PICO: In COPD patients, does self-management compared to standard treatment, reduce exacerbations and hospital admissions?
Discuss about the Nursing for Worldviews on Evidence?Based Nursing.
COPD is both chronic and incurable. The outcome of the treatment can, therefore, be measured through the changes in the impact of degree of disease activity. The treatment of such incurable disease is either through self-management or standard treatment. Both treatments are aimed at reducing hospital admission and acute exacerbations that minimize the effect of the disease (Khalil et al. 2016). There is difficulty in determining the best nursing condition that when applied to the patient will not lead to the two worse situations. There are increased and widening gaps between the medically possible and what priority is for the patient. The dilemma extends to determining which of the two is more important to the patient in terms of cost-effectiveness. This is managed by performing a cost-benefit analysis.
According to this stalemate, the patient should be given individual treatment and left to be observed after 2 weeks. During the monitoring, the personal understanding of the treatment and self-management plan should be made known to the patient. This further complicates the situation making the question very relevant. The selected question is relevant since it also seeks to find out if one medical nurse is enough to deal with one COPD patient. The possibility of the outcome when one medical nurse is left to deal with the patient. The outpatient clinic services of the COPD patient may also come in handy in trying to find out if self-management or proper treatment will lead to reduced exacerbations and hospital admissions for such patients. The satisfaction of the COPD patients does it come from directly from the way the direct treatment or from self-management. There could be a possibility of any of the two methods of COPD management having side effects having developed this question, it’s easier to determine which has side effects.
The economic logic of scarce resources requires that the most cost-effective method be used. It might be viewed as self-management but it is difficult to determine directly hence the question is important in trying to determine the economic logic of the COPD treatment management (Bryant?Lukosius et al. 2016). From the patient perspective, the one that requires more input and requires more sacrifices can be difficult to decide, this makes the inquiry very relevant to the COPD patients. The involvement of health care workers, which one of the two treatment strategies do they feel comfortable practicing and advice their patient to undertake. The inquiry seeks to find the answers to such disturbing issues in nursing conditions. Being that COPD accounts for so many patients and the number is growing to find out which treatment method will help solve for this patients the method go for outright when they are diagnosed with this disease.
Background
Which form of treatment can be best for the chronic form of the disease? The self-management could be affordable but probably not the best form of treatment for chronic forms of the disease. This inquiry and question in relation to the infection COPD.
Evidenced-based practice is the best practice that can be used to determine if the COPD patients can either use the direct treatment or self-management to reduce exacerbations or severity of the disease. The scientific and evidenced-based practice is the use of important clinical decision making based on science and research-based evidence. The contentious, and judicious use of current, related and important truths and evidence to make any related decisions about the health care decisions related to patients and any other medical stakeholder.
The evidenced practiced should be used in this context because of the following very critical issues based on the nature of the infection and also the features of evidence-based practice.
The target population; since the disease is critical and has affected a better part of the population. Any related implementation should be evidenced based. If the implementation does not practice from scientific research, the result might be fatal. A good number of the population might be affected by the implementation of either of the methods i.e. self-management and direct treatment. If one is implemented while the other neglected then the negative results might lead to a lot of people losing their lives due to lack of proper scientific based evidence. Based on this nature of the disease evidenced best practice is the best to implement.
The nature of the disease; the COPD disease is one that takes two forms. It is mild and if not taken care of becomes chronic. The chronic parts of the COPD can be difficult to manage without proper medications and routine. The change in the treatment of the two forms can cause very grave issues in the patient’s nature of disease if it’s not based on scientific evidence. The sudden change of treatment from self-management to direct treatment without evidenced-based practice might lead to side effects that will make the infection chronic. The effects of chronic COPD might be very demanding from the patient. This emphasizes the need for evidence-based practice.
