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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Critical Appraisal Skills for Healthcare Students Are you struggling to make sense of complex research papers and craft insightful critiques for your academic assignments? Then look no further! Critical Appraisal Skills for Healthcare Students is your indispensable guide to understanding research papers, mastering critical appraisal, and most importantly, succeeding in your summative assignments. While this text is written with Level 5 students in mind, you will find it is a useful text at any academic level when required to engage in evidence-based practice. In today's ever-evolving healthcare system, the ability to critically appraise research evidence is crucial. In pre-registration programmes, this core skill is often assessed through written assignments. However, students can struggle not only to interpret research papers and evaluate their quality, but also to write about this appraisal in an academic way. This comprehensive textbook equips healthcare students with the evidence skills they need, while also enhancing their ability to produce high-quality assignments. Authored by experienced academics with over two decades of teaching research and evidence-based practice, this text covers core topics such as: * The significance of evidence in practice, locating and selecting appropriate literature, and navigating assignments based on the appraisal of research * Strategies for reading research papers and understanding them before appraisal * The fundamentals of critiquing research, with Key Fact sheets summarising the design issues of specific types of research * How to move beyond EBP for academic assessment, towards using evidence in everyday professional practice Critical Appraisal Skills for Healthcare Students is an excellent core text to master the art of critical appraisal and enhance academic performance.
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Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
Dedication Page1
Foreword
Preface
Acknowledgements
PART I: FINDING YOUR WAY AROUND!
CHAPTER 1: Introduction to Using This Book
1.1 INTRODUCTION
1.2 WHO IS THE BOOK FOR?
1.3 WHAT IS IN THIS BOOK?
1.4 CHAPTER SUMMARY
CHAPTER 2: Professional Practice and the Mandate for Evidence‐based Practice
2.1 INTRODUCTION
2.2 RELEVANCE: WHY HEALTHCARE PROGRAMMES HAVE EBP MODULES
2.3 DEVELOPMENT: WHERE DID EBP COME FROM?
2.4 DEFINITIONS: WHAT IS EBP?
2.5 PROCESS: HOW DOES EBP WORK?
2.6 HIERARCHIES: WHAT EVIDENCE IS BEST?
2.7 DEBATE: WHAT ARE THE CRITICISMS OF EBP?
2.8 WRITING ABOUT EBP IN YOUR ASSIGNMENT
2.9 ASSIGNMENT EXAMPLES
2.10 END‐OF‐CHAPTER CHECKPOINT
2.11 CHAPTER SUMMARY
REFERENCES
CHAPTER 3: The Task at Hand
3.1 INTRODUCTION
3.2 THE IMPORTANCE OF LEARNING OUTCOMES
3.3 HOW TO FOLLOW THE EBP PROCESS FOR AN ASSIGNMENT
3.4 CHOOSING A TOPIC
3.5 TURNING A TOPIC INTO A QUESTION
3.6 HOW TO DEVELOP A ‘GOOD’ QUESTION
3.7 BENEFITS OF A GOOD QUESTION
3.8 WRITING ABOUT EBP QUESTIONS IN YOUR ASSIGNMENT
3.9 ASSIGNMENT EXAMPLES
3.10 END‐OF‐CHAPTER CHECKPOINT
3.11 CHAPTER SUMMARY
REFERENCES
CHAPTER 4: Locating and Identifying Research
4.1 INTRODUCTION
4.2 HOW MUCH TIME DO YOU HAVE?
4.3 WHY ARE YOU SEARCHING FOR LITERATURE?
4.4 PREPARE TO BE FRUSTRATED!
4.5 LOOKING FOR THE EVIDENCE
4.6 HOW TO FIND RESEARCH
4.7 TRANSPARENT REPORTING OF SEARCH METHODS
4.8 WRITING ABOUT SYSTEMATIC SEARCHING IN YOUR ASSIGNMENT
4.9 ASSIGNMENT EXAMPLES
4.10 END‐OF‐CHAPTER CHECKPOINT
4.11 CHAPTER SUMMARY
REFERENCES
CHAPTER 5: Preparing the Ground for Appraisal
5.1 INTRODUCTION
5.2 FINDING YOUR WAY AROUND A RESEARCH PAPER
5.3 GETTING TO GRIPS WITH YOUR PRIMARY STUDY
5.4 GATHER YOUR TOOLS
5.5 WRITING ABOUT THE TYPE OF RESEARCH AND ITS LAYOUT IN YOUR ASSIGNMENT
5.6 ASSIGNMENT EXAMPLES
5.7 END‐OF‐CHAPTER CHECKPOINT
5.8 CHAPTER SUMMARY
REFERENCES
PART II: DIGGING IN THE DETAIL!
CHAPTER 6: Critical Appraisal
6.1 INTRODUCTION
6.2 HOW TO USE PART 2
6.3 INTRODUCING THE QUANTITATIVE RESEARCHER
6.4 INTRODUCING THE QUALITATIVE RESEARCHER
6.5 INTRODUCING THE MIXED‐METHODS RESEARCHER
6.6 DECISION TIME
6.7 THE FINAL DECISION
6.8 PREPARING FOR APPRAISAL
6.9 FOCUSING IN ON APPRAISAL
6.10 CRITICAL APPRAISAL
6.11 WHAT DOES BEING ‘CRITICAL’ MEAN?
6.12 ‘AM I DOING IT RIGHT?’
