Nursing Research and Evidence-Based Practice (EVP) Your Name

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Nursing Research and Evidence-Based Practice (EVP)

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Nursing Research and Evidence-Based Practice (EVP)

As a nurse, taking care of the patients is my primary responsibility.Therefore, the main purpose of this paper is to talk about a recentclinical experience where I provided care for a patient. Here, I willdetermine the extent to which the care was provided based on evidenceand research findings, the Population, Intervention, Comparison,Outcome, and Time (PICOT) question, and other relevant backgroundquestions. Finally, I will discuss the barriers, which might keep theproposed EVP from being implemented in my organization.

The Care Scenario

Mr. Y is a68 years old man, who was brought to the Emergency Department. He wassuffering from sepsis that could have been linked with lowergastrointestinal bleeding and diverticulitis. He had been havingshortness of breath for the last 24 hours, but he did not have anyabdominal pain. Initial examination revealed that his SpO2 was 94percent, which was lower than the normal level. So, based on thestandard procedure, his primary physician ordered to transfuse 2units of RBCs (red blood cells), as both his hematocrit andhemoglobin levels were lower than the normal level. When the secondRBCs was being transfused, Mr. Y’s SpO2 dropped to 83 percent. Healso became tachycardic and hypertensive. From this, I assumed thathis deteriorated condition might have something to do with the secondunit of transfusion. So I did some research on the EVPs of standardtransfusion procedures.

Background and PICOT Questions

Background Questions

What are the standard preconditions of RBCs transfusion? What arethe best practices? Is it supported by current EVP to administer 2units of RBCs for patients like Mr. Y? If not, then what EVP could weuse to keep Mr. Y’s conditions from deteriorating? Can a loweramount of RBCs be used?

PICOT Question

In elderly patients with sepsis, how does the use of 1-unit of RBCs(at lower HB levels) compared to administering 2-units of RBCsinfluence the patient’s vitals such as SpO2 during the first 3hours of hospitalization?

EVP on RBC transfusion

RBCs transfusion is done for increasing the blood’s capacity tocarry oxygen. RBCs transfusion increases the circulation of RBCs,thus replacing the RBC lost for various reasons and enhancing theblood’s capability of carrying oxygen (Carson &amp Carless, 2013).Several studies conducted on this issue concluded that for lesssevere patients, a restrictive amount of RBCs transfusion (1-unit ofRBCs at Hb &lt7-8 g/dL) is as effectual as administering 2-units ofRBCs. But it significantly reduces the risks of MI (myocardialinfarction). So the suggested best practice is to first administer1-unit of RBCs, reassess the patient, and then administer anadditional unit of RBCs if needed. Otherwise, the single unit isenough (Murphy et al., 2014).

Barriers of Implementing This EVP in My Organization

The main barriers to implementing this EVP in my clinicalenvironment are- various transfusion practices in the ICUs,excessively confident estimates about the current practices, andknowledge differences. Proper communication should be made with thehospital authority to help them realize the usefulness of the EVP andthe importance of implementing it.


This assignment enthused me to critically evaluate one of theclinical practices at my workplace and to conduct research forfinding out the best EVP for this particular issue. It also helped meidentify the hindrances of implementing the EVP in my organizationand come out with strategies to overcome it.


Carson, J. &amp Carless, P. (2013). Theevidence base for red blood cell transfusions.&nbspISBTScience Series,&nbsp8(1),89-92.

Goss, C., Giardina, P., Degtyaryova, D.,Kleinert, D., Sheth, S., &amp Cushing, M. (2014). Red blood celltransfusions for thalassemia: results of a survey assessing currentpractice and proposal of evidence-basedguidelines.&nbspTransfusion,&nbsp54(7),1773-1781.

Murphy, D., Pronovost, P., Lehmann, C., Gurses,A., Whitman, G., Needham, D., &amp Berenholtz, S. (2014). Red bloodcell transfusion practices in two surgical intensive care units: amixed methods assessment of barriers to evidence-basedpractice.&nbspTransfusion,&nbsp54(10pt2),2658-2667.

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