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Evidenced-based Practice Proposal Research Process

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Evidenced-based Practice Proposal Research Process

Evidenced-based Practice Proposal Using the Research Process

Research is a systematic review of an issue using different approaches. It collects and evaluates data to support problem solving. It provides new data and information in solving problems. Evidenced-based practice combines clinical expertise with research. In this paper, we will discuss an overview of my selected EBP project which provides foundation to the MSN EBP project, identify nursing concern to be improved, the purpose statement for the EBP proposal, PICOT question and literature search process, the theoretical framework to be used in this EBP proposal, and conclusion. Evidenced-based Practice Proposal Research Process

In this assignment I shall discuss the concepts of evidence based practice (EBP), and briefly outline its importance for my professional practice. I shall select a relevant aspect of practice to my professional discipline, here i will provide a rationale for selecting this aspect within the context of evidence based practice. 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 evidence based practice. Evidenced-based Practice Proposal Research Process

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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’ Sackettet 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. This means that any care or support we deliver, must be evidence based. If care or support we provide has a rationale, then this enables us to deliver it with a meaningful purpose. According to the Nursing and Midwifery Council (NMC) 2008 we as healthcare professionals must deliver care on the best evidence or best practice. 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). Evidenced-based Practice Proposal Research Process

As healthcare professionals I feel any care we deliver , should have a rationale to back up anything we carry out. I feel 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. It is fundamental that we keep our skills and knowledge current, which enables us to provide effective care.

Davidoff et al (2005) found that (EBP) in its earlier days of evidence based medicine, which provides a suitable way in producing efficient clinical decisions, this also avoids routinely work practice and increases clinical performance (Evidence based medicine working group 1992). In the above statement it demonstrates that EBP which was formerly known as Evidence Based Medicine was to deliver the correct means for building

Evidence based practice is fundamental in professional practice. Justifying care that we deliver as healthcare professionals may help protect us from any litigation and claims against us. These complaints may be made by patients/clients that we care for. It is important that we adhere to policy’s 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) 2008, may result in professional misconduct.Evidenced-based Practice Proposal Research Process

Q2

I have selected an aspect of professional practice, which is the treatment of depression and its effectiveness in adults with cancer. I personally feel there is a high prevalence in cancer patients suffering with depression. In my experience, I have found that there are many cancer patients suffering from depression . According to Barraclough (1994) states that depression is the most common psychiatric illness in patients with terminal cancer (1994). The high prevalence of depression in cancer patient has influenced me carry out my own research, which will effectively enhance my knowledge further. Hinton (1963) found that 24% of patients dying in an acute hospital were depressed . It has been found by Casey (1994) 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 identifying a diagnosis in depress.Evidenced-based Practice Proposal Research Process

Q3

“Qualitative research is a naturalistic, interpretative approach concerned with understanding the meanings which people attach to phenomena (actions, decisions, beliefs, values etc) within their social worlds” Ritchie and Lewis (2003).

This defines that a qualitative study is what is realistic and interpretative approach regarding the definitions which people associate phenomenon

The objective of a qualitative research is to describe, explore, and give explanation the phenomenon what is being studied (Marshall & Rossman, 2006). Here,

In this qualitative study it was found that depression is the common psychiatric illness in patients suffering with terminal cancer Barraclough (1994). The study found that depression can not merely lowers quality of life for those suffering with cancer and their families, nevertheless patients whom are depressed may well have physical indications that are complex to palliate. It found that If patients that are primarily treated for their physical conditions, are more likely to recover from depression. Maguire sourced that up to 80% of psychological and psychiatric morbidity, which develops in cancer patients often goes unrecognised and untreated (1985).Evidenced-based Practice Proposal Research Process

It speaks about how patients are non-compliant in discussing symptoms freely 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 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 indefinate the need for additional training in identifying psychosocial and psychiactric symptoms, which also demonstrates the difficulty nurses are faced with in convincing medical staff to follow up assessment or prescribe antidepressant medication .

