Evidence Based Practice Samples for Students †MyAssignmenthelp.com

Question: Discuss about the Evidence Based Practice. Answer: Evidence Based Practice (EBP) Evidence based practice is the type ofnursing practice in which the current evidence are used in making decisions about patient care (Hall Roussel, 2016). It is a type of problem solving approach for the clinical learning. It is a systematic search and a type of critical appraisal of the evidences to find the answer to a clinical problem. The EBP is a method which allows the medical practitioner to study journals, clinical guidelines and other resources based on the information, and then apply the findings to clinical practice. The evidence does not make the decision but it helps to support the process of patient care. It includes three important components which is needed to the practice, these are: Best research evidence Clinical expertise Patient values and preferences These three components enhance the clinical outcomes and the quality of life. EBP generally requires new skills of clinical learning, which includes literature searching and the application of the evidence for the evaluation of the problem. The EBP is usually needed to generate the questions for the therapy, the diagnosis, and the prognosis of the diseases. Key Steps in the EBP Process Framing the Clinical Question Finding the Evidence Assessing the Evidence Making the Clinical Decision Concepts in Evidence-Based Public Health Systemic Review: basic appraisal and assessment of research that endeavors to address an engaged inquiry utilizing the techniques proposed to lessen the probability of predisposition. The procedure of organizing a systemic review incorporates a search of the writing, also including unpublished examinations. Meta-Analysis: outline that joins a quantitative system for consolidating the results of various examinations into summary. Risk Assessment: It is a type of approach to deal with the threat to people and populations by natural contaminations. Decision Analysis: precise way to deal with basic leadership under vulnerability; includes recognition of every single accessible option and assessing the probabilities of potential results related with every option, esteeming every result, and, on that basis of the probabilities and qualities, a quantitative study is estimated. Economic Evaluation: relative analysis of the alternatives in terms of their expenses and results. Expert Panels and Consensus Conferences: examination of research contemplates and their importance to being healthy conditions, remedial and therapeutic strategies, arranging health policies, and group interventions. Ordinarily the boards of specialists are assembled by government offices or particular wellbeing associations. Practice Guidelines: methodically created to help expert and patients decisions about health care for particular clinical conditions; might be created by government offices, establishments, or by the gathering of master boards. Barriers of evidence based practice The structures and culture of the associations are the main barriers of evidence based practice. Components which are external to the individuals are of most important. Existing hierarchical structures is the proof of the existence of a generally respectful culture which stresses the routine in basic leadership are clearly mentioned in NHS. Given this reality, associations should receive various methodologies to encourage and advance the utilization of proof by and by basic leadership. Barriers to the utilization of research in clinical practice have been cited as often as possible. Studies have researched imaginable barriers to the selection of EBP by medical nurses. These examinations have distinguished regular obstructions over various nations. Truly, the essential boundaries to the utilization of research have been connected to the support given by the association in which medical attendants work, the medical attendants' examination esteems and aptitudes, the nature of research, and how the exploration is imparted or displayed. Facilitators of evidence based practice The key facilitating factors for EBP include support, encouragement, and recognition by the management and administration. Numerous facilitators of research utilization have been recognized in the articles. These facilitators incorporate administrative and associate help, accessibility of time to audit and execute examine discoveries, accessibility of significant research, partners' help, strong arrangements, and preparing openings. Barriers and facilitators to inquire about usage were classified into authoritative variables, singular components, communicational elements, and nature of research (Harvey Kitson, 2015). PICO The PICO is a technique to study evidence based practice and makes a framework to find the answer of a health care question. The PICO stands for