Running head: EVIDENCE-BASED PROJECT

Evidence-Based Project
Courtney Ksioszk
Chamberlain College of Nursing
NR452: Capstone
Summer 2015

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Meeting the Needs of Humans

Throughout life we are constantly learning and evaluating experiences. We are taught
many different things throughout school which have lead up to our near departure of nursing
school and into the real world. We are required to take classes in school prior to ever starting
nursing classes. These classes have helped set the foundation of what will be the building blocks
of our education. We take biology, chemistry, anatomy and physiology, as well as classes such
as developmental psychology all of which play a part in helping mold us as future nurses who
can identify and effectively create interventions and make plans to properly and safely care for
our patients.
Science classes were created to set a foundation for further education. Biology teaches us
the basic functions and uses of the human body at a molecular level. Anatomy and physiology
teaches us the exact function and use of the body. It teaches us where the bones meet, where the
muscles connect, the difference between a ligament and tendon as well as the official use of the
organs. Anatomy and physiology, I feel played the largest part in my personal education in
helping me to understand the human body and the vast amount of things that it is capable of.
Understanding the body has helped me in the clinical setting in order to understand why a patient
is presenting the way that they are by which body system is not working properly. Without the
foundation of anatomy and physiology I do not believe that I ever would have been able to fully
grasp the disease processes. I also do not believe that I would be able to properly identify
interventions without knowing this information.
We were not only required to take science classes but other classes that related more to
the social aspect of how the human mind works. Developmental psychology was a class that

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helped to identify how the human mind works. It also explains how certain behaviors are
indicative of certain diseases. For example, children with Aspergers are commonly identified by
having poor social skills, being very intelligent and finding obsessions with certain objects or
subjects. Developmental psychology helped me most in my pediatric rotation. It helped me to be
able to associate certain behaviors with certain age groups. This is extremely important when
assessing a child, in order to know if they are meeting the baseline standards for their age group.
These classes are all taken prior to nursing in order to lay a foundation that students can
grow and learn from. After taking these classes we are then able to enter into nursing classes.
Nursing classes teach us a variety of things that are put in place to prepare us for our future as
nurses. Nursing classes teach us disease processes, assessment skills, communication skills,
developmental levels, as well as how to effectively and efficiently provide interventions as well
as a safe plan of care. A few tools that I found to be extremely helpful throughout my rotations in
the hospital were the read back to the doctor on telephone orders as well as the SBAR. I found
the read back on the phone to be very important for a number of different reasons. One reason is
that a number of the doctors do not speak very clear English. This could cause an error to occur
if the nurse did not read back the order of the doctor to make sure that it was correct.
The SBAR I have found to be very important as well because it lays a framework of how
to communicate with the doctor in an effective way to include the exact details that are needed.
Since SBAR provides a standardized means for communicating in patient care situations, it is
effective in bridging difference in communication styles and helps to get all team members on
the same page (Dingley, Daugherty, Derieg, & Persing, 2008). This also promotes teamwork
and collaboration through multidisciplinary staff. I have found that I have not only used this tool

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with doctors but also with other staff throughout the hospital when communicating care that is
needed for a patient.
Education is the true foundation of learning. It is important to understand the need for not
just the nursing classes in themselves but the classes that were needed prior to taking them. All
of these classes combined have provided us with knowledge and skills needed in order to
become successful nurses in providing safe and effective patient centered care. They have given
us the tools that we need to communicate well. They have also provided us with understanding
disease processes and allowing us to be autonomous in decision making by trying to be a step
ahead in understanding and accommodating patients needs.
Information Technology
Technology is constantly changing and evolving. I cannot remember one year that I have
been alive that there has not been some form of change in technology or some sort of new device
on the market that is supposedly bigger and better than the last thing. Technology has provided
great advancements throughout health care. Although some may see downsides to the amount of
technology provided, I feel that it is helped health care to advance in many ways and has also
decreased the amount of errors made.
Throughout my experience in clinical I have used a number of different types of
technology. The main technology that I used was the computer. Every hospital that I have done
clinical at has moved to electronic charting. Electronic charting has come a long way and has
provided many advancements for health care. Electronic charting has provided for all of the
patients information to be in one place. I know that when I worked in a hospital previously to
nursing school they still did paper charting. I remember a time that someone had picked up the

