Walker & Avant’s methodology (2005) is used to analyze the concept of the word effective; this provides clarity to the meaning of the concept and identifies its unique attributes, particularly in relation to medical treatment. Antecedents and consequences of presumed effective medical treatment are discussed followed by empirical referents, which aid in illuminating the concept of effectiveness. Assumedly, “effective” is an adjective most healthcare professionals and their patients would hope to use in describing the outcome of the treatment or the care provided.
The purpose of this concept analysis is to understand that for physicians and nurses to provide truly effective treatment, it must attend to multiple needs of the patient, not just their illness.
Not only is it important for healthcare providers to construct and implement a treatment plans, but also to involve patients in medical decision making about their treatment. To determine effectiveness, healthcare providers must assess how treatment of the illness effects the patient in addition to their own evaluation of treatment.
The dictionary definitions of effective are (a) adequate to accomplish a purpose, producing the intended or expected result; (b) in operation or in force, functioning;
(c) producing a deep or vivid impression; (d) prepared and available for service; and (e) a member of the armed forces fit for duty or active service (“Effective”, n.d. a). According to Stedman’s Medical Dictionary (2006), the medical definitions of effective are (a) the extent to which a treatment achieves its intended purpose; (b) A measure of the accuracy or success of a diagnostic or therapeutic technique when carried out in an average clinical environment.
According to Wikipedia (n.d. b), the usage of effective includes (a) mathematics, can be used as a synonym of algorithmically computable; (b) physics, an effective theory is, similar to a phenomenological theory, a framework intended to explain certain effects without the claim that the theory correctly models the underlying processes;
(c) heat transfer, effectiveness is a measure of the performance of a heat exchanger; (d) business/management, effectiveness relates to getting the right things done; (e) human–computer interaction, the accuracy and completeness of users tasks while using a system; and (f) medicine, effectiveness relates to how well a treatment works in practice. This concept analysis will focus on effectiveness in relation to treating an illness and patient outcome. As previously stated, it is important to consider how treatments can also have an effect on the patient. A patient’s illness must acutely be treated, but it is imperative to also set long term goals so the most effective and desired outcome can be achieved.
Walker & Avant (2005) describe defining, or critical attributes as the characteristics that are most frequently associated with a concept. These attributes are key factors that must be present in defining the concept that is analyzed. Literature reviewed helped determine the characteristics attributed to the concept of effective in terms of nursing and medical treatment including, being free of disease or illness, decreased discomfort and suffering, scientific support, and improved quality of life. Another characteristic of effective nursing and medical treatment that should be considered is cost.
Patients are sometimes informed about optional medical treatments that are available, but experimental and not yet approved by the FDA, nor covered by one’s medical insurance. There are many experimental treatments that have proven to be effective in curing illness but sadly, most cannot afford to pay for these treatments. This also applies if a person’s insurance does not cover a specific test, medicine, or treatment. A patient’s personal experience should also be taken into consideration; people with the same illness could receive the same therapy or treatment, but have different outcomes.
An 11 year old boy presents to the emergency department with an obvious deformity to his left lower leg after falling off his bike, he is triaged and quickly seen by a physician for treatment. The physician puts a cast on his leg and informs the boy’s parents that his injury is not indicative of surgery and the bone should heal properly while casted. They are told to return in six weeks to have the cast removed and to evaluate the healing progression. The boy’s parents are then advised of activity restrictions, given a prescription for as needed pain medication and discharged home.
They returned six weeks later and reported compliancy with the activity restrictions and he that only complained of pain the first couple days following the injury, which was managed well by the prescribed pain medication. The physician’s reassessment of the patient’s leg indicated optimal healing had occurred and the cast was removed, thus achieving the desired outcome. This case identifies that the patient’s pain was well managed and restrictions on activity were followed.
The outcome identifies the patient is free of injury and discomfort, and quality of life was not affected, modeling all the critical attributes indicative of effective treatment. An 18 year old male is transported to a hospital via ambulance for an injury he sustained while playing in his high school’s football game. It was is reported to the healthcare team that he was tackled to the ground by an opposing player and Due to the risk of injury to his spinal cord and the patient complaining of sever back pain, radiological tests were performed. Tests showed in addition to the injury sustained during the game, he also suffered from some degree of spinal stenosis. The physicians explained a need for immediate treatment as it was imperative to surgically repair the damage to his spine by undergoing a spinal fusion.
The physicians also inform them in order to achieve optimal healing and reduce the risk of further, irreversible long term damage, he will be unable to play football again. This news is very upsetting for the patient because not only is he unable to play again, it was his dream to make football a career and was already accepted to college on a football scholarship. This patient was discharged from the hospital a week after his surgery with outpatient physical therapy sessions if needed and a prescription for pain medication. The healthcare team explained to the patient, despite the possibility of mild back pain, the surgical treatment he underwent was effective.
The concept of effective treatment related to this patient’s injury is that of a borderline case. Although the outcome of his treatment restricts his physical activity, healthcare providers were able to successfully treat his injury with surgical intervention. Pain medication was prescribed to decrease any discomfort or pain that may occur because from experience and scientific data, healthcare providers are able to recognize what treatments are proven successful to achieve the best outcome for the patient. A 17 year old girl, suffering from anorexia and bulimia, is admitted to the hospital for the fifth time in seven months. Every admission, including this one, she has received enteral feedings to improve caloric intake and hemodynamic status.
