Analysis and Application of Clinical Practice Order Instructions: You will develop a summary that you could use within an evidence-based practice (EBP) committee or related venue to share with your colleagues.
•Select (1) one of the following issues: HOMELESS
• Analyze and critique the guidelines and complete the Clinical Practice Guideline Summary Sheet in Doc Sharing. Components include
o scope and purpose of the clinical practice guidelines;
o stakeholder involvement;
o the rigor of development;
o recommendations; and
o application.
References should be no more than 5 years old. Please see attached rubric and guidelines for the summary.
Analysis and Application of Clinical Practice Sample Answer
Analysis and Application of Clinical Practice Guideline
Scope and Purpose
The document addresses HIV and AIDS as two distinct diseases (Audain, Bookhardt-Murray, Fogg, Gregerson, Haley, Luther, Treherne, & Knopf-Amelung, 2013). It is targeted toward disease management practices, their prevention, as well as treatment. In addition, the guideline includes the diagnosis, evaluation, and patient counseling practices in its scope for the two ailments. The document covers multiple medical specialties including infectious diseases, obstetrics and gynecology, hematology, and psychiatry among others. The targeted users of the document include advanced practice nurses, physicians, pharmacists, nurses, dieticians, social workers, public health departments, and other relevant groups. The document has the objective of assisting clinicians to offer high-quality services to unstably housed HIV patients. The designers of the guideline hope to do so by providing evidence-based recommendations regarding optimal management practices for patients of HIV and AIDS in the selected population. The targeted patient population for the guideline is unstably housed people including the youth, women, minority groups, and immigrants. The guideline investigates the prevalence rates for both HIV and AIDS among the selected population. It also focuses on important concepts of the diseases such as CD4 cell count and viral loads among users of antiretroviral medications. Other considered outcomes include the complications of the two diseases, their morbidity, as well as mortality. The interventions in the guideline focus on disease diagnosis, treatment, as well as management.
Stakeholder Involvement
The document engages different professionals as well as lay people. It includes peer educators, peer advocates, and outreach workers who are expected to facilitate access to the targeted patient population (Audain et al., 2013). The group would also facilitate practices such as diagnostic testing and treatment of individuals for the two diseases. The team also includes clinical professionals who are expected to actively engage patients when delivering services to them. The clinical team includes paraprofessionals in addition to professionals. Clinicians are expected to assess patients and understand their personal challenges influencing their management of the selected diseases. Stakeholders from the clinical setup would base their care on patient-centeredness so as to engage patients in decision-making approaches. Clinicians also have the role of addressing psychosocial and medical factors that bar patients from accessing high-quality health care. Team members would establish a therapeutic relationship with the patients and build mutual trust. The team would engage in regular meetings so that members can support one another and promote professionalism. Members would also engage in continuous education so as to promote both active engagement and professionalism. Possible conflicts of interest include a tendency by healthcare professionals to pursue financial gains at the expense of patient wellness during the study. For instance, some professionals may be motivated by marketing drugs and other services to the target population rather than focusing on helping the troubled community. However, the authors state that the clinician network would practice in a way that it avoids any conflicts of interest. The network further indicates that members who would have conflicts of interests would disclose them and withdraw from making decisions where the conflict of interest would happen (Audain et al., 2013).
Rigor of Development
The developers of the guideline relied on both primary and secondary sources of data. They also consulted electronic databases, and they used both qualitative studies and randomized control trials hence enhancing the rigor of their document. The developers relied on authoritative and reliable data from sources such as World Health Organization, National Health care for the Homeless Council, Pubmed, and Google Scholar (Audain et al., 2013). The designers also enhanced the rigor of the guideline by ensuring that their data search was thorough, and it covered a considerably lengthy period of clinical practice. In their development of the guideline, the authors considered pre-existing guideline and borrowed insight from informative bibliographies (Audain et al., 2013). The authors also indicated that their inclusion criteria involved an expert evaluation of the importance of different sources to clinical practice. Only sources that would apply to clinical care for homeless persons with HIV or AIDS were included. Shortcomings in the developing the rigor of the document include failure by the authors to indicate the exact number of sources they consulted. Also, the authors failed to indicate the methodologies they applied in determining the quality of the sources they used. Again, the authors did not indicate the methods they used in analyzing the evidence they gathered. However, the developers indicated clearly that they used expert consensus when developing the recommendations. They also peer reviewed the document before publishing it. Such activities were necessary in enhancing the rigor of the document. The authors also indicated the benefits of applying the guideline to the target community. The primary benefit was that the guideline would increase the accessibility of standard healthcare services to homeless persons who had HIV or AIDS. In addition, the authors outlined the potential harms of applying the guideline to clinical practice. The document advocated for the use of antiretroviral medications, yet patients could develop severe reactions to the drugs. The living conditions including lack of proper shelters would exacerbate side effects such as explosive diarrhea, a reaction that often accompanies the use of protease inhibitors. In addition, symptoms such as nausea and numbness would be exaggerated if patients did not take enough food. The treatment of HIV and AIDS may also trigger mental illnesses, and the guideline placed patients at such a risk. Other severe occurrences associated with the interventions proposed in the guideline include development of Stevens-Johnson syndrome and hepatic impairment.
