Evidence-Based Practice: Levels And Types Of Evidence And Implementation Essay.

Levels of evidence

Evidence-based practices are practices in health that are not regularly provided in care delivery. However, the practices are available for a number of illnesses such as heart failure, asthma, and diabetes. The patient safety research has put a lot of emphasis on analysis of data to identify the issues regarding patients and demonstration of how the new practice will lead to improvement in patient safety and improved quality. Nevertheless, less attention has been paid to how these practices will be implemented. Implementation of evidence practices requires strategy since they are complex hence the strategy should address the complexity of individual practitioners, top; leadership and care systems, ultimately changing to be evidence-based practice. Nursing has a great history of utilizing research in practices. The profession of nursing has provided great leadership for care improvement through the application of the findings in research (Clancy et al., 2006). The evidence-based practice is the judicious and conscientious use of best evidence in aggregation with clinical know-how and patient values to guide health care decisions. Best evidence practices comprise of the empirical evidence from randomized controlled trials, evidence of other scientific methods such as qualitative and descriptive research. After enough evidence is gathered the practice should then be guided by research evidence in conjunction with clinical know-how and patient values. In some situation whereby the research base is not sufficient and available, decision making by the health care is derived from the non-research evidence sources such as scientific principles (Titler, Kleiber and Steelman, 2017).

Based on methodological validity, quality of their design and patient care applicability assigned to the level of evidence, the decision state the recommendation strength. The levels comprise of: First, level 1: systematic review evidence or meta-analysis of the randomized controlled trial of all relevant or guidelines that are clinical evidence based on the reviews that are systematic of the randomized controlled trial, or more randomized control trial that have a good quality of similar results. Second, level 2: evidence should be obtained from at least one randomized controlled trial that is well designed such as a large multi-site randomized controlled trial. Thirdly, level 3: considered as the non-experimental study.at this level is the review of the systematic review of the randomized control trial of the previous level without or with meta-analysis (Hopkins, 2017).Fourthly, level 4: this is evidence that emerges from case controls that are well designed or cohort studies. Fifthly, level 5.These are evidence that emerges from the systematic reviews of the qualitative and descriptive studies commonly referred to as meta-synthesis. Level 6: These are evidence that emerges from a single qualitative or descriptive study. Level 7: There is evidence from the reports that come from the expert or the opinions of the authorities (Ackley et al.,2008)

Types of evidence

Types of evidence are used in making a decision regarding the patient care. Some types of evidence are regarded stronger than others since not all types are equal.

Moving up the pyramid, the study design is more rigorous and make provision for less systematic error that can lead to deviate from the truth. Case reports and case series: It consists of a collection of reports on the individual patient's treatment. These reports use no control groups to do outcome comparisons. This is because they have limited statistical validity. Case-control studies; these type of evidence does a comparison between those patients who have a certain condition and those who are not suffering from that condition. The researcher tries to figure out the factors that might have caused or associated with the condition. Researchers do rely on the patient medical report for the collection of data. These type of research compared to cohort studies and randomized controlled trials is less reliable, this is because the statistical relationship does not provide a base for the assumption that one factor caused the other factor. Cohort studies identify patients who are undergoing treatment for particular conditions of those who are exposed to the certain condition, the patient's progress is observed and comparison on their outcomes with those who are not exposed to that condition. Being an observational stud and less reliable to randomized controlled studies, because the two categories of people may have variance in was other than in the variable under research. Randomized controlled clinical trials: The trials are carefully planned experiments that bring its treatment on the real patients(Guides.mclibrary.duke.edu, 2017).The allow comparison between intervention groups and control groups and include methodologies that reduce the potential for bias(Guides.mclibrary.duke.edu, 2017).The trial can provide sound evidence of cause and effect. Systematic reviews: It focuses on answering the specific question based on clinical topic. Research with sound methodology is done on a wide-ranging literature search. The research is reviewed, quality assessment was done and summary of result according to programmed criteria of review questions. Meta-analysis; this type of evidence thoroughly examine a number of valid studies on a topic and mathematically combine the results using the accepted statistical methodology to report the results as if it were one large study (Guides.mclibrary.duke.edu, 2017).Cross-sectional studies: This type of evidence presents a relationship between diseases and other factors at one point in distinct population. This type of evidence only comprises of prevalent cases since it lacks data on timing of exposure and the relationships outcomes. They are mostly is used for diagnostic test comparisons. Being a controlled trial that looks at patients having varying degrees of a condition and administers diagnostic tests to all the patients in the stud group.to determine the usefulness of potentials, the sensitivity and specification of the new test compared to that of gold standards (Library.elmhurst.edu, 2017).

