NURS FPX 4025 Assessment 2

Applying an EBP Model

Student name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Professor’s Name

Submission Date

Role of Evidence-Based Practice on Appendicitis

Evidence-based practice (EBP) is essential in the modern world of nursing as it helps to make sure that the credible research is included in the process of treating a patient to provide the latter with safety, quality, and outcomes. Among the patients who survived the appendectomy procedure, the common practice of postoperative procedures has been associated with a delayed recovery rate, complication, and hospitalization (Abu-Baker et al., 2021). Nurses can solve these challenges with the help of an EBP model since they can systematically evaluate and integrate evidence-based strategies such as enhanced recovery after surgery (ERAS) rules. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model is used in this paper in regards to one of the delayed recovery phenomena in appendectomized patients, and demonstrates how the systematic implementation of evidence can result in care delivery and patient outcomes.

Issue Associated with Diagnosis

Delayed postoperative recovery with the concomitants such as long-term pain, slow mobilization, and long-term stay is one of the leading issues of acute appendicitis that requires appendectomy. The consequences of the current conventional postoperative care practices (delay of oral intake, limited early ambulation, use of opioids as the only pain management method) are slower recovery, decreased ambulation, early postoperative complications (e.g., ileus or infection), and more expensive healthcare. These delays have a harmful impact on patient safety and satisfaction and cost health care systems due to the growing length of stay and resource utilization (Abu-Baker et al., 2021). The advocacy of the EBP approach will be highly beneficial in this issue because the existing literature has identified the ways to improve recovery and facilitate its effectiveness by introducing early ambulation, multimodal administration of pain, initiation of oral intake, and ERAS. As demonstrated by Li et al. (2024), ERAS has the potential to reduce the number of complications, shorten the length of stay in a healthcare facility, and the cost received by the customer without sacrificing safety. Adopting these evidences into the clinic will allow nurses to improve patient outcomes, satisfaction, and organizational goals to improve quality and reduce costs.

Evidence-Based Practice Model

Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is a systematic aid designed to guide nurses in their clinical issue to evidence-based improvement. Its structure is the acronym PET, which means Practice, Evidence, and Translation, providing a systematic method of shifting between problem identification and a solution implementation (Tsistinas, 2020). In the Practice question phase, where the clinical issues are clearly clarified and operationalized into expert questions, occasionally in the PICOT form, the relevant stakeholders are invited to the table. The Evidence stage emphasizes searching, screening, and synthesizing the best quality studies and determining the level and quality of the evidence on a standardized rate scale (Tsistinas, 2020). The final step, which is Translation, is geared towards establishing the feasibility of changes in practice, trying it in actual life, measuring the outcomes, and then presenting the results in preparation for an extensive job.

This model is particularly applicable to the situation with delayed recovery following appendectomy, as it integrates two dimensions that are the rigidity of the evidence assessment and the expediency of its implementation. Compared to other models that emphasize the synthesis of evidence in specific instances, JHNEBP is more holistic when it comes to change (ensuring that the path to change takes into account the notion of interprofessional collaboration, plan-do-study-act (PDSA) structure, and sustainability planning) (Tsistinas, 2020). The findings indicated that the opportunities for nurses have to do not just involve implementing evidence-based interventions but also inspiring the structural shifts to ensure the integration of EBP over a long period (Ominyi & Alabi, 2025). It is a desirable methodological rigor and dwells upon applicability, and can be applied to implement ERAS evidence into effective postoperative care interventions among appendectomy patients.

Application of the Evidence-Based Practice Model to Acute Appendicitis

The JHNEBP Model was methodically used during the search for the relevant evidence on delayed recovery among patients who underwent appendectomy. The interprofessional team developed a (Population, Intervention, Comparison, Outcome, and Time) PICOT question in the Practice Question phase which is as follows: In patients recovering after appendectomy (P), what were the effects of the application of ERAS protocols (I), as compared to the use of standard post-surgery care (C) on pain management, recovery, and the length of stay at the hospital (O), in the acute care setting (T)? This was the question on which specific research was based. Data searching was done in databases accessible, i.e., PubMed, CINAHL, and ProQuest Nursing and Allied Health, and the search used the following keywords: appendectomy, enhanced recovery, postoperative outcomes, and ERAS. Since Moris et al. (2021) examined the diagnosis and treatment of acute appendicitis in detail, it is positive to learn about the clinical examination, imaging, and treatment. The peer-reviewed articles that were published within the last ten years were sifted to facilitate the current and reliable information. The sources were subsequently critically evaluated, and randomized controlled trials were evaluated by the JHNEBP Evidence Level and Quality Guide as Level I and clinical guidelines as Level IV, thereby allowing the team to prioritize high-quality studies.

