Evidence-Based Practice in Mental Health - Essay Example

Evidence Based Practice Introduction According to O’Brien (2008 p 27) Evidence based practice can be defined as the union of quality research evidence with clinical expertise and patient values. In addition, evidence based practice can also be referred to as the application of quality research guidelines, clinical experience, patient preferences, and culture in attaining professionalism. In this definition, several factors are important if put into consideration. The three important pillars of evidence based practice should include clinical guidelines contained in the researches, clinician expertise, and patient likes and dislikes. Evident research should never refer to situations whereby there is whole sale imposition of research without attending to the patient. Further, lack of appreciation to the available research is not evidence based practice. Research is the main part of the evidence based practice in mental health. All clinicians are expected to begin with research and then integrate with their expertise and patient values (Schultz and Videbeck, 2008 p 418). Consequently, the patients also form a crucial component of the evidence based practice in mental health and addictions. Clinicians should also perform the integration of patient characteristics and make the final decisions wile informing the patient what is likely to take place in the treatment process. Clinicians should always make the ultimate judgment regarding a particular intervention or treatment plan. However, untrained persons unfamiliar with the specifics of the case should never be allowed to make treatment decisions (Stickley and Bassett, 2008). Definition of the pillars Best available research Keedy (2003, np) assert that Clinical research should ensure that accuracy and relevancy in trying to solve the problems being experienced by the patient. In addition, the clinical research should be unbiased. Further, the research should also address factors such as disease prevalence and patient populations suffering from the mental disorder. Consequently, clinical research is not complete without focusing on treatment methods. The research should also ensure that it factor in systematic reviews, reasonable effect sizes as well as clinical relevance. Finally, the research should have supporting evidence. Clinical expertise According to Allen and Lyne (2006 p 78), Clinicians are expected to have appropriate experience in terms of skills that will lead to the promotion of positive therapeutic outcomes. The clinician should be able to conduct assessments, come up with diagnostic decisions, assess patient progress, understand cultural differences and seek available resources that are necessary. Patient characteristics The interest of the patient should be considered by all clinicians. Factors such as patient strengths and the socio cultural context are important in understanding the needs of the patient. Decisions should be made by collaborating with patients in reaching the right solution to their medical problems. Probable costs should also form part of the decision making process. However, there are cases whereby patients may require unique decisions and intervention that are not present in the current research. Collaborating with patients is crucial in achieving success of mental health and addiction services (Malloch and O’Grady, 2010 p 37). Importance of evidence based practice Evidence based practice ensure that clinicians promote effective mental health and addiction practices. Individual clinicians, when applying the pillars of evidence based practice, will be able to increase efficacy, and efficiency of delivering quality medical care to patients. Further, evidence base practice ensures that there is increased applicability of services given to certain patients or patient groups. The applicability services include assessment, case formulation, how to prevent diseases, establishing therapeutic relationships and consultation. Consequently, effective application of all the pillars of evidence based research enhances public health (Fulford, Peile and Carroll, 2012 p 7). Health professional state that: the use of previous credible research is one of the standards of good practice. In situations whereby health professionals used interventions that are not evidence based; clients are at risk of personal injury and professionals at risk of charges of malpractice (Kent, and Mccormack, 2011 p 28). Psychological Treatment in Bipolar Disorder Bipolar disorder victims are affected in their brains. Bipolar disorder affects emotional and cognitive functioning of individuals. Due to the facts that it affects the brain, psychological therapy can prove to be effective in treating the disorder. The main aim of the psychological therapy is to ensure that the patient becomes compliance to the medication instructions, to create bonds with patients and those they interact with, to reduce antisocial behaviors, and to learn new coping skills (Psychoeducation.org, 2007). According to evidence based practice, several psychological therapies for bipolar disorder have been developed. The therapies include cognitive-behavioral, psycho educative, couples-partners, family, social rhythms and interpersonal. Cognitive behavioral therapy has randomized clinical trials that recommend their use in treating patients with bipolar disorder (Psychoeducation.org, 2007). Clinical