Introduction
Evidence-based nursing, which combines research data with clinical expertise, is essential for improving patient outcomes. The issue of non-compliance with VTE prophylaxis negatively affects the quality of care and requires adequate research evidence. The purpose of the following work is to discuss two articles representing different types of evidence, address the levels of evidence, and assess the value of the sources for the evidence-based problem (EBP) of VTE.
Discussion
The first article for the analysis is a systematic review by Etxeandia-Ikobaltzeta et al., which investigates VTE patient preferences. The researchers developed a special protocol (PROSPERO) and utilized an inclusive methodology to systematically review the findings. Pregnant patients demonstrated high rates of compliance with LMWH prophylaxis, while 46%-55% of cancer patients had a positive attitude to prophylactic injections and external compression devices (Etxeandia-Ikobaltzeta et al. 2020, p. 960). Thus, the results reflect varied preferences and compliance with different VTE prophylaxis methods among diverse patient populations.
The levels of evidence evaluate the strength of a study and the potential for future implementation of its findings. Based on the AACN evidence-rating system described by Peterson et al. (2014), a systematic review may fall into two categories: randomized control trials (Level A) or reviews of previous studies (Level C). The systematic review by Etxeandia-Ikobaltzeta et al. might be categorized into Level A, as it analyzes randomized control trials. Moreover, the source fits into Level A of the hierarchy because it reviews quantitative experimental studies, while weaker non-experimental studies are rated as Level C.
Since the article belongs to the highest level of the evidence-based care pyramid, it provides useful and credible evidence for the problem of VTE non-compliance. For instance, patients find that VTE complications such as pulmonary embolism (PE) and deep vein thrombosis (DVT) have a moderate impact on their lives, which helps to understand VTE compliance (Etxeandia-Ikobaltzeta et al., 2020). Additionally, the study examines 123 participants, offers evidence on the significant impact of pregnancy-related PE and DVT, and contributes to the understanding of a particular patient population (Etxeandia-Ikobaltzeta et al., 2020, p. 959). The evidence is valuable for EBP patient education aimed at improving compliance of pregnant patients with VTE prophylaxis.
The second article is a peer-reviewed study by Blackwell et al., which investigates the admission of chemical agents such as low molecular weight heparin (LMWH) and Aspirin for VTE prevention. The researchers examined trauma patients’ compliance by assessing 75 questionnaire results from 19 post-operative patients and 51 non-surgical management patients (Blackwell et al., 2017, p. 1). The results demonstrate that 31 patients preferred LMWH, 30 patients chose Aspirin, and 9 patients rejected prophylactic measures. Only 5 out of 30 patients demonstrated non-compliance and reported missed doses of LMWH. Overall, the authors consider LMWH as an effective and well-tolerated thromboprophylaxis and indicate the lack of evidence for Aspirin use.
According to the AACN classification, the article belongs to Level C. The study fits into the category of qualitative research evidence, as it investigates the phenomena using an in-depth approach to the material (Peterson et al., 2014). The strength of the method is the combination of observation and interviewing research techniques, which might help to develop a proper understanding of the EBP problem of VTE.
The article provides useful evidence related to VTE patient non-compliance. The evidence is valuable as it demonstrates that trauma patients have equal preferences for both LMWH and Aspirin. The study indicated that there is inadequate evidence for Aspirin effectiveness for VTE prevention, so EBP patient education materials should focus on the benefits of LMWH use (Blackwell et al., 2017). Additionally, the questionnaires’ results contribute to the understanding of surgical and non-surgical patients’ responses to prophylactic measures such as LMWH and Aspirin admissions.
Conclusion
All in all, the review of the articles containing different types of evidence demonstrated that both sources provided valuable and reliable evidence for the EBP problem of VTE patient non-compliance. While the first source is experimental and includes the highest quality of evidence, the second source is also useful as the data obtained through the use of questionnaires can applied for future research and implementation.
References
Blackwell, J. R., Raval, P., Quigley, J., Patel, A., & McBride, D. (2017). Patient compliance with venous thromboembolism prophylaxis (VTE). Journal of Clinical Orthopedics and Trauma, 369, 1–5.
Etxeandia-Ikobaltzeta, I., Zhang, Y., Brundisini, F., Florez, I. D., Wiercioch, W., Nieuwlaat, R., Begum, H., Cuello, C. A., Roldan, Y., Chen, R., Ding, C., Morgan, R. L., Riva, J. J., Zhang, Y., Charide, R., Agarwal, A., Balduzzi, S., Morgano, G. P., Yepes-Nuñez, J. J., … H. J. Schun̈emann. (2020). Patient values and preferences regarding VTE disease: A systematic review to inform American Society of Hematology guidelines. Blood Advances, 4(5), 953–968.
Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Rigs, L., & Whiteman, K. (2014). Choosing the best evidence to guide clinical practice: Application of AACN levels of evidence. Critical Care Nurse, 34(2), 58–68.