Proposing a clinical practice decision based on Evidence, clinical expertise, and patient values/preferences in the case of Mary a clinical patient Evidence-Based Practice (EBP)

The goal of EBP is the integration clinical expert opinion, external scientific evidence, and patient perspective to present high-quality services matching the interests, values, needs, and choices of the individuals we serve (Melnyk, 2011). Using evidence maps to provide clinicians, researchers, clients, and caregivers with tools and guidance to engage in evidence-based decision making. The evidence maps will highlight the importance of the three components of evidence-based practice: clinical expertise, current best evidence, and Mary’s perspectives.

In Mary’s situation as we have understood the above case, Case Series, and Case Control clinical trial methodologies will be most appropriate to be applicable.

What is evidence based medicine

Clinical questions

Have the diagnose is the prognosis of Mary’s situation been adequately carried out, and with that done what therapeutic assessment is best suitable for Mary keeping in mind the prevention of additional body weight.

•    Evidence suggest that Mary had undergone an initial test and she is on medication, these suggest that Mary’s nurse is already working on a model suitable for her treatment process.

•    With the evidence collated so far, does it prove that Mary is a thigh risk of adding more weight if she doesn’t have a planned model on the treatment process this is because her glucose level is still above target? And certain kinds of food and beverages can advance diabetes and as well repeal the effects of the treatment she is undergoing.

•    Mary is an Obese (45) year old woman, does the composition of Mary’s biological system makes it very clear that there certain limitations in the things Mary can do. And in the kind of treatment, she can undergo. So far she has been able to maintain an adiabatic diet and takes her medication as scheduled, but she worried about heart diseases and weight gain due to the impact of the drugs and high hemoglobin.

•    Within a specified period that Mary started her treatment the scheduled date of her next appointment with her nurse.Mary’s treatment has been quite useful, hemoglobin A1 Chas decreased and as well her blood glucose level ranges between 160190mg/dt. Mary can ensure that she keeps up with her medication as prescribed by her nurse, and try some exercise activities to help in reducing sugar levels and hemoglobin content in her body entirely.

Evidence based medicine examples

PICO: Population, Intervention, Comparison, Outcome and Time.

Step1: Framing the Clinical Question

Population / patient / diseases	Intervention / indicator	Comparison / control	Outcome	Time
Type 2 diabetic African-American women	Increase the physical activities, alter medication, and education	Avoid energy food distributed by sugar	Improve the glucose level	Make follow ups at two weeks
Cardio vascular disease	High cholesterol and high blood pressure	Healthy lifestyles	Living free of the disease	Make follow ups at two weeks
High hemoglobin	Iron deficiency	Medication	Red need hemoglobin	Make follow ups at two weeks
Blood glucose level	Fasting hyperglycemia	Cheat sugar intake	Healthy heart	Make follow ups at two weeks
Heart disease	Cardio vascular disease	Healthy lifestyle changes, dieting and exercise	Living free of the disease	Make follow ups at two weeks

Evidence based medicine standards

Patient/Population/Problem

Mary is a (45) year old lady with her primary problem being obesity, which is co – existing with other conditions.

Population

Here we have our evidence drawn from the case of Mary who is suffering from Obesity, Diabetes, and high Hemoglobin. The evidence clearly here without asking questions will be Mary’s oversized weight; these have contributed to her health risks.

Outcome

Our issue of interest here is for Mary to be able to undergo proper treatment, under close supervision and with exercises also to prevent /reduce the addition of weight gain due to the high doses of medication.

Finding the Evidence

Evidence in the case shows that Mary (45) year old African American woman is suffering from Obesity, Diabetes, with a family history of cardiovascular disease which means there is a high possibility of that disease affecting her in the future. Also suffering from very high hemoglobin which is at 8.5 currently and considered above target (DiCenso, 2005).

Although a positive effect seems are anticipated, the level of evidence on this topic is not active. Further research is needed to ensure the efficacy of these initiatives (Titler et al., 2001). Very few studies checked the benefit of incentives on adherence to medications in chronic patients with metabolic/cardiovascular diseases, and with biologic indicators as their outcome.

Systematic reviews

Systematic reviews form the basis of evidence-based clinical practice guidelines. And with all that information Mary’s nurse can address and use such data to fully implement treatment on the patient.

Individual Studies

Mary’s case is an individual study; this is so due to the number of cases treated concurrently. Past evidence has proven that articles and guidelines that were stated down overall on the period of time show noneffective to the treatment of new disease patterns. Therefore, it is advisable to get hands-on observation and recent research details and guidelines to use.

Assessing the Evidence

Systematic Reviews

In assessing the evidence, we look at the cultural and family medical background of the Mary who is an African American and her family has had a history of cardiovascular disease. This review is relevant to our clinical questions because; it helps us understand what point of view both the clinician and the client were operating and trying to understand the progress of the situation.

Making the Decision

At this level, it is imperative to join clinical know-how, the patient’s view, and the available scientific proof in making a particular clinical decision with the patient (Mary). Therefore, we must closely consider all clinical guidelines to ensure we examine the positive result as we follow these guidelines. Mary and her nurse should work to get her from a position of trust and complete openness as they collect data, try to establish new frameworks on how best to draw up new models of treatments that will work more efficiently for Mary and other patients.

References

Melnyk, B. M., ; Fineout-Overholt, E. (2011). Evidence-based practice in nursing ; healthcare: Lide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams ; Wilkins.

DiCenso, A. (2005). Evidence-based nursing: A guide to clinical practice. St. Louis, Mo: Mosby.

Van, L. B., Hankemeier, D. A., ; Welch, C. E. (2015). Evidence-guided practice: A framework for clinical decision making in athletic training.