NURS FPX 4025 Assessment 2 Applying an EBP Model

Name

Capella university

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Applying an EBP Model

Status Epilepticus (SE) represents a medical emergency that features recurrent seizures that occur without seizure recovery time, requiring urgent medical care. An untreated case of this emergency medical situation results in severe complications affecting brain cells and the body’s functioning, as well as increased chances of death (Arnet et al., 2023). An Evidence-Based Practice (EBP) model is a framework for finding research with high-quality standards that can optimize diagnosis and treatment with improved patient results. The paper investigates SE diagnosis using the Johns Hopkins Evidence-Based Practice (JHNEBP) model to evaluate high-quality research supporting informed clinical decisions.

Issue Associated with the Diagnosis

Patients develop SE through three different circumstances, including the deterioration of existing epilepsy along with new-onset seizure disorders and from medical conditions unassociated with epilepsy. The use of improper anticonvulsant drugs impacts SE development in adults and children who have received an epilepsy diagnosis. Research shows that nonadherence to prescribed medication schedules in patients with SE contributes to epilepsy. Studies demonstrate that suboptimal anticonvulsant levels exist in 34% of adult patients and 21% of child patients with SE. SE affects 18.3 to 41 out of 100,000 Americans annually throughout the United States, demonstrating this neurological emergency’s broad scope (Lu et al., 2020).

One critical issue associated with SE is medication nonadherence in epilepsy management, which increases the risk of prolonged seizures. Failure to adhere to anticonvulsant therapy results in breakthrough seizures and health complications in patients with SE. It also causes more hospital stays and deteriorated long-term neurological consequences. Mediating the best clinical practices to enhance medication adherence in at-risk patients remains essential for lowering SE occurrence and intensity (Arnet et al., 2023).

Medical practitioners who utilize an EBP model systematically design and implement research-tested approaches, which include patient education programs to boost medication compliance and stop SE. An EBP approach proves advantageous as it enables clinical decisions to use the best evidence while incorporating patient preferences and expert clinical insights. Healthcare professionals use a thorough review of recent research to identify adherence interventions that achieve their best outcomes in actual clinical practice. EBP implemented in epilepsy care by healthcare providers helps minimize the incidence of SE and decrease its impact on patients (Mersal et al., 2021).

EBP Model and Its Steps

The JHNEBP model follows the PET framework, which includes Practice Questions, Evidence, and Translation, a problem-solving approach for healthcare staff that integrates research results into clinical practice (Johns Hopkins Medicine). Using JHNEBP, nurses can research the relationship between medication nonadherence in epilepsy care and SE. The Practice Question step begins with identifying relevant clinical issues and creating a focused question to navigate the evidence search.

The research question focuses on how EBP works to improve medication adherence among epilepsy patients, which reduces the occurrence of SE. The Evidence step requires doctors to execute literature surveys while valuing research outcomes and extracting the evidence from the available studies. This process stage examines evidence-based support for interventions, including patient education programs, digital adherence monitoring, and pharmacist-led medication reviews.

The final step of Translation integrates identified evidence into clinical practice through assessing feasibility and evaluating patient outcomes measurement. The care process for improving SE medication adherence should include developing organized adherence frameworks and healthcare provider training in motivational interviewing and electronic medicine timetable alerts.

The JHNEBP model works best and is appropriate for this issue since it establishes an organized method to turn research evidence into usable solutions, benefiting patients directly. The model allows healthcare professionals to implement EBP, which maintains sustainability based on individual patient requirements, enhancing epilepsy care and SE prevention (Piccicacchi & Serino, 2024).

Application of the Model to Evidence Search

Searching for evidence about medication nonadherence in SE followed the JHNEBP model by applying the PET framework. The initial Practice Question step demanded the formation of a research question that concentrated on the clinical issue. The research question through PICO methodology focused as: In epilepsy patients at risk of  SE (P), how do evidence-based adherence interventions (I), compared to standard patient education (C), improve medication compliance (O) over 12 weeks (T) (Mersal et al., 2021)? The keywords used for research are “status epilepticus,” “medication adherence,” “antiepileptic drugs compliance,” “nonadherence and seizure control,” and “epilepsy management. 

Evidence collection involved a systematic review of medical literature through PubMed, CINAHL, Cochrane Library, and Google Scholar, focusing on medication adherence interventions for epilepsy management. The process of selecting peer-reviewed research faced obstacles because several studies demonstrated weak clinical trials or employed small participant numbers.

NURS FPX 4025 Assessment 2 Applying an EBP Model

In the Translation phase, healthcare professionals evaluated evidence integration approaches by implementing mobile health (mHealth) adherence tools, pharmacist-led interventions, and behavioral counseling. Implementing different interventions across different healthcare settings required assessing factors such as patient literacy, socioeconomic status, and healthcare access because these elements affected treatment adherence outcomes. Through the JHNEBP structure, a structured method enabled nurses to gather evidence to create practical intervention methods that improved medication adherence and decreased SE risks despite the difficulties encountered (Piccicacchi & Serino, 2024).

