Analysis of Nursing Practice - Essay Example

? Evidence Based Practice Evidence Based Practice Introduction Evidence based practice in nursing focuses research ondata that are already gathered from primary or even other secondary sources. It provides ready data for analysis and most importantly, the data are sources are always varied. In this work, reviews of already done research will be carried out to determine the effect of stroke, or hypoperfusion of brain parenchyma Stroke, or hypoperfusion of brain parenchyma, is the most commonly encountered neurologic condition. Because of its pathophysiology, stroke is one of acutely presenting symptoms with debilitating consequences. In fact, if not managed properly, it can result to paralysis or even death. Its cure depends on quick response and efficient treatment. For those suffering from the complications of stroke, they still have to undergo multi-faceted care involving maintenance medications, regular physical and laboratory examination, and rehabilitation, if necessary (Cornmark, 2000). Certain practices are necessary to avoid bad outcomes of stroke. These practices are compiled in clinical practice guidelines, to which clinical management of diseases is based from. A country has a particular set of guidelines, made by the appropriate experts of that country. For stroke management, information in guidelines include 1) ways for public and professional individuals to recognize quickly and to act on stroke symptoms, 2) immediate access to specialized stroke units, advisory for discharge planning, and 4) information about community-based services and access to review, by a specialist stroke team as required (Salisbury et al., 2010). From findings, better healthcare modalities can be put in place to help save the lives of the many patients suffering from stroke. Finally, the medical practitioners may use the research the findings to disapprove or approve the previous methods. Importance of the Study Despite the availability of guidelines, healthcare professionals are not necessarily mandated to follow them. This study determines whether or not following national guidelines for stroke improves the healthcare experiences of patients, families and caregivers. The PICO is as follows. "Do stroke patients, their families and caregivers have better healthcare experiences when stroke management follows national guidelines?"  Keywords; - ‘stroke patients and their carers’, ‘stroke management following national guidelines’, ‘stroke management not following national guidelines’ and healthcare experiences. Using PICO, in stroke patients, the following variables will be considered: P   Population/patient  =   patients with recurrent stroke condition  I   Intervention/indicator  =   prophylactic antibiotics  C   Comparator/control  =   no treatment  O   Outcome  =   reduction in recurrence rate of stroke Therefore, to find the most recent study that can best this answer this question, a PubMed literature search was conducted with keywords – ‘stroke’ experience healthcare’, ‘patients’, and ‘stroke’16 articles satisfy these criteria. The study by Salisbury et al. (2010) was chosen because the scope of analyzed heal hospital discharge (article 5). According to the article, it is a phenomenological qualitative study. An appropriate critical appraisal tool developed by Letts et al. (2007) from McMaster University was then used for this study. A phenomenological design is appropriate since this study aimed to determine the experiences of stroke management by patients and their caregivers. The method used to conduct this study was described to be qualitative, semi-structured, face-to-face interviews that were undertaken between April and May 2007. There are several causes of mental disorders and other related infections. For example, manic depression and episodes related to mania, brain disorders, and cerebral malaria are some of the causes of the disease. In addition, mental disorders can be hereditary, meaning that if the parents suffered from the disease, one of the offspring could suffer from the same. Therefore, exposure to conditions that would make the person to develop such status should be avoided at all cost. Diagnosis Since BP1 is an acute manic and/or could last for several weeks, its effect could be severe, thereby calling for urgent medical intervention before the situation worsens (Salisbury et al., 2010). Therefore, as soon as the person notices signs of mental disorders such as depression, change of mood, general weakness, and severe headache, he/she has to go for medical examination so that the medical condition could be corrected (Salisbury et al., 2010). Notably, immediate identification would guide the process of medical intervention. Treatment Mental disorder is a clinical issue that needs specialized treatment. Here, psychotherapy is the major treatment that could be administered to the patient. In such scenario, the health professional on mental issues, such as clinical psychologists should be involved in an interpersonal intervention