HLSC122 Evidence for Practice

Hierarchy of evidence can be defined as the core principles related to evidence based practice in nursing and healthcare setting that attempts to address the question related to the effectiveness of the care approach (Doleac, 2019). The evidence hierarchy allows the health care professionals and the nurses to adopt the top-down approach for locating one of the best evidences for well conducted systematic review as well as moving down to the next level of evidences for answering the question related to the effectiveness of evidence based practice adopted. This study will identify two of the best pieces of evidences or research studies and we’ll state whether these evidences feet according to the hierarchy of evidence while explaining the aim of the selection.

This study majorly focuses on the medical ground therapy at paediatric patient by discussing on the scenario of hospitalization among children which tends to have negative experience on them. Majority of the research studies have revealed that more than half of the patients who are majorly the children, experience anxiety and high level of restlessness while undergoing a surgical procedure during that free surgical setting. Hospital and healthcare organisations adopt clown therapy approach undertaken by healthcare professionals by implementing destructive strategies and interventions for reducing the anxiety level of the children at the paediatric setting.

Lopes-Júnior et al., (2020) adheres to the hierarchy of evidences since it is the best available evidence for the court principle of evidence based practice that attends to address the effectiveness of the Clown therapy in reducing anxiety and restlessness children at the paediatric setting during the preoperative scenario. Lopes-Júnior et al., (2020) in the study targeted to evaluate evidences from randomised controlled trial as well as non randomised control trial towards the effectiveness of the hospital clown therapy for several symptoms related to anxiety among children admitted in the paediatric setting with chronic and acute conditions. This research study is in line with the steps of the hierarchy of evidences. Firstly this study explores and discusses the background information together with expert opinion of the context of hospitalization and the symptoms that are seen among children during the pre operative setting. The research study father not discusses about the case-control studies and the case scenario by discussing about the emergence of hospital clown therapy at Northern America during the 1980 which has since became a popular practice at the paediatric setting. Towards the discussion of case study, this research for the most discussed on the American physician patch Adams that started clowning for the patient during the mid 1970 there by considering pioneer in the therapeutic clowning. The se of the hierarchy of evidences includes cohort studies as well as randomised control trials that has also been considered by the authors of this research study while conducting systematic review as the methodology of the research in guidance from the PRISMA protocols. Regarding critically appraise individual articles or article synopsis and evidence synthesis and guidelines under filtered information, the research study highlighted the search strategy as well as the selection of the research studies on an independent basis. The researcher of the study measured Cohen’s K for intercoder agreement at each of the screening phase for the systematic review. The overall research study focused on the systematic reviews related to data extraction and quality assessment followed by evaluation of the current studies related to the experience of the participants in line to the Clown therapy. The study focused on hospital clown therapy for the symptom cluster management among children by highlighting the significant decrease in the crying period and improvement in the emotional responses due to hospital clowns among children.

Könsgen et al. (2019) also followed the steps of hierarchy of evidences under the best available evidences of addressing the question of effectiveness of hospital clowns for children in paediatric unit. The background information followed by case-control studies and cohort studies reveal the operation areas of the clowns at the medical context which are multifaceted. The study focused on the cohort studies highlighting anxiety and distress which are common factors among children undergoing any specific medical procedure. This study also adopted randomised control trials in 2018 by searching Central, Medline and Embase. The researchers of the study adopted cochrane risk of the bias tool for assessing risk related to buyers of the included studies for the aim of primary outcome for address in children's anxiety. The study adhered to the level of critically appraise individual articles and evidence synthesis and guidelines followed by systematic reviews in evaluating 11 random control trials within 733 children who had the risk of high biasness. The overall systematic reviews of the research articles adopted by the researchers followed by primary research methodology revealed grounding to lower anxiety among children.

References

Doleac, J. L. (2019). Evidence-based policy” should reflect a hierarchy of evidence. Journal of Policy Analysis and Management, 38(2), 517-519.

Könsgen, N., Polus, S., Rombey, T., & Pieper, D. (2019). Clowning in children undergoing potentially anxiety-provoking procedures: a systematic review and meta-analysis. Systematic reviews, 8(1), 1-12.

Lopes-Júnior, L. C., Bomfim, E., Olson, K., Neves, E. T., Silveira, D. S. C., Nunes, M. D. R., ... & Lima, R. A. G. (2020). Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials. bmj, 371.

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