- Evidence-based practice
- Introduction
- The evidence-based practice is involved in making of the decision about how to promote the various health services or help in providing care through the various available evidences within practitioner expertise. In addition the evidence-based practice also entails systematic collection of data through observation and experimental finding to help in making decision. Application of the evidence-based research in decision making has been stressed by various professional organization such as the American Nurses Association among other bodies in order to ensure that evidence is provided when making decision in nursing. The continued application of the practice has also been due to pressure from the public and the private sectors. Various core foundation of the evidence-based practice include the question approach to practice that leads to scientific experimentation, observation and the analysis of the data recorded. The topic I have chosen is to help in focusing on the health-related to quality of life in the breast cancer patient with lymphedema who survived more than the one year after surgery.
- Test 1: quantitative research
- Article: Lee, So Hyun, et al.’’ Health –Related Quality of life in Breast cancer patients with Lymphedema Who Survived More than one year after surgery.’’ Journal of breast cancer 15.4(2012):449-453.
- The paper used the appraisal quantitative research where I have assessed the quality of the research in terms of the relevance. I have therefore used the acronym RAAMBO.
- Recruitment
- The research is based on the Kyungpook National Hospital University hospital. The researcher recruited the breast cancer survivors who visited the clinic. In this case or the patients who were recruited had initially had no observable signs of related to lymphodema or the related treatment. The normal population of the patients who came for regular check up was also included in the study. In order to widen the research the author also ensured that he also included the patient from all the age groups.
- Allocation and adjustment
- The studied group was also adjusted to help ensure that the data collected in the most random way. In this case a doctor who was not actively involved in the research was selected. The doctor was supposed to indentify the names of the patient to be involved in the research. Proper care was also made to ensure that the normal participants were not aware that their quality of life was to be compared to that of the breast cancer patients.
- Maintenance
- The researcher also ensured maintenance of the groups in heterogeneous as possible ways. In this case he ensured that the normal patients were not aware that their quality of life was compared with that of the patient with breast cancer.
- Measurement
- In order to measure the quality of life of the two groups the same quality measurement strategies were used. However for the case of the patient with breast cancer they were further screened for the development of the lymphodema.
- Bias
- One of the major biases of the research is the fact that some of the breast cancer survivors got information of the research and in turn adjusted their responses. In addition, since the study was conducted for over one year it is therefore evident that some of the material facts greatly changed.
- Outcomes
- Considering the research carried it is evident that the outcome of the research was objected and at the same precise. One important factor that led to success of the research is the fact that the research incorporated the concept of using doctors who were not aware of the research in selecting the name of the patients who were to be involved in the research.
- Reflective Summary
- During the course of this study I have been able to improve my knowledge in practicing evidence-based research. In this case I have been able to learn the various ways of analyzing the clinical data using the quantitative research method (Määttä, 2010). At first it was a bit hard to understand the various statistical data analysis methods used in the analysis of the data however with time I was able to understand some of these concepts. In relation to this research I have found out that it is important for one to ensure that he or she does not major so much on the bias in the study since it may lead to one discrediting a good study (Banning, 2005). In addition, choosing the topic has helped me to understand the effect of the quality of life on the breast cancer patient who have been diagnosed with the lymphedema
- Qualitative paper
- Text2
- Freitas-Silva, Renata, et al. Comparison of quality of life, satisfaction with surgery and shoulder- arm morbidity in breast cancer survivors submitted to breast- conserving therapy or mastectomy followed by immediate breast reconstruction. ‘Clinics65.8 (2010)
- The modified radical mastectomy has been one of the standard surgical treatments of breast cancer in most of the developed countries. This method has also been associated with negative consequence of the arm function and the occurrence of the lymphedema. Analyzing the title of this of study it is evident that the author sought to compare the quality of life of the satisfaction with surgery and the shoulder-arm morbidity among the breast cancer survivors. In this case the breast cancer survivors were either submitted to the breast-conserving therapy or the mastectomy followed by immediate breast reconstruction.
- Areas of strength in the research
- The researchers
- Analyzing the profile of the two researchers in the article it is evident that they have been previously in the study related to breast cancer. This therefore implies that there is a high chance that the date provided by the researchers is credible. Considering also their literature search it is evident that the two researchers worked hard to establish what other people had done in the field.