Importance of evidence for practice

Retrospective Research; it follows the same route of inquiry as a cohort study. The topic under research begins with an absence or presence of a risk factor or an exposure and are followed until the outcome of interest is observed. Nevertheless, the stud design uses data that has been collected previously and preserved in databases. Patients are identified for an exposure and data is followed by an outcome of interest (Guides.mclibrary.duke.edu, 2017).

Evidence-based practices have gained a lot of nursing momentum. Evidence-based practices require a total shift in the way students are taught to a more a research practice that is relevant and bridges the gap between clinicians and researchers to more close working relationships. Importance of evidence-based is that it provides an opportunity for the nursing care to be more effective, individualized and dynamic, streamlined to maximize clinical judgment effects. Nursing care will keep pace with latest innovations in the technology field and take advantage of the development of the new knowledge when evidence is used for the definition of best practices rather than practice existing support (D, 2017).

Based on research it’s evident that the patient’s outcomes show improvement ion occurrences when the practices by the nurse are in an evidence-based manner. Based on research it is clear that most important factor that leads to the success of the evidence based practice is their employing organization support to conduct and utilize research. Other facilitators include research mentors, the presence of clinical setting of advanced practice nurses, educators who are well knowledgeable about research. Nurses have identified various organization and individual barriers to research utilization. Lack of knowledge on how to do the research process critique, lack of awareness of conducting research process and lack of support from colleagues of practice change are among the barriers to individual change. Lack of sufficient time to implement new ideas and lack of research access and a shortage of awareness of available educational tools required for conducting research are among the barriers facing the organization. Colleagues have suggested the strategies for curbing this barrier to the evidence-based program which comprises of, research role model employment, the formation of an uncompetitive relationship with academic and participation in research interest groups.

Adaption of evidence-based practiced can be viewed from the on the look of those who conduct research or the knowledge generators, those who utilize the information found in the evidence-based practice. Based on AHRQ model, there are three major steps of knowledge transfer: Creation and distillation of knowledge, dissemination and diffusion, implementation and organization adoption. First, creation and distillation of knowledge. This entails conducting research and packaging the findings of the research into products to be put into action e.g, specific practices recommendation, hence increasing the chances of a research evidence finding its way to be put into practice. It is significant for the distillation of knowledge process to be guided and informed by the research end user and research findings to be implemented in care delivery. Criteria for end user should include the end user perspectives as well as the consideration of the traditional knowledge generations. Second, dissemination and diffusion. This involves incorporating with the opinion leader who is professionally and healthcare organization for knowledge dissemination that can form the basis of action to users who are potential. Brokers and connectors to practitioners can be linked through research intermediaries. Intermediaries can be those that are considered effective in research-based dissemination such as programs on cancer prevention. Partnership in dissemination provide an authoritative seal of approval for new knowledge and help in finding the influential group whose demand can create a demand for the evidence in practical application. Lastly, implementation and organizational adoption of the end user. Being the final stage in the knowledge transfer process, this stage put emphasis on having the individuals teams and institution to adopt and use consistently the evidence based research findings and innovation in daily practices. For a successful implementation and sustenance of evidence-based practice in healthcare, it requires a complex interdependency in the organization, the subject under research and characteristics of the social system and the individual clinicians (Greenhalgh et al.,2005).There is various strategy for implementation which include, using the champion change in the institution ho can address the challenges associated with implementation. To apply evidence-based practice it requires considerable efforts from the organization and the individual level. Once an evidence-based practice is incorporated into the organization structure is no longer regarded as an innovation but regarded as standard of care.

Barriers to implementation of evidence

The purpose of the research was to investigate the correlation between the burnout, symptoms that are depressive and the safety of the patient's perceptions. Burnout did a mediation through use of the mediation model between the association of the symptoms of the depression and perception of the patient's safety. It is evident that the depressive symptoms are on the higher end in employees working in healthcare and the care of patient’s safety. Very few researchers have done an investigation on the nurses based on this variables. The aims of the article were to investigate the relationship between the symptoms that are regarded as depressive and perception of the patient care, and burnout.

In the second article, it discusses the study of palliative care. According to the research, 90,000 people were reported dead in 2010, among them, 80 percent of the dead were assessed to be in need of the palliative care.The change in Europe has indicated that the population is becoming sicker and older, this calls for the attention of a demand in palliative care development(World Health Organisation,2011a). Majority of people in hospitals today are dying, the nurses in this hospitals are in need workers who poses knowledge of palliative care. The main objective of the care is that people will experience life quality until the end(Regional Cancer Center,016). The knowledge and the skills of the provider by the healthcare in this field are crucial to goal attainment. According to the study is evidence that nurses who are looking for jobs have insufficient competencies and experience of the dying person care(Ek et al,201).

