In this assignment I shall discuss the concepts of evidence based practice (EBP), and briefly outline its importance for my professional practice. I shall select a relevant aspect of practice to my professional discipline, here i will provide a rationale for selecting this aspect within the context of evidence based practice. I will discuss the extent to which my selected aspect of professional practice is informed by various types of evidence. In relation my chosen aspect of professional practice, I shall then identify factors that may facilitate and hinder the implementation of evidence based practice.
Evidence based practice (EBP) is to demonstrate the best practice, which has been supported, with a clear rationale to back it up. Whilst using (EBP), this also acknowledges the patient/clients best interest. (EBP) is:'the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patient/clients' Sackettet al (1996).
In this definition Sackett facilitates an understanding between (EBP) and decisions we make in everyday practice. This demonstrates the strong connection between both aspects. Here, Sackett emphasises the importance of decisions we make as healthcare professionals, and how clearly they should be stated. This shows that decisions are well thought-out, which demonstrates that the use of evidence is used sensibly and carefully. This means that any care or support we deliver, must be evidence based. If care or support we provide has a rationale, then this enables us to deliver it with a meaningful purpose. According to the Nursing and Midwifery Council (NMC) 2008 we as healthcare professionals must deliver care on the best evidence or best practice. The code of conduct clearly states that any advice we give must be evidence based. If we fail to adhere to the code, then this may result in disciplinary action by the (NMC).
As healthcare professionals I feel any care we deliver , should have a rationale to back up anything we carry out. I feel that as healthcare professionals we are expected to understand why we are caring for patient/clients, whereby a rationale is provided for the care that we provide. (EBP) helps us as healthcare professionals keep updated with policies and procedures. It is fundamental that we keep our skills and knowledge current, which enables us to provide effective care.
Davidoff et al (2005) found that (EBP) in its earlier days of evidence based medicine, which provides a suitable way in producing efficient clinical decisions, this also avoids routinely work practice and increases clinical performance (Evidence based medicine working group 1992). In the above statement it demonstrates that EBP which was formerly known as Evidence Based Medicine was to deliver the correct means for building
Evidence based practice is fundamental in professional practice. Justifying care that we deliver as healthcare professionals may help protect us from any litigation and claims against us. These complaints may be made by patients/clients that we care for. It is important that we adhere to policy's and procedures for the best practice available, which may prevent us from making any errors. As practitioners we are accountable for our actions. Justifying what we do is vital, which must have a rationale behind it. Failure to adhere to (NMC) 2008, may result in professional misconduct.
I have selected an aspect of professional practice, which is the treatment of depression and its effectiveness in adults with cancer. I personally feel there is a high prevalence in cancer patients suffering with depression. In my experience, I have found that there are many cancer patients suffering from depression . According to Barraclough (1994) states that depression is the most common psychiatric illness in patients with terminal cancer (1994). The high prevalence of depression in cancer patient has influenced me carry out my own research, which will effectively enhance my knowledge further. Hinton (1963) found that 24% of patients dying in an acute hospital were depressed . It has been found by Casey (1994) that patients suffering with depression may be assessed by asking them if they have symptoms such as ; loss of pleasure in activities, feelings of guilt and worthlessness, or thoughts of self harm, which may help in identifying a diagnosis in depress.
"Qualitative research is a naturalistic, interpretative approach concerned with understanding the meanings which people attach to phenomena (actions, decisions, beliefs, values etc) within their social worlds" Ritchie and Lewis (2003).
This defines that a qualitative study is what is realistic and interpretative approach regarding the definitions which people associate phenomenon
The objective of a qualitative research is to describe, explore, and give explanation the phenomenon what is being studied (Marshall & Rossman, 2006). Here,
In this qualitative study it was found that depression is the common psychiatric illness in patients suffering with terminal cancer Barraclough (1994). The study found that depression can not merely lowers quality of life for those suffering with cancer and their families, nevertheless patients whom are depressed may well have physical indications that are complex to palliate. It found that If patients that are primarily treated for their physical conditions, are more likely to recover from depression. Maguire sourced that up to 80% of psychological and psychiatric morbidity, which develops in cancer patients often goes unrecognised and untreated (1985).
It speaks about how patients are non-compliant in discussing symptoms freely with nursing and medical staff. It mentions that in the United Kingdom (U.K) clinical nurse specialists play an important role in assessing the symptoms and providing advice to cancer patient with highly developed and metastatic cancer (Gray et al,1999). This qualitative study was purposely carried to deter how clinical nurse specialist manage, assess, and perceive depression in patients, in both hospital and community settings. Atkin et al (1993) found that 43.4% of nurses reported that early recognition of, signs of anxiety and depression was part of their role. It shows indefinate the need for additional training in identifying psychosocial and psychiactric symptoms, which also demonstrates the difficulty nurses are faced with in convincing medical staff to follow up assessment or prescribe antidepressant medication .
In conclusion to this study it shows the significant difficulties clicnical nurse specialist have in regards to training and support in psychological and psychiatric assessment, and the management of palliative care patients.
I shall now crtique the study. Firstly,none of the nurses had any form of mental health training. I therefore feel their lack of knowledge may falsify the findings of the study. Lastly, the demographic area may have been expanded a little further, I therefore feel that the findings were minimalistic.
