It article focuses on steps taken in translating the theory of evidence-based health informatics to practice. In this article, Rigby et al. (2016) want to demonstrate and promote the benefits for the application of the scientific process in the design and implementation of health IT. They used global experts’ reviews to achieve their study’s objective. The experts are linked to the International Medical Informatics Association (IMIA). Important topics discussed in this article include detection and mitigation of health informatics’ safety issues, health technology assessment (HTA), and indicators of e-health progress.
Patients’ harm prevention requires health care providers to translate evidence into practice and policy. Although health informatics have numerous benefits, they can disrupt healthcare delivery, risking patient safety (Rigby et al., 2016). Therefore, it is essential to address safety issues associated with the technology. The strategies proposed in this article to mitigate the safety issues include installation of safety management systems, setting standards, provision of guidelines and regulations, certification, and use of emergency safety issues’ surveillance.
Safety management systems can help identify and alleviate risks throughout health informatics’ life cycle. Operational standards using the technologies can allow the management of clinical risks related to the design and implementation of health IT. Guidelines are important because they direct healthcare providers on how to use health informatics without jeopardizing patients’ safety. Equally, it is essential to have government agencies that regulate and certify technologies used in healthcare delivery. Also, facilities using health informatics should have a mechanism for monitoring and reporting incidences linked to the technologies to promote patient safety.
HTA involves the evaluation of health technology’s features and effects to address its direct and unintended impacts. Additionally, the process helps address indirect and unplanned consequences of health technology, facilitating informed decision-making. Sedig et al. (2017) indicate that health informatics provide high-quality information needed in decision-making for evidence-based healthcare delivery. The common indicators of e-health progress identified in this research article include the healthcare system’s efficiency, improvement and care quality, as well as the equity of access to services. These indicators are important because they determine whether the evidence-based application of health informatics has positive impacts on the delivery of healthcare or not. The authors conclude that the use of scientifically valid evidence in the implementation of health informatics is vital because it can help know actual benefits, risks, as well as effects.
Sedig, K., Naimi, A., & Haggerty, N. (2017). Aligning information technologies with evidence-based health-care activities: A design and evaluation framework. Human Technology, 13(2), 180-215. Web.
Evidence based practice is becoming very popular all over the world today. This follows the ever rising cases of chronic diseases and the practitioners who are ever joining the field. The practitioners’ competence and skill is also very commendable. Greenhalgh T. (2006 p98), says that “In every year, two thirds of the cases go for alternative medication.” This could be very true following the changing health trends.
Results
In the year 2004-2005, one hundred and ninety three cases were interviewed. The result was distributed among health professionals, young children, and the elderly and other professionals who had no knowledge in the medical field. Eighty seven percent of the practitioners admitted being inadequately. But this high percentage still attends to the ever increasing number of the cases that require their attention. Sixty two percent admitted finding themselves in the field without undergoing any training. There also emerged beliefs and a strong pull between practitioners and allied parties.
Analysis
Different fields of practice influenced the results depending on the area of study and professionalism. This could be self explanatory however; much more issues arise when analyzing the result. This could though give the allied parties a voice and need to demand for the training of alternative medicine practitioners just like they do.
Method
To become successful in the evidence research, questioners were used in the justification of evidence based practice. “These were to evaluate the allied health care professionals and practitioners’ basic knowledge, skills and beliefs concerning the main principles of evidence based practice.” Lewith, G (2001 p 66).
Reliability of the Research
The research can be said to be a success but critically, it really did not bring out the evidence. Out of the respondents, almost two thirds of the respondents complained of insufficient time to use the evidence based practice. Lack of resources also was a challenge that forty percent complained of as a barrier. In research it is required to have sufficient research materials to help in come up with quality research.
Skills to analyze the research also were very limited as nobody could analyze the statistics and come up with proper analysis. Other problems associated with research could be possibly lack of unity among the researches in carrying out and analyzing the research. Finally it could also be a challenge of inability to appraise the evidence based practice. “The researchers must have also lost the morale to keep up carrying on the research because of the same result! This led to monotony and premature drawing of conclusion.” Polar S. and Thomas S. A. (2008 P 341).
Recommendations
Due to the fact that respondents acted positively towards the evidence based practice, it is only because majority of them were young children and elderly people who might have not been keen or just responded without taking much interest. However, the minority of the respondents: who were of the middle age, responded in a negative manner. It is therefore recommended that the research be distributed equally among the sample population. Peters M. (2005 P 423-426) and Kane, M. (2004 P 67) recommend that the research could be of more value if the research could be carried out in a more modern way, she says;
“It was therefore recommended that the Universities Commission and the Medical Rehabilitation Therapists’ Registration Board should ensure the inclusion of evidence based practice into undergraduate physiotherapy curricula in the world as this will provide the baseline knowledge needed for the implementation of evidence based practice. Also emphasis should be placed on ensuring a regular publication and wide circulation of the professional journals on physiotherapy. A potential limitation to this study is the small sample size of the respondents. This is due to the fact that as at the time of this study.”
It is therefore recommended that the sample be large enough to gather the information that cannot be biased. It should also be balanced to cater age and gender.
References
Greenhalgh, T., 2006, How to read a paper: the basics of evidence based medicine. 3rd edn, Blackwell: Australia.
