In this article the authors have undertaken a cluster randomised controlled trial (RCT), unblinded, with 79 general practices in England participating, involving 2,142 patients. Of interest, originally, 41 practices had shown interest in this trial, 15 of these practices already had nurse-led clinics and so were ineligible to participate. With respect to the trial, there was a comparison of three groups of patients with coronary heart disease in primary care: an audit group, a GP recall group and thirdly a nurse recall group. The primary outcomes of the trial were associated with three risk factors: blood pressure (BP) and cholesterol levels, together with ascertaining smoking habits. Secondary outcomes were related to anti-hypertensive, …show more content…
Findings included an improvement in assessment of all three risk factors especially cholesterol levels in the GP and nurse recall groups. Yet there were insignificant differences in risk factor reduction. Secondary outcomes varied with all groups having increased prescriptions for lipid lowering medication; minimal change in the prescription of anti-hypertensives and an improvement in the prescription of anti-platelet medication in the nurse recall group only. As quality of life tools were used rather than a total focus on medication adherence, I consider this added a more holistic basis to the trial. Given would the advent of nurse prescribers is a relatively new occurrence, I wander if this would have made even more of a difference to the groups. In conclusion, follow-up care by nurses is as effective if not better than doctors. This journal article does partially supports the proposed research question but only addresses three modifiable risk factors and is not specific to symptom …show more content…
(Neil Crawford Campbell et al., 1998) Four years later, patients were followed up. (P. Murchie, Campbell, Ritchie, Simpson, & Thain, 2003) On both occasions, research demonstrated the benefits of attending nurse-led clinics for the secondary prevention of CHD. The article I have chosen to annotate is the 10 year followup of the original RCT. Given the time incurred, I consider the accumulated data as strong evidence that has being reviewed and evaluated vigorously. There were only a few other studies that showed long term results, two – five years, regarding the use of nurse-led clinics for the secondary prevention of CHD. (Cupples & McKnight, 1994; Moher et al., 2001) Total mortality was less and survival of coronary events had been better, though statistically insignificant in the nurse-led group. At the 10 year follow-up, survival of coronary events, results graphically converge. Otherwise the study indicated that overall the GP and nurse-led group results were similiar for total mortality, other causes of death, coronary death and hosptial admissions for cardiac events. This research supports the notion that nurse-led clinics convincingly are as effective as seeing a Doctor for the management of symptoms and reducing cardiovascular risk
The systematic review indicated (1) ‘Case management interventions were associated with reduction in all-cause mortality at 12 months follow up, but not at six months’. (Takenda, et al, 2012) The systematic review also went on to state that while case management interventions were not associated with reduced mortality, case management interventions were indicated to reduce the occurrence of patients presenting to hospital with exasperations of chronic heart failure. The benefits of case management based interventions were apparent after 12 months had lapsed. Six of the twenty five studies assessed (2) heart failure clinics, and the evidence for this intervention was less convincing with the review stating ‘there was no real difference in all-cause mortality, readmissions for HF or between patients who attended a clinic and those who received usual care’. (Takenda, et al., 2012)
Implications for nursing practice are as follows. First, the study indicated that additional medical intervention is not always supportive of positive patient outcomes. Instead, it
Coronary heart disease is a common term for the build-up of plaque in the heart’s arteries that could lead to heart attack (Coronary Heart Disease, 2017). Furthermore, there are many known coronary heart disease factors that can be controlled. These are high blood cholesterol, high blood pressure, diabetes and pre-diabetes, obesity, smoking, lack of physical activity, unhealthy diet and stress (Coronary Heart Disease Factors, n.d). The techniques of motivational interviewing are more persuasive than coercive and more supportive than argumentative. The motivational interviewer must advance with a firm sense of purpose, clear methods and skills for seeking that purpose, and a sense of timing to mediate in specific ways at quick brief periods of time (Miller and Rollnick, 1991). The clinician uses motivational interviewing on account of four general principles in mind. The key principles are to express empathy, avoid argument, roll with resistance and support self-efficacy (Treatment, C. for S. A.,
Patients under the care of advanced nursing professionals who were advised to take an proactive role in the development of management plan under the supervision of their nurse practioners and medical doctors. were more effective in their compliance than those While no significant differences were in the outcomes that included A1C and the levels of triglyceride, there were notable increases in patients who comply with activities related to caring for self and willingness to make healthy lifestyle changes in the areas of increased physical activity and nutritional intake.
The key to a successful healthcare reform is interdisciplinary collaboration between Family Nurse Practitioners (FNPs) and physicians. The purpose of this paper is to review the established role of the FNP, appreciate the anticipated paradigm shift in healthcare between FNPs and primary care physicians, and recognize the potential associated benefits and complications that may ensue. Description of the Topic Definition The American Nurses Association (2008) has defined the FNP, under the broader title of Advanced Practice Registered Nurse (APRN), as one “who is educationally prepared to assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic interventions” (p. 7).... ... middle of paper ... ...
Liem E, Lin C, Suleman M et al. Anesthetic requirement is increased in redheads. Anesthesiology. 2004;101(2):279-283.