6.13 WRITING ABOUT CRITICAL APPRAISAL IN YOUR ASSIGNMENT
6.14 ASSIGNMENT EXAMPLES
6.15 END‐OF‐CHAPTER CHECKPOINT
6.16 CHAPTER SUMMARY
REFERENCES
CHAPTER 7: Appraising Quantitative Research
7.1 INTRODUCTION
7.2 CHARACTERISTICS OF QUANTITATIVE RESEARCH
7.3 TYPICAL QUALITY MARKERS FOR QUANTITATIVE RESEARCH
7.4 QUANTITATIVE DESIGNS KEY FACTS SHEETS
7.5 YOUR TURN!
7.6 WRITING ABOUT QUANTITATIVE RESEARCH IN YOUR ASSIGNMENTS
7.7 ASSIGNMENT EXAMPLES
7.8 END‐OF‐CHAPTER CHECKPOINT
7.9 CHAPTER SUMMARY
REFERENCES
CHAPTER 8: Appraising Qualitative Research
8.1 INTRODUCTION
8.2 CHARACTERISTICS OF QUALITATIVE RESEARCH
8.3 TYPICAL QUALITY MARKERS FOR QUALITATIVE RESEARCH
8.4 QUALITATIVE DESIGNS KEY FACTS SHEETS
8.5 YOUR TURN!
8.6 WRITING ABOUT QUALITATIVE RESEARCH IN YOUR ASSIGNMENT
8.7 ASSIGNMENT EXAMPLES
8.8 END‐OF‐CHAPTER CHECKPOINT
8.9 CHAPTER SUMMARY
REFERENCES
CHAPTER 9: Writing Up Your Research Appraisal
9.1 INTRODUCTION
9.2 WRITING ANALYTICALLY
9.3 PREPARING TO WRITE USING THE DJES TOOL
9.4 USING DJES TO BUILD ANALYTICAL POINTS
9.5 EXAMPLES USING DJES
9.6 APPRAISAL OUTCOME
9.7 END‐OF‐CHAPTER CHECKPOINT
9.8 CHAPTER SUMMARY
REFERENCES
CHAPTER 10: Appraisal in Context
10.1 INTRODUCTION
10.2 THE RELATIONSHIP BETWEEN PRIMARY RESEARCH AND EBP
10.3 EVIDENCE SYNTHESIS
10.4 EVIDENCE IMPLEMENTATION
10.5 WRITING ABOUT EVIDENCE IMPLEMENTATION IN YOUR ASSIGNMENT
10.6 ASSIGNMENT EXAMPLES
10.7 END‐OF‐CHAPTER CHECKPOINT
10.8 YOU MADE IT TO THE END… OR IS IT?
10.9 FINAL WORDS OF WISDOM
REFERENCES
Appendix
A.1 MIXED METHODS KEY FACTS SHEET
A.2 BLANK KEY FACTS SHEET FOR COMPLETION
A.3 BLANK DJES SHEET FOR COMPLETION
REFERENCES
Index
End User License Agreement
List of Tables
Chapter 1
TABLE 1.1 Features in this book.
Chapter 3
TABLE 3.1 Ways to engage in EBP for a summative assignment.
TABLE 3.2 EBP question frameworks.
TABLE 3.3 Examples of unstructured questions.
Chapter 4
TABLE 4.1 Impact factors of nursing journals.
TABLE 4.2 Common types of journal article.
TABLE 4.3 Example of inclusion and exclusion criteria used in a systematic ...
Chapter 5
TABLE 5.1 Is it primary or secondary research?
TABLE 5.2 Typical content in a published research article.
Chapter 6
TABLE 6.1 Questions to identify methodology.
TABLE 6.2 Specific research designs.
TABLE 6.3 Recommended resources for appraisal.
Chapter 7
TABLE 7.1 Shared characteristics of quantitative research.
TABLE 7.2 Types of data in quantitative studies.
TABLE 7.3 Common quantitative data‐collection methods.
TABLE 7.4 Types of probability sampling.
TABLE 7.5 Descriptive statistics.
TABLE 7.6 Non‐parametric and parametric tests.
TABLE 7.7 More statistical tests.
TABLE 7.8 Explanation of quality markers in quantitative research.
TABLE 7.9 Types of bias.
Chapter 8
TABLE 8.1 Shared characteristics of qualitative research designs.
TABLE 8.2 Common qualitative data collection methods.
TABLE 8.3 Qualitative sampling methods.
TABLE 8.4 Examples of qualitative analysis methods.
TABLE 8.5 Strategies used by qualitative researchers to confirm their resul...
TABLE 8.6 Example theme and subthemes.
TABLE 8.7 Explanation of quality markers in qualitative research.
Chapter 10
TABLE 10.1 Common types of review designs.
List of Illustrations
Chapter 1
FIGURE 1.1 The EBP process for academic assessment.
Chapter 2
FIGURE 2.1 Basic model of EBP.
FIGURE 2.2 Advanced model of EBP.
FIGURE 2.3 Traditional hierarchy of evidence explained.
Chapter 4
FIGURE 4.1 How to select a field to restrict a search.
FIGURE 4.2 How Boolean logic works.
FIGURE 4.3 Example database search using Boolean logic ‘OR’ to achieve high ...
FIGURE 4.4 Example database search using Boolean logic ‘AND’ to achieve high...
FIGURE 4.5 Flow chart for evidence acquisition based on the PRISMA guideline...
