Evidence-Based Practices in Oncology Nursing - Research Paper Example

 Evidence-Based Practices in Oncology Nursing Cancer has become a major health care problem today. With the health practices people are into today the prevalence of cancer and cancer related diseases has hit the mark on the community health scale and has drawn focus and attention of the health care arena. With the prevalence of cancer more and more health care services are being utilized in providing quality nursing care such patients. Today's health care environment demands constant improvement in patient outcomes. And oncology nursing care are particularly interested in effective cancer-symptom management and is more focused on identifying essential resources that facilitate easy access to the best evidence-based management for common cancer symptoms. Evidence Based practices in support of nursing has been expanding greatly and is now the focus of all nursing fields including oncology nursing in creating a demand to bring evidence tested knowledge and incorporating it into practice. With this, the society of oncology nurses or the Oncology Nursing Society (ONS) is committed to identifying the evidence base for oncology nursing and demonstrating the impact of oncology nursing interventions on patient outcomes (Stanley, 2006, p. 142). Evidence-Based Practices in Oncology Nursing Evidence-based practice is a multi-step, dynamic process that incorporates best external data and best clinical judgment that is according to patient response to nursing interventions. Even one individual nurse may complete this process however a multidisciplinary team approach allows for even bigger perspectives on a clinical problem and provides a more precise outcome. With the new ways of health care practice brought about by evidenced-based practice nurses are given the chance to provide the best possible nursing care that can provide desirable outcome based on evidence altogether with the way which Nursing Care Delivery Model is suited for the situation. Nursing care delivery models are mechanisms for organizing and delivering patient care. Nursing care delivery models focus on structure, process and/or outcomes. Along the evolution of nursing and the sprout of nurse educators and scholars, many nursing care delivery models have also been developed that eventually evolved to different types and kinds from various developments and modifications of use. Some have been developed using task approaches where patient care tasks are listed and categorized under the level of care required providing the task. More recent models have arisen out of a psychological approach, focusing on patient satisfaction with nursing care and job satisfaction among nurses. Some of the most obvious reasons for such variations are cost of nursing care delivery, availability of personnel, patient care needs and individual and organizational preference. Nevertheless regardless of what nursing care delivery model is utilized by nurses, the purpose of any delivery system is to provide high quality care, efficiently and effectively as possible (Neisner & Raymond, 2002, p. 7). Nursing Care Models and the development of Evidence-Based Practice The author of this essay deemed three Nursing Care Delivery Models that would best support evidenced-based practice in oncology nursing-- Patient-Centered Care, Team Nursing and Nursing Case Management. Models of care are important because it is how evidenced-based patient care is delivered to the patient. Evidenced-based practices will be null and void if nursing care delivery is poor in the first place it will not be properly delivered or worst not delivered at all. Patient-Centered Care (Table 1) is a model first utilized during the hospital reengineering era of the 90’s. This method uses multi-skilled workers and a team approach to nursing. By virtue of this method, patients are being grouped together according to similarity of cases. The four principle of this method are: simplifying outcomes, grouping similar patient population together, bringing services closer to patients and broadening staff skills by cross-training care providers which are all designed in developing a system of efficient patient care (Neisner & Raymond, 2002, p. 9). For example, patients having Chemotherapy induced nausea and vomiting are grouped together under the care of a group of highly competent and skilled workers under the supervision of a registered nurse as the team leader in giving nursing care. These patients having the same symptoms can be placed under an observation or study whether what is the best practice for relieving such symptoms for cancer patients. This way the result of such study or observation is a highly reliable source for developing evidence based practice because results are from a group of similar subjects experiencing the disease rather than from the perspective of one patient alone. In this way Patient-centered care method is essential for the development of evidence based practice in giving care to oncology patients. This method is advantageous for developing evidence based practice because