Study On The Definition Of Evidence Based Practice

nurture On The Definition Of separate Based formulaI take a leak got studied Nursing for 4 years in the Philippines and I save not hap the term tell apart Based Practice. It took me by impress that such(prenominal)(prenominal) subject exist. On my first day of class at Thames Valley University I have learned that EBP is abtaboo exploring a aesculapian intervention through re reckon of published reckon articles base on clinical trial conducted by various inquiryers and clinicians. The exhibit starts by proposing a search interrogative, and I chose to focus on Pain charge scarce I have notice that pharmacological guidance is too common. For such reason, I have decided to aim the attention of my research to Non-pharmacological Man durationment such as Diversional Therapy. This kind of therapy is seldom intake in the clinical setting because a lot of medicines are existence disc everywhereed and used as often. As the process continues, I have learned how to mighty hypercritically appraise an article and notice its importance no issuing how old it was and enhance my problem solving skills. exceptmore, adjusting and in some manner changing the schooling method is a big alteration I have encounter as I need to spend a lot of while reading and making the paper. After all the amplitude I gravel into making this Folder of test, I meditate the entire course a success. I have learned so often of stark naked things that somehow I ignored before.Mapping GridModule memorizeing Out spots secern 1 take the stand 2 raise 3Evidence 4Identify and critically check precedingities for improving perpetrate.varlet 12check bit 1PAsses the ability to identify differentiate and critically appraise its value.Page 15 para 2Pcritically analyze the replace description and under rest most the nature of record in nearlyness manage practice.Page 12Para 1CPage 18- 21Para 2, 3, 4, 5, 6PEvaluate the possibility and efficaciousness of certainty for c hange over in practice.Page 24- 25Para 2, 5PLearning Log contract twenty-four hour period 1 11th October 2010TopicUnderstanding the Nature of EvidenceKey Concepts/IssuesEvidence Based PracticeHistoryDevelopment training/Learning rag conclave preachingInformation Skills Development schoolroom ActivityAMExploration of the Concept of Evidence Based Practice.PMSources of Evidence ontogeny calculate Skills Library academic term (1)Brief NotesEvidence based practice is providing the outmatch evidence of interposition to facilitate effective word/intervention. A discussion of what to be expected from folder of evidence as it highlights how the folder impart be collated and how to set aims and objectives for FOE. break d feature Day 2 25th October 2010TopicQuestioning Practice/ query Questions finding EvidenceKey Concepts/IssuesThe relationship between heads and types of evidenceQuestioning stimulate practice explore types of research misgivings.Developing simple and structure search strategiesTeaching/LearningLectureGroup reciprocationGroup manifestationInformation Skills Development schoolroom ActivityAMGroup video display Evidence Based PracticeGroup Poster insertionConcepts Definitions and Understandings SessionRelationship betwixt Questions and Types of EvidenceDescriptive and Relational QuestionsPM create verbally Search freighterdid Questions for Evidence Based PracticePICO Identifying Preliminary Search TermsDeveloping Search Skills Library Session (2)Brief NotesWe discussed how to proposed a searchable headway and how principal(prenominal) it is. I formulated a topic based on my suffer interest and experience beforehand. Revision of question in like manner was supervised and disruption employ PICO framework. take on Day 3 8th November 2010TopicDifferentiating Between Research Paradigms.Key Concepts/IssuesEvidence Based PracticeExperimental ResearchNaturalistic ResearchTeaching/LearningLectureGroup Discussion examineInformation Skills DevelopmentClassroom ActivityAMQuiz Review Research DesignsDiscussion of Types of Questions (researchable and unsearchable questions).Group ready to Refine concluding Practice Issue and Search QuestionRefine PICO Framework for SearchPMInclusion and Exclusion Criteria idea Tools, CASP, SIGN, AGREEGroup Work Assessment and Discussion of Two Papers Retrieved Last Week. (Question, Design, Methods and Results).Brief NotesI have learn the different types of research designs that supports my research scheme for the 5 indigenous articles together with supporting documents that will be used in making EBP. This session also emphasizes the importance of PICO as this will assist how to refine searches. Different appraisal tool was also discussed and its importance as this go out effective filter for the reliability and validity of published literature.Study Day 4 29th November 2010TopicSystematic Reviews/Meta-analysis An Introduction judge Evidence Part 1.Key Concepts/IssuesSystematic ReviewsDeveloping Critical Appraisal