NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

The purpose of this paper is to explore the impact of Evidence Based Research (EBR) on nursing practice. Included in the review will be research examples as related to the author’s field of practice in occupational health, both qualitative and quantitative. Also reviewed will be a brief discussion on barriers to the use of EBR and possible interventions to overcome those barriers. Importance of Evidenced Based Research. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

In 2002 Brown gave a definition of Evidence Based Practice (EBP) as “professional understanding and action that is based on the thoughtful use of knowledge and information from available, reliable, and dependent sources.” In 2008 Houser gave a further definition to EBP as the balance of clinical experience, proven evidence from scientific studies with patient input. This input from patients will incorporate their values, preferences, and systems influence. Evidence Based Practice is a fluent process that requires nursing professionals to be current and correct on information as it pertains to their daily practice. Regardless of who defines EBP, the intent is to ultimately improve quality of the care that is delivered to the client. Today’s consumers of health care have increased access to information via public sources. This increased knowledge, whether it is correct or incorrect, is a motivating factor for nursing professionals to have current and correct information available when working with clients in making health care decisions. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

Nowadays for all health care professional including nurses Evidence-Based Practice (EBP) is an expected core competency irrespective of discipline. EBP is necessary to integrate the best research with clinical expertise and patient value to establish best health outcomes (Winters & Echeverri, 2012). This essay will describe concise outline of Evidence based practice. Further it will discuss necessity of EBP into nursing practice and how EBP will helpful to improve the quality of care. The possible role of EBP in nursing will be explored. In addition it will identify some barriers of EBP which a nurse has to take in consideration during practice which need to be explored. However, there is still need to further research and evaluation of new technique to make the EBP more effective. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

Evidence Based Practice
EBP is the judicious and explicit use of best current evidence for making decisions for the care of individual patients (Sackett, 1997). Nurses are accountable for the holistic care of patients in providing care to the patients along with management of common symptoms. Nurses must be confident and comfortable in their knowledge of basic principles so they can provide appropriate care to the patients and they must implement suitable interventions to deal with patients’ responses to this common treatment effectively (Chlan, Tracy, & Grossbach, 2011). All health care professionals should have access to up-to-date evidence in order to sustain best practices (Chlan, et al., 2011). As an alternative to practice that is based solely on the experience and knowledge of practitioners, EBP has been introduced in the field of nursing (Chlan, et al., 2011).

Structure of EBP is very systematic as it is based on seven scientific steps. Before putting evidence into practice nurse has to analyze this step so they can confirm it utility. For EBP first step for nurse is to do Community assessment. It contains information about existing socio-economic and physical…NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

References: Brownson, R. C., Baker, E. A., Left, T. L., Gillespie, K. N., & True, W. R. (2011). Evidence-based public health: OUP USA.
Chlan, L., Tracy, M. F., & Grossbach, I. (2011). Achieving quality patient-ventilator management: advancing evidence-based nursing care. Critical Care Nurse, 31(6), 46-50.
Fisher, J. E., & Happell, B. (2009). Implications of evidence-based practice for mental health nursing. [Article]. International Journal of Mental Health Nursing, 18(3), 179-185. doi: 10.1111/j.1447-0349.2009.00607.x
Leeman, J., & Sandelowski, M. (2012). Practice‐Based Evidence and Qualitative Inquiry. Journal of Nursing Scholarship, 44(2), 171-179.

