Study On The Definition Of Evidence Based Practice

Study On The Definition Of consequence establish exampleI strike studied care for for 4 years in the Philippines and I pee-pee non encounter the term rise Based Practice. It took me by surprise that such subject exist. On my rootage day of class at Thames Valley University I have learned that EBP is about exploring a medical intervention through unbelief of published re take c are articles based on clinical trial conducted by various re tryers and clinicians. The parade starts by proposing a research question, and I chose to focus on Pain counseling but I have notice that pharmacological concern is too common. For such reason, I have decided to aim the attention of my research to Non-pharmacological precaution such as Diversional Therapy. This kind of therapy is seldom used in the clinical setting because a lot of medications are being discovered and used as often. As the process continues, I have learned how to properly critically appraise an article and notice its im portance no matter how old it was and upraise my problem solving skills. Furthermore, adjusting and somehow changing the learning method is a big alteration I have encounter as I exigency to spend a lot of date reading and making the paper. After all the amplitude I put into making this Folder of Evidence, I flip over the entire course a success. I have learned so much of new things that somehow I ignored before.Mapping Grid mental faculty Learning OutcomesEvidence 1Evidence 2Evidence 3Evidence 4Identify and critically examine priorities for improving institutionalize.Page 12Para 1PAsses the ability to identify induction and critically appraise its value.Page 15Para 2P precisely analyze the change commentary and discretion about the nature of evidence in health care practice.Page 12Para 1CPage 18- 21Para 2, 3, 4, 5, 6PEvaluate the possibility and in force(p)ness of evidence for change in practice.Page 24- 25Para 2, 5PLearning LogStudy Day 1 11th October 2010TopicUnder stand the Nature of EvidenceKey Concepts/IssuesEvidence Based PracticeHistoryDevelopmentTeaching/Learning bring up mathematical group DiscussionInformation Skills DevelopmentClassroom ActivityAMExploration of the Concept of Evidence Based Practice.PMSources of EvidenceDeveloping Search Skills library Session (1)Brief NotesEvidence based practice is providing the best evidence of give-and-take to facilitate effective discussion/intervention. A discussion of what to be judge from folder of evidence as it highlights how the folder will be collated and how to set aims and objectives for FOE.Study Day 2 25th October 2010TopicQuestioning Practice/ question Questions Finding EvidenceKey Concepts/IssuesThe relationship between questions and types of evidenceQuestioning own practice explore types of research questions.Developing simple and structure search strategiesTeaching/LearningLecture assort Discussion stem PresentationInformation Skills DevelopmentClassroom ActivityAM assort Presentat ion Evidence Based PracticeGroup Poster PresentationConcepts Definitions and Understandings SessionRelationship Between Questions and Types of EvidenceDescriptive and Relational QuestionsPMWriting Searchable Questions for Evidence Based PracticePICO Identifying Preliminary Search TermsDeveloping Search Skills Library Session (2)Brief NotesWe discussed how to proposed a searchable question and how key it is. I develop a government issue based on my own interest and experience beforehand. Revision of question as well as was supervised and breakdown utilize PICO framework.Study Day 3 8th November 2010Topic polariating Between enquiry Paradigms.Key Concepts/IssuesEvidence Based PracticeExperimental ResearchNaturalistic ResearchTeaching/LearningLectureGroup DiscussionQuizInformation Skills DevelopmentClassroom ActivityAMQuiz Review Research DesignsDiscussion of Types of Questions (researchable and unsearchable questions).Group soundbox of work to soften Final Practice Issue and Search QuestionRefine PICO Framework for SearchPMInclusion and Exclusion CriteriaAppraisal Tools, CASP, SIGN, AGREEGroup turn over Assessment and Discussion of Two Papers Retrieved Last Week. (Question, Design, Methods and Results).Brief NotesI have learn the different types of research designs that supports my research scheme for the 5 basal articles together with supporting documents that will be used in making EBP. This session also emphasizes the importance of PICO as this will help how to refine searches. Different idea tool was also discussed and its importance as this provide effective filter for the reliability and validity of published literature.Study Day 4 twenty-ninth November 2010TopicSystematic Reviews/Meta-analysis An Introduction judge Evidence Part 1.Key Concepts/IssuesSystematic ReviewsDeveloping Critical Appraisal SkillsTeaching/LearningLectureGroup DiscussionGroup PresentationIndividual arrangeClassroom ActivityAMGroup Presentation