Evidence-Based Care versus Opinion-Based and Ritual-Based Care - Essay Example

Evidence-Based Care versus Opinion-Based and Ritual-Based Care and Evidence based nursing is the use of research findings in nursing practices to improve the quality of administered nursing care (Stevens, 2013). Evidence in this context refers to researched and documented information whose credibility has been ascertained through a peer review process. The nurses consult the most contemporary research information and try to implement the findings that are going to significantly improve the quality of the nursing care. The research evidence used is usually generated through a rigorous methodology and data analysis and approved through a peer review mechanism (Makic et al, 2013). Ritual-based nursing care, on the other hand, follows nursing procedures that have been designed and documented to be followed (Eizenberg, 2010). Here nurses implement directions without questioning their reasons or effectiveness. Individually held opinions and rituals, therefore, are being practiced without acknowledgement of the reason for their practice. Evidence based nursing practice is aimed at achieving the provision of the highest quality of nursing care. It is more effective than relying on the traditional diagnosing and treatment methods since it employs contemporary knowledge during the decision making process (McCrae, 2011). Of late, nurses are increasingly giving evidence-based nursing care preference over ritual-based and opinion-based. This paper critically analyses why this is so. It does so by pointing out the importance and benefits of relying on research evidence and showing the implications of evidence-based practice on nurses and their profession. A ritual is a predetermined order of performing an activity (Stanhope and Lancaster, 2009). Opinion and ritual-based nursing practices involve administering nursing care practices without thinking of the reasons behind such a practice (Makic et al, 2013). A nurse in this model undertakes a nursing practice primarily because it has always been done that way. Nursing practices based on rituals and opinions are characterized by ceremonial and observance practices. There is extensive observation of protocols and formality. Prescription is based on stereotyping individuals and routines (Stevens, 2013). The ritual-based model was popular among the nurses in the past because the nurses were not tasked with making decisions that would make them liable. The nurses were, essentially, not decision makers but rather implementers of book details. As long as they implement the manual instructions to the latter, they had the satisfaction that they had performed their duties effectively. Ritual-based nursing practices were relatively successful in administering nursing care to clients in the past (Askham and Chisholm, 2006). However, as the technology advanced, it became crucial that the quality of nursing care be improved too. Ritual-based nursing practices became hamstrung by its several limitations. The first limitation is that it is based on routines, beliefs and formalities with very few facts involved (McCrae, 2011). The beliefs, furthermore, were often unsubstantiated and were tantamount to individually held opinions (Cribb and Entwistle, 2011). This led to nurses performing many tasks some of which were not beneficial to them or their clients, hence time and money wasting. Ritual-based nursing practice also led to increased instances of misdiagnoses because of its stereotyping nature. For example, some nurses would administer less painkiller drugs to male patients because it was generally believed that men can handle more pain than females. This was detrimental to the male clients in the long run. However, its major limitation is that ritual and opinion based nursing care was institution-driven rather that patient driven (Reay, Berta and Kohn, 2009). The nurses discharged their duties with a sense of accountability towards the institution they were working for instead of towards the patient they are administering the care to. Ritual-based and opinion-based nursing practices were beginning to fail the patients and, by extension, the nursing practice. Nursing care best practices started shifting towards the evidence-based model which relies on contemporary knowledge to come up with effective nursing care practices that are backed by evidences (Stevens, 2013). There are several reasons why most nurses prefer to use evidence-based nursing models as opposed to opinion-based or ritual-based care models. The first is that evidence based nursing care allows for designing of healthcare interventions that are less prone to errors as compared to ones that are reliant on rituals and opinions (Reay, Berta and Kohn, 2009). Nursing is a noble profession and its main objective is to ensure the well-being of the clients. It, therefore, becomes critical for nurses that the decisions made be based on evidence and be as error-proof as possible. The best possible way to achieve this is by using information that has been generated through