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patients chart, that was extremely full and a number of the patients documents fell all over the
floor. This was not only an inconvenience but trying to reorganize and navigate the patients chart
was more difficult after this happened. Electronic charting provides a way for everyone to see the
patients information, throughout the hospital such as the techs, doctors, nurses, and therapists.
This is also a positive thing because doctors are able to look at the patients charts prior to
actually seeing the patient which gives them a heads up on the patients history and possibly any
additional information that needs to be discussed.
Another piece of technology that has made great advancements in the hospital is the
fingerprinting system. A nurse must not only put in her login information when accessing the
Pyxis system but she must also scan her fingerprint. This has provided the hospital with another
measure of safety. No one without this validated information in the system is able to access
anything in the medication system.
There is mounting evidence that systems that use information technology (IT), such as
computerized physician order entry, automated dispensing cabinets, bedside bar-coded
medication administration, and electronic medication reconciliation, are key components of
strategies to prevent medication errors (Agrawal, 2009, p. 684). The medication scanner has
also been another tool that has provided very positive feedback. The medication scanner matches
the patients wrist band with their MAR. If the medication that is being scanned does not match
that patient it alerts the nurse to check what is being given. This has decreased the amount of
medication errors immensely. This has been a safety feature that has saved lives. The scanning
system also indicates if there is an assessment that needs to be done prior to giving a medication.
For example if insulin is needed for the patient, you are unable to move forward in the scanning
system until you provide a blood glucose reading.

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One piece of technology that I have found to be very fascinating is that of the ventilator.
It is amazing to me that someone created a machine to help patients to breathe. I find it
interesting that there are certain settings that allow for a certain percentage of oxygen to be given
to the patient which also indicates how much of a percent the patient can breathe on their own.
This machine is safely monitored by a respiratory therapist but I find this to be a piece of
technology that is extremely important and that has saved many lives.
Communication and Teamwork
Communication is fundamentally the most important component of any relationship. I
know that personally when I do not communicate well with others or I do not feel that others
have communicated well with me there has been a very large misunderstanding which may or
may not lead to a negative consequence. Communication and teamwork in the healthcare setting
is of utmost importance to provide a high quality of care for every patient. Teamwork is also
necessary in order to make sure that every aspect of care is being tackled properly as well as
everyone feeling that they are doing their part in caring for the patient.
Clinical experiences taught me very quickly the importance of good communication. It
also taught me that there are always more people involved with a patients care than we think.
For example, during my collaborative rotation I was in the ICU. It was extremely important for
the nurses to communicate well in cases where they need other nurses help or are going on
break and need another nurse to watch over their patients while they are gone. I feel that in the
hospital the communication between the nurses amongst each other and the communication
between the nurses and the doctors are the two that we identify most.

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Communication is not only important from nurse to nurse and nurse to doctor because
there are many more people involved in each individual patients care. We had one instance
where a patient was getting moved from the ICU onto another unit in the hospital. However, the
room that we moved the patient from needed to be cleaned immediately so that another patient
that was post-op could have that room. It was extremely important to communicate to the
cleaning lady the need of that room to get cleaned right away. With effective communication she
came immediately to that room and made sure that it was cleaned in a timely manner. This not
only demonstrates effective communication but it shows the importance of teamwork and
making other people who are not directly involved in a patients care feel that their services are
needed and that care for the patient could not be done without them.
I have also been on the end of observing extremely poor communication between two
doctors, which resulted in the absence of teamwork. According to Baker, Day and Salas (2006),
Teams make fewer mistakes than do individuals, especially when each team member knows his
or her responsibilities, as well as those of other team members (p. 1584). I had a patient who
had coded one morning at clinical and there were many doctors that were involved in the care of
this woman. I did however find that there were also many different opinions being thrown
around about this womans care between them. The doctors were arguing in the hallway over the
care of the patient. One doctor mentioned that there was nothing he could do for this woman and
that she was going to die. Another doctor said that there were measures that could be taken that
would help her to recover. The fact that they had differing opinions was difficult enough but this
then led to the doctors both relaying different information to the nurse which then confused the
continuity of care for this woman.

