Design an evidence-based practice project

Design an evidence-based practice project in which inform as why EBP was chosen and its content and the process needs to be explained

Introduction

Background of EBP Project

EBP or Evidence-based Practice is one of the most essential constituents of nursing. It is the process of offering the best possible healthcare services to the patients that is based entirely on the evidences gathered through several years of research (The Open University of Hong Kong, 2017). This EBP Project has been undertaken as a part of the nursing curriculum and practice so that it is possible to contribute to the field of nursing by participating in a nursing research project that will be helpful in gathering essential information on patient behaviour and the reasons, such that the study can be used in future as a reference to test similar occurrences in nursing practices.

Reason for topic selection

The topic that has been chosen for this EBP Project is “Self-neglect by patients and nursing interventions”. This topic has been chosen to be worth undertaking a research study on because of its relevance to the profession of nursing. In nursing practice there are several situations where the patients do not cooperate with the doctors and nurses in taking treatment or medicines. This creates an ethical dilemma on the part of the nurse and doctor as to whether they should intervene or allow the patient to take his own decision (Torke & Sachs, 2008)

Content of the EBP Project: Five Phases of Research Process

Phase 1: Identifying the research focus:

The focus of this EBP research project has been the self-neglect by several patients in the course of administering nursing services and the ethical dilemma that is faced by a nurse in such a situation. It has been observed through evidences in literature that many patients on attaining old age, often refuse to take medical interventions as they feel that they are better persons to judge their current medical conditions and they can decide for themselves that whether they need to undergo a certain treatment or prognosis. The research has highlighted that the nurse has to face a dilemma in such a situation if he or she finds that the patient is neglecting a medicine or treatment that might prove to be fatal in the end. Here, lies the choice of action to be undertaken by the nurse in terms should he or she force the patient to take the medicine or treatment or should he or she leave the patient with his own choice of decision (Paper Masters, 2017).

Phase 2: Developing a research plan:

The study consisted of using the methodology of data collection from primary as well as secondary sources (Kothari, 2015). The primary data has been collected from some patients in the nursing home in order to gather their opinions on self-neglect and whether the patient should have the liberty to decide whether to undergo a treatment or not. The secondary sources consisted of the various sources of literature available over the internet as well as some course modules those have provided relevant knowledge on the research subject (The Open University of Hong Kong, 2017).

Literature Review

According to Day and Warren (2008), self-neglect is mainly an issue with the ageing and elderly population. From evidence it can be comprehended that for ensuring the best nursing practice it is essential to have identification at an early stage so that a preventive measure can be selected. It has been observed that many of the healthcare professionals complain about self-neglect of patients those are elderly (Day & Leahy-Warren, 2008).
In the opinion of McDermott (2011), it is a big challenge for the healthcare professionals to undertake the appropriate ethical decision-making in the scenarios of self-neglect by the older people receiving treatments. Ethical dilemmas lead to various outcomes those might be undertaken by a nurse of doctor depending upon his personal observations and beliefs on ethical theories in practice such as Autonomy, Beneficence, Justice and Non-maleficence in nursing practices. (McDermott, 2011).
The analysis of preliminary sources of literature and practical observations at the nursing home has led to generation of the following hypothesis:
“Self-neglect of patients offers an ethical dilemma scenario for a nurse and intervention procedure is either resorted to or not depending on the personal ethical observation of the nurse at that moment and also on the decision-making capacity of the patient about his own wellness.”

Phase 3: Collecting Data

The primary data collection has been conducted from some patients in the nursing home of a wide age range of 21- 70 years. The Random Sampling has been used for choosing the 25 participants of the research (SAMHSA, 2017). The instrument that has been used in the data collection is the Interview Questionnaire that consisted of open-ended questions. A sample of the interview questionnaire is provided as follows:

What is your age?
What kind of disease are you suffering from?
How long have you been admitted?
Are you happy with the services of the nurse?
Do you receive any intervention from nurse?
Do you support medical intervention by the nurse or prefer to decide your own line of treatment?
Is it ethically right for a nurse to force intervention if it is for your beneficence as a patient?
 