Kane, M., 2004, Research Made Easy in Complementary & Alternative Medicine, Sydney: Churchill Livingstone.
Lewith G. Jones, WB and Walach H., (eds) 2001. Clinical Research in Complementary Therapies: Principles, problems and solution, Edinburgh: Churchill Livingston.
Peters M., 2005. Research analysis of evidence based med. EPM publishers: Nairobi.
Polar S. and Thomas S. A., 2008. Introduction to Research in the Health Sciences, 5th ed, Churchill Livingstone: Elsevier.
Evidence based practice (EBP) is a process through which decisions are reached based on scientific and clinical principles. Through EBP, the preferences and values of patients are harnessed to ensure that there is a cohesive healthcare program. Evidence based practice is subject to various challenges including conflicting personal preferences and beliefs (Bostrom, Rudman, Ehrenberg & Wallin, 2013). EPB changes are often slowed down by inadequacies of time and finances. These two factors are necessary in order to sensitize medical practitioners and patients among other healthcare stakeholders about EBP. This essay outlines a plan for resources that can be used to support EBP changes in a clinical setting.
The challenges that are encountered during the implementation of EBP changes can be overcome through the co-operation of all healthcare stakeholders. To ensure closer interaction between the patients and healthcare providers, the human resource departments are required to institute measures that will streamline the progress of the EBP plan. These measures include employing healthcare staff that are drawn from various communities, genders, age groups, and social classes among other social groupings. This strategy will lead to a comprehensive understanding of the tastes, preferences, and tastes of patients from these social groups. Where it is not possible to have a large number of healthcare staff who are drawn from various social groups, it would be expedient to equip the contemporary staff with skills that can enable them to understand the environment that they are working in. Consequently, the healthcare staff will be able to deliver health services effectively. Healthcare workers should also be sensitized on the need to respect and uphold patients’ likings to enable the latter feel as part of the medical practice. This is a very important step considering the patients and healthcare practitioners could be from different social settings and hence have differing beliefs.
A substantial amount of financial capital should be committed to EBP research in order for professionals to understand the tastes, likes, dislikes, and beliefs that are associated with individuals from each social setting or group. This financial strategy will enable the healthcare providers to understand their patients in a better manner. Consequently, the healthcare professionals will be prepared to serve their clients to the best of their ability. Inadequacy of information concerning finance can be a major hindrance to the progress of EBP. People of different communities, nations, races, and even religions have varying beliefs that should be taken into consideration if EBP is to be harnessed.
Concepts are better comprehended when they are practiced as opposed to when they are read theoretically. The ability of healthcare professionals’ leadership to appreciate EBP directly corresponds to its increased application in their daily working environment (Miake-Lye, Hempel, Ganz & Shekelle, 2013). The health facility management should embrace EBP and encourage its use in healthcare centers. The leaders should carry out extensive training across all departments of healthcare facilities to educate their staff on the practice. In addition, a reliable system of monitoring employee-activity should be set up to ensure that staff members are able to apply their knowledge of EBP ethically.
Healthcare facilities’ management should be flexible enough to accommodate the preferences of some communities in order for practitioners to deliver health services in the most appropriate method. This move would be necessary especially in communities that do not have a static lifestyle like the nomadic communities. Offering healthcare to an ever-moving people requires mastery of the EBP. Nevertheless, when a good understanding exists between the health care providers and the community, it is easy for EBP changes to be achieved.
References
Bostrom, A, Rudman, A, Ehrenberg, A, & Wallin, L. (2013). Factors associates with evidence-based practice among registered nurses in Sweden: A national cross-sectional study. BMC Health Services Research, 2(13), 165- 177.
Miake-Lye, I., Hempel, S, Ganz, D. & Shekelle, P. (2013). Inpatient fall prevention programs as a patient safety strategy. Annals of Internal Medicine, 15(8), 390-396.
The notion of healthcare has always been primarily focused on patient satisfaction with the treatment patterns and the ability to reduce the overall disease incidence in the community through frequent and efficient interventions. In order to define the ways to improve the current pattern of patient care, it is of paramount importance to dwell upon the fundamental constituents of the following satisfaction rate.
Hence, according to the researchers, the first scholarly attempts resulted in the development of the Triple Aim, which encompassed the notions of the individual patient experience in healthcare, the tendency to improve the overall population health, and cost reduction (Sikka et al., 2015). Over the years, the following endeavor has evolved into the Quadruple Aim, encompassing the notion of care provision improvement as well. As a result, it was estimated that the achievement of such ambitious goals requires much effort in terms of healthcare financing and proficiency levels among the practitioners.
Hence, clinical practice professionals decided to develop an approach to the problem-solving patterns in healthcare that would contribute to the aforementioned aspects. As a result, the notion of evidence-based practice (EBP) was introduced, claiming the importance of data analysis in terms of addressing the relevant healthcare issues (Kim et al., 2016).
The approach itself depends on the secondary data analyzed in studies, patients’ preferences, and expectations from quality healthcare. In fact, when encompassing the implementation of EPB, the major role is played by the nurses and their interventions in the treatment processes (Crabtree et al., 2016). Thus, once clinical practitioners and nurses start implementing findings outlined from the evidence, the goals indicated in the Quadruple Aim are gradually becoming more likely to be achieved in the short-term perspective.
