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Evidence-Based Practice

Introduction 

The current case study is based on a 57 years old male, James, a retired teacher and was admitted within the surgical ward due to an acute abdomen. By an investigative laparotomy procedure, a tumour was diagnosed within James's large colon, followed by a colostomy surgical intervention.  James and his wife live together in their residence, and their daughter and a two-year-old granddaughter. Upon physical examination, it was found that James's BMI was 29, and, a recent diagnosis of type 2 diabetes mellitus was also made. James has been put on oral hypoglycaemics and is prone to smoking; however, he is trying to withdraw. For the evaluation of James' case study, the evidence-based practice can be used. Evidence-based practice (EBP) is a method which aims to enhance the processes by which a high quality empirical study findings can be achieved and implemented into the most effective practical choices to enhance health. The results obtained from systemic data using observational and experimental studies and, the formation of research questions and testing hypotheses all involve the evidence that supports the clinical practice (Sheu, 2015)

At present, there are numerous definitions of EBP; this terminology can be considered as a broad term which comprises of different fields of interest such as evidence-based medicine, evidence-based nursing, evidence-based public health etc. Within each area of research, different explanations of EBP exist. In nursing, EBP is defined as a problem-solving strategy regarding delivering high-quality and effective healthcare, which incorporates the best evidence from research and patient care data with medical proficiency, patient's choice, and beliefs (Melnyk et al., 2010). Therefore, EBP is essential for nurses to critically analyse the empirically verified data to increase a patient's health outcomes and deliver care to a certain group of individuals. 

Identifying Literature 

Search Strategy 

To gather the data set for analysing the present case study, the databases used include Google Scholar and Cochrane Library to obtain empirical research and systemic reviews for better understanding. In addition to this, textbook resources were also included for better reference. The main purpose of selecting these particular databases was due to their accessibility, since several web-based resources including indexes, journals can have certain costs associated with them, these dataset mentioned above provide a wide range of studies with free access in a much time-saving and feasible manner (Cullum et al., 2013).

Inclusion Criteria

For the literature search of the current case study, all the latest articles were selected based on the age group of the population i.e. all adult groups ranging from 40 years or above. The participant's previous health status was considered, and the studies in which participant group who did not present signs of any mental illness were also included.

Exclusion Criteria

For this study, any research focused on mental health illnesses was excluded, studies focusing on tumours in other regions of the body were also disregarded.

Research Method

In this aspect, the papers analysed would include qualitative research, quantitative research and literature reviews. To evaluate and obtain data from the latest studies, the studies not more than one decade old would be used (i.e. from 2011 onwards). In this aspect, for acquiring the latest studies and retrieving data from the relevant studies, certain keywords were used; colostomy, surgical intervention, type 2 diabetes mellitus, T2DM. Moreover, to further scrutinise the data, certain search operators were also used called BOOLEAN operators, including key terms; AND, OR, THE, NOT etc. Therefore, this method was used to assure that the studies with the most relevant data are selected to limit any biasness. Another element of significance is that the UK and non-UK based studies were chosen for comparative analysis. In this manner, the incidence of a medical condition and the clinical interventions applied for managing it in different regions can be determined. Although by selecting non-UK based research, the limitation based on the region can occur nonetheless, with the help of this research method, the possibility of critically analysing studies and finds effective approaches for clinical application (Bramer et al., 2018). 

Quantitative Research 

Quantitative research method can be defined as the method of gathering and evaluating numerical information. This research method is usually used to determine the certain patterns and averages, make assumptions, random test association between two particular variables and generalise the results to a broader group of individuals (Alan Valdez, 2019). Quantitative research is usually applied in descriptive, correlational and experimental studies. In this prospect, for descriptive research, the overall summary of the research variables are collected. Meanwhile, in the correlational research, usually, the analysers examine the relation between the selected study variables. On the other hand, in experimental research, the cause and effect relationship is systemically analysed among the variables (Cathala and Moorley, 2018). 

The main aim of using a quantitative research approach within nursing is to gather and evaluate measurable data correctly. Given this is a kind of method that involves the numerical findings, the accuracy and dependence of the result are often high, which is also effective while forming a study conclusion (Alan Valdez, 2019). Moreover, the quantitative evidence usually provided vital information to be applied in practice; likewise, this method's major strength is its efficiency in generating reliable data with limited errors. For instance, through this research, after the impact of a certain pharmacological agent has been tested on a target population, the observed findings' statistical data can provide results that would be generalised to a much bigger audience (Goertzen, 2017).

