Explain why evidence-based practice (EBP) does not merely mean applying the best evidence in making clinical decisions.
post 1 by Goodnews Evidence-based practice (EBP) does not merely mean applying the best evidence in making clinical decisions. Instead, the evidence must be considered in light of patient concerns and preferences. The consideration of patient preferences is imperative due to variations in patients and their situations. Effective clinical decisions require the application of appraised evidence when it is relevant to the specific patient’s preferences. The importance of patient preferences is underscored in one of the personal clinical experiences. Patient preferences are an essential part of clinical practice as patients become increasingly engaged in healthcare processes. One of my experiences that highlighted the importance of consideration of patient preferences involved a female Hispanic patient with diabetes. Her condition was poorly managed and required immediate treatments for glycemic control. One of the evidence-based interventions to reduce blood sugar levels is the use of pharmacological treatments (Mosen, Glauber, Stoneburner & Feldstein, 2017). However, these medications are either administered orally or through injection. In this case, the patient was given a Sulfonylurea to be taken orally. Although the patient expressed some concerns over these medications and its potential side effects, the decision to prescribe this medication was the sole decision of the practitioner. In her follow-up hospital visit, the patient still had hyperglycemia. Upon an assessment, it was revealed that the patient failed to take medications as recommended. Although the prescribed medication is an effective and evidence-based treatment for hyperglycemia, the failure to consider the preferences of the patients and engage them in decision making affects the patient’s willingness to take it. Unaddressed patient concerns could lead to patients’ mistrust in practitioners and poor disease prognosis (Melnyk & Fineout-Overholt, 2018). The patient is, thus, at a high risk of developing severe disease complications. Shared clinical decisions are crucial for positive patient outcomes. According to Hoffman, Montori, and Del Mar (2014), shared decisions are made through the collaborative efforts of both the patient and healthcare provider. The consideration of patient’s concerns and preferences is a crucial element in shared decisions (Kon, Davidson, Morrison, Danis & White, 2016). In the presented case, shared decision making would have improved glycemic control. Notably, a change in the treatment based on patient preferences would lead to improved medication adherence. However, the prescribed medications must offer effective treatment for the patient’s condition. Based on this case, nurses and other healthcare practitioners must strive to apply the best evidence in the context of patient preferences. As Melnyk and Fineout-Overholt (2018) asserts, valid clinical judgment requires the application of proof when it applies to the patient’s condition. Thus, treatment plans should be based on best evidence and patient preferences. Patient decision aids provide useful tools to enhance shared decisions making. As Melnyk and Fineout-Overholt (2018) note, these decision aids allow the discussion about treatment plans based on patient preferences and clinical evidence. Generally, the active participation of patients in the decision-making process improves their desire to comply with the established treatment plan. In the presented experience, the patient decision aid would have addressed any patient’s concerns with the medications (Hoffman, Montori & Del Mar 2014). The apparent outcome from the shared clinical decisions is improved patient compliance with the treatment plan and improved health outcomes. In conclusion, evidence-based practice must be driven by both clinical evidence and patient preferences. In my professional practice, I will use shared decision making when developing treatment plans. The decision will not only improve the patient experience and outcomes, but it will also enhance my professional expertise in evidence-based practice. References Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence- based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/1910118 Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788386/ Mosen, D. M., Glauber, H., Stoneburner, A. B., & Feldstein, A. C. (2017). Assessing the association between medication adherence and glycemic control. Am J Pharm Benefits, 9(3), 82-88. post 2 by kanae Evidence-based decision making is supported by best evidence, clinical expertise, and patient preferences/values, and ignoring or omitting any one of them could end with unstable, less than the optimal result (Laureate Education, 2018). In order to incorporate all three aspects, patients require healthcare professionals to be their advocate and provide knowledge of best evidence and their clinical expertise to guide shared decision making (SDM). Hoffman, Montori, and Del Mar (2014) state that SDM is the process of clinician and patient jointly participating in a health decision after discussing the options, the benefits, and harms, and considering the patient’s values, preferences, and