Please follow guidelines and examples and do use the template downloaded also the evidence
Evidence Based Decision Making (M30125) Assignment 2 (40%) Evidence Based Decision 750 word limit Due date: 12th January 2023 12 noon LO to be assessed “Discuss the context, barriers and enablers for evidence informed decision-making” This assignment is focused on identifying the evidence that you used to make a decision in practice and any barriers or enablers that prevented you, or helped you to use these different types of evidence in your decision making. By evidence, we mean your own clinical expertise and the patient’s views as well as the research evidence and clinical guidelines. You also need to consider the context (setting) that you were working in, as this is likely to have affected the decision that you were able to make. You can use a decision that you made during placement, it is a good idea to choose a simple decision so that the focus of the assignment is on the evidence used to make the decision rather than on the complexities of the decision itself. Please ensure that you reference appropriately. For this assignment, we recommend that you structure your report using the following template, to ensure that you are including all of the correct information. Details are given on the template about what information is required in each section. Course specific examples have been provided on moodle in the ‘Assessment and Support Materials’ section, to show you how previous students have completed this assignment. Please remember that they are a guide only and are not designed to demonstrate a ‘perfect’ answer, but only to give you an example of how previous students have completed this assignment. A blank copy of the template is available on moodle (in the ‘Assessment and Support Materials’ section). Decision: Background: In this section outline the circumstances leading up to the decision that you made. Include enough information about the patient and their situation so that your marker will understand the factors that influenced your decision. Remember to maintain patient confidentiality i.e. do not include the patient’s name or any identifying information. Key issues: Explain the key issues that you needed to consider when making your decision and which were the most important things to take into consideration. Decision: State your decision clearly in a single sentence (if possible) Patient Views: What did the patient want to happen? Enabler(s): What factors helped you to gain a good understanding of what the patient wanted? Barrier(s): Were there any factors that prevented you from understanding what the patient wanted? Clinical Expertise: What was your personal experience of this situation or this type of patient? Enabler(s): Were there any factors that helped you to use your personal experience in making this decision? Barrier (s):Were there any factors that stopped you from using your personal experience in making this decision? Guidelines/Research Evidence: What do the guidelines recommend? What does the research recommend? Enabler (s): What were the factors that allowed you to use guidelines or research evidence in your decision making? Barrier(s): Were there any factors that stopped you from being able to use guidelines or research evidence in your decision making? Context: Was there anything about the context (setting) that affected the decision that you were able to make? E.g. time of day, access to resources. Conclusion: What are your thoughts about using different types of evidence to underpin your decision making? How did the different factors that you have mentioned influence your decision? You might want to consider how the barriers and enablers influenced your use of different types of evidence when making decisions and the impact that the context had on the decisions that you are able to make. References You need a full reference list, usually using APA style, 7th edition as per the library guidelines - https://library.port.ac.uk/w165.html. Evidence Based Decision Making (M30125) Assignment 2 (40%) Evidence Based Decision 750 word limit Due date: 12th January 2023 12 noon LO to be assessed “Discuss the context, barriers and enablers for evidence informed decision-making” This assignment is focused on identifying the evidence that you used to make a decision in practice and any barriers or enablers that prevented you, or helped you to use these different types of evidence in your decision making. By evidence, we mean your own clinical expertise and the patient’s views as well as the research evidence and clinical guidelines. You also need to consider the context (setting) that you were working in, as this is likely to have affected the decision that you were able to make. You can use a decision that you made during placement, it is a good idea to choose a simple decision so that the focus of the assignment is on the evidence used to make the decision rather than on the complexities of the decision itself. Please ensure that you reference appropriately. For this assignment, we recommend that you structure your report using the following template, to ensure that you are including all of the correct information. Details are given on the template about what information is required in each section. Course specific examples have been provided on moodle in the ‘Assessment and Support Materials’ section, to show you how previous students have completed this assignment. Please remember that they are a guide only and are not designed to demonstrate a ‘perfect’ answer, but only to give you an example of how previous students have completed this assignment. A blank copy of the template is available on moodle (in the ‘Assessment and Support Materials’ section). Decision: Background: In this section outline the circumstances leading up to the decision that you made. Include enough information about the patient and their situation so that your marker will understand the factors that influenced your decision. Remember to maintain patient confidentiality i.e. do not include the patient’s name or any identifying information. Key issues: Explain the key issues that you needed to consider when making your decision and which were the most important things to take into consideration. Decision: State your decision clearly in a single sentence (if possible) Patient Views: What did the patient want to happen? Enabler(s): What factors helped you to gain a good understanding of what the patient wanted? Barrier(s): Were there any factors that prevented you from understanding what the patient wanted? Clinical Expertise: What was your personal experience of this situation or this type of patient? Enabler(s): Were there any factors that helped you to use your personal experience in making this decision? Barrier (s):Were there any factors that stopped you from using your personal experience in making this decision? Guidelines/Research Evidence: What do the guidelines recommend? What does the research recommend? Enabler (s): What were the factors