• _Integrating EBP Step 4: Integrate the Evidence With Clinical Expertise and Patient Preferences to Make the Best Clinical Decision The next key step in EBP is integrating the best evidence found from the literature with the healthcare provider’s expertise and patient preferences and values to implement a decision. Consumers of healthcare services want to participate in the clinical decision-making process, and it is the ethical responsibility of the healthcare provider to involve patients in treatment decisions (Melnyk & Fineout- Overholt, 2006). Even if the evidence from a rigorous search and critical appraisal strongly supports that a certain treatment is beneficial (e.g., HRT to prevent osteoporosis in a very high-risk woman), a discussion with the patient may reveal her intense fear of developing breast cancer while taking HRT or other reasons that the treatment is not acceptable. Moreover, as part of the history-taking process or physical examination, a comorbidity or contraindication may be found that increases the risks of HRT (e.g., prior history of stroke). Therefore, despite compelling evidence to support the benefits of HRT in preventing osteoporosis in high-risk women, a decision against its use may be made after a thorough assessment of the individual patient and a discussion of the risks and benefits of treatment. Similarly, a clinician’s assessment of healthcare resources that are available to implement a treatment decision is a critical part of the EBP decision-making process. For example, on follow-up evaluation, a clinician notes that the first-line treatment of acute otitis media in a 3-year-old patient was not effective. The latest evidence indicates that antibiotic A has greater efficacy than antibiotic B as the second-line treatment of acute otitis media in young children. However, because antibiotic A is far more expensive than antibiotic B and the family of the child does not have prescription insurance coverage, the practitioner and parents together may decide to use the less expensive antibiotic to treat the child’s unresolved ear infection • _Randomized Control Trial – Gold Standard A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control . The control may be a standard practice, a placebo ("sugar pill"), or no intervention at all. • _ Leadership development plan for practice When considering a leadership development plan, there are formal and informal strategies. Students must have formal and informal opportunities to develop leadership skills in each domain. These can occur in the classroom, clinical practice, student leadership, and health-related service projects. In general, lessons learned in one domain will apply to leadership situations in other domains. Health policy leadership is discussed separately because it has specific features that are somewhat different from the APN's everyday leadership activities.
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- Winter '17
- Nursing, APNs