Introduction and Overview of Evidence-Based Practice (EBP)
Many healthcare initiatives that are developed and researched by modern scholars focus on interventions for people with existing health-related problems. Smoking is an example of a harmful activity that is advocated against by most health care specialists (Fiore, Jorenby, and Baker, 2016). However, it remains a part of many people’s lives, despite it potentially exacerbating their symptoms or even becoming the cause of another disease. This report is concerned with the discussion about patients with chronic obstructive pulmonary disease (COPD) and their smoking habits. This topic is interesting because smoking is often linked to breathing problems, but some patients with CORD cannot or do not want to stop smoking, even though it may harm their health further.
The need to address this problem is a part of evidence-based practice (EBP) because it allows nurses to develop a viable framework for promoting smoking cessation based on reliable existing research. EBP is a vital part of any nurse’s work as it helps nurses to make decisions based on the best available findings (Stokke et al., 2014). Nurses have to be able to appraise scholarly research and find the most trustworthy evidence to implement it into their practice.
Appraisal of Two Research Papers
Qualitative Research
The process of critiquing qualitative studies has a number of requirements. For instance, it should account for such aspects as the study’s credibility, dependability, confirmability, and transferability (Shenton, 2004). The strategy of assessing these papers to determine their usefulness in EBP should include these characteristics, the overall quality of the findings, and their applicability in a particular situation (Holland and Rees, 2010). Furthermore, the evidence’s relevance to this type of research can also be evaluated. The following article is a study of case reports which are placed near the bottom of the hierarchy of evidence (Rousseau and Gunia, 2016). This type of information is not very easy to generalize and may be prone to bias (Leung, 2015).
An article by Nykvist, Larsson, and Dahlborg Lyckhage (2014), called “‘It’s about me’ – a narrative analysis of female smokers with chronic obstructive pulmonary disease (COPD) and their relationship to smoking” is a qualitative study of women’s experiences with smoking and COPD. It was published in the Scandinavian Journal of Caring Sciences. The main purpose of this research is to find the primary reasons which women with COPD use to continue smoking. The authors explore these reasons in a conversation with six women and attempt to outline the main arguments and construct a narrative that presents a typical psychological portrait of a woman with COPD who smokes. The narrative created by the authors is believable as it is extensively described.
The presence and description of qualitative methods are explicit in this study. The researchers pay significant attention to explaining their course of action. For example, they argue that qualitative research can help other people understand the experiences of participants on a deeper level (Nykvist, Larsson, and Dahlborg Lyckhage, 2014). Moreover, the study provides readers with a framework used during the discussion and analysis parts of the research. Therefore, the transferability and dependability of this framework are rather high because other researchers may base their analysis on similar processes (Holloway and Galvin, 2017). The context of the study is clearly defined, which allows other scholars to make comparisons.
The description of the methodology is vital to this study because it shows how researchers not only connect necessary information but also familiarise themselves with it and find a set of patterns and similarities between cases. The study presents real experiences from six women, and the authors use direct quotes to increase the validity of their findings. The authors state that they reread the findings multiple times to find behavioral patterns. The selection criteria create a very limited group of participants, which decreases the level of applicability. The study is approved by an ethics committee, and all participants provide their informed consent.
The authors comment on their findings, do not use leading questions in their interactions with participants, and present the review of the phenomena analyzed in the article. Moreover, they describe their professional experiences to improve the credibility of their arguments. The confirmability of the presented research depends on the authors’ ability to recognize the limitations of their conclusions (Flick, 2014). In this case, the researchers state the necessity to avoid bias in their assessment. They point out that they “had no knowledge of [the participants’] medical histories before the interviews” (Nykvist, Larsson and Dahlborg Lyckhage, 2014, p.378).
The authors find a clear answer to their initial aim, as they are able to pinpoint a number of similar behaviors that encourage women to smoke. The main strength of this article is its in-depth analysis of the women’s experiences, while its lack of awareness about its potential shortcomings may be considered a significant disadvantage. The findings of the study can be used in practice as they present an argument to explore individual cases.
Quantitative Research
Quantitative studies also play an essential role in EBP. These methodologies allow nurses to examine and test various hypotheses and reveal correlations between different conditions and settings (Ingham-Broomfield, 2014). In this case, the critique of articles based on quantitative research is also crucial for nurses who want to implement EBP in their work. The trustworthiness of these studies is also based on the credibility of the authors’ experience and the quality of the gathered data.
The study by Pride (2001) presents a review of correlation levels for smoking cessation and its impact on COPD progression based on the article “Smoking Cessation and Lung Function in Mild-to-Moderate Chronic Obstructive Pulmonary Disease” by Scanlon et al. (2000). This quantitative research is an extensive analysis of the effects that long-term smoking cessation can have on patients with COPD because it considers such factors as age, sex, demographics, substances’ use, and main respiratory symptoms. It was published in the American Journal of Respiratory and Critical Care Medicine.
The article utilizes a randomized control trial (RCT) methodology, which is considered to be the most reliable type of evidence that can be used in EBP (Holland and Rees, 2010). This methodology seems suitable for the study’s aim as it allows the authors to present factual findings to support their hypothesis.
The researchers analyze data from more than 5500 individuals, which is a significant sample size (Scanlon et al., 2000). Thus, the sample may be considered to be representative of the population and its individual groups. The study uses a survey of participants who belong to different groups according to their age, gender, and other characteristics. The sample does not show any biases as it uses data from various individuals.
