Preventive medicine can be categorized as primary, secondary, or tertiary. Primary prevention aims to remove or reduce disease risk factors and is the principle activity of the Health Guardian. Secondary prevention techniques promote early detection of disease or precursor states normally beginning with a holistic health assessment. Tertiary prevention measures are aimed at limiting the impact of established chronic disease through strategic lifestyle changes.
The steps of a Evidence Based Practice, which the Health Guardian masters, centers around cultivating a spirit of inquiry. They must ask compelling and provoking clinical questions. The objective is the finding and identification of relevant evidence used to answer these clinical questions. The Health Guardian must critically appraise the gathered evidence, become an expert in the art of moving evidence to a sustainable effort of change. Many times, success revolves around the ability to create and sustain a culture and environment for long-term evidence-based caregiving.
In some cases, the Health Guardian is out of touch with weakness or emerging threats. This is made possible by not pushing your current limits. In a lifestyle of complacency, it can be very difficult to identify weakness, and it's only when we attempt doing activities out of the norm that we discover we could use some strengthening in a particularly under used organ system.
Many times, we can get the impression that the Health Guardian avoids the rest of the medical world. In truth, it’s just the opposite. As a member of the Primary Care Team, the Health Guardian must maintain dialogue with other professionals. They should collaborate with others, and of course stay current by reading accepted literature. But, accessing data is one thing. Creating dialogue on the data is something entirely different and more productive when it comes to change and health improvement. Dialogue should aim for a joint understanding of health problems. Dialogue is a means by which Health Guardians, team members, peers at large, and loved ones can inform each other of their assumptions and their diagnoses.
Continually increasing health standards is key to pathology prevention, addressing chronic illness, increasing self-reliance, and quality of life. Of course, this implies that the Health Guardian is aware what the current standard is, and where the constraint to health improvement is. Addressing a health issue that isn’t the current constraint will produce no observable result. Also, the increased health expectations create dissatisfaction with the current level of living. As you may or may not have heard, change and health transition management involves many factors and is no small task. But the Health Guardian must begin somewhere, do what they can now, and continually research and implement this practice.
Given the consistent need for current information in Healthcare, frequently updated databases that hold the latest studies reported in journals are the best choices for finding relevant evidence to answer compelling clinical questions. It is imperative that all Health Guardians have some connection with librarians and access to databases. With your PICOT question in hand, your next step is to determine the sources most likely to contain the best evidence. The Health Guardian need peer-reviewed research to answer their questions, and most often the source of that evidence will be a database of published studies. These databases contain references to the healthcare literature, including conference proceedings, books, or journal publications. Knowing how to search these databases is essential to a quick, successful retrieval of answers to a clinical question.
Answers to clinical questions may be found in a variety of evidence sources, ranging from your practice data found in the healthcare record to research articles in journals. The transition of evidence to electronic format has enabled clinicians to gain more immediate access to external evidence through the use of point-of-care resources that integrate almost seamlessly into the electronic health record (EHR). Various types of evidence sources exist, including textbooks, journals and consolidated sources.
Which evidence source or data base is a good match to your clinical question? Reliable, accurate evidence is needed to reduce the risk, uncertainty, and time involved in clinical decision making that will lead to desired patient outcomes. For point-of-care decisions, Health Guardians may choose to consult one of the pre-appraised summarized sources mentioned earlier. However, when making practice changes, it is important to either find a synthesis that has conducted an exhaustive search or get as close to that as possible by searching multiple databases to try to ensure that studies are not missed.
Sources of evidence located through such search engines as Google or Google Scholar can provide value for background information; however, caution should be used and careful evaluation of the evidence retrieved from these sources is required. Health Guardians should follow an appraisal process to ensure the information is reliable. When choosing between Google and Google Scholar, busy Health Guardians need to keep in mind that Google Scholar searches across evidence that is found primarily in academic publications and will therefore be mostly peer-reviewed evidence, although the publications will vary in quality.
Within the Health Guardian’s Clinical Strategy, the ‘burning clinical question’ needs to be stated to drive clinical investigation, diagnostics, and care practice. This ‘burning clinical question' needs to be stated in PICOT format, or Patient population, Intervention or issue of interest, Comparison intervention or group, Outcome, and Time frame. This is to assure that the Health Guardian’s practice yields the most relevant and best evidence from a search of existing literature. The strategy should include a prioritization method for multiple questions, and prevents biased decisions based on that which the Health Guardian is most familiar with, or that which provides the least path of resistance. But rather, points the Health Guardian to the best and most relevant randomly controlled trials or other evidence.