workers are unit based and spend more time in direct-care activities thus observation outcomes are highly reliable. Team Nursing (Table 2) is another nursing method deemed by the author of this study to be one of the best nursing care models for oncology nursing. It is the most commonly used model today. In team nursing, the nurse as the team leader coordinates care for a group of patients. The goal of team nursing method is for the team to work as one whole unit in disseminating the care activities to the patient. Although many members of the team act for patient care, the nurse as the team leader is still accountable for all the patient care. Team conferences happen wherein every team member’s expertise is solicited and is used in the plan of care. Every member’s input is considered essential for the process to work and the nurse must have an effective nursing and leadership skills. Team Nursing is essential in using, developing and evaluating evidenced-based nursing practice because in team nursing the degree of recommending a practice whether it is highly safe, effective and efficient according to meeting standards is based on not just one person alone but with the whole group of skilled health workers who can attest for the patient (Neisner & Raymond, 2002, p. 8; University of North Carolina School of Nursing, 2012). Team method is advantageous in a way that the care is not fragmented because although members of the team delivers the care, only one nurse is held accountable hence the evaluation of nursing practice is adequate and reliable. Moreover, Nursing Case Management (Table 3) is another model that is deemed to support evidence based practices. The hallmark of case management method is that this method allow for mobilization of resources over the course of an illness because nursing case management focuses on specific patient populations, following the patient through an entire episode of care (Neisner & Raymond, 2002, p. 11). In addition the process provides automatic reassessment at prescribed intervals. Through this reassessment process, patient’s response to the care given is evaluated and when this evaluation comes off the Care Map steps are immediately taken to identify why, and what needs to be done to get the patient back on the expected outcome or wellness. This method is in best support of developing evidence based practice in such a way that nursing care practice value is always based on research or study based on patient response. This method is a systematic method that has components of the nursing process such as assessment, planning, implementation, evaluation, and interaction. This way nursing practice is continuously being studied according to patient response hence it can evaluate whether such practice can be applied. For example nursing case management method for Breast cancer patients can evaluate the effectiveness of non-pharmacologic pain management for other non-cancer chronic illness and find out whether it is effective and thus can be utilized University of North Carolina School of Nursing, 2012). The Nursing and the EBP Processes: are they the same? The nursing process is similarly performed the way evidence- based practices are developed. According to Oncology Nursing Society (2012) the development of evidence-based practice is achieved through a series of steps like how nurses come up with solutions using the nursing care plan. The evidence-based practice process involves the following steps: 1) Problem Identification- in the nursing process problem identification can be attributed to assessment process. Here, in a similar context nurses assess patients to identify problems that needs to be addressed or needs nursing care planning of action; 2.) Finding the Evidence- or finding the best evidence with which to answer the problem is in tune with the planning phase of the nursing process. Here plan of care is carefully thought over and analyzed; 3.) Critique- Determining the merit, feasibility and utility of evidence is the way nurses implement a nursing care to patients; 4.)Summarizing, Application to Practice and evaluation of outcome jives with the end process of the nursing process which is evaluation process. Here the effectiveness of the practice is evaluated and recommendations are made depending on the acceptability of the outcome (Oncology Nursing Society, 2012). The Nurses’ Role in EBP Nurses play an important role in the planning and providing evidence-based practice. Nurses who play the role as patient advocates play a vital role in evaluating and documenting the effectiveness of the treatment as well as communicating the plan of care to patients. Nurses are key players in developing evidence-based practice as part of the health care team that interacts with the patient mostly thus delivering the plan of care within the level of every patient is what makes nursing care personal to every patient. This way patients understand the positive regard in participating in the treatment plan and in developing desirable outcome for future recommendations based on evidence. Communication: a way in developing EBP