Assignment Prompt

The purpose of this assignment is to identify a clinical practice guideline in your specialty area. You will be challenged to evaluate this guideline and discuss its use in clinical practice. This assignment is due at the end of Week 8 but can be completed anytime during this course. This assignment requires a considerable amount of time for completion. Do not wait until week 8 to begin this assignment.

Choose a health problem that you may commonly see in primary care nurse practitioner practice. Describe the health problem and recommended medical management for it. Research published clinical practice guidelines and evaluate the practice guideline you have selected based on the components listed in the Clinical Practice Guideline Template below.

Clinical Practice Guideline Prompts:

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HEALTHCARE PROBLEM IDENTIFIED: Briefly describe the health problem you have identified. Include a discussion of morbidity, mortality, epidemiology and pathophysiology related to this health problem

PRACTICE GUIDELINE: Describe the clinical practice guideline used for this problem. Reflect on the questions included. Expand on your answer using support from evidence

Does the clinical practice guideline adequately address the health problem? Describe.

Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?

Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?

How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.

ANALYSIS: Think about future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.

Does this clinical practice guideline need revision(s)? Please explain your answer in detail.

If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?

How might changes in US demographics and healthcare reform affect this clinical practice guideline?

What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?

EVALUATION How would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.

LEARNING POINTS (3-5 bullet points outlining key learning in this case.)

REFERENCES (APA formatting, current within past 5 years.)

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Week 8: Benchmark Assignment – Evaluation of Clinical Practice Guideline

Healthcare Problem

           Hemorrhage is a healthcare problem that can lack a holistic approach. Traumatic bleeding, injuries, puncture wounds, heavy or prolonged menstrual bleeding, leukemia, hemophilia, low blood platelet count, liver disease, vitamin k deficiency menorrhagia, amongst others, contribute to hemorrhage. Care providers usually do not notice that excessive bleeding needs emergency care (Qureshi et al., 2016). Hemorrhage is life-threatening. According to the world health organization, bleeding from injuries has caused approximately 9% of deaths worldwide. 35% of deaths are attributable to hemorrhages from traumatic injuries. The condition burden sits at around 12%. Even though complementary therapies have been employed, there is still a huge gap in the providence of holistic care meant for hemorrhage. Health providers usually center on the ancient approach of healthcare, which all about dressing wounds. There is a concern about how patients connect with their mind, body, and spirit. As a result, patients get emotionally, socially, intellectually, or spiritually disturbed. Optimal care is all about finding a balance in all factors of health. Less effort is directed on wellness and prevention of diseases. My specialty area is short of comprehensive and personalized methods of providing treatment for bleeding. Since healthcare cannot “treat the whole you,” life expectancies have decreased and premature mortalities increased. 

Practice Guideline

           Hemostasis optimization and casualty care are the clinical practices used to address hemorrhage (Cinnella et al., 2019). The first healing process of bleeding starts in hemostasis. Medics focus on ensuring that the victims’ blood remains within his/her blood vessels. The question about hemostasis is whether the process will combine with thrombosis to stop bleeding and prevent the victim from infections. Without hemostasis, the action of platelets and fibrin, a person would ooze blood to death. The clinical guideline avers that with hemostasis, the body or blood vessels should vasoconstrict; hence, blood flow slowed. With platelet plug formed, the blood clots to prevent more bleeding. However, hemostasis and casualty care are ineffective without the support of thrombosis (thromboembolism or arterial thrombosis).

Does The Clinical Practice Guideline Adequately Address The Health Problem?

           Hemostasis and casualty therapy have served their purpose, but a multidisciplinary strategy would be vital to improving the outcomes. All surgical procedures are closely associated with hemostasis. The practice has been fruitful due to the use of anesthetics and operative techniques. However, during severe bleeding, critical injury, and increased severity, surgical intervention does not address penetrating trauma. New solutions are needed to decrease, stop bleeding, and foster recovery within the shortest time (Jasemi et al., 2017). Topical agents of hemostasis have not ultimately yielded the desired results. The mechanisms of action of the agents are confusing to the surgeons. An atherosclerotic lesion or plaque might arise even after applying hemostasis. Even though Hemostasis agents stimulate the sympathetic nervous system, some homeostatic functions such as sexual arousal, digestion, respiration, cardiac, and urination can be affected. Victims of hemorrhage end up getting an acute stress response, which might affect their well-being. Physiological reactions increase anticipation and unsettledness, which is bad for a hemorrhaging patient. Although Hemostasis and casualty therapy induce blood clotting, blood flow to muscles increases, muscle tension increases, heart rate speeds up, and blood pressure blood sugars rise. The sudden physiological changes are not desirable to a hemorrhage victim. Hypertensive individuals are susceptible to attacks due to chronic stimulation initiated through hemostasis. Emergency/casualty therapy is slow for normotensive controls (Mancini, Crotty, & Cook, 2018). Hemostats are also associated with disruptive bleeding.

Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?

         Hemostasis and casualty care is rendered contemporary in the medical administration of hemorrhage (Mancini, Crotty, & Cook, 2018). Caregivers learn methods of applying lifesaving medical procedures to prevent increased bleeding and development of life-threatening complications such as anemia, amongst others. Hemostatic strengths lean towards potential survival after bleeding over non-survival. With adjunctive hemostats, hospitals or medical resources are sparingly used. After all, not ball bleeding patients need a blood transfusion. The application of hemostasis is associated with reduced hospital and operating time. Most traumatic and surgical bleeding cases are addressed through hemostasis.

Does this clinical practice guideline adequately direct the healthcare provider to manage a patient with this problem?

           The application of hemostasis does not take a holistic care approach. During disruptive bleeding and complications associated with hemostasis, the health care provider is physically strained and tormented. The chances are that s/he is anxious or depressed with the practice. The probability of making personalized recommendations during hemostasis is very low. Healthcare providers want to exercise their autonomy, but confinement practice might cause stress. Usually, a nurse is not moved to ask about all the symptoms because they focus on what they observe. Lack of taking a holistic approach leads to assumptive decision making. With hemostasis and casualty care, a healthcare provider is unable to doctor outside the box. Other clinically proven practices such as acupuncture, surgery, and supportive care might be ignored for hemostasis and casualty therapy.

ANALYSIS: Think about the future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.

            Patients suffering from an intracerebral hemorrhage, hemorrhagic stroke, and spontaneous intracranial hemorrhage need advanced therapies and healthcare policies to improve their well-being. Hemostatic therapy agents are not enough to decrease the condition’s morbidity and mortality (Cinnella et al., 2019). It is always a challenge to tend to patients suffering from intracerebral hemorrhage. In the future, there should be a balance of needs of hemorrhagic patients. Direct evidence support should consider pharmacologic, Interventional procedures, Blood pressure control, management of elevated intracranial pressure, hydrocephalus management, surgery, and holistic/multidisciplinary care would prove to be beneficial. If a patient is experiencing complications or chronic pain, whole healthcare would address the condition and help in recovery (Mancini, Crotty, & Cook, 2018). Different therapists should be recommended to handle all complications that come with the condition. Patients should be mindful of nerve pain and consider acupuncture. Changes in healthcare policies should back the use of all available resources for treating the disease (Obama, 2016). Wellness is made doable, but care is insufficient if the victim does not prioritize self. Healthy eating and physical exercises are essential for addressing hemorrhage. 

Does this clinical practice guideline need revision(s)? Please explain your answer in detail.

              Hemostasis optimization and casualty care need further revision. The guideline should command a series of interventions to foster care improvements and avert disease complications. Curing hemorrhage becomes overwhelming when the needs are not fully addressed. Holistic/multidisciplinary care empowers caregivers to make apt decisions (Jasemi et al., 2017). Instead of imposing many therapies, the patient is included in the conversation to deliberate the most suitable changes to reduce bleeding morbidity and mortality rate. A comprehensive approach ensures both the physician and the patient set wellness goals. There should be a policy that encourages patients to build strong relationships with doctors to remain healthy.

If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?

              If homeostasis obligations were changed, a multidisciplinary directive would make all parts of care interdependent. The negative impact is the imbalances associated with complications and severity and chronic injuries that need advanced interventions (mancini, crotty, & cook, 2018). The living balance of a hemorrhaging patient is not based on physical wellness by optimal recovery. Instead of curing what is being observed, comprehensive care of hemorrhage should focus on the fundamental of functional medicine. A workable clinical practice guideline is based on natural, emotional, social, and preventive care (loscalzo & giannini, 2017). It is illogical to look at a patient based on the condition s/he exhibits. Clinical practice should ensure the overall positive of being. Society, health care facilities, and individuals are responsible for reducing the rate of bleeding. Active participation in prevention will improve wellness and keep the body healthy. Refining the drive of clinical practice will influence optimal well-being.

