Report on the Use of Evidence Based Nursing Within Long Term Conditions (LTC)
Write a report on the use of evidence based nursing within long term conditions (LTC), including personal reflection on how you have recently used evidence based practice in the care of a person with a long term condition. 1. Introduction. 2. 1. This report discusses the significance of using evidence based nursing for the treatment and management of long term conditions. It focuses on how evidence based practice influences the patient care and includes personal reflection of caring for a person with a long term condition with experience of using evidence based care. . What is evidence based nursing? 3. 2. Evidence based nursing practice indicates making decisions about a patient’s care on the basis of current best available evidence (Beyea & Slattery, 2006). It enables health care professionals of all varieties to provide the best quality of care to the patient based on up to date research and knowledge. There are a range of different resources including clinical guidelines, local and national policies, reports, current and past research and personal reflections (Dale, 2005).
These sources of evidence can inform the health practitioner of good nursing practice which can then allow them to deliver excellent nursing care with an evaluative and qualitative approach (Thompson et al, 2004). Good quality information in a suitable format supported by guidance from a health professional has also been shown to increase people’s levels of confidence in the decision making process (Embrey & Fox 2010). Getting up-to-date, accurate and unbiased information can help everyone make informed decisions and communicate effectively with care professionals. . What is a Long Term Condition? 4. 3. Long term conditions are those which current medical interventions can only control not cure (Furze et al, 2008). The Department of Health (2010) estimates there are around 15 million people in England with at least one long term condition. These include transmissible diseases, such as HIV, and non-transmissible diseases, such as diabetes, chronic obstructive pulmonary disease, and asthma. There are mental health long term conditions, such as schizophrenia, and ongoing impairments, such as joint disorders.
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There are also a number of neurological conditions, for example Parkinson’s disease, multiple sclerosis, Guillain Barre Syndrome and myasthenia gravis. Denny & Earle (2009) suggest patients with long term conditions need ongoing nursing and medical management; their everyday lives are likely to change dramatically and with many long term illnesses, such as multiple sclerosis, the illness can become progressively worse, so they therefore need continuing quality care, and support should be organised to meet their needs.
4. Use of evidence based nursing care related to Long-term Conditions. 5. 4. To meet the needs of the patients the government has recently set out a new strategy to support the management of people living with a long term condition and to aid them to live independently. Public consultations run by the strategic health authority to establish the major health concerns of people showed that long term conditions were a priority area for action. The results clearly indicated they wanted more control over their care and lives (Milne and Greenwood, 2009).
There have been a range of documents published by organisations set out to help the management of people with a long term condition. 5. 5. 1. One important document, published by The Department of Health (DOH), is The Long Term (Neurological) Conditions National Service Framework (NSF) started in March 2005. This planned to transform the way health and social care services support people who live with long-term neurological conditions. The principles of the NSF (Appendix 1) are also relevant to service development for other long term conditions and support the government’s strategy for support (DOH, 2005).
An additional document published in June 2004 by the DOH is The NHS Improvement Plan: Putting people at the heart of Public Services, and also the Our Health, Our Care, Our Way White Paper published in 2006. These apply to health and social services working with local agencies involved in supporting people to live independently, such as providing transport, housing, employment, benefits and pensions. Another study to support this is the Personal Health Plan which was set up in July 2008. It has been developed specifically for people with long term conditions to help them to adapt to life with a long erm condition and to take control of their care. 5. 5. Evidence shows that this research based practice and the use of national clinical guidelines has improved quality of care and the patient’s outcome (McInnes, 2001). Although there is room for improvement; national service frameworks are devised for patients living with only one long term condition, and many suffer from a range of conditions that also need better management. 5. Personal Reflection. 6. 6. On reflection, whilst observing nurses in practice, I found that a lot of the sources of information came from reliance on humans as information sources.
Experiential sources, such as the Multiple Sclerosis Clinical Nurse Specialist or other experienced colleagues, appeared the most accessible, useful and reliable source when a clinical decision was needed. This choice of information is based on experience rather than research. McKenna & Cutcliffe (2000) suggest all clinical decisions should be based on research and evidence. I feel nurses should back experiential sources of information up by using other easily accessible sources, such as local protocols and guidelines. Or for drug related information, the British National Formulary (BNF) can be used.
