Essay On Evidence Based Practice In Nursing
The Nursing and Midwifery Council (NMC) agree that if a nurse is following The code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008) they must recognise how crucial the value of evidence in practice is. They must be able to understand, judge and apply relevant research and theories to their work and so highlighting areas where further research could be undertaken. Evidence based practice is commonly described as the combination of the most up to date research and clinical expertise as well as patient values (Sackett, et al. 2000). This means that it takes into consideration the patients situation, the patients values and goals, the best available research as well as the clinical expertise of the practitioner.
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This makes it so important as it is the tool to improve healthcare, as the more knowledge that people gather around their area, the more able they would be in the workplace.In this essay I will be describing three types of evidence in practice, quantitative, qualitative and audit.
Aliaga and Gunderson (2000) describe a quantitative study to be one that gathers large amounts of numerical data and using it to explain an occurrence by way of mathematical based methods i.e. statistics. I chose a report of describing the emotional outcome of people caring for stroke survivors. I found this evidence through refining my search on the UWE library page firstly to make sure that it was peer reviewed and also that it was about a stroke patient. This study set out to understand more fully about the people who care for the victim’s of strokes. They wanted to understand the relationship between the caregiver, patient and if this had any correspondence with poor caregiver outcomes. This was measured through the patient and caregiver both filling out two questionnaires, one about general health and the other an anxiety and depression scale, this is what makes this evidence quantitative, it visibly measures the patients and carers happiness. I think that this was very beneficial to them as they would have been able to get a much broader picture of what the care was like. If only the carer was asked they could be biased and this could be the same if only the patient was asked. This could be due to people having a different perception and standard of how care should be given care and how giving that care affects them. Anderson et al. (1995) comments on the careers thinking their patient to be a burden, this can then lead to isolation and exhaustion, this would very much reduce theire ability to be a competent career. The use of a likert scale would also have eased the confusion as all of the multiple choice questions are 1-5. This study did not have a control group and so the information would not be able to comment of whether the caregivers that they used for their trial would have had different outcomes than those caring for a different type of patient. Qualitative studies generally include large amounts of data, for example, here there was originally meant to be 417 patients that they trial would have been based on however there were many complications for instance they died before follow up, refusal to do the follow up or having a brain tumour and not a stroke brought the amount down to 229. This is almost half of the amount that they were meant to have and so probably isn’t enough. Whilst they were exclusions for example low probability of surviving the next few days and having an additional illnesses, perhaps more exclusions should have been made to reduce this drop in participants. This would have helped make the results of the study be less variable. This text shows how psychologically difficult it is from the point of view of the caregivers looking after their patient, this is relatable to the care of Mr Omar Banerjee as when he comes home it is likely that due to his wife, being a house wife, would be able to look after him. (Warleby et al. 2000) stated that the psychological well being of the family and career would be significantly lacking in relation to the control or the norm. This shows us the extent of the impact of how someone else’s’ illness can affect you as a caregiver.
Qualitative research is the development of a concept which helps you to understand social occurrences in natural settings so that you are able to see the meaning, experiences and views of the participants (Pope & Mays 1995).
