NR-439 RN Evidence Based Practice

Using Significant Clinical Issue in surgical ICU, describe the knowledge gap that research could fill.

Research Problems and Designs

Coagulation abnormality is a common issue in surgical patients that are critically ill. These changes are said to be caused by a number of factors that include liver dysfunction, drugs interactions, nutritional, and underlying processes of the disease. Particularly, inflammation and infection interact with the immune system coagulation to encourage a net pro-coagulant condition characterized by augmented factors of cellular tissue, reduced fibrinolysis and plasminogen activator inhibitor (McGilvray & Rotstein, 2001). Although there are various research works demonstrating the causes of coagulation in critically ill surgical patient, and possible measures to manage coagulation among this population, there are still no measures that can be employed to prevent coagulation before it take place. This paper wishes to investigate on measures that can be employed to prevent coagulation among critically ill surgical patients.

The research question states that: What clinical measures that can be employed to critically ill surgical patient to prevent coagulation abnormalities before they take place rather than treating it after it has taken place. In this case the Patient population includes critically ill surgical patient of all age, gender and ethnicity, Intervention Issues diagnosis of any abnormality and countering it before surgery.  Comparison is treating coagulation abnormalities after surgery. Outcome is eliminating coagulation abnormalities before surgery to ensure normal blooding clotting after the surgery. Time is before a patient is taken to the surgery.


Research Database Description

The issue to be investigated is whether coagulation abnormalities mostly witnessed by critically ill surgical patients can be prevented by conducting coagulation assessment long before a patient goes through the surgery and treating any identified coagulation abnormalities before surgery, especially when a surgery is not an emergency. Coagulation abnormalities are severe conditions that affect most critically ill surgical patients. When not well managed, these abnormities can result to excessive loss of blood which can even result to death. In this regard, earlier treatment of any coagulation abnormalities would play a great role in preventing more complication in critically ill surgical patients and increase their chances of survival (Sawhney et al., 2014). The research database relevant to this topic is the national center for biotechnology information (NCBI). This research database is relevant because it provide a number of journals demonstrating various researches carried out in different biotechnology field and the relevant out. This gives all researchers a guide on various medical issues experienced at different sections of medical operation and develops the researches further where possible. The database URL is <>

To locate the best database to use for this research, I initially used Google search to identify any journal or material addressing critical issues in the critically ill surgical patients. From there I identified a number of articles discussing various issues regarding surgical operation clinical issues. I selected one article and identified its source. This included the database that was holding the journal. From here I searched for various clinical surgical issues for critical ill patients and I got the led from the database.  This was not easy at all, since before coming up with the idea of searching the database through articles, I had considered going through all medical based databases search for any possible research work that handles issues in the surgical patients in ICU. However, there was no any positive result. Therefore, I encountered a number of challenges before coming up with the technique which led me to the selected database.


McGilvray, I. D., & Rotstein,  O. D. (2001). Assessment of coagulation in surgical critical care patients. In Surgical treatment: Evidence-based and problem-oriented. Retrieved from <>

NCBI (2015). Retrieved from <>

Sawhney, C., Kaur, M., Gupta, B., Singh, P. M., Gupta, A., Kumar, S., & Misra, M. C. (2014). Critical care issues in solid organ injury: Review and experience in a tertiary trauma center. Saudi Journal of Anaesthesia, 8(1), 29-35.



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