2020 Nursing Research Paper
Evidence-Based Presentation
Introduction
Evidence-based research guides practitioners in their clinical practices. Being a nurse in a neurosurgical ICU, the selected study “Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know?” informs care delivery in the critical care unit, thus improving the quality of care and the level of patient satisfaction. This paper will focus on analyzing aspects of the selected evidence-based practice. First, the paper will provide a detailed description of the selected EBP. Besides, it will discuss the process used to locate and selecting this EBP sources. It will also discuss various characteristics of the EBP source, including type of source, background, objectives, search methods, selection criteria, data collection & analysis, level of evidence, major results, and the conclusions. The paper will also cover the method for communicating the EBP source, the targeted audience, and two potential uses of selected EBP.
A Description of the Selected EBP
The selected EBP is “Evidence-based dexamethasone dosing in malignant brain tumors what do we really know?” This article was obtained from the Wilmington University Library. It was authored by Jessurun, C.A.C et al. (2019). The first author Charissa A. C. Jessurun from the Faculty of Medicine, University of Amsterdam/Amsterdam University Medical Center. He is based at the Academic Medical Center (AMC), Amsterdam, Noord-Holland. The second author Alexander F. C. Hulsbergen, works at Computational Neuroscience Outcomes Center (CNOC). He also works at the Brigham and Women’s Hospital and Harvard Medical School in the Neurosurgery Department. Besides, he works at Haaglanden Medical Center in the Department of Neurosurgery. Lastly, he works at the Leiden University Medical Center in the Department of Neurosurgery.2020 Nursing Research Paper
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The third author Logan D. Cho works at Brigham and Women’s Hospital in the Computational Neuroscience Outcomes Center (CNOC). He also works at Harvard Medical School in the Department of Neurosurgery. Linda S. Aglio is the fourth author of the selected EB source. She works at the Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), in Harvard Medical School and Brigham and Women’s Hospital. She works at Harvard Medical School and Brigham and Women’s Hospital in the Department of Anesthesiology, Perioperative and Pain Medicine. The source was also authored by Rishi D. S. Nandoe Tewarie, who works at Haaglanden Medical Center in the Neurosurgery Department. Furthermore, he works at Leiden University Medical Center in the Department of Neurosurgery. The last author is Marike L. D. Broekman, who works at Haaglanden Medical Center in the Neurosurgery Department.
The Process Used to Locate the EBP Source and EBP Repositories that were Utilized
The selected EBP was found via a search on the Wilmington University Library. The article search was based on some keywords, including “Evidence-based dexamethasone dosing” and “brain tumors.” The provided link was utilized to access the full study online. EBP repositories were utilized to locate the EBP source. Specifically, three key elements for medical decision making were utilized during the search process. According to Mays (2020), the three components enhance the search process. First, the search was guided by the best external evidence. The best scientific evidence for addressing public health issues in neurosurgical ICU was selected. Secondly, the search was guided by the clinical expertise of an individual practitioner. I was particularly looking for a source that presented evidence that was in line with the clinical expertise of a nurse working in a neurosurgical ICU. Finally, patients’ preference was considered during the search process. Most patients in neurosurgical ICU prefer dexamethasone dosing to be used during their surgeries due to its wide range of benefits. According to Gupta (2017), dexamethasone is an ideal peri-operative agent both as an adjuvant to peripheral or intravenously. This drug is cheap and readily available in the market. Besides, the agent is anti-inflammatory, and it prevents some post-operative side effects such as nausea and vomiting. Finally, dexamethasone is attributed to a sense of overall well-being and good quality of recovery, which, in turn, makes the patient to be discharged earlier.
Additionally, the search process was guided by four steps. First, the patient problem was identified using professional knowledge and skills. In this case, the need for safe and effective anesthesia to be used during operations in the neurosurgical ICU was identified. Patients required anesthesia with minimal post-operative side effects. Consequently, this EB source was selected since it was about dexamethasone dosing, which has limited side effects. Secondly, the literature was researched to obtain relevant research. EB about the use of dexamethasone dosing during surgeries was searched from the Wilmington University Library. The third step involved the evaluation of the research evidence. The set criteria regarding the scientific advantage guided the evaluation process. The last step involved choosing an intervention with the most valid evidence. In this case, the article, “Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know?” by Jessurun et al. (2019) was selected as the most appropriate EB source.
