Research Process and Development of Evidence

Question: Describe about the Report for Research Process and Development of Evidence. Answer: Evidence-based practice (EBP) refers to an interdisciplinary approach in nursing practice. The approach has been gaining ground since its introduction in clinical medicine in 1992. Its origin was in the field of medicine where it began as evidence-based medicine (EBM) (Wallin, Bostrm, Wikblad Ewald, 2003). Later it soared to other areas among them dentistry, psychology, audiology, nursing, and social work among others. There are three primary principles of EBP, which are listed below. (1) Gathering the best research evidence that explains whether and why a treatment method works. (2) The presence of clinical experience and judgment to determine the health state and diagnosis of the patient. (3) The preferences and values of the patient (DiCenso, Guyatt Ciliska, 2014). There are different types of evidence gathered in EBP. They include the meta-analysis and systematic reviews, randomised controlled trials, cohort studies, case-control studies, and case series/reports. The particular instance determines the nature of the evidence required in question (Horn Gassaway, 2007). Therefore, these different types are used evidence methodologies applied in various scenarios. The health practising must understand what each entails, and ensure that he/she identifies the one that best fits in the case under analysis (DiCenso, Guyatt Ciliska, 2014). Meta-analysis evidence incorporates information gathered from quantitative methods, independent studies, and synthesis of summaries and conclusions that can be effective therapeutically (Banning, 2005). The second type of proof is systematic review collected from published books and articles. Randomised controlled trial, which is another kind of evidence, is gathered previous works involving clinical trials, with one treatment and a control experiment. The research process used to gather randomised controlled trial evidence is a random selection of treatments. Cohort studies refer o evidence collected on identified and distinct populations. Case-control studies are another critical type of proof used in clinical practice. The process of gathering such evidence involves the identification of an affected group and another that is not affected by the diseases being studied. The type of proof seeks to determine the exposure to diseases in different regions. Finally, there is the case ser ies and reports, which are clinical presentations that are often followed by evaluative studies, and eventually diagnosis (DiCenso, Guyatt Ciliska, 2014). It is important to note at this stage that there is no comparison in the case series and reports. It is expected that the practitioner should determine the level of evidence to use in clinical practice. It is not possible to find the highest level of evidence (experimental study), which is often, gathered using systematic reviews and controlled trials. The second tier of evidence is the quasi-experimental studies, in which the information is collected using a combination of randomised controlled studies and quasi-experiments. Meta-analysis research approach may be utilised or not. The third level of evidence comprises of non-experimental studies. Qualitative studies and systematic reviews with or without meta-analysis fall under this level. Other standards include the opinion of authorities based on scientific research and based on experimental and non-research evidence. The grading or rather hierarchy of proof helps other practitioners who might use the information gathered to determine the strength of the literature and sources of the knowledge before applying in EPB (Tabak, et al. 2012). Evidence-based practice (EBP) is widely recognised in the health sectors globally. It is seen as a crucial driver towards positive outcomes in clinical and nursing practices. Scholars define EBP as "careful incorporation of most reliable research evidence into clinical practice and patient values and needs with the aim of delivering cost-effective, and high-quality health care services" (Grove, Burns, Gray,2014, p.4). Therefore, based on the definition it is evident that EBP provides nurses with the opportunity to use safe and suitable treatment approaches and decision-making procedure. It is through doing the use of evidence that the quality and cost-effectiveness of health care services improves as well. Considering the importance of EBP in clinical practice, nurses should not view it as an extra workload. The knowledge base they gain from various educational programs, which prepare them for the research in the development of EBP, serve a critical role in ensuring that they understand the importance and significance of basing different medical interventions on researched information (Majid, et al. 2011). It is general practice for nurses to reflect daily on the various treatment options they have used during the day. That helps them identify weaknesses and strengths in different treatment methods and also enables them to evaluate the various options and how effective they are when used on patients. The reflection forms the basis of the research process through which evidence in clinical practice is developed. Making references to the evidence gathered does not imply that the process has to be lengthy, complicated, and full of protocols, with access to the internet and local policies, and based on best practice statements/reports (Satterfield, et al. 2009). However, nurses have to develop the ability to differentiate the bases knowledge and skills. That way they can easily apply the evidence from research studies in their practice with great ease. During the investigation process, nurses are required to take their time and formulate effective