You are to create an 8- to 9-slide PowerPoint presentation in which you do the following: Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to

Running head: CRITICAL APPRASAL

Critical Appraisal

Lakme O’Connell

Walden University

Essentials of Evidence Based Practice

NURS-6052

7/6/20

Critical Appraisal

Based on my review, the best practice that I chose was the study conducted by (Delgado, 2020) on managing patients in critical care. The research study is relevant for my nursing practice and therefore useful in promoting nursing care in critical patients such as those in intensive care units. Critically ill patients undergo excruciating pain due to medical procedures and the underlying disease processes. Through analgesics have widely been used to manage such patients, several limitations have been encountered. Nurses have not been able to balance patient comfort by use of analgesics and the complications linked with analgesic treatment. By evaluating sources of discomfort in the patient and adjusting the pain techniques for alleviating pain in such patients, nurses can ensure that the risks of complications due to the analgesics are minimized.

In 2018, guidelines were established for patients in the management of Pain, Agitation, Delirium, Immobility and Sleep, commonly called PADIS (Devlin et al., 2018). This was a slight deviation from the original document in 2013 cited PAD (Barr et al., 2013). Although the 2018 document addresses a wider perspective including immobility and sleep, both guidelines are based on research as well as expert opinion.

A more detailed analysis by Barnes-Daly et al., (2017) highlighted that compliance to the choice of drugs, among other mechanisms commonly stated as ABCDEF resulted to improved clinical outcomes of patients in critical care. The bundle was implemented across seven community hospitals. An interpersonal team model was applied to the patients in the hospital’s ICUs to operationalize the PADIS guidelines. The bundle was further expanded to incorporate other aspects, such as prevention of pain, assessing and managing delirium, early mobility, and the choice of sedation (Marra, Ely, Pandharipande, & Patel, 2017).

References

Barnes-Daly, M., Phillips, G., & Ely, E. (2017). Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals. Critical Care Medicine, 45(2), 171-178. doi: 10.1097/ccm.0000000000002149

Barr, J., Fraser, G., Puntillo, K., Ely, E., Gélinas, C., & Dasta, J. et al. (2013). Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine, 41(1), 263-306. doi: 10.1097/ccm.0b013e3182783b72

Delgado, S. A. (2020). CE: Managing Pain in Critically Ill Adults: A Holistic Approach. AJN, American Journal of Nursing, 120(5), 34-42. doi: 10.1097/01.naj.0000662808.81949.d6

Devlin, J., Skrobik, Y., Gélinas, C., Needham, D., Slooter, A., & Pandharipande, P. et al. (2018). Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine, 46(9), e825-e873. doi: 10.1097/ccm.0000000000003299

Marra, A., Ely, E. W., Pandharipande, P. P., & Patel, M. B. (2017). The ABCDEF Bundle in Critical Care. Critical Care Clinics, 33(2), 225-243. doi:10.1016/j.ccc.2016.12.005