DNP 820 TOPIC 6 DQ 2

DNP 820 TOPIC 6 DQ 2

The three main components of evidence-based practice are clinical expertise, best evidence, and patient preference. However, patient preference and clinical expertise are often at odds with each other. Provide an example of an instance in which you would need to mediate this issue and  what interprofessional collaboration might be needed. Explain how you would handle the situation. Provide relevant literature to support your response.

The three main components of evidence-based practice are clinical expertise, best evidence, and patient preference. However, patient preference and clinical expertise are often at odds with each other. Provide an example of an instance in which you would need to mediate this issue and  what interprofessional collaboration might be needed. Explain how you would handle the situation. Provide relevant literature to support your response.

Evidence-based practices (EBP) are in place to promote interventions for positive patient outcomes although it may not always impact positive patient preferences or a patient experience. The plan of care for Sickle Cell Disease (SCD) patients arriving at the emergency department transitioned from orders based on physician preference to an EBP protocol. The analgesic protocol has three dosages of intravenous opioids at specific intervals and with an increased dosage at each interval. This opioid dose strategy was proven to have greater improvement in pain experience (Tanabe et.al., 2017). The organization this DNP learner works in implemented this analgesic protocol in the emergency department and a EBP implementation of patient-controlled analgesia (PCA) in the acute care setting. According to Carullo et.al. (2022), a clinical practice guideline (CPG) was implemented regarding bolus PCA dosage reduced length of stay. It is said to also have reduced opioid utilization, hypoxia and ACS in patients with SCD. During the first year of implementation, most of the patients with SCD were upset with the new protocols and demanded continuous intravenous pushes of opioids rather than the analgesic protocol. In order to mediate the concerns of the patients, consistent education sessions occurred and complete standardization across the organization also occurred. It was discovered that anytime a provider placed orders outside of the protocol, mediation needed to re-occur. Instances of issues continue to occur due to missed education for providers and nurses who are unaware of the protocol as well. Moreover, the protocol also removed any intravenous administration of diphenhydramine (Benadryl) and replaced it with an oral dose only. Regardless of education, the incorrect order of Benadryl is amongst the primary reason for de-escalating a disgruntled and/or aggressive patient. According to Den Hertog & Niessen (2019), communication tools that aim to capture patient preferences include asking empathic questions, giving individual attention, click-making tools to build rapport, and antennae monitor for individual patient needs. All these aspects enhanced the patient’s experience of quality of life.  

Carullo, V., Morrone, K., Weiss, M., Choi, J., Gao, Q., Pisharoty, S., Moody, K., & Manwani, D. (2022). Demand‐only patient‐controlled analgesia for treatment of acute vaso‐occlusive pain in sickle cell disease. Pediatric Blood & Cancer, 69(8). https://doi.org/10.1002/pbc.29665 

Den Hertog, R., & Niessen, T. (2019). The role of patient preferences in nursing decision‐making in evidence‐based practice: Excellent nurses’ communication tools. Journal of Advanced Nursing, 75(9), 1987–1995. https://doi.org/10.1111/jan.14083 

Tanabe, P., Silva, S., Bosworth, H. B., Crawford, R., Paice, J. A., Richardson, L. D., Miller, C. N., & Glassberg, J. (2017). A randomized controlled trial comparing two Vaso-occlusive episode (VOE) protocols in Sickle cell disease (SCD). American Journal of Hematology, 93(2), 159–168. https://doi.org/10.1002/ajh.24948 

RESPOND HERE

EMANUELA it is true that Evidence-based practices (EBP) promote interventions for positive patient outcomes. EBP use factual information obtained from nursing research. As a result, evidence-based practices are accurate and these practices guarantee accurate results in healthcare settings. The value of EBP has compelled many healthcare organizations to implement evidence-based practices. However, the detailed nature of EBP has scared other healthcare providers and institutions. Still, healthcare organizations have developed strategies to help in implementing EBP (Lanza et al., 2018). The protocols in EBP can be helpful in attending to Sickle Cell Disease (SCD) patients arriving at the emergency department. SCD patients require planned healthcare due to the nature of their disease. Therefore, evidence-based practices play an important role in the planning process. DNP learners and related healthcare professionals are integral in the implementation and the use of EBP (Melnyk, 2020).  Educating other healthcare professionals on EBP will enable them to have smooth time in the implementation process. Patients may also be sensitize on their positions in evidence-based practices.