a rigorous research process and has been scrutinized by peers for credibility and reliability (McCrae, 2011). Ritual-based care and opinion-based care, oftentimes, do not incorporate professional advice in decision making. This increases the probability of making a wrong decision, for example, erroneous diagnosis. This can lead to complications and even the death of the patient. Secondly, nursing care based on evidence from records can be collated from a diverse range of disciplines (Stevens, 2013). The prevalence of making better, informed decisions increases. Rituals are usually based on certain cultures and religious beliefs. The rituals may have a scientific basis or not (Eizenberg, 2010). Irrespective of the presence of scientific backing, technological advancements very easily render them obsolete. Additionally, opinions are usually held by an individual. Even professionals at the same institution can have differing opinions on a subject (Linton and Prasun, 2013). Decisions made based on researched evidence are more effective as they are generated through a holistic approach as compared to ritual-based or opinion-based (Askham and Chisholm, 2006). Thirdly, evidence-based nursing care allows for standardisation of the nursing practices and procedures across the globe (Makic et al, 2013). One of the main advantages of standardisation is that it allows for flexibility for nurses. Evidence-based nursing relies on research studies that are performed to global standards. This means that the findings have a universal outlook and application (Linton and Prasun, 2013). Nurses can change their locations and work stations and still be able to apply the findings anywhere around the global. Ritual-based care is restricted to a particular country or location and, therefore, has no universal application (McCrae, 2011). Opinion-based decisions are worse because opinions change depending to an individual and time (Makic et al, 2013). Apart from the desire to have a worldwide application of nursing practices, standardisation also enables the rationalisation of nursing teaching curricula across different countries worldwide (Eizenberg, 2010). This is because the teachings are based on researches that are evidence-based and can be proven anywhere in the world. The same cannot be said of rituals and opinions. An educational curriculum teaching based on rituals and opinions cannot have even a continental application. Additionally, teaching opinions and rituals is hard and cannot be applied globally in a standardised manner (Reay, Berta and Kohn, 2009). Global cooperation in the health sector is imperative to improve the quality of nursing care for patients in the world. A country cannot survive on its own. Evidence-based research and nursing practices provide an apt vehicle to achieve and obtain quality medical services. Evidence-based nursing care, unlike ritual-based and opinion-based, keeps pace with the latest technological advancements and research knowledge (Stevens, 2013). The information used to design the medical interventions has been tested and proven through trials. Evidence is, thus, the latest credible information on the subject under consideration. Rituals and opinions lack this element of newness. The rituals and opinions that were being performed and held decades ago are still the same in some countries and cultures (Makic et al, 2013). They are not changing to accommodate the rapid-changing medical sphere. For instance, there are mosquitoes that have developed resistance to some of the drugs administered to treat malaria. If a doctor still uses a drug that is now ineffective, his or her patients cannot be said to be receiving the best quality nursing care since the nurse is not utilizing the best medical care that there is. This happens mostly when a doctor makes opinion-based and or ritual-based diagnoses. However, if the nurse is up-to-date, he or she will be able to determine that there are better anti-malaria drugs that have been invented that are more powerful. This happens when the nurse consults the research studies conducted. Evidence-based nursing care, therefore, easily becomes the most effective as compared to the other two. Additionally, evidence based nursing care saves on treatment cost (Eizenberg, 2010). This is unlike opinion-based and ritual-based nursing interventions which can, at best, be termed as trial and error treatment methods in these contemporary times. This is because the decisions made by those nurses are not backed by hard evidence (Stevens, 2013). Even if there is evidence, it is credible since it has not undergone the rigorous process of peer reviewing where it can be criticized and any shadow of doubt pointed out. On the other hand, extensive researches enable development of cost-effective means of treatment. There is less wastage of time and resources as during the trial and error treatment processes. This is because the research processes have allowed for exploration of cheaper means of medical interventions. Also, patients’ confidence in a research-based nursing care is more than in