Use our essay title generator to get ideas and recommendations instantly
There is a lot of talk about evidence-based practice in the medical community, and it may seem as though it is being overstated. However, that is definitely not the case. Evidence-based practice is very important in order to make sure healthcare outcomes are the best they can be. Any problematic outcomes can be improved through the use of scholarly inquiry and analysis. Being able to analyze issues properly and in a scholarly manner provides food for thought and also provides an opportunity for the most realistic and logical decision for patient care. This is not to say that logic is the only way to determine something, but that particular steps have to be taken in the vast majority of circumstances to ensure the patient is getting the best care. Nurses must not simply make a choice as to what kind of care to provide to a patient. The…
Evidence-ased Practice: Systems Theory and Diffusion of Innovation Theories to Healthcare Delivery and Nursing Practice
The ability to acquire accurate and timely information enhances nursing practice and patient outcomes. Search engines and healthcare nursing databases operate in different ways, and it is necessary for healthcare professionals to understand how to access and efficiently use both public and professional resources. ecause today the public has greater access to electronic health information, healthcare professionals must be aware of the information their patients are accessing and be proficient at identifying credible sources. It is important for healthcare professionals to know how to use professional databases. Nursing practice needs to be based on evidence and access to healthcare databases assist nurses in identifying best practices. The use of theories from other disciplines also expands the breadth and depth of knowledge available to guide healthcare delivery and nursing practice. relating systems and diffusion of innovation…
Laszlo, A. And Krippner, S. (1998) Systems Theories: Their Origins, Foundations, and Development. Published in: J.S. Jordan (Ed.), Systems Theories and A Priori Aspects of Perception. Amsterdam: Elsevier
Science, 1998. Chapter 3, pp. 47-74.Retrieved from: http://archive.syntonyquest.org/elcTree/resourcesPDFs/SystemsTheory.pdf
These authors examine systems theories in terms of its origin and foundation. Examined is natural systems, reduction to dynamics, emergent properties and synergy, and the systems approach.
Martin, RL (2011) The Impact of System & Diffusion Theories in Evidence-Based Practice. Retrieved from: http://www.scribd.com/doc/57300149/A-Discussion-on-Evidence-Based-Practice
Task a: Nursing esearch Journal in APA-Format
Chaney, D. & Glacken, M. (2004). Perceived Barriers and Facilitators to Implementing esearch Findings in the Irish Practice Setting. Journal of Clinical Nursing, 13, 731-740.
The five areas of research, background information, literature review, methodology discussion, data analysis, and conclusion in the journal article.
Areas of esearch eport
The researchers used information from previous studies like Treacy & Hyde, 2003 to create background for the research. The background indicates that nurses increasingly recognize the role of research in daily practice. However, there is evidence that there is a lack of actual application of research results in practice. The researchers identify the researches background as the lack of empirical investigations of the barriers to the implementation of research findings in nursing practice.
eview of literature
The researchers carry out a review of literature to support the topic and find evidence…
Allison, R., Flowerdew, K., & Elsmlie, A. (2012). Promoting a discussion about adherence to psychiatric medication. Mental Health Practice, 16(3), 18-22.
Browne, G. & Quinn, C. (2009). Sexuality of People Living with a Mental Illness: A Collaborative Challenge for Mental Health Nurses. International Journal of Mental Health Nursing, 18, 195-203.
Buck, K.D. & Lysaker, P.H. (2010). Clinical Supervision for the Treatment of Adults with Severe Mental Illness: Pertinent Issues when Assisting Graduate Nursing Students. Perspectives in Psychiatric Care, 46(3), 234-244.
Chaney, D. & Glacken, M. (2004). Perceived Barriers and Facilitators to Implementing Research Findings in the Irish Practice Setting. Journal of Clinical Nursing, 13, 731-740.
Hauck, Winsett and Kuric (2013) published "Leadership facilitation strategies to establish evidence-based practice in an acute care hospital" in the Journal of Advanced Nursing. The focus of this article is the role that leadership plays in the implementation of evidence-based practice. They note that there are three ways in which leadership can support the implementation of evidence-based practices. They can implement evidence-based practices in the strategic plan. They can support and mentor people within the organization, and lastly they can provide the resources for the education of the workforce. The authors found that when these interventions were implemented, "total group scores for beliefs and organizational readiness improved significantly" (Hauck, Winsett, Kuric, 2013, p.664).
Summary of Key Points
The authors noted that nurses outperformed other role types in this area. Thus, one of the key elements of nursing implementation is that the nursing leadership in the organization needs to…
Hauck, S., Winsett, R., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal of Advanced Nursing. Vol. 69 (3) 664-674.
Evidence-based practice is an approach that has been applied to clinical practice and nursing. Evidence-based practice started initially in medicine and went to fields like education, psychology, nursing and dentistry. It should be noted that the research is based on studies that were carried out and these studies go on to fit the scenario that is currently being dealt with.
Treatments that are supported empirically are the ones that are proven to be efficacious in a controlled research within a population. If a person knows that they are being treated after following a study with successful results, they will feel much better receiving the treatment as well (Chambless & Hollon, 1998) In simple words, decisions are made after looking at the best possible evidence that there is. It should be noted that the characteristics, needs, and preferences of the people in the study should match those of the case at…
Addis, M. And Krasnow, A. (2000). A national survey of practicing psychologists' attitudes toward psychotherapy treatment manuals..Journal of Consulting and Clinical Psychology, 68 (2), p. 331.
Chambless, D. And Hollon, S. (2013). Review Defining empirically supported therapies..J Consult Clin Psychol., 66 (1), pp. 7-18.
Dozois, D. (2013). Psychological treatments: Putting evidence into practice and practice into evidence..Canadian Psychology/Psychologiecanadienne, 54 (1), p. 1.
Meyer, B. And Dale, K. (2010). The impact of group cognitive complexity on group satisfaction: A person-environment fit perspective. Institute of Behavioural and Applied Management.
Janvnbakht, Hejazi, & Ghasemi (2009) have clearly identified the purpose of their study. hey have also stated the importance and relevance of the research topic to the current evidence-based practice. An already diagnosed illness of anxiety and depression is included in the study and evaluation of the history of other psychiatric illness confirmed before the study. he use of participants with an already diagnosed illness facilitates the study of the effectiveness of the yoga intervention in alleviating disorders and symptoms associated with anxiety and depression. here is an adequate description of the sample of the participants, response rate, and sample attrition.
Critical Appraisal of the Research Article (cont'd)
However, it fails to provide a detailed inclusion and exclusion criteria used in the study alongside the actions taken to maintain blinding.
For example, the study fails to include strategies adopted to maintain blinding such as training the therapist not to discuss…
They incorporate their own data with that of other authors who have conducted similar researches found in the MEDLINE database.
For instance, they use the studies conducted by Milchalsen, Gupta, and Taherkhani to support their evidence of the effectiveness of the intervention.
Despite the contradiction of the results obtained by Pearson, Field & Jordan (2007), in their study,
Evidence-based practice (EBP) is the term that refers to the need for nursing to be based on research that has been conducted in the most thorough scientific manner, consistently tested, rigorously proved, and only then published by peer-refereed academic journals.
Evidence-based nursing is popular in nursing since it joins science with practice and bases nursing on a more critical scientific basis. It puts the nurse, so to speak, in the driver's seat and allows her -- in fact encourages her -- to question her transmitted teachings, to critically review authoritative sources of her field, and to herself conduct studies would she so wish.
This is important in various ways: firstly it makes nursing a more of an intellectual study for students who may need and wish for that intellectual component. Secondly, it frees nurses form the traditional, often submissive and uncritical obeisance to doctors. Nurses are encouraged to critically question…
Cluett, ER Evidence-based practice http://www.elsevierhealth.co.uk/media/us/samplechapters/9780443101946/9780443101946.pdf
Sackett DL, Rosenberg WMC, Gray JAM et al. (1996) Evidence-based medicine: what it is and what it isn't. British Medical Journal. 312;169 -- 171
Sackett DL, Straus SE, Richardson WS et al. (2000) Evidence-based medicine. How to practice and teach EBM, 2nd edn. Churchill Livingstone, Edinburgh
Scott, M., & McSherry, R. (2009). Evidence-based nursing: clarifying the concepts for nurses in practice, Journal of Clinical Nursing, 18,1085-1095
A study conducted by Leep Hunderfund et al. tested the effectiveness of a follow-up assessment and risk factor specific intervention measures in reducing falls in an inpatient setting (2011). The study suggested that the Hendrich isk Fall Model works as an effective primary screening tool and, when used in combination with further physician assessment, reduces the number of patient falls dramatically. Ang, Mordiffi and Wong corroborated these results in a study that demonstrated a reduction in fall rates in response to the implementation of specific intervention measures (2011). The intervention was targeted at risk factors identified by the Hendrich Fall isk Model and showed how the risk assessment tool could be used effectively with more specific measures to increase specificity.
The evidence found relating to the research question is intermediate in strength. While some comparative studies used the assessment tools on the same population to evaluate predictive value, others used…
Ang, E., Mordiffi, S.Z., & Wong, H.B. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. Journal of Advanced Nursing, 67, 9, 1984-1992.
Hendrich, A.L., Bender, P.S., & Nyhuis, A. (2003). Validation of the Hendrich II Fall Risk Model: A Large Concurrent CASE/Control Study of Hospitalized Patients. Applied Nursing Research, 16(1), 9-21.
