Research Part 1

ResearchEBP
How sure are we that it works?
What evidence is there?
What is the level of evidence?

EBP is based on,
Evidence based practice is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.

Research
Clinical experience – standards or consensus statements, expert opinion
Patient preferences

The evidence we need may also come from the basic sciences

Questions
Does nursing care make a difference?
Are nurses in control of their practice?
Does nursing have a scientific basis?

Process
Clearly identify the problem
Find evidence
Deduce solution using critique
Apply
Evaluate using audit and reflection
To save time we may use systematic reviews

Systematic reviews
Capture all data
Critique data for us
Only use primary sources
Target a specific outcome
Assess unpublished data

Evidence
Demonstrated effectiveness
Appropriate to local situation
Up to date
Complied by credible experts
Involves patient prospective
Based on reliable and valid research findings
Based on primary source research
Acknowledges costs and benefits
Evidence based guidelines and protocols

The features of evidence-based practice

Links directly to powerful sources of electronic information through the internet, databases and library links that provide details of relevant past and current research.

Emphasizes the need for participants not only to read research but to critically evaluate it. In terms of nursing research, this includes the evaluation of both quantitative and qualitative evidence.

Seeks to effectively bridge the gap between theory and practice by applying research findings to individual patients or populations.

Measures success in terms of the achievement of outcomes of care partly as experienced by the patient.

Emphasizes professional responsibilities by making clinical decisions explicit. This provides both a platform for personal reflection and also the basis for the audit of the individual’s professional performance by others.

Attempts to inject clinical decision making for the prevention, detection and care of health disorders with the systematically ordered knowledge derived from both inductive and deductive reasoning that has been accrued in the process of research.

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research, (Sackett, 1996).

Clearly any concept that proposes that practice be based on current, valid and reliable information is appealing. This is especially so because it is, or certainly should be based on sound logic positivist science. This should be carried out in the culturally, social and spiritually context we are working in.