Critical Appraisal of a Research Study Relevant to Clinical Practice - Essay Example

CRITICALAPPRAISAL OF TUTTON E., SEERS K. & LANGSTAFF D. 2007. Professional nursing culture on a trauma unit: experiences of patients and staff.Journal of Advanced Nursing, 61 (2), 145 -153. INTRODUCTION In their Journal of Advanced Nursing, Tutton E, Seers K, and Langstaff aimed to explore the daily experiences of patients and staff in the unit dedicated to the care of adult patients  who had sustained injuries. Their concern was on the increasing individuals suffering traumatic injury and who needed increased intensive care and rehabilitation. This ethnographic study took place on a trauma unit in the United Kingdom between November 2004 and January 2006. Sixteen periods of observation, qualitative interviews with 40 patients and 19 staff, and four focus groups with staff were undertaken. Thematic analysis was conducted and the data analyzed carefully. The patient-centered care process was transforming and it was expressed through the themes of closeness, therapeutic care and team work. Being close displayed the sudden and devastating nature of injury and the need for the staff to let go of their emotions in order that they may maintain a positive momentum. Therapeutic care provided the necessary link between the staff and the patients, and it was combined with a proactive dynamic approach to care. Team work identified the importance of maintaining expertise and at the same time making the system work for patients to ensure quality care. In this study, they concluded that it was possible to provide a frame work for individuals and units to develop and better recovery promoting practice, and they said that it could apply in other areas similar to that. However, there are other approaches that can promote quality care that were not mentioned in this paper. One of them is the evidence-based practice. This is practice based on research and evidence from experiences from the work that the practitioners do. This study was based on examining the role of advanced practice nurses, that of the frontline staff and the role of the patients in the promotion of evidence based practice. Gerrish K and Lacey A 2007, in the article, The Research Process in Nursing (5th Edition) examined the role the advanced practice nurses (APNs) play in the promotion of evidence-based practice among the frontline staff. They outlined the empowerment of the frontline workers as an important aspect of contemporary healthcare policy for ensuring quality services from them. This, they farther explained, had been supported by the introduction of new Advanced practice roles such as consultant nurse and modern matron, to augment the existing clinical nurse; specialist, nurse practitioner and practice development nurse roles. Policy guidance on the advanced practice roles places on the nurses the obligation and duty to defend their practice on research evidence and bring about change. Even though there’s widespread realization that there is need for the nursing practice to be based on evidences, sound evidence, the staff experiences a big challenge in the attempt to put in place this evidences-based care at an individual level, even the organizational level, particularly the frontline nurses who despite the fact that they are willing to use research, they often lack the skills to conduct or interpret the research themselves. In addition, the organization may not be very supportive, hence bringing about restricted local access to information, which is a barrier. The colleagues may also not be supportive, hence demoralizing. (Bryar et al 2003). A research on evidence-based practice singles out the contribution that ‘opinion leaders’ such as the advanced practitioners in nursing influence the practice of the frontline staff. They can either disseminate information on evidence based practice to them or can become intermediaries between the clinical and the research communities in facilitating evidence-based practice. (Milner et al 2005). This study aimed to examine the contribution of advanced practice nurses (APNs) to promoting evidence based practice among the front line staff. It was directed to find the approaches these nurses use, the factors that promote or those that prevent this promotion, the functions of the APNs in this promotion, the impact that the promotion had on them-both staff and the patients and the educational implication of the promotion highlighting its importance in evidence-based care provision. Through the survey, it was found that the APNs had a broad evidence-based practice mainly through research findings which was valued for providing a rational care, promoting high quality care, ensuring quality standards and improving patient outcomes. At their disposal, they have several sources of evidence ranging from experience, interacting with other APNs and members of the multi-disciplinary team. The evidence is usually internalized into guidelines, transmitted through education programs or judged by colleagues to be relevant. APNs employ different approaches in promoting the evidence-based practices among the frontline staff, and over