References
Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–175. Web.
Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340–348. Web.
Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost, and meaning in work. BMJ Quality & Safety, 24, 608–610. Web.
From the analysis of the five areas, I can say that the evidence presented supports the conclusion made by Babcock et al. (2004). Specifically, the researchers found that in three of the four hospitals that took part in the study, the infection rates of ventilator-associated pneumonia fell by between 38 and 61 percent following the educational intervention program. These results were observed in both adult children’s hospitals as well as community hospitals. Hence, the results could be generalized to different health settings. This conclusion was arrived at following the data analysis and results from the analysis which supports the conclusion.
The major ethical issue that arose from the study was access to personal health information of the participants. Specifically, the researchers needed to gain access to the common database kept by the Infection Control and Hospital Epidemiology Consortium of the health system where the information about ventilator-associated pneumonia is kept (Babcock et al., 2004). Gaining access to the health records of patients is a very sensitive issue because health records are confidential and should only be used by professionals who provide direct care to patients. Thus, the researchers had to obtain permission from the institutional review board and the hospitals’ administrations so as to access the patients’ health records.
The study was purely quantitative in nature. A qualitative research would also have been appropriate in a similar situation. Specifically, a qualitative study would entail in-depth interviews with the health practitioners working in the intensive care units to determine how the educational program has benefitted them and what knowledge and skills they gained from the intervention that helped them to better reduce the rates of ventilator-associated pneumonia. A qualitative study would enable the researchers to go beyond collecting numbers and instead to gain a deep understanding of the problem. The researchers would have understood the problem from the point of view of the medical staff. Such information is impossible to obtain through quantitative research yet it is important for any study.
Literature Search
Identification of a Nursing Care or Management Problem for a Therapeutic Nursing Situation
The problem requiring a therapeutic nursing situation is the use of general care versus specialized ventilation associated pneumonia (VAP) bundle in the reduction of ventilation associated pneumonia among mechanically ventilated ICU patients.
Matrix of Primary Research Sources
The matrix of primary sources is attached as a separate document.
Annotated Bibliography
Babcock, H., Zack, J., Garrison, T., Trovillion, E., Jones, M., Fraser, V., et al. (2004). An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: A comparison of effects. CHEST, 125(6), 2224-22231.
Babcock et al. (2004) studied adult and pediatric patients admitted in two teaching and two community hospitals located in Midwestern United States. They then tracked ventilator-associated pneumonia in each of the hospital through the use of infection control experts and surveillance. Incidences of VAP were reported in a common database at the Infection Control and Hospital Epidemiology Consortium. The educational program was introduced to all the patients admitted in the four participating hospitals and a follow up done throughout the study period. A statistical software (SPSS) was used to analyze data. Chi-square analysis was used to compare the rates of VAP. The combined annual rate of VAP with intervention was 7.81/1,000 ventilator days compared to 8.75/1,000 ventilator days without the intervention, hence no statistically significant difference. On individual basis, three out of the four hospitals recorded a statistically significant difference in the VAP rates following the intervention, with the largest decrease recorded in a community hospital.
Crunden, E., Boyce, C., Woodman, H., & Bray, B. (2005). An evaluation of the impact of the ventilator care bundle. Nursing in Critical Care, 10(5), 242-246.
The researchers studied patients admitted at the combined Intensive and High Dependency Care Unit at East Surrey Hospital. The study design involved an audit of the hospital’s compliance with evidence-based protocols followed in care bundles and if the protocols reduced ventilation length of the patients. Descriptive statistics (percentages, mean, median and standard deviation were used to describe the characteristics of the population; student’s t-test was used to compare APACHE II, length of ventilation and LOS data. The mean ICU LOS was reduced by 39%; there was a reduction in the mean duration of ventilation by 43%.
El-Khatib, M., Zeineldine, S., Ayoub, C., Husari, A., & Bou-Khalil, P. (2010). Critical care clinicians’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia. American Journal of Critical Care, 19(3), 272-276.
The population entailed clinicians working in an intensive care unit of a university bed. The sample of clinicians used included only those clinicians who were not aware of similar prior studies. The researchers used a multiple-choice questionnaire design to carry out their study. Descriptive statistics (percentages and means) were used to describe the accuracy of the responses; analysis of variance and Scheffe test were used to compare the scores; Chi-square analysis was used to compare the proportion of the accurate responses; linear regression was used to establish the correlation between scores and participants’ demographics; SPSS was used to carry out the statistical tests. No differences were found in the knowledge of protocols for VAP prevention among the clinicians; no differences were found in the knowledge of protocols for VAP prevention based on ICU experience.
Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., et al. (2009). Reducing ventilator-associated pneumonia through advanced oral-dental care: a 48-month study. American Journal of Critical Care, 18(6), 523-534.
In this study, Garcia et al. (2009) studied a population of patients enrolled in a medical intensive care unit of a university medical center. The sample included patients who were 18 years and above and who were receiving mechanical ventilation for more than 2 days at the medical center. The research design used was a randomized control study in which the researchers studied two different groups of patients: the control and the intervention groups and made comparisons. Descriptive statistics were used to describe the demographic characteristics of the population; student t-test, Mann-Whitney analysis and mortality analysis were used to test the variables of the study. VAP rate was higher in the control group (8.6%) than in the intervention group (4.1%); VAP rates decreased by 33.3% during the intervention; the intervention significantly decreased the duration of mechanical ventilation and length of hospital stay.
