Application of Evidence-Based Practice in Operational Theatre

Discuss about the Evidence Based Practice Nursing Research for Operational Theatre.

This paper examines the use of evidence practice in a health care. (EBP) involves the application of best scientific and clinical evidence to treat patients. The paper discusses the application of EBP in operational theatre. The personnel in operational theatre, especially individuals who perform surgical procedures, are exposed bloody body fluids, large quantity of blood and different types of materials for example bone (Schaefer and Welton 2018). These materials are capable of transmitting numerous pathogens. The different types of pathogens that can be transmitted include HIV, hepatitis B (HBV) and hepatitis C (HCV). The operating theatre also represents the environment of the hospital that has higher number of sharp instruments. Hence, the contaminated objects can cause percutaneous injuries which can lead to the transmission of disease to health workers who operate in the environment of Operational theatre. The hands- free techniques has been developed in order to decrease the risks of sharp injuries. The use of HFT reduces the risks associated with the use of sharp instruments in the Operational Theatre as compare to the passing of instruments thru hand to hand (Melnyk et.al 2018). I synthesized and reviewed different research studies that compliance with the use of HFT and factors that enhances its use by using different articles, secondary search of reference and online database (Alving, Christiansen and Thrysoe 2018). I reviewed related factors using the model of Hopkins Nursing Evidence Based practice. I found out that the perception of health care workers ‘has a great influence on the use of HFT. The perception of health works is that the application of HFT to pass sharp instruments is effective than using hand to hand because it protect them against bloody contamination and sharps injury. Workers especially clinical professionals are expose to numerous life altering disease when they use hand to hand as compare to using HFT. The application of HFT reduces the risk that is associated with the surgical procedures in the operational theatres (Rohan, Hayman and Lake 2018).

The data was collected on eligible injuries and eligible surgeries, contaminations and glove tears from different hospitals and three intervention hospitals. All the three hospitals were publicly funded, private and nonprofit hospital. In the hospital the available data was collected using Baseline period 1. The implementation of the data collected took place after a period of one week. Because of low use of HFT and low outcome of incident rates, the intervention was implemented using the three hospitals for a period of three months (Kim, Jeong and Park 2015).

The Risks of Sharp Injuries in the Operating Theatre

Eligible surgeries involved both emergency and elective surgeries that lasted for duration of 20 minutes, were performed everyday on weekdays. The report on the percutaneous injuries and contamination was conducted by the anesthesia personnel.

In order to enhance good response, there is inclusion of one-page and a double-sided questionnaire was also conducted for each surgery that was performed using HFT and hand to hand. Circulating nurses recorded the number of injury that the health workers encountered and number of people that were present. The outcome from the study is that the use of HFT by the surgical personnel is more effective than the use hand to hand. The eligible personnel (i.e. the assistant of the surgeons, surgeons, residents, circulating nurses and resident) contacted a percutaneous injury, mucocutaneous contamination and glove tears (Schirm, Banz, Swartz and Richmond 2018).

The intervention was then made using the opinion of the nurses and other health care workers who offered knowledge about the importance of using HFT in the operational theaters as compares to the use of hand to hand. The core reason why the implementation of the HFT should be allowed in the environment was then stated using the advantages of the Effectiveness of HFT as compares to hand to hand in passing sharp instruments during surgical procedures in the operational theatre.  The use of Video in collaboration provided in the collection of data provided written text and Voiceover which gave up to date data about the occurrence of injuries and various exposures that occurred during surgery and other different information. The nurses discuss how HFT can be applied in the Operational theatre. The implementation of the intervention was made possible by the nurses and the entire health worker that are in the department of the Operational theatre. The interactive and teamwork among the health workers was found to be important factors in the implementation of the intervention that was derived from the study. Given the different of terminology linked to sharps injuries, there is also application of primary search and secondary search. The research obtained from the study of the two articles shows strong evidence from the review of the articles on the effectiveness of the HFT application in the operating. Among the finding is that the use of HFT reduces the injuries that are associated with the sharp instruments. The surgical personnel should encourage the use of the HFT in the Operational theatre that involves the use of sharp instruments during their daily activities. 

