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Critical Evaluation of Evidence-Based Practice Methods and How These Can Be Used in Your Practice

Introduction 

Evidence-based practice (EBP) is a systematic method for making decisions in clinical practice based on the effective evidence collected by taking help from experts and improving patient value. This process is used in the healthcare sector to collect reliable data and make decisions about the treatment of patients based on those collected sources of data. Some steps of this process are making a clinical question,  searching the suitable evidence,  critical appraisal,  and integrating the collected evidence with the choices made by the patient and advice given by medical expertise. EBP  helps in making decisions which in return enhances clinical leadership as it helps in promoting consistency and high clear standards in the clinical sector to improve the efficiency of healthcare services provided by organisations. Comprehensive care is extremely important in clinical practices which can be provided by the use of effective evidence as it helps in reaching a suitable conclusion regarding any treatment choice for a patient (Di Maio et al. 2022). Physicians will be able to make better choices regarding the treatment of a patient by using diverse perspectives from different stakeholders and evidence-based strategies which ultimately will result in overall patient satisfaction and positive outcomes for patient health. 

Identification of Evidence Methods 

Systematic Reviews and Meta-Analyses 

Description

Meta-analyses and systematic reviews complicated methodologies in terms of evidence-based practices. In the process of systematic review,  using a structured approach,  relevant research studies are identified and put together on a specific research objective or research question. Snoswell et al. (2023) commented that It is a detailed search method in different databases by giving inclusion and exclusion criteria and also critically upgrading the study quality of the collected research articles to improve the decision-making of physicians. It is the aim of the systematic reviews to present an unbiased summarisation of the current evidence for the physicians. Meta-analyses are an extended version of the systematic review method as it uses statistical measures to combine multiple studies and quantitative data as per the data received from Parums (2021). One of the main steps of the evidence-based process is to combine the preferences of patients with the gathered evidence to enhance patient outcomes which is known as the application of evidence to the making of decisions [refer to 4B EBP in Clinical Leadership Lecture]. 

Critical Analysis

Systematic reviews and meta-analyses are extremely valued and able methods for judging the high levels of evidence. As per the views of the study of Harari et al. (2020), as these processes are extremely rigorous and comprehensive,  broad study ranges are used in these processes, which helps in reducing the bias risk which can be integrated with the help of selective reporting. It becomes a reliable source of data as findings are synthesised from different studies which is far more trustable than individual studies. On the other hand, Metelli and Chaimani (2020) have debated that if the quality of the included studies is not reliable, meta-analyses and systematic reviews cannot be trusted for their validity or reliability. 

Randomised Control Trials 

Description 

Randomised controlled trials are extremely important for health care organisations as in this process different random individuals are selected for creating evidence. It is a type of visual and practical evidence as random individuals are treated based on which the physicians can make decisions regarding continuing the effective Healthcare practice (Zabor et al. 2020). However, it also reduces a certain bias in making decisions based on evidence which can be a challenging factor for the clinical authority (Karanatsios et al. 2020). RCTs are extremely advantageous for checking the effectiveness in clinical therapies as random individuals take part in the process.

Critical Analysis

As per the estimated analysis from the study of Sarri et al. (2022), the process of RCT is one of the most important aspects of clinical research as they are effective in producing methodological rigour. The selection bias is reduced by the process of randomisation and the controlled setting which helps in testing only important differences between groups. In addition, Callréus (2022) has stated that this helps physicians to make decisions by deriving causal inferences regarding the impact of the intervention. On the contrary, there are ethical concerns in the process of RCT when potentially beneficial treatments are withheld from the treatment groups or the control groups or when unknown risk is led to the participants as per the arguments of Robertson (2021). This risk is also intensified by the complex procedure of the RCT method and the high cost related to the conduction of RCT which reduces their feasibility, especially in the case of long-scale research. However, even after these challenges, the method of RCT is one of the most important and impactful frameworks for clinical research which helps in providing important evidence for making choices in case of the practice of the physicians. 

Observational Studies 

Description 

Observational studies include the orderly perception and examination of results without controlling the considered environment or the subjects being considered. These things can be classified into a few sorts: cohort studies, case-control considers, and cross-sectional studies. As per the investigation of Kent et al. (2023). Cohort studies take after a group of people over time to evaluate the improvement of results based on introducing certain chance variables or intercessions. Case control is about comparing people with a particular result (cases) to those without (controls) to recognize components that will have contributed to the result. As per the opinions in the study of Wang and Cheng (2020), cross-sectional thinking is about surveying the predominance of results or characteristics in a population at a single point in time. All these methods of evidence help the physicians to make accurate choices regarding medicine choices for patients and or the diet type for the patients. 

