ebp, ena, and enrs

1
EBP, ENA, AND ENRS Jean A. Proehl, RN, MN, CEN, CPEN, FAEN , Cornish, NH In place of Editor-in-Chief Reneé Holleran, Ms. Proehl is the guest editor for the May issue of JEN How do you assess placement of a gastric tube? Will your method protect your patient from the potentially cata- strophic consequences of a misplaced tube? Gastric tube placement verification is but one example of a common nursing action that has been guided by the way weve always done itand not by evidence. As a result, patients have suffered significant complications and even death because gastric tubes were inadvertently placed in the respiratory tract. What is the standard of care or best prac- tice regarding gastric tube placement? Better yet, what does the evidence support? The terms standards of care, best practice, and evi- dence-based practice (EBP) are often used interchangeably, but they are not synonymous. Standards of care are mini- mal expectations or norms for the care of patients. Best practices are benchmarks of excellence or tried and true ways of doing things. Standards and best practices may be somewhat evidence-based, but there is a paucity of evi- dence available upon which to base most of nursing practice. As a result, most things are based on historical practice or anecdotal evidence. When evidence is available, it may be difficult to interpret in the context of stretcher-side practice. During the 2007 strategic planning process, ENA decided to develop evidence-based clinical practice resources that stretcher-side emergency nurses could use to improve patient care. The Guidelines for the Development of Evidence-Based Emergency Nursing Resources 1 describe the process for the development of Emergency Nursing Resources (ENRs). Four ENRs have currently been completed: family presence during inva- sive resuscitative procedures, capnography for procedural sedation and analgesia, verification of gastric tube place- ment, and needle-associated pain in pediatric patients. Four additional topics are in progress: wound cleansing, difficult IV access, orthostatic vital signs, and tempera- ture measurement. The Guidelines for the Development of Evidence-Based Emergency Nursing Resources, all of the current ENRs, evi- dence tables, and resource tables are available at http:// www.ena.org/IENR/ENR/Pages/Default.aspx. Beginning with this issue, the ENRs will also be published in JEN. A few words of caution before you get your hopes too high. As you read the ENRs, you may be surprised to find that there is not enough evidence to make recom- mendations about many practices. Or, where there is evi- dence, it may be not strong enough to make high level recommendations. In the process of developing ENRs, we are often left with more questions than answers. There are a plethora of topics yet to be definitively studied and many opportunities for nurse researchers to contribute to the evidence needed to support safe emergency nursing practice and care. By the way, if your answer to the very first question in this editorial was auscultation over the epigastrium during air insufflation (i.e., the whooshtest), your practice is out of date and potentially dangerous. Review the gastric tube placement ENR and take the information back to your hospital. With a little help from ENA, you can update your practice and improve patient care. REFERENCE 1. Walker-Cillo G, Barnason S, Egging D, et al. Guidelines for the Devel- opment of Evidence-Based Emergency Nursing Resources. Des Plaines, IL: Emergency Nurses Association; 2009. Jean A. Proehl is Emergency Clinical Nurse Specialist, Proehl PRN, LLC, Cornish, NH, Chairperson, ENR Development Committee, and Editor, Advanced Emergency Nursing Journal. For correspondence, write: Jean A. Proehl, RN, MN, CEN, CPEN, FAEN; E-mail: [email protected]. J Emerg Nurs 2011;37:217. 0099-1767/$36.00 Copyright © 2011 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. doi: 10.1016/j.jen.2011.03.015 Notice I would like to inform JEN readers and ENA members that as this issue of JEN is going to press, ENA has just been notified that the ENRs have been accepted into the Agency for Healthcare Research and Quality's NATIONAL GUIDELINE CLEARINGHOUSE TM and will soon be available at www.guidelines.gov. GUEST EDITORIAL May 2011 VOLUME 37 ISSUE 3 WWW.JENONLINE.ORG 217

