Evidence Based Practice: A Step-by-Step Guide for Dementia Caregivers

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Contents
INTRODUCTION..............................................................................................................1
STEPS OF EVIDENCE-BASED PRACTICE....................................................................1
STEP 1......................................................................................................................... 1
ASK...............................................................................................................................1
STEP 2......................................................................................................................... 2
AQUIRE / SEARCH...................................................................................................... 2
STEP 3......................................................................................................................... 3
CRITICAL APPRAISAL.................................................................................................3
STEP 4......................................................................................................................... 3
APPLY.......................................................................................................................... 3
STEP 5......................................................................................................................... 4
Evaluate........................................................................................................................4
STEP 6......................................................................................................................... 4
Disseminate the outcomes............................................................................................4
CONCLUSION................................................................................................................. 4
REFERENCES.................................................................................................................5
APPENDIX.......................................................................................................................5
PICO (T)....................................................................................................................... 5
1

INTRODUCTION
The evidence-based practice came into existence since 1992 and is referred to as the
interdisciplinary approach of clinical practice that started first in medicine and then
spread its root to allied health and social care professionals and services ( Straus,
Glasziou Richardson & Haynes., 2018). It is more specifically defined as the
conscientious, judicious, extraordinary use of recent best evidence in taking the
decisions regarding the care of the patient in health and social care. It involves
correlating the clinical expertise of the individual with the best available evidence from
external sources and systemic researches. The best clinically relevant researches found
its grounds since the introduction of evidence-based practice (Grove & Gray., 2018).
The researches nowadays are conducted to provide the best possible pieces of
evidence that can be used to disseminate the knowledge and evidence in clinical
practice with new breakthroughs and better practice modalities. The researches and
evidences do not prove to be making the decision for generalized cases but it helps the
clinician to carry a proper assessment of the patient’s requirement and apply the
evidences to provide better care. The three aspects that work together to ensure best
possible practice and achieve evidence-based practice includes 1) best possible
evidence, 2) clinical expertise and 3) patient requirements, values and belief (Schaffer,
Sandau and Diedrick., 2013).
Evidence-based practice has various advantages and is important in current conditions.
As the burden on health and social care is increasing due to newer diseases and
conditions the evidence to provide better interventions should also be present to aid the
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clinicians to make the best decision during their practice (Kim and Mallory., 2014). It is
important as it provides the best care that is possible with aim of providing the best
possible patient outcomes. It enables the health professional to use more precise and
recent advancement that are evidence-based and it is identified that patient is also very
positive towards such practice. This assignment will discuss the steps included in
evidence-based practice. The steps of evidence-based practice and its relevance to the
process is been described (Grove & Gray., 2018). Also, the topic of care that is the
quality of life in dementia patient is used to give appropriate examples to explain these
steps in-depth.
3

STEPS OF EVIDENCE-BASED PRACTICE
STEP 1
ASK
The very first step of the evidence-based practice includes assessment of the patient.
When the person chosen for the evidence-based practice is assessed for clinical
condition properly the first step is to ask or in a precise manner formulate a question in
a clinical form that can be answered by evidence-based practice (Schmidt and Brown.,
2017). This step involves rising of a clinical question from the patient’s problem. The
information that is provided from the patient is used to frame a question and in order to
do so the PICO (T) tool is used. PICO tool is considered as a tool that enables the
professional to frame a question depending on four aspects that are problem/patient/
population, intervention/indicator, comparison, and outcome. “T” stands for the type of
question to be framed and articles chosen to review it. The PICO tool uses four different
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questions asked for self while formulating a question for the practice (Echevarria &
Walker, 2014). The clinician must consider the population, problem or patient that he is
choosing for evidence-based practice, the intervention or indication of prognosis and
outcomes for the patient that he is studying; to compare the evidence-based researches
with the current interventions and to evaluate the outcomes of the practice. When these
aspects are addressed the question is framed to be answered from the evidence-based
process.
As in the current assignment, the question framed using PICO (T) is
"Do providing family counselling and support to dementia patient's caregivers provide a
better quality of care for them?"
STEP 2
AQUIRE / SEARCH
The second step after the formulation of a question is the searching for adequate and
best evidence from the literature and researches present. This step includes searching
of various articles, journals, papers, documents and researches to find the most
adequate information that can support the evidence we are trying to search the answer
to (Schmidt and Brown., 2017). The most common way of searching for evidence is a
systemic review. The systemic review is a process of searching best researches and
articles on a chosen topic in a planned and strategic manner. It follows a proper strategy
and search plan to review articles that are suitable for the topic.
The search in this particular topic was conducted by using the Google Scholar
database. Keywords were entered in the database as dementia, family counselling,
support, quality of life. The database searched thousands of articles using the keywords
entered. Initially, the research showed 15,300 relevant articles with the same keywords
used. This number was reduced and sorted by customizing the publication date to be
2013 to 2019. The number of the search was reduced and most relevant articles were
chosen by applying inclusion and exclusion criteria (Aromataris & Riitano., 2014).
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After application of these criteria like the article chosen should be peer-reviewed, it
should be internationally published, should not be older than 6 years from current date,
the sample in the article should match the patient requirement in the practice evidence-
based practice is focused at, research chosen should have proper ethical
considerations followed and the research used for evidence should be suitable for the
intervention compared or studied. These criteria help in searching the best possible
evidence for the practice and the clinician can achieve success in evidence-based
practice he is focused on.
Dam et al, (2016) in their research highlighted how the family members of dementia
patient face various challenges but the family support and counselling interventions
helps them to cope with them and allows them to have a better quality of life. Support
from peers, health care workers as well as support groups is considered beneficial in
promoting better physical and mental quality of life of the individual.
STEP 3
CRITICAL APPRAISAL
Critical appraisal is the third step where the articles were chosen are reviewed and
critically appraised. Critical appraisal means finishing the strength and limitations of the
research and concluding the efficacy of the research for a given question (DiCenso,
Guyatt & Ciliska., 2014). There are different critical appraisal tools used to help in the
process like CASP, CRAAP etc. these tools are introduced to evaluate the research
validity and reliability. Validity refers to the validation of the research for the given
question and reliability means how well the research findings can be trusted and used
own practice. These two aspects of research are well marked before using it for
evidence-based practice.
In this assignment, we have used the CASP tool of critical appraisal. CASP stands for
critical appraisal systemic programme. It is a tool that ensures the validity and reliability
of research on three aspects that is the research valid, what the findings of the research
are and how the findings help local practice (Moult et al., 2014).
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The article reviewed regarding the family counselling and support services effect on
health and quality of life of dementia carer is critically evaluated by the CASP model
Validity Findings How it helps local practice
The article is peer reviewed
and valid
The findings show how the
interventions for a family
carer in dementia care like
counselling and social
support help in enhancing
their quality of life.
This research helps by
disseminating the
knowledge regarding
benefits of social support
for the family carer of
dementia patient on the
quality of life; it helps by
promoting evidence for
enhancing the social
support services and
facilities for families of the
dementia patient and allows
them to have a better
quality of life.
STEP 4
APPLY
The application of the searched and chosen evidence is done in this step. The patient
has to be benefited by the chosen evidence I order that the outcomes are positive and
good (LoBiondo-Wood & Haber., 2017). The application of the evidence is done by
addressing some basic requirements like is the patient selected and the research
sample given in the article has same condition, as in given article the study is for a
dementia patient and their caregivers so this criterion is fulfilled. The other thing to be
considered is the article chosen is feasible, reliable, and beneficial to the patient.
7