Integration of Evidence-Based Practice into Professional Nursing Practice
In this paper we will discuss the integration of evidence based practice into professional nursing practice. Scott & McSherry (2008) define evidence based practice as the combination of individual, clinical, or professional expertise with the best available external evidence to produce practice that is most likely to lead to positive outcomes for a patient. Despite literature surrounding what evidence based nursing is and isn’t, nurses struggle to get evidence into practice. Many reasons have been reported including a lack of understanding about evidence based nursing means. Scott & McSherry (2008) also define evidence based nursing is a process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient outcomes. We will also discuss nursing’s simultaneous reliance on and critique of EBP in the context of critical reasoning. There will also be discussion of a study done that examined the effects of integrating evidence based practice into clinical practicum among RN-BSN students and the limitations of evidence based practice and an alternate view of decision making. Lastly we will discuss evidence that challenges the traditional practice regarding injection sites (Cocoman & Murray 2010). NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

According to Guem et al. (2010) evidenced based practice is a problem solving approach to clinical care that incorporates the conscious us of the current best available evidence, a clinician’s expertise, and the patient values. Evidence for evidence based practice does not always rely on research findings. Sources used can include research findings, clinical experience, quality improvement data, logical reasoning, recognized authority, and client satisfaction, situation, experience, and value (Leddy & Pepper 2008 p. 266). On the contrary evidence based nursing is essential because of its potential to save time and money and improve patient outcomes by decreasing costs, through standardizing and streamlining costs (Scott & McSherry 2008). It is important o understand the difference between evidence based practice and evidence based nursing because at times they are used interchangeably. Scott & McSherry (2008) state that the nursing practice has welcomed EBP but when it comes to EBN, it is still yet to come reality because the concept is much unsophisticated and can lead to problems associated with its use and misuse. EBN is merely a construct and has yet to be successfully implemented (Scott & McSherry 2008). In essence the dilemma with EBN is that we don’t really know the definition of nursing. Although there are problems with the definition we know that clinical judgment is one of the major concepts used in nursing thus it reinforces the notion of EBP and ultimately EBP. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

To advance the profession and ensure solid standards of practice, we should look beyond evidence based practice, while useful in implementation it is just one of many other component parts (Jutel 2008). Evidence based practice is like the new black in nursing practice and already occupies a prominent position, several international nursing organizations support its use as a strategic action in the advancement of the profession. Despite the emphasis on EBP, there is also a strong opposition to it, not with the actual use of EBP being a problem but with the fundamentals on which it stands. These arguments complain of the veracity of the criteria used in EBP which simultaneously undermines and cannot support EBP (Jutel 2008). If it had not been for the cultural turn which recognized that things are not always as they seem or that power, society, and culture contribute as much as science to generating knowledge, the debate about EBP would have never surfaced (Jutel 2008). Although nurses argue against EBP, they lack important tools necessary to replace EBP. “Nursing education places high value on authority…NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

References: Cocoman, A. & Murray, J. (2010). Recognizing the evidence and changing practice on injection sites. British Journal of Nursing, 19(18), 1170-1174.
Eui, G. O. et al. (2010). Integrating Evidence-Based Practice into RN-BSN Clinical Nursing Education. Journal of Nursing Education, 49(7). 387-392.

In this assignment I shall discuss the concepts of Evidence Based Practice (EBP), and briefly outline its importance to my professional practice. I shall select a relevant aspect of my practice in relation to my professional discipline. I will provide a rationale for selecting my aspect of professional discipline, which will be within the context of (EBP). I will discuss the extent to which my selected aspect of professional practice is informed by various types of evidence. In relation my chosen aspect of professional practice, I shall then identify factors that may facilitate and hinder the implementation of (EBP). NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

Q1

Evidence based practice (EBP) is to demonstrate the best practice, which has been supported, with a clear rationale to back it up. Whilst using (EBP), this also acknowledges the patient/clients best interest. (EBP) is ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patient/clients’ (Sackett et al, 1996).

In this definition Sackett facilitates an understanding between (EBP) and decisions we make in everyday practice. This demonstrates the strong connection between both aspects. Here, Sackett emphasises the importance of decisions we make as healthcare professionals, and how clearly they should be stated. This shows that decisions are well thought-out, which demonstrates that the use of evidence is used sensibly and carefully, which means that any care or support we deliver must be evidence based. It shows that Sackett understands that if care or support we provide has a rationale, then this enables us to deliver it with a meaningful purpose. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

According to the Nursing and Midwifery Council (NMC) we as healthcare professionals must deliver care on the best evidence or best practice (2008). The code of conduct clearly states that any advice we give must be evidence based. If we fail to adhere to the code, then this may result in disciplinary action by the (NMC) (2008).

