Nursing Assignment: Evidence-Based Practice in Clinical Settings

This nursing assignment delves into the core concepts of evidence-based practice (EBP) within the nursing profession, referencing the Registered Nurse Standards for Practice. It explores how EBP enhances nurses' clinical decision-making by integrating research, clinical expertise, and patient values. The assignment examines the importance of patient preferences, illustrated through a dementia care example. It reflects on clinical experiences, identifying barriers and enablers to EBP implementation, such as family cooperation and resource availability. The role of randomized controlled trials (RCTs) as high-level evidence is explained. Furthermore, the assignment critically appraises an RCT on music therapy for depression, evaluating its strengths, weaknesses, and the reliability of its findings. It analyzes the study's results, determining the effectiveness of music therapy and providing a recommendation for its integration into standard depression treatment based on benefits, harms, and cost considerations.

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According to the Registered Nurse Standards for Practice (2016), what is the role of evidence
based practice in the nursing profession?
Evidence based nursing is implemented by registered nurses to promote the use of evidence in clinical
decision makings, strategy adoptions, and facilitating safe and patient-centred nursing care. With the
help of evidence based nursing guidelines an framework, the nurses can utilise sound scientific
information which is uptodate in their nursing practise to achieve the best possible health outcomes.
This is performed by analysing available research findings critically to identify the crucial areas
which could be useful in the nursing practice. With the incorporation of the relevant evidence in
healthcare decisions and processes, nurses can stay alert on latest innovations and apply the strategies
which are ethically considerable and complies with the legislation (Nursingmidwiferyboard.gov.au
2016).
How can the Evidence Based Practice Model enhance nurses’ clinical decision-making?
The judicious use of available evidence is particularly helpful in the decision-making process
of nursing, which aids the nurses with support of scientific data and guides them to make
informed decisions which would deliver a significant patient outcome. With the application
of justifiable evidence based nursing plans, it is possible to achieve and enhance the quality
of healthcare provide toa targeted population. Nurses can also effectively maximise the
benefits of evidence based decision making in establishing nursing interventions tailored to
cater to specific complications in the clinical setting that usually face challenges or barriers,
therefore, increasing patient satisfaction and maintaining positive implications (Mackey and
Bassendowski 2017).
One of the components of Evidence Based Practice is the consideration of the patient’s
values and preferences. What does this mean? Using an example, explain the
importance of this component.

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Essential components of care delivery are the patient’s values and preferences which must be
acknowledged during clinical decision making, especially in the nursing practice, to
accomplish the desired patient outcomes. Evidence based nursing is driven by actively
combining the interventions developed from relevant research, clinical expertise, and the
values and preferences of the patient with the help of shared decision-making models, which
identifies the importance of considering the patient as an integral part of the care process, and
the need for engaging them while developing the nursing interventions. For example, for an
older patient living with dementia, at any point of care who might require to be shifted to an
acute care facility, the nurse along with other healthcare personnel must involve the patient as
a primary character in devising the care plan (Friesen-Storms et al. 2015).
Reflecting on your last clinical placement or clinical work experience, explain four
barriers and four enablers to the implementation of evidence-based practice in the
clinical settings?
My recent experience is of providing nursing care to a 75 years old man who has been living
with progressive dementia from the last ten years. In the care delivery, I came across certain
obstacles which reduced the efficiency of the evidence based nursing care. Likewise, there
were few supporting factors which ultimately aided in resolving the concerning issues. Four
significant barriers were lack of cooperation from the patient’s family, a deficit in patient’s
knowledge, unavailability of resources, and absence of a support framework in the care
setting. The enablers that facilitated the implementation of evidence based practice were
patient counselling, behavioural training for the patient, education and awareness training for
the family of the patient, and establishment of a donation fund for increasing the resources.
Why are randomised controlled trials considered to be ‘higher level evidence’?