In conclusion to this study it shows the significant difficulties clicnical nurse specialist have in regards to training and support in psychological and psychiatric assessment, and the management of palliative care patients.

I shall now crtique the study. Firstly,none of the nurses had any form of mental health training. I therefore feel their lack of knowledge may falsify the findings of the study. Lastly, the demographic area may have been expanded a little further, I therefore feel that the findings were minimalistic.

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. Literature should be selected on a specific subject, with a clear rationale of the methodology. The main purpose of a systematic review is to is to keep their audience updated. Evidenced-based Practice Proposal Research Process

This systematic review provides us with evidence on cancer patients receiving interventions such as drug therapy, which demonstrates antidepressants and their effectiveness. 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). It established that depression has a strong link with a person’s quality of life. It also shows that cancer patient’s survival rate may be decline if their immune response is impaired (Anderson et al, 1998; Newport and Nemeroff, 1998; Faller 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 among depression and 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.

On the contrary previous reviews which have failed to identify the dissimilarity between both depression and depressive symptoms, whereas it found that very little data from clinical trials, which show psychotherapeutic interventions, which are effective in reducing cancer patients suffering from depression.

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. Furthermore, given the respect of the methodological boundaries of the studies to this day, the need for further knowledge should not influence the implementation of poor efficacy.

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, providing them with appropriate healthcare services.

In respect to the hierarchy of evidence chart Sackett (1996) states that a systematic reviews are at the peak of the chart, which demonstrates that 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). In conclusion, the strength and validity of evidence from both these approaches are greater than what is produced. This demonstrates that the appraisal of the efficacy, which shows that. Evidenced-based Practice Proposal Research Process

Wallace et al (2001) found that antidepressants may stimulate the growth of a malignancy, which shows the need for a more rigorous examination of pharmacological treatment, and the importance of a substitute such as psychotherapeutic.

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. There needs to be something in place to help prevent the high dropout rate in those suffering with depression, which help aid the accuracy of this studies. If the study had been more thorough, then this may enhanced the results of both pharmacological and psychotherapeutic efficacy.

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 lower level of evidence, which may be classed as an inadequate source of information (Ellis 2000, Lake 2006, Morse 2006b, Rolfe & Gardner 2006). This states that systematic reviews are classified as a high quality source of information, and anything else lower than this is seen as invalid.

Katrak et al (2006) found that new evidence, which shows that research can be obtained from clinical trials, this may be benificial in respect with public health. However, traditional or unsystematic reviews can be apparent and suitable to attain, which can also be deceptive at times, above all they are scientific Murlow(1987).Evidenced-based Practice Proposal Research Process

Q4.

The National Institute for Clinical Excellence published guidelines specifically for the management of depression in primary and secondary care in the (UK)United Kingdom, suggest that screening for depression must be carried out in primary-care and general hospital settings for those who have a higher prevalently, which include those with imperative physical health condition/illnesses NICE (2004). Check nice website

Murlow CD, Cook DJ and Davidoff F (1997) Systematic Reviews. Critical links in the great chain of evidence. Annals of Internal Medicine 126(5):389-91

Aveyard,H,Sharp, P(2009) A beginners Guide to evidence based practice, Berkshire, Open University Press

Claibourne ,S,Rootenberg,J.D.,Katrak,S(2006)Effect of a US National Institutes of Health programme of clinical trial on public and health costs.Lancets 367: 1319-27.

Murlow, C.W. (1987) The medical review article:state of the science. Ann. Intern. Med. 106: 485-8.

