Peculiarities of Evidence-Based Practice - Assignment Example

Question 1 Ontology From general researches existing, it becomes slightly impossible to distinguish what should be in otology and in knowledge base. This is because the view point of the term will depend on the intended usage. From the philosophical point of view by Hookway (1995) in his book Pragmaticism, the term is viewed as a knowledge trying to discover what kinds of things exist, actually what entities do we have in the universe. In as much as we have myriad definitions, they all come to agree with Gruber (1995) who said that an artificial intelligence that exists is that one that can be represented. Epistemology It must be understood that ontology and epistemology appears to be terms that are related and because of this, Ferrier is believed to be the first person to discern this term from ontology. He said, ‘it is a theory of knowledge.’ However, much has been done in an attempt to explain what epistemology is. Though Montague gave a more comprehensive definition, his works could not stand test of time changes in events. The definition that suits contemporary society is by Edgar and Sedgwick (2003) who stated it to be “theory of knowledge”. They explained that the core aim of epistemology is to analyse what knowledge is all about, its jurisdiction for holding it and the reliability when one claims to have it. Importance of ontology and epistemology to the study of evidence-based practice Evidence based practice is a term Sackett David. He defined this term as "The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett et al 1996 pp. 71-72). Philosophical understanding of evidenced-based practice as brought out by Lines (2001) suggests that nurses need to approach their practice with their professional experience but other evidenced research need to form basis of the professional experience. Paramedic field has been dealing with rapidly changing, dynamic and heterogeneous knowledge. In fact, Davidoff suggest that nurses will always try to gather information from about 19 articles a day just to be updated with medical journals (Davidoff et al. 1995). From the definition above, ontology and research based practice relates since clinician and/or medics will approach their practice from knowledge based. As paper based terminology seems to be fading away, a more knowledge based (ontological) approach is needed in order to cope up with ambiguous communication of detailed and complicated medical data. For instance, if the nurse has no knowledge in her approach, how does she cope with a clinical study in which some record of a patient has temperatures in Fahrenheit while others in Celsius degrees? Or even worse, less evidenced data is available in aggregated records? In such cases, the tacit knowledge which is routinely source of nurse’s potential mismatch or misunderstanding can be made even explicit if ontological approach is adopted. When epistemology is not considered in research based practice then scientific reflection will not be possible. In other words, nurses will require epistemology to make critical analysis of principles hypotheses and findings to determine the next move. Significance of epistemology to evidence based practice in medicine can be summed up by arguing that its exponents is to ensure strong ethics and avoiding unnecessary harm to the patient. Since the term holds that knowledge is known either by individual or by people, it helps in evidence based practice in the sense that many of the issues we encounter or have been encountered must be done on evidence synthesis. Question 2 Definitions of evidence-based practice i. Philosophical approach While the definition of this term does vary among different scholars and academic centers, the best definition is that which has integrated best research evidence with values of patient and clinical expertise. Talking of clinical expertise, Sackett et. al (2000 p. 102) defined the term as "The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." ii. Paramedic approach Within the context of social work, evidence-based practice is defined based on three dimensions: Need to learn what treatments to client are. This needs to be done on the best available research findings, whether experiential or not. Evidence-based practice is also concerned with the discussion of client’s views about the treatment which should also consider other differences such as culture. (Gilgun, 2006) also add that determination and autonomy of the client need to be honoured at such a case. While talking of evidence based practice, we need to consider things that the profession does not allow us to do and those that we can do. iii. Psychological approach In psychology, evidence-based practice refers to the ‘process of integrating best available research with medical or clinical experience with reference to characteristics, culture and demands of the patients’ (American Psychological Association 2002, pp.1052-1059). Similarity and difference between the definitions of evidence-based practice Similarities Differences 1 The most obvious concept that cuts across these definitions is that they all have the ability to enhance effective psychological practice as well as public health. This is possible because these definitions outline ways of applying empirically supported mechanism of scientific assessment, therapeutic similarities in case formulation and intervention. Basing on paramedic and psychological definitions of evidence-based practices, the difference comes when patient/client-doctor preferences conflicts. This is because psychological approach suggests that certain clients might require decisions and interventions applied to them which are not directly derived from research options. When this happens, paramedic definition also wants medics to approach the situation with already existing research. 2 These definitions all show that medics ought to employ scientific discourse that has been derived from epistemologies of both realism and positivism when handling clients. And when they are doing this, it is important to note that evidence generated from randomised controlled trials will be significant in their evidence hierarchy. The other difference is that psychological approach of the definition can only be effective if patient’s specific problems such as personalities, preferences and socio-cultural background are given consideration. However, other definitions look at the practice from doctor’s perspective and can make decisions irrespective of client’s problems. in other words, medical experts have the mandate o integrate best research evidence like information regarding the client they have obtained during treatment period. 