Evidence-Based Practice, Evidence Search Strategy - Essay Example

?Evidence based Practice       Evidence based Practice Evidence based practice is one of the most practiced medical care practices in the modern world. Despite the fact that it has not been in existence for long, most of the departments in med-care have been able to adopt it. This being the case, it becomes necessary to understand what exactly Evidence based practice (EBP) is and why it is such an important contribution in the medical field. To start with evidence based practice is a resource intensive method that allows medical practitioners make decisions that help them promote healthcare using available evidence. It worth noting that the evidence may not be readily available to the healthcare provider and he/she may need to go to the field to look for this evidence. If I were to say, this is a good decision making basis as it takes into consideration all the variable factors in the field before arriving into conclusion. Introduction To start with, evidence based practice only came to being in the early 1990s. This being the case, there hasn’t been much development that would change the concept so much. Basically, evidence based practices is used to make decisions regarding each specific patient using evidence that could have been gathered during the treatment process of a similar patient (Aveyard, 2009). It is worth noting that even though patients may have closely related problems, they may also be different in many ways especially because of their different genetic composition and other factors. However, the evidence collected from other cases as well as the one in question is of paramount importance as gives a solid basis of decision making. This paper has been based on the PICO method of evidence based practice. The main advantage of using evidence based practice is that it reduces the chances of making mistakes. If some mistakes were made in a previous case, through evidence based practice, the mistakes can be avoided. However, it important to note that a mistake in a previous case could cause a replica of the same if the evidence from that case is used. Caution must be exercised when using evidence based practice to avoid replication of mistakes (Denby, 2008). In addition, evidence based practice cannot be carried out on its own. The nursing and other medical practitioners must use their experience and knowledge on the matters. They should also be able to reason with the situation at hand since not all situations are completely comparable. Decisions arrived at using evidence based practice, are basically more justifiable than impromptu decisions. Both time and caution are taken in the case of evidence based practice and thus increasing their accuracy (Poell & Woerkom, 2010). This may be however be tricky because some situations may require emergency attention and using evidence based practice would mean that more time is spent before embarking on the treatment process. This may reduce the chances of survival of the patient. It is thus in line to say that evidence based practice is not applicable in emergency situations that give the practitioners very little time to reason and react. In such cases, the only evidence in play is the practitioner’s experience. It may be rather difficult to document suck kind of evidence in writing from. However, it could also be recorded in other digital forms like videos for future use. Evidence based practice is a very effective method of making decisions. While this is the case, noteworthy is the fact that it has only been limited to the health sector. This paper tries to explain the concept of evidence based practice. Levels of evidence Melnyk and Fineout-Overholt classified evidence into seven distinctive levels of evidence as discussed below. (1) Evidence from a systematic review or meta-analysis of all relevant randomised controlled trials (RCTs), or evidence-based clinical practice guidelines based on systematic reviews of RCTs, - this is considered to be the strongest and the most justifiable level of evidence. This is to mean that it is the most credible level of evidence. (2) Evidence from at least one well-designed RCT, this is the second level of evidence in the hierarchy of their ranking. It is evidence from this level that is later considered to be level-one evidence if its credibility is verified and it is generally accepted. (3) Evidence from well-designed controlled trials without randomisation,- closely related to evidence from at least one well designed RCT only that this time the evidence is not randomised. It is the third most credible level of evidence. (4) Evidence from well-designed case-control and cohort studies- this is the level of evidence acquired from a group of individuals with similar problems or characteristics often carried out within a given scope of time. (5) Evidence from systematic reviews of descriptive and qualitative studies, - this is a more scholarly level of evidence whereby it is obtained from reviews and critics of other forms of evidence (Sackett, 2000). This is usually done in more than one instance. (6) Evidence from a single descriptive or qualitative study –this is more like the previous only that in this case the evidence is from a single review or critic. This is the reason why it is less credible as compared to the earlier. (7) Evidence from the opinion of authorities or reports of expert committees.-This is the lowest level of evidence and also the least credible level. This is usually based on the opinions of people who are generally considered to be knowledgeable in the field. In many instances, evidence at this level is not usually documented formally. Evidence Search Strategy Evidence search strategy could refer to the method through which practitioners and medical experts retrieve or compose new evidence. Evidence based practice involves a number of processes that occur in succession of one another and that are quite unique in themselves. The five main processes and which are generally acceptable include (1) formulation of a well based question (2) identification of resources that may be critical to the matter and that might be considered useful in answering the question posed in the first part (3) critically analysing the resources to establish their credibility (4) applying the said evidence and finally (5) re-application of the evidence and testing for improvement (Proctor & Renfrew 2000). Each one of these steps is dependent on one another and has critical contributions to healthcare. By looking at some of the variable factors as well as the factors that may be specific to medicine, we can comfortably be able to understand the matter and consequently answer the question posed. All the steps have been elaborated in this paper using the case of Patient X situation. Patient Description Patient X had recently been diagnosed with Squamous cell lung cancer at the age of 47. This was both shocking and tragic at the same time especially considering the fact that she was non smoker. Unfortunately, her cancer had already developed and was in its late stages. At first she had thought of it to be tuberculosis due to the coughs and pain in the upper abdomen. Nobody would have suspected that it was lung cancer especially since she was a non-smoker. She even went ahead to prescribe some medicine for herself. Being a high school teacher with a low income, most of the people in the modern world would also have taken her option. It was only after usage of the drugs without any improvement that she decided to take a test. She was so afraid of concealing the information to her family and her children especially. Later on when the family came to know of the cancer, it had developed a lot and thus making it even