Applying Evidence-Based Practice In Meeting The Fourth Domain Of The NHS Outcome Framework

Choose one domain from NHS Outcome Framework and give a rationale why you have chosen this domain. Identify one qualitative or quantitative primary peer-reviewed research paper published in last 5 years, relating to the chosen domain. Critically appraise the strengths and weaknesses of the research paper using an appropriate qualitative or quantitative critical appraisal framework. There are a number of these tools available e.g. CASP.

Outline what the key focus of the essay is, what you will be undertaking and why. This will also include how the essay will be structured.

• What is evidence based practice and what is the significance of evidence based nursing in the current health and social care environment?
• Referring to the principles of evidence based practice, provide a rational for your chosen domain and it’s relevance in practice
• Briefly outline the chosen research paper and provide a rationale for your choice; how does it relate to the chosen domain.

Critically appraise the chosen study, e.g. discuss the strengths, weaknesses and limitations of the study’s design using the appraisal tool.Discuss and justify whether or not the findings are therefore robust enough to be used to change or support practice in your chosen domain?

The Key Elements of Evidence-Based Practice

Evidence-based practice is very important in the contemporary nursing setting because new ways of nursing are being invented. Consequently, ability to apply evidence-based practice is very important. The goal of the paper is to focus on how evidence-based practice can be applied in meeting the fourth domain of the NHS framework. The domain expects the NHD to ensure that people have a positive experience of care. However, the domain does not give prescriptions on how the positive experience of care can be achieved. Evidence-based practice is one way of addressing this gap. The paper will attempt to apply the evidence-based practice in addressing the requirement of the domain. The first part of the paper will to identify and describe some of the key elements of evidence-based practice. It will also focus on steps for doing evidence-based practice. The second part will be to analyse the relevance of evidence-based practice in addressing the fourth domain of NHS framework. The third part of the paper will identify one evidence-based article focus on the fourth domain and explore the effectiveness, reliability and relevance of the article in fulfilling the expectations from the fourth domain of NHS framework. Based on the findings from such sources, the paper will conclude by stating whether the findings from the article can be applied in bringing the positive experience of care.

Evidence-based practice and its significance in current health and social care environment

Evidence-Based Nursing or practice is born of Evidence-Based Medicine and the need to build a coherent model of Care Science. The origins of the Evidence-Based Practice must be placed in the eighties. It was the Canadian University of McMaster that coined the expression of MBE to refer to a clinical learning strategy whose drivers define it as "the conscious, explicit and judicious use of the best available evidence for decision-making about patient care."

The evidence-based practice conceives the solution to the doubts or questions raised by a case according to the following method: formulate a question precisely based on the patient's problem, locate the available evidence in the literature, critically evaluate the validity and usefulness of the patient (ELLIS,  2016). These tests, apply the conclusions of that evaluation to clinical practice and evaluate the changes produced after the intervention.

Evidence-based practice is achieved through a number of steps. The first step is to convert the patient's problem into a question. First, it must be capable of being answered and reduced to clear and precise terms. It is about looking for valid answers to make an approximation to the truth, with clinical applicability. Generally, the clinical question answerable is structured under the acronym PICO (P-atient, I NTERVENTION, C-OMPARISON and O-utcome-score) (ELLIS,  2016).

The Relevance of Evidence-Based Practice in Addressing the Fourth Domain of the NHS Framework

The second step is to search for the best possible evidence. Evidence-based practice is as a result of a correct critical and synthesised bibliographic search (preferably of the last three years), through scientific journals, bibliographic databases (Medline, Embase, Cochrane, Cinalth, Cuiden, Bodie, etc.), doctoral theses, publications, textbooks, etc. (ELLIS,  2016).

The third step entails a critical evaluation of information. It should be noted that once the resources have been selected, the analysts will proceed to make a critical reading of the documents found. This will allow them to select those articles of methodological quality, sufficient relevance and usefulness for our professional practice. Currently, there are two systems for classifying the levels of evidence: The SIGN system (with recommendation grade A, B, C, D) and the GRADE system (classifies the quality of the evidence in High, Moderate, Low, Very Low).

The fourth step entails application of the intervention. At this step, nurses are expected to take into account the risks, benefits, expectations, preferences of the patient and their needs. The last step is to evaluate changes. This step aims to reflect and objectify the improvement in the care and health outcomes of patients that nurses hope to obtain by modifying their daily clinical practice and based on the improvement of proven and accepted scientific evidence.

Evidence-based practice plays a significant role in the nursing environment. It should be noted that in an environment in which the scientific model prevails, it is difficult not to conceive the idea that care should be based on solid evidence that is universally accepted, both by health professionals and by users who demand care. That is why the 21st-century Nursing professional should be updated according to the advances that are continuously being made in the fields of science and technology to improve the quality of healthcare and identify real and potential problems supported by results of perfectly validated studies.

