The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model

Discuss the nursing plan for Emma using evidence-Based practice model.

Emma is 75 years old woman. She was diagnosed with colorectal cancer. The concerned doctor had advised for the surgery. Then she will be sent for further treatment like chemotherapy, radiotherapy. After observing Emma’s health condition, the doctor has planned the treatment. A colon surgery was performed here. Emma responded well with the surgery. Then doctor advised her to stay in the home for three months. After three months her further treatments will be started. In these three months, it is necessary for Emma to be healthier so that she can give good response to the treatment. At present, she has released successfully from the hospital. Now the nurses are refereed for homecare services for these three months. Therefore, the nursing plan is applied using Evidence-Based Practice model. In this particular article, this model will be discussed by taking this example.

The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model is a powerful approach to solve the problem in clinical decision-making. It is associated with user-friendly tools to guide group or individual in their practitioner use. It is designed in such a way that it can meet the nursing needs by using a process called PET (Buysse et al., 2012). This process includes three steps: translation, evidence and practice question. The main aim of this model is to assure that best practices or research findings should be incorporated in patient care in appropriate and quick way.

This is the first step in this process. The team should be made in such a way that the patient could stay safely in her home. Members invest and show interest in addressing a specific practice. However, in team they work more effectively. The doctor is the key member inn this team, as he is answer of the patient and her problem. The other stakeholders of this team include nurses, families, dietician, physician, pharmacist and patient (Hall & Roussel, 2012).

This is the second stage. The PICO element will be appliedto the questions.  In PICO, P- population/patient, I-intervention/indicator, C-comparator/control, O-outcome. As in this case, the patient has undergone colon cancer, o the stated question will be according to her situation (Townsend, 2014). How frequent is colon cancer in females? In patients with colon cancer in first stage, do the edible drugs, compared to no chemotherapy, reduce the recurrencerate?  What will be the outcomes of chemotherapy for the patients above 75? In these three months, which all things shoud be taken care of? What will be the diet for these three months?

Recruit Interprofessional Team

The patient here is identified with colorectal cancer. This cancer appears due to the abnormal growth of cells in the colon. According to the statistical analysis, in 2012, this is the second most cancer in women. One million of people ge affected by this cancer every year. It results about 715,000 deaths (Schneider & Whitehead, 2013). This cancer occurs due to many reasons, like problems in epithelial cells lining the gastrointestinal tract. It also causes due to heredity, lifestyle. The treatment of this cancer includes surgery, chemotherapy, and radiation therapy.

In this case, the patient has discharged safely and to send her home so that she can be prepared for future treatment. Based on this scenario, the team members are selected. The doctor is the key member in his team. He knows the problem. His responsibility will be to get the information of the patient on fifteen days interval. He should also share this data with other team members. The nurses will be provided with the patient. The responsibility of the nurse will be observing the patient for round the clock. The nurses will take care of her medications, diet, and dressing (Gone, 2013). They can also help in palliative care. The responsibility of the dieticians will be to provide with the perfect diet chart according to her present condition. The dietician should also upgrade the diet while her visit to doctor. Physician’s responsibility will be to perform different medical tests if needed. Pharmacists will take care of the medicines. If any changes are made, then the pharmacists will upgrade with the correct medication with proper dose. The pharmacist will also provide the knowledge about the medicine. Family members will take care of everything. Their main duty is to provide support to the patient both mentally and physically. In this whole team, the patient has more responsibilities. She should response with all the provided treatments. She should take the challenges and participate actively (Aveyard & Sharp, 2013). She should also cooperate with the other team members for better treatment.

The team members will search for the evidences for this case. These evidences include both external and internal data. These evidences consist of clinical practices follow-ups in these three months, quality improvement data, regulatory, safety or risk management data. This information will be internal evidences. They can tally these data with other professional organizations of respective departments. They also can take the opinions of internal and external health experts (Polit & Beck, 2012). These evidences also include community standards, staff and patient surveys and satisfaction data. In the appraisal level, these non-research and research evidences will be appraised by applying non-research evidence appraisal tool and research evidence appraisal tool. In this tool, different questions will be asked. In this scenario, the questions will be based on the three months planning treatment after discharge. Then, based on those questions the collected evidences will be rated as low-major, good or high flaws. Fromm this appraisal, the team members will be motivated to maintain the quality and level (Kearon et al., 2012).

Developing EBP question

In this case, the team will numerically summarize the answers of the evidences in levels from 1-5. The relevant findings of each answer of EBP question will be written in summary for next level (McDonald et al., 2014). Through synthesis process, the team will make the quality and strength of the collected evidence by taking the considerations in applicability to the setting and population, consistency of finding the evidences, quality and level. This will drive the subjective and objective process of the treatment.

