introduction Flashcards
Why do we need research in midwifery?
o To ensure the delivery of safe, effective, high quality care
o To meet clinical governance requirement
o To facilitate the autonomy of nurses and midwifery
What is evidence based practice:
Is the integration of best research evidence with clinical expertise and patient values.
What types of evidence
- Expert opinion
- Traditions
- Personal experience
- Audit
- Research
What is EBP?
- Integration of best research evidence
- With clinical expertise
- Clients unique values and circumstances
What is the levels of hierarchy of evidence
The levels of hierarchy are prioritised by rigour and generalisation
o Level 1: Opinion
o Level 2: Qualitative Studies
o Level 3: Cohort and case-control studies
o Level 4: Randomised Controlled Trials
o Level 5: Systematic reviews
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.
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.
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.
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.
The process of EBP
Assess: identify the clinical problem. Most of the time there is a clear diagnosis and treatment. However sometimes that is not the case so it is important to search for research evidence. 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.
What is PICO
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.
Process of EPB
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.
The different 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
