Methods Used in Evidence-Based Practice - Essay Example

?RESEARCH METHODS USED IN EVIDENCE-BASED PRACTICE This study explains the basis of evidence-based practices relating to the clinical field pertaining to nursing. This article employs recommendations described by Ryan-Wenger in terms of title-length in addition to the absence of common conventions such as a dedicated methods heading. The investigation is structured in the form of a literature meta-analysis concerning an article specific to the nursing profession and its relationship to evidence-based practice. A hybrid approach is used to derive comparisons between a case study, and a literature meta-analysis of related findings. Other investigations concerning the problems of the nursing field, and ways to implement evidence-based practices in other areas are used to supplement this comparison. It is not in doubt that these procedures are effective, this article explores additional means to expand these practices more thoroughly throughout the clinical profession. Introduction In the interests of the nursing profession, the term evidence-based practice is a relatively recent development. The term represents the new framework for the medical field in general representing the logical culmination of scientific principles essential to the foundations of modern medicine. But the term itself was first described in the work of the evidence-based medicine working group in the early 1990s (Cullum et al. 2007). For all areas of human endeavor with any intersect with the material or biological sciences and evidentiary area approach is the fundamental precept that permits reliable scientific progress as an alternative to superstitious or intuitive practices predating the advent of the scientific method. In addressing this theme a patient safety research article from Berland and colleagues (2012) will be subject to examination. The article itself focuses on a specific tasks relative to the healthcare profession, providing a direct analysis utilizing evidence-based practice. Primarily, this article will address the specific research findings of Berland and colleagues (2012) , who conducted a study on the experiences of homecare nurses in the area of patient safety. This is an example of evidence-based practices applied to resolve the specific issue of patient safety. Pursuant to an exploration of this article, additional background will be given on evidence-based medical practices in general. Before the modern movement towards evidence-based practice, similarly related terms such as evidence-based medicine (Beyea & Slattery, 2006) described the fundamental approach of utilizing scientific evidence as the primary assumption needed to identify the most efficacious treatment strategies based on the objective appraisal of the physical facts pertaining to the case at hand. Qualitative Overview During any research project, executive decisions must be made concerning the best strategy by which to derive conclusions from the available information. There are two principle categories of data that are meaningful in terms of human interactions and endeavor: quantitative and qualitative. Quantitative information is primarily numerical, using ratio-level data that allows precision calculations often of physical phenomenon. It is essential for mechanistic processes involving functions or forces that can be duplicated or replicated. This stands in contrast to qualitative data. Qualitative data reflects findings relating to social interactions or behavioral motivations that do not immediately entail numerical representation. Qualitative findings often use ordinal or normative information in order to draw behavioral conclusions. Many of the issues relevant to this article are dependent upon behavior and human interactions, such as questions of leadership and responsibility. These functions of behavior are not amenable to hard numerical data under most circumstances, and therefore a qualitative approach is most useful for the type of research included in this analysis. For the Berland study, the first line of the Methods section quotes as: “An exploratory qualitative research design”. Aims The aim of the Berland study was an exploration of the experiences of homecare nurses (in Norway) relating to patient safety. This investigation will include a literature meta-analysis in order to evaluate the Berland article. The goal is a hybrid approach, whereby the Berland study will be compared with a range of other sources to form a more complete picture of evidence-based practice. Sample The Berland study is an assembly of 20 nurses from the home care sector in Norway. This information will be included in a general meta-analysis of investigations covering evidence-based strategies applicable to the medical profession. The investigation is intended to be applicable throughout a variety of clinical settings. The evidence-based strategies will be used to evaluate the Berland article. The hybrid approach used will sample 22 other research studies on evidence-based practice. The sampling strategy relies on a qualitative consensus based on an aggregate of these 22 lines of investigation. This approach allows a form of triangulation on the most probable conclusions that fit the findings of all data considered. Transferability These findings are transferable in a variety of ways, both in terms of further research and practical implementation. The findings from the Berland study described herein are applicable to other home care nurses where questions about leadership and responsibility exist. The meta-analysis of other research describes two essential vectors of implementation for evidenced-based practice that suggests both new mechanisms of function that represent targets of future research, as well as a way to direct improvement strategies on an individual, clinical basis for immediate practical utility. Data Collection Method and Audit Trail The Berland study itself is a qualitative investigation where data is collected through a series of 1.5 to 2 hour interviews conducted by the original author. The author also served as moderator. For the current discussion, data is gathered through a process of literature meta-analysis concerning other studies concerning evidence-based research and the implications for the nursing profession. Similar investigations are identified to derive conclusions concerning the field of nursing as a whole, and how evidence-based practice can be incorporated into routine procedures. The validity of this method presumes the validity of the studies included. Discussion of Berland is supplemented with a literature meta-analysis