Hitcho, E.B., Krauss, M.J., Birge, S., Clairborne Dunagan, W., Fischer, I., Johnson, S., Nast, P.A., Constantinou, E., & Fraser, V.J. (2004). Characteristics and circumstances of falls in a hospital setting: a prospective analysis. Journal of General Internal Medicine, 19, 7, 732-9.
Leep Hunderfund, A.N., Sweeney, C.M., Mandrekar, J.N., Johnson, L.M., & Britton, J.W. (2011). Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology Inpatients. Mayo Clinic Proceedings, 86, 1, 19-24.
Clinical Practice Guidelines (1)
Authors combined several studies for efficacy
Block, S.L. (2)
Older data (over 10 years) and used only one research study.
Kelley, et.al. (3)
Credible and systematic; great review of literature
Older data (over 10 years) and used only one research study.
No scholarly or academic research, materials is hearsay and anecdotal.
Clinical Practice Guidelines (1)
Inclusion of Primary esearch
Includes Guidelines for Best Practices
Summarization of a number of sources, generalized but academic.
Block, S.L. (2)
Includes Primary esearch
Scholarly, peer reviewed and focused on a single research topic within an academic publication.
Kelley, et.al. (3)
Summarization of a number of sources, generalized but academic.
Includes Primary esearch
Includes Best Practice Guidelines of AOM
Summation of esearch
Possible as a component…
Diagnosis and Management of Acute Otitis Media. (2004). Pediatrics. 113 (5): 1451-65.
Sources of Evidence-Based Literature. (2006). NYU School of Medicine. Ehrman Medical
Library. Retrieved from: http://library.med.nyu.edu/library/instruction / handouts/pdf/ebmsources.pdf
Minors, Privacy Rights of HIPAA. (2010). University of Miami -- Miller School of Medicine. Retrieved from: http://privacy.med.miami.edu / glossary/xd_minors.htm
Evidence-Based Practice Section G: Evaluation
Section G -- Evaluation
Methodology and data collection rationale. The role of leadership styles and training in nursing situations has been described in the literature and there is a substantive body of work suggesting that leadership can significantly affect the praxis of nurses and the outcomes of patients (Looke, 2001). Training that occurs over time is believed to enhance adoption of desirable behaviors in the workplace environment, and to strengthen the implementation of transformational leadership (Bowles & Bowles, 2000). Because individuals develop leadership skills over time, it is rational to survey nurses who receive training in transformational leadership at intervals during and after training to assess their levels of transfer of training to practice. The Leadership Practices Inventory (LPI) will be used to conduct face-to-face interviews of nurses receiving training in transformational learning. Use of the LPI will broaden and deepen the data collected about…
Validity. Quantitative data will be triangulated against the qualitative data collected through surveys and interviews of subjects. A baseline survey will establish levels of knowledge about the implementation of transformational training, about evidence-based practice, and about change in organizations. This first survey will strengthen the validity of subsequent surveys and interviews by establishing definitions and meaning of terminology used in subsequent surveys and interviews. The transformational leadership training itself will further solidify subjects' conceptual understanding, thereby contributing to content validity.
Interaction of testing and treatment poses the greatest threat to construct validity in this study because of the inherent need to test formative learning and the use of surveys and interviews which can function in much the same way as a test by signaling valued or awarded behaviors to subjects. Pilot testing of survey questions will contribute to construct validity.
Threats to internal validity in this study include social interaction, mortality, maturation, and testing (Carmines & Zeller, 1974). Social interactions can be a threat to internal validity if nurses who do not receive training behave differently because of
Evidence-Based Practice & Transformational Leadership
Transformational leadership may be defined as an innovation as it is not in wide or general practice across the medical and healthcare fields. An innovation must, by definition be characterized by benefits that are accrued only through adoption of the innovation into practice or general use. Transformational leadership has been shown to have benefits for patients and patient care, as well as for those practice transformational leadership in their work, and the colleagues that are directly impacted by these transformational leaders. Because of the benefits that accrue to those who practice transformational leadership, it is anticipated that the attrition of nurses may be ameliorated by a diffusion of transformational leadership into the practice.
Diffusion of innovation theory. A variety of change models have been employed to describe the introduction and adoption of innovations in professional practice. The diffusion of innovation theory, a change…
he study involved giving adolescents a questionnaire to determine if they perceived their weight and appearance with accuracy; most females overestimated their weight and most males underestimated their weights. However, this was just 35% of the participants. he bulk of the participants (65%) were able to assess their body weight accurately. On the other hand, the results of the study indicate the need for interventions to help develop health body images and healthy assessments of body weight.
his study was conducted in a thorough and comprehensive manner as the details of the study reflect. he researchers were wise to engage a large sample, so as to create a comprehensive amount of feedback and findings and to be able to look for trends with accuracy. he findings of this actual study point to the need for parents and authority figures to be better connected to the body image ideals of their…
Toruner, E.K., & Savaser, S. (2010). A controlled evaluation of a school-based obesity prevention in Turkish school children. Journal of School Nursing, 26(6), 473-82.
Tsai, P.Y., Boonpleng, W., McElmurry, B.J., Park, C.G., & McCreary, L. (2009). Lessons learned in using take 10! with hispanic children. The Journal of School Nursing, 25(2), 163-172.
Yost, J., Krainovich-Miller, B., Budin, W., & Norman, R. (2010). Assessing weight perception accuracy to promote weight loss among U.S. female adolescents: A secondary analysis. BMC Public Health, 10, 465.
In fact the inabilty of the sociall work profession to adequaelty and discretely define EBP, specifically the main goal of this work, may in part be to blame for scholalry blunders, such as the use of evidence-based practice in a title of a work that is highly qualitative, anecdotal or even based on a single or small set of case studies.
Just as Weed lists the various levels of evidence, The American Psychological Association (APA) went a step further by establishing a task force to judge good evidence for a range of psychological disorders. According to osen and Proctor (2003), as taken from the APA, the most basic criterion used by this task force is that well established and empirically validated data requires a design that involves two or more rigorous studies that support the proposed intervention.
History of EBP
Newly gained interest in EBP makes it appear as a…
Bhattacharyya, Suman, B., Dr. (2008). Evidence-Based Medicine and Outcomes
Analysis- An Evaluation. The Indian Association of Medical Informatics.
Retrieved on April, 28, 2009 from http://www.iami.org.in/journal1/ebmedicine.asp
Bellamy, J., Bledsoe, S., Mullen, E., Lin F., Manuel, J., (2008). Agency-University partnership for evidence-based practice in social work. Journal of Social Work Education, Fall 2008, 44 (3).
It is however also important to consider the importance of internal individual factors such as the self-confidence levels of nurses. According to Hockenberry, Wilson and Barrera (2006), for example, note that nurses could feel considerably intimidated by the demands of EBP in nursing practice. Their limited knowledge of the research process thus serves as a barrier to its effective implementation.
Furthermore, the authors also raise the management problem, with nurses feeling a lack of power within their environment even if they do believe that they are able to handle the requirements of effective evidence-based practice. This brings the issue of research back to the leadership issue. In addition, nurses often experience a lack of autonomy, authority, and a basic lack of adequate resources to offer excellent patient care. The authors however suggest that overcoming the barriers to effective EBP could lead to increased job satisfaction for nurses.
In this way,…
Drury, Peta. (1998). Barriers to evidence-based nursing care: listen to the clinicians! Retrieved from: http://www.ciap.health.nsw.gov.au/hospolic/stvincents/stvin98/a9.html
Hockenberry, Marilyn, Wilson, David, & Barrera Patrick. (2006, Oct.). Implementing Evidence-Based Nursing Practice in a Paediatric Hospital. Medscape Today. Retrieved from: http://www.medscape.com/viewarticle/543728
Malloch, Kathy & Porter O'Grady, Timothy (2009). Introduction to evidence-based practice in nursing and health care. Jones & Bartlett Publishers.
Meny, Bernadette Mazurek (2002, March-April). Strategies for overcoming barriers in implementing evidence-based practice. Paediatric Nursing. Retrieved from FindArticles.com.
Evidence-Based Practice in Nursing
Evifence-based Practice In Nursing
Purpose of the appraisal
The article chosen is Hauck, Winsett, and Kuric (2013) Leadership facilitation strategies to establish evidence-based practice in an acute care hospital, because it addresses a vital aspect of nursing practice. Evidence-based practice is critical for nursing in order to ensure that preventable complications are avoided. Improving patient care is one of the burdens that is placed upon hospitals, and this would only be achievable if they implement evidence-based practice. This is a research article focusing on the effects of leadership towards establishing evidence-based practice strategies within a hospital. The researchers intended to analyze the beliefs of nurses on the importance of using evidence-based practice to improve patient care (Hauck et al., 2013). The researchers also investigated the readiness of the organizational in using evidence in the daily nursing practice. The research article focuses on an area that has…
Hauck, S., Winsett, R.P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal of advanced nursing, 69(3), 664-674. doi: 10.1111/j.1365-2648.2012.06053.x
The purpose of this paper is to discuss current theories, concepts and research involving Motor Learning. The research provides evidence-based information discussing how humans utilize motor-learning throughout the lifespan. The discussion includes stages of motor learning, practice contexts, feedback and use of imagery in motor learning. Also provided is information concerning how people learn who have disabilities resulting from at least two different conditions, Parkinson's which affects motor learning and stroke.
Motor Learning Acquisition
According to Li, Sullivan, Kantak, & Winstein (2007), the capability of acquiring motor learning requires "both cognitive and motor processes" meaning mental processes including the ability to make decisions and plan, and interpret, as well as motor processes including the ability to move muscles and perform mechanical tasks. When an individual can use neurological functions to compute tasks and plan, then these can translate into a motor function. The first step in…
Dickstein, R. & Deutsch, J.E. (2007 July). Motor imagery in physical therapy practice.
