Top 10 ways to improve clinical problem-solving and avoid the Òno evidenceÓ dilemma according to peer-reviewed literature

Many problem-solving strategies do not use the EBP approach. A "problem" impedes progress towards a goal. Information is any component of knowledge that changes actions in relation to a problem. Problem-solving has multiple steps of which a small part is synthesizing published literature. Since EBP does not meet basic criteria of how people ÒknowÓ things or solve problems, information is invariably lacking using that approach. Alternatives to EBP can be used instead. Purpose: Participants will identify alternative problem-solving strategies if faced by a lack of information using EBP. Methods: Literature searches were performed using Pubmed, Cochrane Library and Cumulative Index of Nursing and Allied Health Literature. A variety of key words were used to broadly access peer-reviewed literature related to problem-solving and clinical reasoning. Key concepts were derived from the papers and representative papers were chosen. Results: #10 If you have no information, stay out of the discussion Maitland (submitted) #9 Know the limitations of EBP 5-step process. Use many sources of information. E.g. Nevo and Slonim-Nevo, 2011(1) #8 A casuistic approach that does not use the word ÒevidenceÓ E.g. Tonelli, 2007(2), 2009(3) #7 Appraisals that include biological rationale, generalizability and sociocultural aspects E.g. Berkwits, 1998(4); Bellomo and Bagshaw, 2006(5) #6 Multifactorial causation model of diagnosis E.g. Maitland, 2010(6) #5 Hypothesis Oriented problem solving Rothstein et al., 2003(7); E.g. Franki et al., 2014(8) #4 Five broadly-defined components of knowledge exchange E.g. Ward, 2012(9) #3 Above all, consider the ethics of your decisions even if EBP does not E.g. ter Meulen, 2005(10); Watine, 2011(11) #2 Sir Austin Bradford HillÕs criteria for causation: Does the intervention cause a change? Bradford Hill, 1965(12); E.g. Maitland, 2004(13) #1 Use a scientific approach to develop theories that will predict future events E.g. Hj¿rland, 2011(14) Discussion: Published papers offer alternative ways to view problem-solving. Unlike EBP, they are not exclusive. For example, the Bradford Hill approach has been used for reviews of the medical literature considering the ethics of the proposed intervention. Practitioners should examine constructs in abstract problem-solving more thoroughly to discern important differences in literature information content: for example, valuable case histories compared with self-supporting testimonials. The level of rhetoric associated with EBP runs high and it is important recognize the biases caused by using the EBP approach. Conclusions: Health professions, across the disciplines use a variety of sources for knowledge, skills and behaviors in their approach to patient problems. While there is no perfect approach to problem-solving, there are stronger conceptual approaches compared with EBP. By understanding a range of approaches, the versatile health care provider can be more adaptable to the context of patient problems.

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  • Control #: 2015561
  • Type: Poster
  • Event/Year: CSM2015
  • Authors: Murray E. Maitland
  • Keywords: Problem-solving |Clinical reasoning|Evidence-based practice

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