Peter Smith, a 67-year-old Indigenous man, presented to his general practitioner (GP) with his daughter, with a ten-month history of constipation and abdominal discomfort. More recently, he has felt very fatigued and had been experiencing lower abdominal pain. In the weeks prior to Peter consulting his GP, he had noticed his stools were long and narrow, and small amounts of bright blood on the toilet paper. Peter had ignored many of these early signs as he thought that as he was getting older. Peter is of Aboriginal descent, and recently moved from the outback to join his daughter in the city as he has not been looking after himself. The GP performed a digital rectal examination to eliminate the presence of haemorrhoids. On examination, the GP palpated a firm irregular non- capsulated mass in Peter’s rectum. The GP arranged a consultation with a gastrointestinal specialist. The specialist performed a colonoscopy. During the colonoscopy, a biopsy was taken of the large sessile lesion located in the proximal third of Peter’s rectum. Three polyps were also removed from Peter’s colon. The biopsy results confirmed a stage IIA rectal adenocarcinoma. Peter has been admitted to the surgical ward for an abdominal-perineal resection and the formation of a sigmoid colostomy. Peter’s postoperative recovery was uneventful. On Day 6, the Registered Nurse from night duty reported to the Stomal Therapist Clinical Nurse Consultant (CNC) that an area of approximately 5cms x 3cms surrounding Peter’s colostomy was excoriated with sloughy areas. The stoma itself remained viable and was working well. The Stomal Therapist CNC believed that there has been an increase in patient colostomy skin breakdown on the colorectal postoperative ward. The CNC is concerned that there has not been adherence to to the ward’s policy for colostomy skin care that is based on the research evidence. The Stomal Therapist CNC undertook a baseline audit and indeed found that the cleaning of the skin around the stoma during colostomy bag changes was not done uniformly or according to the ward’s policy. This resulted in new strategies to be implemented that aimed to increase compliance with ward policy. Following the introduction of these strategies, a follow-up audit found there has been an increase in compliance with the ward’s policy and a subsequent significant decrease in colostomy skin breakdown.

Read through the following information to understand, and meet the requirements of this assessment:

Step 1: Literature search Using the case study as a starting point for a situation where the nursing care provided may not be based on evidence-based practice, conduct a journal search for literature on the barriers and facilitators of compliance with evidence-based practice.

Note: You will use this literature to support your argument in answering the key areas. Key information

For help with performing a literature search revisit Module 3.

Step 2: Collect evidence to respond to the key areas

Using the literature you have found, collect evidence to respond to the following: 1. Within the patient-centered care model, discuss barriers and facilitators to achieving compliance with evidence-based nursing; 2. Discuss two (2) strategies that may help decrease non-compliance of a policy or clinical practice guidelines; 3.Discuss how you could help ensure the capability of maintaining and sustaining adherence to a policy or clinical practice guidelines beyond the initial implementation period.Step 3: Structure and write your report Using your responses to the key areas and your supporting evidence prepare a report. Your report should consist of the following sections:

Introduction

Your introduction should introduce the significance of evidence-based practice in providing quality nursing care and briefly preview the key areas to be discussed in your report (25 words)

Body

The body of your report should contain a discussion that answers the three (3) key areas:

• The barriers and facilitators to achieving compliance with evidence-based nursing practice. (400 words)
• Strategies to help decrease non-compliance to a policy or clinical practice guidelines. (350 words)
• Recommendations for maintaining and sustaining adherence to a policy or clinical practice guidelines beyond the initial implementation period. (400 words)