PRAC 6635 Week 5: Reflections on Evidence-Based Practice, Clinical Practice Guidelines, and Standards of Care
Reflections on Evidence-Based Practice, Clinical Practice Guidelines, and Standards of Care
Evidence-based practice (EBP), Clinical Practice Guidelines (CPGs), and Standards of Care constitute the fundamental components of contemporary psychiatric care. These frameworks enable medical professionals to deliver consistent, high-quality treatment grounded in empirical research and patient-centered care (Grassi et al., 2023). Nevertheless, clinical situations may occur in which clinicians have divergent therapeutic methodologies. This paper presents a reflective assessment of a clinical scenario that features contrasting treatment approaches between my preceptor and me. This will examine the case specifics, contrast treatment strategies, advocate for an evidence-based alternative, and contemplate professional collaboration and future clinical decision-making.
Patient Case Summary
The case concerned a 21-year-old male, L.E., who sought psychiatric services after several emergency department visits for acute panic episodes. He experienced spontaneous chest tightness, palpitations, dyspnea, and a sensation of impending doom, lasting approximately 12 to 15 minutes. These incidents transpired daily without discernible triggers. He possessed no psychiatric history, substance abuse, or notable medical issues. The family history indicated such symptoms in his mother. Vital signs revealed tachycardia throughout assessment; nevertheless, the ECG displayed a normal sinus rhythm. L.E. refuted the presence of depressive symptoms, hallucinations, or suicidal ideation. A tentative diagnosis of panic disorder was proposed based on his history, symptoms, and evaluation. No pharmacological interventions had been commenced at the time of assessment. The example prompted inquiries about the most effective initial strategy, specifically regarding the comparison between pharmaceutical and non-pharmacological therapies, as well as the timing of specialist referrals (Zatrahadi et al., 2023).
Compare Treatment Plans
My preceptor advised commencing psychotherapy as the exclusive therapeutic approach, explicitly directing L.E. to cognitive behavioral therapy (CBT) without prescribing pharmacological medication. The justification provided was to prevent potential pharmaceutical side effects and to assess illness development through non-pharmacological methods (Vigod et al., 2025). The preceptor recommended psychoeducation regarding panic episodes and advocated for journaling to uncover possible concealed triggers. Despite the absence of pharmacological interventions, the preceptor intended to reevaluate the necessity for medication following four therapy sessions. No laboratory evaluations or screening instruments, including the Panic Disorder Severity Scale (PDSS), were employed. This methodology prioritized a conservative, vigilant observation technique, predominantly utilizing therapy as the primary therapeutic modality.
As a nurse practitioner adhering to evidence-based Clinical Practice Guidelines, I advocate for an integrated treatment plan that incorporates both pharmacological and non-pharmacological approaches from the outset. I would commence treatment with a low-dose selective serotonin reuptake inhibitor (SSRI), such as sertraline, which is frequently advised as a first-line therapy for panic disorder. Simultaneously, I would recommend L.E. for cognitive behavioral therapy, ensuring a comprehensive approach. I would perform a comprehensive diagnostic evaluation, encompassing thyroid function assessments and toxicology screenings, to exclude medical or substance-induced etiologies (Ziffra, 2021). I would also utilize the PDSS to assess the severity of symptoms and the effectiveness of the treatment. This two-pronged method tries to treat immediate symptoms with drugs while also building long-term coping mechanisms through therapy. This will help reduce functional impairment and improve quality of life more quickly.
Justification
Clinical Practice Guidelines for the management of panic disorder, including those from the American Psychiatric Association (APA), endorse SSRIs as the primary pharmacological intervention alongside CBT. Numerous studies have demonstrated that the combination method yields significantly superior results in symptom alleviation and relapse prevention compared to either intervention used individually (Mahoney et al., 2024). SSRIs such as sertraline and fluoxetine exhibit established safety profiles in young people, accompanied by tolerable side effects. Furthermore, the preliminary application of screening instruments such as the PDSS improves diagnostic precision and enables clinicians to assess treatment efficacy objectively. The integrative approach targets both the neurochemical and cognitive-behavioral aspects of panic disorder, according to best practice standards, facilitating expedited symptom management and alleviating patient suffering, while minimizing interruptions in daily activities.
L.E.’s everyday, unprovoked panic episodes were substantially hindering his academic and social life. Considering his absence of mental history and his discomfort regarding his symptoms, a strategy that swiftly mitigates physiological symptoms will probably enhance engagement and compliance with treatment. Pharmacological intervention with an SSRI may rectify neurotransmitter imbalances associated with panic attacks, whereas CBT may assist him in recognizing and reframing catastrophic ideas (Ziffra, 2021). Given his genetic susceptibility, early pharmacological management may also avert the progression or exacerbation of symptoms. Additionally, utilizing diagnostic tools and laboratory tests would aid in a comprehensive alternative diagnosis, thereby reducing the risk of mismanagement. This method, based on research, considers both biological and psychosocial factors. This makes sure that L.E.’s treatment is tailored to her complete needs.
