, they are minimal. One of the recommendations that can be traced from the articles reviewed is the factors that impact welcoming of evidence based practices, which include personal and professional. As thus, the factors should be studied to see how they could be modified to suit evidence based practices. Another recommendation from the guideline is the importance of evidence-based practices in nursing. These practices need implemented in the sector to ensure that only working criteria is applied in nursing and patient care. However, this recommendation needs to be laid down with care because not all evidence based practices will be relevant to all healthcare institutions. As thus, a practice needs to be properly investigated and all its basics counterchecked before it can be adopted by an institution. Areas for Future Research Before an organization can suggest evidence based practices to their workers, there is a need for them to portray the workability of the practices. For example, the selected guideline has discussed evidence based practices and how functional they have been in other organizations. This can be done through giving real accounts of other health institutions which had adopted the practice in the past, or which currently engaged them and expose how much they are working. Researchers can combine this information and make research journals that will be used as evidence in making nurses believe in these practices. On the other hand, there is a need for research on evidence based practices that work across the whole platform. This is because such practices can be adopted easily by all organizations since they have been proofed and tested by most people. However, the research that can be conducted on this aspect needs to be deep and extensive and should have considered all factors that lead to the classification of the evidence practices as uniform and applicable all across the nursing profession. Conclusion From the evaluation that has been done, it is clear that that evidence based practice is supported by most people in organizations and how evidence based practices can be implemented. However, the embrace that has been identified has a lot of hindrance factors and as thus; there is need for them to be worked on thoroughly as a way of ensuring that they are properly implemented. In the six articles that have been reviewed in relation to the selected guideline, there is evidence that personal and professional factors are among the main factors that impact evidence based practices alongside improper introduction and impositions. In an overview, there is need for all the industry players in the nursing profession to work in conjunction with the interests of their organizations and their well being in successfully implementing evidence based practices. References Academy of Nutrition and Dietetics. Critical illness evidence-based nutrition practice guideline. Chicago (IL): Academy of Nutrition and Dietetics; 2012. Various p.Dalheim, A., Harthug, S., Nilsen, R. M., & Nortvedt, M. W. (2012). Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC health services research, 12(1), 367. Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y. L., Chang, Y. K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses perceptions, knowledge, and barriers. Journal of the Medical Library Association: JMLA, 99(3), 229. Mantzoukas, S. (2008). A review of evidence‐based practice, nursing research and reflection: levelling the hierarchy. Journal of Clinical Nursing, 17(2), 214-223. Mashiach Eizenberg, M. (2011). Implementation of evidence‐based nursing practice: nurses’ personal and professional factors? Journal of advanced nursing, 67(1), 33-42. Rycroft‐Malone, J., Harvey, G., Seers, K., Kitson, A., McCormack, B., & Titchen, A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of clinical nursing, 13(8), 913-924. Schmidt, L. A., Nelson, D., & Godfrey, L. (2003). A clinical ladder program based on Carpers fundamental patterns of knowing in nursing. Journal of nursing administration, 33(3), 146-152. Van Achterberg, T., Schoonhoven, L., & Grol, R. (2008). Nursing Implementation Science: How Evidence‐Based Nursing Requires Evidence‐Based Implementation. Journal of Nursing Scholarship, 40(4), 302-310. Read More