Ritualistic Care in Practice

The purpose of this essay is to validate the use of evidence based practice via constructing a literature review of ritualistic care in practice. Literature may be obtained from various sources for example books, Internet, articles, and research. The most up to date literature is found in the form of relevant and valid nursing research. Research is important source of information for the nursing profession because it is critical and valid to the development and refinement of knowledge in order to enhance practice. Nursing research can be defined as the systematic objective process of analysing phenomena of importance to nursing (Earlene, 2001).

Many articles indicate that a gap exists between research/theory and practice. This is due to a number of different factors such as lack of research, lack of access to research, barriers placed by staff etc. To reduce this gap the approach of evidence-based practice has been introduced (Rolfe 1998, Upton 1999). Evidence based practice can be defined “as an approach to problem-solving in clinical practice” (Roseburg and Donald 1995) or the” systematic interconnecting of scientifically generated evidence with the tacit knowledge of the expert practitioner to achieve a change in a particular practice for the benefit of a well defined client/patient group” (French, 1999). Within literature multiple definitions of the term evidence based practise exist as they do for many other nursing terms (Upton, 1999).

Evidence based practice originated from evidence based medicine which was defined by Sackett (1996, pg 71) as the ” conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” the term was developed to teach medical students. Evidence based medicine then developed into evidence based heath care, which is an even broader term than evidence based medicine and can be defined as the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Evidence based practice is even more wide-ranging term.

The major justification for evidence-based practice within nursing is to improve patient care. Other benefits of evidence-based practice include demonstration of effectiveness, justify skill mix, problem solving, identifying needs, provides a rationale for practice, provides consistent information, enhances professional status and to show purchases the use of evidence based practice (le May, 1999). Strategies to enhance evidence-based practice include research-based articles, the internet, computer, conferences, journal clubs, motivation, research centres, workshops, databases, lectures, meetings, funding for courses, study days, articles, books, more good quality valid research, in all areas of practice, as well as additional understanding of evidence based practice.

Obstacles which may hinder the utilization of research / change / utilization within practice may includes time, resources, pressure of work, to much change, nursing colleagues being uncooperative, medical staff blocking implementation, implementation may require resourcing, other professions may think research is sub-standard, inability to access research, insufficient skills in critical appraisal, language of research make it inaccessible, lack of motivation, fear, resistance to change, ritualised practice, beliefs that research wont make a difference, research data is not relevant, current practice is ok as it is, (le May, 1999). With regard to the topic chosen, some obstacles, which may hinder change, included people’s beliefs that the old way it is the best way, or this is the way it has always been done. However ritualised practice/care is believed to be an obstacle in itself. Parker (1999) believes that the persistence of ritualistic care is due to the lack of familiarity with research.

Ritualistic action can be defined as carrying out a task without thinking it through in a problem-solving logical way, therefore ritualistic practice could be interpreted as carrying out a care/practice without thinking it through in a problem-solving logical way (Philipin, 2002). Ritual practice has been described as irrational unscientific, unsafe, and repetitive (Philipin 2002, Geffrey 1997, Biley 1997). Although there is view points which, regard rituals as valuable such as the anthropologists. The negative side of ritualistic care is talked about more, and usually brings areas of practice/care into light, what need additional valid up to date research.

In Wash and Ford (1989) classic text they called for a “drive for the replacement of ritualised practice”. Later in 1994, Ford and Walsh stated that lack of an in-depth theoretical framework leaves nursing vulnerable to ritualistic practice. Strange (2002) perceives ritual practice as economically unproductive and primitive. Therefore presenting a disapproving view of ritualistic practice/care. This negative approach to ritualistic practice is thought to have originated from the fact that we are a technical society and so turn from primitive practice and the fact that irrational is often linked with emotion, which is not scientific.

Negative examples of ritualistic care/practice can be seen throughout clinical practice and these are often task based. Several examples of care that have been termed ritualistic, which will be reviewed in more detail include pre-operative fasting, pressure sore care, observation and drug rounds. Excessive pre-operative fasting has long been recognised a ritualistic practice even as early as 1883 when Joseph Baron Lister said ‘while it is desirable the there should be no mater in the stomach when chloroform is administered, it will be very salutary to give a cup of beef tea about two hours previously’ (Jester, 1999). However preoperative fasting was not always carried out as it was only made mandatory in practice after Mendelson’s lamark study in 1946 before which a drink was often recommended before the procedure (Greenfield, 1997)

Pre-operative fasting is believed to eliminate the risk of vomiting/gastric aspiration during induction which may lead to complications which could be fatal (O’Callagham, 2002). O’Callagham (2002) states that it is a ‘medical and legal requirement that a patient must not be anathetised without a period of fasting from food and fluids, except in emergency surgery’. The length of time, which a patient should be fasted from fluids and food, is still controversial as it takes variable amounts of time for the stomach to empty depending on what is what is eaten and what is drank.

Walsh and Ford (1989) found that patients were ritualistically starved from anything from 8 to 20 hours and deemed it as unthinking and irrational as research shows that fasting time would cause no harm be 4-8 hours for food and 2 hours for clear fluid (Philps 1993, Morris 2002). In the case of solid food Nimmo et al (1983) cited in Walsh and Ford (1989) found that a light meal of toast had 2-3 hours before surgery had no effect.

Also Chapman (1996) Hung (1992) Maltby (1993) cited in Jester (1999) demonstrated that it was safe for patients to have food 6-8 hours before surgery. In the case of clear fluids Agarwel et al (1986) cited in O’Callagham (2002) demonstrated that patient who drank 150ml of water prior to surgery had lowered gastric volumes that patients who had fasted since midnight. Also the amount of saliva swallowed would be more that a small drink of water. Starvation for vast periods of time can be uncomfortable and source of increase stress (Walsh and Ford, 1989). Apart from being uncomfortable it could also put the elderly at risk of dehydration and confusion, which may in turn lead to the operation being cancelled (Jester, 1999).

In addition vomiting after surgery is usually due to drinking to soon following surgery, patients who have drunk within a few hours of induction of anathesia should be less thirsty post-operatively and try not to drink to soon (Smith, 1997). There sufficient knowledge that preoperative fasting is a classic example of ritualistic practice that the days of nil by mouth at midnight should be drawing to a end (Morris, 2002) and patients fasting times should be calculated individually. Although Biley (1997) says that the pre-operative fast is part of the hospital process and so not having as long may make experienced patients of hospital life, feel like they are excluded.

Evidence-based practice (EBP) can be seen throughout history dating back to the mid 19th century when Florence Nightingale gathered research to improve the quality of care provided to patients while analyzing hospital data (Miller, Ward & Young, 2010). EBP has …

Nursing theory must offer the standards that support practice and assist in creating additional nursing knowledge (Colley, 2003). There exist continuing contentions on nursing theory and what comprises nursing knowledge, but no clear conclusions have been made. Nurses become confused …

Nursing is probably the most holistic health-related profession. It warrants the nurse to approach one’s practice in a manner that not only focuses on the health issues of the patient but rather encompassing the whole well being of the person. …

Palliative care is a specialized segment of health care which involves minimizing and preventing the patients’ pain and suffering. Patients suffering from chronic illness, end of life or curable illness may be placed in palliative care. The goal of palliative …

David from Healtheappointments:

Hi there, would you like to get such a paper? How about receiving a customized one? Check it out https://goo.gl/chNgQy