Chapter 5
FIGURE 5.1 Example of a journal layout.
FIGURE 5.2 The research process.
FIGURE 5.3 Typical layout of a published study.
Chapter 6
FIGURE 6.1 Research methodology decision tool.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
Dedication Page1
Foreword
Preface
Acknowledgements
Begin Reading
Appendix
Index
WILEY END USER LICENSE AGREEMENT
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Critical Appraisal Skills for Healthcare Students
A Practical Guide to Writing Evidence‐based Practice Assignments
Charlotte J. Whiffin
University of Derby, Derby, UK
Donna Barnes
University of Derby, Derby, UK
Lorraine Henshaw
University of Salford, Manchester, UK
Illustrations byBrandon Smith
This edition first published 2024© 2024 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Charlotte J. Whiffin, Donna Barnes, and Lorraine Henshaw to be identified as the authors of this work has been asserted in accordance with law.
Registered OfficesJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.
Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data Applied for:
Paperback ISBN: 9781119722816ePDF: 9781119722892epub: 9781119722847
Cover Design: WileyCover Image: © Jacob Lund/Shutterstock
For David, Emily, Grace, and Mum xFor my friends xFor Toby, Niamh and Leo xx… and for all our students
Quality is not an act, it is a habit.Aristotle
All great achievements require time.Maya Angelou
The important thing is not to stop questioning. Curiosity has its own reason for existing.Albert Einstein
Nothing in life is to be feared. It is only to be understood.Marie Curie
Nothing is impossible, I do nothing every day.Winnie the Pooh
Foreword
Dr Andrew Dainty
Senior Lecturer in Pre‐Qualifying Health Care, University of Derby, UK
Every year, thousands of healthcare students are faced with the seemingly mammoth task of mastering critical appraisal skills, and developing the knowledge and skills required to apply them to research used to underpin professional healthcare practice. In fact, for some, the very mention of the word research brings about apprehension and feelings of general anxiety. If this applies to you, then thankfully you have come to the right place. The authors of this book are experts in helping students grasp fundamental critical appraisal skills, and so Critical Appraisal Skills for Healthcare Students came to fruition because of this passion.
Evidence‐based practice is ultimately about ensuring that people receiving care have access to the most appropriate interventions, underpinned by robust scientific evidence. While it is true that clinicians will not always be able to appraise individual research studies themselves, understanding the concepts behind appraisal is essential for one to grasp the premise behind how evidence‐based guidelines are formed. Despite the need for meticulous appraisal, research studies are seldom rejected outright, and appraisal takes place to arrive at a balanced decision based on the facts and potential sources of bias. This results in the identification of certain strengths and limitations. In fact, all research has both, but even the most poorly designed of studies can often have some element of usefulness.
Throughout the following chapters the authors will take you on a journey, and hopefully this will help to demystify some aspects of critical thinking and appraisal that are frequently encountered by healthcare students. If you are struggling with these topics and you have been looking for a good place to start, then Part 1 is all about some of the fundamental aspects of locating and identifying different types of research.
Locating research, identifying the different types of research, and determining its potential usefulness can often be tricky. This book provides information to save time and energy searching for studies that are relevant to the task at hand. Once you have some understanding of the fundamentals of research evidence, Part 2 will provide you with information that can be used to develop critical thinking and will show you how to apply this appraisal to your practice. The truth is that there is no perfect choice of methods, because all types of research have strengths and limitations.
This book explores the process of developing critical writing skills and is intended to help you to write for academic assessments. The authors cover the formulation of coherent and logical argument based on consideration of the merits and limitations of research. The book is about the skills and knowledge needed to aid you in the process of appraisal, the basis of which should enable you to have a good understanding of what research is all about, and how to judge its worth. Once developed, these skills will serve you well for the rest of your career in healthcare, and this book is a good foundation on which to base your continual professional development related to research.
Preface
For over a decade, we have had the pleasure of teaching healthcare students about research and the art of critical appraisal. Many students arrive at their research modules feeling overwhelmed and intimidated about what lies ahead. Helping students to understand research, while watching their enthusiasm and confidence grow, has been a highlight of our teaching careers. This is especially true when students tell us at the end of the module that they have ‘secretly’ grown to enjoy research!
While it's important to point out that not all students start with a negative perception of research, we understand why some do. The use of research is often invisible or undervalued in practice. It also has a reputation for being boring and requiring superhuman boffin powers to understand it. We have loved smashing these myths during our teaching, by encouraging lively classroom debates about controversial clinical evidence and entertaining students with our favourite research jokes (what do you mean you didn’t know there were any research jokes?).
However, we found that problems arose after class, when students started to work on their assignments and were faced with some serious textbooks. These were often either too detailed for those needing to appraise a study rather than conduct one, or too basic for getting to grips with the complexities of evidence‐based practice. Students also said they struggled to find resources to help them write about research and make critical points about studies in an informed and analytical way.
So our aim was to create a book that met these needs: not too advanced, not too basic, not too theoretical, and not too lightweight. Instead, like Goldilocks' perfect porridge, we aimed for something ‘just right’.
The Goldilocks theory of research textbooks
While it would be lovely to think that this book will inspire students to conduct their own research, we wanted to create a book that helps students more practically with the thing that is most important to them when they start a research module – to pass the assignment! We also wanted to create a book that is a little more fun, so that learning about research is enjoyable rather than unbearable.