The research nature of the evidence-based practice; research and research finding is critical in determining the best method of the two to use in the COPD treatment method. Research involves critical analysis and evaluation of a situation. For instance, findings would be made on the effects of the two practices (Carman et al. 2016). Comparative analysis will be made to determine the better of the two methods, with pros and cons of each discussed. From the analysis of such in-depth analysis, the fear gap between the research and the actual implementation of the practice is narrowed hence making the best decision for the practice. The research can even lead to incorporation of pertinent issues that were not even their before. A third method can be devised therefore from research. This further emphasizes the importance of evidence-based practice before the implementation of the two methods as a treatment formula of the two (Bosch 2016).
COPD Treatment Options
The quality and performance of the two methods depend also on systems, processes, functional, satisfaction and cost outcomes. Evidence-based practice will determine the quality of the performing the two methods. This means that the cost of each will be determined, the reaction of each patient, the practice standards that will be observed and the one that is more involving. The more the evidence-based practice determines quality, the relevant it remains in determining the treatment of the COPD disease (Manns, Norton and Darrah 2015).
The clinical question is supposed to help determine the best formula to develop the way out in helping to determine the best treatment of the disease out of the two. The more effective the question the best information that will be retrieved to help in the development of data so as to, spend little time analyzing and evaluating the result of the needed information. Making logical question help in the identification of the main concept and saves the overall time energy in the search process (LoBiondo-Wood and Haber 2014).
According to the journal; the kalmanovitz center for knowledge management, University of California, San Francisco. A developed good formula called PICO is the best to form the clinical question. The PICO involves four important parts that lead to the effective clinical question.
In our case, we know our patient as a COPD patient. We, therefore, develop questions that are of importance in terms of the problem which is seeking to reduce, hospital admission and excessive exacerbations. The question will formulate at this point is.
- Which type of COPD disease are you suffering from? This is to help to determine the type of COPD of our patient?
- Which type of excessive exacerbations do you have? This is to help determine the extreme form of the disease?
- How many times are you admitted to the hospitals? This is to help us determine the extent the disease can go when to the fullest effect.
This is the process of changing the current continuous problem in trying to solve the problem that has been caused. The method employed to restore parity is the intervention, it is normally aroused from the problems identified in the first part of the formula. Some of the questions that can be asked from this part include;
- What medications do you take for your condition? Help us determine the immediate solution to the provisions.
- Do you get admitted to the hospital or get treated at home? This helps us determine if the method used is self-management or direct hospital treatment. The process of direct hospital treatment might be the preferred treatment but that then leads us to the next question and formula (Greenhalgh 2014).
Comparison of intervention is the process that helps us develop a comparative analysis of which is the best intervention problem for our case, the COPD disease and how it can be treated in the best way possible. The question asked from this stage include;
Which method do you prefer between self-management and direct treatment? These are to determine which method is patient friendly
Why do you prefer the said method to the other one? This is to help determine the pros and cons of the particular intervention methods
Challenges in Determining Best Nursing Practice
Have you ever tried the other method and didn’t you like it? This the question that helps in determining the attitude of the affected to both the intervention method
Would you consider changing methods any time soon? This to help determine the readiness of the patient to cross over from one intervention method to the other. It also determines the strong belief that the patient has in considering their treatment as part of their life (Kon, Davidson, Morrison, Danis and White 2016).
What do your family members think about the disease and the effects that it has on them?
This question is supposed to help in knowing the public general attitude and the knowledge they have in determining their attitudes of not only the disease but also the intervention method employed. It also helps determine their readiness to help an affected person (Peters et al. 2015).
This stage helps determine the total average sole feeling about the problem and how others feel it would have been the best solving the problem. The problem is supposed to help to get the feeling of others. The questions asked in this last formula include;
What do you think could be done to help solve the problem COPD? This help analyzing on what to find the other possible methods apart from the two methods
What do you think could be done to improve both self-management and direct treatment? This helps us in determining the effects of using both the method. The questions are useful in determining the possible outcomes.