ritual-based or opinion-based nursing care (Linton and Prasun, 2013). This is because they perceive nurses who make decisions based on hard evidence to be informed and knowing what they are doing. Of course, it is important for patients to have confidence in the treatment process because it has a huge bearing on their chances of responding to the treatment being administered (Cribb and Entwistle, 2011). Patient’s treatment is as much physical and physiological as it is psychological. It is, thus, important that patients approve of the treatment option being explored and have confidence in it. Lastly, evidence-based nursing care allows for tailored, individualised and streamlined nursing care (Carmelli, Sheaffer and Halevi, 2009). Patients are unique and different. Medical interventions cannot be applied equally across the board. The unique patient’s values and ability to respond to a certain mode of treatment should be considered when designing a care intervention. Evidence from research studies enables this tailor making. On the other hand, rituals and opinions held, oftentimes, need to be applied uniformly across the board and, therefore, do not offer tailored treatment to individual patients. For instance, one of the programmes in the UK health care that fosters the service users’ involvement is cognitive behavioural therapy employed in the field of psychotherapy (Askham and Chisholm, 2006). Here, the patients are actually active participants in deriving solutions for their mental health problems such as depression and anxiety and other personality disorders such as obsessive compulsive disorder and posttraumatic stress disorders among others. If no such intervention existed in psychotherapy, all patients with mental health needs would have been given the same psychotherapy treatment regardless of an individual’s mental health need. In the end those interventions may be ineffective. There are various implications of the shift from opinion and ritual-based nursing practices towards evidence-based nursing care. The most important implication is that the care practices will now be based wholly on facts and less on emotions, manual instructions and individual opinions (McCrae, 2011). Based on evidence generated from researches, nursing care will now be humane, democratic and, most importantly, therapeutic. Evidence-based nursing care is rooted on the four pillars of clinical expertise, patient’s preferences, research evidence and available resources (Stevens, 2013). Many nursing practices are bound to change as a result. For instance, using the opinion and ritual-based nursing care, a patient in pain would have been given a prescribed dose of painkillers, nothing more. The nursing decision was based on stereotyping patients and had less understanding of the individual needs of the patient. Evidence-based nursing goes beyond the manual instructions and does not rely on stereotypes. Evidence-based nursing care is individualized and tailored to a patient’s needs as opposed to blanket application of concepts (Makic et al, 2013). A good example of individualized nursing care is Cognitive Behavioural Therapy. Cognitive behavioural therapy is a combination of cognitive therapy and behavioural therapy and is a major form of evidence-based nursing care practice (Roth and Pilling, 2008). CBT is used to correct dysfunctional emotions and undesirable, potentially harmful, behaviours. CBT is goal oriented and is applied following systemic procedures (Spence, Donovan and Brechman-Toussaint, 2000). In this evidence-based approach, the therapist and the client jointly identify the problem, illness or condition and then identify ways to overcome them. The therapy procedures and goals may differ according to the individual undergoing the treatment and the dysfunctional emotion or behaviour that is being treated (Beck, 1979). What makes it evidence-based and superior to the ritual-based approach is that CBT is problem-focused and action-oriented (Roth and Pilling, 2008). It acknowledges the fact that people are different and that the traditional symptom-based general treatment may not be effective in psychotherapy. Evidence-based nursing practices not only rely on symptom-based diagnoses but go a step further to consider the individual traits of the client in order to offer treatment. Furthermore, clients in evidence-based nursing care are included in decision making whereas those in the ritual-based and opinion-based models are not (Reay, Berta and Kohn, 2009). Evidence-based nursing care would, therefore, change the expert-led approach under the ritual-based nursing care to a more consultative approach that is based on factual information. Evidence-based nursing care also means that nurses will have to know their patients better. This is primarily because the clients have to be involved in the decision making process through making their preferences known (Eizenberg, 2010). Nurses have to build a rapport with their patients so as to get more information to help them provide the nursing care. For instance, instead of following the manual-based