It looks at peoples experiences, attitudes, beliefs and perceptions of a situation (forchuk & Roberts 1993). To show this style of research I looked at a qualitative report about understanding the lives of the families affected by stroke. The aim of this study was to look at the lives of stroke survivor’s careers with reference to caring and coping as well as looking at the factors that had an impact on their lives. This piece of literature was issued to me by my course leader Clive Warn during lesson two of Appreciating Evidence for practice. Qualitative data collection can involve using artifacts, documents interviews or a mixture of all (Summerskill,W. 2001). This study is very specifically a quantitative study as it took all of its information from the stroke victims and career. To take this information a qualitatitive descriptive design was used (sandelowski 2000), data was collected through interviews of them both together and some of just the carerer. This can be a bonus and a drawback, if the patient wasn’t there the carerer could have interpreted them wrongly or been able to say necessary things that they wouldn’t have felt comfortable saying when the patient was present. I think that this situation could have been improved by way of interviews being taken of the care receiver and giver together and separately. The sample size for this study was 30 even though typical of a qualitative study is still rather small, especially considering that only 7 of the carers were male. Everyone is the sample group were also all Caucasian and either British or Irish. As this study was not open for generalisation it is acceptable that, geographically, it was such a small study. This piece of research was commissioned by North Ireland
Chest, Heart ad Stroke association and so from this I can gather that it is a very neutral source and no bias. This study topic is very similar to that I have previously used that for the quantitative pieve of evidence, this makes it very clear what the differences were that made this study qualitatitive and the other quantitative. This study was all about the interview, it only mattered what the career and patient said in the interview and no questionnaires were given out. This study cited and referenced many other sources to gather its information these sources ranged from 1990-2011, the majority residing in the later dates which is helpful as it shows the information is up to date. This study also critiqued itself by commenting on its own weaknesses which is important for the reader so that they are able to get a fuller picture of the report. I believe that this study would be helpful for the family of Omar Banerjee as from the transcripts of their time in hospital they seem very stressed and unsure about what is required of them, for instance Mrs Banerjee feels compelled to come and visit Omar every night even though the nurses say it isn’t necessary. This study is based on the psychological effects that come with having a stroke and I would think it would be very comforting for the family to know that other people are going through the same thing. This study also encourages the implementation of trained carers and healthcare professionals delivering skills training for the family so that when the patient goes home the family would feel more knowledgeable as to what they are doing. I feel that this would be very helpful for Mrs Banerjee and the rest of the family whilst looking after her husband as she would feel more in the loop as to what is happening.
An audit refers to a snapshot image of a clinical performance in a certain time frame (Hoffmann et al. 2010). Audits are generally used to make a change and improve the quality of something quickly. The audit that I found to show this form of research was on the distribution of urinary incontinence in patients following a stroke. It looks at what care people can receive and what could be done to lead to an improvement in the quality of continence in stoke patients. This audit ran from 1998-2004, however from 2004 there was additional information on urinary catheterisation which in itself is a strength, however this highlights the fact that catheters were used excessively to manage urinary incontinence. As an overview, this could be thought to be a generalisation of patients, as if they are all treated the same way their needs could not be being met. This is made even more likely due to the fact that 54% of all the patients in 2004 were not treated in a specialist stroke unit, so the knowledge may not be present. A strength of this audit is that it is objective and so not focussing on someone’s feelings or opinion. This helps the audit to remain unbiased and so able to focus more on patient. Another strength is that they have re-audited 7 times this shows the importance of evidence based practice as when the care of the patients improves it shows up in the next audit (McGovern,D. 2001). This is relatable to Omar Banerjee as since he has been admitted to hospital he hasn’t be allowed to eat or drink anything. However, his wife tells us that he is soon able to have a tube down his nose the next day do feed him. This means that the will start to have to eliminate. Regardless if he is continent or incontinent he will need a catheter. If he is incontinent however, due to him having survived a stroke this evidence emphasises the importance of him being cared for by someone with the appropriate expertise and in a specialist unit.
The advantages of using an audit to calculate urinary incontinence instead of a quantitative or qualitative style of writing is that it looks at what is happening there and then. That information can then set against a standard that has already been made and then a conclusion and change can be put into play immediately. If a quantitative or qualitative style of writing was used it would take a lot longer to find specific participants, gather the data, use an ethical process and more which could take a long time, by which time the data could have changed.
From looking at the strengths and weaknesses of these studies I am able to determine that if I was to be looking after a patient with a stroke I would not be able to just look at one of these types of information. I would assume that the patient would want to know the statistics, the personal experiences as well as the level of clinical performance. This is the qualitative, quantitative and audit. Personally I would feel the safest to know either the patients or the clinical health practitioner’s personal experience. This is due to me thinking that it is a very different thing reading about facts and figures but hearing someone went through the same thing and can relay their experience is far more reassuring to me. However, to have a more rounded idea of a circumstance, looking at all styles of evidence is the most beneficial.
