59 minutes ago Luke Powell  Initial post - Luke Powell COLLAPSE Top of Form Introduction As nurses, we are guided by evidence-based practice to ensure that the care we deliver is safe and appropriate for our patients. During nursing school, we are encouraged to seek out scientific research to support why we do what we do and are taught to continue to do so even after we leave the classroom. We make decisions based from sources including coursework, our textbooks, and clinical experience (Polit & Beck, 2017). However, I have caught myself asking “what does the research say?” especially when completing cares. In particular, do sequential compression devices (SCD) actually contribute to the prevention of deep venous thrombosis (DVT). Nursing research is conducted to answer questions or solve problems (Polit & Beck, 2017). As I have began to ask my coworkers as to why we use SCDs, the answer is always that this is what we have always done. According to Polit and Beck (2017), this is described as unit culture, and these interventions are based on tradition rather than sound evidence. PICOT Question Many of the patients that I see in the intensive care unit (ICU) can expect to be there for at least three days. Most are too sick to be able to get out of bed and move around the room. This inactivity can potentially put them at risk for developing a DVT. To help prevent this from happening, knee high SCDs are utilized. However, the organization that I work for does not have the evidence they found listed anywhere to support the use of SCDs. In fact, when looking at unit council notes from years ago, the same question was brought up and it was noted that there is no evidence to support their use in the ICU.  When conducting research for evidence-based practice (EBP), it is important to create a clinical question that can be answered with research evidence (Polit & Beck, 2017). My PICOT question is “In patients admitted to the ICU, does the utilization of SCDs reduce the risk of DVTs as compared to the use of low dose subcutaneous heparin during a three day admission?” My background questions include: what is a DVT, and what is its pathophysiology? Using PICOT, I can turn this research question into search terms that help to prevent my search from being too broad (Walden Student Center for Success, 2012). Adoption of Evidence-Based Practices Overall, I do believe that my organization is willing to change processes or procedures, if the evidence is there to support such a change. The only problem that I can identify with making those changes is that they must be presented to a committee who reviews our current policies and procedures every two years. Unless there is a strong need to make changes, it could take some time before the specific policy or procedure is up for review. As for my coworkers, we are constantly reevaluating and questioning why we do what we do. It is not that we are trying to find faults within our organization rather that we are try.

1. 59 minutes ago
Luke Powell
Initial post - Luke Powell
COLLAPSE
Top of Form
Introduction
As nurses, we are guided by evidence-based practice to ensure
that the care we deliver is safe and appropriate for our patients.
During nursing school, we are encouraged to seek out scientific
research to support why we do what we do and are taught to
continue to do so even after we leave the classroom. We make
decisions based from sources including coursework, our
textbooks, and clinical experience (Polit & Beck, 2017).
However, I have caught myself asking “what does the research
say?” especially when completing cares. In particular, do
sequential compression devices (SCD) actually contribute to the
prevention of deep venous thrombosis (DVT). Nursing research
is conducted to answer questions or solve problems (Polit &
Beck, 2017). As I have began to ask my coworkers as to why we
use SCDs, the answer is always that this is what we have always
done. According to Polit and Beck (2017), this is described as
unit culture, and these interventions are based on tradition
rather than sound evidence.
PICOT Question
Many of the patients that I see in the intensive care unit (ICU)
can expect to be there for at least three days. Most are too sick
to be able to get out of bed and move around the room. This
inactivity can potentially put them at risk for developing a
DVT. To help prevent this from happening, knee high SCDs are
utilized. However, the organization that I work for does not
have the evidence they found listed anywhere to support the use
of SCDs. In fact, when looking at unit council notes from years
ago, the same question was brought up and it was noted that

