Evidence-based Practice in Wound Cleansing

licence- assemble Practice in breach CleansingIntroductionThis essay defines the concept of show-based charge and discusses the impressiveness of bear witness-based send for master act. The essay also selects an spirit of dedicate that is applicable to adult toy with, namely the map of piddle vs. saline solution for anguish clean, turn ins a rationale for choosing that aspect inside the linguistic linguistic context of evidence based coif, and, draftsmanship on practice experience and examples of approbate evidence, discusses the extent to which the aspect of headmaster practice is informed by contrasting types of evidence. In addition, the essay, with reference to the selected aspect of professional practice, discusses the factors that back tooth obturate, or hinder the implementation of, evidence-based practice.Evidence-based practice is usu all in ally taken to mean using the current stovepipe evidence in making decisions about the sustainment of ind ividual endurings (see Sackett et al., 1996), with a more late(a) definition beingness, Evidence-based practice requires that decisions about health c atomic number 18 ar based on best available, current, valid and relevant evidence. These decisions should be made by those receiving c are, informed by the tacit and explicit knowledge of those providing anguish, within the context of available resources (see Dawes et al., 2005).The importance of evidence-based practice for professional practiceIn term of the importance of evidence-based practice for professional nursing practice, offering evidence-based assessments and discourses has become far-flung across the nursing profession due to the subscribe to for the NHS to be seen to be accountable to their long-sufferings as crack up of the NHS Plan (see Griepp, 1992). In essence, in the context of the NHS Plan and the consequences of this for professional practice, the aim of evidence-based nursing practice is to treat the pa tient in the best possible way, as dictated by the more or less up-to-date evidence available, in a timely manner, in stage to ensure the highest possible quality of care for that individual patient (Cluett and Bluff, 2000). in spite of appearance the theoretical account of the NHS, the NHS Plan has meant many changes to nursing practice, including improvements in the slant of armed service but mainly placing emphasis on the prompt delivery of evidence-based care and the pro-active mesh of the patient in their own care. As get around of this change, which is a sea-change in the way in which the NHS has traditionally viewed care, nursing provide need to commit themselves to vitalitylong learning and professional development, within an evidence-based practice frame be prone. This evidence-based poser dictates that nursing provide must intention the current best evidence when making decisions about patient care, in order to conform to the dictates of their circumstance gu idelines for professional practice.This is especially pertinent considering the need to empower patients through involvement in patient care, chthonic the dictates of the NHS Plan as Playle and Keeley (1998) argue, patients are no longer passive receivers of care as the NHS now needs to be seen to be accountable to their patients. Offering evidence-based assessments and treatments fulfills the requirements to be accountable to patients through the use of up-to-date question to inform treatment practices, for example (see also Griepp, 1992).rationale for choosing the use of piss vs. saline in affront cleaningThis naval division of the essay discusses an aspect of practice that is relevant to adult nursing, namely the use of irrigate vs. saline for appal cleanup spot, and provides a rationale for choosing that aspect within the context of evidence-based practice. This aspect practice has been chosen as it is commonly bring in nursing practice many individuals present with v exs at all nursing levels, including AE, community nursing and intensive care, amongst others. The issue thus has general importance in nursing practice across many different areas of practice.An analysis of the extent to which the use of pee vs. saline for annoy cleanup spot is informed by different types of evidenceThis section of the essay get out now draw on my practice experience, and, using examples of appropriate evidence, volition discuss the extent to which the use of pissing vs. saline for wound groom is informed by different types of evidence.Cunliffe and Fawcett (2002) found that nurses are presented with a build of wound cleansing options, from the products that female genitalia be used to cleanse wounds to the dressings that cigaret be used. The work found that this makes it hard for nurses to make decisions about patient treatment, which means that nursing staff, instead of looking to the literature for advice, turn to the RCN guidelines, which is non an ideal basis for evidence-based practice (Cunliffe and Fawcett, 2002).Betts (2003) found that wound cleansing with urine does non differ from wound cleansing with other substances, in harm of wound transmission and wound healing (similarly to Gannon, 2007 Hall, 2007 and Griffiths et al., 2001). Fernandez and Griffiths (2008) conducted a systematic round off of the literature on the use of water for wound cleansing and found that, whilst saline is usually favoured for wound cleansing, tumble water is also a viable resource, as it does not increase infection and there is slightly evidence that using pink water actually reduces the