Analysing Research

The most relevant quantitative papers found were by Anand et al. (2010), Kiran et al. (2013), RI and RI, (2017), Jensen et al. (2019) and Lee et al., (2020). The quantitative research which would be critically appraised is conducted by Lee et al. (2020) and, its title is "The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy." 

In this research, the authors mentioned a clear aim of their research, which was also reflected in the study's title. For this study, the authors gained relevant data from the National Inpatient Sample Database from 2005-2010. The research method chosen was based on the retrospective cross-sectional population-based study. From the de-evaluated data from the NIS database, the researchers obtained the Institutional Review Board (IRB) and, acquired informed consent from every participant in the study. In this manner, around 49,064 participants on the first and second stage of colon cancer undergoing colostomy were chosen with the mean age of 70.35 years of age. The authors highlighted independent variables such as demographic characters, hospital data, and illness history and severity of diseases. 

Concerning the severity of the clinical outcomes, the patients were groups based on minor, moderate, major and extreme loss. For the method, it is apparent that the authors added participants with the similar age group decreasing biasness of participants and increasing the research findings' reliability. The authors used statistical analysis to evaluate the data and findings; the patients successfully found diabetes with increased postoperative complications in colon cancer patients. The study's limitation was based on the population, which was online based on in-hospital patients, and the possibility of other complications in out-patients was lacking. Moreover, the research was based on the US population, thus causing geographic restriction.

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Qualitative Research

The Qualitative studies consist of data collection and evaluation; the data used is non-numerical (e.g. text, audios, etc.) better to understand certain concepts, assumptions, or experiences. This approach is applied to get a comprehensive insight into certain issues, research questions or produce new research ideas. Meanwhile, there are currently several approaches associated with qualitative research; these methods are usually flexible and aim to gain a deep understanding of the data highlighted. The most widespread quantitative research approaches include grounded theories, ethnography, action research, narrative speech and phenomenological research. These approaches have certain similarities; however; they focus on different objects (Silverman, 2020). 

Moreover, qualitative findings usually present the conceptual framework highlighted in the quantitative studies. Moreover, this research method develops knowledge regarding how people and the correlated factors influence a certain intervention's impact; it also explains the subject variation on the intended result of interference. Theoretically and metaphorically, qualitative research supports enhancing the nurses' understanding of patients' experience, thus enabling more personalised interventions in patient care and the expectant problems experienced by certain patients in a specific situation. Given that nurses are specialists' human carers in the healthcare sector, the qualitative studies also increase the clinical proficiency of healthcare workers by initiating differing human responses on interventions that can be unpredictable. Thus, the data gathered through qualitative research increases nurses' capability to be empathetic, prioritise patient-centred care and adds to the cultural competencies (Pathak et al., 2013). 

Research Analysis

The relevant studies located through the search strategy were conducted by Person et al. (2012), Zhu et al. (2019) with the title "The relationship between diabetes and colorectal cancer prognosis: A meta-analysis based on the cohort studies" For this study, the authors conducted a comprehensive search strategy in numerous databases and, performed a meta-analysis regarding the impact of diabetes on the colorectal prognosis. The authors performed a detailed search method and successfully included 36 cohort data and additional data by professional software like Kaplan-Meter curves. In this research, the aim of the meta-analysis was well-established and also highlighted in the title. The authors also presented the inclusion and exclusion criteria of their study, which validated their research method. 

For the quality assessment of the research method, two of the authors independently obtained the finalised studies' quality assessment assurance by applying the Newcastle-Ottawa Quality Assessment Scale (NOS). Moreover, the statistical tool was used for analysing their qualitative data. Subgroup analysis was also undertaken using region, research method, sample size, source of population and the DM established to determine the potential heterogeneity within the included papers. The authors did not proceed with the subgroup analysis if the study number was less than or equals to 1. Through the detailed research and validity of the included data, the researchers determined the lifespan of diabetes patients with colorectal, colon and rectal cancer. This study appeared to be a good example of qualitative research since the authors thoroughly used applications and tools during their data selection and retrieved relevancy among the literature. 

Guidelines

Guidelines are methodically produced evidence-based documents that support the clinical practitioners, recipients of care and other stakeholders to conduct informed decisions regarding the necessary healthcare interventions and procedures. In this manner, guidelines are considered an official recommendation and advisory declarations required to be reliable to be compliable under different kinds of circumstances and nature of events in which guidelines would be applied. The guidelines' basic feature and purpose are also illustrated in other formats, usually titled protocols, consensus statements, expert committee recommendations, and integrated care pathways (García et al., 2014). 