Use of Hands-Free Technique for Safe Surgical Procedures in Operational Theatre

Nursing as a career is quite challenging, and nurses are required to relay on various mental and physical resources to cope up with the continuously challenging healthcare environment.  As a result of the seriousness needed in the medical field research reports used by nurses are critically reviewed to ensure the safety of patients under the care of nurses. This appraisal applies the uses critical analysis tools CATs as one of the tools used by various medical scholars to increase competence as well as help medical practitioners make informed medical decisions. The section of the study, therefore, applies CATs to assess the validity and authenticity of the articles about nursing.

Medical injuries have been common among nurses of the past years with no perfect interventions generated to help nurses avoid such injuries. The article was written by Dionne Williams in the year 2016 on factors associated with the use of safety-engineered needles and hands-free techniques; current practices among operating room nurses are properly organized with ideas flowing from the beginning form the top to the bottom.  The article is well written with good ideas which can help room nurses escape various medical risks resulting from medical injuries during operations.  The title of the article is well written and related to the whole content. However, the author has not shown how medical injuries are generated.  At the beginning of the article, the author begins with an abstract which summarizes all aspects the content is all about. The author of the abstract explains the approach the article is going to take giving incite to the readers of the article. The abstract is also succinct explaining the salient points which are well elaborated in the content as well as the inferences obtained inform of results. 

The author of the articles has explained the main theme of the discussion “nurse room injuries” how the theme can be applied by nurses in their daily lives.  Anyone reading the article can get incite of medical room injuries based on the effort employed by the author.  The author of building the content of the paper uses various past studies to come up with a proper definition of the main theme of discussion.  To achieve provision of relevant background, the author has applied various sources from diverse groups of writers ranging from parents, patients, students and professors from diverse backgrounds.  The author through these studies has insisted the point on which mechanisms which can be used to solve medical injuries in theatre.

Factors Affecting the Use of Hands-Free Technique

The author of the article has taken and relevant approach to the topic of inquiry based on researched method techniques and designs.  To meet the study objective, the author has used a descriptive correlational study survey. The techniques were administered to the most current room nursing practices. The study involved the use of a PRECEDE mechanism which was applied to the study of information gathered regarding work environment and operation room safety practices. What the methodology involved in the article is qualitative approach thus no major statistical analysis was required on the obtained.  In comparison to the past studies on the same topic, it can be concluded that the correlation used is within consistency and accuracy limits leading to valid results obtained (Gordon, Lauver and Buck 2018).

The results obtained from the study have been shown simply and comprehensively describing the details of the nurse participants.  The result obtained was clearly showing the participant who is using the SESIP needles, as well as HFT, were recorded and analyzed. Among the participant, it noticed that 46 % of room nurses use SESIP needles while 42% use HFT. Various factors making various nurses use SESIP needles were determined as well as with valid reasons highlighted in the result section. The study has got a proper conclusion with recommendations on which policies which can be applied to help improve the current rate of medical injuries affecting room nurses. Apart from proper conclusion with, the article identified various limitations of the study and recommended ways in which future reports on the same topic can be improved to provide accurate information than this current study.

Similar to the qualitative report above, the authors of the second article stress on the “injuries happening with sharp objects in clinical operations.” This second study is similar to the initial study, but authors take a quantitative approach.  Pamela, Sean, and Faan systematically explain that nurses neglect in operation rooms care much for their patients to the extent that some of them neglect themselves. The study has a short abstract providing an insight of the study by outlining the subject of the study, methodology use and results.   The content of the study is well organized and related to the topic of study (Gordon, Lauver and Buck 2018)