Features of Systematic ReviewGroup Discussion How Does an SR Differ From a Traditional Review?Appraising a Systematic Review Individual Exercise and Group Discussion.PMUsing Appraisal ToolsAppraising of an RCT and a Qualitative Study Using CASP or an Alternative Appraisal Tool.Group Discussion Analysing the Appraisal Process and Effectiveness of the Appraisal Tool.Brief NotesA systematic review is a study that identifies, appraise, select ans synthesize a collection of research articles with relevance to each piece of work.Critically pass judgment a systematic review article excludes littleer quality studies to decrease error and bias in the findings. It Assess the validity ofresearch by agency of determining whether themethods used during the study potful be trusted toprovide a genuine, accurate account of the treatment being studied.Study Day 5 6th December 2010TopicEstablishing the Quality of EvidenceKey Concepts/IssuesMaking Judgements About the Quality of EvidenceSynthesising EvidenceTeaching /LearningLectureGroup DiscussionworkshopIndividual ExerciseClassroom ActivityAMGRADE How to Move from Evidence to Recommendations.Workshop- Grading EvidencePMTutorialsIndependent Work or Further Electronic Searches.Brief NotesAs I appraise each firsthand articles collected, a summary of critical idea of the 5 primary articles was made. This strategy helped me to make an apprehension toward the affirmation of each articles towards making the summative 3.Study Day 6 13th December 2010TopicImplementing EBPKey Concepts/IssuesTranslating Evidence Into PracticeImplementing EBPGuiding Principles for Implementing EBPBarriers to Implementing EBPTeaching/LearningLectureGroup DiscussionGroup PresentationIndividual ExerciseClassroom ActivityAMGroup discussionIdentify Barriers to Implementing Evidence Base in PracticeIdentify Strategies to carrying into action that Avoid/Overcome these Barriers.PMStudents to work in pairs to devise a search strategy for use in one electronic database to ide ntify an article that describes and evaluates the introduction of evidence based change in practice.Brief NotesImplementation has its various barriers to consider such as time, support, lack of intimacy, lack of motivation of the workers and too much research evidence. As a group activity we refresh an implementation article as to determine the process of implementation of the studied intervention.Study Day 7 10th January 2011TopicEvaluating EBPKey Concepts/IssuesEvaluating Changes in PracticeApplication of a Framework for Evaluating Change.Final Module EvaluationTeaching/LearningLectureGroup DiscussionGroup PresentationIndividual ExerciseClassroom ActivityMeasurement for Improvement/ChangeSustainability of ChangeExamine Effectiveness of Evaluation Strategies.Module Evaluation and Individual TutorialsBrief NotesIt discussed about the military rank process of a study and the use of guidelines in each step. Evaluation meant by achieving a research aims and objectives and most impo rtantly if the study conducted able to get along the hypothesis, as this entails whether the study is effective or not.SUMMATIVE WORKSummative 1 Concept of Evidence-based PracticeThe challenge for best quality of care, combined with the want for recommended usage of resources has heightened the pressure on health care professionals to ensure that clinical procedures is based on sound evidence. Frequent change and advancement in treatments, an increasingly numbers of research information, and the incr easiness of expectations from clients to provide the best care possible, place high demands on healthcare providers to maintain a service that is based on current best evidence. (Bennett and Bennett, 2000). Evidence-based practice (EBP) is a clear path to healthcare wherein health professionals use the best evidence possible, such as the most fitted information addressable, clinical decisions for mortal longanimouss. EBP values, enhances, and builds on clinical expertise, knowledg e of disease process, and patho-physiology (McKibbon,1997). Evidence-based practice presume knowledge of and skills in literature searching, research methodologies apprehension , appraisal and apprehension of research. It also requires healthcare professionals to have access, critique and coordinate literature study with clinical experience and clients aspect. In order to gain a great interpretation about the nature of evidence in the context of health care, consideration needs to be given to the history of the evidence-based health care deed while the concept was originated in medicine, it has influenced a liberal range of health professions (Trinder Reynolds, 2000).In addition, it is an approach to decision-making that has permeated all aspects of healthcare. Its characterize can be seen in some of the leading health systems and government health policies across the world. EBP model highlights the value of research as a source of information which is