Evidence-Based Practice - Research Proposal Example

Evidence Based Practice Introduction Evidence based practice is an approach that spans through various disciplines like medicine, dentistry, education, psychology and information science. The method requires that all decisions made regarding practice be based on research studies that are selected and interpreted. The research study interpretation should be done according to norms that are typical of an evidence-based practice. Clinical practice using evidence-based practice aims to integrate clinical expertise/opinion, scientific evidence from research and patient’s perspective/opinion (Skipper, 2009). Evidence based practice considers the best interests, values and needs of the patient. In evidence-based practice, systematic research is used to garner external clinical evidence, which is integrated with the caregiver’s individual clinical expertise. The methodology focuses on patient values and the most appropriate research evidence in the decision making process for the patient. The evidence obtained does not dictate the decision-making process, but helps in adding support for patient care. Through this, clinical decision-making is complemented by the evidence, which enhances the quality of life and maximal clinical outcomes for the patient. For this practice to be effective, clinicians are required to harness new skills in searching for literature and the application of formal rules of evidence in evaluating this literature. Realizing evidence-based practice requires adherence to a systematic research protocol enshrined in a series of steps. These steps ensure that the desired outcome is attained, and the purpose of the study implemented with regard to the clients’ welfare. These steps include assessing the patient to establish the problem, which is used to construct a clinical question. Resources are then selected to form the base of the research intended to come up with a viable review regarding the case. Evidence gathered from the research is analysed and appraised for its truthfulness and practicability in relation to the case (Howlett et al, 2013). The patient is then briefed on the intended course of action as per the study and its applicability in clinical practice evaluated. A self-evaluation procedure is the final step in evidence-based practice where those involved, reflect on their performance with respect to the newly acquired insights. This paper aims to produce research-based evidence to be applied in answering a question designed for use in a client who is hypertensive and overweight. The evidence is to be used in forming a referral guideline for nurses in practice. A search strategy is going to be formulated, refined and evidence sources selected. The evidence garnered will be analysed for validity and applicability to the client described. Gaps in knowledge regarding the subject are going to be identified and discussed. Patient History Betty is a 74-year-old woman with a history of hypertension since the age of 40. She weighs 162 kg and stands at 170 cm tall. Betty has struggled to lose weight all her life and has long since given up on her attempts. She has remained active and relatively fit until the last 2 years. Her hypertension was previously well controlled with Metoprolol 100 mg bd, but in the past 2 years, it has frequently been raised to over 160/90 on several occasions. In the last year, she has had recurrent chest and left arm pain with no evidence of Ischemia found as each time she has had normal ECGs and troponin levels. In the past year, she has also noticed more shortness of breath and wheezing. This has partially improved with inhaled Beclomethasone diproprionate. Recent blood tests show that her cholesterol is normal, but her fasting blood sugar is 6.1. Her full blood picture, urea, electrolytes and liver function tests are normal. Betty also has a history of pernicious anaemia and osteoarthritis. Betty is divorced and has a daughter aged 51 who also has hypertension. She is independent and has recently felt somewhat depressed because of her inability to do everything she would like to do at home, without feeling tired and short of breath. The immediate matter of concern regarding Betty’s condition is her weight problem which could be the cause of all of her other problems. In order to improve the service for patient health and well-being, and improve understanding, an answerable question was designed. It was meant to obtain the best possible practice involving a patient with hypertension and prior cases of atrial fibrillation. With respect to this, paramedics are faced with the question of how to handle a client who has all of these complications in case of an emergency. When a paramedic encounters a patient like Betty, they should explore ways of stabilizing the patient without aggravating the patient’s other conditions. Thus, the question that finally emerges is which applicable treatment should be recommended to control high blood pressure in an emergency, and in a patient with atrial fibrillation. Atrial fibrillation can cause stroke in a patient, so the question that emerges is how to stabilize such a patient in light of such circumstances. Evidence Resources and Search Strategy The main objective of this evidence gathering activity was to acquire the most effective and applicable anti-hypertension therapy and drug to use. The medication being used to control Betty’s hypertension is called Metoprolol, which is also used to treat heart pain, some neurologic conditions and