Through evidence-based practice, the nursing professional can access a large number of scientific publications, evaluate their validity and applicability critically, and most importantly, incorporate it into their daily clinical practice. Investigating in the field of nursing is necessary as in any other discipline, especially when our group wants to demonstrate that nursing is a scientific profession, allowing nurses to improve the quality of care provided to their patients and thus satisfactorily comply with our code deontological and ethical.

relevance of evidence-based practice in helping nurses to ensure that people have a positive experience of care.

Critical Appraisal of the Chosen Study

Evidence-based practice is relevant in ensuring that nurses achieve the goal of ensuring that people or rather patients have a positive experience of care. The evidence-based practice will enable nurses to determine what should be done in order to ensure that patients are satisfied. It should be noted that investigating the perception of hospitalized patients is a complex process since it depends on the specific characteristics of this patient (their culture, expectations, personal factors), as well as previous experiences and the disease itself (Beck & Doscher, 2018). However, with evidence-based practice, nurses will get specific areas to concentrate on in order to ensure that patients have a positive experience of care.

Firstly, using evidence-based practice principles, nurses must be able to convert patient’s problem into question (GODSHALL, 2015). At this point, nurses will have to choose questions related to how to ensure the positive experience of care. The nurses will have different questions because no single intervention can bring the positive experience of care. It should be noted that the personal relationships that nursing exercises with its patients in the practice of care are essential for professional performance. The nursing staff stays 24 hours a day to care for patients, provides assistance of a biological, technical, psychological, social and spiritual nature and personal relationships sustain the performance of their activities. Several authors consider that the personal relationship has a therapeutic effect, in some cases, they affirm that this may be a determining factor in the success of their performance. Consequently, using the principle of evidence-based practice, nurses would be able to pose questions such as: What biological aspects can bring the positive experience of care to the patient? What technical aspects can bring the positive experience of care to the patient? What psychological aspects can bring the positive experience of care to the patient? And also, what social and spiritual aspects can bring the positive experience of care to the patient?

The chosen research paper for this study is entitled “Nurse handover: patient and staff experiences”. The paper was authored by Jane Bruton, Christine Norton, Natasha Smyth, Helen Ward and Sophie Day. It focuses on the idea of nurse handover and how it influences patient and staff experience. The paper is relevant to the fourth domain of NHS because it focuses on one aspect of bringing the positive experience of care. The article is relevant because it focuses on one aspect that is very important in influencing the way patients and nursing staff experience the care.

Conclusion

There are a number of strengths associated with the article. Firstly, the article is evidence-based. This means that the findings from the article are based on evidence obtained from the hospital settings. The study was conducted by observing the nursing handover and then interviewing the patient and staff to give their views on how the handover influence their experience towards nursing care. The central elements considered is the kind of communication that nurses use when they are handing over the duty to the new nurses.

The second rationale used in selecting the article is the publication or production year. The article was published in 2016. A good evidence-based paper should be current because nurses need to be updated on current issues and current discoveries.

The third rationale is that the article is patient-centred. In evidence-based practice, decision-making must take into account the preferences of the patient and those around him. These are the three sources that are the foundation of Evidence-Based Nursing and will allow you to decide in a thoughtful way taking into account the ethical considerations, the recommendations, the new knowledge of the practitioner.

Despite the above strengths, the paper has some weaknesses. Firstly, the article is not objective because most of the findings are based on interview findings. Interview findings, in most cases, are based on opinions of the respondents. It should be noted that in evidence-based practice, the clinical experience must be based on a systematic analysis of the clinical observations, in a reproducible and unbiased way, avoiding any intuitive interpretation of the information.

The paper identifies three forms of handovers. These include office based, NIC handover, and bedside handover (Bruton, Norton, Smyth, Ward & Day 2016). The paper further reveals that patients are only aware of the bedside handover. The findings showed that patients felt reassured when the staff knew about them. Equally, they felt insecure if the nurse did not appear to know about their care or treatments (Bruton, Norton, Smyth, Ward & Day 2016).

I believe that the findings are robust enough to be used to change or improve the process of bringing positive experience of care. This is because the article chosen meets virtually all the checklist requirements as presented in CASP model. To start with, the statement of aim of research is clearly indicated. The purpose of the article was to find impact and experience of nurse handover from patient and staff perspectives. Secondly, the choice of methodology is appropriate. The researchers chose qualitative methodology and this is appropriate because the goal is to find out opinions and views of the patients and staff. Thirdly, based on the nature of the topic, the research design was appropriate. The researchers cooperated with the nurses in determining the participants. Interview and observations were used. In addition, the recruitment strategy used is appropriate. The only shortcoming is that the number of participants selected are few. Another justification why the research is reliable is that the data collected meet the topic’s need. The researchers collected views on different forms of handover and analysed each handover independently. The interview process is clearly elaborated. Another strength associated with the study is that the data obtained was analysed rigorously and the researchers managed to identify key themes.

