Evidence-Based Practice and Applied Nursing Research Essay Paper

Evidence-Based Practice and Applied Nursing Research Essay Paper

Evidence Table

A1. Quantitative Article: Duthie, E., Favreau, B., & Ruperto, A. (2015, February 4). Quantitative and Qualitative Analysis of Medication Errors. Retrieved February 8, 2019, from .
Background or Introduction	249 New York State hospitals implemented an experimental mandatory adverse event reporting system that examine hospital policy issues and identify useful interventions for future prevention.
Review of the Literature	In total, 14 articles were referenced within the publication.  The supporting material related to drug facts and comparisons, human errors, incident reporting, medication error prevention, and hospital guidelines.
Methodology Struggling to meet your deadline ? Get assistance on Evidence-Based Practice and Applied Nursing Research Essay Paper done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline	An 11member panel utilized random error reports received by the New York State Department of Health from the 249 participating hospitals. A committee of multidisciplinary professionals spent 24 months performing a quantitative analysis that examined several variables to include: where in the medication administration process did the error occur? what departments were involved? how often did the same error occur? what medications or medication class was involved?
Data Analysis	A quantitative analysis of numeric data was used to calculate statistics regarding both fatal and non-fatal medication errors received from the 249 participating in the tracking program.  This type of methodology allows for greater objectivity when results are reviewed.  Also, for purposes of developing new hospital policies and procedures, numerical quantitative data is viewed as credible and more reliable.

Evidence-Based Practice and Applied Nursing Research Essay Paper

Quantitative Conclusions:  The medication error tracking received from the 249 pilot hospitals was successful in meeting the program mandates.  The data collected from fatal or near-fatal errors was instrumental in improving patient safety.  The information compiled will generate educational initiatives to address identified weaknesses.  These initiatives will provide knowledge and skills that proactively implement a safer medication administration system.

Quantitative: Protection and Considerations: The researchers indicate the information compiled originated from each hospital’s risk management department and there was no need to obtain informed consent.  “In quantitative research, ethical standards prevent against such things as the fabrication or falsifying of data and therefore, promote the pursuit of knowledge and truth which is the primary goal of research.” (Duthie, 2015).

Quantitative: Strengths and Limitations:  The data collected provides useful and practical data to the healthcare industry in order to reduce the incidence of medication errors that cause fatal and non-fatal outcomes.  An initial lack of compliance from each reporting institute proved to be a problem with data collection.  However, the New York Patient Occurrence Reporting and Tracking System (NYPORTS) provided reeducation to the staff of each recruited hospital and cooperation was eventually achieved.  It was determined the most common pitfall of medication administration is human error.  Even with a careful, updated tracking system, a deficit in knowledge must be remedied by continuing education.

Quantitative: Evidence Application:  The expectation of this tracking program is to improve patient outcomes.  If implemented, these initiatives will provide healthcare workers the skills and knowledge to proactively prevent medication errors that result in serious harm.

Evidence Table – Evidence-Based Practice and Applied Nursing Research Essay Paper

B1. Qualitative Article: Duthie, E., Favreau, B., & Ruperto, A. (2015, February 4). Quantitative and Qualitative Analysis of Medication Errors. Retrieved February 8, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK20445/.
Background/Introduction	In total, 14 articles were referenced within the publication.  The supporting material related to drug facts and comparisons, human errors, incident reporting, medication error prevention, and hospital guidelines.
Review of the Literature	In total, 14 articles were referenced within the publication.  The supporting material related to drug facts and comparisons, human errors, incident reporting, medication error prevention, and hospital guidelines.
Discussion of Methodology	An 11member panel utilized random error reports received by the New York State Department of Health from the 249 participating hospitals. A committee of multidisciplinary professionals spent 24 months performing a qualitative analysis that included findings that related to: lessons learned emergent themes corrective counseling or education absent of punitive fixes
Data Analysis	The research panel consisted of multidisciplinary professionals who were experts in medical qualitative analysis.  Upon receipt of the medication error reports, the panel categorized the collected information using a coding system.  Another qualitive approach is the narrative analysis. This is more subjective and allows a “point of view” approach by asking the following questions: what is this about? who?, what?, where?, when? then what happened? so what?