of related and relevant studies. Records and technical equipment in Berland were deliberately monitored by the last author in order to increase the likelihood of the data being preserved accurately. Among the nurses themselves, there was concern over documentation by study participants in terms of transfer of records between shifts in their own clinics, but this is not an indictment of the investigators studying the subjects. Ethical Issues & Trustworthiness No ethical dilemmas or conflicts of interest are declared or implicit. The veracity of the study itself is dependent upon the assumption that all the studies researched employed the scientific method during the investigative process. Berland itself demonstrated the standard protocols of confidentiality and objectivity in its implementation. There were no observed violations of patient interests, or questions regarding informed consent. Appropriate measures exist in the Berland study to diminish the potential for bias. Much of this was demonstrated in the sample strategy. Both male and female nurses were offered the opportunity to avoid gender bias; and the purpose of the study was to gather data on working nurses with regular contact with patients – and thus no managers were selected. However, due in part to female preponderance in the nursing profession, only females ended up participating in the survey, but this is not the result of deliberate bias on part of the investigators. To enhance trustworthiness, the investigators conducted ongoing debate concerning the findings and discussion. This process might have been enhanced by involvement of external experts not involved in any other part of the study. Reflexivity In order to diminish the likelihood of confirmation bias, an open-ended question style was used on participants in order to prevent leading the subjects into a desired or biased conclusion. Yes/no questions were deliberately avoided. Participants were asked to describe experiences, not confirm an assumption already extant on part of the researchers. When differences occurred, subjects were asked to elaborate at length. This elaboration makes it less likely that reported insights will be ignored or distorted by the researchers to confirm a pre-existing, circular bias. Data Analysis There is no controversy in the literature concerning the validity of evidenced-based practice, therefore the method to evaluate the information is essentially a qualitative, recommendation-based policy. Additional qualitative studies are reported on, in the form of a literature meta-analysis to derive a singular conclusion. Consistent with the objectives described in the Aim of the study, evidence-based practice is confirmed by the supplementary articles, and implemented in a practical fashion by Berland. Literature Review Evidence-based practice depends upon a systematized approach to the standard procedures of the profession under discussion. It is possible to delineate the specifics of this technique into two broad categorizations that encompass the objectives of evidence-based practice but which are larger than either. Research utilization. This is the necessary and valid practice of remaining current with the most recent and relevant research in the investigators field of study. The medical field, like any profession within intersect with the physical sciences rises and falls based upon real-world physical outcomes. The nursing profession itself begins and ends with methodologies to improve patient outcomes. To achieve the best outcomes possible under as many circumstances as are likely to occur, dedicated efforts must be made to adjust procedures and assumptions based on the most recent information. Throughout the 20th century and especially in the 1970's the best clinical research has informed nursing practice (Leighs, 2013). It is essential to determine which studies are useful for the issues at hand, either in terms of the resolution of a problem – or greater efficiency in the implementation of known procedures. New research must be evaluated, and a determination must be rendered based upon which findings and clinical reforms demonstrate pertinence for the specific clinical practice at hand. A trial process may be necessary, where the concepts expressed in new research are vetted under real-world conditions in order to determine whether the results of the research can be duplicated. Evidence-based practice is an expression of an integral component of the scientific method itself: peer review and the repetition of research. It is essential during the course of scientific progress to publicize research, and for other investigators to be able to duplicate the results claimed under similar conditions and circumstances. And therefore, through evidence-based practice nurses are both beneficiaries and participants in the overall scientific process. Nurses in real clinical situations can benefit from good science, and by documenting their experiences they can provide verification that the results claimed in a body of research does indeed work in a realistic clinical setting; or they can determine that the research does not work. Either outcome advances scientific knowledge. And implementing the best research, choosing those measures that are effective and adjusting standard procedures accordingly creates a corporate culture of continuous improvement in patient outcomes and problem resolution in the interest of patient and institution alike. Performance improvement. The essential practical benefit of evidence-based research is represented in an improvement in the overall quality of services rendered. Performance improvement by necessity enhances outcomes through functional efficiency, cost reduction when possible, and of course client/patient satisfaction – in the nursing profession translating into superiority of patient medical outcomes. Performance improvement is an integral component of evidence-based practice, but is less dependent upon the scientific method and standard modalities of clinical research. Performance improvement may be entirely limited to the facility in question. Improvements can be gleaned by procedures specifically adapted to the scheduling, personnel, and structure of the individual facility in question – and are therefore not applicable in terms of scientific research in general. But through the implementation of research utilization and evidence-based monitoring of outcomes, these overall principles can lead to a general improvement in efficiency for individual facilities. Those specific measures may not translate to other clinical settings, but using evidence-based practice in association with