Traditional nursing practices—think bed rest, sponge baths and hospital corners—often were developed by trial and error and passed on through generations of nurses in religious and military service.
Today, modern healthcare requires nurses to collaborate with interdisciplinary treatment teams to deliver scientific or evidence-based practices to their patients. They ask a multitude of questions and take into account a whole host of factors, including their patient’s age, medical history and cultural background, before determining the best course of action.
“Nursing is an evolving science and very individualized,” said Rosemary Smith, dean of the University of Wisconsin Oshkosh’s College of Nursing. “For example, we used to turn patients confined to their hospital beds every two hours to prevent bedsores. Now we know from scientific research that more continuous body movement is necessary.”
Some of UW Oshkosh’s top nursing alumni are leaders in providing evidence-based practice throughout the lifespan in clinical and educational settings alike.
A 2007 recipient of UW Oshkosh’s Outstanding Young Alumni Award, Michele Polfuss BSN ’96, MSN, Ph.D., of Appleton, is a certified pediatric nurse practitioner. She treats children who have diabetes and other endocrine problems at Children’s Hospital of Wisconsin in Milwaukee, serves as a clinical instructor at Marquette University and studies childhood obesity.
At Children’s Hospital, Polfuss works with a team of physicians, nurse practitioners and nurses to care for children and their families who are dealing with a variety of concerns related to the endocrine system.
“Any time you work with children (or any other individual), you want to be sure that you are treating them according to guidelines or treatment protocols that are based on solid evidence,” she said. “It would be frightening and unsafe if healthcare providers performed their care based on hunches.”
Polfuss is responsible for obtaining the child’s history and physical, ordering laboratory or radiology tests, diagnosing and treating the child through ordering or adjusting medication or through lifestyle recommendations and educating the family on the child’s care and/or treatment.
“When I provide care, using evidence-based information allows me to talk with the family about why it is important to do the recommended treatment, but I also can back up my information by discussing how it has been tested and proven to be the best option,” Polfuss said.
One example of evidence-based care for overweight children is using a technique called “motivational interviewing” when discussing nutrition and exercise changes that could be hard for the child and family to make.
“Motivational interviewing is a way to talk to a patient to assess how ready they are to make a behavior change versus telling them what they need to do,” she explained. “This process allows individuals to guide their own treatment and lets the provider guide the process.”
Polfuss is excited that nurses are not only providing the care but also playing an integral role on the healthcare team to produce the evidence-based information.
“Working directly with patients allows nurses to observe how the care they provide impacts the individual. If we believe something else may work better or benefit the family, we are able to perform research and test our ideas,” she said.
UW Oshkosh alumna Cindy Brylski BSN ’95, of Greenville, works as a public health nurse and lactation consultant for Outagamie County and as an on-call lactation consultant with ThedaCare hospitals. As a public health nurse, she provides information about community resources and helps address clients’ barriers to getting connected to those resources.
“We also provide education throughout the pregnancy regarding what to expect during the prenatal and postpartum periods, and when to call the doctor if there is a concern. I make home or office visits to anyone in our jurisdiction in need of lactation support services,” Brylski said.
She also co-chairs the Breastfeeding Alliance of Northeast Wisconsin and is involved with the Fox Valley Postpartum Depression Task Force, which is a community group dedicated to education regarding postpartum depression.
In her work, both communicable disease and immunization follow-up are determined by evidence-based practice.
“Continual training and updates are required in public health and in hospital settings to assure the care we deliver is based on the most current evidence,” she said.
For instance, during nursing school and Brylski’s first few years working in the field, it was a common practice to aspirate (pull back on the plunger after insertion but before injection) when giving vaccines. “However, in 2002 the General
Recommendations on Immunization no longer recommended aspiration before injection, since no data existed to document the necessity of this procedure,” she explained.
Another example involves medical advice about parents co-sleeping with their babies. “When I went back to school as a nontraditional student, co-sleeping was not discouraged and sometimes recommended so moms and dads could get more sleep. But since the mid-1990s, strong evidence has proven it is not safe for babies to sleep with their parents,” Brylski said.
When UWO alumna Maria Brenny-Fitzpatrick MSN ’05, was an undergraduate nursing student at the College of St. Teresa in Winona, Minn., there was little mention of evidence-based practice.
“Quite frankly, those involved with nursing research were sometimes considered a bit ‘out there,’ and those nurses who questioned the status quo were frequently thought of as irksome and troublemakers,” she said. “Nurses were educated to practice based on long-standing traditions, beliefs, intuition and clinical experience.”
Now, evidence-based practice is the order of the day for the co-founder and team leader of the University of Wisconsin Hospital’s Acute Care for Elders Interdisciplinary Consult Team.
Brenny-Fitzpatrick provides guidance on the care of geriatric patients and their families and serves as a mentor for nursing students. Recently promoted to transitional care program director for the UW-Health System, she works to define a shared vision for care transitions.
“I work side by side daily with doctors, pharmacists, physical therapists and social workers. The expectation in the group is that the recommendations we provide are evidence-based whenever possible,” she said. “As an example, our pharmacological and non-pharmacological treatments for delirious patients are based on the most current research and literature findings.”
“Whereas years ago, the agitated delirious patient may have been sedated, restrained or even secluded in a quiet darkened room, today nurses are encouraged to individualize interventions for each patient guided by the patient’s medical history, findings on physical and neurological examination and the clinical setting,” Brenny-Fitzpatrick explained.
The prevention and treatment of delirium involves dealing with the underlying cause and addressing sensory issues, pain, mobility and other factors.
“Nurses are required to be critical thinkers in choosing which evidence-based intervention they will use, and they also need to be true interdisciplinary team players since many interventions require a team assessment and approach,” she said.
To ensure that the best patient care continues to evolve, Brylski, Brenny-Fitzpatrick and Pohlfuss all stress how important it is for nursing students to learn strategies for delivering evidence-based practice.
Brenny-Fitzpatrick noted that students should be supported with the time, mentors and the necessary technology to allow access to databases and literature.
Brylski agrees. “I think it is imperative that today’s nursing students learn evidence-based practice skills. It is the process of research, observation and experience. Critical-thinking skills are necessary in searching for, assessing and applying the literature to current practice,” she said. “Practice needs to evolve with current evidence.”