Evidence-Based Practice in Kim et al.’s Study

Introduction

Evidence-based practice (EBP) aims at enhancing patient care and improving working conditions for nurses. EBP enhances nursing education as a component part of the clinical improvement studies for nurses. EBP has provided an opportunity of identifying a suitable clinical project from the available literature that supports the rationale of the project. Switching from past learnt experiences in nursing school to EBP is a formidable task that requires abundant professional literature to support the transformation process.

In the hospital situation, students get assistance from qualified hospital librarian who can assist in identification of suitable materials for EBP study. This is the only way to eliminate the fear of conducting research.

The researchers conducted a randomized, double blind clinical trial. The patient population included children with the age of two to ten years old that suffer from acute asthma exacerbation. The processes involved excluding patient allergic to prednisolone, corticosteroid use within two weeks, patients who vomited within the last 24 hours, and any condition that required vascular access. The researchers exposed patients over six years to either generic prednisolone (15 mg/5 mL) or Orapred (15 mg/5 mL). The researchers observed patients for cases of vomiting for a day.

The researchers decided to appraise the study based “Vomiting of Liquid Corticosteroids in Children with Asthma” based on the fact that it provided EBP study opportunity based on the nature of intervention. This is because the study highlighted oral corticosteroids as a crucial part of managing children who suffer from acute asthma exacerbations. Nurses attribute vomiting to oral corticosteroids. The new form of drug hinted that there were reductions in cases of vomiting where nurses administer prednisolone and Orapred. This study also had narrow and specific objective of making comparisons in incidences of vomiting among patients who took a generic prednisolone, and those who took Orapred. Duration of the study was also short, and results were readily observable.

A brief overview of the study

The primary aim of this study was to compare cases of “vomiting and taste between patients who took the generic preparation of prednisolone and those who took Orapred” (Kim et al, 2006).

This is a quantitative research design involving experimental approach with specific study evidence. The researchers used randomized double blind clinical trial to conduct the research. The researchers chose a sample of children aged between two and ten years old suffering from acute asthma exacerbations. The researchers exclude patients with cases of “allergy to prednisolone, those who used corticosteroid within two weeks, those who vomited within the last 24 hours, require vascular access, and any patient with the preferences for other forms of corticosteroid” (Kim et al, 2006). The researchers obtained a “taste score using a scale (1 = bad to 5= great)” (Kim et al, 2006). Duration was 30 minutes for observing cases of vomiting. The researchers used Mann-Whitney U test for establishing media taste score and calculated relative risk of vomiting (Kim et al, 2006).

The researchers used “randomized, double blind clinical trial at the emergency department of children’s care” (Kim et al, 2006). Human Rights Review Board approved the research. The researchers also obtained consent from parents of the children who participated in the study.

Research analyses involved calculating the study sample assuming that 30% of the sample in the generic prednisolone group vomited compared to 10% in the Orapred group. The study involved 100 samples. The researchers used descriptive statistics in analyses of the demographic data. There was also student t test for analysis of continuous variables such as age. The research also utilized normalization transformation where necessary. The researchers used “Mann-Whitney U test for comparing median between the two groups” (Kim et al, 2006). The researchers calculated relative risk (RR) of vomiting and established confidence intervals.

The findings indicate that there are “significantly fewer cases of Orapred and vomiting and a better taste score in relations to the generic prednisolone” (Kim et al, 2006). Future studies should strive to improve on the limitation of this research such as short time for patients to vomit, negative effects of vomiting, account for cases of severe asthma, and the taste test could have influenced blinding.

A brief conclusion

The study report presented conclusive results based on the research objective. Strengths of evidence were easy to observe making outcomes factual i.e. it was easy to notice study samples who have vomited, and those who have not. The study design and methodology are simple to follow; thus, making this study suitable for EBP studies. The research methodology and analysis processes are also easy steps that students can use to advance their knowledge in EBP.

Apart from the above limitations and implications for future research, the research also has both weaknesses and strength in relation to sampling, methods, and findings. Sampling of the study was adequate and representative based on randomization approach. The method of the study was clear and involved easy approach. On the other, findings of the study were conclusive based on the research objective, but the study had several limitations mentioned above.

The study has many limitations, which may render its finding irrelevant. The researchers did not account for many variables that could have influenced the outcome among the samples. These include short duration of observation, magnitude of asthma in patients, stress of medication struggle, and effects of vomiting among samples of the study, and influence of taste test on blinding.

Discussion about the potential application of the study findings to practice

Relevance of practice

The hospital setting is relevance to the research since the aim is to serve a specific healthcare department (emergency department). This is a micro setting within the department of emergency. Thus, implementation of EBP outcomes can enhance improvement of care among acute asthma patients.

The population or sample is also relevant. The sample provides specific indicator that only concern use of specific drugs among asthma patients. The number of the sample was also large enough for drawing a conclusive result.

Feasible to implement

Clinical setting is feasible for implement of research outcome. It is also feasible because it involves a particular setting rather than a general setting. Nurses can also apply results from this setting in other places of similar patients.

Resources have also posed challenges to organizations. Any successful EBP needs adequate resources, and collaboration among staff and other stakeholders. This testing the feasibility of the results will require resources, but the outcome will reflect the best practices in nursing (LoBiondo-Wood and Haber, 2011).

Stakeholders are fundamental for feasibility of EBP. Stakeholders make the research relevant and provide useful information for decision-making team. Involvement of stakeholders will ensure accountability and transparency for upholding the integrity of the process. Stakeholders will also actively participate in the process due feelings of ownership.

Staff in EBP must collaborate and work with others for ensuring the research feasibility and implementation. Mentorship and development of relevant skills among nurses is crucial for successful EBP studies. Staff should support others through processes such as analysis, evaluation, reporting, and critique of the results.

Costs influence feasibility of the EBP outcomes. There should be sufficient funds for implementation of the research outcome, and for further research in order to discover the best practices, and procedures in managing vomiting related medication in treatment of asthma at the emergency department.

Values, data, and preferences in EBP usually integrate the best evidence in EBP for all stakeholders who the process serves. This research creates such opportunities to stakeholders for implementation.

Risks of the project feasibility and implementation may be due to lack of adequate funds and expertise. However, such barriers do not outweigh outcomes to patients and nurses. Risks are minimal, and the hospital can overcome them through integration of different sources of funds and expertise. Implementation of the EBP outcomes in asthma patients department shall enhance nursing practices, keep the field current, improve decision-making, and achievements of high quality care in nursing.

Apply

Implementation of the asthma study evidence needs multifaceted approaches so as to promote applications of evidence in clinical works and decision-making. Individuals and the hospital have to participate in the implementation process of the outcome. How to implement the program involves the following.

  • Systematic review of EBP outcomes.
  • Analysis of costs and possible cost-cutting opportunities.
  • Multi-disciplinary group to undertake implantation process.
  • Stakeholders’ involvement.
  • Development of policy guidelines.
  • Identification of sources of funds.
  • Developing relevant evaluation procedures, performance indicators, and outcome evaluation plans.
  • Developing intervention measures.
  • Implementing monitoring processes.

References

Kim, M., Yen, Kenneth, R., Ryan, N., Tom, Brandos, J. and Hennes, H. (2006). Vomiting of Liquid Corticosteroids in Children With Asthma. Pediatric Emergency Care, 22(6), 397-401.

LoBiondo-Wood, G. and Haber, J. (2011). Nursing research: Methods and critical appraisal for evidence-based practice (7th ed.). St. Louis: Mosby Elsevier.