harder to treat. By the time she was hospitalised, she had about two years before she died. The decision for her was on whether to spend so much money to extend her life with only some few months. Based on the evidence from earlier cases, the cancer was not completely cleared off the system and this would only prolong the life of the individual with some few months (Poell & Woerkom, 2010). Taking chemotherapy would mean that she would only have some probably a few more months before she died. On the other hand, she also had the option of enjoying the remaining part of her life without necessarily having to remain in the unfriendly hospital environment. Developing an answerable clinic question While formulating an answerable question, formulation of an answerable question is usually the basis of a good research. An answerable and quality question follows the P.I.C.O policy (whereby P represents Populations/People/Patient/Problem, I represents- Intervention(s), C represents- Comparison and O the Outcome). The question should define the nature of the victim as dictated in the Populations/People/Patient/Problem. The question should be able to establish what part of the population is affected by the problem. It should also be in a position to bring out the possible interventions that could be taken. Additionally, it should be able to compare the situation with other situations of the same nature. Finally it should also be able to predict the sort of outcome expected from the question. The main purpose of this part is to provide medical practitioners with a query which they must react to: for instance; what are the likely causes of The formulation of the question should help them identify the best decision in the case by either using already existing evidence of by formulating new evidence. A well based question should be able to take into consideration some of the most important factors that pertain to the patient’s health (Proctor, & Renfrew, 2000). The question determines all the other parts of the process in that if wrongly formulated, reaction will be on wrong questions and thus wrong solutions. This part must therefore be taken with a lot of seriousness. In the case of Patient X, the most appropriate question in line with the PICO policy would have been “What method of curing cancer would be appropriate for curing lung cancer (INTERVENTION) in non-smoker adults (POPULATION/PEOPLE) is most appropriate for full treatment (OUTCOME) along with other forms of cancer (COMPARISON).” Identifying resources and evidence The second step would be identifying resources that could possibly be used to in answering the question and also in treating the cancer. Considering that this is a much rare form and cause of cancer, there was not many resources that could be depend upon. The purpose of this step is to establish the suitability of resources to be used in answering the question. Bearing in mind that the life on an individual is of paramount importance, the evidence chosen must be in correspondence with the question at hand. Additional evidence and resources could be used to take care of some matters that may come up as a result of the differences in genetic composition of an individual. Examining the credibility of the resources The credibility of the resources used in answering the question ought to be examined since it is the life of an individual that is at stake. Later on, she took the chemotherapy and like she had predicted, she started losing her hair. Most of the evidence found was from mainly medical practitioners’ journals and some literature material on general forms of cancer. These were considered to be very credible since the credibility of the writers was not questionable either. They were basically knowledgeable in the field and more importantly, had experience in through treatments of other forms of cancer as well as lung cancer. The main reason for examining the credibility of the information is to ensure that the evidence used in the case, is only what should be used. Evidence from the highest level in the table is considered to be the most credible evidence and thus the most popular. Credible evidence should be able to answer the question posed at the first stage. In addition, the evidence should be able to solve the problem at hand in addition to other problems of the same nature (Melnyk, & Overholt, 2005). It should be open to allow for additions from other cases that occur after its preparation. The authors of the information should also have good knowledge on the matter. It would be inappropriate for an amateur to create evidence to be used in the treatment of people in a health facility. Applying the evidence The evidence acquired from the two types of sources was adequate since there is no much difference in treatment of most types of cancer. Like all the other cancers, there aren’t many choices to choose from. In addition to the cost of administering the treatment, the suitability, side effects and effectiveness are some of the additional factors that should be considered (Dopson & Fitzgerald, 2005). Basically, the chemotherapy part is the point at which the evidence was applied. Basically, consistency of the radiations is what is very important for the best results. The results of the chemotherapy showed that there was a slight reduction in the size of the tumor. That was only the first stage of the whole treatment process which turned out to be more successful than most of her friends and family had expected. Re-application of the evidence and testing for improvement Here, documented evidence is then tried out on new patients who exhibit similar health complications. The main purpose of this is to try and establish a pattern in which the evidence may be used in future cases. As a matter of fact, most of the evidence used on patients is usually in this stage of the process. The process of evidence search may also be concluded at this stage. In the event that the evidence is not yet credible, it could undergo the same process again. Additionally, it is worth noting that evidence from this level is classified under level-seven in the levels of classification. In my opinion, evidence based practice also helps patients decide on the best possible way of solving their medical problems like in the case of Patient X where she was had to weigh options based on the evidence presented to her. Though this is not usually the case all the times, doctors and nursing professionals often make the decision for the patient. Despite the fact that some doctors make the choices to satisfy their selfish needs, most of them make decisions on the best course of action for their patients. Conclusion Evidence based practice is a very effective method of decision making in the health fraternity. It is considered to be a very effective way of arriving at decision using evidence from previous cases as well as the case in question. However, the credibility of the information may be subject to some factors and more so it’s ranking in the levels of evidence. The higher the evidence in the ranking table, the more credible it is and thus it is more likely to be used. The process of evidence search is mainly composed of five stages which are dependent on one another. References Aveyard, H. (2009). A beginner's guide to evidence based practice in health and social care professions. Maidenhead, Berkshire, England: McGraw Hill/Open University Press. Denby, D. J. (2008). Evidence based medicine. S.l.: Xulon Press. Dopson, S., & Fitzgerald, L. (2005). Knowledge to action?: evidence based health care in context. New York: Oxford University Press. McKibbon, K.A., Wilczynski, N., Hayward, R.S., Walker-Dilks, C., & Haynes, R.B. (1995). 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