EVIDENCE-BASED HEALTH CARE
Evidence-Based Health Care
Evidence-based practice is an interdisciplinary approach in clinical practice among other fields. Evidence-based integrates three key principles identified as; 1. Using the available research evidence to support whether a treatment is effective or not (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). 2. Clinical expertise must be used to identify the unique diagnosis and state to each patient, regarding the potential intervention risk and benefit (Spring, 2007). 3. It stipulates the value and preferences of the client must be considered. Evidence-based is the process of integrating the best evidence, supported by clinical expertise while considering the values and preferences of the patients to make decisions that promote health care. Evidence refers to the findings of a research by using systematic data collection through experiments and observation, as well as the formulation of questions and hypotheses testing (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013). Thus, in the clinical practice, evidence-based practice is the use of the current and best evident to make health care decisions for individual patients. The evidence must be research proven to ensure the delivery of the best health care services. The clinician must be updated regarding the literature of the treatment to influence their decision-making practices.
Evidence-based practice (EBP) is dependent on the understanding of the clinician and their evaluation of the existing research and the clinical practice. To save time when evaluating evidence, several processes are used to evaluate the literature of a treatment (Dollaghan, 2007). The process involves a 6-step procedure as follows:
Structure or brainstorm a clinical problem
Read through the literature for sorting the work and critiquing the work (Titler, 2008)
Develop a clinical bottom line (recommendations for the clinical practice)
Implement recommendations, and document them including any changes made in the intervention.
Share result of the EBP with others, e.g. by writing them.
EBP Implementation to Clinical Practice
In clinical practice, EBP is used in making health care decisions in reality. It is applied in patient-centered health care delivery. That is, the clinicians deliver health care based on the evidence that supports a treatment that works. The treatment is also given and implemented on patients individually. As stated earlier, the values and preferences of the patients towards the treatment are of high importance. The clinician provides to the patient the understanding of the treatment as given by the literature in the EBP where once the patients understand; they can agree or disagree on using the treatment. The clinician so provides his or her perspective towards the treatment, which supports whether they apply the treatment or not (Rycroft-Malone, Titchen, & Kitson, 2004). The clinical practice is based on the relationship between the practitioner and the patient, which allows the use of evidence research to support the decision to be implemented. The clinicians base the delivery of health care services on four types of evidence. That is; research, clinical experience, local context information and patient experience. The clinicians have to choose between internal, intuitive and external scientific approaches to drawing conclusions on the evidence.
EBP is the process of integrating current knowledge into the health care decisions today that positively influence the patient outcomes. Employing EBP in the clinical practice is meant to improve delivery of quality health care through producing the intended health outcome. The application of EBP was developed to fill the gap between what the practitioners knew and apply in health care. Thus, by using EBP, current knowledge on existing illnesses is used to ensure quality health care is delivered (Stevens, 2013). The usage of EBP in clinical practice reduces the usage of illogical variation by using only the best evidence to provide care and make health care decisions. EBP increases accountability in quality improvement and safety in health care.
According to (Flynn, Martin, Burns, Philbrick, & Rauen, 2013), the application of EBPleads to improved outcomes in the patient care delivery process. Making a decision based on evidence involves the development of generating informed health care decisions. That is; it is the process that involves using the past and current knowledge of a health care issue to make a decision on the treatment processes and approaches to apply. Evidence-based practice is linked to improving health care decisions while reducing health costs for the patients (ICN, 2012). EBP helps the clinicians to make informed decisions, support changes in the clinical practice to develop quality approaches and treatment in health care. EBP has assisted the clinicians to provide more personalized care to the patients leading to more desirable outcomes. In clinical practice, it is important since it provides a wide range of information, cost containment, and consumer understanding regarding the care options and treatment available for patients (Brooten & Youngblut, 2001). EBP has allowed clinicians to maximize clinical judgment in administering nursing care and treatment. That is; the clinical practice uses evidence to define practices instead of supporting existing practices. That is; the provision of health care is based on using the latest technologies and information to make health care decisions (Brooten & Youngblut, 2001).