potentially less sloped than new(prenominal) sources for informing practice, it also clearly acknowledges the importance of integrating this research with clinical expertise and clients perspectives (Sackett et al., 2000). Moreover, it involves complex and reliable decision-making based not on available evidence alone but also on patient characteristics, situations, and preferences. Changing practice is not easy to do therefore careful selection of the topic is rattling significant. For the benefit of the patient is of first importance when selecting a topic, however it can not be the main basis as to literary evidence is inadequate to figure what are the benefits. Researchers must also consider the time, level of consumption and other resources for the study. Research evidence is most frequently free-base in peer-reviewed journals as this is where results are first published and where enough detail on methodology exists to make informed judgements on the validity and clinical relevance of the findings (Bury Jerosch-Herold, 1998). Research using the strongest and most appropriate study design for the question being studied, will provide the best evidence.Summarizing the evidence is a vast intellectual drive according to Fitzpatrick (2007). Healthcare workers must be capable combining ideas and recommendations from an extent of references to make appropriate advices. Implementing a plan is consider challenging because standards and regulation of an giving medication can either help or ruin an EBP approach to care. Evaluation process involves short term and long term coverage to provide ingrained data.Word count= 503Reference identifyBennett S Bennett J (2000) The process of evidence-based practice in occupational therapy Informing clinical decisions. Australian Occupational Therapy Journal. 47 p171-180.McKibbon K (1997) Evidence-based practice. Bulletin of Medical Library Association. 86(3)p396-401Trinder, L., Reynolds, S. (Eds). (2000). Evidence-Based Practice A critical a ppraisal. Oxford Blackwell Science.Sackett D, Richardson W, Rosenberg W, Haynes R (2000).Evidence based medicine How to practice and teach EBM (2nd edn). Edinburgh Churchill Livingstone.Bury T Jerosch-Herold C. (1998). class period and critical appraisal of the literature. Evidencebased healthcare. A practical guide for therapists Oxford Butterworth Heinemann. p136-161Fitzpatrick J (2007. Finding the research for evidence-based practice,part one The development of EBP 103 (17) p.32-33Summative 2 Critical discussion on formulating question using PICOThere are many times that new information is required when contemplating clients in order to analyze clinical problems and make treatment resolutions, and these questions pertains to a specific client or groups of people. Questions usually arise concerning the effectiveness and choices of an intervention, how treatments are best implemented and whether there are any associated difficulties included (Bennett and Bennett, 2000).The questi on for this study is about the effectiveness of Diversional Activities as a form of suffering management to paediatric clients. Pain management is the alleviation of agony and suffering of a patient with the use of Pharmacological and Non-pharmacological treatment or nursing intervention. Diversional therapy is a non-pharmacological approach and a client centered practice that recognizes the leisure and recreational experiences of an individual (Diversional Therapy Association of Australia,2008).Through the act of psychological and behavioral factors regarding pain, costless medicine are significant in altering pain experiences. These interventions bears to minimize fear, worry, pain and heighten a clients bodily process.According to Bennett and Bennett (2000), when there is uncertainty, the need for information can be interchange into a clinical question. Clearly framing a question not only clarifies what to aim, but it can also facilitate the search for answers. Sackett et al. (1 997) point out that the identification of congruent data for answering a particular clinical question may be facilitated by diving the question into components including A client or a dilemma being considered, an intervention or power being considered, outcomes of interest you would like to measure or achieve and a parity. PICO represents an acronym for Patient, Intervention, Comparison and Outcome. These four components are the essential elements of the research question in EBP and of the wind of the question for the search of evidence (Santos et al. 2007). The PICO strategy can be used to compose several kinds of research analysis, originated from clinical practice, human and material resource management, the search of evidence assessment instruments, among others. The research question allows for the correct definition of which evidence is needed to solve the clinical research question, focuses on the research scope and avoids prickss searching (Fleming, 1999). Based on the c linical question formulated and utilization of PICO, a literature search strategy can then be formulated that includes search terms reflecting each component of the question.The next step in the evidence-based practice process is to search the literature for evidence that may assist in acknowledging the question posed. The literature search will be focused by the clinical question that has been identified with use of PICO, as well as other relevant information (Bennett and Bennett, 2000). While evidence for informing clinical decisions may come from various sources including clinical experience, education, textbooks, discussion amongst colleagues and from clients, evidence from well-performed research may be less prone to bias or to the tendency to believe what we want to believe ( Tickle-Degnen, 1999).The internet and the portals of open-access journals allow for accessibility to knowledge, keywords such as non-pharmacological, complimentary medicine and diversional therapy were us ed to search for the 5 primary articles to be used for this study. An article must be good and interesting, should be well written, and old articles are also considered. Moreover, comprises a body of knowledge in academic and scientific based from an original research.Word count= 548Reference ListBennett S and Bennett J (2000) The process of evidence-based practice in occupational therapyInforming clinical decisions. Australian Occupational Therapy Journal. 47 p.171-180Diversional Therapy Association of Australia(2008) what is diversional therapy?online. available athttp//www.diversionaltherapy.org.au/Home/tabid/38/Default.aspxFlemming K.(1999) Critical appraisal 2 Searchable questions.NT Learn Curve 3(2) p. 6-7.Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB (2000) Evidence-based medicine how to practice and teach EBM.Churchill Livingstone. 2nd edition.Santos C, Pimenta C, Nobre M.(2007) The PICO strategy for the research question construction and evidencesearch. Rev Lat ino-am Enfermagem maio-junho. 15(3) p.508-11.Tickle-Degnen,L. (1999). Organizing, evaluating and using evidence in occupational therapy practice. American Journal of Occupational Therapy 53 p.537 539.Summative 3 Synthesis of research findings.This part of work is the review of the 5 primary articles chosen for the topic effectiveness of diversional activities for pain management to pediatric clients. The articles will be analyzed by using CASP tool, examining each relevant findings and by compare and contrasting ideas of each authors, thus, resulting to further evaluation of such intervention in hospital and non-hospital setting for its efficacy. This research desires to have a thorough understanding of non-pharmacological intervention in managing pain to children that soon will complement pharmacological management by provide stronger evidence. Pain is a dreadful feeling and activated experience related to injury or damage to children s body, it is usually caused by trauma, dise ase, medical procedure or surgery. Pain may affect children s appetite, sleeping patterns and lessen energy level hence disabling child to do things. Pediatric pain is complex and often difficult to assess, that is why effective pain management in children is a challenge to medical practitioners because there are many special considerations when providing treatment. On the other hand, non-pharmacological therapies or diversional activities are treatment that do not use medicines to decrease or subordination child s pain. They may convey comfort to the patient during a long standing condition or illness. Certain activities may help improve the child s state by making him/her more comfortable and warm uped. It involves methods such as teaching and leading your child through thinking exercises and other techniques. It can also be used before and after a child undergoes abominable experience, such as medical procedure or surgery.Vessey et al. (1994) stated that, Distraction is the si ngle most commonly used diversional activity among children. Fernandez (1986) stated that distraction refers to the cathexis of attention to a non-noxious event or stimulus in the immediate environment. When a patient worries too much about his/her pain causes more pain than what is really there. Vessey et al (1994) surveyed 100 children, aged 3 years to 12 years, majority are males (62%) to examine the effectiveness of Distraction method during venipuncture or needle prick, the child s memory may lead to stressful psychological responses, such as crying, and physical responses such as venous constriction during the procedures. It is important that in conducting a study the respondent s age, developmental level and prior hospital experience must be considered during the selection, Broome (1985). Furthermore, Researchers uses the Wong-Baker FACES pain rating outdo in evaluating children s perception of pain. Wong-baker pains scale is know to