Evidence-based practice in applied nursing

Nursing

Evidence-Based Practice & Applied Nursing

A good research report contains five different areas. The first is the Abstract. The abstract provides two major purposes: it helps a person decide whether to read the paper, and it provides the reader with a framework for understanding the paper if they decide to read it. It should include a statement of the problem, the people who were studied, the dependent and independent variables, the instruments, the design, major findings, and conclusions. The second area is the Introduction. This area should be a paragraph or two that presents the investigated problem, the importance of the study, and an overview of the research strategy. The opening paragraphs are usually followed by a review of the literature in order to show how this research builds on prior knowledge by presenting and evaluating what is already known about the research problem. The third area is that of the Method. The method section contains separate descriptions of the sample, the materials, and the procedures. The next area is that of the Results. This section presents a summary of what was found in the research. It should include a description of the techniques that were used, each analysis and the results of each analysis. The last section is that of Discussion. In this section, there should be a discussion and interpretation of the data for the reader, along with implications of the findings and recommendations (Rudner and Schafer, 1999).

In the article Meeting the needs of family carers: an evaluation of three home-based palliative care services in Australia by Thomas, Hudson, Oldham, Kelly and Trauer in 2010 the following things were found when the areas of a report were looked at. Each area in the diagram contains the elements that were included in the article. (See Figure 1).

Figure 1

In the abstract the researchers state the problem that they are going to look at as being an examination of the current type of assessment and types of care provided to family caregivers in regards to palliative care. A focus group and file audit were carried out at two metropolitan and one regional home-based palliative care service in Australia. These palliative care locations reported substantially different levels of services provided to family caregivers and also reported multiple barriers to providing services for family carers. Only one site had a formal structured procedure to assess caregiver needs and none of the sites used a separate caregiver care plan or offered a structured intervention to assist carers with their role. Family meetings were offered infrequently by most sites. A number of obstructions to supporting carers were highlighted including lack of resources, and areas for improvement were also suggested by health professionals (Thomas, Hudson, Oldham, Kelly and Trauer, 2010).

In the introduction section the researchers addressed the problem being looked at along with its importance. Family caregivers give the bulk of support to patients receiving palliative care at home and without this contribution the well-being of patients and their capacity to remain at home would be compromised. Therefore it is appropriate that support for family caregivers during the care giving phase and into bereavement is a core element of palliative care philosophy and practice. The literature review showed that while policy promotes a broad assessment of caregiver needs and a plan to adequately meet caregiver needs within palliative care, there is a lack of studies in the Australian context which examine the current type of assessment and level of care provided to primary family carers and other family members. The aims of this study were to: determine how primary family caregiver needs are currently assessed and what level of support is available to primary family caregivers in three home-based palliative care services within Australia, to identify areas for improvement in support to primary family carers and explore the barriers to offering caregiver support (Thomas, Hudson, Oldham, Kelly and Trauer, 2010).

The method section of the report addressed the description of the samples along with the materials and procedures used. Three Australian community palliative care services participated in the study. The three sites were chosen in order to reflect services across different parts of Australia and to ensure the results reflected both metropolitan and regional perspectives. Approximately 85% of patients at the three sites had a diagnosis of advanced, non-curative cancer. Two methods of data collection were utilized. Focus groups with health professionals were conducted to explore staff perspectives on services that are currently available for carers, how well such services meet carers' support needs, perceived barriers to supporting carers and ways to improve services for carers. A semi-structured interview schedule was developed by the research team and used for all focus groups. Secondly, a file audit was conducted to establish and quantify the frequency of actual support services received by carers (Thomas, Hudson, Oldham, Kelly and Trauer, 2010).

The results section of the report showed that participants at each of the three sites reported that while they did assess the needs of carers on admission, this assessment was not formally structured but rather an ongoing assessment where services were offered on a perceived needs basis at varying times throughout their care. Participants highlighted a number of barriers to caregivers receiving adequate support. A common theme reported by all included a lack of resources and lack of availability of external services to provide timely services. For the metropolitan sites, internal resource issues related to: services to provide focused hours of care (to provide carers with respite), services for carers who do not speak English, resources for counseling, social work and nursing staff, and waiting lists for equipment or referrals to occupational therapists (Thomas, Hudson, Oldham, Kelly and Trauer, 2010).