Qualitative Conclusions:  The narrative data used in qualitative analysis appears to be the best source for implementing initiatives that will reduce medication errors.  The data collected from fatal or near-fatal errors was instrumental in improving patient safety.  The information compiled will generate educational initiatives to address identified weaknesses.  These initiatives will provide knowledge and skills that proactively implement a safer medication administration system.

Qualitative: Protection and Considerations:  Qualitative research is centered around the “do no harm” platform.  One aspect of preventing medication errors is imploring the facility to provide staff with continuing education.  In addition, there needs to be a clear, detailed policy for disclosure of information to the patient regarding a medication error.

Qualitative: Strengths and Limitations:  The data collected provides useful and practical data to the healthcare industry in order to reduce the incidence of medication errors that cause fatal and non-fatal outcomes.  An initial lack of compliance from each reporting institute proved to be a problem with data collection.  However, the New York Patient Occurrence Reporting and Tracking System (NYPORTS) provided reeducation to the staff of each recruited hospital and cooperation was eventually achieved.  It was determined the most common pitfall of medication administration is human error.  Even with a careful, updated tracking system, a deficit in knowledge must be remedied by continuing education.

Task A: Significance and Background of a Healthcare Problem

A.1 Health Care Problem

In this Evidence Based Practice and Applied Nursing Research, the health care problem considered was the brain tumor. In the human body, cells usually die after their useful life. Tumor refers to a situation in which the body cells do not die which leads to accumulation of cells (the new cells and old cells). A brain tumor is a situation in which these cells accumulate in the brain. Since the skull is a rigid structure, the abnormal growth of cells in the brain will exert pressure on the brain which can have adverse effects (Cook & Freedman, 2012). This cancer can occur either by cancerous cells being generated in the brain (primary tumors-adults) or when they are transmitted from other parts of the body (secondary tumors-children and elderly). The types of brain tumors are; malignant (cancerous and more dangerous) and benign (non-cancerous and easier to remove surgically). The symptoms include poor judgment, headaches, and poor performance of sensory nerves, consciousness loss, vomiting, and seizures. When a doctor notices these symptoms, the patient is asked about their family history (since it is inheritable), then Computed Tomography (CT) or Magnetic Resonance Enterography (MRE) scan are done. The scans determine the presence/absence of tumor. Finally, the physician conducts a biopsy for checking if the tumor is cancerous or not. This cancer can be treated through; surgery (when the tumor is not deep rooted or located in sensitive parts of the brain), radiation or chemotherapy (when surgery is not feasible or to completely destroy the cancerous cells post-surgery).

A.2 Significance of Brain Tumors

The number of patients diagnosed with a brain tumor has been increasing over the past years; this can be attributed to the high exposure to radioactive rays as well as lifestyle habits.  According to data from cancer.net, approximately 23,800 (17,600 of whom will die) primary and 4,830 secondary brain tumor diagnosis will be made. (“Brain Tumor: Statistics | Cancer.Net”, 2017). In addition to other nervous system cancers, brain tumors are ranked number ten as a death causative. Tumors can be inherited: it is a significant disease when considering a marriage partner. Treatment is also quite high. Depending on the type of tumor, the cost can be as high as six hundred thousand (where apart from surgery, radiation and chemotherapy are needed) or an amount less than fifty thousand dollars (where only one treatment method is used). These costs affect the financial status of the family. Also, after treatment, the patient requires additional attention. It may include home care (by the family), admission into care institutions, and therapy sessions such as physical (to regain body balance) or speech. The patient may also suffer mental distortion which is not recoverable hence they can no longer participate in physical activities such as working. If the individual were the bread winner, they family would suffer economically. The effects of brain tumor make it an important disease to treat and prevent.

A.3 Current Practices Related to Brain Tumors

Medical researchers are continually coming up with new methods to detect, treat and offer care to the diagnosed. These current practices are discussed below.