3 Summative argument in the definitions is that it must entail integration of individual clinical expertise. This must be done using available external clinical evidence analysed from systematic and/or scientific research. This similarity proves the concept of Sackett that wants evidence based practice be explicit, conscientious judicious when making decision regarding care given to individual patients. Unlike psychological and philosophical, paramedic dimension wants research available to be clinically relevant and valid within the practice. However, contents of the definitions from the other approaches assume that interventions that are yet to be studied in controlled trials can still be effective. Question 3 Effects of components of evidence-based practice Though it is a fact that evidence-based practice in clinical or nursing setup has improved patient’s outcome, it still requires clarification as components affects the delivery of care in paramedics field. i. Clinical expertise and the delivery of patient care Being flexible but skillful when delivering treatment, it can really affect evidence-based practice because medical experts will ignore other components of evidence-based practice as they believe that they have good diagnostic judgments, systematic situation formulation and treatment planning needed to handle the patient. Through their research, Erickson-Owens and Kennedy (2001) shed more light on implications of ‘Clinical expertise.’ Though they conceded that evidence-based practice is a learned skill that is handy for clinicians, they advice that it also requires personal intellectual skills and curiosity so as to explore it even further. “Though we need to follow our medical procedures the way research set it, situation at hand should not be overlooked” (p.137). They summarise the argument by adding that, “expertise and competence within the particu­lar clinical setting are important, but clinical educators also must be familiar with current, best evidence.” (p.139) Many of the nurses who have been practicing for long believe that approaches or components of evidence-based practice outlined to be practiced are not necessary. They make this assumption because they believe their expertise can manifest tact, framing of interventions and monitoring patient’s progress. This self belief in one’s expertise is hugely evidence-based research as other components will be ignored by the nurse. ii. Patient preferences and the delivery of patient care Nathan and Gorman argue that sometimes nurses are faced with hard time when handling patients whose culture and preferences need to be considered (Nathan and Gorman 2007). Though they concede that better services can be delivered when there is effective response from the patient, such over reliance on these preferences can undermine the impact of tested interventions and nurse’s personal approach which consequently renders the model of evidence based practice futile. iii. Research and the delivery of patient care The integration of best available research by nurses is one component that has really affected the outcome of evidence-based practice. By the time nurses solely rely on scientific results needed for the medical interventions, her or his expertise, and even patient’s preferences are at stake. These bodies of evidence from a variety of methodologies do not attest to the effective implementation of nursing as some cases are unique and might need our experience or medical history of the particular patient. Norcross, J. and Goldfried (2005) added that some cases that can be said to be unique and do not really depend evidence is the psychotherapy integration which nurses will have to rely much on the patient. iv. Resources and the delivery of patient care One big issue with nurses in clinical settings is that they may lack access to needed resources so as to update themselves accordingly. (Ervin 2002) explains that evidence-based practice can only become effective if registered nurses can get resources such as journals within their clinical settings. Lack of these resources has really derailed implementations of evidence-based practice. For instance, research conducted by (Mitchell et al., 1995) showed that among 126 registered nurses located in Ontorio hospitals, just 51% of the agencies available had the required resources in their library. References American Psychological Association. (2002). Criteria for evaluating treatment guidelines. American Psychologist, 57, 1052-1059. Davidoff, F., Haynes, R., Sackett, D. and Smith, R. (1995). Evidence-based medicine. British Medical Journal. Edgar, A. & Sedgwick.P.(Eds) (2003, 2nd ed). Cultural Theory, The key concepts. London: Routledge Erickson-Owens, D. A., and Kennedy, H. P. (2001). Fostering evidence-based care in clinical teaching. Journal of Midwifery & Women’s Health, 46, 137-145. Ervin, N. E. (2002). Evidence-based nursing practice: Are we there yet? The Journal of the New York State Nurses’ Association, 33(2). Gilgun, J. F. (2005). The four cornerstones of evidence-based practice in social work. Research on Social Work Practice, 15, 52–61. Gruber, T. (1995). Toward Principles for the Design of Ontologies. Journal of Human and Computer Studies. Hookway, P. (1995). Pragmaticism. Oxford companion to philosophy. Oxford: Oxford University Press. Lines, K. (2001). A philosophical analysis of evidence-based practice in mental health nursing. Journal of Mental Health Nursing, 10, 167-75. Mitchell, A., Janzen, K., Pask, E., and Southwell, D. (1995). Assessment of nursing research utilization needs in Ontario health agencies. Canadian Journal of Nursing Administration, 8(1), 77-91. Nathan, P. E., and Gorman, J. M. (Eds.). (2007). A guide to treatments that work (3rd ed.). New York: Oxford. Norcross, J. and Goldfried, M. (Eds.). (2005). Handbook of psychotherapy integration (2nd ed.). New York: Oxford University Press. Sackett, D., Rosenberg, W., Muir Gray, J., Haynes, R. Richardson, W.  (1996). Evidence based medicine: British Medical Journal. Sackett, D. L., Strays, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). 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