These are the questions those were asked to the participants of the interview within the nursing home. The patients were clearly notified about the purpose of the research and it was assured to them that their identities would not be revealed and names would not be mentioned in the research process. Hence, the ethics of research study were observed in the process. The data collection was followed by the analysis of the results and making the logical interpretations.

Phase 4: Analyzing data and interpreting findings:

The data that have been collected have been analysed to arrive at the results and interpretations. 
Results:
The results of the interviews depicted that the majority of the participating patients those voiced their support in favour of self-neglect and thought that the patient should have the right to decide and agree to the line of treatment in a healthcare setting were mainly the elderly patients. Apart from this, the decision of whether to force intervention on such patients for their wellness depends on the ethical observation of the healthcare provider such as the nurse. 

Phase 5: Reporting findings:

The findings from this research will contribute to understanding that the decision to intervene or not depends on a number of factors some of those depend on the nurse and the others on the capacities of the patients in decision-making.

Evidence-based practice in the Clinical Setting

Relevance and significance of project to evidence-based practices

The said project is expected to contribute effectively to EBP in clinical setting. The intervention decision by a nurse should be based on the patient’s capacity to decide his own wellness. The capacity of the patient in taking decisions for himself often influences ethical dilemma of the nurse. The ethical dilemma that the nurse faces in such a situation is further influenced by the decision-making capacity of the patient to understand the degree to which the patient can think about his own well. The responsibility is on the nurse to clearly determine the nature of the self-neglect through an effective and comprehensive assessment of the patient in terms of the medical and social history of the patient, a historical analysis of a similar situation, interviewing some of the family members and some of the healthcare professionals those have served the patient.

Ways of incorporating project findings into nursing practice

The findings from the project have revealed that a nurse might decide to intervene if he or she observed Deontology as it is their duty to do the best for the patient irrespective of the outcome. The nurse might also observe Utilitarian approach if he or she believes that the patient has the right to choose his own course of treatment so that the patient can receive the maximum satisfaction. It is difficult to suggest that a choice of intervention in a self-neglect case is ethically wrong for the nurse, because if the nurse believes in his or her duty then he or she would have to undertake the intervention procedure even if the patient does not approve of it. This might or might not be beneficial for the patient. On the other hand another nurse might believe that it is necessary to respect the choice of the patient in terms of whether he should receive a certain treatment or not. This outcome might also have positive or negative consequences on the final outcome of the treatment. These are major findings those have been possible to gather from this EBP Project. Future researches in nursing interventions can utilize the information contained in this report

Conclusion

On a concluding note to this Evidence-based Practice Project, it can be said that in course of the research process it was possible to understand the relevance of self-neglect, mainly by the elderly patients on the nursing interventions. The research has depicted that this situation of ethical dilemma may have various consequences in terms of the method of interventions chosen by the nurse. The decision to intervene in self-neglect cases depends on the ethical observations and beliefs of the nursing professionals. In some situations interventions have shown positive while in some others they have revealed negative outcomes on the patient. The choice of intervention rests with the healthcare professional.

References

Day, M. R., & Leahy-Warren, P. (2008). Self-neglect 2: nursing assessment and management. Nursing Times; 104: 25, 28-29.
Kothari, C. R. (2015). Research Methodology: Methods and Techniques. Retrieved from http://www.modares.ac.ir/uploads/Agr.Oth.Lib.17.pdf
McDermott, S. (2011). Ethical Decision Making in Situations of Self-neglect and Squalor among Older People. Journal of Ethics and Social Welfare; 5(1), 52-71.
Paper Masters. (2017). Evidence Based Practice in Nursing. Retrieved from papermasters: https://www.papermasters.com/evidence-based-practice-nursing.html
SAMHSA. (2017). Data Collection Methods: Pros and Cons. Retrieved from https://www.samhsa.gov/capt/tools-learning-resources/data-collection-methods-pros-cons
The Open University of Hong Kong. (2017). Unit 4: Evidence-based practice and an overview of nursing research. NURS S310: Professional Nursing Practice, 3-10.
The Open University of Hong Kong. (2017). Unit 5: Research process. NURS S310:Professional Nursing Practice, 1-7.
Torke, A. M., & Sachs, G. A. (2008). Self-neglect and Resistance to Intervention: Ethical Challenges for Clinicians. Journal of General Internal Medicine, 23(11), 1926-1927.

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