Critical Analysis

Observational studies help in understanding the real-world implications and interventions for physicians to make important decisions regarding patient outcomes. Observational studies are extremely important for rare patient conditions as per the analysis of Fang et al. (2020). In terms of clinical negligence, sometimes medical staff do not provide care to patients which is accepted by them which may cause injury or negative health conditions [refer to advanced clinical negligence]. However, these are the studies based on observations so the challenging factors can impact the outcome and exposure creating a bias for the results. For instance, lifestyle factors such as exercise and diet can create confounding issues for the connection between health outcomes and medical intervention. As opined by Colnet et al. (2024), causality cannot be established by using the studies of observations, unlike the method of RCT. Even after these challenges, observational studies cannot be replaced in public health and epidemiology as they help provide a wide context to understand the impacts of exposures and interventions in natural care settings. 

Models for Selecting Methodologies 

Rosswurm and Larrabee’s Model 

The first step of this model is to identify the requirement for change in clinical practice. Using the model, physicians can identify the requirement for a change in their strategy. The next stage is to establish a connection between the potential interventions and the problem along with the desired outcomes. Therefore, in this stage, the physicians need to develop critical questions regarding the patient and the different ways in which they can be protected by using the collected evidence. The third stage is to synthesize the collected evidence. A physician conducts appropriate research and performs a critical appraisal of the most effective evidence for example systematic review (Purssell and McCrae, 2020). It is extremely focused on this stage that the changes are based on reliable findings of the research and high quality. 

In the next stage, a practice change is designed in which a detailed plan is implemented for the change the practice involves setting goals and creating outlines for different strategies for change. the next stages of implementation and evaluation of the selected change. The practice change is monitored effectively by collecting data and properly evaluating the outcomes. Therefore, it is an important stage for the physician to pay attention to. This model is extremely effective for meta-analysis and systematic reviews due to their comprehensive approach. Both these studies can be combined with multiple studies which helps in providing a high quality in the collected evidence that can help a physician to make appropriate decisions. 

Greenhalgh et al.’s Diffusion of Innovations in Health Service Organizations

Greenhalgh diffusion of innovations is an important model in the context of evidence-based practice which has certain elements of innovation, communication channels, time and social systems. An individual or organisation focuses on a new practice or idea. After this, Healthcare innovation is transmitted. Evidence is collected to start an innovation that can help in improving the Healthcare conditions of different patients according to the perception and analysis of physicians (Darling et al. 2021). A network of individuals that impacts the creation of the innovation is also involved as per the model which helps in making important decisions regarding patient care. 

The Iowa Model of Evidence-Based Practice

The Lowa model of EBP focuses on identifying the focus problem and surgeon new information that can help in resolving the problem. Some of the triggers focusing on the problem are clinical problems while some of the triggers focusing on knowledge are based on new findings of research (Tucker et al. 2021). A physician can assemble a multi-disciplinary team in the second stage to address the identified issues and start planning for a literature review and implementing change. In the next stage, relevant literature research related to the issue helps in understanding the ways to solve the issue. The next step is to determine if the evidence is sufficient or not. The next stage is based on piloting the change of practice and after that, the pilot is evaluated for dissemination of results (Mudderman et al. 2020). This model can be extremely linked with the randomised controlled trials as the method provides effective evidence regarding the efficiency of any intervention to understand their effectiveness in practice changes.  

Evaluating Appropriate Evidence 

Critical Appraisal 

A critical appraisal is an effective method that helps in critically appraising or analysing the evidence methods used by the Healthcare authorities in the organisations. Critical appraisal technique works by examining different methodologies and results and understanding if they are appropriate for the clinical activities in the Healthcare organisations or not. The critical appraisal method is helpful for improving the care of patients and establishing a sound reputation for the medical organisation (Long et al. 2020). It is the responsibility of the physicians to focus on the different evidence so that they can recommend the correct medicine to a patient. If effective critical appraisal is not performed by the physicians and in accurate medicine is provided to a patient, it could have a negative impact on the health of the patient. Therefore, critical appraisal is extremely important and should be conducted under the opinions of the experts in the medical field. Effective evidence should be tested by the physicians by focusing on the soundness and flexibility of the evidence to understand if it is of effective quality or not. Quality checking is extremely important for the evidence as it helps in understanding if it would be able to provide the needed data for making informed decisions (Willians et al. 2020). Critical appraising should not only be done by focusing on the positive approach but should also be done by focusing on the negative approach as combining both these approaches can help in understanding the effectiveness of an evidence.

