Evidenced Based Practice: Assessment And Intervention.

In this essay, I am going to consider how evidence-based practice can be used to support, justify, legitimate and/or improve clinical practice. I am also going to explore and discuss primary and secondary research evidences about how nursing interventions can potentially improve the quality of life of patients in the community suffering from heart failure. I will gather these evidences using a literature search which I will include an account of. Using a critiquing framework for support, I will appraise both primary and secondary evidences that I have chosen. I will also look at potential non-evidential factors that can influence evidence utilisation in practice. Finally, a conclusion will be drawn.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

Pressure ulcers occur over bony prominences when skin is compressed for long periods of time, affecting the blood supply to certain areas, leading to ischaemia development (Waugh and Grant, 2001). Compression of skin is caused by pressure, shearing and friction, but can also occur due to pressure exerted by medical equipment (Randle, Coffey and Bradbury, 2009). NICE (2014) states that the prevalence of pressure ulcers in different healthcare settings in December 2013 was 4.7%, taken from data available for 186,000 patients. The cost of treating ulcers can vary depending on severity from £43 up to £374 (NICE, 2014). Evidence based practice skills are essential in nursing as it allows the best available evidence to be used to improve practice and patient care, while improving decision-making (Holland and Rees, 2010). I will be critiquing two research papers; qualitative and quantitative, using a framework set out by Holland and Rees (2010), and will explore the impact on practice. Using a framework provides a standardised method of assessing quality and reduces subjectivity.

Evidence-Based Practice (EBP) was initially a movement in medicine, dating back to early 20th century (Spring, 2007). It was described as a careful decision making process about the care of individual patients using best available evidence by Sackett, Rosenberg, Gary, Haynes, and Richardson (1996). Greenhalgh (2010) gave a similar definition but with more emphasis on the mathematical assessment of the potential benefit and harm. By now, EBP has been widely adopted by many health disciplines, including psychology. In 2005, the American

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

Constance, evidenced based practice (EBP) and quality are important and they are becoming a focus of healthcare payment models that reward for better quality and outcomes. With the repeal of the Sustainable Growth Rate (SGR) legislature and the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, the United States has changed the rules around what determines how much health care providers are paid for services. Starting in 2019, providers including physicians and advanced practice nurses (APNs), will receive payments that are adjusted by the cost associated with, and the quality outcomes of the care provided to their patients for services rendered during 2017 (MACRA, 2015). It is important that all care providers

Evidenced-based practice (EBP) originated in Canada from a new form of medical school which was launched during the 1970s at an institution called McMaster University (Hoffmann, Bennett, & Del Mar, 2010). This new medical program was uncommon in a variety of its methods. The primary variation was the abbreviated three year medical program which is very brief in comparison to other medical school framework (Hoffmann, Bennett, & Del Mar, 2010). Instructors conceded that the ideal concept of teaching medical students everything they would possibly need to know in regards to practicing medicine with in this program was an unattainable undertaking (Hoffmann, Bennett, & Del Mar, 2010). In response to this epiphany, instructors at this institution transformed their educational approach and focused on instruction that would provide students with the skills and tools they would need to effectively locate health information while practicing as healthcare professionals (Hoffmann, Bennett, & Del Mar, 2010). This scientific approach to healthcare is now known as evidence-based practice (Hoffmann, Bennett, & Del Mar, 2010). In the past, healthcare practitioners made decisions for patients based on personal and professional experience, hearsay, and lack of scientific evidence (White, 2004). An evidence-based practice links the

In healthcare, evidence based practice (EBP) has grown and become important in providing the best quality care possible to patients. There are numerous ways to collect and use the research in the nursing profession. Studies are constantly being done to help better nursing and all of the healthcare field in order to help patients live better and maintain their health. There are different types of research such as qualitative and quantitative. Qualitative uses the human experience or something that has been lived by someone and quantitative examines for meaning and goes more in depth to research things and strives to test a hypothesis or makes use of statistical data to answer research questions (LoBiondo-Wood

While there are many people that think that evidence based practice and practice based evidence should stay the way that they are. If you took both of these and used them together it could provide the appropriate treatments and meet the needs of the patients. Evidence based practice and practice based evidence play a big part in the treatment of a patient and their mental health. Evidence based treatment would be a lot better if the research was focused on each patient and what their needs are. There a many mental disorders that require different treatments and most of them are evidence based, but this does not look at each patient individually, and there a many people with health problems that could use both of the research and evidence to help them get better.