Grap, M. (2009). Not-so-trivial pursuit: Mechanical ventilation risk reduction. American Journal of Critical Care, 18(4), 299-309.
The study conducted by Grap (2009) involved a population consisting of patients admitted in a respiratory intensive care unit. The research design used was observational in that the researcher did not control the intervention but instead made a comparison between non-randomized sequential groups. Descriptive statistics were used to describe the characteristics of the backrest elevation. The use of elevated backrest reduces aspiration and hence VAP to some extent.
Grap, M., Munro, C., Hummel, R., McKinney, J., Sessler, C., et al. (2005). Effect of backrest elevation on the development of ventilator-associated pneumonia. American Journal of Critical Care, 14, 325-333.
The researchers studied patients admitted at the respiratory intensive care unit of Virginia Commonwealth University Health Systems. A non-experimental, longitudinal, descriptive design was used in the study. Descriptive statistics were used to describe the features of the population; a forward-selection multiple regression analysis was used to predict CPIS on the fourth day. The results showed no direct correlation between the height of backrest and VAP. VAP was highly likely to occur in more seriously ill patients who spent more time at backrest elevations.
Hawe, C., Ellis, K., Cairns, C., & Longmate, A. (2009). Reduction of ventilator-associated pneumonia: active versus passive guideline implementation. Intensive Care Medicine, 35, 1180-1186.
Hawe, Ellis, Cairns and Longmate (2009) conducted their study using a sample of patients admitted at the intensive care unit of Stirling Royal Infirmary. The sample used included patients who were admitted at the unit between September 1, 2005 and December 31, 2007. The research design used was a quasi-experimental design that was used to assess the effects of a bundle of evidence-based approaches to VAP. Passive implementation was correlated with poor compliance with VAP prevention bundle; active implementation was correlated with a substantial improvement in compliance with VAP bundle.
McCarthy, S., Santiago, C., & Lau, G. (2008). Ventilator-associated pneumonia bundled strategies: An evidence-based practice. Worldviews on Evidence-Based Nursing, 5(4), 193-204.
McCarthy, Santiago and Lau (2008) studied patients admitted in intensive care units of different hospitals. The research design used in the literatures reviewed was observational in that the researchers did not control the intervention but instead made a comparison between non-randomized sequential groups. Results from the literature review varied widely and include: a decrease in the ventilator days following the intervention; a strong correlation between VAP rate and compliance rate; non-development of VAP with the intervention.
Tolentino-DelosReyes, A., Ruppert, S., & Shiao, P. (2007). Evidence-based practice: use of the ventilator bundle to prevent ventilator-associated pneumonia. American Journal of Critical Care, 16, 20-27.
The study by Tolentino-DelosReyes, Ruppert and Shiao (2007) involved nurses working in the coronary care unit and surgical ICU of a large hospital located in a large metropolitan city. The research design was a clinical education project that was used to evaluate the knowledge of nurses concerning the use of ventilator bundle to prevent VAP. Descriptive statistics were used to describe the characteristics of the population; independent t test and chi-square analysis were used to measure and compare the pretest and posttests scores of the nurses. An education program lasting as little as 30 minutes can help to enhance the nurses’ knowledge concerning VAP prevention strategies.
Westwell, S. (2008). Implementing a ventilator care bundle in an adult intensive care unit. Nursing in Critical Care, 13(4), 203-207.
The study involved patients admitted at an adult ICU of a district general hospital. The research design was an audit of the hospital’s compliance with evidence-based protocols followed in care bundles. Descriptive statistics were used to describe the hospital’s compliance rate and the rate of VAP reduction following different interventions. Daily audit of care bundles is strongly correlated with compliance which in turn is correlated with VAP reduction rates.
Tools used and Efficacy of the Therapeutic Approaches
The researchers reviewed above made use of different tools to measure the variables of the studies. However, I do not believe that the tools used affected the results of the studies in any way. This is because in the studies that appeared to be similar in the objectives and variables to be measured, the results were similar despite the fact that different tools were used. For instance, the studies that examined the effect of educational intervention programs – Babcock et al. (2004), El-Khatib et al. (2010) and Tolentino-DelosReyes (2007) – used different approaches yet got similar results.
Each of the studies reviewed above made a case for the efficacy of the therapeutic approach. This was done by highlighting the effect (either positive or negative) of the different therapies on patient outcomes mainly the development of ventilator-associated pneumonia. The major therapeutic interventions identified in the studies were: educational intervention program to increase nurses’ knowledge on preventing ventilator-associated pneumonia, the use of elevated backrest, and the implementation of a bundle of evidence-based approaches to VAP. The studies which assessed the use of educational intervention programs and a bundle of evidence-based approaches to VAP all found the therapies to be effective in reducing the incidences of ventilator-associated pneumonia. On the other hand, the studies that assessed the effect of elevated backrest had mixed results. For instance, Grap (2009) found that the use of elevated backrest reduces aspiration and hence VAP. However, Grap et al. (2005) found no direct correlation between the height of backrest and VAP. VAP was highly likely to occur in more seriously ill patients who spent more time at backrest elevations.
