Evidence based practice

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Nov 24, 2024

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1 Evidence-Based Practice in Research Study Name Course Name Tutor Institution Date Word count: 2491 Words

2 Table of Contents Introduction ........................................................................................................................................... 3 Section 1 ................................................................................................................................................ 3 Section 2 ................................................................................................................................................ 4 Literature Review .............................................................................................................................. 4 Method .............................................................................................................................................. 5 Findings/ Discussions ......................................................................................................................... 6 Section 3 ................................................................................................................................................ 7 Conclusions ............................................................................................................................................ 9 Reference list ....................................................................................................................................... 10

3 Introduction This essay provides a critical evaluation of the study article by applying the model of Caldwell. The article’s sections for “Detection and management of the deteriorating ward patient: an evaluation of nursing practice” (Odell, 2014), will be explored by focusing on literature review, method, and discussion/findings in quantitative research. Besides, this essay will evaluate the potential benefits and role of utilizing evidence-based practice (EBP) within the sector of healthcare, ethical significance in the study, and issues emerging when EBP and ethics are not observed both in the healthcare setting and in a study. Section 1 Based on the study, EBP (evidence-based practice) is termed as the application of documented and research materials and reinforced evidence in supporting or determining a grave decision or judgment. EBP involves all professional practice types including journalism, education, law, and healthcare (Springs and Baruch, 2019). In the healthcare setup, EBP can be defined as the structure drawing data from available scientifically backed- up facts in establishing the approaches of care delivery. Moreover, this is a universal approach involving three major elements; healthcare professional skill, patient preferences and perceptions, and scientific research. According to the healthcare professions, EBP is regarded as the common theory (Trujillo, 2021). Evidence-based practice's origin within healthcare occurred in the mid-19th century in an enlightenment era with the scientific approach application when physicians and scientists applied scientific inquiry and research methodology towards medical issues. According to the arguments from certain champions who used robust evidence in promoting the solutions of healthcare, EBP originates from the European Renaissance, the early civilization of Greece, and Oriental medicine when experts used documentation, opinion, experience, and experimentation in diagnosing, measuring, and treating tips to disease and ailments (Meulen, 2017). Moreover, in the 1970s EBP emerged as a movement that led to the authenticated epidemiological data usage with well-planned exploration studies especially the RCT (randomized controlled trial) approach in establishing effective and functional treatment schemes and diagnostic mechanisms. Since capital, resources and time can continually be reserved and limited, healthcare vocation should provide health services that are deemed to be effective and efficient, established as economical, efficient, and reliable (Boswell and

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4 Cannon, 2022). It is said that relying on precisely fashioned, solid scientific analyses, surveys, and scientific studies as sources of data and evidence, and facilitating the RCT application provides more accurate and reliable data than other sources of evidence. Therefore, EBP can be seen as a medical practice and healthcare strategy where clinicians assess backed facts' strengths while using them to better medical processes for the patients (Connolly et al., 2022). Furthermore, integrating EBP into the daily process of healthcare professions has the possibility of improving patient outcomes and their practice setting (Brown, 2017). Thus, in boosting nursing science, one must enhance the process for future experts in healthcare and improve patient outcomes. This is essential in imparting nursing learners’ vital knowledge of EBP and the way of accessing knowledge and applying it as needed (Evans, 2022). Additionally, resolution-making and EBP was related to improved patient safety, care quality, and various positive results of the clinic in single reports through the literature (Crisp et al., 2020). Evidence-based practice benefits within the healthcare practice include; effective, efficient, and precise and patients’ best care. Section 2 This essay section critiques the provided article. When analyzing the article's strength, it will also be vital assessing the validity of applying the Caldwell model. The research’s three sections to be critiqued include Literature review, method, and discussions/findings. The research critique has been discussed as an objective structure regarding the research strengths and weaknesses when creating a sensible judgment about the importance of the research on the particular study field. Literature Review This is the best practice of assessing and summarizing previous theories and research while identifying controversial areas and existing gaps in the study. In this article, there is evidence showing the performance of the main literature review. For instance, the literature review conducted search methods by applying four key sources namely; electronic database, key reports, experts in the healthcare field, and reference lists. Besides, the works of Odell et al. (2007) formed the concept that has been most referenced in this research to generate familiarity and theoretical background knowledge to this research. The reporting process of the literature review adhered to three wide search categories formed for a database search