- Data collection
- The study involved convenient sampling method where the participants who were undergoing their routine check up at the Breast cancer outpatient department of the Universidad federal de Goi. The data from the medical records was also used. In addition, the survivors of the breast cancer were also invited. However this sampling method used by the researcher is also considered some analyst ineffective (Bruce& Stanistreet, 2008).
- Data analyses
- After the completion of the last interview the data analysis begun. Various qualitative analysis techniques were used to analyze the data collected. In this case the fisher’s exact test, student t test odd ratios and regression analysis were used to analyze the data. Out of the 75 patient who were included in the study 6.67% of the patient failed to turn to the interview. In addition, the data triangulation was used in the collection. Moreover the multidimensional questionnaire were also used in the data collection, this helped to provide a good basis of for data analysis. Most importantly the study was approved by the Breast Cancer Outpatient Department. This show indicate that the department had was contented with the data analysis method they had proposed to use in their study.
- Discussion
- According to the study there is a high level of similarities between the quality of life among the patient after the breast cancer treatment and the breast reconstruction therapies. In this case the satisfaction levels among the patient were also found to be similar. The study also indicated that the women exposed to the breast conserving therapy had a higher chance of developing random range of emotion restriction as compared to those who went through breast reconstruction surgeries. This research is also critical since it has helped to clarify the various contradicting information concerning the arm morbidity.
- Reflective commentary
- Analyzing this text it is evident that the text can help to improve the practice of providing care to the patient who are subjected to the breast cancer therapy. From the article it is evident that the nurses need to gather adequate information from the patient before deciding on the type of the care the patient should receive. The findings of this research are clear in the making of the comparison between surgery satisfaction level and shoulder-arm morbidity among the different breast cancer who underwent mastectomy and the breast reconstructions. Use of the various participant records and interview enhanced credibility of the result. However it is important to note that the study has some weakness since the sampling method that was used was did not sufficient information.
- Text three
- What is the evidence for practice?
- Considering what we had covered in the module I thought it was a good idea to investigate the role of evidence-based nursing in making decision. The main reason for engaging in the evidence-based practice is because I personally find it challenging to accept decision blindly. Although studies indicate that it might not be possible to provide evidence for every health care problem it is important for nurses to ensure to ensure that try to look for any evidence before making decision (Gerrish,et el 2012). The health care professional should engage on the research to help provide information that can be used in the making the decision. In relation it is important for the healthcare providers to critique the available information of the in to determine the validity of the information provided.
- Evidence based practice is important since it help to provide a variety of new and emerging ways of working with complex and conflicting values in medicine and health care. In the building and learning clinical skills, the value based practice add some approach to these concept that there is diversity in the individual values and in addition there is a need to incorporated of this diversity of the decision making (De Pedro-Gómez, et el 2012). According to the evidence based practice principle one must first try to indentify the knowledge gaps that are available in the analysis of the current literature. In order to analyze the research it is important for one to formulate the necessary questions needed to analyses the evidence. Application of the efficient literature finding can also help in analyzing the evidence. Most importantly the rule of evaluating the evidence should be applied.
- Reflective commentary
- This text help exploring the importance of the evidence based practice in decision-making. In this case it is possible to argue that the health care should ensure that they engage in research in order to be equipped with knowledge related to the patient care practices (Määttä, 2010). While conducting research it is important for the researchers to first indentify the knowledge gap that is available in the current literature. In addition it is important to critique the available information in order to determine its validity (Gerrish,et el 2012).
- Text four: decision-making
- The following is a scheme that shows the how the summarizes the evidence based research
- It is prudent to note that evidence does not make decisions but help patient care activities. Merging these three aspects into clinical decisions ensures the best clinical results. The EBP is elicited by the patient experience that raises questions about the therapy, the authenticity of the diagnosis tests, the prospects of the diseases or disorders etc. evidence based practices needs thorough literature understanding and analysis from the clinician.
- Steps to the evidence based practice
- Patient assessment by the clinician
- 1. The patient should be the starting point. This arouses many clinical questions that help in the patient care.
- Asking questions
- 2. the clinician constructs a well organized question based on the case
- Evidence acquisition
- 3. Identify the correct resources and conduct research.
- Evaluate the evidence for appropriateness
- 4. The evidence should be as close to the truth as possible based on the case.
- Actualization:
- 5. Combine evidence with the expertise and the patient likings and apply the whole by talking to the sick.
- Personal –evaluation
- 6. Reassess your performance with the patient to ensure it is to the best.
