Evidence-Based Practice in Healthcare: Management of Sickle Cell Disease

This essay examines two evidence-based and peer-reviewed journals on the management of sickle cell disease with an objective of determining the most appropriate and well-researched interventions. The first journal is a qualitative study exploring the different types of strategies adopted by adult patients diagnosed with SCD to attain optimal physical health. The second journal is a cross-sectional quantitative survey that aims to assess the factors related to the use of complementary and alternative medicine (CAM) among adults diagnosed with SCD in a university.

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Introduction
Evidence-based practice in health and social care is a process in which the practitioner pools
together evidence-based interventions with clinical experiences and ethics, in addition to the
preferences of the clients and culture as a guide for diagnosis and provision of treatment
services. This essay examines two evidence-based and peer-reviewed journals on the
management of sickle cell disease with an objective of determining the most appropriate and
well-researched interventions. A brief background on existing research and the prevalence of
the disease is also provided to provide more insight into the relevance of the topic of the
essay.
Background
Sickle cell disease (SCD) is related to severe comorbidities leading to a shortened lifespan
with low-quality life and sometimes with renal failure (Panepinto and Bonner, 2012).
Additionally, Brandow, Farley and Panepinto (2014) found out that majority of the SCD
patients experience frequent pain episodes and are usually placed on routine dialysis.
However, SCD is often managed in outpatient settings and do not often require
hospitalization. But there is a dearth of information on the most appropriate strategies for
self-management of SCD, hence the need for the research.
Evidence-based practice (EBP) is the integration of clinical proficiency, patient values, and
the most appropriate evidence into the process of decision making for effective patient care.
EBP obtains evidence from either quantitative or qualitative research or both. Quantitative
research is a type of research used to quantify the matter under study generating numerical
data to be transformed into a meaningful statistic. On the other hand, qualitative research is

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exploratory research used to acquire an insight into the underlying reasons, views, and
interests in a given phenomenon (Creswell and Creswell, 2017).
Journal one
The qualitative study by Tanabe et al. (2010) purposes to explore the different types of
strategies adopted by adult patients diagnosed with SCD to attain optimal physical health.
The journal has a clear purpose for the study but no stated aim and objectives. The study was
undertaken by Tanabe, Porter, Creary, Kirkwood, Miller, Ahmed-Williams, and Hassell after
being receiving financial aid from the Sickle Cell Adult Provider Network. The National
Institutes of Health offered financial support to Dr Tanabe, while a grant was given to Dr
Porter by the Agency for Healthcare Quality and Research. The main type of research method
used in the study is the grounded theory making use of the constant comparative approach.
The approach is appropriate for the study because it is usually applicable in instances where
there is little information regarding the topic of research (Fraenkel, Wallen, and Hyun, 2011).
The study doesn’t have a critical review of relevant literature except for some few references
in the introduction part. This compromises the quality of the study because it has no basis
upon which it is conducted and therefore no research gap to be filled (Dunne, 2011). The
sample participants included 7 clients with SCD and one social worker. Purposive sampling
was used to select the respondents who were attendees of a workshop dubbed “best self-
management practices for SCD” organized by the Sickle Cell Adult Provider Network
(SCAPN). A brief survey was conducted on their demographics and data related to self-
management practices collected at the end of the panel member discussion using audiotaped
digital recorders. The tape recording was most appropriate for the study because it provides
the most accurate summary of the interview in addition to the researcher’s comments for