Lastly, we wanted to be guided by those who had started us on this journey, by sharing their anxieties and insecurities with us, and inspiring us to develop creative research teaching practice. So this book was created with students, for students, and we hope it gives you all the tools you need to succeed!
Charlotte (Charlie) Whiffin RN PhD
Donna Barnes RN PhD
Lorraine Henshaw RN DProf
Acknowledgements
We would like to thank Naila Dracup, information specialist, who reviewed Chapter 4 on locating evidence and provided additional advice and guidance on the content. This just goes to show how valuable it is to work with a librarian!
We would also like to thank all the students who contributed to this book. The book is written with students, for students, and we hope your insights and reflections will help others both survive and thrive in their evidence‐based practice and research modules in the future.
Danielle Anderson
Rebecca Baxter
Franzer Baldove
Jaclyn Beardmore
Katie Cockayne
Carly Forrester
Lucy Gee
Jodie Hinchliffe
Kelly Kemp
Alasdair MacDonald
Ellis Mack
Catia Neiva
Georgina Noble
Beth Orton
Rosamund Pocklington
Benjamin Powell‐Jones
Amy Pyrek‐Wright
Lucy Stanway
Naomi Somers
Laura Taylor
Colleen Thompson
Sylvie Umutoni
Terri Wilson
Alan Wilton
PART IFINDING YOUR WAY AROUND!
CHAPTER 1Introduction to Using This Book
1.1 INTRODUCTION
Classic – a book which people praise and don't read.
Mark Twain
There are plenty of ‘classic’ research texts and all have their place in the learning journey. But do we ever really ‘read’ research textbooks? Perhaps some people do, but it is more likely that we move from book to book, acquiring pieces of information that we then put together like a jigsaw puzzle in an assignment. Our aim for this book is that its sections can be dipped into and out of to suit your learning needs. But we also want it to be a book that can be read easily from cover to cover and hopefully enjoyed. So, fingers crossed!
1.2 WHO IS THE BOOK FOR?
This book is primarily aimed at academic level 5 healthcare students who need to complete critical appraisal assignments of primary research. However, the content is also suitable for academic level 4 or 6 assignments on the concept of evidence‐based practice (EBP), using research evidence for healthcare, and extended literature reviews.
The book is designed to support students with applying their learning about research and EBP to written assignments and developing their academic writing skills. These skills can be used for non‐research assignments too, since they support students to locate, understand, and use research evidence on any healthcare topic.
1.3 WHAT IS IN THIS BOOK?
Throughout the book you will follow our EBP process for academic assessment (Figure 1.1). Our model broadly follows the traditional EBP process (more on this in Chapter 2), but we have added a few stages so you can apply it more easily to your academic work. Our process will support you to work through each stage in a logical order and relate these to the chapter content. However, each stage may be applied differently within the context of your specific assessment, so always check your assignment brief to be sure.
In each chapter there are several features to support your learning and help you to navigate your way through the content (see Table 1.1). Through these we highlight key content, encourage active engagement and consolidation, and provide worked examples.
In addition to the features listed in Table 1.1, we have also separated the book into two distinct parts. Part 1 explains what you need to know before you conduct critical appraisal activities for academic assessments. Part 2 then gives you the tools to appraise research and write about this appraisal to meet level 5 criteria.
1.3.1 Part 1: Finding Your Way Around!
In this first chapter, ‘Introduction to Using This Book’, we do exactly that! We explain who the book was written for and what makes it unique. We will also explain how to use this book to get the most out of the contents.
FIGURE 1.1 The EBP process for academic assessment.
Chapter 2, ‘Professional Practice and the Mandate for Evidence‐based Practice’, takes a necessary look at the relevance of EBP to the healthcare profession and why so many professional programmes include assignments based on appraisal activities. We review definitions, models, hierarchies, and criticisms of this approach to patient care.
Chapter 3, ‘The Task at Hand’, asks you to take a closer look at your learning outcomes and assignment briefs to make sure you are well prepared.
Chapter 4, ‘Locating and Identifying Research’, aims to give you the skills to find good‐quality healthcare evidence. Although some of you will have been given a research study to appraise for the assessment, some of you will need to locate your own. Either way, this chapter will support you to develop the searching skills that are fundamental for evidence‐based practice and for level 6 assignments that require you to conduct a literature review.
Chapter 5, ‘Preparing the Ground for Appraisal’, encourages you to be sure that you have a primary research paper for appraisal, that you are able to navigate your way around it, and gives you some much‐needed strategies and tips for successfully reading research evidence.
1.3.2 Part 2: Digging in the Detail!
Chapter 6, ‘Critical Appraisal’, starts you off on the journey to critical appraisal of primary research. The chapter first ensures that you know what type of research you have so that you can use the subsequent chapters appropriately. To help you in this task, we introduce some fundamental characteristics of qualitative, quantitative, and mixed methods research. We then focus in on appraisal, what this really means, and what tools are available to help you.
TABLE 1.1 Features in this book.
Five minutes with
…
. are personal reflections that have been contributed by our students and are about how they felt during their EBP/research modules, how they completed the module tasks and wrote their assignments, and any tips and tricks they feel you may benefit from.
Assignment tips
offer some useful suggestions for how you may use the chapter content in your assignment.
Research essentials
provide definitions or explanations of key terms or concepts that you may not be familiar with, but are important to understand for critically appraising research.
