There is a need for health services stipulation to apply the best evidence instead of applying the customary methods (Stevens et al, 2001). However, this is only possible if practitioners, researchers, scholars, politicians, managers and public in general conducted a high quality research. Different methods of researches that are evident-based tend to have lack support from most users. This is because those researches are lack of proper referencing which the reviewer could not access.
This module has requisite us to articulate the definition of evidence based practice, analyzing different forms of evidence and reflect on possible tactics utilized in the implementation of evidence based practice. To aid me in achieving those outcomes, I have use resources from database like ebscohost, books, researches, journals and search engine like Google.
The paper I choose focuses on a descriptive-correlation method of research based on operating room nurse’s knowledge and practice of sterile technique. This research is vital due to several cases of surgical infection taking place in operating room. The aim of the study is to determine the information and extent of applying sterile technique among operating room nurses in four selected hospitals in Samar, Philippines.
Globalization comes with a large number of professional developments and policies especially in the nursing sector. Working in a government hospital in the Middle East, and attached to operating department is tough because research carried out on operating room nurse’s knowledge and practice of sterile techniques clearly shows a clear association between knowledge and practice (Luo et al,2010). This study was conducted on four hospitals in Philippines. Inclusion standards were set for this study is participation among nurses are nurses with permanent employment, nurses who agreed to participate on this study and nurses working in the identified hospitals.
The research concludes that knowledge has a positive effect on the extent of practice by the nurses. Different International bodies as Commission for health improvement prove that evidence based practice is researched on daily basis by different scholars. Evidence based practice (EBP) requires the nurse to be able to apply his/her knowledge in operations without necessarily consulting. EBP
Sackett et al (2000) denote evidence-based practice is a popular discipline that applies in clinical practices since 1992, and started with the medicine sector as Evidence Based Medicine (EBM). It later spread out to other fields like nursing, education, dentistry, psychology, and library among others. EBP demands that these practical decisions need to come from confirmed research studies, and they should interpret according to particular EBP norms. EBP is the incorporation of the best research evidence with clinical expertise and patient values. This explanation emphasizes on the patient’s situations, goals, available evidence and the practitioner’s expertise. However, there are some patients who reject the administration based on their different culture and values. Besides that, the practitioner might understand underlying hindrances like finances that may halt the application of EBP.
Evidence Based Practice in nursing includes the major decisions made by the professionals, which in my area includes the surgeries. Some of these decisions include appraising, accessing, and integrating research evidence with their professional judgment and with their clinical decision-making (Department of Health, 2002). The research on operating room nurse’s knowledge and practice of sterile techniques intention is to identify the extent of nurses applying their knowledge in practice pertaining sterile technique. There are several factors on why nurses are reluctant to apply EBP in their daily work. Evidence based practice include making decisions by combining any knowledge acquired from the nursing practice, patients inclination, and applying research evidence.
It means that the nurses have a variety of options including sitting back and watching, or taking action based on their experience. Nevertheless, the decision made is crucial hence it need brainwave. A clinical question is essential before making evidence-based decision. So, it is important to search for a suitable EBP to help in making the right decision at the particular situation. Lastly, the nurse evaluates the different effects of the action taken.
Strengths of EBP
Since the early years of Florence Nightingale, research became popular till the first nursing journal published in United States in 1952 which began considering evidence based practice. Nightingale is famous for her systematic thinking and applied religious faith that favored systematic approach. According to Keith (1988), Nightingale had a good access to governmental information and other material making her work knowledge based. She applied graphical presentation in form of pie and bar charts unlike others who used tables. The health ministry requested Royal College of Nursing in 1966 to examine the effectiveness of nursing. From then onwards, various research programs came up including Information provision and wound care.
Anyhow, Rodgers (2000) noted that the progress of EBP is slow but it is successful as the years go. Utilization of evidence-based knowledge broadens the relationship between the nurses and the management like the clinicians. Another major strength in evidence-based practice includes a research carried out around 1990’s on the physical constraint normally applied on older frail generation. The result showed harmful and prolonged routines thus it made a change in the national policy within acute care hospices and long-term care settings (Evans et al, 2006). These changes presented a drop in constrained home care residents from 1980s 75% to 2004s 8%. Nurses applied excessive pressure on the elderly without realizing of the psychological torture involved.