2. there is no evidence to support their use in the ICU. When
conducting research for evidence-based practice (EBP), it is
important to create a clinical question that can be answered with
research evidence (Polit & Beck, 2017). My PICOT question is
“In patients admitted to the ICU, does the utilization of SCDs
reduce the risk of DVTs as compared to the use of low dose
subcutaneous heparin during a three day admission?” My
background questions include: what is a DVT, and what is its
pathophysiology? Using PICOT, I can turn this research
question into search terms that help to prevent my search from
being too broad (Walden Student Center for Success, 2012).
Adoption of Evidence-Based Practices
Overall, I do believe that my organization is willing to change
processes or procedures, if the evidence is there to support such
a change. The only problem that I can identify with making
those changes is that they must be presented to a committee who
reviews our current policies and procedures every two years.
Unless there is a strong need to make changes, it could take
some time before the specific policy or procedure is up for
review. As for my coworkers, we are constantly reevaluating
and questioning why we do what we do. It is not that we are
trying to find faults within our organization rather that we are
trying to ensure that we are providing the best and safest care
for our patients. So if change, supported by EBP, does need to
happen, our culture would quickly adopt and adhere to it.
Barriers to Change
As with any change, there is some resistance to be expected.
People are often resistant to change because they are either
comfortable with the previous way of completing a task or they
fear that they may not appear competent when trying to adhere
to the new way. The barrier that I identified from the article
that is most relevant for myself and the nurses that I work with
is difficulty in finding time at the workplace to search for and
read research articles and reports (Majid et. al, 2011). The ICU
can be in a constant state of busy and often times I find it nearly
impossible to sit down and try to conduct research. I know that

3. the research is out there, however, I feel that it is sometimes
impossible to take the time to find it. To help overcome this
barrier, I believe that the use of a clinical resource nurse would
be appropriate. He or she would be able to provide websites that
we could access while at work to look at the current research
available. They could also utilize our emails to send us facts
that are relevant to the cares we provide in the ICU that could
help us to begin asking the questions necessary to create
change.
Resources
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.-L., Chang,
Y.-K., & Mokhtar, I. A. (2011).
Adopting evidence-based practice in clinical decision making:
nurses’ perceptions, knowledge, and barriers. Journal Of The
Medical Library Association: JMLA,99(3), 229–236. https://doi-
org.ezp.waldenulibrary.org/10.3163/1536-5050.99.3.010
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating
and assessing evidence for
nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Walden Student Center for Success. (2012). Clinical Question
Anatomy. Retrieved July 9, 2014,
from https://academicguides.waldenu.edu/c.php?g=80240&p=52
3911
2 hours ago
Jessica Smith
RE: Discussion - Week 1 Initial Post
COLLAPSE
Top of Form
Week 1 Initial Post
Informatics and technology have become a common part of our
country’s health care system. In this day and age, I believe
many people take this ability for granted. I know I did prior to

4. taking my current position. I currently work as a charge nurse
within the Tennessee Department of Corrections. I work at a
maximum security prison that houses 2,000+ male inmates and
does not utilize much technology or informatics within their
current system. One such system that I took for granted and now
no longer have access to is electronic health records. Utilization
of electronic health records (EHR) has become standard across
our health care system (Martelle, Farber, Stazesky, Dickey,
Parsons, & Venters, 2015). However, it is certainly not standard
within the Tennessee Department of Corrections’ health care
system. This particular issue is the gap in my organization that I
will explore as I believe our current paper charting system lacks
the many benefits that EHR offer. In our current system, these
patients’ files are often difficult to locate if they are signed out
to another provider. This can mean that the patient must be seen
and treated without immediate access to their records,
increasing the possibility of adverse outcomes. Many of these
patients are very poor historians and are unable to recall details
such as current medications they are taking. In addition, many
patients within this population have a tendency to utilize
medical services with an ulterior motive as the end goal.
Providers must also attempt to track down the nurses in order to
gain an insight into the patient should the paper chart be
inaccessible. Additionally, when patients are transported to
community appointments, their charts are not allowed to leave
the facility, leaving the community provider with limited
information in regards to their patient. This often leads to many
phone calls between the community provider and the prison
health staff. As you can see, the inability to access their records
leads to wasted time and resources, increasing health care costs
associated with these particular patients.
Implementing EHR within our organization would allow
immediate access to our patients’ records and decrease the
possibility of adverse outcomes. An electronic system would
also assist in the ability to track health issues and outcomes of
our patients. EHR would assist our abilities to deliver

