Evidence-Based Practice Report: Analysis of Healthcare Practices

This report provides a comprehensive overview of evidence-based practices (EBP) in healthcare, focusing on nursing perspectives and the importance of research in improving patient outcomes. It delves into various levels and types of evidence, emphasizing the significance of EBP in healthcare settings. The report analyzes barriers to the implementation of EBP, such as lack of knowledge, time constraints, and organizational support. It also demonstrates an understanding of the research process, including knowledge transfer strategies. Furthermore, the report critiques two articles, one on burnout and another on palliative care, correctly identifying the type of evidence used in each. The methodology section outlines the research design, data collection methods, sampling approaches, and analytical techniques employed in the studies. The conclusion summarizes the key findings and implications of EBP in healthcare, highlighting the need for continued research and implementation to enhance patient care and safety.

Running Head: EVIDENCE BASED PRACTICE 1
EVIDENCE BASED PRACTICE
AUTHOR’S NAME
UNIVERSIT OF AFFILIATION

EVIDENCE BASED PRACTICE 2
Table of Contents
1.0 Introduction--------------------------------------------------------------------------------------------------------------------3
1.1.1 Levels of evidence------------------------------------------------------------------------------------------------------4
1.1.2 Types of evidence---------------------------------------------------------------------------------------------------4
1.1.3 Importance of evidence for practice.'------------------------------------------------------------------------6
1.2 Barriers to implementation of evidence--------------------------------------------------------------------7
1.3Demonstrates awareness of research process----------------------------------------------------------7
2.0Provides a critique of two articles correctly identifying the type of evidence---------------------------------8
2.1.1Burnout article----------------------------------------------------------------------------------------------------------- 8
2.1.2 Palliative care article---------------------------------------------------------------------------------------------------8
3.0 Methodology-------------------------------------------------------------------------------------------------------------------9
3.1The research design-------------------------------------------------------------------------------------------------------9
3.2Data collection.---------------------------------------------------------------------------------------------------------------- 9
3.2.1Palliative care article----------------------------------------------------------------------------------------------------9
3.2.2 Burnout article---------------------------------------------------------------------------------------------------------10
3.3Sampling method------------------------------------------------------------------------------------------------------------10
3.3.1 Palliative care article-------------------------------------------------------------------------------------------------10
3.3.2Burnout article----------------------------------------------------------------------------------------------------------10
3.4Approach to analysis--------------------------------------------------------------------------------------------------------11
4.0CONCLUSION------------------------------------------------------------------------------------------------------------------11
References-------------------------------------------------------------------------------------------------------------------------12
Bibliography-----------------------------------------------------------------------------------------------------------------------14

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1.0 Introduction
Evidence-based practices are practices in health that are not regularly provided in care delivery.
However, the practices are available for a number of illnesses such as heart failure, asthma, and
diabetes. The patient safety research has put a lot of emphasis on analysis of data to identify the
issues regarding patients and demonstration of how the new practice will lead to improvement in
patient safety and improved quality. Nevertheless, less attention has been paid to how these
practices will be implemented. Implementation of evidence practices requires strategy since they
are complex hence the strategy should address the complexity of individual practitioners, top;
leadership and care systems, ultimately changing to be evidence-based practice. Nursing has a
great history of utilizing research in practices. The profession of nursing has provided great
leadership for care improvement through the application of the findings in research (Clancy et
al., 2006). The evidence-based practice is the judicious and conscientious use of best evidence in
aggregation with clinical know-how and patient values to guide health care decisions. Best
evidence practices comprise of the empirical evidence from randomized controlled trials,
evidence of other scientific methods such as qualitative and descriptive research. After enough
evidence is gathered the practice should then be guided by research evidence in conjunction with
clinical know-how and patient values. In some situation whereby the research base is not