How might changes in us demographics and healthcare reform affect this clinical practice guideline?

           Minorities, the young, and the marginalized would be the most affected group. People from low social class and segregated persons influence how hemostasis is dispensed. The wealthy, political class and majority are favored and supported by the clinical practices. The probability of accessing hemostatic care as a minority or a marginalized person is very lean. Patient protection reforms would affect clinical practice guidelines. 

            The changes would bring about a comprehensive care system that tests preexisting conditions and supports preventive services (jasemi et al., 2017). The medical loss ratio associated with other conditions would improve accessibility to care quality. Collaborative care in hemostasis will increase accountability and clinical trials for better healthcare outcomes.

What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?

           An analytic and intuitive approach will increase the prospect of modifying clinical practice. Clinical judgment would measure patients’ needs and make decisions that do not focus on treating hemorrhage symptoms. A mixture of autonomous and collaborative decision-making would ensure clinicians demonstrate prosperity in applying the practice. The desire to make instant decisions and get immediate results is not promised (Jasemi et al., 2017). Cognitive skills in care would help blend both clinical and holistic strategies. A functional practice would focus on personalizing the model of care given. However, the patient-practitioner relationship is significant. A healthcare provider has to be close to the patient to study and understand the cause and cure of the bleeding. Comprehensive/holistic care helps patients experience overall vitality, bold, mentally alright, heal, and self-regulate (Jasemi et al., 2017).

EVALUATION: how would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.

           A comprehensive/holistic care is more effective than hemostasis and casualty therapy. An interconnected system would yield better results (Jasemi et al., 2017). Collaboration in care fosters healthy living and well-being. Other than physical harm, a compressive practice would pinpoint and offer a solution to emotional, psychological, and spiritual concerns caused by bleeding. Therapeutic communication causes confidence, bravely, and daring to save lives. A holistic strategy takes into account patient preferences to provide the right medication for the disease. A revised clinical practice would identify factors that delay recovery. Incorporating a philosophy of responsibility and self-care does improve the ultimate outcomes of traditional hemostasis. A blend of  mainstream and complementary, or alternative healing modalities (CAM) are patient-centered, functional, and sustainable for hemorrhage recovery. A multidisciplinary approach is more effective because the practitioner can identify stress, other health concerns as personal worries. Even though hemostasis is all about pace, prevention is more effective than the use of conventional therapy. The Steps of revising the clinical practice guideline include even though everyone is responsive to accept the word of God?

  • all injuries to be taken seriously
  • we all have a character with healing 
  • hemorrhage victims are persons, not the medical condition
  • Alleviating hemorrhage is not enough; fixing the cause is the main problem.
  • The right questions should be asked after the clinical practice is refilled.

              In summation, a comprehensive model of clinical practice is more beneficial, although it is rarely used. All healthcare problems need analytical. Intuitive reasoning is that clinical issues are broken down into constituent parts that are easy and quick to solve. Hemostasis is a sole guideline, yet a methods driven approach would help reduce mobility and mobility associated with controllable hemorrhage. Non-revised clinical practice will solve problems related to risk, certainty, and hesitation .reforms in the healthcare policies provide alternatives and factors to reduce the epidemiology, mortality associated with hemorrhage.

References

Cinnella, G., Pavesi, M., De, A. G., Ranucci, M., & Mirabella, L. (2019). Clinical standards for patient blood management and perioperative hemostasis and coagulation management. Position Paper of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Minerva anestesiologica85(6), 635-664.

Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A concept analysis of holistic care by hybrid model. Indian journal of palliative care23(1), 71.

Loscalzo, Y., & Giannini, M. (2017). Clinical conceptualization of workaholism: A comprehensive model. Organizational Psychology Review7(4), 306-329.

Mancini, S., Crotty, A. M., & Cook, J. (2018). Triage and Treatment of Mass Casualty Decompression Sickness After Depressurization at 6400 m. Aerospace medicine and human performance89(12), 1085-1088.

Obama, B. (2016). United States health care reform: progress to date and next steps. Jama316(5), 525-532.

Qureshi, A. I., Palesch, Y. Y., Barsan, W. G., Hanley, D. F., Hsu, C. Y., Martin, R. L., … & Toyoda, K. (2016). Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. New England Journal of Medicine, 375(11), 1033-1043.