Physical Therapy, Vol. 87(7): 942.
Hubbard, I.J., Parsons, M.W., Neilson, C., & Carey, L.M. (2009 June). Task-specific training: Evidence for and translation to clinical practice. Occupational Therapy
International. 16(3-4):175-89. Wiley InterScience.
Such measures (such as testing prior to licensure examination) according to the authors might provide benchmarking allowing "early remediation to improve pass rates" and would help promote the success of licensing among nursing students. document all components of the research process including identifying their sample size, collecting aggregate data from tests administered previously, using questionnaires mailed to schools participating in the exam in the past and defining students and probability scores for purposes of the study.
The researchers attempt to answer the question whether the HESI Exist Exam and trade will accurately predict student's success on two licensure exams, the NCLEX-N and the NCLEX-PN. To do this the authors propose replicating a study in the past that used a larger sample size and comparing their data to previous studies. The researchers find that their data supports earlier findings suggesting the E2 a predictive measure of student success in the long-term.…
Adams, F. & Cook, M. (1998-Dec). "Implementing evidence-based practice for urinary catheterization." Br J. Nurs, 7(22): 1393-4.
"Evidence-Based Nursing Practice." (2003). UTA/TDPRS. 12, October 2005:
Newman, M., Britt, R.B. & Lauchner, K.A. (2005 -- May, June). "Predictive accuracy of the HESI exit exam -- A follow up study." CIN: Computers, Informatics, and Nursnig & Nurse Educator.
. Even when the child in a home whee DV occus is not physically hamed, most of the time, these childen know about the violence. As a esult, they may expeience emotional and behavio poblems (The Domestic Violence…, N.d.).
A victim of DV needs to be eminded:
She is not alone.
She is not at fault.
Help is available.
In The physician's guide to domestic violence, P.R. Salbe and E. Taliafeo (N.d.). about stess that DV evolves fom the aim fo powe and contol. They define domestic violence as "a patten of contolling behavios aimed at gaining powe in ode to contol an intimate patne. It is not just about hitting o punching. It is a patten of assaultive and coecive behavio, including psychological, sexual and physical abuse" (Salbe & . Taliafeo). The syndome of dominance and contol the pepetato initiates leads to the victim's inceasing entapment, also known as…
Shakil, Amer MD. (N.d.). Hurt, insult, threaten and scream brief domestic violence screeningtool. Retrieved May 5, 2009 from http://www.uic.edu/orgs/uiccfp/hitspage.htm
Substance abuse and mental health service administration. (2006). Florida Mental
Health National Outcome Measures (NOMS): CMHS Uniform reporting System. Retrieved July 10, 2008 from http://mentalhealth.samhsa.gov/publications/allpubs/SMA06-4195/Chapter15.asp
Substance abuse and mental health service administration. (2005). United States Mental
Relating Watson's heory to Hypertension 2
Especially meaningful to the active practitioner is the metaphysical, phenomenological, existential, and spiritual slant of Watson's holistic method. he intuitive dimension is stressed throughout the caring process. As the nurse's relationship with the patient grows, develops, and deepens, the nurse adjusts his or her approach to the patient's developing needs, interests, and values. Watson's ten clinical caritas can be used in formulating the proper approach. It can be combined with creative caring techniques adapted to the patient's unique personality or condition in achieving his or her recovery (Enzman-Hagerdorn, 2004).
Dealing with the Problem of Hypertension
he predominance of hypertension in today's society, and in many of the patients one meets, signaled an imperative to this writer: how would the integration of Watson's theory into the healing process of such individuals impact their blood pressure? According to Watson's theory, the "caring moments" shared by the…
The predominance of hypertension in today's society, and in many of the patients one meets, signaled an imperative to this writer: how would the integration of Watson's theory into the healing process of such individuals impact their blood pressure? According to Watson's theory, the "caring moments" shared by the nurse and patient transform both since their interactions are laced with unconditional acceptance, positive regard, and mutual respect. A positive atmosphere is created wherein healing can occur on many levels at once. The nurse's attitude and competence is, of course, key here (Vanguard Health Systems, 2011).
An inroad to that competence is achieved through in-depth study of the problem at hand. What exactly is Hypertension? What causes it? Can it be cured? According to a Mayo Clinic Report, hypertension is the result of high blood pressure, a common condition in which the force of blood against the artery walls is high enough that it may eventually cause health problems, such as heart disease. It is a common condition in many people. (mayoclinic.com, 2011),
Evidence-based practice is a fairly recent paradigm in medicine that places emphasis on applying new skills for healthcare workers such as nurses and physicians that include performing efficient literature searches and applying formal rules of evidence in examining the clinical literature in order to find the best answer to a problem (Evidence-Based Medicine Working Group, 1992). These skills are in addition to traditional clinical skills and understanding patients' emotional needs. The evidence-based practice represented a shift from old processes used by health care workers such as intuition, unsystematic clinical experience, and pathophysiologic rationale in applying diagnoses or treatments to consumers of healthcare services (Evidence-Based Medicine Working Group, 1992).
This particular paradigm shifts in medicine developed due to the increasing use of randomized controlled trials (CTs) in medicine which were rare up until 1960s and 1970s. CTs became standard practice for the development of treatments such as medications (Hoffmann, Bennett,…
Evidence-Based Medicine Working Group. (1992). Evidence-based medicine: A new approach to teaching the practice of medicine. JAMA, 268 (17), 2420-2425.
Hoffmann, T., Bennett, S., & Del Mar, C. (2010). Evidence-based practice across the health professions. New York: Elsevier.
Evidence hierarchy exists as a means of evaluating the strength of the evidence that has been provided in a study. The highest order of evidence, for example, is a meta-analysis of randomized-controlled trials (CTs) that have clear results. The lowest are case reports, which would be viewed as anecdotal in nature. One of the distinguishing features of the hierarchy of evidence is that the best studies are those that can be extrapolated to a larger population, while the weakest are ones that generally cannot be extrapolated. This hierarchy was developed to support the growing call for evidence-based practice in health care (Evans, 2003).
My project seeks to compare wait times in outpatient centers compared to traditional emergency room settings. For this study to rank high on the hierarchy of evidence, there would need to be more than just a comparison of wait time statistics -- an independent variable would need…
Borgerson, K. (2009) Valuing evidence: Bias and the evidence hierarchy of evidence-based medicine. Perspectives in Biology and Medicine. Vol. 52 (2) 218-233.
Evans, D. (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing. Vol. 12 (1) 77-84.
Prevention of Pressure Ulcers
Evidence-Based Practice for Intervention
Project Question: Can quarter hour turning and positioning minimize pressure ulcers within the elderly population who are bed bound residing in hospitals or nursing homes?
The elderly often deal with various potential problems throughout their life, from pain and chronic disease, to harsh medication and treatment. Often elderly patients are forced to live in nursing homes and stay in hospitals to avoid accidental death and help them with eating and cleaning themselves. While living in hospitals and elderly homes, sometimes the elderly are bed bound. One common dilemma these bed bound elderly patients suffer from are pressure ulcers. esearch indicates turning someone every two to four hours will lessen rate of pressure ulcer occurrences. The latest articles demonstrate not only the efficacy of turning but also provide supplemental supportive actions like mattress substitution and longest time interval for turning that will still…
Ayello, E.A. (2011). Predicting Pressure Ulcer Risk. Retrieved from The Hartford Institute for Geriatric Nursing website: http://consultgerirn.org/uploads/File/trythis/try_this_5.pdf
Bergstrom, N., Horn, S., Rapp, M., Stern, A., Barrett, R., & Watkiss, M. (2013). Turning for Ulcer ReductioN: A Multisite Randomized Clinical Trial in Nursing Homes. Journal of the American Geriatrics Society, 61(10), 1705-1713. doi:10.1111/jgs.12440
Defloor, T., Bacquer, D.D., & Grypdonck, M.H. (2005). The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. International Journal of Nursing Studies, 42(1), 37-46. doi:10.1016/j.ijnurstu.2004.05.013
Gill, S.S., & Rochon, P.A. (2006). Preventing Pressure Ulcers: A Systematic Review. JAMA, 296(8), 974-984.
This week’s material helped me to understand in a clear way how we should think about nursing. Getting to know the history of nursing allowed me to put nursing theory into historical context. The personal worldview of nursing that I really like is that of Leininger (2008) and the transcultural approach to nursing.
The components of theory and how theories have developing nursing all depend on evidence-based research. Using theories and applying them in practice supports evidence-based practice, which leads to higher quality of care for patients. Testing theories is important for ensuring that the evidence is supportive of the practice.
Middle range theories allow nurses to integrate a sociological perspective in with empirical evidence, so that nurses can see how, for example, an empathetic approach to patients or a transcultural approach might yield tangible positive results. Various middle range theories, such as transcultural…
Leininger, M., M. (2008). Transcultural nursing: Its importance in nursing practice. Journal of Cultural Diversity, 15(1), 37.
Wiseman, T. (1996). A concept of analysis of empathy. Journal of Advanced Nursing, 23, 1162-1167.
Evidence-based practice is not incompatible with patient-centric care. Although evidence-based practice is concrete, there are different models and frameworks in use. One of the most important models for evidence-based practice is the ACE Star Model of Knowledge Transformation. The ACE Star Model of Knowledge Transformation incorporates research and evidence into the practice environment without sacrificing patient preferences.
