week 5 .0

Hello Professor and Class

The project aims at identifying the implication of utilizing evidence-based model in the treatment procedure on patients with chronic ailments. The researcher would be interested in measuring the usefulness of the model on satisfaction and decision-making process. The appropriate method to use in the research is quantitative approach. The quantitative method is a scientific approach that is characterized by statistical procedures to enhance data analysis. The aim of the quantitative approach is to explore ‘cause and effect relationship’ connecting the variables under study (Gerring, 2011). In particular, for purposes of this research, descriptive research design is the most feasible. The method helps in making depiction of the participants either through observation or a case study. Quantitative will help answer questions on what happens following the subjection of participants to certain conditions under study. Being action-orientated, the quantitative approach generates outcomes that provide a particular change in a particular field. In this research, the method will help inform the caregivers on the need to use the EBP model based on the findings that will show positive outcomes on patients as well as improvements in decision-making process among the professionals.

My PICO Question is: in patients with Diabetes, is there reported improved decision-making and patient education when using EBD model compared to conventional approaches in reducing the burden of pain through enhanced professional interactions?

Diabetes is a chronic disease that is affecting people in society. It is caused by the reduction effectiveness of insulin in the patient’s body. I will use self-management and literacy techniques to help patients prevent diabetes. Some of the self-management and literacy techniques I will apply patient education formula will include advising them to eat healthily, jeep the right body weight, and doing exercise regularly. In the effort to curb diabetes from spreading will create awareness to the community to understand its causes and risk factors. The variables to consider include satisfaction, decision-making process, and professional interactions. The EBP model will be of great help to the patients in making improvements in the prevention of diabetes, where evidence is turned into actions. Through an improved decision-making process, professionals from different fields will share credible information that will be instrumental in the management of chronic ailments. Medical professionals have a significant influence on the overall clinical outcomes though they require proper strategies that target the specific needs of a patient.  

Reference

Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications

Brown, J. M. (2014). Evidence-based practice for nurses. Burlington: Jones & Bartlett Publishers.

Proposal on Evidence-Based Practice

Yahima Montero

Chamberlain University

Class RN 505

Proposal on Evidence-Based Practice

Relationship between EBP and Research

Healthcare deals with many complicated health-related issues in pursuit of the best outcomes for the patients. In the healthcare sector, nursing is an essential aspect for all patients requiring help regarding their health status. However, to provide this help, health care providers need to have a foundation of information reflecting quality care. Thus, there is a need for evidence-based practice (EBP) that is centered on research. According to Stavor, Zedreck-Gonzalez, & Hoffmann (2017), EBP should be managed using specific clinical applications that are based on up-to-date research. The process of establishing a pool of knowledge has been given many names over the years, such as quality care, evidence-based practice, and best practices. However, irrespective of the term given to this practice, the foundation of the care must be centered on research.

The definition of EBP also encompasses various aspects such as research, client preferences, nursing expertise, and thought process. However, as much as all these aspects are required, the actual caregiving in a healthcare setting requires a nurse to use their experience in making decisions because some of the cases they encounter are unique (Stavor et al., 2017). All in all, the scientific data generated from the research is the foundation upon which healthcare providers make their decisions.

Differences between EBP and Research

The primary goal of the research is to develop new knowledge or validate an already-existing pool of knowledge (Baker et al., 2014). Therefore, research studies are usually systematic and scientific while trying to test hypotheses or answer particular research questions using standard rigorous methods (Baker et al., 2014). Despite research involving investigations, discoveries, and exploration, it also requires the researcher to understand Science philosophy. As Baker et al. (2014) indicate, data generated from the research is considered valid and reliable if the researchers used scientific methods in an orderly and sequential manner. On the other hand, EBP does not entail developing or validating any knowledge. Instead, it involves translating already existing evidence and using it to enhance clinical decision making (Baker et al., 2014). Despite most of the evidence in EBP emanating from research; it goes beyond research to include patients’ preferences and clinical practice. EBP will also sometimes involve knowledge from experts and opinion leaders where no existing knowledge is found.

Contribution of EBP to Professional Nursing

EBP has contributed massively to professional nursing. For a start, it has changed the nature of nursing education. Today, education institutions such as colleges and universities have changed their curricula on the BSN program to incorporate EBP (Balakas & Smith, 2016). Students that are pursuing a degree in nursing, be it through RN or BSN programs, are being engaged in coursework that teaches them how to improve their overall knowledge and to have professional accountability (Balakas & Smith, 2016). These programs focus on critical thinking skills while also urging nursing students to put into perspective the patient’s cultural, socioeconomic and clinical backgrounds in addition to relevant scientific research.

