Evidence-Based Practice and Clinical Effectiveness - Assignment Example

Evidence-Based Medicine Evidence-Based Practice and Clinical Effectiveness Evidence-based practice involves the transformation of new knowledge and practices into clinical form for the effective delivery of healthcare to patient and career growth for the nurse and/or medical practitioners (Jolley, 2013). Evidence-based practice is vital in the process of clinical decision making, and hence ensures effective communication and clinical conversancy that ensures effective healthcare for the patients, especially patient autonomy in mental healthcare. Effective nursing practice will help in improving healthcare services and facilitate the growth and development in the health sector. Additionally, evidence-based practice enhances the achievement of clinical effectiveness through knowledge and informed decision making, and hence it facilitates the achievement of clinical effectiveness as a vital component of clinical governance (Williams, 2011). The integration of evidence-based practice helps in growth and development of the healthcare system at large through effective communication, consultation and decision making for nurses and medical practitioners. It enhances the relationship between medical practice and ethics through knowledge of the intended health outcomes (Kent & McCormack, 2010). Quality healthcare is defined by effective and reliable health services and integrates each stakeholder within the healthcare system. Though evidence-based practice can easily create conflict in decision making, it is a vital way of improving healthcare services through the use of intended health outcomes in improving patients’ conditions (Mccormack, Manley & Titchen, 2013). Evidence-based practice is characterized by knowledge transformation, which aims at quality improvement of healthcare processes and practices through intended health outcomes. On the other hand, evidence-based practices help in the cooperation, collaboration, integration and communication of healthcare practices, and hence ensure that care for the patients is ethical, informed, continuous, and reliable. The deployment of evidence-based practice within a healthcare system will help in integration of research techniques in clinical expertise, especially for the nurses, and hence there is consideration of patients’ values and active participation of healthcare providers in health research and learning (Eileen, 2006). Informed consent involves threshold elements, including competence (the ability to understand and make decisions) and the voluntariness of treatment for patient through autonomous treatment. Information elements include the disclosure of material information and treatment alternatives, the recommendations through consultation, and the understanding of the information and the recommended plan. Clinical expertise is critical in healthcare provision and quality improvement. Evidence-based practice enhances competency in nurses and other medical practitioners, thereby improving the communication within healthcare systems for informed decision making processes. Evidence-based practice involves the use of best clinical evidence and knowledge for the care of patients, with a close evaluation and comparison of clinical evidence with economic evidence during the decision making, and the integration of patient autonomy and informed consent in mental healthcare (Mcintosh-Scott et al, 2014). Effective healthcare demands for effective decision making processes, which in turn commands the use of effective use of clinical and economic evidence through the implementation of strategies for cost effectiveness analysis. Cost effectiveness analysis involves the evaluation and quantification of clinical outcomes and costs of healthcare procedures and treatment through the estimation of the economic value of the treatment or care, in comparison to alternative treatments (Melnyk & Fineout-Overholt, 2011). It involves the integration of efficiency and safety of treatments and procedures with cost relativity, and hence it must consider both clinical and economic evidence. The evidence-based practice considers the technological advancements and global economic dynamics in ensuring effective and safe healthcare procedures that are easily accessible and affordable for the patients. Cost effectiveness analysis is influenced by technology advances, new drugs, or procedures, which influence clinical and economic outcomes. Evidence-based practice requires intervention strategies and procedure for effective cost effectiveness analysis to determine the expected best health outcomes for the patients (Mason-Whitehead, 2008). Patients’ confidence is vital for any healthcare institution or system, and hence the nurses and other medical practitioners must ensure the use of evidence-based practice for improved and informed decision making. This helps in the provision of improved, effective and cost-effective treatment and care to the patients and helps in improving confidence of the patients in the healthcare system (Pearson, Field & Jordan, 2007). The medical practitioners should work as a team for effective sharing of experience and best practices for improved health outcomes. Evidence-based practice integrates research evidence, practitioner expertise, and patient values and preferences in the clinical decision making process. Medical practitioners must effectively evaluate their patients for the identification of their respective abilities, needs, preferences, social background, and values for the integration with current research evidence and medical expertise to be used in effective decision making. Additionally, the medical practitioners must be able to learn, acquire and maintain knowledge and skills for high professionalism and working ethics through the