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Communication and teamwork are extremely important in the healthcare setting. Without
either of these things patients would not be provided safe and effective care. There are also many
people involved in the care of one patient that it is important to make sure that all ends are tied
properly. I believe that it is important to make people feel like part of the team even if they do
not directly affect the patients care. It is important to create a positive atmosphere where people
can feel open enough to communicate effectively and not feel that their contribution is devalued
or unimportant.
Critical Thinking, Clinical Reasoning and Evidence Based Practice
Critical thinking has been engrained in us since the moment we started nursing classes.
As a nurse it is important to be able to walk into a room, assess the situation and the patient and
to think critically in order to provide a necessary intervention. In nursing school, fundamentals is
where this all began. We are taught how to properly assess a patient. With the information that
we gather throughout our assessment we must then properly identify the vital signs and critically
think to evaluate whether or not these vital signs or normal or abnormal. After we have made a
decision on what these vital signs are saying or what the assessment had shown we must then
create interventions and a plan of care. All of these things are done through critical thinking.
Without critical thinking we would not be able to properly identify, intervene or care for a
patient. All of the information provided would mean nothing without the ability to critically
think and make decisions based on that information.
Clinical reasoning can be defined as thinking through the various aspects of patient care
to arrive at a reasonable decision regarding the prevention, diagnosis, or treatment of a clinical
problem in a specific patient (Hawkins, Elder & Paul, 2010, p. 42). Clinical reasoning is used in

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the care of the patient when gathering data and making judgments about it. For example when a
nurse receives the patients lab results, they have to assess the lab values and make decisions
based on what they are conveying. Also, a patients history provides a lot of information about a
patient. It is important to gather this data and then use clinical reasoning skills in order to
decipher what is important and not important to this particular case that is being treated. Clinical
reasoning is also important in regards to giving medication. It is important to make sure that
there are no drug-drug interactions, as well as make sure that the dosage is right in order to
provide safe care for the patient.
As nurses we not only provide patients with critical thinking and critical reasoning we are
also making decisions based on evidence based practices. Evidence based practices provide that
there is a safe way to do everything and that it has been proven over time. We are taught that it is
always important to check the patients name, birthday and patient identification number with the
MAR as well as verbally from the patient. This has been put into place because it has been
proven that it a way to decrease the amount of medication errors. We are also taught that there
are a number of procedures that we must strictly follow sterile precautions when performing
these types of care so that there is as minimal of a chance to spread infection as possible.
Evidence based practice has been effective because it provides proven information in ways not to
harm a patient but to provide the safest care possible.
Quality and Safe Patient Care
From day one of nursing school we have been taught the importance of providing patients
with quality and safe patient care. Of all of the things that we have learned, safety has been the
one thing that has been repeated over and over again. Early in nursing history, Florence

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Nightengale advocated for safe care. She proposed that nurses through their practice had to put
the patient in the best condition possible for nature to act upon the patient (Ballard, 2003). Since
the days of Florence Nightengale there have been a number of tools and safety measures that
have been put in place by hospitals in order to make sure that patients are being cared for in a
safe manner. Making sure that a patient has on yellow socks if they are a fall precaution helps to
identify them as needing assistance as well as help the healthcare team to know that this
individual is a fall precaution. They have also made sure to place alarms on the patients beds to
alert a healthcare personnel when the patient is trying to get up out of a bed or chair without
assistance. They have also provided gait belts to use when transferring a patient in order to
provide safety for the patient as well as the person that is helping the patient up.
A number of hospitals keep a count of how many days it has been since their floor has
experienced a fall. This helps the hospital staff to know whether or not these safety precaution
measures are being upheld. The medication scanner is also another tool that was put in place to
provide a higher level of patient safety. There are committees put into place who watch over the
number of incidences taking place in the hospitals. There are also people who watch over the
amount of hospital acquired infections that are spread throughout the hospital in a certain amount
of time. These committees are put into place so that we are made aware as healthcare
professionals and can make sure that we are taking proper precautions to provide safe and quality
care to all patients.
The quality of care a patient receives is directly related to the communication the patient
and their family are able to provide us about the patient. For example, there are many patients
who have specific wishes about their end of life care. One patient may want CPR to be
performed as well as being put on a ventilator and one patient may just want medication. These