SkillsTeaching/LearningLectureGroup DiscussionGroup presentment man-to-man ExerciseClassroom ActivityAMGroup Presentation Features of Systematic ReviewGroup Discussion How Does an SR Differ From a Traditional Review?Appraising a Systematic Review soulfulness Exercise and Group Discussion.PMUsing Appraisal ToolsAppraising of an RCT and a Qualitative Study Using CASP or an Alternative Appraisal Tool.Group Discussion Analysing the Appraisal Process and authorisation of the Appraisal Tool.Brief NotesA systematic review is a test that identifies, appraise, select ans synthesise a collection of research articles with relevancy to each piece of work.Critically appraising a systematic review article excludes lesser fiber studies to minimize error and bias in the findings. It Assess the validity ofresearch by means of determining whether themethods used during the study can be trusted toprovide a genuine, accurate account of the treatment being st udied.Study Day 5 6th December 2010TopicEstablishing the timbre of EvidenceKey Concepts/IssuesMaking Judgements About the Quality of EvidenceSynthesising EvidenceTeaching/LearningLectureGroup DiscussionworkshopIndividual ExerciseClassroom ActivityAMGRADE How to Move from Evidence to Recommendations.Workshop- Grading EvidencePMTutorialsIndependent Work or Further Electronic Searches.Brief NotesAs I appraise each primary articles collected, a summary of critical appraisal of the 5 primary articles was made. This schema helped me to train an touch toward the affirmation of each articles towards making the summative 3.Study Day 6 13th December 2010TopicImplementing EBPKey Concepts/IssuesTranslating Evidence Into PracticeImplementing EBPGuiding Principles for Implementing EBPBarriers to Implementing EBPTeaching/LearningLectureGroup DiscussionGroup PresentationIndividual ExerciseClassroom ActivityAMGroup discussionIdentify Barriers to Implementing Evidence Base in PracticeIdentify S trategies to Implementation that Avoid/Overcome these Barriers.PMStudents to work in pairs to devise a search strategy for use in one electronic database to identify an article that describes and evaluates the introduction of evidence based change in practice.Brief NotesImplementation has its various barriers to consider such as time, support, miss of knowledge, lack of motivation of the workers and too much research evidence. As a group exercise we critique an implementation article as to determine the process of implementation of the studied intervention.Study Day 7 10th January 2011TopicEvaluating EBPKey Concepts/IssuesEvaluating Changes in PracticeApplication of a Framework for Evaluating Change.Final Module military ratingTeaching/LearningLectureGroup DiscussionGroup PresentationIndividual ExerciseClassroom ActivityMeasurement for Improvement/ChangeSustainability of ChangeExamine Effectiveness of Evaluation Strategies.Module Evaluation and Individual TutorialsBrief NotesIt discussed about the military rank process of a study and the use of guidelines in each step. Evaluation meant by achieving a research aims and objectives and close importantly if the study conducted able to answer the hypothesis, as this entails whether the study is effective or not.SUMMATIVE lock additive 1 Concept of Evidence-based PracticeThe challenge for best fiber of dispense, combined with the need for recommended usage of resources has heightened the pressure on health handle professionals to ensure that clinical procedures is based on sound evidence. Frequent change and advancement in treatments, an increasingly numbers of research data, and the incr comfort of expectations from clients to provide the best plow possible, place high demands on healthcare providers to bear a service that is based on current best evidence. (Bennett and Bennett, 2000). Evidence-based practice (EBP) is a clear path to healthcare wherein health professionals use the best evidence possibl e, such as the most suitable information available, clinical decisions for individual patients. EBP values, enhances, and builds on clinical expertise, knowledge of disease process, and patho-physiology (McKibbon,1997). Evidence-based practice simulate knowledge of and skills in literature searching, research methodologies apprehension , appraisal and apprehension of research. It also assumes healthcare professionals to have access, critique and coordinate literature study with clinical experience and clients aspect. In order to gain a great interpretation about the nature of evidence in the context of health care, consideration needs to be given to the history of the evidence-based health care movement while the concept was originated in medicine, it has influenced a wide domain of health professions (Trinder Reynolds, 2000).In addition, it is an approach to decision-making that has permeated all aspects of healthcare. Its characterize can be seen in m any(prenominal) of the l eading health systems and government health policies across the world. EBP lay highlights the value of