Fundamental Ways of Knowing and Caulfield's Pillar of Accountability

Introduction

The importance of health research and practice is that it helps to develop better understanding of the trend of disease, outcome regarding complex treatment for public health issues, functional abilities, modified pattern of care, way to reduce healthcare cost and other (Frohard‐Dourlent et al., 2017). In this assignment, the question posed in respect to health research and practice is that “Is there any value in nurses developing EBP skills?”. The essay will critically evaluate two research papers in connection with the question in which one of them uses quantitative research methodology (Duncomb, 2018) and another uses qualitative research methodology (Tacia et al., 2015).

The idea regarding evidence-based practice was found to be formulated in the 1800s when Florence Nightingale implemented certain healthcare changes on the basis of exploration and collection of existing healthcare evidence (Mackey and Bassendowski, 2017). The term “evidence-based practice” was initially introduced by Gordon Guyatt and his team back in 1991. This is to change the emphasis in the decision-making in the clinical field from intuition, pathophysiological rationale and unsystematic clinical experience to clinically and scientifically relevant research idea and information in the nursing field (Djulbegovic and Guyatt, 2017). Evidence-based practise (EBP) is referred to patient-centred approach which is developed on independent scientific research, patient experiences and clinical expertise. The nurses involved in using EBP approach are required to use most current research evidence in determining the course of treatment and care for the patients or service users or public (Albarqouni et al., 2018).

The use of EBP by the nurses has high value because it helps them to create improved patient outcomes. This is evident as EBP approach leads the nurses to use most current scientific and clinical data and information to plan quality and informative patient care according their health issues to create better outcome (Kim et al., 2017). The EBP use is of value because it minimises the nurse's error and complication in care delivery. This is because the existing evidence assists to resolve their doubts and queries which are responsible for creating complication in care and deliver less quality to the patients (Shayan et al., 2019). In nursing, EBP approach is of high value because it guides the nurses through the presentation of existing care evidence for similar health condition regarding the way to avoid unnecessary care cost in treating chronically ill patients (Friesen et al., 2017). The EBP approach is also value for nurses as it helps them to develop advanced critical thinking along with enhanced decision-making skills for care. The nurses through EBP use are able to get adapted to variety of care situations which they have not faced practically to be managed and become efficiency in working within inter-disciplinary teams. The EBP is value for the nurse as it makes them more confident in executing their work (Harbman et al., 2017).

According to NMC (2018), under the principle of “Practise effectively” it is mentioned that nurses are to refer to existing evidence in developing enhanced ideas of care for patients. They are to act in delivering care on the basis of the best evidence available for the planned support (NMC, 2018). Thus, it indicates that development of EBP is value for nurses to be able to follow the principle of care mentioned by the stator nursing body that is Nursing and Midwifery Council in the UK. However, EBP development by nurses is not always holistically supported to be developed by the nursing community and other healthcare situations. There are various perceived barriers faced by nurses in developing EBP skills. However, there are few facilitators for EBP approach that allows the nurses to learn regarding it. Thus, a planned literature search is been executed with the help of Cochrane Library and CINHAL to determine two key articles (one quantitative and another qualitative) to understand barriers and facilitators regarding development of EBP skill for nurses. The Holland and Rees EBP practise tool is to be used for critiquing the quantitative article by Duncomb (2018) and CASP qualitative tool is to be used for critiquing the qualitative article by Tacia et al. (2015).

Critical Evaluation of Quantitative paper

The quantitative data in EBP provides empirical knowledge necessary for the nursing practice and support the nurse’s personal as well as experimental knowing critical for the care practise to frame a robust care. In critiquing the study of Duncomb (2018), the Holland and Rees framework is been used. This is because the framework is easily available online and contains detailed list of questions based on which an effective critique of each aspect of the research paper could be made without hindrance (Holland and Rees, 2010).

The Holland and Rees framework inform that to critique a research paper initially it is to be ensured whether or not it has mentioned a detailed focus of the study through the title and if measurable variables for the study is mentioned (Holland and Rees, 2010). In the study by Duncomb (2018), a well-developed title concerning the focus of the study that is facilitators and barriers to implement evidence-based practice for nurses is presented. This acts as strength of the study because having a research title that focus the key concern of the study helps to highlight the fact expected to be present and explored in the study (Benton et al., 2020). However, the measurable variables for the study are not mentioned due to which the cause and effect relationship in the research is difficult to the identified. The background section in the Duncomb (2018) is comprehensive as it highlights what EBP is and factors that exist to obstruct or promote use of research-based evidence in nursing as well as is supported through a well-discussed literature review.

The presence of enhanced literature review is important because it highlights the nature of previous studies been performed to gather information regarding the topic and it supports the present understanding of the topic too (Sanchez-Gordon and Luján-Mora, 2018). In the study of Duncomb (2018), in the literature review the author did highlight from exiting research that lack of time in implementing new ideas or evidence at work, insufficient knowledge, insufficient power to make changes in the care plan of the patients and poor access to research evidence are barriers in implementing EBP by nurses as determined from exiting evidence. The facilitators in implementing EBP by nurses in the literature review is also mentioned such as administrative support and others indicating the exiting review did provides an overall information about existing data present regarding the topic to be explored. The aim of the study is important in mentions the overarching goal to be fulfilled by the study and key variables in the research (Shimizu, 2019). The study by Duncomb (2018) did provided a detailed aim of the study which is that it would explore the perception of nurses at work regarding barriers and facilitators which influences their capacity to implement EBP in practice.