Weaknesses of Evidence Based Research
Today, science has expanded and advance compare to those years during Nightingale years. In spite of this progressive development, there is still a gap on contemporary knowledge and the extensive adoption to improve the health sector. Bass (2010) stated EBP appliance in nursing profession is similar in all fields or disciplines. The major challenge is the readiness to apply these evidence-based researches due to different drawbacks that include lack of understanding, inclusion, and lack of necessary education programs. To further strengthen this argument, Pravikov et al (2005) mention most nurses have two years degree program which does not accommodate evidence based practice. Moreover, EBP weakness also includes accessing of vital information on the research done.
The information gathered in research is publishing in various resources like database, journals, health magazines, newspapers, books and online. Therefore, users find it difficult to access especially in work place. In nursing, the clinical specialists and the doctors who own higher skills in recognizing problems, analyzing, and translating are far from reach. Hence, they are hesitated to apply EBP in their practice.
Usefulness of Evidence Based Practice in my clinical Practice
Perioperative nurse must be knowledgeable on sterilized technique. Reflecting on my experience being a perioperative nurse for five years now, to enhance better understanding on the importance of sterile technique and the consequences of not applying sterile technique, EBP is the best tactic. For instance, EBP is based on studies done on sterile technique and they show result for not applying sterile technique may lead to surgical infection. EBP make perioperative nurses like me acknowledge importance of sterile technique and we are accountable for patient’s safety. Hereafter, nurses could make decision-making on evidence-based in their practice. It is crucial for nurses to be familiar with different decisions they partake and consider the consequences associated with the decision made. It is also important for nurses to be given the necessary skills required to enable them construct the vital questions and efficiently and effectively look for the available study evidence that best applies to these questions.
The research on operating room nurse’s knowledge and practice evidently show that many nurses have not applied their knowledge in practice. Helpful information that I picked in this study is the importance of sterilizing the operating instrument. This study based on surgical sites infections that are common in most operating rooms. Globally, studies shows that, 2-5% of the patients undergoing operation suffer from surgically related infections. This definitely raises most hospital concern and wants more research to be carried out in order to identify where the problem lies. Surgical site infection causes many deaths during the operations, and that is the reason why different strategies like sterilizing technology came up.
Many patients have died because of infected surgical wound and this calls for an evidence based study to resolve the prevailing problem. EBP faces major emphasis from American Psychological Association (APA), American Nurses Association, Occupational Therapy Association, and American Physical Theory association. In psychiatry, rehabilitation, medicine, psychology, and other professional bodies, loose bodies of knowledge apply, and this is a major drawback on their performances. Evidence based practice begins with a profiling research which informs the professionals and their clients what works best for them. Easy access to EBP information enhances both clients and the practitioners to identify their helpful treatment before intervention starts.
The article that I will critic is on operating room nurse’s knowledge and practice of sterile technique by Leodoro et al (2012)(Appendix 1).I have choose this article as it has link with my profession and it is very knowledgeable for me being a perioperative nurse. The critic tool that I have chosen is step by step guidelines in critiquing a quantitative research study by Coughlan et al (2007)(Appendix 2). The methodology tool applied in this study was descriptive-correlation research method. The descriptive method describes the knowledge and the extent of which the nurses applied the sterilization technique in practice. In addition, the correlation method is dissimilar relationships among the different variables used.
This study was conducted in four hospitals in Philippines and the results are based on answers by nurses with permanent employment, nurses who agreed to participate on this study and nurses working in the identified hospitals. There are three-part questionnaire consisted of demographics profiles of the participants. This part carries 10 multiple-choice questions and 10 general questions with an expected score of 20, and intended to measure the nurse’s knowledge scope using sterilized instruments. Questionnaire 11 includes a checklist whereby the participants rated out of 5 points with 1 being lowest rate. The data analyzed through inferential and descriptive statistics consisting of frequency, standard deviation, percentage and mean. Critiquing Descriptive-correlation Tool
Analyzing research studies require suitable tool looking at the methodology used. Tanner (2003) suggests these tools normally bear questions that aid the analyzer in determining the different steps followed in this research. It is notable that some steps are more vital than others. Descriptive-correlation tool applied in this study is credible based on many factors. The researcher uses simple language that is easy to understand without consultation. This means there are no scientific jargons that sometimes pose a threat to the readers. The authors seem to understand the subject matter clearly according to the list of questions in their questionnaire. The questionnaire cover most elements related to the operating room’s practice.
For instance, hand washing, scrubbing, intraoperative phase and circulator role. The purpose of this study is vital due to several incidents that related to surgical wound infection. In the article abstract, they mention the overview of their study, including the research problem which is in prevention of surgical site infection and contamination, sterile technique need to be implemented. They also remark the sample, methodology, finding and recommendations which is mention earlier in the need for the nurses to control and protect the patients from surgical site infections. The grammar used in this study is straightforward, easy to understand and systematically arranged. Usually, a reader like me demands an interesting research that motivates us to continue analyzing, and this presents well in the above-mentioned analysis. There are certain factors that strengthen this research, which includes the identification of the research problem. The hypothesis used is that most nurses have the knowledge on sterile techniques but due to some reasons, they fail to apply it in practice.