Credibility and Relevance of Resources

The CRAAP (Currency, Relevance, Authority, Accuracy, and Purpose) criteria help healthcare providers assess the validity and applicability of sources involving SE and medication adherence. A recent systematic review from the Cochrane Database of Systematic Reviews examines how to improve patient adherence to antiepileptic drugs (AEDs) (Al-Aqeel et al., 2020). This recent source satisfies the Currency criterion because it belongs to the most up-to-date research field. The source demonstrates direct significance to this topic because it contains evidence-based strategies to enhance medication adherence.

According to Al-Aqeel et al. (2020), the effectiveness of education and counseling for individuals with epilepsy showed varied outcomes, with moderate certainty in the evidence. In contrast, behavioral strategies, such as frequent reminders, demonstrated a more positive impact on adherence, also supported by moderate-certainty evidence. The source maintains its accuracy because it follows a methodological framework that involves reviewed findings from various clinical investigations. Since it serves educational and research goals, the purpose of this information is to make it reliable for clinical practice guidance.

Keikhosrokiani et al. (2024) evaluated the effectiveness of mobile health (mHealth) intervention regarding medication compliance improvements for epilepsy patients. Using updated research with strong evidence makes this study more credible than discussions from experts or observational findings. The results showed that a personalized mHealth solution can improve the digital care pathway for epilepsy by managing medications and tracking seizures. The study authors work at leading research institutions, proving their authority and expertise to the readers. 

NURS FPX 4025 Assessment 2 Applying an EBP Model

Healthcare professionals benefit from best practices and adherence strategies in SE management, which are presented by the American Epilepsy Society (AES) (Vossler et al., 2020). The document by Vossler et al. (2020) maintains its high credibility because it contains expert consensus alongside clinical recommendations built from comprehensive research, although it is somewhat older. The strength of the relevance lies in its supply of standardized guidelines used throughout healthcare institutions.

Since the medical organization boasts respected authority, it ensures that the information stems from expert consensus. The study by Vossler et al. (2020) on the diagnostic and management strategies for SE is relevant for these tasks. For example, the authors recommend that first-line treatment for SE should begin with a bolus of IV lorazepam, diazepam, or phenobarbital. This guideline helps nurses in early intervention, medication administration, and monitoring of treatment effectiveness for patients with SE.

Conclusion

An EBP approach is essential to improve patient outcomes when treating SE and medication nonadherence. The JHEBP model presents a formal collection of procedures to identify and measure the value of interventions that boost medication adherence effectiveness. High-quality materials from clinical guidelines, randomized controlled trials, and systematic reviews underwent a systematic review for both credibility assessment and relevant content evaluation. AES guidelines emerged as the most applicable diagnostic tools because they offer standardized, evidence-based recommendations that medical practitioners commonly use. Healthcare providers can enhance neurological outcomes and lower the risk of SE while developing more effective medication adherence strategies by using this research.

References

Al-aqeel, S., Gershuni, O., Al-sabhan, J., & Hiligsmann, M. (2020). Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy. Cochrane Database of Systematic Reviews, 2020(10). https://doi.org/10.1002/14651858.cd008312.pub4  

Arnet, I., Dietrich, F., Rüegg, S., & Allemann, S. S. (2023). Nonadherence and epileptic emergency—reasons and solutions. Clinical Epileptology, 36(4), 280–287. https://doi.org/10.1007/s10309-023-00627-8  

Johns Hopkins Medicine. “Johns Hopkins Evidence-Based Practice Model.” Www.hopkinsmedicine.org, 2022, www.hopkinsmedicine.org/evidence-based-practice/model-tools. 

Keikhosrokiani, P., Polus, M., Guardado Medina, S., & Isomursu, M. (2024). The effectiveness of medical adherence mobile health solutions for individuals with epilepsy: Protocol for a systematic review. JMIR Research Protocols, 13, 55123. https://doi.org/10.2196/55123  

Lu, M., Faure, M., Bergamasco, A., Spalding, W., Benitez, A., Moride, Y., & Fournier, M. (2020). Epidemiology of status epilepticus in the United States: A systematic review. Epilepsy &Behavior, 112, 107459. https://doi.org/10.1016/j.yebeh.2020.107459  

Mersal, F. A., Qalawa, S. A., & al Algharib, A. G. (2021). Impact of applying evidence-based guidelines for epileptic patient on their knowledge, self efficacy, drug adherence and quality of life. Indian Journal of Public Health Research & Development, 12(2), 122–130. https://doi.org/10.37506/ijphrd.v12i2.14105   

NURS FPX 4025 Assessment 2 Applying an EBP Model

Piccicacchi, L. M., & Serino, D. (2024). A systematic review of the Mozart effect in adult and paediatric cases of drug-resistant epilepsy: A sound approach to epilepsy management. Epilepsy & Behavior, 154, 109743. https://doi.org/10.1016/j.yebeh.2024.109743  

Vossler, D. G., Bainbridge, J. L., Boggs, J. G., Novotny, E. J., Loddenkemper, T., Faught, E., Amengual-Gual, M., Fischer, S. N., Gloss, D. S., Olson, D. M., Towne, A. R., Naritoku, D., & Welty, T. E. (2020). Treatment of refractory convulsive status epilepticus: A comprehensive review by the American Epilepsy Society Treatments Committee. Epilepsy Currents, 20(5), 245–264. https://doi.org/10.1177/1535759720928269