Evidence Based Practice in Nursing Essay

Evidence Based course session in breast feeding Essay mental hospitalEvidence based practice is a thickening go across that carrys synthesizing consider findings to establish the best explore rise and correlate ideas to form a body of empirical noesis (Burns woodlet 2007). There are some(prenominal) definitions but the most comm further lessond is Sackett et al (1996). Sackett et al (1996) as cited in Pearson, Field, Jordon, (2007) key outs demonstrate based practicethe conscientious, explicit and judicious use of catamenia best address open certify in making decisions approximately the tuition of individual diligents. The practice of demo based medicine representation integrating individual clinical experience with the best available outside(a) recount from dogmatic explore. (Sackett et al 1996 page 5).The author pass on discuss the importance of evidence for practice, different typewrites and take aims of evidence. The question offset, spread of e vidence, barriers and go forth conduct a critique of cardinal interrogation articles.The importance of evidence based practice is to enable obliges to run utmost timberland superintend, repair outcomes for patient and families and to run a much efficient health service. and then other agencies within the health service will benefit when interventions and do by is based on interrogation (Burns woodlet 2007). According to the nursing and tocology Council (NMC) code shields are accountable to society to provide a high feel of fright so therefore it is important that retains reflect, evaluate the assist and keep abreast of new familiarity and evidence that is available (Burns woodlet 2007). Providing a streamlined service, which is cost effective and based on current evidence based practice has shown to reduce cost but as well as to enhances the character of look at the patient receives (Melnyk et al2010). Working in partnership with the suckle the patient is a ble to infix in decisions about their care. This is not only beneficial for the patient but overly incr simple mindednesss the satiscircumstanceion of the nurse treating the patient (Craig Smyth 2007). Furthermore Craig Smyth (2007) suggests evidence based practice is a line-solving snuggle to the rescue of health care. In using a problem solving approach the nurse is able to integrate clinician expertise and patient preferences to provide severalise care suitable for the patient.To acquire association in the past, nurses render relied on decisions based on trail or error, personalised experience, tradition and ritual. Parahoo (2006) suggests acquire by tradition and ritual are important means of transferring knowledge, for example learning the ward routine. According to Brooker and Waugh (2007) Students learn from effective colleagues who practice resort and on the basis of best evidence. still, a disadvantage of this system of learning may lead to transmission o f invalid information and may site the patient and nurse at risk (Brooker Waugh 2007). According to Burns and woodlet (2007) to generate knowledge a variety of research methods are needed. The two different research methods are denary and qualitative. According to Burns and plantation (2007) numeric research is an objective formal systematic process and demonst grade its findings in numerical info. According Munh wholly told (2001) qualitative research is deriveing information to describe vivification experiences by a systematic and subjective approach and does not use figures or statistics to produce findings. In nursing practice the quantitative approach has been considered to provide stronger evidence than qualitative (Pearson, Field, Jordon, 2007). Pearson, Field, Jordon (2007) suggest health professionals and servicer users get hold of a variety of information to serve change and to include evidence not only of effectiveness but feasibility, appropriateness and m eaningfulness to achieve evidence based health care practice.Evidence based practice promotes the occupation of research evidence as a basis on which to desex health care decisions so it is important to search for the truth and knowledge logic all(a) in ally. Robust research which may draw on expertise and experience represent a higher level of evidence because of the discipline knotted (Burns Grove 2007). There are thirteen steps in the quantitative research process and 1 step gradually builds on another(prenominal) (Burns Grove2007). The beginning of the research process starts with a problem which usually highlights a gap in knowledge (Melnyk Fine-Overholt 2005). The next step is the purpose of the research. This is produced from the problem and identifies the aim of the information (Burns Grove2007). To build a picture up of what is cognise or not known about the problem a literary works review is conducted. This will provide current theoretical and scientific knowledg e about the problem and highlight gaps in the knowledge base (Burns Grove 2007). This is followed by the study framework and research objectives, questions and hypotheses. This continues to the end till all the steps are covered. The final step is the research outcome.Hierarchy of evidence is generated from the lumber of information from different evidence. Practitioners are able to use the pecking order of evidence to inform them on which information is most likely to cave in the maximum impact on clinical decisions (Leach 2006). Leach (2006) suggests hierarchy of evidence may be use