The introduction part of the study begins with a thesis statement which provides emphasis on the study topic. Authors of this second article have explained the need for room nurses to use safety measures while dealing with patients (Stavor, Zedreck and Hoffmann 2017). Within the introduction, the authors of the article use previous studies stressing the subject. The primary aim of the study is achieved through the application of literature review. The study takes quantitative methodology in order achieves the aim of the study (Brownson, Colditz and Proctor 2017).The study takes a different qualitative approach where various papers were reviewed using John Hopkins evidence-based nursing research.  The data obtained online has been critically analyzed based quantitative research techniques.  The reviewed articles provided the required statistics which was well analyzed in a hypothetical but accurate manner within the required limits and results obtained. The study discussions focused on the study findings and results on comprehension of medical care can be achieved by room nurses.  To overcome most injuries in operation rooms by nurses, the study within the discussion section provides reasons and ways in which nurses can avoid medical injuries while performing operations (Linzer and Clarke 2017). The study is important to room nurses at it provides nurses with ideas and ways to avoid injuries during operations (Melnyk, Fineout, Giggleman and Choy 2017).The content of the article concludes with recommendations which the authors believe will help room nurses to avoid medical injuries happening in operation rooms.  The authors end the study by highlighting various limitations which future authors studying the same topic should avoid.  However, the article is relevant and can assist medical practitioners to avoid medical injuries which occur in operation rooms (DiCenso, Guyatt and Ciliska 2014). 

Effectiveness of Hands-Free Technique in Reducing Injuries Associated with Sharp Instruments

The main goal of this study is to examine the impact of suitable surgical work practice, HFT, on the rate of contamination, injuries, and glove tears. It is true that use of HFT decreases the actual rate of injury than the use of hands to hands in the Operational theatre. The study has some limitation as it depend on circulating nurses to offer information on the factors that causes various injuries in the operational theatre (Grove, Burns and Gray 2014). The operational theatre surgery does not apply the use of standardization due to their complexity, but the passing of sharp instruments between the personnel of the surgical procedure does. HFT involve the use of interdependent team practice for the all the workers. The study suggest that most of the health workers sustained injury when passing instruments during the surgical procedures therefore there is need of the Operational theatre to make use of HFT as it reduces the risk that is associated to the passing of instruments (Jirojwong, Johnson and Welch 2014).

Increasing the use of HFT in passing sharp instruments decreases the vigilance level by the team of surgical members especially, when all the team uses hand-free or all sharp instruments on a central zone by residents and surgical (Renolen, Høye, Hjälmhult, Danbolt and Kirkevold 2018). This is different when the team uses hand to hand , as it requires personnel that ensure that the instruments being passed is properly placed or to remind all the team that that the instruments is being pass to avoid the injury that are associated with the use of hand to hand. The use of HFT in the operational is more affective in a population that requires the need of active behavior from the entire team. The study shows that the perception of the workers also has strong influence on the use of HFT (Townsend and Morgan 2017). For the process to be effective appropriate intervention should be put in place to improve the use of the HFT this is because the process is capable of solving the problems in HFT (Mackey and Bassendowski 2017). Another possible limitation is the inability to measure the characteristics of the health workers and the surgical team in order to come up with the perception of the entire team in regard to the use of the HFT. Despite the effectiveness on the use of HFT in passing sharp instruments, professional sometimes avoid using HFT because some Surgeons recommend use using the techniques in picking sharp instruments from the basin or field would distract them during the operation because they will have to remove their from the site (surgical site), and this may increase time taken in performing a particular activity (increases length of surgery). Due to additional injuries caused by the use of hand to hand in passing sharp objects during surgery, in order to reduce the injuries the operational theatre professional encourage the use of HFT that reduces the incidents that are linked to the use of sharp instruments (Butcher, Bulechek, Dochterman and Wagner 2018).