Enhancing scans: cancer scans such CT and MRE are important in diagnosing tumors and tracking their possible regrowth after treatments. Due to the small size of tumors, the scan cannot produce clear resolution images. Efforts are being made to increase the imaging ability.

Tumor markers: these are substances found in the body liquids such as blood and urine, and tissues that are released by cancerous cells. Physicians use the indicators (also known as biomarkers) for various purposes such as: deciding whether to use radiations or chemotherapy after surgery, determination of patient’s prognosis (tumor monitoring, recovery likelihood or tumor reoccurrence).

Biological Response Modifier: experiments are being conducted on a new type of therapy (immunotherapy) where the aim is to boost the immune system of the body thus enabling the patient to ‘fight’ the disease. Current research involves utilization of dendritic cells which target particular molecule on the tumor’s surface, destroy them and boost body immune.

Oncolytic virotherapy is a possible treatment alternative. The oncolytic virus can kill cancerous cells. Upon it being injected into the tumor sites, it ‘eats up’ the cells which in turn release particles of virus which destroy the remaining tumors: the process continues until the entire tumor has been destroyed.

Blood-brain blockade loosening: the brain consists of a protective layer which prevents rays from reaching some parts of the brain during chemotherapy. This practice is aimed at temporarily interfering with the barrier to allow the rays penetrate. However, it might cause damage to sensitive parts of the brain which may lead to adverse effects such as permanent memory loss or body coordination.

A.4 Impact of Brain Tumor on Cultural Background of organization or patient(s)

During chemotherapy, the patients become too weak to do simple tasks such as feed themselves, take a bath or visit the washrooms. The nurses are tasked with these duties. Washing an adult or helping them in the washrooms can be discomforting for some people and new graduates tasked with these duties on their first days may give up on their nursing career. After discharge, the patients are expected to receive homecare from family members who might develop psychological distress due to the care the patient demand. In situations where the disease is inherited, a family might be viewed as caused which affects children psychologically, and fear among the household members as any of them might be sick in the future.

Task B: The PICO Table – Evidence-Based Practice and Applied Nursing Research Essay Paper

	Example:
P (problem)	Mood disorders (depression, distress and anxiety) Anxiety in Brain tumor patients
I (intervention)	Pre and post-surgery patient screening of mood disorders.
C (comparison)	No therapeutic communication
O (outcome)	Creation of doctor-patient trust relationship and reducing anxiety disorder thus aiding in the healing process of patients.

PICO Question: In brain tumor patients suffering from anxiety disorder, does screening the patient compared to no screening help reduce mood disorders and as a result aid patients in the healing process.

Task C: Search Strategy – Evidence-Based Practice and Applied Nursing Research Essay Paper

C.1 Keywords; Brain tumors, anxiety, screening, mood disorders, depression, and anxiety

C.2 Number and types of article available for Consideration

A search for peer reviewed journals was made in the pubmed.gov website using the keywords stated above. The materials were sorted to reveal only those less than five years old (those after 2012) and then further sorted by publication date so that the latest journals appear first.

At first, the keyword brain tumor was used which retrieved 190,777 articles. The number reduced to 75 after using all the stated keywords. Apart from brain cancer, the materials also included breast, brain, land and ovarian cancer. Most of the journals were quantitative research based articles on alternative medical treatments, dealing with patient’s pre and post-surgery and also public education on cancer.

Research Evidence Articles – Evidence-Based Practice and Applied Nursing Research Essay Paper

Van der Vossen, S., Schepers, V. P., van der Sprenkel, J. W. B., Visser-Meily, J., & Post, M. W. (2014). Cognitive and emotional problems in patients after cerebral meningioma surgery. Journal of rehabilitation medicine, 46(5), 430-437.

The authors were investigating depression and anxiety disorder which result after surgery of cerebral meningioma. They also aimed at finding out factors which result in these disorders. The study was done on patients who had undergone treatment between the years 2007 and 2009. The research used medical records and questionnaires which were conclusive that, post-surgery, forty percent of patients may experience emotional problems which may result in depression or anxiety. The article recommends screening each time a person comes from cerebral meningioma surgery.