risk of infection, plane in sharp-worded wounds. Their conclusion was that boiled tap water can be used as a wound cleansing promoter (Fernandez and Griffiths, 2008), a conclusion also reached by Moscati et al. (2007), ONeill (2002), Valente et al. (2003), Whaley (2004) and Riyat and Quinton (1997).Thus, the evidence from the research conducted o n this subject suggests, overwhelmingly, that tap water is a viable alternative to saline for wound cleansing. The RCN guidelines for wound cleansing lull, however, state that saline should be used for wound cleansing. The next section willing look at this discrepancy in detail.The factors that facilitate or hinder the implementation of evidence-based practice in wound cleansingThis section makes reference to the selected aspect of professional practice in order to discuss the factors that facilitate or hinder the implementation of evidence-based practice. There are many structures designed to support evidence-based nursing practice, including research and development that translates in to best practice guidelines. However, whilst it is clear that nursing staff, under the dictates of the NHS Plan, need to work within an evidence-based care framework, there are no guidelines as to how research is best incorporated in to their practice, in terms of what research should be used or wh at questions should be asked of that research, and so nursing staff often end up following guidelines that are produced for them, by the NHS. These guidelines are based on current research, and so do provide evidence-based care for patients, in some sense, but following guidelines does not involve nursing staff being directly involved in evidence-based care.As one of the main principles of evidence-based practice is that decisions about care should be based on the best currently available evidence from research, this topographic point is not ideal. Under a true evidence-based practice framework, nursing staff should be regularly undertaking literature searches themselves, to ensure that they themselves keep up to date with the research, and that they are aware of any new recommendations for nursing practice that are suggested by this research. They should then be implementing these new recommendations.This, however, provides difficulties, in that nurses are bound, by their professi onal training, to provide the usual standards of care, with the possible implication that, should a nurse try a new treatment method on a patient, following their research on a subject, as part of the evidence-based framework, and this treatment is not successful, the nurse would return let the patient down, under the guidelines provided for their professional practice. This, thus, provides a dilemma for nursing staff, who are bound to work under an evidence-based framework, but who are in practice reliant on the timely provision of updates to treatment guidelines, which are based on an evidence-based framework but which have not been researched individually by the nursing staff.For example, as has been seen, there are many research publications that show how water can be beneficial in cleansing wounds, but the current recommended practice from the RCN guidelines is that irrigation of the wound with saline is usually sufficient with the provided rationale for this being that, cle ansing traumatic wounds with saline was associated with a lower rate of clinical infection when compared to tap water (Angeras et al., 1992), the RCN guidelines do concede that no clinical runnels have been performed comparing tap water and saline water in wound cleansing and, as such, that there is no real evidence-base for these recommendations. nursing staff working within an evidence-based framework could skim the literature supporting water as an effective wound cleanser, and could base their treatment on this literature, which, whilst being within the scope of evidence-based practice, as recommended by the NHS Plan, would go against what they are recommended to do by their professional body. In the example discussed in this essay, therefore, the evidence as provided by the research has not yet been translated in to an up-to-date practise of guidelines for nursing staff to follow. It seems, therefore, that patients are not being treated accord to the best possible set of tr eatments according to the research, but, as the RCN guidelines state, there has, as yet, been no clinical trial of wound cleansing with water vs. saline, and so, eve if the research suggests tap water is an effective, if not more effective wound cleanser than saline, until a clinical trial has been undertaken testing this, the recommendations for treatment will not change.In this strip, however, a clinical trial is extremely difficult to imagine, due to the temporary and highly individual nature of wounds, which makes it impossible to provide clinical trial conditions to test water vs. saline as wound cleansing agents. As such, even though the literature suggests that tap water is an effective, if not more effective, wound cleanser than saline, saline will still continue to be used, as this has been used historically, and because no clinical trial has been set up proving the effectiveness of tap water, meaning that tap water cannot be recommended as a wound cleanser, in that it is not recommended in the RCN guidelines for nursing staff.breast feeding staff are, however, under the evidence-based practice framework, able to apply, supervise lizard and record wound cleansing using tap water. This approach allows nursing staff to approach the sour