Hypothetical Patient Study Utilizing Evidence-Based Practices - Essay Example

? Hypothetical Patient Study Utilizing Evidence-Based Practices (EBP) Hypothetical Patient Study Utilizing Evidence-Based Practices (EBP) Textbook definitions and descriptions on how to provide care for various patients usually seem straightforward and easy to understand. However, when it comes to real-life situations, there is a greater need to rely more on steps or methods that, while derived mostly from texts and publications, are much more applicable in real life. This is where evidence-based practices (EBP) come in handy, wherein information collated by various researches are applied in medical practice, and then further assessing whether or not the methods used gave better results than without using it (Nettina, 2013). While the application of the results of researches is deemed important, the process of assessing the impact of the EBP implemented must not be forgotten, since there is a need for a continuous thinking and judgment of various practices that will give the best results in caring for patients (Fairley, 2006; van Achterberg, et al., 2008). Aside from choosing methods that seem to give the best current evidences, the patient must also be taken into consideration since it is possible that the practices are either not applicable with the patients or might have complications in the execution of (Nettina, 2013). This pushes medical teams to not only learn about various EBP’s but to get their information updated regularly as well. Description of the Hypothetical Patient EBP’s are the products of various methods of many medical teams in different situations, and it is expected that some will only be useful a handful at a time. A hypothetical scenario referenced from Rajapakse & Rodrigo (2009) and altered slightly will be used as an example in creating a hypothetical treatment plan which utilizes various EBP’s in accordance with what the patient needs: A 43 year-old man was admitted to outpatient services and is presented with severe epigastric pain. The man describes the pain as “the feeling of being pierced repeatedly through the torso, from front to back”, but seems to reduce when leaning forward. After learning the man’s medical history, it was found out that he has been feeling this kind of pain for the past 4 or 5 years, but did not actively seek any kind of medical attention. There were also previous ultrasound scans of his gallbladder showing chronic cholecystitis, with some stones still present. In addition, he has been drinking heavily for the past two decades or so. His blood pressure at the time of his admittance was 110/80 mmHg. When his abdomen was assessed, tenderness over the epigastric region was observed but with the absence of abdominal guarding. In this scenario, it shows that while the initial reason for the man’s admission was due to epigastric pains, but after assessing the whole situation, he suffers in more than one condition during that given time. The bulk of problems seem to have stemmed from the man’s heavy alcohol drinking, which lead to the development of a shrunken gallbladder, developing chronic cholecystitis, and might be the reasons for the abdominal pain. This shows that there is not only a need to treat the man’s epigastric pain, but his alcohol problems must also be given attention to, since this can be considered to be the root of the man’s health problems in the first place (Hoffman, et al., 2011; Moss & Burnham, 2007). In this scenario, aside from providing care for the man’s physical illness, there is also a need to address some behavioural issues to allow the man to not only heal physically, but aim to attain an overall quality of life and well-being. Thus, with regards to the assessment of the patient, medical staff must not only bring immediate relief to the man, but rather take into consideration his circumstances in order for him to be healed in a holistic way as well. EBP Application Before selecting the appropriate methods for this hypothetical case study, there must be an overall assessment on what kind of EBP will be used, and this can be accomplished by following the five steps to EBP: Asking a question that needs to be answered; Finding any answers; Assessment of the available evidences; Applying the evidences in real-life; and Reassessing whether the EBP made any improvements in comparison to methods used before it (Barker, 2013). By formulating a solution to the given hypothetical case scenario using these five steps, it will be easier for nurses and other medical team members to create sound judgments on what kind of care will be provided, which is important especially in emergency scenarios. Formulation of an answerable clinical question In formulating the clinical question, it is important to identify who will need the treatment, what treatments will be used, what alternative options are available, and coming up with an expected outcome for the whole method. Emphasis must be given with the last step, since this will be give weight in the assessment of whether or not the EBP was useful or not. This process of formulating a clinical question is called PICO, from P – patient/population or problem, I – intervention, C – comparison, and O – outcome, and this basically anchors the steps needed in formulating an EBP (Barker, 2013). Using the given hypothetical case notes, the PICO may look something like this: (P) - a 43 year-old male patient admitted due to epigastric pain suffers from chronic cholecystitis due to alcohol drinking problems; (I) – surgically remove the gallbladder; (C) – assess for other possible complications, recommend for patient to undergo rehabilitation for alcohol problem; (O) – patient’s epigastric pains will disappear, alcohol consumption will be much more controlled, providing him with a better quality of life. Based on the PICO, the clinical question may be reworded as such: “Among middle-aged male patients having epigastric illnesses along with alcoholism, will surgical removal of the diseased area be sufficient enough, or should other procedures such as assessment of other complications and addressing the behavioural problem be done to improve their quality of lives? Selecting evidences from various resources using research strategies Various sources are available for medical personnel to find any publication related to the cases that they needed to apply EBP with. The fastest way to get updated with the latest EBP’s would be to search many databases online, and these evidences are usually classified according to the content which many nurses base their practices on: research evidences; clinical experiences; user/carer perspectives; and local context (Barker, 2013). Depending on the expertise of the team members or what the patient might need, any one of these or all of these kinds of evidences may be sought and assessed for possible usefulness for whatever situation or scenario that might happen. For the hypothetical case given, a combination of research and clinical evidences