instructions for treating cancer, it would be wise to ask chronic cancer patients about their medical health records and consult the previous records of their cancer treatments before designing the new intervention. Nurses, thus, have to have full knowledge and information about their patients and the patients have to be involved in decision making (Linton and Prasun, 2013). Nursing practice must uphold high levels of professionalism in handling of patients. This is only achievable when the nurses adhere to the set regulations and follow standardised research generated provisions for interventions (Eizenberg, 2010). Nurses should not use their own individual judgment to handle patients. In some countries, evidence based nursing care is part of the best practices in nursing. All nurses and institutions are supposed to use make evidence-based decisions. The governments or the nurse unions may terminate the working contracts of nurses who are not compliant with that regulation or are still providing ritual-based or opinion-based medical care. Research-based care will also revolutionize the best practices in the healthcare industry. As time passes by, the evidence-based practice becomes more and more popular. Some countries, for example the UK, have already listed evidence-based nursing care as the yardstick for determining the quality of healthcare services. For an institution to be accredited by the government, it must prove that its nurses are using the evidence-based nursing care practices to attend to patients. This also implies that healthcare institutions and practitioners that intend to get research grants from the government will have to prove that they are complying with research-based care standards. Research-based care has also reduced instances where nurses are being sued for negligence (Reay, Berta and Kohn, 2009). This is because the nurses know what to do in every situation. Furthermore, if anything goes wrong, nurses can defend their actions using the guidelines generated from the research finding they used to administer the medication. The nurses, therefore, have better protection in contemporary practice since the risks of being accused of negligence have greatly been reduced (Cribb and Entwistle, 2011). Research-based nursing care also implies that the medical students being churned out of medical teaching institutions ought to have good researching skills (Stevens, 2013). Right now, being a nurse possessing medical knowledge per se is not satisfactory; one ought to be able to interrogate medical journal and other publications to stay abreast of the medical advancements and contemporary knowledge in the healthcare sector. The nurses, thus, have to have the will to constantly update their knowledge on the fields of their concern in the medical sector (Stevens, 2013). Their institutions have to provide the necessary means to facilitate this current information access, ma be by subscribing to online databases such as PubMed in order to access nursing journals or organize frequent workshops and seminars to discuss the latest patient care techniques. Lastly, the increased adoption of evidence-based nursing care necessitates more research to be conducted on the same. For it to become a best practice in the healthcare sector, the practitioners ought to have information about it. There are many countries that are still lagging behind in terms of offering up-to-date healthcare services (Makic et al, 2013). The governments should facilitate the adoption of evidence-based nursing care by offering grants and enabling the collaboration between researchers and clinicians. The collaboration should enable better clinical outcomes as the knowledge unearthed is transformed into forms that can be implemented by nurses as interventions. As is evident from the discussion, nurses are increasingly adopting evidence-based nursing care practice as they gradually shun ritual-based and opinion-based nursing practices. This is because of the many advantages relying on evidence generated from research studies has over relying on personal intuition and emotions or rituals determined years ago. Evidence-based nursing care is able to apply contemporary knowledge in designing healthcare techniques (McCrae, 2011). Furthermore, this knowledge is credible since it has been generated through a rigorous research process and has also been vetted by the academic and qualified peers. Research-based nursing care, therefore, provides the best opportunity for patients to receive quality healthcare as opposed to the other two and it is not surprising that nurses are increasingly being reliant upon it. References Askham, J., & Chisholm, A. (2006). Patient-Centred Medical Professionalism: Towards an Agenda for Research and Action. Picker Institute Europe, Oxford Beck, A. (1979). Cognitive Therapy for Depression. London: Guilford Press. Bern-Klug, M. (2010). Transforming palliative care in nursing homes: The social work role. New York: Columbia University Press. Carmelli, A., Sheaffer, Z., & Halevi, M. (2009). 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