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Challenging nursing's sacred cows
Issue Date: April 2008 Vol. 3 Num. 4
Authors: Carol A. Rauen, MS, CCNS, PCCNKathleen Vollman, MS, MSN, CCNSRichard B. Arbour, MSN, CCRN, CNRNMarianne Chulay, PhD, RN, FAAN
Until recently, healthcare practitioners have answered questions about clinical practices with their best guesses, intuition, and tradition. But evidence-based practice (EBP) compels us to use solid scientific evidence instead, and to base nursing protocols on this evidence. As defined by the Institute of Medicine, EBP is the integration of the best research, clinical expertise, and patient values when making decisions about patient care.
This article discusses three commonly performed acute-care nursing practices that are not based on evidence:
• instilling normal saline solution (NSS) into the patient’s endotracheal tube before suctioning
• turning critically ill patients manually every 2 hours
• relying on the Glasgow Coma Scale (GCS) alone for routine neurologic assessment.
When these practices were introduced, no research supported them. Yet many practitioners keep performing them, despite recent research that suggests they should be changed. This article examines these three practices critically.
Instilling NSS before ET suctioning:
Helpful or harmful?
For years, nurses and respiratory therapists have been taught to instill 5 ml of sterile NSS into a patient’s endotracheal (ET) tube before suctioning. According to the traditional theory, this practice decreases mucosal viscosity, eases secretion removal, and improves oxygenation. Although at one time the theory seemed to make sense, research from the past 20 years shows it’s incorrect. Here’s what current research (primarily involving adults) tells us:
• Instilling NSS before suctioning decreases oxygen saturation and forced expiratory volume (a sign of bronchospasm).
• This practice may increase the risk of hospital-acquired pneumonia (HAP), as bacteria from the
Challenging nursing's sacred cows
Issue Date: April 2008 Vol. 3 Num. 4
Authors: Carol A. Rauen, MS, CCNS, PCCNKathleen Vollman, MS, MSN, CCNSRichard B. Arbour, MSN, CCRN, CNRNMarianne Chulay, PhD, RN, FAAN
Until recently, healthcare practitioners have answered questions about clinical practices with their best guesses, intuition, and tradition. But evidence-based practice (EBP) compels us to use solid scientific evidence instead, and to base nursing protocols on this evidence. As defined by the Institute of Medicine, EBP is the integration of the best research, clinical expertise, and patient values when making decisions about patient care.
This article discusses three commonly performed acute-care nursing practices that are not based on evidence:
• instilling normal saline solution (NSS) into the patient’s endotracheal tube before suctioning
• turning critically ill patients manually every 2 hours
• relying on the Glasgow Coma Scale (GCS) alone for routine neurologic assessment.
When these practices were introduced, no research supported them. Yet many practitioners keep performing them, despite recent research that suggests they should be changed. This article examines these three practices critically.
Instilling NSS before ET suctioning:
Helpful or harmful?
For years, nurses and respiratory therapists have been taught to instill 5 ml of sterile NSS into a patient’s endotracheal (ET) tube before suctioning. According to the traditional theory, this practice decreases mucosal viscosity, eases secretion removal, and improves oxygenation. Although at one time the theory seemed to make sense, research from the past 20 years shows it’s incorrect. Here’s what current research (primarily involving adults) tells us:
• Instilling NSS before suctioning decreases oxygen saturation and forced expiratory volume (a sign of bronchospasm).
• This practice may increase the risk of hospital-acquired pneumonia (HAP), as bacteria from the