4. Quality and Evidence-Based Practice
Open Resources for Nursing (Open RN) and Amy Ertwine
The American Nursing Association (ANA), various professional nursing organizations, and federal agencies continually work to improve the quality of client care. Nurses must also be individually dedicated to providing quality client care based on current evidence-based practices.
Quality of Practice
One of the American Nurses Association (ANA) Standards of Professional Practice is “Quality of Practice.” This standard emphasizes that “nursing practice is safe, effective, efficient, equitable, timely, and person-centered.”[1] Quality is defined as, “The degree to which nursing services for healthcare consumers, families, groups, communities, and populations increase the likelihood of desirable outcomes and are consistent with evolving nursing knowledge.”[2] Every nurse is responsible for providing quality care to their clients by following the standards set forth by various organizations, as well as personally incorporating evidence-based practice. Quality is everyone’s responsibility, and it takes the entire health care team to ensure that quality care is provided to each and every client. For example, turning an immobile client every two hours to prevent pressure injuries requires the dedication of many staff members throughout the day and night. Quality actions can also be formalized on a specific unit, such as the review of data related to client falls with specific unit-based interventions formally put into place. This commitment to quality practice requires lifelong learning after nurses have completed their formal nursing education to remain current with new evidence-based practices.
Learning how to provide safe, quality nursing practice begins in nursing school. The Quality and Safety Education for Nurses (QSEN) project encourages future nurses to continuously improve the quality and safety of the health care systems in which they work. The vision of the QSEN project is to “inspire health care professionals to put quality and safety as core values to guide their work.”[3] Nurses and nursing students are expected to participate in quality improvement (QI) initiatives by identifying gaps where change is needed and implementing initiatives to resolve these gaps. Quality improvement is defined as the combined and unceasing efforts of everyone – health care professionals, clients and their families, researchers, payers, planners, and educators – to make the changes that will lead to optimal client outcomes (health), improved system performance (care), and enhanced professional development (learning).[4] Nursing students can immediately begin to contribute to improving the quality of nursing practice by participating in quality improvement initiatives.
Read more about the QSEN project.
Evidence-Based Practice in Nursing
Evidence-based practice is a component of the ANA’s “Scholarly Inquiry” Standard of Professional Practice. Evidence-based practice is defined as, “A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories; clinical expertise and evidence from assessment of the healthcare consumer’s history and condition, as well as health care resources; and client, family, group, community, and population preferences and values.”[5]
Utilizing evidence-based practice means that nurses and nursing students provide client care based on research studies and clinical expertise and do not just do something “because that’s the way it has always been done.” A simple example of nurses promoting evidence-based practice to help clients is using peppermint to relieve nausea. Throughout history, peppermint was used for an upset stomach and to relieve the feeling of nausea. This idea was frequently rejected in the medical field because there was no scientific evidence to support it. However, in 2016, Lynn Bayne and Helen Hawrylack, two nurse researchers, developed a peppermint inhaler for clients to use when they were feeling nauseated and found it was 93% effective in relieving nausea.[6]
Nursing students should implement evidence-based practice as they begin their nursing career by ensuring the resources they use to prepare for client care are valid and credible. For this reason, information to credible and reliable sources is provided throughout this textbook.
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association ↵
- QSEN Institute. (n.d.). Project overview. http://qsen.org/about-qsen/project-overview/ ↵
- Batalden, P. B., & Davidoff, F. (2007). What is "quality improvement" and how can it transform healthcare? BMJ Quality & Safety, 16(1), 2–3. https://doi.org/10.1136/qshc.2006.022046 ↵
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- ChristianaCare News. (2016, May 16). Nurse researchers develop peppermint inhaler to relieve post-op nausea. https://news.christianacare.org/2016/05/nurse-researchers-develop-peppermint-inhaler-to-relieve-post-op-nausea/ ↵
Learning Activities
(Answers to "Learning Activities" can be found in the "Answer Key" at the end of the book. Answers to interactive activities are provided as immediate feedback.)
- The nurse is conducting an assessment on a 70-year-old male client who was admitted with atrial fibrillation. The client has a history of hypertension and Stage 2 chronic kidney disease. The nurse begins the head-to-toe assessment and notes the patient is having difficulty breathing and is complaining about chest discomfort. The client states, “It feels as if my heart is going to pound out of my chest and I feel dizzy.” The nurse begins the head-to-toe assessment and documents the findings. Client assessment findings are presented in the table below. Select the assessment findings requiring immediate follow-up by the nurse.
Vital Signs
| Temperature | 98.9 °F (37.2°C) |
|---|---|
| Heart Rate | 182 beats/min |
| Respirations | 36 breaths/min |
| Blood Pressure | 152/90 mm Hg |
| Oxygen Saturation | 88% on room air |
| Capillary Refill Time | >3 |
| Pain | 9/10 chest discomfort |
| Physical Assessment Findings | |
|---|---|
| Glasgow Coma Scale Score | 14 |
| Level of Consciousness | Alert |
| Heart Sounds | Irregularly regular |
| Lung Sounds | Clear bilaterally anterior/posterior |
| Pulses-Radial | Rapid/bounding |
| Pulses-Pedal | Weak |
| Bowel Sounds | Present and active x 4 |
| Edema | Trace bilateral lower extremities |
| Skin | Cool, clammy |
2. The following nursing actions may or may not be required at this time based on the assessment findings. Indicate whether the actions are "Indicated" (i.e., appropriate or necessary), "Contraindicated" (i.e., could be harmful), or "Nonessential" (i.e., makes no difference or are not necessary).
| Nursing Action | Indicated | Contraindicated | Nonessential |
|---|---|---|---|
| Apply oxygen at 2 liters per nasal cannula. | |||
| Call imaging for a STAT lung CT. | |||
| Perform the National Institutes of Health (NIH) Stroke Scale Neurologic Exam. | |||
| Obtain a comprehensive metabolic panel (CMP). | |||
| Obtain a STAT EKG. | |||
| Raise the head-of-bed to less than 10 degrees. | |||
| Establish patent IV access. | |||
| Administer potassium 20 mEq IV push STAT. |
3. The CURE hierarchy has been introduced to help novice nurses better understand how to manage competing patient needs. The CURE hierarchy uses the acronym “CURE” to help guide prioritization based on identifying the differences among Critical needs, Urgent needs, Routine needs, and Extras.
You are the nurse caring for the patients in the following table. For each patient, indicate if this is a "critical," "urgent," "routine," or "extra" need.
<td">
| Critical | Urgent | Routine | Extra | |
|---|---|---|---|---|
| Patient exhibits new left-sided facial droop | ||||
| Patient reports 9/10 acute pain and requests PRN pain medication | ||||
| Patient with BP 120/80 and regular heart rate of 68 has scheduled dose of oral amlodipine | ||||
| Patient with insomnia requests a back rub before bedtime | ||||
| Patient has a scheduled dressing change for a pressure ulcer on their coccyx |
||||
| Patient is exhibiting new shortness of breath and altered mental status | ||||
| Patient with fall risk precautions ringing call light for assistance to the restroom for a bowel movement |
Test your knowledge using this NCLEX Next Generation-style Case Study. You may reset and resubmit your answers to this question an unlimited number of times.[1]