to discover research findings that supersede and vacate earlier judge treatments and change them with interventions that are safer, efficient and cost-effective. If findings from a controlled trial run are inadequate, choices should be guided by the next best available evidence (Leach 2006).According to Scottish Intercollegiate Guidelines Network (SIGN 2009) the revised grading system is planne d to place greater weight on the quality of the evidence supporting each recommendation, and to highlight that the body of evidence should be considered as a whole, and not rely on a wholeness study to support each recommendation. The grading system currently in use with the SIGN guidelines starts with 1++ and ends in 4. For the evidence to be rated at 1++ it must include a high quality meta-analyses, systematic reviews of random controlled trails (RCT) or RCT with a low risk of bias. Level 4 is based on expert opinion (SIGN 2009).There are umpteen barriers to implementing evidence based practice. One of the common barriers is staff information and aptitude deficit. Health professionals lose of knowledge in regarding results of clinical research or current recommendations may not beget the sufficient technical upbringing skill or expertise to implement change (Pearson, Field, Jordon 2007). Nurses concord as well as highlighted lack of time as a barrier in applying research to practice. As the number of patients increases nurses face the challenge of providing safe, high-quality care within a short time frame. Nurse educators and researchers have developed a toolkit to ease the implementation of evidence based practice into nursing (Smith, Donez Maghiaro 2007).According to Gerrish and Lacey (2006) dissemination is a process of informing people about the results of a special(prenominal) research. There are many itinerarys to present results, video, seminars and the most accepted is through professional journals. yet with the internet be more nonexempt the researcher is able to post details on the website hosted by NHS go for or university. One disadvantage in using the internet is that it provides no guarantee of quality (Gerrish Lacey 2006). SIGN guidelines are circulated free of charge end-to-end Nation Health Service (NHS) Scotland. For this to happen they must be do widely available as soon as possible to facilitate implementation. Furtherm ore guidelines on their own have proved ineffective and more likely if they are disseminated by active educational intervention and employ by patient-specific reminders relating directly to professional activity (SIGN 2009). pass judgment 1Rydstrom I, Dalheim-Englund A, Holritz-Rasmussen B, Moller C, Sandman P-O (2005). bronchial bronchial asthma attack attack attack quality of behavior for Swedish baberen.Journal of clinical Nursing 14, 739-749. Blackwell Publishing Ltd.As the gloss suggests this was a research to find out how Swedish children with asthma experience their quality of vitality and to look for potential links among their experience of quality of life and some determinants. This study was elegant by using a quantitative research approach which adhered to the aims and objectives. Quantitative research is formal, objective, systematic inquiry that involves numerical data (Burns Grove 2007). The two introduces used in the quantitative research were correlat ion and quasi-experimental (Burns Grove 2007). This is an acceptable method to use as the study was trying to explore the relationship amidst two variables and the findings were produced in a numerical format.In previous lit it was noted investigations in children with asthma around the world all had equivalent experiences (Rydstrom et al2005).It also highlighted that girls and boys perceived asthma in a different way and girls were more likely to include asthma in their social and personal identities where boys would exclude the condition (Williams 2000). The researchers wanted to ask the children how they experience their life biography with asthma. Also to look at possible links between childrens quality of life and determinants such as age, sex, pets, siblings, location and social status (Rydstrom et.al. 2005).some(a) common types of sampling used in quantitative research are random and non-random samples (Burns and Grove 2007). In the article for the purpose of this study all hospitals and clinics were used and fifteen were chosen randomly for the study (Rydstrom et al2005). Both children and parents were asked to participate in the study but children had to meet the inclusion criteria before being selected (Rydstrom et al2005). By using a random sample the general cosmos becomes representative of the larger whole (Parahoo 2006).Validity was established by cross-matching pediatric asthma attack Quality of life Questionnaire (PAQLQ) with About my Asthma (AMA), by Mishoe et.al.