Evidence Summary of the Articles
The evidence table is composed of ten articles generated from the search process. In order to answer the clinical question of this study, some of the articles chosen focus on the VAP bundle approach while the others focus on other strategies used in the general care of VAP. By including studies that focus on these two different approaches to VAP, it is possible to compare the effectiveness of the two approaches used in preventing VAP and thereby identify the better alternative. The studies that focus on the VAP bundle approach have promising outcomes in terms of reduction of VAP rates, reduction in the length of ventilation days and reduction in the length of hospital once discharged to the general ward. On the other hand, the studies that focus on general care approach have mixed results, with some showing positive results, others showing negative results, and yet others showing no difference at all. Further critical analysis of the literatures and synthesis of the evidence would help to clarify the contradicting results.
Recommendation of a Nursing Strategy
Based on the evidence presented above, I would recommend a strategy that incorporates both an educational intervention program and ventilator-associated pneumonia bundle. These two strategies seem to have a significant positive effect on reducing ventilator-associated pneumonia. An educational program equips nurses with knowledge and skills on what to do and what not to do so as to minimize the chances of mechanically ventilated ICU patients developing VAP. On the other hand, a VAP bundle provides utmost care to the mechanically-ventilated ICU patients thereby reducing the risk of VAP. However, compliance with the bundle protocols is equally important.
Importance of Theoretical Model for Nursing Research
A theoretical model provides guidance to the nursing research (Houser, 2007). It forms the basis upon which researchers formulate their research questions, construct their research design, collect data, analyze data and interpret the data. Without theory to guide the research process, a researcher would produce a study and data that make no sense and which do not add value to the existing knowledge of the practice. A theory can help a researcher to conduct a study that proves whether or not the theory holds in different circumstances. A theory-guided research is thus important in providing evidence-based nursing practice (Fitzpatrick & Wallace, 2005).
Reference List
Babcock, H., Zack, J., Garrison, T., Trovillion, E., Jones, M., Fraser, V., et al. (2004). An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: A comparison of effects. CHEST, 125(6), 2224-22231.
Crunden, E., Boyce, C., Woodman, H., & Bray, B. (2005). An evaluation of the impact of the ventilator care bundle. Nursing in Critical Care, 10(5), 242-246.
El-Khatib, M., Zeineldine, S., Ayoub, C., Husari, A., & Bou-Khalil, P. (2010). Critical care clinicians’ knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia. American Journal of Critical Care, 19(3), 272-276.
Fitzpatrick, J. J., & Wallace, M. (2005). Encyclopedia of nursing research. New York: Springer Publishing Company.
Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., et al. (2009). Reducing ventilator-associated pneumonia through advanced oral-dental care: a 48-month study. American Journal of Critical Care, 18(6), 523-534.
Grap, M. (2009). Not-so-trivial pursuit: Mechanical ventilation risk reduction. American Journal of Critical Care, 18(4), 299-309.
Grap, M., Munro, C., Hummel, R., McKinney, J., Sessler, C., et al. (2005). Effect of backrest elevation on the development of ventilator-associated pneumonia. American Journal of Critical Care, 14, 325-333.
Hawe, C., Ellis, K., Cairns, C., & Longmate, A. (2009). Reduction of ventilator-associated pneumonia: active versus passive guideline implementation. Intensive Care Medicine, 35, 1180-1186.
Houser, J. (2007). Nursing research: reading, using, and creating evidence. Sudbury, MA: Jones & Bartlett Learning.
McCarthy, S., Santiago, C., & Lau, G. (2008). Ventilator-associated pneumonia bundled strategies: An evidence-based practice. Worldviews on Evidence-Based Nursing, 5(4), 193-204.
Tolentino-DelosReyes, A., Ruppert, S., & Shiao, P. (2007). Evidence-based practice: use of the ventilator bundle to prevent ventilator-associated pneumonia. American Journal of Critical Care, 16, 20-27.
Westwell, S. (2008). Implementing a ventilator care bundle in an adult intensive care unit. Nursing in Critical Care, 13(4), 203-207.
Every day the problem of the shortage of nurses aggravates extremely fast. American Psychiatric Nurses Association warns about providing mental health to all patients because of nurses shortage. Today there are fewer nurses, and this is a serious concern. One of the primary objectives is to inspire young students to become in an infirmary and re-employ older infirmarians to offer patients expert care. The significant benefit of the EBP is that it enables nurses to utilize innovative treatment approaches. The primary objective of health care is to provide safe, efficient healthcare (Schneider et al., 2016). In order to successfully address the future problem, nurses can develop new techniques and resolve health concerns.
Implementing evidence-based practices is indeed a complex and ongoing process that must be carefully conducted and investigated. In constantly changing care contexts, nurses work (Dobson & Dobson, 2018). However, this does not mean that this method is not successful. By examining each patient, you can come to discoveries in medicine that will help you make decisions faster and better in the future. However, some problems can interfere with these analyzes. The problem of communication is one of the fundamental ones. Misunderstandings occurring during the analysis can lead to failures and incorrect results; respectively, the meaning of the analysis will be lost. Different qualifications of employees can also lead to problems during the internship. The skill level will determine the implementation methods and strategies; however, if employees are prepared for practice at different levels, the practice process will be complicated due to the different employee knowledge levels. Moreover, the last problem raised in the post is resources. The resource issue is also relevant as it is sometimes challenging to involve stakeholders. It should be taken into account and prepared for the lack of resources to use the available ones better.
