Evidence-Based Practice and Applied Nursing Research


The paper will highlight mainly Arredondo et al ’Expanding Cultural Considerations: Challenges and Promises. Some material can considerably support the idea that evidence-based practice is useful in medical practice or other health-related fields. Though most professionals cannot conclusively confirm teat the rehabilitation techniques lead to healing and depicted cultural competency, this concept remains critical in health (Acevedo, 2008, p. 112). Regardless of the good intent that many researchers and scholars could have, there is a lofty try to develop instruments that gauge the level of cultural competence. Furthermore, since there is no strict or standard definition of cultural competence it’s very of the idea to put it into real practice. Very few studies have so far made us of experimental designs to study culture competence while others have used quasi-experiment to active similar results. This is because it’s very hard to measure the level of the provider’s competence in terms of cultural sensitivity. The study indicated that over 54 measures have so been used in some instances to assess the cultural competence levels.

The most common tool is tri-partite as identified by Arredondo and colleagues (Bhui et al, 2007, p. 3). This tool covers the aspects of awareness, skills of the provider as well as the extent of knowledge (Acevedo, 2008, p. 112). The examples here include the Multicultural Counseling inventory that has been successful in some studies though it’s not been exploited fully. The second example is multicultural Awareness Skills and Knowledge are also very important. Considering the arbitrary nature of the definition of cultural competence, there is a wider range of methods that have been developed to assess the outcome of the concept. As a result, it’s been very hard to prove that cultural competence improves the results of the patient (Arredondo et al, 2008, p. 262). On the whole, however, a patient that has undergone culturally competent therapy has been found to cope very well and progress faster due to a positive response to the intervention.

Ethical Issues

Management problem: There are a lot of issues that come along when evidence-based practice is being put to work. This concept is a global issue and its purpose is to find a standard guide in medical practice that is founded on exclusionary quantitative scientific study. The study may have experienced the following ethical implications from various perspectives (Bhui et al, 2007, p. 3). As many researchers push the efforts to find evidence-based solutions in the medical field, it’s imperative to integrate these researches into real practice in operational and nursing practice (Arredondo et al, 2008, p. 262). It is also becoming a requirement for hospitals to exercise this type of treatment to increase their credibility. As more hospitals, therefore, adopt this type of intervention, there is no clarity between using the method for quality improvement or as research.

There is no clarity between several types of evidence-based undertakings that result in ethical issues which could be unrecognized in a real clinical setting environment. This is because the over-zealous nurses could lack proper training to conduct the study.

It’s been a real challenge to determine whether the evidence-based practice is set to study medical practice as a research or as a quality improvement tool. This way it’s almost very hard to determine the type of regulation that deals with it. Are the human subjects protected the same way nursing research does or which way is this done? A major concern is that there has been no guideline set to direct the study.

Patient autonomy is very critical and should be respected at all times and by all means. This will come to play particularly when addressing the consequence3s of evidence-based medicine. The patient and doctor have to deliberate on the form of treatment rather than offering very limited options which narrow down to one sensible option against other irrational ones(Bhui et al, 2007, p. 3).

The Research Model Used

The tools of study: The study is a meta-analysis model whereby a broad range of relevant literature has been sought both published and unpublished. The materials eligibility included all the papers and researches done after the 1980s unto the current ones. In the first part of the paper, the researchers address the tools that are used for retrieving starting with what is included and what should not be included in the study. The criteria are then used to describe the database and strategies that are relevant in identifying the best information for the topic (Arredondo et al, 2008, p. 262). The screening process and other procedures are also described here. The second part of the research deals with the methods that were applied to make the meta-analysis. The quality is described and summarized. Data sources, processes, and analyses are also discussed. The eligibility criteria were simple with the following being included. All languages from the 1980s to the present with participants aged 18 years and above. The researchers used culturally competent means of the intervention of a medical problem. Researchers included studies in environments like rehabilitation centers and healthcare surroundings. The level of understanding of the meaning of disability, patient’s attitude, and overall beliefs concerning disability (Ida, 2007, p. 51). Researchers utilized random control trial whereby the control and the sample were involved with control getting normal care while participants taking evidence-based therapy.

The exclusion of researches included the use of one group of participants in pre and post-test. Those researches that did offer any kind of treatment were excluded and even those whose participants were less than 18 years. All the information that fitted the criteria of the study was involved in the research.

The search strategy was to develop a primary strategy for MEDLINE and these researches were accessed through PubMed. Medical topics (MESH) were used and keywords helped narrow down to the key sources. Cultural competence, disability, and intervention were the major words used. The researchers also carried out hand searches by making use of the electronic databases. The Grey Literature technique was also very beneficial in identifying relevant information for the study. Relevant information was retrieved by using the online style of accessing library materials by requesting them from authors (Ida, 2007, p. 51). The abstracts were screened and also a full-text screening was to identify the viability of the sources. Participants were randomly assigned to control and experimental groups.

Other Appropriate Types of Research

Systematic reviews form another strategy that can be used for research besides Meta-analysis. This is where peer-reviewed articles and papers that are specifically addressing a certain topic, a health problem in this context are re-examined (Arredondo et al, 2008, p. 262). The exercise is usually very rigorous and standardized for these publications. Systematic reviews are currently gaining momentum in their use in the medical field and thus replace other techniques like traditional narratives and sources like expert commentaries.