The physician can also focus on the objective evaluations of the evidence by using the checklist in the critical appraisal process. The CASP checklist is used in clinical practice by physicians to examine the design of the study or randomisation of the effective size and the statistical analysis to check if all the outcomes for patient art are clinically significant or not (Haile, 2022). However, certain challenges such as specific acquisition of knowledge and skills or lack of education and training in EBP negatively impact the process of critical appraisal. Resources and time needed for the process of critical appraisal might not be provided all the time in the clinical sector due to which this process can provide irrelevant results. In conclusion, critical appraisal is an important technique for evidence-based practice which helps in understanding whether the evidence can be trusted or whether it is of high quality or not. The CASP checklist is an important tool that helps in evaluating research studies based on their relevance and validity. Continuous collaboration and training are extremely important for using critical appraisal in clinical practice to increase the opportunity for healthcare practices based on effective evidence. Furthermore, effective asset utilisation results from avoiding ineffective or detrimental mediations. By ensuring that the clinical approach is driven by high-quality data, basic examination helps to better long-term outcomes and optimises healthcare asset utilisation. In clinical practice, physicians get a huge amount of health from critical appraisal by using the tool of critical appraisal skills program (CASP).

Hierarchy of Evidence 

The hierarchy of evidence could be a framework that positions the quality and unwavering quality of diverse types of research evidence. At the most reduced level are master suppositions and case studies, which regularly depend on recounted evidence and can be profoundly subjective. To guarantee objectivity in discoveries, the case considered must be carefully chosen. Moving up the pecking order, proven from observational studies, such as cohort and case-control ponders, is considered more vigorous due to organized information collection strategies and bigger test sizes. Be that as it may, these ponders can still be defenceless to predispositions and bewildering variables. At the best of the hierarchy are randomized controlled trials (RCTs) and efficient surveys and meta-analyses (Younas et al. 2022). RCTs are respected as the gold standard for clinical research since they minimize inclination through randomization and the utilisation of control groups. 

Precise audits and meta-analyses, which synthesize information from different considerations, give a comprehensive and high-level rundown of evidence on a particular point. This chain of command of evidence is crucial in clinical hone, directing physicians to create educated choices based on the foremost solid thinks about and investigate articles. By utilizing evidence such as orderly surveys, physicians can make choices without being influenced by clashing conclusions. The hierarchy of evidence of proof makes a difference healthcare specialists centre on the leading accessible proof, such as meta-analyses and systematic reviews, when choosing medications for patients, instead of depending on master opinions or personal information (Jamshidi and Pati, 2023). This approach underpins the determination of intercessions based on the most noteworthy quality proof, improving understanding and certainty in clinical choices. 

The application of the hierarchy of evidence under clinical practices ranks the effectiveness of physicians strategically. Eventually, it enhances the precision and strength of the following group of individuals in healthcare settings with a perfection process (Nieuwboer et al., 2019). This hierarchy includes six primary quadrants such as systematic reviews, trials with randomised control, cohort studies, case-control studies, case series and case reports, expert opinion and editorials. 

Figure 1: Level of evidence in clinical practice

(Source: Heinen et al., 2019)

Application of the hierarchy of evidence brings the effectiveness of conducted studies under the healthcare process along with conflicting findings. These are primary actions that assist physicians in identifying the primary findings of their activities with relevance. The application of this system assists physicians in getting a better amount of contextual information that is effective for answering relevant queries from the patients. Besides, it also maintains a proper system in the database with other fields related to social welfare education and criminal justice that are directly linked with authority (Algunmeeyn et al., 2023). Its application also includes systematic reviews regarding the healthcare field that are crucial to managing psychological development and learning problems related to the topic and it also provides better evidence that is available to possible social care fields. The presence of a hierarchy of evidence improves the development method with systematic review. Apart from this, it supports the organisation during database maintenance (Sadera, 2020). It promotes better practice for the clinical process and it provides the physician effective strategies to deal with the children. Systematic review improves the variety of clinical questioning with the development of treatment and diagnosis which is necessary for the position to provide its patients. 

Besides, it is one of the feasible designs for better exposure status that includes multiple outcomes. The case-control quadrant is one of the primary factors here that enhances the efficiency of performance within a short period of time with a better opportunity to analyse the outcome of red diseases. On the other hand, the application of a hierarchy of evidence controls the characteristics of research participants while addressing different types of co-founding factors (Heinen et al., 2019). In order to deal with the limitations and biases that are present in the healthcare industry, the application of the following model is effective in identifying the limitations and strengths of the entire process with an adequate amount of accuracy. Under clinical practice, there are different subjects that are presently related to human and cohort studies to improve the formulation of the entire process with potential hypotheses while asserting the safety-related concern against certain devices and drugs (Lyons et al., 2022). In addition, the application of the hierarchy evidence under the healthcare practices improves the patient handling method for physicians with better control in the overall treatment process.  

