Friday, July 13, 2007
Promoting surgical EBP by choosing a research spearhead
Evidence Based Practice (EBP) is encouraged in our hospital, initially among doctors. To stimulate surgical nurses in using EBP we have performed studies in which nursing interventions were questioned as to the effectiveness or known for their variation in clinical practice. A spearhead in our research was local wound care, as in this field there is widespread variation in intervention usage.
To formulate condensed evidence based recommendations for local wound care on the surgical departments.
We conducted two systematic literature review (SR) to summarise the evidence; a) on dressings for surgical wounds healing by secondary intention and b) on silver dressings for treating infected wounds. Followed by a randomised clinical trial (RCT), inter- and intra-observer studies for the levels of agreement of doctors and nurses when classifying wounds and regarding their choice of wound dressings and a conjoint analysis to get insight in the preferences of doctors, nurses and patients for the ‘ideal’ dressing a conjoint analysis.
Results and condensed recommendations for practice:
From the SRs we concluded that only small and poor-quality trials exist, therefore evidence was insufficient to formulate recommendations.
Based on our RCT we recommend the use gauze-based dressings for wound care on surgical wards and in the extramural setting as gauze is less expensive and effective as to wound healing and pain.
We recommend the use of specific schemes for classification of wounds which guides in the choice of local wound care materials.
The preferences for wound dressing attributes (pain during dressing changes, hospitalisation, and wound healing time) were similar for doctors, nurses and patients. To achieve a more consistent local wound care, clinical decision-making should be in accordance with these preferences.
Special attention is pay to the implementation results of the above recommendations
This transdisciplinary research project on wound care research is a tangible proof