This makes it so important as it is the tool to improve healthcare, as the more knowledge that people gather around their area, the more able they would be in the workplace.In this essay I will be describing three types of evidence in practice, quantitative, qualitative and audit.
Aliaga and Gunderson (2000) describe a quantitative study to be one that gathers large amounts of numerical data and using it to explain an occurrence by way of mathematical based methods i.e. statistics. I chose a report of describing the emotional outcome of people caring for stroke survivors. I found this evidence through refining my search on the UWE library page firstly to make sure that it was peer reviewed and also that it was about a stroke patient. This study set out to understand more fully about the people who care for the victim’s of strokes. They wanted to understand the relationship between the caregiver, patient and if this had any correspondence with poor caregiver outcomes. This was measured through the patient and caregiver both filling out two questionnaires, one about general health and the other an anxiety and depression scale, this is what makes this evidence quantitative, it visibly measures the patients and carers happiness. I think that this was very beneficial to them as they would have been able to get a much broader picture of what the care was like. If only the carer was asked they could be biased and this could be the same if only the patient was asked. This could be due to people having a different perception and standard of how care should be given care and how giving that care affects them. Anderson et al. (1995) comments on the careers thinking their patient to be a burden, this can then lead to isolation and exhaustion, this would very much reduce theire ability to be a competent career. The use of a likert scale would also have eased the confusion as all of the multiple choice questions are 1-5. This study did not have a control group and so the information would not be able to comment of whether the caregivers that they used for their trial would have had different outcomes than those caring for a different type of patient. Qualitative studies generally include large amounts of data, for example, here there was originally meant to be 417 patients that they trial would have been based on however there were many complications for instance they died before follow up, refusal to do the follow up or having a brain tumour and not a stroke brought the amount down to 229. This is almost half of the amount that they were meant to have and so probably isn’t enough. Whilst they were exclusions for example low probability of surviving the next few days and having an additional illnesses, perhaps more exclusions should have been made to reduce this drop in participants. This would have helped make the results of the study be less variable. This text shows how psychologically difficult it is from the point of view of the caregivers looking after their patient, this is relatable to the care of Mr Omar Banerjee as when he comes home it is likely that due to his wife, being a house wife, would be able to look after him. (Warleby et al. 2000) stated that the psychological well being of the family and career would be significantly lacking in relation to the control or the norm. This shows us the extent of the impact of how someone else’s’ illness can affect you as a caregiver.
Qualitative research is the development of a concept which helps you to understand social occurrences in natural settings so that you are able to see the meaning, experiences and views of the participants (Pope & Mays 1995).
