Transcript What is Research and Evidence?

Exploring the Concept of
Evidence-Based Practice
Dr Tina Harris
Lead Midwife for Education
Adapted from a presentation originally developed by Dr
Susan Dyson
Aims
By the end of the session you should be able to:
• Articulate the concept of evidence-based practice
• Appreciate the importance of using evidence to
underpin professional practice
• Understand the principles for determining what is
best available evidence
What’s in a Word (or phrase)
• What do you understand about evidence –
based practice (EBP)
- discuss with your neighbour
Evidence-based practice 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 evidence from
systematic research” (Sackett et al, 1996:7172)
Evidence-Based midwifery Practice
• …involves integrating the best available
research evidence with professional expertise
while taking account of patient preferences
• …is a complex undertaking that involves
identifying and appraising different sources of
evidence
Evidence for breast feeding
• Best way to help a woman successfully breast
feeding
– What is happening?
– What needs to happen to resolve the problem
– What is the best way to do this
In more detail…
• We can extend the concept of EBP from
individuals to groups of patients, health care
services and policy initiatives (Muir Gray,
2004)
• Ongoing research adds to the `body` of
knowledge and ensures the knowledge base
for practice is constantly evolving
EBP for midwives
• The onus is on midwives to keep up-to-date
with research, both `generic` and `applied`, so
as to provide best possible care
• The evidence drawn on to underpin practice
should be in the public domain, open to
scrutiny, clinically based, take account of
women and their families.
Research to underpin EBP
• Research findings as evidence
- Systematic research process should ensure
confidence in research findings
- All research has limitations, so research reports
should be subject to `critical scrutiny`
- Evidence drawn from one source is insufficient as
grounds for changing practice
- Research findings often need considering alongside
professional expertise to identify best practice
• Research findings may be applied directly to
practice in the form of clinical protocols or
practice guidelines, be used persuasively to
present a case for changes in policy or practice
Professional Expertise to underpin EBP
• Professional expertise or `practical` knowledge
(derived from professional experience) can inform
EBP, when used alongside `technical` or
`propositional` knowledge (derived from research)
• Midwives often draw on these sources of knowledge
more often than formal sources, i.e. published
research reports
Patient experience to underpin EBP
• Can be `individual` e.g. collected during individual
episodes of care
• or `collective` e.g. collected during group or
community participation in health care planning or
service delivery
• Users of health cares services are becoming more
involved in all aspects of care using a variety of
mechanisms to inform preferences and/or opinions
e.g. user forums, satisfaction surveys, internet, NHS
organisations
Hierarchy of Evidence
•
•
1.
2.
3.
4.
5.
EBP draws on different types of evidence
What constitutes `best` available evidence – the socalled `hierarchy`
Systematic Review Multiple Randomised Controlled
Trials (RCTs)
RCT
Non RCT
Non Experimental
Descriptive studies, Expert Committees
Characteristics of all research
All types of research are or aim to be:
• Planned
• Cautious
• Systematic
• Reliable
Ways of finding out or deepening understanding
Examples of Research
• Ethnicity Question and Antenatal Screening
(EQUANS)
A Department of Health funded study using
quantitative and qualitative methods to find out
about the efficacy of asking pregnant women an
ethnicity question as a way of detecting risk of
carrying genes associated with Sickle Cell Disease
(SCD)
Project Lead Dr Simon Dyson: Reader in Applied Social
Sciences
RCT and non-RCT
• Cultural diversity of pre-registration nursing
programmes
A Health Care Workforce Deanery (HWD) funded study
using qualitative and quantitative methods to
understand the experiences of South Asian nursing
students on under-graduate nursing programmes
Project Lead Dr Sue Dyson: Principal Lecturer in Nursing
Non experimental
• Midwifery practice in the third stage of labour
A study which aimed to identify and explain the variety of ways
midwives manage the third stage of labour.
Project Lead Dr Tina Harris: Principal Lecturer in Midwifery
Non experimental
• The experience of obesity in childbearing
– Aim to explore with obese women their
experiences of childbearing to inform future care
of this client group.
– Project lead Rowena Doughty
– Non experimental
In summary…
We should be able to articulate what evidence-based
practice is
We should understand something of the importance of
using evidence in professional practice
We should understand the principles behind
determining what is best available evidence
References
– Spiby H and Munro J (2009) Evidence based
midwifery: applications in context.
Chichester:Wiley-Blackwell. Chapter 1.
– Rees C (2011) Introduction to research in
midwifery. London:Churchill Livingstone
– Cluett R and Bluff R (2006) Principles and practice
of research in midwifery
References
• Gerrish, K and Lacey, A (2006) The Research Process
in Nursing (5th Edn) Blackwell Publishing. Oxford.
• Sackett, D.L., Rosenburg, W.M., Muir Gray, J.A.,
Haynes, R.B., Richardson, W.S., (1996) EvidenceBased Medicine: what it is and what it isn’t. British
Medical Journal 312: 71-72
• Muir Gray, J.A. (2004) Evidence-based policy making
(editorial) British Medical Journal 329: 988-989