with the patient so that the information that the latter gives are treated appropriately (Salisbury et al., 2010). Under psychotherapy, the medical expert would use distinctive psychological techniques such as Cognitive Behavioral Therapy (CBT), in identifying the disease and prescribing for the treatment. CBT could involve counseling the patient in an attempt to reverse the behavior (Salisbury et al., 2010). In addition, the medical expert could carry out psychoanalysis of the patient to determine the kind of medication appropriate for the person. Effects on Treated People In reality, the treatment of mental disorder especially counseling might improve the quality of life of the patient, perhaps leading to immediate halt of the medical condition. Such medical intervention could reduce severe effects of the disease and eliminate other dangers such as death (Salisbury et al., 2010). Therefore, it is important for the patient to seek early medical intervention before the situation gets out of hand. Effects on Untreated People For cases of untreated people, the effect of the disease is far reaching and could particularly lead to permanent state of insane. It might also lead to the increased use of routine medication, with serious side effects on the body (Salisbury et al., 2010). Sometimes, the patient could succumb to the medical condition especially if the patient did not get adequate and timely medical intervention when the initial signs were detected on the body. Literature Review Evidence based nursing normally involves the identification of concrete findings from research and applying them in daily nursing work so as to improve the quality of the patients care. The aim of evidence based nursing is to provide the patient with cost efficient and high quality care (Abott & Sapsford, 1998). Analysis carried out to determine the role played by research in patients nursing care have revealed that patients who get research based nursing care often show substantial outcome in their physiological, psychosocial and behavioral outcomes as opposed to those who are getting the usual nursing care (Booth, 1996). In this respect, various methods are used to gather information for a conclusive evidence based program implementation. Hierarchy of Evidence Gathering the problematic information may include taking the observable perspective of the problem on the ground. This can be taken through checking the influencing indicators and the trends of the study sample (Glasper, 2000). The information should explicit various intervention measures put forward as well as the areas with the gaps to be filled. Direct interviews are another form of getting the formation needed by the researcher on the topic of the study (Bowling, 2001). To some extent it is better research approach since as more information are given primarily and with the victims themselves. The methods applied should be logically questioned and given the best approach in answering aspects such as “validity” “reliability” and “bias” (Crombie, 1996). All nurses need this information for the success of an organization in implementing programs in respect to quality work as well as the best standards (Abott & Sapsford, 1998). In patients suffering from stroke, the information given by the research should show the current trends, the intervention measures and possible future intervention measures. The intention of the research on nursing based evidence is to give the best health care services to patients and to improve the medical line. Different studies have been carried out to develop these ideas (Abott & Sapsford, 1998). In addition, nurses have faced myriad challenges in their work environment regarding information they receive. Data information has offered a lot of challenges in field of nurses operation (Holloway & Wheeler, 1996). Some of the most problems faced by data records used by the nurses include the following outlines (Bowling, 2001). Information inadequacy, nurses in some organizations find with a lot of difficulties getting efficient and effective data to give them the information needed (Cornmark, 2000). Due to dynamic nature of health care provision, nurses do undergo problems of acquiring continual training as well as getting outdated data which thwarts their performance (Abott & Sapsford, 1998). At times, data given by the researches might be poor. This can be as a result of nonprocedural data handling mechanism or unavoidable errors caused by changes in demographic patterns (Crombie, 1996). Unqualified researchers can cause errors in the data type they produced (Holloway & Wheeler1996). The errors can occur either from collection of data, evaluation or interpretation of their information. The result leads to improper implementation of programs and poor focus on nurses care delivery (Cornmark, 2000). Sampling, Data Collection and Data Analysis Brief Description of Study Methods Participants were selected from patients and caregiver who had attended an outpatient clinic for more than six months. Participants were