Why General Practitioners Do Not Implement Evidence - Essay Example

The research "Why general practitioners do not implement evidence: qualitative study" written by A CFreeman and K Sweeney deals with the General practitioners do not always act on evidence in clinical practice and its implications to the nursing practice. Since this is a qualitative research, this research focus on understanding the complexity of humans within the context of their lives and on building a whole or complete picture of a phenomenon of interest. (Beasley, 2003) Therefore, qualitative methods involve the collection of information as it is expressed naturally by people within the normal context of their lives. Briefly describe the design of the study and explain why you think it is either appropriate or in-appropriate to meet the purpose. The researchers presented a clear rationale for the research, setting it in context of any current issues and knowledge of the topic to date. Aside from this they have presented adequate information for the review of related literature to back up readers regarding any existing or past researches with the same topic. The review of related literature of the research article is a focused summary of what has already been published regarding the question or problem for which there is a gap in knowledge. The literature of the research article gives the readers' a picture of what is already known or has already been studied in relation to the problem and identifies where the gaps in knowledge may be. (Caldwell, 2005) The literature review in the research being critiqued does not necessarily only include published research studies. It also may include published reports about issues related to practice or a description of a theory. (Babbie, 2004) A theory is a written description of how several factors may relate to and affect one each other. The factors described in a theory are usually abstract: that cannot be readily observed and immediately defined and recognized by everyone. The research report of the article used discusses a theory in its introduction section, the study tests and further explains the relationships proposed in that theory. The meta-category perspective is used in the research report. (Fischer, 2005) It is expected that the study will be based on this, and that is to examine some aspect of life events and perceptions affect the variables in the research. The literature review should reflect the current state of knowledge relevant to the study and identify any gaps or conflicts. It should include key or classic studies on the topic as well as up to date literature. There should be a balance of primary and secondary sources Related studies, on the other hand, are studies, inquiries, or investigations already conducted to which the present proposed study is related or has some bearing or similarity. They are usually unpublished materials such as manuscripts, theses, and dissertations. (Creswell, 2003) Since the study is based on existing theory, then the researcher already has an idea of what relationships to be found. These ideas are stated in the form of a hypothesis, a prediction regarding the relationships or effects of selected factors on other factors. For any study to include a hypothesis there must be some knowledge bout a problem of interest so that the researchers can propose or predict that certain relationships or effects may occur. The research provided two sections for the hypotheses: Life stage (age) hypotheses and Country culture hypotheses. (Fawcett, 2004) Identify ethical issues related to the study and how they were/were not addressed. Ethical issues pertinent to the study are discussed. The researchers identified how the rights of informants have been protected and informed consent obtained. The patients who participated in the study were informed regarding the purpose of the research and approval was sought from them prior to the interviews. Health service research committees were responsible for getting the permission of these patients. (Fowler, 2002) The information regarding and confidentiality of the study were both communicated to them both in written and oral form. During the interview processes, the patients were regularly monitored for any signs of discomfort or anxiety that may affect their care. Identify the sampling method and recruitment strategy that was used. The researchers made clear which research strategy they are adopting, i.e. qualitative. A clear rationale for the choice was also provided, so that the readers can judge whether the chosen strategy is appropriate for the study. (Hodge, 2003, 2005) The research made use of qualitative methods which focus on the understanding and breaking down on the different parts of a phenomenon to see how they do or do not connect. Therefore, quantitative methods involve collecting information that is specific and limited to a particular parts or events of the research subject being studied. "Three focus groups of established general practitioners were set up in three areas, each located around a different district general hospital. The hospitals were in the south west of England and covered the area served by a single primary care research network. Each area is geographically separate by about 80km and tends to develop its own medical community. The groups did not contact each other throughout the study and were not in regular social or professional contact outside the study. By using these separate groups, we aimed to improve the trustworthiness of the data." (Freeman et. al, 2006) Methods sections of research reports usually include information about three aspects of the research method: sample, data collection procedure and the data analysis methods. Knowledge gaps that involve a concrete response or action lend themselves to a quantitative approach, in which each factor that might contribute to a problem is identified, defined, and measured. The methods section of the research report describes overall process of implementing the research study, including who was included in the study, how information was collected, and what interventions, if any, were tested. The methods section describes those systematic procedure used to collect information to the reader The sampling subsection in the methods section of the research report describes how people were chosen for the study, what was done to find them, and what, if any, limits or restrictions were placed on who could participate in the study. Understanding samples and sampling is important part of making intelligent decisions about the use of research in practices therefore, samples and samplings should be discussed properly. Discuss whether sampling and recruitment were appropriate to the aims of the research Data collection methods are described, and appropriate to the aims of the study. The researchers describe how they have assured that the method is auditable. The method of data collection was auditable. The tabulation of the interview results was a good presentation of the data collected from the patients for easier analysis. The method of data analysis was somewhat credible and confirmable. This was due to the feeling of pain being relative and the magnitude may be varied from one patient to another. (Brman, 2003) Identify the data collection method(s) and discuss whether the method(s) is/are appropriate to the aims of the study. The data analysis strategy was identified; the processes were used to identify patterns and