Principles of research and evidence based practice - Essay Example

? Principles of research and evidence based practice. Principles of research and evidence based practice. Evidence-based practice in the nursing field has gained a lot of momentum and the definitions vary .The findings of research, clinical knowledge, knowledge gathered from science, and all the medical expert opinions fall under what many in the field call "evidence" although practices that are based on research findings always tend to result in the required patient outcomes in different settings the geographic locations notwithstanding. According to Schofield (2000, pg. 14), the impetus and desire for this evidence-based practice in matters nursing comes from healthcare practitioners, readily available medical information. Evidence-based practice requires changes in nursing education and other aspects like practice-relevant kind of research, and closer working relationships among all the concerned groups, that is, researchers and clinicians. Evidence-based practice does provide many opportunities for the whole concept of nursing care to be a bit more effective, individualized, dynamic and streamlined. This, nevertheless, helps in minimizing the effects of the clinical judgments (Cullum, 200, pg 4). In incidences where evidence is used to define some of the best practices rather than just supporting the existing practices, the profession of nursing care manages to keep pace with some of the latest technological advancements and also takes advantage, in many ways, of new medical research findings and knowledge developments. This paper consists of two parts; in the first part we examine the close relationship between the research process and development of evidence for practice. The second part will try and appraise the different types of evidence and evaluate their appropriateness for implementation in practice. The different types of evidences vary on the basis of the fact that they are normally from different sources. This evidence based practices, often abbreviated as EBP, basically aims at applying the best valid and reliable evidence which has been gained by use of scientific method to making clinical decisions. This evidence for practice is extremely important in the sense that it seeks to help in assessing the strength and validity of evidence of the benefits and risks of treatment, or even lack of it and medical diagnostic tests. It helps clinicians to learn and be in a position to know whether given treatments plan will do more harm or good. According to Margolis (1999, pg. 135,) the evidence’s quality can be accessed on the basis of the type of source, that is, from those clinical tests that are controlled and trials, systematic and analytical reviews of the double-blind variety, and not forgetting other aspects like conventional wisdom. This can also be based on other factors like clinical relevance, validity of the statistics, and currency. According to Ehrenberg (2003, pg 281,) evidence based practice recognizes the fact that most of the aspects of medical and health care depend on very particular and individual factors like quality or  life value judgments, and this are normally subject to scientific research methods. This evidence based practice , however, attempts to clarify those medical activities and practice parts that are principle and part of the scientific methods and applying those methods in ensuring that best prediction of expected outcomes in treatment of medical illnesses , even as the raging debate on what desirable outcomes should be (Ramstadius,1997,pg. 5). The research process is well known by most of the researchers in the medical field. Those involved in the carrying out of research in evidence based practice, if the current research finding are anything to go by, are well versed with the scientific research process. The systematic process that characterises research has to be strictly adhered to whenever those who intend to do any kind of medical researching .This ensures that the findings and data that is collected is not just valid but reliable and can be reproduced when given to a totally different individual with the same specimens. Healthcare being a very sensitive area of human life, keenness and objectivity has to be ensured in the carrying out of the research. There are so many organizations and agencies that are responsible for dissemination of the data and findings of research on evidence based practice. There are, of course, barriers that impede implementation of this evidence. According to Lambert, (1992,pg 79,) practitioners in the medical and related fields have various mechanisms, policies, regulations, and behaviours which may encourage or even act as barriers to the implementation of evidence. These evidence based practices on matters health care are always available for so many conditions for instance heart failure, asthma, diabetes and many more. Unfortunately most of these practices and strategies are never strictly adhered to and put in practice during implementation. For some time now, research on safety of the patients has always focused on data analysis on identifying patient safety concerns and issues. They also have, traditionally, demonstrated that new practices have the ability of improving quality in health care delivery and the safety of the patients. Much less attention was given to the whole concept of implementation and yet by simply putting in practice that which is learned from research health care will be made much safer (Andreozzi 2005, pg 325-329). Implementing the evidence based practices in health care is not one of the easiest thing ,it requires well put together strategies that can address the intricate and complexity of care systems ,individual practitioners ,the leaders ,the ever changing cultures in healthcare to be evidence based practice environments. Evidence based practices should always use current based data and evidence together with clinical and medical expertise to guide some of the vital health care decisions .What can be considered to be the best evidence includes in-depth empirical evidence gathered by scientific methods like qualitative and descriptive research as well as use of data from case reports, scientific principles and opinions from experts. Once we have enough and sufficient research evidence, the medical practices have to be guided by research evidence together with not just clinical expertise but also patient values. In some instances, however, there might lack a sufficient and rich research base hence prompting the healthcare choices and decisions to be principally derived from non-research sources like opinions from experts or even scientific principles. National agencies like government hospitals, universities and colleges that train practitioners in the health sector together with nongovernmental organizations should take up the responsibility of facilitating the implementation of good evidence into health practice as well as local strategies.  