further stratified based on their mobility level at the initial clinic assessment and time since stroke. Patients with severe communication difficulties were excluded, but caregivers of stroke patients with communication difficulties were included. Informed consent from all participants was obtained before the interview was conducted. A focused topic guide was used to facilitate the interview. The questions were broad to allow participants the freedom to raise issues. The recurrent thoughts, ideas, comments and concepts were identified from transcript. Reviews of these transcripts were subsequently conducted (Salisbury et al., 2010). Critical Appraisal Limiting the sampling to the patients of an outpatient clinic limited the diversity of stroke patients included in the study, and thus may not represent the total population with stroke. The small number of participants negatively affects the reliability of the study’s validity. These patients may also have a considerably better access to social services. The purposive sampling done in this study was used to obtain data from stroke patients suffering from various debilitations. Participants, and their relations with the researchers, were well-described. Based from this description, the samples are applicable to answer the research question. The information provided was adequate to understand the conduct of the study (Burns & Grove, 2001). Limitation Limitation of resources can be a very big issue to nurses care delivery. When there is a problem with the resources like finance, workforce, raw materials and time span, executing duties becomes impossible even when the best research model has been applied (McSherry & Abbott, 2002). This hinders the activities of nurses in taking care of the patients. Evidence Based Nursing Resources Systematic Reviews This is a general data handling processes. It gives detailed analysis on data from the time of collection to presentation of the research work. The review gives details on how the data was collected in regard to the sample of population, the geographical field where the data was collected, the methods of collection and recording. It also gives the information on the interpretation and evaluation of data (Bowling, 2001). The statistical evaluations are also put in place and solution to the problem is also sent forward. The reviews are studied by the nurses to help them understand the problem on the ground and come up with an appropriate plan of action (Holloway & Wheeler, 1996). Clinical Evidence research This kind of research is aimed at improving patient’s Clinical evidence research help practicing and student nurses with the knowledge on data accessing and analyzing. Holloway & Wheeler (1996) believed that the clinical instructions can guide practitioners within the framework of a systemized observation, experience and the reliance on nursing research to create sound practices in nursing. Essentially, Burns & Grove (2001) argued that competence and expertise within a given clinical setting are important. In deed, the current and best practices are very crucial in clinical based research. Even though clinical research has always produced good results, the nursing profession still struggles with the implementation of the results. In some cases clinical researchers face the challenge of inadequate time for carrying out research, inaccessibility to information and services and learning opportunities (Holloway & Wheeler, 1996). Patients’ Evidence Based Research Patient evidence based reports are gathered from researches conducted on patient. The patients’ researches may cover those areas such as customer satisfaction with the services provided, health improvement status by the services given, reliability and consistency in receiving clinical interventions, the accessibility of the services provided and their affordability (Burns & Grove, 2001). The reports once collected, are used to evaluate the company’s success in meeting patient’s demands. Most adjustments in nursing operations in this case are guided by patients’ perspective (Edinburgh, 2006). Research Evidence Based Nursing This is the most advanced nursing method. It involves the organization carrying out either internal or external researches on the areas perceived with weaknesses (Burns & Grove, 2001). This method engages selected and tested approaches on addressing the nursing issues. Researches identify the problems, evaluate them, interpret and suggest possible solutions to the problems at hand. A research can be on the influence of staffing and health care deliver, as an example (Edinburgh, 2006). Journal Based Evidence These are journal materials which are distributed to the nurses to analyze and check problems then give the best solution approach to them (Lo Biondo & Haber, 2005). The journals can be local or from diverse regions. They are very vital as they come periodically, they updates the nurses on their work (Edinburgh, 2006). Evidence Based on Practice Guidelines Guidelines are the routine checkers on the daily activities