research as a source of information which is potentially less biased than another(prenominal) sources for informing practice, it also understandably acknowledges the importance of integrating this research with clinical expertise and clients perspectives (Sackett et al., 2000). Moreover, it involves complex and time-tested decision-making based not on available evidence alone but also on patient characteristics, situations, and preferences. Changing practice is not favorable to do therefore careful selection of the topic is very significant. For the make of the patient is of first importance when selecting a topic, however it can not be the main basis as to literary evidence is short-staffed to figure what are the benefits. Researchers must also consider the time, level of breathing in and other resources for the study. Research evidence is most frequently found in peer-re viewed journals as this is where results are first published and where enough detail on methodology exists to make informed judgements on the validity and clinical relevance of the findings (Bury Jerosch-Herold, 1998). Research using the strongest and most appropriate study design for the question being studied, will provide the best evidence.Summarizing the evidence is a ample intellectual endeavor tally to Fitzpatrick (2007). health care workers must be capable combining ideas and recommendations from an extent of references to make appropriate advices. Implementing a plan is consider challenging because standards and regulation of an organization can either help or ruin an EBP approach to care. Evaluation process involves short term and extensive term coverage to provide essential data.Word count= 503 cite ListBennett S Bennett J (2000) The process of evidence-based practice in occupational therapy Informing clinical decisions. Australian Occupational Therapy Journal. 47 p17 1-180.McKibbon K (1997) Evidence-based practice. bulletin of Medical Library Association. 86(3)p396-401Trinder, L., Reynolds, S. (Eds). (2000). Evidence-Based Practice A critical appraisal. Oxford Black tumesce Science.Sackett D, Richardson W, Rosenberg W, Haynes R (2000).Evidence based medicine How to practice and teach EBM (2nd edn). Edinburgh Churchill Livingstone.Bury T Jerosch-Herold C. (1998). Reading and critical appraisal of the literature. Evidencebased healthcare. A practical guide for therapists Oxford Butterworth Heinemann. p136-161Fitzpatrick J (2007. Finding the research for evidence-based practice,part one The development of EBP 103 (17) p.32-33Summative 2 Critical discussion on formulating question using PICOThere are legion(predicate) times that new information is required when contemplating clients in order to analyze clinical problems and make treatment resolutions, and these questions pertains to a specific client or groups of people. Questions usually tog u p concerning the effectiveness and choices of an intervention, how treatments are best implemented and whether there are any associated difficulties included (Bennett and Bennett, 2000).The question for this study is about the effectiveness of Diversional Activities as a form of infliction concern to paediatric clients. Pain vigilance is the succour of agony and suffering of a patient with the use of Pharmacological and Non-pharmacological treatment or nursing intervention. Diversional therapy is a non-pharmacological approach and a client relate practice that recognizes the leisure and recreational experiences of an individual (Diversional Therapy Association of Australia,2008).Through the act of mental and deportmental factors regarding wo(e), complimentary medicine are significant in fixation pain experiences. These interventions bears to minimize fear, worry, pain and heighten a clients bodily process. gibe to Bennett and Bennett (2000), when there is uncertainty, the n eed for information can be interchange into a clinical question. Clearly framing a question not that clarifies what to aim, but it can also facilitate the search for answers. Sackett et al. (1997) point out that the identification of congruent data for answering a particular clinical question whitethorn be facilitated by diving the question into components including A client or a dilemma being considered, an intervention or indicator being considered, outcomes of interest you would like to measure or get hold of and a comparison. PICO represents an acronym for Patient, Intervention, Comparison and Outcome. These four components are the essential elements of the research question in EBP and of the construction of the question for the search of evidence (Santos et al. 2007). The PICO strategy can be used to compose several kinds of research analysis, originated from clinical practice, kind-hearted and material resource management, the search of evidence assessment instruments, amo ng others. The research question allows for the correct definition of which evidence is needed to solve the clinical research question, focuses on the