Evidence for Nursing: Concepts and Case Study Assessment

This report delves into the core concepts of evidence-based practice within the nursing profession, examining its role as defined by the Registered Nurse Standards for Practice and its impact on improving patient outcomes. The assessment explores how the Evidence-Based Practice Model enhances clinical decision-making, emphasizing the importance of patient values and preferences. It also investigates barriers and enablers to implementing evidence-based practice in clinical settings and analyzes the significance of randomized controlled trials as higher-level evidence. Furthermore, the report critically appraises a case study on the effectiveness of music therapy for depression, evaluating its strengths, weaknesses, and trustworthiness, and providing recommendations based on the benefits, harms, and costs of the intervention. The analysis includes detailed interpretations of study results, statistical significance, and the overall efficacy of music therapy for the treatment of depression, drawing on provided resources and the student's clinical experience.

EVIDENCE FOR NURSING Assessment Item 2: Understanding
research concepts
Intent
This assessment allows you to demonstrate your understanding of evidence based practice concepts and
processes and apply your knowledge to case studies.
Instructions
 Read the questions carefully and answer all parts of the questions.
 If required, provide references.
 Follow the word limits.
PART One: Evidence based practice concepts (17.5 marks)
1. According to the Registered Nurse Standards for Practice (2016), what is the role of evidence based
practice in the nursing profession? (100 words±10% , 4 marks). Needs referencing.
The role of evidence-based practice in nursing profession is to provide better quality clinical care so
that the health outcome of patients can be improved. Nurses are engaged in coordinating and provide safe
and quality of care. This includes comprehensive assessment, development of a plan, implementation and
evaluation of outcomes. (Nursing and Midwifery Board Ahpra, 2017). Nurses work in collaboration so that
better care can be provided to patient. They share a therapeutic and professional relationship with
individuals, families, patients and communities (Nursing and Midwifery Board Ahpra, 2017). Standard one
lays emphasis on that Nurses provide person-centred care to patients who are suffering from depression.
(Nursing and Midwifery Board Ahpra, 2017). Whereas, standard 2 reflects on engaging in effective
therapeutic and professional relationships. (Nursing and Midwifery Board Ahpra, 2017). Nurses Provide safe
environment, build up trust to achieve the best outcome. (Nursing and Midwifery Board Ahpra, 2017)
2. How can the Evidence Based Practice Model enhance nurses’ clinical decision-makings? (100 words±10%,
4 marks). Needs referencing.
The model is based on three aspects which enhances nurse’s clinical decision making. Firstly, clinical
expertise allows nurses to encounter with patients’ conditions and situations. It lays focus on that nurses
must be engaged in communicating effectively with patient so that better decision can be taken. (PMC,
2010). The second, Evidence helps in making effective use of knowledge arising from the clinical expertise
and research. it encourages nurses to be engaged and continue implement on new protocol guidelines to
help solve the conflict between patients and staff (Thompson etal. n.d.). Lastly, Patient preferences provides
direction for selecting treatment options and tailoring interventions. It also helps inform choices in clinical
decisions. (PMC, n.d.). Therefore, the model help nurses to make decision however, the complexity of
decision-making for nurses continues to increase in patient acuity and technological advances (PMC, 2018).
3. One of the components of Evidence Based Practice is consideration of the patient’s values and
preferences. What does this mean? Using an example, explain the importance of this component (100
words±10%, 4 marks). Needs referencing.
Patient’s values and preferences means providing services according to patients need. It further recognises
and helps patients share their unique preferences and allows to fully inform them for the available and
supporting options (VA gov, 2016). This includes disease prevention, diagnosis, treatment and rehabilitation.
In addition, this component encourages nurses to ensure that patients have a significant understanding of
these options by actively allowing them to be engage and feel safe with them (VA gov, 2016). This
component is important because it allows the nurses and patients to avoid creating conflict during
Evidence for Nursing Assessment 2: Understanding evidence based practice concepts 1

conversation, solving problems and generating better outcomes for them. For example, nurses work in the
competitive environment with different patients. They try their best to treat the patients according to their
needs through communicating with them. This also allows nurse to self-manage their time and collaborate
with other staff to further improve patient’s needs (PMC, 2013).
4. Reflecting on your last clinical placement or clinical work experience, explain four barriers and four
enablers (facilitators) to the implementation of evidence-based practice in the clinical settings? (100
words±10%, 4 marks).
On my last clinical placement, I came through few barriers such as limited peer support – where sometimes
lack of knowledge was a barrier when I needed help in medical terms, medications, and procedures of how
they were to be done. Communication is another barrier where it was difficult to communicate with some
patients as they did not understand the instructions and procedures I was trying to explain and what I
wanted them to do. I had to then break down the information for them to be able to understand and use
less of the jargon words and medical terms to make it easier. Understanding needs of patients and dealing
with them was also a difficult part as I was trying to work alone with them to get more hands on and get
more experience as possible and giving a handover at the end of shift. However, RN’s did help me get
through the shifts by explaining and helping what was needed to be done on the day, organising a shift
planner and ensuring patients safety is needed at all times. My Facilitator and the nursing unit manager also
help me throughout my placement where by analysing gaps in my perfomance.
5. Why are randomised controlled trials considered to be ‘higher level evidence’? (50 words±10%, 1.5
marks). Needs referencing
RCTs are assumed the highest level since they are designed to be unbiased and have less risk of systematic
errors. For example, by randomly allocating subjects to two or more treatment groups, these types of
studies also randomize confounding factors that may bias results. A case series or expert opinion is often
biased by the author’s experience or opinions and there is no control of confounding factors (PMC, 2012).
PART TWO: The case study (17.5 marks)
No need to use references in your answers to the questions below.
Read the article by Erkkila at al. (2011), titled ‘Individual music therapy for depression: randomised
controlled trial’. A copy of this article is in the Assessment 2 folder.
6. 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) (200
words±10%, 9 marks).
The results from this study are trustworthy because it gives a rationale and systematic information about
clients dealing with depression. It is being related with musical therapy.
Evidence for Nursing Assessment 2: Understanding evidence based practice concepts 2

