Introduction 1-3 Flashcards
Why do we need research in midwifery?
- To ensure the delivery of safe, effective, high quality care
- To meet clinical governance requirement
- To facilitate the autonomy of nurses and midwives
What is evidence based practice?
Is the integration of best research evidence with clinical expertise and patient values
With clinical expertise
- Challenges in supporting women to make realistic healthcare decisions and requires
that we:
o Understand what good evidence is
o Make a judgement about how rigorously it was produced
o Determine how applicable it is to the individual
Types of evidence
- Expert opinion
- Traditions
- Personal experience
- Audit
- Research
Levels of hierarchy of evidence
- Priotised by rigour and generalisability
Level 1: Opinion- EB guidelines will often include elements of expert
opinions. Opinions produces variations in practice and in the end we do not find out what opinion is the most useful. There are many aspects where EBP
still does not exist and therefore opinions are what people rely on.
Level 2: Qualitative Studies- essential part of EBP as they often provide
valuable insight into patient preference and other aspects of care that cannot
be quantified or measured in any different way.
o Level 3: Cohort and case-control studies- quantitative studies- studies that
can measure the effectiveness of interventions. Cohort studies is a study of a
group of defined people who are followed over a time period. The rationale
for this type of research is that it is not always ethical to experiment on
people. Cohorts can reflect an element of time which is useful
epidemiological resource. Case-control studies are retrospective
epidemiological studies where people gave contracted a particular disease
and are compared with a group of people that didn’t retract the disease.
o Level 4: Randomised Controlled Trials- these evaluate interventions by
comparing two or more treatments using a strict scientific process. The
principle is to conduct a fair test and minimise the occurrence of bias, which
might lead the researcher to make the wrong conclusions and to exclude the
possibility of chance. Single RCT’s may not always provide a clear answer
about the usefulness of an intervention because they are not large enough or
may not represent high quality research.
o Level 5: Systematic reviews- Collecting all the studies that address the same
research question and analysing them in one mass to see if they will give a
clearer answer. Analyse existing research rather than collecting new data.
Practicioners should look for effective treatment initially from a systematic review but if none is found to follow the hierarchy down until appropriate evidence is
found.
Process of EBP - 5 A’s
ASSESS: identify the clinical problem.Using EBP process a full
assessment and discussion with the woman will be prompt a search for
research that will provide an answer for her question.
ASK: Frame the problem in the form of a structured clinical question. This is
important as it will maximise the chance of finding a good solution.
Structuring a questions is done by PICO.
ACQUIRE : search for research studies. PICO can be useful when looking for
reaserch too
APPRAISE: read the papers that meet the criteria, analyse the quality and
validity and also the clinical significance of the finding. Meta-analysis
APPLY: Return to the patient and evaluate your performance
PICO - part of ASK
POPULATION - the group of people that are interested in and want to
find research studies. The more narrowly defined population are the
ones more likely that suit the patient group. By using a set of inclusion
and exclusion criteria you will find the most relevant literature.
INTERVENTION AND COUNTER INTERVENTION - is used to mean any
treatment or care option that we want to consider to solve the
problem. We also need a counter intervention. This needs to be fair.
There may be no counter intervention so in that case you use
‘standard care’.
OUTCOME- this should be aligned to the solution we hope to find and
as close the the originals choice.
What are the types of knowledge
Traditional knowledge- Originally based on traditionally held beliefs which over time was
passed on. Possessing the knowledge also created a sense of identity and empowerment.
Personal knowledge- a source of knowledge developed by individual midwives through
their experience and expertise.
Intuition- instinctively knowing the best care.
Knowledge from other disciplines- psychology, human biology, medicine, pharmacology
and physiology. It is imperative that it is applied to midwifery to ensure problems that arise
can be individualised. Important that midwives generate their own body of knowledge
rather than relying solely on knowledge from other disciplines
Research- well-conducted research studies provide the most reliable source of knowledge
for midwifery practice. All the other types of knowledge should be underpinned by relevant
research-based evidence.
Research paradigms- a framework that consist of ideas, beliefs, opinions and values. These
are sometimes referred to as ontological, epistemological and methodological beliefs. The
paradigm therefore provides a philosophical underpinning and it also shapes the way a
research study is conducted and the way the new knowledge is developed.
Research- well-conducted research studies provide the most reliable source of knowledge
for midwifery practice. All the other types of knowledge should be underpinned by relevant
research-based evidence.
Part of part of paradigms
Each paradigm has its own number of research methods according to the paradigm view.
The most commonly used paradigms in healthcare are positivism, pragmatism and
interpretivism- also known as naturalism or constructivism
Research paradigms
Research paradigms- a framework that consist of ideas, beliefs, opinions and values. These
are sometimes referred to as ontological, epistemological and methodological beliefs. The
paradigm therefore provides a philosophical underpinning and it also shapes the way a
research study is conducted and the way the new knowledge is developed.
Types of paradigms
Positivism- foundation is sciences and maths. Facts and events have underlying causes. An
objective reality exists. Quantitative approach- testing a theory, prediction, measurement
and objectivity. To become objective the researcher adopts a position of neutrality.
Interpretivism- counter movement to positivism. Truth consist of multiple realities that are
subjectively perceived by individuals. They acknowledge that it is quiet likely that will be
close similarities between the understanding and meaning of individuals who have
encountered similar experiences. Use flexible qualitative methods.
Pragmatism- aims to seek meaning and the context is also regarded as being important.
Researchers believe that a person’s experience is determined by the situation. Uses aspect
on both quantitative and qualitative. Outcome is more important than the process.
Researcher selects a more appropriate approach. By combing both methods it strengthens
the whole study.
It should always be possible to identify which pragmatic stance that a study has followed
RESEARCH METHODOLOGY
RESEARCH METHODOLOGY IS THE PHILOSOPHY OR PRINCIPLES OF AN APPROACH TO
RESEARCH WHICH DETERMINES THE WAY IN WHICH A RESEARCH METHOD IS CARRIED
OUT. IT INCORPORATES A NUMBER OF RESEARCH METHODS WHICH IS SPECIFIC WAYS IN
WHICH A STUDY IS CONDUCTED.