Individual patient preferences and values are of high importance when making clinical judgments regarding research findings implementation. Decision making using EBP requires the critical and clinical thinking of the patients and practitioners respectively to provide accurate and quality care. According to (Weijden, et al., 2010), patients have differences in characteristics, preferences, ethics, values and morals among others. These factors play a major role in influencing the decisions they make; including those made regarding medical interventions and health outcomes. Thus, when including the preferences of the patients, they are given a chance to critically analyze a medical choice and select one that best fits with their morals, values, and references. More importantly, the clinicians allow the patients social and cultural factors to influence their decisions as they affect the health care they attain (Siminoff, 2013). Involving patients in decision making is a way of eliciting communication also, which provides more knowledge on the symptoms of the patients besides their values and beliefs that they must consider when engaging in a clinical encounter. For instance, a patient suffering from chronic neck pain may prefer the continuation of using anesthetics rather than using therapy. That is; the patient’s moral values may be against the therapeutic methods, or prefers anesthetics to therapy for pain relief.
Despite existing research findings showing that the usage of therapy is more effective, the patient may be against its application for treatment. In such a situation, the value and beliefs of the patients’ are used to develop the treatment to be applied to the individual patient. On the other hand, another patient may prefer using therapy to the consumption of anesthetics. In such two possible scenarios, the usage of EBP is perceived and its importance in dealing with individual patients when applying treatment.
Challenges of EBP integration into Clinical Practice
One of the key challenges that hinders the application of EBP into clinical practice is the emphasis on the status quo. The fact that there are processes and procedures that have been implemented in dealing with several health issues, the practitioners find it challenging to adopt to the current practices and evidence for health care delivery. Thus, the clinicians often follow tradition when delivering healthcare rather than the current best evidence. This can be evidenced in numerous approaches such as measuring blood pressure noninvasively in children (Flynn, Martin, Burns, Philbrick, & Rauen, 2013).
Noninvasive blood measuring in children has been used for more than 20 years. The method is questioned regarding its reliability and accuracy in providing the health care needed. Currently, the best evidence supports that the oscillometric method is the best for measuring the blood pressure of a patient. However, the auscultatory method is the standard method for measuring blood pressure, its accuracy and reliability is not complete and thus, cannot assist in making accurate treatment decisions. Thus, evidence-based involves comparing the standard method and best EBP method to attain accurate results (Flynn, Martin, Burns, Philbrick, & Rauen, 2013).
Another key challenge is the belief that most practices were based on research. However, it is clear to understand that EBP decision making is not based on evidence solely. The clinical judgment of a practitioner is involved as well as values and preferences of the clients among others. Through evidence-based approach, the practitioners make the right decisions by asking good questions to assist improve the quality health care delivered. In practice, thus, it leads to problems because research findings generalize the practice situations. However, given that the EBP is applied based on an individual, where their preferences and values are considered, the generalization should not occur as a problem.
Additionally, as (Farley, et al., 2009) presents, challenges may derive from ethical issues. That is; based on the values and preferences of the patients and clinicians, some research findings may have evidence of biases, which inhibits the application of the research into practice. The clinician’s expertise must also determine the quality of the research findings among other solutions to ensure ethical means are met prior to applying the possible treatment into practice (Farley, et al., 2009).
Another challenge derives from the workload the clinicians and nurses have, which hinders them from been informed of the newest evidence. Thus, they are forced to continue using the standard or traditional approaches. That is; deprived of the current and best approaches, they have no option but to continue using traditional methods of treatment (Majid, et al., 2011). The lack of adapting to the EBP is also linked to an inadequate understanding of the Jargons used in research and poor or lack understanding of the statistical terms employed in the research findings.
Step 1: Clinical Question
Pico Table 1:
What is the best treatment method for smoking for young adults aged 25-35 years between bupropion consumption and nicotine replacement therapy for the long-term and effective abstinence from smoking?
Type of patients or problem
Comparison intervention(if any)
Step 2: Literature Search
Smoking among adults aged 25 years to 35 years
Le Cook, et al., (2014) present that smoking in the USA has reduced significantly. However, the article evaluates the cessation of smoking among people with mental illnesses. Smoking though has reduced over the years, it is still one of the major causes of death in various countries such as North America (Elizabeth, Daniel, Guy, & Paul, 2014). (Le Cook, et al., 2014), does not address smoking among those aged 25-3 years, but smoking generally while focusing on abstinence of smoking on individuals with mental illnesses.
Consumption of Bupropion
Elizabeth, Daniel, Guy, & Paul, (2014) show that smoking of tobacco is a cause of many deaths in North America. However, in a test to investigate the effect of pharmaceutical interventions, the authors discovered that bupropion enhanced the effects of nicotine measure, which affects the relapses to smoking.
