Overview of Selected Evidenced-Based Practice Project
Evidence-based practice is an approach to health care that ensures the best possible outcomes for the patients. In its currently accepted form, the approach is founded on three core principles: the values and expectations of the patients, the clinical expertise of the provider, and evidence from available academic sources. The three principles are combined using critical thinking with the ultimate goal of achieving the best result. It is important to understand that due to the constant involvement of critical approach and assessment of the process, the approach also necessitates adjustments as soon as the need for change is identified in one of the three domains. For instance, if the selected intervention is evidenced to provide insufficient improvement, it would be reasonable to consider other options.
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Research is thus one of the crucial elements of evidence-based practice. The main reason for this is the inherent limitations of individual judgment. Both the field expertise of the clinician and the preferences of the patient are subject to cognitive biases and cannot serve as the ultimate determinant of the decision-making in healthcare (Grove, Burns, & Gray, 2015). On the other hand, the research conducted according to the academic standards eliminates the overwhelming majority of the said limitation and can thus be used to determine the objective value of the selected approach to the client.
The nursing issue selected for the project is the challenges experienced by mothers during the breastfeeding process. According to the consensus, the rates of initiation and continuation of breastfeeding in many high-income countries are inadequately low (Renfrew, McCormick, Wade, Quinn, & Dowswell, 2012). The negative impact of the issue is twofold. On the one hand, the mothers who do not possess enough knowledge to breastfeed successfully experience a range of problems that include physical pain, psychological discomfort, and undesirable social and cultural issues. On the other hand, and, perhaps, more importantly, the lack of breastfeeding hurts public health, including the behavioral issues and challenges in education for the children that were not breastfed (Ericson et al., 2013). While the support and counseling of breastfeeding mothers have been considered effective in resolving the issue, it is necessary to obtain reliable data in support of these claims.
Application to Selected MSN Program Specialty Track
My MSN Program specialty track is a Family Nurse Practitioner. The responsibilities pertinent to the specialty include diagnosis and management of the common health problems, promotion of healthy living, and education of individual patients and families. The diversity of care provided in the primary setting includes breastfeeding issues and constitutes a high probability of encountering the problem in my future practice. By that point, it would be beneficial to identify the components of the intervention that could be applied to the issue and evaluate their relative efficiency to estimate the patient outcomes.
Resolving the issue of insufficient breastfeeding initiation and continuation is expected to impact the advancing practice in my specialty tracks in two major areas. First, the confirmation of the effectiveness of the suggested approach would likely impact the choice of strategies available to the nurses for supporting the breastfeeding mothers. The breastfeeding support phone line is a highly specialized area and requires the allocation of resources and equipment for successful functioning. To obtain the necessary administrative support to introduce the practice, it is required to provide robust evidence of its efficiency by the principles of evidence-based practice.
Second, the positive outcome of the project is expected to have numerous indirect effects. One of these is the overall improvement in the health of the patients, including the relief of issues such as breast pain and breast engorgement. By extension, the exhaustion and stress related to the problem will be decreased. Finally, a positive impact on child health can be expected, accompanied by respective improvements in behavior and academic performance. The combined effect of the said impacts will decrease the load on nursing practitioners, which is extremely important considering the constantly growing population and an increasing proportion of aging patients. Thus, the issue is directly related to my specialty track.
Nursing Issue and Supportive Evidence Regarding the Issue
Breastfeeding is an important part of the child’s development cycle, bearing multiple short- and long-term effects on their health as well as the health of the mothers. The areas of impact include child mortality, prevention of several gastrointestinal and respiratory diseases, childhood obesity and diabetes in children as well as the increased risk of breast cancer and cardiovascular disease in adults (Forster et al., 2014). While the magnitude of the adverse impacts varies depending on several factors such as socioeconomic status, it is safe to conclude that the effects of not breastfeeding are universally negative across different population groups (Colen & Ramey, 2014).
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It is also important to understand that the issue of not breastfeeding bears significant considerations from the economic standpoint, primarily due to the high cost of care for the mothers and children who develop chronic conditions associated with the issue. Importantly, the lack of breastfeeding success cannot be attributed solely to the individual decision of the mother as it is strongly dependent on previous experience and available knowledge on the matter. As such, it is reasonable to expect that sufficient support provided to women will aid them in the initiation and continuation of the practice.
The issue is relatively common in the selected practice setting. According to the data provided by the CDC, only twelve states have met the objectives set for breastfeeding as a part of the Healthy People 2020 initiative (CDC, 2016). The most significant discrepancy is observed in the infants of six months or younger, where the current rate is just below fifty-two percent as opposed to the sixty percent set as a target (CDC, 2016). The difference is reduced with each subsequent age group, but several areas are still behind schedule in meeting the goals. It is also important to remember that the stated proportion is an aggregated result and that different states demonstrate varying results. It is also notable that the rates for breastfeeding after six months are universally lower, which suggests that mothers discontinue the practice despite the successful initiation. It is, therefore, possible to characterize the issue as relatively frequent in the practice area in question.
