Evidence Based Practice
The author’s intention is to identify an aspect of clinical practice which lends itself to change at a micro level. The definition of a micro-change is an intervention of change aimed at the individual or the way small teams work. The micro-level change is not to be confused with a service change (Walsh, 2009).
When considering a change in practice we need to firstly understand why we need to make a change? Secondly when making a change, we need to justify a decision. This can be achieved by exploring the components which encompass decision making within nursing practice. Cullum et al (2007) identifies four requirements:-Clinical experience, valid researched evidence, available resources and lastly but no less important the patient
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There is a section within the guidance named “Screening for malnutrition and the risk of malnutrition in hospital and the community” (NICE 2006 pp63-69) this section inevitably lends itself to the author’s micro change in development. The recommendation within the guideline agrees that malnutrition is a major concern in healthcare and accepts the need for health professionals in the community to screen patients. However, only if there is clinical concern e.g. wound care or weight loss. The guideline also supports the need to routinely take assessment of weight and height to determine body mass index (BMI) and risk of malnutrition. Arrowsmith (1999) and Jones (2002) both argue the fact that many nutritional screening tools have been developed without using a BMI. According to the guidance, “screening should also be considered if there is a likelihood of future weight loss or impairment of nutritional intake”. In conclusion for the recommendation to be carried out, NICE (2006) state “The Malnutrition Universal Screening Tool (MUST, 2003), for example may be used”.
However, the research recommendations appear problematic, the end quote for example “may be used” is vague. The guidance development group (NICE 2006) criticizes the lack of evidence in supporting the claim that screening methods are beneficial in general .To combat this problem, they develop a consensus statement and summarize “ as a priority it is important that