Other models of evidence-based practice can be loosely grouped into three main categories: Research Utilization, and Knowledge Transformation Processes; Strategic/ Organizational Change Theory to Promote Uptake and Adoption of New Knowledge; and Knowledge Exchange and Synthesis for Application and Inquiry (Stevens, 2013, p. 3). Each of these models presents different angles or perspectives on how to use and implement evidence-based practice in the healthcare environment. Critical to a successful integration of evidence-based practice is accessibility of information. As Stevens (2013) points out, healthcare workers operating under strict time and resources constraints cannot pore…
Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing 18(2), DOI: 10.3912/OJIN.Vol18No02Man04
The Role of Nursing Research in Demonstrating Evidence-Based Practice
It helps for hospitals to embed in their culture evidence-based practice. This is particularly important as it demonstrates that in addition to conducting an evaluation of published studies, nurses also make use of such research studies in both operational and clinical undertakings/procedures. It is important to note that although some could think of nursing research and evidence-based practice as overlapping, both are manifestly distinct. While “nursing research is theory based and systematically designed to answer, test an intervention, or solve a problem,” evidenced based practice is seen to be “a lifelong problem-solving approach to how health care is delivered that integrates the best evidence from high-quality studies with a clinician’s expertise and a patient’s preferences and values” (Baker, 2017). When the health care decisions regarding a specific patient take into consideration the preferences of the said patient, the clinical expertise of…
Baker, D.J. (2017). Nursing Research, Quality Improvement, and Evidence-Based Practice: The Key to Perioperative Nursing Practice. AORN Journal, 105(1), 3-5.
Gap in Literature
LR employment can help decrease duration of dependency on mechanical ventilators and the resultant PICU outcomes. Methodical LR review protocol among pediatric patients receiving mechanical ventilation has, of late, been recorded with the international prospective register of systematic reviews (PROSPERO). Limited quantities of superior-quality scientific proofs exist that inform the effectiveness and safety of ETS within pediatric settings. This is mainly because of the absence of clinical trials informing bedside practice (Bilan & Molayi, 2016).
Literature on the subject indicates that suction using normal saline, or in the absence of it, alters respiratory and hemodynamic parameters. While the former has adverse effects, changes aren’t significant with the exception of elevated heart rate, which indicates minor risk. But the outcomes of other research works reveal a significant linkage. The outcomes of the current research may, perhaps, be attributed to a different research design and the absence of samples;…
Adib M, Ghanbari A, Alavi C. E, Leyli E. K. (2014). Effect of endotracheal suctioning with and without normal saline on hemodynamic and respiratory parameters in patients undergoing mechanical ventilation in ICU of hospitals supervised by Guilan University of Medical Sciences. Biomed Pharmacol J, 7(2).
Bilan N, Molayi S. (2016). Effect of lung recruitment maneuver in children with acute lung injury. Int J Pediatr, 4, 1787–94.
Irajpour, A., Abbasinia, M., Hoseini, A., & Kashefi, P. (2014). Effects of shallow and deep endotracheal tube suctioning on cardiovascular indices in patients in intensive care units. Iran J Nurs Midwifery Res, 19(4), 366-370.
Evidence-Based Practice (EBP) is the assimilation of the best research evidence with clinical proficiency and patient values. This takes into account placing equal emphasis on the situation of the patient, his or her goals, objectives, values and aspirations, the best accessible research evidence and the clinical proficiency and expertise of the practitioner. Evidence-based practice in psychology can be defined as the incorporation and assimilation of the best accessible research with clinical knowledge and expertise in the context of patient features, culture, and preferences. In psychology, the main purpose of evidence-based practice encompasses the promotion of efficacious psychological practice, improvement of public health by making use of empirically supported principles of psychological evaluation, case formulation, therapeutic association, and intervention (Drisko, 2012).
Therefore, taking this into consideration, evidence-based practice can be delineated as a wider notion that account for not only knowledge and understanding but also action in three fundamental components of…
American Psychological Association. (2016). Policy Statement on Evidence-Based Practice in Psychology. Retrieved from: http://www.apa.org/practice/guidelines/evidence-based-statement.aspx
Bauer, R. M. (2007). Evidence-based practice in psychology: Implications for research and research training. Journal of Clinical Psychology, 63(7), 685-694.
Davey, G. (2011). Applied Psychology. Hoboken: John Wiley and Sons Ltd.
Drisko, J. (2012). Evidence-Based Practice. Retrieved from: https://sophia.smith.edu/~jdrisko/evidence_based_practice.htm
Evidence Base Practiced eseach
Evidence Base Practiced esearch
Evidence-based practice is considered to be a combination of the best practice gotten from patient care data, research study, and expert opinion so as to identify dissimilar approaches of improvement in providing high quality care that reflects things such as needs, values, interest and selections of the patient. Skills and Knowledge gained in the procedure of evidence-based practice assist health care workers to bring about reforms in healthcare and raises individual responsibility of practice. Comparing evidence-based practice, getting comprehending of why things are done the way they are done and establishing actions that endorse evidence-based practice with the purpose of providing care that is better. With that said, this essay will argue why Evidenced-based practice is important to nursing practice.
One reason why evidenced-based practice is important to nursing practice is for the reason that Evidence-based practice is a key approach to…
Calkins, M. (2006, July 8). Evidence-Based Nursing Education for Regulation (EBNER). Leading in Nursing Regulation. Chicago, Illinois, United States.
Kronenfeld, M. (2007). Review for librarians of evidence-based practice in nursing and the allied health professions in the United States. J Med Libr Assoc, 95(4), 1-407.
Winters, C.A. (2012). Teaching Strategies to Support Evidence-Based Practice. Academic Education, 32(3), 49-53.
Evidenced-Based Practice - Environment
There are perhaps few environments and professions within which change is both as important and as difficult as it is within health care. While there are many barriers to the change process, there are at least an equal amount of drivers that indicate the necessity for change. In evidence-based practice, nursing practitioners, administration personnel, management personnel, and all involved in the health care profession need to form teams with patients and family members in order to ensure an optimal environment for change. This is not a process that will happen overnight, especially in the hospital and nursing home settings, where recognizing the need for change is often subordinate to more immediate and severe problems such as personnel and funding shortages.
The readiness for change in the hospital and nursing home environment is often subordinate to practical day-to-day challenges, including severe personnel and funding shortages. These create…
Current Nursing (2011). Change Theory: Kurt Lewin. Retrieved from: http://currentnursing.com/nursing_theory/change_theory.html
Dudley-Brown, S. (2012. Challenges and Barriers in Translation. Translation of Evidence Into Nursing and Health Care Practice edited by Kathleen M. White and Sharon Dudley-Brown. New York: Springer Publishing Co.
Pipe, T.B., Wellik, K.E., Buchda, V.L., Hansen, C.M., and Martyn, D.R. (2005). Implementing Evidence-Based Nursing Practice. Urologic Nursing 25(5). Retrieved from: http://www.medscape.com/viewarticle/514532 _5
White, K.M. (2012). Change Theory and Models: Framework for Translation. Translation of Evidence Into Nursing and Health Care Practice edited by Kathleen M. White and Sharon Dudley-Brown. New York: Springer Publishing Co.
In principle, the EBP concept relies on fundamental areas of focus within a total-process approach to delivering the highest quality healthcare services (Hardcastle, Usher, & Holmes, 2006; Williamson, 2009). In clinical medicine, that begins with the formulation of the most relevant clinical questions, and continues with the use of the skill to identify the best current evidence, appraise it systematically, and optimally applied to specific situations. Meanwhile, throughout that process, clinical healthcare practitioners simultaneously incorporate their entire knowledge base and clinical experience with their understanding of the needs, values, and expectations of patients and other stakeholders. Finally, the EBP approach to nursing and healthcare includes the ongoing empirical evaluation of clinical procedures within a continuing process whose most important purpose is to improve the future of healthcare delivery by applying the data describing previous experience (Hamric, Spross, & Hanson, 2009).
Hamric, A.B., Spross, J.A., and Hanson, C.M. (2009). Advanced…
Hamric, A.B., Spross, J.A., and Hanson, C.M. (2009). Advanced Practice Nursing: An
Integrative Approach. St. Louis, MO: Saunders.
Hardcastle, M., Usher, K., and Holmes, C. "Carspecken's five-stage critical qualitative research method: An application to nursing research." Qualitative Health
Research, Vol. 16, No. 1 (2006): 151 -- 161.
SYSTEMS THEOY vs. DIFFUSION OF INNOVATION THEOY
Systems theory and diffusion of innovation theory
Systems theory and healthcare delivery in the U.S.
According to theorist Ludwig von Bertalanffy, it is essential to view organisms -- both living and man-made -- as functional systems in a holistic sense to understand their true nature. This principle is manifested in the human body and also the organizations which provide healthcare. "A complex adaptive system is a collection of individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent's actions changes the context for other agents. Examples include the immune system, a colony of termites, the financial market, and just about any collection of humans (for example, a family, a committee, or a primary healthcare team)" (Plsek & Greenhalgh 2001: 625).
Complex systems, such as the healthcare delivery system,…
Bryant, R. (2010). Extending the reach of nursing knowledge and innovation. Nursing and Health Policy Perspectives. International Nursing Review, 57(4), 406.
Retrieved from CINAL at doi:10.1111/j.1466-7657.2010.00864.x
Fitzgerald, L. (2002 et al.). Interlocking interactions, the diffusion of innovations in health care.
Human Relations 55(12) 1429-1449. Retrieved from Google Scholar:
Statistics in Social Work
The steps of evidence-based practice include formulating an answerable question. How does knowing about statistics improve our ability to be an evidence-based practitioner at this step?