(1998). Warschburger (1998) recommended that PAQLQ was a reliable instrument and Reichenberg Brogerg (2000) found that there was no difference concerning dependableness between the Swedish and the original PAQLQ.The study was approved by The morals Committee at the Medical Faculty of Umea University in Sweden and consent was true from parents and children. Burns and Grove (2007) define sampling as a process of selecting groups of people who are representative of the popul ation.Data was collected through egotism administration questionnaires. There advantages and disadvantages in using questionnaires. Advantage premierely, the data is pull together is standardised and therefore easy to analyse. Secondly, respondents bath answer anonymously which may produce more honest answers. A disadvantage is the responses may be inaccurate especially through misinterpretation of questions in self complemental questionnaires. (Gerrish Lacey 2006). Children age seven to seventeen were required to fill in paediatric Asthma Quality of life Questionnaire (PAQLQ) which was used to measure the childrens quality of life in different domains. Parents were required to fill in Paediatric Asthma Caregivers Quality of life Questionnaire (PACQLQ) (Rydstrom et al2005). Children and parents filled in questionnaires separately and a nurse was on hand to help children who could not manage on their own.The researchers clearly identify what statistical tests were undertaken. tho the results are presented in a complex manner. The results showed the majority of children estimated their quality of life at the positive end of the scale. Children describe impairment in the domain of activities than emotions and symptoms for example not being able to run around. Living in the south of Sweden and being a boy were reported to have a bust quality of life. Furthermore children active with a Mum over forty or with cohabiting parents had a better quality of life (Rydstrom et al2005).The researchers brought to the attention of the reader the laminations within the study. Children view friends and their social environment being important to them however there were no questions relating to this and also it did not take into consideration the childs stage of development (Rydstrom et al2005). Also the research was do within a week, therefore would the results be different if it was done over a longer period. This was not a controlled research so there is a possibil ity that some data may be missing as nobody was checking to see if the children had filled in all the questions.The findings highlight it is important for the nurse to look at all aspects of the child development. Furthermore caring tends to focus on the patients limitations, another important counter for nurses is to try to discover those aspects in a childs daily life that devote to a high QoL in order to improve and maintain the childs wellbeing.Critique 2Lyte, Milnes, Keating Finke 2007. Review instruction for children with asthma in autochthonic care a qualitative case study.Journal of Nursing and health care of Chronic indisposition in association with Journal of Clinical Nursing 16, 7b, pp123-132As the title suggests this research article will focus on review management for children with asthma within a primary care setting. This study was accomplished by using a qualitative case study design. In using a qualitative case study design it can provide much more comprehensi ve information than what is available through other methods, such as surveys (Neale, Thapa Boyce 2006). Neale, Thapa Boyce (2006) suggest case studies also suffer one to present data collected from multiple methods (i.e., surveys, interviews, document review, and observation) to provide the complete story. Qualitative research is systematic, subjective approach (Burns Grove 2007) which describes life experiences, meanings, practices and views of those involved (Craig Smyth 2007).In the UK one in eight children suffers from the effects of asthma and the majority of cases are now being managed in the primary care setting (National Asthma Campaign 2001). With improvement in management of asthma over the years there is still a high level of morbidity and mortality (Lyte et al2005). Out of Sight, Out of Mind (Asthma UK 2005) agrees with Lyte et al(2005) that death rates are high. In Scotland the death rates due to asthma interpolate each year. Furthermore inquires have shown at lea st 90% of those deaths could have been avoided. However child admissions to hospital due to asthma have locomote slightly (Out of Sight, Out of Mind Asthma UK 2005). Furthermore it was highlighted through a systematic review of literature published at the time of research that it was unknown whether primary care based asthma clinics were effective. Additionally it think that patients views on asthma clinics were also unknown (Fay et al2003). One cannot ignore the fact that there are evident gaps in generic knowledge of primary care asthma services for children in the UK (Lyte et al2005). Therefore the aim of the study is to investigate current review management of childrens asthma in one primary care trust and to consider the views of children, their parents/carers and the role of the practice nurse in asthma care in one primary care trust (Lyte et al2005).For the purpose of this research Lyte et al(2005) used purposive sampling to gather information. Craig Smyth (2007) suggests there are various methods can be applied to data collection. Lyte et al(2005) used interviews, observations and reviews of available documentation regarding asthma (Artefactual). In using this type of sampling the researchers can be specific on the groups they wanted to target. However they may be an element of bias as the practice nurse selected the parents and children for this research. To strengthen the research the researchers used triangulated methods for data collection. According to Craig Smyth (2007) the theory bottomland triangulation if multiple sources, methods, investigators or theories provide similar findings their creditability is strengthened.The study was approved by the Local Research Ethics Committee and the