Wallace WA, Balsitis M, Harrison BJ, (2001) Male breast neplasms in association with selective serotonin re-uptake inhibitor therapy: a report of three cases.Eur J Surg Oncol 27: 4429-4431

Casey P. Depression in the dying- disorder or distress. Progr Palliat Care 1994; 2: 1-3.Evidenced-based Practice Proposal Research Process

Sackett DL, Rosenberg WMC, Muir GrayJ.A, Haynes R.B and Richardson WS (1996) Evidence based medicine. What it is and what it isn’t,British Medical Journal 312:71-2

Maguire P. Improving the detection of psychiatric problems in cancer patients. Soc Sci Med 1985; 20 :819-23

Gray R, Parr A, Plummer S, Sanford T, Ritter S, Mundtleach B, Goldberg D, Gournay K. A national survey of practice involvement in mental health interventions. J Adv Nurs 1999; 30: 901-906

Bottomley A. Psychosocial problems in cancer care: a brief review of common problems. J Psychiatr Ment Health Nurse 1997; 4: 323-31

Adamek M, Kaplan M. Caring for depressed and suicidal older patients: a survey of physicians and nurse practitioners. Int J Psychiatry Med 2000; 30: 111-25.

Atkin K., Lunt N., Parker G. & Hirst M. (1993) Nurses Count: A

National Census of Practice Nurses. Social Policy Research

Unit, University of York, York.

Payne S. Depression in palliative care patients: a literature review. Int palliat Nurs 1988; 184-91

Catherine Marshall & Gretchen B. Rossman (2006). Designing Qualitative Research. Thousands Oaks: Sage Publication, (4th edition), london

Overview of Selected Evidenced-based Practice Project

Research is the process to gather new data and discover new knowledge. According to the U.S. Department of health and Human Services (n.d.), “research is a systemic investigation designed to develop knowledge”.  Research is a systematic process, not just about discovering knowledge. Research is considered valid and reliable when a scientific method is used in consecutive steps by the researcher. Research assists in applying new treatments, methods, and practices to patient care, which results in increased effectiveness.Evidenced-based Practice Proposal Research Process

Evidence-based practice is a moderately new concept. EBP is a problem-solving approach to clinical decision-making to make patient outcomes better. EBP incorporates knowledge of the research process, and clinical judgement and decision-making. EBP is to improve safety and quality, and enhance optimal care of patient (CCN, 2017). According to Melnyk et al. (2010), there are seven steps of the evidence-based practice process starting with inquiry, come up with clinical questions, Search for the best literature, review the evidence, combine literature review with one’s clinical expertise to make changes, assess the outcomes of changes, and disperse the results. EBP reflects high-quality evidence from research, clinician expertise, patient preferences, available resources, and the context in which care is delivered (Dadich & Hosseinzadeh, 2016). EBP doesn’t always utilize research. It also relies on best evidence by leaders and experts.Evidenced-based Practice Proposal Research Process

Evidence-based practice can’t be implemented without research. Research is conducted to generate new knowledge or to validate existing knowledge based on theories. Evidence-based practice doesn’t validate existing knowledge or develop new knowledge. According to Conner (2014), research is about developing new knowledge, whereas EBP is finding and translating the best evidence into clinical practice. Research uses quantitative or qualitative methodology to develop new knowledge, while EBP uses first-rate clinical evidence from research to make safe decisions for patients (Conner, 2014). EBP is combination of best research evidence, clinical expertise, and patient values in making decisions about the care of individual patients”(Straus and Sackett, 1998).

My MSN program specialty track is Family Nurse Practitioner. My practice focus is primary care setting. Advance practice and master prepared nurses have a better understanding of evidence-based research and implement. As the nursing profession continues to evolve, expectation is that the nurse follows scientific foundation to support the care. As a master’s-prepared advanced practice nurse, we combine past and current evidence-based knowledge and skills, and apply them to current practice to improve patient outcome (CCN, 2017). Masters prepared nurses are responsible for implementing EBP into current practice. The Master’s-prepared advanced practice nurse is expected to improve practice in selected specialty track by examining knowledge gaps, come up with research, and find solutions to improve practice (National League for Nursing [NLN], 2010). Research has proven that when nurses practice using EBP, patient outcomes improve (Black et al., 2014). Evidenced-based Practice Proposal Research Process