two thirds of them influenced the way the frontline staff provides their care. However, they feel that they have a positive impact on the frontline staff; but in most cases they often take corrective action to remedy shortfalls in the standard of care provided by the frontline either by taking action to facilitate or stop a clinical problem. On the contrary, they give them opportunities to develop their skills and knowledge beyond standard practice. APNs vary in their evidence based practice support skills, for instance, the nurse consultants are seen as the most knowledgeable, skilled and confident according to these survey findings. This brings out the educational qualification differences. Those who had high educational qualifications are perceived as being the ones who have an upper hand in outlining ways of promoting evidence-based practice. Patients APNs are also seen to provide an environment where evidence-based practice could take place. This evidence was used by frontline staff to inform their practice such that patients were able to decide with appropriate evidence as their basis. They also exerted an impact on the organization and the delivery of services including the achievement of a positive impact on how long a patient stayed in hospital, the rates of admission, and shifts for workers and policy and practice changes. Evidence-based practice promotion depends so much on the relationship between the APNs and the various parties in the organization. The personal attributes of the APN affects the motivation of the frontline. Those APNS who are complimentary to their frontline staff are always more effective. Those who are conservative with their skills end up retaining their patients but stand the risk of disempowering staff. As much as they valued the support of senior staff like doctors and managers, APNs valued the freedom they were given to be creative in developing their role, even though without the support of these support staff, they faced more obstacles. Medical champions on the other hand received support for evidence based initiatives that APNs were planning to take forward and often became the clinical mentors. The commitment towards evidence-based practice led to establishment of resources and structures to support it. APNs used networks both within and without the organization to access the relevant evidence required, to share information on evidence-based initiatives and providing peer support. They also created their own networks which developed the knowledge and skills of frontline staff, for example the nurse link schemes. Due to their importance in promoting the evidence-based practice, APNs need to be armed with a wide range of knowledge and skills. This will lead to critical analysis of the evidence they come about, development of auditing skills, be in apposition to judge and research and in the process master the decision making skills. This will lead to the transformation of the management and information technology. There’s also need to develop personal and professional relational skills to ensure that they effect the promotion of evidence-based practice. The recommended educational level is the masters’ level which ensures proficiency in critical assessment, analysis and evaluation to support advanced practice, and the promotion of evidence-based practice by being intermediaries. The frontline staff needs support to build their knowledge and skills in the evidence-based practice and critical thinking. In addition to the acquisition of the technical knowledge and skills the nurses and other health care practitioners should also emphasize on the acquisition of social skills and the focus on tactics of ensuring good relations with the patients, their families and other health care professional. A modern matron was quoted saying: It can be difficult when you know that several things need to change. If you try to push too many things too quickly, you will loose the staff, they wont buy into it. So it is about working with them, building up that relationship so that they respect you and are willing to work with you.’ To improve the quality of healthcare given, there is need for increased professional growth among the people in the healthcare fields; that is the nurses and other practitioners. Quality healthcare is not all about the evidence-based practice and advanced practice nurses. Nurses also need to undergo training while in the field. This enables them to top up on the already possessed skills and knowledge and it promotes the quality of service rendered to the patients. Researches have been carried out to outline the best possible procedures that should be carried out to ensure that the professional education is effective. Methodologies are the most important in this area. Continuing professional education has been given priority hence giving it the weight and significance, for example, in the UK alone, the National Health Services spends around 1 billion pounds per year on continuing professional development (Brown et al, 2002). However, there’s little evidence as to whether the continuing education has impacted on the nurse’s ability to deliver higher