Unveiling the Essence of Evidence Based Practice in Healthcare

Introduction:

An Evidence Based Practice (EBP) is a scientific practice which is based on several scientific and mathematical evidences to formulate a strong, inductive or deductive argument for direction and judgment making. The opposite of evidence based practice is the use of convention, unproven methods and perception in the research. The term EBP can also be described as “the integration of the best research evidence with clinical expertise and patient values”. The practice of this approach by the clinician results in a better quality of service for the patients involved.

The actual model of evidence based practice comprises of three different fundamental pillars such as the following:

1) The best evidence obtained from any clinical research which has implemented a sound methodology.

2) The superiority in the clinical practice field depends on factors such as the overall experience of the clinicians, the educational concept and the skills owned during the whole process.

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3) The exceptional beliefs and expectation of the patients that a clinician may face when encountering a patient

The different steps that are followed while conducting an evidence based practice are:

a) Formulation of an answerable question, b) the searching of the best available evidence which is relevant to the research questions, c) the critical appraisal of the evidences so that the weak and non relevant evidence can be ruled out, d) the implementation of the evidence to make patient centred decision, e) the ultimate step is evaluation of the outcome of the practice in relation to the concerned patient.

Often with the use of evidence based practice the physicians receives an excellent outcome with respect to the concerned patient but they forget to share the concept with their colleagues and with the healthcare organisation (Refer Fig: 1) (McKibbon, 1998; Sackett, 1997).

the model of Evidence Based Practice (EBP) (Source: McKibbon, 1998)

Fig: 1 the model of Evidence Based Practice (EBP) (Source: McKibbon, 1998)

Implementation of EBP in Nursing Practice:

The implementation of EBP in the nursing practice helps to develop a patient centred health plan based on the current online evidences, their personal experience and the individual beliefs and opinions of the patient. The high quality research helps to guide the nurses with up to date evidences, helps them to improve their current skills and also allows them to learn new ones. This experience helps them to build a rewarding career both in the field of research and clinical practice. This approach of nursing is also known as the Evidence Based Nursing (EBN) and guides the nurses to make quality decisions concerning the patient. It makes use of the following two parameters such as systemic research and the critical appraisal technique. Few example of evidence based practice in nursing are:

1) Infection Control department; 2) during the use of oxygen by the patients of chronic obstructive pulmonary diseases; 3) the application of non invasive techniques for measuring the blood pressure among the children; 4) the concept of intravenous catheter size and administration of blood (Koehn, et al, 2008; Spiby, et al, 2009).

Critical Appraisal Framework of the data analysis based on of Moule, P. (2018):

Rationale for choosing this tool:

For the present study the data analysis will be done based on the Critical Appraisal Skill Programme (CASP) to ensure a qualitative research. This particular tool helps to conduct critical analysis in a wide variety of settings which includes the public health. This is a set of 8 appraisal tool checklist based approach designed to be used in an educational programme or in a workshop setting. This particular quality appraisal tool is used to analyse the Randomised Controlled Trials (RCT), Systematic Reviews, Case Control Studies, Cohort Studies, Economic Evaluations, Qualitative studies, Diagnostic Studies, and Clinical Prediction Rule. The website of the programme is (www.casp-uk.net) and it is a virtual platform. The tool helps in finding the right information by highlighting the searches from various types of sources which includes the secondary sources, bibliographic sources and the gray literatures. The appraising section of the tool focuses mainly on the validity and reliability of the scientific papers, the significance of the outcome and the application of the findings to the concerned research project. There are several standardised checklist available on this webpage and this can be downloaded. The section that deals with the “acting on the evidence” focuses on the application of the data findings to our own research hypothesis, thinking about the practicality of the issues which may affect our study. The patient centred study is also explained and provides evidence to explore that context of the research topic.

There is a separate checklist which consist of about 10 -12 questions are available for the Randomised Controlled Trials (RCT), Systematic Reviews, Case Control Studies, Cohort Studies, Economic Evaluations, Qualitative studies, Diagnostic Studies, and Clinical Prediction Rule study. The checklists are wide ranging which can give direction to any researcher and can also guide on the outcome of the study. The CASP guidelines are very easy to follow even by a junior researcher.

