I have studied Nursing for 4 years in the Philippines and I have not encounter the term Evidence Based Practice. It took me by surprise that such subject exist. On my first day of class at Thames Valley University I have learned that EBP is about exploring a medical intervention through research of published research articles based on clinical trial conducted by various researchers and clinicians. The process starts by proposing a research question, and I chose to focus on Pain Management but I have notice that pharmacological management is too common. For such reason, I have decided to aim the attention of my research to Non-pharmacological Management such as Diversional Therapy. This kind of therapy is seldom used in the clinical setting because a lot of medicines are being discovered and used as often. As the process continues, I have learned how to properly critically appraise an article and notice its importance no matter how old it was and enhance my problem solving skills. Furthermore, adjusting and somehow changing the learning method is a big alteration I have encounter as I need to spend a lot of time reading and making the paper. After all the amplitude I put into making this Folder of Evidence, I consider the entire course a success. I have learned so much of new things that somehow I ignored before.
Mapping Grid:
Module Learning Outcomes
Evidence 1
Evidence 2
Evidence 3
Evidence 4
Identify and critically examine priorities for improving practice.
Page 12
Para 1
[P]
Asses the ability to identify evidence and critically appraise its value.
Page 15
Para 2
[P]
Critically analyze the change description and understanding about the nature of evidence in health care practice.
Page 12
Para 1
[C]
Page 18- 21
Para 2, 3, 4, 5, 6
[P]
Evaluate the possibility and effectiveness of evidence for change in practice.
Page 24- 25
Para 2, 5
[P]
Learning Log:
Study Day 1: 11th October 2010
Topic
Understanding the Nature of Evidence
Key Concepts/Issues
Evidence Based Practice
History
Development
Teaching/Learning
Lecture
Group Discussion
Information Skills Development
Classroom Activity
AM
Exploration of the Concept of Evidence Based Practice.
PM
Sources of Evidence
Developing Search Skills Library Session (1)
Brief Notes
Evidence based practice is providing the best evidence of treatment to facilitate effective treatment/intervention. A discussion of what to be expected from folder of evidence as it highlights how the folder will be collated and how to set aims and objectives for FOE.
Study Day 2: 25th October 2010
Topic
Questioning Practice/Research Questions: Finding Evidence
Key Concepts/Issues
The relationship between questions and types of evidence;
Questioning own practice explore types of research questions.
Developing simple and structure search strategies
Teaching/Learning
Lecture
Group Discussion
Group Presentation
Information Skills Development
Classroom Activity
AM
Group Presentation: Evidence Based Practice
Group Poster Presentation
Concepts Definitions and Understandings Session
Relationship Between Questions and Types of Evidence
Descriptive and Relational Questions
PM
Writing Searchable Questions for Evidence Based Practice
PICO Identifying Preliminary Search Terms
Developing Search Skills Library Session (2)
Brief Notes
We discussed how to proposed a searchable question and how important it is. I formulated a topic based on my own interest and experience beforehand. Revision of question also was supervised and breakdown using PICO framework.
Study Day 3: 8th November 2010
Topic
Differentiating Between Research Paradigms.
Key Concepts/Issues
Evidence Based Practice
Experimental Research
Naturalistic Research
Teaching/Learning
Lecture
Group Discussion
Quiz
Information Skills Development
Classroom Activity
AM
Quiz Review Research Designs
Discussion of Types of Questions (researchable and unsearchable questions).
Group Work to Refine Final Practice Issue and Search Question
Refine PICO Framework for Search
PM
Inclusion and Exclusion Criteria
Appraisal Tools, CASP, SIGN, AGREE
Group Work Assessment and Discussion of Two Papers Retrieved Last Week. (Question, Design, Methods and Results).
Brief Notes
I have learn the different types of research designs that supports my research scheme for the 5 primary articles together with supporting documents that will be used in making EBP. This session also emphasizes the importance of PICO as this will help how to refine searches. Different appraisal tool was also discussed and its importance as this provide effective filter for the reliability and validity of published literature.
Study Day 4: 29th November 2010
Topic
Systematic Reviews/Meta-analysis: An Introduction Appraising Evidence Part 1.
Key Concepts/Issues
Systematic Reviews
Developing Critical Appraisal Skills
Teaching/Learning
Lecture
Group Discussion
Group Presentation
Individual Exercise
Classroom Activity
AM
Group Presentation Features of Systematic Review
Group Discussion How Does an SR Differ From a Traditional Review?
Appraising a Systematic Review Individual Exercise and Group Discussion.
PM
Using Appraisal Tools
Appraising of an RCT and a Qualitative Study Using CASP or an Alternative Appraisal Tool.
Group Discussion Analysing the Appraisal Process and Effectiveness of the Appraisal Tool.
Brief Notes
A systematic review is a study that identifies, appraise, select ans synthesize a collection of research articles with relevance to each piece of work.
Critically appraising a systematic review article excludes lesser quality studies to minimize error and bias in the findings. It Assess the validity of
research by means of determining whether the
methods used during the study can be trusted to
provide a genuine, accurate account of the treatment being studied.
