Is there a difference between “common practice” and “best practice”?
When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.
Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.
Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?
identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.
systemic lupus erythematosus (SLE). The disease may be mild or severe and life-threatening (Wallace 2010). The prevalence of lupus ranges from approximately 40 cases per 100,000 persons among Northern Europeans to more than 200 per 100,000 persons among blacks (Johnson et al. 1995). In the United States, the number of patients with lupus exceeds 250,000. The life expectancy of such patients has improved from an approximate 4-year survival rate of 50% in the 1950s to a 15-year survival rate of 80% today (Merrell and Shulman 1955; Abu-Shakra et al. 1995). Even so, a patient in whom lupus is diagnosed at 20 years of age still has a 1 in 6 chance of dying by 35 years of age, most often from lupus or infection. Later, myocardial infarction and stroke become important causes of death (Cervera et al. 2003). Anatomy and Pathophysiology SLE is an inflammatory and multi-systemic autoimmune disorder characterized by an uncontrolled auto-reactivity of B and T lymphocytes. This results in the production of auto antibodies (auto-Abs) against self-directed antigens and causes tissue destruction (Cuchacovich and Gedalia 2009). Pathogenesis of SLE is a multi-factorial event and the exact mechanism of disease development and progression is still unclear. Multiple factors are known to be associated with the development of the disease such as genetic, racial, hormonal, and environmental factors. Defects in apoptosis are one of the proposed mechanisms involved in patho-physiological events of SLE. Imbalance in apoptotic machinery leads to the production of auto-antibodies. These antibodies lack the ability to differentiate between pathogenic and normal host cells and cause increase cell death and abnormalities in immune tolerance (Andrade et al. 2000; Rahman and Isenberg 2008). It is believed that all the major components of immune system are involved in SLE progression at various levels. Mostly proteins present in cell nucleus are targeted by the immune system. The likely environmental triggers for SLE include ultraviolet light, drugs, and viruses. These stimuli cause the destruction of cells and expose their DNA, histones, and other proteins, particularly parts of the cell nucleus. It is observed that in patients suffering from SLE, there is increased cell death in monocytes and keratinocytes and hyper expression of Fas protein by B and T cells of the immune system. Tingible body macrophages (TBMs) are large phagocytic cells present in the germinal centers of secondary lymph nodes. They express CD68 protein. These cells normally engulf B cells which have undergone apoptosis after somatic hypermutation. In some patients with SLE, significantly fewer TBMs can be found, and these cells rarely contain material from apoptotic B cells. Also, uningested apoptotic nuclei can be found outside of TBMs. This material may present a threat to the tolerization of B cells and T cells (Gaipl et al. 2006). Monocytes isolated from whole blood of SLE sufferers show reduced expression of CD44 surface molecules involved in the uptake of apoptotic cells. Most of the monocytes and tingible body macrophages (TBM), which are found in the germinal centres of lymph nodes, even show a definitely different morphology; they are smaller or scarce and die earlier. Serum components like complement factors, CRP, and some glycoproteins are, furthermore, decisively important for an efficiently operating phagocytosis. With SLE, these components are often missing, diminished, or ineff>GET ANSWER