Based on the synthesis of the evidence and overall appraisal, the team will design possible pathways to translate the evidence into practice. There are four common pathways, which will suggest developing the further recommendations (DiCenso et al., 2014). In this particular case, evidences were good with consistent results that support a practice change. Based on this the changes will be done in the scenario.

The team communicates with different stakeholders and practitioner associated with this particular case to know if the change is good fit, appropriate or feasible for that setting. They examine the benefits and risks of the implemented recommendations. For example, in this case the team will consult with the radiologists regarding the doses of the radiotherapy. They will consult regarding the patient’s reaction with the therapy in this age. After reviewing these recommendations, the team will develop a practice plan to implement into the practice (Laska et al., 2014). A guideline or protocol will be developed based on the EBP questions, which had asked before. The team members will set a timeline of three months. The feedback of this process will be taken from other stakeholders, clinicians or organization leaders. To implement the action the team has to take care of financial, material and human resources in consideration. In this case, the radiation therapy and chemotherapy will be costly. Therefore, the team has to pay attention on that. The successful implementation will be performed by supporting each other and working closely. Next step will be the final implementation of the plan. Before implementing, all the team members and other stakeholders and staffs, who are associated with this case, will be communicated orally and verbally. They all will be connected with the updates regarding the implementation (Carr & McNulty, 2014). During this implementation, the team members have to answer all the trouble shoot problems and questions.

The outcomes of the implementation will be recorded. These outcomes will be tallied with the answers in the question development tool. The evaluation of the outcomes will be decided with the degree to how much these outcomes reached. As in this case, the positive outcomes have recorded. This meets much of the responses in the question development tool (Rubin, 2012). It helps the team to develop the confidence level more. If in case, any negative outcomes will b observed, then the team needs to alter the changes. Now the team will communicate with other stakeholders and staffs associated with this case and report bout the outcomes. The team also can add the valuable feedbacks made by those members. It will help to gain more knowledge in this practice.

Scope of EBP

After reviewing the process, the team members will figure out the next step. In this case, the radiotherapy treatment has planned for three months. Therefore, after this implementation, the team members will notice the changes. According to that further treatment will be figured out (Hurlburt et al., 2014). The changes will be made after doing lot of research works. If necessary then training also will be provided to meet the expectations.

In this final step, the whole process will be reviewed.  In this case, positive outcomes have been found. Now, the organization has to share these findings internally and externally to get the better result (Kearon et al., 2012).

Conclusion:

In this particular case, the treatment plan is made by following EBP model. Each step of this model has been followed strictly. Due to this reason, the treatment shows positive response. Even the team members’ effort and constant support has made the plan more successful. There are certain cases, where, the plan did not work. However, the team members gain more knowledge and experiences from those failures. To conclude this, it can be said that, through clinical decision making and solving the clinical problems the main aim of evidence based model has justified.

References:

Aveyard, H., & Sharp, P. (2013). A Beginner’s Guide to Evidence-based Practice in Health and Social Care. McGraw-Hill Education (UK).

Buysse, V., Winton, P. J., Rous, B. E. T. H., Epstein, D. J., & Lim, C. I. (2012). E

Carr, A., & McNulty, M. (2014). The handbook of adult clinical psychology: an evidence based practice approach. Routledge.

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-based nursing: A guide to clinical practice. Elsevier Health Sciences.

Gone, J. P. (2013). A community-based treatment for Native American historical trauma: prospects for evidence-based practice.

Hall, H. R., & Roussel, L. A. (2012). Evidence-based practice. Jones & Bartlett Publishers.

Hurlburt, M., Aarons, G. A., Fettes, D., Willging, C., Gunderson, L., & Chaffin, M. J. (2014). Interagency collaborative team model for capacity building to scale-up evidence-based practice. Children and Youth Services Review, 39, 160-168.

Kearon, C., Akl, E. A., Comerota, A. J., Prandoni, P., Bounameaux, H., Goldhaber, S. Z., … & Crowther, M. (2012). Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines.CHEST Journal, 141(2_suppl), e419S-e494S.

Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51(4), 467.

McDonald, K. M., Romano, P. S., Geppert, J., Davies, S. M., Duncan, B. W., & Shojania, K. G. (2014). Measures of patient safety based on hospital administrative data: The patient safety indicators. Technical Review 5 (Prepared by the University of California San FranciscoBStanford Evidence-based Practice Center under Contract No. 290-97-0013). Rockville, MD: Agency for Healthcare Research and Quality, 2002. AHRQ Publication, (02-0038).

Polit, D. F., & Beck, C. T. (2012). Resource manual for nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer Health/Lippincott Williams & Wilkins.

Rubin, A. (2012). Statistics for evidence-based practice and evaluation. Cengage Learning.

Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: Methods and appraisal for evidence-based practice. Elsevier Australia.

Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.