How understanding statistical principles can enable you to better understand if a question is answerable or not.
Are 'baselines' in descriptive function, or predictive function available for assessment.
In application of statistics to social phenomena, the frequency, duration and intensity of the subject tested will contribute to analysis where more than nominal (i.e. numbered) distributions are involved. Merely 'counting' a population is not a significant activity in statistical renderings as independent variables require dependent variables in order to acquire statistical meaning. Evidence-based practice references studies that 'replicate' existing tests, toward reinterpretation of former statistical outcomes in a new study of parallel significance, with variables of the same classification. Patterns in longitudinal tests over time offer insights into stasis or transformations…
evidence-based practice use in nursing for making decisions using evidences to provide care to patients. This assignment has highlighted five main principles of EBP. These principles should be considered while implementing EBP. Moreover, there are certain challenges and barriers in implementing EBP. This assignment focused on strategies for implementing EBP.
Introduction of evidence-based practice to the workplace:
Changing the accepted confirmation of an NG (nasogastric) tube
Currently, I am employed at a medical and geriatric unit in a rehabilitation hospital. The unit is such that the majority of the nurses (60%) have over ten years' experience of practice. Thus the nurses on the unit are highly-trained professions who are extremely competent at their jobs. However, nurses of this level of experience are also often extremely change-resistant. Due to the level of the morale on the unit, nurses are often reluctant to alter the standard operating procedures with which they have…
Earley, T. (2005) Using pH testing to confirm nasogastric tube position. Nursing Times,
101 (38):26 -- 28. Retrieved:
Kotter's 8-step change model. (2013). Mind Tools. Retrieved:
Evidence-based practice model
EBP project issue: Obesity
"The prevalence of obesity (BMI > 30) has been increasing; currently; at least 27% of the adult population is obese" (McTigue 2003: vii). Despite being one of the most pervasive health problems in modernity, there is relatively little information on obesity available in the annals of evidence-based medicine. This may be due to the fact that obesity is such a complex and multifactorial disease, without a clear etiology. Perfectly-controlled studies can be difficult to construct. Many different factors can impact a person's ability to maintain a health BMI, spanning from genetics to culture to lifestyle to social and economic factors.
A 2003 evidence-based review of existing studies of obesity in adults found in MEDLINE from January 1, 1994 to July 31, 2001 only found four meeting the relevant criteria of studying persons suffering from obesity. There were no CT (randomized controlled trials,…
McTigue, K. (2003 et al.). Screening and interventions for overweight and obesity in adults.
Agency for Healthcare Research and Quality (AHRQ). Systematic Evidence Review, 21.
New research findings on evidenced-based approaches to tackle childhood obesity. (2012).
Evidence-Based Practice citation that was of interest to the author of this document is called "Closing the quality gap: A critical analysis of quality improvement strategies: volume 5 -- asthma care." It focuses on the phenomenon in which "there remains a significant gap between accepted best practices for asthma care and actual care delivered to asthma patients" (Stanford University, 2007). Specifically, the authors of this document sought to analyze a host of articles related to best practices for treating asthma for juveniles and adults to see which quality improvement strategies had the most efficacy. It analyzed a variety of articles that utilized various frameworks for research including interrupted time series trials and randomized controlled trials. The various strategies considered pertained to patient education, practitioner education, auditing and others.
The primary recommendations have a direct correlation to educating the patients and their families. The evidence demonstrates that for juveniles, consulting and…
Grove, S.K., Burns, N. Gray, J.R. (2012). The Practice of Nursing Research. Elsevier -- Health Sciences Division.
Hutchinson, A.M., Johnston, L. (2004). Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting. Journal of Clinical Nursing. 13(3), 304-315.
McCloskey, D. (2008). Nurses' perceptions of research utilization in a corporate health care system. Journal of Nursing Scholarship, 40(1), 39-45.
Practice Issue Evidence-Based Practice (EBP) Project in courses DNP program, asked
The practice issue I have chosen to explore is whether or not q2 hourly turning and positioning actually decreases the incidence of pressure ulcers in the elderly bed bound population in nursing homes. The conception that turning does help to relieve the pressure associated with these types of ulcers has been longstanding. Specifically, there is clinical evidence to indicate the fact that "Unrelieved pressure is a well-known clinical risk factor for ulcer development" (Salcido, 2004, p. 156). As such, the turning of patients at least every two hours has been carried on for quite some time in the nursing population, although there are some salient points of concern that need to be addressed with this issue.
One of the major things that individuals need to be aware of who take on such a practice is the fact that the…
Leeds, L. (2004). Importance of turning q2. www.denvernursingstar.com. Retrieved from http://denvernursingstar.com/specials/newsletter_view.asp?newsid=310&catid=85&active=0&mode=current&count=0
Salcido, R. (2004). Patient turning schedules, why and how often? Advances in Skin & Wound Care: The Journal for Prevention and Healing. 17(4), 156.
Wound, Ostomy & Continence Nurses Society. (2012). Patient turning and repositioning: current methods & challenges, a WOCN perspective. www.sageproducts.com. Retrieved from http://www.sageproducts.com/documents/pdf/education/studies_articles/sacral/WOCN%20White%20Paper_Aug2012.pdf
Evidence-Based Practice Project
A literature review conducted by abie and Curtis (2006) aimed at establishing the effects of washing hands in reducing respiratory infections. The literature was obtained by searching CAB Abstracts, PubMed, Embase, Cochrane, and Web of Science library. The inclusion strategy for the review were any studies that reported having an impact of hand washing to reduce respiratory infections. All articles included in the review were published before June 2004. This was a quantitative systematic review, which made it an effective method of analyzing and evaluating the selected studies. After searching for the relevant articles, the researchers found 395 articles, but only 61 articles were selected after the researchers reviewed their abstracts (abie & Curtis, 2006). The review and selection process continued and the final review included only eight articles, which the researchers established were more relevant to their study. Having eliminated the articles that focused on children…
Loeb, M., McGeer, A., McArthur, M., Walter, S., & Simor, A.E. (1999). Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Archives of internal medicine, 159(17), 2058-2064.
Rabie, T., & Curtis, V. (2006). Handwashing and risk of respiratory infections: a quantitative systematic review. Tropical medicine & international health, 11(3), 258-267.
Smith, P.W., Bennett, G., Bradley, S., Drinka, P., Lautenbach, E., Marx, J., . . . Stevenson, K. (2008). SHEA/APIC Guideline: infection prevention and control in the long-term care facility. American journal of infection control, 36(7), 504.
Polit and Beck (2008) Evidence-Based Practice is "broadly defined as the use of the best clinical evidence in making patient care decisions, and such evidence typically comes from research conducted by nurses and other health care professionals" (3). There are several facts we must note about Evidence-Based Practice here. The first fact is that it is intended to improve patient care. The evidence is supposed to improve the decisions that are made about patient care. But his evidence has to be collected and analyzed first. Because this evidence comes from research conducted by nurses, we can understand better what the role of the nurse must be in collecting evidence. I myself work as a charge nurse in an acute care setting; I hold a BSN degree and I am currently studying for my Masters degree in Nursing Practice. Would it be appropriate for me to gather evidence in order to…
Polit, DF, Beck, CT. (2008). Nursing research: Generating and assessing evidence for nursing practice. 8th edition. Philadelphia: Lippincott Williams & Williams.
Evidenced-Based Pactice (EBP)
The objective of this study is to eview an aticle titled "Evidence-Based Pactice Habits: Tansfoming Reseach into Bedside Pactice" (Rauen, Flynn, Bidges 2009 p 46). The authos point out that nusing pactice in the United States is moe focused on the taditional-based pactice than evidence-based pactice. Many pactices in citical nusing cae ae still continuing despite that the eseaches contadicting the pactices. The study believes that insufficient administative suppot, lack of time, limited access to infomation ae the baies in the clinical-based pactice thee decades ago still exist today. While the benefits of evidence-based pactice ae well undestood, nevetheless, thee is a still a baie in tansfoming the eseach findings into pactice. To eliminate the poblems, the acceditation bodies that evaluate and mandate the EBP (evidence-based pactice) assist in moving the eseach fowad. The authos suggest that it is citical to developing a cultue of inquiy that…
references and research studies to find solutions to the patient's problems suffering from acute respiratory distress, heart failure, cardiac surgery and sepsis. There is also a need to make a research on the studies that discuss the hemodynamic parameters in backrest versus supine elevated position, prone position and lateral position. The authors argue that the evidence-based practice can assist the nursing practitioner to observe the difference between CVP (central venous pressure) and PAP (pulmonary artery pressure) in patients in supine and flat position compared with the position that is more than the spontaneous variability. Thus, the evidence-based research assists in enhancing a greater understanding of the positioning of the patient when monitoring patients" hemodynamic parameters.
Rauen, Flynn, Bridges (2009) further point out that a method nurses can employ in taking accurate measurements of patients hemodynamic parameters is to use the position specific reference in order to correct the hydrostatic pressure. The author believes that nurses can measure the output of the thermodilution cardiac when the bed is elevated by up to 20°. The authors also believe that the application of EBP requires nurses to investigate series of studies about patients in cardiac ICU (intensive care units) and patients in medical-surgical units to assist in obtaining the CVP and PAP of patients' supine, as well as patients with bed head elevation from 0° to 60°.
The EBP is the conscientious use of the available evidence to make effective decisions regarding the patient care. With integration of the clinical evidence and clinical expertise as well as using a sound methodology, nursing practitioners are able to make decisions to improve the patients' healthcare.