There are two checklists namely the Diagnostic Checklist and the Economic Evaluation Checklist. STARD stands for Standards for the Reporting of Diagnostic Accuracy Studies is the most prevalent checklist available in the website www.stard‑statement.org offers a detailed flowchart and checklist. But the use of CASP diagnostic Checklist consisting of 12 questions is much easier and also simple to follow. CASP economic evaluation checklist provides an easy guideline to evaluate the economic benefits of the study.

The CASP works on the basis of a systemic process due to which the strengths and weakness of any study can be identified. It also guides the researcher in the study design approach and regarding the application of the study in the local context in a most cost effective way. Study designs are exposed to a wide range of variables that develops bias in the study design and therefore it is recommended to use standard lists of checklist to ensure the quality of the study undertaken. Sticking to the guideline of CASP enhances the significance of the study along with its findings (Singh, 2013).

The critical appraisals of the data analysis of the two given articles were conducted based on the mentioned guidelines of Moule, P. (2018).

Article 1:

The study conducted by authors Wang, et al, 2019 was aimed to investigate about the significance of the social media use and professionalism in the field of nursing. The use of social media is becoming very common among healthcare personnel and it is considered to be an essential tool because of the easy accessibility in the research practice of healthcare education, clinical practice and education in the medical field. In the past, several researchers have referred the use of social media by the health care professionals as an “unprofessional behaviour”. Very few literatures are available in the databases about the significance of the use of social media by the nurses and about its professionalism. Currently social media is considered to be a platform for the distribution and receiving of information and also for any personal communication (Kaplan, et al, 2010; Rhodes, et al, 2016; Guraya, et al, 2016).

In the field of nursing practice the use of social media is helpful to provide guidance concerning the education, helps them to make a smooth progress in the field of critical care and expanding the relevant methodologies and subject based research for the nursing practice. Certain unprofessional behaviours have also been observed among the nurses with the use of social media such as uploading of improper pictures or comments on the social media sites which violates the aspect of patient privacy and confidentiality. Though these are potential threats to the field of nursing still the use of social media is helpful for them concerning their education. The literature review presented a non biased approach towards the topic and it critically appraised all the relevant literatures whether in favour or not in favour of the topic. Therefore the present study was found to be significant for conducting evidence based research. The literature survey was conducted with the recent literatures from the past 10 years and though few literatures were available on the online databases, it guided the researchers to frame the hypothesis of research. The researchers did not mention specifically about any search strategy or electronic databases for the collection of data and also not used any keywords in the present study (Wang, et al, 2019).

The nurses are taking part in the research area to build knowledge and develop new skills and these accounts for a stronger evidence for inform practice. Therefore the present study adopted a cross sectional descriptive design to conduct the survey and applied the method of convenience sampling for the selection of registered nurses. The researchers adopted a cross-sectional approach because it guides in the planning and allocating the health resources. This type of study can be purely descriptive and helps in the evaluation of a problem in a particular population (Hennekens, et al, 1987). The method of convenience sampling also known as “non probability sampling” and can be widely applied in the clinical research. The researchers can include the subjects depending on the availability. Moreover, it is a quick, economical and convenient approach (Elfil, et al, 2017). The Chinese nurses who had received their nursing certificate and aged above 18 years, working in the hospital environment were included in the study to design the anonymous questionnaire at eight different conferences and one study program that were held in the China. The research hypothesis and questions were raised after going through the literatures and based on the current problem. The study was conducted by following the parameters such as the data collection methods, ethical considerations and the statistical analysis of the findings. The study got the approval from the university’s Biomedical Research Ethics Committee (No. 2018261). The study was absolutely realistic and ethical for the participants too because the subjects were informed that their participation was voluntary, they could leave the survey at any step they wanted and the security and confidentiality of the data were also taken into consideration as it was saved with password. The personal revealing information on the social media of the participants was not accessed for the survey (Wang, et al, 2019). This was in accordance to the guidelines of the right to confidentiality by the patient as mentioned in the Nursing and Midwifery council (NMC, 2018).