be a reliable and valid device for child ren 3- 18 years of age in evaluating their pain,Wong and Baker (1988). In using distraction, the patients may paint, play with friends, watch TV and play with board games or video games and other novelty toys to help them relax and deflect their attention during the procedure since it provokes curiosity and require children to use their auditory, visual, tactile and /or kinesthetic senses. These activities may keep them from thinking about the pain.Weekes et al (1988) straiten is known to pubic louse patients for years during and after the completion of anti cancer treatments. According to National Institute of Clinical Excellence (NICE), (2005) the role of imagination can play in a childs ability to cope with painful operations. The NICE concluded that there was a strong evidence for the use of hypnosis in alleviating degenerative pain associated with cancer. Richardson et al (2006) mentioned that hypnosis is a method where the subject is guided by another to respond to suggesti ons for changes in subjective experience such as perception, sensation, emotion, melodic theme or behavior. It can be utilized in a variety of ways to cut down stress, acquire coping strategies and halt the experience of pain. Self-hypnosis tends to ease self management of symptoms, hence providing a sense of self-efficacy and control over pain and distress, however, it creates less therapeutic benefit compared to therapist- directed hypnosis. It is evident that patients who underwent hypnosis reported less anxiousness and pain while using direct and indirect forms of hypnosis, demonstrating leveled effectiveness. Though, there is some evidence that under hypnosis, girls exhibited more distress behavior compared to boys, Katz et al (1987). Richardson et al (2006) concluded that hypnosis has potential as a clinically valued intervention that could impart to the establishment of procedure- related pain and distress in pediatric cancer patients.Oshikoya et al ( 2008) reported that com plementary and selection medicine has been advantageous for children by some parents, such benefits includes prevention of illness, maintenance of good health, relief of musculoskeletal pain, control of asthma symptoms, treatment of mild respiratory problems, relief of sickle cell anemia and enhancement of the immune system in cancer. 80% of the parents used alternative medicine to cure their children during the study, however, 7% discontinue the use of such practice because the symptoms of the illness come about in their children with exacerbation after their regular medications had been discontinued. Moreover, Kemper et al (2010) expressed that pediatric patients benefit from stress diminution by means of using complimentary medicines and techniques such as biofeedback which teaches the child to control and calm body s reactions when there is pain, it is one of the treatments researched most extensively for migraine, Allen (2004). Guided imagery is used by letting the patient im agine that he/she is his/her favorite place, the patient will feel safe and relaxed and pain may be decrease. Relaxation and self-hypnosis methods that re mostly used for migraines and headache by asking the child to occur slowly and deeply and let the patient imagine that his/her muscles are relaxing.. Holroyd and Drew (2006) stated that cognitive behavioral therapy has been utilized successfully to help manage headaches, depression, and anxiety, Lawler and Cameron (2006). This practice has proven effective in reducing migraine headaches, improves mood and cognitive function through an experiment. Also, Acupuncture and Massage can help both adults and pediatric patients who have chronic headache and can be provided by family members, which allows for more regular, inexpensive and favorable treatments.Salantera et al (1999) investigates 265 nurses about the knowledge and abilities of nurses towards pain management of pediatric clients. Health care practitioners such as nurses, are well placed to provide such supportive interventions in both pharmacological and non-pharmacological treatments. According to Ross et al (1991) Healthcare providers lack of knowledge and negative attitudes may lead to under medication and under treatment of pain. Nurses are close to the children the whole day and have more chance to use non-pharmacological pain management methods in their work. Clarke et al (1996) that education about pain was most inadequate in areas of non-pharmacological interventions to relieve pain, the variation between acute and chronic pain, and the anatomy and physiology of pain. Nurses knowledge differed according to their age, education, and place of work, and uses a fairly wide range of non-pharmacological pain alleviation methods, most of the time the nurse was in the active role and the child was passive, restricting the child to take an active part in their own pain comfort. Studies shows that