research scope and avoids unnecessary searching (Fleming, 1999). Based on the clinical question formulated and utilization of PICO, a literature search strategy can then be formulated that includes search cost reflecting each component of the question.The next step in the evidence-based practice process is to search the literature for evidence that may assist in acknowledging the question posed. The literature search will be focused by the clinical question that has been identified with use of PICO, as well as other pertinent information (Bennett and Bennett, 2000). While evidence for informing clinical decisions may come from various sources including clinical experience, development, textbooks, discussion amongst colleagues and from clients, evidence from well-performed research may be less prone to bias or to the tendency to su ppose what we want to believe ( Tickle-Degnen, 1999).The internet and the portals of open-access journals allow for accessibility to knowledge, keywords such as non-pharmacological, complimentary medicine and diversional therapy were used to search for the 5 primary articles to be used for this study. An article must be good and interesting, should be well written, and old articles are also considered. Moreover, comprises a physical structure of knowledge in academic and scientific based from an original research.Word count= 548 acknowledgment ListBennett S and Bennett J (2000) The process of evidence-based practice in occupational therapyInforming clinical decisions. Australian Occupational Therapy Journal. 47 p.171-180Diversional Therapy Association of Australia(2008) what is diversional therapy?online. on tap(predicate) athttp//www.diversionaltherapy.org.au/Home/tabid/38/Default.aspxFlemming K.(1999) Critical appraisal 2 Searchable questions.NT Learn Curve 3(2) p. 6-7.Sackett DL , Straus S, Richardson S, Rosenberg W, Haynes RB (2000) Evidence-based medicine how to practice and teach EBM.Churchill Livingstone. 2nd edition.Santos C, genus Pimenta C, Nobre M.(2007) The PICO strategy for the research question construction and evidencesearch. Rev Latino-am Enfermagem maio-junho. 15(3) p.508-11.Tickle-Degnen,L. (1999). Organizing, evaluating and using evidence in occupational therapy practice. American Journal of Occupational Therapy 53 p.537 539.Summative 3 Synthesis of research findings.This part of work is the review of the 5 primary articles chosen for the topic effectiveness of diversional activities for pain management to paediatric clients. The articles will be analyzed by using CASP tool, examining each relevant findings and by compare and contrasting ideas of each authors, thus, resulting to further evaluation of such intervention in hospital and non-hospital setting for its efficacy. This research desires to have a thorough understanding of non-pharmaco logical intervention in managing pain to tykeren that soon will complement pharmacological management by provide stronger evidence. Pain is a dreadful feeling and emotional experience related to injury or damage to baby birdren s body, it is usually caused by trauma, disease, medical procedure or surgery. Pain may affect children s appetite, sleeping patterns and lessen verve level hence disabling child to do things. paediatric pain is complex and often difficult to assess, that is why effective pain management in children is a challenge to medical practitioners because there are many special considerations when providing treatment. On the other hand, non-pharmacological therapies or diversional activities are treatment that do not use medicines to decrease or control child s pain. They may convey comfort to the patient during a long standing condition or illness. Certain activities may help improve the child s state by making him/her more comfortable and relaxed. It involves met hods such as teaching and leading your child through thought exercises and other techniques. It can also be used before and after(prenominal) a child undergoes painful experience, such as medical procedure or surgery.Vessey et al. (1994) stated that, bewilderment is the single most commonly used diversional activity among children. Fernandez (1986) stated that distraction refers to the direction of attention to a non-noxious event or stimulus in the immediate environment. When a patient worries too much about his/her pain causes more pain than what is really there. Vessey et al (1994) surveyed snow children, aged 3 years to 12 years, majority are males (62%) to examine the effectiveness of Distraction method during venipuncture or needle prick, the child s memory may lead to stressful psychological responses, such as crying, and physical responses such as venous constriction during the procedures. It is important that in conducting a study the actent s age, developmental level and prior hospital experience must be considered during the selection, Broome (1985). Furthermore, Researchers uses the Wong-Baker FACES pain rating home in evaluating children s perception