The study was conducted by eight numbers of registered nurses which included one PhD candidate, the other four working in the clinical setting possessing the associate, baccalaureate and the master degrees respectively. Therefore the participants were highly qualified for conducting the research. No funding issues were mentioned in the study. There were two preferred methods to study the social media use and the online professionalism by the health care professionals. The first approach was to analyse the content of social media page of the health care provider. The second approach was to investigate about the problem by self-report questionnaires for which hardly any evidences for the nursing practice were available. Therefore the present study adopted both the approach. A total of 1100 questionnaires were dispensed among the targeted study population, 60% response rate was obtained as an outcome of the study (Wang, et al, 2019). The use of questionnaire for the study has shortened up the elaboration scope and the reliability and validity of the study results (Artino Jr, 2005).

The outcomes of the study were considered to be realistic as 84.5% of all the participants believed that the use of social media had a positive impact upon their clinical practice. 93.5% of subjects used WeChat social media and the probable reasons were receiving the important information from the work group, for networking, to remain being updated with informational news and for relaxing. Maximum number of participants had accessed the medical knowledge from social media and also posted any informational news. 62.7% of them reported that they exchange work information with their colleagues and 50% of them also mentioned that their facilities had guidelines in the social media. The professionalism of the registered nurses was also investigated and half of them reported that they had received friend request from their patients. 7.6% of the participants stated that they might have posted unidentifiable patient content on the social media, 32.5% observed that phenomena and 50.3% of the participants also mentioned that they have witnessed objectionable patient information on the social media by their colleagues. These findings were supported with relevant literatures and as only 60% of the participants had responded the data was derived from that population only. The findings were analysed with descriptive statistics with the application of SPSS version 22 and Microsoft Excel 2013. The study was found to be statistically significant. The researchers did not mention any level of significance for the statistically justified data. The study conclusion was strictly based on their study outcome and there was no misleading or false content mentioned within. The study supported the alternate hypothesis. The author highlighted few limitations of the study such as the use of self administered instrument has lowered the reliability of the study because of the social desirability bias. 100% responses were not obtained and only the nurses who were very much active on the social site participated. Moreover, some nurses may have separate personal and professional social media accounts and that aspect could not be clarified. The study was conducted with the target population of China so it cannot be generalized (Wang, et al, 2019).

Article 2:

The other study conducted by the authors Lewis, et al, 2019 aimed at exploring the different perception of nurses regarding the use of mobile phones by the women and the significance of the use upon the care offered by the nurses in the delivery room during the birth of child. The study was done because it has become a common scenario now that women in birth suite use mobile phones very often. Hardly any evidences were available on the perception of the midwives that how the use of mobile phones impacts the care services. Literatures are available on the impact of mobile phone use on pregnancy and in case of parenting. Previous study findings revealed that women used mobile phones within the first hour of post birth to announce about their delivery in the social media and also several people contacted them to remain updated about the delivery. There are also some apps available online where the women can contact the professionals and from there they can also gather useful information. Therefore the study adopted a qualitative descriptive approach, collected and analysed the data for accurate conclusion (Lewis, et al, 2018; Lupton, et al, 2016). As a research can give explanation to the various questions that arises while providing care to the concerned group of patients, the study was conducted to explore the perception of nurses on the above mentioned problem (Foddy, et al, 1994).

The study was conducted by five clinical and academic midwives having a wide range of clinical experiences of assisting women in the labour room. The study space was allocated by the tertiary public maternity hospital in Western Australia. The study was jointly funded by the Western Australian Nurses Memorial Charitable Trust and the tertiary public maternity hospital in Western Australia.