Strengths: includes clinical interview for DSM-III-R (Mini-SCID) used in health centres and polyclinics for
diagnosing depression (Carney & Freedland, (2017).. The basic principle of the intervention is to encourage
and engage clients in expressive musical interaction. It is very important for the therapist to actively facilitate
and support the client’s therapeutic process by using musical elements like rhythm, harmony, melody,
dynamics and timbre.
Weaknesses: includes Anxiety because of the frequent comorbidity of depression and anxiety. The severity
of depression prevented the clients from participating in the measurements or engaging in verbal
conversation, or they had insufficient knowledge of the Finnish language. Electroencephalographic
biomarkers impact the research of music therapy on brain processing of (negative) emotions.
The CASP for randomised controlled trials help us in critical appraisal of this study by providing us valid
results of the study such as music therapy plus standard care showed greater improvement than those
receiving standard care only in depression symptoms (mean difference 4.65, 95% CI 0.59 TO 8.70), and
anxiety symptoms (1.82, 95% CI 0.09 to 3.55) and general functioning (-4.58, 95% CI -8.93 to -0.24 at 3
month follow up. It shows that this study along with the previous research indicates that music therapy with
its specific qualities is a valuable enhancement to establish treatment practices (Smith ET.AL., (2018).
7. 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 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 (100 words±10%, 5
marks).
It is considered that music therapy is effective and ineffective at some existent. 91 people were randomly
screened as 79 were eligible to participate in study. Some participant refused to take part in the study
therefore 79 in total were randomised 62 were females; ages ranged from 18 to 50 years and 33 participants
were randomised to music therapy (Elder, (2018). Total of 12 participants dropped out before the 3-month
follow-up. The dropout rate was higher in the control group which is ineffective as people were lacking
motivation and health issues. 3 months follow up took place immediately after the intervention in the music
therapy group. Furthermore, calculation for Fisher’s exact test and odds ratios with 95% confidence intervals
for dichotomous outcomes, and Welch’s t-test with 95% confidence intervals for changes in continuous
outcomes. Participant’s outcome was unobserved for 3 months, in order to provide a conservative estimate
based on all participants initially randomised. It showed larger effect size then intention-to-treat analysis,
however statistical significance levels were unchanged.
8. Would you recommend music therapy for patients with depression? (Justify your answer taking into
consideration the benefits, harms, and the cost of the intervention) (100 words, ±10% 3.5 marks)
I would recommend music therapy for patients with depression because it contains a lot of benefits like
improving mood, brings change in life style, decrease in stress and anxiety. It helps in improving functioning
e.g. involvement in activities and relationships, it can involve regular meets with a qualified music therapist
which may help in improving mood through emotional expressions (HealthyPeople.gov, n.d.). Harm related
to depression can include quitting study early. In the article it shows the control group developed serve low
back pain due to music therapy. Cost of intervention generally functions the quality of life where it was
chosen on the bases of their wide use in studies of phycological interventions for people with mental health.
All participant who participated in both music therapy and the control group continued to receive treatment
as usual while participating in the study. Whereas basic principal of intervention is to encourage and engage
clients in expressive musical interaction.
Evidence for Nursing Assessment 2: Understanding evidence based practice concepts 3

References
Elder, G. H. (2018). Children of the great depression. Routledge.
Smith, C. A., Armour, M., Lee, M. S., Wang, L. Q., & Hay, P. J. (2018). Acupuncture for depression. Cochrane
database of systematic reviews, (3).
Carney, R. M., & Freedland, K. E. (2017). Depression and coronary heart disease. Nature Reviews
Cardiology, 14(3), 145.
Thompson, C. Cullum, N. McCaughan, D. Sheldon, T. & Raynor P. (n.d.). Nurses information use, and clinical
decision making – real world potential for evidence-based decisions in nursing. Evidence-Based Mental
Health. https://ebn.bmj.com/content/7/3/68
Healthy People.gov. (n.d.). Music Therapy for Depression. https://www.healthypeople.gov/2020/tools-
resources/evidence-based-resource/music-therapy-for-depression
Evidence for Nursing Assessment 2: Understanding evidence based practice concepts 4

Nursing and Midwifery Board Ahpra. (2017, February 01). Registered nurse standards for practice.
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/
registered-nurse-standards-for-practice.aspx
PMC: US National Library of Medicine National Institutes of Health. (2018, January 23). Decision-making in
Nursing Practice: an Integrative Literature Review.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867219/
PMC: US National Library of Medicine National Institutes of Health. (2012, July 01). History of Levels of
Evidence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/
PMC: US National Library of Medicine National Institutes of Health. (n.d.). Improving Health Care by
Understanding Patient Preferences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC61299/
PMC: US National Library of Medicine National Institutes of Health. (2013, December 6). Incorporating
patient and family preferences into evidence-based medicine.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029304/
PMC: US National Library of medicine National Institute of Health. (2010, August). Understanding Clinical
Expertise: Nurse Education, Experience, and the Hospital Context.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998339/
VA Gov. (2016, August 30). Section 2 patient preferences.
https://www.va.gov/nursing/ebp/docs/DefiningPatientPreferencesCurriculum_www.pdf
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