References

Lanza, A., Roysircar, G., & Rodgers, S. (2018). First responder mental healthcare: Evidence-based prevention, postvention, and treatment. Professional Psychology: Research and Practice, 49(3), 193. https://doi.org/10.1037/pro0000192

Melnyk, B. M. (2020). Reducing healthcare costs for mental health hospitalizations with the evidence-based COPE program for child and adolescent depression and anxiety: a cost analysis. Journal of Pediatric Health Care, 34(2), 117-121. https://doi.org/10.1016/j.pedhc.2019.08.002

Topic 6 DQ 2

The integration of the concepts of patient preferences and values as well as clinical expertise with evidence from well-conducted studies becomes part of everyday decision-making for professionals involved in patient experiences (Melnyk & Fineout-Overholt, 2019). Evidence-based medicine continues to evolve in the profession of nursing and with the introduction of new models of care for evidence-based clinical decision-making patients’ circumstances, patients’ preferences, actions, values and expectations, best research evidence, and individual clinical expertise play a central role in how these components are integrated. Evidence-based decisions involve the combination of best research evidence with clinical expertise and patient values. Clinician preferences based on clinical expertise play a major role in how similar cases are managed and often lead to variation in practice (Szajewska, 2018). This does have a negative influence on the patient’s preferences as their input is not often acknowledged in the decision-making process and is thus reflected in the quality of care provided (Szajewska, 2018; Engle et al., 2019). Ginex (2018) stated that patient preferences vary based on personal priorities, beliefs about health, sociocultural influences, and spiritual values and may be neglected due to numerous barriers presenting at the time of accessing care such as time constraints, literacy, previous knowledge, and gender, race, and sociocultural influences. In addition, research has shown the successfulness of patient-centered care approaches in enhancing patient experiences, trust, care quality, chronic disease management, and outcomes (Bokhour et al., 2018).

There are various tools and instruments at our disposal that may help us to provide good clinical judgment in incorporating patient preference and clinical expertise and improved outcomes for patients and families (Morgan et al., 2020; Melnyk & Fineout-Overholt, 2019). The highest level of interprofessional care namely intentional collaboration allows healthcare professionals to design and harmonize an integrated plan of care intentionally working together and sharing ideas for the patient and their family. Collaboration among healthcare professionals is crucial in achieving high-quality, patient-centered care (Morgan et al., 2020). This requires in-depth knowledge, skills, and experiences of interprofessional care, through a self-assessment checklist to gain proficiency. Also, interprofessional collaboration enhances the quality of care through the continued improvement in decision-making(Busari, Moll & Duits, 2017).

A qualitative approach to evidence-based practice especially when incorporating the perspectives of patients allows patients diagnosed with cancer and facing significant challenges to input their personal feelings. values and preferences and its effect on the interpretation of various evidence (Thorne, 2018). Patient in these situations requires healthcare professionals to understand their preferences as they ultimately impact their quality of life, daily wellness, and overall health outcome. Interprofessional collaboration must elaborate on shared goals, transparency, and role clarity and positively influence team functioning to attain patients’ best options and needs and encourage quality and safety of care provision and health outcomes for patients (Wranik et al., 2019). Improving patient undergoing treatment for cancer or diagnosed with cancer experience is crucial and with the assistance of interprofessional collaboration, the patient experience of care, the health of populations, healthcare-related costs, and healthcare provider experience can improve significantly and thus provide a balanced perspective of the use of the evidence-based model in clinical care settings by integrating and incorporating equally all aspects of evidence based-practice (Davidson et al., 2022).

