Limitations Of Evidence Based Practice

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This assignment aims to explore and to critically analyse the limitation of evidence based practice (EBP) in this article which is relevant to my current clinical practice setting. With the various form of EBP from the articles that I have chosen, I hope to be able to identify the strengths and limitations of EBP and differentiate each level of evidence in this research. I will use my critical thinking skills to critique the research journal and will give constructive recommendations and strategies to overcome barriers that will affect the implementation of this EBP in my workplace. People with end stage renal failure (ESRF) requiring haemodialysis (HD) keep on increasing each year in my workplace. Out of 62 HD patients in my workplace…show more content…
Out of 35 participant randomised for RLT, 1 commenced to BH, 1 died, 2 received transplants, 2 withdrew during the study and 29 participants complete the study. The quality of life subscales in mean scores for both groups are the same. The final inspection on the VA site is the same appearance but the data was not shown. Pain scores measured using Wong-Baker scale is the same at baseline mean of 0.81. 47 complications are recorded in 28 patients during the entire study, 33 complications in 17 patients on BH as compare with only 14 complications in 11 patients in RLT group. The overall results in my critique paper shows that BH cannulation resulted in more infection, haematoma formation and VA site pain than with the RLT. However, the researchers in this critique paper recommended a further larger scale longitudinal study to get the best evidence about the two techniques of needling VA in dialysis patients. I will get the best evidence from other research study, journals, articles and guidelines on VA to critique this study. I will use my critical thinking and analysis skills to prove that BHT is better that RLT in preventing VA…show more content…
As far as I concern, there is no guidelines or protocol about buttonhole cannulation in Malaysia. In this discussion, I use British Columbia VA Guidelines (2009) because this guideline is more suited and similar to our unit current practice. The contents of this guideline are including the indications of BHT, risk factors, caregiver characteristics, prevention, treatment, monitoring of VA infection, cannulaltion of buttonhole using sharp and blunt needles, removal of the scabs, skin disinfection protocol and needle removal. I feel that this guideline is very useful for us to follow. To conclude, BHT will reduce complications and prolonged VA life compared to usual practice of RLT provided that the dialysis staff and patients should be educated on BHT and correct timing for changing from sharp to blunt needles. The problem of infected VA can be overcome by training of the dialysis staff about this procedure and after attending the course, they must do eco-training to other clinical staff and

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