research questions. They then have to go back to the issues and carefully seek for answers. That means that they have to expand their clinical expertise to incorporate research skills, which are essential in finding evidence. Grove, Burns, and Gray (2014) identify critical article reviewing as one of the best ways for nurses to locate the evidence they are looking for within a short time. It is possible for nurses to make effective decisions by thoroughly analysing and critiquing previous research journals. The primary focus when carrying it the reviews should be on the reliability and validity of the information contained in the journal articles. It is possible for nurses to predetermine the most likely effects of the evidence they find from various sources on their clinical outcome (Rycroft-Malone Bucknall, 2011). During the research and evidence development process nurses must take in to account the legal and ethical dilemmas that arise from time to time in their clinical practice (Gerrish, et al. 2007). They must also identify gaps within their research processes and suggest ways improve the available evidence through further/expanded studies. In a nutshell, nurses are expected to harness critical clinical question formulation, literature searching skills, and research analysis skills in the process of developing their EBP. They must also have access to various agency databases, which support the development of evidence-based practice. These include theCumulative Index to Nursing and Allied Health Literature (CINAHL) and the British Nursing Index (BNI) (Tabak, et al. 2012). It is important for nurses to seek clarifications from their colleagues to ensure that they questions they formulate meet the ethical and legal considerations. They clinical research questions must show respect to the beliefs and values of patients and employees in the health facility. Therefore, care must be taken to ensure that the issues are developed in a highly ethical manner. Nurses should try to search the highest level' of evidence such as systematic reviews, which involve the ranking and compilation of evidence acquired by research methods use to collect such information (Hunink, et al. 2014). Systematic reviews often analyse the findings of high-quality studies, with most of them being reviews of randomised controlled trials. Such reports identify the interventions that are likely to work and limitations in the studies, which must be addressed before the application of the evidence from such sources. By doing this, bias is reduced in the process and effects of various inter ventions are not overestimated. Through the use of proof, nurses reduce the time require in carrying out critical appraisals. It is important to note that although the clinical practice is patient centred, there is the still lack of appreciation when it comes to best evidence for a patient's response emotionally, physically, and mentally. Instead, the primary focus is on scientific interventionism (Rycroft-Malone Bucknall, 2011). There are several barriers to the implementation of EBP in clinical and hospitals. The first common barrier is the lack of information and skills required for the process to function effectively (Kitson, 2002). There are many cases of health professionals lacking adequate knowledge in regards to clinical research findings and recommendations. As a result, they lack the skills to apply the information from evidence-based research studies in their practice (Munroe, Duffy, Fisher, 2008). At the end of the day, such health professionals rely more on their expertise than clinical evidence (Majid, et al. 2011). Another barrier is the lack of time to apply research in their practice (Grol Wensing, 2004). It is especially the case in clinical facilities where the number of nurses remains low as the patients continue to increase. In such situations, nurses and other health professionals face the challenge of applying research in their practice and at the same time providing medical care ser vices within a short time frame. To handle the issue of time management, educators and researchers have developed a toolkit to help ease the application of evidence-based practice in clinical practice (Majid, et al. 2011). Despite the development of the "toolkit", there are cases where health professionals have no prior knowledge to use the equipment preventing them from applying evidence in their practice. Polit and Beck (2013) indicate that the dissemination process informs people about the findings of specific research studies. There are different methods of presenting such results, among them seminars, videos, and professional journal articles (Tabak, et al. 2012). However, with the development of technology and the fact that the internet is accessible in almost all parts of the world; it is possible for researchers to post the results of their studies on National Health Service (NHS) trust or university websites. However, there is a significant shortcoming in that information from the internet provides no guarantee of quality and reliability (Gerrish Lacey 2006). Scottish Intercollegiate Guidelines Network guidelines are circulated for free across Scotland. Therefore, they must be made available in all hospitals as soon as they are available; however, on their own, they have proved to be ineffective. It is especially the case if the dissemination is done through educational interv entions and later implemented using patient-specific means that relate directly to the nursing activities (Tabak, et al. 2012). So far this paper has discussed various elements of evidence-based practice in clinical practice and the research process through which information for use in healthcare service delivery is acquired. The paper has also considered the importance of EBP and