Employment and Application of Evidence-Base Practice Research Proposal

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Employing Evidence-Base Practice

The influence of evidence-based practice (EBP) 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 a team of healthcare professionals in McMaster University in Ontario, Canada. In the early days, the idea faced mixed reactions: enthusiasm of academic and research professionals and doubt and exception from the practical field staff. However, over the decade the advent of improved communication and readily available data and diagnoses on the internet, the feasibility of, evidence-based medicine gained strength and widespread acceptance in the busy family health care services (White, 2004).

The formal structure of evidence-based medicine originated in 1992 in the Journal of the American Medical Association1 detail was: the Physician would be required to study the vast amount of literature made available to him towards a particular diagnostic measure of a waiting patient. It would be required of the physician to analyze and arrive upon the correct course of action by dissecting the evidence provided to him. That immediately raised concerns of the patient who would have to wait interminably. According to John Ely, MD, Associate Professor in the Department of Family Medicine at the University Of Iowa College Of Medicine that was impossible to implement in day-to-day situations. In retrospect even the original proposers of this concept realize as much (White, 2004).

"A majority of the clinicians want to incorporate evidence-based concept into their practice," says Ely, "that doesn't however, mean researching original material, rather it means cross-referencing the basic guidelines and concise adaptation of the theoretical premise for offering services based on the evidence provided." David Sackett, MD, an original team member of the McMaster group EBM means, "the holistic, exclusive and balanced use of practical evidence to arrive upon the selected course of action." EBM basically means the fine, systematic amalgamation of clinical experience and expertise aided by research material findings to decide on the most suitable course of action."(White, 2004) (Sackett et. al, 1996)

"The best practitioners make use of both, the evidence and their own experience and skills." says Sackett. "Every individual needs personal care and experience and skill is needed to analyze the evidence material that may have been referred to. Too much dependence on evidence is not advisable, hence. At the same time experience alone cannot suffice to counter newer dimensions in health care practices and support of evidence would go a long way to provide better remedies to the patients." Evidence-Based Medicine has always been practiced, for about five decades, even by the conventional experience-based medical clinicians and physicians, the difference that has now arisen is that of more solid evidence demanded by the EBM practice. The conventional physicians did not take into account very rigorously researched evidence" says Robert Flaherty, MD, a family physician at the Montana State University Student Health Service, a teacher who evaluates and sermons medical literature. "There has been a widespread, often, blind following to the researched evidence portrayed in the materials now made available and used in practice. However there were many variations and contradictory instances recorded in the journals and the best way to approach evidence was still being explored for tens of years."(White, 2004)

Evidence-Based Medicine has been able to develop the systematic study procedure of the vast amount of evidences now available for each of the subjects and select the best applicable amongst them and critically evaluate them for practical use. "In recent times, there has been an exponential rise in the literature of well analyzed and critically evaluated subjects that promise to be more pragmatic from the physician's point-of-view than was available traditionally," said Flaherty. "The medical fraternity now has the advantage of readily available material for treatment procedures" (White, 2004).

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Why do we need EBM?

The dilemma faced by the physicians is that of: vast amount of available literature and the complex nature of modern medicine. That is in addition to the limitations of time and human capacity to absorb and use information. These factors together constitute the vagaries of medical treatment inconsistencies. Ely and colleagues, in 1999 tried to understand the way physicians approached the critical, issues faced by their patients. It was found that more than sixty percent of the disturbing issues that arose weren't pursued very diligently by the doctors. As a result, such patients (at least 3 out of 10) never got an answer to their problems. Ely goes on to say" If pursued, at least 80% of the time, a satisfactory answer is likely to be found."(White, 2004)

The EBP Movement

The main aim of EBP is to create a strong connect between conventional expertise and evidence to provide for the best course of action in health care services. What has been disquieting concern is the increased prevalence of major harm to patients that could have been avoided (IOM, 2000). A mapped methodology of approaching health care was formulated in the Quality Chasm report (IOM, 2001). In it, nation's experts in the field laid an emphasis on inculcating EBP. The gap between EBP and traditional methods was sought to be narrowed down thus (Stevens, 2013).

Evidence-based practices promise better outcomes. That involves, extending the expertise with evidence, services provided, and setting up goals to be achieved. This approach bases itself on the belief that better access to researched material can engender a better approach at providing corrective action and course in healthcare and result in patient well-being. The main is aim to form a formidable team of traditional expertise with more and better evidence. By inference, it means that the inconsistencies at play can be reduced and actions can be taken from more solid premises (Stevens, 2013).

The birth of EBP was caused by the gap between known facts and traditional practices that did not make use of these facts (IOM, 2001). The statement at the Crossing the Quality Chasm (IOM, 2001), by the IOM experts, that is relevant even today: "there is a huge gap between what could have been done and what is, instead being done in health care" (IOM, 2001, p. 1). It sought the participation of all professionals in the field to change the system and procedures radically. EBP was proposed as the bridge to cross the divide. The experts are still evolving the process through IOM Chasm reports (IOM, 2003; IOM, 2008a; IOM, 2008b; IOM, 2011a); in each of them the most important point that is made out is that of evidence-based practice (EBP) to enhance the quality of healthcare. The effect perceived effect is to standardize healthcare service and hence reduce the inconsistencies that are prevalent in experience- based healthcare practices that result in unforeseen outcomes in the patient. There is also the factor of accountability from patients for the actions taken by physicians that is driving the EBP evolution to provide better, standardized healthcare (Stevens, 2013).

Experts in medicine define EBP as "Summation of best research incidences clubbed with clinical skill and valuable outcome for patient" (Sackett et al., 2000, p. ii). As such, EBP integrates evidence with medical skill and patient's individual preferences. This definition has been altered many times over but still is useful in integrating nursing with the tenets of EBP, broadly speaking. The above forms the basis of the enduring and comprehensive meaning of the coinage, "EBP" (Stevens, 2013).

The EBP process has been highly evolutionary and revisionary in many dimensions of reach beyond what was till recently practiced in nursing and medical health care-giving. This paradigm shift engendered new streams of disciplines into the medical arena, those of the likes of: new systems to critically review evidence, new professions of information providers, management teams into service providers in healthcare, new cultures in healthcare practice and new horizons of science to build the "evidence-based practice" (Shojania & Grimshaw, 2005). The changes that were thus brought about altered the perspective of nurses to look at objectives of their job totally. They saw results, evidences and practices from a radically different point-of-view (Stevens, 2013).

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Using evidence to guide your practice

The present times demand more emphasis on evidence. In the last 10 years, the medical system is expected to base their practice on.....

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