The Adoption and Implementation of Evidence-Based Practice - Research Paper Example

Upton, P. Scurlock-Evans, L. Stephens, D. Upton, D. . The Adoption and Implementation of Evidence-Based Practice (EBP) among Allied Health Professions. International Journal of Therapy and Rehabilitation 19 (9), pp. 497-503. Evidence Based Practice (EBP) is being considered as one of the optimal practices, which is being used in number of fields including healthcare or medicine, social work, psychology, etc. Although, it is being utilized in varied fields, it is widely used in the healthcare, with various sub-sectors in healthcare like Allied Health Professionals (AHP) also maximally adopting it. The basic idea behind this EBP is, healthcare organizations or healthcare practitioners including AHPs while carrying out their tasks will pick the best possible evidences that are ‘available’, or even the best applicable information obtainable, so that they can carry out their tasks in an effective manner, and also take competent decisions. “Evidence based practice is an approach to decision making, during which medical practitioners uses the best evidences available, particularly in consultation with the patient, to decide upon the option or approach which suits that patient best.” (Armstrong and Gray, 2009, pg. 20). This utilization of EBP among the AHPs is the subject of discussion in the article, The Adoption and Implementation of Evidence-Based Practice (EBP) among Allied Health Professions written by Penney Upton, Laura Scurlock-Evans, Danielle Stephens and Dominic Upton. Thus, this article will be critically reviewed here focusing on the various aspects of article, including its purpose, its literature review, methodology, sampling process, data collection process, study’s results finally ending with clinical implications. Purpose of the study The authors of the article Upton, Scurlock-Evans, Stephens and Upton lay out the purpose of the study at the outset itself, which is “to assess and characterise adoption of EBP within AHP’s clinical practice.” (Upton et al. 2012). They expand on the purpose of the study by basically defining EBP, and by explaining about the target group of the study. According to the authors, EBP is an important and widely accepted practice in healthcare settings to ensure that health care professionals particularly AHP are provided information about the recent evidences and also the researches relating to their clinical practice. To study about EBP adoption among AHPs, the authors focused on AHPs working in NHS Scotland. The authors particularly focused on the newly qualified AHPs, particularly called Newly Qualified Practitioners (NQP), with differing years of clinical practice experience. “To describe and compare the extent of self reported EBP implementation within a crosssectional sample of NQPs in their 1st, 2nd and 3rd year of clinical practice.” (Upton et al. 2012). Literature Review Before delving into the adoption and implementation of EBP by AHPs in NHS Scotland, the author as part of literature review provide a background regarding the topic of EBP, its implementation in healthcare setting particularly among AHPs, challenges that could be faced during implementation phase, results of previous studies, etc, etc. Through this review of the literature, the authors particularly want to bring out the positive aspects of EBP, and how it can be effectively applied in healthcare setting. Then, by focusing on the AHPs, the authors strongly stress how important AHPs’ performance has become in the current healthcare environment particularly regarding patient care, and so how the beneficial EBP can be further optimize those AHP’s performance. (Rycroft-Malone et al. 2003). With EBP strongly hypothesized to optimize AHPs’ performance, but still extensive and in-depth studies not being done on that aspect, it became a crucial for the researchers to study about it, which in a way could have facilitated the authors to initiate this study. Firstly, to bring out the positive aspects of EBP, the author starts of by providing a single definition of EBP. “Evidence-based practice (EBP) is a widespread approach to health care, which aims to promote decision-making based upon the integration of the best research evidence with patients’ values and clinical circumstances” (Shaneyfelt et al, 2006, p.1116, cited in Upton et al. 2012). Although this single definition of EBP seems adequate, the authors could have provided definitions of EBP from other sources as well, thereby providing the readers varied perspectives as well as scope about the definition of EBP. The authors then provide the insight of how EBP are being strongly adopted by healthcare organizations in UK particularly from mid 1990s, because of the benefits it can provide, instead of depending on traditional assumptions. (McCormack, Manley and Garbett 2008). The authors then list out the benefits that could be provided by EBP, “it promotes improvement in patient outcomes and the effectiveness of care, in conjunction with reducing the costs associated with health care.” (Upton et al. 2012). These above lines are the only lines in the literature review, in which the authors directly talk about the benefits of EBP. The authors could have elucidated more benefits of EBP in the literature review by providing key facts as well as real world examples. That is, the authors could have included studies of EBP application in real healthcare organizations, and also listed out the benefits that have been incurred by those organizations. The authors then focus on AHPs and how the can adopt EBP. The authors explain who and all constitute Allied Health Professionals (AHPs). The authors broadly explain that “AHPs are those individuals working within health domains that are distinct from medicine, dentistry and nursing.” (Arena et al, 2011 cited in Upton et al. 2012). As an extension of that definition, the authors list out healthcare personnel, who are classified or categorized as AHPs, and they are “podiatrists, physiotherapists, occupational therapists and language