use of evidence-based practice (Boateng, 2010). In the current day environment and economic dynamics, the economic evidence has been perceived by many as inevitable (Newell & Burnard, 2011). The priority and ethical practice for all nurses and medical practitioners is based on effective treatment and care for the patient. All clinicians and medical practitioners must be able to make informed decisions through critical analysis and knowledge of economic and clinical evidence. Evidence-based practice tends to create a difference between clinical effectiveness and cost efficiency, whereby clinical effectiveness is considered vital for cost effectiveness of a treatment or therapy. This creates an insight that evidence-based practice in healthcare systems is likely to increase the costs of treatment or therapy due to the need for extensive knowledge and evidence for effective decision making processes (Pooler, 2012). On the other hand, economic evidence tends to influence decision making process due to the assumption that the decision making is done under budget constraints. However, the best practice involves and prioritizes on the well-being of the patient rather than their economic statuses or the prevalent economic trends (Chorpita, Becker & Daleiden, 2007). On the other hand, the medical practitioners must also be able to evaluate treatment and prevention procedures, and decision making protocols, for effective recognition of informative and cost effective tools for clinical decision making (Chambers, Boath & Rogers, 2007). Furthermore, the nurses and medical practitioners must also incorporate and monitor current healthcare trends through effective research and consultations for the identification of the best outcomes for healthcare procedures. The use of evidence-based practice ensures advancement and growth of the health sector through effective healthcare provision and decision making processes, and hence the improvement of drugs and equipment. Technology advancement and economic dynamics have led to discrepancies in the health sector in terms of decision making processes, and hence the integration of cost effectiveness analysis into evidence-based practice has helped in facilitating effective clinical decision making through establishment of effective healthcare interventions (Morris, Devlin & Parkin, 2007). Evidence-based practice brings about conflict in decision making, though its prioritization of patients’ values and preferences creates space for the provision of effective and affordable healthcare for the patients. Both clinical and economic evidence are vital in clinical decision making and practice, and hence nurses and other practitioners must understand and practically implement the clinical and economic evidence in their decision making (Aceijas, 2011). Forms of Evidence There are many forms of evidence in the evidence-based medical practice that help in the decision making process through the integration of expertise, research and patient references in ethical clinical decision making. Research is a vital part of evidence-based practice, especially in the relationship between doctors and their patients (Scott & Spouse, 2013). Nurses, doctors and other medical personnel who practice evidence-based medicine are bound to engage in research and consultations for the determination of the best health outcomes for their patients through effective decision making. Following the current technology trends, evidence can be easily retrieved from electronic databases, such as Medline and online journals. There are several forms of evidence in the research process, including: Clinical Trials: Evidence-based practice requires the doctors, nurses and other medical practitioners to initiate research for the determination of the best health outcomes for their patients, since they are the same people who provided health services to the patients (Pawlik & Sosa, 2013). The aim of clinical research is the identification and determination of the required knowledge for informed decision making processes, which ensures the maintenance of a healthy population. Clinical trials are a type of research that involves the consultation with previous and current research for the determination of expected clinical outcomes for medical diagnosis or drugs for the best interest of the patients’ health. Clinical trials help the medical practitioners and healthcare professions to acquire knowledge and skills about diseases, treatments, and health through practical evidence (Pawlik & Sosa, 2013). They are able to identify with known clinical outcomes for certain diagnosis or drugs, in addition to discovery of new clinical outcomes for specific new diagnosis procedures, drugs, or equipment. Clinical trials help in the improvement of healthcare services through best clinical outcomes, and the growth and development of healthcare knowledge and skills. Clinical research mostly involves patients and evaluation of both the pros and cons of two or more treatment procedures (Newell & Burnard, 2011). Systematic Reviews: These involve the collection, analysis and summary of empirical evidence for a defined research question. Systematic reviews may be integrated with meta-analysis, which involves the use of statistical methods in the analysis and interpretation of empirical evidence or research (Bronson & Davis, 2012). They follow an explicit methodology, review of diverse studies, evaluation of research findings for previous research, statement of clear and concise objectives, and a systematic presentation of the findings of the reviewed research. In evidence-based practice, healthcare professionals are bound to use reviewed articles for summarized empirical evidence due to the demand of the use of the best available evidence in their respective clinical decision making (Gerrish & Lacey, 