Data Collection and Recording Process - Essay Example

Introduction: Evidence based practice is the forefront of discussion in health-care. It has emerged into a global phenomenon, as most of the practices are based on evidence generated results. The fundamental basis of evidence based practice is that, delivery of health care should be good and with sound evidence. Evidence based practice is available for almost all conditions like asthma, diabetes and heart failure (Titler n.d.). Even though the field of nursing has conducted many researchers, the implementation of evidence into practice has confronted many barriers. The only way to address deliverance of quality of care is the implementation of evidence based practice (Barker 2010). What is Evidence Based Practice? Evidence-based nursing, evidence-based nursing practice (Barker 2010) are some of the terms used in relation to it. Many definitions are given for evidence based practice: According to RCN (1996:3) evidence based practice is defined as “doing the right thing in the right way for the right patient at the right time” (Barker 2010, p. 4). Ingersoll (2000, p. 152) defined evidence based practice as “the conscientious, explicit and judicious use of theory-derived research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individuals’ needs and preference” (Hopp & Rittenmeyer 2012, p. 37). In simple terms EBP involves good practice and improvement in the delivery of quality of care. EBP is the use of current best evidence in association with patient value and clinical expertise, so as to guide health care decisions. The best evidence is collected from empirical research studies with randomized controlled trials; the rest may be derived from case studies, reports, scientific principles and opinions from experts (Titler n.d.). The practice may be guided in conjunction with the evidence collected, patient values and expert opinions. The critical elements of EBP may be represented as the integration of evidence, clinical expertise, patient preference and context of care. (Malloch & O’Grady 2010). The unique feature of EBP is that it is not solely an academic research, it provides a strong validity for the formation of a clinical basis for the delivery of positive clinical outcomes. The steps that are involved in the evidence based practice involve (Melnyk n.d.): 0. Spirit of inquiry is cultivated 1. Clinical question is addressed in PICOT format 2. The relevant and most best evidence is searched and collected 3. The evidence is critically appraised 4. The best evidence is integrated with clinical expertise and patient value and expertise. 5. The outcomes based on the evidence is evaluated 6. The outcomes of EBP decision or change are disseminated. During the past, health care professional and nurse’s used the term ‘research utilisation (RU)’ (Melnyk n.d.) which referred to the implementation of research knowledge into clinical practice. EBP is different from RU, as the clinicians consider number criteria in clinical decision making, of which evidence is the most important. The evidence obtained from the research studies is implemented into clinical practice in accordance with the patient value and clinical. EBP ensures the delivery of highest quality of care to the patient. Nurses play a crucial role in the delivery of care; therefore, nurses need to keep abreast with the innovative techniques of health care delivery, where EBP plays an important role. A study conducted by Shaheen Majid et al. (2011) found that nurses had a positive attitude towards EBP. However, the study found that there are various barriers that hindered nurses from adopting EBP. Barriers like lack of training in EBP and lack of time in implementing it. In another study conducted by Kohen and Lehman (2008) on assessing the perceptions of nurses toward evidence based practice found that the nurse participants had moderate scores on practice and attitude towards evidence based practice. Various models of EBP are available and are used in practice in various clinical setting. One of the models derived from Agency for Healthcare Research and Quality (AHRQ) (Titler n.d.). The steps involved in knowledge transfer of EBP are knowledge creation and distillation, diffusion and dissemination and organizational adoption and implementation (Titler n.d.). Knowledge creation and distillation involves conducting research and then converting the relevant research finding into products for clinical use. Diffusion and dissemination involves collaborating with health care organizations along with the opinion of professional leaders to disseminate the knowledge, so as to form the basis of clinical practice. The final stage in the knowledge transfer process includes the adoption of this knowledge by the organizations, institutions and individuals. This involves encouraging the organizations to put the relevant evidence into daily clinical practice. Qualitative Research Critique Qualitative research studies provide rich and in-depth information of the real life experiences from people who have knowledge in that particular phenomenon. (Polit & Beck 1995, p. 17). Unlike quantitative research, the variables in qualitative research cannot be manipulated and entered into a hypothesis or a theory. (Nieswiadomy 2008, p. 59). In the article by Joan R. S et al. (2009) regarding adults with type 2 DM, a qualitative study was conducted to research the perceptions towards a service redesign in adults with type 2 DM. Appropriateness of Qualitative Research: Researchers in this study wanted to explore the perspectives of adults with type 2 DM towards service redesign. To accurately assess the perceptions of adults towards the redesign, the researchers used focus group approach. Some characteristics that qualify a qualitative research study were identified by Nieswiadomy (2008) which include the subjective data, small sample size, multiple truths provided by the research and researchers participation in the study along with the participants. This study fits all the above mentioned criteria and it is also important to note that the qualitative research methods are the most appropriate to use for the study of this phenomenon. The aim of a qualitative research study is to assess the “in-depth perception” Nieswiadomy (2008) which is the underlying goal of this study. Qualitative