It looks at peoples experiences, attitudes, beliefs and perceptions of a situation (forchuk & Roberts 1993). To show this style of research I looked at a qualitative report about understanding the lives of the families affected by stroke. The aim of this study was to look at the lives of stroke survivor’s careers with reference to caring and coping as well as looking at the factors that had an impact on their lives. This piece of literature was issued to me by my course leader Clive Warn during lesson two of Appreciating Evidence for practice. Qualitative data collection can involve using artifacts, documents interviews or a mixture of all (Summerskill,W. 2001). This study is very specifically a quantitative study as it took all of its information from the stroke victims and career. To take this information a qualitatitive descriptive design was used (sandelowski 2000), data was collected through interviews of them both together and some of just the carerer. This can be a bonus and a drawback, if the patient wasn’t there the carerer could have interpreted them wrongly or been able to say necessary things that they wouldn’t have felt comfortable saying when the patient was present. I think that this situation could have been improved by way of interviews being taken of the care receiver and giver together and separately. The sample size for this study was 30 even though typical of a qualitative study is still rather small, especially considering that only 7 of the carers were male. Everyone is the sample group were also all Caucasian and either British or Irish. As this study was not open for generalisation it is acceptable that, geographically, it was such a small study. This piece of research was commissioned by North Ireland
Chest, Heart ad Stroke association and so from this I can gather that it is a very neutral source and no bias. This study topic is very similar to that I have previously used that for the quantitative pieve of evidence, this makes it very clear what the differences were that made this study qualitatitive and the other quantitative. This study was all about the interview, it only mattered what the career and patient said in the interview and no questionnaires were given out. This study cited and referenced many other sources to gather its information these sources ranged from 1990-2011, the majority residing in the later dates which is helpful as it shows the information is up to date. This study also critiqued itself by commenting on its own weaknesses which is important for the reader so that they are able to get a fuller picture of the report. I believe that this study would be helpful for the family of Omar Banerjee as from the transcripts of their time in hospital they seem very stressed and unsure about what is required of them, for instance Mrs Banerjee feels compelled to come and visit Omar every night even though the nurses say it isn’t necessary. This study is based on the psychological effects that come with having a stroke and I would think it would be very comforting for the family to know that other people are going through the same thing. This study also encourages the implementation of trained carers and healthcare professionals delivering skills training for the family so that when the patient goes home the family would feel more knowledgeable as to what they are doing. I feel that this would be very helpful for Mrs Banerjee and the rest of the family whilst looking after her husband as she would feel more in the loop as to what is happening.
An audit refers to a snapshot image of a clinical performance in a certain time frame (Hoffmann et al. 2010). Audits are generally used to make a change and improve the quality of something quickly. The audit that I found to show this form of research was on the distribution of urinary incontinence in patients following a stroke. It looks at what care people can receive and what could be done to lead to an improvement in the quality of continence in stoke patients. This audit ran from 1998-2004, however from 2004 there was additional information on urinary catheterisation which in itself is a strength, however this highlights the fact that catheters were used excessively to manage urinary incontinence. As an overview, this could be thought to be a generalisation of patients, as if they are all treated the same way their needs could not be being met. This is made even more likely due to the fact that 54% of all the patients in 2004 were not treated in a specialist stroke unit, so the knowledge may not be present. A strength of this audit is that it is objective and so not focussing on someone’s feelings or opinion. This helps the audit to remain unbiased and so able to focus more on patient. Another strength is that they have re-audited 7 times this shows the importance of evidence based practice as when the care of the patients improves it shows up in the next audit (McGovern,D. 2001). This is relatable to Omar Banerjee as since he has been admitted to hospital he hasn’t be allowed to eat or drink anything. However, his wife tells us that he is soon able to have a tube down his nose the next day do feed him. This means that the will start to have to eliminate. Regardless if he is continent or incontinent he will need a catheter. If he is incontinent however, due to him having survived a stroke this evidence emphasises the importance of him being cared for by someone with the appropriate expertise and in a specialist unit.
The advantages of using an audit to calculate urinary incontinence instead of a quantitative or qualitative style of writing is that it looks at what is happening there and then. That information can then set against a standard that has already been made and then a conclusion and change can be put into play immediately. If a quantitative or qualitative style of writing was used it would take a lot longer to find specific participants, gather the data, use an ethical process and more which could take a long time, by which time the data could have changed.
From looking at the strengths and weaknesses of these studies I am able to determine that if I was to be looking after a patient with a stroke I would not be able to just look at one of these types of information. I would assume that the patient would want to know the statistics, the personal experiences as well as the level of clinical performance. This is the qualitative, quantitative and audit. Personally I would feel the safest to know either the patients or the clinical health practitioner’s personal experience. This is due to me thinking that it is a very different thing reading about facts and figures but hearing someone went through the same thing and can relay their experience is far more reassuring to me. However, to have a more rounded idea of a circumstance, looking at all styles of evidence is the most beneficial.