5 including general ward patients, physiological deterioration, and nursing observations (Bandurska, 2022). Based on the article, most of its sources are out-dated as they range from 1990 to 2007 as the cut-off date. Schein et al (1990) indicate that this was the year considered as the publication year outlining the suboptimal care concept. Besides, literature by Andrews and Waterman (2005) was reviewed in identifying that recording important signs is the established function of ward nurses and seems to be known as the key to physiological deterioration detection. Odell, (2014) also highlights the studies of other authors in this field via the works of Shearer et al. (2012) and Hands et al. (2013), acknowledging a comprehensive review of scarcity on monitoring practice. The study indicated that observation activity may be associated with patterns of nursing shift other than the need of a patient, and though sicker patients have the possibility of vital signs assessed overnight, there is still a lack the compliance with protocols of clinical escalation (Greenhalgh et al., 2023). Method It is the way to explain how the researcher plans to conduct the research. Research methodology is also a systematic and logical plan for resolving the research problem. Based on the critiqued study, the researcher aims to audit ward nursing practice to adhere to the protocol of early warning score in the initial management and detection of worsening ward patients while investigating factors that might affect practice (Greenhalgh et al., 2016). Since the research methodology should provide a clear statement about the chosen research method, this article applied the quantitative research method in achieving sufficient data on nursing practice audits against the protocol of EWS in the initial management and detection of worsening ward patients. However, the quantitative type is vital as study results may be illustrated in a statistical form (Bandurska, 2022). After careful analysis of the presented numbers, it seems possible to predict future results of the patients hospitalized. The study’s population interest was adults aged over 18 years, and nonobstetric inpatients who suffered the CRA in the general ward for the past year. The data was taken from South England. The study focused on a single-site general hospital having 700 beds. The research applied a multi-state, intricate design in selecting the sample. Besides, the study’s ethical approval was approved by the local committee of research ethics. Due to the scarcity of related research data in England, this study validates the approach selection. Nonetheless, the author has failed to describe, analyze, or explore any research model, framework, ideological underpinnings, philosophical orientation, or quantitative models related to this work. The

6 methodology field of quantitative research is vast, sophisticated, and filled with a range of methodological frameworks and theoretical models having several ways where the rules of quantitative research are applied in studying projects. Further, this article lacks methodological explanation and transparency that might bind the capability of replicating and reproducing the study while restraining the transferability beyond the population’s study sample. The study of this report has failed to provide sufficient transparency to allow the author to assess its methodological precision since there lacks any concepts for exploration and proof of the author’s attempt to validate the approach or assess its limitations and advantages of the methodological framework. However, the quantitative research approach application has been vindicated. Based on evidence-based practice, the quantitative research approach is mostly compelled by statistical data valuation and it impacts the general project design. Contrarily, the approach of qualitative research aims to identify themes through the exploration of the sample group’s attitudes and perceptions. Quantitative research as the phenomena for systematic investigation gathers quantifiable data while performing computational, mathematical, or statistical techniques. Thus, healthcare research can apply a quantitative research approach to improving clinical services while supporting variations in the health sector. In this article, the author employed quantitative research in the study, this enables the researcher to identify averages and trends, test relationships, make predictions, and generalize results for a huge population. The quantitative method application is suitable for collecting accurate and reliable data, collecting data quickly, wider data scope analysis, and eliminating bias. However, quantitative research might be applied in performing further qualitative studies when assessing common phenomena experienced in a certain incidence. Findings/ Discussions Based on the study, rigidity can be termed as the level a study attains standards suitable for primary research pieces by applying systematic reviews. In quantitative research, Greenhalgh et al., (2023) explain the discrepancy in rigidity when discussing the credibility, reliability, and validity of the study. While the article's author might detract from the study's robustness, it may be argued that for entire context components assessed for statistical significance, it’s only the weekdays that indicated that patients suffered the CRA event during the bank holidays or weekend and were more probably to experience poor adherence towards EWS