Nicotine Replacement Therapy
Barbeau, Burda, & Siegel, (2013) present that quitting nicotine smoking can be challenging including the withdrawal symptoms. However, according to research findings, Nicotine Replacement Therapy has the capacity of increasing the effective quitting of smoking rates. The E-cigarettes can effectively assist smokers to quit smoking and avoid relapse o withdrawal symptoms.
Abstinence from Smoking
Cinciripini, et al., (2013) present that prolonged smoking abstinence can be achieved. Varenicline and Bupropion were used hand-in-hand where the results of their experiment showed that the varenicline is associated with an effective reduction of smoking and suppression of depression. Varenicline is more effective than bupropion in smoking cessation. However, bupropion was also effective in reducing the negative effects such as sadness, unlike that os varenicline.
Pico Components of (Cinciripini, et al., 2013)
Type of patients or problem: Abstinence from smoking in about 294 communities. The patients were volunteers who wanted to quit smoking.
Intervention: Nicotine Withdrawal through a placebo-controlled clinical trial. In addition, behavioral counseling was part of the intervention
Comparison intervention (if any): Varenicline, Bupropion, and Counselling
Outcome: ProlongedAbstinence from Smoking Cessation, Negative Affect, and Depression among others linked to nicotine withdrawal.
Barbeau, M. A., Burda, J., & Siegel, M. (2013). Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. Addiction Science & Clinical Practice, 8,5.
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Cinciripini, M. P., Robinson, D. J., Karam-Hage, M., Minnix, A. J., Lam, c., Versace, F., . . . Wetter, W. D. (2013). Effects of Varenicline and Bupropion Sustained-Release Use Plus Intensive Smoking Cessation Counseling on Prolonged Abstinence From Smoking and on Depression, Negative Affect, and Other Symptoms of Nicotine Withdrawal. JAMA Psychiatry, 522-533.
Dollaghan, A. C. (2007). The Handbook for Evidence-based Practice in Communication Disorders. New York: Paul H. Brookes Pub.
Elizabeth, G. G., Daniel, F. C., Guy, H. A., & Paul, F. J. (2014). Examination of the effects of varenicline, bupropion, lorcaserin, or naltrexone on responding for conditioned reinforcement in nicotine-exposed rats. Behavioral Pharmaology, 775-783.
Farley, J. A., Feaster, D., Schapmire, J. T., Ambrosio, D. J., Bruce, E. L., Oak, S., & Sar, K. B. (2009). The Challenges of Implementing Evidence Based Practice: Ethical Consierations in Practice,Education, Policy, and Research. Social Work and Society International Online Journal.
Flynn, B. M., Martin, A. S., Burns, S., Philbrick, D., & Rauen, C. (2013). Putting Evidence into Nursing Practice: Four Traditional Practices not Supported by the Evidence. Critical Care Nurse, 28 — 44.
ICN. (2012). Closing the Gap: From Evidence to Action. International Council of Nurses, 1-51.
Le Cook, B., Wayne, F. G., Kafali, N., Ma, L. Z., Shu, C., & Flores, M. (2014). Trends in Smoking Among Adults with Mental Health Trearment and Smoking Cessation. The Journal of American Medical Association, 172-`182.
Lilienfeld, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L., & Latzman, R. D. (2013). Why many clinical psychologists are resistant to evidence-based practice: root causes and constructive remedies. Clinical Psychology Review, 883 -900.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.-L., & hang, Y.-K. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 229- 236.
Rycroft-Malone, J., Titchen, A., & Kitson, A. (2004). What counts as evidence in evidence-based practice? JAN: Informing Practice and Policy Worldwide through Research and Scholarship, 81 — 90.
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn’t. BMJ, 71-72.
Siminoff, A. L. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC Medical Informatics and Decision Making.
Spring, B. (2007). Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know. Journal of Clinical Psychology, 611–632.
Stevens, R. K. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. The Online Journal of Issues in Nursing.
Titler, G. M. (2008). The Evidence for Evidence-Based Practice Implementation. In G. R. Hughes, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (p. Chapter 7). Rockville (U.S.): Agency for Healthcare Research and Quality.
Weijden, V. D., Legare, F., Boivin, A., Burgers, S. J., Veenendaal, V. H., Stiggelbout, M. A., . . . Elwyn, G. (2010). How to integrate individual patient values and preferences in clinical practice guidelines? A research protocol. Implementation Science, 5-10.