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are very different wishes but these need to be properly conveyed to the staff that is in charge of
the patients care. I recently had a patient who was 98 years old and her family did not want her to
have CPR but only medications given. She ended up passing away on my shift. It was important
for the nurse to know that these were the wishes of the patient so that no actions were taken that
were not wanted. This allowed us the ability to safely and properly care for this patient and her
wishes in her last minutes.
Novice Nurse
Stepping out into the real world of nursing is extremely scary. It is difficult to truly grasp
the change in role from student to nurse. Once we become a nurse we are now in charge of
making decisions on behalf of someone else and their care. It is also scary to think that there are
so many things that we have learned but still feel that we do not know anything. I struggle with
realizing that I know more than I think I know. Becoming a nurse also allows us the ability to
form strategies and plans of care in the way we want things to be done. We can take experiences
from our clinical and knowledge and wisdom we have learned from nurses that we have
followed and apply those to our armor as nurses. A number of hospitals now, provide that a new
nurse must follow another nurse for a four month period. This is to help the new nurse to become
acclimated to the hospital and unit as well as become comfortable with the new shift in roles.
Individually as new nurses we need to be aware of our own shortcomings. We also need
to make sure that we are available for constructive criticism. There are many people who are
alongside us with the same goals as we have, which are to help and save patients lives. These
are people we can look to for support, wisdom, and a shoulder to help pick us up when we have a
negative outcome with a patient. Not every day is going to be easy as a new nurse, in the

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beginning; I feel that there are going to be a lot more difficult days than easy days. However, it is
essential to becoming a good, well rounded nurse to make sure that we step out of our comfort
zone and learn everything we can so that we can provide the safest of quality care to all patients.
As a new nurse it is important to understand the role you play in learning and developing who
you want to be as a nurse for the future generations to come. One day will come, when I am no
longer a new nurse but a nurse who can provide my experiences and knowledge to those coming
after me. I feel that the most important part of being a new nurse is finding an old nurse you want
to be like and let that mold your nursing care.
Conclusion
As I look back on the past two and a half years and the amount of education I have
received, I look towards the future with excitement and with new eyes. I cannot wait to join the
nursing field to make a difference in the lives around me. I want to be a shoulder to cry on for
families who cannot understand what is happening. I want to provide safe and quality care to
patients who cannot do it for themselves. I want to be part of a team who is working towards the
same goal. I want to ultimately live my life to serve others and to show what compassion and
kindness look like. This journey has been such a blessing and has challenged me and helped me
to grow in many ways personally, that I never knew were possible. I am grateful to this field, to
those who strive for excellence and for all who have come before me and those will continue to
come after me, living out a life of servanthood and love.

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References

Agrawal, A. (2009). Medication errors: prevention using information technology systems. British
Pharmacological Society, 67(6), 681-686.
Baker, D.P., Day, R., & Salas, E. (2006). Teamwork as an essential component of high-reliability
organizations. Health Services Research, 41(4), 1576-1598.
Ballard, K.A. (2003). Patient safety: A shared responsibility. The Online Journal of Issues in
Nursing, 8(3).
Dingley, C., Daugherty, K., Derieg, M.K., Persing, R. (2008). Advances in patient safety: New
directions and alternative approaches. Denver, CO: Agency for Healthcare Research and
Quality.
Hawkins, D., Elder, L., & Paul, R. (2010). The thinkers guide to clinical reasoning.
Tomales,CA: Foundation for Critical Thinking.