Systematic reviews were first defined as 'concise of the best available evidence that address sharply defined clinical questions' (Murlow et al 1997). Here, it states that a systematic review involves gathering quality information, which is then analysed, whereby it is then summarised. Literature should be selected on a specific subject, with a clear rationale of the methodology. The main purpose of a systematic review is to is to keep their audience updated(MMMMMMM)
This systematic review provides us with evidence on cancer patients receiving interventions such as drug therapy, which demonstrates antidepressants and their effectiveness. In this systematic review it found that depression is the most common in cancer patients, which often goes undiscovered and untreated (Lloyd-Williams, (2000); Bailey et al,(2005). It established that depression has a strong link with a person's quality of life. It also shows that cancer patient's survival rate may be decline if their immune response is impaired (Anderson et al, 1998; Newport and Nemeroff, 1998; Faller et al,2004) . It is known that in previous systematic reviews and meta-analyses of the effectiveness of interventions for cancer patients whom are suffering from depression have been unsuccessful in differentiating among depression and depressive symptoms. Dale and Williams (2005) refers to the findings from this review, which demonstrate that there little trial data on the effectiveness of antidepressants, which are prescribed to reduce major depression and depressive symptoms in those suffering with cancer.
On the contrary previous reviews which have failed to identify the dissimilarity between both depression and depressive symptoms, whereas it found that very little data from clinical trials, which show psychotherapeutic interventions, which are effective in reducing cancer patients suffering from depression.
A number of small-scale trials showed that psychotherapeutic interventions, more so Cognitive Behavioural Therapy (CBT), which may be effective in treating cancer patient whom have depressive symptoms. Furthermore, given the respect of the methodological boundaries of the studies to this day, the need for further knowledge should not influence the implementation of poor efficacy.
In conclusion, this review shows that there is a hard-pressed need for a more rigorous process in the examination of the effectiveness and consequences regarding approaches towards in managing depression in cancer patients, providing them with appropriate healthcare services.
In respect to the hierarchy of evidence chart Sackett (1996) states that a systematic reviews are at the peak of the chart, which demonstrates that this a strong piece of evidence. The results of a systematic reviews are produced in such a way, whereby a thorough examination of evidence is processed (Murlow,1987; Cook et al.,1998). In conclusion, the strength and validity of evidence from both these approaches are greater than what is produced. This demonstrates that the appraisal of the efficacy, which shows that00000000000000
Wallace et al (2001) found that antidepressants may stimulate the growth of a malignancy, which shows the need for a more rigorous examination of pharmacological treatment, and the importance of a substitute such as psychotherapeutic.
It would be highly unethical to use these findings as a prejudice against patients with cancer who wish receive treatment for depression and depressive symptoms, because of the limited data on effectiveness. There needs to be something in place to help prevent the high dropout rate in those suffering with depression, which help aid the accuracy of this studies. If the study had been more thorough, then this may enhanced the results of both pharmacological and psychotherapeutic efficacy.
This source of evidence fits into the hierarchy of evidence at the apex of the chart. It is known that a singular RCT or Several RCT's are well thought-out as the uppermost level of evidence, and anything below this is classed as lower level of evidence, which may be classed as an inadequate source of information (Ellis 2000, Lake 2006, Morse 2006b, Rolfe & Gardner 2006). This states that systematic reviews are classified as a high quality source of information, and anything else lower than this is seen as invalid.
Katrak et al (2006) found that new evidence, which shows that research can be obtained from clinical trials, this may be benificial in respect with public health. However, traditional or unsystematic reviews can be apparent and suitable to attain, which can also be deceptive at times, above all they are scientific Murlow(1987).
The National Institute for Clinical Excellence published guidelines specifically for the management of depression in primary and secondary care in the (UK)United Kingdom, suggest that screening for depression must be carried out in primary-care and general hospital settings for those who have a higher prevalently, which include those with imperative physical health condition/illnesses NICE (2004). Check nice website
Murlow CD, Cook DJ and Davidoff F (1997) Systematic Reviews. Critical links in the great chain of evidence. Annals of Internal Medicine 126(5):389-91
Aveyard,H,Sharp, P(2009) A beginners Guide to evidence based practice, Berkshire, Open University Press
Claibourne ,S,Rootenberg,J.D.,Katrak,S(2006)Effect of a US National Institutes of Health programme of clinical trial on public and health costs.Lancets 367: 1319-27.
Murlow, C.W. (1987) The medical review article:state of the science. Ann. Intern. Med. 106: 485-8.
Wallace WA, Balsitis M, Harrison BJ, (2001) Male breast neplasms in association with selective serotonin re-uptake inhibitor therapy: a report of three cases.Eur J Surg Oncol 27: 4429-4431
Casey P. Depression in the dying- disorder or distress. Progr Palliat Care 1994; 2: 1-3.
Sackett DL, Rosenberg WMC, Muir GrayJ.A, Haynes R.B and Richardson WS (1996) Evidence based medicine. What it is and what it isn't,British Medical Journal 312:71-2
Maguire P. Improving the detection of psychiatric problems in cancer patients. Soc Sci Med 1985; 20 :819-23
Gray R, Parr A, Plummer S, Sanford T, Ritter S, Mundtleach B, Goldberg D, Gournay K. A national survey of practice involvement in mental health interventions. J Adv Nurs 1999; 30: 901-906
Bottomley A. Psychosocial problems in cancer care: a brief review of common problems. J Psychiatr Ment Health Nurse 1997; 4: 323-31
Adamek M, Kaplan M. Caring for depressed and suicidal older patients: a survey of physicians and nurse practitioners. Int J Psychiatry Med 2000; 30: 111-25.
Atkin K., Lunt N., Parker G. & Hirst M. (1993) Nurses Count: A
National Census of Practice Nurses. Social Policy Research
Unit, University of York, York.
Payne S. Depression in palliative care patients: a literature review. Int palliat Nurs 1988; 184-91
Catherine Marshall & Gretchen B. Rossman (2006). Designing Qualitative Research. Thousands Oaks: Sage Publication, (4th edition), london