References
Dobson, D., & Dobson, K. S. (2018). Evidence-based practice of cognitive-behavioral therapy. Guilford publications.
Schneider, Z., Whitehead, D., LoBiondo-Wood, G., Faan, P. R., Haber, J., & Faan, P. R. (2016). Nursing and midwifery research: Methods and appraisal for evidence-based practice. Elsevier.
The post is focused on the role of a registered nurse to provide patient care through the implementation of evidence-based practice (EBP), also referred to as validated clinical interventions. The explanation of the concept is provided in detail, and it is stated that EBP is the valuable approach intended to utilize modern techniques to benefit patients’ wellbeing. It is shown, in the post, that customer satisfaction is achieved through better service delivery with the use of EBP. Moreover, the opposite is also discussed by examining reasons of resistance to adopting the concept in the regular implementation in the clinical setting. The potential issues, such as scarcity of time and knowledge among nursing practitioners and barriers to integration in the workplace setting, are outlined based on the trustful source. However, the instances of how practitioners can encourage the integration of EBP are provided based on abstract situations and reliable evidence.
The post lack information regarding the steps of implementation of EBP to ensure the readers’ correct understanding of the entire concept. The stages of EBP application are: Ask a question about what could be improved and why, acquire the current evidence through a literature search, and appraise the literature to ensure the utilization of credible resources (Wilson, & Mary-Jean, 2021). Then, the findings can be applied to clinical decision-making, evaluation of outcomes obtained can be conducted, and the information, which might be helpful to others, disseminated (Wilson, & Mary-Jean, 2021). Moreover, it is vital to examine levels of evidence to ensure the understanding of what sources of information are validated, relevant and can be used to implement EBP. The highest methodological quality evidence is obtained from randomized controlled tries or clinical practice guidelines, while the least credible is evidence from the opinion of authorities (Dang & Dearholt, 2018). EBP can be a vital addition to day-to-day clinical practice and can result in better care outcomes.
References
Dang, D., & Dearholt, S.L. (2018). Johns Hopkins nursing evidence-based practice: Model & guidelines (3rd ed). Sigma Theta Tau International.
Her chief complaint includes irregular periods, severe acne, and frequent hair loss.
Health problems began about one year ago.
She denies voice changes.
Blood tests prove a high hormone level.
A 33-year-old African-American woman visits the clinic because of her acne and hair loss have worsened during the last several months. She reports on her irregular periods during the last year. From time to time, she cleans her face to remove several acnes. Today, she has more than 20 dark spots on her skin. She is also concerned about her inability to stop hair loss. She was adopted, and she does not know her genetic history except the fact that her birth-mother had type 2 diabetes. She does not observe voice changes. She does not have children, and she is not married (no serious relationships). The results of the blood test show a high level of androgens. A pelvic examination proves increased ovaries. Polycystic ovary syndrome is the diagnosis.
Medical Management
Anti-androgens – Aldactone – to control the level of androgens.
Anti-estrogen – Clomid – to increase the ovulation rate.
Anti-diabetic – Metformin – to prevent hyperglycemia.
Polycystic ovary syndrome (PCOS) is a hormonal type of disorder that is observed among women of reproductive age. It is characterized by irregular periods, the excess of male hormones, and polycystic ovaries (Sirmans & Pate, 2014). Every medication has to be prescribed by a professional only after all necessary tests are made, and the diagnosis is proved (Dreischulte & Guthrie, 2012). In addition to lifestyle changes, medications have to be prescribed. They help to control the level of androgens (anti-androgens), promote anti-estrogen therapy (clomiphene citrate), and slow down the progression of diabetes (anti-diabetic agent). No side effects are observed as a result of the interactions between the drugs in the chosen medication approach.
Drug One: Aldactone (Spironolactone)
Dosage: 50 mg daily.
Mechanism of Action: receptor binding.
Adverse Effects: nausea, breast tenderness, hyperkalemia.
Contraindications: anuria, renal function impairment.
Aldactone is known by its generic name Spironolactone. It is prescribed to patients with PCOS to stabilize the level of androgens. This tablet is usually prescribed in dosage between 25 and 200 mg per day (Williams, Mortada, & Porter, 2016). It may be taken with food. As one of the main antagonists of aldosterone, this drug aims at receptors’ binding. It increases the amount of water and sodium and acts as a diuretic by its mechanism. The most serious adverse effects include nausea, breast tenderness, and hyperkalemia. It is not recommended for patients who have anuria or renal function impairment. The interactions with various ACE inhibitors, digoxin, and corticosteroids may lead to severe complications.
Clomid is the brand or trade name of Clomiphene Citrate. This drug is used to promote ovulation induction among women who suffer from PCOS (Sirmans & Pate, 2014). Due to estrogenic and anti-estrogenic properties, Clomid has the function to release gonadotropins and other hormones that may lead to mutations and ovulation. Blurred vision, nausea, and headaches are the main adverse effects of the chosen drug. Women who have cancer or thyrotoxicosis, suffer from depression, or are pregnant should avoid using Clomid. Though its interactions with other drugs remain open for discussions and research (Williams et al., 2016), its use has to be approved by a doctor.