In the course of the Translation stage, the information that was synthesized was evaluated in comparison to the way it would be verified in the practice setting, and the ERAS protocols were noted as viable and applicable in surgical units. Liu et al. (2024) established the opportunity to enhance evidence-based nursing interventions and improve interventions through the use of structured nursing care that could allow patients with appendicitis and evidence-based nursing interventions for the surgical site wound infection to get cured at a faster rate. One of the challenges encountered in this process was the problem of narrowing down generalized findings, as the major research carried out on ERAS was, in most cases, on colorectal or major abdominal surgery analysis and not on appendectomy. To address this, the inclusion criteria will be revised to prioritize the studies on laparoscopic surgery and generalizable ERAS interventions, such as pain management, fluid balance, and early mobilization. Such a procedure allowed choosing the evidence that might be regarded as credible and directly applicable to the procedure of appendectomy recovery.

Credibility and Relevance of Evidence

Li, Z.-L., Ma, H.-C., Yang, Y., Chen, J.-J., & Wang, Z.-J. (2024). Clinical study of enhanced recovery after surgery in laparoscopic appendectomy for acute appendicitis. World Journal of Gastrointestinal Surgery, 16(3), 816–822. https://doi.org/10.4240/wjgs.v16.i3.816

The former is a randomized controlled study by Li et al. (2024), which evaluated the utility of the Enhanced Recovery After Surgery (ERAS) practices in laparoscopic appendectomy. The article is an extremely pertinent study, as it is peer-reviewed, applied a large RCT design, and provided statistically significant outcomes in terms of pain reduction, hospital stay reduction, and cost reduction in the ERAS group. Its unconditional attention to patients in appendectomies makes it stand out among the general ERAS-based research, which makes it the most effective piece of evidence in this diagnosis.

Moris, D., Paulson, E. K., & Pappas, T. N. (2021). Diagnosis and management of acute appendicitis in adults: A review. Journal of the American Medical Association, 326(22), 2299–2311. https://doi.org/10.1001/jama.2021.20502

The second source is a guideline article by Moris et al. (2021) on an open-access medical journal, the Journal of the American Medical Association (JAMA), which is highly credible and peer-reviewed. The credibility of the journal is enhanced by the experienced levels of the authors, who are also surgeons and radiologists, in addition to the stringent levels of editorial standards and the extensive range of influence of the journal in clinical practices. Although the article addresses the management issue of appendicitis to a great extent, the value of its application is determined by the evidence-based views on the diagnostic methods, surgical decision-making, and postoperative therapy, which match the ERAS schedule and new recovery pathways. The review has demonstrated a good amount of depth of research over smaller studies done on a single institution, and this is one of the reasons why the review will be of special interest when making evidence-driven decisions applied in the care of appendectomy.

Liu, F., Zhou, J., & Wu, X. (2024). Effects of evidence‐based nursing on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta‐analysis. International Wound Journal, 21(3). https://doi.org/10.1111/iwj.14539 

The third reference is a meta-analysis study by Liu et al. (2024) in the International Wound Journal that examined the outcomes of evidence-based nursing interventions to prevent the occurrence of surgical site wounds in patients undergoing appendectomy. The article is quite credible as it is peer-reviewed, meta-analytic in style, and published by a wound care and surgical outcome journal. Compared to other factors, it applies in that it addresses a major complication of infection after an operation since the evidence-based nursing practices were well accredited to minimize the occurrence of wound infection and consequently achieve full recovery. This meta-analysis compiles information taken from multiple trials, contrary to a narrative review or small research, which will offer less powerful generalizability and dependability.

Conclusion

The Evidence-Based Practice Model of Johns Hopkins Nursing provided a systematic method of solving the issue of slow recovery after appendectomy. Based on the high-quality studies, ERAS protocols were effective in pain reduction, bowel recovery, and length of hospital stays. These findings can be applied to ensure safer and more feasible patient-based treatment. This process highlights the very important relevance of the EBP to translate research into actual clinical measures.

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