may be used to find out the best course of action in treating the patient. Summarizing the evidences Various evidences can be used to support the course of action in treating the hypothetical patient. This means that medical personnel must find out the best solution through systematic methods such as using a hierarchy of evidences based on the methods used in creating the evidences, with systematic reviews of randomized clinical trials (RCT’s) being in the lowest rank and descriptive studies or expert committee reports being in the top of the hierarchy (Barker, 2013). This is because not all publications are equal since the validity or the usefulness of the publication as evidence will be highly-dependent on the purpose for using these results, and the implication is that publications containing results of actual tests done by the authors would have more bearing over publications which either only provide reviews or feedbacks on past experiments without analysing the significance of each one versus another, and as a whole (meta-analysis). In creating an EBP for the patient, publications such as reports by institutions will be considered to be of utmost importance, followed by case study reports, and lastly basic researches which can either be well-designed RCT’s or other kinds of experimental studies that uncover trends by being repeated in various demographics through a wide timespan. For this paper, the following summary will be used in formulating an EBP for the patient: Chronic cholecystitis is caused by excessive alcohol consumption compounded within a period of time, and if not taken care of properly can affect other parts of the digestive system such as the liver or the pancreas (Lippi, et al., 2012). In order to minimize the problems in attempting any kind of invasive procedure on the patient, procedures such as the use of extracorporeal shockwave lithotripsy may be used as a first step (Dumonceau, et al., 2012). While it may suffice to provide treatment to patients by either removing the gallbladder altogether and restricting their meals, it may not be enough to prevent further complications in the future if their behaviours regarding alcohol consumption are not modified either before or after the surgery (Chabria, 2008; Hoffman, et al., 2010; Marcaccio, et al., 2006; Moss & Burnham, 2006). Lastly, aside from pre- and post-surgical behavioural modifications for the patient as well as designing a nutritional plan for the patients, and over-reliance on the use of drugs and the lack of control in prescribing antibiotics in the treatment of cholecystitis must be minimized to reduce the burden on the patients’ bodies post-surgery and thereafter (Murata, et al., 2011). Examination of evidence validity, importance, and applicability for the patient Seven publications were used in the formulation of a proposed EBP for the patient. Based on the content of each, these are the hierarchy rankings of each one: Chabria (4 – non-experimental studies); Dumonceau, et al. (5 – expert committee reports); Hoffman, et al. (4 – non-experimental studies); Lippi, et al. (1 – systematic reviews); Marcaccio, et al. (5 – expert committee reports); Moss & Burnham (1 – systematic reviews); and Murata, et al. (5 – descriptive study). Since many of the publications were high-ranking, it is easy to judge that the evidences were valid (Barker, 2013). Also, these papers are relevant as well since not only were the evidences related to the admission problems of the patient, but also to his prior diagnoses and possible post-op treatments as well. While the applicability to the patient might pose problems from to the lack of focus on specific age groups in the publications due to privacy and ethical reasons, or the need for additional publications that replicate the patient’s scenario in some ways and have definitive results (e.g. age group of cohort, similarities in medical conditions and hospital admittance, rehabilitation of these patients if applicable) creating a solid proposal for implementing an EBP from these researches can be further enhanced by the need to address the problems not just by the initial patient, but for patients to be admitted in the future as well. Some Limitations of EBP in the Hypothetical Scenario Aside from the need to support evidences of a continuity of treatment from surgery to behavioural modification post-operation, the EBP structure for the patient still had some limitations since it did not consider facts such as whether the patient would actually undergo any one of the proposed procedures (lithotripsy, behavioural modification) or both. Due to this lacking, it is possible that another consensus be made among medical professionals who will be handling this case, and find more evidences on the treatments that they plan for the patient (Barker, 2013). To prevent possible problems or issues in the course of treatment, it is essential that many evidences must be gathered, assessed, and summarized to get a gist of the whole scenario, find all methods of providing care for the patient including those implemented concurrently in many places with published and reliable results (von Achterberg, et al., 2008). By doing so, the most appropriate treatment may be selected with confidence of obtaining the expected results for the patient. References Barker, J. (2013). Evidence-based practice for nursing. Thousand Oaks, CA: SAGE Publications, Inc. Chabria, S. B. (2008). Inpatient management of alcohol withdrawal: a practical approach. Signa Vitae, 3(1), 24-29. Dumonceau, J. M., Delhaye, M., Tringali, A. N., Dominguez-Munoz, J. E., Poley, J. W., Arvanitaki, M., & ... Bruno, M. (2012). Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, 44(8), 784. Fairley, D. (2006). Factors influencing effective independent nurse prescribing. Nursing times, 102(31), 34-37. Hoffman, R. S., Weinhouse, G. L., Traub, S. J., & Grayzel, J. (2011). Management of moderate and severe alcohol withdrawal syndromes. Waltham: Up To Date. Lippi, G., Valentino, M., & Cervellin, G. (2012). Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail. Critical reviews in clinical laboratory sciences, 49(1), 18-31. Marcaccio, M., Langer, B., Rumble, B., & Hunter, A. (2006). Hepatic, Pancreatic, and Biliary Tract (HPB) Surgical Oncology Standards. Toronto: Cancer Care Ontario. Moss, M., & Burnham, E. L. (2007). Alcohol abuse in the critically ill patient. The Lancet, 368(9554), 2231-2242. Murata, A., Matsuda, S., Mayumi, T., Yokoe, M., Kuwabara, K., Ichimiya, Y., & ... Horiguchi, H. (2011). A descriptive study evaluating the circumstances of medical treatment for acute pancreatitis before publication of the new JPN guidelines based on the Japanese administrative database associated with the Diagnosis Procedure Combination system. Journal of hepato-biliary-pancreatic sciences, 18(5), 678-683. Nettina, S. M. (2013). Lippincott Manual of Nursing Practice. Ambler, PA: Lippincott Williams & Wilkins. Rajapakse, S., & Rodrigo, C. (2009). 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