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reference. Moreover, it allows the researchers to repeatedly listen to the recording for
purposes of clarity and the direct quotes can be included in the research report, thus
increasing the credibility of the research report (Tessier, 2012).
There are different pieces of evidence of reliability and validity in the study. Researcher bias
was minimized by allowing only the committee members and not the researchers to select the
presenters and topics for the workshop. Noble and Smith (2015) observe that the validity of
qualitative research is often threatened by researcher bias, thus minimizing it in the study
increased the validity of the research. Interrater reliability was also achieved by ensuring that
the principal investigator and a research fellow who were not privy the research conducted an
independent review of most of the transcripts. Furthermore, the constant comparative method
was used to assess the interrater reliability among the researchers and found to be 59%.
Drost (2011) observes that the interrater reliability is significant in research because it shows
the level of external consistency in the collected data that improving the reliability of the
findings upon which the study is based. Member checking was also undertaken to examine
the validity of emergent themes.
The study found out that eight major strategies were used by the participants in managing
SCD with self-awareness having the highest frequency and more emphasis on journaling and
body awareness. The other strategies include self-awareness, diet, education, and alternative
medication and success factors. The study outcomes have been stated clearly under themes
and sub-themes in addition to a table summary with selected quotes showing the emergent
themes. The limitations acknowledged in the study includes the impossibility of audio
recording the audience involvement in the discussion, which could have provided in-depth
information. The ethical issues addressed in the study is that the researchers obtained
informed consent from participants before audio recording the interview.

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The researchers also link theory with practice in the discussion section by comparing the
findings with previous studies. However, the study doesn’t have a conclusion and does not
provide recommendations for changing practice except for the emphasis on the emerging
themes supported by previous literature. The report indicates the need for further research in
assessing the hindrances to self-care management among patients with SCD and examining
motivation and self-efficacy.
Journal two
Introduction
Sickle cell disease is commonly known for its irregular pain episodes of erratic intensities.
SCD is characteristic of distinct pain which poses a serious challenge to patients, families and
healthcare providers (Thompson and Eriator, 2014). As a result it distorts ones comfort and
effectiveness at work, school, and in social interactions (Panepinto and Bonner, 2012). The
most common cause of hospitalizations among SCD patients was the frequent pain episodes
(Ballas, Gupta and Graves, 2012). Thus, there is need for more research into the
complementary and alternative medicine for managing the pain.
The focus of the study by Thompson and Eriator (2014) is to ascertain the factors that
influence the use of complementary and alternative medicine (CAM) among SCD patients.
The research clearly indicates that it aims to assess the factors related to the use of CAM
among adults diagnosed with SCD in a university. The study was undertaken by Thompson
and Eriator and funded by the authors themselves since the article doesn’t disclose any
external source of funding. Additionally, the study is a cross-sectional quantitative survey.
The authors have undertaken a relatively comprehensive literature review under the
introduction section. Several previous references on relevant literature have also been

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provided thus making the review comprehensively critical. The study sample consisted of
African American adults diagnosed with SCD and had been encountering pain for the past six
months. Sample selection was done by invitation to the study and the use of selection criteria
to the inclusion of qualified participants into the study. A sample size of 227 patients was
included in the study.
Data collection was achieved by the use of a three-page survey questionnaire. Then the dully
filled questionnaires were given back to the principal researcher. The use of questionnaires
for data collection was appropriate in the context of the study because it allows a researcher
to gather data from a relatively large sample in an efficient and economical way. Moreover, it
provides quantifiable feedbacks for the research title and thus making analysis easier
(Creswell and Creswell, 2017). The research also contains pieces of evidence of reliability
and validity. For instance, the data collection instrument was tested for reliability using the
Cronbach’s alpha coefficient which was found to be more than 0.80. Furthermore, the
questionnaire was tested for content validity during the pilot test by professionals in the field.
The authors found out that 92% of the respondents had encountered pain for the past six
months to two years. 91.6% of the participants consented to have used CAM for the past six
months to manage pain. The use of CAMs was higher in the unmarried, females, the educated
and among those with improved household income. These outcomes have clearly been
presented with detailed explanations for each of them under different themes. Moreover,
summary tables have also been used to provide a clear visual display of the outcomes and for
easy comparison and analysis (Creswell and Creswell, 2017).
The authors have also acknowledged multiple limitations to the study. For instance, the
research did not assess the possible causes for the use of CAM by the patients and whether