Applying evidenced-based practice has three steps. Step one is making sure the research is creditable. Going into detail about step one should model a social work practice. In a social work practice, you always want to make sure you are looking for clarity and in some cases it helps to paraphrase it or reword it differently. As a social worker you have to be non-judgmental and try to understand every perspective. You have to be unbiased when it comes to wording and how it affects the meaning of the conversation. Also, making sure the research on the surveys or interviews are fair and represent the entire population. The second step is when you match your outcome of the research in your own “practice wisdom." As a social worker you want to compare the research you made with prior experience. You want to have different perspective and information that help you understand the client better. Lastly, the last step is to ask questions to the clients about their significance of what they have accomplished by working with you. Just asking what the client has learned can help

Nurses have many responsibilities. Providing safety and the highest quality client care is one of the top priorities. The collective goal for the Quality and Safety Education for Nurses (QSEN) is to educate nurses and future nurses to constantly refine their knowledge, skills and attitude to provide the highest safety and quality to their patients (Cronenwett et al., 2009). Evidenced-based Practice is one of competencies written by QSEN. This is a process which involves the healthcare provider to efficiently and effectively collect appropriate data and research activities to provide optimal healthcare to the patients (Cronenwett et al., 2009).

Utilizing evidence based practice in nursing is paramount today in the always evolving field of nursing. Having the clinical expertise and knowledge of a nurse is just the first step in making decisions for the treatment of a client. Adding the most recent and up to date evidence alongside with the client’s values and preferences is ideal to guiding the process of healthcare (Kelly & Tazbir, 2010). When evidence based guidelines are set forth in the plan of care for a client, the clinician has an abundant of amount of data to make sound decisions on. This allows the nurse to make the best decision or develop the best strategy to deliver care. Evidence based practice also allows

Rachel is a forty-six year old, African American. Rachel suffers from generalized anxiety disorder. She lives with her two college-age daughters in a dangerous neighborhood on the south side of Chicago. Rachel only leaves the house typically between two and four times a month, usually to get her monthly haircut, gets a few items at the grocery store, or goes see her primary doctor. Whenever she needs something, food or otherwise, she has one of her daughters go do it for her. In the past two years, she has held one job for less than a month. Her daughters help pay household bills when they can, but it’s just not enough. Rachel’s bills are piling up, debt collectors keep calling, and it doesn’t faze her.

According to Friedman (2014), the quality and productiveness of clinical care have become most important in many Western countries as the cost of health care continues to rise. Public facilities such as clinics are advice to assess and improve their treatment services as well as tools to target evidence-based practice interventions (Levy et al., 2014). On the other hand, treatment effectiveness, clinical accountability, higher standardization, and cost-effectiveness is another important factor to the administrators, policymakers’, clinicians, and patients alike, complexities comes when controlling what evidence is contemplate acceptable. Some researchers in the field of psychotherapy have suggested that clinicians are not well-enough trained

Mrs. Lowe is a 39year old female who presented to the ED for chest pain and anxiety. She states recent change in anxiety medication, however due to financial strains she could not afford the new medication prescribe to her. Per documentation she reports relational issues with her family as the primary stressor contributing to her distress. At the time of the assessment Mrs. Lowe denies suicidal ideation, homicidal ideation, and symptoms of psychosis. She expressed feelings of irritability, tearfulness, and hopelessness. Mrs. Lowe reports recently her mother died last month, conflict with daughter who just moved back into her home, and a aunt who recently had a stroke moving into her home as well. Mrs. Lowe also reports due to medical issues