The document discusses evidence-based practices in nursing related to breast cancer. It notes the increasing cases of breast cancer have posed challenges for healthcare. Treatments for breast cancer patients have been inadequate, leading to poor health outcomes. Several factors are attributed to the rise in breast cancer cases, including increased screening, lifestyle changes, hormone replacement therapy, and age. The real causes of breast cancer have not been fully established. The document then formulates a research question in PICOT format about monitoring white blood cell counts in cancer patients receiving chemotherapy at home versus at a healthcare facility.

1. EVIDENCE-BASED PRACTICES & NURSING
2
Evidence-Based Practices & Nursing
Walden University
NURS-6052N-37, Essent of Evidence-Based Practices
Literature Review
Increase in cases of breast cancer has been a major challenge in
the healthcare setting. Additionally, treatments for patients
suffering from breast cancer have been inadequate and this has
created a major crisis thus leading bad health conditions for
people living with breast cancer. Additionally, there has been an

2. alarming increase in the number of patients suffering from
breast cancer. This particular question on why the levels of
breast cancer have increased has not been answered since this
particular disease has been termed as being very complicated to
understand mainly because its causes are many. However, this
increase in the number of breast cancer cases has been
attributed to a number of factors. To start with, screening of
breast cancer has been a reason for the rise in breast cancer
cases. Previously women were never screened for this particular
disease. However, with the introduction of new technology
screening has become a common thing. Screening has helped in
the detection of breast cancer especially during the early years
of development. Therefore anytime there is a screening clinic it
is expected that the number of women suffering from the breast
will increase.
Secondly, lifestyle changes have also attributed to the rise in
breast cancer cases. In the modern day world, women have
greatly changed their lifestyles this has been attributed to the
growth of their careers and also an increase in women’s income.
These changes in status have made women to change their
lifestyles this means that they can afford to spend more on
leisure and thus engage in activities such as alcoholism.
Alcohol is one of the major cause of breast cancer among
women also it is known to increase the chances of breast cancer
in women. Statistically, it has been proven that an increase in
the units of drinking by a woman can lead to an increase in the
risk of getting breast cancer. Additionally, eating fast foods has
also been a major attribute of breast cancer. Women who tend to
have excess weight are at a higher risk of getting cancer when
compared to women who have less weight (Polit ,& Beck,
2017).
Other factors that have been known to increase the chances of
breast cancer in women include; hormone replacement therapy.
The use of hormone replacement therapy has been known to be a
predisposing factor for breast cancer. According to research, it
was found out that the more the woman uses HRT the more the

3. chances of getting breast cancer. Additionally, women who tend
to have children during their late age are at a higher risk of
getting cancer when compared to those who get children at an
early age. This particular aspect explains why women in less
developed countries are less prone to breast cancer. Age has
also been known to increase the chances of one getting breast
cancer. After reaching the age of menopause, women tend to be
prone to getting breast cancer (Hoffman,et al, 2014).
There has been inconsistency and contradictions when it comes
to the real causes of breast cancer. The real cause of this
particular disease has not been established but there have been a
number of predisposing factors that have been established and
that have been known to increase the chances of breast cancer in
women. Currently, the real cause of this particular type of
cancer has not been identified. Initially, it was believed that the
major cause of breast cancer was a genetic inheritance,
however, this was not to be true and it was concluded that most
of the cases are sporadic. Additionally, it was suggested that
environmental pollution could also be a factor or a cause of
breast cancer but from epidemiological data, this particular idea
was disapproved. Another major factor that brought
inconsistency was the idea that breast cancer is caused by an
infection, however, this particular suggestion did not have any
biological evidence or any form of epidemiological support.
Since the introduction of oral contraceptives, it has been
suggested that these particular type of medication is responsible
for breast cancer. However, research has shown that there is no
connection between breast cancer and oral contraceptives. A
research that involved women with breast cancer and women
without breast cancer showed that there was no relationship that
existed between oral contraceptives and breast cancer. Lastly, it
was found that there was no relationship that existed between
breast implants and breast cancer. However, there have been
anxieties that women who have implants are at a risk of getting
lymphoma which is a rare type of breast cancer. In conclusion,
it can be said that dietary fat is not the only cause of breast