The division of individuals into control groups is clearly stated and explained. For instance, one of the groups goes through an established program of care for COPD, while another engages in “an intensive, long-term smoking cessation program” (Scanlon et al., 2000, p.382). The study provides a clear framework of actions, the criteria for exclusion and inclusion, and the dropout rates. They employ computer analysis and present various charts and graphs to illustrate their findings.
The study is approved by an ethics committee, all participants gave their consent. The study found a correlation between prolonged smoking cessation and mitigation of COPD symptoms in patients going through an intensive program (Scanlon et al., 2000). The authors give clear recommendations to medical workers to use new interventions and focus on intensive smoking cessation programs. The authors’ definition of all methods and their commentary on the results of the study further enhances provides some insight into the acquired data. One of the main drawbacks of the study is the lack of awareness of the possible shortcomings that could be present in this study. However, the study also presents many valuable findings that can be used by nurses to promote smoking cessation.
Meeting Patient/Service User Needs
The implementation of EBP by nurses should also include the opinions of service users. Patient participation in the decision-making process is essential because it provides nurses with viewpoints that are relevant to the users’ most vital concerns (Domecq et al., 2014). For example, service users’ engagement in research that analyses their health-related problems may benefit from their contributions as it could outline the main areas of significance.
However, the participation of patients in the process of EBP assessment and implementation can encounter some obstacles. According to Greenhalgh et al. (2015), a patients’ role in research is often undermined and considered to be less important than other factors. Other types of barriers to user’s participation may include the power imbalance between medical workers and patients and the “focus on people who seek and obtain care” and not individuals who cannot or are not willing to access care (Greenhalgh et al., 2015, p.200).
Service users should be involved in EBP to improve their relevance to patients’ experiences. Shippee et al. (2015) suggest increasing their role in studies through added participation. For example, patients can form special advisory boards and influence the course of EBP through discussions and recommendations. Various online resources can also be used by service users to share their experiences and opinions. Patients take up the central place in EBP as their health is the main topic of discussion in the majority of all research. For instance, individuals who smoke can contribute to the analysis of the effects of smoking on various conditions.
Application to Practice
The use of studies in practice can change the established system and bring improvements to patient care. For instance, the qualitative research described above can be utilized to develop an intervention for smokers who find it difficult to quit for personal reasons. Nykvist, Larsson, and Dahlborg Lyckhage (2014) analyze the arguments that women with COPD can use to justify their habit of smoking. Thus, the findings of this study can be implemented in institutions that work with patients to promote smoking cessation. For instance, Efraimsson et al. (2015) state that while many nurses provide a significant amount of information about smoking to patients with COPD, only a few of the patients agree to cessation. Therefore, this study can become a source of education about patients’ experiences for nurses.
The study can be used to promote smoking cessation with a new approach. For example, women from the described study focus on personal reasons such as low self-esteem and desire to conform to the groups’ interests (Nykvist, Larsson, and Dahlborg Lyckhage, 2014). Therefore, nurses can focus not just on the health benefits of smoking cessation but also on the psychological reasons behind patients’ behavior. Service users who do not feel valued without their old habits may benefit from conversations about their excuses to continue smoking. The focus should shift away from physical symptoms to discussions about mental health and well-being (Nykvist, Larsson, and Dahlborg Lyckhage, 2014). Such changes can be implemented with smoking COPD patients in a hospital or outpatient setting.
The PDSA (Plan-Do-Study-Act) model for quality improvement can be used to implement this approach into practice. It can allow nurses to evaluate the process of change and see whether it has positive outcomes for patients. The existing interventions for smokers and the research conducted by scholars can contribute to the success of this intervention and become enablers of change. On the other hand, people’s unresponsiveness to nurses’ suggestions for smoking cessation can be considered a barrier to the approach’s successful implementation. According to Jiménez-Ruiz et al. (2015), people often continue smoking even when they are diagnosed with pulmonary diseases.
The authors state that patients do not receive enough advice about health maintenance, and many smokers find it hard to follow the typical guidelines. The authors note that these patients often require additional counseling. Therefore, their adherence to old behavioral patterns and resistance to change can be a significant barrier in such cases.
Conclusion
Patients with COPD often continue smoking due to a lack of education and an emotional attachment to the process. To promote smoking cessation, nurses can use EBP. They should choose the best evidence to create new interventions and engage patients in the process. Research critique should be rigorous but fair.
Reference List
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Efraimsson, E.Ö., Klang, B., Ehrenberg, A., Larsson, K., Fossum, B. and Olai, L. (2015) Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care. European Clinical Respiratory Journal. 2(1), p. 27915.
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Scanlon, P.D., Connett, J.E., Waller, L.A., Altose, M.D., Bailey, W.C., Sonia Buist, A. and Tashkin, D.P. (2000) Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 161(2), pp. 381-390.
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Shippee, N.D., Domecq Garces, J.P., Prutsky Lopez, G.J., Wang, Z., Elraiyah, T.A., Nabhan, M., Brito, J.P., Boehmer, K., Hasan, R., Firwana, B. and Erwin, P.J. (2015) Patient and service user engagement in research: a systematic review and synthesized framework. Health Expectations. 18(5), pp. 1151-1166.
Stokke, K., Olsen, N.R., Espehaug, B. and Nortvedt, M.W. (2014) Evidence based practice beliefs and implementation among nurses: a cross-sectional study. BMC Nursing. 13(1), p. 8.