RUNNING HEAD: Evidence Based Practice

Evidence Based Practice Paper

Amber Dykstra
NURS 324

Evidence Based Practice

Purpose of Paper

1. Purpose (all reasoning has a purpose)

The purpose of my Evidence Based Practice

topic is to review the wet to dry dressing
procedure and find alternative dressing
choices. Wet to dry is a very painful dressing
change that can be done up to three times a
day. If there are less painful, but just as
effective dressings, they should be considered.
2. Questions at issue or central problem (all
The issue at hand is wet to dry dressing is very
reasoning is an attempt to figure something
painful. Does the effectiveness of wet to dry
out, to settle some question, solve some
dressing justify the pain a patient has to go
problem)
through? Are there other procedures that are
just as effective as wet to dry dressing but less
painful?
3. Point of view (all reasoning is done from
I have had patients with stage three pressure
some point of view; think about the
ulcers and diabetic foot wounds and have a wet
stakeholders)
to dry dressing. When I changed their
dressings, my patients cry out in pain.
According to Lee Johnson of Johns Hopkins
University School of Medicine, this pain
occurs because sensitive nerve fibers in the
wound bed are being exposed.
4. Information (all information is based on
According to Lee Johnson, there are
data, information, evidence, experience,
alternatives to wet to dry dressings. Wet to dry
research)
dressings can delay wound healing by
removing migrating epithelium. Alternatives
include but are not limited to foams, alginate
and hydrofibers, hydrogels and cellulose, and
hydrocolloids.
5. Concepts and ideas (all reasoning is
Debridement gets rid of the slough, but what if
expressed through, and shaped by, concepts
it is being performed four times a day, how
and ideas)
effective is that?
6. Assumptions (all reasoning is based on
I believe that there are more humane methods
assumptions-beliefs we take for granted)
to debride a wound. When a patient
experiences pain, they do not heal as well.
7. Implications and consequences (all
A consequence to reducing wet to dry
reasoning leads somewhere. It has implications dressings is the cost of wound supplies may go
and when acted upon, has consequences)
up. The type of wound being treated depends
on the dressing type. The mechanics of wound

Evidence Based Practice

8. Inference and interpretation (all reasoning

contains inferences from which we draw
conclusions and give meaning to data and
situations)

alternatives also would have to be taught to

nurses and doctors. The cost to run classes may
make the budget rise as well.
Wet to dry dressing has been used for years by
physicians and nurses. The medical world has
evolved and focused more on the patients,
experience. I have experienced my patients
being in pain. My goal as a nurse is to reduce
their pain level and assist in healing the wound.

Annotations
Annotation 1
Johnson, L. (2009). Beyond wet-to-dry: a rational approach to treating chronic wounds. E Plasty.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680240/.
Lee Johnson has a BA and works at the Johns Hopkins University School of Medicine. This
article is targeted for nurses and doctors who treat different kinds of wounds. Johnson describes
three categories of wound dressings and what they are intended for. Occlusive dressings create a
moist environment, promote mechanic debridement, and reduce wound pain. Antimicrobials are
used when there are too many bacteria and healing is inhibited. These antimicrobials aide in
protecting wounds from MRSA and VRE as well. The last wound dressing is the impregnated
gauze. These gauzes have multiple uses but continue to keep the wound moist and debride
without as much pain caused by wet to dry dressing changes. Johnsons article describes
alternatives that are less painful but just as effective, if not more, than wet to dry dressings. He
demonstrates my point on how wet to dry dressings may cause more harm than good when being
performed.
Annotation 2

Evidence Based Practice

Dinah, F. (2006). Gauze packing of open surgical wound: empirical or evidence-based practice?
Ann R Coll Surgical English, 88(1), 33-36.
Dinah is a surgical physician in the Department of Orthopaedic at St. Helier Hospital in
Carshalton in the United Kingdom. The article is discusses the types of dressings appropriate for
surgical use. Dinah also discusses the cost of the dressings. Although the more advanced
dressings to cover wounds are more expensive, the cost equals and is sometimes less, than wet to
dry dressing. Wet to dry dressings are performed multiple times a day and labor has to factor into
the cost as well. The more advanced dressings require changing daily and allow nurses to
perform other duties. This article is for the nurses who specialize in wound treatment. It shows
that wet to dry dressings doesnt save as much money as it was thought to.
Annotation 3
Ovington, L.G. (2007). Hanging wet-to-dry dressings out to dry. Home Healthcare Nurse, 19(8),
477-484.
Liz Ovington is a consultant for wound products. In the article she discusses why gauze dressing
changes should not be the first option. Her first reasoning is that there is impeded healing due to
a lack of heat. When the gauze becomes cold and wet, it does not evaporate the wound fluids
such as slough. She also discusses why there is in increased risk for infection. In one study she
states that bacteria could get through 64 layers of dry gauze. Infection rates are higher than if
hydrocolloids were used. Ovington also discusses how there are many patients who change a
wet-to-dry dressing at home and the risks of not having a clean environment. If these patients
were to have foam, they could replace the foam daily without difficulty. Ovington is educated
clinicians that there are more options and why they should be appropriately utilized.

Evidence Based Practice

Reflection
How did the planning process, where you thought about what you wanted to change,
prepare you for the EBPP?
While planning I had to think about what I really wanted to change and be able to have
more knowledge to educate people on my point of view. I thought about my recent work
experiences and how my patients did not look forward to their dressing change. I realized that it
was a topic that there has to be research on, and more people need to be educated on alternatives
to wet-to-dry dressing.
How did the peer evaluation process prepare you for the EBPP?
The peer evaluation made me evaluate why I felt wet-to-dry dressing is more
inappropriate. I feel that as nurses we dont always question the physician practice. I feel that we
should be able to make suggestions as to what to do for treatment. I realized while reading others
evidence based practice that there are many topics that should be changed and evaluated.
Evidence based practice is in place for a reason and as nurses we should review the research to
come up with appropriate protocols and policies.
Do you feel you are prepared to elicit change in your practice with your proposal?
How does it fit into quality health care?
If the opportunity were to present itself to me I feel that I have the knowledge and
courage to ask the physician questions. My first question would be why they chose wet-to-dry
dressing. Next would be to ask why the other alternatives were not appropriate for the particular
wound being discussed. I dont see many wet-to-dry dressings on my current floor, but my
patients surprise me everyday. I now feel a little more educated on the alternatives being used.
However, they are still the physician, but I can learn from them.

Evidence Based Practice

What could you have done better?

I feel that I shouldve explained both the pros and cons of wet-to-dry dressing. There is a
reason that it is still the number one form of dressing used in surgical rooms today. I understand
why physicians would use it first. It does absorb a lot of the blood. However, post-surgical
settings should be reviewed and the dressing type changed.
How well do you think you are using the EOR? Do they make sense to you (why or
why not?)
I feel that I use the EOR but not all of the time. They make sense to me, but again, while
in my everyday nursing practice I dont think about it. If I have a question I research the answer.
I believe I perform the 8 steps. The step I think most about while doing it is the implications and
consequences. I feel that it is an important part of decision making.