Critical Awareness of Evidence Based PracticeI have worked on a ward for nearly 29 years prior to my latest role. Evidence based practice has been the driving force for improved patient care with Health care organisations all across the globe. It is working towards the improvement of services to ensure the positive development of patient care and ultimately the service outcomes (Gifford et al., 2013). However, my actual involvement proactively within this process has been limited up until recently. I am aware that I do have a responsibility to stay up to-date with relevant evidence based research and abiding by the professional standards of practice outlined in the NMC (2018). I a appreciate that these standards serve a puripose and also a level of accountability. I have welcomed this learning outcome to allow me to get involved with the process and gain insight and the skills involved with evidence based practice within my role and my work place. In my new role, it plays it part for service improvement. It is my obligation and responsibility to keep up my skills and knowledge especially as standards are continually changing and evolving (Brown, 2017).However, the process is one that has to be understood to provide a suitable conclusion to proceed with a change of practice. In my case, I explored the steps of evidence based practice (Evidence A) by using a mind map and a summary (Evidence B). By breaking down the process into steps this helped me to organise my approach. The first part was designing my question and then leading onto what was needed to be done to achieve the desired outcome. Of course, with most things barriers did emerge and lack of knowledge of the process was my first. The creation of a suitable question was a challenge as my desired query was a quite focused but whilst exploring the literature I found th relevant material I required was not in abundance which led me to the conclusion I needed to broaden my question parameters. Was this useful for what I had orginally intended? Yes, I think so purely because the service change I had in mind was made up of many elements which I had not given due consideration to prior to starting my search. Once I had decided on my topic the next element was to make sense of the literature. Learning Outcome 2. Literature ReviewThe ability to review, and to report on relevant literature is a key academic skill. It is an understanding, interpretation, analysis, clarity of thought, synthesis, and development of argument. The process of conducting and reporting your literature review can help you clarify your own thoughts about your study. It can also establish a framework within which to present and analyse the findings.After writing my literature review (Evidence C), I was more aware of the up-to-date relevant work of others and that the research questions I devised were actually very relevant. I am acutely aware that my research will not instantly solve a problem or change practice right at this moment as a more realistic view is that it will address a gap more then fill one! This part of the module was interesting and challenging at the same time. On a negative, the time spent trying to find relavent evidence was enormous and at times demoralising. The whole process of using keywords that were relevant and sifting through many articles that had little associatioin with my question. From further reading, I found that it was easy to go off on a tangent from my original question but as mentioned previously this was not time wasted as usefull information was gained. Carrying out the literature review I found the support from Diana Ridley “ The Literature Review” (2012). This was a new skill to master and her comprehensive approach gave me a suitable framework to use. In regards to the literature, I did find it was all qualitive and it was quite evident that due to the nature of my topic the information required was not of a quantative value. Also during my research, it became very apparent how little evidence was UK based. The major articles and research were mainly from Australia and Denmark and I can only conclude that they have more finance and funding towards pancreatic cancer than here in the UK. The whole process of the literature was quite involved and the challenge of sifting through the evidence to create relevant themes was very time consuming and sometimes quite overwhelming with data overload. I did find this part of the module very difficult to complete, but once I organised myself and reasoned out what I wanted to know it became clearer. Learning Outcome 3. SBAR I have been used to using an SBAR within the ward area and in all honesty did not consider using it elsewhere for communication purposes. I have learned since delving deeper into the SBAR’s purpose that it is a great tool for getting any information across to many different people in many different roles and situations. It is because of it’s universal nature it has given me a platform to give weight to my project for setting up guidelines for the safe discharge of my patient group. To enable my idea to be put into practice I would need to communicate it to a number of people who are involved in the discharge process. This SABR (Evidence D) allows me to exchange information and promote my recommendations to all levels within my work area. I would normally feel very uncomfortable in these situations partly due to me feeling inexperienced and also communicating with someone more senior than myself. SBAR demonstrates that I have formulated my thinking and also the receiver knows what to expect. The SBAR also allowed me to improve my critical thinking skills as I have had to assess the situation and consider a suitable solution and this was concluded in a study (Hughes 2008). Also from this study I have to agree to the improved sense of promoting autonomy within my role. I understand that I must act as a leader, coordinating care with multidisciplinary teams contributing to the a collaboration of care (Crowell, 2015). One of the elements with the SBAR is the detailed description of the Background or the long term problem in simple terms. Part of my role was to be involved with an annual business meeting for our department where we up date the fellow multidisciplinary team members of our service and any new service changes. I was one of the main speakers and presented a powerpoint to briefly explain the situation regarding the pancreatic cancer patient group and the proposal I had for improving discharge for them. Although feeling intimidated at first, once I got talking and explaining the problem there was signs of support from my peers and senior management. This was encouraging and I did learn that getting sufficient facts presented well does have a positive impact on getting support.Learning Outcome 4. Discharge Guidelines ProposalFrom using the evidence from the literature review I also used the documentation within my own work area that was not being properly incorporated to create a starting point for a discharge package from pancreatic cancer patieints. On my exploration of possible existing templates and documentation, I was able to compile a draft package for further discussion and peer review for modification in the future. (Evidence F). A Discharge Summary from Macmillan was already available but not implemented at all in my hospital and a discharge protocol devised from that needed modifying. As mentioned in the previous learning outcome, to get stakeholders interested and to potentially support this practice change I took the opportunity to present a short power point presentation at our annual business meeting. This was valuable moment as there was a captive audience of influential people that would have an impact for supporting this change. I needed to get across to them the route I was taking by using evidence based practice to give credibility to my actions and my objective to improve discharge planning.Learning Outcome 5. CASPAs a nurse I am highly aware of the need to maintain my professional knowledge and competence by using current evidence, best practice and where applicable, validating research to deliver (Nursing and Midwifery Council 2018). I am aware from completing my first module that I write too descriptively and I have a desire to move towards a more critical style of writing. I know that I lack high level critical analysis and recognise the need to question everything I read and write. By using the CASP framework it gave me a structured approach and this has helped me analyse the evidence whilst being able to remain objective. I have learned that critiquing must be an impersonal evaluation and to avoid having confirmation bias, which is the tendancy to process information by looking for, or interpretating information that is consistent with one’s existing beliefs (Casad 2016). I have been aware that sometimes I do give more weight to information that supports my belief than is warranted by the evidence so by using CASP it steers me in the right direction to analyse the evidence in an objective manner. This is my first time to review a paper and using CASP and it has forced me into asking the “so what?” and “what now?” (Borton, 1970).As time goes on and the more appraisals I do the more comfortable I will become and more critical of the evidence I use.
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