Introduction to Sources of Evidence - Essay Example

Introduction to Sources of Evidence Introduction: Evidence-based learning in the field of medicine has become extremely popular in recent times and is linked to the use of scientific methods in deciding what is best in the care of patients. The Centre for Evidence-Based Medicine provides this definition "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The exdtension of this practice among nursing professionals is called Evidence Based Nursing. Evidence-based practice owes its popularity to Professor Archie Cochrane, a Scottish epidemologist, and his book “Effectiveness and Efficiency: Random Reflections on Health Services”, which was published in 1972”. From then the advocates of the use of evidence-based learning in the field of healthcare have managed to position this practice as the best means for providing care for patients. Evidence-based poractice calls for the systemic review and judicious use of the available evidence. This means identifying the types of evidence that would be useful in making decisions on the practice of healthcare and the manner in which these can be integrated with the expertise that comes from clinical expertise and the choice of the client to achieving the best standards in the practice of healthcare. This provides the strength of evidence-based practice and from it also comes its limitations. The criteria of evidence-based practice calls for identifying the types of evidence. This means that there should be enough useful research studies done on the subject and the lack of it would leave gaps in the use of this practice. On the other hand a surfeit of literature causes the problem of sifting through this voluminous literature to identify useful information. (Guyatt, G. et al. Evidence-based medicine.(1992). A new approach to teaching the practice of medicine). Literature Searching: The search for research studies to provide evidence for the practice of evidence- based medicine could be done in two ways. The first is using the collection of medical and nursing journals available in libraries. This means a lot of work in sifting through the journals available and is limited to these journals. Developments in the field of information and technology have provided a more convenient means in the Personal Computer and the Internet databases to enable more thorough searches through greater periods of time from the luxury of the chair at home. This does mean knowing having access to the databases and knowing how to use them. In this case the databases of MedScape, Medline, Pub Med and Google were utilized. The search term ‘evidence-based learning’ on MedScape, Medline and Pub Med while throwing up a number of titles, hardly produced anything useful. The problem with Google was that too many unrelated sites started popping up and it was decided to discard it as it made searching the Internet for relevant information very laborious. Change of the search term to Evidence-based practice provided many useful research studies making sifting a little laborious. Expanding the search term to the ‘role of nursing in evidence-based practice’ gave hundreds of titles on Medline and covered many different aspects on the role of nursing in evidence-based practice. When the search term ‘role and contribution of nurse to learning disabilities was’ was entered the same result was observed. On changing the search term ‘exploration of the role of the community nurse’ additional titles on community nursing became available. The change of the search term to ‘exploration of the role of the community nurse in learning disabilities, within the NHS in England’ no additional titles were observed suggesting that this may be a topic that is little explored. This experience has provided this learning. Using the Internet for the evaluation of research studies requires judicious use of Internet sites and search terms. On some topics an overwhelming amount of research is available and the evaluation requires time and patience. Research Summarizing: The research paper under evaluation presents a perspective on the role of community nursing learning disability in present day English society. Change is an inevitable part of human endeavour and it is in this perspective changes in the role of community nursing, learning disabilities (CNLD) is examined in this paper. (Mobbs, C. et al. An exploration of the role of the community nurse, learning disability, in England). The evaluation of the utility of any research paper begins with its relevance. The paper would have relevance in the case that its claim that there is a change in the role of community nursing learning disabilities in England and the need for such research. In a recent study conducted to review the caseload and the working practices of community nurses in view of the changes in government policy within the United Kingdom on the keeping in line with the need to promote health facilitation for the people with learning disabilities, the finding was that community nurses have a requirement to review their current role to meet the policy objectives and then challenges that care of the people with learning disabilities throw up. It goes on to say that there is a requirement to revise the education pattern, because of the nature of the changing role of community nursing, learning disabilities. (Barr, O. 2006. The evolving role of community nurses for people with learning disabilities: changes over an 11-year period). This study thus justifies the claim of the earlier study on the changing role of community nursing for people with learning disabilities and reinforces the need for research into the subject. Yet another research study suggests that the lack of sufficient research acts as a hindrance to the use of evidence-based practice among the nursing professionals. (Mckenna, H; Ashtons, S and Keeney, S. 2004. Barriers to evidence based practice in primary care: a review of the literature). The next step in the evaluation of a research paper is to examine its validity. The study of the subjects and methodology provide the means for this. The study was attempted across all the identified 170 NHS trusts to which questionnaires were sent and responses