TranslatingEvidence into Practice
Inmany health care settings, evidence based practice (EBD) has beenshown to play a very important role not only in the diagnoses ofailments but also in the treatment of diseases. Unfortunately, whenit comes to pediatric patients, many healthcare workers do not useEvidence-based nursing practices. Because of this, researchers havefound that physician-patient and physician-parent communication isnecessary in order to diagnose and treat pediatric patients. Thispaper looks at the communication problem and what evidence-basedpractices can be used to improve patient outcomes.
Thepaper is divided into three sections. The first part looks at thecommunication problem and what mostly causes the problem. The secondpart is a literature review of what scholars and practitioners havefound out concerning healthcare provider communication withpediatric-patient parents as compared to healthcare providercommunication with the patients alone.
Thethird and final part is an application of the results of the variousstudies to a current nursing practice. The section also looks at theadvantages and problems associated with the nursing practice chosenand how other practitioners can benefit from the evidence collected.
PICOQuestion and Significance to Nursing
Withpediatric patients, what is the impact of healthcare providercommunication with parents of pediatric patients on diagnosisaccuracy, compared to healthcare provider communication withpediatric patients alone on pain management?
Nursingissue: Pain Management
Nursesuse most of their time interacting with patients. As such, they areat the best position to identify cures as well as build a positiverapport with patients, which in turn allow the sick to share theirfeelings towards the treatment. Besides, the patients can also helpthe nurses to identify treatment tailored to the requirements of thepatient. In the case of pediatric patients, nurses may consult theirparents if they cannot communicate their health status (Bramhall,2014). For example, the mother can report to the nurse if the childhas a pre-existing condition, has been diagnosed as allergic to givenmedication, had taken the required vaccines for specific diseases orthe development stages of the symptoms prior to admission at thehealth center. On the same note, the nurse can enhance the accuracyof his or her findings through asking the sick child simple questionssuch as whether they have a stomachache, feeling hungry, or evendescribe their general feelings. As a result, effective nurse-patientand nurse-parent communication prevent labeling of patients as wellas props up development of a good therapeutic relationship that isthe cornerstone of nursing work (Collins, 2015). Consequently, thePICOT question seeks to establish the relevance of the pediatricnurses consulting with both the young patients and the parent.
Doughty,Williams, Brigham & Seashore (2010) asserts that provision ofspecial communication training to chief residents of pediatriciansignificantly enhanced the leadership capacity as well as thediagnosis capacity. The results are credible because the authorsused qualitative data gathered from pediatricians who have completedthe Chief Resident Training Program (CRTP) from year 1988 to 2003.The resource asserts that the primary sectors that the traininghelped the professionals to improve drastically include consciousnessof personality traits, sending and receiving feedback, relationshipwith others and the capacity control conflict at the workenvironment. Overall, the resource shows apparent CRTP effect on theprogram’s participants on both short and long-term basis.
Intheir study, Crossley and Davies (2005) concluded that parents arecrucial sources of knowledge for a pediatrician. Parents often havedetailed health information regarding their children. As a result,therapists can diagnose children faster and more accurately when theycollaborate with the parents. Nonetheless, there lacks efficientmethods for evaluating the quality and intricacy of the approach thatmakes it quite complicated to apply the method effectively. Theresource is dedicated on determining the critical constituents of thechildren consultation. In order to come up with accurate data, thesource applies content analysis of pertinent published as well asunpublished content. The credibility of the findings is high becausethe authors are both research pediatricians. In conclusion, theresearch finds that acquiring information from parents lead to fasterand more convenient diagnosis of the health status of their youngones. However, the authors argue that an improved approach isnecessary for pediatricians to learn about the minors’ medicalcondition from their folks.
Harrington,Norling, Witte, Taylor & Andrews (2007) evaluated thephysician-parent training program in communication skills intended toenhance information sharing concerning medical prescription to theyoung ones. The implication of future research on the studyindicates that parents have a better comprehension of the healthstatuses of their children. Subsequently, they can simplify diagnosisof the condition of minors when they are actively involved in theirtreatment process.
Kreps(2015) noted that communication is imperative in the health careindustry, especially to the pediatricians. Kreps also noted that inpractice, pediatricians tend to apply the same skills that are usedwith adult patients. According to Kreps, nurses rarely communicatewith parents during hospitalization of the children because thedecision is absolutely made by a pediatric therapist while the nursesare mainly required to implement the strategies the doctor findsafter an analysis.