Explore it
boxes give an opportunity to investigate additional resources that will extend your understanding of the chapter content.
Checkpoint activities
offer you a chance to engage more actively with the content, to check your understanding and encourage deeper learning.
Assignment examples
towards the end of most chapters are small snippets of real students' work to illustrate how students have written about the chapter content in their level 5 assignments. Be warned! Don't copy these and paste them into assignments. You could be accused of plagiarism or, worse, professional misconduct. Instead, use the examples to help you develop your own academic writing style.
End‐of‐chapter checkpoints
at the end of each chapter give you a way of checking your understanding of the chapter content. By completing a checkpoint you will have a good sense of what you know about the topic, and what you don't. Therefore, these checklists may increase your confidence in what you know and will identify areas where you would benefit from further learning.
Key facts sheets
at the end of
Chapter 7
, ‘Appraising Quantitative Research’, and
Chapter 8
, ‘Appraising Qualitative Research’, provide quick summaries of specific research designs so you can focus on the important issues associated with these. Each facts sheet includes our EDECA appraisal considerations (Ethics, Design, Enrol, Collect, Analyse) that explain what to look out for in these studies.
Chapter 7, ‘Appraising Quantitative Research’, and Chapter 8, ‘Appraising Qualitative Research’, address the appraisal of quantitative and qualitative research, respectively, enabling you to focus in on the issues that are most relevant to your chosen study. First, we review typical aims and methods associated with each research type and provide a ‘key facts sheet’ for each of the most common research designs associated with quantitative and qualitative approaches. As there is no mixed methods chapter in this book, for reasons we will explain later, we have included a mixed methods fact sheet as an appendix for those who may find this useful.
Chapter 9, ‘Writing Up Your Research Appraisal’, shows you how to incorporate research appraisal into a written level 5 assignment. We tackle the challenging issue of differentiating between descriptive and analytical writing styles, and how you can demonstrate your informed understanding of research quality within your assignment. We achieve this through our DJES tool, ‘Describe–Evaluate–Justify–Support’, and provide worked examples so that you can demonstrate your ability to critically appraise research while also meeting level 5 academic criteria.
Chapter 10, ‘Appraisal in Context’, is the final chapter, in which we come full circle back to the concept of EBP. Here we explain the end goal of locating and appraising evidence, which is to apply the knowledge in a professional healthcare context. We consider some aspects that inhibit the use of evidence in practice as well as some strategies for facilitating it. We close with some final words of wisdom.
1.4 CHAPTER SUMMARY
In this short first chapter we have introduced this book and described its contents. We have explained who we had in mind when we wrote the book and how to get the best from it. Now it's time to buckle up and get ready for evidence‐based practice and the journey through critical appraisal to writing, and passing, your assignment!
CHAPTER 2Professional Practice and the Mandate for Evidence‐based Practice
FIVE THINGS TO LEARN FROM THIS CHAPTER
Evidence‐based practice (EBP) originated from evidence‐based medicine (EBM), which advocates a scientific approach to practice.
EBP consists of three interrelated parts: evidence; expertise; patients.
EBP is a stepped process involving asking questions; locating the evidence; appraising the evidence; integrating the evidence; and evaluating the outcomes.
Hierarchies of evidence illustrate the weighting given to different types of evidence in solving clinical problems.
There are limitations and criticisms relating to EBP that must be addressed when considering effective ways to use evidence for practice.
FIVE MINUTES WITH SARA, MIDWIFERY STUDENT
Do you see evidence being used in practice?
I think evidence is used in practice, but I do not always think that people know the reason behind why they are using it fully. Sometimes it seems like we as students are more aware of the evidence base on an issue than the registered staff who have been in practice a long time.
It takes a long time for evidence to filter through to practice, because of the EBP process. It also takes a lot of organisational support. COVID was a good example of how changes can be implemented quickly when everyone is on board and supporting it. Otherwise, it can take years to change the existing culture of the ward. The other issues are just the current pressures ‐ no staff, no time.
In what assignment did you have to write about EBP?
I've written about EBP several times during my programme. Specifically, a couple of appraisal assignments and now my dissertation. However, EBP has been incorporated in most assignments throughout the course, particularly in year 2.
What advice would you give to students learning about EBP for the first time?
I think it's helpful to motivate yourself, for example thinking about the benefits to your own practice and your future working life. When you understand evidence you can understand the reasons for certain changes in practice and it can help you to keep up with developments. Healthcare is so dynamic, and things are always changing. You need to be able to adapt.
You should read the materials given and attend classroom lessons as we are all different types of learners. Ask questions, remember there are ‘no silly questions!’ EBP will be part of your future careers and it will be required on a daily basis. This reinforces the importance of understanding EBP so it can be put into practice in order to provide safe and quality care.
2.1 INTRODUCTION
In this chapter we will introduce you to the concept of evidence‐based practice, which is more commonly known by its abbreviation, EBP. This may be something you are familiar with already or just starting to learn about, but what does it actually mean for you, the patients you care for, and the profession you are joining? This chapter will help you to understand how EBP can benefit your professional practice and the care you provide, but will also explain its complexities and how they can be discussed in your EBP assignments.
The chapter begins by explaining the relevance of EBP for healthcare professions and why research assignments are so commonly found in pre‐registration healthcare programmes. The chapter then explores the historical development of the EBP movement, the evolution of its definition, and the EBP process. We then determine what is meant by ‘evidence’ and why hierarchies exist to rank some evidence as stronger than others. Finally, we present current debates and different perspectives on EBP and end by giving some guidance on how you can discuss EBP in your assignments.