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7 protocol within the hours past their CRA thus adding to the study’s credibility (Grove and Gray, 2018). The article addressed the research aim properly. Besides, while the article title summarizes the research study, it is vital to confirm if variables have been included in the research while highlighting the major study focus to be simulated. With the population being adults 18 years regarded as a small population, the study is transferable and can be applied to other professions wholly because of the phenomenon of commonplace and settings in various professions (Koutoukidis and Stainton, 2020). The findings discussed were classified into four major themes namely; recognition, reviewing and recording, reporting and rescuing, and responding. It described the existing evidence on the nursing practice observed in detecting the deteriorating or at-risk ward patients. Even though it was suggested that nurses are major players in detecting deteriorating patients, deterioration has been perceived as inherently difficult and uncommon to detect. Besides, the study’s limitation in search terms construction is that many combinations of search terms were applied including keywords from the renowned papers in search criteria. Besides, fast staff turnover negatively affected teamwork while contributing to a lack of confidence on the junior staff side (Lehane et al., 2023). It was also said that observations were routine, tasks of low priority, and scores had early warnings that were occasionally completed and inaccurate. The relatives' or patients' role in detecting worsening has not been considered in the healthcare planning. The study recommended that factors contributing to an issue should be addressed including; levels of ward staffing, knowledge level and ward nurses experience, educational prospects, and communication issues of doctors or nurses (Odell, 2014). With the author’s selection of transparency and accuracy, the article applied statistics and tables in calculating the validity of the collected data thus limiting bias from the reported data. Section 3 In any evidence-based research, ethical considerations are vital. They comprise a set of rules that direct one’s research practices and designs. The rules comprise informed consent, voluntary participation, and confidentiality, protection from potential harm, anonymity, and results/findings communication. Further, in evidence-based practice, ethical issues that arise are some forms of knowledge are excluded in EBP discounts or downgrades forms of knowledge that are applied by healthcare practitioners, which are critical for best practice; they comprise intuition, experience, and anecdote (Occa et al., 2020).

8 In the healthcare sector, ethical considerations are required in protecting individuals without sovereignty, for instance, patients, children, and animals; by not leading them to harm, obtaining informed consent, being just and fair, and for confidentiality and data protection (Meulen, 2017). Ethics involves evaluating people’s rational validation of moral judgments based on what seems right or wrong, just or unjust. Ethical research provides directions for performing liable research. Besides, it educates and monitors experts conducting the study to guarantee the criterion of high ethics. The study attained data protection, confidentiality, and informed consent through the providers of healthcare services and other hospital staff where the committees for ethics reviewed then approved its study (Occa et al., 2020). The author had an informed accord from his potential participants and then recorded it before making the proformas. The patients’ records observed confidentiality and privacy by eliminating their historical records and names for anonymity; they used their number identifiers when collecting data. Additionally, the patients have the freedom of removing their consent which might mean that the recorded materials might be deleted. The research involving people must be conducted in a manner that respects their safety, rights, and dignity (O'Keefe and Brien, 2023). Based on Odell, (2014), he was able to abide by the key principles of ethical research. Participation in this research was regarded as voluntary thus creating no reference towards financial reimbursement of any kind. No person was forced to participate or be compelled in the study (Odell, 2014). Besides, working honestly has been seen as the major rule which the researcher adhered to during his study. Further, since more facilities of healthcare are included in evidence-based practice, the lines between EBP to enhance quality and the research of EBP seem to be confused (Schein et al., 1990). This might be because of a lack of clarity in categorizing various EBP activities leading to ethical problems which might not be identified in the clinical setting by over- zealous nurses who lack proper training to conduct research studies (Scott et al., 2019). In the case of integrating EBP into nursing practice, the healthcare agencies seem to promote the nursing programs of evidence-based practice as quality improvement programs when they should be conducting research studies (Sharma, 2018). The ethical problems on EBP include some knowledge forms that are not documented in EBP due to its downgrades or discounts knowledge forms that are used by healthcare professionals

9 important for best practices like intuition, anecdote, and experience. Besides, an EBP function contrary to patient-oriented care is a problem for progression as knowledge discounted from through the practice is mainly precise to the case study (Spector and Starmer, 2019). Besides, other issues of ethics entail becoming testable through RCT might not be the same while resolutions based on evidence-based practice might be biased. Conclusions This essay discussed the article critique and explained the advantages associated with EBP within the set-up of healthcare. Evidence-based practice has several benefits to patients and healthcare practitioners in delivering healthcare services. Besides, EBP improves ROI in hospitals and patient outcomes. It is also said to enhance the healthcare’s efficiency and effectiveness in the provision of healthcare services. The essay critiqued three sections in the presented article namely literature review, method, and discussions/findings. The article’s author focused on ethical principles during the research as per the evidence-based practice. Moreover, the author had the determination not to cause any harm to the interested parties and participants during the research while protecting the vulnerable group.