Strategic plans should include methods of conducting searches for best evidence by considering the elements of the PICOT questions. Each of the keywords from the PICOT question should be used to begin the systematic search. The strategy should include a hierarchy of evidence used to address interventions and/or issues. This is a suggested hierarchy for the different levels of evidence for each kind of PICOT question. Level - l Evidence from a systematic review of all relevant randomized controlled trials (RCTs). Level – 2 Evidence obtained from well-designed RCTs. Level - 3 Evidence obtained from well-designed controlled trials without randomization. Level – 4 Evidence from well-designed case-control and cohort studies. Level – 5 Evidence from systematic reviews of descriptive and qualitative studies. Level – 6 Evidence from a single descriptive or qualitative study. Level – 7 Evidence from the opinion of authorities and/or reports of expert committee. Although studies are compared and contrasted in narrative and integrative reviews, a rigorous methodology with explicit criteria for reviewing the studies is often not used, and a summary statistic is not generated. Therefore, conclusions and recommendations by authors of narrative and integrative reviews may be biased.
The Clinical Strategy of the Health Guardian should also include critical appraisal methods of evidence including components of rapid critical appraisal, evaluation, and synthesis strategies. This is vital in that it involves critical appraisal of the evidence obtained from the search process. Although the Health Guardian may view critical appraisal as an exhaustive, time-consuming process, the first steps of critical appraisal can be efficiently accomplished by answering three questions as part of a rapid critical appraisal process in which studies are evaluated for their validity, reliability, and applicability to answer the clinical questions. These questions ensure relevance and transferability of the evidence to individual Health Guardian.
How will the Health Guardian integrate the evidence with their clinical expertise and family preferences to make the best clinical decisions, and put evidence into action? Your Strategic Clinical Plan should outline this. In addition, consumers of healthcare services, and others impacted, want to participate in the decision-making process. It is the ethical responsibility of the Heath Guardian to figure out just how to involve all impacted in treatment decisions. A Health Guardian also needs to determine how to assess healthcare resources that are available to implement a specific treatment decision, which is a critical part of the Clinical Strategy. The extended family culture is another important consideration when implementing evidence into your practice.
Your Clinical Strategy should also describe a plan for evaluating the outcomes of practice change-based on evidence. This type of evaluation is essential to determine whether the change-based evidence resulted in the expected outcomes when implemented in the real-world clinical practice setting. Measurement of outcomes is important to determine and document the impact of your healthcare quality and practice.
Dissemination of the outcomes of the evidence-based practice is also an important part of your clinical strategy. All too often, Health Guardians achieve many positive outcomes through making changes in their care, based on evidence, but those outcomes are not shared with others, even family members facing the same issues. As a result, others do not build upon your outcomes nor the process that led to them, and Health Guardians and family members in other settings do not benefit from that knowledge.
The decision-making steps of EBP, which the Health Guardian masters, centers around cultivating a spirit of inquiry, shrouded within the scientific method. EBP helps the Health Guardian determine an effective course of action for care delivery. EBP involves the five steps of: forming a clinical question to identify a problem, gather the best evidence, analyze the evidence, apply the evidence to a holistic practice, assess the results.
Palliative care is a subcategory of Clinical Practices focused on improving quality of life for people living with serious illness. Serious illness is defined as “a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/ or is burdensome in symptoms, treatments or caregiver stress.” Palliative care addresses and treats symptoms, supports patients’ families and loved ones, and through clear communication helps ensure that care aligns with patients’ preferences, values, and goals.
Palliative care is the responsibility of all Health Guardians and Clinicians. They should have the skills to provide “primary palliative care” including managing pain; treating dyspnea; identifying mood disorders; communicating about prognosis and patient preferences for care; and helping address spiritual distress. Randomized studies have shown that palliative care provided alongside disease-focused treatment can improve quality of life, promote symptom management, and even prolong life.
Near the end of life, palliative care may become the sole focus of care, but palliative care alongside cure-focused treatment or disease management is beneficial throughout the course of a serious illness, regardless of its prognosis. Palliative care includes management of physical symptoms, such as pain, dyspnea, nausea and vomiting, constipation, delirium, and agitation; emotional distress, such as depression, anxiety, and interpersonal strain; and existential distress, such as spiritual crisis.