standards of care. (Barriball et al, 1992; Waddell, 1991; Wood, 1998). Distribution of the material and formal continuing professional education alone are not effective methods for ensuring improvement because the models that are usually distributed have to go to the expert for update in a Higher Education institution. This has led to the introduction of a new method called the problem based learning that’s an alternative way. It has been introduced in many fields like medicine, nursing, social work and so on. It started being a feature of educational programs during the 1960s. Since then it has been adapted by the USA, Europe, The Middle East, The Far East and Australia. Many medical schools in the UK use it, though the number is not known. Nursing education has not been left out either. In fact it shows us the extend to which this approach is used. The use kicked off in Canada (Rideout et al, 2002), Australia (Alavi, 1995) and so on. There is lower case problem based learning (pbl) and upper case problem based learning (PBL) the lower case pbl is one in which the problem is made the centre of focus n the learning process. The upper case PBL on the other hand sticks to the structures and s and procedures first systematized by Howard Barrows (1986). Emphasis in this case was placed on integrated learning a process of cognitive, meta cognitive and personal development. The aim of PBL was to help students develop deep cognitive samples of the problems presented to them. Bailey and colleagues (2003) stressed that its other aim was to enhance and make it culture of the clinical community. Problem based learning has been criticized and innovated at professional levels in education, reports Maudsley,(1999). The literature on the same is wide spread in, many journals, books and databases in many subjects. There’s empirical evidence that it produces proficient and consistent workers who can be retained throughout their professional careers. Though some researchers argued that it did not improve the performance and competence of those in the medical field, it is evident that they do use this method as their researches and the results are so positive. This makes the claim a kind of contradiction. Nursing education has a major policy initiative involving the use of personal development learning for the production of independent learners who are able to plan for their own career. Each nurse has a personal development plan that helps him to identify and develop knowledge and skills that will support their progress in the career. Roles of nurses are increasing as time goes by hence there will be a great difference between the old practitioners and the new. Apart from the methodologies employed, there is the initial training for the nurses who are usually recruited in the field. The world is so dynamic that we cannot overlook the fact that there is a rising demand for new skills to improve the quality of the services provided. Nursing education endeavors to produce nurses who are fit for employment in the increasingly competitive market. This is done through out the course. This has put pressure on the programmers for thee need to respond to the dynamic changes in the health care services and policy drivers. Personal development planning is understood as the policy agenda that focuses on employability and the acquisition of generic and workable skills. For example in the UK the higher education sector is currently committed to putting into operation a system of personal development plans of development files for students in all courses. The impulsion for this inventiveness came as a reaction to the Dearing report in1997 which was endorsed by the government and affected higher education institutions. There has been much on the levels of proficiency and confidence of many qualified nurses (Kenny 2004a). The frontline of heath care is in the community with an expectation of new ways of working. Nurses have been taking new roles to render more flexible patient centered services. This demands a change in their education. Preparation of nurses for practice has been problematic evidently in this dynamic and demanding educational and workplace environment (Kenny 2004b). Their proficiency is buried depending on the opportunities the come across in training. Everyone must therefore know what is expected of a newly registered nurse and be in a position to identify any areas lacking in proficiency. It is acknowledged that internship experiences are very important features of preparation for the real work. The University of Wolverhampton has gone to an extent of developing a new curriculum that emphasizes the looking at of social political and cultural features of nursing. This develops their knowledge on the importance of health as opposed to illness and they fit in well in their roles as community nurses. Conclusion Several research papers on clinical practice highlight different conditions that can lead to improved healthcare provision. Generally all these work together for one to realize quality healthcare services. For instance the advanced practice nurses are as important as front staff in thee provision of their services. The