of pain. Wong-baker pains scale is know to be a reliable and valid device for children 3- 18 years of age in evaluating their pain,Wong and Baker (1988). In using distraction, the patients may paint, play with friends, take to be TV and play with board games or video games and other bauble toys to help them relax and deflect their attention during the procedure since it provokes curiosity and require children to use their auditory, visual, tactile and /or kinesthetic senses. These activities may keep them from thinking about the pain.Weekes et al (1988) Distress is known to cancer patients for years during and after the completion of anti cancer treatments. According to national Institute of clinical Excellence (NICE), (2005) the role of imagination can play in a childs ability to cope with p ainful operations. The NICE concluded that there was a strong evidence for the use of hypnosis in alleviating chronic pain associated with cancer. Richardson et al (2006) mentioned that hypnosis is a method where the subject is guided by another to respond to suggestions for changes in subjective experience such as perception, sensation, emotion, thought or behavior. It can be utilized in a variety of shipway to cut down stress, acquire move strategies and halt the experience of pain. Self-hypnosis tends to ease self management of prognostics, hence providing a sense of self-efficacy and control over pain and detriment, however, it creates less therapeutic benefit compared to therapist- directed hypnosis. It is evident that patients who underwent hypnosis describe less anxiousness and pain while using direct and indirect forms of hypnosis, demonstrating leveled effectiveness. Though, there is some evidence that under hypnosis, girls exhibited more suffering behavior compared to boys, Katz et al (1987). Richardson et al (2006) concluded that hypnosis has potential as a clinically valued intervention that could impart to the establishment of procedure- related pain and inconvenience in pediatric cancer patients.Oshikoya et al ( 2008) reported that complementary and preference medicine has been advantageous for children by some parents, such benefits includes prevention of illness, alimentation of good health, relief of musculoskeletal pain, control of asthma symptoms, treatment of spiritless respiratory problems, relief of sickle cell anemia and enhancement of the resistive system in cancer. 80% of the parents used option medicine to mend their children during the study, however, 7% discontinue the use of such practice because the symptoms of the illness come about in their children with exacerbation after their regular medical specialtys had been discontinued. Moreover, Kemper et al (2010) express that pediatric patients benefit from stress les sening by means of using complimentary medicines and techniques such as biofeedback which teaches the child to control and calm body s reactions when there is pain, it is one of the treatments researched most extensively for migraine, Allen (2004). Guided resourcefulness is used by letting the patient presuppose that he/she is his/her preferred place, the patient will feel safe and relaxed and pain may be decrease. Relaxation and self-hypnosis methods that re mostly used for migraines and chafe by asking the child to breathe slowly and deeply and let the patient imagine that his/her muscles are relaxing.. Holroyd and Drew (2006) stated that cognitive behavioral therapy has been utilized successfully to help manage headaches, depression, and anxiety, Lawler and Cameron (2006). This practice has proven effective in decrease migraine headaches, improves mood and cognitive function through an experiment. Also, Acupuncture and abrase can help both adults and pediatric patients who have chronic headache and can be provided by family members, which allows for more regular, inexpensive and favorable treatments.Salantera et al (1999) investigates 265 carrys about the knowledge and abilities of nurses towards pain management of pediatric clients. Health care practitioners such as nurses, are well placed to provide such supportive interventions in both pharmacological and non-pharmacological treatments. According to Ross et al (1991) Healthcare providers lack of knowledge and negative attitudes may lead to under medication and under treatment of pain. Nurses are close to the children the whole day and have more chance to use non-pharmacological pain management methods in their work. Clarke et al (1996) that education about pain was most inadequate in areas of non-pharmacological interventions to borrow pain, the difference between acute and chronic pain, and the anatomy and physiology of pain. Nurses knowledge differed according to their age, education, and plac e of work, and uses a fairly wide range of non-pharmacological pain relief methods, most of the time the nurse was in the active role and the child was passive, restricting the child to take an active part in their own pain comfort. Studies