References

Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., Lavela, S. L., Hill, J. N., Solomon, J. L., & Lukas, C. V. (2018). How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Services Research, 18(1), 168. https://doi.org/10.1186/s12913-018-2949-5

Busari, J. O., Moll, F. M., & Duits, A. J. (2017). Understanding the impact of interprofessional collaboration on the quality of care: a case report from a small-scale resource-limited health care environment. Journal of Multidisciplinary Healthcare, 10, 227–234. https://doi.org/10.2147/JMDH.S140042

Davidson, A. R., Kelly, J., Ball, L., Morgan, M., & Reidlinger, D. P. (2022). What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review. BMC Primary Care, 23(1), 8. https://doi.org/10.1186/s12875-021-01595-6

Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J., & Meterko, M. (2019). Evidence-based practice and patient-centered care: Doing both well. Health Care Management Review, 46(3), 174–184. Advanced online publication. https://doi.org/10.1097/HMR.0000000000000254

Ginex, P. K. (2018). Integrate Evidence with Clinical Expertise and Patient Preferences and Values. ONS Voice, 33(3), 37.

Morgan, K. H., Barroso, C. S., Bateman, S., Dixson, M., & Brown, K. C. (2020). Patients’ Experiences of Interprofessional Collaborative Practice in Primary Care: A Scoping Review of the Literature. Journal of Patient Experience, 7(6), 1466–1475. https://doi.org/10.1177/2374373520925725

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13: 9781496384539

Szajewska H. (2018). Evidence-Based Medicine and Clinical Research: Both Are Needed, Neither Is Perfect. Annals of Nutrition & Metabolism, 72 Suppl 3, 13–23. https://doi.org/10.1159/000487375

Thorne S. (2018). What Can Qualitative Studies Offer in a World Where Evidence Drives Decisions? Asia-Pacific Journal of Oncology Nursing, 5(1), 43–45. https://doi.org/10.4103/apjon.apjon_51_17

Wranik, W. D., Price, S., Haydt, S. M., Edwards, J., Hatfield, K., Weir, J., & Doria, N. (2019). Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health policy (Amsterdam, Netherlands), 123(6), 550–563. https://doi.org/10.1016/j.healthpol.2019.03.015

REPLY

patient preferences and values determine decision-making process for healthcare professionals.  Most healthcare organizations aim at providing patient-satisfactory services. Therefore, healthcare professionals take time to identify patient preferences and values before planning healthcare services (Melnyk et al., 2018). Most patients may look for alternative healthcare services if they feel that their values and preferences are ignored. Thus, it is the mandate of healthcare workers to determine patient preferences and values before tailoring healthcare services at address patient expectations. Evidence-based medicine continues to evolve in the profession of nursing (van Os et al., 2019).  The emergence of new health complications has dictated the evolution. Evidence-based medicine allows healthcare professionals to access factual information about different healthcare concerns. The information can be shared to various players to facilitate the intervention process. Evidence-based decisions involve the combination of best research evidence with clinical expertise and patient values. These choices address patient preference and values. Therefore, healthcare organizations rely on evidence-based decisions in handling various healthcare situations.

References

Melnyk, B. M., Gallagher‐Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first US study on nurses’ evidence‐based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence‐Based Nursing, 15(1), 16-25. https://doi.org/10.1111/wvn.12269

van Os, J., Guloksuz, S., Vijn, T. W., Hafkenscheid, A., & Delespaul, P. (2019). The evidence‐based group‐level symptom‐reduction model as the organizing principle for mental health care: time for change?. World Psychiatry, 18(1), 88-96.  https://doi.org/10.1002/wps.20609

Evidence-based practice requires the clinician to have clinical expertise and involves high-quality research. However, all people have the right to autonomy when making medical decisions and patient preference must be part of the discussion. Part of integrating evidence-based practices into practice must be having the ability to incorporate patient preferences (Hertog & Niessen, 2019). One prime example where current evidence conflicts with patient preferences surround the recommendation of immunizations, especially the COVID-19 immunization.