circumstances. Healthcare professionals must understand the patient’s culture and values and provide patient education, which becomes an essential tool for the patient to make their own decision. When I was a charge nurse in a long-term care facility about ten years ago, I learned how important involving patients in making clinical decisions. One day, an activity coordinator in the facility approached me and expressed her concern that one of the residents would not come out of her room at all to join activities happening in the facility throughout the day. She said the resident seems to avoid interacting with other residents and eats all her meals in her room instead of coming out to the dining room to join others. The activity coordinator even reached out to the resident’s daughter to see if anything that she could do differently to encourage the resident to come out and socialize with other residents. The daughter was puzzled and told us that her mom was normally a very social and out-going person who loves to make friends and interact with others. At this point, I decided to take a visit to the resident and investigate what was going on with her. The resident was reluctant to tell me at first but eventually opened up and told me that her “water pill” is causing urinary incontinence, and she is embarrassed about having accidents during the day while being around other people. As a nurse, I knew diuretics are one of the best evidence-based treatment for fluid overload due to congestive heart failure, so I explained to her that how important taking her diuretic is for her heart condition. She said she understood the importance of taking diuretics for her heart, but she wished it didn’t cause overacting bladder. I found out that she takes her diuretic once a day in the morning, and she usually has urinary incontinence during the day. Diuretics are typically given in the morning so that it will not disturb their sleep during at night. I asked her whether she preferred taking the diuretic in the afternoon or the evening so that she can enjoy her day with other people. She suggested taking her diuretic at dinnertime so that she can go back to her room after dinner. That way, she can take care of her incontinence in her room before bedtime. She said she usually had incontinent episodes a few hours after taking a diuretic. If she takes diuretic at dinnertime, she can go back to her room and read a book for a few hours in her room until she needs to empty her bladder. After her care plan was updated in accordance with her preference, I started seeing her coming out her room more often and interacting with other residents. It is evident that her quality of life improved by adjusting the time to take her diuretic. Incorporating the patient’s preference impacts the outcome of her treatment plan. The example above displayed that it was essential to explain why she needed to take a diuretic for her CHF so that she could make informed decision to continue adhering to the medication regimen. My knowledge of EBP and clinical expertise as a nurse, and the patient’s value and preference assisted in guiding SDM. As a result, she felt empowered by participating in making decisions on her own care. Moreover, her quality of life has been significantly improved. The decision aid on taking diuretic was unavailable in the Ottawa Hospital Research Institute’s Decision Aids Inventory. However, I remember the patient and her daughter were needed to decide on whether to have ICD (Implantable Cardioverter-Defibrillators) at some point, so I decided to select a decision aid for ICD. It would assist patients and their families with heart failure in making informed decision effectively on whether to have an ICD or not. The decision aid brochure created by Matlock (2014) has lots of pictures and infographics as well as the interactive “fill-in-the-blank” page to evaluate patient’s own quality of life after deciding to have or not to have ICD. This decision aid is very useful because it is written in simple language with visual information that non-medical people could easily understand, and provide enough information on current EBP, benefits and risks of having ICD so that patients can make an effective, informed decision. The Ottawa Hospital Research Institute’s Decision Aids Inventory has an extensive amount of decision aids for many medical conditions and procedures. I want to use the decision aids from the inventory for my patients in my future professional practice because they are a very effective tool when you want to pass important information to them regarding their options. I would also like to use them to educate myself on what information need to be included or addressed when I educate and advocate my patients, and I definitely would like to use them personally for my family and friends when they need assistance in making difficult medical decisions. References Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/1910118 Laureate Education (Producer). (2018). Evidence-based Decision Making [Video file]. Baltimore, MD: Author. Matlock, D. (2014). A decision aid for Implantable Cardioverter-Defibrillators (ICD). Retrieved from https://patientdecisionaid.org/wp-content/uploads/2016/06/ICDInfographic-4.8.19.pdf