2010). Systematic reviews facilitate the acquirement of new knowledge and skills on specific clinical procedures through a review of multiple research articles that contain a related topic. They help in the elimination of uncertainty in clinical decision making and create a consensus and reference point for future decision making within the healthcare system (Littell, Corcoran & Pillai, 2008). Additionally, systematic review involves the comprehensive search for primary articles or journals on a specific clinical question, establishment of research criteria for choice of articles, critical appraisal of the primary articles for quality assessment, and the presentation and summary of the research results as per the explicit methodology (Bronson & Davis, 2012). Guidelines: Effective research requires the establishment of guidelines to ensure that credit is given to previous and current research, and that there are no violations of physical or intellectual rights. Every research and opinion in the health sector is bound to be respected, credited, reviewed, and/or criticised, depending on the implications and sensitivity of the research findings. Research is a vital part of evidence-based practised, and hence it must be conducted in the most ethical and professional way to ensure the best outcomes are achieved for current and future informed decision making. The use of guidelines helps in the decision making process, whereby a practitioner dealing with patients with mental illness is able to make informed decisions, with the consent or virtual consent of the patient (Newell & Burnard, 2011). Qualitative Research: Qualitative research involves the assessment and deep insight of specific issues, where the research results are specific rather than representative (Marshall & Rossman, 2011). Evidence-based practice is based on the condition of the current patient and the existent experience or research available on the same condition. It helps in the generation of data about certain diagnosis or treatment procedures or drugs within the patient population, under the same healthcare system. It involves patients and practitioners as the participants for the identification of desired best health outcomes. It involves the understanding of new knowledge and skills through first-hand experiences and real-time interactions. This is important in evidence-based practice where the practitioners interact directly with the patients, for recognitions of their values and preferences, and amongst themselves, for consultation and development of a consensus, for easier decision making. Qualitative research involves observation and hence eliminates distortion of information between the observer and the observed actions or characteristics for credibility of the research findings (Marshall & Rossman, 2011). Consensus of Expert Opinion: The use of consensus of expert opinion is popular in evidence-based practice, especially in effective disease management. Evidence-based practice facilitates the application of integrated clinical and economic evidence as per the status and features of each patient, and hence the medical practitioners are able to apply evidence in the determination of diagnosis and treatment procedures on each of their patients. The use of consensus of expert opinion helps the practitioners to identify knowledge gaps and implement useful research findings into their practice. It brings together diverse medical expertise and provides the best action plans for specific clinical questions. The practitioners are able to apply their basic medical knowledge through assessment of the significance of recommendations, and the effective application of these recommendations. Additionally, the practitioners are able to assess the pros and cons of treatments or therapies, and evaluation of alternative treatments, for the identification of the best health outcomes (Pooler, 2012). Government Reports: Government reports acts as basic guidelines, policies and regulation on the best medical practices. They highlight ethics in the health sector that regulate the medical practitioners along their lines of duty. The use of government reports creates a sense of individual and collective responsibility and professionalism for the evidence-based health practitioners, and also ensures credibility of research due to the use of authentic materials. Additionally, the use of government reports helps the practitioners in the identification of the requirements of the healthcare system, and understanding their roles in ensuring effective and affordable healthcare services for the entire population. The healthcare system is usually managed by the central or federal governments, and hence government reports are vital in the provision of previous medical experiences and research for the improvement of current research through evidence-based practice (Jolley, 2013). Economic Analysis: Economic analysis is important in evidence-based research and practice in terms of identification and recognition of clinical and economic evidence as vital elements of evidence-based practice (Gerrish & Lacey, 2010). The medical practitioners must be able to differentiate between clinical and economic evidence for effective decision making. Economic evidence is inevitable in clinical decision making, especially in the evaluation of best treatment and alternative treatment (Hammer, Moynihan & Pagliaro, 2013). Clinical and economic evidence are vital in clinical decision making and practice, and hence nurses and other practitioners must understand and practically implement the clinical and economic evidence in their decision making, which will ensure the presence of effective and affordable healthcare services (Morris, Devlin & Parkin, 2007). Critical Appraisal and Assessing the Quality of Evidence Critical appraisal helps in the