Trials in Cognitive Behavior Therapy Durham et al (2005) conducted clinical trials for Cognitive behavior therapy in treating anxiety disorders and psychosis. In addition, the researchers examined the effectiveness of the treatment method as well as its cost effectiveness. Design The researchers contacted and interviewed the participants. They carried out the study in two perspectives. The first perspective involved eight randomized, controlled clinical trials while the second perspective being two randomized, controlled, clinical trials for CBT. The research was conducted from 1985 to 2001 in central Scotland (Durham et al, 2005). Interventions The researchers conducted follow up interviews between 1999 and 2003 after they had treated patients using cognitive behavior therapy. The researchers ensured that the interviews for trials were done by research psychologists and psychiatric nurses who did not bother about the treatment condition. The trials were in two phases, trials 1-8 and trials 9-10 (Durham et al, 2005). Main Outcome Measures In measuring the outcomes for trial 1-8, anxiety disorder interview Schedule (DSM-IV) for diagnosis and Co-morbidity, clinical Severity (0-8) and the Hamilton rating scale were used. Trials 9-10 were measured using the interview-based positive and negative syndrome scale (PANSS) (Durham et al, 2005). Results In trial 1-8, about 52 % of the participants who had at least one diagnosis in the course of treatment had better health outcomes than 10 % of the general population. Importantly, treating patients using CBT was successful due to long-term diagnosis than in cases where CBT was not used. The success of CBT was initiated by effective completion of medication irrespective of modality. In addition, the success of CBT did not depend on the number of follow ups made (Durham et al, 2005). Conclusion The researchers asserted that psychological therapies must recognize the fact that anxiety disorders tend to follow a chronic course. In addition, good outcomes in psychological therapies done in short-term, may not lead to health benefits in the long terms: CBT should be a continous process. Follow ups should be made to ensure that the patients are taking their medication effectively. Failure of the CBT method was attributed to failure in completing the medication irrespective of the amount of follow ups done by the clinician (Durham et al, 2005). Cognitive Behavior Therapy Due to evidence based practice in the above research, CBT has been used in treating bipolar disorder. This method of treatment aims at preventing mood disturbances in patients. CBT aims at changing the thought patterns of patients as well as their behaviors. However, success can only be registered in CBT after using proper medication (Staff, 2012). Clinicians use CBT based because they believe that thoughts affect the way patients behave. External factors such as people and events cannot lead to feelings and behavior changes in the patients. In particular, negative as well as unrealistically positive thoughts have been attributed depression among individuals suffering from bipolar disorder (Staff, 2012). To effectively treat bipolar disorder using CBT, patients must be educated about their illness. The patients must understand the situation they are undergoing and the importance of taking their medication instructions effectively. Educating patients ensures that they are informed of their condition in making appropriate decisions concerning treatment methods (Staff, 2012). Consequently, clinicians cooperate with patients to eradicate negative as well as positive unrealistic thoughts. The main work of the therapist or the clinician is to challenge the negative or unrealistic thoughts in the patient. The negative thoughts in bipolar disorder patients lead to depression. Further, the therapist challenges distorted self talk. The dropping of the distorted thoughts is aimed at replacing them with more constructive thoughts that cannot lead to depression but improves the mood (Staff, 2012). Evidence based practice focuses on early warning symptoms that can be noted in individuals suffering from bipolar disorders. The patient should be well educated to ensure that the depression triggers are effectively managed by the therapist. The therapist aims at replacing the negative and unrealistic thoughts with realistic thoughts that can improve patient moods. In addition, patient education is aimed at improving disease management by focusing on important principles such as biological basis, causes that arise from the environment, and outcomes. CBT should therefore sett specific treatment goals that can be achieved as well as coming up with coping skills necessary to help bipolar disorder victims (Staff, 2012). Factors that hinder implementation of EBP Reduced spending, increased governmental regulation, and shifts in the site of care significantly affect evidence based practice. However, health providers need to focus more attention on the need of patients and patient education. Patient satisfaction must involve the assessment of how healthy and satisfied patients are and how much their care costs. Patients have long complained of having little say in their treatment, receiving inadequate information, and experiencing post-treatment abandonment. The main focus for clinicians is on getting the patient out of the hospital but not on who is going to take care of them when