of the nurses. Guidelines within an organization are useful to the nurses, they show task divisions, guidelines gives clear path on ethical practices and organization values (Burns & Grove, 2001). Guidelines help in making decisions in care delivery as well as setting disciplinary system against malpractices. Nurses need to get good guidelines to keep with standards and organization values (Greenhalgh, 2001). Center for Evidence Based Nursing. This method seeks on training and educating nurses through workshops, seminars and courses based on research areas. The main aim is to keep the nurses on current practices. Systematic analysis on how effective is Hydroxyurea Therapy in those with Stroke. Therefore, those suffering from stroke or hypoperfusion of brain parenchyma are the most widespread form of stroke that often affects the lives of people ranging from adults to the children. In the event that stroke realized in the body, they have a tendency to block the free flow of blood in the blood vessels, the cells are characterized by sticky and stiffness nature causing the blockage in the human brain (Burns & Grove, 2001). Whenever there is obstruction on blood flow, it can cause infections, pain and serious injuries to body organs. Today, the position of genetic and molecular modifiers, effects of inflammation, endothelial damage and cellular adhesion have made it easy to our understanding on pathophysiology of the disease. For example, the recent discovery of nitric oxide in crescent shaped cell pathogenesis. Account of the Evidence that Underpins this Section of Guideline The information for this search was obtained from the internet after logging into the website of an organization that reviewed the various researches that had been carried out (Russel, 2008). From the review of one of the research carried out in 1998 to determine the effectiveness of hydroxyurea treatment in patients, the following were observed. In the study, systematic review was used to analyze on the effectiveness of hydroxyurea treatment for patients with stroke. The inclusion of data relied on questions based on the applicability and availability of data relevant to the area for study (Booth, 1996). In the research, it was indicated that the data was searched from published articles, databases as well as hand searching lists and consulting experts in the field. Articles were used only when they addressed key question. Only articles that were addressed in English were included. In addition, the researchers ensured that there were no original data and finally studies with less than twenty participants were excluded. For the random controlled samples scoring system was developed (Russel, 2008). On the other hand, for the observational studies quality forms were developed based on the on the previous forms that were used by Evidence Based Practice Center. High quality studies were carried out where the studies score up to eighty percent quality points. Grading for the evidence was based on the scheme that is recommended by the Grading of Recommendations Assessment together with Development and Evaluation Group (Russel, 2008). The researcher considered the strength of the study design, this was followed by nonrandomized controlled samples and also observation (Russel, 2008). In the end 37 articles were reviewed that describe observational studies were used as well as eight articles describing randomized controlled trials. The results were obtained as follows. After six months trial in Belgian patients, there were reported low rates of hospitalization and hospitalized days in the hydroxyurea group (the group of patients who had used hydroxylurea) at 1.1 admission and 7.1 days of hospitalization. For the group that did not did not utilize hydroxyurea, the rate of hospitalization was 2.8 days admissions and twenty three point four hospitalized days. Foetal haemoglobin increased by 10.7 percent increase in the treated group (Russel, 2008). The mean for the untreated group the foetal hemoglobin percentage ranged from 5 to 10 percent while the percentage increased between 15 to 20 percent after treatment. Furthermore, it was reported from the studies that the frequency of cries decreased significantly in pediatric cases (Greenhalgh, 2001). The results were obtained using the administration of fixed dose of hydroxyurea. In the study it was found that pain reduced in many cases from three point one to one point two after eighteen months of therapy. More importantly, the degree of hospitalization decreased to zero point five percent per year. Based on the survey, it was supported by the research that with the treatment using hydroxyurea, there was high likelihood that the frequency of hospitalization (Russel, 2008). Results Patient characteristics (age, type of stroke, and years since stroke) were detailed in Table 1 of the article. The average years post-stroke of patients were 4.63 ± 1.93 years. When asked what patients felt and what caregivers noticed during the onset of stroke, a wide range of symptoms: paralysis, dizziness, change in facial features, and rubbish talking, were noted (Letts et al, 2007). Some were mistaken to be drunk or acting foolish. Studies show that although some were responded to immediately, some were misdiagnosed, and were even sent home. For immediate management, caregivers were noted to have greater recall. In terms of patient discharge, it was revealed that some caregivers felt that their patients were not discharged based on guideline recommendations (Letts et al, 2007). During rehabilitation, some were not satisfied with the competency of their healthcare providers, although community-based programs were appreciated. However, these were not supported with quantitative data. Manipulating the Evidence In order to manipulate available evidence, the collected data showed that for disabled stroke patients, some were not managed based on guidelines. The authors explained the data by saying that the risk of death and disability is decreased considerably with the rapid diagnosis and management of stroke, which is dependent on the knowledge of its presentation (Letts et al, 2007). A Chart Showing the result of clinical, research and patient evidence on the effectiveness of hydroxyurea in patients from the systematic research Sample Population Rate of Hospitalization Hospitalization days per year Foetal haemoglobin from mean range Amount of Hydroxyurea Drugs administered Hydroxyurea group 1.1 7.1 17.5 15gm/kg/day Placebo group( group not under hydroxyurea treatment 2.8 23.4 7.5 ­- Summary of Evidence about Effectiveness and Efficacy of Hydoxyurea in stroke Pediatric Outcome Evidence Grade Basis for Grade Increase in foetal haemoglobin High One good randomized controlled trial; consistent observational studies. Reduction in hospitalizations High One good randomized controlled trial; consistent observational studies. Reduction in pain cries Moderate One good randomized controlled trial; inconsistent observational studies Reduction in neurological events Low Observational studies Reduction in transfusion frequency Insufficient Few observational studies. From the research it was shown that administration of hydroxyrea drugs resulted into the reduction of clinical problems associated with stroke. The amount of haemoglobin increased considerably while the frequency of blood transfusion also reduced. The 15mg/kg/day can be retained, however, cases of possible side effects needs to be taken into account so that most appropriate dosages are applied (Lo Biondo & Haber, 2005). Recommendations Although the study implies that management not based on guidelines may lead to disability, the validity of the study is not optimal, because of its poor sampling, sampling methods and data analysis. Another study may be appraised to answer the clinical question. Conclusion It can be concluded that evidenced based nursing can provide the nursing professionals with very important information in the daily undertakings. However, a lot more work needs to be done to train nurses on information gathering and application. The gathering of information can be from internet sources which appear to challenge to most of the nurses. Furthermore, it can be concluded that that hydroxylurea is effective in controlling stroke. References Abott, P., & Sapsford, R., 1998. Research Methods for Nurses and the Caring Professions. Buckingham: Open University Press. Booth, A., 1996. The SCHARR guide to Evidence Based Practice. Sheffield: Sheffield Centre for Health. Bowling, A., 2001. Research Methods in Health. Buckingham: Open University Press. Burns, N., & Grove, K., 2001. The Practice of Nursing Research. Philadelphia: W.B Saunders Publishers. Cornmark, D., 2000. The Research Process in Nursing 4th ed. Oxford: Blackwell Scientific Publications. Crombie, I., 1996. The Pocket Guide to Critical Appraisal. A Handbook for Healthcare Profession. London: BMJ Publishing Group. Edinburgh, K., 2006. Nursing Research: Principles, Process, and Issues. London: MacMillan. Glasper, A., 2000. Evidence Based Child Healthcare. London: MacMillan Press. Greenhalgh, T., 2001. How to Read a Paper: the basics of Medicine. London: BMJ Publishing Group. Holloway, I., & Wheeler, S., 1996. Qualitative Research for Nurses. Oxford: Blackwell Scientific Publications. Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., & Westmorland, M., 2007. Critical Review Form – Qualitative Studies. Ontario, Canada: McMaster University. Lo Biondo, W., & Haber, J., 2005. Nursing Research: Methods, Critical Appraisal and Utilisation 4th Ed. Missouri: Mosby Press. McSherry, R., & Abbott, P., 2002. Evidence-Inform Nursing: A Guide for Clinical Nurses. London: Routledge Publishers. Russel, E., 2008. Hydroxytreatment Treatment for Sickle Cell Diseases. Retrieved on 6th May 2011From< http://consensus.nih.gov/2008/sicklecellabstracts.htm> Salisbury, L., Wilkie, K., Bulley, C., & Shiels, J., 2010. After the stroke': patients' and careers’ experiences of healthcare after stroke in Scotland. Health and Social Care in the Community, 18 (4), pp. 424 – 432. Read More