Evidence Based Medicine

Evidence Based Medicine




Evidence Based Medicine


Psychiatric facilities rely a lot on the use of opioids to sedate and subdue their patients and residents. Due to diminished cognitive and emotional capacities, these patients and residents are very prone to outbursts and angry rampages. During such times, they are a danger to themselves, other patients and even the staff and doctors in the facility. Opioid sedatives have been used for a long time in calming patients down and allow for intervention. Opium based sedatives and drugs however have a high addiction rate as they bond directly with nerve endings and synapses. This significantly increases the risks of addiction as the residents and patients’ threshold for the drug increases. This is further complicated by the significant in born resistance and susceptibility of different individuals. The significantly low research in psychiatric medicine and practice has also denied practitioners enough information to base their practice on resulting in significant variations in practice and procedures. This paper will discuss the role of evidence-based guidelines in successfully addressing treatment. It will further describe the significance of the process in ensuring low rates of relapsing in patients being treated for addiction. Finally, it will conclude by addressing the significant role that nurses play in the building and development of the body of knowledge in medicine.

Phenomenon of Interest

The diminished cognitive, physical, and emotional capacity of psychiatric patients results in unique and considerable challenges in ensuring accountability in procedures. Since the patients cannot speak for themselves in a majority of cases, cases become highly subjective . The significant physiological differences in patients also create challenges in the administration of care. Guidelines help in reducing the inherent risks associated with caring for patients especially in cases where they are unable to communicate effectively with their caregivers. They ensure this by providing strict guidelines and procedures that have a good record of accomplishment of efficiency and effectiveness. Following these guidelines ensures the safety and health of both patient and healthcare practitioner and provides a trail for establishing where things went wrong in the event of an accident or death. The healthcare system has faced increasing scrutiny and legal action in recent years. This statistic is predicted to increase in coming years due to the increasing ease of access to information. Anybody with an internet ready device today can quickly look up diagnostics by simply typing in the symptoms. This growing phenomenon has been blamed for the rise in litigations as patients and their loved Google symptoms without necessarily incorporating further details of care and patient history. In a world where information is free, guidelines provide significant defense to healthcare facilities and practitioners. First, procedures ensure nurses safety and health. Guidelines provide protection for nurses and other health facility workers by ensuring the adequacy and quality of tools and equipment.

They also enhance security by providing assistance by classifying patients according to their aggression and agitation rates. Second, procedures provide a safety net for nurses when things go wrong, which they sometimes do. Complexities of procedures differ from one person to another. This means that although some procedures might work perfectly with some patients, they might worsen others. Following guidelines indemnifies the practitioners from any unforeseen results like addictions. Third, procedures build on the body of knowledge and practice making processes and procedures more effective and efficient. By ensuring meticulous monitoring and recording of events and occurrences, procedures allow nurses to be able to adjust strategies to ensure higher efficiency. It also effectively creates a precedent from which to base future procedures and increase their effectiveness. Policies in psychiatric care are a significantly outdated. This is the result of a low number of studies into the field as compared to others. This also affects the efficiency of executing evidence-based practices. There is simply not enough knowledge base to base decisions and practices on. These coupled with the uniqueness of each case and patient presented and admitted to psychiatric care increases the complexities of care and the risks of lawsuits.

How Facilities Are Addressing the Problem

With the rising need for the development of a comprehensive knowledge base in the practice of psychiatric medicine, practitioners are using clinical guidelines to develop practical knowledge and research. They have however had to rely heavily on the numerous works already completed in other fields as a basis for their research and assumptions. These have been instrumental in improving the quality of care by establishing strict codes and standards. These have been instrumental in ensuring the decrease of variations in procedures and increasing the dissemination of the newfound knowledge. There have however been significant setbacks to the adoption of guidelines to practice from both institutions and practitioners. This can largely be blamed on the status quo that has long existed. The uncertainty of their effectiveness is not helping speed adoption either. In this case, the needs for self-preservation is also making the adoption process long and slow as nobody wants to be held liable for blame. To get around these bureaucratic roadblocks, psychiatric facilities have formed special committees to oversee adoption and implementation (Ivanovic, 2012). This increased support from management and administration has significantly increased the rate of adoption by ensuring there is adequate availability of resources for success. It has also increased oversight to ensure protocols are followed and that accountability is high.

This has also helped in increasing healthcare practitioners’ bandwidth for making scenario-based decisions based on the dynamics and circumstances that present themselves. This has greatly improved flexibility and helped ensure the effectiveness and efficiency of procedures. It has also increased patient satisfaction and comfort by ensuring shorter recovery times and lower relapse rates. APN nurses are the backbone of healthcare facilities. They are tasked with the progressive monitoring and documentation of patient progress and instrumental in providing insights into the effectiveness of procedures to care. They also have more practical experience doing procedures and can quickly ascertain what is working and what is likely to fail (Bryant-Lukosius, Spichiger, Martin, Stoll, Kellerhals, Fliedner and Grossmann, 2016). Since APN nurses are in constant close contact with patients, they are also the best people to carry out surveys and collect feedback from patients and other healthcare practitioners. Since they are also in the hospital for longer durations than doctors are, they are exposed to many other practitioners. Consultations and discussions with this wider group of healthcare specialists results in the enhancement of procedures and processes (Johnson, Low and LaCroix, 2013). This also significantly helps to build on the body of knowledge and practice of medicine. The greatest asset they probably provide to the entire system is their acute observation and analysis skills. By dynamically observing patient progress, they are able to map out both the processes and reactions of the patients. This gives a more comprehensive basis for future research and practice. This is instrumental to building and enhancing the body of knowledge and increasing effectiveness and efficiency. This effectively ensures faster adoption and encourages investment into further studies and practice.

Agree Tool

The Agree II tool is effective for medical practices of any size and scope. It has also proven to be effective in providing metrics against which health facilities can be appraised in a practical and systemic manner. This tool focuses on the clinical guidelines, which are the basis for the efficiencies of healthcare services operations. They provide guidelines for the provision of care and the treatment of patients to ensure quick recovery times and less time spent in the facility. The tool plays a significant role in ensuring that policies and guideline developed by healthcare professionals and facilities are effective and efficient. It has also proven useful in the development of policies at a larger scale of regulators. This has significantly increased the quality of service delivery and accountability in healthcare systems across the world. It has also been instrumental in the establishment of a body of knowledge and procedures since its inception 13 years ago. The tool was created to ensure guideline policies by keeping the inherent biases of the process at bay. It establishes this by ensuring that the development process incorporates practicality both internally and with set regulations and standards. It does this effectively by providing a suitable framework for evaluating, developing, and reporting in guidelines and procedures.



Bryant-Lukosius, D., Spichiger, E., Martin, J., Stoll, H., Kellerhals, S. D., Fliedner, M., Grossmann, F., De, G. S. (2016). Framework for Evaluating the Impact of Advanced Practice Nursing Roles. Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 48, 2, 201-9.

Ivanovic, E. (2012). Systematic reviews – To support evidence-based medicine. Pflege, 25, 4, 307.

Johnson, B. T., Low, R. E., & LaCroix, J. M. (2013). Systematic Reviews to Support Evidence-based Medicine (2nd edition) by Khalid Khan, Regina Kunz, Jos Kleijnen and Gerd Antes: A Review. Research Synthesis Methods, 4, 1, 102-108.