EVIDENCE-BASED PRACTICE IN NURSING
The explicit, conscientious, and judicious application of current evidence in making decisions regarding the care of a patient is known as an evidence-based practice. It involves the integration of individual proficiency in clinical work with the best existing external medical evidence from systematic study. EBP does not only revolve on applying the best evidence of research into decision making. It covers the use of skills, training, and experience that a health professional possesses and putting into consideration the situation and values of the patients. The context of practice in which the professional is working is also essential. Clinical reasoning is the name given to the entire process of assimilating all this information (LoBiondo-Wood & Haber, 2017). A 20-year-old G1P0A0 patient experiencing abdominal cramping and spotting is a good object of study in the application of EBP in nursing. The study would begin by asking some questions to identify the current best evidence (symptoms) and then assimilate the information to identify what the patient is suffering from. Clearly, these are signs of early miscarriage.
By early miscarriage, I mean the loss of pregnancy before the end of the first trimester. Most of these miscarriages happen before the gestation of the pregnancy is ten weeks. However, women may experience some miscarriages very early, before they are even sure that they are pregnant. Some of the questions I would ask patient G1P0A0 are; how much are you spotting (are you getting your pads saturated?) how many times a day do you change your pads? How intense is the abdominal cramping? How often do you experience the cramping? For how long have you been experiencing these symptoms? No matter when it comes, miscarriage is a very sad and hard experience. In the modern world, miscarriages have been so common than most of us can realize. Between ten and twenty females who learn about their pregnancy have an early miscarriage? These rates are higher especially when women check pregnancy tests at home immediately after they lose their periods and thus learn about them being pregnant very early. In a study conducted by Santulli et al., (2016), he observed that by a single chance, about 1% to 5% of women will experience miscarriages in a row. Nonetheless, there are rare cases of individuals experiencing three or more miscarriages in a row, a condition known as recurrent miscarriage.
Since the patient had tested positive for pregnancy, he answers for these questions are used to identifying more exclusive details on if the patient had a normal pregnancy or miscarriage. A pregnant woman may at times experience mild abdominal cramping and some spotting especially during the period of implantation. On the contrary, intense cramping followed by spots are signs of miscarriage. In the field of medicine, early pregnancy is referred to as an early failure of pregnancy. This simply means that the pregnancy failed to develop. Most early miscarriages occur due to circumstances that no one can control, and we believe that they were destined to occur even before the woman learns to be pregnant.
Even though pregnant women may experience light bleeding during their early stages of pregnancy, it does not mean that they are destined to have a miscarriage. This spotting may not be bloody, sometimes it could be a brown discharge. Abdominal cramping and pains are symptoms of miscarriage. These might be accompanied by headaches, dizziness, and tissue passage through the vagina, a pink vaginal fluid, and other symptoms of pregnancy such as nausea and breast tenderness. Therefore, our patient (A 20-year-old G1P0A0) presented the main symptoms of miscarriage (stomach cramps and blood spotting). She tried making an OB appointment for evaluation but the appointment didn’t go through for several weeks. This was the right thing for her to do. If anyone experiences the symptoms of miscarriage, she has to contact a medical practitioner for evaluation. A lot of changes are necessary within the genes and cells of a pregnant woman. Sometimes, these changes may not occur perfectly. Some of the health conditions that result in early miscarriage are heavy smoking, poorly controlled diabetes, use of abusive drugs, physical problems within the uterus (e.g fibroids), and hypothyroidism or hyperthyroidism.
All miscarriages don’t require treatment. It is up to the patient to decide whether to wait until the pregnancy passes without undergoing any treatment. We as doctors are determined in offering evidence-based options for all patients, as well as the advantages and disadvantages of all available options after diagnosing you with a miscarriage. All Rh-negative patients require treatment with Rh-immune globulin, regardless of the option that they choose. Rh-immune globulin is an injection that prevents pregnant women from forming substances inside their bodies that may harm the unborn baby in future pregnancies.
Based on the medical evidence shown by the patient, I would prefer medical management for her condition. It is a form of treatment whereby medicine is used to make the tissue pregnancy get out of the body through the uterus (Schmidt, & Brown, 2017). Similar to what happens during a natural passage of the tissue, these medicines cause bleeding and cramping. These medicines operate like the management of expectant, only that the patient knows the exact time when the pregnancy tissue should pass. For the majority of women, the pregnancy passes within a day of taking the medicine. Just like expectant management, doctors have the opportunity of reviewing how much bleeding is too much, the type of medications to apply during the treatment, and what to expect. If the pregnancy fails to pass after this entire process, the doctor has to repeat it, do a suction aspiration, and then continue waiting. An ultrasound is important because it establishes the exact state of the uterus. Assessment and treatment of a patient with these symptoms would also involve taking a urine pregnancy test, an ultrasound to see the inner part of the uterus, and a blood HGC test. If the patient is experiencing a miscarriage, levels of HCG are detected (Schreiber et al., 2016). An HGC blood test also indicated the viability of the pregnancy. However, rather than the initial HCG, subsequent tests are vital as they help in knowing the progress of the condition.
After assessing and treating the patient using evidence-based practice, I would recommend her to an OB or a gynecologist for further treatment to prevent the occurrence of miscarriages in the future. EBP helps in the provision of available and effective care to improve the outcomes of the patient. People get the best of care which is based on best available evidence. A part of offering professional services to patients is for health professionals to ensure that their practice is informed by the best existing evidence. Lastly, EBP ensures that health resources are used with integrity and that relevant evidence is put into consideration when making decisions regarding the funding of health services.
References
LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-e-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.
Santulli, P., Marcellin, L., Menard, S., Thubert, T., Khoshnood, B., Gayet, V. … & Chapron, C. (2016). Increased rate of spontaneous miscarriages in endometriosis-affected women. Human Reproduction, 31(5), 1014-1023.
Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses: Appraisal and application of research. Jones & Bartlett Learning.
Schreiber, C. A., Chavez, V., Whittaker, P. G., Ratcliffe, S. J., Easley, E., & Barg, F. K. (2016). Treatment decisions at the time of miscarriage diagnosis. Obstetrics and gynecology, 128(6), 1347.