However, there are a few things that must be looked into that include organizational, cultural and / or attitudinal behaviours which enhance or impede the implementation of evidence based practices. According to Baker (1994, pg. 64,) to avoid such impediments, certain knowledge transfer steps have to be observed. First ,we have the creation of knowledge and its distillation ,secondly we have diffusion of the knowledge before dissemination .Last but not least ,organization have to be helped on how to adopt before implementing these evidence based practices. These knowledge transfer stages are basically viewed from the lens of medical practitioners who are keen and have determined, from patients’ portfolio that concern safety, what needs to be disseminated. Before the dissemination a lot has to be considered, for instance, consulting the experts and the health care organizations. In this section we attempt to critique the different types of evidence and evaluate their appropriateness for the implementation process during practice. The first article that this study will critique is ‘Improved healing rates for chronic venous leg ulcers: Pilot study results from a randomized controlled trial of a community nursing intervention’ this was a quantitative research solicited from the International Journal of Nursing Practice 2005; 11: 169-176 Edwards H, Courtenay M, Finlayson K, Lewis C, Lindasay E, Dumble J. This was a quantitative research and one of the best types of research. Quantitative research in the first place is the empirical and systematic investigation of particular phenomena by use of mathematical and statistical techniques. The primary objective of a quantitative type of research is not just to develop but to also employ good theories, models, and hypotheses that pertain to a problem. The whole measurement process is vital to quantitative research in the sense that it provides the necessary link between mathematical explanations and observation of the relevant relationships. Quantitative research was appropriate for this study because it, as usual, asks very specific question and in the process collects good information or data from the population to answer whatever question that has been asked. The researcher analyzed the data and findings with the help of numerical statistics making it more valid. (Bland 1992, pg. 36-55).The researcher used quantitative methods; it always yields unbiased result which can be generalized to a bigger population. This being a study that was using quantitative methods, the researcher had to go to health centres which offer an environment where people with the same problems are brought so that they can socialize in a more supportive away as they share information. Here, a sample of thirty three (33) clients suffering from a below the knee venous ulcer (leg) got randomized and given treatment, others in their homes while others in some care centre. All the participants were subjected to the treatment-both in the control group and in the intervention group. This was carried out by a team of well trained nurses who have specialised in wound care using evidence-based kind of assessment and cure guidelines. The data was later on collected upon admission of the research study and exactly after twelve (12) weeks since its admission. The results, indeed, showed a tremendous improvement in the healing among those in the intervention group when compared to those in the control group. This was done by measuring the size of the area that had the ulcer and also the scale of ulcer pressure for the healing scores. The results basically suggest that when patients are put up in a place where they are taken care of , the environment there provides lots of benefits in additional to the provided wound care treatment and expertise together with evidence-based treatment (Heinen 2004, pg 341-354).The knowledge that was gained from the study, in many ways, provides evidence that can be used to guide service delivery, improving client experience and outcomes. This was a quantitative research and all the aspects that were incorporated blended in well. This was done with a methodology that suited it. The hypothesis that the researchers were using was that the patients /clients who got the intervention of the care givers of the leg club intervention were to have a relatively improved ulcer healing and recovery rates compared to their counterparts who never received the intervention. The research design that was used was that of randomized controlled trial, this was used to basically evaluate the effectiveness of a well established community nursing intervention in as far as improving the healing rates of a deadly venous leg ulcer. The data collection entailed clients in both the intervention group and in the control groups receiving pre- assessments and post-assessments. The pre and post assessments were done at recruitment time and just before the first intervention and at exactly twelve (12) weeks since the first assessment. The data was then collected on demographic information, the general health status of the patients, status of ulcer, functional ability, and the levels of pain and patients quality of life. All the data related to healing ulcer were collected using the following methods: Area size: by the dot-point method by measuring the size of the area of ulcers. The progress in healing the ulcer was also measured by use of the pressure ulcer scale for healing, commonly referred to as (PUSH). Other additional health and clinical data that was related to healing was also collected, for instance, the presence of oedema, infection, venous eczema, recurrence and also the development of other new forms of ulcers at each and every time point. Various data collection tools and effective sampling methods were employed, for instance, the pilot study sample comprised of thirty three ulcers clients who were referred to St Luke’s nursing service in the Brisbane and Gold Coast regions of Queensland, Australia took part. Sixteen of them were randomly allocated to an intervention group and the remaining seventeen to the control