According to Holland and Rees framework, in a quantitative study, the broader methodology include survey, correlation or RCT study and during critiquing the article the suitability of the methodology with the given aim is to be studied (Holland and Rees, 2010). The study of Duncomb (2018) used survey methodology in framing a descriptive and comparative quantitative research. The benefit of survey methodology is that it provides opportunity for high representativeness of the sample along with ensures collecting data in convenient way with little or no subjectivity and ensures precise results to be found (Phillips, 2017). The survey methodology is suitable to the aim of the study because it allows statistically significant data regarding the facilitators and barriers of implementing EBP by nurses to be gathered to determine and compare to what extent any of the barriers and facilitators have influence in EBP implementation.

The Holland and Rees framework further mention to get concerned in determining the tool of data collection for critiquing a study (Holland and Rees, 2010). In quantitative study, survey is the most common data collection tool being used because it allows easy allocation of participants and gathering of data in a user-friendly way (Delnevo et al., 2017). The survey data collection process is used in the study of Duncomb (2018) in which each participant was specially addressed for three-weeks and the responder in the pilot study were asked not to share their experiences with others. The advantage of survey is that that clarified data to be collected in cost-effective way within less time (Delnevo et al., 2017). However, the limitation of the survey is that it does allow to develop rapport with the participants due to which only objective data is gathered and it does not allow neutral experiences to be identified that could create bias in study (Brower et al., 2017). The importance of performing a pilot study before the actual study is that it provides opportunity to execute preliminary analysis of determined hypothesis which allows the researchers to get ideas and clues in increasing the changes of executing a successful and clear study (Ismail et al., 2018).

The study of Duncomb (2018) used SPSS (Statistical Package for Social Sciences) version 22 for coding and analysing the qualitative data in the study. According to Lozano and von Haartman (2018), in most of the quantitative studies, descriptive statistics are presented which is also seen in the study of Duncomb (2018). This acts as strength of the study because it helps in simplification of the larger amount of collected data in a sensible way (Lozano and von Haartman, 2018). The advantage faced in the study by using SPSS is that it helped to allow generation of tabulated format of information, reports, trends and other in simple way. The comparison between the data collected in the study of Duncomb (2018) was executed by use of variance analysis (ANOVA). The level of statistical significance set for the study is p= 0.5 to interpret the results of significance.

In the study by Duncomb (2018), the stratified random sampling process is used for gathering 100 participants who are registered nurse and each were provided a open-ended questionnaire including 32 questions. The advantage of using stratified random sampling is that it provides better ability to the researcher in selecting sample by covering the population because it allows them to have control on all subgroups to be included in the sample from the entire population (Sharma, 2017). The ethical consideration in the study by Duncomb (2018) is effectively followed as all the participants are treated according to the guidance by the Ethic Committee in The Bahamas. Moreover, informed consent from all the participants are collected and no force was made on them to join the study. The advantage in the study on following all ethical principles is that it allows the researcher to prove all the study is executed in a moral way with no violation of their legal and ethical obligation and ensure no harm is caused to the participants (Suhonen et al., 2018).

The key findings of the study were that 72.1% participants mentioned they never tried to implement EBP in practice previously. The main barriers in implemented EBP by the nurses include inadequate resource to implement the research information (82.5%) and inadequate training in implement EBP (83.6%). The key facilitators for EBP identified in the study are training for EBP (88.5%) and setting effective organisational policies and protocols in implementing EBP (86.9%). The study did mention a clarified conclusion which is nurses show a zeal to implement EBP in care but require enhanced training and learning of EBP concept (Duncomb, 2018). The study did mention the key limitation faced in performing the research which are self-administered questionnaire that subjected to develop respondent’s self-assessment of their skills rather than all, lack of EBP competency test which could allow to identify key abilities required by nurses in EBP implementation.

Critical Evaluation of Qualitative paper

The qualitative research includes collection and analysis of non-numerical data for understanding concepts, experience or opinion regarding the study (ten Hoeve et al., 2017). The qualitative study of Tacia et al. (2015) is to be critiqued by using CASP qualitative research framework. According to the framework, the presence of aim and its relevance is to be judged (CASP, 2020). The aim of the study of Tacia et al. (2015) is clearly mentioned which is to identify barriers in the adaptation of evidence-based practice (EBP) by nurses. The presence of clarified aim is important for the study as it helps to present the summarisation of facts in single sentence to be achieved in the research (CASP, 2020). The CASP framework in critiquing the study is required to identify whether the qualitative methodology is appropriate for the study (CASP, 2020). The qualitative methodology is appropriate for Tacia et al. (2015) because its use allowed to address the research aim that is identify the barriers to EBP practise and the way they are creating hindrance for the nurses due to which they are been unable to implement EBP in care.

