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Evidence Based Practice in Nursing Research



The nursing procedure that is discussed in this essay is the routine shaving of the surgical site. Nurses traditionally expect patients undergoing surgery to have hair removed from the surgical site with the aim of reducing infection at the surgical location. The shaving of hair at the surgical site has primary been done using the disposal safety razors. As much as the shaving of hair was believed to be more effective in the prevention of surgical site infections (SSI), many questions have been raised about its efficiency in terms of eliminating the risk factors on patients undergoing surgery.

For instance, present research points to the view that the routine shaving of hair from the surgical site is in fact harmful, since it increases the threat of surgical site infections, and should be completely avoided in the contemporary nursing practice. Therefore, it is recommended that electric clippers must be used to remove the hair out of the surgical site immediately before the surgery. Moreover, it is important to instruct patients on effective hair removal strategies that will prevent them from doing so at home, and only hair that interferes with the surgery has to be removed.

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This essay recommends changes to the routine shaving of the surgical site, highlighting the effect of these changes to stakeholders and any other barriers that might encounter during the implementation of the changes.

The Routine Shaving of the Surgical Site

The routine shaving of the surgical site is a questionable nursing practice found in the nursing field. It is worth noting that the routine shaving of the surgical hair entails the removal of hair at the place, where the operation is supposed to take place. The practice has been mostly executed using the disposal safety razor and surgical clippers. They help in the removal of hair, hence ensuring that the surgical area is clean enough for the surgical procedure. Foley, Chen, Simjee, and Zervos (2011) affirmed that the practice of shaving hair at the surgical site had been in existence since the time immemorial, as it was first introduced in the United States in the 18th century and, then, perceived the correct practice of operation.

Why the Procedure Needs to Be Changed

Numerous shortcomings of the routine shaving of the surgical areas necessitate immediate and effective changes. According to Card et al. (2014), one of the reasons why the present practice of shaving the surgical site must be changed is that it exposes patients to more risks of surgical site infections (SSI). The routine shaving of the hair plays an instrumental role in increasing infections among patients. In fact, it might worsen the outcomes of the operation in instances when the effective care is not provided through the follow up exercises with patients that have undergone surgery. In line with this practice, it is worth noting that the rate of surgical site infection increases with the level of hair removal from the surgical site, hence discrediting its continuous reliability and efficiency in terms of promoting the wellbeing of patients. Again, the surgical site infections have been responsible for increasing the level of mortality among patients undergoing surgery hence are not recommended in any given situation.

More so, the routine shaving of the surgical site needs to be changed because it is quite harmful in nature. It is traditionally damaging to use razors to shave hair off a surgical site. The most significant harm that can be caused to patients in this case is unnecessary injuries that come from the manifestation of the procedure. Tenner, Norrie, and Melen (2011) point out that the physical processes involved in the shaving are dangerous to the patient and must be discouraged by changing this procedure through the improved perception of the nursing practices. For instance, they may lead to cuts and abrasions on patients, thus, negating the overall surgical and recovery process. More so, the harm brought about by this practice might affect the surgical procedure and might lead to negative consequences.

Basis for the Practice

Surgeons in the United States determined the nature of hair shaving around the surgical site in the 18th century. During this time, it was believed that when patients were placed on the operating table, the surgical hair be removed before any surgery took place. They believed in the efficiency of the strategy in term of promoting the entire procedure of operation among patients.

The Rationale for Decision Makers Supporting the Current Practice

The most significant rationale for decisions, supporting routine hair removal from the surgical site, was that it helps to minimize surgical site infections in patients. They noted that shaving the surgical site offered the opportunity for the timely administration of the preoperative antibiotics immediately after the surgery. According to Card et al. (2014) policy makers believed that a complete removal of hair using razor would automatically neutralize threats emanating from bacteria, fungal, and viral contamination that exist in the surgical room or those possessed by surgical stuff. Therefore, they accepted the procedure backing it with the rationale that it will reduce the exposure of health risks on the patients that undergo an operation.

Explanation of Why the Current Process/Procedure Was Implemented

The routine shaving of the surgical site was primary implemented with the aim of improving the post-surgical outcomes of patients. First, it was believed that the routine shaving would promote shorter recovery time among patients. Tenner, Norrie, and Melen (2011) note that people in charge believed that the wound would faster in shaved patients compared to those who have hair around the surgical site.

