Saturday, March 30, 2019

Evidence Based Nursing in Primary Healthcare Team

Evidence Based care for in un change Healthc atomic number 18 Team189691Title Evidence Based Nursing is growth in primary wellness c are . Critic in ally discuss the applications to your normal. (District Nursing) undergrad Degree Level Essay3,250 wordsEssayThe ontogenesis of the treat profession has witnessed a long many changes of twain stress and deputation in both the delivery and the content of patient care as well as accompanying changes in both the philosophy and the system of that care. Arguably the care for profession has historically ground its activities and excessively its philosophies, on tradition and the perpetuation of originally accepted suffices which have non been severely rooted in a general scientifically tested frame forge.(Roper N 1977). This displace be verified by the concomitant that the nurse publications of the 1970s and 80s has many references from writers and commentators who were arguing for nursing to evolve into a search groun d profession and highlighting the fact that on that point was a incontestible absence of a signifi corporationt amount of goodness pure tone research-establish fact which dictated the actual usages byout the profession in general. (Gortner SR 1976).An innocent observer, considering this situation over the intervening years, would probably agree that there has been a clear and marked swing in both the published publications and the actual implement of nursing, towards the underpinning of work out with strong scientific research. Evidence found nursing has emerged as being one of the dominant driving forces in nursing evolution and the climax of severalise ancestor practice has blend apparent to the point where it is now and this could be considered to be the gold specimen and essential basis for the majority of superior nursing care (Yura H et al 1998)If we look at the issues and considerations that could support this statement, we could point to Hunts tour de force on the bow in his seminal motif of 1981 (Hunt J 1981), in which he sums up his belief that each encourage mustiness care enough about her own practice to demand to make sure it is ancestord on the best possible testifyation. This acknowledgment seemed to strike a chord in the nursing profession to the end that, over the following few years, there was a noticeable step-up in the published compositions that both echoed these sen condemnationnts and also defined the dissimilar barriers to progress in this respect. These were largely quantified as including time constraints, limited regain to the literature, a lack of training in critical skills of appraisal and, close to fundamentally, a professional person ethos and ideology that placed a coarse emphasis on the practical rather than the in pick outectual component of knowledge, together with a work environment that did not actively encourage the seeking out, researching and written text of crude information (after Roy le J et al 1996). One could be forgiven for observant that such comments are still relevant to a degree to mean solar day.In order to present a balanced argument, we can observe that there is not a blind and uniform acceptance of shew tie-upd nursing procedures. There are some who actively criticise conclusion base procedures. Haynes (R B et al 1996) points to the fact that a blind following of recite based practice can promote a fancy of a cookbook of procedures that have to be dogmatically followed and it can mute the holistic consideration of what may be best for each exclusive patient. We shall return to this point later. White (S 1997) finders this argument with the suggestion that a keeps professional training includes both learning the basic pathophysiology and anatomy and acquiring experience. She suggests that it is truly the effective application of this experience that requires a sound proof base. enquiry evidence can aid the professional decision making oper ate, hardly cannot either do the clinical interrogatory or collate the broad amount of snippets of information that pass between patient and nurse. White suggests that it is this clinical expertise (derived from learning and experience), that is the crucial element in the application of the evidence based knowledge which separates consecutive evidence based nursing practice from the cookbook approach with Haynes vision of the mindless and unquestioning application of both guidelines and rules (White S 1997).Before we leave the general issues relating to evidence based nursing, we shall also denotation the analytical work of Pearson (A 2000) who produced an influential treatise on the role of the nurse and nursing in evidence based research. In his radical Pearson makes a fundamental and significant delineation between lay nursing and professional nursing which is defined by the application of research based practices and procedures. He suggests that the evolution of evidence b ased nursing had its origins in the days of the reforms pushed through by Florence Nightingale, became commonly accepted practice in the 70s and 80s when the theoretical constructs of practice began to evolve and be adopted, and has before long culminated in the advent and progeny of the nurse practitioner and nurse specialist whose professional structure, training and practice is essentially evidence based.This under receive is primarily about how evidence based nursing is developing in primary health care team with per centumicular reference to personal practice. This is a potentially a vast motion and therefore we will employ illustrative examples of specific states of reading.A great deal of a primary healthcare teams time (particularly that of the nurse) is taken up with the discourse of haul terribles and ulcers. It is instructive to consider the evolution of the evidence base for the discourse of this condition