Evidenced Based Practice

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.

Researchers investigate the nurses’ clinical practices about utilization of EBP to direct their practices. But despite the enriched source of literature, nurses’ knowledge of Evidence Based Practice

Evidenced Based Practice (EBP) is essential to enable all nurses to provide the most current up to date practises for their patients. This process involves research, systematic review of current practises, critical thinking skills, evaluation and application to the clinical setting. In addition to this, the nurse must take into account the patients’ preferences. For nurses to have professional autonomy they must be able to justify their actions and demonstrate an understanding of why they perform the tasks they do. This defines them as unique professionals judged by their knowledge and not simply by their hands on skills.

The Smith family is an African American family currently residing in Bartlett, TN. The family owns a home in an established, middle class neighborhood. The Smith’s home is clean, updated and organized. John and Jane Smith, 48 and 45 respectively, live in the home with their 18 year old son, Junior. Both Mr. and Mrs. Smith are college graduates and have been financially preparing for their son’s matriculation to college. Mr. Smith was diagnosed with Amyotrophic Lateral Sclerosis (ALS) in the fall of 2015. Mr. Smith has recently been terminated from his job, leaving Mrs. Smith as the sole wage earner. Mrs. Smith is suffering from acute anxiety and is experiencing panic

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

The impact of evidence based practice has been brought into nursing through education, practice, and science over the last decade. Evidence based practice provides quality care to patients that is effective, safe, and efficient. Evidence based practice promises moving care to a high level of producing the intended health outcome for the patients. “EBP is aimed at hardwiring current knowledge into common care decisions to improve care processes and patient outcomes” (Stevens, 2013). EBP empowers nurses and expands their skills by using the best available evidence to guide nursing care and patient outcomes.

Evidence based practice is the incorporation of individual clinical expertise with best research evidence and patient values and expectations. Health care decision of individual patients should be based on best available research evidence. A health decision made from a sound research evidence has the potential to ensure best practice and reduce variations in health care delivery. In health science, an ever increasing plethora of studies being published and is challenging for clinicians to keep up with the literature. Integrating research into practice is time consuming and need methods for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on the latest research evidence. Systematic reviews and meta-analyses summarize the research evidence, which is generally the best form of evidence, thereby making the available evidence more accessible to decision makers and are positioned

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

Evidence - Based Nursing, An introduction (2008, p. 285 ) “ The rapidity of change and the reorganization of nursing services within the health care sector presents challenges for the advancement of EBP. Managers and administrators should facilitate the uptake of practice based on current, high-quality research by formalizing the expectation that nurses care be Evidence Based”.

Evidence-Based Practice integrates the best research with clinical expertise and patient values for optimum care and participates in learning and research activities to the extent feasible. EBP might impact interventions such as prevention diagnostic tests or therapy may affect the ability to compare alternatives, and in some cases, lead to the decision that no intervention is the best choice. EBP can improve nursing care. EBP within nursing care is a problem-solving approach to making clinical, educational, and administrative decisions that combines the best available scientific evidence with the best practical evidence” (Newhouse,2006, p.337).EBP increases nurses clinical knowledge. EBP within nursing care also helps to get research results

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).

Practicing the current evidence-based and research will help nurses to deliver care to their patients. And nurses should apply evidence-based nursing practice in their practices. For instance, during the simulation practice, nursing students elevated the patient’s bed in sim-flower position to increase the o2 saturation level of the patient. Thus, they followed the evidence-based practice to increase the o2 saturation level of the patients and patient benefits from the practice.