Essay Sample on Finding Evidence in Health and Social Care

Introduction

Evidence-based practice has been one of the most debatable processes of the last few decades. Even though it has not been comprehensively given recognition in literature Florence Nightingale has been credited by some researchers to have initiated the concept of improving the outcomes of the patients with the use of sound evidence. It was developed and aroused from evidence-based medicine which has been defined by Professor David Sackett plus other scholars with an attempt of finding the best evidence that will assist medical practitioners coming up with the best decisions for their patients. Whereas the use of EBP acknowledges the best interest of the patient/client, (EBP) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual client/patients.

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Evidence-based practice (EBP) is a process that is ongoing by which nursing theory, evidence, practitioners' clinical expertise are evaluated critically and taken into consideration, in conjunction with the involvement of patients so as to offer the finest nursing care for each patient, whereas research-based practice is the process of critically analyzing and evaluating the findings of a research than finding out how the findings fit into the clinical practice. For decades nurses were using the available research as a guide in the nursing practice and in their efforts to improve the conditions of their patients but of late research-based practice have been replaced by Evidence-Based Practice.

In the above definition, Sackett is facilitating an understanding among the decisions that we make every day while in practice and EBP, hence demonstrating a strong link between the two aspects. Here, Sackett lays emphasis on the importance of the decisions we come up with as healthcare specialists, and how they should be clearly stated. This demonstrates that the decisions that are made are well thought-out, which further shows the evidence is use is done in a careful and sensible manner, which means that any care or support that is delivered is evidence-based. It confirms that Sackett has an understanding that if the support or care that we provide has a rationale, therefore this permits us to be able to deliver with a meaning full purpose.

EBP has taken the form of several steps to address information to come up with various relevant interventions: question asking, evidence search, appraising evidence critically, evidence collaboration with clinical expertise, personal client values then finally evaluation. The form that the question takes can determine the information about a patient. Clinical questions normally include numerous components: P- Problem, patient and/or population, I- Indicator or intervention, C-Comparison, O- Outcome of interest (PICO). Minus a well-structured question, it becomes very hard and takes a lot of time to pinpoint the resources that are appropriate and search for evidence that is relevant. Evidence-Based Practice (EBP) is a procedure and the questions arising from PICO play a very significant role in the procedure. The PICO question doesn't just arrive from anywhere. The question often arises as a background or informational question, however it becomes a PICO question once a conclusion must be come up with that has an effect on the practice.

Evidence based policy evidences are always grouped into two distinct categories: qualitative and quantitative evidences. They are both extremely important for evidence that is policy related. The quantitative evidence for example incidence, prevalence and cumulative incidence might elaborate the extent and severity of the problems that are facing public health through proportion or frequency and measurement of rate nevertheless evidence of this type usually presents a little understanding of the existence of some relationships. Alternatively non numerical data or qualitative evidence might be derived from methods such as group interviews, participants or focus group. Qualitative evidence might have on influence on the deliberations of policy, setting of priorities and suggesting of policy solutions by expressing convincing stories.

PICO is an acronym that is used in describing the four major elements of a clinical question that is good. The four words each stand for P- Problem, patient and/or population which majorly involves how you would describe a group of patients that are similar to yours, I- Indicator or intervention which entails the key intervention or the exposure that you are actually considering, C-Comparison which involves the major alternative that can compare to the intervention and O- Outcome of interest.

The questions below usually require the search for primary medical literature and they are they are always the best suited for the PICO questions.

Background Questions: they usually are concerned with the use of general knowledge. They usually have 2 parts only: A root question (why, when, who, how, what) and a test, disorder, treatment. These questions can frequently be answered by consultation from a clinical database or by just using a textbook.

Foreground Questions are questions that are specific to knowledge. They usually include the ones that affect medical results and they usually entail an extensive range of sociologic, psychological and biologic issues.

The usual first stage in coming up with a well solid question is to properly identify the problem of the patient or population by coming up with a description of the patients' major complaint or by taking a broader view of the condition of the patient as compared to a larger population. Problem is further refined or shaped with the utmost significant characteristics that may have an influence on the results like disease level or the status of health, and race, previous conditions, age, current medications, and gender.