barriers to its practical application in the health care sector. Further, to this essay will be critical reviews of two journal articles. Each article will be evaluated on the basis its appropriateness for application in EBP. Critique 1 Kyle, R. G., Neall, R. A., Atherton, I. M. (2016). Prevalence of overweight and obesity among nurses in Scotland: A cross-sectional study using the Scottish Health Survey.International journal of nursing studies,53, 126-133. As the title of the article suggests, Kyle, Neall and Atherton (2016) seek to explore and identify the prevalence of obesity among nurses. The aim is to use nurses as a health promotion tool by studying their habits and behaviours and how they influence the obesity rate among the nurse professionals. Unlike other studies on obesity, the three researchers take a professional group as a representative sample. The fact that nurses handle different health issues implies that they ought to be role models when it comes to eradication of certain ailments, Therefore, estimating the prevalence of obesity and overweight among them is crucial. The aim of the research, in the article, was to determine the overweight and obesity rate among nurses in Scotland and compare the data to the prevalence in other professionals, which are not health related. It is evident from the onset that the study does not intend to provide a solution to a particular health issue. Hence, it is only likely to serve as an informative study, but not necessarily a useful evidence source. Moreover, it is a cross-sectional study, hence, describes the relationship between obesity and the nature of one's profession. It is evident that although Kyle, Neall and Atherton incorporate statistical data in their article, most of the information is on prevalence. There is little information on how to change the outcomes and the timing of exposure in cross-sectional studies (Whittemore, 2005). Therefore, most of the information in the article is not applicable in intentions, but rather useful in diagnosis. Studies such as this one, which is more useful in diagnos tic tests than actual treatment, are referred to as blind comparison studies (Tabak, et al. 2012; Brownson, et al. 2010). The information in this study can be used a controlled trial. Therefore, it can be categorised under the third level of evidence, which incorporates information from quasi-experiments and other controlled trial cases (Brownson, et al. 2010). It is possible to compare information on the prevalence of obesity among healthcare professionals to workers in other fields and determine which factors cause the discrepancies. Through such comparisons, a nurse can easily identify the risk factors associated with obesity and overweight issues. Therefore, although this study does not provide treatment options, it can be used for diagnostic and preventive purposes in the health care sector. Further, the research uses quantitative research analysis methods. Estimates of obesity and overweight prevalence in different occupational groups are calculated using a 95% confidence interval. The researchers also develop a logistic regression model to compare the odds of being obese for nurses compared to people in other professions. The researchers also identify the software used to analyse the data, which is SAS version 9.1.3. Grove, Burns and Gray (2014) indicate that the primary focus of quantitative studies in evidence-based practice is to measure the relationship between variables. Therefore, the creation of logistic regression model to compare the chances of a healthcare professional being obese provides a basis to measure the relationship between the health occupation and obesity. The aim is to ensure that changes in variables are taken into consideration during the research process. Out of the 17.294 individuals who participated in the study, only 411were nurses. The samp le is relatively small to represent the nursing professionals. Hence, most of the information is generalised as opposed to being specifically based on the nurses and the prevalence of obesity among them. Moreover, the study seeks to compare very many occupations at the same time, which narrows down the chances of identifying the specific factors causing the high prevalence rate of obesity among nurses. The research uses interviews as the main method of data collection,. The researchers identified households that were eligible to answer face to face and computer assisted interviews and asked them question on the issue of obesity. The approach is not likely to have yielded the best results since most of the people are likely to view such information as sensitive and private. Therefore, the best way to gather information in a study such as this one is through questionnaires as more people are likely to believe that their information will be kept confidential. The primary objective of the study is well stated, but the research lacks an objective research question to accompany the main aim. It is necessary for the evidence-based practice research to provide an analysis of the interventions, which are useful (Rycroft-Malone Bucknall, 2011). Therefore, this study ought to have compared its findings to previous similar studies to identify whether the prevalence rate has increased or decreased. In the case of an increment, the focus should have been on the factors that have caused the change and how the situation can be rectified. On the other hand, if it was determined that the prevalence rate had declined, and then the researchers ought to have provided an explanation of why obesity rates among nurses have decreased. Currently, although the study is informative regarding identifying the prevalence of obesity and overweight issues among nurses in Scotland, it lacks to provide the completeness required