Accordingto the literature review, communication with the parents of pediatricpatients enhances the healthcare’s provider diagnosis accuracycompared to healthcare provider communication with pediatric patientsalone. Nonetheless, the pediatric healthcare provider should usenurse-patient and nurse-parent communication findings as a secondarysource of information. As such, he or she should use simple interviewquestions on both the parent and the patient to acquire basicinformation about a client (Prendergast, 2011). The therapists shouldthen conduct independent tests on the patient based on the gatheredinformation to confirm their eligibility. In case the healthcareprovider’s result does not match the symptoms or the informationacquired from either the patient or the mother, he or she should relyon the evidence-based data. The communicated information is onlysupposed to augment the accuracy of the deduced results (Prendergast,2011).
Treatmentof some conditions may be difficult to conduct independent tests.Therefore, effective communication with young patients becomesnecessary to understand the condition they suffer. For example,Purvis (2015) notes that therapist-patient communication is criticalfor a child suffering from an orthopedic condition because thehealthcare provider needs to know the specific place the child feelpain. Kreps (2015) backs up the findings with the evidence thatcommunication should be conducted in diverse stages classificationsthat include group, intrapersonal, societal, organizational andinterpersonal levels. The study claims that intrapersonalcommunication has particularly become critical in pediatrichealthcare provision because it helps nurses to conceptualizetreatment approach based on issues such as the patient’s attitudes,values and beliefs (Phillips, 2009).
Themain advantage of evidence-based practice is that healthcare providerbases their decision on the rigorous analysis of data. Subsequently,healthcare provider does not rely on custom, single observations andrules (McKay, 2007). Second, the treatment method is beneficial whenintegrated with clinical judgment as it helps therapists to preparecustomized treatment. Third, there are already established manualsthat guide nurses to draw conclusions regarding a given subject.Third, EBPs encourage financiers to allocate resource toinvestigation methods that promise to yield the most accurate results(McKay, 2007). On the contrary, one of the weaknesses of using EBPapproach is that therapists use a variety of approaches to determinethe most suitable approach. Second, it is restricted to thebaccalaureate nurses with vast knowledge in the field. Second, itencourages analysis of techniques that have not yet been scrutinizedto determine their reliability. Finally, it may assume the “vice ofconsumers”, therefore, failing to apply proven information (McKay,2007).
Itis important to use Lewin’s Three-Step change theory, especiallywhen moving the children to special rehabilitation centers for painmanagement. By using Lewin’s theory, it will be possible tounfreeze the current situation, move towards the new approach, andthen refreeze after arriving at expected outcome. By moving patientsto special centers, it will become easier to diagnose problems andtreat patients thus improving patient outcomes. In these centers, thetreatment will focus on investigating deterministic features thatcould have affected the unconscious mind of a child with irrationalbehaviors or signs of abnormal biological and instinctual behaviors.The facility offers a suitable environment where young patients canconfide to a sensitive nurse about their psychological issues (Kreps,2015). Besides, the patient’s parents also explain to the nurseabout the past life of their child. Finally, the nurse compares thetwo versions of information to determine the possible cause of achild’s mental disturbance. The therapy will aim at identifying thepossibility of a child suffering from traumatic conditionsunconsciously because of tough childhood experiences.
UsingLewin`s change theory, the first step of the treatment will involvemotivational interviewing of the patients. The objective of thequestioning is to help pediatric nurses have a clue of a client’sbackground. The next phase will involve evaluation of the informationgathered from both the sick child and his or her parent. This step isvaluable because it facilitates problem diagnosis, determinespossible motivation for the change agents, as well as evaluates thelikelihood for change occurrence (Kreps, 2015).
Themain issue the treatment will address is childhood pain. Sincecommunicating with a child can be a challenge to many people, thepediatric nurses at the facility will use their expertise to deducethe cause of the problem from the patient and the parents.Consequently, parents with children that appear to have unknownmental challenges will benefit from the service. Pain affects manychildren, but poor communication capability makes parents assume thattheir young ones suffers from emotional unintelligence. According toPurvis (2015), communicating with young patients is challengingbecause most of them do not understand their problems.
