Chloe EBP essay G (2)

Evidence Based PracticeIntroductionThroughout this essay I will be assessing and evaluating the methodological quality of two articles which focus on the attendance of cervical cancer screening. The topic became an interest of mine while I was on placement with the district nursing team. I came across a patient who was not going to attend her screening as she is a wheelchair user and would be unable to get onto the couch without the use of a hoist. We were able to help with this by arranging for the practice nurse to visit her at home to carry out the test. Around this time there was also a lot of media publicity emphasising the decrease in the number of attendants for screening, which was currently at the lowest it had been for 20 years. A television advertisement was launched to help raise awareness of the importance of screening. The test is a relatively simple intervention which is able to save lives by detecting abnormal cells long before they become cancerous. Given the benefits, I was curious as to the reasons why women do not attend, and if there was anything that nurses working in the community could do to improve the situation. I would personally like to learn more about this topic so that I am able to provide relevant information and advice and encourage women to take up the opportunity of being screened.PICO ToolI developed my question: ‘What are the barriers in the participation of cervical screening’ by using the PICO Tool; a format for developing a good clinical research question prior to starting one’s research. (Yale University’s Cushing/Whitney Medical Library) states that “PICO is a mnemonic used to describe the four elements of a sound clinical foreground question:”Patient/Population – Women aged between 25 and 64 who do not routinely attend their cervical smear test.Intervention – Have the knowledge and understanding of the different barriers people face when attending a cervical smear test and be able to encourage change in practice to address these issues.Comparison – Women who routinely attend their cervical smear testOutcome – An increased number of women to regularly attend their cervical smear test. Evidence Based Practice & The NMC CodeThere are many definitions of Evidence Based Practice (EBP). One definition was introduced by The Joint Commission International’s (2010) which appears in NHS England’s Information Standard ‘Finding the Evidence’ (2013). It gives a clear explanation of how research, clinical expertise and patient choice fit together to enable evidence based practice to work effectively:“Evidence-based practice has been defined as an approach to providing care to patients that involves the use of clinical research combined with clinical experience, patient characteristics, and patient preferences to make clinical decisions regarding treatment and management.” (Joint Commission International 2010). Evidence based practice can have benefits for patients and their families, nurses and other health care professionals. The aim of evidence based practice is to improve the quality of care for patients. This, in turn, can lead to better outcomes and help to reduce deterioration in those with chronic conditions.Incorporating evidence based practice throughout a nurse’s education and clinical experiences develops more advanced critical thinking and decision-making skills. Nurses are better able to adapt to situations, utilise informatics and work in interdisciplinary teams. They feel a greater sense of confidence and pride in their work.Evidence based practice also reduces health care costs as it introduces new ways of working in line with up to date and lower costs of care. Roughly one in four Americans are living with multiple chronic illnesses and the cost of caring for these patients can often be substantial. Using EBP’s patient-cantered approach may help eliminate unnecessary costs linked to treating chronically ill patients as well as reduce expenses for healthier patients, too.By promoting evidence based practice, nurses can adhere to the latest standards set out by The Nursing and Midwifery Council (NMC) Code of Conduct (2018) in order to remain on the register and practise in the UK. The standards are based around 4 themes, which are to:Prioritise people – the heavy focus on raising the overall quality of care may lead to improved outcomes and health for patients. It promotes consistent clinical recommendations for patient to follow. Using the most current healthcare research can help minimise complications associated with chronic illness and prevent additional illness or disease. Practise effectively – deliver care without too much delay and to the best of your knowledge, based on the best evidence currently available. Continuously reflect and improve practice through up to date training and research to eliminate practices that have become obsolete.Preserve safety – health care professionals should be aware of the latest scientific knowledge and technologies, and apply their research findings into practice to ensure the quality of care is effective and safe. Examples include evidence to prevent falls, reduce infection rate, and reduce pressure ulcers. Promote professionalism and trust –having expert, evidence-based knowledge from research will allow nurses to provide care, information and advice to patients confidently, which they will be more likely to listen and adhere to as it is proven to be accurate, reliable and trustworthy. Search Strategy The CINAHL database was used when searching for the articles. It is defined by… http://www.napavalley.edu/Library/Documents/CinahlGuide.pdf as “the largest and most-in-depth database used to view journal articles about nursing, allied health, biomedicine and healthcare.” As part of my search strategy, the following key terms were used to identify articles of particular relevance to my question: smear test OR cervical cancer screening OR PAP test AND ‘ barriers’ ‘did not attend’ or ‘failure to show’. This generated 4036 results. The publication date was narrowed from 2013 – 2019 to ensure that the articles are relevant to current practice. This produced 2097 results. The source type was applied to convey academic journals only, resulting in 1375 results. Further restrictions were made by refining Age (all adults) and Gender (female), producing 775 results. The articles were also refined to have full text available, references available and abstract available. By applying a systematic and controlled method to my search, the final number of articles listed were 17, of which I chose 2 out of.Critically Appraising The ArticlesH Kitchener’s research article titled ‘A cluster randomised trial of strategies to increase uptake amongst young women invited for their first cervical