Some nurses bear the knowledge but they lack the confidence to put this evidence-based research into practice. There are four major reasons that limit the nurses from using EBP. Retsas (2008) stated research reports similar to the above-mentioned are normally complex, statistical, academic and nurses find it difficult to interpret or work with the research products. The research article on operating room nurse’s knowledge and practice of sterile technique is a study that is markedly academic and statistical. This may cause confusion to nurses during interpretation. The results are graphical and the nurse might have problems understanding it. This particular research is consistent and any nurse whether a graduate or a trainee can easily relate to it except of the graphical result. Beginning from the introduction, methodology, participants, instrument analysis, results and conclusion, the study is systematic with a great flow of intense knowledge. The researcher clearly links each step to the other with the objective of the study, which follows with a literature review.
In their literature review, the research is rather shallow compared to other great researches. It is lacked of specific details on the occasions where nurses have failed to apply the technology and the consequences that follow. The literature failed to analyze the different surgical tools applied in the operating rooms by the nurses. However, they identified the hospital and the need for the research. The literature should include the history of evidence-based practice including when it began and why. The hypothetical structure lacks in this study, which is necessary for reader who needs to understand and analyze the research. The researchers did not go in depth into the subject matter although the introduction had a good review of the search information. In terms of theoretical framework, which is a necessity in most researches (Basset & Basset 2003), the author failed to identify a conceptual model that would assist the reader as guidance.
The research paper is lacked of proper relationship between different concepts in its literature. However, most theoretical frameworks work best in experimental and quasi-experimental researches unlike in descriptive studies similar to the above mentioned. According to Dale (2005) in every research, it is vital to identify the main question and this was not seen in this research. For example, the researcher should have asked how competent the management of the operating room is in educating their staffs on sterile technique. This would assist the researches in analyzing the situation because the failure to practice sterile technique could be perioperative nurses not sent for continuous education leading to lack of competency. These questions are likely to come from patients or the nurses themselves. The questions may derive from the customary practices or from different literature. The sample in this study, for me the size is relatively small compared to the many operating rooms in Philippines.
Anyhow, the choice of participants in regards to age group, and gender is great. In terms of experience, the researcher should have picked people with longer experience in the job. Most of the participants are below five years’ experience in this research. The attendance for educational training of these participants is equally poor so it could not provide a conclusive result. The distribution of the sample is also inadequate because female participants are 73% compared to their male counterparts who are at 23%. A bigger sampling in all categories would have provided a better data analysis. This study was carried out in hospitals and chances for the nurses were conversant with the subject at hand. However, the participants were from only one-region hospitals and different issues may have limited their voluntary information.
At times, the participants are not sure of their confidentiality, despite them signing confidentiality forms; they still have the fear of being exposed. The nurses could fear intimidation from the superiors, and this drives them to give false information in favor of the organization. The researcher got the approval from the ethics committee at Samar Provincial hospital, and the other hospitals before they began conducting their research. No participants were forced or harm during the survey. Neither there was any bias because the respondents were not selected purposively. In the operational definitions, the researcher ensured that the reader fully comprehended the study by applying simple concepts and terms in the research (Parahoo, 2006). The researchers have used clear and simple understanding terms to carry out this study.
The research design used in the research on operating room nurses’ knowledge and practice of sterile techniques is a descriptive-correlation method, which is a recent method of study that is very effective. This is because it integrates the description of the nurses’ knowledge and the extent at which they practice the use of sterile technique together with a correlation analysis showing the relationship between the two variables. However, most of these studies relate because the objective regards patterns in group behaviors, tendencies, averages, and properties (Robson 2002). There is a possibility of mentality to take place as most of the researches done clinical credibility because these research products are not conclusive. This is a major drawback for nurses to agree in applying the results (recommendation) which also decrease the confidence in the products used for the survey like the questionnaire and the sample. In my opinion, the study did not succeed to offer a proper clinical direction and so the nurses prefer not to use them. Most nurses prefer a research that is more prescriptive and clinical concerning their work place.