The discussion area reported that to the best of the authors' knowledge, this study was the first to examine how family caregiver needs are assessed and what services are provided to family carers to meet their needs in home-based palliative care services in Australia. While current policy promotes comprehensive assessment of carers, there is little evidence to show that the palliative care services in this study have incorporated formalized procedures for assessing and responding to family caregiver needs in a comprehensive way. The results of this study highlight that the potential variability in palliative care services in relation to the services they provide and the barriers they are working within. This study also highlighted the variation in services provided to carers between palliative care services in some regions across Australia, specifically for rural services (Thomas, Hudson, Oldham, Kelly and Trauer, 2010).

The focus of the research done in this study was to look at the ways in which caregivers were currently assessed and what level of support is available to primary family caregivers within Australia and to identify areas for improvement in support to primary family carers and explore the barriers to offering caregiver support. The research in the study supported the conclusion that there are not a lot of formal assessments processes in place which is affecting the consistency of care that is being provided to those who are in need of palliative care.

There are three ethical principles important to nursing research: autonomy, beneficence, and justice. Independence is the fundamental ethical principle underlying self-determination and informed consent. Beneficence is the basic ethical principle guiding the health care surrogates and health care providers to act in the best interest of the research subject. Justice is a fundamental principle in research subject solicitation (Ethics in Critical Care Nursing Research, 2005). In this particular instance for the research done for this article there were not any ethical issues that arose. All health professionals at each of the three sites were informed of the study via a short presentation by a member of the research team who invited staff to participate in a focus group. Staff from all disciplines was invited to participate in order to ensure that a comprehensive range of perspectives were explored. Participants in the focus groups were assured that their involvement was entirely voluntary and their participation or otherwise would in no way affect their employment. Focus groups were facilitated by someone unconnected with the service. Ethics approval was obtained for all sites involved in this study and written informed consent was obtained from all (Thomas, Hudson, Oldham, Kelly and Trauer, 2010).

Types of research can be classified into a threefold system. If random assignment is used, then the design is one of randomized experiment or true experiment. If random assignment is not used and it uses either multiple groups or multiple waves of measurement then it would be labeled as a quasi-experimental design. If it is neither of these then it is referred to as a non-experimental design. This threefold categorization is useful for describing the design with respect to internal validity. A randomized trial generally is the strongest of the three designs when the interest is in establishing a cause-effect relationship. A non-experiment is generally the weakest in this respect. The simplest structure of non-experiment is a one-shot survey design that consists of nothing but a single observation. This is one of the most common forms of research and, for some research questions is clearly a strong design (Ethics in Critical Care Nursing Research, 2005).

The research that was done in this article would be considered a non-experimental type. There were two types of observation that were conducted. The first type was that of focus groups and the second being the file audit, both of which are observational in nature. In this case this was the most appropriate type of research design to use. Since they were simply trying to see what was actually going on in this area and how that was affecting patients the only real way to tot this was by observation. From this article a nursing care issue that can be raised is that of how palliative care nurses manage family involvement with end of life issues. Are there any standard procedures that are used and if not should there be. The attached matrix shows a listing of primary research sources used to look at this issue.

Annotated Bibliography

Agnew, a, Manketelow, R, Taylor, B.J., Jones, L. (2010). Bereavement needs assessment in specialist palliative care: a review of the literature. Palliative Medicine. 24(1), p46-59.

In this article, Agnew, Manketelow, Taylor and Jones, identify and review grief measurement tools and their suitability for use in palliative care settings. They believe that there are certain tools that work and ones that don't. This article is an original article in a peer reviewed journal that utilizes 80 detailed references. These detailed references will be very useful in conducting further research (Agnew, Manketelow, Taylor and Jones, 2010).

Duke, Sue and Bennett, Helen. (2010). A narrative review of the published ethical debates in palliative care research and an assessment of their adequacy to inform research governance. Palliative Medicine. 24(2), p111-126.