patients play a role too to ensure quality healthcare provision. Summatively, there is need for educational training and practice. We cannot overlook research that lays ground for evidence-based practice that is highly recommended in health care provision. This clearly reveals that to promote the clinical practice, there’s need to conduct a diversified research that does not necessarily highlights all the contributions of various fields that directly affects clinical practice. REFERENCES Crookes, P. and Davies, S. (Eds) 2004. Research into Practice: Essential Skills for reading and applying research in nursing and healthcare (2nd Edition) Edinburgh: Baillière Tindall. Gerrish, K. and Lacey, A. 2006. The Research Process in Nursing (5th Edition), Oxford: Blackwell Publishing. Hamer, S. and Collinson, G. 2005. Achieving Evidence-based Practice: A Handbook for Practitioners. Edinburgh: Baillière Tindall in association with the RCN. TUTTON, E. SEERS, K. & LANGSTAFF, and D. 2007: Professional nursing culture on a trauma unit: Experiences of patients and staff. Journal of Advanced Nursing, 61 (2), 145 – 153. Bryar R, Closs S, Baum G et al (2003): The Yorkshire BARRIERS project: Diagnostic Analysis of Barriers to Research Utilization. International Journal on Nursing Studies. Fitzgerald L, Ferlie E, and Hawkins (2003): Innovation in Healthcare: How Does Credible Evidence Influence Professionals? Health and Social Care in the Community. McCaughan D, Thompson C, Cullum N et al (2002):, Acute Care Nurses’ Perceptions of Barriers to Using Research Information in Clinical Decision Making. Journal of Advanced Nursing. Milner M, Estabrooks C and Humphrey C (2005): Clinical Nurse Educators as Agents for Change: Inceasing Research Utilization. International Journal of Nursing Studies. Thompson C, McCaughan D, Cullum, N et al (2001): The Accessibility of Research-based Knowledge for Nurses in The United Kingdom Acute Care Settings. Journal of Advanced Nursing. Wilkie K. The nature of Problem-based learning, Problem based learning in nursing, Eds. S Glen & K Wilkie, (Basingstoke, Macmillan Press, 2000) Wolf F. Problem-based learning and Meta-analysis: Can We See the Forest Through The Trees?: Academic Medicine Wolff A, and Rideout E, The Faculty role in Problem Based Learning, Transforming Nursing: Education Through Problem-Based Learning, Ed. Ride out E, (Sudbury MA, Jones and Bartlett, 2001) Wood I, The effects of continuing professional education on the clinical practice of nurses: A Review of the Literature: International Journal of Nursing Studies, Wiley K. Effects of a self-directed learning project and preference for structure on self-directed learning readiness: Nursing Research. Waddell D, L, and The Effects of Continuing Education on Nursing Practice: A Meta-analysis: Journal of Continuing Nursing Education. Appendices: Appendix I The paper was a report of study that explored the daily experiences of patients and the staff in the unit put aside for adult patients who had sustained injuries. With the numbers of patients in this section increasing, this study was done so that the factors that affect the ability of the staff to ensure optimum recovery in the practice, which were unclear. Appendix II . Advanced practice nurses are those who have demonstrated expert knowledge and skill while maintaining an element of clinical involvement. Diversity in the job titles and role description of nurses occupying such roles, the definition includes clinical nurse specialists, clinical educates, community matrons, modern matrons, consultants, nurse practitioners, practice development nurses and others within the nursing profession who are not listed here. There is no restriction to the above named. Appendix III The study on APNs had two major related stages. The first stage was a survey by postal questionnaire of 855 APNs in a hospital’s primary care section, in all the seven strategic healthcare authorities in England in 2004-2006.The second stage involved 23 case studies of APNs. It involved a range of other stakeholders- a range of healthcare professionals, managers, patients and family members with whom the nurses worked. Data was collected through interviews with the APNs and the stakeholders and observation of the APNs in practice. Appendix IV Emphasis that health practitioners should go through an in-profession training that helps them better the services they render to the patients. There can be several methods of carrying out this training but the best approved in this study is the problem-based leaning approach which is divided into two; The lower case (pbl) is where the problem is the center of learning, and the upper case (PBL) emphasizes the integration of learning even though there has to be a problem identified. Appendix V The society is so dynamic and we cannot concentrate on the practicing nurses only. The last section of this paper looks into the way those training nurses for the field should face the challenges of a dynamic world with new demands in healthcare. The confidence and the competence of the nurses depend greatly on the training they go through as they prepare for the field. Read More