shows that children like to have some responsibility for their own care. Furthermore, Pederson and Harbaugh (1995) transparent that there are obstacles in terms of using non-pharmacological pain management in hospital setting and found to be that excess workload, lack of proper materials, lack of knowledge and skills, and not knowing the child were the most common problems nurses confronts. Some of them felt that they receive very brief education on non-pharmacological pain management, and 90% had no documented evidence of the use of any non-pharmacological modalities to relieve pain that will serve as nurse s guidelines. The nurses who thought they had good knowledge about non-pharmacological management got a lower score from the survey, nurse s consider themselves knowledgeable in stress reduction but not in play therapy and hypnosis method. Effective pain management in children requires cognition of both pharmacological and non-pharmacological methods. There are evidence found that nurse s characteristics, such as age, knowledge, experience, intuition, attitudes and beliefs, as well as nurses personal experience with pain, determines their implementation of pain interventions and knowledge about it. Nurses should be encouraged to actively seek new information and hold up their training. More comparative, dismantling, constructive, and process oriented research strategy is required in the area of non-pharmacological pain management and different practice of pain alleviation should be generalized.Non- pharmacological approach has been found to be an effective assistant method for the control of pain. A wide range of complementary and pick medicine therapies are being used by children, including herbs and dietary suppl ements. abandoned the influence of psychological and behavioral factors on pain, non-pharmacological interventions are important in altering pain perception/behaviors. Diversional activities are intervention used for managing pain in both children and adult to reduce fear and, minimize distress and pain and increase a childs sense of control. For these techniques to be effective, it must be appropriate to patient s age and developmental abilities and must also be appealing to the recipient. There is still continues need to educate the medical community regarding the long term outcomes of pain control.Word count = 1514 university extension ListAllen KD (2004) Using biofeedback to make childhood headaches less of a pain. Pediatric Annual. 33 241-245Broome M (1985). The child in pain A model for assessment and intervention. Critical care quarterly, 8 47-55Fernandez E (1986). A mixture system of cognitive coping strategies for pain. Pain. 26 141- 151.Holroyd KA, Drew JB (2006) Behavio ral approaches to the treatment of migraine. Seminar Neurology. 26 199- 207Katz E, Kellerman J, Ellenberg L (1987) Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology 12 379- 394Kemper K, Breuner C, (2010) Complimentary, Holistic, and Integrative euphony Headaches. American academy of pediatrics, 31(2) p.17- 23Lawler SP, Cameron LD (2006) A randomized, controlled trial of massage therapy as a treatment for migraine. Annual Behavioral Medicine. 32 p50-59National warmheartedness for complimentary and alternative medicine, NIH (2007) Non-pharmacological pain management therapies for children. Available at http//nccma.nih.govNational Institute for clinical excellence (NICE) (2005) Service guidelines for improving outcomes in children and young people with cancer-second consultation. Available at http//www.nice.org.uk/pdf/cacancer_2ndcons_manual.pdfOshikoya K, Senbanjo I, Njokanma O, Soipe A ( 2008) Use of complimentary and alte rnative medicines for children with chronic health conditions in Lagos, Nigeria. BMC complimentary and alternative medicine 8 (66), p.1- 8Pederson C, Harbaugh B. (1995) Nurses use of Non-pharmacological techniques with hospitalized children. Issues comprehensive pediatric Nursing 18 91- 109Richardson J, metalworker J, Pilkington K (2006) Hypnosis for procedure-related pain and distress in pediatric cancer patients A systematic review and methodology related to hypnosis interventions. Journal of Pain and symptom Management, 31 (1) p.70- 83Ross RS, Bush JP, Crummette BD (1991) Factors affecting nurses decisions to administer PRN moderating medication to children after surgery an analog investigation. Journal of pediatric Psychology, 16 151-167Salantera S, Lauri S, Salmi T, Helenius H (1999) Nurses knowledge about pharmacological and non-pharmacological pain management in children. Journal of Pain and symptom Management, 18 (4) p. 289- 299Vessey J, Carlson K, McGill J (1994) Use of Di straction with Children during an acute pain experience. Nursing Research, 43(6) p. 369-372Weeeks DP, Savedra MC (1988) Adolescent cancer coping with treatment- related pain. Journal of Pediatric Nursing 3 318- 328.Wong D, Baker C (1988) Pain in children s comparison of assessment scales. Pediatric Nursing, 14 19- 17.