EBP has also led to improved quality of care. As Balakas & Smith (2016) affirm, it has led to improved patient outcomes. Today, nurses are using available new research to minimize complications on patients, especially with chronic illnesses (Balakas & Smith, 2016). This helps the nurse to conduct the correct diagnosis, offer the right treatment, and prevent other diseases. . Another benefit of EBP is that it has led to superior nursing skills. A nurse who has incorporated EBP in their education and clinical experiences has advanced decision making and critical thinking skills (Balakas & Smith, 2016). Moreover, such a nurse is good at utilizing informatics, operating in interdisciplinary teams, and adapting to different situations (Balakas & Smith, 2016). Thus, EBP helps nurses to develop satisfaction and pride in the work that they do.

MSN Specialty Program and Practice

My MSN specialty track is a family nurse practitioner who is well versed in nursing theory, research, healthcare policies, informatics, and professional role development. I am aiming to work in the family practice department. In my future practice setting, EBP will help me to improve the quality of care that I provide to my patients. For example, I will use the available research to conduct diagnoses and offer treatment after I have reviewed a patient's health records to avoid misinformed judgments and inadequate healthcare provision.

Nursing Concern

One of the concerns among many nurses is patients' refusal on recommended treatments. When this occurs, nurses are left in a difficult situation, worrying about the patient's health and

wondering if they have done enough to help the patient. The nurses also face the risk of taking all the blame if the patient who refused treatments suffers from a poor outcome. According to Puts et al. (2015), this dilemma revolves around a patient’s rights and the nurse’s obligations thus touching on ethical perspectives. In this regard, ethical tension emanates when the nurse's responsibility to provide the best possible care conflicts with the obligation to understand and respect a patient's autonomy (Puts et al., 2015). The law acknowledges that a patient has the right to decide on the care they are willing to accept (Puts et al., 2015). Thus, nurses are left in a position where they must balance these two obligations without favoring any of them.

Nurses respect their patients' autonomy if they involve them in discussions about the care they are giving. Nonetheless, providing a listing of the medical information and allowing the patients to decide the medical care to receive is not what many patients or nurses want (Mahal et al., 2014). Patients want the nurses to comprehend and contextualize information and make relevant recommendations based on the patient's goals and medical evidence (Mahal et al., 2014). Still, the patients do not want the nurses to make crucial decisions on their behalf. In any case, the paternalism where health care providers make unilateral decisions regarding the welfare of a patient in unethical today (Mahal et al., 2014). Thus, nurses face the challenge of trying to help their patients without being paternalistic.

The issue of patients refusing treatments is common in most healthcare settings. Patients, especially the elderly, are known to decline medical advice across the healthcare sector, from hospitals, nursing homes, to outpatient clinics. For example, there are numerous cases of inpatients leaving healthcare centers against medical advice, non-adherence to treatment, and failure to make regular follow-ups.

When patients refuse to adhere to recommended treatments, the nurses are greatly affected. As Katz et al. (2015) indicate, healthcare providers, derive satisfaction when they give care to a patient and improve their healthcare outcomes. If a patient refuses treatment, it puts their health at risk, and this affects the nurse who feels that they are powerless to help. Moreover, if a patient refuses treatment, and there is a poor outcome, the nurse may take all the blame and even face lawsuits for malpractice. Hospitals are also affected if a patient refuses treatments. In such cases, their brand may be affected if there is an unfortunate outcome as it may appear as if the hospital is not providing quality care.

In most cases, the consequences are dire when patients refuse treatments entirely. For a start, the patients may develop further complications and in worst cases, lose their lives (Katz et al., 2015). The healthcare providers are also affected and left wondering if they did enough to provide quality care to the patients. In some cases, the family of the patient also sues the healthcare provider or hospital for a failure to deliver quality services. Such lawsuits are a financial burden to healthcare organizations.

To solve this problem, nurses should start by understanding why a patient has declined the available treatments. This will create an opportunity for the nurse to intervene. Nurses can also deal with the issue by engaging in harm reduction. As Choi et al. (2014) indicate, this entails identifying other acceptable treatment options that the patient could be willing to accept. For example, if a patient wants to leave a healthcare setting AMA, a nurse may arrange for the patient to meet up with their primary care provider in a day or two which the patient may agree.