Reason for Selecting this EBP
This EBP was selected since it supports my clinical practice as a nurse working in the neurosurgical ICU. As a neuroscience nurse, I support patients who are diagnosed with various neurological problems. Additionally, I work together with specialists during their operations in the Intensive Care Unit. Thus, I am supposed to understand the most effective and safe medication to be used as anesthesia during the exercise. As a result, this EBP was selected since it advocates for dexamethasone dosing in the operation of malignant brain tumors. Similarly, this anesthesia is suitable for the operations of patients with various neurological problems.2020 Nursing Research Paper
Characteristics of the EBP Source
Multiple aspects characterize the EBP source. First, the type of study is clinical practice guidelines. This type of study includes recommendations for optimizing patient care informed by a systematic review of evidence. The selected EBP source advocates for the use of dexamethasone dosing in malignant brain tumors. This medication optimizes patient care through its benefits, such as limited post-operative side effects and faster recovery. More so, the EBP source was characterized by the background of the study. This study was necessitated by increased dexamethasone (DXM) dosing in individuals diagnosed with a malignant brain tumor. Another key feature of this source was its objective. This study primarily focused on conducting a systematic review of literature on the relationship between dexamethasone (DXM) dosing and the clinical outcomes of patients with malignant brain tumors.
The article was also characterized by methods that were utilized during the literature search. The authors performed a systematic search in PubMed, Embase, Web of Science, Cochrane, Academic Search Premier, and PsycINFO. They were interested in studies that had discussed the benefits of dexamethasone dosing in glioma or brain metastasis (BM) patients. Some of the benefits that they considered were the reduction in the volume of edema, symptomatic relief, and increased survival rate. The selection criterion was another feature that made the source unique. The authors selected studies, which discussed the impact of DXM doses on symptoms presented by glioma or brain metastasis (BM) patients. They selected fifteen articles for qualitative review following the screening of 1812 studies.
The source was also characterized by data collection and analysis techniques. Data was collected through qualitative review. This data collection technique was preferred due to its usefulness in the literature search. According to Eyisi (2016), qualitative systematic review data search since it presents particular research on a topic. Therefore, it enables scholars to search for the required evidence from primary qualitative studies systematically. The researchers then bring the findings together to come up with a conclusion for their study. The authors reviewed the fifteen articles selected for this study for the impact of dexamethasone dosing on patients with a malignant brain tumor. Another key feature of this source was the level of evidence. The study had Level I evidence. According to Glasofer and Townsend (2019), the evidence is obtained from meta-analysis of all relevant RCTs or a systematic review in Level I evidence. The evidence for the selected source was obtained from a systematic review of multiple evidence-based clinical practice guidelines. These guidelines were based on systematic reviews of RCTs with similar results.
The major results of the study also characterized this source. The available evidence revealed that patients might experience more adverse events if higher doses of the medication were administered to them. Additionally, this dosing might not improve the clinical condition of the patient. Furthermore, shorter survival in the palliative setting resulted due to higher DXM doses. On the contrary, the study findings indicated that a high dosage of DXM might result in symptomatic improvement in glioma patients. The study conclusion was the last feature of this study. The authors concluded that evidence on the efficacy and safety of various dexamethasone dosing in patients with a malignant brain tumor is conflicting and limited. The evidence revealed that low doses of DXM are not inferior to higher doses in some situations.2020 Nursing Research Paper
Method to Communicate the Study Findings of EBP Source
Communication is critical since it will enhance the dissemination of the study findings to the practitioners to facilitate health-related evidence in clinical practices. The study findings will be communicated by targeting the message to specific audience segments. In this communication strategy, the message is designed for a particular subgroup based on demographic features of its members, including gender or sex, age, racial or cultural background, profession, language, religion, education level, among other “psychographic” characteristics such as individual’s attitudes about a particular subject. This communication strategy is preferred due to its potential effectiveness in large-scale communication efforts.
In this case, the “targeted communication to audience segments” strategy will be used to inform other healthcare professionals who are working in a neurosurgical ICU about effective and safe dexamethasone (DXM) dosing during the operation of patients with various neurological problems. Therefore, utilizing this communication technique will create awareness among the targeted audiences, thus enhancing their clinical practices through health-related evidence. Specifically, the quality of care provided to patients with neurological conditions will improve significantly. Additionally, the level of patient and provider satisfaction will also be improved.
