Describe about the Evidence for Nursing for the Model of Clinical Judgement.
Part 1: General Content Questions
Importance of using short and specific search terms in database search instead of long descriptive sentences
Short and specific search terms easily identify information that an individual is searching for from the database. It does it in a way that can easily be interpreted by the search engine in its retrieval of necessary records. Descriptive sentences are ambiguous and commonly fail to retrieve the required records (Bernadette & Fineout-Overholt, 2011). A search term is a query that leads to the information that an individual is searching. It should hence be short and specific. Descriptive sentences may lead to misinterpretation of the search statement.
Relationship between two frameworks that underpin Tanner's Model of Clinical Judgement and Evidence-Based Practice
The two frameworks that underpin Tanner's Model of Clinical Judgement and evidence-based practice are needs of the patient and the patient's health problems. There is a great relationship between the two. A patient's needs and health problems are concerns that worry the individual. Needs and health concerns are conditions that need urgent attention. An individual would only be happy and also feel comfortable when his or her needs are all met. At the same time, an individual would feel well and comfortable when his or her health problems are all sorted out.
The purpose of a systematic review compared with a single randomized controlled trial
A systematic review advocates for the use of meta-analysis component. The component involves the usage of statistical methods in the synthesis of data. The data is finally reduced to a quantitative estimate. A single randomized controlled trial is based on probability. There is no guarantee of surety. One has to stick with the result of the controlled trial irrespective of the kind of result that has been obtained (Alba , Gordon , & Donna , 2015).
Appraisal of the quality of a systematic review
The quality of a systematic review is based on the performance of the selected statistical method. It the statistical method performs poorly then it is highly likely to compromise the quality of the systematic review. However, it the performance is good and outstanding, then the high quality review should also be expected at the same time (Abernethy, Currow, & Frith, 2003).
Part 2: Research Methodology and Results:
Advantage of using randomised control trail study design in the article by Abernethy et al., 2013
The use of randomised control trail became advantageous because it was the only alternative at hand that could be used. The participants recorded completely different scores. The score could hence not be relied on. Instead, a randomised control strategy remained as the only alternative since it was not based on the outcome of the majority (Abernethy, Currow, & Frith, 2003).
Primary and secondary outcomes in the study
The primary outcome is the very immediate results that were obtained from the study. In the study, the outcome is the thirty-eight participants who completed the study. The outcome further describes the members. The majority of them were senior men who suffered from the chronic pulmonary disease (Shifaza, Evans, & Bradley, 12-55). They had been put on supplemental oxygen. The body functions of the individuals weren't in perfect condition. The secondary outcome, on the other hand, provides any additional results, for example, the information regarding the ten individual participants who withdrew over the period.
Why the study used to cross over design
Cross was used because it could easily be controlled by double-blind, peaceable as well as the randomised method. The process would not be the same if design method would have been used. It was hence appropriate for the cross to be used.
Has the study used adequate sample size?
Yes, the study used an adequate sample size. A total of 48 participants were identified. The number was large enough and was hence more representative regarding the total existing population. A good sample size should not be too small. At the same time, the number shouldn't be enormous to the extent that it poses management challenges.
How the author assess dyspnoea in the study
The author argues that patients who were treated with morphine showed positive improvements in the later times of the day compared to patients who had been put on placebo treatment. The author, therefore, indicates that dyspnoea is a treatable disease. However, its treatment depends on the kind of medicine that is administered to the patient. Some medicines responded positively towards the treatment of the disease while others didn't record an immediate impact.
Looking at figure 2 above, the p-value is <0.05. This shows that the overlap area of Placebo control and oral Morphine ranges between 0.006 and 0.05. It is equal to 0.006, but less than 0.05. The P value, therefore, lies within the region of Oral Morphine. In other words, it indicates positive improvements (Alba , Gordon , & Donna , 2015).
Thinking of the overall result from the case study and the presented figure, the results show that oral morphine effectively treats refractory dyspnoea. The patients showed average improvement and eventually high improvement when morphine was administered to them. However, a negative response was recorded when placebo was administered to the patients. The patients didn't record any improvement at all.