were received from 136 indicating a high level of response at eighty-one percent, though not all were fully filled. The questionnaires not filled in fully were filtered out. These numbers have not been specified, but the authors point out that the response of eighty percent is the highest seen in research exploring the activities of community learning, learning disabilities. Thus the coverage is adequate for the validity of the study The data received has been well tabulated into easily understandable statistical tables enabling the verification of the statistical assumptions, which are found to be true. The statistical methods are adequate for the validity of the study. The ethical issues and administrative sanction issues have been addressed and as such these issues do pose a threat to the validity of the research. The authors of the research have adequately addressed the validity of the study by proper coverage, use of sufficient statistical methods and addressing the ethical and administrative sanction issues. A very detailed discussion has been provided to provide the means by which the authors have arrived at their conclusion. The means as found in the discussion are very clear and are not questionable. The authors have arrived at a justifiable conclusion and have limited the utility of the conclusion that they have come to on the basis of the study to a time period in keeping with changes that are seen in as a result of developments seen in activities of human societies. Therefore this research study has valuable input for the nursing professionals engaged in community nursing of people with learning disabilities. (Mobbs, C. et al. An exploration of the role of the community nurse, learning disability, in England). The second research paper under evaluation looks at the current, as well as, the future role of registered nurses for learning disabilities (RNLD), in keeping with the view that there exists a lot of uncertainty with regard to the future of the nurses for learning disabilities. There was depth in the study under taken in that it attempted to look into the contribution of registered nurses with learning disabilities in terms of knowledge and experience to coping with people with learning disabilities. It also looked into the skills that the registered nurses for learning disabilities provided in the field of learning disabilities. The future requirement of skills in nursing professionals in the field of nursing disabilities was also looked into and finally the possible scenario in the services to be provided in the area of learning disabilities and the role that the registered nurses for learning disabilities would have to play in that scenario. For this purpose it chose three groups of people consisting of operational managers from social, healthcare and the independent sector, head nursing teachers and learning disability nurses. The break up of the three groups was seventeen registered nurses for learning disabilities, eleven operational level managers and four head teachers. The process consisted of a thirty to forty-five minutes semi-structured interview. Permission was obtained from the relevant authorities and the participants given the details of the research study. A statistical table was created for the data input for comparison and analysis. The study included a discussion that led them to conclude that the nurse for learning disabilities remained high in regard. Registered nurses for learning disabilities were a heterogeneous group displaying wide range skills and qualities, which was their greatest asset. This characteristic allowed them to apply their wide range of knowledge and skills to the individual requirements of people with learning disabilities, the situation and the organisation of which they were a part. The only failing was that they had failed to create awareness in other professionals of the role that they played in the care of people with learning disabilities. (Stewart, D. and Todd, M. 2001. Role and contribution of nurses for learning disabilities: a local study in a county of the Oxford-Anglia region). The relevance of the paper lies in the requirement for assessing the current role of the professional in nursing care in the field of people with learning disabilities and the relevance for the future. We have already seen that this is true in the case of community nurses for learning disabilities. Additional support can be seen in that there is limited assessment of the role that registered nurses for learning disabilities play in assessment of the noxious experiences of people with learning disabilities, as they are quite apt not to be able to express it properly. This fact makes it difficult for other nursing professionals to make such assessments. This emphasises that the role of the nursing professional is different from that of other nursing professional as they are dealing with people with learning disabilities. (Donovan, J. 2002. Learning disability nurses experiences of being with clients who may be in pain). The finding that the role of the registered nurse for learning disabilities calls for a wide range of knowledge and skills is justified when a look at the different types of learning disabilities that is present and that these patients with learning disabilities can range from the young to the old. (Selekman, J. 2003. Learning Disabilities: A Diagnosis Ignored by Nurses). Additional support for the relevance and validity of the research study comes from another study that emphasises the need for skill development in nurses that look after people with learning disabilities in case for them to be effective. (Slevin, E. 2004. Learning disabilities: a survey of community nurses for people with prevalence of challenging behaviour and contact demands). The analysis makes this research paper under study a relevant document for acquiring information on the role of nursing in the area of patients with learning disabilities. Applications and Implications for Practice: These two papers provide us clear insight into the role of the nursing profession in the care of people with learning disabilities, whether it as a community nurse for the people with learning disabilities or whether it be as