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Randomised controlled trials (RCTs) are considered as the highest level of evidence because
of the structure they follow. Typically, RCTs are unbiased, thus reducing the chances of
systematic and statistical errors within the study analysis. Through the random allocation of
study subjects across more than two treatment group, the confounding factors that may bring
about biasness are effectively randomised (Burns, Rohrich and Chung 2011).
Can you trust the results of this study? What are the strengths and weaknesses of this
paper? (Hint: refer to the CASP for randomised controlled trials to guide you in the
critical appraisal of this study).
This randomised controlled trial is aimed to determine the effectiveness of music therapy as a
standard care method as compared to its use in the standard treatment of depression. The
study considers the treatment group as the working-age people for the relevance of this
population group in the socio-economic scenario. A single clinical method was adopted to
conduct the trial with distinct outcomes to be measured based on the applied clinical
psychodynamic music theory. The results of this study cannot be entirely trusted due to its
limitations in terms of small sample size and restricted population group. However, the
randomisation of the subjects in more than one group indicates that the trial is unbias with
minimal errors. Another strength of this study is that it adequately accounts for all the
participants who were initially included for the trial at the concluding remarks, even if they
decided to leave the trial early. The primary weakness of the trial is that it is not blinded,
which affects the reliability of the study. Few additional strengths of the study include similar
study subjects with identical demographic features, specifically discussed primary outcomes,
high confidence intervals (95%), and significant clinical outcomes as the result of the trial.
Was music therapy effective in treating the depression of the patients? (Hint: present
and interpret the results for depression outcome- see Table 2 for the summary of the

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results- you need to consider the results for intervention and control groups, whether
the difference between these groups is statistically significant, and if the estimation of
the results for the wider population is precise.
The results obtained from this trial indicate substantial effectiveness of music therapy in
treating the depression group. Based on the statistical analysis, it can be seen that the data of
the difference between two treatment groups are statistically significant. The effects obtained
were also clinically relevant with a medium-to-large range of effect sizes. The trial, therefore,
supports the research objective that music therapy may have a positive impact on the patient
outcomes for the group considered for depression. The estimation for the wider population
identifies that out of four people receiving the therapy, one will shift from no response to
response mode, which indicates a successful intervention of the given treatment.
Would you recommend music therapy for patients with depression? (Justify your
answer taking into consideration the benefits, harms, and the cost of the intervention)
I would recommend the implementation of music therapy into the standard depression
treatment as there is enough evidence to support the efficacy of this intervention I reducing
episodes of depression and promote the overall mental wellbeing of the patients. Findings
from this trial suggest that music therapy holds clinical relevance and is capable of incurring
some advantages when incorporated in the care routine of depression. The trial reported
minimal adverse effects which are insufficient to be considered as potential harms. Costs
associated with the intervention would also be sustainable when compared to the level of
comfort it provides in depression.

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References
Burns, P.B., Rohrich, R.J. and Chung, K.C., 2011. The levels of evidence and their role in
evidence-based medicine. Plastic and reconstructive surgery, 128(1), p.305.
den Hertog-Voortman, R. and Niessen, T., 2019. Patient preferences in nursing decision-
making: Grounded theory study on communication tools in personalized nursing care in EBP.
DiCenso, A., Guyatt, G. and Ciliska, D., 2014. Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Friesen-Storms, J.H., Bours, G.J., van der Weijden, T. and Beurskens, A.J., 2015. Shared
decision making in chronic care in the context of evidence based practice in nursing.
International journal of nursing studies, 52(1), pp.393-402.
Jang, I.S. and Park, M., 2016. Knowledge Management, Beliefs, and Competence on
Evidence-Based Practice, Evidence-Based Decision Making of Nurses in General Hospitals.
Korean Journal of Adult Nursing, 28(1), pp.83-94.
Mackey, A. and Bassendowski, S., 2017. The history of evidence-based practice in nursing
education and practice. Journal of Professional Nursing, 33(1), pp.51-55.
Nursingmidwiferyboard.gov.au, 2016. Nursing And Midwifery Board Of Australia -
Registered Nurse Standards For Practice. [online] Nursingmidwiferyboard.gov.au. Available
at: <https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx> [Accessed 18 April 2020].
Revathy, U. (2015). Clinical decision making in nursing care: Evidence based practice and
seniority. International Journal for Quality Research, 9(1), 77-88.

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Taylor, M.V., Priefer, B.A. and Alt-White, A.C., 2016. Evidence-based practice: Embracing
integration. Nursing outlook, 64(6), pp.575-582.
Theofanidis, D., 2015. Evidence based practice and evidence based nursing education.
Journal of Nursing & Care, 279, pp.2167-1168.