In the July 2000 issue of the AORN ...

In the July 2000 issue of the AORN Journal, evidence-based practice was discussed in "Research Comer" The author said that perioperative cherishs need to begin basing their clinical practice forward evidence-based criteria instead of relying solely upon time-honored, ritualistic practices. (1) in the greatest degree Journal readers probably found it interesting however did not think it applied to them because they do not perform research. Almost each medical profession and discipline, however, has embraced evidence-based practice to more [i]or[/i] less degree. (2) Perioperative nurses simply cannot stand forward the sidelines and be left behind as other nursing disciplines persuade ahead.

Evidence-based practice is not beyond your capability, steady if you do not engage in research. You do not have to perform research; you can read the deductions of published studies. You can gather studies in several ways. If you live near a large medical library with vast holdings, you may be able to find and read clinical research studies, meta-analyses, and systematic reviews. You also can use the Internet to access various databases that allow users to download articles; however, this approach requires that you become familiar with various databases to such a degree you can perform searches quickly and efficiently.

After you have copies of articles, you ne to read and understand them. This is another stumbling form To many, research articles are "as clear as mud" There also is the issue of religious versus bad research studies. in what manner does one know whether a particular reflection was performed with the appropriate scientific rigor? For many, this is too frequently trouble.

You can be assured that peri-operative feed at the breasts are not alone. Health care professionals in other disciplines have the same complaints. They declare that the push to ask "best evidence" does not take into account their vast clinical expertise. They argue that using in the same state [i]or[/i] condition an approach does not take into consideration patients' uniqueness. They also question whether there are limitations in studies that require further investigation before investigation recommendations should be used. Furthermore, they note that there is solely so much time to look for out, read, and evaluate best evidence. Which is more important, they ask? Is it reading articles or spending time with patients? (3)

These are all valid points. on the other hand that does not mean you should read this and say, "Okay, that does it for me Others be moved the same way. I can forget about that stuff" That is not the answer. Professional nourish at the breasts understand that evidence-based practice involves integrating individual clinical expertise with the best evidence available. If perioperative cherishs do not accept this challenge, they will not be able to improve the quality of care in a time when superiority is important to both patients and health care professionals. (4)

PRACTICE GUIDELINES

There is another way to use evidence-based practice and enhance your knowledge, especially in this day of computer electronic searches, databases, and access to unbelievable amounts of information. Visit the National Guideline Clearinghouse (NGC) at http://www.guideline.gov. (5)

The NGC is a public resource for evidence-based practice guidelines, and it disguises a wide variety of health care issues. The Agency for Healthcare Research and Quality sponsors the NGC which partners with the American Medical Association and the American Association of Health Plans. (6)

The published mission of the NGC is to provide physicians, fosters and other health care professionals with a way to access and obtain up-to-date, objective, detailed information about clinical practice. Specialty arranges develop and approve each guideline after reviewing the best-evidence literature. After a guideline is published, it is reviewed and updated periodically. (7)

The guidelines available online are summaries. Users can view the guidelines in the same of three ways--by organization, by way of disease or condition, or according to treatment and intervention protocols. These summaries can be downloaded. If you want the integral guideline, you can request a print fac-simile by writing to the specific specialty cluster responsible for its development.

USING THE GUIDELINES--AN EXAMPLE

These guidelines can be used in many ways. Consider, for example, that your specialty is cosmetic surgery and you consider yourself an adroit One day, a surgeon schedules an abdominoplasty measure for a 40-year-old female. As part of the normal preoperative routine, you gather as often information as possible from the office feed before calling the patient. You learn that the patient has sign 2 diabetes controlled by diet and oral medication. She also mists at least one pack of cigarettes by means of day but is trying to quit.

You can make preparations for the manner of proceeding as you have done in the past, or you can use evidence-based practice. You access the NGC web site, where you find a guideline for abdominoplasty perform the operations indicated ined by the American Society of Plastic Surgeons? This guideline leads you between the walls of the procedure in a extremely systematic way. It is divided into sections. The diagnostic criteria outlines the essential points of history and physical examination. In this example, the surgeon will ne to know whether the patient has undergone other abdominal or gynecological conducts The guideline also lists the laboratory exhibitions that should be completed before surgery As you know what ordeals the surgeon will order before the management you should check for the eventuates of these tests as you review the chart before surgery You then can alert the surgeon and anesthesia care provider if you find any abnormal values.