abnormal rhythms of the heart (Mason, 2013). The drug is well tolerated and but it still has some side effects which can be associated with this case. Shortness of breath or wheezing and aggravated breathing is a well-known side effect of this medication (Mason, 2013). The use of Beclomethasone diproprionate to solve her shortness of breath and wheezing can also be attributed to some of her conditions. Some well-known side effects are blood problems, increased heart rate and breathing problems. Depression is a common side effect with both modes of medications (Mason, 2013). The search strategy conferred upon was to survey any relating systematic reviews as this was felt to be the most effective research tool. It was also decided to cover a broad set aspect of all information available. The strength of research evidence is evaluated by testing prior results from successful application of the methodology. It is an acknowledged fact that randomised control trials form the basis of research used in systematic reviews, and it was recommended for this case. These trials would be used to determine the best course of treatment to handle Betty’s case. To identify relevant information, studies and electronic searching via data bases are used. The data bases selected were Ovid MEDLINE, CINAHL, ACP, EBM and MEDITEXT. All citations that are found are included as in-text citations and included in a reference list at the end of the paper. Evidence sources like ACP were found to contain invaluable information regarding the treatment hypertensive and hypotensive patients with cases of atrial fibrillation (Mahrous, 2010). At the beginning of the research, some inclusion criteria and outcomes were concluded upon, and they included: The included reports and systematic reviews had to include investigations concerning patients with hypertension and possible ischemia. The recommended weight loss method reviewed should not just work but be tolerable and practicable to the patient. The interventions in the randomised controlled trials forming the basis to the systematic reviews were preferably randomised and the randomisation procedure described. Each patient subject should have had the same probability of being included in each comparison group (Keele, 2010). Search terms were as comprehensive as possible because, they are many words and definitions with the same or remarkably similar meaning, and the following were considered for purposes of completeness; i. Atrial fibrillation meaning irregular heart beat. ii. ACP means American College of Physicians. iii. Fasting blood sugar meaning the amount of glucose or sugar present in the blood before a meal. iv. Osteoarthritis means a degenerative disease if the joints. v. Pernicious Anaemia a condition characterised, by the inability of the body to synthesise enough healthy red blood cells due to lack of sufficient vitamin B12. vi. EBM means Evidence based medicine. An initial date range was established to include research, which had been done in the last 5 years as the only one to be used. Examining the Evidence Complications were encountered, in the search, when it was found that some interventions, aimed at controlling high blood pressure, could aggravate other conditions present in the patient. Different categories were presented depending on whether it was purely hypertension related or weight loss in hypertensive patients was selected. This meant that some publications were not offered under hypertension and weight loss, but was offered as a search database under hypertension due to weight gain and remedial measures. MEDLINE is a database that contains millions of records covering various topics in science especially those concerned with biomedicine and health. The MEDLINE database provided more relevant systematic reviews regarding individuals with hypertension and atrial fibrillation, than was found in any other databases. The online ACP website had peer-reviewed journals that provided substantial evidence to address the posed question adequately (Mahrous, 2010). The Physicians Information and Education Resource (PIER) also provided evidence that could be used, by paramedics, to carryout emergency treatment protocols on hypertensive patients (Pier, 2012). Full text of each relevant article was obtained and read for viability and suitability. The resultant data on applicability and any side effect are analysed from the information retrieved. Twenty articles were obtained and read for apposition purposes although none addressed the posed question. Analysis of Evidence for Validity, Importance and Applicability Evidence based practice is a method that can be efficiently used to treat weight related disorders in patients. In this process, the practicability of the recommended intervention is extremely crucial to the success of this study. This area of study has many sources of evidence because hypertension and atrial fibrillation are an area of primary concern to many people. Obesity, which is associated with an individual being overweight, is a serious health concern and its implications in contributing to life threatening conditions like hypertension (Montori, 2006). There was numerous evidence concerning weight loss and hypertension, and conscientious care was taken to refer to the one that had relevance towards the posed question. The best evidence available was from published peer reviewed journals and books. Difficulties were encountered in choosing which information and published research was the most deserving of the topic. Using the