Concerning the healthcare practice, the clinical practitioners are a tool for improving care, increasing healthcare efficiency, and increasing the consistency of care to join the gap between the clinical practice and the scientific evidence regarding healthcare practices. The inauthentic and problematic variations within the practice can be eliminated to promote high-quality and evidence-based treatment through guidelines. Moreover, they can also support methods by which healthcare practitioners can be held accountable for clinical practices. Even though most of the development and analysis of clinical guidelines occur in medicines, nursing professionals are also increasingly adopting guidelines as the strategy of supporting evidence-based practice (Abdelsattar et al., 2015). 

The relevant guidelines located by search strategy include the National Institute of Health and Care Excellence guidelines on Colorectal Cancer complying with the healthcare problem present in the case study (NICE. 2020). NICE guidelines are evidence-based guidelines for health and care within England. Concerning colorectal cancer, the guidelines have provided a detailed recommendation for preventing cancer from managing the disease among positively diagnosed individuals. These guidelines are significant for providing the necessary recommendation regarding lifestyle choices, treatment interventions and care plan for people living with colorectal cancer. These guidelines also support the nurses and healthcare workers regarding decision-making and patient support for maximum recovery in postoperative settings. Likewise, the guidelines also provide alternative treatment methods and present the possible side-effects of the treatments so support the formation of the treatment plan for healthcare workers. With the help of these guidelines, integrated care for colon and rectal cancer patients can be managed to decrease complications associated with the disease and, a timely treatment method can be planned as well. In this manner, guidelines are significant for supporting clinical decision making for nurses. 

Reviews

Uddin and Arafat (2016) mentioned that a review summarises a field of study that supports evaluating certain research questions. Reviews are in-depth synopsis of previous researches conducted in any field of study or domain. By reviewing research and literature, researchers can highlight the theoretical framework and findings from previous studies that could support selecting research topics and implementing the methodology. By critically analysing prior studies, reviews can determine scientific research trends and provide a new direction to future researchers regarding research—review analysis research evidence qualitatively through informal or subjective methods to gather and evaluate literature. A well-established critical review can enable the nurses and healthcare practitioners to analyse the existing concepts and interventions and their reliability by a storytelling format.

Moreover, reviews provide the strengths and limitation of studies as well to help researchers in implementing or disregarding certain practices. There are different types of reviews: a meta-analysis, systemic reviews, traditional or narrative reviews and meta-synthesis. However, systemic reviews are considered the most effective and most valuable for generating high-quality evidence through which clinical practices can be informed. To support patient-centred care, reviews help nurses be well-aware regarding the latest data and work alongside evidence-based practice (Gough et al., 2017). 

Research Analysis 

Through the search strategy applied in this report, the selected reviews include studies by Tsujinaka et al. (2020), Tan et al. (2021) were located. Amongst the researches, Tan et al. (2021) study entitled "The influence of diabetes on postoperative complications following colorectal surgery" is analysed.

For this literature review, the authors used medical databases and the China National Knowledge Infrastructure electronic databases from the beginning till 2020. This review was based on a meta-analysis of proportions and comparative meta-analysis. 55 Studies that consisted of diabetes with colorectal surgery and the inclusion of patients without a positive diagnosis of diabetes placed as controls were mainly incorporated for reviewing.  Therefore, the studies based on randomised control trials and observational studies and cohort, case-control or cross-sectional research was mainly considered. The quality assessment of cohort studies was also performed by applying the Newcastle-Ottowa assessment tool. This assures that the authors presented a well-defined search strategy. The authors used statistical tools for analysing the data gathered through their literature review. Through this review, the authors evaluated the correlation of diabetes as a postoperative complication, other uncommonly reported complications due to diabetes such as renal complications, and gastrointestinal complications were also highlighted.  

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Conclusion

As mentioned earlier, the report conducted a detailed examination of various research areas that can promote and support the application of evidence-based practice in clinical nursing. In this manner, the most widespread research methods, including quantitative, qualitative, review studies, and guidelines, were discussed to understand better their application and efficiency in promoting evidence-based practice. It was observed that among the most reliable researches, quantitative research provided the most reliable and accurate data through the collection and presentation of numerical data which is also easy to conclude and seek close-ended answers. Concerning the present case study of a 57 years old male James, quantitative research findings can support the nurses regarding the reliability of certain medical interventions to manage James, post-colostomy operation diabetes mellitus. 