The psychological status of this patient is also evaluated by a hospital therapist in addition to ongoing outpatient treatment for her eating disorder. The patient’s parents voice their concerns to the healthcare team about her deteriorating health status and frustrations with outpatient therapy not being effective.
They are concerned because even though her health status improves with the treatment she receives in the hospital, outpatient therapy is not helping her maintain it. The physicians recognize with her parent’s concerns and agree she needs intensive therapy from an inpatient facility that specializes in eating disorders. However, the patient’s insurance will not cover extended inpatient treatment and is too expensive for her parents to pay out of pocket, so they must continue treatment that has been seemingly ineffective to her recovery. The outcome in this scenario is that of a contrary case of effective nursing or medical treatment. Although this patient is always acutely treated, she is not free of her disease because she continues to purge food or not eat at all. Her quality of life is also effected due to multiple hospital admits and her daily struggle with food. This patient’s outpatient therapy shows to be ineffective and sadly she continues to suffer with an eating disorder.
It is essential to discuss related framework to identify and clarify the meaning of an analyzed concept. Walker & Avant (2005) define antecedents as events that must occur prior to the occurrence of the concept. In order for a therapy or treatment to be effective, there first must be a person with an injury or illness who seeks medical care. After an individual has gone to an emergency department, urgent care, or physician’s office, they are evaluated by a healthcare team that includes a physician and nurse. Then, the healthcare team diagnosis’s the patient before deciding on the type of treatment warranted to treat their injury or illness. It’s imperative to include the patient in deciding treatment as “active patient involvement in medical decision making improves their quality of life and outcomes from treatment” (Egger, 1995. p. 384).
When a type of treatment has been determined, it may require the patient to legally consent. The patient’s healthcare team is responsible for informing them about the treatment and any associated risks that may occur as a result. Once the patient’s treatment is completed they will be evaluated by the healthcare team, thus resulting in a patient outcome. The consequences, or events that occur as a result of, are the outcomes of a concept (Walker & Avant 2011). The consequences effective medical treatment are improved health status, decreased need for health services, increased patient satisfaction, and healing. All of these outcomes are desired by the patient as well as the healthcare team.
These outcomes can have a huge influence on healthcare by providing data for healthcare providers and individuals researching treatment options. “Outcomes are the ultimate test of the effectiveness of medical care. Patient outcomes are clinical endpoints, functional status, general well-being, and satisfaction with medical care” (Coyle & Battles, 1999. p. 5). Empirical referents can be described as actual phenomena that by their actual existence or presence demonstrated the occurrence of a concept, in which is proven useful in instrument development (Walker & Avant, 2005). It is important to note that empirical referents measure and relate to the defining attributes of effective, not just the concept itself (Walker & Avant, 2011). Since effective (medical treatment) is subjective as well as objective, it is essential to consider both phenomena that occur with this concept.
Improved health status is the most significant phenomena associated with effective health treatment, both subjectively and objectively, relating to the attribute of being free from illness or injury and quality of life. The healthcare team objectively considers a patient’s treatment as effective if it has cured illness, resolved injury, or improved quality of life. Scientific research provide healthcare providers with support in determining what medical treatment has proven effective. For patients, aside from being free of illness or injury, quality of life is typically the most important.
There are many different treatments that cure illnesses, but sometimes alter a person’s quality of life. A patient can be in remission from cancer by receiving radiation and chemotherapy, but also causing a negative impact on their functionality, appearance, and general well-being. In order to determine how treatment has effected a patient’s quality of life, healthcare providers must formulate their own opinion based off of their knowledge of the patient and assess how the patient feels the treatment has impacted their life.
Lastly, a patient’s use of medical services will be decreased or not needed at all. This analysis of the concept of effective medical treatment is defined as an outcome producing the intended or desired outcome. This concept has also shown to be complex, being that it is subjective as well as objective. Healthcare providers and patients must agree that the treatment was effective to the illness or injury. Effective medical treatment is achieved after a person with an illness or injury seeks medical attention and receives treatment for it. A review of literature on this concept concludes that to improve quality of life and patient satisfaction, the healthcare team must integrate the patient’s values and preferences about the intended treatment or therapy (Egger, 1995).
References
Coyle, Y. M., & Battles, J. B. (1999). Using antecedents of medical care to develop valid quality
of care measures. International Journal for Quality in Health Care, 11(1), 5-12. Effective. (n.d. a). In Definitions.net. Retrieved from
http://www.definitions.net/definition/effective
Effective. (n.d. b). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Effective Egger, M. (1995). Systematic reviews in health care: Meta-analysis in context. London: Wiley. Stedman’s Medical Dictionary. (2006). Effectiveness. Retrieved from
http://www.medilexicon.com/medicaldictionary/effectivness
Walker, L., & Avant, K. (2005). Strategies for theory construction in nursing. (4th ed.).
United States of America: Prentice Hall.
Walker, L., & Avant, K. (2011). Strategies for theory construction in nursing. (5th ed.).
United States of America: Prentice Hall.
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