Figure 2: Level of evidence in clinical practice

(Source: Lyons et al., 2022)

Impact on Clinical Practice 

Application of Evidence 

Challenges in time of making clinical decision 

In a time of making clinical decisions, clinical leaders face critical challenges especially due to the overlap of systems due to conditions. In addition, here one of the primary difficulties faced by the clinical leaders is making the people accept the new ideas while getting their traditional views and ideas regarding the health care system. The presence of a wide spectrum related to a particular disorder is very common in the healthcare system due to the tendency of diverse symptoms of diseases (Bryant-Lukosius, 2022). Eventually, that becomes one of the primary challenges for the physician to identify the current problem while recognising potential treatment according to the preference of the patient. Besides this, in time of physical examination making the right clinical decision faces different types of inhibition due to the lack of gentleness from the patient’s side which affects the overall decision-making process in a detrimental way. It also influences the progression and duration of treatment pragmatically and draws a critical impact that is associated with the issues (Greenhill et al., 2021). The diagnosis phase is one of the primary phases of clinical depletion making and lack of cooperation from the patient is one of the primary challenges faced by the majority of physicians all over the world which causes inappropriate management during clinical decision-making. 

Process of thinking and making decisions 

CDS (Clinical Decision Support System) is one of the primary ways that improve the process of making and thinking related to a potent decision. It has a significant impact on improving the safety, quality, effectiveness and efficiency of the healthcare system. In addition, it also supports the effort of physicians to develop, implement, adopt and evaluate primary utilisation of CDS in future virtual to improve the entire decision-making process under the health care system (Aksu and Hussein, 2020). With the assistance of this process, decision-making may become potential and the presence of technical infrastructure also requires such initiative in order to allow the entire health system better opportunity for sharing data with the entire hierarchy. Apart from this proper implementation of this system has the potential to crack and diagnose the negative interaction of drugs which is crucial in the healthcare setting for taking a better review of a patient’s health (Bosworth and Maryon, 203). Thinking about the technological component and advancement is crucial at present in the healthcare industry and it also enhances the decision-making process with the improvement of efficiency and cost-benefit that has a major connection with patient satisfaction. 

Factors that affect clinical decisions 

There are several factors involved in the clinical decision-making process that affect the entire procedure with the lack of core skills, and potential. The following factors have a significant impact on the effective decision-making process and under the current setting of the healthcare industry in the United Kingdom full sets of every type of evidence are crucial (Safaeinili et al., 2020). In contrast, due to the higher end of pressure under the work process, it has become difficult for working professionals to maintain the evidence all the time which affects the decision-making process in the clinical setting. The lack of financial resources is another primary factor that inhibits the implementation of potential decisions due to the demand for technology and innovation in every aspect. Besides pressure and interruption during working time is another major factor that affects the clinical decision-making process which reduces the balance between practice and awareness based on the current situation in the healthcare environment. Getting a better idea regarding the patient’s condition is another crucial factor that has a detrimental effect on the clinical decision-making process (Gupta, 2019). In addition, the presence of a lower rate of knowledge regarding own self is also acts as one of the common issues that influence the decision-making process in the clinical environment in a nugatory way. 

Strategies to improve clinical decisions while enhancing the safety of patients  

Improvement of clinical judgment is the primary strategy to improve clinical decisions while enhancing the safety of patients. The creation of a culture of safety requires the development of teamwork strategies which will enhance the entire clinical decision-making process while ensuring the safety of the patients. Safety is considered the highest priority under the health care norms and providing patients safety with better clinical commitment is crucial for promoting a better safety culture (Miles and Scott, 2019). One of the primary strategies for the improvement of clinical decisions is reducing errors through improving handovers. It reduces the rate of risk and errors that may happen to the patient. Besides it also benefits the attention of the patient with the improvement of the overall caregiving process. Focusing on the entire communication between the hierarchy is also effective for dealing with the failures that are often in time of delivery safety to the patients (Walpole et al., 2019). Poor communication during handover can cause difficulties in providing the patient with the right treatment, therefore transferring and communication methods need to be improved which can act as the primary strategy to improve the clinical decision-making process while reducing the safety-related risk. 

