IN MY EFFORTS to help the students I teach understand what the term evidence-based practice means, I often reflect on my career and marvel at the many practice changes I've witnessed. I'm proud to belong to a profession that's increasingly based on scientific research, not tradition and unproven assumptions.
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In 1914, Florence Nightingale said, "Unless we are making progress in our nursing every year, every month, every week, take my word for it, we are going back."1 Reflecting on this statement, I became curious about past nursing practices in the hospital where I work. I interviewed several nurse colleagues and asked them what they remembered about nursing practices from "back in the day." They had some eye-opening responses.
Creative wound care
When I asked my colleagues who've been in practice for more than 20 years, "What did you do in your practice years ago that's no longer done today?," many mentioned wound care. Some nurses recalled applying an antacid to pressure ulcers, saying they'd been told it would "dry the wound." We now know that wounds heal best in a moist environment.2
One nurse described inverting a plastic bowl over a wound and attaching tubing for delivering oxygen to the tissue to speed healing. Asked how she secured the plastic container to the patient, she said, "with tape!!"
To control the odor of a large infected wound, one nurse remembered opening squares of 4" x 4" gauze and spooning on "a couple teaspoons" of charcoal to wrap up and insert into the wound. When asked if the charcoal helped absorb the odor, she said, "not really, but we thought it did." Later research showed that this primitive way of managing wound odor just doesn't work.3
My specialty is mother-baby care, so I was particularly intrigued by stories of labor and delivery, maternity, and nursery practices. I must admit, I clearly remember performing some practices that now seem preposterous or downright dangerous. Before any research on sudden infant death syndrome (SIDS), for example, we always placed babies on their bellies to sleep, not on their backs, thinking that this would prevent them from aspirating and choking. Studies have since given us evidence that putting babies "back to sleep" can prevent SIDS.4
Forty years ago, bottle-feeding was in fashion, and we considered new mothers who breastfed their babies "unorthodox." Now, studies have established the many benefits of breastfeeding, both physical and psychological, for infant and mother.5 Breastfeeding is now typically the rule, not the exception, in my own practice.
Up in smoke
Many colleagues remembered nurses and other healthcare professionals smoking at the nurse's station-once a common practice, unbelievable as it seems now. Several nurses remembered that patients were allowed to smoke in their rooms-even with oxygen nearby!! The National Institutes of Health formally listed secondhand smoke as a known human carcinogen in 2000,6 and smoking in the workplace and public spaces is now prohibited just about everywhere you go. Considering all the information we now have about secondhand smoke, it's difficult to believe that patients and staff were once routinely exposed to this hazard in healthcare facilities.
What about nurse-physician relationships?
Our professional relationships with physicians have certainly undergone transformation over the years. One colleague recalled that because she was an LPN, not an RN, she "wasn't allowed to call a physician." She also mentioned how nurses had to give up their chair if a physician entered the nurses' station. Commenting on nurses' subordinate status, a nurse educator recalled that nurses calling a physician on the telephone were instructed to begin by saying, "Dr Smith, I'm sorry to bother you, but ...."
Today, studies have shown that mutual respect, interdisciplinary collaboration, and good communication are crucial to patient safety. Poor communication leads to misunderstandings, errors, and ongoing conflict between nurses and other healthcare professionals. Evidence-based communication tools such as SBAR (Situation, Background, Assessment, and Recommendation) can ease tensions and promote quality care by ensuring the clear, concise reporting of patient issues to everyone involved in the patient's care.7
Keep it evidence-based
As I reviewed my notes after talking with my nurse colleagues, I found many more examples of outdated nursing practices that weren't based on research. It was entertaining to listen to these stories; once someone described an old practice, others joined in with memories of their own.
But the significance of these memories goes beyond entertainment. We should constantly reevaluate current nursing practices and ask ourselves if they're based on old customs or on solid evidence.
As the nursing profession continues to advance, you'll someday have stories about outdated practices you're using now. I encourage you to move nursing practice forward by investigating what's best and eliminating outdated practices from "back in the day."
1. LifeTips. Inspirations for nurses. http://nurse.lifetips.com/cat/59407/quotes-on-nursing/index.html. [Context Link]
2. Benbow M. Exploring the concept of moist wound healing and its application in practice. Br J Nurs. 2008;17(15):S4, S6, S8. [Context Link]
3. Alexander S. Malignant fungating wounds: managing malodour and exudate. J Wound Care. 2009;18(9):374-382. [Context Link]
4. Johnson SC. Ongoing education about safe sleep practices to prevent SIDS. Pat Educ Manage. 2008;15(9):97-108. [Context Link]
5. Pinto S, Schub T. Breastfeeding: interventions to promote initiation and extend duration of breastfeeding. 2008. http://web.ebscohost.com/ehost/pdf?vid=5&hid=11&sid=8909acb6-c36f-49d8-a7bbd5e17. [Context Link]
6. National Institutes of Health. Fact sheet: the report on carcinogens. 9th ed. http://www.nih.gov/news/pr/may2000/niehs-15.htm. [Context Link]
7. Sirota T. Nurse/physician relationships: improving or not? Nursing. 2007;37(1):52-55. [Context Link]