group. Those who were eligible for inclusion in the research study were those with a venous ulcer below their knee, those who had an ABPI that ranged between 0.8 and 1.3.Those that were excluded from the study included those who had diabetes mellitus, ulcers of non-venous origin and those who were unable to get to the care centre. The chosen design -randomised controlled trial, was a very appropriate one in the sense that it allowed for very important aspects likes the inclusion of a control group. In the study we see a clear distinction made between the data and their interpretation. The methodology for data collection was also appropriate because they comprised some of the best material for data collection, for instance, the questionnaires and interview schedules making it very appropriate for the study. Many other aspects of the study were very appropriate, like, the systematic data collection and record keeping, the sample and their demographics, the type of sampling, number of participants, and not forgetting the types of instruments used making the study a success .One more thing that made the study a success was that the methods of the research were appropriate to the nature of the question that were being asked. To crown it all, the themes that the study had in mind are all represented; the concepts and categories derived from the data are adequately interpreted. A critique The results of the study were presented in a very clear way and this was made possible by putting them up on graphs. The analysis was in-depth in the sense that they were made very accurate by being calculated using mathematical methods and presented in percentages validating their accuracy.The researchers also did a splendid job by discussing the results of their study in the context of previous related researches.One of the limitations that they found out was that they had a small number of samples during their pilot study. They also had a very high turnover in as far as staffs are concerned at the initial stages hence limiting consistency. But all these were overcome and staff input and continuity was guaranteed. Another limitation was due to leaving out those who could not travel because of physical disabilities. The good thing about this study is that it came up with practical solutions like when ,in their results ,they indicated that patients should be given not just good nursing care but social environment to help them improve their status .The implications of the study on practice is that the knowledge gathered here can be of great assistance in improving quality of nursing service. The second study was ‘ Older patients experience of dressing changes on venous leg ulcers: more than just a docile patient’ from the Journal of Clinical Nursing 14,1223-1231 ,EBBESKOG B & EMAMI A( 2005).First of all this was a qualitative type of research .This is basically another interesting form/method of research in its own right. Qualitative research was suitable for this for it aimed at gathering a good and clear understanding of an aspect of human health. The qualitative research method was employed because it investigates the how and why of a particular phenomena takes place .One more reason to why this particular method was chosen for this study is that it produce very authentic information on only particular cases that were studied combined with many other general conclusions which are only treated as propositions-informed assertions. In cases such as this, the quantitative methods had to be used for the sake of seeking some empirical support for the informed assertions or hypotheses. This form of research was suitable for this kind of data because it allows for data to be collected including group discussions and interviews, direct observation, field notes, pictures, and many more. A good research has to at least include interviews for they always provide very in depth and at times authentic findings (Heinen,2004, pg. 357). This research study typically relied on certain methods while gathering the information, among them: Participant Observation, field notes, reflexive journals, and semi structured interviews, unstructured interviews and structured interview. And last but not least there was analysis of other resourceful materials and documents. The styles of taking part in this were designed in such a way that they act as reflexive learning, other than just being one observational method. While doing the participant observation the researchers basically become part of the group, and adopt some roles to conform to the requirements of the setting (Ebbeskog 2005, pg. 1223-1231).By doing so, the researchers gained a more in-depth insight in the phenomena. Some of the qualitative research methods were not included in the study, for instance, the use of informant interviews. The use of a focus group, which basically entails a moderator who facilitates a small size group discussion among selected population, would have enhanced the results of this study. According to Franks (1995 pg. 24), one specialized and traditional form of qualitative study is what is normally referred to as pilot testing or cognitive testing that this study made use of .This is normally used in aiding the development of survey items in such a qualitative study. This is normally done to help test the validity and reliability of items. Qualitative research was necessary in this kind of study because it asks very broad questions and also collects word information and data from those participating. This paper basically outlines the kind of examination that was undertaken by independent researchers of client records from a small, leg ulcer nursing home in one city. (Moffatt, 2006, pg. 307-312). The main purpose of the examination was to basically establish a clear view about the clients attending the care at the clinic and also to identify some aspects of the services which would benefit people in the wider society from further research. The results that were presented provided the client profiles which mostly fit the bill of that which is normally outlined in other published literature. The methodology that was used allowed for the incorporation of many other aspects of research which helped in ensuring that the study ends up with the best results. The research design was that of randomized controlled trials. A method that was easy to fuse with the data collection tools, sampling methods and approach that was to be used during analysis was necessary. The chosen design, that is, the controlled trial was actually the most appropriate for this