Bunevicius, A., Deltuva, V. P., & Tamasauskas, A. (2017). Association of pre-operative depressive and anxiety symptoms with five-year survival of glioma and meningioma patients: a prospective cohort study. Oncotarget.

In this article, the researchers are investigating the linkage between pre-operative anxiety and disorder symptoms to meningioma and glioma. The journal is based on the fact that patients suffering from the mentioned infections do not get healed. The study involved 152 patients. The study revealed that patients with glioma had higher cases of depression while the difference in anxiety between glioma and manigma was small. Due to low mortality of meningioma, symptoms of depression were more elevated in these patients who contribute to the death of the patients. The article recommends the use of antidepressants, in particular for the meningioma victims.

Non-Research Evidence Articles – Evidence-Based Practice and Applied Nursing Research Essay Paper

SMITH, H. R. (2015). Depression in cancer patients: Pathogenesis, implications and treatment (Review). Oncology Letters, 9(4), 1509–1514. http://doi.org/10.3892/ol.2015.2944

Smith acknowledges that due to the chronic nature of cancer, having stress when diagnosed is normal, but it should not be excessive. Smith recommends screening of the patients to identify the levels of stress thus reduce depression. Smith suggests diurnal cortisol variation as the best screening method. The author identifies the pathogenesis of depression which begins psychologically (as patiently is unable to adjust to the life change), the stress increases and with time, leads to chronic stress. Smith offers various management plans such as therapeutic communication, use of antidepressants and exercise.

Syrjala, K. L., Jensen, M. P., Mendoza, M. E., Yi, J. C., Fisher, H. M., & Keefe, F. J. (2014). Psychological and behavioral approaches to cancer pain management. Journal of Clinical Oncology, 32(16), 1703-1711.

Syrjala aims at explaining the linkage between pain and psychological disorders. The article states that depression, anxiety, and other mental stress contribute to pain. In turn, patients’ mortality increases and adversely their quality of life is lowered. Pain is majorly experienced by cancer patients, and since anxiety and depression contribute to pain, the authors suggest treatment of these disorders should be done when treating pain. The article recommends both physiological (yoga, meditation, and physical activities) and psychological (therapeutic communication, hypnosis and education hot to cope with pain) methods to deal with the disorders. These practices will help the patients in dealing with the life change and thus reduce stress. As a result, a person gains the will to live, eats better, and their quality of life improves.

Task E: Explanation of a recommended practice change that addresses PICO question by using evidence from matrix table

Evidence from the model evidence table indicates that brain tumor patients experience mood disorders (anxiety, depression, and distress) before and after surgery. According to Smith, these diseases cause a patient to feel suicidal, lack of will to live, appetite loss which in turn reduces the immune system of the patient and after that the patient succumbs to the disease. The recommended practice change is offering to screen to before and after surgery. The effect of screening on each of the evidence collected is discussed below.

Bunevicius notes that patients experience mood disorder before operations which are linked to talks relating to the brain tumor, that is, when one contracts cancer, they are going to die. Upon diagnosis, the patient develops a thought that their life is over. Due to this, a patient loses hope of getting healed which adversely affects their immune system. After treatment, the person’s body becomes too weak to recover. Through screening, physicians can detect the problem and offer treatment such as antidepressants or recommending exercise/recreational activities to reduce stress levels.

Evidence from Van der Vossen indicates that meningioma surgery patients may experience anxiety disorders after surgery. The use of anesthesia drugs alters the chemicals in the brain which in turn cause mood disorders (Cook & Freedman, 2012). The disorders can last for months even after treatment. After surgery, the patients need to be scanned and the extent to which anesthesia is affecting the body determined. The patient also needs to make frequent appointments to the hospital after treatment.

The brain is the central nervous system (apart from the spinal cord) which serves the function of controlling all the body activities. Included in these activities is an emotional balance. Syrjala notes that anxiety and depression have a linkage to pain. Due to this, any infection in the brain causes mood disorder. The growth of tumors in the brain is thus more likely to cause emotional imbalance than other types of cancers as evidenced by Cordes in his research that compared Brain metastas and breast cancer regarding mood disorders levels. As a result, patients who have brain cancer should be screened before and after treatment.