Factors that influence decision-making 

Focusing on the circumstances related to the injury and its surroundings is one of the crucial factors that influence the clinical decision-making process. Besides, it also influences the family of the patients in a better way in the future that deals with the functional limitations in a strategic way. Participation of the patient along with their family in the care or treatment process is another positive factor that influences the decision-making process and addresses the internal barriers in a congenial way (Enghiad et al., 2022). Apart from this, there are different other factors present in the health care setting that influence the decision-making process in different ways such as emotions, environment, external factors, differential psychology, previous experience, social factors, values and perception. The idea of ethics and emotions are different in the case of individual people and it also acts as one of the significant barriers under the health care setting. Besides this environment mainly the culture of the surroundings is another fundamental factor that influences the overall decision-making process with familiar or non-familiar away (Kılınç et al., 2022).  In the case of making a decision emotions are one of the primary influencing factors and it processes through different ways that sometimes act as positive or negative factors. Recognising and managing emotions in the right way can influence the clinical decision-making process by taking control of the overall situation in a rational way even under critical circumstances or high pressure. Apart from this government comes under the primary social factor and its credibility is one of the primary concerns that influence the decision-making process (Wood, 2021). On the other hand, social conflict is another practical notion that allows a particular group to manifest their behaviour in a different way which may affect the decision-making process in the clinical setting in a detrimental way. 

Patient-centred Care

Patient-centred care has become one of the primary concerns under interprofessional learning in the healthcare setting. Besides this, it requires a better rate of medical training to emphasize the values and skills that are needed to be provided to the patients in terms of collaborative and compassionate care (Debika et al., 2020). The partnership between the physician and other healthcare professionals requires a better rate of interdisciplinary factors that will allow the patient to focus on the collaboration participation and coordination within the healthcare approach while sharing personal challenges. Besides it is also effective to share a broad decision-making approach that is crucial for allowing the patients an adequate amount of care and treatment based on their need (El Haddad et al., 2019). The traditional process for providing care to patients needs to be diminished in order to pursue better engagement with the modern process that can ensure health development through direct patient care planning. Interpersonal learning is the primary option for the better transformation of the present medical education model that will allow healthcare organisations to meet the primary needs of the upcoming healthcare workforce (Kowalski et al., 2020). Reinforcement of the core value needs to be systematic for taking the right shift into the clinical education process that will enhance the focus under the interprofessional system. It has become crucial to provide patients right care and it is one of the primary responsibilities of physicians to collaborate with multidisciplinary groups in any care setting (Raso et al., 2020). Interprofessional learning is critically related to the primary required standards under the clinical profession in order to enhance the efficiency of communication, proficiency, clinical competence, patient-centred care, ethical practice, teamwork and leadership. 

Healthcare professionals need to focus on the following factors strategically in order to integrate better elements through their benefits. In addition, it also has a central role under the healthcare hierarchy for better and more effective collaboration within the profession across the different disciplines in order to deliver high-quality treatment and care to patients (Spiva et al., 2020). The healthcare setting eventually becomes one of the leading places that includes a higher rate of interdisciplinary and complex. In addition, here the role of interpersonal learning is critical; however, it also assists the next generation to prepare themselves better for becoming a potent healthcare professional (YEŞİLBAŞ and KANTEK, 2020). Besides this, it is essential for meeting the multifaceted wants and needs of patients while having a major contribution to the improvement of present healthcare services of the nation. The role of healthcare leadership is pivotal under the following scenario and it also assists the physicians to advocate the professional and curriculum development programmes in the right way (Fulton et al., 2019). On the other hand, healthcare leadership also ensures patient patient-centred plan in a strategic wave with the better implementation of interpersonal learning opportunities that will ensure the nurses get better concern regarding their roles, responsibilities and rights. The entire care planning leads the healthcare organisation towards a better amount of quality improvement which is the primary initiative to involve professionals from different backgrounds (Lee and Dahinten, 2021). In addition, the role of interpersonal learning influences patient-centred care planning in a strategic way by addressing the healthcare challenges that are complex while identifying effective solutions for better sustainable improvements in the upcoming days. 

Conclusion 

After the analysis, it can be concluded that the hierarchy of evidence under the clinical practice is one of the effective factors for all physicians to enhance their strength and precision in work. It has been highlighted from the study that the application of the following system is crucial for getting contextual information with a particular database that can resolve the queries of patients. Besides, it has been found from the study that clinical decision-making is one of the primary challenges faced by the majority of physicians in the healthcare industry and managing the people is the primary concern here. It has been concluded from the study that clinical leaders and their leadership are the crucial factors here in order to deal with inappropriate management-related challenges that affect the entire decision-making process in a negative way. Besides this, it has been suggested by the study that Evidence-based Practice (EBP) improves the clinical decision-making process with collective assistance from the experts for the improvement of patient values. In addition, it has been found from this report that case-control has become easier with the effective implementation of evidence-based practice that allows the physician to make accurate choices during treatment.  

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