for use in EBP because it does not make recommendations. Critique 2 Tan, M. F., Lopez, V., Cleary, M. (2015). Nursing management of aggression in a Singapore emergency department: A qualitative study. Nursing health sciences,17(3), 307-312. As the title suggest, the article seeks to determine the most efficient as to handle aggression in Singapore emergency departments. Further, the title also suggests that the research being reported was conducted using a qualitative research methodology. In EBP, qualitative case studies are known to provide more comprehensive information compared to other sources of data (Melnyk Fineout-Overholt, 2011). Further, the scholars also indicate that the use of qualitative studies allows researchers to present data gathered using different methods. For example, in this study, the primary sources of evidence were nurses, former nurses and observation. Availability of several data collection approaches improves the validity and reliability of the data. Qualitative research also happens to be more systematic and subjective (Grove, Burns Gray, 2014). The approach also presents useful data based on experiences, practices, and perceptions of professionals who have been involved in the issues bei ng investigated (Melnyk Fineout-Overholt, 2011). Tan, Lopez and Cleary (2015) use a purposive sampling method to ensure that the participants in their study are nurses and former professionals who have had to deal with aggressive patients. Their study is based on the events in a Singapore emergency department, where they also observe how aggressive patients were being handled. The participants are interviewed in regards to their experiences with aggression in emergency departments. The transcriptions of the interviews are later analysed and coded. That helps arrive at the conclusion of the study, which indicates that nurses in Singapore are highly concerned about how to manage aggressive patients in emergency departments. The use of interviews in this study was accurate as the information being collected was not sensitive in nature as far as the participants were concerned. Moreover, the interviews were in English and the people being interviewed are professionals in the health care industry, hence are in a position to understand t he question posed to them. However, it seems as though all the participants were not asked similar questions, which means that the information gathered was not focused on one perspective. The researchers should have formulated clear and succinct interview questions that focus on the primary aim of the study. The study exploited the perceptions and ideas of nurses in regards to aggression in emergency departments. The participants in the study were ten registered nurses who had worked in an emergency department of an acute public hospital in Singapore. Following the thematic analysis, Tan, Lopez and Cleary (2015) developed for primary themes. These are the impact if aggression on nurses, nurses' evaluation of attack behaviour, management of aggression, and organisational supports and responsiveness. The subdivision of the results into four primary themes makes it easy to apply the information in clinical practice because nurses can quickly identify the area they are interested n and compare the findings under the topic. However, further research into the issue is necessary since this study was conducted in a small hospital and the sample size of the participants was extremely low. Only ten registered nurses were interviewed, which means that the information they provided is limited. To ensure validity and reliability of the information in the study, Tan, Lopez and Cleary should have used more sources of information such as available literature sources and surveys. That would have helped to broaden the scope of the data used to analyse the issue and arrive at better and more reliable results. Further research, is also required in the study before its application in EBP to provide improved support for nurses to deliver optimal care to aggressive patients in emergency departments. Finally, although Tan, Lopez and Cleary (2015) approach the issue of aggression behaviour in emergency departments in a systematic manner, which makes it possible for nurses to use the information in EBP, the scope of their research is limited. They would have improved on their research by using more methods to gather information on how to manage aggression in emergency departments. That would have helped them gain more insight in regards to aggressive behaviours in emergency departments. Moreover, the number of participants was small, and the study was carried out in a small hospital, which might limit its application in large healthcare organisations. Conclusion To conclude, it is necessary for health professionals, especially nurse to adopt evidence-based practice. Currently, as discussed in this report there is a barrier to the application of evidence-based practice in clinical practice because of emphasis on specific empirical research findings (Grol Wensing, 2004). The empirical research evidence that most professionals emphasise on is scarce in nursing practice. It is therefore, important for nurses to develop the knowledge of applying different types of evidence in their practice because evidence-based practice in the medical field has proven to be extremely useful in treatment and prevention of illnesses (Youngblut Brooten, 2001). Therefore, nurses must realise the significance of evidence-based practice if they are to improve the quality of the health care services they offer. To achieve this, nurses must equip themselves with the skills and knowledge in accessing and critiquing research studies relevant to their practice (Cronenwe tt, et al. 2007). 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