Besides the methodological qualities, the study selected is robust because the findings are supported by many theories and studies. Firstly, the findings are supported by the theory of the interpersonal relationships of Hildegard E. Peplau. This theory describes the importance of the nurse-patient relationship as a significant interpersonal, therapeutic process. It analyses four psychobiological experiences that force patients to develop destructive or constructive responses to: need, frustration, conflict and anxiety. For Peplau, in the nurse-patient relationship, four phases are identified, starting from orientation and continuing with identification, exploitation and resolution (Haugan, 2014). At orientation, the nurse helps the patient to recognize and understand their health problem to determine their need for care. During identification, the patient identifies with the people who provide care. The nurse encourages the exploration of sensations and the expression of feelings related to their perception of the problem to help the patient cope with the disease and reinforce positive personality mechanisms that provide the satisfaction he needs (Ghahramanian, Rezaei, Abdullahzadeh, Sheikhalipour & Dianat, 2017). So Peplau's theory emphasizes the nurse-patient relationship to enhance a therapeutic interpersonal development. It is based on psychodynamic nursing, based on knowledge of the nurse's own behaviour, which allows her to help others identify their problems. In essence, it is the interpersonal relationship between the patient and the nurse, who travels through four phases, evidenced by the changes in the relationship and the roles played by the nurse, until the patient's need is met and the problem is resolved (Paquette,  2016). In addition, the findings concur with Joyce Travelbee model of relationships between human beings (Ellington, Clayton, Reblin, Donaldson & Latimer, 2018). The Travelbbe model proposes that nursing is carried out through the person-person relationship, where one refers to the nurse and the other to the patient, since he considers that the person-person relationship is first and foremost an experience or series of experiences lived by the nurse and the recipient of their care (patient), according to Travelbee refers to human beings who need assistance. The main characteristic of these experiences is that they meet the nursing needs of patients and their families (Haugan, Moksnes & Løhre, 2016). This theory considers that, in nursing situations, the nurse-patient relationship is the way to achieve the objective of nursing. The relationship is established when the nurse and the patient reach a maximum phase of relationship after having first gone through the original encounter phase, which progresses through phases of emerging identities, progressive feelings of empathy and later sympathy, compassion, until the nurse and the patient get the rapport in the last phase (Haugan, Hanssen & Moksnes, 2013).

I must admit that the findings from the paper has contributed to my professional development in many ways. Firstly, I gained more insights on how evidence-based nursing works. I learned that evidence-based practice is very important and is systematic. Secondly, I learn how to apply evidence-based practice in solving problems. I learn all essentials needed such as the type of evidences to use, the date range to choose and the choice of studies to be used.

Conclusion

A number of issues are discussed in the paper. Firstly, it is noted that evidence-based practice is very important in the modern nursing environment. Through evidence-based practice, the nursing professional can access a large number of scientific publications, evaluate their validity and applicability critically, and most importantly, incorporate it into their daily clinical practice. Investigating in the field of nursing is necessary as in any other discipline, especially when our group wants to demonstrate that nursing is a scientific profession, allowing nurses to improve the quality of care provided to their patients and thus satisfactorily comply with our code deontological and ethical.

The paper further identified one evidence-based paper that could help nurses in determining how to foster a positive experience of care. The article specifically focuses on nurse handover. It is established that the way the nurse's handover the shifts have a significant influence on the experience of care by the patient. The findings showed that patients felt reassured when the staff knew about them. Equally, they felt insecure if the nurse did not appear to know about their care or treatments. Although the article selected had some few weaknesses, the conclusion is that the findings from the article are robust enough to be used to change or improve the process of bringing the positive experience of care.

References

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Bruton, J, Norton, C, Smyth, N, Ward, H, & Day, S 2016, 'Nurse handover: patient and staff experiences', British Journal of Nursing, vol. 25, no. 7, pp. 386-393.

Ellington, L, Clayton, MF, Reblin, M, Donaldson, G, & Latimer, S 2018, 'Communication among cancer patients, caregivers, and hospice nurses: Content, process and change over time', Patient Education and Counseling, vol. 101, no. 3, pp. 414-421. Available from: 10.1016/j.pec.2017.09.013. [13 June 2018].

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Ghahramanian, A, Rezaei, T, Abdullahzadeh, F, Sheikhalipour, Z, & Dianat, I 2017, 'Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication', Health Promotion Perspectives, vol. 7, no. 3, pp. 168-174.

GODSHALL, M 2015, Fast Facts for Evidence-Based Practice in Nursing Implementing EBP in a Nutshell. New York, Springer Publishing Company.

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Haugan, G, Hanssen, B, & Moksnes, U 2013, 'Self-transcendence, nurse-patient interaction and the outcome of multidimensional well-being in cognitively intact nursing home patients', Scandinavian Journal of Caring Sciences, 27, 4, pp. 882-893, Academic Search Premier, EBSCOhost, viewed 11 June 2018.

Haugan, G, Moksnes, UK, & Løhre, A 2016, 'Intrapersonal self-transcendence, meaning-in-life and nurse-patient interaction: powerful assets for the quality of life in cognitively intact nursing-home patients', Scandinavian Journal of Caring Sciences, vol. 30, no. 4, pp. 790-801. Available from: 10.1111/scs.12307. [11 June 2018].

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