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sufficient and available, decision making by the health care is derived from the non-research
evidence sources such as scientific principles (Titler, Kleiber and Steelman, 2017).
1.1.1 Levels of evidence
Based on methodological validity, quality of their design and patient care applicability assigned
to the level of evidence, the decision state the recommendation strength. The levels comprise of:
First, level 1: systematic review evidence or meta-analysis of the randomized controlled trial of
all relevant or guidelines that are clinical evidence based on the reviews that are systematic of the
randomized controlled trial, or more randomized control trial that have a good quality of similar
results. Second, level 2: evidence should be obtained from at least one randomized controlled
trial that is well designed such as a large multi-site randomized controlled trial. Thirdly, level 3:
considered as the non-experimental study.at this level is the review of the systematic review of
the randomized control trial of the previous level without or with meta-analysis (Hopkins,
2017).Fourthly, level 4: this is evidence that emerges from case controls that are well designed or
cohort studies. Fifthly, level 5.These are evidence that emerges from the systematic reviews of
the qualitative and descriptive studies commonly referred to as meta-synthesis. Level 6: These
are evidence that emerges from a single qualitative or descriptive study. Level 7: There is
evidence from the reports that come from the expert or the opinions of the authorities (Ackley et
al.,2008)
1.1.2 Types of evidence
Types of evidence are used in making a decision regarding the patient care. Some types of
evidence are regarded stronger than others since not all types are equal.

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Source(Research Guide VCU )
Moving up the pyramid, the study design is more rigorous and make provision for less
systematic error that can lead to deviate from the truth. Case reports and case series: It consists of
a collection of reports on the individual patient's treatment. These reports use no control groups
to do outcome comparisons. This is because they have limited statistical validity. Case-control
studies; these type of evidence does a comparison between those patients who have a certain
condition and those who are not suffering from that condition. The researcher tries to figure out
the factors that might have caused or associated with the condition. Researchers do rely on the
patient medical report for the collection of data. These type of research compared to cohort
studies and randomized controlled trials is less reliable, this is because the statistical relationship
does not provide a base for the assumption that one factor caused the other factor. Cohort studies
identify patients who are undergoing treatment for particular conditions of those who are
exposed to the certain condition, the patient's progress is observed and comparison on their
outcomes with those who are not exposed to that condition. Being an observational stud and less
reliable to randomized controlled studies, because the two categories of people may have
variance in was other than in the variable under research. Randomized controlled clinical trials:

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The trials are carefully planned experiments that bring its treatment on the real
patients(Guides.mclibrary.duke.edu, 2017).The allow comparison between intervention groups
and control groups and include methodologies that reduce the potential for
bias(Guides.mclibrary.duke.edu, 2017).The trial can provide sound evidence of cause and effect.
Systematic reviews: It focuses on answering the specific question based on clinical topic.
Research with sound methodology is done on a wide-ranging literature search. The research is
reviewed, quality assessment was done and summary of result according to programmed criteria
of review questions. Meta-analysis; this type of evidence thoroughly examine a number of valid
studies on a topic and mathematically combine the results using the accepted statistical
methodology to report the results as if it were one large study (Guides.mclibrary.duke.edu,
2017).Cross-sectional studies: This type of evidence presents a relationship between diseases and
other factors at one point in distinct population. This type of evidence only comprises of
prevalent cases since it lacks data on timing of exposure and the relationships outcomes. They
are mostly is used for diagnostic test comparisons. Being a controlled trial that looks at patients
having varying degrees of a condition and administers diagnostic tests to all the patients in the
stud group.to determine the usefulness of potentials, the sensitivity and specification of the new
test compared to that of gold standards (Library.elmhurst.edu, 2017).
Retrospective Research; it follows the same route of inquiry as a cohort study. The topic under
research begins with an absence or presence of a risk factor or an exposure and are followed until
the outcome of interest is observed. Nevertheless, the stud design uses data that has been
collected previously and preserved in databases. Patients are identified for an exposure and data
is followed by an outcome of interest (Guides.mclibrary.duke.edu, 2017).
1.1.3 Importance of evidence for practice.'
Evidence-based practices have gained a lot of nursing momentum. Evidence-based practices
require a total shift in the way students are taught to a more a research practice that is relevant
and bridges the gap between clinicians and researchers to more close working relationships.
Importance of evidence-based is that it provides an opportunity for the nursing care to be more
effective, individualized and dynamic, streamlined to maximize clinical judgment effects.
Nursing care will keep pace with latest innovations in the technology field and take advantage of

