Common nursing practices based on tradition, not evidence

Many common nursing practices derive from tradition rather than empirical evidence that they are effective, according to an article in Critical Care Nurse.

The researchers, led by Mary Beth Flynn Makic, Ph.D., a research nurse scientist in critical care at the University of Colorado Hospital, examined the evidence associated with four clinical practices common in nursing: managing feeding tubes in children and infants, promoting sleep in the intensive care unit (ICU), turning critically ill patients every two hours and preventing venothromboembolism. Their analysis determined that:

  • It is unclear whether there is a universally effective turning frequency for critically ill patients. Nurses should try to turn patients every two hours, ideally, but make decisions on a case-by-case basis, according to Makic's research. "Critical care nurses are in an ideal position to advocate for the use of support surface therapies if warranted by the severity of the patient's illness and associated immobility," the article states.

  • The best way to improve sleep schedules in the ICU is to modify environment and cluster care to minimize disruptions and limit artificial methods like sedation. "Clinicians should be vigilant about sleep enhancement through patient-centered approaches that enhance optimal ICU recovery," according to the article.

  • Evidence indicates that the best method for feeding tube insertion in children and infants is the age-related, height-based equation method or the nose-ear-mod-umbilicus method. Researchers encourage nurses to make the decision on a case-by-case basis. "Whenever there is a doubt about tube placement, placement should be verified radiographically," the researchers write.

  • Nurses should assess all patients for venothromboembolism risk factors upon admission to the ICU, and maintain chemical and mechanical therapies to reduce the risk. "Recognizing that deep vein thrombosis is a problem is not enough," the article states. "Recognition must be followed with consistent implementation of EBP [evidence-based practice] guidelines to improve care and decrease risk of preventable complications and death from venothromboembolism."

A January study offered 24 key competencies nurses need to integrate evidence-based care into clinical settings, FierceHealthcare previously reported.

To learn more:
- here's the article

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