Evidence-Based Practices - Essay Example

 Evidence-Based Practices: Clinic, Hospitals, And Organizations Introduction Evidence-Based Practice (EBP) is essential to how treatments are provided to the public in an efficient and well-designed process (Melnyk & Fineout-Overholt 2011). When a patient visits a nurse in order to find out what is wrong with some nagging illness, the patient expects that the latest and the best medical solution will be provided to quickly solve the problem so the patient can continue on with living a full life. With busy schedules, nurses must know how to effectively research and come up with solutions in the quickest time available (Pipe, Wellik, Buchda, Hansen & Martyn 2005). The Role of Nurses in Research and EBP: Nurses are the frontline soldiers who meet with patients, conduct assessment reports, and they must research the best health solution applicable to each patient. Nurses, as actual practitioners, are also the best ones to conduct research studies, based on trends they may be seeing in their practices (Melnyk & Fineout-Overholt 2011). Deductions can be made through the research involved in determining solutions, taking accurate records of treatment results, using clinical reasoning throughout the process, and providing outcome treatment results for either supporting current practices or providing a case for the need to change a current process. EBP Models Used in Hospitals/Clinics/Organizations: The model diagram below shows the typical process used in hospitals, clinics, and organizations on how medical practices use EBP as part of the common practice process for providing the best healthcare possible. (Fig. , Melnyk & Fineout-Overholt 2011, p.6) The Institute of Medicine’s Roundtable on Evidence-Based Medicine (IMREBM) addresses healthcare processes within a clinical setting to achieve best results in providing medical solutions. The group is made up of senior leadership from healthcare professionals, policymakers, researchers, third-party payers and patients (Melnyk & Fineout-Overholt 2011). The emphasis is placed on efficiency in providing EBP in a timely manner, generating more evidence in supporting the most effective and valued healthcare strategies and, finally, developing best processes in disseminating healthcare evidence as part of educating the public (Melnyk & Fineout-Overholt 2011; LoBiondo-Wood & Haber 2013). The United States Preventive Services Task Force (USPSTF) is an independent panel of experts who continuously review and recommend better practices in preventive services such as any type of medical screening, preventive medicines and best practices in counseling for the public. This group is sponsored by the Agency for Healthcare Research and Quality (AHRQ) which provides the top or gold level standards in clinical preventive practices (Melnyk & Fineout-Overholt 2011; Titler 2008). The Magnet Recognition Program, as part of the American Nurses Credentialing Center, overlooks the advancement of EBP in United States hospitals and recognizes top-level healthcare institutions which promote and provide excellence in EBP nursing practices (Melnyk & Fineout-Overholt 2011). The Forces of Magnetism is central to the Magnet program which has five central points: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation and improvements in new model developments in care and application of new EBP; and empirical quality results (such as data results) (Melnyk & Fineout-Overholt 2011, p.10). Steps Used for Research and/or EBP in Hospitals/Clinics/Organizations: There are specific steps for conducting research and EBP practices and the first one is that there is a spirit of inquiry, the need to find the best answer through observing/researching previous practices. Therefore, in research, there is the question or a hypothesis that surrounds the research (LoBiondo-Wood & Haber 2013. The first step is how the question is asked, which is in PICOT (Patient population, Intervention or Issue, Comparison to other solutions, Outcome, and Time) format (Melnyk & Fineout-Overholt 2011, p.11). The second step is the search for the best evidence using the keywords. The third step is to conduct critical appraisals of the evidence found. In the fourth step, the evidence is combined with clinical expertise and patient preferences to provide the best solution. The fifth step provides the evaluation of the outcome, including changes made. The sixth step is making sure the information is disseminated immediately within the required documentation procedure so that others will also benefit (Melnyk & Fineout-Overholt 2011). An example of a study (box 3.1, p.49) using the PICOT method is given below, taken from the MEDLINE database. Who I the Research Author?: Clinicians need to know what asthma management solution will work best in promoting children’s adherence to Asthma Self-Management. The authors are all from The College of Nursing at the University of Kentucky, Lexington, KY. The hypothesis was that (P) 7 to 11-year-old children, currently receiving asthma education, Peak Expiratory Flow (PEF) monitoring instruction, and a contingency behavioral management behavioral protocol (I), compared with same age children receiving only PEF monitoring instruction (C), would show higher adherence to PEF management in the home environment (O) (Melnyk & Fineout-Overholt 2011). Funding Sources and Bias: Funding was provided by the National Institute for Nursing Research (NINR), thus eliminating any bias in relation to the manufacturer's product. The motivation for Doing a Study: First or Replication: This appears to be a first study on the use of the three variables mentioned, including testing over a certain time span which provides a different picture at the end of the testing, as opposed to the first four to eight weeks (T). Subjects of the Study and Final Size Sample: This was an RCT study using two groups of children, 77 in total, in one Southern state. The bibliographic record did not state how many children were left at the end of the testing period (Melnyk & Fineout-Overholt 2011). Selection and Exclusion: The selection only regards children ages 7 through 11, who had persistent asthma and, as a whole group, received the PEF instruction. Study Results: At the baseline (Week 4), and the post-intervention (Week 8), the groups had not changed in adherence to PEF monitoring, using the AccuTrax Personal Diary Spirometer, which was a handheld computerized meter (PED) that recorded each monitoring session. However, by the last testing week in maintenance (Week 16), those children in both groups who continued PEF monitoring at least once a day (≥ 80%), had fewer occasions for an asthmatic episode (Melnyk & Fineout-Overholt 2011, p.49). It was not stated if there were any specific issues, noted or not stated, at least in the bibliographic record. Conclusions of Study and Justification: The conclusion showed that the intervention in teaching children the importance of adhering to the recommended regimen for managing their asthma at home, was effective (Melnyk & Fineout-Overholt 2011). Generalization: Suitable for Larger Population?: This type of study is indeed important for the larger general population as it would help many other children to be proactive in managing their asthma health issues at home. Conclusion The asthma study may have come about through reviewing case studies of individual child patients who had received this type of education in monitoring their asthma. Researchers may well have found that conducting a test with groups of children, using measurable standards, would help fine-tune this type of intervention for clinical practices, thus providing value to research (Webb 2011; Weng, Kuo, Yan, Lo, Chen & Chiu 2013). Resources LoBiondo-Wood, G, & Haber, J. (2013). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice (8th ed.). St. Louis, MO: Elsevier/Mosby Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing & Healthcare (2nd ed.). Baltimore, MD: Wolters Kluwer Health. (Melnyk & Fineout-Overholt 2011) Pipe, T.B., Wellik, K.E., Buchda, V.L., Hansen, C.M. & Martyn, D.R. (2005). Implementing Evidence-Based Nursing Practice. Urologic Nursing, 25, 5, pp. 365-370. Retrieved from . Titler, M.J. (2008). The Evidence for Evidence-Based Practice Implementation (Chapter 7). In R.G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Vol.1. (pp.1-113). US: Agency for Healthcare Research and Quality. Retrieved from . Webb, J.J. (2011). Nursing Research and Evidence-Based Practice. Chapter 6. In Cherry, B. & Jacob, S.R. (Eds.), Contemporary Nursing: Issues, Trends & Management (5th ed.), (pp. 104-124). St. Louis, MO: Elsevier/Mosby. Retrieved from . Weng, Y-H., Kuo, K.N., Yang, C-Y., Lo, H-L., Chen, Cl & Chiu, Y-W. (2013). Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings. Implementation Science, 8, 112. Retrieved from . Read More