2.2 RELEVANCE: WHY HEALTHCARE PROGRAMMES HAVE EBP MODULES
EBP or research‐specific modules are common in all healthcare programmes. Even where there are no dedicated modules, assignment briefs and learning outcomes across several modules will specify that students need to demonstrate their ability to locate, understand, appraise, and apply evidence to various health topics. But why is this the case?
Although the use and role of evidence in practice are not always obvious, think for a moment what practice would look like if it was not informed by research evidence, and was instead based on what had always seemed to work. Do you think we could still advance patient care? Improve patient outcomes? Make the experience of being a service user better? The answer is no. To effectively navigate the evolving healthcare landscape, manage complex illnesses, meet the needs of diverse communities and collaborate within a multidisciplinary team, you must be able to engage with evidence.
In professional terms, EBP is an essential criterion for being a health registrant, as it supports standards of autonomy, accountability, and the maintenance of appropriate knowledge and skills. Being competent to engage with a range of evidence means that we can make informed judgements, as part of a healthcare team. This enables us to offer balanced advice to patients about what interventions may be most effective and what side effects might occur. It means we can work with our practice teams to decide what shift patterns might be safest and what skills are essential for the role. It helps us to weigh up the costs and benefits of a new health facility and how that might meet the needs of a particular community. It should come as no surprise, then, that EBP is embedded in our professional codes, meaning that it is a requirement of professional practice to be able to use evidence rather than an optional extra. Box 2.1 gives examples of some regulatory codes of practice and emphasises that joining a professional register means we are agreeing to practice in an evidence‐based way.
Box 2.1 Extracts from Professional Codes
The Code (NMC 2018a, p. 9)
6. Always practise in line with the
best available evidence
To achieve this, you must:
6.1. make sure that any information or advice given is
evidence‐based
including information relating to using any health and care products or services
Standards of Proficiency for healthcare professionals (HCPC 2023a–c)
11. assure the quality of their practice
11.1. engage in EBP
11.2. gather and use feedback and information, including qualitative and quantitative data, to evaluate the response of service users to their care
Assistant Practitioner (Health) Occupational Standard (Institute for Apprenticeships and Technical Education 2016)
Knowledge
Research
and development in the health and social care sector to inform and improve quality of care
Duty 10
Promote an evidence‐based approach to providing health and care services, participating in quality improvement and research activity
In personal terms, there are additional benefits from developing EBP skills. Being able to acquire, understand, and apply evidence related to your field of practice can increase your confidence in practice within your team and when interacting with patients. More broadly, being proficient with evidence can encourage personal development and a self‐motivated learning mindset that can help you problem‐solve and manage challenges in all areas of life. What's not to love about that?
Having said that, we know it can feel like EBP is far removed from real life, conducted and reported by some distant researchers who understand little about the front line of providing care. But often those researchers are health professionals like you, and EBP is a way of bridging the gap between the vast bank of research evidence and the everyday world of practice.
So, your EBP modules and assignments are there to help you personally and professionally to understand the most effective ways of delivering healthcare, and to develop the skills to use evidence to improve your own practice interests.
Assignment Tip
EBP assignments vary considerably in their expected scope and focus, so you should check that you are clear on the assessment brief and learning outcomes for your specific module. For example, while most assignments will require a robust discussion of what EBP is and how it supports good practice, you should clarify how much is expected in terms of the related history, theory, and current debates. Key issues relating to EBP include the following, so check with your tutor if you are unsure:
The relevance of EBP to healthcare professions
The historical development of EBP
The evolving definition of EBP
The process of EBP and how it works in practice
Types of evidence and evidence hierarchies
Debates and criticisms about EBP
2.3 DEVELOPMENT: WHERE DID EBP COME FROM?
EBP is one of the most important developments of the last 50 years for helping healthcare professionals to provide safe and effective patient care. It evolved from EBM, a term that was coined in the early 1990s by Gordon Guyatt, although the foundation for the EBM movement was laid many years before (Smith and Rennie 2014).
One of the earliest examples of using an evidence‐based approach to inform practice was the investigation of pleural fever following childbirth in the 1800s. Ignaz P. Semmelweis was a Hungarian physician and scientist who noticed that women who were supported by physicians had a higher rate of pleural fever and death than those who were supported by midwives. He investigated and tested possible theories for this difference in mortality rates and concluded that it was related to the physicians performing autopsies before attending the labouring women (Best and Neuhauser 2004). His findings led to the recommendation that doctors who perform autopsies should wash their hands prior to delivering a baby. Although the recommendation was contested by some, it was implemented, and led to a reduction in maternal deaths (Best and Neuhauser 2004) and sepsis in newborn babies from 18% to 3% (Cwikel 2008).
Another famous figure of the nineteenth century with a commitment to the systematic collection of health data was Florence Nightingale. Nightingale was an accomplished statistician and used her skills during the Crimean war to measure the differences in mortality rates from, for example, wounds and diseases (MacDonald 2001). She was also a pioneer of graphically representing statistical data, using bar charts and pie charts to communicate her findings to the politicians and senior civil servants who could support the changes she wanted to make (McDonald 2001). These early advocates spearheaded the systematic collection and analysis of health data to improve understanding of disease and patient outcomes long before the term EBP evolved (Mackey and Bassendowski 2017).
