The Care of Patients in Making Clinical Decisions - Term Paper Example

Running Head: Evidenced Based Practice Evidenced Based Practice Name Institution Date Evidenced Based Practice Introduction Medical as well as healthcare is considered to be one of the human disciplines that are most dynamic. Huge amounts of money are usually spent on annual basis to carry out research which is highly sophisticated as well as high quality. This has resulted to an exponential growth within the health care literature. Medicines, medical procedures as well as medical services that are effective are being invented regularly. The main objective for engaging all these efforts to enhance the health care systems is to help doctors, medical technicians as well as nurses to care and treat patients in the best way possible (Majid, Foo, Luyt, Zhang, Theng, Chang, & Mokhtar, 2011). The application of traditional as well as procedures and practices that are well established, health care specialists are now adopting interventions that are innovative. These interventions are based on best practices and solid research which is evidence based. Evidence based practice is one of the techniques and has gained popularity because of the potential it has in effectively handling clinical issues as well as providing better care to patients. Research shows that, caring for patients in the past was influenced by the opinions as well as experiences of the people who were involved in the provision of treatment (Kania-Lachance, Best, McDonah, & Ghosh, 2006). However, evidence based practice marked the shift in health care practitioners from stressing of traditional methods of opinions that are influential to importance of data which is extracted from research and studies that were carried before (Jette, Bacon, Batty, Carlson, Ferland, Hemingway, Hill, Ogilvie, Volk, 2003). In nursing, evidence based practice is essential and improves the care of patients when compared to traditional practices. Nurses are more involved now in making clinical decisions than before, therefore, their utilization of best evidence in making effective as well as decisions that are justifiable is important (Mantzoukas, 2007). Purpose Breathing difficulties is said to be one of the life threatening conditions of a critically ill patient and especially those with acute severe asthma, massive haemothorax, tension pneumothorax and pulmonary oedema. The administration of supplemental oxygen by nurses is done with the use of various devises including, nose masks, face masks as well as nasal prongs. Providing oxygen therapy is seen as the first line treatment for any respiratory failure of a critically ill patient. Oxygen therapy is an intervention that nurses use to ensure that patients who are critically ill receive sufficient oxygen so as to correct the respiratory failure or breathing problems (Gotera, Diaz Lobato, Pinto, & Wink, 2013). Provision of oxygen therapy serves to generate low level of positive airway pressure, improvement of oxygenation, increase in functional residual capacity, increase of the end inspiratory lung volume, reduction of airway resistance and flushing of nasopharyngeal dead space (Sztrymf, Messika, Bertrand, Hurel, Leon, Dreyfuss et al, 2011). This helps in managing reduction in breathing in acute respiratory failure from all causes. Oxygen therapy also serves to restore pulmonary defence mechanisms for critically ill patients. On this basis, this assessment aims at carrying out a systematic research so as to identify what evidence is available in relation to breathing and its intervention of using oxygen therapy for a critically ill patient. Methodology This systematic research utilised PubMed electronic databases to establish what evidence is currently available in relation to breathing and its intervention of oxygen therapy for a critically ill patient. The keywords that were used for primary search include; breathing, oxygen therapy, critically ill patients, clinical evidence and evidence based practice. The major intervention for breathing that was used is oxygen therapy. The major areas of evidence available that were considered in this systematic research include; acute respiratory failure, post-extubation period, preintubation, emergency department, palliative care and acute heart failure. Clinical data that was available was used to describe the evidence which is available on the use of oxygen therapy by nurses in the identified conditions of critically ill patients. Using the related searched articles, identification and presentation of discussions was done while taking into consideration critically ill patients. Discussion of Available Evidence Acute respiratory failure Data for patients with acute respiratory failure was presented on respiratory as well as oxygenation parameters for 20 critically ill patients in the intensive care unit (Roca, Riera, Torres, Masclans, 2010). The nurses used humidified high flow nasal cannula (HFNC) oxygen therapy. Significant improvement in both clinical as well as psychological parameters was achieved within thirty minutes. Therefore, oxygen therapy provides immediate management of breathing problems for patients with acute respiratory failure and especially when supplied using more effective facilities like the HFNC. In this clinical data, the etiology of acute respiratory failure was majorly pneumonia (n = 11), sepsis (n = 3) and miscellaneous (n = 6). The provision of oxygen therapy using HFNC resulted to a significant respiratory rate reduction up to a median of 24.5 breath per minute (p = 0.006) together with an associated significant increase in oxygen saturation of up to 98.5% (p = 0.0003). Through the provision of oxygen therapy, it was established that, the condition of patients with acute respiratory failure were improved. A rapid mitigation of respiratory distress in patients who were more severe was also achieved (Sztrymf, Messika, Mayot, Lenglet, Dreyfuss, Ricard, 2012). Post-extubation period Oxygen therapy is considered to be a treatment which is routinely administered to critical ill patients in ICU with self extubation. Patients usually have respiratory distress in breathing with use of their mouths (Parke, McGuinness, Eccleston, 2011). Oxygen therapy is also provided to patients who have postextubation respiratory failure. The clinical evidence available was for 109 patients who were used in an Italian study (Moccaldo, Vaschetto, Bernini, Antonelli, Festa, Idone, et al, 2011). It was established that, oxygen therapy has potential benefits enhances oxygenation during the post-extubation period. Effective provision of oxygen therapy delivers enough oxygen to extubated patients who usualy need high flow of oxygen. Preintubation In critically ill patients, intubation of the endotracheal is usually associated with life threatening complications that are severe. 20% of these complications are found to result from hypoxemia (Engström, Hedenstierna, Larsson, 2010). The use of ventilation which is non-invasive is necessary for the purpose of enhancing oxygenation prior to intubation of tracheal (Baillard, Fosse, Sebbane, Chanques, Vincent, Courouble, et al, 2006). An experimental study was carried out on eight piglets that were anesthetized with collapse lungs and induced by lung lavage. This study revealed that, administering pharyngeal directly of 10L/min oxygen at the time of intubation serves to delay the time taken to severe desaturation in apnea. This suggests that, it is a useful method that can be used to intubate patients who are critically ill with acute respiratory failure (Engström, Hedenstierna, Larsson, 2010). The provision of oxygen therapy has a reduction effect of the need for intubation in patients who have hypoxemic acute respiratory failure. Emergency department Patients in the emergency department are found to complain mostly about dyspnea as well as hypoxemia. In these conditions, oxygen therapy is usually considered as one of the first treatments that nurses provide to the critically ill patients as per the current guidelines. This is done with the use of face mask or even nasal prongs or the HFNC subject to the severity of the respiratory distress of the patient. Oxygen therapy is seen to provide a fast relief of dyspnea as well as hypoxemia correction in critically ill patients especially when administered with the use of HFNC. A prospective, observational study was carried out in a hospital emergency department in a university (Lenglet, Sztrymf, Leroy, Brun, Dreyfuss, Ricard, 2012). 17 patients who were diagnosed with acute respiratory failure required >9 L/min of oxygen or continuous clinical symptoms of respiratory distress were observed. After being provided with oxygen therapy while using HFNC, there was a significant decrease in dyspnea at a rate of Borg scale from 6 to 3 [p  Read More