The data collection is similar to a quantitative methodology of research whereby different data that includes questionnaires, interviews, and observation tools used. These tools are appropriate with the study aim. Then again, questionnaires are prevalent with different sets of closed questions and few with multiple choices and others with direct answers. The overall reliability and validity was discussed in the weakness and strength of the study done. It was describe as good but not perfect. Its validity, which is its ability to measure the content (Wood et al, 2006), is downcast due to the number of samples were insufficient (21 participants) and also from one region only. For the tool’s reliability, Wood et al (2006) stated reliability is to accurately measure and consistently measure the theory which being studied which was done in this research. The researchers have always emphasized on the extent of sterile technique practice throughout the study.
This study had a pilot study, which assisted the researcher in making some adjustments in their research. The researcher’s data analysis is a well-analyzed methodology since it is not complex and daunting. The ratings are clear and easy to understand. For instance, they used descriptive statistics that include the percentage, frequency, standard deviation and mean. The interpretation of the results included 0-7 as “needed improvement”, 8-10 as “fair”, 11-13 as “good”, 14-16 as “very good”, and 14-16 as “excellent”. This is quite an easy interpretation and anyone is able to analyze and understand. These are inferential tests and it helps the researcher in identifying the relationship among variables. The researcher discussed the findings in simple and clear terms. The researcher has a logical flow of information and the hypothesis is clearly supported by these findings. This study bears significance in its findings as per Russell (2002), and the researcher specifies every result without generalizing it.
They reported each section independently whether it could be gender, age, experience and number of training attended. As mention earlier, the perioperative nurses have knowledge of using sterile techniques but rarely apply them in practice (Luo et al 2010). The research also concluded that half of the nurses had the knowledge on sterile technique. In Goiana hospital, 75.6% seemed to understand the standard precautionary measures on surgical site infection (Melo et al 2006). Most researched documents have no references, which makes them less favorable.
There are known perspectives on accessibility of information and they include the humanistic ideology which involves the notion that human resource is most accessible. There is also a strong belief that local information derived from locally developed technologies is more accessible. The latest technologies information can be retrieve from internet easily accessible. However, the researcher did not mention much on recommendation for nurses to apply sterile technique in practice which is vital in guiding the readers.
The study’s hypothesis that majority of the operating room nurses have the knowledge on implementing sterile technique, but seldom apply it in practice have been achieved as end result of the study. The findings confirmed that the nurses held a strong knowledge of the use of sterile technique according to the table 6 that showed the correlation between knowledge and the extent of use of sterile technique by the participating nurses. The discussion is clear and well elaborated in simple terms. The researcher explains the underlying causes on why nurses rarely apply the knowledge into practice. The issue of occupational culture where questioning is unpopular should be contested, and the nurses should ask any questions in the event of uncertainty. The information on sterile technique and importance of it should be taught to nurses by sending them for educational trainings or emphasize it at all times in work place. This information should be accessible especially the evidence-based literature in order for the evidence-based practice to be implemented.
For instance, books related to operating room and patient’s safety should be kept in operating department where nurses can access them anytime when needed. The researchers also discuss on the strength and limitation of their study which is appropriate as it helps the reader determine the reliability of the study and also the choice to implement it or not. The strength of the study is to ensure there was no selection bias; the respondents were inclusive of the entire population of operating room nurses in four identified hospitals for the investigation. Nevertheless, a wider variety of hospitals would have added this strength. Furthermore, the research shows that the investigation is from one province only, which weakens its strength. The discussion also noted the weakness in the questionnaire method of research because it lacked some details like. It is also clear that some participants fear telling the truth despite their secrecy assurance.
However, the research discussion is clear on its demerits, and although it does not offer any suggestion on a further research, it is vital to have a more detailed study on the same issue. Most researchers offer recommendation because their researches are not conclusive which this particular researcher failed to apply. The referencing in this study is very accurate especially on the in text citation. Most researches fail to offer the in text citation and leaves the readers struggling on locating the referencing. The higher number of references, the stronger the research perceives. Different methods of researches that are evident-based tend to have lack support from most readers.
This research had 18 references, which is the average number, required for any research. However, more references would have strengthened the research. This study has much merit but the method requires evaluation. The sampling requires a larger demographic region in order to accommodate more representatives of the participants. It is crucial for perioperative nurses to apply their knowledge on sterile technique in practice. If sterile technique is not applied during surgery it may lead to surgical infection which will harm the vulnerable patients which may also cause death if not treated well.