Communication is very vital in the development of evidence-based practice in oncology nursing. Open non barred communication should always be encouraged to get the most reliable information needed for evaluating the way care was given to the patient. Patient’s verbal and nonverbal comments regarding a treatment are ways to evaluate the effectiveness of such treatment. This way nurses are able to collect reliable information from reliable sources who experienced the treatment themselves and not merely basing on nurses’ judgment and observation alone because the best source of client satisfaction will always be the client. Some therapeutic communication strategies that can be applied by nurses to encourage open communication are: Active Listening, broad opening statements, general leads, reflecting, open-ended and directing questions, stating observations, acknowledging feelings, reflecting, using silence, clarifying, validating, verbalizing implied thoughts and feelings, focusing, using closed questions and summary statements. Learning from the course The idea of every study is for every aspiring nurse to learn during the acquisition of knowledge, skills and attitude based from the evidence-based studies made by great nurse educators and researchers who have come ahead and have learned during the way. Learning will always be essential. Through learning nurses are able to pass on the legacy of giving the best patient outcome based on factual evidences and not fallacies. In accordance to this, there are three learning that the author of this essay have found most important in the course in guiding to the professional development of a nurse. First, as registered nurse accountability in all actions and decisions is warranted. A nurse can never have ignorance as an excuse because learning is part of the everyday of a nurse. Nurses are accountable for every patient thus before acquiring a nursing job equipping oneself with proper foundations of knowledge, skills and attitude as nurse is vital. Second, treating others as they would like to be treated is a rule of thumb. Nurses should always consider what sick people feel in the same manner be non-judgmental of patients life style or choices when caring for and treating. Putting oneself in other people’s shoe can help find the right approach in dealing with patients. Giving respect in every decision a patient makes is always the right thing to do the same way nurses wanted to be respected. Be a patient advocate and never a patient commander. Lastly, nurses must be diversified and research other cultures when caring for different cultures. This way culture sensitivity helps gain patients trust. Nurses should always be transparent in giving care to clients. Client should always be looked upon as a client and never as a part of a race, culture or minority groups. Nurses treat beyond the color of the skin and are versatile to have an open working relationship to every client regardless of culture. This way evidence-based practice extends beyond every culture. Evidence-based practices will always serve as the foundation for nursing-sensitive patient-outcomes in oncology nursing. Today, knowledge continues to expand and more evidence-based practices are being developed and implemented in the oncology nursing practice settings which is important in evaluating the effectiveness of interventions used for cancer patient management. Indeed the use of evidence-based practice in oncology nursing have facilitated continuous evaluation that results in bringing better recommendations of best practices of patient care (Stanley, 2006). References: Neisner J. & Raymond B. (2002) Nurse Staffing and care Delivery Models: A review of the evidence. Kaiser Permanente Institute for Health Policy Oncology Nursing Society (2012) EBP Process. Oncology Nursing Website. Retrieved from: http://www.ons.org/Research/EBPRA/Process Sauk Valley Community College; Health Careers Department- Nursing (2011) Staffing and Nursing Care Delivery Models PPT. Retrieved from: http://www.google.com.ph/url?sa=t&rct=j&q=nursing+care+delivery+models&source=web&cd=18&cad=rja&ved=0CFQQFjAHOAo&url=http%3A%2F%2Fwww.svcc.edu%2Fdepartments%2FAcademic%2Fhealth_careers%2Fnrs239%2Fppp%2Ffall05%2FNursing%2520Care%2520Delivery.ppt&ei=4jisUPX5AuLAmQXS74CADw&usg=AFQjCNHk53X1JMHlpkX5TI0nZIcmo75ZBQ Stanley K. (2006) Oncology Nursing Society: Evidence-Based Practice. Journal of Oncology Practice, 2(3): 142 University of North Carolina School of Nursing (2012) Leadership in Nursing Practice; Nursing Care Delivery Systems. Retrieved from: http://www.unc.edu/courses/2005fall/nurs/079/960/delivery_systems/activity2.html Table 1. Patient-Centered Care Model Organizational Flow Paradigm (Image source: Sauk Valley Community College; Health Careers Department- Nursing, 2011) Table 2. Team Nursing Model Organizational Flow Paradigm (Image source: Sauk Valley Community College; Health Careers Department- Nursing, 2011) Table 3. Nursing Case Management Model Organizational Flow Paradigm (Image source: Sauk Valley Community College; Health Careers Department- Nursing, 2011) Read More