Study Day 5: 6th December 2010
Topic
Establishing the Quality of Evidence
Key Concepts/Issues
Making Judgements About the Quality of Evidence
Synthesising Evidence
Teaching/Learning
Lecture
Group Discussion
workshop
Individual Exercise
Classroom Activity
AM
GRADE How to Move from Evidence to Recommendations.
Workshop- Grading Evidence
PM
Tutorials
Independent Work or Further Electronic Searches.
Brief Notes
As I appraise each primary articles collected, a summary of critical appraisal of the 5 primary articles was made. This strategy helped me to make an apprehension toward the affirmation of each articles towards making the summative 3.
Study Day 6 13th December 2010
Topic
Implementing EBP
Key Concepts/Issues
Translating Evidence Into Practice
Implementing EBP
Guiding Principles for Implementing EBP
Barriers to Implementing EBP
Teaching/Learning
Lecture
Group Discussion
Group Presentation
Individual Exercise
Classroom Activity
AM
Group discussion
Identify Barriers to Implementing Evidence Base in Practice
Identify Strategies to Implementation that Avoid/Overcome these Barriers.
PM
Students to work in pairs to devise a search strategy for use in one electronic database to identify an article that describes and evaluates the introduction of evidence based change in practice.
Brief Notes
Implementation has its various barriers to consider such as time, support, lack of knowledge, lack of motivation of the workers and too much research evidence. As a group activity we critique an implementation article as to determine the process of implementation of the studied intervention.
Study Day 7 10th January 2011
Topic
Evaluating EBP
Key Concepts/Issues
Evaluating Changes in Practice
Application of a Framework for Evaluating Change.
Final Module Evaluation
Teaching/Learning
Lecture
Group Discussion
Group Presentation
Individual Exercise
Classroom Activity
Measurement for Improvement/Change
Sustainability of Change
Examine Effectiveness of Evaluation Strategies.
Module Evaluation and Individual Tutorials
Brief Notes
It discussed about the evaluation process of a study and the use of guidelines in each step. Evaluation meant by achieving a research aims and objectives and most importantly if the study conducted able to answer the hypothesis, as this entails whether the study is effective or not.
SUMMATIVE WORK
Summative 1: Concept of Evidence-based Practice
The challenge for best quality of care, combined with the need for recommended usage of resources has heightened the pressure on health care professionals to ensure that clinical procedures is based on sound evidence. Frequent change and advancement in treatments, an increasingly numbers of research information, and the increase of expectations from clients to provide the best care possible, place high demands on healthcare providers to maintain a service that is based on current best evidence. (Bennett and Bennett, 2000). Evidence-based practice (EBP) is a clear path to healthcare wherein health professionals use the best evidence possible, such as the most suitable information available, clinical decisions for individual patients. EBP values, enhances, and builds on clinical expertise, knowledge of disease process, and patho-physiology (McKibbon,1997). Evidence-based practice presume knowledge of and skills in literature searching, research methodologies apprehension , appraisal and apprehension of research. It also requires healthcare professionals to have access, critique and coordinate literature study with clinical experience and clients aspect. In order to gain a greater interpretation about the nature of evidence in the context of health care, consideration needs to be given to the history of the evidence-based health care movement while the concept was originated in medicine, it has influenced a wide range of health professions (Trinder & Reynolds, 2000).
In addition, it is an approach to decision-making that has permeated all aspects of healthcare. Its characterize can be seen in many of the leading health systems and government health policies across the world. EBP model highlights the value of research as a source of information which is potentially less biased than other sources for informing practice, it also clearly acknowledges the importance of integrating this research with clinical expertise and clients perspectives (Sackett et al., 2000). Moreover, it involves complex and reliable decision-making based not on available evidence alone but also on patient characteristics, situations, and preferences. Changing practice is not easy to do therefore careful selection of the topic is very significant. For the benefit of the patient is of first importance when selecting a topic, however it can not be the main basis as to literary evidence is inadequate to figure what are the benefits. Researchers must also consider the time, level of consumption and other resources for the study. Research evidence is most frequently found in peer-reviewed journals as this is where results are first published and where enough detail on methodology exists to make informed judgements on the validity and clinical relevance of the findings (Bury & Jerosch-Herold, 1998). Research using the strongest and most appropriate study design for the question being studied, will provide the best evidence.
Summarizing the evidence is a vast intellectual endeavor according to Fitzpatrick (2007). Healthcare workers must be capable combining ideas and recommendations from an extent of references to make appropriate advices. Implementing a plan is consider challenging because standards and regulation of an organization can either help or ruin an EBP approach to care. Evaluation process involves short term and long term coverage to provide essential data.
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Reference List:
Bennett S & Bennett J (2000) The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal. 47 p171-180.
McKibbon K (1997) Evidence-based practice. Bulletin of Medical Library Association. 86(3)p396-401
Trinder, L., & Reynolds, S. (Eds). (2000). Evidence-Based Practice A critical appraisal. Oxford: Blackwell Science.
Sackett D, Richardson W, Rosenberg W, Haynes R (2000).Evidence based medicine: How to practice and teach EBM (2nd edn). Edinburgh: Churchill Livingstone.
Bury T & Jerosch-Herold C. (1998). Reading and critical appraisal of the literature. Evidencebased healthcare. A practical guide for therapists Oxford: Butterworth Heinemann. p136-161