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Page 1: EBP, ENA, and ENRs

EBP, ENA, AND ENRS

Jean A. Proehl, RN, MN, CEN, CPEN, FAEN ,

Cornish, NH

In place of Editor-in-Chief Reneé Holleran, Ms. Proehl is

the guest editor for the May issue of JEN

How do you assess placement of a gastric tube? Will yourmethod protect your patient from the potentially cata-strophic consequences of a misplaced tube? Gastric tubeplacement verification is but one example of a commonnursing action that has been guided by “the way we’vealways done it” and not by evidence. As a result, patientshave suffered significant complications and even deathbecause gastric tubes were inadvertently placed in therespiratory tract. What is the standard of care or best prac-tice regarding gastric tube placement? Better yet, what doesthe evidence support?

The terms standards of care, best practice, and evi-dence-based practice (EBP) are often used interchangeably,but they are not synonymous. Standards of care are mini-mal expectations or norms for the care of patients. Bestpractices are benchmarks of excellence or tried and trueways of doing things. Standards and best practices maybe somewhat evidence-based, but there is a paucity of evi-dence available upon which to base most of nursing practice.

As a result, most things are based on historical practice oranecdotal evidence. When evidence is available, it may bedifficult to interpret in the context of stretcher-side practice.

During the 2007 strategic planning process, ENAdecided to develop evidence-based clinical practiceresources that stretcher-side emergency nurses coulduse to improve patient care. The Guidelines for theDevelopment of Evidence-Based Emergency NursingResources1 describe the process for the development ofEmergency Nursing Resources (ENRs). Four ENRs havecurrently been completed: family presence during inva-sive resuscitative procedures, capnography for proceduralsedation and analgesia, verification of gastric tube place-ment, and needle-associated pain in pediatric patients.Four additional topics are in progress: wound cleansing,difficult IV access, orthostatic vital signs, and tempera-ture measurement.

The Guidelines for the Development of Evidence-BasedEmergency Nursing Resources, all of the current ENRs, evi-dence tables, and resource tables are available at http://www.ena.org/IENR/ENR/Pages/Default.aspx. Beginningwith this issue, the ENRs will also be published inJEN. A few words of caution before you get your hopestoo high. As you read the ENRs, you may be surprised tofind that there is not enough evidence to make recom-mendations about many practices. Or, where there is evi-dence, it may be not strong enough to make high levelrecommendations. In the process of developing ENRs,we are often left with more questions than answers. Thereare a plethora of topics yet to be definitively studied andmany opportunities for nurse researchers to contribute tothe evidence needed to support safe emergency nursingpractice and care.

By the way, if your answer to the very first question inthis editorial was auscultation over the epigastrium duringair insufflation (i.e., the “whoosh” test), your practice is outof date and potentially dangerous. Review the gastric tubeplacement ENR and take the information back to yourhospital. With a little help from ENA, you can update yourpractice and improve patient care.

REFERENCE1. Walker-Cillo G, Barnason S, Egging D, et al. Guidelines for the Devel-

opment of Evidence-Based Emergency Nursing Resources. Des Plaines,IL: Emergency Nurses Association; 2009.

Jean A. Proehl is Emergency Clinical Nurse Specialist, Proehl PRN, LLC,Cornish, NH, Chairperson, ENR Development Committee, and Editor,Advanced Emergency Nursing Journal.

For correspondence, write: Jean A. Proehl, RN, MN, CEN, CPEN, FAEN;E-mail: [email protected].

J Emerg Nurs 2011;37:217.

0099-1767/$36.00

Copyright © 2011 Emergency Nurses Association. Published by Elsevier Inc.All rights reserved.

doi: 10.1016/j.jen.2011.03.015

NoticeI would like to inform JEN readers and ENA members that as this issue of JEN is going to press, ENA has just been notified

that the ENRs have been accepted into the Agency for Healthcare Research and Quality's NATIONAL GUIDELINECLEARINGHOUSE TM and will soon be available at www.guidelines.gov.

G U E S T E D I T O R I A L

May 2011 VOLUME 37 • ISSUE 3 WWW.JENONLINE.ORG 217