Research Approach: The research approach used in the study is explorative qualitative research. This research method study is used when there are no or few previous studies to refer. The main focus is to identify the problems in the preliminary stage. (Exploratory Design, 2013). In this research study, researchers have not quoted any previous literature conducted on the same, which indicates the appropriates of selecting this research design and the study is based on a project conducted by Glasgow Diabetes Project in Scotland. From eight focus group with 35 participants, the researchers came into a conclusion that the people with type 2 DM appreciate their primary health care system with adequate delivery of staff and services. All the participants in the study identified problems in ongoing development of the service. Significance for Nursing and Health Care: This study educates the health care professionals to provide invest more in the care of patients with type 2 DM in primary care setting. The patients appreciate care from the health care provider when they get more information and advice on their health condition. According to WHO, about 347 million people worldwide is suffering from DM and it is the estimated to be the 7th leading cause of death by 2030. The data is alarming. Therefore, it is the responsibility of health care professionals including nurse’s to provide adequate information and education regarding this chronic disease and improve care in the primary care setting. In a qualitative study conducted in Malaysia on the perception and knowledge of people with type 2 DM about their medication, found that more efforts should be invested to improve care and a well-planned educational program should be conducted to improve their awareness regarding the disease. The study identified that people preferred to remain in frequent contact with health care professionals regarding their disease, which occurred in tertiary care setting. This is also suggested by another study conducted by Guliford (Gulliford et al. 2006) in which the researchers concluded that the people’s experience in continuity of care vary between health care organizations and arrangements of care by the organization. Therefore, this study emphasizes to educate the health care professionals to take active participation in the care of people with DM. This statement is proved in another study conducted by Escudero et al. (M Rodríguez et al. 2007) among people with type 1 and 2 DM and they concluded that active participation is necessary from the health care professionals in promoting accessibility to health care. This study provides the in-depth perception of client regarding the health care services they receive. Participants: The researchers clearly explained how the participants were selected. The aim of the study was to explore the views of adults with type 2 DM towards a service redesign. Therefore, all the participants were adults suffering with type 2 DM. The age group and gender of the participants were not specified. The participants represented a range of age, gender; ethnic backgrounds. These participants were seeking health care from secondary care center. In this study, the researchers stated that the participants were recruited from one Local Health Care Cooperative. Sample Size: Nieswiadomy (2008) stated that the sample sizes are small in qualitative studies. A concept of saturation is mentioned in regard to sampling in qualitative studies (p. 61). The samples included 35 participants from eight focus groups and sampling was done on the basis of purposive sampling and random sampling. Focus group was conducted until saturation was achieved. Purposive sampling was done to ensure to have a range of experiences. Data Collection and Recording Process: The data used by the researcher was collected using focus groups. There were eight focus groups with participants in the first five diagnosed of type 2 DM since 2 years and the other two groups with participants diagnosed of type 2 DM recently. According to Nieswiadomy (2008, p. 63) focus group saved time in comparison to data collected through interview. Before each focus group session, the researchers obtained written consent from the participants. To encourage their participation, a topic guide was given to the participants prior to the session. The first five sessions were conducted in the autumn of first year and the second three sessions were conducted in the autumn of the second year. Each session was carried out for a period of 60-90 minutes. All the sessions were tape recorded and transcribed. An assistant was present in the session to take field notes. The study also maintained the anonymity of the participants. The conclusion of the focus group involved a discussion among the participants, to openly express their personal views and opinions. BIAS in Data Collection: The issues of bias were not addressed by the researcher. The study reported the presence of an ethnic group in one focus group that required a translator. At times, the group had informal discussions without translation, and later the summary was just reported to the translator. Possible bias might have occurred in this session as the participant’s actual response could not be validated. There were also sessions were the participants did not actively participate in the session. Consistency of the Research Method: An explorative research study was utilized to complete this study. The analysis of data in qualitative study involves examining the words used. In this research study, the researchers used the topic guide as aid for the analysis of data and interpreting the findings, during and after the data collection. Thematic analysis was carried out based on the data obtained from transcripts, field notes and body language of the participants. Presentation of Findings and Limitations of the Study: After the completion of data analysis, themes were generated. The findings were presented in the form of five themes in a sequence. The study addressed each theme with evidence of transcripts of the participants. The study clearly stated the participants view on the impact of DM and the peer support in helping them cope up with the disease. The study also addressed different areas where care can be improved along with the perception of participants in new