identification and recognition of knowledge gaps for the practitioners, thereby creating specific questions for research and review without underpinning the existing knowledge, skills, or opinions. It involves extensive research on the specified topic to cater for knowledge gaps and expert opinion. Critical appraisal facilitates the maintenance of ethics during the research and ensures the credibility and authenticity of the research (Hammer, Moynihan & Pagliaro, 2013). Additionally, critical appraisal ensures that the research objectives are clear and concise, in accordance to the hypothesis. It also helps in the identification of the effective type of study for the research, with systematic review and meta-analysis recommended as the highest evidence level for treatment research, and systemic review of inception cohort studies recommended for prognosis research (Marshall & Rossman, 2011). Furthermore, expert opinion is considered as the lowest level of evidence acceptable in evidence-based medicine research. Systematic review of randomized controlled trials is considered as the best standard for clinical research due to the efficiency and relation to medical interventions. On the other hand, cohort studies provide prospective studies that are unbiased and authentic for evidence-based clinical research (Joyce, 2011). Critical appraisal also helps in the identification and definition of research methodologies and the prediction of specific outcomes of the research. Critical appraisal basically aims at the evaluation and validation of the scientific evidence and its relevance to the research (Gerrish & Lacey, 2010). Ethical and Professional Issues in Applying and Disseminating Evidence in Contemporary Practice Evidence-based practice in mental healthcare involves the involvement of patient autonomy in the diagnosis, treatment and medication, especially in the prescription of antipsychotic drugs. The patient is entitled to information about the antipsychotics and any other treatment procedure initiated upon them, which ensures the patient’s participation in the decision making (Lorem et al, 2014). Evidence-based practice objects at promoting exhaustive utilization of acquired knowledge derived from multiple sources, through systematic review and meta-analysis, to facilitate effective clinical decision making (Baillie & Black, 2015). Many evidence-based practitioners lack efficient knowledge, skills and time required for obtaining and analyzing evidence. Evidence-based practice is time-consuming and demanding for the practitioners, and many lack the high-level skills and knowledge needed for effective implementation of evidence-based medical practices, such as the critical systematic review and meta-analysis of research articles (Joyce, 2011). According to Lorem et al (2014), patient autonomy is core in evidence-based practice, and hence there is an ethical challenge when the patient is temporarily unavailable to provide a valid consent or opinion in treatment. On the other hand, patience participation and autonomy is a challenge in mental healthcare whereby the patient may be incapable of providing a valid consent. In the case of emergencies, the practitioners are bound to make decisions on behalf of the patient, thereby compromising autonomy. Autonomous treatment requires the involvement of the patient in decision making, especially advance directives that help in establishing surrogate decision making in case there is incompetency or incapability (Lorem et al, 2014). Many medical practitioners focus on the use of practical experience and expertise to analyze and apply research, in addition to using the research evidence to inform their practice. This can be conflicting in decision making due to the requirement of inclusion of the patients’ values and preferences in the clinical decision making processes, in evidence-based practice (Hammer, Moynihan & Pagliaro, 2013). It can further bring ethical indifference and infringement especially if unreliable and unauthentic research evidence is used in clinical decision making (Steinbock, Arras & London, 2009). Additionally, the lack of inclusion of the patients’ values, preferences, or opinions by medical practitioners in clinical decision making also creates biasness in evidence-based medicine (Baillie & Black, 2015). Furthermore, the practitioners may lack effective research and analysis skills that are necessary for the retrieval of relevant evidence and analysis of research results through systematic review (Littell, Corcoran & Pillai, 2008). The practitioners may also lack the knowledge and skills required for the implementation of evidence to specific clinical conditions, which may in turn lead to a misdiagnosis (Farley et al, 2009). Policies and procedures implemented by healthcare institutions may also limit the effective implementation of evidence-based practice (Prasad, 2013). The lack of compliance with organizational policies and the standards of evidence-based practice also create ethical discrepancies. Additionally, popular opinions, such as professional training and standards of practice, knowledge and attitudes or perceptions, and practice environments are also ethical issues within evidence-based healthcare systems (Roux & Halstead, 2009). Surrogate decision making has to be initiated for patients with mental impairment to avoid coercion (Lorem et al, 2014). References Aceijas, C (2011), Assessing evidence to improve population health and wellbeing. Exeter, Learning Matters. Baillie, L & Black, S (2015), Professional values in nursing. Boca Raton, CRC Press, Taylor & Francis Group. Boateng, W (2010), Knowledge Management in Evidence-Based Medical Practice: Does the Patient Matter? Electronic Journal of Knowledge Management Volume 8, Issue 3, 281 – 292. 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