The origins and founding principles of EBP are often attributed to the work of Archie Cochrane in the 1970s. Cochrane was a champion of experimental clinical trials and led the call for physicians only to use treatments that had been shown to be effective through this kind of rigorous investigation. Although controversial at the time, his ideas led to much‐needed debate about the fact that medical decision‐making was largely based on the clinical experience and knowledge of individual physicians (Mackey and Bassendowski 2017). This meant that there was wide variation in the medical interventions that were offered and uncertainty about which were the safest, most effective, and most cost efficient. To address these issues, Cochrane called for medical interventions to be systematically investigated using research, and for those individual investigations to be collated and reviewed to create a reliable body of evidence that health professionals could use to guide their practice. These collections of research evidence are now generally referred to as ‘systematic reviews’ and they follow a rigorous process to ensure objectivity and accuracy (Cochrane Collaboration 2023). Cochrane called for the consistent use of randomised controlled trials (RCTs), a specific type of research study, which he argued provided robust evidence on the effectiveness of treatment and led to the writing of his famous book Effectiveness and Efficiency (Cochrane 1972).
Research Essentials
Research is one source of evidence for EBP. It is characterised by the aim of generating new knowledge through a systematic process of enquiry that involves the collection and analysis of data, related to an explicit research question. There is both primary and secondary research evidence. Find out more about this in Chapter 5.
Primary research has the unique characteristic that new data are collected from participants. The data are collected and then analysed using methods that are appropriate for the research question or aim.
Secondary research collects no new data but instead gathers and analyses existing evidence on a topic to address the review question or aim.
Randomised controlled trials (RCTs) are one type of primary research design. They are highly controlled clinical experiments where people are chosen to receive an intervention, or not, completely at random. This random allocation is key to determining the difference between the results for those who receive an intervention and those who do not. Find out more about RCTs in Chapter 7.
Systematic reviews are rigorous summaries of research evidence, typically of RCT designs, that have been compiled in an objective manner, according to a recognised and documented set of steps. Systematic reviews are a type of secondary research and you can find out more about these in Chapters 4 and 10.
The call for systematic reviews of healthcare interventions led to the creation of the Cochrane Centre, founded in Cochrane's name after his death in 1985. This centre later became the Cochrane Collaboration and is now an important international network providing rigorously appraised evidence to inform healthcare decision‐making on a free‐to‐use website (Cochrane Community 2023).
Explore It
Have a look at the Cochrane resources to understand their relevance to healthcare.
First visit the Cochrane website and familiarise yourself with the organisation, its aims, and what it does: www.cochrane.org.
After this go to the Cochrane Library: www.cochranelibrary.com.
Note the difference between these sites and consider how the Cochrane Library can help inform decision‐making in practice.
2.4 DEFINITIONS: WHAT IS EBP?
The most‐cited definition of EBP originates from the work of David Sackett, although it actually relates to EBM. Sackett, a pioneer of clinical epidemiology, is regarded by many as the father of EBM, as he taught medical students that patient care should be informed by scientific evidence rather than tradition or expert opinion (Box 2.2).
Sackett et al.'s (1996) definition reflects the following elements of EBM as it was considered at the time:
Current best evidence
Making decisions about patients
Using clinical expertise alongside research evidence
These demonstrate that up‐to‐date and high‐quality research evidence is central to EBP and suggests that to judge this, research needs to be appraised. Sackett et al.'s (1996) definition also refers to decision‐making informed by clinical experience, rather than suggesting that research evidence alone should direct health professionals. Four years later Sackett et al. (2000) updated their definition to:
The integration of best available evidence, clinical expertise and patient preferences and values.
(Sackett et al. 2000, p. 1)
Aim: To understand how the definition of EBP has changed.
Instructions: Compare Sackett et al.'s (1996) definition to Sacket et al.'s (2000) definition. What is the same and what is different?
Box 2.2 David Sackett and His Definition of EBP
Evidence‐based medicine 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
p. 71)
Perhaps you noticed that the definition of EBP has evolved away from making decisions about patients to focusing on patient preferences and values, reflecting the shift towards more patient‐centred care. The three core components of EBP can now been seen as evidence, expertise, and patients.
EBP is now integral to different fields of healthcare (Satterfield et al. 2009) and its principles are integrated into healthcare policy, driving the development of organisations such as the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). These organisations act as a bridge between research and practice as they gather a range of evidence, appraise its quality and the strength of its conclusions, and offer guidance for how health professionals might use it.
Assignment Tip
When using definitions in assignments, do not simply quote someone else. Instead, analyse the definition and make notes about what stands out about it, if it is considered seminal or contemporary, and how it contrasts with other definitions. Remember you are being assessed on your understanding of the topic, so just quoting sources could suggest that you do not understand the concept enough to explain it yourself.
EBP has also become a subject with distinct specialist areas such as evidence‐based public health and evidence‐based social work (see Box 2.3). Various modifications now exist, with each specialty adapting the original EBM definition to fit the relevant scope of practice (Sattterfield et al. 2009). While these variations can be a little confusing, they demonstrate how integrated the evidence‐based approach now is within modern healthcare.
Box 2.3 Derivatives of EBP
Evidence‐based public health: ‘A public health endeavour in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods’ (Rychetnik et al. 2004, p. 538).