services. While the research study did present the perceptions regarding the participants on the service redesign, there were also numerous limitations to the study result. A possible limitation is that, as the sample size involved in the study was small, the results cannot be generalized. Another possible limitation is that, the study might have focused only on the issues of primary concern regarding their disease condition. Implications of the Study: The study addressed the issue of concern and primarily suggests the health care sources should provide adequate staff in primary care settings. The study also suggests the importance of giving written information about the disease condition to the patient, which has been emphasized in other studies. The researchers also suggest the policy makers to create a balance between primary care setting and secondary care setting. Moreover, they also suggested conducting a follow up research to ensure the continuity of care in primary care setting. The implications of the study identified were in relation to the results of other studies, relating to the importance of facilitating the health care process. (M Rodríguez et al. 2007). Conclusion: Qualitative studies provide an in-depth perception of the person’s own experience. Joan.R.S et.al (2009) examined the perception of adults with type 2 DM towards service redesign. The critique evaluated the research based on various criteria in relation to sample size, the method adopted, clarity of the findings as well as the limitations. The critique found that the above mentioned criterion had been addressed in the study. Implementation of Evidence Based Practice: Implementing the research evidence is final step of the evidence based practice. Various strategies may be employed to implement the evidence based practice. However, many barriers were identified in the implementation of evidence based practice. Elimination of these barriers helps in the proper implementation of EBP. The barriers include: Limitations in the Systems for Implementation of EBP: Human factors: inadequate knowledge about EBP, negative attitude towards EBP, lack of skill Barriers due to organizational factors: inadequate administrative support, work overload with no time for research, failure to prioritize between unit work and research (Houser & Oman 2011). Other factors that act as barrier include lack of sufficient time. In a study conducted by Wallis and Lara (2012) found that lack of time and lack of organizational support was the two cited barriers among nurses in implementing EBP. Based on the above mentioned barriers, strategies may be developed to implement the EBP. It includes the following: 1. Adequate training and educational support: by providing adequate training and practice, clinicians may find confidence to identify the evidence for their practice. 2. Creating an environment that appreciates innovative approach: this approach can be achieved only by creating a culture that value and support the EBP. In a study conducted by Michal (2010) suggested that to facilitate EBP, there is need to improve access to library, computers and internet facilities. The study emphasized on the need to increase the organizational support and incentives for the implementation of EBP in nursing practice. Use of decision system that is computerized has positive effect on the implementation of EBP. Communication systems like mass media, opinions from professionals along with education are some of the strategies that may help adopt the use of EBP. Use of core group ((Titler n.d.), which involves a group of practitioners whose common goal is the dissemination of information, it will help in implementing practice change. As nurses’ mostly learn from peer group and social interactions, this group will help to develop a more positive attitude towards the EBP. EBP is considered important as it also forms the basis for Magnet Status Accreditation (Houser & Oman 2011) to the hospitals. Conclusion: Traditionally care of patients mostly depended on the experience and opinion of the professionals involved in the treatment. EBP deploys the shift of the health care professionals from the traditional practice based on experience and opinion to innovative methods of practice based on research. Even though the implementation of EBP entails many barriers, there are strategies to overcome this. As nurses are mostly involved in the care of patient, it is important for nurses to utilize the best and exact evidence for providing highest quality of care. EBP opens new ways of caring with better patient outcomes. Reference List Barker, J. 2010. Evidence-Based Practice for Nurses. SAGE Publications Ltd. Available at [Accessed on 06 April 2014] Exploratory Design. 2013. LYNN University. Available at [Accessed on 01 April 2014] Gulliford et al. 2006. Measuring Continuity of Care in Diabetes Mellitus: An Experience – Based Measure. US National Library of Medicine. Available at [Accessed on 01 April 2014] Hopp, L & Rittenmeyer, L. 2012. Introduction to Evidence-Based Practice: A Practical Guide for Nursing. F. A. Davis Company. Available at [Accessed on 06 April 2014] Houser, J & Oman, KS. 2011. Evidence-Based Practice: An Implementation Guide for Healthcare Organizations. Jones & Bartlett Learning, LLC. Available at [Accessed on 06 April 2014] Malloch, K & O’Grady, TP. 2010. Chapter 1: A New Age for Practice: Creating the Framework for Evidence. Jones & Bartlett Publishers, Inc. Available at [Accessed on 06 April 2014] Melnyk, BM. n.d. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Available at [Accessed on 01 April 2014] M Rodríguez et al. 2007. Expectations Held by Type 1 and 2 Diabetes Mellitus Patients and their Relatives: The Importance of Facilitating the Health-Care Process. US National Library of Medicine. Available at [Accessed on 01 April 2014] Nieswiadomy, RS. 2008. Foundations of Nursing Research. Pearson Education. 5th Edn. Available at [Accessed on 31March 2014] Polit, DE & Beck, CT. 1995. Nursing Research: Generating and Assessing Evidence for Nursing Practice. J. B. Lippincott Company. Available at [Accessed on 31March 2014] Titler, MG. n.d. Chapter 7: The Evidence for Evidence-Based Practice Implementation. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Vol. 1. Available at [Accessed on 31March 2014] Read More