Abstract
A nursing practice based on the evidence implies a conscious search and critical evaluation of the available scientific evidence and the subsequent selection of the optimum tactics to the patients’ treatment taking into account their individual characteristics and requirements. In other words, the evidence-based practice involves a combination of individual clinical expertise and the best evidence obtained by systematic research.
Part A explains the importance of the mentioned notion that is associated with modern requirements. Part B interprets why nurses have to know research methods in order to implement evidence-based practice. Part C focuses on the role of nurses in the prevention of breast cancer among African women by appropriate professional knowledge and evidence-based research.
Introduction
Nowadays, there is a significant shift in medicine towards an Evidence-Based Practice (EBP) that is not a new science but is a new approach to acquisition, analysis, and interpretation of scientific information. EBP is the best way to implement the results of clinical trials in the treatment of patients. It is the integration of relevant research evidence with clinical expertise and patient expectations. Principles of EBP are used primarily in clinical practice, yet they apply to any field of medical science, including preventive medicine, public health, and health care organization. In this connection, this paper aims at examining the importance of the EBP, its research methods, and global health care peculiarities.
The Evidence-Based Medical Practice
Evidence-based medical practice is an attempt to change the current system in the course of centuries of authoritarian approaches to medicine. The point of view of experts is often contradictory. Occasionally, the judgment, once expressed by an authoritative expert, roams from one direction to another one lacking clear evidence (Majid et al., 2011). In its turn, the EBP does not deny the importance of personal experience and the significant contribution of researchers in solving this or that problem, but also focuses on the following provisions:
- in most clinical situations, diagnosis, prognosis, and treatment of the individual patient should be expressed regarding probability;
- in clinical observations, bias and systematic mistakes might occur;
- clinicians should rely on observation based on solid scientific principles, including ways to reduce bias and evaluation of the role of chance.
Knowing the basics of evidence-based practice is the key to the analysis of clinical research from the standpoint of modern requirements. In this regard, the evidence-based practice might be referred to as a new approach to the collection, analysis, synthesis, and interpretation of scientific information in order to choose the adequate treatment for a particular patient (Brown, 2013). Why is there a need for evidence-based practice? One of the obvious reasons is the increase in the volume of scientific information.
Year per year, clinical practice introduces more and more new drugs as well as surgical methods of treatment and diagnostics. Although they are actively studied in numerous clinical trials, the results of them are often ambiguous and sometimes even opposite to each other. At the same time, there is a need for access facilitation to scientific information (Brown, 2013). Today, any Internet user can read hundreds or thousands of articles within a few minutes.
However, to use this information, in practice, it is necessary not only to carefully analyze information but also to synthesize it with the most reliable treatment or diagnosis of a particular case and previously received evidence-based experience.
A problem of the rational use of resources for one or another treatment option is another reason for the EBP significance. In recent years, there has been a clear trend towards greater use of proven therapies of proven effectiveness in appropriate clinical trials (Stevens, 2013). Reflecting on the mentioned trend, one might note some efforts to develop treatment standards.
The third reason ensuring the relevance of the EBP is a need for ensuring efficiency, safety, and reliability of treatment. Therefore, all the variety of methodological tools and algorithms of research are based on the principles of the evidence-based practice pursuing a key goal of authenticity (Majid et al., 2011). Sometimes, in the medical literature, it is reported of large researches, the results of which cannot be considered credible on closer examination. This happens due to the underestimation of the values of performance requirements for modern methodological clinical research. In other words, the principles of evidence-based practice are essential for any nurse who has to critically analyze and interpret scientific data and use it in practice.
Scientific Data
Once a nurse formulated a research question and searched for corresponding literature, creating a list of the most relevant articles, he or she needs to estimate the value of collected data presented in scientific publications. A hierarchical pyramid of scientific data allows assessing the quality of available data. Brown (2013) states that it includes the following levels enumerated from the top to the bottom of the pyramid: a systematic review of studies related to one subject, randomized controlled trials, quasi-experimental research, non-experimental research, and an expert review. These research methods are of great importance for nursing practice in any field of operation.
As it was noted before, the evidence-based nursing process is a method of science-based implementation of appropriate patient care. From this angle, the nursing process brings a new understanding to the role of nurses in health practice requiring them to have not only good training but also the ability to creatively apply new knowledge and work with the patient as an individual as sometimes, the constant presence and close contact with the nurse are the main links between the patient and the outside world. Knowing methods of research, the nurse can perform their work more effectively that consists of the following aspects:
- identifies the specific patient care needs;
- highlights some of the existing needs and priorities of care expected outcomes of care, and predicts consequences;
- determines the action plan, a strategy aimed at meeting the needs of the patient;
- evaluates the effectiveness of nursing interventions;
- ensures the quality of health care delivery (Dalheim, Harthug, Nilsen, & Nortvedt, 2012).
Thus, the core objective of the evidence-based nursing practice is the maintenance and restoration of the patients’ requirements in meeting their basic human needs and ensuring a high quality of life. This task would be impossible without considering the patient’s physical health problems as well as psychological ones, including the social and spiritual needs of the personality. Considering every person through the prism of the basic human needs and evidence, the nurse decides how he or she can help the patients in overcoming their diseases and social adaptation (Hong, 2010).