Evaluation of Two Articles on Nursing Injuries

The action that the health sector should take into consideration is that management, and teamwork should be encouraged in the operational theater to improve the effectiveness in the use of HFT. Different approaches should be used to in service training and education and there should be inclusion of annual safety training and demonstrations. This training and education should target professionals that require the most improvement in the operational theatre (Murphy, Staffileno and Foreman 2017). In addition, when the management did not fully support the use of the HFT, it can increase the rate of the injury (LoBiondo-Wood and Haber 2017). Managers should therefore, should encourage the use of the HFT by offering the required support to guide different professionals that perform the surgical procedure to comply with the requirement of the HFT (Williams 2016).The managers should also reinforced safety and provide feedback as the use of the HFT reduces the injury being cause by sharp objects in the operational theater (Blais 2015). Therefore, they should come up with the interventions in order to improve the use of HFT to the entire team. The all team should also apply the use of the universal standard of the hand free techniques. Future studies on the injuries the professional experience during the surgical procedure should measure the compliance of the HFT thru direct observation rather than thru survey. There is higher perception of the workers in relation to the use of the HFT. The clinical professional and the nurses’ belief that the use of HFT reduces the risk associated with the injury (Melnyk, Long and Fineout 2014). This is because HFT encourages use of safety behavior. Surgical technologist and nurses should choose the appropriate zone for every procedure that they will be performing and ensure that each and every workers that are involve in the Surgical procedure access the equipment safely. Greater application of the HFT in the system was strongly related to the high enabling scores. Use of the HFT resulted in six times reduction in injury in the system (Nieswiadomy and Bailey 2017). Valuable knowledge acquired from the previous research on the use of sharp related instruments influence the effort of the operational theatre professional in the effective use of the HFT (Beccaria, Beccaria and McCosker 2018).

Conclusion

The paper is important as it try to discuss the effectiveness of the use of the HFT in passing of the sharp instruments during the surgical procedure.  The use of HFT helps in reducing the risk which are associated with the injury. In the study, most of the surgeons did not use the HFT. The surgeons resist the use of HFT than the Nurses. The reason is that lack of the evidence on the effectiveness of HFT use as compares to the use of hand to hand when passing instruments from one person to another. HFT is more significant in nursing but the implementation process is mostly being affected by the order of evidence. To enable the effectiveness of the HFT in passing the sharp instruments in operational theaters, hierarchy of evidence should not be used and they should use reflection as the main component when deriving the evidence base practice (Dang and Dearholt 2017). The implementation of the HFT requires training of all the professionals and the workers in the operational theatre and it is mostly inexpensive. In order to enables full implementation of the process into the system, penalties and incentives is needed to enable effective application of the HFT in the operational theatre. The management and the agencies in charge of the enforcement can help sustain and enact implementation that will enable the use of the HFT in the surgical procedure as the process is more appropriate than the use of hand to hand passing of instruments from one person to another (Spiva et.al 2017). The articles also state the perception of the workers on the use of HFT as compare to that of the hand to hand in passing of the sharp instruments. Most of the clinical profession avoids the use of the HFT because it can create confusion and it also waste time as compare to the use of hand to hand in passing of sharp objects. Therefore it can be concluded that the use of Evidence based nursing in the operational theatre can help the institution to make quality decisions. HFT apply the approach of the EBP as the foundation. The main goal of HFT is to implement and use up to date method in providing care for the health care workers and the professionals (Kim et.al 2017). It can also improve the safety for the patients because there will be less injury in the operational theatre. The use of EBN is more efficient and cost effective and improves the delivery of the services in the health care system. in order to implement HFT , patient’s preference, patient’s knowledge and the study of evidence should be included in order to produce a suitable solution to the work being performed (LoBiondo and Haber 2014).

Application of Critical Analysis Tools to Assess Validity and Authenticity of Articles

References 

Alving, B.E., Christiansen, J.B. and Thrysoe, L., 2018. Hospital nurses’ information retrieval behaviours in relation to evidence based nursing: a literature review. Health Information & Libraries Journal.

Beccaria, L., Beccaria, G. and McCosker, C., 2018. A confirmatory factor analysis of the student evidence-based practice questionnaire (s-ebpq) in an Australian sample. Nurse education today, 62, pp.69-73.

Blais, K., 2015. Professional nursing practice: Concepts and perspectives. Pearson.