the development of standard procedures accompanied by research utilization specific improvements are attainable. It is the broad measures that lead to setting specific performance improvement that are transmissible, rarely the individual measures themselves, except to the extent that commonalities exist between actual clinical facilities. There are a number of issues relevant to most clinical settings that are applicable targets for process improvement. It is generally assumed throughout the healthcare profession that smoking in clinical settings is strictly forbidden, but there are a variety of strategies available for enhancing smoking abstinence or cessation among patient populations. Different clinical settings should utilize the research of other hospitals in order to identify the best measures for alleviating tendencies to smoke, and ways to improve compliance to anti-smoking initiatives. Rates of compliance can be studied and included in analyses and meta-analyses of smoking prevention programs in order to achieve continuous improvement to the extent that it is possible. While the exact circumstances may not translate to different clinics, the overall objective is of great relevance to the healthcare profession and certainly a target of research utilization and continuous performance improvement. Another area in which evidence-based practice is essential in terms of real-world physical consequences is the issue of on-the-job safety. High risk occupations have pioneered research in this field, and it is eminently applicable to the nursing profession and efforts to employ evidence-based practices. This form of research has been implemented successfully in professions with a high degree of physical danger, such as commercial airlines as well as petroleum operations according to the research of Berland et al. (2012). And the findings in these fields relating to safety can and should be translated to the clinical profession as it pertains to nursing. Berland continues to describe the history of the staff safety measures taken in the high risk industries, with the intent of relating these findings to nursing and healthcare. This research identified a singular theme relating to responsibility as being a principal challenge among nurses in the area of patient safety. A broader investigation will focus upon additional themes relevant to evidence-based practice described above. Berland's central theme will then be evaluated based upon the subsequent research of others exploring evidence-based practices. For nurses, there are two essential objectives making safety studies especially relevant: preventing occupational hazards to the nurses themselves while drawing blood or collecting other samples for testing in addition to higher risk medical procedures. Safety standards are essential in this context in order to avoid not only contamination by infectious agents but also the issues of liability in case of negative patient outcomes. The second overall objective is and must always be protecting patient health in general. While any procedure is performed there is some inevitable element of risk, and an exploration of safety related methodologies has the potential to lead to performance improvement in terms of medical outcomes. These solutions are not always factors purely of a medical nature; poor training and a lack of leadership will impede the performance of otherwise sound medical practices unless efforts are made to identify and rectify such problems as they occur, and to prevent them from occurring. Despite widespread interest throughout the history of the healthcare profession, more research is needed due to the fact that the nursing profession has been slow to create a uniform definition on exactly what safety means, and how to achieve it on a universal basis (Berwick, 2003; Pravikoff et al. 2005; Melnyk & Fineout-Overholt, 2010). Safety in general is not a singular procedure nor the sole responsibility of any one individual or department, it is an ongoing process involving the entire spectrum of clinical workers. As a result, the aforementioned issue of leadership is highly relevant as essential for the implementation of effective safety procedures. Therefore, the dimensions of human resources and organizational structure cannot be ignored in an expertly run clinical setting under any circumstances. It is worthwhile to investigate large-scale operational improvements in the nursing profession that can be achieved through evidence-based practice. While certain specific recommendations that may work in a given clinical setting may not be universally applicable, there are issues in the healthcare profession that frequently manifest as problems across the medical spectrum (Funk et al. 1991; Thompson et al. 2001; Nelson et al. 2002; Newhouse et al. 2005). Research utilization demonstrates that while most hospitals pay close attention to issues of safety and patient outcomes during specific procedures occurring for the treatment of acute conditions for inpatient departments, in between major procedures limited and inconsistent safety data exists in the field of primary care. Some studies in the past decade indicate that risk factors may exist among older patient populations – not necessarily in the course of curative treatments, but rather during the convalescent periods in between (Wagner, et al. 2009: Jeong, 2013). There is a possible gap in safety standards for many institutions implying an elevated risk of adverse events (Madigan & Tullai-McGuinness 2004; Masotti, et al. 2004; Odegard & Andersson, 2006; Berland, et al. 2012). More research utilization is necessary to determine to what extent age plays a factor and whether in fact there is laxity in primary care conditions that may exacerbate adverse events in older populations. There are a wide range of other quality/performance improvement projects of great relevance to the nursing profession that represent valid targets for research utilization and performance improvement. Some possibilities might take the form of an ergonomics investigation and optimization for the nursing staff. Consistent and predictable needs, such as phlebotomy or blood pressure monitoring should be subjected to constant scrutiny both internally and externally: internally to make sure that the necessary procedures nurses abide by do not cause unforeseen difficulties or unacceptable safety hazards (Polit & Beck, 2003). Is the equipment typically employed by nurses safe and effective for repeated uses? Are there excessive or repetitive motions required as a result of data entry, or in the use of medical equipment with the potential to inflict