Foundations in Evidence based Practice - Essay Example

Foundations in Evidence Based Practice Introduction: Evidence based practice has become the buzz word in every aspect of the healthcare delivery system. The concentration thus is on finding the best evidence through clinical evidence to the detriment of the three other vital components of clinical experience and judgement, patient preferences and the resources available. Evidence Based Practice: According to DiCenso, Cullum and Ciliska, 1998, the four component model of evidence-based practice comprising, clinical evidence, clinical experience and judgment and available resources is a simple means of making effective clinical decisions by a nursing professional in the interest of care of patients.

Clinical expertise and patient preference are the overriding components of this model with clinical expertise coming to the forefront, when patients are too frail to provide adequate patient preferences Nursing professionals are taught the means of collecting clinical evidence through the evaluation of information from clinical research. However not always is pertinent and adequate information available on a timely basis. In addition clinical evidence may be at odds to patient preference and the clinical experience for the given clinical problem.

Thus mere adherence to clinical evidence does not contribute to evidence based practice. (Steinberg & Luce, 2005). Patients are individuals with their individualistic desires in the treatment and management of their clinical problems. Quality of life and quantity of life are two perspectives in clinical problems. Clinical evidence may focus on one of these aspects, while patient preference may be for the other. Clinical evidence cannot be imposed through a paternalistic attitude ignoring the dignity and autonomy of the patient.

Clinical experience provides the means in such situations to respect the preferences of the patient. It is this blending of clinical evidence with clinical experience and judgment that provides the means to respect patient autonomy and deliver evidence based practice. (Cody, 2003). Support and information, attentiveness and respect for the individual contribute to patient autonomy (Proot, Crebolder, Abu-Saad, Macor & ter Muelen, 2000). Care in the critical care units involves high costs due to the involvement of expensive life supporting devices like the mechanical ventilator.

Clinical evidence suggests that three to six percent of patients in critical care units would require extended use of the mechanical ventilator and the prognosis is such cases is a high rate of mortality and poor quality of life in the rest. Thus clinical evidence suggests that prolonged use of costly mechanical ventilators is ill advised. However clinical experience has shown that in many cases the limited survivors have been happy to pay the costs for the quantity of life it has provided irrespective of the poor quality of life.

Clinical judgement of the nursing professional calls for assessment of the patient preference of the possibility of quantity of life, irrespective of the quality and the costs involved, and standing in opposing to any denial of continued use of the mechanical ventilator (Guentner, et al, 2006).Conclusion: Evidence based practice thus means employing the four means of clinical evidence, clinical experience and judgement, patient preference and available resources to effective and acceptable resolution of medical problems.

Patient preferences when possible and clinical experiences have prominence. Literary ReferencesCody, W.K. 2003. ‘Paternalism in nursing and healthcare: central issues and their relation to theory’. Nursing science quarterly, vol. 16, no. 4, pp. 288-296.DiCenso, A., Cullum N. & Ciliska, D. ‘Implementing evidence-based nursing: some misconceptions’. Evidence-Based Nursing, vol.1, pp. 38-40.Guentner, K. et al, 2006. ‘Preferences for Mechanical Ventilation Among Survivors of Prolonged Mechanical Ventilation and Tracheostomy’.

American journal of critical care, vol. 15, no. 1, pp. 65-77.Proot, I.M., Crebolder, H.F., Abu-Saad, H.H., Macor, T.H. & ter Muelen, R.H. 2000. ‘Facilitating and constraining factors on autonomy: the views of stroke patients on admission into nursing homes’. Clinical nursing research, vol. 9, no. 4, pp. 460-478.Steinberg, E.P. & Luce, B.R. 2005. ‘Evidence Based? Caveat Emptor!’ Health Affairs, vol. 24, no. 1, pp. 80-92.