The design used in the first article on burnout was a cross-sectional questionnaire that was distributed to the three acute trust.

In the second article on palliative care, the design used was a qualitative design. This means that the people experience the phenomenon was put into study. The similarity for the qualitative design studies is that the intention of the researcher arrives at the understanding of the phenomenon of the student from a perspective that is holistic (Willman et al,2016). The article under study is based on the research of qualitative study, the study has been analyzed with an aim of attaining the overview of the study problem that is descriptive in nature (Friberg.2012). The approaches used for the research might have been an inductive or a deduction approach.The approach used primarily for this study was an inductive approach, this means that the study has been used as prerequisites as possible for a phenomenon from outside with an aim to arrive at a conclusion (Priebe & Landstrom,2012).

Various articles were looked for in the database of the MEDLINE. The database contains research that focuses on the nursing care(Karlsson,2012). Through the search of the material that is scientific in nature in a variety of databases are considered to have incremented the ability to obtain the article that is responsive to the literature review. Keywords that were formulated in order to aid in the purpose of the research. There was the minimization of risk being relevant studies fell away(Friberg,2012). There was a truncation of the word nurse in order to include word endings of similar words that contain same meaning. The inclusion of the criteria of the article that was to be used for the results were peer-reviewed articles, which contains the qualitative term. There was the exclusion of articles published in the year 2007 since they were regarded to be lacking information research information. The article also with both the qualitative and quantitative methods were excluded in the research too.

The data collection tools used in the burnout article was a questionnaire, depressive symptoms, perception on the safety of the patient and burnout measures were completed by nursing staff in a total of three hundred and twenty. The period for this was between 015 December and 2016 February.

There was a total of 517 topics that were read the articles that were found during the search, with the intention of finding the articles with relevant information to the topic under study. of the 517 topics,163 were put into examination since they were regarded as articles that contained relevant information to the topic under study. The articles were considered relevant for the purpose of the research in the examination of the abstract. The intention was to discuss the topic thoroughly in a way that it could bring consensus on articles that could be regarded appropriate, in relevance to the purpose of the study. Most of the articles were returned when in search for databases. In an examination of qualitative studies, a variety of questions should question to review single study quality(Forsberg&Wengstrom,2016). The 14 articles were selected on criteria of compliance with the purpose of the assurance of quality through the use of documents for quality assessment. The 14 articles that were put on researcher were able to fulfill at least the 11 of 12 criteria comprised in the protocol of quality of the audit. The first four criteria were also fulfilled in the articles. The obtain ace of the result a total of fourteen articles were used.

The analysis of the burnout research indicated that, when tested in the separate analysis, symptoms of depressive and burnouts were in association with measures of the patient's safety. The proposed a model of mediation was fully supported by the association made between the depressive symptoms and perception of the patient safety mediated through burnout.

The approach for analysis used in palliative care article was a five-step model. This was recommended to be used of the work of the graduate. Step one, the articles were read various times in order to have an understanding of theof the concept as a whole. Step two involved the finding identification in each study outcome with regards to candidate research aims and objectives. The third step, the text in the article were highlighted with overlaps pens. The findings were then put into a compilation in order to create a single document that has a clear overview. The fourth step involved the processing of the similarities and the differences. This was achieved through the use of the different colored pen to mark the difference and the similarity. To avoid ignorance of any material, the studies were thoroughly checked against the set themes and subheadings. The final stage, which was the fifth stage included the analysis of the themes which were presented clearly and in an easy way to understand.

Conclusion

Provision of palliative care in hospitals requires both the negative and positive nurse’s experience. Lack of competencies is most likely to have an impact on the quality of the care of the life ending. The nursing profession being emotionally draining requires the use of the ability to have effective communication. It is considered of great significance when the nurses are able to offer palliative care to a dying person. Job satisfaction can be offered when there is the provision of a good environment.

Its more likely for burnout and depression symptoms to have implications on the safety of the patient. Nevertheless, the ways of improving the safety of the patient can be best targeted at the burnout improvement in specific. The interventions on the burnout are regarded to be most effective when focused on the organization and individual.

With most guideline tools for appraisals assessing the literature search and the synthesis presentation and evaluation of the practices that are evidence-based. Despite there being a conflict of interest and values of developers guideline and the patient involvement, there is an insufficient consideration. Greater emphasis should be placed on the evidence-based practices to allow further development

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