of evidence-based practice in a series of steps (as recommended by Cluett and Bluff, 2000), within the guidelines provided by the RCN. The first step is delimit the research question, based on evidence gained from treating patients in practice, which, in this case would be, What is the best way to cleanse a patients wound, using tap water or saline?. The next step would be to search for and to read all the relevant literature, and then to decide, on the basis of that literature, what the best treatment options are for the patient. This would, as has been seen, overwhelmingly suggest that tap water is the best treatment option, but the RCN guidelines would suggest that saline is the best treatment option. The nurse would thus be obliged to use saline but could apply, monitor and record wound cleansing using tap water, as part of the evidence-based framework they are encouraged to follow.Evaluation of the care provided and the processes through which the care was decided upon and administered would constitute the third and final step of the evidence-based framework (as given by Cluett and Bluff, 2000), which would gather all the relevant information and then would pass judgment the results of this treatment in terms of finding a better upshot for wound cleansing. This step-by-step approach to evidence-based practice allows for gradual improvements in the delivery of patient care through a process of gathering evidence of best practice. As has been seen, however, often nursing staff are not encouraged to follow this pathway as they are obliged to be bound by the guidelines for treatment provided by their professional body, the RCN, which, in this case, recommends a treatment option that seems outdated, according to the current research.ConclusionAs shown by the appraisal of evidence for the use of tap water vs. saline as a wound cleanser, evidence-based practice in a nurses working life can be hindered by their professional guidelines, which, in this case, have not been updated based on the findings of current research. Whilst evidence-based practice facilitates best treatment practice for patients (as dictated by the NHS Plan) through the step-by-step approach outlined by Cluett and Bluff (2000), in this case, this facilitation is not enabled through the failure of the RCN to update their guidelines.Angeras M.H. et al. (1992). similarity between sterile saline and tap water for the cleaning of acute traumatic soft tissue wounds. European Journal of Surgery, 158 6-7 347-50.Betts, J. (2003). step upiew wound cleansing with water does not differ from no cleansing or cleansing with other solutions for rates of wound infection or healing. Evidence Based Nursing 6, pp.81.C luett, E. and Bluff, R. (eds.), 2000. Principles and Practice of research in midwifery. Bailliere Tindall.Cormack, D., 2000. The research process in nursing. Oxford Blackwell Science.Cunliffe, P.J. and Fawcett, T.N. (2002). Wound cleansing the evidence for the techniques and solutions used. Professional Nursing 18, pp.95-99.Dawes, M. et al., 2005. Sicily averment on evidence-based practice. BMC Medical Education 5, pp.1-2.Fernandez, R. and Griffiths, R. (2008). Water for wound cleansing. Cochrane Systematic Syst Rev 23, pp. CD003861.Gannon, R. (2007). Wound cleansing sterile water or saline? Nursing Times 103, pp.44-46.Goldenberg, M.A., 2006. On evidence and evidence-based treat a commentary on common criticisms. CMAJ 163(7), pp.837-841.Griepp, m.E, 1992. Undermedication for pain an ethical model. Advances in Nursing Science 15. pp.44-53.Griffiths, R.D. et al. (2001). Is tap water a safe alternative to normal saline for wound irrigation in the community setting? Journal of Wound care 10, pp.407-411.Guyatt, G. et al., 2004. Evidence-based treat has come a long way. BMJ 329, pp.990-991.Hall, S. (2007). A review of the effect of tap water vs. normal saline on infection rates in acute traumatic wounds. Journal of Wound Care 16, pp.38-41.Hinchiff, S. et al. (2003). Nursing practice and health care. Hodder Arnold.LoBiondon-Wood, G. Haber, J. (2006) Nursing Research Methods and Critical Appraisal for Evidence-Based Practice. St. Louis. Mosby.Moscati, R.M. et al. (2007). A multicenter relation of tap water vs. saline for wound irrigation. Acad Emerg Med 14, pp.404-409.NLH (2006). What is the evidence-based method of wound cleansing either with tap water or normal saline? lendable from http//www.clinicalanswers.nhs.uk/index.cfm?question=2518 Accessed 20th March 2008.ONeill, D. (2002). Can tap water be used to irrigate wounds in AE? Nursing Times 98, pp.56-59.Patel, S. and Beldon, P. (2003). Examining the literature on using tap water in wound cleansing. Nursing T imes 99, pp.22-24.Riyat, M.S. and Quinton, D.N. (1997). Tap water as a wound cleansing agent in AE. J Accid Emerg Med 14, pp.165-166.Sachine-Kardase A, et al. (1992). Study of clean versus aseptic technique of tracheotomy care based on the level of pulmonary infection. Noseleutike 31(141), pp.201-11.Sackett et al., 1996. Evidence-based medicine what it is and what it isnt. BMJ, 312, pp.71-2.Salami, A.A. et al. (2006). A comparison of the effect of chlorohexidine, tap water and normal saline on healing wounds. Int J Morph 24, pp.673-676.Valente, J.H. et al. (2003). Wound irrigation in children saline solution or tap water? Ann Emerg Med 41, pp.609-616.Watret L., Armitage M.A. (2002). Making Sense of Wound Cleansing. Journal of Community Nursing, 16(4), pp.27, 29-32, 34.Whaley, S. (2004). Tap water or normal saline for cleansing traumatic wounds? Br J Comm Nurs 9, pp.471-478.