Following this, the article chosen here can be applied to dementia patient and the
caregivers of the patient as part of evidence-based practice.
STEP 5
Evaluate
This step helps in evaluating the application of the evidence found. The evaluation
consists of an audit that measures and monitors the effects of intervention being applied
associated with the searched evidence and its benefits for the patient. In this case, the
family of dementia patient should be provided with measures of social support and
evaluated for better health and wellbeing routinely to evaluate the positive outcomes of
the evidence-based practice applied (DiCenso, Guyatt, & Ciliska., 2014).
STEP 6
Disseminate the outcomes
Disseminating the outcomes refer to how the practice and the outcomes of evidence-
based practice inform the future scope of nursing and clinical practice and how it will be
beneficial in helping the local clinical practice in future. The performance of own is
evaluated in this step and how the evidence-based practice procedure helped in the
professional and clinical development of the clinician is evaluated (Brown., 2014).
Here the evidence-based approach used to find evidence for the interventions of social
support and family counselling for the dementia patient's family enhanced the clinical
practice in the manner it enables the individual to make informed decisions and
evaluate the benefits of social and peer support for the caregivers. It helps the author to
learn family based practice and patient-oriented care that is beneficial to both the
patient and his family.
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CONCLUSION
This assignment helps in thoroughly understanding the steps that are to be followed for
evidence-based practice. It ensures better exampled and choice of topic that allowed
the author to formulate a question for practice as well provides a relevant example for
the evidence-based practice. The assignment also highlights the importance of
evidence-based practice and informs about continuous clinical development of the
health care professionals through evidence-based practice.
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REFERENCES
1. Aromataris, E., & Riitano, D. (2014). Constructing a search strategy and
searching for evidence. Am J Nurs, 114(5), 49-56.
2. Brown, S. J. (2014). Evidence-based nursing: The research-practice connection.
Jones & Bartlett Publishers.
3. Dam, A. E., de Vugt, M. E., Klinkenberg, I. P., Verhey, F. R., & van Boxtel, M. P.
(2016). A systematic review of social support interventions for caregivers of
people with dementia: are they doing what they promise?. Maturitas, 85, 117-
130.
4. DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-based nursing: A guide to
clinical practice. Elsevier Health Sciences.
5. Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT
question. Nursing2018, 44(2), 18-19.
6. Grove, S. K., & Gray, J. R. (2018). Understanding nursing research: Building an
evidence-based practice. Elsevier Health Sciences.
7. Kim, M. and Mallory, C. (2014). Statistics for evidence-based practice in nursing.
Jones & Bartlett Publishers.
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8. LoBiondo-Wood, G., & Haber, J. (2017). Nursing research: Methods and critical
appraisal for evidence-based practice. Elsevier Health Sciences.
9. Moult, J., Fidelis, K., Kryshtafovych, A., Schwede, T., & Tramontano, A. (2014).
Critical assessment of methods of protein structure prediction (CASP)—round
x. Proteins: Structure, Function, and Bioinformatics, 82, 1-6.
10. Schaffer, M.A., Sandau, K.E. and Diedrick, L. (2013). Evidence‐based practice
models for organizational change: overview and practical applications. Journal of
Advanced Nursing, 69(5), pp.1197-1209.
11. Schmidt, N.A. and Brown, J.M. (2017). Evidence-based practice for nurses.
Jones & Bartlett Learning.
12. Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B.
(2018). Evidence-based medicine: how to practice and teach EBM. Elsevier
Health Sciences.
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APPENDIX
PICO (T)
Population/problem/
patient
Intervention/
indicator
comparison outcom
e
Type
Patient suffering from
Dementia
The problem includes low
quality of life of dementia
carers
Social support
Family counselling
Peer support
Treatment with
other
interventions
such as
pharmacologic
al to improve
mental status
Better
quality
of life
The type
of
question
includes
a therapy
question
And the
type of
article
chosen
will be
controlle
d trial
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