The CASP framework asks to determine if the research design used is appropriate in addressing the aim of the study (CASP, 2020). In the study by Tacia et al. (2015), the focus group study design is been used to meet the aim of the study. This study design allows creating in-depth understanding of participants by the researcher to uncover their personal beliefs and attitudes regarding the study topic (Dahlin-Ivanoff et al., 2019). Thus, its use is relevant in the study because the design allows the researchers to specifically identify and understand the beliefs and attitudes of the nurses that are acting as barriers towards implementation of the EBP in care along with their perception regarding environmental and social factors that are acting as barriers for EBP implementation. The CASP framework mention to identify if the participant recruitment strategy is appropriate for the study (CASP, 2020). The study by Tacia et al. (2015) informed that the participants are selected to form community hospital located in the Mid-western region of the US. The participants included 4 nurse practitioner, 11 inpatient direct care nurses and 3 nurse administrators.

The study by Tacia et al. (2015) clarified the reason behind the sample participants been chosen which is evident as the researchers mentioned that they aim to gather assistance with promotion as well as adoption of evidence-based practice in nursing culture and for fostering nurse-led clinical research. Thus, the nurses to form academic partnership was chosen in fulfilling the aim. The CASP framework further informed that in critiquing a study, it is to be determine whether the data collection used addresses the issue highlighted in the study (CASP, 2020). In the study by Tacia et al. (2015), the focus group interview is used as the data collection method. The researchers explicitly mentioned the way the interview is been conducted. This is evident they presented in details the questions asked and mentioned that the response was audio-recorded. Moreover, they mentioned that the interview of each focus group was done for two-hours and they were provided refreshment along with allowed to have freedom to leave (Tacia et al., 2015). The limitation of audio-recording response of participants is that it does not allows to record the expression, emotions and feelings of the participants which are important in determining the true meaning of the responses (Broekema et al., 2020).

The CASP framework for qualitative study mentions to determine whether the relationship between the researchers and participants been adequately considered in the research. In this purpose, the researcher’s role in formulating the research question and objectives along with data collection is required to be critically analysed (CASP, 2020). In the study by Tacia et al. (2015), which used a qualitative methodology, the researcher understood that their role may bring inherent bias in the study out of personal viewpoints and background dynamic. Therefore, they worked in line to modify their role and considered to work in as a non-threatening group by creating a supportive atmosphere and using reflective dialogue among the participants in the focus group. This leads to the analysis that the role of the researcher with the participants are critically examined by the researchers themselves and effective actions are taken so that personal bias and influence can be avoided in data collection, research question formation and others.

The CASP framework mentioned in critiquing a paper it is to be ensured if they have focussed on managing ethical issues in the study (CASP, 2020). As mentioned by Tacia et al. (2015), the researchers to maintain ethical considerations in the study have attained informed consent from the participants. Moreover, effective actions are taken to maintain confidentiality and autonomy of the participants. In addition, the participants are allowed to leave the study at any time and no force by the researchers are mentioned to be provided to any participants in involving in the study. This indicates that there are sufficient details through which ethical aspect of the research is maintained. The fulfilment of ethical consideration in the study acts as beneficial because it ensures the researchers worked in collaborative way to show mutual respect, maintain fairness and abide by mortal values in enriched execution of the study (Suhonen et al., 2018).

The CASP framework mentioned in critiquing a paper it is to be ensured if they have focussed on managing ethical issues in the study (CASP, 2020). As mentioned by Tacia et al. (2015), the researchers to maintain ethical considerations in the study have attained informed consent from the participants. Moreover, effective actions are taken to maintain confidentiality and autonomy of the participants. In addition, the participants are allowed to leave the study at any time and no force by the researchers are mentioned to be provided to any participants in involving in the study. This indicates that there are sufficient details through which ethical aspect of the research is maintained. The fulfilment of ethical consideration in the study acts as beneficial because it ensures the researchers worked in collaborative way to show mutual respect, maintain fairness and abide by mortal values in enriched execution of the study (Suhonen et al., 2018).

Conclusion

The above discussion informs that evidence-based practice (EBP) implementation for nurses is valuable for them as includes creating better patient outcome, avoid error in care, reduce care cost, improve care quality and others. However, certain barriers are causing hindrance in achieving the value. In this context, the study by Duncomb (2018) mentioned that EBP implementation by nurses is unable to be achieved due to inadequate presence of research resources and training methods in using research requires to develop evidence and implement them in framing the care. However, the study by Tacia et al. (2015) mentioned lack of motivation and knowledge of EBP, cultural barriers, time management, patient factors and reduced access to research information are posing hindrance in implementing EBP by nurses that is valuable for them in the nursing practice. Thus, the key message from both the papers is that EBP is valued implementation in care by nurses but they are to be provided adequate resources, training, time, better patient care options and others to resolve barriers which are hindering its actual implementation. The information from the two papers can be applied to nursing to make the nursing managers and healthcare organisation realise the actions to be taken in implementing EBP that has valued accomplishment for the nurses to deliver better care.

References

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