Purpose Statement

This proposal seeks to ascertain how educating patients on the essence of using EBP can reduce cases of patients refusing the recommended treatments.

PICO Question

Can educating patients on the importance of EBP reduce cases of patients declining recommended treatments?

The implication of Expected Outcome to my Future Practice

The expected outcome is that patients will embrace EBP fully and understand its essence in healthcare provision. Once patients have understood the nature of EBP, likely, cases of patients declining treatments will significantly reduce (Choi et al., 2014). As a future family care nurse, this will be essential in my practice knowing that my patients are confident in the quality of care that I am giving them. Also, nurses will be in a position to handle as many patients as possible since EBP reduces tests and procedures done in diagnosis. Moreover, patients will be satisfied with the care given without demanding for additional treatments or declining the available ones.

Purpose of Conducting a Literature Review

Conducting a literature review is essential in understanding the existing research on why patients decline treatments. In this regard, it is necessary to contextualize the reasons given by patients for failing to adhere to medications and ascertain what would have been done to prevent such cases from happening. Another essence of conducting a literature review is to get insights on whether most patients understand what EBP is and how it can be used to improve their health outcomes. It is highly likely that most patients decline treatments because they do not understand their essence. Thus, it is essential to study whether most patients are knowledgeable about EBP.

Steps Followed to Conduct a Literature Review

I assessed the CINAHL Plus with Text database which extensively covers matters on allied health and nursing. Also, I used Google Scholar, which is a search engine that specializes in academic output while also allowing a user to download a full text. The key phrases in my search were EBP and patients declining recommended treatments. Some of the minor phrases that I used in my search were healthcare challenges, the use of technology in hospitals, and problems facing nurses. One of the specialty organizations that are relevant to this proposal is the Nurses' Association of the American College of Obstetricians and Gynecologists. Using information from this proposal, this organization can improve patient care and practice by educating women on the treatment methods availed to them.

Theoretical Framework

This proposal relies on the theory that patients decline the availed treatments because they are not knowledgeable about how health care providers have arrived at their decisions. Therefore, the assumption is that most patients are not knowledgeable about EBP and how it is used in healthcare settings to improve outcomes. For this reason, this proposal suggests that educating patients on EBP would help reduce cases of declining treatments. The literature review on this proposal studies the reasons why patients reject medications which will then guide healthcare providers in developing solutions that can handle this challenge.

References

Baker, K. M., Clark, P. R., Henderson, D., Wolf, L. A., Carman, M. J., Manton, A., & Zavotsky, K. E. (2014). Identifying the differences between quality improvement, evidence-based practice, and original research. Journal of Emergency Nursing, 40(2), 195-197.

Balakas, K., & Smith, J. R. (2016). Evidence-based practice and quality improvement in nursing education. The Journal of Perinatal & Neonatal Nursing, 30(3), 191-194.

Choi, M., Kim, H. S., Chung, S. K., Ahn, M. J., Yoo, J. Y., Park, O. S., ... & Oh, E. G. (2014). Evidence‐based practice for pain management for cancer patients in an acute care setting. International Journal of Nursing Practice, 20(1), 60-69.

Katz, I. T., Dietrich, J., Tshabalala, G., Essien, T., Rough, K., Wright, A. A., ... & Ware, N. C. (2015). Understanding treatment refusal among adults presenting for HIV-testing in Soweto, South Africa: a qualitative study. AIDS and Behavior, 19(4), 704-714.

Mahal, B. A., Aizer, A. A., Ziehr, D. R., Hyatt, A. S., Sammon, J. D., Schmid, M., ... & D'Amico, A. V. (2014). Trends in disparate treatment of African American men with localized prostate cancer across National Comprehensive Cancer Network risk groups. Urology, 84(2), 386-392.

Puts, M. T., Tapscott, B., Fitch, M., Howell, D., Monette, J., Wan-Chow-Wah, D., ... & Alibhai, S. M. (2015). A systematic review of factors influencing older adults’ decision to accept or decline cancer treatment. Cancer Treatment Reviews, 41(2), 197-215.

Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital. JONA: The Journal of Nursing Administration, 47(1), 56-61.