Evidence for Decision-making – different perspectives

1
Evidence for Decision-making different
perspectives

• B71P02 - Foundations in
• Evidence Based Practice

2
Session Outcomes

• At the end of this session you will be able to
• Identify a range of perspectives that influence
  evidence based nursing practice
• Consider the extent to which these perspectives
  facilitate or complicate evidence based nursing
  practice
• Appreciate how user involvement influences the
  delivery of care

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Different Forms of Evidence

• Evidence based practice is the process by which
  nurses make clinical decisions using the best
  available research evidence, their clinical
  expertise and patient preferences, in the context
  of available resources (DiCenso et al, 1998)

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Perspectives on Evidence
Research Evidence
Nursing action
Patient / User perspectives
Clinical expertise
Nursing outcomes
Practice context
5
Research Evidence

• Arising from well conducted and reviewed research
  studies, ideally conducted in clinical areas.
• Published in peer reviewed journals and other
  sources (Cochrane library) and thus exposed to
  external/expert scrutiny
• Clinical expertise and the user voice may be
  present in published research e.g. through action
  research or qualitative studies of user
  experience
• ..there has been anxiety that the emphasis on
  evidence ignores practitioners skills and
  individual patient preferences (Closs and
  Cheater (1999)

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Clinical expertise

• Gates and Atherton (2001) note that in a study
  conducted by Tsafrir and Grinberg (1998)
  physicians considered review articles and
  meta-analysis extremely reliable for information
  purposes but for practical patient care they
  tended to rely upon the judgement of peers and
  experts (p.518)
• There is a potential gap between national agendas
  and what nursing staff consider to be local
  priorities (Brooks Barrett, 2003)
• Colbrook (2002) writes that the Medical Defence
  Union advise that healthcare staff are not
  obliged to follow national clinical guidelines
  when they can justify that they were not in the
  patients best interests or applicable to the
  patients particular circumstances.

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User/patient perspectives

• practitioners do not necessarily know what is
  in the best, personal interests of an individual
  patient.. (Closs Cheater, 1999)

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User/patient perspectives

• there is abundant evidence demonstrating wide
  discrepancies between patients and
  professionals judgements about what constitute
  desirable or successful outcomes (Closs
  Cheater, 1999)

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User/patient perspectives

• past experience, individual beliefs,
  family/peer pressure or greater access to
  information may lead patients to request a
  particular intervention (Closs Cheater, 1999)

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User/patient perspectives

• It is not only practitioners who need to know
  about the latest evidence of the effectiveness of
  treatments and services. Service users need this
  information in order to make their own choices
  based on the research evidence and a whole range
  of other complex factors, some of which will be
  unique to them (Needham, 2000, p.144)
• A well informed patient may change the practice
  of the health professional and information can
  change the patient-practitioner relationship from
  one in which the patient passively accepts advice
  to one in which the patient becomes a partner in
  shared decision-making (Needham, 2000)

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Implementing EBP A Conceptual Framework

• Kitson et al (1998) have argued that implementing
  research into practice may be expressed in this
  equation
• SIf (E,C,F)
• Where SIsuccessful implementation
• Eevidence Ccontext Ffacilitation
• and ffunction of.

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Session summary

• ...Evidence based practice is not simply a
  pragmatic, logical process, involving access to,
  and the subsequent use of best research evidence.
  There is an interplay of multiple factors that
  influence decisions about patient care an
  amalgam of evidence, context, expert
  practice/experience and patients preferences and
  wishes (Closs Cheater, 1999)

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References

• Barnett (1997) in Brechin, A. (2000) Introducing
  critical practice in Brechin, A., Brown, H. and
  Eby, M. (eds) (2000) Critical Practice in Health
  and Social Care, London, Sage Publications/Open
  University.
• Brookes, N. and Barrett, A. (2003) Identifying
  nurse and health visitor priorities in a PCT
  using the Delphi technique, British Journal of
  Community Nursing, Vol.8, No.8, pp. 376-380.
• Closs, S.J. and Cheater, F.M. (1999) Evidence
  for nursing practice a clarification of the
  issues, Journal of Advanced Nursing, Vol.30,
  No.1, pp. 10-17.
• Colbrook, P. (2002) The Legal Status of NICE
  Guidelines, The Medical Defence Unit, London.
• DiCenso, A., Cullum, N. and Ciliska, D. (1998)
  Implementing evidence-based nursing some
  misconceptions, Evidence Based Nursing, Vol.1,
  pp. 39-39.
• Gates, B. and Atherton, H. (2001) The challenge
  of evidence-based practice for learning
  disabilities British Journal of Nursing, Vol.10,
  No.8, pp. 517-522
• Gomm, R. (2000) Would it work here in Gomm, R.
  and Davies, C. (eds) (2000) Using Evidence in
  Health and Social Care, London, Sage
  Publications/Open University.
• Kitson, A., Harvey, G. and McCormack, B. (1998)
  Enabling the implementation of evidence based
  practice a conceptual framework, Quality in
  Health Care, 7, pp. 149-158.
• Needham, G. (2000) Research and practice making
  a difference in Gomm, R. and Davies, C. (eds)
  (2000) Using Evidence in Health and Social Care,
  London, Sage Publications/Open University.