As healthcare professionals I feel any care we deliver should have a rational to justify anything we carry out. I believe that as healthcare professionals we are expected to understand why we are caring for patient/clients, whereby a rationale is provided for the care that we provide. (EBP) helps us as healthcare professionals keep updated with policies and procedures (ref). It is fundamental that we keep our skills and knowledge current, which enables us to provide effective care.

(EBP) in its earlier days of evidence based medicine, which provides a suitable way in producing efficient clinical decisions, avoiding routinely work practice, which increases clinical performance (Evidence Based Medicine Working Group 1992, Davidoff et al ,1995). In the above statement it demonstrates that (EBP) contributes to significant clinical decisions, which may subsequently develop. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

It is important that we adhere to policies and procedures for the best practice available, which may prevent us from making any errors. As practitioners we are accountable for our actions. Justifying what we do is vital, which must have a rationale behind it. Failure to adhere to (NMC) may result in professional misconduct (2008).

Q2

Here I shall formulate the question according the (PICO) method, which is population, intervention, comparison intervention, and outcome. This was devised by Sackett et al, which is a useful method in order to make questions more purposeful (1997).

My selected aspect of professional practice is the Treatment of Depression and its Effectiveness in Adults with Cancer.

I personally feel there is a high prevalence of depression in cancer patients. In my experience, I have found that there are many cancer patients, which may be suffering from depression. According to Barraclough (1994) states that depression is the most common psychiatric illness in patients with terminal cancer. The high prevalence of depression in cancer patient has influenced me carry out my own research, which will effectively enhance my knowledge. Personally, I feel that by developing my knowledge on my chosen topic will help enable me to have a greater understanding, t in my future practice. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

Hinton (1963) found that 24% of patients dying in an acute hospital were depressed. It has been found by Casey that patients suffering with depression may be assessed by asking them if they have symptoms such as ; loss of pleasure in activities, feelings of guilt and worthlessness, or thoughts of self harm, which may help in recognizing a diagnosis in depression (1994).

Q3

The objective of a qualitative research is to describe, explore, and give explanation to the phenomenon what is being studied (Marshall & Rossman, 2006. (Morse & Richards 2002) established that there many techniques used in the collection of data involved in the production of a qualitative study, but the commonly used are observing and interviewing partakers. A meta-analysis is within a qualitative study, whereby the findings of qualitative are carefully examined, the methods and theories from different studies, to form an overview or conclusive ways of thinking about phenomena Thorne et al (2004).

In my experience I have found that many patients whom have cancer have been low in mood, but often go left untreated. Maguire found that up to 80% of psychological and psychiatric morbidity, which develops in cancer patients often goes unrecognised and untreated (1985). NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

It speaks about how patients are non-compliant in discussing symptoms unreservedly with nursing and medical staff. It mentions that in the United Kingdom (U.K) clinical nurse specialists play an important role in assessing the symptoms and providing advice to cancer patient with highly developed and metastatic cancer (Gray et al,1999).

This qualitative study was purposely carried to deter how clinical nurse specialist manage, assess, and perceive depression in such patients, in both hospital and community settings. Atkin et al (1993) found that 43.4% of nurses reported that early recognition of, signs of anxiety and depression was part of their role. It shows the difficulty nurses are faced with in convincing medical staff to follow up assessment or prescribe antidepressant medication.

I shall now critique the study. Firstly, none of the nurses had any form of mental health training. Therefore, I feel their lack of knowledge may have falsified the findings of the study. Lastly, the demographic area may have been expanded further afield, which subsequently makes the findings minimalistic. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

The view proposed by Long (1995, p94) that the most problematic characteristic of the hierarchy of evidence model, is that it completely lacks recognition of qualitative study methods. According to Sackett et al (1996) a qualitative is in the ranking of research evidence at the base. Here, it shows that a qualitative study has inadequate efficacy, whereby it lacks randomization, it also has scarce before and after studies.