The peculiar feature of metformin is that it is both a generic and brand name of the drug. However, the trade name Glumetza can also be found. It is an insulin-sensitizing agent that promotes glucose tolerance in diabetic and pre-diabetic patients. It can decrease the intestinal absorption of glucose and improve insulin sensitivity. Its recommended dose is between 1,500 mg and 2,250 mg daily (Williams et al., 2016). Though the properties of this drug are effective in dealing with insulin resistance, such adverse reactions as nausea, diarrhea, and hypoglycemia cannot be ignored. The patient should be informed about such contraindications as renal failure or sensitivity to hydrochloride. Interactions with such drugs as glyburide, furosemide, and digoxin should be avoided because such a combination can result in zero treating effect.
Alternative Therapies
Healthy eating.
Physical exercises.
Acupuncture.
Vitamin D.
Herbal interventions.
PCOS patients may also address alternative medicine and choose a therapy that meets their interests, cultural values, and traditions. This type of disorder is characterized by multiple changes in the body and makes a woman choose the most appropriate option for her health but never personal demands. Therefore, alternative medicine may be an effective solution for patients with PCOS. For example, healthy eating and physical exercises can be offered on a regular basis. Acupuncture and Vitamin D therapy can help to deal with insulin sensitivity. Finally, herbal interventions including the tablets with Galega officinalis or Tribulus terrestris can be chosen (Arentz et al., 2017). Still, official approval and pre-treatment assessment are required to make sure that such alternatives are not harmful to the patient.
Evidence-Based Support
Arentz et al. (2017): Herbal therapies for PCOS patients.
Dreischulte & Guthrie (2012): Medication safety.
Legro et al. (2013): Diagnosis and treatment of PCOS.
Sirmans & Pate (2014): Medication management for PCOS.
Williams et al. (2016): PCOS clinical guidelines.
Treatment of PCOS is a significant task for many medical and healthcare facilities. It is not enough to diagnose a patient and offer several treatment options. It is more important to give clear explanations, develop trustful relationships, and demonstrate care and support. Arentz et al. (2017) investigate alternative treatments that can be offered to PCOS patients. They focus on herbal therapy and explain how infertility can be treated. Research by Dreischulte and Guthrie (2012) helps to clarify the basics of medication management and introduce a safe and effective pharmacological care plan. Lergo et al. (2013) discuss various diagnostic and treatment tools for PCOS patients, categorizing the stages of the disease and including possible co-morbid diseases. Sirmas and Pate (2014) introduce effective medication management for PCOS, focusing on all heterogeneous endocrine characteristics of the disease. Finally, Williams et al. (2016) explain available medications and dosages to treat all symptoms of PCOS.
Barriers to Practice
Collaboration in medication management
Interprofessional communication
Healthcare literacy
State and federal laws and policies
Cultural Diversity
Drug prescription does not usually take much time. Still, its outcomes and necessary preparations play a more important role. This process is also challenged by a number of barriers that may be related to a disease process. PCOS patients and healthcare professionals who have to work with them have to consider such issues as medical management collaboration, interprofessional communication, state/federal laws and policies, cultural diversity, and healthcare literacy (Dreischulte & Guthrie, 2012). Collaboration in medication management can be a problem because of the necessity to take several drugs at the same time. To make the right choice, clinicians have to communicate. Unfortunately, because of not strong enough healthcare literacy, patients fail to understand the importance of each element of the offered therapy. In addition, state and federal laws may prevent the development of PCOS research. Today, many US policymakers and lawmakers are interested in promoting the awareness of PCOS among the population. However, the threat of cultural diversity cannot be ignored because the USA is a multicultural country with a number of immigrants and communities being created.
Cultural Diversity
Medication management is culturally biased:
Infertility is not acceptable
Extreme hair growth or loss should be controlled
Contraception is not always allowed
Readiness to share the diagnosis with others
Culture may be a significant barrier to medication management of PCOS. There are many issues in dealing with some groups of people that can promote misconceptions about human cultural beliefs. PCOS is the disease that makes women unable to have children, and infertility can be a shame for some cultures. The presence or absence of hair is another concern. In civilized countries, women have to shave legs, hands, and face (in case of emergency). Urban citizens may avoid such procedures. Even the use of contraceptive pills as a part of anti-PCOS therapy can be an issue for some cultures. Contraception remains a taboo in many nations. Finally, not all people can receive psychological help because of the inability to share their health problems and diagnosis. Medication is challenged because of poor communication and collaboration between cultures.
Healthcare Literacy
PCOS is a gender-related disorder
4-8% of women suffer from PCOS
40% of women cannot have children because of PCOS
Family history is a risk factor
PCOS is a medically treated disease supported by personal goals
Regarding medication management for PCOS patients, healthcare literacy is not as properly developed as it should be. The reasons for such barrier may be such a factor as its gender-related nature or a small percentage of cases. Only 4-8% of women have PCOS and receive treatment according to the diagnosis given (Sirmas & Pate, 2014). Despite the fact that PCOS is the reason for why about 40% of women who cannot have babies, not much attention is paid to its prevention and management (Legro et al., 2013). Family history is another issue that influences healthcare literacy. Not many family members are ready to discover their PCOS-related problems and use this information during wellness check-ups. Finally, PCOS is the disease that can be treated with the help of medications and pharmacologic therapies. Still, many patients and medical workers neglect the role of personal motivation and needs in such a care plan.