Nursing Evidence-Based Practice
The press for evidence-based practice in nursing and for nurses as consumers of research is driven by a number of substantive factors. The state nursing boards and The Joint Commission (TJC) insist that policies and practices have a foundation in research. The keystone of this trend is that nurses must be able to read nursing research discriminately, understand how medical research relates to practice, and must sufficiently possess high levels of new literacy so that they can evaluate the research articles they review. When nurses are competent consumers of research, they are better prepared to integrate the research into their practice.
In addition to the emphasis on evidence-based practice and research consumption in nursing, strong economic forces are also directing this trend toward practicing nurses becoming consumers of research and evidence-based practitioners. Healthcare stakeholders require greater accountability with respect to effective practices, transparency, and efficiency in order…
Methicillin-esistant Staphylococci (MSA), most common Healthcare Associated Infections
The PICOT question to be discussed is: For adult patients using catheters, does the use of sterilization practices reduce the future risk of health associated infections like MSA compared with standard procedure in one week?
The answer is yes.
The support given to answer the question will be based on peer-reviewed journals and scientific literature. A summary of the evidence will be availed in a chart plus a conclusion that summarizes evidence used will also be given.
Methicillin-resistant Staphylococcus aureus (MSA) bacteria is resistant to several antibiotics. A significant proportion of MSA infections in the community are on the skin. It results in alarming infections of the bloodstream, surgical site infections and pneumonia in health facilities. Studies have revealed that one person in every three individuals have staph in the nose - most of the time they don't show any illnesses (General…
General Information About MRSA in the Community. (n.d.). Retrieved February 21, 2015, from http://www.cdc.gov/mrsa/community/index.html
Sydnor, E., & Perl, T. (2011). Hospital Epidemiology and Infection Control in Acute-Care Settings. Clinical Microbiology Reviews,24(1), 141-173. Retrieved February 21, 2015, from http://cmr.asm.org/content/24/1/141.full
Program-Evaluation -- Evidence-Based Practice: Case Study eview
There is growing recognition that the used of evidence-based practices promotes improved clinical outcomes and can help guide clinicians in their respective disciplines. This paper draws on the Clinician's Guide to Evidence-Based Practices: Mental Health and the Addictions to provide a description of a salient case study and the identification of the critical elements that require the review of published research to guide professional practice. In addition, a summary of a research study by Spengler, P. M., White, M. J., Egisdottir (2009) that informs evidence-based counseling practice related to the selected case study as it would occur in a specialization area is followed by a discussion concerning relevant ethical, legal, and socio-cultural considerations that apply to the case and research article selected. Finally, a summary of the research and important findings concerning the need for evidence-based practices to guide professional practice today are…
Dodson, W. W. (2007, April). Make ADHD treatment as effective as possible. Current Psychiatry, 6(4), 82-85.
Elik, N. & Corkum, P. (2015, January 1). Overcoming the barriers to teachers' utilization of evidence-based interventions for children with ADHD. Perspectives on Language and Literacy, 41(1), 40-45.
Holland, K. & Higuera, V. (2015, February 26). The history of ADHD: A timeline. Healthline. Retrieved from http://www.healthline.com/health/adhd/history#Overview1 .
Norcross, J., Hogan, T., & Koocher, G. (2008). Clinician's guide to evidence-based practices: Mental health and the addictions. New York, NY: Oxford Press.
Translation of esearch in Evidence-Based Practice
Nursing involves men and women who are willing to help the patients with their skills like health maintenance, recovery of ill or injured people and the treatment. They develop a care plan for the patient sometimes in collaboration with the physicists or therapists. This paper discusses the current nursing practice in which I am involved and needs to be changed.
Identification of a Current Nursing Practice equiring Change
Description of the Current Nursing Practice
Children of all age groups are facing a grave problem these days: obesity. It is considered as a chronic disease when the weight-gain reaches dangerously increased level, which becomes risky for the health. The raised body mass becomes dangerous for children and some schools are now looking into this matter with concern. They are sending notices to the parents to take care of their child's diet, and within…
Berkowitz, B. & Borchard, M. (2009). Advocating for the prevention of childhood obesity: A call to action for nursing. The Online Journal of Issues in Nursing, 14. Retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T ableofContents/Vol142009/No1Jan09/Prevention-of-Childhood-Obesity.html
Clark, A. (2009). The role of school nurse in tackling childhood obesity. Nursing Times, 100. Retrieved from http://www.nursingtimes.net/Journals/2012/12/07/p/u/c/040608the-role - of-the-school-nurse-in-tackling-childhood-obesity.pdf
Collins, P.M., Golembeski, S.M., Selgas, M., Sparger, K., Burke, N.A., & Vaughan, B.B. (2007). Clinical excellence through evidence-based practice model to guide practice change. Topics in Advanced Practice Nursing eJournal, 7. Retrieved from http://www.medscape.com/viewarticle/567682_2
Jenike, L.R. (2013). A primary care intervention for overweight and obese children and adolescents (A Capstone Project). Retrieved from http://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1027&context=nursing_dnp_ capstone
According to research, evidence-based practice (EBP) results to greater quality care, enhanced patient outcomes, minimized costs, and more nurse satisfaction when compared to conventional approaches to care. Evidence-based practice is simply a problem-solving approach to healthcare delivery, which incorporates the best evidence from research and patient care records with clinician skill and patient values and likings. The greatest quality of care and best patient outcomes could be gotten when provided in a caring situation and in a supportive educational culture. The aim of this paper is to evaluate a published work founded on evidence-based practice. The other part of the paper contains a summary of the important points in the article, steps in the development and execution of evidence-based practice, and the manner through which this new information could be implemented.
Capnography is still an essential tool in the measurement of invalidated "carbon-dioxide" (CO2). Latest "Advanced-Cardiac-Life-Support" or…
Kodali, B., & Urman, R. (2014). Capnography during cardiopulmonary resuscitation: Current evidence and future directions. J Emerg Trauma Shock, 7(4), 332-40.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). The Seven Steps of Evidence-Based Practice. AJN, 110(1), 51-53.
Evidence-based practice has become popular in several disciplines of healthcare and continues to do so. One of the major characteristic of EP is its reliance on scientific evidence, individual choices and needs of the patient and clinical expertise. It is one of the healthcare approaches, in which the professionals make use of the hard evidence available in order to make healthcare decisions for a patient. It builds, enhances and values clinical knowledge, and expertise of pathophysiology and the mechanisms of disease. Furthermore, it also includes conscientious and complex decision-making, that is based not just on the evidence available but also on the situation, preferences and characteristics of the patient. EP recognizes the individuality in healthcare and accepts that it is constantly changing and involves several probabilities and uncertainties. It is ultimately the formation of a process that has been practiced for years by the best clinicians (McKibbon, 1998 ).
Covell, D.G., Uman, G.C., Manning, P.R., (1985) Information needs in office practice: are they being met? Ann Intern Med; 103(4):596-99
Matson, E., (1996). Speed kills (the competition). Fast Company, (3):84-91.
McKibbon, A. (1998 ). Evidence-based practice. Bull Med Libr Assoc, 397-401.
Sackett, D.L., Richardson, W.S., Rosenberg, W., Hayes, R.B., (1997) Evidence-based medicine: how to practice and teach EBM. New York: Churchill Livingston.
Evidence-based practice (EBP) is defined as the conscientious, judicious, and explicit use of current best evidence to make decisions about patient care. EBP incorporates the best available evidence in order to guide nursing care and improve patient outcomes. This will assist health practitioners to address health care questions by using an evaluative and qualitative approach. EBP is a problem-solving approach to clinical practice and involves the search for and critically appraising the most relevant evidence, one\\'s clinical experience and the preferences of the patient (Fortunato, Grainger, & Abou-El-Enein, 2018). The process involved in EBP allows the practitioner to assess research, clinical guidelines, and other information resources that are based on high-quality findings and apply the results obtained to improve their practice.
Since EBP heavily relies on research and searching for available evidence to support a hypothetical question in order to solve a current problem, it is vital that one understands…
Progressive Mobility Protocol
This paper is a project based on PICO. The clinical question that serves as the foundation for this data-based design is; for immobile critical care patients, does the use of a nurse driven progressive mobility protocol reduce ICU LOS compared to every hour of repositioning? In this paper, the adult patients admitted to an ICU represent the population (P) of interest. The nurse driven progressive mobility represents the intervention (I), the comparison (C) is the critical care patients repositioned every two hours, and the reduction in LOS represents the result.
Most hospitals place critically ill patients on bed rest and reposition them every two hours in the intensive care unit. Some literature reviews provide evidence in favor of progressive mobility protocols. In addition, the paper also reviews the safety of mobilization of the critical patients and the negative effects bed rest may have on…
Plis, L. (2009). The Effectiveness of A Nurse-Driven Progressive Mobility Protocol on Reducing
Length of Stay in the Adult Intensive Care Unit. Retrieved from https://www.chatham.edu/ccps/pdf/Plis.L.Final_Capstone.pdf
Melnyk, B.M. & Fineout-Overholt, E. (2005). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice.Philadelphia, PA: Lippincott Williams & Wilkins
Goldhill, D., Imhoff, M., McLean, B., & Waldmann, C. (2007). Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-analysis. American Journal of Critical Care, 16(1), 50-61.
Evidence-Based Practices When Working With Clients
Evidence-based practice is a concept that emerged in the field of medicine to help lessen mistakes or errors during treatment. This concept seeks to do so through ensuring clinical decisions are grounded on the best available research evidence. Since its emergence, the concept of evidence-based practice has become common in the medical field and is constantly used to help improve patient outcomes. The tremendous success of this concept in medicine is attributable to its integration of the best available research evidence, clinical judgment and expertise, and patient preferences and values.