However, it does give emphasis to the fact that open ended question were asked in a qualitative study, which demonstrates its feasibility. An open ended question can have many answers, whereby it can be answered in many ways than one. If in depth answers are obtained, then this may enable the researchers to capture a greater insight of the situation.

Nevertheless, it has been discovered that identifying the findings in a qualitative study can be complex, this may due the style of reports, or they may be perceived wrongly (Sandelowski & Barroso 2004). NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

Systematic reviews were first defined as ‘concise of the best available evidence that address sharply defined clinical questions’ (Murlow et al 1997). Here, it states that a systematic review involves gathering quality information, which is then analysed, whereby it is then summarised. A systematic review is a vital source of evidence-informed policy and practice movement, which connects research in decision-making (Chalmers, 2003).

Secondly, this systematic review provides us with evidence on cancer patients receiving interventions such as drug therapy, and their efficacy. In this systematic review it found that depression is the most common in cancer patients, which often goes undiscovered and untreated (Lloyd-Williams, (2000); Bailey et al,(2005). NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

It also shows that cancer patient’s survival rate may be decline if their immune response is impaired. (Andersen et al, 1998; Newport and Nemeroff, 1998; Reiche et al, 2004) and poorer survival (Buccheri, 1998; Faller et al, 1999; Watson et al, 1999; Faller and Bulzebruck 2002; Herjl et al, 2003; Goodwin et al, 2004). It is known that in previous systematic reviews and meta-analyses of the effectiveness of interventions for cancer patients whom are suffering from depression have been unsuccessful in differentiating between depression/depressive symptoms.

Dale and Williams (2005) refers to the findings from this review, which demonstrate that there little trial data on the effectiveness of antidepressants, which are prescribed to reduce major depression and depressive symptoms in those suffering with cancer.

Nevertheless, previous reviews which have failed to identify the dissimilarity between both depression and depressive symptoms. It shows little data from clinical trials, which demonstrate psychotherapeutic interventions, which may effective in reducing depression in cancer patients.

A number of small-scale trials showed that psychotherapeutic interventions, more so Cognitive Behavioural Therapy (CBT), which may be effective in treating cancer patient whom have depressive symptoms.

In conclusion, this review shows that there is a hard-pressed need for a more rigorous process in the examination of the effectiveness and consequences regarding approaches towards in managing depression in cancer patients, and providing them with appropriate healthcare services. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

In respect to the hierarchy of evidence chart Sackett (1996) states that systematic reviews are at the peak of the chart, which demonstrates this, a strong piece of evidence. The results of a systematic reviews are produced in such a way, whereby a thorough examination of evidence is processed (Murlow,1987; Cook et al.,1998). Sackett and Straus (1998) found that systematic reviews of (RCTs) are ranked as the ”best” evidence in making clinical decisions in relation to a patients care.

Within this study a systematic review of randomised controlled trials (RCT) of pharmacological and psychotherapeutic implementation for cancer patients with depression/depressive symptoms. This study had a specific criterion for the selection of (RCTs) of the pharmacology and psychotherapeutic interventions. Partakers were either adult cancer patients with depression, or depressive symptoms receiving interventions such as pharmacology and psychotherapeutic.

This source of evidence fits into the hierarchy of evidence at the apex of the chart. It is known that a singular RCT or Several RCT’s are well thought-out as the uppermost level of evidence, and anything below this is classed as a lower level of evidence, which may be classed as an inadequate source of information (Ellis 2000, Lake 2006, Morse 2006b, Rolfe & Gardner 2006). Evidence shows that (RCTs) are considered highly effective sources of information (Muir Gray, 1997;Mulrow & Oxman, 1997; Sackett et al.,1997). NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay

It would be highly unethical to use these findings as a prejudice against patients with cancer who wish receive treatment for depression and depressive symptoms, because of the limited data on effectiveness.