ebp, ena, and enrs
TRANSCRIPT
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
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