According to Renfrew et al. (2012), education is a crucial factor that determines breastfeeding success. Specifically, the greatest percentage of mothers that were breastfeeding received better health education and support compared to those that received no support at all (Renfrew et al., 2012). The accessibility to educational resources and counseling provided by healthcare organizations was considered another important determinant of success with a positive correlation between the resources present within the community and the rates of breastfeeding continuation (Renfrew et al., 2012).
Admittedly, support is a broad category that commonly includes delivery by a qualified nursing practitioner, the involvement of community organizations, one-on-one consultations, and dedicated educational events. Therefore, it would be reasonable to limit the scope of the project to proactive telephone support. One of the reasons behind this particular choice is the negative correlation between the socioeconomic status and breastfeeding success where the disadvantaged women tend to terminate the practice earlier (Renfrew et al., 2012). Telephone-based consultations do not pose challenges in terms of financial accessibility, and their delivery can be adjusted to the time restrictions that commonly prevent mothers from engaging in other activities (e.g. community meetings). Therefore, it is reasonable to expect higher population involvement in response to the selected intervention.
The two main stakeholders involved are breastfeeding mothers and nursing practitioners. The former are impacted directly by experiencing a range of physical, psychological, and social issues identified above and indirectly – by experiencing the health and behavioral disorders associated with discontinuation in the long run. The latter receive greater workload as a direct result of the issue and are required to provide extended care to mitigate the associated problems such as chronic conditions. Other stakeholders include healthcare organizations that face administrative issues resulting mostly from the long-term outcomes of the problem as well as additional expenses and families of the impacted individuals who are strained both financially and emotionally by the negative health outcomes. Finally, educational organizations are impacted by the long-term outcomes of the issue, such as the declined academic performance and disrupted behavior (Ericson et al., 2013).
The successful implementation of the project is expected to clarify the effectiveness of the proposed support method and determine its applicability to nursing practice. As a result, it is reasonable to expect the increase in the number of breastfeeding mothers and, by extension, the decrease of the adverse public health effects associated with it. Also, the decrease in expenses associated with additional care, overall improvement of patient outcomes, and the minimization of excessive workload among nurses can be expected.
Evidence-Based Practice Question
By the information presented in the previous section, the following components of the PICOT are proposed.
For the post-partum mother, would post-discharge breastfeeding support phone calls increase the likelihood of breastfeeding success versus mothers receiving no post-discharge support phone call at six-week post-partum?
Where the population is post-partum mothers, the proposed intervention is breastfeeding support phone calls, a comparison is a group receiving no post-discharge support phone calls, the outcome is an increase of breastfeeding success, and the time for the project is six weeks.
Breastfeeding initiation and continuation has major impacts on the health and overall wellbeing of mothers. Besides, the children who have not breastfed exhibit negative changes in behavior, health, and academic performance in the long term. Finally, as a result of the health issues, healthcare organizations need to allocate additional resources and time to alleviate the adverse effects of chronic conditions emerging as a result of unsuccessful breastfeeding initiation. While the issue is preventable, the current rate of improvement in the field is insufficient to be considered a success. Also, the approaches outlined in the academic literature are broad enough to include a variety of options whereas the information on the relative efficiency of the specific strategies is scarce. The goal of this project is to evaluate the effectiveness of proactive support to the breastfeeding mothers delivered via the phone to determine its value for evidence-based practice.
During the assignment, I improved my knowledge of the selected nursing issue by applying the data available in the literature to personal experience. I also learned to handle the findings of the published studies and assess their applicability to the issue at hand by examining the definitions and variables used by different researchers. Finally, I improved my overall understanding of the role of research in evidence-based practice.
CDC. (2016). Breastfeeding report card. Web.
Colen, C. G., & Ramey, D. M. (2014). Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science & Medicine, 109, 55-65.
Ericson, J., Eriksson, M., Hellström-Westas, L., Hagberg, L., Hoddinott, P., & Flacking, R. (2013). The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: Study protocol for a randomized controlled trial. BMC Pediatrics, 13(1), 73-82.
Forster, D. A., McLachlan, H. L., Davey, M. A., Amir, L. H., Gold, L., Small, R…. McLardie-Hore, F. E. (2014). Ringing up about breastfeeding: A randomised controlled trial exploring early telephone peer support for breastfeeding (RUBY)–trial protocol. BMC pregnancy and childbirth, 14(1), 177-186.
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Grove, S. K., Burns, N., & Gray, J. (2015). Understanding nursing research: Building an evidence-based practice (6th ed.). St Louis, MO: Elsevier Health Sciences.
Renfrew, M. J., McCormick, F. M., Wade, A., Quinn, B., & Dowswell, T. (2012). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Systematic Review, 5(5), 1-142.