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the development of the new knowledge when evidence is used for the definition of best practices
rather than practice existing support (D, 2017).
1.2 Barriers to implementation of evidence
Based on research it’s evident that the patient’s outcomes show improvement ion occurrences
when the practices by the nurse are in an evidence-based manner. Based on research it is clear
that most important factor that leads to the success of the evidence based practice is their
employing organization support to conduct and utilize research. Other facilitators include
research mentors, the presence of clinical setting of advanced practice nurses, educators who are
well knowledgeable about research. Nurses have identified various organization and individual
barriers to research utilization. Lack of knowledge on how to do the research process critique,
lack of awareness of conducting research process and lack of support from colleagues of practice
change are among the barriers to individual change. Lack of sufficient time to implement new
ideas and lack of research access and a shortage of awareness of available educational tools
required for conducting research are among the barriers facing the organization. Colleagues have
suggested the strategies for curbing this barrier to the evidence-based program which comprises
of, research role model employment, the formation of an uncompetitive relationship with
academic and participation in research interest groups.
1.3Demonstrates awareness of research process
Adaption of evidence-based practiced can be viewed from the on the look of those who conduct
research or the knowledge generators, those who utilize the information found in the evidence-
based practice. Based on AHRQ model, there are three major steps of knowledge transfer:
Creation and distillation of knowledge, dissemination and diffusion, implementation and
organization adoption. First, creation and distillation of knowledge. This entails conducting
research and packaging the findings of the research into products to be put into action e.g,
specific practices recommendation, hence increasing the chances of a research evidence finding
its way to be put into practice. It is significant for the distillation of knowledge process to be
guided and informed by the research end user and research findings to be implemented in care
delivery. Criteria for end user should include the end user perspectives as well as the
consideration of the traditional knowledge generations. Second, dissemination and diffusion.
This involves incorporating with the opinion leader who is professionally and healthcare

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organization for knowledge dissemination that can form the basis of action to users who are
potential. Brokers and connectors to practitioners can be linked through research intermediaries.
Intermediaries can be those that are considered effective in research-based dissemination such as
programs on cancer prevention. Partnership in dissemination provide an authoritative seal of
approval for new knowledge and help in finding the influential group whose demand can create a
demand for the evidence in practical application. Lastly, implementation and organizational
adoption of the end user. Being the final stage in the knowledge transfer process, this stage put
emphasis on having the individuals teams and institution to adopt and use consistently the
evidence based research findings and innovation in daily practices. For a successful
implementation and sustenance of evidence-based practice in healthcare, it requires a complex
interdependency in the organization, the subject under research and characteristics of the social
system and the individual clinicians (Greenhalgh et al.,2005).There is various strategy for
implementation which include, using the champion change in the institution ho can address the
challenges associated with implementation. To apply evidence-based practice it requires
considerable efforts from the organization and the individual level. Once an evidence-based
practice is incorporated into the organization structure is no longer regarded as an innovation but
regarded as standard of care.
2.0Provides a critique of two articles correctly identifying
the type of evidence.
2.1.1Burnout article,
The purpose of the research was to investigate the correlation between the burnout, symptoms
that are depressive and the safety of the patient's perceptions. Burnout did a mediation through
use of the mediation model between the association of the symptoms of the depression and
perception of the patient's safety. It is evident that the depressive symptoms are on the higher end
in employees working in healthcare and the care of patient’s safety. Very few researchers have
done an investigation on the nurses based on this variables. The aims of the article were to
investigate the relationship between the symptoms that are regarded as depressive and perception
of the patient care, and burnout.

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2.1.2 Palliative care article
In the second article, it discusses the study of palliative care. According to the research, 90,000
people were reported dead in 2010, among them, 80 percent of the dead were assessed to be in
need of the palliative care.The change in Europe has indicated that the population is becoming
sicker and older, this calls for the attention of a demand in palliative care development(World
Health Organisation,2011a). Majority of people in hospitals today are dying, the nurses in this
hospitals are in need workers who poses knowledge of palliative care. The main objective of the
care is that people will experience life quality until the end(Regional Cancer Center,016). The
knowledge and the skills of the provider by the healthcare in this field are crucial to goal
attainment. According to the study is evidence that nurses who are looking for jobs have
insufficient competencies and experience of the dying person care(Ek et al,201).
3.0 Methodology
3.1The research design
The design used in the first article on burnout was a cross-sectional questionnaire that was
distributed to the three acute trust.
In the second article on palliative care, the design used was a qualitative design. This means that
the people experience the phenomenon was put into study. The similarity for the qualitative
design studies is that the intention of the researcher arrives at the understanding of the
phenomenon of the student from a perspective that is holistic (Willman et al,2016). The article
under study is based on the research of qualitative study, the study has been analyzed with an
aim of attaining the overview of the study problem that is descriptive in nature (Friberg.2012).
The approaches used for the research might have been an inductive or a deduction approach.The
approach used primarily for this study was an inductive approach, this means that the study has
been used as prerequisites as possible for a phenomenon from outside with an aim to arrive at a
conclusion (Priebe & Landstrom,2012).
3.2Data collection.
3.2.1Palliative care article
Various articles were looked for in the database of the MEDLINE. The database contains
research that focuses on the nursing care(Karlsson,2012). Through the search of the material that
is scientific in nature in a variety of databases are considered to have incremented the ability to