More to the point, in order to organize quality care, nurses focus on the collected and carefully analyzed information about their patients. It helps to determine the patients’ needs. To do this, the nurse assesses the following groups of parameters: status of major functional systems of the body, emotional and intellectual background, the range of adaptation to stress, and sociological data. Since the nursing evidence-based practice is a systematic process, its organizational structure consists of several successive stages: nursing patient examination, diagnosis of their condition (identification of needs and problems), scheduling assistance aimed at meeting the identified needs, implementation of the necessary nursing interventions plan, and evaluation of the results and correction, if necessary (Dalheim et al., 2012). Finally, among the advantages of knowing research methods as well as their implementation in the nursing practice, one might note the following points:
- systematic and individual approach to nursing care;
- active patient and family involvement in the planning and provision of care;
- possibility of widespread use of professional standards;
- efficient use of time and resources that address the basic needs and problems of the patient;
- patients receive comprehensive and quality health care;
- knowing research methods demonstrates the level of professional competence of a nurse;
- responsibility and reliability of nursing services and medical care;
- safety of health care.
Being a systematic method of solving issues, evidence-based nursing practice can be applied in different areas of practice. It helps to ensure the nurses’ greater autonomy, and responsibility that supports the expansion of their role promotes cooperation among health care workers and stimulates professional growth.
Scientific Publications
A recent study, “Fostering Early Breast Cancer Detection: Faith Community Nurses Reaching At-risk Populations,” research supports the fact that women belonging to different racial and ethnic groups may have different risks of developing certain types of cancer. According to Shackelford, Weyhenmeyer, and Mabus (2014), “African American women and women living in rural areas have a higher risk of breast cancer development” (p. 113).
The authors of the article state that among the most frequently occurring cancer breast cancer ranks the first place confidently. The global trend of the constant increase in the number of breast cancer patients and mortality statistics confirm it. In recent years, malignant tumors in the mammary gland become more common. Several studies have shown that African women have a tendency to develop an aggressive form of breast cancer, also known as triple-negative cancer.
The research focuses on a specific study as the authors suggest, “that women living in rural areas fall ill from cancer, particularly breast cancer, much less” (Shackelford, Weyhenmeyer, & Mabus, 2014, p. 114). Medical institutions in large and industrial cities that have a bad environmental situation state the highest rates of breast cancer.
Speaking of a role of faith community nurses, the report also confirms that prevention of breast cancer is the most topical issue in terms of public health, especially its “female half that sick more often than men according to statistics” (Shackelford, Weyhenmeyer, & Mabus, 2014, p. 113). Many people die from this type of cancer. However, the basic number of deaths happens because of the fact that the disease is detected at later stages when metastasis (cancer cells) have spread throughout the body and hit the major organs disrupting their functioning.
Thanks to modern methods of treatment, the disease is treatable and most favorable prognosis usually states in the early stages, when it is possible to reach “the five-year survival rate of more than 90 percent of cases” (Marks & Sterngold, 2014, p. 114). Nevertheless, the main question that is of interest to many is whether it possible to prevent a dangerous disease or not? Among a set of measures aimed at improving the quality of cancer care, the largest part of the human resources in the health system – the role of nurses is given great importance. The nurse is a vital element in providing a comprehensive and effective care to the patients.
Shackelford, Weyhenmeyer, and Mabus (2014) claim that “faith community nurses were determined to be valuable resources that could affect the quality of care across the continuum for at-risk populations” (p. 116). Taking into account the specificity of cancer patients and the social significance of care of cancer patients, the need for specialization of nurses in this field is extremely increasing requiring special knowledge and skills in cases of chemo- and radiotherapy, in palliative treatment in terms of rehabilitation, and provision of psychological support to patients and their families.
To educate regular nurses as faith community nurses and improve their competence, a grant through the National Vulnerable Populations Community Grants Program to St. John’s Hospital in Springfield, IL was provided. The effective educational strategy comprised videos and DVDs that featured the aforementioned educational content and life-size breast models. As a result, it was stated that faith community nurses played a key role in providing breast care education to at-risk populations. In other words, nurses applied the evidence-based practice to their patients.
Conclusion
In conclusion, it should be emphasized that the utilization of principles of the evidence-based practice involves a combination of individual clinical expertise and the best evidence obtained using a systematic analysis of clinical trials. Every nurse should know the basic principles, namely, research methods concerning the evidence-based practice as its value to clinical practice is great. All the actions for the treatment, prevention, and health promotion should be based on evidence and not on the individual opinions. Also, it was revealed that the evidence-based practice takes place in the context of global health as well.
References
Brown, S. J. (2013). Evidence-based nursing: The research-practice connection (3rd ed.). Sudbury, MA: Jones and Bartlett Learning.
Dalheim, A., Harthug, S., Nilsen, R. M., & Nortvedt, M. W. (2012). Factors influencing the development of evidence-based practice among nurses: A self-report survey. BMC Health Services Research, 12(367), 1-10. Web.
Hong, W. S. (2010). Evidence-based Nursing Practice for Health Promotion in Adults With Hypertension: A Literature Review. Asian Nursing Research, 4(4), 227-245. Web.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236. Web.
Shackelford, J., Weyhenmeyer, D., & Mabus, L. (2014). Fostering Early Breast Cancer Detection: Faith Community Nurses Reaching At-risk Populations. Clinical Journal of Oncology Nursing, 18(6), 113-117. Web.
Stevens, K. R. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. The Online Journal of Issues in Nursing, 18(2), 1-12. Web.