Evidence-Based Decision-Making Essay

Objective: To identify quality indicators with the largest potential to improve health outcomes in the Ontario COPD patient population.

Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.

According to Stevens (2013), the call to develop and implement evidence-based practice (EBP) within all healthcare disciplines is fueled by legislative demands for improvement in standard medical metrics such as mortality and morbidity. However, increasing demands by the public for evidence related to the metrics and outcomes of such concepts as quality of life illustrate what may be more important to the client (Stevens, 2013). This client-directed focus has resulted in patient-centered outcomes research (PCOR) (Stevens, 2013). "The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information

In order to find the patients baseline an assessment of functionality is needed for comparison. When assessing a patient it is important to pay attention to the abilities of activities of daily living regularly. An assumption of Orem’s Self-Care Deficit Theory is that a person’s knowledge of potential health problems is needed for promoting self- care behaviors (Nursingtheory.org, 2013).

Evidenced-based practice (EBP) should be a driving force behind establishing optimal clinical practices. These efforts hold the potential to improve patient outcomes and reduce costs (Ahrens, 2005). It is true that evaluation tools are very effective for any kind of evidence-based change project. It helps in finding out the project needs, implementation and outcomes. Ideally, evaluation begins when a group of patients’ assessment is initiated and continues across the life of a program to ensure adequate implementation (Jacobs et al., 2012).

For this week, I chose to do my discussion on the presentation presented by Nhat Le. The title of his presentation was “Annual Cost for a COPD Patient”. The main objective of his research was to compare and contrast Medicare and private insurance coverage and understand the annual costs of patients dealing with COPD. Along with the cost, he also discussed the treatment and medication options available for COPD patients. Upon reading his presentation, I learned that along with medical therapies, it is essential to have a good nutritional plan for these patients as well, because patients dealing with severe COPD may suffer from unintended weight loss and have trouble eating enough due to their symptoms such as shortness of breath and fatigue.

The aim of this paper is to formulate a PICOT question and describe how important this research question is to nursing practice. It will include a summary of five research articles related to my PICOT question and identify a nursing practice that is supported by current research. The paper will also explain how a nursing practice that is supported by evidence-based practice can contribute to better outcomes. Lastly, I will share a strategy to share evidence-based practice throughout my organization and explain the importance of the practice.

Type your answers to the following questions using complete sentences and correct grammar, spelling, and syntax. Click Save as and save the file with your last name and assignment, e.g.,NR439_Research_Database_Smith. Submit to the Research Database basket in the Dropbox by 11:59 p.m. MT Sunday at the end of Week 4. The guidelines and grading rubric for this assignment may be found in Doc Sharing.

This essay will be a critical review on the study conducted by Majid et al (2011). The article which is titled ‘Adopting evidence-based practice in clinical decision making:

Evidence-based health care is the “conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services” (Cochrane, 2014). Best evidence is based on current information from relevant, peer-reviewed research that can include such topics as the effects of health care, the potential for harm, the accuracy of diagnostic tests, and the reliability of prognostic factors (Cochrane, 2014). Several different scales exist to quantify and assess this evidence, such as the one used by the U.S. Preventive Task Force (USPSTF, 2012). For purposes of the DNP program, the scale utilized by the Joanna Briggs Institute is more applicable (JBI, 2013, pdf). The JBI Grades of Recommendation consist of an “A” grade and a “B” grade. An “A” grade signifies a strong recommendation based desirable effect, adequate supporting data, beneficial of low impact to resource utilization, and that values, patient experience, and preferences have been considered. A “B” grade signifies a weak recommendation where it is unclear if desired effect outweighs undesired effect, the supporting evidence is not of high

PICO questions break down the components of an evidence based decision making process into chunks of information which are more easily compiled in order to formulate an appropriate research question. P= Patient problem or population, I= Intervention, C= Comparison (where it is applicable), and O=Outcomes. For this change project question, the PICO formatted question is broken down as follows:

Evidence-based practice (EBP) offers a framework utilization of systematic high-quality research, an analysis which consistently enhances measurable client outcome and clinical decision-making grounded in rationality; EBP depends on data collected through experimental research and accounts for individual client characteristics and clinician expertise. The potential benefits of EBP comprise of increased service delivery and quality of care, heightened accountability, and a bridging of the research-practice gap (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). It is imperative that research scholars are cognizant of research outcome dependability and validity prior to implementing results

We have to think about the qualitative factors that are involved in our decision making too. In the decision making process, as we saw in a case called The Nancy M. Hohman, we saw that many times the numbers will not speak louder than our personal preferences. The Nancy M. Hohman was a less than one year old ship, worthy US$ 40 million, carrying 200,000 tons of crude oil and 28 crew members and had an engine malfunction 9 miles way off the coast of South Africa. However, Port Elizabeth (the nearest one) was too small for the ship and the next close one was 380 miles away.

Cardiac Rehabilitation programme is offered to patients post myocardial infarction. Rehabilitation is defined by the Royal College of Nursing RCN, (2000,pg.3) as re-enablement which means "helping people adapt to changes in their life circumstances." Cardiac rehabilitation is defined by Jowcett and Thompson 1996 cited in Noy (1998,pg.1033) as "the process by which patients with coronary heart disease are enabled to achieve their optimal physical, emotional, social and economic status". Furthermore, it is also defined by the World Health Organisation WHO, (1993) cited in the National Service Framework for coronary heart disease DOH, (2000,pg.3) as the "sum of activities required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and social conditions, so that they (people) may, by their own efforts preserve or resume when lost, as normal a place as possible in the community". Rehabilitation is a complex activity that requires contributions from many members of the healthcare team. Rehabilitation is a planned, goal-directed activity that requires assessment and re-assessment using standardised measures to monitor progress. It must include patients and their families and friends.

Everything you do is a choice. You choose the way you are living today. As we walk on the path of life, we are presented with cross roads and forks. Some are pretty obvious which turn we should take. However, not everything is easy in life. And in the fast pace life we are currently living in right now, we move so fast that we meet many more challenges than before and often, we hastily decide on the choices we make.