Reflect on Differences
The principal distinction between my preceptor’s plan and my own is in the timing and incorporation of pharmacological intervention. My preceptor initially favored a non-pharmacological approach, concentrating exclusively on cognitive-behavioral therapy and psychoeducation. Conversely, my strategy involved the prompt commencement of an SSRI in conjunction with CBT to get expedited symptom management. A further point of contrast was the diagnostic evaluation—my methodology incorporated laboratory tests and the Panic Disorder Severity Scale. In contrast, my preceptor did not employ formal instruments to gauge baseline symptom severity (Hirsch et al., 2021). These differences highlight a distinction in clinical urgency and the emphasis on symptom measurement. Both approaches are based on patient-centered care; however, my approach is more proactive and is informed by new guidelines that recommend combined therapy as the best option for moderate to severe cases.
Several factors may have contributed to the different approaches. The clinical experience of my preceptor may make people more likely to trust non-drug therapies, especially with younger patients who do not have a complicated mental background. In addition, her clinical method may focus on lowering the amount of medication she takes unless her symptoms get worse. My selection was primarily guided by evidence-based literature and established recommendations, as I am still acquiring clinical expertise and depend on published standards to inform my practice. Patient-centered treatment was also significant; although my preceptor advocated for a gradual commencement of therapy, I prioritized swift symptom alleviation due to the patient’s anguish and functional impairment. These variances demonstrate how evidence-based therapy is perceived via the perspectives of provider experience, training, and patient situation, underscoring the necessity for collaborative, reflective clinical reasoning (Vigod et al., 2025).
Lessons Learned
This experience highlighted the importance of integrating evidence-based protocols with personalized patient care. It demonstrated that although clinical practice guidelines offer a robust framework, professional judgment must also consider each patient’s distinct environment, preferences, and symptom intensity. I acknowledged the significance of early intervention in panic disorder and how prompt, well-informed treatment choices can avert functional deterioration. This scenario heightened my admiration for organized methods, such as the PDSS, and underscored the importance of clear documentation and comprehensive assessments (Grassi et al., 2023). Henceforth, I will adopt a more holistic approach to treatment planning, simultaneously evaluating pharmacological and non-pharmacological possibilities while remaining cognizant of both immediate alleviation and long-term management objectives.
In forthcoming clinical interactions, I will employ a dual approach: adhering to Clinical Practice Guidelines while tailoring care plans to meet individual needs and preferences. I now recognize the significance of statistically evaluating symptom load to inform decision-making and monitor progress. I will adopt a more proactive approach in evaluating diagnostic tests to exclude medical etiologies, particularly when symptoms are vague or coincide with somatic complaints. This instance highlighted the importance of early psychoeducation in enhancing mental health literacy, particularly among young adults (Mahoney et al., 2024). I aim to cultivate transparent and cooperative relationships with patients by clearly articulating the risks and benefits of various treatment modalities and ensuring their active participation in care decisions.
When treatment plans vary across clinicians, I will engage in future collaborations with professionalism, humility, and evidence-based discourse. Instead of immediately contesting a colleague’s conclusions, I would engage in a polite dialogue by referencing current guidelines or recent literature and articulating clinical concerns using shared decision-making terminology. For instance, I could state, “I have encountered recent recommendations regarding panic disorder advocating for the earlier initiation of SSRIs—what is your perspective on this strategy in this instance?” This form of communication promotes reciprocal learning while preserving collegial respect (Hirsch et al., 2021). I will request an explanation to understand the reasoning behind the alternative approach better. This method enhances interprofessional collaboration, ensuring that patients receive care based on both clinical experience and the latest evidence.
Conclusion
This reflection exercise underscored the significance of amalgamating evidence-based standards with personalized care. Through the analysis of various treatment methodologies, I refined my clinical reasoning and augmented my enthusiasm for professional collaboration. Henceforth, I will apply these lessons to facilitate prompt, patient-centered interventions while fostering open and respectful communication with colleagues to enhance patient outcomes.