a registered nurse for learning disabilities. The role of the nursing professional in the care of people with learning disabilities has changed with times and is expected to remain dynamic as the perceptions on the provision of care for people with learning disabilities come under a scanner and the policies keep changing. Knowledge about the challenges that the professional in the care of the people with learning disabilities faces are very different from the role of the other professional nurse and calls for a not just a wide range of skills and knowledge, but also a set of personal characteristics that could provide the warmth, understanding and compassionate care that the people with learning disabilities. These demands on the nursing professionals in the care of the people with learning qualities have make them t be held in high esteem in the field of healthcare and as such are a valuable asset to society as a whole. The lack of these qualities or the lack of the required skills and knowledge would make the nurses for people with learning disabilities ineffective in their functioning. Awareness of these challenges that the nurse for people with learning disabilities face and the qualities and characteristics required in these nursing professionals is not freely available, nor are the other professionals in the field of healthcare really aware of it. Thus awareness is limited and to acquire this awareness it requires experience as a nursing professional in the field of learning disabilities, or healthy discussion with such a professional, or the study of relevant research studies in this field. Relevant research in many aspects of nurses for learning difficulties can be found, but there exist areas that remain uncovered and research studies into these areas would throw more light on the role of the nurses for people with learning disabilities. In the daily evaluation of their practice needs the nursing professionals are assisted by the principles of evaluation based nursing. This means that the nursing professionals need to look for evidence and validate its reliability. This becomes more relevant when it is understood that nurses as part of the healthcare profession are confronted almost on daily basis with the need to evaluate the assessment, treatment, prevention and cost-effectiveness of the patients that are in their care. The nursing profession has evolved form just compassionate and care requirements from the days of Florence Nightingale to the additional requirements that put their knowledge and skills at tests in the changing world. This calls for them constantly to update their knowledge and sharpen their skills in the care of their patients. (Evidence Based Nursing). These implications for the nursing profession are even more when we come to the nursing professionals in the care of people with learning disabilities. These professionals deal with a section of society that may be even unable to care of their personal needs and hence the demands on the characteristics of the professionals as well as their knowledge and skills are very challenging and evidence-based practice provides them with a solution to face these challenges. These two research studies provide a clear insight intro the current roles as well as what the future is likely to demand from the nursing professionals in the care of the people with learning disabilities. As such its implications for the nursing professionals and those that aim to take up this challenging profession is that then care of the people with learning disabilities is different from the demands of normal care and there is requirement to be prepared for the demands that will be faced. Failure to do this would lead to inefficient care of the people with learning disabilities and put them at risk. The future direction that these responsibilities are likely to take is would demand even more from the nursing professionals I the care of the people with learning disabilities and this calls for constant searching for evidence, validating it and assessing its utility in the care of this section of society that has much more demands for nursing care. Conclusion: Evidence-based practice is the norm of healthcare I these modern times. This makes it important for the nursing professional and especially the nurses in the care of the people with learning disabilities to keep looking out for evidence that would be useful in the care of their patients. Research studies are available for this and yet there is the need to validate and evaluate it before employing it in their functions as professionals in the field of healthcare. Failure to do would make them ineffective healthcare professionals. Literature Review Barr, O. 2006. ‘The evolving role of community nurses for people with learning disabilities: changes over an 11-year period’. Journal of clinical nursing. Vol. 15, Issue 1, Pp. 72-82. Donovan, J. 2002. ‘Learning disability nurses experiences of being with clients who may be in pain’. Journal of advanced nursing. Vol. 38, Issue 5, Pp. 458-466. ‘Evidence Based Nursing’. UNIVERSITY OF MINNESOTA. [Online). Available at: http://evidence.ahc.umn.edu/ebn.htm. Guyatt, G. et al. 1992. ‘Evidence-based medicine. A new approach to teaching the practice of medicine. Journal of the American Medical Association’ Vol.268, Pp. 2420-2425. Mckenna, H; Ashtons, S and Keeney, S. 2004. ‘Barriers to evidence based practice in primary care: a review of the literature’. International journal of nursing studies. Vol.41, Issue 4, Pp. 369-378. Mobbs, C. et al. An exploration of the role of the community nurse, learning disability, in England. Selekman, J. 2003. ‘Learning Disabilities: A Diagnosis Ignored by Nurses’ from Paediatric Nursing. Medscape. [Online]. Available at: http://www.medscape.com/viewarticle/448020. Slevin, E. 2004. ‘Learning disabilities: a survey of community nurses for people with prevalence of challenging behaviour and contact demands’. Journal of clinical nursing. Vol. 13, Issue 5, Pp. 571-579. Stewart, D. and Todd, M. 2001. ‘Role and contribution of nurses for learning disabilities: a local study in a county of the Oxford-Anglia region’. British Journal of Learning Disabilities. Vol. 29, Pp. 145-150. Read More