Meanwhile, regarding the qualitative research, the nurses would gain better insight regarding James's condition and his perspective regarding the disease. Through qualitative research, authors can analyse certain trends, patient experiences etc. Therefore, this research method is equally necessary to support nurses in providing patient-centred care to James based on his preference. This report also discussed the main purpose and object of clinical guidelines; it was analysed that such clinical guidelines provide significant statements and advice to the medics, stakeholders and the patients regarding an area of research to increase their understanding and outlook on the respective disease condition. Lastly, the review research method was discussed as well, which is a search method that evaluates previously conducted studies on any subject of matter by thoroughly appraising the research method. Review studies are significant in clinical practice since they highlight the strengths or weaknesses of previously conducted studies and provide the researchers with a direction on which future researches can be based. In this aspect, it can be concluded that evidence-based practice based on scientific research is significant for supporting clinical practice for improving the healthcare services and quality of service delivery. In this manner, healthcare workers and nurses can analyse the reliability and proficiency of any treatment intervention to support James's care while ensuring that his values, choice of treatment, and satisfaction are intact. 

References

Abdelsattar, Z.M., Reames, B.N., Regenbogen, S.E., Hendren, S. and Wong, S.L., 2015. Critical evaluation of the scientific content in clinical practice guidelines. Cancer, 121(5), pp.783-789.

Alan Valdez., 2019. What Are the Benefits of Quantitative Research in Health Care?. Available at https://careertrend.com/what-are-the-benefits-of-quantitative-research-in-health-care-13657338.html

Anand, N., Chong, C.A., Chong, R.Y. and Nguyen, G.C., 2010. Impact of diabetes on postoperative outcomes following colon cancer surgery. Journal of general internal medicine, 25(8), pp.809-813.

Bramer, W.M., de Jonge, G.B., Rethlefsen, M.L., Mast, F. and Kleijnen, J., 2018. A systematic approach to searching: an efficient and complete method to develop literature searches. Journal of the Medical Library Association: JMLA, 106(4), p.531.

Cathala, X. and Moorley, C., 2018. How to appraise quantitative research.

Cullum, N., Ciliska, D., Haynes, B. and Marks, S. eds., 2013. Evidence-based nursing: an introduction. John Wiley & Sons.

García, L.M., Sanabria, A.J., Álvarez, E.G., Trujillo-Martín, M.M., Etxeandia-Ikobaltzeta, I., Kotzeva, A., Rigau, D., Louro-González, A., Barajas-Nava, L., Del Campo, P.D. and Estrada, M.D., 2014. The validity of recommendations from clinical guidelines: a survival analysis. Cmaj, 186(16), pp.1211-1219.

Goertzen, M.J., 2017. Introduction to quantitative research and data. Library Technology Reports, 53(4), pp.12-18.

Gough, D., Oliver, S. and Thomas, J. eds., 2017. An introduction to systematic reviews. Sage.

Jensen, A.B., Sørensen, TI and Pedersen, O., 2018. Increase in clinically recorded type 2 diabetes after colectomy. Elife 7.

Kiran, RP, Turina, M., Hammel, J. and Fazio, V., 2013. The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control?. Annals of surgery, 258(4), pp.599-605.

Lee, K.C., Chung, K.C., Chen, H.H., Cheng, K.C., Wu, K.L., Song, LC and Hu, W.H., 2020. The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy. BioMed Research International, 2020.

Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B. and Williamson, K.M., 2010. Evidence-based practice: step by step: the seven steps of evidence-based practice. AJN The American Journal of Nursing, 110(1), pp.51-53.

NICE., 2020. Colorectal cancer. Available at https://www.nice.org.uk/guidance/ng151

Pathak, V., Jena, B. and Kalra, S., 2013. Qualitative research. Perspectives in clinical research, 4(3).

Person, B., Ifargan, R., Lachter, J., Duek, S.D., Kluger, Y. and Assalia, A., 2012. The impact of preoperative stoma site marking on the incidence of complications, quality of life, and patient's independence. Diseases of the colon & rectum, 55(7), pp.783-787.

RI, V. and RI, H., 2017. Colorectal cancer in patients with type 2 diabetes mellitus: A single-center experience. Journal of Biological Regulators & Homeostatic Agents, 31(4), pp.1101-1107.

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Tan, D.J.H., Yaow, C.Y.L., Mok, H.T., Ng, C.H., Tai, C.H., Tham, H.Y., Foo, F.J. and Chong, C.S., 2021. The influence of diabetes on postoperative complications following colorectal surgery. Techniques in Coloproctology, pp.1-12.

Tsujinaka, S., Tan, K.Y., Miyakura, Y., Fukano, R., Oshima, M., Konishi, F. and Rikiyama, T., 2020. Current management of intestinal stomas and their complications. Journal of the anus, rectum and colon, 4(1), pp.25-33.

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Zhu, B., Wu, X., Wu, B., Pei, D., Zhang, L. and Wei, L., 2017. The relationship between diabetes and colorectal cancer prognosis: a meta-analysis based on the cohort studies. PloS one, 12(4), p.e0176068.

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