References
Grassi, L., Caruso, R., Riba, M., Lloyd-Williams, M., Kissane, D., Rodin, G., McFarland, D., Campos-Ródenas, R., Zachariae, R., Santini, D., & Ripamonti, C. (2023). Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline. ESMO Open, 8(2), 101155. https://doi.org/10.1016/j.esmoop.2023.101155
Hirsch, C. R., Krahé, C., Whyte, J., Krzyzanowski, H., Meeten, F., Norton, S., & Mathews, A. (2021). Internet-delivered interpretation training reduces worry and anxiety in individuals with generalized anxiety disorder: A randomized controlled experiment. Journal of Consulting and Clinical Psychology, 89(7), 575–589. https://doi.org/10.1037/ccp0000660
Mahoney, A. E. J., Dobinson, K., Millard, M., & Newby, J. M. (2024). A clinician’s quick guide to evidence-based approaches: health anxiety. Clinical Psychologist, 1–3. https://doi.org/10.1080/13284207.2024.2402333
Vigod, S. N., Frey, B. N., Clark, C. T., Grigoriadis, S., Barker, L. C., Brown, H. K., Charlebois, J., Dennis, C., Fairbrother, N., Green, S. M., Letourneau, N. L., Oberlander, T. F., Sharma, V., Singla, D. R., Stewart, D. E., Tomasi, P., Ellington, B. D., Fleury, C., Tarasoff, L. A., . . . Van Lieshout, R. J. (2025). Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l’humeur, des troubles anxieux et des troubles connexes périnatals. The Canadian Journal of Psychiatry. https://doi.org/10.1177/07067437241303031
Zatrahadi, M. F., Miftahuddin, M., Ifdil, I., & Istiqomah, I. (2023). A bibliometric analysis of the anxiety disorder topics in 2023. Konselor, 12(2), 74–85. https://doi.org/10.24036/0202312245-0-86
Ziffra, M. (2021). Panic disorder: A review of treatment options. Annals of Clinical Psychiatry, Volume 33, No. 2, e22–e31. https://doi.org/10.12788/acp.0014
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Reflections on Evidence-Based Practice, Clinical Practice Guidelines, and Standards of Care
As an advanced practice provider, you may encounter situations where your clinical judgment differs from your colleagues. For this reflective assignment, you will begin to gain experience in recognizing Clinical Practice Guidelines (CPG) for Standards of Care from evidence-based practices. You will critically evaluate a treatment plan you feel your preceptor may have deviated from Clinical Practice Guidelines and develop your own clinical reasoning skills. This assignment will begin to prepare you for next quarter’s implementation of treatment planning and interventions in patient cases. Keep what you learned from this assignment in your critical thinking processes for future Practicum Experiences.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCE
To Prepare
- Identify a Case:
- Choose a patient case from your clinical experience where you and your preceptor approached the treatment plan differently.
- Research evidence-based information pertinent to your chosen patient for treatment Clinical Practice Guidelines and Standards of Care.
Submission Requirements:
- Length: 3-4 pages, double-spaced, APA format.
- Cite at least 3 peer-reviewed sources to support your analysis.
Evaluation Criteria:
- Clarity and completeness of the case summary.
- Depth of analysis and comparison between treatment plans.
- Use of evidence-based rationale for your alternative plan.
- Reflection on learning and future application.
- Proper use of APA formatting and references.
Assignment
Write a paper:
Briefly summarize:
- The patient case, including all relevant information: the patient’s history, assessment findings, medications, any pertinent testing, presenting symptoms, and the final diagnosis (ensure patient confidentiality).
Compare Treatment Plans:
- Describe your preceptor’s recommended treatment plan and interventions.
- Explain the alternative treatment plan you would have recommended as a nurse practitioner based upon Clinical Practice Guidelines and Standards of Care.
Justify Your Approach:
- Use evidence-based guidelines, clinical research, and relevant literature to support your alternative plan.
- Discuss why you believe your approach would be effective, considering the patient’s history, condition, and individual needs.
Reflect on Differences: - Analyze the differences between your plan and your preceptor’s.
- Consider factors such as clinical experience, knowledge, patient-centered care, and the influence of evidence-based practice in decision-making.
Lessons Learned:
- Reflect on how this experience has influenced your clinical practice and approach to treatment planning.
- Discuss how you can apply what you learned to future patient care.
- How might you approach another provider professionally in the future when you find treatment plans differing during collaboration on the patient case?
By Day 7
Submit your Reflection Paper. You do not need your preceptor’s signature for this assignment.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK9Assgn2_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
PRAC_6635_Week9_Assignment2_Rubric
| Criteria | Ratings | Pts |
|---|---|---|
| This criterion is linked to a Learning Outcome The case summary is clear, complete, and includes all relevant information. It covers the patient’s history, assessment findings, medications, any pertinent testing, presenting symptoms, and the final diagnosis. | 10 to >8.0 pts Excellent The response thoroughly and accurately describes the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis.