5. coordinated, quality health care to an often difficult-to-treat
population within a challenging environment (Martelle et al.,
2015). In addition, consistency in care would be more easily
achieved when a patient is being treated by both correctional
health providers and community health providers. Because EHR
store a massive amount of information, quality assurance and
performance improvement projects greatly benefit from the use
of this type of health records (Hoover, 2017).
As with any system, there are always difficulties faced. Paper
charting does offer the ability to access health records in the
event of a power outage or computer system malfunction, a
benefit that EHR cannot offer. However, in my opinion, this is
the only benefit to a paper charting system. I have always
worked with EHR up until my current position within the
correctional system. While EHR can offer some difficulties in
regards to navigating the system, our current paper charting
system is very time-consuming. Everything has to be triple
charted, at the minimum, and completely handwritten out (there
is no checkbox system for charting, etc.). One simple, straight
forward sick call requires approximately an hour of paperwork.
If the encounter is more in-depth or more complicated, the time
is almost doubled to complete all the required charting. The
amount of time needed to complete all the charting and to
investigate a patient’s medical history, utilizing the current
system I must, is mind-blowing to me. I would be grateful to go
back to EHR. One study I located assessed nurses’ thoughts on
EHR. I found it very interesting that, in this study, many nurses
believed that using EHR was time-consuming and took time
away from their patients ( Perna, 2014). I would be interested in
researching this further and assessing how my fellow classmates
feel about this. Do you believe that EHR systems take time
away from patient care? More time than a paper charting system
would? If so, can you explain how so?
References
Hoover, R. (2017). Benefits of using an electronic health
record. Nursing2017CriticalCare, 12(1), 9-10. Retrieved

6. from https://ovidsp-tx-ovid-com.ezp.waldenulibrary.org/sp-
3.32.2a/ovidweb.cgi?WebLinkFrameset=1&S=GGACFPDLFPD
DKIODNCDKNEJCEIENAA00&returnUrl=ovidweb.cgi%3f%26
Titles%3dS.sh.22%257c1%257c10%26FORMAT%3dtitle%26FI
ELDS%3dTITLES%26S%3dGGACFPDLFPDDKIODNCDKNEJ
CEIENAA00&directlink=https%3a%2f%2fovidsp.tx.ovid.com%
2fovftpdfs%2fFPDDNCJCNEODFP00%2ffs046%2fovft%2flive
%2fgv023%2f01244666%2f01244666-201701000-
00003.pdf&filename=Benefits+of+using+an+electronic+health+
record.&navigation_links=NavLinks.S.sh.22.1&PDFIdLinkField
=%2ffs046%2fovft%2flive%2fgv023%2f01244666%2f01244666
-201701000-
00003&link_from=S.sh.22%7c1&pdf_key=B&pdf_index=S.sh.2
2&D=ovft
Martelle, M., Farber, B., Stazesky, R., Dickey, N., Parsons,
A., & Venters, H. (2015). Meaningful use of an electronic
health record in the New York city jail system. The American
Journal of Public Health, (9), 1752. Retrieved
from https://ezp.waldenulibrary.org/login?url=https://search.ebs
cohost.com/login.aspx?direct=true&db=edsgea&AN=edsgcl.435
430609&site=eds-live&scope=site
Perna, G. (2014). Nurses dissatisfied with EHRs, report
finds. Healthcare Informatics. Retrieved
from https://www.hcinnovationgroup.com/clinical-it/electronic-
health-record-electronic-medical-record-ehr-
emr/news/13024111/nurses-dissatisfied-with-ehrs-report-finds
REPLYQUOTEEMAIL AUTHOR
Bottom of Form
14 hours ago
Jessica Dunne
RE: Discussion - Week 1
COLLAPSE