Vaccines have been a hotly debated item. Unfortunately, when the global pandemic of COVIDS-19 came to be, vaccines also became intensely politicized and in addition to a health pandemic, there was a misinformation pandemic spreading. This was more prevalent than previous health issues as social media created a platform for misinformation to flow. There are numerous reasons for this chasm that has been created. However, in order to overcome this hotly debated topic, healthcare clinicians need to be on the same page. The debate was convoluted when people within healthcare professions were sharing different messages, not always supported by research, surrounding the vaccine. This is where evidence-based practice can support best practices. Scientifically sound evidence provides proof of vaccine efficacy. Healthcare providers have the role and professional responsibility to provide the information including benefits and risks and then allow the patient to decide. Hertog and Niessen (2019) recommend building rapport, listening to patient needs, and asking empathetic questions to understand patient preferences as useful tools to support patient autonomy. This provides an understanding of patient beliefs, apprehension, and baseline knowledge.

In order for healthcare consumers to make an informed decision based on current best practices, healthcare professionals need to have a research-based consensus. In a study conducted by Gautier et. al (2022), 44.5% of healthcare students were identified as vaccine-hesitant. The personal preference of a healthcare provider can interfere with patient education and interaction. There was a difference in hesitancy between medical and nursing students as well as the background experience students had. To remedy this difference, Gautier et al. (2022) recommend interdisciplinary training on vaccines. This would provide training for the interdisciplinary team to enhance clinical expertise and share a consistent message to healthcare consumers based on factual scientific evidence versus hearsay.

References

Gautier, S., Luyt, D., Davido, B., Herr, M., Cardot, T., Rousseau, A., Annane, D., Delarocque-Astagneau, E. & Josseran, L. (2022). Cross-sectional study on COVID-19 vaccine hesitancy and determinants in healthcare students: interdisciplinary trainings on vaccinations are needed. BMC Medical Education, 22, 299.

Hertog, R. D. & Niessen, T. (2019). The role of patient preferences in nursing decision-making in evidence-based practice: excellent nurses’ communication tools. Journal of Advanced Nursing, 75 (9), 1987-1995. Doi: https://doi.org/10.1111/jan.14083.

RESPOND HERE

I concur with you that evidence-based practice (EBP) involves high-quality research. Healthcare professionals are involved in fact-finding process that help in disclosing accurate information on different healthcare aspects. At the same time, clinical expertise is required in the implementation and the use of EBP (Immonen et al., 2022). Most healthcare providers have credited EBP for improving patient positive outcome. As a result, different healthcare institutions have shown their desire to implement evidence-based practices. Part of integrating evidence-based practices into practice must be having the ability to incorporate patient preferences (Li et al., 2018). However, for the incorporation to be successful, healthcare professionals are expected to identify patient preferences. Conflict of preferences between healthcare provider and patients may create dispute that can interfere with the provision of quality and reliable healthcare services. Healthcare professionals need to have a research-based consensus, especially, when handling healthcare concerns such as the COVID-19 pandemic. Evidence-based practice reduces chances of mistakes that may interfere with healthcare service delivery.

References

Immonen, K., Tuomikoski, A. M., Kääriäinen, M., Oikarinen, A., Holopainen, A., Kuivila, H., … & Ylimäki, S. (2022). Evidence-based healthcare competence of social and healthcare educators: A systematic review of mixed methods. Nurse Education Today, 108, 105190. https://doi.org/10.1016/j.nedt.2021.105190 Li, S. A., Jeffs, L., Barwick, M., & Stevens, B. (2018). Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic