Evidence Based Health Care

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Evidence Based Health Care

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Evidence Based Health Care

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Question:
Discuss about the Evidence Based Health Care.

Answer:

Introduction:
As stated by Ferreira et al. (2014), Asthma is a chronic disease of deformation or obstruction in the airways of the human lungs. The aetiology of asthma states that the bronchial tubes which allow air to enter or exit the lungs get inflamed. The airways become swollen and the muscles that encircle the bronchioles get tighten causing obstruction in the air passage. Evidence based practice have shown that metered-dose inhaler (MDI) has proved to be an effective way of reducing the difficulties associated with this disease. According to Reznik, M., Silver & Cao (2014), the health care community has recognized evidence practice as the gold standard in order to provide provision of compassionate and safe health care system. This essay will focus on the strategies for implementation of evidence based clinical practice to use MDI with spacer for asthma patients. In addition to this the challenges involved in the implementation of this clinical practice will also be highlighted in this essay.
Background:
I am working in respiratory ward in a hospital. There are several patients with asthma attack would be admitted to my ward for treatment and management of the disease. I have found out that some patients are with uncontrolled asthma due to poor “Metered-dose inhaler (MDI)” technique. Moreover, they always resist using spacer for MDI inhalation. According to Topal et al. (2016), when an MDI is inhaled without a spacer directly, 90% of the dose get scattered in the mouth and the oropharynx. Such depositions can be largely abolished when a spacer is used. Spacers can aid in directing the administration of the dose inside the respiratory pathway specifically. Spacers are chambers that contain aerosol into which the MDI dose is administered and from which the patient inhales. This process occurs usually via a one-way valve, so that the dose cannot be lost during the process of exhalation. Spacers can also reduce local and total body side-effects of inhaled drugs. Spacers should always be used with MDIs that deliver inhaled corticosteroids (Sadreameli et al., 2016).
As discussed by Ronk et al. (2012), Spacers can make administration of medication easier and helps to reach the dose to lungs without much deposition. In addition to this a spacer reduces the chances of less medication deposition in the mouth and throat, which might lead to irritation and mild infections. Thus, it is recommended for anyone, of any age, using a puffer, should consider using a spacer. Certain literatures show using spacer for MDIs inhalation can improve asthma symptoms and reduce asthma attack compared to using MDI only (Mitselou et al., 2016). But there are some patients who due to difficulty in the use of spacer and deficit of knowledge do not want to use spacer. So I would like to implement an education program on using MDIs with spacer to reduce asthma attack. A study revealed the fact that on introducing a spacer to patients in a hectic, inner-city pediatric ED is an effectual and efficient intervention which improves the working of asthmatic children in regards to decree of cough and wheezes and school absenteeism (Zar, 2014). Education program would include face to face education, assess and demonstrate technique of using spacer for inhalation, free provide spacer to patient use, video sharing and follow up plan.

Barriers:
Although literature review reveals the fact that MDI linked spacer use has shown tremendous relief in asthmatic patients, still there are several barriers that exist in this world. For example, religious and cultural views, workload associated with the use of MDI spacer, increased cost and knowledge deficit contributes to ineffective treatment. One of the most significant barrier which is linked to the treatment of asthma using MDI spacer is that not only there is existence of cultural difference between the professionals and the patient but there is a huge language gap (Berger et al., 2014). Communication plays an important role in the treatment of patients who are receiving clinical benefits in a culturally diverse environment. Based on the practices of our ward the asthmatic patients are treated with antileukotrienes or leukotriene modifiers and immunomodulators. Generally, the nurses administer oral corticosteroids for patients in accordance to the medication administration record (MAR) after proper assessment of their relief level and motivate them to use MDI spacer as an efficient clinical management. However, the outcome is not satisfactory. According to Nielsen et al. (2013), the reason of these major challenges is high admission rate and misconceptions about the side effects and lack of knowledge about the use of the spacer. Such factors give the reason to construct an education program that can help in reduction of problems which are associated with asthma.

Education Program:
As discussed by Nielsen et al. (2013), there are several barriers to the thriving implementation of research findings into the clinical sector. Promoting a change in plan or clinical policy using an evidence based approach might remain ineffective unless specific strategies are employed in this arena. Fortunately, there are some researches or studies which showed that there are some benefits of educational intervention for people with asthma. According to a systematic review and meta- analysis educational interventions improved knowledge and attitudes and reduced average and worst pain intensity scores which is a pain assessment tool, when compared with usual care (Rowe et al., 2012). Studies reveal that inhalation of doses are important as a part of the asthma treatment. Advices vary depending on the clinicians and nurses (Levy et al., 2013).
According to Turyk et al. (2013), home-based, multifaceted interventions have proved to be effective in reducing the morbidity in children. However, the recognition of the independent factors that contributes to the positive outcomes and also delineating effectiveness by the stage of asthmatic symptoms would aid in refining the intervention process. The MDI spacer education program would include face-to face interview, distribution of leaflet, sharing and presentation of video and evaluation process for example follow-up session. In the hectic schedule the face-to-face interview is not the only mode of educating the patient and his or her family. Moreover, it is time consuming, not cost effective and due to lack of man power and resources such a method can be ineffective. Therefore, it is essential to design and strategise education program that can be effective in removing all the barriers related to the use of spacer linked with MDI and can educate patient and their family in mass Nielsen et al. (2013).

