Diagnosis of Malaria

Evidence-Based Practice and Patient-Centered Care

Evidence-based practice was developed to help health practitioners to effectively apply evidence in order to achieve the desired outcome for patient care. Evidence-based practice is described as the deliberate and wise application of current evidence in conjunction with clinical experience and patient values to guide health care decisions (Martin 2009, Pg. 378-381). This notion implies that the patient is central to all healthcare practices. This is done through the reference to the valid evidence from the past practice, clear rational judgment by the health practitioner considering the prevailing condition and finally, all is done in consideration with the patient’s preference.

The Role of Nursing and Midwifery Council

To enhance this, The Nursing and midwifery council requires that those who provide health services should be accountable for the health services they offer and that the services should be in the most professional way as possible and in line with the best available evidence. This ensures that the patient receives the best-customized care since clinically relevant evidence, professionalism and patient preferences are all combined and considered (Stickney 2011, Pg. 85).

The Clinical Skill of Malaria Diagnosis

For this study, the aspect of clinical skill identified was the assessment and diagnosis of malaria, a disease that is often confused in symptoms with typhoid and other fever-based infections. This skill was identified for study in response to the increasing confusion that has always occurred during the clinical assessment of the disease symptoms and signs by the health practitioners who confuse the symptoms leading to uninformed conclusion making to either diagnose malaria or typhoid.

The Challenges of Malaria Diagnosis

Malaria diagnosis provides an important frame in determining the availability of the disease and administering a treatment module that assists in preventing further dangers that can be posed by the disease and spread to other people by the local mosquitos. Malaria diagnosis is always difficult in areas where malaria is not very common since clinicians may fail to see malaria as a potential ill, further the laboratory technicians may fail to detect malaria causing microorganisms i.e. parasites when examining the blood smears placed under the microscope (Zuricic 2015,Pg 113-129). In areas where malaria is common, malaria transmission is so high such that most of the people in the area are malaria carriers but not actively by malaria. In such conditions, finding malaria parasites in a sick person does not necessarily imply that the disease is as a result of the malaria parasites.

Research Question and PICO Analysis

The aim of this researching this clinical practice skill was to identify whether microscopic diagnosis would be a better alternative to the clinical diagnosis which has been deemed slightly inaccurate.

Malaria prevalence in some parts of the world has reached epidemic stages. An inaccurate method used can result in misdiagnosis of malaria. It is therefore vital to use an appropriate diagnosis method to enable early and efficient administration of treatment of the disease. The effective approach to determine an appropriate background check information is by forming research questions that are Population, Intervention, Comparison, and Outcome an approach commonly known as PICO. This method is commonly applied in the research study involving the Evidence-Based Practice to frame a clinical question. Separation of the question into four components helps to identify the relevant information that the research is determined to obtain (Redat 2015, Pg. 467-476). The PICO analysis for this clinical skill is obtained in table 1.0.

Research Strategy and Terms

The research question formulated for this question was 'Does microscopic diagnosis of malaria provide a more accurate diagnosis compared to clinical diagnosis in patients?' With the determination of the research question, a robust research strategy was developed with various research terms as explained in the table 2.0 below.

Table 2.0: Terms

- Patient

- Intervention

- Comparison

- Outcome

- Randomly served patient

- Clinical Diagnosis of malaria

- Microscopic Diagnosis of malaria

- Accuracy in Malaria Diagnosis

- Population

- Intervention

- Comparison

- Outcome

- Randomly served patient

- Clinician tests

- Malaria

- Malaria diagnosis

- Accuracy

- Patient with inactive malaria parasites

- Microscope results

- Malaria diagnosis

- Malaria diagnosis module

Comparison of Clinical Diagnosis and Microscopic Diagnosis

From the analysis, it was obtained that patients who were presented and their data used for the study were from across the sexes and ages. The study covered both the two methods of malaria diagnosis i.e. the microscopic diagnosis and the clinical diagnosis of malaria. Qualitatively, the results showed that the accuracy prevalence of the result outlay was pegged on the microscopic diagnosis. In the microscopic diagnosis, the patients are practically made to undergo the test by providing their blood samples to be used as specimens in the experiment. The steps required in the tests are keenly undertaken to determine the results. When the results are deemed to negative, subsequent tests are undertaken to determine the presence of other possible illnesses like acute anemia or even flu but when the results were obtained to be positive then the relevant treatments were administered and in most instances, the patients responded positively to the treatments. On the other hand, the clinical diagnosis made it routine that once the known symptoms were prevailing then treatments were recommended which in some cases brought complications being that malaria suspected to have been present were absent. This was a process deemed to be in a way hazardous in health practice (Chan 2013, Pg. 349-352).

Critique of Clinical Diagnosis and Microscopic Diagnosis

From the PICO study analysis, it is evident that clinical diagnosis of malaria being the traditional and widely applied method of malaria diagnosis has to a greater percentage failed to merit on the in trigs of the disease module requirement Clinical Diagnosis is dependent on the patient's symptoms and the physical findings by the clinician during the examination.

The known symptoms of malaria being fever, chills, sweats, headaches, muscle pains, nausea and vomiting are often not specific and are also found in other diseases like the "flu" and common viral infections. In the same way, the physical findings are in most cases not specific to the only malaria.

