Research In Clinical Practise
Introduction to Portfolio
The research articles to be critiqued relate to the author’s area of
practice; community nursing and in particular; the cost-effectiveness
of community leg ulcer clinics. The author currently manages a leg
ulcer clinic and an insight into the research underpinning their
cost-effectiveness would be of benefit in her quest to deliver
evidence-based practice in line with the principles underpinning
clinical governance.
Management of venous leg ulcers had advanced considerably over the
last decade. This is due to various factors from greater knowledge of
the aetiology of leg ulceration to more recent developments, such as
dedicated leg ulcer clinics (Dowsett, 2004). However, it is a concern
that leg ulcer clinics are being justified by nurses and organizations
based on uncontrolled studies and narrative accounts (Bosanquet et al,
1993; Fletcher, 1995; Stevens et al, 1997; Thorne, 1998; Audit
Commission, 1999). It has been widely suggested that the establishment
of community leg ulcer clinics could increase healing rates for leg
ulcers and standardise care (Moffatt et al, 1992; Simon et al, 1996;
Stevens et al, 1997). However, research surrounding their cost
effectiveness is extremely limited.
As interest in healthcare research grows, the number of definitions
and explorations of the topic has increased. Most definitions of
research follow a similar theme with the search for knowledge being
emphasised as a fundamental reason for undertaking research studies
(Clifford, 1997). Cormack (2000) defined research as an attempt to
increase the sum of what is known by the discove...
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...rities. BMJ, 312, 1648 - 1651.
Simon et al (2004) Management of venous leg ulcers BMJ Online, Vol.
328 (7452) 2004. [Online]
http://bmj.bmjjournals.com/cgi/content/full/328/7452/1358 (Accessed
Jan 2005).
Stevens J, Franks PJ, Harrington M, (1997) A community/hospital leg
ulcer service. Journal of Wound Care. 6, 2, 62 - 68.
Tingle J, and Cribb A, (2002) Nursing Law and Ethics. 2nd ed. Oxford,
Blackwell Science.
Thorne E, (1998) Community leg ulcer clinics and the effectiveness of
care. Journal of Wound Care. 7, 2, 94 - 99.
Thurlby K, and Griffiths P, (2002) Community leg ulcer clinics vs.
home visits: which is more effective?. British Journal of Community
Nursing. 7, 5, 260 - 264.
Valente S, (2003) Critical Analysis of Research Papers. Journal for
Nurses in Staff Development. 19, 3, 130 - 142.
The latest culture of nursing includes evidence-based practice. Without proven rationales, nursing interventions would not be substantiated with facts, and the credibility of nursing practice would suffer. Using descriptive and inferential statistics, evidence can be revealed, and the practice of nursing can be improved with better patient outcomes (Kim & Mallory, 2014). Within each specialty one can find evidence-based practice, such as the setting of critical care nursing, where many critically ill patients require mechanical ventilation due to acute respiratory failure secondary to the primary critical illness. Nutrition is a key component within the total care nursing practice that is typically observed in the critical care setting (Ramprasad & Kapoor, 2012).
Evidence –Based Practice is a process through which scientific evidence is identified, appraised, and applied in health care interventions. This practice obliges nursing experts to depend on logical research and confirmation more frequently than experience or instinct. EBP is intended to guide medicine of patients in a regulated methodology. This model joins together research, investigation and patient history to give the most exhaustive consideration conceivable. EBP got mainstream throughout the late 1970s. In any case, the thoughts behind the practice were presented much sooner than by nursing pioneer Florence Nightingale. As stated by Carole Cooper, "Nightingale evaluated nature's turf, gathered information, distinguished intercessions and observed patient results." This methodology mirrors current evidence- based practice. Utilization of EBP expanded throughout the 1970s and 1980s in light of calls for additional productivity in patient consideration. While restorative exploration discoveries were accessible, specialists and attendants were not equipped to get to or execute the new data rapidly enough. This new system joined together components of useful information and experience with clinical examination discoveries and investigation.
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
Within this essay Evidence based Practice will be identified and the significant effect it has on the nursing profession, barriers will also be explored in the implementation of Evidence Based Practice.
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
According to the article, Empirically Supported Treatments are treatments that have medical evidence including high-quality research to show their work. Evident-Based Practice is research findings from a collection of data through observation and experiment, formulations of questions and testing of hypothesis. EBT applies the best available research result/evidence when making decisions about health care. The therapist employs the knowledge, cumulated experience, and clinical skills. According to the article, APA endorses multiple types of research evidence such as efficacy, effectiveness, cost-effectiveness, treatment utilization that contribute to effective psychological practice (APA, 2005).