they leave hospital (Hannigan, 2003). Quality care attainment and effective clinical practice depends on the clinician’s ability to appraise available research. There may be lack of skills to evaluate research thereby contributing to malpractice. Importantly, workload can lead to lack of time in assessing available research materials to make informed medical decisions. In addition, competing priorities have also been cited as the main challenges to evidence based practice. These problems arise due to clinician’s lack of knowledge of research methods. Further, lack of confidence and support from other professional colleagues can also lead to poor evidence based practices (Townsend, 2010). Implementation of evidence based practice has also experienced challenges in environments that do not honor the true conventional methods of practice. This is caused by reluctance to appreciate research results that have been carried out. Nurses should learn the benefits of following the guidelines of evidence-based nursing practice. The main purpose of evidence-based care is to provide effective treatment methods to the society. The decision making process cannot be effective without values, resources and evidence from other researches. All clinicians should be taught how to critically read and understand other evidences in medical research (American Psychiatric Association, 2003 p 81). Another barrier that can pose challenges to the implementation of evidence based practice is lack of continuing education programs. Educational institutions are not capable of providing workshop experiences to clinicians due to limited funds, staff, and time. An important research may be dismissed due to lack of funds, staff and time. Valuable treatment can never be achieved by clinicians if they abandon the contribution of evidence. The clinicians will not be able to learn new ideas. In addition, patients may suffer from such decisions (Holland and Rees, 2010 p 42). The fear interfering in a superior nurse’s duties can also lead to poor implementation of evidence base practice. New clinicians may fear telling experienced nurses that there are new methods of treatment available. Resistance to change can be deduced from the superior nurse intolerance to new methods of treatment. Availability of evidence can never be a guarantee that clinicians will not be biased in their decision making process. Even if clinicians find and apply the evidence, they may still engage in making inconsistent and unbiased decisions (Stut and Hayes, 2004 p 216). Conclusion Evidence based practice is important to all health professionals. Evidence based practice ensures that clinicians use available research in making informed decisions that cannot lead to patient injury as well as legal battles in the court. In addition, evidence based practice and new research guidelines can be used to educate and train clinicians and may take an increasing role in curricula of the undergraduate and postgraduate training heath-care professionals. Importantly, evidence based practice ensures that there are appropriate choices made about which treatment modes are most likely to bring benefit for patients. Finally evidence based care lead greater cost-effectiveness in the delivery of effective services to clients as well as ensuring that clinical malpractice and human suffering is reduced in the hands of clinicians. References Allen and Lyne (2006), the Reality Of Nursing Research; Politics, Practices And Processes, London: Taylor And Francis. American Psychiatric Association (2003), Evidence Based Practices In Mental Health Care, New York; American Psychiatric Publishers. Fulford, K., Peile, E And Carroll, H (2012), Essential Values-Based Practice: Clinical Stories Linking Science With People, Cambridge: Cambridge University Press. Hannigan, B (2003), The Handbook Of Community Mental Health Nursing, London: Routledge. Holland, K and Rees, C (2010), Nursing Evidence Based Practice Skills, New York; Oxford University Press. Keedy, S (2003), Community Mental Health Nursing and Dementia Care, New York; Mcgraw-Hill International. Kent, B And Mccormack, B (2011), Clinical Context For Evidence Based Nursing Practice, New York: John Wiley & Sons. Malloch, K And O’Grady, T (2010), Introduction To Evidence Based Practice In Nursing And Health Care, New York; Jones & Bartlett Learning. O’Brien, P (2008), Psychiatric Mental Health Nursing; an Introduction to Theory And Practice, New York; Jones & Bartlett Publishers. Schultz, J and Videbeck, S (2008), Lippincot’s Manual of Psychiatric Nursing Care Plans, London; Lippincott Williams & Wilkins. Townsend, M (2010), Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence Based Practice, London; F.A Davis Company. Durham RC, Chambers JA, Power KG, Sharp DM, Macdonal RR, Major KA, Dow, MG and Gurnley AL (2005), Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland. Psychiatry and Behavioural Sciences, Division of Pathology and Neuroscience, University of Dundee, Scotland, UK.. retrieved on 24th September 2012, from: http://www.ncbi.nlm.nih.gov/pubmed/16266559 Psychoeducation.org (2007), psychotherapy for bipolar disorder, retrieved on 24th September, 2012, from: http://www.psycheducation.org/depression/Psychotherapy.htm Staff, M (2012), bipolar disorder: treatment and drugs, retrieved on 24th September, 2012, from: http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=treatments-and-drugs. Read More