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obtain the article that is responsive to the literature review. Keywords that were formulated in
order to aid in the purpose of the research. There was the minimization of risk being relevant
studies fell away(Friberg,2012). There was a truncation of the word nurse in order to include
word endings of similar words that contain same meaning. The inclusion of the criteria of the
article that was to be used for the results were peer-reviewed articles, which contains the
qualitative term. There was the exclusion of articles published in the year 2007 since they were
regarded to be lacking information research information. The article also with both the
qualitative and quantitative methods were excluded in the research too.
3.2.2 Burnout article
The data collection tools used in the burnout article was a questionnaire, depressive symptoms,
perception on the safety of the patient and burnout measures were completed by nursing staff in a
total of three hundred and twenty. The period for this was between 015 December and 2016
February.
3.3Sampling method
3.3.1 Palliative care article
There was a total of 517 topics that were read the articles that were found during the search, with
the intention of finding the articles with relevant information to the topic under study. of the 517
topics,163 were put into examination since they were regarded as articles that contained relevant
information to the topic under study. The articles were considered relevant for the purpose of the
research in the examination of the abstract. The intention was to discuss the topic thoroughly in a
way that it could bring consensus on articles that could be regarded appropriate, in relevance to
the purpose of the study. Most of the articles were returned when in search for databases. In an
examination of qualitative studies, a variety of questions should question to review single study
quality(Forsberg&Wengstrom,2016). The 14 articles were selected on criteria of compliance
with the purpose of the assurance of quality through the use of documents for quality assessment.
The 14 articles that were put on researcher were able to fulfill at least the 11 of 12 criteria
comprised in the protocol of quality of the audit. The first four criteria were also fulfilled in the
articles. The obtain ace of the result a total of fourteen articles were used.

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3.3.2Burnout article
The analysis of the burnout research indicated that, when tested in the separate analysis,
symptoms of depressive and burnouts were in association with measures of the patient's safety.
The proposed a model of mediation was fully supported by the association made between the
depressive symptoms and perception of the patient safety mediated through burnout.
3.4Approach to analysis
The approach for analysis used in palliative care article was a five-step model. This was
recommended to be used of the work of the graduate. Step one, the articles were read various
times in order to have an understanding of theof the concept as a whole. Step two involved the
finding identification in each study outcome with regards to candidate research aims and
objectives. The third step, the text in the article were highlighted with overlaps pens. The
findings were then put into a compilation in order to create a single document that has a clear
overview. The fourth step involved the processing of the similarities and the differences. This
was achieved through the use of the different colored pen to mark the difference and the
similarity. To avoid ignorance of any material, the studies were thoroughly checked against the
set themes and subheadings. The final stage, which was the fifth stage included the analysis of
the themes which were presented clearly and in an easy way to understand.
4.0CONCLUSION
Provision of palliative care in hospitals requires both the negative and positive nurse’s
experience. Lack of competencies is most likely to have an impact on the quality of the care of
the life ending. The nursing profession being emotionally draining requires the use of the ability
to have effective communication. It is considered of great significance when the nurses are able
to offer palliative care to a dying person. Job satisfaction can be offered when there is the
provision of a good environment.
Its more likely for burnout and depression symptoms to have implications on the safety of the
patient. Nevertheless, the ways of improving the safety of the patient can be best targeted at the
burnout improvement in specific. The interventions on the burnout are regarded to be most
effective when focused on the organization and individual.

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With most guideline tools for appraisals assessing the literature search and the synthesis
presentation and evaluation of the practices that are evidence-based. Despite there being a
conflict of interest and values of developers guideline and the patient involvement, there is an
insufficient consideration. Greater emphasis should be placed on the evidence-based practices to
allow further development
References
Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care
guidelines: Medical-surgical interventions. (p. 7). St. Louis, MO: Mosby Elsevier.