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¶ … Evidence-Based Practice

Theory and Concepts

Model Comparison

Synthesis of Results

The EPB (Evidence-based practice) is identified as the problem-solving approach assisting clinicians to integrate patient's values and preference to achieve patients' outcomes. When EPB is implemented with the context of culture, caring, and environment, it has the ability to deliver effective patients outcomes. Evidence have revealed that EPB is an effective tool enhance healthcare efficiencies as well as reducing variation in costs and care. (Melnyk, Fineout-Overholt, Gallagher-Ford et al. 2012). Despite the tremendous benefits of EBP to the healthcare organizations, many clinicians in the United States do not practice an effective standard care laid down by the EBP (McGinty & Anderson, 2008). Tremendous barriers still exist that prevent healthcare organizations from achieving effective health outcomes. Based on the identification of barriers to the application of the EBP, this paper evaluates different models that can assist in answering the PICOT question.

PICOT Question

"In post liver transplant patients (P) how does lifestyle modification such as physical activity (I) compare to a sedentary lifestyle (C) affects patient quality of life (O) within 4 months (T)."

Theory and Concepts

The beliefs of some nursing professionals are rooted on the ground that they do not need evidence to implement their practice. However, the perception of nursing practitioners often devalues the clinical expertise and experience. Eberhart, (2014) highlights the relationship between the three elements of evidence- based practice (patient's preference, clinical expertise, and evidence) and nurses' core values, which can move nursing profession towards EBP paradigms. However, changing clinical practice to achieve the goal of EBP is still complex and challenging, thus, a core concept that shifts the nurses core beliefs towards EBP rest on the development of knowledge, beliefs, and effective decision. The theory of evidentialism "explains what is needed for an individual to have a justified belief about a particular proposition, situation, or decision. A justified attitude toward a proposition and the decisions and actions based on that attitude that follows are determined by the person's evidence." (Eberhart, 2014 p 17). The theory of the evidentialism delivers a philosophical framework to assist professional nurses achieving higher obligation and incorporate relevant and current evidence in their professional practice. In reality, nursing practitioners are to develop strong beliefs towards EBP to assist post liver transplant patients achieving effective health outcomes since obesity is one of the complications of the post-liver surgery.

The global prevalence of obesity has dramatically increased in the last three decades, which has resulted in different types of adverse health effects. Particularly, high-fat disposition in the human body is one of the significant factors that influences the growth of the acute liver disease. The "ALF (Acute liver failure) is an uncommon condition where rapid deterioration of liver function results in coagulopathy and alteration in the mental status of a previously healthy individual." (Adair, & Toogood, 2014 p 359). By consequence, the severe liver disease can have a significant effect on patients' quality of life and their life expectancy. Although, different treatments have been implemented to cure liver disease, however, a treatment such as multi-drug regimens can have a variety of side effects. While therapy with drug prescription is unavoidable, a change of lifestyle intervention can play a critical role in achieving health improvement for patients suffering from the chronic liver disease. Typically, a lifestyle modification is strongly advised for individuals suffering from NAFLD "(non-alcoholic fatty liver disease)" (Carter-Kent, & Feldstein, 2011 p 3) and patients currently undergoing liver transplantation. Even when an effective pharmacologic intervention is considered, a lifestyle change still represents an adjuvant treatment because the medication can be very expensive, and may lead to an adverse in the case of a prolonged use.

Liver transplantation is a "replacement of a diseased liver with" (Carter-Kent, & Feldstein, 2011 p 3) a healthy liver. While the surgical procedure may be demanding, however, a liver transplantation is one of the viable treatment for the liver. Janet, (2012) points out that the liver transplantation procedure involves removing the diseased liver from the patient abdomen, and replaced it with a new healthy liver connecting the blood vessels and biliary systems. While there may be a success rate at a post-liver transplant, nevertheless, obesity has been identified one of the post-transplant complications within a healthcare environment, and by consequence, obesity is a major factor that can lead to the type 2 diabetes and cardiovascular disease.

