NURS 716 Week 1 Discussion Board Forum 1 on the Spirit of Inquiry and Evidence-Based Practice Example

Discussion Board Forum 1: Making the Case for Evidence-Based Practice

NURS 716 Applications of Evidence-Based Care, Discussion Board Forum 1

Thread by [Student Name]

The surgical unit, its data and the people replied to are composites written for a model discussion.

For six years I placed the same gel pad under the sacrum of every patient having a long abdominal surgery in our operating room, and I never asked whether it worked. We did not reassess skin until the patient reached the recovery unit, where a nurse would sometimes chart a reddened area that did not blanch. It was usually dismissed as positioning redness that would fade, and because patients were transferred to surgical floors within hours, no one in the operating room ever learned whether it did. Then a quality report showed that our surgical service had the highest rate of hospital-acquired pressure injuries in the hospital, most of them sacral and heel injuries in patients whose surgeries lasted more than three hours. Only then did anyone ask the question that should have been asked years earlier: what does the evidence say about preventing pressure injuries in the operating room?

Melnyk and Fineout-Overholt (2015) place the spirit of inquiry at the start of evidence-based practice, before any question is formed or any database searched. It is a habit of curiosity about routine practice, an unwillingness to accept "this is how we do it" as a reason. Once our team asked, the evidence was not hard to find. A single afternoon in two databases turned up randomized trials, meta-analyses and an international guideline, all pointing in the same direction. Prophylactic soft silicone foam dressings, placed on the sacrum and heels before surgery, have been tested in randomized trials and meta-analyses, and repositioning has been studied extensively in a recent Cochrane review (Latimer et al., 2026). The evidence was there; our curiosity was not. When our nurse educator finally summarized it for the department, several of us felt embarrassed that we had never looked, and that embarrassment became the energy for change.

Why did the question go unasked for so long? Gao et al. (2026) interviewed twelve operating room nurses using the Consolidated Framework for Implementation Research and set out to identify the barriers and facilitators to implementing evidence-based prevention of intraoperative pressure injury, noting that standardized guidelines exist but that their translation into practice remains poor. The same is true in our department. Our surgeons and anesthesia staff move quickly between cases, skin checks are not part of the surgical safety checklist, and redness in recovery was never traced back to the operating room. In Melnyk and Fineout-Overholt's (2015) terms, our culture lacked the leadership support, mentors and expectation of questioning that sustain evidence-based practice.

Scripture commends the one who searches. Proverbs says it is the glory of God to conceal things, but the glory of kings to search things out (English Standard Version Bible, 2001/2016, Proverbs 25:2). For a nurse, searching things out is not academic curiosity; it is a way of loving the patient who cannot ask questions while asleep on the operating table.

Reply to the Instructor

Dr. Morgan, you asked how I would begin building a spirit of inquiry in a department where questioning surgeons can feel risky. I would start with data rather than criticism, because data invite inquiry without accusing anyone. Melnyk and Fineout-Overholt (2015) recommend making the clinical problem visible through internal data as a trigger for asking clinical questions, and our pressure injury report did exactly that: once the surgical service saw its numbers, people began asking why. I would also bring in evidence that recognizes patient risk differently than we do. Hooper et al. (2026) studied a perioperative risk instrument in adult inpatient surgery and found its predictive accuracy lower than previously reported, and the patients most likely to be injured were those the anesthesia team had already classed as high risk, at ASA class 3 or above. Sharing a finding like that with the anesthesia team turns a nursing question into a shared one, since anesthesia staff assign that score every day. I would then invite one surgeon, one anesthesiologist and two nurses to look at the evidence together for thirty minutes. Questions asked together feel less like challenges. I would also ask the department chair to open that first meeting, since a leader's visible support signals that questions are welcome rather than risky.

Reply to Melissa

Melissa, I agree with your point that time is the biggest barrier on your medical unit, but I would add that time is often a symptom of priority. Melnyk and Fineout-Overholt (2015) note that organizations make time for what leaders expect and measure. When our department began reporting pressure injuries by surgical service each month, nurses found time to check skin at the end of long cases, because the result now belonged to someone. A bundle study in orthopedic surgery offers another angle: investigators compared a pressure injury care bundle with usual care in 190 patients having orthopedic operations, using a non-randomized controlled design, and examined pain, fear of falling and comfort alongside operating room pressure injuries (Eğilmez et al., 2026). Building prevention into a standard bundle may save time compared with remembering each step separately. Bundles also make omissions visible, since a missing element shows up on the checklist rather than disappearing. On your unit, could a two-minute skin check be added to an existing routine, such as the admission assessment or a bedside shift report, rather than standing alone?

Reply to Jordan

Jordan, you wrote that once evidence is clear, practice should change quickly. I wish that were true, but the operating room taught me otherwise. Even strong evidence for prophylactic dressings did not change our practice until we addressed workflow, supplies and who was responsible for applying the dressing. The Cochrane team studying repositioning schedules shows how long uncertainty can linger around even the most basic preventive measure, since it has needed repeated updates since 2014 to keep pace with new trials (Latimer et al., 2026). Implementation research suggests that context determines adoption: in interviews with operating room nurses, Gao et al. (2026) organized barriers and facilitators using an implementation framework precisely because evidence alone does not explain whether a practice is taken up. The Teacher in Ecclesiastes observed that every activity under heaven has its season (English Standard Version Bible, 2001/2016, Ecclesiastes 3:1), and in practice change the time is set by people and systems as much as by evidence. In our department, what finally moved practice was a change in supplies: once the dressings were stocked in every operating room and listed on the preference cards, nurses used them. What do you think would most speed adoption on your unit: a champion, a policy change or a supply change?

References

Eğilmez, H., Yava, A., & Koyuncu, A. (2026). Investigation of the effect of a pressure sore care bundle in reducing the development of operating room pressure injury in patients undergoing orthopedic surgery: A non-randomized controlled study. BMC Musculoskeletal Disorders, 27(1). https://doi.org/10.1186/s12891-026-10039-0

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gao, Y., Chen, J., Guang, W., Xu, W., Wei, Z., & Yang, H. (2026). A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework. Frontiers in Health Services, 6, Article 1877556. https://doi.org/10.3389/frhs.2026.1877556

Hooper, V., LaFond, C., & Perez, A. C. (2026). The performance of the Scott Triggers instrument in predicting perioperative pressure injury (PPI) development. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.06.012

Latimer, S. L., Chaboyer, W. P., Probst, S., Thalib, L., Palipana, D., Lapkin, S., McInnes, E., Downes, M. J., & Gillespie, B. M. (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 2026(6), Article CD009958. https://doi.org/10.1002/14651858.CD009958.pub4

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Wolters Kluwer.