In heightened malaria condition caused by Plasmodium falciparum, clinical findings like confusion, coma, neurologic focal signs, severe anemia, and respiratory difficulties are more abstract and may increase the chances of suspicion for malaria.

Since the clinical diagnosis of malaria is mostly reliant on the clinician’s observation of symptoms and bodily signs, a rush on the measure for malaria is often arrived at which sometimes may not depict a true manifestation of the disease condition. In circumstances that malaria diagnosis comes out negative, subsequent tests are always made to determine other possible illnesses which always deem then process to be sometimes expensive, involving and to some extent based on trial and error (Stickney 2011, Pg. 89-92).

On microscopic diagnosis, Malaria parasites are identified in the patients’ blood by preparing a blood smear on the microscope slide. Before the blood smear examination under the microscope, the blood smear i.e., the specimen is stained with a stain like the Giemsa stain to give the parasites a distinctive appearance which makes it easy to distinguish the malaria parasite from other parasites and other blood components that may not be required for study then. This technique; the microscopic diagnosis remains the gold standard for the laboratory confirmation of malaria. Nonetheless, it depends on the other parameters of other laboratory experiments like the quality of the reagents, the type of the microscope, and on the experience of the technician (Azrin 2008, Pg. 467-501).

To make the process more accurate, Microscopic examination tests are always performed immediately when ordered by a healthcare provider and once the blood sample is obtained to prevent contaminations of the specimen. The specimens should neither be preserved nor stored for later operation by saying a more qualified personnel as these will lead to distortion of results.

From the research, it is observed that the clinical diagnosis of malaria is mostly dependent on the physical observation of the symptoms and signs of the disease Malaria with no definite surety; meaning when the resultant test for malaria is determined to be negative then the patient is perceived to be normal and that the patient is 'not' suffering from a disease. This practice is a health wisely dangerous practice since the disease parasites are as a result left to replicate and grow leading to further complication. This is the basis on which chronic malaria develops and advance to develop other health conditions.

On the other hand, the microscopic diagnosis of malaria has, as an experimental practice, strived to ensure that the trial and assumption in clinical diagnosis are done away with as physical and practical experimental tests are carried out to determine whether or not the malaria parasite is present. This reduces the chance-taking practice which prevents the growth and replication of the parasites if available.

Advantages and Disadvantages of Microscopic Diagnosis

The research paper on the evidence-based practice on the alternative diagnosis for malaria has proved viable in practice and on workability with numerous strengths and just with a few setbacks. To begin with, on strengths, the Microscopic diagnosis has proved to be more accurate compared to the later and the other methods like the antigen method. This method being entirely relying on scientific experiments tends to give a consistent result on the test disease component which in the case of malaria is a parasite. The method also does not rely on observable signs and symptoms but rather purely on experimental tests hence do not give room for mere assumptions. Further, the diagnosis method leads to carrying of subsequent tests for other diseases in case the targeted malaria test comes out to be negative. This may lead to the disclosure of other illnesses which may be present in the body but were never suspected giving room for their treatment. The Microscopic diagnosis can also be carried out even when there are no symptoms of malaria since the test is entirely on the malaria parasite. Once the test is done and the malaria parasite is identified, treatment can hence be administered at the earliest stage possible.

On the limitations, microscopic diagnosis of malaria has proved to be a relatively expensive process to carry out since a microscope is required in the first place. On the other hand, the process may produce an inconsistent result in case the process is missed at a stage. Contamination of the specimen during the experiment may also lead to inaccurate results.

The Benefits of Evidence-Based Practice and Patient-Centered Care

This practice has to a greater percentage impacted positively by the patient's experience in the clinical service. The patient always feels contented when proper and adequate treatment is given to him or her at the facility. During this process, the patient has the confidence of the practitioner since the result that shall come out of the experiment is deemed to be accurate. When the result is positive, a treatment is immediately recommended and ultimately administered with the confidence that the results were accurately obtained from the experiment since the process does not rely on assumptions. When the results are negative, showing the absence of the malaria parasite, subsequent tests are always recommended to establish the disease-causing organism that may be present in the patient's blood, hence enabling the onset of administering the required medical treatment of the identified disease (Murphy 2009, Pg. 956-1003). The process can also be performed during the general body checkup even in the absence of the disease signs and symptoms.

Conclusion

In conclusion, this evidence-practice has formed a formidable basis of the operation on the practices health, clinical, and nursing. It is through this that the health practitioners have ceased to take chances and stopped languishing in the fallacy of mere assumption that diseases are inferred based on mere signs and symptoms. It is this evidence of proof that general body health checkups are carried out even in the absence of potential disease signs. When proper and required experimental steps are taken, results are accurately obtained to enable treatment of the disease. It is from this that more subsequent disease tests can be carried out to enable administration of treatment at the best initial stage as possible. In the modern health practice, the practitioners are advised to desist from the fallacy belief of fever and bodily manifestations to recommend the availability or absence of a disease like malaria. This has come a long way to ensure that wrong dosage is not administered to patients. The clinicians and health practitioners are hence only able to give the prescription for the tested and proven illnesses, diseases, and complications. In this way, the right drugs are given for the correctly identified diseases, hence no mismatch in the drug-disease drug administration. This is what has formed the basis for the 'only treat the disease that is known'.

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