Carter-Kent & Feldstein (2011) contribute to the argument by pointing out that a liver transplantation can be associated with different risk factors such as cardiovascular disease, diabetes mellitus, hypertension, obesity, and dyslipidemia. Typically, the post-transplant complications occur between 43 and 58% of patients, and diabetes is particularly being identified as a major risk factor. In the contemporary heath environment, obesity can lead to other heath complications such as hypertension, glucose dysregulation, and dyslipidemia, which are key risk factors for the development of the fatty liver disease. Based on the increasing rates of the disease in the few decades, the rate of the chronic liver disease is now a common phenomenon in the United States and other advanced countries affecting between 5 to 17% of children 20 and 35% of adults. Moreover, the chronic liver disease is associated with insulin utilization for patients with type 2 diabetes.

Different studies have revealed that disordered insulin regulation can lead to multiple metabolic problems leading to inflammation of the liver and fat disposition. (Choudhury, & Sanyal, 2004). Moreover, a growing of body of evidence reveals that patients suffering from severe liver damage are at the high risk of developing cardiovascular disease with health consequence such as stroke and myocardial infarction. (Diehl, Clarke, Brancati, 2003).

Given linkages between severe liver damage and cardiovascular disease, the lifestyle changes, and weight loss through physical exercise are paramount to the overall health care for post liver transplant patients. The lifestyle modifications that consist of both physical activity and dietary interventions have been identified as the health management tools to manage the post-liver transplantation. While different models are being suggested for the management of post-liver transplantation, however, these models are not effective because no exact model has been identified to improve the survival rates the patients. For example, liver transplantation failure rates occur between 10% and 15% of the case with 58% of survivors live for only 15 years after the surgery. Since, the patients require lifestyle modification after the surgery for effective management of post-liver transplantation, the EBP (evidence-based practice) has been identified as an effective health management tool for patients after the liver transplantation. While there are different models for nurses to achieve the EBP, the next section evaluates all the models to identify the appropriate model to enhance lifestyle modification for post liver transplant patients using physical activity compared to a sedentary lifestyle.

Model Comparison

This section compares and contrasts different evidence-based practice models to identify the best model that can be used to modify lifestyle of post liver transplant patients using the physical activity, which will assist the patients enhancing the quality of life compared to a sedentary lifestyle, There is an increased evidence that clinical practice should be guided by conceptual framework or models, the evaluation of the models is very critical to identify an appropriate model to answer the PICOT question. The evidence-based practice has gained an increased popularity within the healthcare setting. Despite the benefits to be derived from the health practice, there is still an increasing challenge to deliver a measurable highest quality care. Evidence-based practice is defined as a problem-solving approach to assist healthcare professionals in answering clinical questions. To assist nurses using the evidence-based practice to operate effectively within the clinical setting, they are required to develop, introduce, as well as evaluating the evidence-based practice. Typically, evidence-based practice judiciously and conscientiously uses the current-based evidence combined with the clinical practice to guide the healthcare decisions.

Several models have conceptually contributed to the evidence-based practice; however, analysis of these models is very critical to collect evidence to achieve effective changes within the clinical settings. Different models have been developed for the implementation of the EBP (evidence-based practice). "The Stetler Model in Evidence-based Practice" (Stetler, 2001 p 1) can assist public healthcare practitioners using the evidence-based practice in enhancing an effective planning and implementation. Despite the clinical benefits of the Stetler model, the use of its prescriptive approach is complex and may be difficult for nursing practitioners to develop and interpret. In the contemporary health environment, a major responsibility of nurses is to deliver health education to patients to assist them applying effective physical activity at post-liver transplantation. However, the Stetler model is not effective to design the physical activity for patients with post-liver transplantation.

Similar to the Stetler model, Iowa model has been used to develop a quality of healthcare in numerous clinical setting by providing guidance for clinicians and nursing professionals to make an effective decision regarding the clinical practice. Similar to the Stelter model that uses 5-step stages to implement the evidence-based practice, Iowa model also uses… [END OF PREVIEW]

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