In this article by Sue Duke and Helen Bennett, is a literature review published in a peer reviewed journal that was conducted using 69 different detailed sources. The authors looked the ethical issues that occur in research surrounding palliative care. Although it looks specifically at a framework for reconciling ethical issues raised with potential methodological strategies, this article will be helpful in linking the search for best practice methods with ethics. This article will be very helpful in conducting further research because of the number of sources that are cited in it (Duke and Bennett, 2010).

Abernethy, Amy P, Hanson, Laura C, Main, Deborah C., Kutner, Jean S. (2007). Palliative Care

Clinical Research Networks, a Requirement for Evidence-Based Palliative Care: Time for Coordinated Action. Journal of Palliative Medicine. 10(4), p845-850.

In this article Amy Abernethy, Laura Main and Jean Kutner report on evidence-based palliative care and how it requires a palliative care clinical research network in order to move toward standardization. This article is an editorial in a peer reviewed journal. Even though this article is an editorial, it is still a good source of research-based information, as the authors use 18 detailed references. This number of resources is a valuable source of credible articles on this topic (Abernethy, Hanson, Main and Kutner, 2007).

Hudson, P., Thomas, T., Quinn, K. And Aranda, S. (2009). Family meetings in palliative care:

are they effective? Palliative Medicine. 23(2), p150-157.

In this article by Hudson, Quinn and Aranda, the role of family meetings as a tool in palliative care is looked at. The authors look at whether family meetings are an essential tool for information sharing and planning. This is an article in a peer reviewed journal. It utilizes 18 different sources and will serve as a good exploration of tools that are needed in the palliative care arena. The cited references will be helpful in further exploration (Hudson, Thomas, Quinn and Aranda, 2009).

Murray, Mary Ann. (2008). A question of evidence: decision-making in palliative care nursing.

International Journal of Palliative Nursing. 14(1), p45-47.

In this article by Mary Ann Murray, she looks at current perspectives of evidence-based practice to promote a hierarchy of empirical evidence regarding nurses integrating research evidence into their practices. This is an article in a peer reviewed journal. The author takes a good look at what practices should be included in a best practice model while addressing the complexities of end of life care (Murray, 2008).

Currrow, David C., Wheeler, Jane L., Glare, Paul a., Kaasa, Stein., Abernethy Amy P. (2009). a

Framework for Generalizability in Palliative Care. Journal of Pain & Symptom

Management. 37(3), p373-386.

In this article by Currow, Wheeler, Glare and Kaasa, look at the idea of evidence-based principles being used in palliative care. They look at how new knowledge is generally taken into practice slowly and how the translation of evidence lags behind emerging research. This is an article in a peer reviewed journal. This article will be very useful in establishing the need to evidence-based principles to be included in a standardized model for palliative care (Currrow, Wheeler, Glare, Kaasa and Abernethy, 2009).

Eagle, Lisanne M. And deVries, Kay. (2005). Exploration of the decision-making process for inpatient hospice admissions. Journal of Advanced Nursing. 52(6), p584-591.

This article by Eagle and deVries looks at some of the finding of a qualitative study which describes the decision making processes in regards to palliative care. The authors look at factors that are potentially influential in medical decisions. These factors include: patient diagnosis, symptoms, current location and the stated reason for treatment. This article is an original article in a peer reviewed journal that utilizes 27 references. This article will be very useful in determining what the best practices for palliative care should look like. The vast number of sources that it provides will be helpful in further research (Eagle deVries, 2005).

Finlay, Ilora G. (2009). Developing a Template to Plan Palliative Care Services: The Welsh

Experience. Journal of Pain & Symptom Management. 38(1), p81-86.

In this article by Ilora Finlay, looks at the specialist palliative care needs taking into account populations of all ages. The author looks at providing patient focused evidence-based care and what that should consist of. This is an original article in a peer reviewed journal. This article will be helpful in establishing a standardized model of palliative care (Finlay, 2009).

Murray, Mary Ann. (2007). Crossing over: transforming palliative care nursing services for the

21st century. International Journal of Palliative Nursing. 13(8), p366-376.

In this article Mary Ann Murray looks at the growing demand for end of life care. She looks at the fact that the current dominant model of palliative nursing is not going to be sufficient to keep up. This article is an original article in a peer reviewed journal that will be helpful in establishing the need for a standardized model for palliative care (Murray, 2007).