Pan in brain tumor mutations detected in cerebral spinal fluid states that ‘Central Spinal Fluid (CSF) is contained in the brain thus can be used to identify tumor markers.’ His research indicates that CSF is a major component when investigating the pathogenesis is brain tumors; this is because the cancer is located in the Central Nervous System where CSF is found. Since depression reduces the healing process, a patient/family/caregiver can continually use CSF tests from home to determine the progress of the tumors as the patient is undertaking depression reduction techniques such as exercises, yoga, social interactions, and antidepressants.

From the evidence matrix table data, it is evident that mood disorder is common in brain cancer patients and thus there is a need to address it. Through the intervention of screening patients, anxiety, depression and distress levels can be reduced. Caregivers and nurses need to engage with the patient to determine their stress levels continually. Various aspects of the patient’s life can be monitored; this includes appetite, attitude, speech (speaking too loudly and fast or slowly at a low volume). It is important for the stress levels of the close family members (such as children and spouse) to be determined as this also affects the patient, for example, an elementary school kid whose father is hospitalized is likely to develop depression. A reduction in stress levels will ultimately increase patients’ quality of life and thus help them to recover.

Task F: Process of Implementation of Recommendation from E.

F.1 Stakeholders

Implementation of the recommended practice change requires the efforts of various stakeholders in addition to the nurses. This discussion considered; health care providers, government, and patients.

Health care providers are the professionals who offer medical services to the patients. They include nurses, physicians, and surgeons. Regarding the recommendation, these individuals are the ones to cry out the screening process. Before surgery, the pre-operative nurse needs to file a screening for the patient before they hand them over to the surgeons. After an operation, the surgeon needs to communicate to the post-operative caregiver on the anesthetic drugs and also forward the pre-operative scan results from the pre-operative nurse. The performance of the roles determines a patients’ anxiety, depression, and distress levels, and appropriate monitoring done.

The government plays a significant role as the mediator between patients and health institutes. The state ensures individuals receive the best care by the implementation of policies. The policies suggestion that can be forwarded to the government includes lowering or making the cost of screening to be free. Since scanning is an additional expense to patients, some health institutes may lack to offer it if the patient cannot afford. A reduction or removal of the fee will ensure all patients are scanned.

Patients are the individuals seeking medical attention for an ailment. When one has a brain tumor, they can have poor judgment or mental coordination (SMITH, 2015). To ensure screening is carried out, patients should give their consent to have an individual (family, friend or any person of their choice) to make the medical decisions for them. The patients can also be educated on the benefits of mental screening hence they will adhere to the treatment options (for reducing mood disorder) offered.

F.2 Barriers

Implementation of a change in practice in a health institute is always encountered by various barriers which result due to factors such as financial, time, knowledge and unwillingness to adapt change constraints.

Financial constraint: any change requires funding which may come from the government (in public hospitals), shareholders (in a private institute) and insurance agencies (by covering the new patients’ treatments). For screening to occur a hospital requires to employ additional staff to perform the new task, but due to budget constraint, employment may not be done. Also, the screening process adds up the medical fee of the patient. Current insurance covers will not be covering screening, and thus a patient will be required to pay for the screening and the drugs such as antidepressants (Cook & Freedman, 2012).

Staffing and time barrier: the current staffing of nurses is not sufficient to offer efficient services to all patients. Screening (for example, asking questions to patients to determine their level of distress or by monitoring their behavior) requires time which won’t be found considering the schedule of the nurses.

Knowledge: most of the professionals lack knowledge on proper research into practice methods. Most individuals can conduct sufficient research but lack implementation skills. Thus, with the new recommendation, effective implementation won’t take place.

Unwillingness to adapt to change: most individuals are not open to a change in practice. There is a fixed perception that ‘we have always done things this way thus the change is not necessarily.’ The attitude extends from patients, nurses, physicians to the government.