Systematic reviews make an effort of bringing rigor to the same level while reviewing the research evidence the way the results should be in the first place. The reviews are entirely n based on the peer-reviewed procedure to ensure reproducibility. Essentially if this technique could have been used in the place of meta-analysis, then it could have had the benefits of identifying all relevant information from the unpublished as w well as the published material sources (Ida, 2007, p. 51). The process would choose studies to be assessed. The style also helps to synthesize the outcomes of individual researches into a report that is unbiased (Cartwright et al, 2008, p. 318). Finally, the findings are presented in a manner that is balanced and impartial to address flaws and other considerations.

Systemic review is very important in the medical field considering that there was an explosion in the past century about fields in medical including nursing, medical and allied health care. The trend continues ae3ven today and it has become very difficult to keep track of the primary inventions and innovations or other studies. There is also increased utilization of the internet where articles can be accessed online. Furthermore, medical practitioners face the challenge of building on their skills and increasing utilization of a greater range of electronic media and practical skills (Cartwright et al, 2008, p. 319). There is hence a need for quality information. A systematic review is hence the best way to assess these relationships and assist in drawing sensible conclusions.


With increased technology and extensive studies in the field of medical services, many changes have been proposed concerning the best practice or alternatives for treating patients since health is a very sensitive issue. For this reason, those practices that are founded on concrete evidence are usually very admissible by many practitioners. Experts also insist that the best care should be founded on evidence. In this way, the use of evidence-based practices demands the decision about a health care issue or system be founded on the best alternative available, that is recent, valid and there should be appropriate evidence to back the decision. The decisions in these cases are madder by the patients and they are founded on the knowledge they obtained un-stated from the practitioners within the framework of the available resources.

The current developments in medical care, research requires that any conclusions that will be drawn from a study be supported with extensive scientific knowledge. This is called evidence-based practice in the field of medicine. Under this model, doctors and other medical practitioners are required to prepare clinical research subject of the matter or question in the form of the Problem targeting a particular Population, the possible and subsequently narrowing to the best Intervention, making Comparison of the intervention and then reporting the outcomes. These elements form a model referred to as the PICO paradigm. This guideline is very important in medicine especially clinical investigations and helps to structure clinical questions and to present doctors’ information. PICO structure is fundamentally focused on therapy questions and not very useful in the presentation of other types of medical information.

Recommendation of a Specific Nursing Strategy

Counselors, psychiatrists, and other medical practitioners have over the years been challenged by the changing and well-informed world to be competent when it comes to multicultural awareness issues. This paper identified multicultural ability in the framework that is very critical in guiding the counselors and other practitioners carrying out their roles rationally and ensuring patient service is enhanced. Addressing the issue of cultural diversity is very imperative amidst broad speculation that human health services need to take into consideration cultural diversity to achieve the required results.

Reason for the Recommendation

Past studies and literature indicate that multicultural competence should be conceptualized in three basic dimensions namely; Self-awareness, skills, and knowledge. These dimensions form the basis on which counseling and rehabilitation take place. The multicultural counselors and rehabilitation providers have also developed simple practice guides based on these elements. They are regarded as dependable and moral standards to be guiding the intervention applicable to the broad diversity of clients that professionals are bound to meet. Amidst universal advancement towards achieving competitive mental healthcare, there is a lot of pressure on professional practitioners to work with evidence but still retain patient autonomy. Indeed research suggests that multicultural competence is the keystone in health practice, though future investigations are still recommenced because the evidence is still little but promising. Due to this achievement, researchers have managed to evaluate multicultural competence from a mental healthcare provider’s perspective, patient’s viewpoint, and even third-person way of thought.

Reference List

Acevedo, V. (2008), ‘Cultural Competence In A Group Intervention Designed For Latino Patients Living With HIV/AIDS,’ Health & Social Work, 33, 111-120.

Arredondo, P., Tovar-Blank, Z. G., & Parham, T. A. (2008),’Expanding Cultural Considerations: Challenges and Promises of Becoming a Culturally Competent Counselor in 80 A Socio-political Era of Change and Empowerment,’ Journal of Counseling & Development. 86, 261-268.

Balcazar, F. E., Suarez-Balcazar, Y., & Taylor-Ritzler, T. (2009), Cultural competence: Development of a conceptual framework. Disability and Rehabilitation, 31, (14), 1153-1160.

Beach, M.C., Price, E.G., Gary, T. L., Robinson, K.A., Gozu, A., Palacio, A., Smarth, C., Jenckes, M.W., Feuerstein, C., Bass, E. B., Powe, N.R., & Cooper, L.A. (2005), ‘Cultural Competence: A Systematic Review of Health Care Provider Educational Interventions,’ Medical Care, 43, (4), 356-372.

Bhui, K., Warfa, N., Edonya, P., Mckenzie, K. & Bhugra, D. (2007), ’Cultural Competence in Mental Health Care: A Review of Model Evaluations,’ BMC Health Services Research, 7, (15), 1-10

Cartwright B. Y., Daniels, J. & Zhang, S. (2008), ‘Assessing Multicultural Competency: Perceived Versus Demonstrated Performance,’ Journal of Counseling & Development, 86, 318–322

Dressler, D. & Pils, P., (2009),A Qualitative Study on Cross-Cultural Communication in Post-Accident In-Patient Rehabilitation of Migrant and Ethnic Minority Patients in Austria,’ Disability & Rehabilitation, 31(14), 1181 – 1190

Ida, D. J. (2007), ‘Cultural Competency and Recovery within Diverse Populations,’ Psychiatric Rehabilitation Journal, 31, (1). 49-53

Kumas-Tan, Z. O., Beagan, B. L., Loppie, C., Macleod, A. & Frank, B., (2007), ‘Measuring Cultural Competence: Examining Hidden Assumptions in Instruments,’ Academic Medicine, 82, (6), 548-557.

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