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they will continue to use them in the near future. Additionally, the report acknowledges that
the study relied on self-reported information which might be a true reflection of the reality.
The study was also limited to university set-up thus limiting its generalization to other
settings such as in the community. Ethical considerations have also been considered in the
research. For instance, informed consent was first obtained from the participants prior to the
investigation, and the Institutional Review Board approved the study protocol.
The authors have connected theory with practice in the discussion section. For instance, the
study first reports its findings and compares them with those of other researchers. A classic
example is that the study found out that prayer to be the most prevalent CAM therapy used to
control instances of pain in SCD patients and to relieve stress. These findings have been
backed up by those of White, Peters, and Schim (2011). The conclusion has also been linked
to the study aims. The study aimed at assessing the factors related to the use of CAM among
adults diagnosed with SCD. Similarly, the authors conclude that SCD patients found some of
the CAM strategies to be more effective with most of the user being females, the educated,
and those with better household income.
Suggestions for changing practice have also been provided in the conclusion section. The
Research recommends increased awareness among the healthcare professionals on the CAM
practices because the SCD patients use them alongside standard medical therapy. However,
the study does not expressly indicate the need for future research.
Pieces of evidence in both journal articles examined in this essay are likely to significantly
improve clinical practice. Both studies indicate that self-care management of sickle cell
disease is highly prevalent among patients and therefore, the healthcare professionals should

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improve their services by familiarising themselves with the complementary and alternative
strategies for SCD.
Conclusion
Sickle cell disease is a significant public health problem in the world and the patients undergo
severe pain more often prompting them to look for effective and efficient alternatives to
relieve pain instead of being hospitalised. The essay shows that majority of the patients with
sickle cell disease live with severe pain on a daily basis and employ a variety of self-care
approaches to relieve pain and live a quality life. Some of the SCD patients combine the use
of alternative medications with standard procedures thus prompting the need for healthcare
experts to familiarise themselves with the complementary and alternative strategies for
managing SCD. Both pieces of research are useful in practice because they both underscore
the fact that self-care management strategies are prevalent among SCD patients and thus
demand more attention by healthcare experts.

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References
Ballas, S.K., Gupta, K. and Adams-Graves, P., 2012. Sickle cell pain: a critical
reappraisal. Blood, 120(18), pp.3647-3656.
Brandow, A.M., Farley, R.A. and Panepinto, J.A., 2014. Neuropathic pain in patients with
sickle cell disease. Pediatric blood & cancer, 61(3), pp.512-517.
Creswell, J.W. and Creswell, J.D., 2017. Research design: Qualitative, quantitative, and
mixed methods approaches. 6th ed. California: Sage publications.
Drost, E.A., 2011. Validity and reliability in social science research. Education Research and
perspectives, 38(1), pp.105 -120.
Dunne, C., 2011. The place of the literature review in grounded theory
research. International journal of social research methodology, 14(2), pp.111-124.
Fraenkel, J.R., Wallen, N.E. and Hyun, H.H., 2011. How to design and evaluate research in
education. 8th ed. New York: McGraw-Hill Humanities/Social Sciences/Languages.
Noble, H. and Smith, J., 2015. Issues of validity and reliability in qualitative
research. Evidence-based nursing, 18(2), pp.34-35.
Panepinto, J.A. and Bonner, M., 2012. Health‐related quality of life in sickle cell disease:
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Tanabe, P., Porter, J., Creary, M., Kirkwood, E., Miller, S., Ahmed-Williams, E. and Hassell,
K., 2010. A qualitative analysis of best self-management practices: sickle cell
disease. Journal of the National Medical Association, 102(11), pp.1033-1041.
Tessier, S., 2012. From field notes, to transcripts, to tape recordings: Evolution or
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Thompson, W.E. and Eriator, I., 2014. Pain control in sickle cell disease patients: use of
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White, M.L., Peters, R. and Schim, S.M., 2011. Spirituality and spiritual self-care: expanding
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