In healthcare today, it has become more apparent that evidence-based practice (EBP) is essential to incorporate into every facility, but nurse leaders have noted difficulties during the implementation process. Therefore, Melnyk and Fineout-Overholt recommend that practice changes should be guided by conceptual models and frameworks (2015). In order to effectively integrate EBP into facilities, eight models were created. Within this discussion, the Evidence-Based Advancing Research and Clinic Practice through Close Collaboration (ARCC) Model will be investigated (Melnyk & Fineout-Overholt, 2015).
Evidence-based practice (EBP) is an interdisciplinary approach to clinical practice that many organizations are being utilized. “The benefits of EBP, including greater cost effectiveness, and better patient safety, clinical outcomes, and patient and staff satisfaction are widely acknowledged” (Embedding a culture of evidence-based practice, page 14). In this paper, I will discuss how evidence-based practice is being utilized in the organization I work for, how nurses at the bedside are encouraged to participate in planning and implement evidence-based changes and what factors are available for nurses to use when implementing evidence-based practice. I will also discuss how nurses can suggest or help improve evidence-based practice and sustain a positive environment for EBP.
The evidence based practice model that I have selected is Prolonged Exposure (PE) Therapy for Posttraumatic Stress Disorder. PE is a Therapy for Posttraumatic Stress Disorders, which focuses on cognitive-behavioral treatment program for adults who have experienced single or multiple/continuous traumas and have posttraumatic stress disorder (PTSD). This intervention consists of a course of individual therapy designed to help clients process traumatic events and reduce their PTSD symptoms as well as depression, anger and general anxiety. Treatment is individualized and usually consists of 8-15 sessions once or twice weekly for 90 minute each. The treatment length can be shortened or lengthened depending on the client (Children, Youth and Families Mental Health Evidence-Based Practice Project, 2001).
This paper will discuss several different aspects of using evidence research. It will compare and contrast validity vs. reliability and address wither it is possible to have an instrument that is valid and not reliable. It will also examine type I and type II errors as well as examine the differences between parametric and non-parametric. Lastly, this paper will look probability and what the minimum level of significance is for a research paper.
This reflective essay will discuss three skills that I have leant and developed during my placement. The three skills that I will be discussing in this essay are bed-bath, observing a corpse being prepared for mortuary and putting canulla and taking it out. These skills will be discussed in this essay using (Gibb’s, 1988) model. I have chosen to use Gibb’s model because I find this model easier to use and understand to guide me through my reflection process. Moreover, this model will be useful in breaking the new skills that I have developed into a way that I can understand. This model will also enable me to turn my experiences into knowledge that I can refer to in the future when facing same or similar situations. Gibbs model seems to be straightforward compared to the other model which is why I have also chosen it. To abide by the code of conduct of Nursing and Midwifery Council (NMC) names of the real patients in this essay have been changed to respect the confidentiality.
Evidence-base practice has been defined as “the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care” [1] Evidence-based practice is the mix of best clinical research ,prove clinical ability and patient qualities. The utilization of the evidence for basic leadership, as opposed to the formation of the confirmation through the examination procedure accordingly appears to be a basic contrast amongst research and evidence-based practice. Research is utilized to direct an examination, the after effects of which will add to existing confirmation. Evidence based practice means to look for and evaluate best confirmation, some of which will be given by research.
Evidence based practice is instilled in many nursing students these days on how patient care should be practiced. For some reason, once school is over, many nurses do not go on to further their learning. They lose the passion to research and take nursing as a job with a paycheck. Maintaining competencies can become a challenge for those who are not passionate about learning and learning new ways of practicing can be a struggle beause they do not care.
Clinical trial is biomedical or health related research studies in human being that follow a pre-defined protocol. Research is an activity designed to test a hypothesis that helps in concluding and developing knowledge. It is a protocol that has an objectives and procedures to reach those objectives (1). There are two types of clinical studies. One is interventional studies in which the research subjects are assigned by the investigator to a treatment or other intervention, and their outcomes are measured. Second is an observational study in which individuals are observed and their outcomes are measured by the investigators.
...s expressed by most treating physicians if best treatment is not possible. Most of those wound are sadly sent to a community nurse for dressing change without the patient coming back to the treating physician for assessment of "maintenance wound" treatment.