7. Top of Form
NURS 6052: Essentials of Evidence-Based Practice
INITIAL POST
Evidence-based practice is the standard that guides
clinical practices within the nursing profession. Adams (2010)
asserts that evidence-based practice “is defined as the
integration of best research evidence with clinical expertise and
patient values to facilitate clinical decision making” (Adams,
2010, p. 274). Polit and Beck (2017) maintain that there is no
consensus about what does or does not constitute evidence.
There are, however, agreed upon sources of evidence which
exist within a hierarchy. Systematic reviews are at the pinnacle
because information is derived from multiple sources.
Randomized controlled trials are next, followed by cohort
studies, single case-control studies, cross-sectional studies,
qualitative studies, and finally expert opinion reports.
Knowledge translation is the process of using evidence to evoke
systemic change within the clinical practice (Polit & Beck,
2017).
Managing Delirium
While working on a busy surgical floor, I was caring for a
confused, combative, elderly patient with a urinary tract
infection who had fallen and broken her hip. During report, the
night shift nurse told me that she gave the patient multiple
doses of haloperidol and lorazepam which were ineffective. The
patient continued to be confused and agitated, and because she
was a danger to herself by continually trying to get out of bed,
the night shift nurse obtained an order for soft restraints.
Springer (2015) contends that the nurse should determine if the
utilization of restraints is appropriate based on the patient’s
current behavior, and should only be used when all other
options such as distraction and de-escalation are exhausted
(Springer, 2015). Because I was not there, I must assume that
the nurse used evidence-based practice to decide that the
restraints were necessary.
When I went in to assess the patient, she was sleeping; and in

8. my professional opinion, the restraints were no longer
appropriate. I removed the soft restraints and put the patient on
one to one observation with a nursing assistant. Not long into
the shift, the light for that room came on, and I heard staff in
the patient’s room yelling. I walked in to find the patient
screaming and striking the nursing assistant as he was
attempting to change the patient. It was clear that the patient
was still experiencing acute delirium. However, the television
was on, the blinds were open, and every light in the room was
on. Instead of using a chemical or physical restraint, I turned
off the television, lights, and closed the blinds. I sat down
beside the patient, spoke softly and attempted to reorient her.
Although she was still confused, she was calm.
Bull (2015) asserts that nursing interventions to manage
delirium include providing a therapeutic environment, frequent
re-orientation, anticipating the patient’s needs, ensuring sensory
assistance devices such as glasses or hearing aids are in use,
observing the patient’s response, and proceeding accordingly.
Non-invasive interventions should be exhausted prior to
restraining a patient chemically or physically (Bull, 2015). In
this case, the patient responded to non-invasive interventions. I
continued to use the one to one observation to ensure safety
throughout the shift but did not need to escalate to using
chemical or physical restraints. By implementing evidence-
based practice, I kept the patient safe without using restraints.
Background and PICOT Question
Background questions are broad, generalized questions that
focus on a clinical issue (Polit & Beck, 2017). In this case, my
background questions would be: what is delirium? And, what
causes delirium? The acronym PICOT (population, intervention,
comparison, outcome, and time) is a format used to create a
research question with the subsequent goal of finding evidence-
based solutions to implement into clinical practice (Polit &
Beck, 2017). My PICOT question is: in delirious patients
(population), what are the effects of non-invasive management
techniques (intervention), compared to restraints (comparative

9. intervention), on patient experience (outcome) and does either
intervention increase or decrease the recovery period (time)?
Organizational Critique
I work as a float nurse in my organization, with previous
experience in critical care. As a float nurse, I have a unique
perspective on organizational culture because I work in multiple
units. Overall, my organization does facilitate a culture of
safety that promotes an environment where nurses learn from
mistakes and do not place blame on one another. Written
policies and procedures are easily accessible on the intranet.
Moreover, my organization utilizes nursing shared governance
which has a special committee devoted to practices and
standards. Nurses are encouraged to bring practice issues to
members of shared governance, and clinical practices are
continually being updated and reviewed. If a nurse has an
immediate question about a clinical practice situation, Clinical
Nurse Specialists are available as a resource in addition to
written policies and procedures.
Organizational Barriers
Majid et al. (2011) report that most nurses have positive
attitudes about evidence-based practice. However, some barriers
which reduce the utilization of evidence-based practice include
inadequate time to learn and implement evidence-based
practice; nurses lack understanding of statistical terminology
and research jargon, and technological deficiencies which
inhibit informational searches (Majid et al., 2017). I believe
that inadequate time is the primary barrier to evidence-based
practice implementation within my organization. Time is finite,
and working 12-hour shifts means nurses do not want to stay in
late or come in early for any type of training. I propose that
team nursing would provide individual nurses with the
opportunity to attend training during regular working hours.
Dickerson and Latina (2017) maintain that team nursing is the
practice of nurses working in pairs to deliver patient care. A
pair of nurses make up a team; both nurses get report on all
patients shared by the team, Then, when one nurse needs to step