internet and electronic databases was hindered by some journals failing to be published or all the contents being unavailable. Some reports could not have been included in systematic reviews creating retrieval bias. In spite of all these limitations, due to the popularity of the subject in the posed question, there were enough sources available to warrant proper authenticity of the reviews. Patient understanding of the modes of intervention and their preferences are the ultimate guides in clinical procedure. According to the evidence garnered from the sources, it is clear that paramedics’ primary concern should be prevention of short-term circulatory instability, which can cause stroke. The study establishes that a paramedic should endeavour to stabilise the rhythm and heart rate to achieve circulatory stability (Mahrous, 2010). According to ACP journals, to eliminate risks of stroke paramedics should administer anticoagulants like aspirin or clopidrogrel for patients who are allergic to aspirin. This approach recommended for low risk patients while for people with a high risk of stroke, treatment with anticoagulants like warfarin are recommended. In the event of an emergency, a paramedic should be able to apply methods that will control hypertension, without heightening complications, as atrial fibrillation. Hypertension is associated with a myriad of negative changes in the cardiac physiology and structure. These changes favour the development of arterial fibrillation, which can cause thromboembolic difficulties in the body. With respect to this case, the client suffers from arterial fibrillation a direct consequence of hypertension due to excessive weight (Weir, 2010). This sets the precedent that requires clinicians to come up with a research study formulation through evidence-based practice. This is meant to help in producing a recommendation on a suitable intervention protocol to deal with this problem. Hypertension can be dealt through various approaches depending on the person’s preferences. These approaches are determined by factors such as health of the individual, cost implications of the procedure and the time. These techniques include weight loss through exercise, through dietary approaches and surgical procedures that involve removal of excess body fat (Blackburn et al, 2011). All guidelines for antihypertensive therapy support weight loss, through dietary method. This is because using diet to promote weight loss is the method that has the least side effects if any (Mensah, 2010). In this case though, the method of fasting or going without food as a dietary approach should not be used because at her age, it would certainly lower her blood glucose level, which is a dangerous precedent for development of diabetes (Sarris & Wardle, 2010). Dietary methods like reducing carbohydrate intake and adopting a vegetarian diet are some of the ways that are recommended by this study for this case (Aveyard & Sharp, 2009). Conclusion Upon completion of the assignment and research in an attempt to find the best clinical practice that is supported by evidence from assorted sources. The evidence obtained from published data was supportive enough to give credit to the recommendations proposed by this study. The study question posed by the assignment produced numerous results that made it easier to pin point the research topics that were fitting the question. No identifiable gap was found regarding this subject because it is an area that attracts funding from pharmaceutical companies with stakes. In hypertensive patients with excess weight problems, weight loss through dietary measures helps reduce blood pressure and excess weight. Evidence based research provides extensive information on the expertise required to deal with hypertension especially in patients with atrial fibrillation. Paramedics who are exposed to evidence based practices are better equipped to deal with clients suffering from atrial fibrillation, hypertension and risk of stroke. Evidence based practice is limited when it comes to addressing some clinical scenarios which pass off as common knowledge or practice. The use of evidence-based practice is a new and fitting clinical approach that deals with diseases in a manner that is appropriate and comfortable to the patient. References Aveyard, H and Sharp, P. (2009). A Beginners Guide to Evidence Based Practice in Health and Social Care. Illustrated Reprint Edition. New York: McGraw-Hill International. Blackburn, G. L, Go, V. L. W. & Milner, J. (2011). Nutritional Oncology. Academic Press. Howlett, B. M. A, Shelton, T. G and Rogo, E. J. (2013). Evidence-Based Practice for Health Professionals (Book).Massachusetts: Jones & Barlett Publishers. Mahrous, T. (September 2, 2010). Atrial Fibrillation. North Central Heart Institute , 1-75. Retrieved from: http://www.acponline.org/about_acp/chapters/sd/mahrous10.pdf Mason, J. D. (2013). Capstone Pharmacy Review (Book). Revised Edition. Massachusetts: Jones & Barlett Publishers. Mensah, G. A. (2010). Hypertension and Hypertensive Heart Disease, An Issue of Cardiology Clinics. Elsevier Health Sciences. Montori, V. M. (2006). Evidence Based Criminology. New York: Springer. Sarris, J. & Wardle J. (2010). Clinical Naturopathy: An evidence-based guide to practice. Elsevier Health Sciences. Skipper, A. (2009). Advanced Medical Nutrition Therapy Practice. Illustrated Edition. Massachusetts: Jones & Barlett Learning. Weir, R. M. (2010). Evidence-Based Management of Hypertension. Illustrated Edition. Tfm Pub Limited. Read More