Sick of hearing about evidence-based practice? The idea has always been there: check your facts before you do a thing, right? Otherwise we'd all still be using old-wives tales to provide care.
Old-wives tales include not allowing a pregnant woman to raise her hands above her head because it will strangle the baby. (Seriously?!) Old-wives tales say that a woman cannot get pregnant while breastfeeding. There are many people in the world today thanks to this one!
Question yourself, question your fellow nurses, question your instructor, question policies.
Recently, I found this cute blurb in a respected magazine about a nurse who created Candyland in 1949. We got it up on our user Facebook site only to be quickly corrected by our awesome community. The woman was a schoolteacher. I violated my own rules! It’s so easy to assume that what you read is true, especially when it comes from what should be a trustworthy source!
I am adamant about fact checking things, especially in nursing care. It's important to not spread mischaracterizations of the truth and to avoid causing harm. I don’t care what else a student learns in my clinical rotation as long as they learn to question everything and be curious. It is the most important nursing skill.
No one knows everything.
It is also easy to assume that the way an experienced nurse does a task is correct because they are a trustworthy source.
During a recent clinical rotation, we discussed the use of lotions with powders for wound care.
Any type of cream or lotion creates a barrier- that’s its job. How would powder get through this to also do its job on the wound? To me, this is the only thing that makes sense - powder goes on so that it has contact with the area being treated, then the lotion/cream/emollient/ointment is applied to seal it in and create a barrier.
Others will say that putting ointment on over powder creates powder crumbs. This depends on what is being mixed, to be sure, but I've also never seen it happen when powder is applied in the correct quantity.
Time after time we encounter experienced nurses who place lotion/cream/emollient/ointment on before powder, including this week. Not the regular stuff - the medicated stuff, like antifungals. Anecdotal evidence is not enough. I felt obligated to question my thinking.
Is there evidence for either method?
The answer is not obvious. As a matter of fact, the answer seems to be nonexistent.
has a great algorithm for nursing assessment and management for skin and wound care. It implies that for typical wound care, only one should be chosen: debriding agent, hydrogel dressing, emollient, moisture barrier, honey, or antimicrobial gel. For antifungal treatment, MD Anderson's algorithm provides for application of nystatin powder OR antifungal cream, not both.
This source indicates that there is no reason to combine a cream and powder! Other sources do not address the issue of combined treatments. Maybe we are supposed to alternate them? Maybe they should never be ordered together at all? I've looked in med-surg, pharmacology, and fundamentals texts, online journals, and website galore. I have no answer.
Okay. FINE! What would any reasonable nurse do in this day and age? I have loads of nursing colleagues. I'll just throw out a Facebook poll, right? (Skewed toward 'ointment then powder' by a couple of non-nursing friends who voted.)
It helped about as much as I should have expected.
What is the answer?! I like to base my nursing care on more than a hunch or what is logical to me. Don't you? Ask your friendly hospital wound care and ostomy nurse! It likely depends on the desired outcomes for the patient.
Let us know what you think in the comments!!! How do you find answers to your unsolved dilemmas and mysteries?
110430-F-ND912-057 DJIBOUTI, Africa (April 30, 2011) - Sister Anice, a nurse at the Roman Catholic Diocese of Djibouti, provides medical aid to a Djiboutian man April 30. The nursing staff often sees patients daily to provide continuous care and lessen the spread of infection and disease. (U.S. Air Force photo by Staff Sgt. R.J. Biermann)