Strategies:
The first step involved in the educational program would be to receive approval from the management of the health care organization for conducting this educational program for reducing the risks associated with asthma. Secondly, with the approval of the specific manager a clinical education program can be conducted involving a group of patient and their family members that can be based on face-to-face demonstration. During this program, a highly qualified, registered and experienced nurse can be assigned to bestow evidence based and practical based knowledge to the patients. In order to make the program cost effective, leaflet can be printed from within the organization (Reznik, M., Silver & Cao 2014). Through video sharing and presentation using from the organizational resources patients would be educated about the advantages and need of the MDI spacer. The disadvantages of using the MDI without the spacer would be demonstrated through a small video presentation and also practically. Moreover, the patients would be informed about the fact that using a spacer with a MDI on can minimize the side effects of the medicines consumed as dosage. Once the program learning session is over, follow session would be arranged on weekly basis in order to record the success of the education imparted to the patients. Then the effectiveness of the program would be evaluated. The follow-up process would also involve communication with the patients over the phone after their discharge. If evidence based practice is carried out smoothly then it can be hoped the various barriers associated with the clinical treatment of asthma in regards to MDI spacer can be eliminated and the use of spacer linked with MDI can be put into practice formally in our department (Zar, 2014).

Conclusion:
There are many beliefs associated with the treatment of many chronic diseases. Thus, the health care community has recognized evidence practice as the gold standard in order to provide provision of compassionate and safe health care system. In the recent past evidence based studies have proved to be a successful and effective tool in improving the quality of service provided to the patients. Although it is a known fact that incorporation of the evidence practice in the nursing care can prove to a great achievement in the clinical arena, there are several barriers which the nurses experience daily. In the treatment of asthma with MDI have many side effects or disadvantages. Studies reveal that the use of a spacer can remove the risks associated with the direct use of MDI. Therefore, as a health care professional I would recommend the use of an educational program in our department to support evidence based practice and use of the spacer associated with MDI in the treatment of asthma.

References:
Berger, W. E., Bensch, G. W., Weinstein, S. F., Skoner, D. P., Prenner, B. M., Shekar, T., … & Teper, A. A. (2014). Bronchodilation with mometasone furoate/formoterol fumarate administered by metered‐dose inhaler with and without a spacer in children with persistent asthma. Pediatric pulmonology,49(5), 441-450.
Ferreira, M. A., Matheson, M. C., Tang, C. S., Granell, R., Ang, W., Hui, J., … & Bui, M. (2014). Genome-wide association analysis identifies 11 risk variants associated with the asthma with hay fever phenotype. Journal of Allergy and Clinical Immunology, 133(6), 1564-1571.
Levy, M. L., Hardwell, A., McKnight, E., & Holmes, J. (2013). Asthma patients’ inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the global initiative for asthma (GINA) strategy: a retrospective analysis. Primary Care Respiratory Journal, 22, 406-411.
McCormack, K., & Leo, H. (2015). Using Videos to Teach Children Inhaler Technique: A Pilot Randomized Controlled Trial. Pediatrics, 136(Supplement 3), S273-S273.
Mitselou, N., Hedlin, G., & Hederos, C. A. (2016). Spacers versus nebulizers in treatment of acute asthma–a prospective randomized study in preschool children. Journal of Asthma, (just-accepted), 00-00.
Nielsen, A. E., Noone, J., Voss, H., & Mathews, L. R. (2013). Preparing nursing students for the future: An innovative approach to clinical education.Nurse education in practice, 13(4), 301-309.
Reznik, M., Silver, E. J., & Cao, Y. (2014). Evaluation of MDI-spacer utilization and technique in caregivers of urban minority children with persistent asthma. Journal of Asthma, 51(2), 149-154.
Ronk, J., Alarcon, L., & Loughlin, C. E. (2012). Implementing Standardized Metered-Dose-Inhaler (mdi) Spacer Technique Checklist For Pediatric Asthma Patients Across University Of North Carolina (unc) Children’s Hospital. Am J Respir Crit Care Med, 185, A3359.
Rowe, M., Frantz, J., & Bozalek, V. (2012). The role of blended learning in the clinical education of healthcare students: a systematic review. Medical Teacher, 34(4), e216-e221.
Sadreameli, S. C., Pereira, I., Mann, S., Garger, C., Mercier, L., Lee, C. K., … & Jassal, M. S. (2016). Asthma Management Of Non–icu Pediatric Patients Using A Multidisciplinary Stakeholder-Developed Protocol.Radiology, 28, 304.
Topal, E., Celiksoy, M. H., Catal, F., Sinanoglu, M. S., Karakoc, H. T. E., Sancak, R., & Ozturk, F. (2016, February). Assessment of skills using a spacer device for a metered‐dose inhaler and related independent predictive factors in caregivers of asthmatic preschool children. In International forum of allergy & rhinology (Vol. 6, No. 2, pp. 130-134).
Turyk, M., Banda, E., Chisum, G., Weems Jr, MA, D., Liu, Y., Damitz, M., … & Persky, V. (2013). A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity. Journal of Asthma, 50(7), 729-736.
Zar, H. J. (2014). Alternate Spacer Devices in the Treatment of Asthma in Children. Current Allergy & Clinical Immunology, 27(4), 265.

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