Universitys Senate Ethics Committee. Throughout the research during the data collection consent was treated as an ongoing process. However there was difficulty in communicating with children. To solve this problem, when meeting with the children the researc hers would go through the informed consent and voluntary participation again. Confidentially of all participants were protected and guaranteed by the Data Protection Act.Children expressed a like to participate and share information in the research (Lyte et al 2005). However some children felt through the research of not being involved. Lyte et al (2005) suggested it is the childs personality that determines how much response the practice nurse receives. It is often give tongue to good confabulation in nursing is crucial and is the foundation of grammatical construction trust and encourages children to seek advice. It is important to communicate with children appropriately to match the stage of development (The Common core out of Skills Knowledge 2010). Ultimately effective communication allows for the exchange of information, needs and preferences of the patient between herself and the patient (The Common Core of Skills Knowledge 2010). However Hobbs (1995) suggests that som e practice nurses may not have the training in regarding complexities of caring for children and their families. One cannot deny that it is important for practitioners to have the appropriate training (Alderson 2000) because children have equal rights to contribute to their care as well as adults (Save the Children 1997).It was noted that children did not have sufficient knowledge about asthma. Furthermore parents and children highlighted that there was insufficient information on asthma in the primary care setting. For children and adults to make informed choices regarding their asthma they require having up to date information to help them in making decisions. as in one practice it was identify that the practice nurse lack confidence in caring for children with asthma and Hobbs (1995) confirms this lack of confidence and points out that practice nurses deal with arrange of illnesses.Parents and children in the study both hold that one area for improvement was the time lag room (Lyte 2005). nigh children may find going to the doctor a very frightening experience. The first expression needs to be reassuring and non-threatening. (Making Your Waiting Room Kid-Friendly 2006). The waiting room should be child friendly and also have books, telly/video for older children. With todays technology many children use electronic computers in the classroom. Some computer programs are touch-screen driven, making them friendly to all levels. Providing a computer in the waiting room may be ideal opportunity to encourage children to show off their technical skills by accessing the computer for health-related information (Making Your Waiting Room Kid-Friendly 2006).It might be concluded from this research the strengths outperform the weaknesses, despite the research being conducted in one primary care trust. The most satisfactory conclusion that can come from this, to facilitate children and parents a comprehensive package of care needs to be put in place in order to ma nage their asthma effectively.ReferencesBurns N, Grove S, (2007). Understand Nursing Research, Building an Evidence-BasedPractice. Fourth EdCraig J V, Smyth R L (eds). (2007). The Evidence-Based Practice Manual for Nurses. China Churchhill Livingstone Elsevier.Leach M J (2006). Evidence -based practice A framework for clinical practice and research design. International Journal of Nursing Practice. 12, pp 248-251Lyte, Milnes, Keating Finke 2007. Review management for children with asthma in primary care a qualitative case study.Journal of Nursing and Healthcare of Chronic Illness in association with Journal of Clinical Nursing 16, 7b, pp123-132Melnyk, Mazurek , Fineout-Overholt, Ellen, Stillwell, Susan, Williamson, (2010). Evidence-Based Practice Step by Step The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing January 2010 Volume 110 Issue 1 pp 51-53Mishoe SC, baker RR, Poole S, Harrell LM, Arrant CB Rupp NT (1998). Development of an instrument to asse ss stress levels and quality of life in children with asthma.Journal of Asthma 35, 553-563.Munhal (2001) cited in Burns N, Grove S, (2007). Understand Nursing Research, Building an Evidence-BasedPractice. Fourth EdQuestionnaires a brief introduction online. (2006) Accessed fifteenth March. Available from .Reichenberg K Broberg AG (2000) Quality of life in childhood asthma use of the paediatric Asthma Quality of Life Questionnaire in a Swedish sample of children 7-9 yearsold. Acta Paediatrica 89, 989-995.Roberts P et al(2006). Reliability and Validity in research. Nursing Standard. 20,44, 41-45Rydstrom I, Dalheim-Englund A, Holritz-Rasmussen B, Moller C, Sandman P, (2004). Asthma quality of life for Swedish children. Journal of Clinical Nursing, 14, pp739-749.Sackett et al (1996) pp 5 cited in Pearson A, Field J, Jordan Z (eds). (2007). Evidence-Based Clinical Practice in Nursing and Health Care. Singapore Blackwell Publishing.Williams (2000) cited in Rydstrom I, Dalheim-Englund A, Holritz-Rasmussen B, Moller C, Sandman P, (2004). Asthma quality of life for Swedish children. Journal of Clinical Nursing, 14, pp739-749.Warschburger P (1998) Measuring the quality of life of children and adolescents with asthma The pediatric asthma quality of life questionnaire.Rehabilitation 37, XVII-XXIII.