Application of Clinical Practice - Research Paper Example

Analysis and Application of Clinical Practice Affiliation Bicycle Safety Guidelines Scope and purpose of the clinical practice guideline The scope and purpose of this article is to review the efficacy of using safety helmets by snowboarders and skiers in recreational activities. The article pays close attention to head and neck injuries and their severity together with risk behaviors that are taken up as compensatory measures as the main outcomes of considerations. The target population that this research aims to inform includes end users of bicycles, skiers, snowboarders, health practitioners including advanced practice nurses, physicians, physician assistants and public health departments. The study aims to come up with recommendation that would inform family, practice, preventive medicine and sports medicine alike. 2. Stakeholder involvement A committee known as the Eastern Association for the Surgery of Trauma (EAST) developed the guidelines in this study. This comprise of the authors who are degree holders in medicine and a master’s in public health. The fact that the authors are health personnel with experience and practice in the field of medicine and public health from different hospital and teaching hospitals does not present adequately all the health personnel that the guidelines were intended to reach. Other professional personals including nurses, physiotherapists, and occupational therapists should be included. The means of data collection in the study was electronically done thereby underscoring the involvement of the patients affected by the injuries covered by the study. The researchers did not obtain information from the primary end user of the study regarding thing like behaviors and attitudes that influence the use of helmets. The involvement of the vulnerable groups and patients is lacking in the research findings. With the composition of the committee of guideline development, there is a likelihood of conflict of interest in the way the guidelines are formulated. Since one of the main goal of the guidelines was to offer preventive measures against head and neck injury, the management of the guidelines does not assure the other professionals responsible for the implementation of these preventive measures of the impact in contributing to the research. 3. Rigor of Development The sources of information used by the authors are credible. The study heavily relied on medical literature that had been published from webliographies like PubMed, EMBASE databases and Cochrane Library. The terms of search are relevant to the study and included helmet, helmet use, equipment and head protective devices among others. The period of the literature used was expansive enough, between 1980 and 2011, and thereby validating the changes in new guidelines that might have been in use over time for the sake of comparison. These search terms were however not extensive and did not look at patients. The clinical practice guidelines relied heavily on case-control studies and case series. Other studies that the guidelines referred from are cross sectional, case-cross over and retrospective cohort studies. The statement of the methods used in the article selection criteria are well documented and the procedure acceptable. The researchers came up with a weighing scheme that had three classifications. Class I was made of all prospective randomized control trials, class II had prospective clinical trial together with retrospective analyses that relied on databases that had been approved and class III was made up of retrospective case-series from the database reviews. With the methods and criteria stated above in use, it is fair to conclude that the benefits of the target populations were covered. 4. Recommendations The recommendation from the study advocate for wearing of helmets as a way of reducing head and neck injuries and the severity of these injuries. These recommendations are made at level one and according to the findings of the study do not appear to have satisfactory evidence. This claim is further supported by level two recommendations that use the term “do not appear”. The recommendations are not stated in terms that provide information that can be satisfied as reliable. Instead, the statement of these guidelines only affirms an association between the severity and occurrence of head and neck injuries to non-helmet users. Using this document to write a plan, some of the major recommendation would include the need for health practitioners to teach their vulnerable and target population on the importance and need of helmet use to reduce the occurrence and severity of head and cervical injuries. There should exists clearly formulated policies that require the health personnel to teach the head and neck injury patient regarding the safety of wearing helmets. There should be policies adopted at various levels that monitor, direct and ensure the reduced head and neck injury incidence among bicyclists, motorists, skiers and snowboarders. All the stakeholders should adequately be involved in the training, monitoring and enforcing the use of helmets for preventing head injuries. These stakeholders should include health workers, manufactures of helmets, motorists, bicyclists, skiers, snowboarders and family circles. The nursing role would be categorized into assessment and diagnosis, implementation and evaluation roles. In the assessment stage, the nurses would identify individuals and groups who are at risk of head and neck injuries like motorists, bicyclists, skiers and snowboarders. The assessment would also consider the most vulnerable groups like children or first timers. At this level, the information to be given to each level should be adequately planned for effective monitoring and implementation. The diagnosis done would depend on whether there is a history of previous head or neck injury for categorization and prioritization. The diagnosis could also be done with groups like the most vulnerable and those more susceptible to these injuries owing to the nature of their work. In the implementation phase, the role of the nurse would be teaching the targeted population on the use, importance and the need of helmet use. Demonstrations should be done to ensure that the audience could effectively use the helmet on their own. The nurse would also use the information about the likelihood of severe injuries where individuals fail to use the helmet to facilitate adequate care planning. What this means is that for example during the transfer of patients brought in with injuries on the head from the target population, the nurse should get the history of helmet use for planning. Though standard procedure of operation in the management of patients with head and neck injury will be operational, more care will be focused on patients reported to have injuries within the target population without the use of helmets. 5. Implementation Potential barriers to the implementation of the above clinical guidelines include lack of uniformity. Various localities have different state and institution policy to the adoption and use of clinical guidelines. This presents difficulty in training of the nurses on the guidelines and supplying them with resources to implement the guideline. This is opposed to the adoption of guideline that is considered universal and mandatory for every nurse to know (ACEP, 2014). The potential costs following the recommendations include training costs and storage costs for the helmet. Since the guidelines will require a means of monitoring and evaluation, it may necessitate hiring of extra staff of addition of more duties to existing staff and thus more pay. Other barriers relate to other formulated and adopted state and government policies that affect the adoption and implementation of these guidelines (Graves et al., 2014). One such policy is that exempting compulsory use of helmet in sports like skiing, snowboarding and bicycling among others. In this case the enforcement of the regulation requiring compulsory use of helmet for example where retailers and supplies of equipment like bicycles, snowboards and ski for lease have been allowed by the law to lease these equipment without accompanying them with helmets (Pierce, Palombaro, & Black, 2014). Another barrier relates to the habits and the practice of the end use in complying with the recommendations to use helmets. These habits adopted earlier affect the attitudes of the end user in adopting and benefiting from these guidelines. Teaching and follow up might be used as a means to improve the adoption of the guidelines by the end user (Ross, Brinson, & Ross, 2014). Evaluation and measurement of improved outcome would be based on incidence and severity of head and neck trauma from the target population. It would require carrying out a study on the target population after the adoption and implementation of the guidelines at various levels to assess the level of efficacy. References ACEP. (2014). Universal Bicycle Helmet Use. Retrieved August 18, 2014, from http://www.acep.org/Clinical---Practice-Management/Universal-Bicycle-Helmet-Use/ Graves, J. M., Pless, B., Moore, L., Nathens, A. B., Hunte, G., & Rivara, F. P. (2014). Public bicycle share programs and head injuries. American Journal of Public Health, 104(8), e106–e111. Pierce, S. R., Palombaro, K. M., & Black, J. D. (2014). Barriers to bicycle helmet use in young children in an urban elementary school. Health Promotion Practice, 15(3), 406–412. Ross, L. T., Brinson, M. K., & Ross, T. P. (2014). Parenting influences on bicycle helmet rules and estimations of children’s helmet use. The Journal of Psychology, 148(2), 197–213. Read More