Given its success in the field of medicine, evidence-based practice is being imported into the field of psychology (Lilienfeld, 2014). This trend emerges from the need for clinicians to utilize the most suitable and effective mechanisms to improve their clients' outcomes. Current evidence postulates that utilizing interventions that have been shown to work with…
Integration Evidence-Based Practice Professional Nursing Practice
The concept of evidence-based practice -- EBP is becoming growingly significant in the sphere of nursing. (Stiffler; Cullen, 2010) Evidence-based practice is not entirely a novel concept; it is the manner in which nurses cater to the norms of care and practice efficiently. (Nysna, 2006) According to Linda Burnes Bolton, DrPH, N, FAAN, vice president and chief nursing officer in the Cedars-Sinai Medical Center in Los Angeles, evidence-based practice -- EBP in reality it is only an alternative mode of viewing the conventional theme of the nurses maintaining their sanctified reliability with society. (Wessling, 2008) David Sackett, MD, a Canadian physician, is regarded the father of evidence-based practice. According to Sackett, "evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. . .[by] integrating individual clinical expertise with the best available external…
Adams, Susan; McCarthy, Ann Marie. (2005) "Evidence-Based Practice and School
Nursing" The Journal of School Nursing, vol. 21 no. 5, pp: 258-265.
Ciliska, Donna. (2006) "8. Evidence-based nursing: how far have we come? What's next?"
Evid-Based Nurs, vol. 9, no. 2, pp: 38-40.
Employing Evidence-ase Practice
The influence of evidence-based practice (EP) has found reverberations in the field of medical care giving, academia and scientific endeavors. The need for evidence-based quality arises from the need to afford improved healthcare services that are faster, accurate, and more effective. The nurses have responded to the emerging guidelines set by National expert groups. They have reoriented their practices along the lines of the evidence-based practices that have now accentuated their services and will continue to add value to their industry. The redesigning activities have touched upon the facets of academic background and training as well as field practices. They also took initiative to redesign the methodology to be followed by incorporating the scientifically proven methods and updating their information with the inputs contained from their fraternity elsewhere in the country (Stevens, 2013). "Evidence-based medicine." was a term that first made use of in the 1990"s by…
Bennett, S., & Bennett, J. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal, 171-180.
Bury, T.J. (1998). Evidence-based healthcare explained. In T.J. Bury & J.M.Mead (Eds), Evidence-based healthcare. A practical guide for therapists (pp. 3-25).Oxford: Butterworth Heinemann.
Bennett, K.J., Sackett, D.L., Haynes, R.B., Neufeld, V.R., Tugwell, P., Roberts, R. (1987). A controlled trial of teaching critical appraisal of the clinical literature to medical students. JAMA, 257, 2451-2454.
Egan, M., Dubouloz, C.J., von Zweck, C., Vallerand, J. (1998). The client-centered evidence-based practice of occupational therapy. Canadian Journal of Occupational Therapy, 65, 136-143.
Social Workers' Application of Social Work
Evidence-based practice is defined as a process through which a practitioner combines clinical experience with well-research interventions/measures. Evidence-based practice has not only emerged as an important component in the modern healthcare sector but is also increasingly vital in social work practice. The increased significance of evidence-based practice in social work is attributable to the fact that social workers are constantly seeking well-researched studies to obtain information that enhances their knowledge base. Additionally, competent social work practitioners continue to look for a wide range of theoretical knowledge to enhance their experiences and practice. Therefore, social workers rely on evidence-base practice to enhance their knowledge base and practice.
Evidence-based research influences what a social worker may do in practice through providing a theoretical basis and foundation for practice. Social work practitioners draw from a wide range of evidence-based practice sources to determine what fits into a…
NEW MODELS FO EVIDENCE-BASED PACTICE a professional goal DNP-prepared nurses produce evidence-based models care develop evidence-based guidelines. As continue develop DNP Project Premise engage EBP Project, aim mind.
As a nurse practitioner who works in a diverse range of settings spanning from hospitals to nursing homes to clinics, evidence-based practice is part of my daily routine. Virtually all of the facilities at which I work prioritize evidence-based practice given that the facilities' scarce resources means that time, energy, and money cannot be wasted on untested treatments or treatments based merely upon 'hunches.' Evidence-based practice is based upon demonstrated benefits from particular approaches to patient care in recent literature. I strive to remain current in my own knowledge of EBP, frequently reviewing nursing journals and articles online as well as the websites of professional associations so I am aware of new treatments, approaches, and evidence of what works…
ACE Health Star Model. (2013). University of Texas Health Center San Antonio. Retrieved:
Working with Clients with Dual Diagnosis: The Case of Joe," (n.d.) shows how social policies can directly affect the lives of individuals, impacting their access to and awareness of care options and the availability of specific services. Moreover, social policies can influence mental health practitioners, reinforcing stereotypes and stigmas toward patients with substance abuse disorders in particular. A systematic review of the literature reveals "negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients," (Boekel, Brouwers, van Weeghel & Garresten, 2013, p. 23). Social workers are at the forefront of substance abuse treatment, as social work professionals "regularly encounter individuals, families, and communities affected by substance use disorders," including co-occurring disorders as in Joe's case (NASW, 2013, p. 5). Therefore, in addition to their role in reducing stigma and ensuring evidence-based practice in mental health care, social workers…
The chief concern of the researcher should be the safety of the research participant. This is carried out by carefully considering the risk to benefit ratio, using all available information to make an appropriate assessment and continually monitoring the research as it proceeds.
The scientific researcher must obtain informed consent from each research participant. This should be attained in writing although oral consents are sometimes acceptable after the participant has had the chance to carefully consider the risks and benefits and to ask any pertinent questions. Informed consent ought to be seen as an ongoing process, not a singular event or a mere formality.
The researcher must list how privacy and confidentiality concerns will be approached. esearchers must be receptive to not only how information is protected from unauthorized observation, but also if and how participants are to be notified of any unexpected findings from the research that they may…
American Academy of Pediatrics and American Academy of Family Physicians. (2004). Clinical
Practice Guideline: Diagnosis and Management of Acute Otitis Media. Retrieved March
20, 2010, from Web site:
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…
The Implementation of Evidence-Based Practice
Evidence-based practice is a cornerstone of effective patient care (Mateo & Kirchhoff, 2009). The robustness of any existing body of evidence is only as useful as the ability of advance practice nurses to access, retrieve, and implement that knowledge in the practice environment. Therefore, nurses need systematic and comprehensive strategies for making information available to colleagues. Nurses also need their administrators to invest in the latest tools and technologies that promote evidence-based practice including networks and information systems. Policies and procedures should not only uphold the tenets of evidence-based practice but also make it easier for nurses to find and share knowledge specific to developing practice behaviors in their care environments. Methods of finding knowledge specific to developing practice behaviors include utilizing proprietary databases, interviewing experts in the field, and utilizing online digital resources. Combining these three methods of knowledge acquisition can make research more…
Third, lack of attention to evidence-based practice can lead to inconsistent delivery of care services.
Evidence-based practice relates to almost every aspect of health care at every stage of a client's relationship with the institution. For example, evidence-based practice informs the types of questions asked during the diagnostic procedures and might even impact the diagnosis itself (Bennett & Bennett, 2000). Evidence-based practice impacts the methods by which infections are prevented (Cantrell, 2009). Evidence-based practices impact the extent to which nurses are empowered to make sound, safe, and effective decisions (Scott & Pollock 2008). Evidence-based practice has the potential to transform the structure of a health care organization like MMH. This is because evidence-based practice changes the hierarchical structure in the organization due to the increased responsibility of nurses for conducting their own research. Alternatively, evidence-based practice can be an extension of organizational change. Health care organizations reducing the hierarchical nature…
Artinian, B.M., West, K.S., & Conger, M.M. (2011). The Artinian Intersystem Model. New York: Springer.
Bennett, S. & Bennett, J. (2000). The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal (2000), 47, 171-180.
Burns, N. & Grove, S.K. (2009). The Practice of Nursing Research. St. Louis, MO: Saunders.
Cantrell, S. (2009). Performing under pressure: Caring for decubitus ulcers. Healthcare Purchasing News. Aug 2009.
Facilitating Change to Evidence-Based Practice in Nursing: The Iowa and Stetler Models
The Iowa Model of Evidence-Based Practice
Developed by Marita Titler to promote quality healthcare, the Iowa Model is a source of guidance for nurses and clinicians when making decisions that have an impact on patient outcomes. It infuses research into practice by using a multidisciplinary team approach to address a number of topics that are clinically important (Melryk and Overholt, 2011). This model is represented as an algorithm that has well-defined feedback loops as well as decision points. The very first decision has got to do with whether a particular problem is a priority to an organization and the second decision considers how adequate the evidence is to change practice. After the conduction of a pilot of change, on the basis of the available evidence, subsequent decisions are made on whether to adopt it or not, which is…
Melryk, B. M & Overholt, E.F. (2011). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia: Lippincott Williams & Wilkins
Schaffer, M.A., Kristin E.S. & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing. 69(5). Retrieved 15th January 2015 from http://www.marianjoylibrary.org/Nursing/journalclub/documents/Evidence_based_au.pdf
Palmer and coworkers (2007) write that the aspect of critical thinking forms a crucial part of the nursing profession, as nurses always encounter complex scenarios that call for precise judgments, constant learning, and taking clinical decisions. Therefore, critical thinking covers a large problem-solving and reasoning process wherein every view and clinical choice has its basis in evidence. This process incorporates the active components of deliberation, insight, and emotional intelligence, in addition to information credibility, learning, and scope for study. Critical thinking within the nursing context is impacted chiefly by environmental, psychological, and physiological factors such as confidence level, age, competences, anxiety, exhaustion, prejudice and colleagues.
