Student Name
Capella University
NURS-FPX4025 Research and Evidence-Based Decision Making
Prof. Name
Date
Applying an EBP Model
Status epilepticus (SE) is a neurological emergency characterized by continuous or recurrent seizures without recovery intervals. Immediate medical intervention is essential, as untreated SE can lead to severe brain damage, systemic complications, and increased mortality (Arnet et al., 2023). Evidence-Based Practice (EBP) models provide structured frameworks to identify high-quality research and translate it into clinical decisions that improve patient outcomes. This paper explores the diagnosis and management of SE using the Johns Hopkins Evidence-Based Practice (JHNEBP) model, focusing on evidence that supports clinical decision-making in epilepsy care.
Issue Associated with the Diagnosis
Patients may develop SE due to three main circumstances: worsening of pre-existing epilepsy, onset of new seizure disorders, or other medical conditions unrelated to epilepsy. Incorrect use of anticonvulsant medications contributes significantly to SE development among both adult and pediatric patients. Research indicates that nonadherence to prescribed anticonvulsants is prevalent, with suboptimal drug levels observed in 34% of adults and 21% of children experiencing SE. In the United States, SE affects approximately 18.3–41 per 100,000 individuals annually, highlighting its broad clinical impact (Lu et al., 2020).
Medication nonadherence is a critical factor in SE, increasing the risk of prolonged seizures and associated complications. Patients failing to follow prescribed anticonvulsant regimens are more likely to experience breakthrough seizures, require hospitalization, and suffer long-term neurological consequences. Enhancing adherence through clinical interventions remains vital to reducing both the occurrence and severity of SE (Arnet et al., 2023).
Healthcare professionals who implement an EBP model can design and apply interventions based on robust evidence, such as patient education programs aimed at improving medication compliance. EBP promotes informed clinical decision-making that incorporates research evidence, patient preferences, and clinical expertise. By systematically reviewing current research, healthcare providers can identify interventions that demonstrate practical efficacy in real-world clinical settings. Ultimately, applying EBP in epilepsy management helps decrease SE incidence and mitigate its consequences (Mersal et al., 2021).
EBP Model and Its Steps
The JHNEBP model follows the PET framework, which consists of three components: Practice Question, Evidence, and Translation. This structured approach guides healthcare professionals in integrating research findings into clinical practice (Johns Hopkins Medicine, 2022).
- Practice Question: Clinicians identify specific clinical challenges and formulate focused questions to guide evidence searches. For SE, the primary question is how evidence-based interventions can improve medication adherence in epilepsy patients, thereby reducing SE risk.
- Evidence: This stage involves conducting systematic literature reviews, evaluating study quality, and extracting relevant findings. Interventions reviewed may include patient education programs, digital adherence tools, and pharmacist-led medication management.
- Translation: Clinicians integrate evidence into practice by assessing feasibility, training staff, and monitoring patient outcomes. Examples include structured adherence programs, motivational interviewing, and electronic medication reminders.
The JHNEBP model is particularly suitable for addressing SE and medication adherence because it translates research evidence into actionable strategies tailored to individual patient needs. By doing so, it enhances care quality, optimizes outcomes, and reduces SE-related complications (Piccicacchi & Serino, 2024).
Application of the Model to Evidence Search
The PET framework guided a structured search for evidence on medication nonadherence in SE patients. Using the PICO methodology, the research question was defined 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)
Table 1: Keywords Used in Evidence Search
| Keywords | Purpose |
|---|---|
| Status epilepticus | Identify studies focused on SE |
| Medication adherence | Focus on compliance-related interventions |
| Antiepileptic drugs compliance | Evaluate pharmacological adherence |
| Nonadherence and seizure control | Investigate effects of noncompliance on seizures |
| Epilepsy management | Broader context of clinical care |
Evidence was gathered through databases including PubMed, CINAHL, Cochrane Library, and Google Scholar, emphasizing peer-reviewed research. Challenges arose due to variability in study quality and limited sample sizes.
During the Translation phase, interventions such as mobile health (mHealth) applications, pharmacist-led medication reviews, and behavioral counseling were evaluated. Implementation required consideration of patient literacy, socioeconomic status, and access to healthcare resources. Applying the JHNEBP model allowed healthcare providers to develop practical, evidence-based adherence strategies despite these challenges (Piccicacchi & Serino, 2024).
Credibility and Relevance of Resources
Healthcare professionals assess source validity using the CRAAP criteria (Currency, Relevance, Authority, Accuracy, Purpose). Several studies demonstrate high credibility and clinical relevance:
Table 2: Key Resources for SE and Medication Adherence
| Study | Findings | Strengths |
|---|---|---|
| Al-Aqeel et al., 2020 | Education and counseling moderately improve AED adherence; behavioral strategies more effective | Systematic review, up-to-date, evidence-based |
| Keikhosrokiani et al., 2024 | Personalized mHealth interventions enhance adherence | Strong evidence, authoritative research institutions |
| Vossler et al., 2020 | Guidelines recommend first-line IV benzodiazepines for SE | Expert consensus, standardized clinical recommendations |
Al-Aqeel et al. (2020) confirmed the moderate efficacy of educational interventions, whereas behavioral strategies, including reminders, achieved better adherence outcomes. Keikhosrokiani et al. (2024) found that digital mHealth solutions enhance medication management and seizure tracking. The American Epilepsy Society guidelines (Vossler et al., 2020) provide expert-backed, evidence-based recommendations for SE management, including first-line use of IV lorazepam, diazepam, or phenobarbital.
Conclusion
Implementing an EBP approach is vital for improving outcomes in SE and addressing medication nonadherence. The JHNEBP model provides a systematic method for identifying and evaluating interventions that enhance adherence and prevent SE. High-quality evidence from systematic reviews, clinical trials, and expert guidelines guides clinicians in developing effective strategies tailored to individual patients. Applying these evidence-based practices in epilepsy care can improve neurological outcomes, reduce hospitalizations, and lower the risk of SE.
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
NURS FPX 4025 Assessment 2 Applying an EBP Model
Johns Hopkins Medicine. (2022). Johns Hopkins Evidence-Based Practice Model. 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 patients 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
Piccicacchi, L. M., & Serino, D. (2024). A systematic review of the Mozart effect in adult and pediatric cases of drug-resistant epilepsy: A sound approach to epilepsy management. Epilepsy & Behavior, 154, 109743. https://doi.org/10.1016/j.yebeh.2024.109743
NURS FPX 4025 Assessment 2 Applying an EBP Model
Vossler, D. G., Bainbridge, J. L., Boggs, J. G., Novotny, E. J., Loddenkemper, T., Faught, E., … & 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