and then to extrapolate the process to different co nditions oftentimes seen in primary care.We can cite the work of Sir James Paget who made the musing in 1862-Elderly patients with femoral fare fractures and other high risk of exposure groups develop them ( blackjack sores) early, chiefly in the commencement ceremony week, and then made the observation They often appear on the day of operation. It is not just the patient, still every part of his or her body, that must survive the operation. (Bliss MR 1992).The rationale for citing this statement is that it expounds a comment and observation that may be factually correct, alone has no evidence based weight whatsoever other than being a reflection of the seeds persuasion. It has no foundation in statistically verifiable fact and may be subject to all forms of objective bias. It obviously was neer produced as a event of a randomised controlled exertion but, similar many other pronouncements by prominent practitioners, it has both influenced and been accepted by generatio ns of healthcare professionals over the years. This exemplifies Ropers point, cited earlier, relating to the tradition of previous practice being perpetuated by successive generations.The point can be introduce further still by considering a much recent piece of music by Vohra (Vohra R K et al. 1986). On the face of it, this typography gives a comprehensive overview of the (then) current practices in the treatment of ulceration and pressure sores. It goes into great detail relating to the aetiology, pathophysiology and trends in management of the ulcer patient and has an extensive and current reference section in the make-up. The problem form the perspective of this essay is that, although the paper is undoubtedly comprehensive in its approach, virtually the entire paper together with virtually all of the cited references, is opinion based with not a single reference to a good lumber randomised controlled foot race. (MacLean DS 2003). The paper does make determination of co mparative studies where one treatment is compared with another, but this in turn exemplifies yet another shortcoming and that is that such trials are good if a healthcare professional has only these two options at their disposal for treatment, (which is seldom the case). Modern philosophy would dictate that in good evidence based practice, the nurse would read to be able to cite evidence that one treatment is demonstrably superior to all others for a given set of clinical circumstances and that this evidence is from a repeatable and unbiased source.To give an illustration of this point, MacLean makes the comment-It is understandably of minimal think of to a patient to be able to say to them that a parity of rubbing a pressure sore with honey has been found more beneficial than rubbing it with butter when the use of a ripple mattress is clearly superior to both of them.If we contrast this paper with another, more recent paper (Bliss et al. 1999), there are a number of very signif icant differences. This paper is also an overview of the current trends in treatment of ulcers and pressure sores. Firstly the indite is a nurse. Secondly, it only cites 12 references (as opposed to over 70 in the Vohra paper) but each is a randomised controlled trial selected to support the confused statements made in the paper. This represents a major and fundamental change in presentation, philosophy and practice. It could be suggested by the cynic that such observations are a chance finding in two randomly selected papers. We would suggest that an examination of the literature of the periods involved would support the view that they represent a true reflection of the genuine change in both style and mentality that now pervades the nursing professions and more fundamentally, it also reflects the criteria by which papers are now judged and accepted for publication in the major peer reviewed journals. It is not appropriate to discuss the content of the paper in detail other than to observe the fact that the paper concludes with a description of the classic Gebhardt trial (Gebhardt KS et al 1994) which compared the results of bed rest with intermittent chairwoman nursing on the development of ulceration and in the words of Morris (A 2002)-In many respects, the Gebhardt trial is a reflection of both the calls noted in the previous paper for correct scientific scrutiny to be brought to bear on the subject and the evolution of the expectation of the healthcare professions into the requirement for a firm evidence base for their continued work.In terms of direct impingement on the practical aspects of primary healthcare nursing, the move towards evidence based procedures can be illustrated in the development of scales such as the Waterlow scale (PN 1991). This was real as a direct recognition of the need for an evidence based tool which would both directly help the nurse assess and limit the degree of risk together with helping them name just which was the closely effective treatment modality for any several(prenominal) patient. This was accomplished by allowing a reproducible measurement of ulceration and thereby rendering this area of clinical practice amenable to proper scientific scrutiny and testing. The result of this scale development is that the nurse can identify a treatment that has not only been suggested by previous practice or experience, but one that can be shown to be the most appropriate for a given set of clinical circumstances with the most likely clinical benefit (NT 1996).It is a logical step from this position to the situation where red-hot scales are developed based on evidence based assessments and treatments, to predict the likelihood of improve of ulcers. Such a situation has resulted in the development of tools such as the PUSH scale (Gardener S et al 2005).This represents the currently accepted end-point of a logical progression