The Targeted Audience
The targeted audience is healthcare professionals who are working in a neurosurgical ICU. These medical officers include neurologists and practitioners who provide care to patients with diverse neurological disorders, including epilepsy, multiple sclerosis (MS), stroke, and Parkinson’s disease. Sharing the study findings will create awareness about effective and safe dexamethasone (DXM) dosing to be administered to this patient population. Implementing the evidence-based findings will improve the quality of care provided to the patients in the neurosurgical ICU. In turn, high-quality care will reduce the recovery period of the patients, thus reducing their hospital stay. Additionally, high-quality care will improve the overall well-being of these patients.
Potential Uses of the Selected EBP
The selected EBP has two major uses. First, the EBP study’s findings can be used to create awareness about effective and safe dexamethasone (DXM) dosing among healthcare professionals who are working in a neurosurgical ICU. Informing these medical officers about various doses will enable them to utilize the most effective and safe dosage while providing care to patients with diverse neurological disorders such as epilepsy and multiple sclerosis (MS), stroke in the neurosurgical ICU (Roth et al., 2015). In turn, implementing the evidence-based findings will improve the quality of care provided to the patients in the neurosurgical ICU. Improved care will accrue benefits to the individual patients and the healthcare organization. Patients will benefit from a reduced recovery period, which will, in turn, lower the length of hospital stay. Additionally, high-quality care will benefit patients by improving their overall well-being and quality of life. On the other hand, the healthcare organization will benefit from lowered operational costs. The cost of dexamethasone is relatively low. Additionally, the medical facility is required to purchase a low volume of this drug since it is administered in low dosages. Finally, the operational cost is lowered due to reduced hospital stay. 2020 Nursing Research Paper
Secondly, the selected EBP source’s findings will be used to inform scholars about potential gaps that they can study in the future. The authors of the selected EBP concluded that evidence on the efficacy and safety of various dosing of dexamethasone in patients with a malignant brain tumor is conflicting and limited. Therefore, more research can be conducted in this area to provide more and clear findings of the efficacy and safety of various dosing of dexamethasone on patients with a malignant brain tumor. Additionally, the study finding indicated that adverse events resulted from higher doses of DXM. On the contrary, these dosages’ use did not result in better clinical conditions among patients with a malignant brain tumor. More so, higher dosing of this drug leads to shorter survival in the palliative setting. Conversely, this DXM dosing results in symptomatic improvement among individuals diagnosed with glioma. Nonetheless, studies comparing the impact of different doses directly have not been conducted. Therefore, scholars can conduct studies to compare the impact of different doses on glioma patients. Specifically, they will assess the clinical outcome and symptomatic improvement upon administering various dosages of dexamethasone to glioma patients. Finally, the source reported conflicting results regarding survival rate and edema reduction in glioma patients. Thus, further studies should be conducted to assess the patient survival rate once the medication is administered. Studies to evaluate the rate of edema reduction in glioma patients should be conducted.
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References
Eyisi, D. (2016). The Usefulness of Qualitative and Quantitative Approaches and Methods in Researching Problem-Solving Ability in Science Education Curriculum. Journal of Education and Practice, 7(15), 91-100.
Glasofer, A., & Townsend, A. B. (2019). Determining the level of evidence: experimental research appraisal. Nursing2020 Critical Care, 14(6), 22-25.
Gupta B. (2017). Role of dexamethasone in peri-operative anesthesia management: A review of literature. Res Pract Anesthesiol Open J; 2(2): 33- 39. doi: 10.17140/RPAOJ-2-114.
Jessurun, C. A., Hulsbergen, A. F., Cho, L. D., Aglio, L. S., Tewarie, R. D. N., & Broekman, M. L. (2019). Evidence-based dexamethasone dosing in malignant brain tumors: what do we really know? Journal of neuro-oncology, 144(2), 249-264.
Mays, T. (2020). Evidence Based Practice (NUR 4169): What is EBP? Florida Gulf Coast University. https://fgcu.libguides.com/EBP
Roth, P., Happold, C., & Weller, M. (2015). Corticosteroid use in neuro-oncology: an update. Neuro-oncology practice, 2(1), 6-12. 2020 Nursing Research Paper