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Clinical Problems and Knowledge in Nursing Practice

Clinical Problems and Knowledge in Nursing Practice

Clinical Problems and Knowledge in Nursing Practice

Research, EBP, QI Relationship

It has been established that patients are to receive care based upon scientific research and evidence that promotes the validation of clinical practice, rather than solely on the personal experience of the clinician (Cepero, 2011).  Nursing is an ever-changing field which requires the professional to remain up-to-date, competent, and knowledgeable in order to perform appropriate and current care.  This can be established by following components of the Magnet Recognition Program as discussed within the Journal of American Nurse Association where new knowledge innovation and improvements are key goals in nursing practice (Conner, 2014).  Within the model, the goals exist as promoting quality improvement in a professional setting, identifying excellence of nursing care delivery, and disseminating best nursing practice services; each supported by the utilization and understanding of research, quality improvement (QI), and evidenced-based practice (EBP) (Conner, 2014).  In relation to each other, all three methods have the sole purpose of validating information into clinical practice to provide the most effective and safest plan of care.  Each establish a scientific methodology plan to guide the completion of the study/project, include utilization of literature review and analysis, and each rely on some type of statistical data and measurement technique to form a conclusion (Baker, 2014).

Data in Clinical Practice

Data is gained from nursing research studies by conducting a systemic investigation in order to answer a specific question or test hypothesis (Conner, 2014).  After establishing a particular question or phenomenon the researcher wishes to answer, a literature review takes place with a qualitative or quantitative research design following (Conner, 2014).  Data is then extracted from research findings, published and credited, and now becomes valid to incorporate into clinical practice, update policies, or arise new nursing strategies and skills.

Quality Improvement is a data-guided method in order to enhance outcomes and better improve principles and strategies in the clinical setting (Conner, 2014).  Quality improvement projects are implemented into practice after using a specific method for the process including:

·        Find a process to improve.

·        Organize an effort to work on improvement.

·        Clarify current knowledge of the process.

·        Understand process variation and performance capability.

·        Select changes aimed at performance improvement.

·        Plan the change; analyze current data and predict the results.

·        Do it; execute the plan.

·        Study (analyze) the new data and check the results.

·        Act; take action to sustain the gains.

(Conner, 2014)


Utilizing evidenced-based practice supports in providing the most effective care and making the best treatment plan decisions for the clientele.  After establishing a clinical problem or question, data collection including literature, accredited evidence, integration of clinical expertise and patient preference, and evaluating the results, findings are then conclusive and can be applied into practice (Conner, 2014).  Implementing results into practice guidelines and policies supports professionals in applying best practice methods into their daily care and decisions.

Clinical Problems and Knowledge in Nursing Practice

One clinical problem I commonly witness within my facility is the effectiveness of PRN and STAT medication administration.  I work with psychiatric pediatric clients and therefore can be difficult in monitoring effectiveness of anti-anxiety medications, for example, when self-reporting may be lacking or unable to validate.  This PRN effectiveness issue requires further investigation as it is important to monitor how well a drug aides in patient outcomes.  A quality improvement plan would be appropriate to establish in solving this problem.  Steps include first establishing the problem and need for change of policy or guideline.  A planned methodology must then be set for the QI project such as the Plan-Do-Study-Act (PDSA) to analyze how well my nursing unit monitors and documents PRN effectiveness as compared to the expected standard (Baker et al., 2014).  Literature must be collected in order to establish the expected standard, to examine strategies on how to meet said standard, and evidence validating the standard itself (Baker et al., 2014).

The second clinical problem requiring investigation relates to the use of poly-pharmacy within my unit.  I frequently observe many patients, very young in age, who are prescribed multiple drugs due to their psychiatric history, hyperactivity disorders, and medical conditions overlapping.  This results in patients who are young, low weight, and on a variety of drug classifications which can conclude obvious interactions or complications if not monitored closely.  Therefore, steps to be taken can include the use of evidenced-based practice review where validated research is used to translate current practice and make updated changes accordingly (Baker et al., 2014).  This would involve obtaining literature regarding multiple drug classifications and their possible interactions, reviewing studies of poly-pharmacy and long-term effects, analyzing current practice in my facility, and establishing guidelines based upon validated criteria found (Baker et al., 2014).

After learning about the different forms of research and answering questions to clinical problems, I feel I am less fearful of nursing research itself.  It is intimidating and challenging to see the vast amount of information and literature available within the nursing field, and it’s easy to become overwhelmed and disorganized with such a various amount of data at your fingertips.  However, after recognizing the different forms of studies, being able to differentiate them, and conducting literature reviews accordingly, I feel I can look at a clinical problem and recognize what type of research is needed.  In my clinical practice, I hope to be more competent and not be afraid to ask questions when I see an apparent problem; And in turn, have the autonomy to take the needed steps to begin solving problems I see in my work-setting.

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