and speech therapists.” (Upton et al. 2012). However, the authors missed out listing all the categories of AHPs. Although, it differs from country to country, regarding who and all can be constituted as AHPs, according to The Health Professions Council (HPC), which is the regulator for the AHPs and Healthcare scientists in the UK, there are more than 16 professions, which can be constituted as AHPs. They are art therapist, drama therapists, music therapists, dieticians, occupational therapists, orthoptists, orthotists, paramedics, physiotherapists, podiatrists, prosthetists, radiographers, operating department practitioners, clinical scientists, biomedical scientists, speech and language therapists. (Jones and Jenkins 2006; NHS Careers 2012). However, when viewed from other perspective, as this list is not a fixed one, with more professions being constituted as AHPs, the authors provided a basic list. Although, it is an effective practice being utilized in various sub-sectors in the healthcare sector, its adoption by AHPs and how it fared, has not be studied in an in-depth and extensive manner. Thus, to study the efficacy of EBP among the AHPs, the authors initiate this study. Firstly, the authors point out how AHPs “have a number of distinct features which make it important to understand their unique experiences further.” (Upton et al. 2012). That is, instead of following EBP based studies in physician and nursing domain, it is important to get distinct and exclusive insights from the AHPs’ perspective. Considering the fact that AHPs form a crucial part of healthcare operations including in NHS, and with their performance making key contributions to efficient patient care, the authors’ decision to study about EBP adoption by them appears significant. “AHP services offer critical contributions to the NHS and operate in a wide range of environments”. (Jones and Jenkins 2006). In addition, as the authors point out, despite their crucial role, the scope, spectrum and contribution of AHP services and how they can use EBP for the effective patient care are often not well understood. (Burns and Grove 2007). Due to this shortfall, AHP services are not always aptly used by the healthcare organizations to the optimum benefit of patients as well as NHS as a whole. This perspective also justifies the need for studying about it. Approach & Methodology For this study, the authors used a cross-sectional survey design, in which postal as well as online questionnaire surveys were distributed among newly qualified AHPs employed by NHS Scotland. The survey consisted of questions which focused on the demographic aspect of the AHPs and importantly regarding the validated measure of EBP called the Evidence-Based Practice Questionnaire (EBPQ). “The EBPQ is a 24 item self-report measure which comprises three sections designed to assess the uptake and implementation of EBP (practice subscale), attitudes towards EBP (attitude subscale), and knowledge and skills of EBP (knowledge subscale).” (Upton et al. 2012). According to the authors, each subscale were measured using 7 has the maximum (average) score for each subsection, and a minimum (average) score of 1. (Upton et al. 2012). Then, the scores were used to analyze AHPs ‘affinity’ to EBP, with the higher scores indicating a more positive attitude, or greater use and knowledge of EBP among the AHPs. This use of quantitative method of EBPQ is apt for this study, as it involves garnering practical details or experiences from relevant AHPs, instead of focusing on theoretical knowledge through qualitative method. Importantly, EBPQ is formulated based on both quantitative as well as qualitative approaches. “The EBPQ is not based on theory, but rather on prior quantitative and qualitative research related to barriers to EBP.” (Rice, Hwang, Abreha-Gyan and Powell, 2010). Importantly, EBPQ is a reliable and flexible method for this study, with the authors pointing out how it fulfilled various standards. “EBPQ is quick and easy to administer and has good internal reliability, achieving a Cronbach’s α of 0.87 for the entire questionnaire, an α of 0.85 Practice subscale, an α of 0.79 for the Attitude subscale and an α of 0.91 for the Knowledge subscale.” (Upton and Upton, 2006). Thus, the cross-sectional survey design using EBPQ appears apt methodology approach for this study, without any major biases. Sample and data collection As mentioned in the above section, the surveys were distributed to newly qualified AHPs. That is, questionnaires were sent to about 564 AHPs employed by NHS Scotland, who were appointed to the posts between 2005–2006, and who have taken part in the Support and Development Scheme launched by Scottish Health Executive in 2005. (Upton et al. 2012). Among these 564 AHPs, only around 154 AHPs or NQPs, which is about 27.3 percentages, completed the sent questionnaires and returned it, thus getting selected for the surveys. (3 questionnaires were excluded owing to substantive missing data). Although, this sample could provide adequate data, it would have been better if there was a larger sample, as it could have allowed the authors to come up with more definitive profiles and insights. Importantly, with the majority of the originally sent AHPs, which is around 73 percentage, not replying to the questionnaire, one can assume that many of those 73 percentage of AHPs may not have liked or known EBP, thereby avoiding to complete and return the their questionnaires. The selected sample of 154 AHPs belonged to the professional fields of physiotherapy, occupational therapy, speech and language therapy, podiatry, radiotherapy and dietetics. (Upton et al. 2012). Although, the selected AHPs were from across the number of NHS Scotland Health Boards, the majority of those 154 AHPs were working in NHS Greater Glasgow and Clyde, NHS Lothian and NHS Grampian. As far as ethical principles are concerned, the authors plus researchers have followed all the set standards. That is, they have fulfilled the Declaration of Helsinki guidelines on proper conduct of research, Data Protection