4. cancer, but there are other factors, however dietary fat plays an
essential role in the development of breast cancer (LoBiondo-
Wood, & Haber, 2017).
Treating and surviving breast cancer requires that a lot of health
plans to be initiated. These particular plans should be put
forward in order to ensure that any challenges arising from this
particular issue of breast cancer are handled in the best way
possible. However, mechanisms should be developed to ensure
that the patients of breast cancer are not exposed to radiation at
regular intervals. In addition, the issue of overdiagnosis should
also be put into question. This is because overdiagnosis can be
associated with other lifetime sufferings. In conclusion, the
evidence presented in this paper clearly brings out the fact that
the way breast cancer is handled should be changed and more
research on the causes of breast cancer should be researched on
to enable the formulation of adequate measures that will prevent
the prevalence of this particular illness.
References
Hoffman, A. J., Robinson, C. B., & Weisbrod, B. L. (2014).
Putting evidence into practice: an update of evidence-based
interventions for cancer-related fatigue during and following
treatment. Clinical journal of oncology nursing, 18(6), 38.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-
Book: Methods and Critical Appraisal for Evidence-Based
Practice. Elsevier Health Sciences.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating
and assessing evidence for nursing practice (10th ed.).
Philadelphia, PA: Wolters Kluwer.
Chapter 8, “Planning a Nursing Study”This chapter focuses on
the necessary steps for planning a research study. It describes
different research designs and their key features and discusses
how to plan for data collection.

5. CRITIQUING QUANTITATIVE AND QUALITATIVE
STUDIES 1
Quantitative and Qualitative Research Techniques
Walden University
NURS-6052N-37, Essent of Evidence-Based Practices
Quantitative research technique
Article reference:
https://www.durham.ca/departments/health/cdcp/immSurveyRep
ort.pdf
1. Research issue: barriers to immunization from parents’
perspective

6. Purpose: to find out the barriers to immunization from the
parents’ perspective.
2. Research pre- understandings and literature review
The researcher notes that despite various benefits of
immunization that have been witnessed over time, there still
remain to be low rates of immunization. The researcher reviews
the findings of previous researchers in this field who identified
barriers to immunization as being: lack of trust in vaccination
and lack of information on the significance of vaccination to
children. He also outlines the methodology that these
researchers used to get these findings.
3. Participants and protection of Human Research
participants
The Durnham Region Health Department (DRHD) was engaged
in developing the questionnaire. 6,851 subjects were
interviewed. Purposive sampling was applied whereby all
subjects were parents of 3rd grade pupils. To protect the
confidentiality of the subjects, letters were sent to the heads of
schools of Durham Region who granted permission for the
surveys to be sent to 3rd grade children’s parents.
4. Research design and data collection
A descriptive design was used as the researcher aimed at
finding out reasons for low vaccination rates. Questionnaires
with closed ended questions were used to collect information.
Multiple choice questions were used to collect he data.
5. Credibility
The questionnaire was approved by the Scientific and Ethical
Review Committee and pre-tested on attendees of a monthly
immunization catch up clinic.
6. Data Analysis and findings
Once returned, the surveys were keyed into the MS Access
Database. Descriptive analysis of quantitative data was
conducted using SPSS. Answers to open ended questions were
grouped according to themes.
The data acquired was in numerical terms, making it easier to
draw conclusions from it. 96% of the respondents reported that

7. hey received immunization information from their health care
provider, with 9% citing their source as he media. 42% of
respondents said they had received a vaccination notice. 57% of
those who received notice reported that they had vaccinated
their children but hadn’t notified the health department. 10%
reported that they received the notice but forgot to vaccinate the
children. 4.7% cited their lack of awareness on the
immunization schedule.
7. Discussion of Findings
Challenges in finding immunization services were cited as a
major problem by most parents. Some parents suggested that
there should be local mobile clinics to improve accessibility.
Untrustworthiness of the information acquired as the parents
was also a major challenge.
8. Limitations
The study had a low response rate of 37%. Open ended
questions used in the research were hard to analyze for the
parents, resulting in misinterpretation of the questions.
9. Implications, recommendations and research utilization in
practice
The findings would be used by the DRHD as a basis of
evaluation of immunization programs while making use of the
recommendations given by the parents. From the findings, it
was recommended that here should be local mobile clinics to
improve accessibility to vaccination services. The research can
be a basis for conduction of vaccination awareness programs to
educate parents on the significance of vaccinating their
children.
Qualitative research technique
Article reference:
http://www.sciencedirect.com/science/article/pii/S23528273163
00477
1. Research issue and purpose
What factors affect parents’ decision on whether to vaccinate
their children? The research was aimed at finding out what
factors affected the decision on whether to vaccinate children or