The process of critical thinking proves critical to the development of evidence-based practices (EBPs) of nursing. These practices promote customized nursing care, are more efficient, dynamic, and modernized, and maximize clinical judgment outcomes. EBPs may exhibit a positive contribution to patient…
Palmer, A., Berman, C. L., Bernardo, L. D., Lobato, C., Howard, E., Cramer, S. (2007). Critical Thinking and Evidence-Based Nursing. The Journal of Nursing. Retrieved from American Society of Registered Nurses: http://www.asrn.org
Proffeto-Mcgrath, J. (2005). Critical Thinking and Evidence-Based Practice. Journal of Professional Nursing, Vol 21, No 63, 64 -- 371. Retrieved from HYPERLINK " https://www.ncbi.nlm.nih.gov/ " National Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov
Music Therapy on Depression Name Course Professor Date Part II Nursing Diagnosis: Ineffective coping with psychiatric symptoms exacerbates difficulties brought by a mental health disorder. The ineffective coping strategies are evidenced in poor concentration, low self-esteem, and poor self-care. Population: The population of interest is outpatients suffering from depression. Intervention: Provide opportunities for patients to listening to music to help alleviate or deal with symptoms of this psychiatric disorder. Comparison and Contrast: Does music therapy contribute to less depressive symptoms? How effective is music therapy in helping patients develop suitable coping strategies for depression. Outcome: Improved quality of life including lessened depression levels and improved capabilities to cope with psychiatric symptoms through listening to music. Clinical Question: Is listening to music effective in lessening psychiatric symptoms in depressive patients receiving music therapy? The purpose of this assignment is to explore the effectiveness of using music as an intervention for depressive…
¶ … Music Therapy on Depression Name Course Professor Date Part II Nursing Diagnosis: Ineffective coping with psychiatric symptoms exacerbates difficulties brought by a mental health disorder. The ineffective coping strategies are evidenced in poor concentration, low self-esteem, and poor self-care. Population: The population of interest is outpatients suffering from depression. Intervention: Provide opportunities for patients to listening to music to help alleviate or deal with symptoms of this psychiatric disorder. Comparison and Contrast: Does music therapy contribute to less depressive symptoms? How effective is music therapy in helping patients develop suitable coping strategies for depression. Outcome: Improved quality of life including lessened depression levels and improved capabilities to cope with psychiatric symptoms through listening to music. Clinical Question: Is listening to music effective in lessening psychiatric symptoms in depressive patients receiving music therapy? The purpose of this assignment is to explore the effectiveness of using music as an intervention for depressive symptoms and improved quality of life based on existing evidence-based practice. Narrative Discussion In Chan et al. (2012), the objective of the study was to determine the impact of music on the levels of depression in older adults. To achieve this objective, the researchers conducted a randomized controlled study on 50 older adults who listened to their preferred music at home for 30 minutes weekly for eight weeks. The depression scores that were collected once per week demonstrated that the levels of depression reduced every week among participants in the music group as compared to a non-music group that was subjected to control during the same period. Atiwannapat et al. (2016) carried out a research to explore the impacts of, "active group music therapy and receptive group music therapy to counseling in treatment of major depressive disorder" (p.141). The researchers randomly identified and assigned 14 major depressive disorder outpatients to active music therapy, receptive group music therapy, and group counseling. After assessing participants at baseline, they found that receptive group music therapy is characterized by faster achievement of peak therapeutic effect whereas active group music therapy has higher peak impact. Discussion There were some similarities and differences in both studies that can impact how music therapy is recommended as an intervention for reducing the levels of depression. First, these studies concur that music therapy is a non-pharmacological intervention that can help in management of depression among outpatients. Based on these studies, music therapy is considered because of pharmacological treatment measures are usually associated with adverse impacts and sometimes ineffective. Secondly, the studies involve a randomized controlled trial, which is a true experiment. This research design helps in enhancing the probability that study findings are not due to chance. Given the use of randomized controlled trial for these studies, their findings relatively represent the actual impact of music on outpatient settings. Third, both researches were carried out in outpatient settings and on a weekly basis, which was suitable in determining how the intervention impacted depression patients. Fourth, both studies grouped their participants in different categories i.e. one in which the intervention was used and another control group that was not subjected to the intervention. Chan et al. (2012) conducted the trial in the participant's home where a research nurse visited on a weekly basis to gather depression scores for eight weeks as data was collected between July 2009 and June 2010. The study also utilized a one-tailed repeated measure of assessing covariance i.e. RM ANCOVA to examine effects while a medium effect was selected based on findings from the previous study. Four different categories of music i.e. Malay, Western, Chinese, and Indian were first introduced to the subjects. For data analysis, Chan et al. (2012) utilized descriptive statistics to define the characteristics of the group while chi-square test was used to test homogeneity between groups. Unlike Chan et al. (2012), Atiwannapat et al. (2016) divided their participants into three groups and conducted the study as part of group therapy for outpatients with depression. Participants in this study not only listened to music but also sang and played musical instruments. This study also involved lyric analysis, song writing, and drawing the music by the subjects, which was different from the other study. Therefore, Atiwannapat et al. (2016) explored different aspects relating to music rather than simply listening to music like in the other study. For data analysis, this research utilized statistical analyses including STATA version 13, Kruskal-Wallis tests, and Fisher's exact test. While Chan et al. (2012) conducted the study on older patients aged 55 years or more, Atiwannapat et al. (2016) carried out the research on participants aged between 16 and 65 years. Therefore, the results of the study were difficult to compare because of the differences in age group and the fact that they were completed over different time periods. However, both articles provide significant evidence to demonstrate that music therapy helps in lessening the levels of depression among outpatients. Using Newhouse Level of Evidence, these studies contained weaknesses that need to be addressed as shown in the Appendix. Chan et al. (2012) received a rating of I-B good because of its fairly definitive conclusions that are consistent with an adequate number of well defined studies (Newhouse, 2006). Atiwannapat et al. (2016) obtained a Newhouse score of I-B good because of insufficient sample size but reasonably consistent results and use of reliable and valid research methodology. Part III The patient is 40- to 50-year-old married female a with essentially no psychiatric history presented to the emergency department with her husband due to significant mood lability, feeling a lot of anger towards others and having thoughts of wanting to hurt people over a couple months, but have gotten worse over the last two weeks. She reported that she has been feeling agitated, tensed, and has irritable edge. Thoughts are racing, concentration is poor, feeling more impulsive -- have been hitting wall and kicking a copier machine. She has no psychosis, but has longstanding issues with irritability and anger. Patient denied any previous episodes of depression and agitation. Her symptoms cause interpersonal, employment and familial difficulties. Patient is danger to self and others. She is too impulsive and aggressive to manage outside structured milieu. Despite having no psychiatric history, the 40- to 50-year-old patient is probably suffering from depression since she's showing symptoms of this disorder. She needs an intervention that will help her manage anger and irritation, improve concentration, and avoid tension. These factors have seemingly played a major role in her relationship, family, and employment problems. As evidenced in the two studies, listening to music will be a suitable non-pharmacological intervention to deal with the patient's condition. This is a suitable intervention because the patient has no history of depression and agitation. Music therapy will help improve the patient's condition by giving her other outlets for relieving stress and anxiety, developing safe and appropriate behaviors, and lessening depressive symptoms (Thoma et al., 2013). Final Reflection As a mental health nurse, my work has involved playing different roles that assist patients to control/manage their conditions. I have been involved in maintaining contacts with patients in relation to their health and well being and conducting assessments with regards to management of the patient's condition vis-a-vis the clinical intervention. During this process, I have been involved in ensuring the patient adheres to medication and other intervention measures to effective control and manage his/her condition. Apart from patient interaction and assessment, I have also been involved in care planning and evaluation of evidence of clinical intervention. This has entailed working with physicians to coordinate care processes and conducting research on clinical interventions that are suitable for specific conditions in order to improve care and patient outcomes. This experience has helped me realize that the role of mental health nurse entails carrying out different activities towards delivery of patient care. In this case, mental health nurses not only act as supportive staff to physicians but also carry out other tasks to help improve the health and well-being of patients. This has in turn changed my understanding of the roles and responsibilities of mental health nurses. These practitioners act as the link between the patient and the health care team and coordinating patient care strategies and processes. Moreover, I have realized that planning evidence-based care involves conducting research on evidence-based practices and using them as the benchmark for coordinating and providing care. These experiences have contributed to my growth and development as a nurse by enabling me to understand the role of a nurse and how to use evidence-based practices to plan and coordinate care. In essence, these experiences have been crucial in helping me gain real-world knowledge and skills in nursing. References Atiwannapat et al. (2016, March 26). Active vs. Receptive Group Music Therapy for Major Depressive Disorder -- A Pilot Study. Complementary Therapies in Medicine, 26(2016), 141-145. Chan et al. (2012). Effects of Music on Depression in Older People: A Randomized Controlled Trial. Journal of Clinical Nursing, 21, 776-783. Newhouse et al. (2006). JHNEBP Evidence Rating Scales. Retrieved from Vanderbilt University Medical Center website: http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Mentoring/Section%206/JHNEDP%20Evidence%20Rating%20Scale.pdf Thoma et al. (2013). The Effect of Music on the Human Stress Response. Plos One, 8(8). Retrieved from