that allowed you to use guidelines or research evidence in your decision making? Barrier(s): Were there any factors that stopped you from being able to use guidelines or research evidence in your decision making? Context: Was there anything about the context (setting) that affected the decision that you were able to make? E.g. time of day, access to resources. Conclusion: What are your thoughts about using different types of evidence to underpin your decision making? How did the different factors that you have mentioned influence your decision? You might want to consider how the barriers and enablers influenced your use of different types of evidence when making decisions and the impact that the context had on the decisions that you are able to make. References You need a full reference list, usually using APA style, 7th edition as per the library guidelines - https://library.port.ac.uk/w165.html. Evidence Based Decision Making (M30125) Assignment 2 (40%) Evidence-Based Decision UPXXXXXXXX Word count: 794 Decision: Background: A 25-year-old lady diagnosed with borderline personality disorder [BPD] was referred to our team by the staff at the emergency department (ED) for a mental health assessment. The patient attended ED because she had impulsively taken a mixed overdose of paracetamol and quetiapine to end her life. She is known to have a history of taking mixed overdoses and due to frequent ED attendance, the patient is on the high-intensity service user list. Key issues: Patient's diagnosis of BPD. Patient’s emotional distress and impulsive suicide attempts. Risk of overdose. Suicide attempts are common in people with BPD, with 60–70% attempting suicide at some stage and 10% completing suicide (Garland & Miller, 2020). Decision: The decision was to formulate a joint crisis plan with the patient. The clinical nurse specialist decided with the involvement of the student nurse [SN]. Patient Views: The patient consented to the joint crisis planning meeting. Obtaining informed consent is the obligation of the health practitioner (General Medical Council [GMC],2021). The patient expressed her willingness to engage with the plan; however, she reported that previous crisis plans were not clear enough to follow. The patient requested a handwritten joint crisis plan. Enabler(s): The patient was medically optimized before the assessment. She had full capacity during the planning process. (Mental Health Capacity Act, 2005). The patient had some insight into her mental health condition and freely shared her views about the plan. Barrier(s): However, if the patient was either incapacitated or severely mentally unwell, it would have hindered the planning process. (Mental Capacity Act, 2005). Clinical Expertise: According to the National and Midwifery Council [NMC], 2018, nurses must keep their patients safe. The SN understood the expectations of all nurses to keep patients safe through training. Previous placement experience in joint crisis planning in managing suicide risk among BPD patients was helpful. The clinical nurse specialist (CNS) had years of clinical experience and enough training on risk assessment and management of people with BPD. The CNS had several experiences in joint crisis planning. Enabler(s): The presence of an experienced CNS was key in the planning process. SN's previous placement experience helped to contribute to the planning. Access to patients' medical records before the crisis planning meeting was beneficial. A clear trust policy on health and safety is applied to all employees (National Health Service [NHS], 2020). Barrier (s): SN had only one previous placement experience and therefore had limited knowledge on joint crisis planning as this was the SN’s second time being involved in formulating a joint crisis plan with a patient. Guidelines/Research Evidence: National Institute for health and care excellence [NICE],2019 guidelines states that patients can identify how services can support them to live independent lives during joint crisis planning. Lequin et al. (2021) suggest that a joint crisis plan is perceived positively by the majority of patients, and it gives them the tool to gain better control of their mental health conditions and life. Johnson et al. (2008) state that agreeing on a discharge joint crisis plan will be significant in avoiding future challenges. A follow-up after a joint crisis plan, about half of the participants diagnosed with personality disorder reported a greater sense of control over their mental health condition and better interaction with their mental health team, according to a study published in the journal world psychiatry (World Psychiatry,2015). Policy directives urge professionals to involve service users in shared decision making (The health Foundation, 2012). Enabler (s): Access to various guidelines and trust policy documents, library resources and risk assessment templates was helpful in the decision making. Barrier(s): Lequin et al. (2021) argue that randomized controlled trials did not confirm they are the positive outcome. This seems to reduce the reliability of a joint crisis plan as a positive tool for patients. Context: The patient's care coordinator was unavailable to be contacted because of the time of the day. The care coordinator is the assigned professional who supports the patient's care package in the community and is therefore expected to have input during a joint crisis planning meeting. The patient may still require a crisis resolution team to support her for some time when discharged. Crisis resolution team support people with severe mental health conditions who are currently experiencing an acute and severe psychiatric crisis, which would require hospitalization without the team's involvement NHS, (2022). Conclusion: According to research guidelines, clinical expertise and patients' views are vital when supporting a patient diagnosed with BPD. The CNS and the SN decided to formulate a joint crisis plan that considered the patient's views. The experience of the CNS in joint crisis planning was essential in supporting the patient. Reliable research evidence, trust policy, patient’s views and the clinical expertise of both the CNS and SN all helped to ensure the patient receives the best of care. References: British Medical Journal,2002. Clinical Expertise in the Era of Evidence-Based Medicine and Patient Choice. https://ebm.bmj.com/content/7/2/36. Garland, J., & Miller, S. (2020). Borderline personality disorder: part 1 – Assessment and Diagnosis. BJPsych Advances, 26(3), 159–172. https://doi.org/10.1192/bja.2019.76. General Medical Council,2021. Explaining Risks and Seeking Informed Consent. https://www.gmc-uk.org/ethical-guidance/learning-materials/seeking-informed-consent. Johnson, S., Needle, J., Bindman, J. P., & Thornicroft, G. (Eds.). (2008). Crisis resolution and home treatment in mental health. Cambridge University Press. https://ebookcentral.proquest.com/lib/portsmouth-ebooks/reader.action?docID=355432. Lequin, P., Ferrari, P., Suter, C., Milovan, M