8 to >4.0 pts Good The response accurately describes the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis. 4 to >2.0 pts Fair The response describes the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis, but is somewhat vague or contains minor inaccuracies. 2 to >0 pts Poor The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history, current medications, allergies, and review of diagnosis. |
10 pts |
| This criterion is linked to a Learning Outcome Provide a thorough, insightful comparison between the alternative plan and the preceptor’s approach, analyzing key differences in clinical experience, knowledge, and patient-centered care. Thoughtfully discuss how evidence-based practice influenced decision-making in both plans, demonstrating an understanding of its role in patient care. | 25 to >21.0 pts Excellent The response provides a thorough, insightful comparison between the alternative plan and the preceptor’s approach, analyzing key differences in clinical experience, knowledge, and patient-centered care.
21 to >16.0 pts Good The response compares the two approaches with reasonable detail but may miss some key differences or lack depth in analysis. 16 to >10.0 pts Fair The response provides a limited comparison, without fully exploring the differences in clinical experience or decision-making processes. 10 to >0 pts Poor The response fails to provide a meaningful comparison between the plans, or the analysis is overly simplistic or inaccurate. |
25 pts |
| This criterion is linked to a Learning Outcome Reflect on the differences between alternative treatment plan and preceptor’s plan. Critically analyze the rationale behind each approach and identify how these differences inform clinical decision-making and professional growth in patient care. | 25 to >21.0 pts Excellent The response demonstrates a thorough, insightful reflection on the alternative plan and the preceptor’s approach, analyzing key differences in clinical experience, knowledge, and patient-centered care.
21 to >16.0 pts Good The response demonstrates reflection on the two approaches with reasonable detail but may miss some key differences or lack depth in analysis. 16 to >10.0 pts Fair The response demonstrates a limited reflection, without fully exploring the differences in clinical experience or decision-making processes. 10 to >0 pts Poor The response fails to demonstrate a meaningful reflection on the plans, or the analysis is overly simplistic or inaccurate. Reflections on the case are vague or missing. |
25 pts |
| This criterion is linked to a Learning Outcome Reflect on the lessons learned from comparing treatment plan approaches, assessing how the experience has influenced clinical decision-making and identify how these insights will guide approach to future patient care and collaboration with other healthcare providers. | 25 to >21.0 pts Excellent The response offers a thorough reflection on how the experience has influenced clinical practice and treatment planning, showing growth in clinical reasoning, decision-making, and patient care. It clearly explains how lessons learned will guide future patient care, with specific examples. It also provides a thoughtful approach to handling differing treatment plans, emphasizing respectful, evidence-based communication and collaboration.
21 to >16.0 pts Good The response offers a solid reflection on how the experience has influenced clinical practice and treatment planning, though some areas lack depth. It shows growth in clinical reasoning, decision-making, and patient care, but examples may be underdeveloped. It explains how lessons can be applied to future care with relevant examples and provides a reasonable approach to handling differing treatment plans, though not all aspects of collaboration are fully explored. 16 to >10.0 pts Fair The response provides a basic reflection on how the experience influenced clinical practice and treatment planning but lacks detail. Shows limited growth in reasoning and decision-making. Mentions applying lessons to future care, but examples are vague. Offers a minimal approach to handling differing treatment plans, with limited focus on professionalism or evidence-based communication. 10 to >0 pts Poor The response offers little to no reflection on how the experience influenced clinical practice or treatment planning, showing no growth in reasoning or decision-making. It fails to explain how lessons will be applied to future care and provides no meaningful approach to handling differing treatment plans, lacking professionalism or evidence-based focus. |
25 pts |
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 5 to >4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.
4 to >3.0 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3 to >2.0 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors. 2 to >0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. |
5 pts |
| This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. | 5 to >4.0 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 to >3.0 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 to >2.0 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. 2 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided. |
5 pts |
| This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. Support the alternative plan with at least three evidence-based guidelines or peer-reviewed journal articles. All sources must be current (no more than five years old), credible, and clearly aligned with the patient’s case. | 5 to >4.0 pts Excellent Uses correct APA format with no errors. The response provides at least three current, evidence-based resources from the literature to support the alternative treatment plan for the patient. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.
4 to >3.0 pts Good Contains a few (1 or 2) APA format errors. The response provides at least three current, evidence-based resources from the literature to support the alternative treatment plan for the patient. Each resource represents current standards of care and supports treatment decisions. Missing justification discussion. 3 to >2.0 pts Fair Contains several (3 or 4) APA format errors. Two evidence-based resources are provided to support alternative treatment decisions; may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan. 2 to >0 pts Poor Contains many (≥ 5) APA format errors. One or no resources are provided to support alternative treatment decisions. The resources may not be current or evidence-based or do not support the treatment plan. |
5 pts |
Total Points: 100