Assuch, a motivational interview is required to persuade them to sharewhat is on their mind. The primary benefit the patients will get fromthe treatment is new strength to face the realities of life.Interestingly, several traumatic experiences can be solved if thevictims are provided with appropriate therapy on time. Child neglect,physical violence, and verbal abuse are some of the common causes ofpain among young patients. The friendly atmosphere in the facilityinvites children to share their underlying emotions that deny themhappiness. Afterwards, nurses provide counsel to the patients on waysto achieve progressive change through sharing with their friends aswell as educating parents on efficient ways to relate with theirchildren (Prendergast, 2011).
Specialistsdrawn from diverse fields such as drug addiction, family counseling,and physical therapists will supervise implementation of the program.The groups will classify the patients into categories that arerelated, and then provide the support each patient group needs(Bramhall, 2014).
Themain challenge I have now is acquiring experienced healthcareproviders with pediatric experience. In many cases, nurses who areused to dealing with adult patients often find it hard to deal withchildren because they can rarely explain their feelings. In addition,the therapists are supposed to be very patient and considerate on theemotions of the patients because they are already struggling withself-esteem.However, the blue print of the rehab is alreadyavailable and once we get all the staff we need, we will easily beatthe implementation period enrolled.
Implementationof Evidence based practice:
Todisseminate the EBP findings, I will collaborate with otherhealthcare organizations as well as the opinion leaders in thehealthcare sector. The partnerships function as the connectionbetween researchers and intermediaries such as healthcare facilities(Prendergast, 2011). In other words, they function as the knowledgebrokers since they spread the knowledge and help to improve itsaccuracy through peer-reviews. Some of the members featured in thedissemination process include pharmacists, nurses and physicians(Prendergast, 2011).
Inaddition, I would communicate the significance of the EBP to mycolleagues through creating a model that they can follow to achievesimilar effective results. As a result, I will keep a comprehensiverecord of the quantities of medication prescribed to the client.Besides, I will record the factors that I considered prior todeducing the results (Hughes, 2008).
Afterdisseminating the evidence, I will steer the implementation with theassistance of a change campaigner based in our organization. The bestperson to approach is the resident nurse with vast experience in thefield. The champion should then conduct a pilot test to prove theauthenticity of the continuing organizational technique (Hughes,2008). Once the test proves successful, the lead healthcare providerwill then recommend the treatment approach to other professionals. Bythen, the change ceases to become an innovation for it isincorporated into a standardized care (Prendergast, 2011). To addressconcerns and oppositions of the treatment approach, I will seekpeer-review contributions that from my colleagues who will come upwith solutions for the weaknesses (Hughes, 2008).
Thisessay focuses on determining the reliability of nurse-patient andnurse-parent communication to diagnose the orthopedic condition in ayoung patient. The evidence acquired from interviewing a patient andthe parent is disseminated using the admission card or the patient’shospital file. As such, every healthcare provider that will treat thechild after the diagnosis will know that the patient had previouslysuffered from a certain disease (Prendergast, 2011).
Crossley,J. & Davies, H. (2005). Doctors` consultations with children andtheir parents: A model of competencies, outcomes and confoundinginfluences. MedicalEducation, 39(8):807-19.http://www.ncbi.nlm.nih.gov/pubmed/16048623
Collins,S. (2015). Good communication helps to build a therapeuticrelationship. NursingTimes.Retrieved fromhttp://www.nursingtimes.net/nursing-practice/specialisms/educators/good-communication-helps-to-build-a-therapeutic-relationship/5003004.article
Polit,D. F., & Beck, C. T. (2008).Nursingresearch: Generating and assessing evidence for nursing practice.Ambler, PA: Lippincott Williams & Wilkins.
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Purvis,J.M. (2015). The challenge of communicating with pediatric patients.TheAmericanAcademyof Orthopaedic Surgeons.
Prendergast,M. L. (2011). Issues in Defining and Applying Evidence-BasedPractices Criteria for Treatment of Criminal-Justice InvolvedClients. Journalof Psychoactive Drugs,Suppl7,10–18.
Kreps,G.L (2015). Health communication inquiry and health promotion: AState of the Art Review. Journalof Nature and Science, 1(2):e35.