8. not among parents.
2. Research pre- understandings and literature review
The researcher views vaccination as being necessary for every
child as it is a vital disease prevention method. While the
vaccinations are readily available, there are still low levels of
uptake by the parents.
The researcher included the findings of researchers on this topic
by previous researchers on this topic, with most of the
researches being quantitative in nature. Among these were Web
of Science for Studies findings, research conducted by Embase,
MEDLINE and CINAHL plus.
3. Participants and protection of Human Research
participants
934 subjects were used in the research. 91% of the subjects
were mothers. Prior to the research being conducted, the
subjects were assured of the confidentiality of the information
collected and the researchers signed non- disclosure
agreements.
4. Research design and data collection methods used
A descriptive design was applied as the researcher aimed at
which factors affect the vaccination decision by parents. The
data was collected by use of interviews, some of which were
conducted over the phone. This method was suitable as the data
required is qualitative in nature.
5. Data Analysis and findings
The data was analyzed using NVIVO while the quality of the
data was assessed by use of Critical APPRAISSAL Skills
Program (CASP) tool. Scores were used to rank the findings.
Decision making on vaccination by parents can be deliberative
or non- deliberative in nature. Non- deliberative parents are
those who don’t spend much time deciding upon vaccination
decisions. Deliberative parents comply with the vaccination
measures after making an analysis of the benefits and costs of
vaccination. They make this assessment based on people’s
advice, their own emotions, the media and social judgement.
Practical issues have the greatest influence on people’s decision

9. on whether to vaccinate their children or not. There are parents
who apply both deliberative and non-deliberative technique.
6. Discussion of Findings
Non- deliberative parents comply with vaccination practices
without much thought. These are partly emotion- driven
decisions. It was identified that in deliberative and non-
deliberative parents make their decisions based on trust placed
on their information sources and on those offering the
vaccination. It was found that some parents apply both
approaches depending on the context. The research revealed the
relevance of society in vaccination as the parents who engaged
in discussions with other parents on this subject opted for
vaccination while others engaged in the practice simply because
society pressured them to do so.
7. Limitations
The extent to which the research can be generalized is limited
by the scope of study since the research only focuses on the
United Kingdom. The method doesn’t allow for frequency
analysis of each of the decision-making types.
8. Implications
The research shows the significance of understanding the
mechanisms that affect the vaccination decision. In addition, it
shows the need for vaccination programs to provide more
information so as to give the parents a basis on which the can
make this decision.
9. Recommendations and utilization in practice
Vaccination stakeholders should work in partnership with media
to educate the masses on the benefits of vaccination so as to
promote vaccination rates. This research gives the parents’
views that they need to trust vaccination stakeholders so as to
vaccinate their children. This shows that the stakeholders need
to carry out awareness campaigns through the media to promote
vaccination rates.
Quantitative research provides data that is descriptive in nature.
Using statistical data enables the researcher to know essential
characteristics of the data (Centrell, 2011). For example, in the

10. case of the first research, the data analysis is done and gives
percentages showing various characteristics of the sample. This
can give a better basis for policy formulation by the researcher.
Data collection is however a strenuous process which is
expensive and requires a large sample size. In the example of
the research done, the process involves ensuring approval of the
questionnaire by various bodies which can be hectic.
Qualitative research has various advantages, including giving
detailed information that explains a phenomenon. In the case of
the qualitative research carried out, the researcher is able to
acquire various views from different people, all of which differ.
In addition, the data can be applied to an entire population even
though a small sample was used. However, the data collection
process is time consuming and the success of the research
depends on the skills of the personnel collecting the data (Polit
and Beck, 2017).
From the sample researches used above, it is evident that
qualitative research is as important a scientific research method
as quantitative research. However, it is evident that qualitative
research is better applicable in cases where the researcher seeks
the view of the sample that explain why a phenomenon is as it
is. On the other hand, it is evident that quantitative research is
more applicable when answering ‘what’ questions (Schultz et.
Al, 2008).
References
Cantrell, M.A (2011) Demistifying the Research process:

11. Understanding a descriptive research design, Washington, D.C:
National Academic Press
Polit, D.F & Beck, C. T. (2017) Generating and assessing
evidence for nursing practice, Philadelphia, PA: Wolters Kluwer
Schultz, L. E., Rivers, K.O., & Ratusnik, D.L. (2008) The role
of external validity in evidence- based practice for
rehabilitation, Thousand Oaks: SAGE publications
EVIDENCE-BASED PRACTICES & NURSING
2
Evidence-Based Practices & Nursing
Walden University
NURS-6052N-37, Essent of Evidence-Based Practices

