Evidence-Based Practice in Neonatal Nursing - Term Paper Example

Name Instructor Course Date Introduction The competence and effective performance of nurses in providing care for the patients depends on their activities based on the best available evidence. Evidence-based practise in the nursing sector deals with the combination of the best available research evidence with clinical proficiency as well as the values of the patients, and the careful use of the substantiation in deciding the type of care that should be given to each patient. Nurses are, therefore, devoted to the provision of care to the patients to reach the desired treatment requirements. The evidence-based practise in nursing consists of five distinct stages. These include; devising a question expected to give the most appropriate answer. The clinical questions asked here cover the patient population, the issues, comparison groups, outcome and the time frame. Asking the clinical questions in this manner helps in finding the most relevant search related to the topic. This is followed by gathering the most important information from literature searches and clinical guidelines, conducting critical assessment of the evidence, combining the research evidence with the clinical experience, patient values and preferences and evaluating the clinical outcomes (Kenner and Lott, 2013, p. 850). In neonatal nursing, however, the focus is mainly on the new-born infants. It is defined as the branch of nursing that mainly deals with the new-born infants with different problems such as birth defects, prematurity, cardiac deformities and surgical problems. Although the neonatal period is considered as the first month of birth, some infants remain sick for several months (Meeks et al., 2013, p. 103) This suggests that neonatal nursing is not only concern with the provision of care for newly born infants but also those that experience birth complications for an extended period of time. Some neonatal nurses can take care of the infants up to a period of two years although in many cases, neonatal care ceases when the infant are discharged from the hospitals. This paper seeks to explore the extent of literature in evidence-based practise in neonatal nursing while identifying research gaps and summarising the research findings. Discussion Evidence based practise has been in neonatal nursing has been discussed in literature by many authors globally, with the World Health Organization and the European Commission insisting that provision of health and social services should be centred around the best research evidence. The methodology requires that the decisions regarding health care should be based on the current, pertinent and up to date evidence. Also, such decisions should be made by those receiving care, aided by the knowledge and experience of the caregivers within the limits of the available resources. Therefore, the implementation of evidence based practise in neonatal nursing involves the use of EBP steps and practises to promote the combination of evidence based research and the expertise of the caregivers. According to literature, there are many causes of neonatal conditions in infants forcing them to be cared for in the Neonatal Intensive Care Units (NICU). A common problem in new born infants is low birth weight in which the infants weigh less than 2500 grams at birth. Longer hospitalization periods of such infants commonly result from their inability to register any appropriate weight gain. Also, the longer stay of infants in the NICU due to low birth weight can result in the increase in hospital infections as well as increased costs. According to Salehi et al (2015, p. 2), the evidence based nursing practises involves are golden principles for the provision of nursing care. The performances are based on the evidence of the best researches, clinical experiences, society standards, expertise opinions and patient’s values and it helps the nurses in improving nursing sensitivity and efficiency hence improving the quality of care provided. One of the evidence based nursing performance for increasing the infant weight after birth according to these authors is the massage therapy. Massage therapy has been widely discussed in literature as one of the best practises in the provision of proper care for the premature babies is the neonatal intensive care units. It helps the preterm babies in gaining weight and thus can leave hospital earlier. In explaining the importance of massage therapy as an evidence-based neonatal nursing practise in the neonatal intensive care units, Murtaza and Aly (2013, p. 1-5) indicate that the preterm babies are exposed to health risks such as neurodevelopmental issues, social, health, mental and behavioural problems. They further suggest that massage in preterm infants has many positive benefits to the babies ranging from weight gain in the babies to brain maturation without any records of negative effects. Although this practise can increase the quality of care in such new born babies, there is the concern that only few hospitals provide massage therapy to the preterm infants in their NICUs. Another area in neonatal nursing that has gained more insight in literature is pain management in the neonates. It is important for the nurses providing care to the new born infants to be able to assess pain in the infants for effective management since the infants cannot express the pain felt. Different pain assessment tools have been developed for this purpose. Traditionally these tools have been used in evaluating neonatal pain by considering physical behaviour such as the posture, sleep pattern