College of Nursing
Low back pain a change
There have been many quotes recited by famous people for decades which in one way or another described change. One of the quotes was cited by John F. Kennedy, the thirty fifth president who stated that change is the law of life and those who look only to the past or present are certain to miss the future (Kennedy, 1963). I feel that quote states a lot about change and how it is an ever evolving and constant statement. A Model for Change to Evidence-Based Practice by Mary Rosswurm and June Larrabee addresses six steps for implementing changes based on evidence base research which includes: Step 1- Assess the need for changes an practice; Step 2- Link the problem to interventions and outcomes; Step 3- Synthesize best evidence; Step 4- Design a change in practice; Step 5- Implement the change and evaluate the change in practice; and Step 6- Integrate and maintain the changes. In following Rosswurm and Larrabee’s (1999) model for change, each step in the process will be expounded on in regards to initiating an evidence based practice change in regard to lower back pain. The first step of Rosswurm and Larrabee’s (1999) change model is to assess the need for change. When assessing the need for change internal data is collected and compared it to external data and benchmarks. An historic review shows that there is no change in the pathology or prevalence of low back pain. What has changed is our understanding and management. There are striking differences in health care for low back pain in the United States and the United Kingdom, although neither delivers the kind of care recommended by recent evidence-based guidelines which states treatment initiated first for low back pain indicates the simple analgesics, such as acetaminophen be used before referring to imaging and advice, education and reassurance of favorable prognosis (Low back pain: AHCPR Clincian Guideline). Medical care for low back pain in the United States is specialist-oriented, of high technology, and of high cost, but 40% of American patients seek chiropractic care for low back pain instead. National Health Service care for low back pain in the United Kingdom is underfunded, too little and too late and 55% of British patients pays for private therapy instead. Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs (Waddell, 1996). Step 2 of the 6 steps discussed by Rosswurm and Larrabee (1999) explain that using the language of classifications is needed to link the problem with interventions and outcomes. The classification systems chosen for step 2 will be the International Classification of Diseases (ICD), Nursing Outcomes Classification (NOC) and the Nursing Interventions Classification (NIC). Per the Health Organization (WHO), the ICD provides a classification system by using codes for specific diseases, their signs, symptoms, and other pertinent data. While presently in its 10th edition, the ICD 10 codes for low back pain is M54.5. The M54.5 code is a specific code for the ICD-10-CM that can be used to specify a diagnosis. ICD-10-CM comes into effect beginning October 1, 2013; therefore, this and all ICD-10-CM diagnosis codes should only be used for training or planning purposes until then (WHO, 2010). ICD 9 CM are still being used to code medical procedures until the International Classification of Health Intervention is fully developed; the current ICD 9 code for low back pain is 724.2 (Low Back Pain - Online ICD9/ICD9CM codes). The Nursing Outcomes Classification (NOC) is a comprehensive, standardized classification of patient/client outcomes developed to evaluate the effects of...