10. away for a break, or in this case for training, their partner is
already ready to take care of their patients.
References
Adams, J. S. (2010). Utilizing evidence-based research and
practice to support the infusion alliance. Journal of Infusion
Nursing,33(5), 273-277. doi:10.1097/nan.0b013e3181ee037e
Bull, M. J. (2015). Managing delirium in hospitalized older
adults. American Nurse Today,10(10). Retrieved from
https://www.americannursetoday.com/managing-delirium-
hospitalized-older-adults/.
Dickerson, J., & Latina, A. (2017). Team
nursing. Nursing,47(10), 16-17.
doi:10.1097/01.nurse.0000524769.41591.fc
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., &
Mokhtar, I. A. (2011). Adopting evidence-based practice in
clinical decision making: Nurses perceptions, knowledge, and
barriers. Journal of the Medical Library Association :
JMLA,99(3), 229-236. doi:10.3163/1536-5050.99.3.010
Polit, D. F., & Beck, C. T. (2017). Nursing research generating
and assessing evidence for nursing practice. Philadelphia:
Wolters Kluwer.
Springer, G. (2015). When and how to use restraints. American
Nurse Today,10(1). Retrieved from
https://www.americannursetoday.com/use-restraints/.
Bottom of Form
12 hours ago
Samantha Pitt
RE: Discussion - Week 1
COLLAPSE
Top of Form
By working in Behavioral Health, this writer has seen
many advances in informatics and data that has improved

11. healthcare in terms of efficacy and the ability to reach and treat
more patients. This writer has observed how telemedicine
provides prompt mental health assessments to patients in the
emergency room setting. Not only does this offer a quick
assessment of the patient by a clinician via a computer but it
speeds up getting the patient admitted and can identify a patient
who does not meet the criteria for admission. This is new as
many patients would have to wait for hours in the emergency
room to be evaluated by a psychiatrist which would extend the
admission process. One of the major cons of having the patient
wait is the prolonging of care. Many patients often suffer a
crisis when treatment is not delivered in a timely manner.
When thinking of how informatics could enhance my
area of practice, compliance is the first issue that came to mind.
Many behavioral health patients at some point may become non-
compliant with medications (William, 2015). One of the reasons
for noncompliance is the side effects related to many
psychotropics such as weight gain and gynecomastia in men
(William,2015). This writer’s solution to this problem is to
utilize telemedicine in a way that monitors the patient’s intake
of the medicine each day. A clinician, via video monitoring
could assess the drug and ensure that the patient takes the
medicine. This could also be a good time to assess for side
effects and even get an understanding of the patient’s living
situation and what might not be a conducive living environment.
Another issue in Behavioral Health is the monitoring of
medication levels in the blood as mismanagement of this can be
lethal for many patients (Haring, 2015). Informatics could be
beneficial in that physicians and other clinicians could be
reminded to check these levels by prompts that could be
attached to the medicine whenever it is ordered. There also
could be specific nurse documentation to record the level of the
drug before administering the drug. The nurse must then
complete a blood draw and record it before the med can be
given. This could also work for recording the dates and keeping
track of long-term psychotropic injections.

12. This writer also believes that telemedicine would be a
great advancement for crisis hotlines. Instead of just calling a
hotline when one is contemplating suicide it would be highly
beneficial to see and speak with a therapist that could assist the
client. Many people suffering a crisis may find it difficult to
open up and trust someone over the telephone. Therefore,
having the person visible may bring better results in terms of
improving the trust factor between patients and clinicians.
References
Haring, C. (2015). Influence of patient-related variables on
clozapine plasma levels. American
Journal of Psychiatry, (11), 1471.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics
and the foundation of
knowledge (4th ed.). Burlington, MA: Jones & Bartlett
Learning.
William, B. (2015). Preliminary Findings of Noncompliance
with Psychotropic Medication and
Prevalence of Methamphetamine Intoxication Associated with
Suicide Completion.
Crisis: The Journal of Crisis Intervention and Suicide
Prevention, (2), 78.
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