12. Introduction
Normally, PICOT format is helpful in the formulation of
questions in an evidenced based clinical practice. PICOT
generated questions generally fall under four main categories of
clinical practices. These include; therapy, prevention, diagnosis,
etiology as well as Prognosis, which are the essential elements
in PICOT questions. The PICOT format is valuable in
addressing research questions comprehensively. Five elements
that are normally addressed including; population, intervention,
comparison, outcome and time as well (Riva, Malik, Burnie,
Endicott, & Busse, 2012).
Summary of Case Study
The ever increasingly high incidence of breast cancer conditions
has posed serious challenges in the nursing profession.
Provision of appropriate healthcare to the cancer patients has
been lacking leading to adverse effects of the proliferation of
cancerous cells which further worsen the conditions of the
patients. As primary care, clinicians have the responsibility to
stressing providing healthcare services within healthcare
facilities as well as monitoring treatment in home based
facilities to help manage cancer condition. Most cancer patient
need clinicians who practice evidence-based clinical practices
(Riva, Malik, Burnie, Endicott, & Busse, 2012).
Research Question

13. In cancer patients receiving chemotherapy, will they have
better white blood cell count monitoring with a follow-up at
home versus follow-up at a health care facility during their
treatment?
PICOT Format
1) P-Population: Patients aged 18-60 years-old, breast cancer
who have not received chemotherapy in the past six months are
subjected to the treatment. Patients with other serious health
conditions such as heart diseases were excluded in the study. 30
patients, with 15patients stationed at the healthcare facility
while the other 15 patients receiving home-based care, are
expected to take part in the study.
2) I -Intervention: The patients will receive dosage based on
the age, sex and health general body health as well as the stage
of cancer cells proliferation in the body. The patients are
required take the prescribed drugs at regular intervals. The
subjects will be subjected to treatment under the same during
the research study.
3) C-Comparison: All the subject regardless of variations in
their level of dose requirement will be subjected to the same
treatment for the same duration, 3months. Standardized
treatment will be given to subjects with no extreme variations in
their level of dose requirement and would be used as an active
control group. Using this strategy, it will be possible to
minimize the non-specific effects due to a group of the patient
receiving treatment within the healthcare.
4) O-Outcome: The response in chemotherapy treatments will
be check by examining the numbers of defective cancerous cells
in the body tissues. The patients will report to the theatre in
order to be examined by an oncologist. The results will be
recorded in terms of improved seen in each patient and in the
two categories, that those that received home-based care as well
as those who received chemotherapy treatment within the
healthcare facility (Stevens, 2001).
5) T-Time: The outcome would be measured after 2 weeks for
3months. The results will be recorded at an interval of two

14. weeks from the onset of the study throughout the 3months
In evidenced-based clinical practice, it is imperative to
standardize treatments in order to avoid skewing expected
treatment outcomes. Teaching the subjects, the importance of
chemotherapy treatment should be part and parcel of the
planning process of the patient recruitment into the research
study. More importantly, standardizing instruction to study
subjects is also important in ensuring no additional
interventions are inadvertently introduced during the study
period. Additional intervention can be by way of extra pieces of
advice to the study subjects (Stevens, 2001).
Evidence-based clinical practices, clinicians are
encouraged to not only provide available cancer care choices
but also undertake to provide information on quality care. In
addressing challenges and complication associated with breast
cancer, clinicians should provide timely, accurate information
(Morley, 2009).
Keywords in Literature Review
The keywords to look for in literature review include;
breast net weight, breast biopsies related history, hyperplasia
prior to biopsy, radiation of the chest, breastfeeding, obesity,
excessive use of alcohol, sedentary lifestyles, and chemotherapy
as well as exogenous hormones. These items show the mode of
progression of cancerous cells and influence the type of
healthcare to be provided to patients in evidence-based clinical
practices (Stevens, 2001).
Reference
Morley, P. T. (2009). Evidence evaluation worksheets: the

15. systematic reviews for the evidence evaluation process for the
2010 International Consensus on Resuscitation Science.
Resuscitation, 80(7), 719-721.
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., &
Busse, J. W. (2012). What is your research question? An
introduction to the PICOT format for clinicians. The Journal of
the Canadian Chiropractic Association, 56(3), 167.
Stevens, K. R. (2001). Systematic reviews: The heart of
evidence-based practice. AACN Clinical Issues, 12(4), 529–538.