long-range consequences on the health of staff members? Economics is not simply limited to matters of immediate safety such as might occur when the nurse takes a blood sample or delivers dosage, the possibility of damage or health problems over a cumulative stretch of time are also relevant. In addition, it is also possible to be proactive, to initiate studies based on direct experimentation (Burns & Grove, 2001; Clifford & Murray, 2001; Madsen et al. 2005). During the administration of drugs and the prescription process preceding it there are by necessity a chain of events involving doctors and nurses of different departments, in most large hospitals. If an order for a particular form of drug therapy for antibiotic is first conceived of and documented by a doctor, how much time passes before the correct dosage of that drug is successfully introduced intravenously into a patient? What administrative hurdles might prevent the treatment from occurring faster? This is another valid target of the administrative approach towards evidence-based practice. All major hospitals must at some point deal with liability issues and the degree of responsibility they may or may not bear as a result of adverse events. Therefore the satisfaction of patients and families must also be taken into consideration. An evidence-based approach can be used to analyze trends in the occurrence of adverse events and negative evaluations on part of patients. This information can and should be investigated using statistical modalities in order to identify changes in the rate of adverse events or patient complaints – either improvements or the diminution of overall quality of patient treatment. This information is indispensable, but research utilization must always be employed for the best chance of identifying a possible trend as soon as it is evident. An evidence-based process augmented by statistics can also be used to formulate the most practical solutions based upon what has or has not worked for other clinics in a similar situation. While most hospitals evidently pay adequate attention to the conditions and outcomes of patients during the course of treatment, the end result can never be certain. A far-reaching evidence-based approach must also be employed to identify those instances where adverse reactions may in fact result during major surgical procedures and to gain as much information as possible on these occurrences and to what extent specific practices in the emergency or operating rooms may be responsible. This is especially relevant in cases of multiple occurrences of the same adverse reaction; such as nosocomial (or iatrogenic) infections occurring before or after surgery. Are patients able to maintain adequate blood pressure during coronary procedures? Are there any persistent problems with diabetic control associated with the hospital in question? These are all examples of valid targets for further refinement of the clinical experience through evidence-based practice. Further methods for improvement would also include identification of any areas of standard operating procedures that depend upon inconsistent guidelines or outdated methods based on recent and regular research utilization. Essentially, the commitment to engage in evidence-based practice itself is the first step, specifically an interest in research articles (Fink, et al. 2005; Parahoo, 2006). Parahoo especially provides additional guidelines for the purposes of advising evidence-based research pursuits. Results Berland identified a central premise relating to the failure of responsibility by way of a lack of leadership among homecare nurses as an issue in patient safety. A need for an evidence-based solution is supported by the literature. The leadership deficiencies result in a failure to update procedures, and individual nurses with an inconsistent degree of knowledge pertaining to the specific issues of homecare. There is no evident disagreement or dispute in the literature concerning the value of evidence-based practices, it is a matter of expanding applications. This qualitative investigation has identified two principle mechanisms for expanding evidence-based practice: Research utilization and performance improvement. Conclusions The hybrid approach allows relevant articles to provide supplementary background on Berland. It is apparent that the evidence-based system is not under serious question, the issue remains how best to implement it. With the two broad criteria entailed with evidence-based practice, it is possible to evaluate Berland more thoroughly. This article is mainly relevant in terms of performance improvement. The principal issues at hand are a lack of responsibility for understanding of responsibility among nurses, which is a symptom of poor leadership. Therefore, the most optimal solutions for the issues raised would be an evidence-based approach towards improvements in nursing management. These managers must cultivate an awareness of the day-to-day problems experienced by the nurses under them. This oversight leads to inflexible procedures in need of modification through research utilization; which is emphasized by conclusions indicating insufficient education in the healthcare field. This provides evidence that the secondary objective, that of performance improvement is necessarily tied to the first criteria of research utilization. Specifically, more focus is needed on the issue of nursing management and strategies in this regard. While it is advantageous to expand evidence-based research to as many areas as possible, the individual clinic must focus on its deficiencies. Pertaining to patient safety, attention must be focused not on simply making operations safe, but limiting adverse outcomes throughout the entire experience of hospitalization and outpatient initiatives (Sackett et al. 1996). In immediate practice, the individual nurse would be advised to make recommendations in the field of patient satisfaction as a means of preventing negative trends and expanding the data available for the preemption of adverse reactions. This requires a thorough understanding of the individual nurse's responsibility. Observations should be documented in primary care in addition to actual procedural outcomes in the interest of overall performance improvement. For the individual clinic, it is necessary to explore the extent to which their own problems can be attributed the leadership issues found in the Berland study. References Berland, A., Holm, A.L., Gundersen, D., Signe, B.B. 2012. Patient safety culture in home care: experience of home-care nurses. 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