The study on operating room nurse’s knowledge and practice of sterile technique is a vital research globally and it was fairly conducted. Further research is recommended because this problem continues due to frequent changes in technology and management. The nurses should implement a more basic role in services through application of their skills while addressing questions from outside clinical range. This would in return increase their service demands from the environs. For skills development, the nurses should complement their hands-on function within the department. These nurses should be able to apply their developmental products effectively in order to prove everyone else wrong. People have failed to recognize the efforts applied by the nurses. The management and the clinical experts need to recognize and appreciate the nurses’ efforts through understanding their skills. After all, the management should ensure the nurses knowledge, resources, and skills are readily available in order to assist implementation. This only happens if the research information is excellent, with clarity and enough strength to hinder any doubts from reviewers.
American Psychological Association. (2006). APA presidential task force on evidence based practice. Washington, DC: Barker P. (2000) Reflections on caring as a virtue ethic within an evidence-based culture. International Journal of Nursing Studies 37, 329–336. Bucknall T. (2003) The clinical landscape of critical care: nurses’ decision-making. Journal of Advanced Nursing 43(3), 310–319. Davies H.T.O., Nutley S. & Smith P. (2000) Introducing evidencebased policy and practice in public services. In What Works? Dobson, K., & Craig, K. (1998). Empirically supported therapies: Best practice in professional psychology. Thousand Oaks, CA: Sage. Drisko, J. & Grady, M. (2012). Evidence-based practice in clinical social work. New York: Springer-Verlag. Elwood, J.M. (2007). Critical appraisal of epidemiological studies and clinical trials (3rd ed.) New York: Oxford University Press Gambrill, E. (2003). Evidence-based practice: Implications for knowledge development and use in social work. In A. Rosen & E. Proctor (Eds.), Developing practice guidelines for social work intervention (pp. 37-58). New York: Columbia University Press. Gibbs, L. (2003). Evidence-based practice for the helping professions. New York: Wadsworth. Gilgun, J. (2005). The four cornerstones of qualitative research. Qualitative Health Research, 16(3), 436-443. Gilmour D (2000) Is aseptic technique always necessary? Journal of Community Nursing 14: 4. Howard, M., McMillen, C., & Pollio, D. (2003). Teaching evidence-based practice: Toward a new paradigm for social work education. Research on Social Work Practice, 13, 234-259. Keith JM. (1988) Florence Nightingale: statistician and consultant epidemiologist. International Nursing Review 147–50. Kilpatrick C, Reilly J (2002) The importance of surveillance for hospital-acquired infections. Nurs Times 98: 56-57. Luo Y, He GP, Zhou JW, Luo Y (2010) Factors impacting compliance with standard precaution in nursing, China. Int J Infect Dis 14: e1106-e1114. Mace, C., Moorey, S., & Roberts, B. (Eds.). (2001). Evidence in the psychological therapies: A critical guide for practitioners. Philadelphia, PA: Taylor & Francis. Mantzoukas, S. (2008). A review of evidence-based practice, nursing research and reflection: Levelling the hierarchy. Journal of Clinical Nursing, 17(2), 214-223. Roberts, A., & Yeager, K. (Eds.). (2004). Evidence-based practice manual: Research and outcome measures in health and human services. New York: Oxford University Press. Sackett, D., Rosenberg, W., Muir Gray, J.,
Haynes, R. Richardson, W. (1996). Evidencebased medicine: what it is and what it isn’t. British Medical Journal, 312, 71-72. http://cebm.jr2.ox.ac.uk/ebmisisnt.html Sackett, D., Richardson, W., Rosenberg, W., & Haynes, R. (1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingstone. Simpson, G., Segall, A., & Williams, J. (2007). Social work education and clinical learning: Reply to Goldstein and Thyer. Clinical Social Work Journal, (35), 33-36. Smith, S., Daunic, A., & taylor, G. (2007). Treatment fidelity in applied educational research: Expanding the adoption and application of measures to ensure evidence-based practice. Education & Treatment of Children, 30(4), pp. 121-134. Stevens K.R. & Ledbetter C.A. (2000) Basics of evidence-based practice. Part 1: the nature of the evidence. Semin Periopeative Nursing 9(3), 91–97. Stout, C., & Hayes, R. (Eds.). (2005). The evidence-based practice: Methods, models, and tools for mental health professionals. Hoboken, NJ: Wiley. Stuart, R., & Lilienfeld, S. (2007). The evidence missing from evidence-based practice. American Psychologist, 62(6), pp. 615-616. Trinder, L., & Reynolds, S. (2000). Evidence-based practice: A critical appraisal. New York: Blackwell. Wampold, B. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62(8), pp. 857-873. Wood M., Ferlie E. & FitzGerald L. (1998b) Achieving Clinical Behavioural Change: A Case of Becoming Interderminate. Social Science and Medicine, 47, 1729–1738