Apart from the positive outcomes in terms of the recovery time, the routine shaving of the surgical site was implemented because of the primary role played in the prevention of the wound infection. It is not easy for patients to suffer more damage after surgical procedure because of the cleanliness associated with a shaved area. Hair was automatically perceived as dirty and inhibitory to the surgical and recovery process, thus, calling for the need to shave it a few days before the procedure.

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Recommendations of the Practice Change

Policy makers should adopt a number of recommendations for practice change in the field. Moreover, numerous changes could be undertaken as highlighted in the several recommendations explicated below.

The first significant recommendation for change in the routine shaving of the surgical site is the use of electric clippers instead of shaving hair form the surgical site. Orsted et al. (2010) agrees that the use of electric clippers comes out as one of the key recommendations for practice change because they can be used as alternatives to razors, which cause more harm to patients. They are beneficial because they tend to cut hair further form the patient’s skin unlike razors that cut deeper exposing patients to risks. The use of electric clippers is recommended because it plays a vital role in the reduction of the patient exposed to surgical site infections (SSI).

The second change that can be adopted is not to shave the hair at the surgical site. Accordingly, the presence of hair at the surgical site is not harmful or dangerous to the patient in any given way. It does not necessarily lead to surgical site infections, as believed before. Therefore, it is be desirable to leave hair, as it does not interfere with surgery. In fact, the presence of hair does not restrict the recovery period of patients and, in the end, can be advantageous to the whole process.

The third relevant change that can occur is instructing patients on the best strategies of hair removal, therefore, reducing their potential exposure to infections that can result from the surgical procedure. They should be advised to use clippers, thus, ensuring they do not interfere with the surgical site using ineffective shaving methods. Greene, Mills, Moss, Sposato, and Vignari (2010) hold the view that the recovery of patients will automatically improve if they are instructed on how to clean the surgical site. The surgical site infections are always reduced through involving patients and ensuring that they follow the prescribed measures of dealing with the surgical sites. This minimizes incidences of carelessness among patients, leading to the improved management of the surgical site.

According to Orsted et al. (2010), the fourth relevant recommendations is that the removal of hair from the surgical site has to be done immediately before the operation. In the current approach, the routine shaving of the surgical site is usually done days to the surgery. However, this is quite disadvantageous because it leads to the risk of getting surgical site infections. Removing the hair a few hours to the surgery is more recommendable because it enhances the opportunity for improved outcomes among patients. The most important thing to note in this case is that the removal of hair from the surgical site has to take place outside of the operating room for the obvious reasons of minimizing the dispersal of loose hairs and the risk of contaminating the sterile field or the surgical wound of the patient.

Clinical Implications

The most notable clinical implication that the above recommendations will have on patients is the reduction of the risk of surgical site infections (SSI). Card et al. (2014) reiterate that member of the preoperative team is always looking forward to the mitigation of SSIs among patients. These recommendations will offer patients the opportunity to be free from any signs and symptoms of infections, which indicates about the improved patient’s outcomes during the preoperative procedures. The patient will have the opportunity to handle the recovery process in the most effective manner without the fear of any further infections. The economic burden of addressing further infections is gradually reduced because of the abovementioned recommendations, leading to the belief in the nursing practice.

Another relevant clinical implication for patients is the reduction in the morbidity and mortality rates. Because of the exposure to different types of bacterial infections, some patients have lost their lives in the previous years. However, these recommendations would reduce the number of the deaths of patients. They will have a higher survival rate compared to what is experienced now because of the shaving of the surgical site.

Practice Implications

The above recommendations would also have automatic implications on the nurse practice. They would revolutionize the practice in terms of the procedures of preparing patients for surgeries of all types. Foley, Chen, Simjee, and Zervos (2011) believe that the practice will stand a greater chance of moving from the traditional form of operation to the most modern and reliable form in the care delivery and outcomes. This means that patients will have more trust and belief in the practice because of its focus on the improved outcomes that come with the refusal to shave hair from a surgical site. There would be an automatic practice transformation with the adherence to these procedures in the best ways possible.

Stakeholders

The best ways to a policy change is to involve all stakeholders. The first relevant strategy of involving stakeholders is through a training process that focuses on these new methods of hair removal from a surgical site. For instance, the clinical staff has to be trained on the advantages of using electric clippers over razors, which are likely to increase the risk of surgical site infections.

Another relevant strategy of involving stakeholders is through the education of patients about the preparation of the surgical sites. Orsted et al. (2010) confirms that patients are obviously primary stakeholders in this matter because all these procedures are performed on their bodies. Therefore, educating them to adhere to the best practices of hair removal would be a step toward a positive improvement.