Evidence‐based nursing: ‘An ongoing process by which evidence, nursing theory and the practitioners' clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide delivery of optimum nursing care for the individual’ (Scott and McSherry 2009, p. 1089).
Evidence‐based social work: ‘A process designed to forward effective use of professional judgement in integrating information regarding each client’s unique characteristics and circumstances, including their preferences and actions, and external research findings' (Gambrill 2003, p. 4).
Evidence‐based healthcare: ‘A multi‐professional approach to using and implementing the best available evidence to ensure the clinically and cost‐effective treatment of patients and practice’ (Deighan and Boyd 1996, p. 334).
An EBP definition we have found particularly useful is this one from the Joanna Briggs Institute (JBI), an international research organisation based in Australia:
Clinical decision‐making that considers the best available evidence; the context in which the care is delivered, client preference and the professional judgment of the health professional
(Jordan et al. 2019, p. 58).
This definition has broad appeal for a range of healthcare professions and settings through its use of the term ‘client’ rather than patient. The retention of ‘clinical decision‐making’ reinforces the idea that EBP cannot prescribe care but instead supports professionals to develop individualised approaches to care. Lastly, it brings the context of care into focus. Whether it is an operating theatre, a home, a clinic, or a community centre, the healthcare setting has a significant bearing on how evidence can be applied, and therefore is a vital part of any contemporary definition.
Overall, the definitions tell us that EBP is not simply using research in practice. EBP is an active process of which you are a crucial part. Healthcare professionals exercise their clinical judgement to integrate a range of evidence with patient needs and contextual factors. These elements are captured in various EBP models, which are useful for visualising how they interact (see Figure 2.1).
While the concepts in Figure 2.1 can be considered the core elements of EBP, it's helpful also to identify what kind of contextual factors might come into play, since these may dictate if and how evidence can be applied. Of course, these factors will vary widely depending on the type of healthcare setting, but can be broadly categorised as follows:
Ethical and legal considerations:
such as professional codes, ethical principles, and related legislation.
Organisational context:
such as formal procedures for changing practice, local policies, and type of culture.
Available resources:
such as staffing and costs of implementing an intervention, and equipment available in the setting.
For example, if a treatment was supported by research evidence but was unaffordable for the healthcare organisation, or unwanted by the patient, then it would not be feasible or ethical to enforce it and other options would need to be considered. In this scenario, practice is still evidence‐based because professional judgement is being used to weigh up the appropriate options given the various considerations. Figure 2.2 provides an advanced model of EBP that includes these additional factors that are important in the application of EBP.
FIGURE 2.1 Basic model of EBP.
FIGURE 2.2 Advanced model of EBP.
While the definitions and models shown here are useful for explaining the separate components and how they relate, that are not necessarily helpful for illustrating how EBP works in practice. So let us now consider the process of EBP and its different stages that support the use of evidence in healthcare settings.
2.5 PROCESS: HOW DOES EBP WORK?
EBP is described as a problem‐solving approach (Melnyk et al. 2010). A problem‐solving approach to anything first requires the problem to be defined, after which a solution can be found.
Aim: To reflect on the process of decision‐making
Instructions: Imagine that you want to go on a skiing holiday in France but do not know the best resort, that your washing machine has just broken and you do not know a good appliance repair shop, or that you have had a row with a friend and you cannot decide if you should say sorry. What are the steps you might take to solve these problems? What information would help you to reach a solution?
In a simple problem‐solving approach, the following steps help us to reach a solution:
Define:
Before starting to solve the problem, you must understand it. What is it that you are trying to solve? What goal will you achieve through the solution?
Explore:
This is the messy bit! In this step you are collating resources, assimilating information, and getting lost on Google. You are making decisions about which information is more persuasive than others, e.g. the reviews of the resort may have more impact on your decision‐making than the photos on the website. You will also be thinking about other factors too, such as the cost and consequences of the possible solutions in front of you.
Choose:
Once you have exhausted the relevant information that informs your decision, you can finally choose a solution. This solution will meet your goal, is within budget, and has the least negative consequences.
Action:
Here is when you take decisive action by implementing the choice you have made in Step 3, and this may require planning. What do you need to execute your decision in a way that will not increase the negative consequences you have assessed in Step 2?
Review:
In this final step you are reflecting on what you did, what worked well, and what did not. You will decide if your choice was the right one, and what you would do if faced with a similar problem in the future.
Now let's compare this simple problem‐solving approach to the process of EBP, where Melnyk et al. (2010) and Flemming (2007) both suggest five steps:
Asking
a clinical question: uncertainty from practice is converted into a focused question to trigger the process.
Searching
for the best evidence: the focused question directs a systematic search for relevant research evidence.
Appraising
the evidence: the gathered research is critically evaluated for quality and applicability.
Integrating
the evidence: the gathered research is critically considered alongside the relevant clinical expertise and patient preferences and values.
Evaluating
the outcomes of practice decisions or changes based on the evidence: this might be via a process of self‐reflection, audit, or formal research.
These steps can be easily remembered as the 5As: Ask, Acquire, Appraise, Apply, and Assess (Guyatt and Meade 2015).
The 5As are often presented in a cyclical format emphasising the iterative, as opposed to linear, nature of the EBP process.
Assignment Tip
When discussing the process of EBP, do not just describe or list the steps. Make your writing more analytical by, for example, comparing the stages that different authors discuss, applying them within a professional context, or selecting one or two stages for deeper discussion, using a couple of different sources in support.