Identification of the Nursing Concern to be Improved

I currently work in emergency room, and have seen increased number of patients admitted due to congestive heart failure. Heart failure is also known as Congestive Heart Failure because of fluid buildup in different body organs and extremities (CDC, 2015). In patients with CHF, the heart muscle is too weak to pump enough blood to meet the body’s requirements. Majority of the heart failure cases are chronic or long-term. It affects about 5.7 million adults in the United States (CDC, 2016). According to CDC, approximately 50% of the people who are diagnosed with heart failure die within 5 years of diagnosis. The selected nursing concern is CHF patients fail to manage their care at home, and increased hospital readmissions. More than 20% of the heart failure patients are readmitted within 30 days and up to 50% by 6 months (O’Connor, 2017). Patients with CHF do not weigh themselves at home on regular basis or stop taking their Lasix. By the time they become symptomatic, it is a little late to treat at home. Those patients get admitted to the hospital. It affects their quality of life and affects them financially. Heart failure costs the nation an estimated $30.7 billion each year including the cost of health medical services, pharmacy expenses, and disability. Proposed solution to the selected concern is for CHF patients to use smart phone app where they can record their weight daily, which will be sent to the provider directly and have it recorded in patient’s chart automatically. If patient has gained significant amount of weight, the provider can then call the patient with adjusted Lasix dose or with other medical advice depending on the case. How can the care of CHF patients be improved in order to decrease hospital readmissions and improve quality of life? Evidenced-based Practice Proposal Research Process

Evidenced-based Proposal

PICO also known as PICOT is a mnemonic to describe the four elements of a good clinical question. It stands for P: Patient/Problem, I: Intervention, C: Comparison, O: Outcome and T: Time. PICO helps clarify the research question which makes it easier to find answers. PICO terms can be used to re-write your research question or vice versa. My PICOT question for quantitative research approach is: Is there decrease in number of hospital readmissions among CHF patients above the age of 65 who utilize smart phone app or telehealth to manage their care, compared to the patients who do not, over the course of 6 months? The expected outcome is decreased hospital readmissions and improved quality of life. If CHF patients can be monitored routinely by their primary care providers, CHF exacerbation can be caught early and hospital admission can be avoided. With the use of telehealth, patients can be managed more closely. As a future NP, I will be taking care of patients with CHF, and improved care and quality of life of those patients is my responsibility.Evidenced-based Practice Proposal Research Process

Literature review is not a criticism or a compilation of everything written on a particular topic. Literature review is an analysis of scholarly papers that are related to your topic of interest, research question or proposal. It provides background information on your topic. It could be a work of one person or an introduction to a larger research paper. Reviewing literature leads to more research question. Literature review might make you think there is a need to   rewrite or rethink your research question, and you need to find more literature related to a specific aspect of research question (UWF, 2018). It helps you find what studies are already done, and what were the outcomes. Steps of conducting a literature review are as follow: First you need to choose a topic and define your research question, decide on possibility of review, choose the database, find the literature, and review the literature (UWF, 2018). The specific library databases used for this EBP proposal are Chamberlain University online library and American Academy of Family Physicians. The key search terms used were Congestive Heart Failure and Telehealth, CHF and smart phone app, and CHF and readmission rate. Specialty organizations that are relevant to this EBP proposal are American Heart Association and CHF International.Evidenced-based Practice Proposal Research Process