P Patient, problem or population I Intervention C Comparison or control O Outcome PICO Does the platelet transfusion indications in pediatric cancer patients works or not? P: population (pediatric cancer patients) (aged less than 18) I: Intervention strategy: blood components transfusion (platelets, red blood cells, cryoprecipitate) irradiated products, leukocyte-depleted products, platelet aphaeresis. Comparison: Platelet transfusion is suitable or not Outcomes: indications for transfusions in the specified population. Introduction Transfusion therapy is the mostly used now-a-days for the treatment of pediatric cancer. In this paper the age group which was taken into consideration for addressing is under 18. Despite the knowledge of the principles of immunology which maintains the transplants of a tissue by minimizing the transfusion therapy risks. Additional evidence is needed to determine the most appropriate instance for using transfusion therapy in pediatric cancer patients. The first step was searching for evidence-based clinical practice guidelines in Pub Med, CINAHL, MEDLINE, WHO - World Health Organization, Google scholar, National Cancer Institute Journal and many more. Keywords that were used for the search are: Infant OR Child, Adolescent OR childhood OR Pediatrics OR Minor AND Blood Component Transfusions OR Erythrocyte Transfusions OR Red Blood Cell Transfusion OR Platelet Transfusions OR Blood Component Transfusion OR Aphaeresis AND Tumors OR Neoplasm OR Tumor OR Cancer OR Neoplasm OR Neoplasm AND Random research design OR Evaluation Studies OR follow-up studies OR prospective studies OR cross-over studies OR control OR prospective OR volunteer AND evidence-based medicine Journal no. Title Authors Year of publication Scoring 1 Platelet transfusion: a Clinical Practice Guideline From the AABB Platelet transfusion: a clinical practice guideline from the AABB. Annals of internal medicine, 162(3), 205-213. Kaufman et al. 2015 Recommended 2 Red blood cell transfusion practice in children: current status and areas for improvement? A study of the use of red blood cell transfusions in children and infants. Transfusion, 54(1), 119-127. New et al. 2014 Agreed 3 Characterization of transfusion-derived iron deposition in childhood cancer survivors. Cancer Epidemiology and Prevention Biomarkers, cebp-0292. Ruccione et al. 2014 Agreed 4 Platelet transfusion: a systematic review of the clinical evidence. Transfusion, 55(5), 1167-1127. Kumar et al. 2015 Strongly agreed 5 Current status of platelet transfusion in pediatric patients. Transfusion medicine reviews, 30(4), 230-234 Sloan Parker 2016 Recommended 6 Transfusion therapy evidence-based recommendations for the pediatric cancer patient. Colombian Journal of Anesthesiology, 44(2), 151-160. Pardo-Gonzlez, Linares Torres 2016 Agreed 7 Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in non-massively transfused patients. The American Journal of Surgery, 211(4), 656-663. Havens et al. 2016 Agreed 8 Transfusion?related alloimmunization in children: epidemiology and effects of chemotherapy. Vox sanguinis, 111(3), 299-307. Solh et al. 2016 Recommended 9 Implementation of Evidence-Based Care in Pediatric Hematology/Oncology Practice. In Patient Safety and Quality in Pediatric Hematology/Oncology and Stem Cell Transplantation (pp. 253-275). Springer International Publishing. Werner Ramirez 2017 Strongly agreed 10 Analysis of Prognostic Factors of Hematopoietic Stem Cell Transplantation Patients Admitted to ICU. Abstracts/Biol Blood Marrow Transplant, 22(S19eS481), S19eS481. Fielding, Grigg, Booth 2016 Agreed A key rule in transfusion treatment expresses that the reason for anaemia might be recognized before RBC transfusion. Moreover, the choice to transfusion of RBC must depend on the symptoms instead of by the hemoglobin levels and remember that RBC transfusion is just suggested in the patients who are suffering from leukemia and unable to manage normal range of hemoglobin. There are two basic therapies for this disease. The prohibitive methodology that demonstrates transfusion is based on two principles: haemoglobin level below 8g/dL and proof of hemodynamic degeneration. The second approach is liberal and sets up more elevated amounts of hemoglobin ignoring the hemodynamic effect. The result of this survey suggests the prohibitive methodology, to diminish the extent of transfused patients and the measure of RBC transfused, with no effect on morbidity or term of staying at hospital. The conclusion is thus stated that the advantages of reducing transfusions are more than the threat of RBC transfusion. Platelet transfusion support is resolved on the principle of two methodologies: a prophylactic technique described by recording platelet count to keep the threat of haemorrhage; and the therapeutic methodology that suggests platelet transfusion when bleeding causes. In the