Identifying Outcomes
Follow prescriptions
Avoid diabetic complications
Achieve a complete recovery from PCOS
Improve healthcare literacy
Communicate about personal problems
If the patient follows the medication treatment plan offered, she has all chances to avoid diabetic complications that are connected to her family history. In addition, PCOS can be treated in about a half month in case the dosage and schedules are followed. Finally, healthy eating and lifestyle can become significant contributions to a complete recovery for the patient. Medication and healthcare literacy must be improved at the community and state levels to make sure that all women are prepared to have such hormonal disorder and aware of how to deal with it at its early stage.
Test Questions
TRUE or FALSE statements:
Polycystic ovary syndrome is frequently observed among men and women.
False – it is a female hormonal disorder.
Polycystic ovary syndrome is one of the leading causes of death among the US population.
False – it is characterized by certain health complications, but can hardly lead to death.
Metformin can be combined with Clomid to treat diabetes.
False – the combination of these drugs can be used to treat PCOS but not diabetes.
Cultural diversity prevents effective medication management among PCOS patients.
True – cultural diversity is a barrier to medication management of PCOS.
Polycystic ovary syndrome treatment can be improved through increased healthcare literacy.
True – poor healthcare literacy is still defined as a barrier to effective treatment of PCOS.
References
Arentz, S., Smith, C. A., Abbott, J., Fahey, P., Cheema, B. S., & Bensoussan, A. (2017). Combined lifestyle and herbal medicine in overweight women with polycystic ovary syndrome (PCOS): A randomized controlled trial. Phytotherapy Research, 31(9), 1330-1340.
Dreischulte, T., & Guthrie, B. (2012). High-risk prescribing and monitoring in primary care: How common is it, and how can it be improved? Therapeutic Advances in Drug Safety, 3(4), 175-184.
Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., & Welt, C. K. (2013). Diagnosis and treatment of polycystic ovary syndrome: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 98(12), 4565-4592.
Sirmans, S. M., & Pate, K. A. (2014). Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical Epidemiology, 6, 1-13.
Williams, T., Mortada, R., & Porter, S. (2016). Diagnosis and treatment of polycystic ovary syndrome. American Family Physician, 94(2), 106-113.
When it comes to variables and their implications to find a correct answer, it is important to understand that they are interconnected. As a result, the right choice of the first parameter will help to experimentally determine the balanced measure of the dependent one and illustrate the result of working with uncertainty and unintentional confusion. Due to this fact, evidence-based practice projects need a logical and reliable explanation of independent and dependent variables choosing, which will directly influence the experiment outcome.
To begin with, any professional experiment requires cause-and-effect interconnection, which leads its author to the specific result. When it comes to cause the creation, it is possible to put some word-interpreted data at the beginning of the process. However, when the experiment ends and the outcome analysis must be made, the numerical data is indispensable due to the further analysis needs. More specifically, providing word data that cannot be written numerically is impossible for the qualitative evidence-based project due to the structuring obstacle (Nevile et al., 2020). Most of the data should be categorized by some specific criteria so that if independent variables could be easily changed into another type of data, the outcome of the experiment must be written numerically owing to the further qualitative analysis needed.
In addition, every practice that requires evidence must be provided multiple times for the “clarity” of data. As a result, independent and dependent variables are needed to provide a qualitative analysis. However, there is a significant dependent variable issue since the combination of factors that could be implemented in the same experiment might influence the outcome. To find the solution, it is crucial to provide clear experiments and double-check the independent variable factor singularity (Candel et al., 2019). Consequently, dependent variables will become more interesting for the evidence-based project due to their credibility.
Evidence suggests that persons with severe mental disorders are more likely to have a shorter life. For example, the data mentioned by Roberts et al. (2017, p. 441) suggests that “the life expectancy of people with severe mental disorders is decreased by 10 to 25 years.” This endangered population group includes individuals with schizophrenia, bipolar disorder, and severe depression, which are relatively frequent diseases (Roberts et al., 2017). Thus, mentally ill people constitute a part of the population and suffer from issues connected to their syndromes leading to an earlier death.
Certain circumstances accompanying the mental disorders contribute to the decreased life expectancy of the ill. First of all, suicidal thoughts and intentions are common for persons with disorders. Secondly, medications for the treatment of mental problems can provoke life-threatening physical illnesses such as cardiovascular disease. Thirdly, the inability of a person to fit into society and guarantee a stable profit for life sustenance results in poverty. Then, starvation and poor conditions, as well as harsh behavior of the general population, cause premature death (Roberts et al., 2017). Therefore, individuals with mental disorders are more likely to commit suicide, suffer adverse effects of medications, and experience complicated interactions with the environment.
However, the procedures developed after studying mental illnesses and their treatments may help the deceased ones. The programs of recovery allow their patients to recognize their disorders. Next, they offer medications and recommend adequate amounts of them. Although some persons, such as a girl from the course material, have not considered the drugs necessary, later they realized that it helps them (SW Classes, 2016). Finally, practitioners provide guides for coping with the harmful effects of diseases and strategies for partial recovery. In brief, evidence-based therapy can improve the lives of mentally ill people by counseling them and granting medical care.