Brownson, R.C., Colditz, G.A. and Proctor, E.K. eds., 2017. Dissemination and implementation research in health: translating science to practice. Oxford University Press.

Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. and Wagner, C., 2018. Nursing Interventions classification (NIC)-E-Book. Elsevier Health Sciences.

Dang, D. and Dearholt, S.L., 2017. Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines. Sigma Theta Tau.

DiCenso, A., Guyatt, G. and Ciliska, D., 2014. Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Gordon, J.M., Lauver, L.S. and Buck, H.G., 2018. Strict versus liberal insulin therapy in the cardiac surgery patient: An evidence-based practice development, implementation and evaluation project. Applied Nursing Research, 39, pp.265-269.

Grove, S.K., Burns, N. and Gray, J., 2014. Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.

Jirojwong, S., Johnson, M. and Welch, A.J., 2014. Research methods in nursing and midwifery pathways to evidence based practice.

Kim, S.C., Ecoff, L., Brown, C.E., Gallo, A.M., Stichler, J.F. and Davidson, J.E., 2017. Benefits of a Regional Evidence?Based Practice Fellowship Program: A Test of the ARCC Model. Worldviews on Evidence?Based Nursing.

Kim, Y.G., Jeong, I.S. and Park, S.M., 2015. Sharps injury prevention guidance among health care professionals: A comparison between self-reported and observed compliance. American journal of infection control, 43(9), pp.977-982.

Linzer, P.B. and Clarke, S.P., 2017. an Integrative Review of the Hands-free Technique in the Or. AORN journal, 106(3), pp.211-218.

LoBiondo-Wood, G. and Haber, J., 2014. Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

LoBiondo-Wood, G. and Haber, J., 2017. Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

Mackey, A. and Bassendowski, S., 2017. The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), pp.51-55.

Melnyk, B.M., Fineout?Overholt, E., Giggleman, M. and Choy, K., 2017. A Test of the ARCC© Model Improves Implementation of Evidence?Based Practice, Healthcare Culture, and Patient Outcomes. Worldviews on Evidence?Based Nursing, 14(1), pp.5-9.

Melnyk, B.M., Gallagher?Ford, L., Long, L.E. and Fineout?Overholt, E., 2014. The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), pp.5-15.

Murphy, M.P., Staffileno, B.A. and Foreman, M.D. eds., 2017. Research for advanced practice nurses: From evidence to practice. Springer Publishing Company.

Nieswiadomy, R.M. and Bailey, C., 2017. Foundations of nursing research. Pearson.

Renolen, Å., Høye, S., Hjälmhult, E., Danbolt, L.J. and Kirkevold, M., 2018. “Keeping on track”—Hospital nurses’ struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study. International journal of nursing studies, 77, pp.179-188.

Rohan, A., Hayman, L.L. and Lake, E.T., 2018. Toward Evidence-based Practice. MCN: The American Journal of Maternal/Child Nursing, 43(1), pp.56-58.

Schaefer, J.D. and Welton, J.M., 2018. Evidence based practice readiness: A concept analysis. Journal of nursing management.

Schirm, V., Banz, G., Swartz, C. and Richmond, M., 2018. Evaluation of bedside shift report: A research and evidence-based practice initiative. Applied Nursing Research, 40, pp.20-25.

Spiva, L., Hart, P.L., Patrick, S., Waggoner, J., Jackson, C. and Threatt, J.L., 2017. Effectiveness of an Evidence?Based Practice Nurse Mentor Training Program. Worldviews on Evidence?Based Nursing, 14(3), pp.183-191.

Stavor, D.C., Zedreck-Gonzalez, J. and Hoffmann, R.L., 2017. Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital. Journal of Nursing Administration, 47(1), pp.56-61.

Townsend, M.C. and Morgan, K.I., 2017. Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.

Williams, D., 2016. Factors Associated with Use of Safety-Engineered Needles and Hands-Free Techniques: Current Practices among Operating Room Nurses (Doctoral dissertation, Johns Hopkins University).