Informed consultations on practice changes could also serve as the best strategy for contributing to the recommended changes. For instance, organizing a consultative meeting between the surgical staff and the clinical staff would work to the advantage of patients, as the recommended strategies would be adopted without arguments and professional competition.

Barriers in Applying Research to Practice

The first relevant barrier for applying this research to practice could be the lack of leadership support. Orsted et al. (2010) opines that nursing leaders play a critical role in making decisions for the practice performance. Because of their power and decision-making abilities within the organization, they can attempt to block the success of the new recommendations in terms of their applicability into the practice. They will want to ensure that they promote their own positions and support them, inhibiting the application of this research to practice.

Another barrier for applying research into practice is the low levels of physician acceptance of the new practices. Physicians always want to be treated better compared to the nursing practice, and they may discredit this research and its applicability to practice. The high level of professional competition between nurses and physicians would pose a challenge on the application of the research into practice.

The third barrier to the application of the research is a natural disbelief in change. Tenner, Norrie, and Melen (2011) confirm that many individuals in practice may tend to be rigid to the methods used in the preoperative exercises. Therefore, the natural resistance to change would make it difficult for the application of this research to practice. This is also backed up by the fear of the new training costs that would incur, when informing employees about the new techniques in dealing with hair around the surgical site.

Two Strategies to Overcome the Barriers to Application of Research

The effective overcoming of these barriers will ensure the practice to be successful in the end. Therefore, the first relevant strategy to overcome these barriers is to use opinion leaders to ensure the support of the masses in apply the research into practice. Greene, Mills, Moss, Sposato, and Vignari (2010) note that opinion leaders such as physicians could play a helpful role in encouraging the rest of the leadership team to support the suggested recommendations for the success of the practice in the most effective manner. With opinion leaders, suggestions related to the advantages of the research and the offered transformations would be discussed, ensuring the support of other professionals. Their collaborative work will ensure that the research is gradually put into practice.

The second strategy to overcome the barriers is the development of the stakeholder analysis and the use a team-based problem-solving approach. This strategy would be dedicated to address the lack of the support from physicians and general resistance to change. A stakeholder analysis would be crucial in the identification of the specific groups of individuals that do not support the suggested changes in the organization. Therefore, they would be addressed one by one through a team-based problem-solving approach that makes everything clear in terms of the new suggestions and their implementation into practice.

Implementation of Findings

The implementation of these findings is the ultimate stage in changing the practice. Therefore, the process of implementation would begin with the introduction of the pre-operational program made up of showering and nasal decolonization. This first stage of implementation would ensure that appropriate techniques are followed in the course of dealing with surgical sites. Orsted et al. (2010) states that the adoption of pre-op program would put the new strategies into a working condition as everyone remains cautious about the potential threats posed on patients. This would lead to the realization of the set targets in the best ways possible.

Another implementation strategy involves the introduction of ‘No Shave’ posters across the organization. These posters would be a point of reference for all individuals in the practice and would play a helpful role in ensuring that every razor was eliminated from the field of practice. Penalties would also be put in place for anyone using the traditional ways of shaving the surgical sites of patients. ‘No Shave’ posters would inform all new individuals coming into the practice, ensuring the avoidance of errors and the reduction of the prevalence of surgical site infections.

Conclusion

In conclusion, the routine shaving of the surgical site has been in existence since the 18th century, and it has been used based on the rationale that it prevents surgical site infections. This rationale has always been anchored on the view that hair is dirty and has the potential of interfering with the surgical wound, thus, complicating the process of healing. However, as seen from the discussion above, this is not necessarily true because shaving of hair from the surgical site has the tendency for exposing the wound to the surgical site infections. Moreover, it is a harmful practice because it can cause the injuries in the patient. The specific recommendations that have been explicated in this essay include the use of electric clippers instead of razor blades, avoiding shaving, as it is not necessary, shaving immediately before the surgery takes place, if necessary, and instructing patients to observe the most current hair elimination techniques. It is clear that the adoption of these strategies into practice will not be easy because of factors such as the lack of leadership support and physician support. However, using opinion leaders and team-based problem-solving approaches would assist in the eliminating the resistance to these changes in the organization, leading to success in their applicability. There would be positive outcomes to patients with the implementation of these recommendations, as the morbidity and mortality rates decrease.

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