An Introduction to Evidence-based Practice in Nursing & Healthcare

Alison Pooler

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9781138835672
• eBook ISBN: 9781317903079
• Topic: Medicine
• Subtopic: Health Care Delivery

The beginners guide to Evidence-based Practice for Nursing, Health and Social Care.
An Introduction to Evidence-based Practice in Nursing & Health aims to help students, educators, mentors and professionals to make sense of knowledge derived from research and how to use it as a basis for making sound decisions about patient care. Covering everything from basic terminology to the application of Evidence-based Practice in your everyday routine, this text is the guide to better practice.

Written in a accessible and interactive style, An Introduction to Evidence-based Practice in Nursing & Health clearly sets out what Evidence-based Practice is, why it is important and how you can use it successfully to improve patient care.

Key Features for success in Evidence-based Practice:

• Simply and quickly shows you what Evidence-based Practice is and how you can use it.
• Helps you to develop an understanding of the policies driving Evidence-based Practice and professional development.
• Regular reinforcement of your learning through integrated Activities and end-of-chapter self assessment.
• Extensive references and suggestions for further reading and online research.
• Integrated Glossary keeps you up-to-date with the latest jargon.

Chapter 1

What is research?

AIMS

When you have read this chapter, you should understand:

● The definition of what research is

● The different methodologies employed within research

● The positive and negative aspects of the research methodologies

Introduction

A tutor stood in front of a class and asked the students what they understood by the term ‘research’. A variety of responses came back, which included ‘research is about looking at the literature on a topic area and deciding what is best’, ‘it is about experiments’ and ‘it’s all about publishing papers’.

From this the tutor is able to see that there is a diverse range in the understanding and misunderstanding of the term research. This case highlights the importance of gaining a basic and accurate understanding of what research actually is before we can continue on with this book.

ACTIVITY 1.1

Before you go any further, write down your answer to ‘what is research?’ Keep this definition handy and then review it again when you have finished reading this chapter to see if it has changed or not.

What is research?

It is now widely accepted that all healthcare professionals need to be aware of and be knowledgeable about what research is and the application of the research process and outcomes to their own clinical areas. Research has become a commonly used term in our professional vocabulary and it is expected that all healthcare professionals gain familiarity with research and its appropriate use. So what is research?

The essential nature of research lies in its intent to create new knowledge in whatever field’ (Cormack et al., 2006: p. 93). It achieves this through a process and is guided by scientific principles, depending on the area in which the research is carried out and the methodology used.

Research can also be defined as a search for knowledge, or a systematic investigation to establish facts. The primary purpose of research may be to discover, interpret and develop methods and systems for the advancement of human knowledge on a wide variety of subject matters. In health and healthcare, this can range from a randomised controlled double-blinded study on the effect of a new drug to discovering patients’ feelings of an element of their care to the evaluation of the cost-effectiveness of a patient-led service and the clinical and economic outcome. The areas of research are immense and many different methodologies, which will be classified later, are used.

Generally, research is understood to follow a certain structural process. Although step order may vary depending on the subject matter, the following steps are usually part of most formal research.

● Formation of the topic area

● Defining the hypothesis — an idea of what the question/answer may be that you are trying to find out

● Justification of why the research needs to be done, through a review of the literature in the topic area

● Defining the methodology

● Pilot study

● Redefining, if necessary, following the pilot study

● Gathering of data

● Analysis of data

● Discussion of the results generated from the analysis of the data

● Recommendations to clinical practice and future research.

So, let us go back to the case study at the start of this section. If the tutor again asked the question ‘what is research?’ to his group, hopefully the students, now with increased knowledge and awareness of the subject, would answer ‘it is a process of advancing knowledge in a certain subject area’, ‘it is about answering an unknown question’, ‘it is about discovering new facts and concepts to help in the advancement of healthcare’ and ‘it helps to ensure that we give the best care to our patients’.

What was the answer that you wrote down at the start of this chapter?

Research methodologies

Now that we understand what research is, we need to start to understand the different methodologies, or ways, of conducting the research. Two very broad methods used in carrying out research are qualitative and quantitative research. We will start by understanding what qualitative research is and then contrast this to what quantitative research is. By doing this, we will see that each methodology has its good points and bad points. These need to be considered when undertaking a research project and also taken into account when you are reading a paper and evaluating its value.

Qualitative research

Qualitative research aims to gather an in-depth understanding of human behaviour and the factors that govern such behaviour. This is very relevant to healthcare, but is also a methodology commonly used in the social sciences and market research. When I say that qualitative research looks at human behaviour, it investigates the ‘why’ and ‘how’ of decision-making, not just the ‘what’, ‘where’ and ‘when’.

Let’s take, for example, a ward sister wanting to evaluate whether the method of admitting the patient onto the ward is effective. She would devise a set of questions that are both open-ended and closed so that she could get responses back from the patients and the staff about their thoughts and feelings on what worked well and what did not. The information would be narrative, i.e. words, stories and discussions, and it would be very descriptive, rather than a page of numbers, which is what quantitative research is all about.

Another example may be that a hospital manager wanted to gain insight into whether the nurses that she had put through a nurse prescribing course were using their new skills effectively in practice. Again, questions would be asked, and verbal or written free text would be collected, which would provide a wealth of in-depth context and understanding into the area.

Qualitative research, because of its nature, does not need a large number of participants in the study, which is where it differs from quantitative research. Very often the study groups are small and focused, i.e. they are chosen to take part in the study because of who they are, or what needs they have because of their health condition. This is referred to as purposive sampling.

Types of qualitative research

There are some specific approaches to qualitative research that deserve a mention here, so that you will understand the different ways in which this type of research is carried out, and what these common terms mean when you come across them. If you gain an insight into these different approaches you will then understand why one approach may be selected to answer a specific research question.

1. Grounded theory: this is one of the first qualitative research approaches, and was developed by Glaser and Straus in 1967 (Glaser and Straus, 1999). The purpose of this approach is systematically to develop a theory from a set of data that are collected for the purpose of the specific research question under study. The data is usually collected through interviews and observations.

2. Phenomenology: this is the study of the lived experience. It is the study of ‘phenomena’ — the appearances of things and the meanings they have in our experience. In a phenomenological study, the research topic is studied from the point of view of the lived experience of the research participant. Data is usually collected through in-depth interviews, which allow the participant to explore and give a full account of the lived experience.

3. Ethnography: this is the study of human social phenomena or culture. This type of research focuses on a community to gain insight about how its members behave. Participant observation and/or in-depth interviews may be used to gain the data for the study. The researchers in ethnographic studies usually carry out first-hand observation of daily behaviour, e.g. observing how healthcare professionals act in a hospital setting. They may even participate in the actual process as a participant observer. This is a very time-consuming form of research, but results in a real insight into a situation from being part of that situation or environment.

4. Action research: this is the process where practitioners attempt to study their problems scientifically to guide, correct and evaluate their decisions and actions. Action research is often designed and conducted by practitioners, who analyse the data to improve their own practice, and is therefore very common in healthcare. The outcome of action research is that it has the potential to generate genuine and sustained improvements in organisations because they have been involved in the process and research has not been imposed on them from research performed outside the organisation.

Qualitative research is a term that encompasses many methodologies and with this come many ways of collecting the data which are employed in these methodologies. These can include:

● Focus groups

● Surveys and questionnaires...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Preface
• 1 What is research?
• 2 What is evidence and evidence-based practice?
• 3 Why do we need evidence base in our clinical practice?
• 4 Clinical guidelines and the need for clinical audit
• 5 Change management in the implementation of evidence-based practice
• Answers to post-test questions
• Index