Theoretical Framework

Theoretical framework requires literature review, and defines concepts that are important to your research. Before you define the key concepts of your research, it is important to do a literature review of theories and models that are relevant. It provides scientific justification for your investigation. For my EBP proposal, I have chosen the Patient Centered Nursing and Nola Pender’s Health Promotion model. PCN framework was originally developed in 2006 by McCormack and McCance with intention to evaluate the use of patient-centered nursing. This model addresses all four concepts within the metaparadigm: Person, health, nursing, environment. The PCN framework is developed with the patient at the center of nursing care (McCormack & McCance, 2017). The goal of the patient-centered care is to make patient health and outcomes better. Outcomes are the results of an effective patient-centered care. The expected outcomes with PCN framework include patient experience and satisfaction, engaging patients in their care, feeling of wellbeing, and incorporate mind, body, and soul (McCormack & McCance, 2017). Another theoretical framework which will be used in this EBP proposal is Nola Pender’s Health Promotion model. It was developed after she realized the professional only intervened after patients developed acute or chronic problems. She believed those problems could be prevented before they occurred. It would improve patients’ quality of life and save health care money. The PCN framework is applied to this EBP proposal by involving patients and family in the care planning, which in turn, helps achieve the patient-centered outcomes. In order to prevent CHF exacerbation and avoid hospitalization, it has to be maintained at home, and it cannot be done without patient or family involvement. Pender’s theoretical framework will be applied to this EBP by preventing problems before they occur. It will require the patients to follow their medical regimen such as weigh themselves as per provider’s instructions or take lasix as prescribed so CHF can be maintained and prevent exacerbation.

Conclusion

As we already know research is the process to gather new data and discover new knowledge. It uses systematic process called scientific method. Evidence-based practice is a problem-solving approach to clinical decision-making. EBP is built upon research. However, it doesn’t always use research. EBP uses evidence with clinical expertise. Masters prepared nurses are responsible for implementing EBP into current practice to improve patient outcomes. PICOT question for quantitative research approach was presented along with theoretical framework to be used in this proposal. The PCN and Pender’s theoretical framework will be applied to this EBP proposal.Evidenced-based Practice Proposal Research Process

References

  • Black, A., Balneaves, L., Garossino, C., Puyat, J., & Qian, H. (2014). Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians. JONA: The Journal of Nursing Administration, 45(1), 14-20. Doi:1097/NNA.0000000000000151
  • Center for Disease control (2015). Other Conditions Related to Heart Disease. Retrieved from https://www.cdc.gov/heartdisease/other_conditions.htm

  • Connor, B, T. (2014). Differentiating Research, Evidence-based Practice, and Quality Improvement. American Nurse Today, 9(6). Retrieved from https://www.americannursetoday.com/differentiating-research-evidence-based-practice-and-quality-improvement/
  • Dadich, A., & Hosseinzadeh, H. (2016). Communication channels to promote evidence-based practice: A survey of primary care clinicians to determine perceived effects. Health Research Policy and Systems, 14(1). Evidenced-based Practice Proposal Research Process. Doi:10.1186/s12961-016-0134-z
  • McCormack, B., & McCance, T. (2017). Person-centered practice in nursing and healthcare: Theory and practice. (2nd ed.). Chichester, West Sussex; Ames, Iowa: John Wiley & Son LTD.
  • Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: The seven steps of evidence-based practice: Following this progressive, sequential approach will lead to improved healthcare and patient outcomes. American Journal of Nursing, 110(1), 51–53.
  • National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate, and research doctorate programs in nursing. New York, NY: National League for Nursing.

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  • O’Connor, C. M. (2017). High Heart Failure Readmission Rates. JACC: Heart Failure, 5(5), 393. doi:10.1016/j.jchf.2017.03.011
  • McCance, T. McCormack, B., & Dewing, J. (2011). An exploration of person-centeredness in practice. Online Journal of Issues in Nursing, 16(2). doi:10.3912/OJIN.Vol16No02Man01
  • Petiprin, A. (2016). Nursing Theory. Retrieved from http://nursing-theory.org/nursing-theorists/Nola-Pender.php
  • Straus, S.E. & D.L. Sackett. (1998). Using research findings in clinical practice. British Medical Journal 317 (7154):339-42
  • U.S. Department of Health and Human Services. (n.d.). Module 1: Introduction: What is Research? Retrieved from https://ori.hhs.gov/module-1-introduction-what-research
  • University of West Florida (2018). Literature Review: Conducting & Writing. Retrieved from https://libguides.uwf.edu/litreview. Evidenced-based Practice Proposal Research Process