...smoking, high cholesterol diet, age, gender, sedentary lifestyle, contraceptives and hormone replacement therapy. Nurses can fill significant treatment gaps in the risk factor management of patient with coronary heart disease. “Cardiac rehabilitation programs including nursing education exert a beneficial effect on patients’ quality of life, exercise capacity, lipid profile, body mass index, body weight, blood pressure, resting heart rate, survival rate, mortality rate and decreased myocardial infarction risk factors.” ( Health Science Journal, 2012). Healthcare professionals should discuss with the patients therapeutic lifestyle changes, emphasizing the role of diet in heart disease. Nurses should provide information and teaching about medications to lower cholesterol levels and also discuss the relationship between diabetes, hypertension and CAD.
Quality of care and patient outcomes rely heavily on practice based on evidence found in systematic reviews of randomized-control trials. While administration often-times implements core measures that involve EBP in their regulations, it is ultimately the nurse’s responsibility to include EBP into their care of patients. Nurses have an obligation to include EBP into their care because “it leads to the highest quality of care and the best patient outcomes” (Melnyk & Overholt, 2015). The nurse leaders really have a responsibility here because it is their responsibility to stress the importance of EBP as well as reviewing research to determine the best possible findings to implement into their unit’s care. Careful monitoring must be performed to assure compliance because “despite the multitude of positive outcomes associated with EBP and the strong desire of clinicians to be the recipient of evidence-based care, an alarming number of healthcare providers do not consistently implement EBP” (Melnyk & Overholt, 2015). Often times, I find seasoned nurses act putout with anything that changes their methods of care. The important thing to remember is that seasoned nurses, while often-times set in their ways, are great nurses and presenting EBP findings and their success during implementation will keep them involved with EBP because they ultimately want to do what’s best
The NHS Outcomes Framework has five standard domains which is set out to improve the quality and outcome of care and services that is being delivered to the patients and service users (National Quality Board, 2011). As such, this project plan is focused on domain 2 as it has been mentioned before, is based on improving the quality of people with long term conditions. Nurses will give cardiac discharge advice to patients on self care, thus identifying how to improve and manage their condition so that they can continue with their normal lifestyle. Furthermore patients will be advised on how to overcome stress and depression which will help them in maintaining the activities of living (DoH, 2013).
Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for the delivery of optimal health care (qsen.org). Like most medical professions, nursing is a constantly changing field. With new studies being done and as we learn more about different diseases it is crucial for the nurse to continue to learn even after becoming an RN. Using evidence-based practice methods are a great way for nurses and other medical professionals learn new information and to stay up to date on new ways to practice that can be used to better assess
Healthcare is viewed in an unrealistic way by most individuals. Many people view a physician as the only means to find a solution to their problem. Nurses are still seen by some as simply “the person who does what the doctor says.” This is frustrating in today’s time when nurses are required to spend years on their education to help care for their patients. In many situations nurses are the only advocate that some patients’ have.
Evidence Based Medicine (EBM) has been a truly evolving and expanding standard for the practice of medicine and healthcare around the world. This expanding body of knowledge and expertise has been melded into medicine becoming the gold standard of care, in addition to possibly the only manageable way to extract precise and up to date clinical information. The evolution of EBM has been thoroughly evolving since its inception into the lexicon of mindset of medicine. It is believed that Evidence based medicine is relatively new to the practice of medicine, the initial exposure is dated only to the 1970’s, and its implementation to the 1990’s, as far as many researchers can deduce,1 given what the body of research has presented. Given its relative infancy in the overall practice of medicine it has truly become intertwined in the evolution of clinical education and clinical medicine. With the preponderance of research and clinical studies in healthcare, the future of competent and effective healthcare is completely dependent upon the utilization of EBM. The current status of the physician assistant is and will be to continue to incorporate EBM in the education of its’ students and will proceed to effortlessly employ EBM in daily clinical practice.
The first article is entitled “of mice but not men: problems of randomized clinical trials,” is written by Samuel Hellman and Deborah S. Hellman discusses the issues of randomized medical testing and experiments on patients. The article describes the role of the personal physician and how the physician can take an ethical or unethical path of treating his/her patients. The relationship between the patient and physician is greatly emphasized because according to the article trust is very valuable in medicine especially when a patient’s life is at risk. A Kantian and a Utilitarian view of randomized clinical trials are debated but the authors clearly steers towards a Kantian point of view.
Although most nurses do not get enough recognition in medical environments, nurses often do the same tasks as physicians. Even though becoming a doctor requires more education, nurses are the staple of American medicine. From Florence Nightingale to present day, nurses continue to build relationships and provide care for a wide variety of patients. There are differing views regarding the importance of nurses, but I believe they are just as important as physicians and can make just as much of an impact as any other medical provider.
The journal I read was Individual Music Therapy for Depression: randomized controlled trial. The idea of this trial was to try to understand weather music therapy and long side of standard care is beneficial or not. At the time the most common treatment for depression was medication and psychotherapy. In the past there have been studies done on the efficiency of music therapy and they concluded that it was beneficial. However only one study was done were the participants were apart of the working class. Due to that this study limited its participants to only those of the working class in order to collect more research on the effects of music therapy on this group of people.