Recommendations
The document offered recommendations for the design of service delivery, engagement of stakeholders, effective diagnostic approaches, and patient management strategies (Audain et al., 2013). The recommendations would have optimum applicability to nursing practice. A plan developed on the basis of the recommendations would require clinicians to establish flexibility in the service system. They would do so by allowing walk in appointments, providing outreach services, and resolving challenges instantly (Audain et al., 2013). The document also requires clinicians to facilitate the accessibility of mainstream health care to the patient population of interest. Again, the stakeholders would coordinate interdisciplinary practice so as to provide healthy foods to the patients, proper housing facilities, clothing, and other fundamental needs. Nurses would play the role of treatment advocates where they would encourage medication adherence among the selected population (McCarthy, Voss, Verani, Vidot, Salmon, & Riley, 2013). They would establish therapeutic relationships with the patients and educate them on the benefits of adhering to treatment when managing diseases. They would also be educators where they would enlighten patients on the basics of HIV and AIDS. They would teach the population on preventive measures and management practices that would promote the quality of their lives. In addition, nurses would educate patients on effective self-management approaches to maintaining one’s health at its best. The professionals will also be important in diagnosing and testing target populations for the two diseases (Kurth, Lally, Choko, Inwani, & Fortenberry, 2015). Their contribution would require financial support from the relevant agencies. Crucial facilities for the effective implementation of the interventions include correctional facilities and shelters. The professionals would also require laboratory equipment that would not only enable them determine the HIV and AIDS status, but also the health of their clients regarding other illnesses such as hepatic impairment and tuberculosis. For optimal outcomes of their interventions, nurses would also require to provide basic commodities such as food to their clients, especially if they suggest that patients use antiretroviral drugs. Other needs that would require financial input include educative materials such as books as well as things such as protective condoms.
Implementation
The authors of the document did not include an implementation strategy for their guideline. The guideline is associated with the occurrence of numerous undesirable experiences for patients. Such complications would hinder the adoption of the proposed approaches to disease management. In addition, the selected population is likely to face multiple personal challenges and they may not cooperate in the promotion of their health. Patients may also face societal stigmatization and fail to contribute actively to the implementation of the suggested strategies (Saki, Mohammad Khan Kermanshahi, Mohammadi, & Mohraz, 2015). Also, the scheme would require considerably large amounts of funds that may not be available. The above factors would be hindrances to the effective implementation of the interventions. The authors did not include a cost analysis in their document. Their proposed interventions would require the healthcare sector to invest more in the care of HIV and AIDS patients. The sector would also make such that care is accessible to the disadvantaged population. In addition to medication, the document advocates for provision of basic services to the unstably housed population. Such a move would necessitate extra funding in the healthcare sector. Reduced morbidity and mortality of HIV and AIDS among the selected population would be outcome indicators for the interventions. Other indicators would include improved quality of lives among the target group.
Analysis and Application of Clinical Practice References
Audain, G., Bookhardt-Murray, L.J., Fogg, C .J., Gregerson, P., Haley, C .A., Luther, P., Treherne, L., & Knopf-Amelung, S. (Editor). (2013). Adapting your practice: treatment and recommendations for unstably housed patients with HIV/AIDS. Nashville, TN: Health Care for the Homeless Clinicians’ Network, National Health Care for the Homeless Council, Inc.
Kurth, A. E., Lally, M. A., Choko, A. T., Inwani, I. W., & Fortenberry, J. D. (2015). HIV testing and linkage to services for youth. Journal of the International AIDS Society, 18(2Suppl 1), 19433. http://doi.org/10.7448/IAS.18.2.19433
McCarthy, C. F., Voss, J., Verani, A. R., Vidot, P., Salmon, M. E., & Riley, P. L. (2013). Nursing and midwifery regulation and HIV scale-up: establishing a baseline in east, central and southern Africa. Journal of the International AIDS Society, 16(1), 18051. http://doi.org/10.7448/IAS.16.1.18051
Saki, M., Mohammad Khan Kermanshahi, S., Mohammadi, E., & Mohraz, M. (2015). Perception of Patients With HIV/AIDS From Stigma and Discrimination. Iranian Red Crescent Medical Journal, 17(6), e23638. http://doi.org/10.5812/ircmj.23638v2