The study findings highlighted the following: 10 focus groups comprising of 63 Australian midwives were involved in the present study. The study recognized four key themes and corresponding sub themes such as ‘considering consent’ included subthemes ‘establishing boundaries’ and ‘taken by surprise’; ‘competing with the phone’ encompassing ‘missing the experience’ and ‘delaying care’; ‘being with woman’ encompassing ‘affecting relationships’ and ‘not my right to deny’; and finally ‘bringing others into the room’ with subthemes of ‘keeping in touch’ and ‘seeking a second opinion’. The focus group study in general encourages the participation of patients who felt reluctant before and it also does not discriminate among the group of participants. The focus group study is based on the group discussions with the participant’s opinions, beliefs which are voiced. As the participants may not always express the truth and answer according to the opinions of the interviewer which hampers the reliability and accuracy of the results (Kitzinger, 1995). The structured interview adds to the validity of the study as the researchers put forward targeted questions to the group but it do not allow the participants to discuss openly on the issues (Pulakos, et al, 1995).

The study allowed the focus group facilitators to motivate the attendees to participate in the discussion. The groups were audio recorded and an additional observer was there who recorded interactions and the non verbal cues among the group attendees. The questions for the focus group were prepared after going through the literature survey and also by critically analysing the clinical knowledge of the research team in their practice setting. Overall four key questions and prompts were designed. All the research questions were developed straightway from the problem of the study. The study got the ethical permission from the Women and Newborn Ethics Committee (Approval Number 2017038QK) located at King Edward Memorial Hospital, Perth, Western Australia. The data was also not made public maintaining the confidentiality of the participant. The researchers had clearly stated about the ethical considerations that had to be maintained throughout the research but nothing was mentioned about the informed consent aspect of the participants (NMC, 2018).

The literature review of the study was up to date employing a wide variety of research articles relevant to the hypothesis and questions framed for the research. The researchers did not mention any specific databases for the study and also not mentioned any key search terms. The author formulated an unbiased literature review which included the literatures both in favour and not in favour of the title. All the relevant literatures were critically analysed and the different opinions of the researchers of different papers were included in the study. Though very few literatures were available on the perception of the midwives on the use of mobile phones by the nurses, the review guided the researchers to frame the hypothesis and questions of the research. The authors mentioned that extensive study is required to generalize the findings of the study to other population setting.

The study highlighted several literatures in the result and discussion section of the article supporting the findings of the study. They also discussed about the different outcomes revealed in the other studies in this section to make their argument strong. The author did not manipulate the findings of the study to support any hypothesis and there was no evidence of lost data reported by the authors. Transcriptions from the focus groups were allowed to thematic analysis and the analysis were directed with six steps. Five members of the research team analysed a cross section of the transcripts and each data was reviewed twice by two members of the team. Then the data was deconstructed to recognize the patterns and similarities out of the midwives’ sentence and the team met weekly to negotiate, refine and clarify the themes over two months. The analysis of the data was continued till saturation was achieved and member checks was applied among 10 midwives participants and these procedures were applied to ensure the credibility and authenticity of the data. The study conducted was qualitative in nature and the researchers did not apply any statistical software for the analysis of the data. Therefore, no justification of the statistical analysis was mentioned within the study (Braun, et al, 2016; Saunders, et al, 2018).

The conclusion and recommendations of the study was based on the overall findings of the present study and other studies. The study supported the null hypothesis. The sample population for the study included 10 focus groups which included 53% midwives working on the birth suit. Majority of the members were within the age of 36 years and were registered midwives. They had more than 5 years and 21 years of clinical experience respectively. Among the limitations mentioned by the researchers for the study were the midwives of the study centre were self selected. The sample population of the study did not represent the whole population of the women in birth suite. The research cannot be generalised and the authors suggested extensive study to transfer the findings of study to other setting or population.

Therefore after going through both the study in details, it is evident that the nurses must practice according to the guidelines of Nursing and Midwifery council based on the best evidence available and the information given by the patient (NMC, 2018). The quality of the health care research is based on three aspects such as reliability, validity and credibility. The data reliability depends on the reproducibility of the results and the credibility aspect measures whether the data of the study is believable or not. The above two studies has met these parameters though the second study was qualitative in nature and did not apply any statistical analysis of the parameters (Guest, et al, 2012). Discover additional insights on Systematic Mechanism of Blood Pressure Control by navigating to our other resources hub.