study and an alternative design would have been unnecessary. This was a very good design in the sense that it does allow for the incorporation of many other aspects that are necessary for ensuring accurate and reliable results are realized .For example it included the inclusion of aspects like control group. The methodology for data collection did not fail in any way because the study collected enough data that later on was very helpful in the providing of such valid findings. The materials that era used to assist in data collection like the questionnaires were very instrumental in this study, for without them this study would have found difficulties in collecting some verbal results that the analysis heavily relied on. The other thing is the sampling. The sample of this study was relatively good owing to the fact that not so many people have such an illness (Courtney, 2005 pg. 169-176). The sample was appropriate, especially the number of participants, demographics, and type of sampling given the intricacies and the general nature of this study. The methods used in the research are appropriate to the nature of the question that was asked, and this can be seen in how they were answered without any technical hitches. The employed instrument like the interview schedule in many ways is justified because that was the only best way to capture very authentic information of the clients. One more thing that made the study stand out was the data collection and record keeping which were very systematic. All the concepts and categories that were derived from the data were adequately interpreted and a clear distinction drawn between the data and their interpretation. A critique The results of the study were reliable and very clear for they provided answers to the research questions and the main problem. The researchers also did a splendid job in the sense that they discussed the results in the context of previous findings giving it a more holistic approach. The study had it limitations for instance getting people who had the illness and were willing to participate proved to be a bit of an issue but the authors tried their best to get the best results out of it.Overally, the article had many good elements for instance it pointed out some of the implications it had on practice of Medicare in as far as ulcers of the said variety is concerned. Despite some of the small time limitations that unsuccessfully undermined the reliability of the study findings ,a lot was achieved ,for instance ,the whole process of scrutinizing and examining the results simply highlighted the clinicians’ conscientiousness in as far as collecting, recording and analysing physical data that relate to the clients together with their wounds. The study also brought to the fore the issue concerning how well social, cultural and psychological aspects of the patients were being handled when formulating the treatment plans. This was done because patients with ulcers in some cases tend to develop other complexities that need to be addressed to ensure that the patient heal in peace. Conclusions This paper had two intensive sections section one and section two. The first section looked at quite a number of issues. First, it looked at the different types of evidence, levels of evidence and went ahead to explain how important the evidence is for practice. This also identified the various sources of evidence that may be used to inform practice and what is generally considered to be best evidence. This paper went an extra mile to try and ensure that acknowledge concerning why evidence is important for clinical practice. This paper tried to explain why good quality evidence is important and how it can be generated. In section two the paper appraised the different types of evidence and evaluated their appropriateness for implementation in practice. This section provided a critique of two articles correctly identifying what type of evidences they were.   The research process was well organised and all the necessary steps and methods were brought on board. The research process of the articles had a very straight forward approach and their critiques, research design, method, description and even the reference have been mentioned above. The sampling too was a good composition of patients from different backgrounds and they too have been critiqued, described .The methods of data collection was by use of tools like questionnaires ,interviews and surveys which made everything happen smoothly hence making the data analysis more easy and in the process lead to findings that were valid and reliable. References Andreozzi GM, Cordova R, Scomparin MA, Martini R, Deri A & Andreozzi & de Laat E. Venous leg ulcer patients: a review of the literature on lifestyle. 14:1223-1231. Bland M. On living with chronic leg ulcers. In: Madjar I & Walton JA (Eds). adherence to clinical guidelines in a Swedish primary health care district. British Journal of Surgery 1992; 79: 10321034. Ebbeskog B & Emami A. Older patients’ experience of dressing changes and pain-related interventions. J Clin Nurs 2004; 13:355-366. Heinen MM, van Achterberg T, Scholte op Reime W, van de Kerkhof PCM. Improved healing rates for chronic venous leg ulcers: pilot study results Int J Nurs Pract 2005; 11:169-176. Franks PJ, Moffatt CJ, Connolly M et al. Factors associated with healing leg ulceration from a randomized controlled trial of a community nursing intervention. Scand J Caring Sci 2003; 17:278-284. Kerkhof PCM & van Achterberg T. Leg ulcers: a review of their impact on daily life. J Clin Nurs 2004; 13:341-354. Margolis DJ, Berlin JA, Strom BL. Risk factors associated with the failure of a venous leg on venous leg ulcers: more than just a docile patient. J Clin Nurs 2005; Moffatt CJ, Franks PJ, Doherty DC, Smithdale R & Martin R. Sociodemographic factors in chronic leg ulceration. Br J Dermatol 2006; 155:307-312. Nelson EA, Bell-Syer SEM, Cullum NA. Compression for preventing recurrence of venous ulcers. The Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, 2000; 4. No. CD002303. Schofield J, Flanagan M, Fletcher J, Rotchell L, Thomson B. The provision of leg ulcer services by practice nurses. Nursing Standard 2000; 14: 5460. Ramstadius B. Leg ulcer management. Australian Nursing Journal 1997; 5: 2021. Lees TA, Lambert D. Prevalence of lower limb ulceration in an urban health district. New Zealand Journal of Surgery 1994; 64: 258261. Persoon A, Heinen MM, van der Vleuten CJM, de Rooij MJ, van de. Nursing and the Experience of Illness. London: Routledge, 1992, p.36-55. Read More