themes. The researchers identified how credibility and confirmability have been addressed. Almost all data-gathering devices are used in collecting data for a research study. The interview is very important. The patients who fit the description for the requirements for the sample population were interviewed to be able to gather data since they might be able to shed light on the problem. Long probing interview may be conducted especially with the patient himself. (Kerlinger, 2003) Another important tool is observation. This involves observing the patient's behavior of an adequate length of time and some other observable conditions that might have contributed something to the maladjustment of the patient. The authors who made research study may act as participant-observers which were more effective. The questionnaire is another instrument. This is given to the patient himself and to some people who may be able to contribute something to the discovery of important data about the case. Needless to say, all pieces of information are carefully and accurately recorded. Statistical procedures are then applied to analyze and organize or summarize the data in which case frequencies, types, trends, uniformities, or patterns of behavior are revealed. These serve as the basis for resolving the problem or conflict. This is interpreting the evidence available Identify how the data was analyzed and discuss whether the method(s) of analysis is/are appropriate to the aims of the study. The conclusions in the research report specifically describe or discuss the researcher's final decisions or determinations regarding the research problem. The research report includes the implications for practice. The conclusion state either new knowledge or confirmation of previous knowledge. The goal of the research is to generate knowledge that can be used in nursing practice: in the conclusions section of a research report, the findings of the study are directly translated into that new knowledge: that is, the conclusions go beyond simply saying what was found in the study. (Shaughnessy, 2006) They present the implications of or meaning of those for future practice. As such the conclusions of a research report is powerful. They are used as a basis for decisions about direct employee relations, whether one-on-one care or developing clinical standards or pathways that direct business management. "The main clinical areas the general practitioners discussed included hypertension, ischaemic heart disease, and anticoagulation. Other topics developed in the group's discussion included diabetes, chronic obstructive pulmonary disease, hemorrhagic, cholesterol, and the use of investigations." (Freeman et. al, 2006) Because of the power and importance attached the conclusions, the determinations and decisions described in the conclusions of the research report are carefully worded and list relevant limitations. The conclusion section of a research report has fewer unique research terms than does the rest of the report. One term that appears in the conclusion sections is the limitations. Limitations are the aspects of the study that create uncertainty concerning the meaning that can be derived from the study as well as the decisions that can be based on it. (Lattal, 2004) The description of the study's limitation addresses the beginning's section of the report such as the study's methods and samples. Aside from this, limitations do not mean that the results of the study are flawed or meaningless. They do indicate the boundaries or constraints to the knowledge generated by the research. Finally, the conclusion section of the research report contains recommendations for future research regarding the problem of interest. These recommendations directly address the limitations that have been described and suggest additional studies that are needed to further build on the new knowledge generated from the study described in the report. The implication for nursing practitioners from this study, as well as from previous research, is that it may be naive to assume relative consistency in behavior within a culture. RIGOR In qualitative research, error can be introduced into a study in two ways. Problems may occur with process of data collection, with the process of data analysis, or both. Because data collection and analysis are closely linked in qualitative research, error that occurs in data collection is not easily separated from error that occurs in data analysis. (Abramson, 2003) Rigor is both strict process of data collection and analysis and a term that reflects the overall quality of that process in qualitative research. Rigor is reflected in the consistency of data analysis and interpretation, the trustworthiness of the data collected the transferability of the themes and the credibility of the data. Qualitative researchers use several tools and processes to guarantee that each of these aspects of rigor is ensured. (Bailey, 2004) Trustworthiness refers to the honesty of data collected from or about the participants. The researchers of the article being critiqued established a meaningful relationship with the participants which required them time to develop. The participants willingly shared information and communicated their feelings, insights and experiences without feeling pressured or wanting to censor what they share. Confirmability is present in the research because there is consistency and repeatability in the decision making about the process of data collection and data analysis. Transferability is also shown throughout the research due to the fact that the extent to which the findings of the study are confirmed and applicable to different groups or in a different setting from where the data was collected. Credibility is shown through the researchers' confidence that the reader's can have the truth regarding the findings f the study. The conclusion section of the paper indicates whether there is still a need for further research. Implication in Nursing Practice Evidence based medicine applied by doctors affects the practice of the nursing profession. Although evidence based medicine has heightened awareness of the most effective management strategies for many conditions, much of the evidence is not acted on in everyday clinical practice. The instructions given by doctors to nurses regarding the care for patients can be affected by the non usage of evidence based medicine. This research paves the way for nurses to take part in the interdisciplinary approach in caring for patients through constant communication with doctors and providing professional insights to help doctors in decision making situations. Abramson, J.H. (2003). Survey Methods in Community Medicine. NY: Churchilll Babbie, E. (2004). Survey Research Methods. 2nd Edition CA: Wadsworth Publishing Co Bailey D. Research for the Health Professional: A Practical Guide. London: Sage, 2004. Beasley D. Beasley's Guide to Library Research. Toronto: University of Toronto Press, 2003. Brman A. Quantity and Quality in Social Research. London, New York: Routledge, 2003. Caldwell, K., Henshaw, L. and Taylor, G. (2005) Developing a framework for critiquing health research. Journal of Health, Social and Environmental Issues. Vol.6 No.1 p45-54 Creswell, J. (2003). 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J., Zechmeister, E. B., & Zechmeister, J. S. (2006). Research Methods in Psychology (Seventh Edition ed., pp. 143-192). New York, New York: Higher Education. Read More