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10 Reference list Andrews, T., and Waterman, H. (2005). Packaging: A grounded theory of how to report physiological deterioration effectively. Journal of Advanced Nursing , 52 (5), 473-481. Bandurska, E. (2022). The voice of patients really matters: Using patient-reported outcomes and experiences measures to assess effectiveness of home-based integrated care—A scoping review of practice. Healthcare , 11 (1), 98. Boswell, C., and Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice . Jones & Bartlett Learning. Brown, D. (2017). Evaluation matters as much as intervention. Practice Nursing , 28 (2), 57- 57. Connolly, T., Papadopoulos, P., and Soflano, M. (2022). Diverse perspectives and state-of- the-Art approaches to the utilization of data-driven clinical decision support systems . IGI Global. Crisp, J., Douglas, C., Rebeiro, G., and Waters, D. (2020). Potter & Perry's fundamentals of nursing ANZ edition - eBook . Elsevier Health Sciences. Evans, D. (2022). Introduction to research and evidence-based practice. Making Sense of Evidence-based Practice for Nursing , 1-10 Greenhalgh, T. M., Bidewell, J., Warland, J., and Lambros, A. (2016). Understanding research methods for evidence-based practice in health 1e WileyPLUS learning space + Wiley E-text powered by VitalSource . Wiley. Greenhalgh, T. M., Bidewell, J., Crisp, E., and Warland, J. (2023). Understanding research methods for evidence-basedpractice in health, print and interactive E-text . John Wiley & Sons. Grove, S. K., and Gray, J. R. (2018). Understanding nursing research E-book: Building an evidence-based practice . Elsevier Health Sciences. Hands, C., Reid, E., Meredith, P., Smith, G. B., Prytherch, D. R., Schmidt, P. E., and Featherstone, P. I. (2013). Patterns in the recording of vital signs and early warning scores: Compliance with a clinical escalation protocol. BMJ Quality & Safety , 22 (9), 719-726. Koutoukidis, G., and Stainton, K. (2020). Tabbner's nursing care: Theory and practice . Elsevier Health Sciences. Lehane, E., Curtin, C., and Corrigan, M. (2023). Teaching strategies for shared decision- making within the context of evidence-based healthcare practice: A scoping review. Patient Education and Counseling , 109 , 107630.

11 Meulen, R. T. (2017). Evidence-based practice in medicine and health care: A discussion of the ethical issues . Createspace Independent Publishing Platform. Occa, A., Morgan, S. E., Scaglione, T. L., Kuzbyt, B., and Bookman, R. J. (2020). What would an evidence-based tinnitus patient education program look like? Findings from a scoping review. Journal of Communication in Healthcare , 13 (3), 188-200. Odell, M. (2014). Detection and management of the deteriorating ward patient: An evaluation of nursing practice. Journal of Clinical Nursing , 24 (1-2), 173-182. Odell, M., Rechner, I., Kapila, A., Even, T., Oliver, D., Davies, C., Milsom, L., Forster, A., and Rudman, K. (2007). The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards. Resuscitation , 74 (3), 470- 475. O'Keefe, K., and Brien, D. O. (2023). Data ethics: Practical strategies for implementing ethical information management and governance . Kogan Page Publishers. Schein, R. M., Hazday, N., Pena, M., Ruben, B. H., and Sprung, C. L. (1990). Clinical antecedents to in-hospital cardiopulmonary arrest. Chest , 98 (6), 1388-1392. Scott, P., Keizer, N. D., and Georgiou, A. (2019). Applied interdisciplinary theory in health informatics: A knowledge base for practitioners . IOS Press. Sharma, S. (2018). Knowledge, attitudes, beliefs and behaviors of physiotherapists to evidence-based practice: A cross-sectional survey. International Journal of Healthcare Education & Medical Informatics , 05 (01), 6-11. Shearer, B., Marshall, S., Buist, M. D., Finnigan, M., Kitto, S., Hore, T., Sturgess, T., Wilson, S., and Ramsay, W. (2012). What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service. BMJ Quality & Safety , 21 (7), 569-575. Spector, N., and Starmer, A. (2019). Hospital medicine and clinical education, an issue of pediatric clinics of North America . Elsevier Health Sciences. Springs, S., and Baruch, J. (2019). Evidence synthesis methods. Research Methods in Health Humanities , 321-340. Trujillo, V. (2021). Evidence based practice beliefs and implementations among healthcare professionals .

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