screen: The strategic trial’ was chosen as it is a randomised controlled trial. REFERENCE This ranks high on the Hierarchy of Evidence Pyramid. REFERence certain research methodologies produce better quality evidence than others. Some methodologies are considered more reliable than others.In the pyramid, the higher the methodology the more reliable it is considered to be. The evidence is considered to have less bias, and the results are more generalisble – which means they can be applied to more peopleuses a quantitative research design throughout, REFERENCE therefore Coughlan, M (2007)‘guidelines for critiquing a quantitative research study’ will be used as an appraisal tool. Elements Influencing the Believability of the Research:Report Titlearticle title captures the reader’s attention by including ‘randomised trial’ in the first line, as this is known to be a ‘gold standard tool’ used in studies. It is 21 words, which is slightly longer than the recommended 10-15 words for an article title. REFERENCE. However it is clear, unambiguous and accurately conveys the purpose of the study. Article title Abstract … abstract offers a clear, succinct overview of the research study. The information provided within the abstract is straight to the point and offers the reader a detailed description of what the researchers set out to achieve. It details the sample sizes and the methods undertaken by the study and how/why the participants were chosen. The brief conclusion that is provided is of a good standard and shows what the researchers found after conducting their study. The way in which this particular abstract is written makes it much easier to get to the point of the study on a whole, in that there is no unnecessary information provided. AuthorsAll of the authors involved in the study have a knowledgeable background around women’s health. The senior author, Henry Kitchener, is a research scientist at the Institute of Cancer Sciences based at The University of Manchester. He designed and approved the protocols in the study and has previously carried out many other research studies, including more around cervical screening. Author Emma Crosbie worked closely with Kitchener to conduct the research. She is a gynaecology cancer surgeon who has also previously taken part in other research based on screening and prevention of gynaecological cancers. This indicates that both authors have expertise knowledge and qualification in this field which increases the credibility of the research.It could be argued that there may be some bias in the research, due to Crosbie’s role as the executive scientific editor for the British Journal of Obstetrics and Gynaecology. There could possibly be conflict of interest in Kitchener’s position, too, as he is the Chair of the Advisory Committee for Cervical Screening. However it states in the article that “views expressed here are those of the author and not those of Public Health England.” ?Writing Style? article appears to be well written. It is concise and well organised, making it easy for the reader to follow. It is grammatically correct and avoids the use of jargon. Tables and figures used APA formatWritten appropriate for the target audience? > other professionals?Elements Influencing the Robustness of the Research:PurposeThe purpose of the study is clearly identified – reasoning for prompting conduct of researchWithin the literature the author states… goals / hypothesis / aimsLiterature ReviewPrimary empirical dataStrong introduction that justifies the research question and raises an interest about the study. Previous research done? – topic basedIs author making assumptions / supported with previous researchMethod section > accurate ? variables menthioned?Theoretical FrameworkAimsThe objective is clearly stated and reflects the information presented in the literature review. hypothesized that a facility to book an appointment for a cervical screen online would fit better with the current habits of young women.Sample Has the target population been identified? How was the sample selected? Was it a probability or non prob sample? Is it of adequate size? Are there any inclusion/ exclusion criteria? Was randomisation successful Randomisation done properly? – minimise allocation biasThe baseline characteristics of the participants in the control group and…Balanced distribution of baseline characteristics as it has used a random sequence method to allocate patients in the controlled group. Was it concealed from researchers and participants– can not foresee the assignment of participants.If not ^ this is known as selection bias if randomisation was not adequately concealed eg there are systematic differences between the groups compared were similar – minimise confounding biasWere the 2 groups similar at baseline with respect to important confounders – minimise confounding biasWere they treated equally apart from intervention – was it blind? How was it assessed? – information biasInternal validity of the study appears to be high– extent to which it is free from biasEthical ConsiderationsCarried out ethically? Were participants fully informed about the nature of research? Was autonomy / confidentiality guaranteed to participants?MethodologyIs the research design clearly identified? – Experimental, randomised control trial study – this is backed up by Pragmatic RCT narrow exclusion criteria – greater generalised ability to clinical practise – greater external validityIt is clear to identify that the author used a quantitative research design for the study as they have included… Data AnalysisWhat type of data and statistical analysis was undertaken? Was it appropriate? How many of the sample participated? Significance of the findings? were drop outs included in final analysis – minimise attrition bias. Intention To Treat (ITT) Analysis was used – always analysed once randomised. Even those that disconnected from study?DiscussionAre the findings linked back to the literature review? Were the strengths and limitations of the study discussed? Was a recommendation for further search made? Could they have done anything differently? ReferencesWas all material cited accurately that were used as part of the study?Were all the books, journals and other media accurately referenced?ConclusionAfter evaluating the evidence of both articles. Article Articledid article answer q? what have you learnt? How could it improve practice? Relevant recommendations? Did it draw any fundamental conclusion that could influence practice? Was the validity, believability and reliability of the resource good or questionable summarise key points in relation to your question and reflect on how your findings relate to practiceReference List

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