and cry of the infant. Consideration is also given to the physiological characteristics such as the breathing and the heart rate of the new born. Murki and Subramanian (2011) in their research provides the use of sucrose as an evidence based practise in the management of pain in neonatal nursing. The research retrieved studies from CENTRAL, MEDLINE and CINHAL. According to the study, it was found out that the allocation of sucrose to the infants within the dosage of 0.5 to 2ml of 12%-50% solution two minutes before heel lance provided effective pain relief for both term and preterm infants. However, there lies a controversy as to whether sucrose can be used in pain management for other painful procedures such as subcutaneous injections, circumcision and bladder catheterization. Other areas of significant concern in neonatal care provision is neonatal skin care and breastfeeding. Skin care in neonatal nursing is important since the neonates with different conditions such as diarrhea can suffer from skin breakdown. For the preterm neonates in the NICUs or the hospitalized term neonates, the care against skin breakdown involves the use of barrier ointment to avoid skin breakdown and diaper rash. In extreme cases, transparent dressings are covered on the reddened areas to avoid further problems. Other services provided by the neonatal caregivers to the infants are; improving thermoregulation in infants, the use of comfort measures during stressful procedures and conducting follow ups for the discharged neonates. Barriers and Facilitators of Evidence Based Care Although the use of evidence based neonatal practises enables the nurses to combine their proficiencies and the scientifically proven evidence in the provision of excellent care for the neonates, the implementation of this approach in many hospital settings faces many difficulties. These make the implementation of evidence based neonatal practises difficult. Many studies have cited the barriers that hinder the use of research in providing the best quality care for the neonates. According to such studies, similar barriers have been established across the globe in neonatal wards and the intensive care units. The barriers to the use of research in providing quality patient care in neonatal settings have been associated with the support provided by the organizations and the institutions in which they work, their values and skills and the quality of research. Other barriers that have been identified include the lack of capacity by the nurses to command changes in the institutions in which they work, poor understanding of statistics and the lack of time to read the literature. Research has also been conducted on the facilitators of the evidence based practises in the neonatal care. The facilitators and barriers of EBP can be put into many groups. One such classification is the organizational factors that occur in the setting or environment where the EBP should be implemented. According to nurses in different countries, the EBP process is time consuming and getting the relevant literature is also difficult. As a result, most of the institutions in which they work do not encourage the use of evidence based practises but encourage the use of experience and proficiency in the provision of care for the patients. One of the barriers of concern that hinder the successful implementation of the evidence based neonatal nursing practises is the attitude of the nurses towards the EBP. Attitude refers to the behaviour of an individual based on opinion. The attitudes of the neonatal nurses towards EBP can either hinder or encourage its use in the neonatal intensive care units or the neonatal wards. Although the EBP approach is important in providing quality care for both the term and preterm infants with different health complications in neonatal wards, recent research reveals that the nurses apply this approach to a lesser extent. Instead, most neonatal staff rely on their experiences and know-how in the provision of neonatal care. In an investigation of the attitudes of the nurses towards evidence based practise in neonatal nursing, Chia and Sellick (2005, p. 1-7) use the kangaroo care as the best available neonatal evidence based practise and try to find out the attitudes of nurses towards this practise. According to the study which involved a survey followed by in depth interviews of the nurses in an Australian hospital, there was the wide acceptance by the nurses that kangaroo care is important in ensuring the proper growth of the neonates as well as establishing the bonding between the infant and the mother. However, many of the nurses surveyed agreed that the EBP are not properly implemented in the neonatal wards although it is one of the best methods of ensuring improved quality care for the neonates. In attempting to understand the attitudes of the neonatal nurses towards EBP, it is also important to investigate the perceptions of their educators towards the same since it has a direct correlation with how the nurses will react towards EBP. According to a study conducted by Hussein and Hussein (2013, p. 3-10) on the attitudes of the nursing educators towards evidence based practise, it was found out that many of the nursing educators had positive attitudes towards EBP thus translating it to their students. The investigation used structured questionnaires to measure the attitudes of 144 nursing educators’ attitudes towards EBP and their perceptions of its related barriers. Among the items assessed included the role of EBP in improving patient care, whether or not evidence based practise is a waste of time as well as the