Corneal abrasions during general anesthesia

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Please reply to A with 200 words
A
Within the healthcare field nurses have multiple ways of gaining evidence that will help provide optimal care for patients. There is both internal and external evidence. When speaking of internal evidence this is information within the health/patient record. When speaking of external evidence, this information is gathered from journals or other medical databases for research. The goal of any healthcare facility is to continuously improve the efforts on how care is delivered to patients within any setting.It is also important to have patient satisfaction to establish a good reputation within the community. When healthcare professionals look at a patient’s healthcare record, it is an event of what measures have been taken throughout the patient’s history.

Having an extensive history allows providers to come up with treatment recommendations that will get patients back to optimal health. For example, if someone presents to urgent care with chest pains, often the thought is a cardiac event. Having a healthcare record available that indicates a history of anxiety, would save a few steps and help nurses and doctors rule out cardiac events. Knowing information sooner, also helps expedite the care and development of a treatment plan for the patient. Although it can sometimes be difficult for patients to recall information during a visit, especially an emergency, it is still important for healthcare professionals to be patient and document any information received. It is also true that a lack of patient medical history can make it difficult to resolve certain issues. Sometimes patient’s don’t know their history and it makes it difficult to resolve medical issues.

It is known that many medical conditions are hereditary which makes patients genetically predisposed to many health issues. Especially if the patient has frequent medical events and the care provided is ineffective.When healthcare professionals are unable to find concrete explanations for symptoms, it is not beneficial for the patient. Sure symptoms can be treated, but the goal is to find the problem and treat appropriately. “ Diagnostic errors include missed, delayed or wrong diagnosis and how they are defined is a central issue for measurement” (Cheraghi-Sohi, 2021). Having lack of internal evidence can also delay care for patients, especially in an urgent or emergency situation. Once there is clear, concise internal evidence, healthcare providers can use external evidence and treat a patient’s condition based on research that has proved to be beneficial in the past. It is this same type of combined evidence that assists with evidence based practice. The more evidence gathered, both internal and external, the better chance of providing the best care and helping patients maintain the healthiest lifestyle.

Cheraghi-Sohi, S., Holland, F., Singh, H., Danczak, A., Esmail, A., Morris, R. L., … & Reeves, D. (2021). Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review, BMJ Quality and safety 977-985.
Please reply to B with 200 words
B
An evidence based practice uses internal and external evidence to provide patients with the best quality care within the facility. Internal evidence is based on quality improvement data collected within the facility, and patient assessments and evaluations about the quality of care they receive. External evidence is found in scientific literature that includes results, data, statistical analysis, and conclusion of a study. (ASHA). According to another article, there is an old model for evidence-based practice which equates internal evidence with clinician expertise and external evidence with best available research. The new model still equates internal evidence with clinician expertise but external evidence includes research evidence and patient evidence along with other clinicians and stakeholders. (McKeon, McKeon, 2020). External evidence can be acquired by utilizing various search databases. Some of these databases are EBSCO, ASHAWire, PubMed ( MEDLINE), PsycNet, ERIC, speechBITE, and JSTOR.

Evidence-based practice provides the nurse with information that will help in providing the best care plan that will improve the patient’s quality of life and best health outcomes. This practice utilizes internal evidence which provides the nurse with information about the patient’s likes, dislikes, and needs. This will indicate patient satisfaction and areas that need to change when patients express dissatisfaction. It also provides data on quality improvement within the facilities that will provide information on where areas need to be improved. External evidence provides expertise through scientific literature which will assist in finding a model that will help implement any changes that may be necessary. (ASHA).

One study I was involved with was on corneal abrasions during general anesthesia. We collected data on all the anesthesia providers and how they protected the patients eyes. The protective ways were; lubricant in the eyes, lubricant in the eyes and taping them shut, taping only, and making sure the eyes remained shut. We analyzed the data and found the incidence of when corneal abrasions occurred and compared the result with national data. It was determined that lubricating the eyes with or without taping the eyes shut provided the best possible outcome. Following this policy created an excellent reduction in corneal abrasions during general anesthesia.
Both internal and external evidence are needed to help develop a clinical inquiry to assist in creating an evidence-based practice. External evidence is used to assess the appropriateness of any strategy that may be implemented in the facility’s practice. The combination of internal and external evidence help the nurse to be clinically prepared to meet any clinical encounters that may occur while striving to achieve quality improvement for the patient.

Reference

ASHA. EBP Process-Step 2: Gather Evidence. American Speech-Language-Hearing Association. (https://www.asha.org/research/ebp/gather-evidence).

McKeon, Patrick O., McKeon, Jennifer M. Medina. (2020). The Symbiosis of Internal and External Evidence: When Preparation Meets Opportunity. International Journal of Athletic Therapy and Training. (https://idrottsforum.org/international-journal-of-athletic-therapy-and-training-vol-25-2020-issue-1/).

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