Exploring the Concept of Evidence-Based Practice

Dr Tina HarrisLead Midwife for Education

Adapted from a presentation originally developed by Dr Susan Dyson

Aims

By the end of the session you should be able to:• Articulate the concept of evidence-based practice• Appreciate the importance of using evidence to

underpin professional practice• Understand the principles for determining what is

best available evidence

What’s in a Word (or phrase)

• What do you understand about evidence – based practice (EBP)

- discuss with your neighbour

Evidence-based practice is..

• “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external evidence from systematic research” (Sackett et al, 1996:71-72)

Evidence-Based midwifery Practice

• …involves integrating the best available research evidence with professional expertise while taking account of patient preferences

• …is a complex undertaking that involves identifying and appraising different sources of evidence

Evidence for breast feeding

• Best way to help a woman successfully breast feeding– What is happening?– What needs to happen to resolve the problem– What is the best way to do this

In more detail…

• We can extend the concept of EBP from individuals to groups of patients, health care services and policy initiatives (Muir Gray, 2004)

• Ongoing research adds to the `body` of knowledge and ensures the knowledge base for practice is constantly evolving

EBP for midwives

• The onus is on midwives to keep up-to-date with research, both `generic` and `applied`, so as to provide best possible care

• The evidence drawn on to underpin practice should be in the public domain, open to scrutiny, clinically based, take account of women and their families.

Research to underpin EBP• Research findings as evidence - Systematic research process should ensure

confidence in research findings- All research has limitations, so research reports

should be subject to `critical scrutiny`- Evidence drawn from one source is insufficient as

grounds for changing practice- Research findings often need considering alongside

professional expertise to identify best practice

• Research findings may be applied directly to practice in the form of clinical protocols or practice guidelines, be used persuasively to present a case for changes in policy or practice

Professional Expertise to underpin EBP

• Professional expertise or `practical` knowledge (derived from professional experience) can inform EBP, when used alongside `technical` or `propositional` knowledge (derived from research)

• Midwives often draw on these sources of knowledge more often than formal sources, i.e. published research reports

Patient experience to underpin EBP

• Can be `individual` e.g. collected during individual episodes of care

• or `collective` e.g. collected during group or community participation in health care planning or service delivery

• Users of health cares services are becoming more involved in all aspects of care using a variety of mechanisms to inform preferences and/or opinions e.g. user forums, satisfaction surveys, internet, NHS organisations

Hierarchy of Evidence

• EBP draws on different types of evidence• What constitutes `best` available evidence – the

so-called `hierarchy`1. Systematic Review Multiple Randomised

Controlled Trials (RCTs)2. RCT3. Non RCT4. Non Experimental5. Descriptive studies, Expert Committees

Characteristics of all research

All types of research are or aim to be:• Planned• Cautious• Systematic• ReliableWays of finding out or deepening understanding

Examples of Research• Ethnicity Question and Antenatal Screening

(EQUANS)A Department of Health funded study using

quantitative and qualitative methods to find out about the efficacy of asking pregnant women an ethnicity question as a way of detecting risk of carrying genes associated with Sickle Cell Disease (SCD)

Project Lead Dr Simon Dyson: Reader in Applied Social Sciences

RCT and non-RCT

• Cultural diversity of pre-registration nursing

programmesA Health Care Workforce Deanery (HWD) funded study

using qualitative and quantitative methods to understand the experiences of South Asian nursing students on under-graduate nursing programmes

Project Lead Dr Sue Dyson: Principal Lecturer in NursingNon experimental

• Midwifery practice in the third stage of labour

A study which aimed to identify and explain the variety of ways midwives manage the third stage of labour.

Project Lead Dr Tina Harris: Principal Lecturer in Midwifery

Non experimental

• The experience of obesity in childbearing– Aim to explore with obese women their

experiences of childbearing to inform future care of this client group.

– Project lead Rowena Doughty

– Non experimental

In summary…

We should be able to articulate what evidence-based practice is

We should understand something of the importance of using evidence in professional practice

We should understand the principles behind determining what is best available evidence

References

– Spiby H and Munro J (2009) Evidence based midwifery: applications in context. Chichester:Wiley-Blackwell. Chapter 1.

– Rees C (2011) Introduction to research in midwifery. London:Churchill Livingstone

– Cluett R and Bluff R (2006) Principles and practice of research in midwifery

References

• Gerrish, K and Lacey, A (2006) The Research Process in Nursing (5th Edn) Blackwell Publishing. Oxford.

• Sackett, D.L., Rosenburg, W.M., Muir Gray, J.A., Haynes, R.B., Richardson, W.S., (1996) Evidence-Based Medicine: what it is and what it isn’t. British Medical Journal 312: 71-72

• Muir Gray, J.A. (2004) Evidence-based policy making (editorial) British Medical Journal 329: 988-989