F.3 Strategies to overcome barriers

Training: before changes are made, the stakeholders should be educated on the importance of the recommendation. Through the program, individuals will appreciate it and thus become open to the changes. The training can be done through the media (through government initiative to educate its citizen on the benefits of screening to the recovery of the patient) or one-on-one by paraprofessionals in the hospitals which will target the patients and healthcare providers.

Donation: funds can be solicited to aid the health in implementing the changes. The funds will finance; employment of new staff, purchase of screening tools, integration of the department into the hospital as well as subsidize the screening cost to the patients. The funds can come from the Non-governmental organization, the state or citizens. There is need to ensure that the targeted donors fully appreciate the need for pre and post-operative screening of brain tumor patients to receive the donations.

F.4 Indicator of outcome

The indicator to be used would be an assessment of the number of patients diagnosed with anxiety, depression or distress after undergoing treatment of brain tumor. The diagnosis can be based on patients who have recovered. The diagnosis shall then be compared to the number of recoveries. If the number of diagnosis decrease (from previous records) and improvements increase, then it shall be concluded that screening patients with brain tumor help in improving recovery of brain cancer. If the files indicate a decrease in diagnosis with no significant change in recovery, the conclusion is: screening helped reduce mood disorder levels, but the changes did not help the patients healing process. Conclusion for no change in both, is, screening has no effect on mood disorders and recovery of brain tumor patients and thus the recommendation is not necessary for health care practice.

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References – Evidence-Based Practice and Applied Nursing Research Essay Paper

• Brain Tumor: Statistics | Cancer.Net. (2017). Cancer.Net. Retrieved 9 June 2017, from http://www.cancer.net/cancer-types/brain-tumor/statistics
• Cook, L., & Freedman, J. (2012). Brain tumors (1st ed.). New York: Rosen Pub
• Kaye, A., & Laws, E. (2012). Brain tumors. Edinburgh: Saunders/Elsevier.
• Taylor, L., Umphrey, A., & Richard, D. (2012). Navigating Life with a Brain Tumor. New York: Oxford University Press, USA.
• Research Articles
• Cordes, M., Scherwath, A., Ahmad, T., Cole, A., Ernst, G., & Oppitz, K. et al. (2014). Distress, anxiety and depression in patients with brain metastases before and after radiotherapy. BMC Cancer, 14(1). http://dx.doi.org/10.1186/1471-2407-14-731
• Behnan, J., Isakson, P., Joel, M., Cilio, C., Langmoen, I., Vik-Mo, E., & Badn, W. (2014). Recruited Brain Tumor-Derived Mesenchymal Stem Cells Contribute to Brain Tumor Progression. STEM CELLS, 32(5), 1110-1123. http://dx.doi.org/10.1002/stem.1614
• Bunevicius, A., Deltuva, V., & Tamasauskas, A. (2015). Association of pre-operative depressive and anxiety symptoms with five-year survival of glioma and meningioma patients: a prospective cohort study. Oncotarget. http://dx.doi.org/10.18632/oncotarget.15743
• Pan, W., Gu, W., Nagpal, S., Gephart, M., & Quake, S. (2015). Brain Tumor Mutations Detected in Cerebral Spinal Fluid. Clinical Chemistry, 61(3), 514-522. http://dx.doi.org/10.1373/clinchem.2014.235457
• Vossen, S., Schepers, V., Sprenkel, J., Visser-Meily, J., & Post, M. (2014). Cognitive and emotional problems in patients after cerebral meningioma surgery. Journal Of Rehabilitation Medicine, 46(5), 430-437. http://dx.doi.org/10.2340/16501977-1795
• Non-Research Articles
• Smith, H. (2015). Depression in cancer patients: Pathogenesis, implications and treatment (Review). Oncology Letters. http://dx.doi.org/10.3892/ol.2015.2944
• Syrjala, K., Jensen, M., Mendoza, M., Yi, J., Fisher, H., & Keefe, F. (2014). Psychological and Behavioral Approaches to Cancer Pain Management. Journal Of Clinical Oncology, 32(16), 1703-1711. http://dx.doi.org/10.1200/jco.2013.54.4825