Effect of Morphine on the sleep of the participants
Morphine never interfered with the sleep patterns of most patients. Very few participants who were placed on the medicine complained that they experienced breathlessness as a result of using the medicine and hence disturbed their sleep. According to bmj.com, the statistical data showed p=0.039.
Consideration of Morphine therapy for patients who are suffering from refractory dyspnoea
I would consider Morphine therapy for treatment of my patients. Tests have shown that morphine is an effective medicine in the treatment of refractory dyspnoea. Placebo which is the other alternative treatment mechanism has recorded no positive impact on patients. However, several side effects come along with the administration of Morphine. Such side effects include nausea, vomiting, sedation and chest pains (Alba , Gordon , & Donna , 2015). I would still downplay the side effects because it is not guaranteed that all the patients who are placed on Morphine are likely to experience the side effects. The medical research showed that out of a total of 38 patients, only ten withdrew from the morphine treatment following the side effects (Shifaza, Evans, & Bradley, 12-55). From the statistics, over 50% of the patients didn't experience any problem with the medicine. I would only advise my patient to withdraw from the medicine if he or she experiences the side effects.
Relative risk of healing (RR), absolute risk difference (ARD) and number needed to treat (NNT)
Relative risk healing is the average number of patients who were healed after treatment. The average risk would hence be (60% + 75%)/2 = 67.5%. The absolute risk difference, on the other hand, would be given by; 75% - 60% = 15%. Finally, the total number needed to treat was considered to be 100%
Interpretation of RR, ARD, and NNT
The relative risk healing of leg ulcer under the two bandages is above average. The difference between the two methods is also slight. As a result, the ARD is only 12%. The two methods can be applied to any given number of patients.
Comparison between bandage A and bandage B
It is good to use bandage B over bandage A in the treatment of leg ulcers. Bandage B treated a higher percentage of patients compared to bandage A. It treated 75% of patients while bandage A treated 60% of patients. Anyone who is in need of urgent treatment would, therefore, go for the bandage that has a higher chance of treatment. The results are therefore clinically significant.
Part 3: Implementation of EBP
Barriers to implementing new research findings into clinical practice
There are several barriers that that hinder the implementation of new research findings in the clinical practice. Most sources have indicated that the poor support from the health organizations where nurses work has been the primary barrier. The conclusion has been attributed to factors such as quality of the research, presentation of the research, and research value and communication criterion of the research (Alba , Gordon , & Donna , 2015). The major barriers include inadequate time, poor statistical understanding and inability to change patient care due to lack of authority.
Why it is important for to take this subject as preparation for my role as a junior clinician
The subject of Evidence for Nursing is very important for my role as a junior clinician. The practices that mainly focus on research findings are likely to lead to patients' improvements. The practices would also equip me with knowledge and skills that would contribute towards that improvement of the settings within the healthcare centre (Bernadette & Fineout-Overholt, 2011). The subject also enables me to be more dynamic and effective in my area of specialisation. As a result, I would be able to make appropriate clinical decisions that I would otherwise not been able to make. Finally, the subject provides knowledge that can promote operations within the hospital settings, a move that would greatly benefit patients (Youngblut & Brooten, 2011).
Abernethy, A. P., Currow, D. C., & Frith, P. F. (2003). Randomised, double blind, placebo controlled crossover trial of ... British Medical Journal, 523-526.
Alba , D., Gordon , G., & Donna , C. (2015). Evidence-based Nursing: A Guide to Clinical Practice. Chicago: Elsevier Health Sciences.
Bernadette , M. M., & Fineout-Overholt, E. (2011). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Lippincott Williams & Wilkins.
Shifaza, F., Evans, D., & Bradley, H. (12-55). Nurses’ Perceptions of Barriers and Facilitators to Implement EBP in the Maldives. Advances in Nursing, 2014.
Youngblut , J. M., & Brooten, M. (2011). Evidence-based nursing practice: why is it important? Pubmed, 33-59.