However, not all patients’ clinical status will fit within clinical guidelines or protocols; therefore, clinical judgement and intuition gained from personal experience may be most appropriate in those circumstances. 6. Experience of using evidence based practice in the care of the patient with a long term condition. 7. 7. During clinical placements I have used various assessment tools, such as the Glasgow Coma Scale (GCS), when caring for patients with long term conditions. The GCS gives a reliable, objective way of recording the conscious state of a person (Teasdale & Jennett, 1974).
It is used by both medical and nursing staff for initial and continuing assessment, and has a value in predicting an ultimate outcome for the patient. Within each category (eye-opening, verbal and motor responses), each level of response is allocated a numerical value, on a scale of decreasing neurological deterioration. Three figures are obtained in each section, which add up to a maximum score of 15 and a minimum of three. 7. 8. 2. I used this assessment tool on a patient who had suffered from a multiple sclerosis relapse. Their GCS score was 15 throughout their stay in hospital, therefore showing no improvement or deterioration.
Evidence shows this assessment tool lacks reliability and accuracy; there have been reported differences in GCS scores of two or more on the same patients by different practitioners (Jennett, 2002). This indicates that clinical decisions should not solely be based upon GCS, but be used as a component of monitoring neurological function. 7. Conclusion and recommendations. 8. 8. To conclude, it is in doubtful that evidence based nursing helps improve the quality of care and management to people suffering from a long term condition.
There are many sources out there for health professionals to gain the knowledge and research to carry out practice based on this evidence. Nurses are increasingly considered as key decision makers within any healthcare team; they are expected to use the best available evidence in their judgements and decisions. For current practice to continue to be evidence based, all healthcare professionals should be given training on how to use and find the best available evidence and all sources should be regularly assessed and updated. Appendix Appendix 1 – The principles of the National Service Framework: 1: A person?centred service.
People with long term neurological conditions are offered integrated assessment and planning of their health and social care needs. They are to have the information they need to make informed decisions about their care and treatment and, where appropriate, to support them to manage their condition themselves. 2: Early recognition, prompt diagnosis and treatment People suspected of having a neurological condition are to have prompt access to specialist neurological expertise for an accurate diagnosis and treatment as close to home as possible. : Emergency and acute management People needing hospital admission for a neurosurgical or neurological emergency are to be assessed and treated in a timely manner by teams with the appropriate neurological and resuscitation skills and facilities. 4: Early and specialist rehabilitation People with long term neurological conditions who would benefit from rehabilitation are to receive timely, ongoing, high quality rehabilitation services in hospital or other specialist settings to meet their continuing and changing needs.
When ready, they are to receive the help they need to return home for ongoing community rehabilitation and support. 5: Community rehabilitation and support People with long term neurological conditions living at home are to have ongoing access to a comprehensive range of rehabilitation, advice and support to meet their continuing and changing needs, increase their independence and autonomy and help them to live as they wish.
6: Vocational rehabilitation. People with long term neurological conditions are to have access to appropriate vocational assessment, rehabilitation and ongoing support, to enable them to find, regain or remain in work and access other occupational and educational opportunities. 7: Providing equipment and accommodation People with long term neurological conditions are to receive timely, appropriate assistive technology/equipment and adaptations to accommodation to support them to live independently, help them with their care, maintain their health and improve their quality of life. : Providing personal care and support Health and social care services work together to provide care and support to enable people with long term neurological conditions to achieve maximum choice about living independently at home.
9: Palliative care People in the later stages of long term neurological conditions are to receive a comprehensive range of palliative care services when they need them to control symptoms, offer pain relief, and meet their needs for personal, social, psychological and spiritual support, in line with the principles of palliative care. 0: Supporting family and carers Carers of people with long term neurological conditions are to have access to appropriate support and services that recognise their needs, both in their role as carer and in their own right. 11: Caring for people with neurological conditions in hospital or other health and social care settings People with long term neurological conditions are to have their specific neurological needs met while receiving treatment or care for other (DOH, 2005).