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Conclusion:

The evidence based practice plays an important role in the nursing practice as it helps them to improve their service by improving their skills and also by learning new skills and providing patient centred care. The steps to conduct the EBP and the advantages had been discussed in the report. The critical appraisals of the data analysis of the two given articles were conducted based on the mentioned guidelines of Moule, P. (2018).

References:

McKibbon, K.A., 1998. Evidence-based practice. Bulletin of the medical library association, 86(3), p.396.

Sackett, D.L., 1997, February. Evidence-based medicine. In Seminars in perinatology (Vol. 21, No. 1, pp. 3-5). WB Saunders.

Koehn, M.L. and Lehman, K., 2008. Nurses’ perceptions of evidence‐based nursing practice. Journal of advanced nursing, 62(2), pp.209-215.

Spiby, H. and Munro, J. eds., 2009. Evidence based midwifery: Applications in context. John Wiley & Sons.

Singh, J., 2013. Critical appraisal skills programme. Journal of pharmacology and Pharmacotherapeutics, 4(1), p.76.

Kaplan, A.M. and Haenlein, M., 2010. Users of the world, unite! The challenges and opportunities of Social Media. Business horizons, 53(1), pp.59-68.

Rhodes, S.D., McCoy, T.P., Tanner, A.E., Stowers, J., Bachmann, L.H., Nguyen, A.L. and Ross, M.W., 2016. Using social media to increase HIV testing among gay and bisexual men, other men who have sex with men, and transgender persons: outcomes from a randomized community trial. Clinical Infectious Diseases, 62(11), pp.1450-1453.

Guraya, S.Y., 2016. The usage of social networking sites by medical students for educational purposes: a meta-analysis and systematic review. North American journal of medical sciences, 8(7), p.268.

Lewis, L., Barnes, C., Allan, J., Roberts, L., Lube, D. and Hauck, Y.L., 2019. Midwives’ perceptions of women’s mobile phone use and impact on care in birth suite. Midwifery, 76, pp.142-147.

Wang, Z., Wang, S., Zhang, Y. and Jiang, X., 2019. Social media usage and online professionalism among registered nurses: A cross-sectional survey. International journal of nursing studies, 98, pp.19-26.

Braun, V., Clarke, V. and Weate, P., 2016. Using thematic analysis in sport and exercise research. In Routledge handbook of qualitative research in sport and exercise (pp. 213-227). Routledge.

Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H. and Jinks, C., 2018. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & quantity, 52(4), pp.1893-1907.

Lewis, L., Barnes, C., Roberts, L., Cook, N., Morris, S., De Leo, A. and Hauck, Y.L., 2018. Women’s mobile phone use in birth suite: A West Australian perspective. Sexual & Reproductive Healthcare, 18, pp.10-12.

Lupton, D., 2016. The use and value of digital media for information about pregnancy and early motherhood: a focus group study. BMC Pregnancy and Childbirth, 16(1), p.171.

Kitzinger, J., 1995. Qualitative research: introducing focus groups. Bmj, 311(7000), pp.299-302.

Pulakos, E.D. and Schmitt, N., 1995. Experience‐based and situational interview questions: Studies of validity. Personnel Psychology, 48(2), pp.289-308.

Foddy, W. and Foddy, W.H., 1994. Constructing questions for interviews and questionnaires: Theory and practice in social research. Cambridge university press.

Nursing & Midwifery Council, 2018. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates.

Artino Jr, A.R., 2005. Review of the Motivated Strategies for Learning Questionnaire. Online Submission.

Hennekens, C.H. and Buring, J.E., 1987. Analysis of epidemiologic studies: evaluating the role of confounding. Epidemiology in medicine, 287, p.323.

Elfil, M. and Negida, A., 2017. Sampling methods in clinical research; an educational review. Emergency, 5(1).

Guest, G., MacQueen, K.M. and Namey, E.E., 2012. Validity and reliability (credibility and dependability) in qualitative research and data analysis. Applied thematic analysis. London: Sage Publications, pp.79-106.

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