- The following are some of the clinical question: PICO
- Mnemonic of PICO helps the clinician to recall the constituents of a well-researched question. The components of the question need to be the Patient or the problem, Intervention or prognostic, comparison and the outcomes that need to be avoided in relation to the disease.
- Problem/patient—P
- Various characteristics of the patient are considered first. This may be inclusive of the problem like diseases, co-existence, sex, age etc. In addition it is important to also consider the patient primary information that may be related to the disease.
- Intervention,, or exposure—I
- This is question of what you want to do to the patient. For example prescribing drug or ordering for a test?. The intervention may also include determining the factors that influence the prognosis such as the age and co-existing problems among others.
- Comparison—C
- This involves exploring the available alternatives for the intervention? Here the clinician weighs whether there could be several options like comparing drugs or not prescribing any drug to the patient.
- Outcomes-- O
- Finally as the clinician you need to ask yourself at this point, questions like; what am I to do for the patient? Do I relieve the pain? Cure the disease or relieve of the symptoms?
- Another important aspect of evidence-based practice is the Type of questions and type of study.
- The most common types of questions include; Diagnosis, Therapy, Prognosis, Harm or Etiology
- Reflect commentary
- Considering the above outlined it is evident that the clinician need to ensure that they follow the above outlined steps in clinical decision-making. Analyzing the above question involved in decision making it is also evident that there is need for the health providers to ensure that they establish a good relationship with the patient. This can help to ensure that the patient is able to provide the clinician with all the necessary information needed in decision-making. Moreover it is also important to ensure that the patients are also given information related to the various risk factors, treatment options available (De Pedro-Gómez,et el 2012) From my study I also argue that there is need for the health provider to explain to the patients the various effects of the breast cancer has on their quality of life. Providing such information to the patient can help them to develop proper eating habit and therefore prevents some of these adverse side effects.
- Critical analysis of how this information will be used in practice to inform future
- decision making
- The breast surgery has various profound impacts on a woman body image (Alderman & Jagsi, 2010). Most of the women value the breast since it is associated with reproduction as well as the sexual appeal. Women who suffer breast cancer have to deal with the trauma of disfigurement as well as the fear that there is a chance that their partner may reject them. The breast cancers therapy has been known to change the body reality and the ideal. This may in turn affect the body presentation of the women. Various negative perceptions that the women who have undergone mastectomy may have include the dissatisfaction with their body appearance. The women may also find it in appropriate that they have surgical scars on their body. In addition most of the women also become reluctant to see their own naked bodies. The major negative impact of the breast cancer mastectomy is the fact that it can lead to feeling of diminished sexual attractiveness among the affected women.
- The qualitative paper studied establish that mastectomy has affects the quality of the patient. My role in this is to analyze the evident that is presented in the study and how it can be used to make decision in life. In this case I begin by analyzing the authors who conducted this research in order to establish whether the data they have presented is credible. However, in this case it is evident that there is a chance that the researchers conducted a credible research since they have previously conducted research related to breast cancer.
- Moreover another major aspect that shows that the research was credible is the fact the research was approved by the Breast Cancers Outpatient Department of the Universidade federal de Goias, Goiania Brazil where the study. This implies that the doctors in these department believed that the research would help in contributing the already available knowledge on the effect of the breast cancer mastectomy on the quality of life of the patients. Analyzing the study finding it is also evident that the result were credible since the scientific method were used to obtain the hemodynamic parameter were used to where the data on surgery admission was collected. In addition, the article was first reviewed in 2010 after which it was accepted for publication in the same year. This acceptance indicates that various bodies were satisfied with the research finding in the report and hence they were able to authorize publication of the article.
- From what we have covered in the module, I have been able to learn that there is need to critique the study in order to establish whether the finding in the study is credible. This skill will help me in among other to develop toward becoming evidence-based practitioners (Gerrish,et el 2011). The critique appraisal paper that I have provided will help in addition of information to the present knowledge on the effect of the quality of life after the patient has undergone mastectomy. In this case I will not add extra information beside what is presented in the article, however I will critique the study basing on the methods that others researchers have used to critique the study. I therefore feel confident the ideas that I will present to my colleague will help to contribute to the already available information on the effect mastectomy on the quality of life of an individual.