practicality of the approach. Although the study indicated a wide acceptance of the EBP among the nurse educators, there were notable differences in the perceptions of the nurse educators towards evidence based practises. The study indicated general positive attitudes of the nursing educators towards EBP agreeing that it helps in improving the quality of patient care. Many of the educators also agreed that the EBP improves patient centred care and that the research improves the day to day nursing activities. The negative attitudes of the nursing educators examined also were associated with the tedious nature of the evidence based nursing practises as well as its impracticality. These groups of nurse educators preferred sticking to the traditional practises that mainly involve their professional expertise and experiences rather than shifting to the new methods of research in caring for the patients. Such attitudes of the nursing educators as well as the nurses themselves translated to neonatal care, have made the implementation of the best evidence research difficult. Although the research gives the various attitudes of the nursing educators towards EBP which in turn influence the attitudes of their students, it does not indicate the extent to which EBP is taught in the nursing schools. Another area of important concern in evidence based neonatal care is the knowledge of the care givers on EBP. Evidence based practise in nursing involves the practical use of the empirically attained knowledge. More than 70% of the neonatal deaths that occur in hospitals can be prevented through the use of evidence based practises such as neonatal thermoregulation, exclusive breastfeeding and massage therapy. However, for the proper implementation of these practises in neonatal care, there is the need for the neonatal staff to have sufficient knowledge about these practises and procedures. A more knowledgeable staff facilitates the implementation of EBP while those without enough knowledge on EBP will hinder its implementation. A proper understanding of the degree of knowledge is important in establishing the kind of neonatal care needed in various situations. However, there lies a great difficulty in the sustainable implementation of this knowledge into practise with very few studies investigating knowledge translation. The proper implementation of evidence based practises in neonatal intensive care units and the neonatal wards requires the neonatal staff to have sufficient knowledge of these practises to improve neonatal care and prevent neonatal deaths. However, there is the concern that many neonatal nurses do not have sufficient knowledge to enable them deliver. In investigating knowledge as either a barrier or a facilitator of evidence based practise in neonatal nursing, a study was conducted in Vietnam with the aim of assessing the level of knowledge of evidence based practises among the neonatal nurses in a province in Vietnam (Eriksson et al., 2009, p. 23). The study involved a cross-sectional survey of the knowledge translation in neonatal care, which is implementing knowledge into practise for improved neonatal care in Quang Ninh province. In the study, sixteen multiple choice questions from five areas of evidence based practises in neonatal care were distributed to 155 community health centres hence reaching 412 primary health care workers. According to the study, it was established that the level of staff knowledge about the evidence based neonatal practises differed depending on the geographical locations of the nurses. Overall, it was noted that the knowledge of the neonatal staff regarding the evidence based practises in neonatal care provision is scarce. This was regarded by the study as a major hindrance towards the implementation of EBP in neonatal nursing. The study only achieved 60% of the potential points in the knowledge survey, indicating deficient knowledge in the evidence based neonatal care among the nurses. Although the survey was important in enabling the research to establish the level of knowledge among the neonatal practitioners on the evidence based care, the tool used failed to include other factors such as population mapping and poverty levels that can also lead to poor quality neonatal care and the death of the neonates. In a similar study involving the level of knowledge of the neonatal nurses as either facilitators or barriers of the effective implementation of the evidence based neonatal nursing practises, Khoza and Tjale (2014, p. 9) use neonatal pain management as a basis of finding out how knowledgeable the neonatal nurses are in implementation of EBP. The main aim of the study was to use neonatal pain management in investigating the knowledge and attitudes of the neonatal nurses towards the EBP. The study involves a non –experimental survey using the Modified Infant Pain Questionnaire to collect data from 150 nurses working in neonatal wards in central Gauteng. The study established the need for the nurses to have a foundational knowledge in evidence based neonatal practises to be able to deliver quality care to the neonates. However, the study assumed that knowledge results in the identification of pain and thus the effective management of the pain. The acquisition of such knowledge is based on formal learning through research and informal learning through clinical experiments. The investigation, however, established that most of the neonatal nurses working in the neonatal intensive care units and the neonatal wards have limited knowledge concerning EBP in neonatal pain management making it difficult for them to properly detect and manage pain in the newly born infants. The study also indicates the difficulty in knowledge translation of the evidence based neonatal practises from theory to practise but does not recommend strategies to enhance this translation. The awareness about the presence of evidence based neonatal practises is can also act as a barrier or facilitator of the implementation of the evidence based neonatal care in hospitals. Neonates suffer from different health conditions at birth ranging from the premature births to complications such as brain and cardiac maturation issues. The provision of medical care to such infants requires that the nurses are aware of the existing evidence based practises given the prevailing neonate conditions. (Melnyk and Ellen, 2011, p. 430) For instance, in improving weight gain for preterm neonates in the neonatal intensive care units, the care providers need to be aware of the existence of massage therapy as a scientifically proven method of ensuring weight gain in the neonates. This way, the implementation of scientifically proven evidence in the provision of care for the neonates is improved. Conclusion With regards to the above discussion, it is evident that the use of scientific research is important in improving care for the neonates and reducing their deaths. Also, evidence based practise in neonatal care for the neonates has been proven to also benefit the mothers by increasing the attachment of the neonates to their mothers. However, its implementation faces many difficulties ranging from personal factors to institutional factors. It is recommended that trainings should be increased to increase the knowledge of the neonatal nurses in evidence based practise (Buonocore et al., 2010, p. 138). Also strategies of knowledge translation should be established to enable the nurses to put into practise the acquired knowledge on EBP. Works Cited Kenner, C, Lott, J. (2013). Comprehensive Neonatal Nursing Care. Springer Publishing Company, p. 850. Meeks, Maggie, Maggie Hallsworth, and Helen Yeo. Nursing the Neonate. New York, NY: John Wiley & Sons, 2013, p. 103. Salehi, Z, Nouri, J and Ebadi, A. (2014). The Effect of Education and Implementation of Evidence-Based Nursing Guidelines on Infants’ Weight Gaining in NICU. Canadian Centre of Science and Education, p. 2. Aly F, Murtaza G (2013). Massage Therapy in Preterm Infants. Pediat Therapeut, p. 1-5. Chia, P, Sellick, K (2005) The Attitudes and Practices of Neonatal nurses in the Use Of kangaroo Care, p. 1-7 Hussein, A. H, Hussein R. G (2013). The Attitudes and Barriers towards Evidence-Based Practice among Nursing Educators. Journal of American Science, p. 1-10. Eriksson, L, Wallin, L, Ewald, U. (2009). Evidence-based practice in neonatal health: knowledge among primary health care staff in northern Viet Nam, p. 23. Khoza, S. L. T and Tjale, A.A. (2014). Knowledge, Attitudes and Practices of neonatal Staff Concerning Neonatal Pain Management, p. 9. Melnyk, Bernadette M, and Ellen Fineout-Overholt. Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2011. Print, p. 430. Buonocore, Giuseppe, Rodolfo Bracci, and A M. Weindling. Neonatology: A Practical Approach to Neonatal Management. Milan: Springer, 2010. Print, p. 138. Summary Table Authors Aim Methods Results/ Finding Aly F, Murtaza G (2013) To describe how massage therapy can be used as an EBP practise in improving the care of preterm babies in neonatal intensive care units A cross sectional study involving neonates in a neonatal intensive care unit. The study revealed that the neonates who were subjected to massage therapy had reduced neurological problem, few stress behaviours and increased brain maturation. Eriksson, L, Wallin, L, Ewald, U. (2009). To evaluate the knowledge of primary health practitioners of evidence based practises in a Vietnamese province A cross sectional survey involving 412 nurses in 12 districts in a Vietnamese province. The knowledge of the staff regarding evidence based practise in neonatal care is limited. Hussein, A. H, Hussein R. G (2013). To investigate the attitudes of the nursing practitioners towards EBP, thus translation of the practise to their students. A cross sectional study involving the use of structured questionnaires administered to 144 nursing educators in nine academic nursing departments in the Faculty of Nursing, Alexandria University . Many of the nursing educators have positive attitudes towards evidence based neonatal care practises hence the ease of translation to their students. Khoza, S. L. T and Tjale, A.A. (2014). To conduct an assessment of the current practises in EBP neonatal pain management to evaluate the skills, knowledge and practises of nurses in neonatal pain management in two academic hospitals in central Gauteng A non- experimental survey involving the use of an Infant Pain Questionnaire to obtain data from 150 doctors and nurses working in two academic hospitals in central Gauteng The nurses and doctors relied on pharmacological pain management strategies with many reports of the lack of standard guidelines for neonatal pain management. Chia, P, Sellick, K (2005) To examine the attitudes and the practises of the Australian neonatal nurses in the use of kangaroo care and identify the barriers of using KC in the neonatal intensive care units. A dual phase research approach involving a descriptive survey followed by detailed interviews. The study involved 34 nurses working in the NICU of a large public hospital in Melbourne. Kangaroo care was seen by many of the interviewed neonatal nurses as a good EBP as it increases the relationship between the infant and the mother. Read More