Act 1998 to ensure security and confidentiality of participant data and finally ethical approval was also granted from the Institute of Health and Society Research Ethics Committee at the University of Worcester. When one focuses on the internal consistency of the EBPQ and the resultant sample and data collection process, it reflected positive signs. That is, according the authors themselves, the questionnaire as a whole demonstrated excellent internal consistency, with a Cronbach’s α of .89. (Upton et al. 2012). Although, the attitude subscale had a lower Cronbach’s α of .64, on the whole the sampling and data collection appears to be apt and effective for the relevant study. Results, clinical implications, its reliability, validity, and conclusions The findings from the EBPQ and the resultant analysis suggested that the AHPs or NQPs within NHS Scotland have an above average understanding regarding the application of EBP in a healthcare setting. In addition, this study by Upton et al. (2012), also point out how the practice as well as knowledge scores were higher than those reported by other studies which have used the EBPQ. (). Some key additional results emerged from this study that provided key insights regarding the section of NQPs who are more willing to adopt EBP. That is, “NQPs who had completed three years of clinical practice tended to be higher users of EBP (65.8%, n=25) than that of first or second year NQPs (34.2%, n=13).” (Upton et al. 2012). In addition, the authors provided evidence of how NQPs who were 29 years of age and under being more likely to implement EBP (86%, n=33) than NQPs of 30 years and above (13.2%, n=5). (Upton et al. 2012). All these key results of this study have strong clinical implications. The first and basic implication is that although there are barriers in implementing EBP in workplaces of AHPs, these results clearly that majority of the AHPs understand the importance as well as benefits of implementing EBP. The other implication is, employees or AHPs who have completed more years in the job are more likely to adopt EBP more, often than fresh AHPs, which is understandable considering the fact that those AHPs would have more exposure as well as knowledge regarding application of EBP within their workplace. The other key implication is, the study pointed out how AHPs, who were 29 years and below were more likely to adopt EBP, and that is also understandable because AHPs who are 30 and above may be influenced by traditional views and clinical practice, which could impede them from showing interest in the newly developing EBP. (Brown, Wickline, Ecoff and Glaser 2009). As far the reliability as well as validity of the study is concerned, it was on the positive lines albeit with certain issues. As the researchers plus authors used adequate sample size and thereby got apt data, the results were valid. In addition, as the authors followed all the relevant ethical procedures in the collection of data, the results were also reliable. As far as drawbacks are concerned, there are issues regarding the sample size. That is out of the 564 AHPs, who were provided with EBPQ, about 154 AHPs only completed and returned it. As pointed out earlier, a “larger sample would allow for more definitive profiles with the construction of more reliable clusters, and may help to avoid any potential ceiling effects which could potentially confound results.” (Upton et al. 2012). Although, there was no reply from majority of the initially set sample size, in the overall analysis, it appears that adequate and importantly relevant data were received. The other drawback or limitation is regarding the relatively narrow demographics adopted, as AHPs with varied backgrounds could have been included to provide a more extensive and the same in-depth results. The study by Upton et al (2012) came up with key findings of how newly qualified AHPs have good knowledge and understanding of EBP, thus increasing the possibility of its optimum implementation in their workplace. At the same time, the study also states how those AHPs need to be educated and trained in relation to EBP and its application. As far as future researches are considered, the limitation of narrow demographics can be correctly managed by having a broader categorisation of demographics like including questions about the AHPs previous work experience, qualification route taken, etc., all of which can provide more multidimensional insights. References Armstrong, J and Gray, M., 2009. Evidence-based Healthcare: How to make Health Policy and Management decisions. Churchill Livingstone. Brown, C, Wickline, M, Ecoff, L and Glaser, D., 2009. Nursing Practice, Knowledge, Attitudes and Perceived Barriers to Evidence-Based Practice at an Academic Medical Center. Journal of Advanced Nursing, Vol. 65, No. 2, pp. 371–81 Burns, N. & Grove, S. (2007). The Practice of Nursing Research 5th ed. Missouri: Elsevier. Jones, R and Jenkins, F., 2006. Managing and Leading in the Allied Health Professions. Radcliffe Publishing. McCormack, B, Manley, K and Garbett, R., 2008. Practice Development in Nursing. John Wiley & Sons. NHS., 2012. Careers in the Allied Health Professions. Available from http://www.nhscareers.nhs.uk/media/1487503/AHP.pdf(accessed on May 16, 2014) Rice, K, Hwang, J, Abreha-Gyan, T and Powell, K., 2010. Evidence-Based Practice Questionnaire: A Confirmatory Factor Analysis in a Social Work Sample. Advances in Social Work, Vol. 11, No. 2, pp. 158-173 Rycroft-Malone, J, Seers, K, Titchen, A, Harvey, G, Kitson, A and McCormack, B., 2003. What Counts as Evidence in Evidence-based Practice? Nursing and Health Care Management and Policy. Blackwell Publishing Ltd Upton, D and Upton, P., 2006. Development of an Evidence-Based Practice Questionnaire for Nurses. Journal of Advanced Nursing, Vol. 53, No. 4, pp. 454–8 Upton, P. Scurlock-Evans, L. Stephens, D. Upton, D. (2012). The Adoption and Implementation of Evidence-Based Practice (EBP) among Allied Health Professions. International Journal of Therapy and Rehabilitation 19 (9), pp. 497-503. Read More