children like to have some responsibility for their own c are. Furthermore, Pederson and Harbaugh (1995) explicit that there are obstacles in terms of using non-pharmacological pain management in hospital setting and embed to be that excess workload, lack of proper materials, lack of knowledge and skills, and not knowing the child were the most common problems nurses confronts. Some of them felt that they receive very brief education on non-pharmacological pain management, and 90% had no documented evidence of the use of any non-pharmacological modalities to relieve pain that will serve as nurse s guidelines. The nurses who thought they had good knowledge about non-pharmacological management got a lower score from the survey, nurses consider themselves knowledgeable in stress reduction but not in play therapy and hypnosis method. Effective pain management in children requires cognition of both pharmacological and non-pharmacological methods. There are evidence found that nurse s characteristics, such as age, knowledge, experience, intuiti on, attitudes and beliefs, as well as nurses personal experience with pain, determines their implementation of pain interventions and knowledge about it. Nurses should be encourage to actively seek new information and extend their training. More comparative, dismantling, constructive, and process oriented research strategy is required in the area of non-pharmacological pain management and different practice of pain alleviation should be generalized.Non- pharmacological approach has been found to be an effective adjunct method for the control of pain. A wide range of complementary and alternative medicine therapies are being used by children, including herbs and dietary supplements. Given the influence of psychological and behavioral factors on pain, non-pharmacological interventions are important in altering pain perception/behaviors. Diversional activities are intervention used for managing pain in both children and adult to reduce fear and, minimize distress and pain and increase a childs sense of control. For these techniques to be effective, it must be appropriate to patient s age and developmental abilities and must also be appealing to the recipient. There is still continues need to educate the medical community regarding the long term outcomes of pain control.Word count = 1514Reference ListAllen KD (2004) Using biofeedback to make childhood headaches less of a pain. Pediatric Annual. 33 241-245Broome M (1985). The child in pain A model for assessment and intervention. Critical care quarterly, 8 47-55Fernandez E (1986). A classification system of cognitive coping strategies for pain. Pain. 26 141- 151.Holroyd KA, Drew JB (2006) Behavioral approaches to the treatment of migraine. Seminar Neurology. 26 199- 207Katz E, Kellerman J, Ellenberg L (1987) Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology 12 379- 394Kemper K, Breuner C, (2010) Complimentary, Holistic, and Integrative Medicine Headaches. American academy of pediatrics, 31(2) p.17- 23Lawler SP, Cameron LD (2006) A randomized, controlled trial of massage therapy as a treatment for migraine. Annual Behavioral Medicine. 32 p50-59National Center for complimentary and alternative medicine, NIH (2007) Non-pharmacological pain management therapies for children. Available at http//nccma.nih.govNational Institute for clinical excellence (NICE) (2005) Service guidelines for improving outcomes in children and young people with cancer-second consultation. Available at http//www.nice.org.uk/pdf/cacancer_2ndcons_manual.pdfOshikoya K, Senbanjo I, Njokanma O, Soipe A ( 2008) Use of complimentary and alternative medicines for children with chronic health conditions in Lagos, Nigeria. BMC complimentary and alternative medicine 8 (66), p.1- 8Pederson C, Harbaugh B. (1995) Nurses use of Non-pharmacological techniques with hospitalized children. Issues comprehensive pediatric Nursing 18 91- 109Richardson J, smith J, Pilkington K (2006) Hypnosis for procedure-related pain and distress in pediatric cancer patients A systematic review and methodology related to hypnosis interventions. Journal of Pain and symptom Management, 31 (1) p.70- 83Ross RS, Bush JP, Crummette BD (1991) Factors affecting nurses decisions to administer PRNanalgesic medication to children after surgery an analog investigation. Journal of pediatric Psychology, 16 151-167Salantera S, Lauri S, Salmi T, Helenius H (1999) Nurses knowledge about pharmacological and non-pharmacological pain management in children. Journal of Pain and symptom Management, 18 (4) p. 289- 299Vessey J, Carlson K, McGill J (1994) Use of Distraction with Children during an acute pain experience. Nursing Research, 43(6) p. 369-372Weeeks DP, Savedra MC (1988) Adolescent cancer coping with treatment- related pain. Journal of Pediatric Nursing 3 318- 328.Wong D, Baker C (1988) Pain in children s comparison of assessment scales. Pediatric Nursing, 14 19- 17.