Intervention identification is the second stage in the process of PICO. Identifying the new treatment routine that is being considered is important or the question that the patient is asking about, thus keeping the process centered on the patient. This might comprise the use of a precise diagnostic test, actual treatment, therapy, medication. Intervention is a new consideration for the patient.

The second last stage for the PICO question is the comparison question, which is usually about the alternatives that you are taking into consideration from the intervention. The comparison is characteristically the acknowledged process you perform. With the just specification of one comparison and intervention, it enables a computerized search that is effective. The comparison is the solitary alternative component in PICO question since an alternative is lacking, nevertheless, when one is there, it should be used.

The outcome is usually the final stage in the PICO questions. This provides a specification of what you want to accomplish from your plan, affect or improve. It should be in a manner that can be measured and can actually solve the problem. Examples of outcomes include maintaining or improving function, esthetics enhancement, and specific symptoms eliminations.

Ever since the Mechanical Ventilation (MV) and Nasal Continuous Positive Airway Pressure (NCPAP) the result that has been most relevant includes several controlled trials that are random in nature and it was agreed upon that the nature of the PICO question had to be refined to a level that they are actually answerable and searchable.

Implications of EBP

Nurses perform a key role in providing and ensuring EBP and are in a good position to work with other healthcare team members to detect clinical problems and use the evidence that exists to improve the practice.A lot of opportunities are available for the nurses to question the current nursing practices and use the evidence to make care extra effective.

Let's take an example of an evidence-based project that was published recently that describes the possible benefits of ceasing the practice of routinely listening to bowel sounds of the patients that have been performed to elective abdominal surgery. The authors upon reviewing the literature and conducting an assessment of the current practice, and they afterward came up with a new development and did an evaluation on the new practice guideline. The authors stated that the parameters in the clinics such as the flatus return and the first post-operation movement of the bowel were extra helpful than the sounds of the bowel in coming up with a determination of the return of gastrointestinal mobility right after the abdominal surgery. The evidence-based project made the authors realize that this can help the nurses in saving time minus having any negative outcomes on the patient. Nurses all over the country have been involved in one way or another in multidisciplinary efforts that are supposed to help in the reduction in the severity and number of pressure ulcers and falls. Projects of such a manner can help save money and improve the processes of care and their outcomes. With the implementation of the obtainable evidence-based guidelines relating to pressure ulcers/injuries and falls, the level of care has improved, plus the severity and number of outcomes that are negative have tremendously decreased.Other relevant examples of evidence-based research include the projects that are supposed to increase the level of compliance with requirements for cancer screening and glucose control improvement.

Recent studies provide evidence that nurses mostly provide care with accordance to what they were taught in their respective nursing schools and they rarely use reports from research, journal articles and hospital libraries for their reference. Upon the findings of this research and the average age of nurses being more than 40 years, it means a majority of nurses are using outdated methods. This doesn't translate to the patients' getting quality care or quality health outcomes. The blame should not full fall on the nurses only, as enhancement of the students in the nursing profession to understand and then apply evidence is also a role of the learning institutions where they learn their profession. Evidence-based practice provides an approach that is critical in ensuring that the level of care is updated and it reflects on the latest research evidence. Nurses need to have a professional autonomy and for this to happen they just have to demonstrate a good understanding on the reason why they execute the tasks and also show justifications to their actions.

Scenario 1

As an adolescent health worker you are concerned about cyber bullying and that it may be is an issue for your clients.

Populate the PICO for the chosen scenario for an answerable question about effects of interventions

• P- Among the youths, what is the age bracket that has been involved most in cyber bullying?
• I- what is the various intervention processes that exist that are used to reduce cyber bullying?
• C- How do the various forms of interventions programs compare to one another?
• O- How will this contribute to the decrease in cyber bullying?

Frame the PICO as a question (write out your information needs in the form of a question):

Among the youths who have happened to be invo...