Week 2: The Clinical Question
Week 2: The Clinical Question
Week 2: The Clinical Question
I think all of us at one time or another has certainly asked our selves…There has to be a better way of doing this. In this discussion you need to choose a systematic review from the topics provided in the class resources that is pertinent to your current or past practice. Remember you will not really be expected to implement the practice, just how you would start the process. For instance, CAUTI or catheter associated urinary tract infections are a major problem in the hospital. In surgical patients especially. When I worked on the surgical floor years ago, I was made aware of the non sterile catheter insertion procedure done in pre-op. The staff would just pour a little water over the peri area and insert. We had some raging post op UTIs needless to say even when the Foley was removed on day one.
Follow the steps above in your discussion question and tell us some of your stories of research-practice gaps. Your capstone project one is fill out the Practice Issue and Evidence Summary Worksheet on your chosen systematic review. Please review your posting requirements You should have one initial post and 2 posts to 2 different class mates.
I encourage all of you to use one of the systematic reviews provided in the class resources section, this is a starting point and not the only reference you should use, it is just a start your research. If there is another topic you would like to use, you must have a systematic review that covers that topic. The systematic review must be used as one of your references but other references will certainly be necessary.
Also, please come to the questions and answer web-ex I’m having next week. It is posted in the announcements.
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The systematic review that I chose was obstetrics with a focus on skin to skin care. I currently work on a pediatric unit where NAS babies are transferred after they are stable following birth. I have seen many children sit on this unit for a month too two months going through withdrawal. These children have myoclonic tremors, increased muscle tone, inconsolable irritability, and an overall rough start in life. Most of these children don’t have a high parental involvement; but I was wondering what the affects would be on their weaning process if they had daily skin to skin. I want to know if their negative symptoms would dissipate faster, would they come off the drugs faster, and would their overall health improve quicker allowing them to either go home or be placed in foster care. I believe it is important to my current practice because we have a large population of mothers that go through the methadone clinic in town. If we found a way to improve family centered care while simultaneously shortening the weaning process for the infant and minimizing withdrawal symptoms it could mean the difference between these babies staying with us for a few weeks compared to a few months. “:Newborns with moderate to severe NAS are typically treated with oral opioids, and then weaned over days to weeks. Pharmacologically treated NAS is prolonged and costly, with lengths of stay of 2 to 12 weeks and estimated charges of $90 000 per admission (Holmes et al).” Research practice gap is when there is evidence based research supporting a specific practice but it hasn’t been implemented into actual patient care.
Holmes, A. V., Atwood, E. C., Whalen, B., Beliveau, J., Jarvis, J. D., Matulis, J. C., & Ralston, S. L. (2016). Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. Pediatrics,137(6). doi:10.1542/peds.2015-2929
I’m not pediatric or OB oriented but the theory of “healing touch” is one that I am familiar with. This is such a sad situation for both baby and parents and I have heard that it is getting worse all over the country with the epidemic of inappropriate opioid use. I nursing self would say that yes skin to skin contact would help these babies recover faster and at least comfort them in their struggle to withdraw. According to Artigas, V. 2015, supportive care such as aromatherapy massage therapy, music therapy as well as skin-to-skin contact have been shown to promote weight gain and feeding tolerance, increased sleep cycles and decreased neurologic symptoms. It make sense that healing touch and providing a sense of security for the infant would decrease the affects of NAS especially considering Erickson’s stages of psychosocial development- an infant would be at the stage of Trust vs. Mistrust. Feeling safe and protected at the infant stage would promote trust.
Artigas, V. (2014). Clinical Practice: Management of Neonatal Abstinence Syndrome in the Newborn Nursery. Nursing For Women’S Health, 18509-514. doi:10.1111/1751-486X.12163
Professor, this is true in many cases. What we are seeing is that most of these parents have not been educated on what to expect after delivery for the infant. They have no idea that a prescribed medication they are taking and the physician is aware of, leads to a 6-8 week hospitalization for the baby. They feel very uninformed and lots of guilt. Our taskforce has suggested a “referral” for these patients taking SSRI to talk with NICU personnel about the process before delivery, as well as receive brochure about NAS and what they can do to help the process. For many, rooming in would be possible if they have time to make arrangement for children, talk to close family members that may be willing to assist. When they are unprepared, and family are questioning why the infant is in hospital , it often leads to feeling that it needs to be a “secret” . These families shun their support system, instead of being able to utilize them, because of feelings of shame and guilt. This is why educating this patient population is vital