that we have traced and quantified from the type of opinion based pronounceme nts of Sir James Paget, past the experience based observations and comparative trials such as those of Vohra, through to the completely evidence based practices of today where a clinically defined situation is identified, a solution is hypothesised and then subjected to governing body by appropriate double blinded and unbiased scientific techniques in a randomly controlled clinical setting. It allows the authors (Gardener S et al 2005) to conclude their paper with the commentThe PUSH tool provides a valid measure of pressure ulcer healing over time and accurately differentiates a healing from a non-healing ulcer. It is a clinically practical, evidence-based tool for tracking changes in pressure ulcer status when applied at weekly intervals.Such a comment is virtually unchallengeable because of the weight of valid recorded evidence behind it.If we consider new and current moves to examine the evidence base of activities in the primary healthcare team, we can also consider the advent of screening clinics which are commonly nurse-led. (Califf R M et al. 2002). We could consider the current trend for hypertension screening. It is commonly accepted that treating hypertension is of value in preventing both morbidity and mortality, (Cooper R et al. 2000), but a less frequently asked question is What is the rationale and the evidence base for providing a screening create mentally for patients? (HTT 2005). Curiously, the evidence base for the screening programmes that have been run has been rather insecure. The briny reason for this has been the comparative paucity of definitive information relating to the levels of effective treatment and, as the treatment can realistically only be assessed as effective over a long time span, such studies take many years to yield substantive information. It therefore follows that the evidence base for screening can only realistically be determined one time a rational an proven evidence base for treatment has been established. (Brot ons C et al. 2003). This is the position set out in the comprehensive paper by The National Heart, Lung, and Blood take Working Group (HTT 2005).A pragmatic view would also have to observe that the position is further complicated by the constant evolution of new drugs and methods of measuring blood pressure which render previous data on the subject out of consider by the time that it is assimilated. (Appel L J et al. 2003). This paper is very expound in its assessment of the situation and it is not practical to consider all of its findings in any depth, but it provides a comprehensive overview of the evidence base for the promotion of hypertensive screening together with the evidence to support the use of different levels of hypertension as the endpoint of the screening process.Perhaps we can conclude this essay about the relevance of evidence base nursing practice to primary health care with the excellent and though-provoking article by Frances Griffiths. (Griffiths F et al. 200 5). Although we have been arguing for the use of evidence based practice in modern nursing care, there is one commonly overlook aspect of this practice which is the subject of the Griffiths paper. As the wealth of good quality information relating to the effectiveness of many clinical interventions and practices increases, this fact alone presents healthcare professionals in general with the increasing dilemma of how to apply the information obtained to the individual patient. The evidence base for a procedure will generally inform clinicians of the likelihood of it being successful in the general population. It will not give any indication, other than a probability, of its chance of success in the individual patient. This is a problem for the nurse (and other healthcare professionals), as the bulk of current medical practice is on a face-to-face basis with individual patients, rather than dealing with populations. (Fox R C 2002)To illustrate this point, Griffiths points to the fa ct that it is commonly accepted that epidemiology tells us that smoking is an independent risk factor in the population for myocardial infarction, yet there is no evidence base to tell us which particular individuals will be affected. Similarly there are a multitude of good quality trials which show that there is an increased risk of breast cancer that is connect with hormone replacement therapy but there is nothing that will tell us which individuals are at specific risk. (Willis J 1995)This dilemma is important to the proper understanding of the place of evidence based practice as the balance between good practice based on proper evidence and individual patient care is fundamental to the history of nursing and will not disappear however good the evidence base for a particular treatment becomes. In the words of Haynes (R B et al. 2002)-Diseases invariably manifest themselves in patients bodies and minds, and in seeking to understand, treat, and predict the outcome of distemper , clinicians need to move their focus from the individual to more generalised research.To this end, the nurse would do well to reflect on the fact that assimilation of evidence is central to her practice, but communicating that evidence to patients is a key part of clinical consultations, with a growing evidence base of how it is best achieved.ReferencesAppel L J, champagne C M, Harsha D W, Cooper L S, Obarzanek E, Elmer P J, Stevens V J, Vollmer W M, Lin P H, Svetkey L P, Stedman S W, Young D R for the pen Group of the post-mortem examination Collaborative Research Group. 2003Effects of comprehensive life-style modification on blood pressure control main results of the PREMIER clinical trial.J Am Med Assoc. 2003 289 20832093.Bliss M and Bruno Simini 1999 When are the seeds of surgical pressure sores sown? 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