The systematic approach is the best method approach to answering clinical conundrums. This is because it exploits evidence-based practices and the evidence-based research. The systematic approach has different stages that include; clinical situation, clinical question, search, evidence review, numbers, clinical answer, patient preferences, ultimate answer. The evidence review of from scholarly articles under the recent articles and Journals that in our case include articles with COPD general attitudes ranging from the important to the less important. The following are journals used in the evidence-based research on COPD (American Speech-Language-Hearing Association 2016.).
The best evidence reviewed article is the British journal of community nursing that exploits the types of intervention methods i.e. self-management and direct treatment, the journal also exploits exacerbations and frequent hospital visits for COPD patients. The next important journal is the knowledge management for the University of California and San Francisco that exploits the use of the formula that helps in determining research question (LoBiondo-Wood and Haber 2017).
The Importance of Evidence-Based Practice
Another journal of importance is the changes in the healthcare professions scope of practice. This journal exploits the various forms of evidence-practice and how they are used in different forms of management and opinion (Carman et al. 2016). It further exploits the importance and methods within the scope of internal jurisdiction. The journal further exploits the historical basis of underlying interventions in previous cases that have worked before (Brownson, Deshpande and Gillespie 2017). The world health organization’s journal recommends that the official document used in the risk of avoiding the negative effects of the COPD disease.
References
American Speech-Language-Hearing Association, 2016. Scope of practice in speech-language pathology.
Bosch, M., Tavender, E.J., Brennan, S.E., Knott, J., Gruen, R.L. and Green, S.E., 2016. The many organisational factors relevant to planning change in emergency care departments: a qualitative study to inform a cluster randomised controlled trial aiming to improve the management of patients with mild traumatic brain injuries. PloS one, 11(2), p.e0148091.
Brownson, R.C., Deshpande, A.D. and Gillespie, K.N., 2017. Evidence-based public health. Oxford university press.
Bryant?Lukosius, D., Spichiger, E., Martin, J., Stoll, H., Kellerhals, S.D., Fliedner, M., Grossmann, F., Henry, M., Herrmann, L., Koller, A. and Schwendimann, R., 2016. Framework for evaluating the impact of advanced practice nursing roles. Journal of Nursing Scholarship, 48(2), pp.201-209.
Carman, K.L., Maurer, M., Mangrum, R., Yang, M., Ginsburg, M., Sofaer, S., Gold, M.R., Pathak-Sen, E., Gilmore, D., Richmond, J. and Siegel, J., 2016. Understanding an informed public’s views on the role of evidence in making health care decisions. Health Affairs, 35(4), pp.566-574.
DiCenso, Alba, Gordon Guyatt, and Donna Ciliska. Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences, 2014.
Greenhalgh, T., 2014. How to read a paper: The basics of evidence-based medicine. John Wiley & Sons.
Hamer, S. and Collinson, G., 2014. Achieving Evidence-Based Practice E-Book: A Handbook for Practitioners. Elsevier Health Sciences.
Holly, C., Salmond, S. and Saimbert, M. eds., 2016. Comprehensive systematic review for advanced practice nursing. Springer Publishing Company.
Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J. and Loscalzo, J., 2015. Harrison’s principles of internal medicine, 19e.
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Kon, A.A., Davidson, J.E., Morrison, W., Danis, M. and 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), p.188.
LoBiondo-Wood, G. and Haber, J., 2014. Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Manns, P.J., Norton, A.V. and Darrah, J., 2015. Cross-sectional study to examine evidence-based practice skills and behaviors of physical therapy graduates: is there a knowledge-to-practice gap?. Physical therapy, 95(4), pp.568-578.
Peters, M.D., Godfrey, C.M., Khalil, H., McInerney, P., Parker, D. and Soares, C.B., 2015. Guidance for conducting systematic scoping reviews. International journal of evidence-based healthcare, 13(3), pp.141-146.
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