- Considering the data and the study methods applied in the research it is evident that the peer education is needed on the patient who have undergone mastectomy. This is to help in improving the quality of life of these patients. There were no significant changes in the quality of life among the patient in the control group. Mastectomy affected the patient in terms of their general health, psychological functions, socials function. In this case therefore I present an argument that psychological intervention during the patient treatment of breast cancer using mastectomy technique can help to ensure that the patients leads a positive life. The main reason for concentrating on the psychological aspect of the patient is because it can help to improve other aspect in the patient life.
- Many women who have undergone mastectomy need to be encouraged to join support group. This can help them to cope up with their illness. According to a research carried out by Till (2003) the support group can help to play a critical role in improving the life of the women with breast cancer (Bernardi,et el 2008). In relation to this a study carried out by Ganzel (2000) showed that the body image, sexual function, satisfaction in the sexual performance greatly improve when women are introduced to various support groups (Fadaei, et el 2011) This intervention can help to ensure that women are able to freely talk about their sexual concerns in group and therefore they are able to improve on their quality of life.
- Another important point to note is that the women is that the women who want to undertake the surgical management of the breast cancers need to be provided with information on how it can affect the quality of their life (Gui,2009). In this case the information should be provided with these information early enough to enable them to make informed decisions regarding the suitability of the method regarding the cancer treatment. Providing information to the patient regarding the possible effect of mastectomy on their quality of life can help to prepare them psychologically early enough to deal with these problems. The information on the effect of the effect of the mastectomy on the quality of life of the patient can also find a considerable application in other areas such guiding the policy makers, patient advocates or the professional’s society ( Bernardi,et el 2005). This is because they can use such information to improve on the quality of life of the patient.
- Having gone through the study I have therefore been able to appreciate the role of questionnaire in collecting information from the patient. In this case, therefore it is important for the surgeons to ensure that they collect information from the patient regarding their quality of life after mastectomy. This can help to provide more information regarding the effect of mastectomy on the patient quality of life. In addition the use of questionnaires to the patient can help to improve communication with the patient therefore allowing the physician to be more effective in addressing the specific issues related to the patient’s quality of life.
- In my conclusion I propose that considering the above study it is evident that the clinician need to ensure that they provide the women-undergoing mastectomy with information related to the effect the it may have on the quality of life. This can help to ensure that these women take informed decision regarding the method to use in the treatment of the breast cancers. he women who have undergone mastectomy also need to be encouraged to join various support groups. These support groups can help deal with the psychological, social problems that women face. Most importantly having gone through this study I have been able to appreciate the role of evidence-based practice in making clinical decision.
- Reference
- Alderman, A., & Jagsi, R. (2010). Discussion: Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications. Breast Cancer Research And Treatment, 121(3), 635-637
- Banning, M. (2005). Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers' views. Journal Of Clinical Nursing, 14(4), 411-41
- Bernardi, D., Errante, D., Galligioni, E., Crivellari, D., Bianco, A., Salvagno, L., & Fentiman, I. S. (2008). Treatment of breast cancer in older women. Acta Oncologica, 47(2),
- Bruce, N., Pope, D., & Stanistreet, D. (2008). Quantitative methods for health research: A practical interactive guide to epidemiology and statistics. Chichester, England: John Wiley & Sons.
- De Pedro-Gómez, ,., Morales-Asencio, J., Bennasar-Veny, M., Artigues-Vives, G., Perelló- Campaner, C., & Gómez-Picard, P. (2012). Determining factors in evidence-based c linical practice among hospital and primary care nursing staff. Journal Of Advanced Nursing, 68(2), 452-459. doi:
- Fadaei, S., Janighorban, M., Mehrabi, T., Ahmad Ahmadi, S., Mokaryan, F., & Gukizade, A. (2011). Effects of cognitive behavioral counseling on body Image following mastectomy . Journal Of Research In Medical Sciences,
- Gerrish, K., McDonnell, A., Nolan, M., Guillaume, L., Kirshbaum, M., & Tod, A. (2011). The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal Of Advanced Nursing, 67(9), 2004-2014.
- Gerrish, K., McDonnell, A., Nolan, M., Guillaume, L., Kirshbaum, M., & Tod, A. (2011). The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal Of Advanced Nursing, 67(9), 2004-2014.
- Gui, G. (2009). Health-related quality of life assessment after breast reconstruction. Advances In Breast Cancer, 6(4), 16.
- Määttä, S. (2010). Clinical librarians as facilitators of nurses' evidence-based practice S Määttä and G Wallmyr Evidence-based nursing practice. Journal Of Clinical Nursing, 19(23/24), 3427-3434
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