case of platelet transfusions, allo-immunization might be avoided, A with respect to ABO platelets. Un-identical ABO platelet organization is a satisfactory transfusion when platelet count deficiencies are an issue, or when the patient requires HLA platelets that are not ABO coordinated. In RH D negative patients, concentration is to be negative, especially in ladies. The platelet prescribed volume is 10-20 ml/kg for kids under 15 kg and one unit for aphaeresis for patients more than 15 kg, 11 at an implantation rate of 20-30 cc/kg/h. Literature Study Kaufman et al., 2015, told that Platelet prophylaxis, as compared with a therapeutic platelet transfusion strategy, reduces but does not eliminate the risk for bleeding in hospitalized patients with therapy-induced hypo-proliferative thrombocytopenia. However, low-dose platelets must be transfused more often because they provide a lower platelet increment. New et al., 2014, studied and reported that pediatric RBC transfusion practice has demonstrated significant variation in pre-transfusion Hb, frequent prescribing in units rather than milliliters, and a high proportion of single transfusions during admissions. Future education and research should target transfusion triggers and prescription volumes for children in all clinical areas. Ruccione et al., 2014, examine 75 patients up to age 14, who are receiving PRBC transfusions and conclude that excessive iron content may occur in children and also in the adolescent during the treatment of PRBC transfusion. Kumar et al., 2015, had done 17 RCTs and 55 observational studies, and concluded that prophylactic transfusion results in bleeding as compared to therapeutic transfusion is not so different. Results observed do not show a much difference in bleeding in patients. Sloan Parker, 2016, stated that Prophylactic platelet transfusions for children undergoing cancer treatment are not well characterized and require further investigation. The effect of routine platelet transfusion in pediatric cardiac surgery on postoperative outcome is unknown. The determination of platelet count threshold before various invasive procedures and clinical settings should be studied. Pardo-Gonzlez, Linares Torres, 2016, studied 56 journals concluded that Red blood cells transfusion is done by restrictive strategy in which prophylactic platelet transfusion is done. Cryoprecipitate is recommended when fibrinogen levels fall below 100 mg / dL, and indications on irradiated blood products were established. It resulted that transfusion of cryoprecipitate is very limited. Havens et al., 2015, queried at 2 tertiary academic hospitals about the EGS, and got the results that despite of similar blood loss; EGS patients received higher rates of intra-operative blood product transfusion, which was independently associated with major complication. Solh et al., 2016, done a retrospective cohort study at two different hospitals and evaluated two groups: study group, patients with oncology receiving chemotherapy and control group, patients without cancer. They found that alloimmunization frequency was low and it is not possible to determine an association between chemotherapy and alloimmunization due to the low event rate. Werner Ramirez, 2017, discuss five topics, handoff communication, identification and early treatment of sepsis and three approaches to disease prevention or mitigation-influenza vaccination, time to antibiotics in immune compromised patients, and iron chelation therapy for patients receiving erythrocyte transfusion. Each of these is relevant to pediatric hematology/oncology patients and providers and demonstrates how quality improvement methods lead to a higher delivery rate for evidence-based care. Fielding, Grigg, Booth, 2016, although a number of stem cell transplantation (HSCT) patients need intensive care to treat life threatening complications, many of them are hard to be improved. It might be caused by complicated conditions consist of multiple organ failure or immunodeficiency. Conclusion Thus it can be conclude that the platelet transfusion is very risky in pediatric cancer patients, as it leads to heavy bleeding which cause anaemia. References Hall, H. R., Roussel, L. A. (2016). Evidence-based practice.nursing Jones Bartlett Publishers. Harvey, G., Kitson, A. (2015).Implementing evidence-based practice in healthcare: a facilitation guide. Routledge. Kaufman, R. M., Djulbegovic, B., Gernsheimer, T., Kleinman, S., Tinmouth, A. T., Capocelli, K. E., ... Mintz, P. D. (2015). Platelet transfusion: a Clinical Practice Guideline From the AABB Platelet transfusion: a clinical practice guideline from the AABB. Annals of internal medicine, 162(3), 205-213. New, H. V., Grant?Casey, J., Lowe, D., Kelleher, A., Hennem, S., Stanworth, S. J. (2014). Red blood cell transfusion practice in children: current status and areas for improvement? A study of the use of red blood cell transfusions in children and infants. Transfusion, 54(1), 119-127. Ruccione, K. S., Wood, J. C., Sposto, R., Malvar, J., Chen, C., Freyer, D. R. (2014). Characterization of transfusion-derived iron deposition in childhood cancer survivors. Cancer Epidemiology and Prevention Biomarkers, cebp-0292. Kumar, A., Mhaskar, R., Grossman, B. J., Kaufman, R. M., Tobian, A. A., Kleinman, S., ... Djulbegovic, B. (2015). Platelet transfusion: a systematic review of the clinical evidence. Transfusion, 55(5), 1116-1127. Sloan, S. R., Parker, R. I. (2016). Current status of platelet transfusion in pediatric patients. Transfusion medicine reviews, 30(4), 230-234. Pardo-Gonzlez, C. A., Linares, A., Torres, M. (2016). Transfusion therapy evidence-based recommendations for the pediatric cancer patient. Colombian Journal of Anesthesiology, 44(2), 151-160. Havens, J. M., Do, W. S., Kaafarani, H., Mesar, T., Reznor, G., Cooper, Z., ... Haider, A. H. (2016). Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in nonmassively transfused patients. The American Journal of Surgery, 211(4), 656-663. Solh, Z., Athale, U., Arnold, D. M., Cook, R. J., Foley, R., Heddle, N. M. (2016). Transfusion?related alloimmunization in children: epidemiology and effects of chemotherapy. Vox sanguinis, 111(3), 299-307. Werner, E. J., Ramirez, D. E. (2017). Implementation of Evidence-Based Care in Pediatric Hematology/Oncology Practice. In Patient Safety and Quality in Pediatric Hematology/Oncology and Stem Cell Transplantation (pp. 253-275). Springer International Publishing. Fielding, K., Grigg, A., Booth, D. (2016). Analysis of Prognostic Factors of Hematopoietic Stem Cell Transplantation Patients Admitted to ICU. Abstracts/Biol Blood Marrow Transplant, 22(S19eS481), S19eS481. Evidence Based Practice Samples for Students – MyAssignmenthelp.com Question: Discuss about the Evidence Based Practice. Answer: Evidence-based practice (EBP) is a crucial element of optimal quality care in all areas ofnursing and is fundamental to influence positive changes across the diverse health care systems. EBP is known to be a continual interactive process that involves the conscientious and judicious and explicit utilisation of the best available evidence for providing care to patients coming in multifaceted health issues. Since it is the responsibility of the nurses to optimise patient outcomes and improve clinical practice, along with ensuring transparency and accountability in decision making, EBP is to be adhered to at all levels (LoBiondo-Wood Haber, 2017). The position taken in relation to EBP for registered nurses is that EBP is needed for improving patient outcomes in clinical settings. Registered nurses are to provide best quality patient care through acquiring competencies for evidence-basednursing practice as a part of their professional development. In this context, it is to be highlighted that healthcare organisations must come forward and provide support and training to RNs for enabling them to carry out EBP. Without the sufficient training and support, it would not be feasible to place nurses in a position to demonstrate capabilities for EBP. As opined by DiCenso et al., (2014)nursing is a profession that is an amalgamation of both science and arts, relying on knowledge from the physical, social, behavioural and biological sciences for making decisions. Nursing knowledge is to be gained though a number of ways that include formal education, research and clinical practice. For gaining competence in science and art of nursing, one must engage in life-long learning. Evidence-based practice refers to the integration of best available evidence for literature into own practice for the purpose of enhancement of clinical expertise and respect for patient values. It considers external and internal influences on practice, thereby encouraging a critical thinking process while caring for a patient population or a system. EBP is the approach taken by nurses for making decisions that are appropriate and based on clinical expertise in combination with relevant and recent research on the concerned nursing topic. This form of practice has been linked with providing care based on principles understood from critically analysing high quality research and their significant findings (Stevens, 2013). EBP is guided by the NMBA registered nurse standards for practice that entails nurses to engage in continual research for improving their practice. According to Standard 1, nurses are required to think critically and analyse their practice. An RN is required to use a diverse range of thinking strategies and the evidence at disposition for making important decisions and providing safe practice within suitable person-centred frameworks. The Standard 5 entails nurses to appraise relevant and comprehensive information and document them for future purposes. Based on this documentation agreed plans could be developed in partnership with patients. According to Standard 6, RNs are to delegate ethical goal-directed actions on the basis of evidence that ensure planned outcomes (nursingmidwiferyboard.gov.au, 2016). According to Melnyk et al., (2014) the transition EBP is characterised by three phases; practice, evidence and translation. The process is multifactoral and involves a series of key steps. The first and most crucial step is the identification of a trigger that is a clinical question arising from current practice. With knowledge focus, a current practice can be questioned for shared scientific knowledge, while with problem focus an improvement can be made in the existing facts. The following steps consider carrying out a research independently or in teams, critically analysing te research, drawing implications for practice from the research and forming teams to disseminate the findings. The evidence gathered from the research are to be imparted to all members of the professional team, so that collaboration in bringing about a change in practice is fostered. Patient outcomes are influenced largely by EBP with the underlying notion that the care process is guided by recent updates in practice principles. The areas where practice development can be made include acute syndromes for patients, readmission, multifactoral morbidities and mortality rate. The effectiveness of interventions is increased when recent updates are included in this process. The chances of committing errors are also reduced to a considerable extent (Hosking et al., 2016). Emparanza et al., (2015) highlight that though patient outcomes are being improved in the present era with the application of current research evidence, the process is a slow one, with not much achieved within a considerable time frame. The authors opined that failure to translate undertaken research into suitable practice still remains to be a refractory issue. A commitment towards implementing research evidence needs to be coupled with the reorganisation of a healthcare setting to enable a multidisciplinary culture. Healthcare organisations must provide adequate training to RNs so that they are able to work towards better and more eminent performance indicators. A provision of access to research papers and relevant literature is crucial. Any organisation that does not have such form of support would not be able to promote EBP. It is not to be expected that nurses would be at the vanguard of providing EBP without training and support. Patient outcomes can only be made better if more number of RNs are given training in EBP and are provided with easy access to adequate information for supporting this. Mackey and Bassendowski (2017) in this regard state that funding is necessary to support an increase in training and resources. In light of adequate funding, professionals from the field can be appointed for provided training to the nurses and guide them on how to carry out a proper research. Weekly sessions that are interactive are suitable in this regard. Regular feedback given to the nurses is essential for ensuring that the learning is appropriate. Coming to the end of this paper, it is to be highlighted that nurses must critique evidence-informed literature in nursing discipline practice and translate them into practice. Participation in research is fundamental for evaluating and promoting evidence-based nursing practice. It is the responsibility of the concerned healthcare organisations to encourage and train nurses so that they can achieve the aim of delivering suitable EBP. With the support received from their end, nurses can transform their practice for the betterment of the patient populations. References DiCenso, A., Guyatt, G., Ciliska, D. (2014).Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences. Emparanza, J. I., Cabello, J. B., Burls, A. J. (2015). Does evidence?based practice improve patient outcomes? An analysis of a natural experiment in a Spanish hospital.Journal of evaluation in clinical practice,21(6), 1059-1065. Hosking, J., Knox, K., Forman, J., Montgomery, L. A., Valde, J. G., Cullen, L. (2016). Evidence into practice: Leading new graduate nurses to evidence-based practice through a nurse residency program.Journal of PeriAnesthesia Nursing,31(3), 260-265. LoBiondo-Wood, G., Haber, J. (2017).Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences. Mackey, A., Bassendowski, S. (2017). The History of Evidence-Based Practice in Nursing Education and Practice.Journal of Professional Nursing,33(1), 51-55. Melnyk, B. M., Gallagher?Ford, L., Long, L. E., Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs.Worldviews on Evidence?Based Nursing,11(1), 5-15. Registered nurse standards for practice. (2012). nursingmidwiferyboard.gov.au. Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas.Online Journal of Issues in Nursing,18(2), 4-4.