Research for Evidence-Based Practice in Healthcare

Robert Newell, Philip Burnard

• Publisher: Wiley-Blackwell
• Year: 2011
• ISBN:
  9781118297063
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

This is an essential, accessible introduction to the practicalities of research and evidence-based practice aimed at all pre-registration nursing and healthcare students. It places research and evidence in the context of clinical practice, introduces the main methodological approaches in qualitative and quantitative research, and describes the processes of research appraisal, dissemination and implementation.

The new edition of Research for Evidence-Based Practice in Healthcare has been updated to include information for a broader health care audience. It engages students with the research and evidence agenda, demonstrates the relevance of research and evidence to nursing practice, and provides the skills needed to explore these areas in greater detail.

Special features:

· A practical guide to research methods and evidence-based practice

· New edition of a successful student textbook

· Includes a glossary of common research terms

· Provides case studies, key points, further reading, and activities throughout

· Accompanying website with links to further reading

SECTION 1
Contextual Materials

1

Introduction to Healthcare Research for Evidence-Based Practice

Introduction

This book is about research in healthcare, seen principally from the viewpoint of students undertaking pre-registration and postregistration educational programmes. We are both active healthcare researchers and are passionate believers in research by healthcare professionals (HCPs)¹ for the benefit of the patients and clients we serve. Our own background is principally in mental health nursing, although, as teachers and researchers, we have widened the scope of our work beyond a purely mental health focus. Likewise, as researchers we have typically worked in multidisciplinary research, with the broad range of other HCPs, with medical practitioner researchers and with researchers from a range of non-clinical disciplines. In preparing this book, we have sought to make it relevant to colleagues from across the disciplines, and we hope this comes over in the material that follows. We both started to get interested in research from early on in our clinical careers, and did a good deal of research while still mainly working as clinicians. The real reason we started in research was because we were interested in whether the things we did with patients and clients made a difference to their experiences of illness, recovery and health. If you have picked up this book, we guess you have a similar interest, and we hope we can work with you in developing that interest and finding ways you can translate your ideas into practical projects, whether these be through your own research or your examination of the research literature to inform your practice.

In the following pages, we will try and take you through the various elements of undertaking a piece of research. Even if you do not have to do research yourself as part of your educational course, this book is still for you for three reasons. First, much of the material we present is essential, not just for doing your own research, but for understanding the research of others. Because almost all healthcare courses these days require you to critically appraise the research that is already out there, you need an understanding of how to do that. Books and articles which just deal with critical appraisal are fine, as far as they go, but you will certainly have a much better understanding of how to evaluate published research if you have a clear idea of the various elements that go into a research project, the methods used by researchers and the reasoning behind methodological choices they have made. This book will give you that information.

Second, you will almost certainly encounter, during your course or later, the need to undertake some project work, for example developing a new guideline or a new way of organising care. All the information given here will help you to organise and evaluate that project.

Finally, a great deal of clinical practice is investigated by medical practitioners and non-clinical researchers, partly because comparatively few HCPs other than medical practitioners go on to become fulltime researchers. We want to increase the number that do, so that HCPs are increasingly responsible for evaluating their own practice and get the credit for doing so. Ultimately, we would like you to be in a position to decide you want to be one of those people, so part of the job of this book is to give you a taste of what is involved, including some of its complexities, so that you will want to go on and find out more. We believe that research is essentially a practical skill and is best learnt through an apprenticeship system, and so the best piece of advice we can give you is to get hold of someone who has experience of actually doing research, translating research into practice, doing a systematic review and so on, and learn from them.

Then, use this book as your workshop guide. If you cannot find such an experienced researcher, then we hope this book will be able to tell you some of the things they would have. The book is not heavily referenced (usually only a few per chapter), but each of the references is important, and is easily available, either from your library or from the internet. We have made considerable use of web sources so as to make it easy for you to find the best supporting information. We know web sources do not necessarily remain current forever, but we believe the best ones do. When we came to write the second edition of this book, we found only a few sites that were no longer available.

The scope of healthcare research

Until quite recently, healthcare research had a reputation for being an introspective pursuit which was more concerned with investigating its own workforce than undertaking clinical research. Some commentators have suggested that becoming a teacher of healthcare professionals frequently involved ceasing to have any clinical responsibility for patient care or, indeed, much contact with clinical settings at all. In consequence, those teachers wishing to do research had little access to patients or were often out of touch with issues which were important to patients. They did, however, have contact with students, and so ended up developing research interests related to education and the views and experiences of student nurses. Sometimes, it was difficult to see how this research would benefit patients. Although this criticism was chiefly aimed at nurse researchers, our experience with the broad range of healthcare professionals suggests it holds true equally in other disciplines, a belief reinforced by the fact that initiatives to increase research by non-medical health disciplines have typically been applied across the range of disciplines.

We do believe that healthcare research is changing for the better, though, and is nowadays much more concerned with patient care, rather than being overly inward looking towards its own professions. Whilst we recognise that it is important for research to be done into such things as the opinions and experiences of students and members of the healthcare professions, or the ways in which these professionals are educated, we also think that the eventual point of all healthcare research should be the greater good of patients. Therefore, we suggest, the vast bulk of research into such issues as the views of the professions themselves should have immediate consequences for patient care. If it does not, then why do we want healthcare researchers doing it, rather than, say, sociologists or educationalists? Surely, examination of, for example, occupational therapists’ opinions of their educational preparation, can be done as well by researchers from other disciplines. Given that healthcare researchers are a rare breed, we hope that the growing focus on clinical research, where nurses can make a distinctive contribution, will continue.

That said, many people are largely unaware of the contributions to research that healthcare professionals have made already, or the effect which that research has had on care. Just two fairly random examples from our own areas of interest give an idea of the scope of research by healthcare professionals. Professor Mary Jo Dropkin, from the University of Long Island, has written definitive studies of the psychosocial impact of head and neck cancer. Her work is cited by researchers across the whole range of health disciplines and has changed the way we think about head and neck cancer. In the UK, Professor Trudie Chalder from Kings College, London, is a world-recognised expert in fatigue, and developed the leading mode of treatment in this area. Once again, her work is referred to by all the healthcare professions. When you consider that fatigue is cited as a major symptom in almost all long-term physical conditions, it is easy to see the extent of this HCP’s contribution to the potential well-being of patients via her research.

Whose business is research in healthcare?

As you can tell from the above, we think it is primarily the business of HCPs themselves to evaluate and develop our care through research. These days, almost all large-scale research is undertaken in teams, and almost all these teams are multidisciplinary. All HCPs need to be equipped to take a full part in these teams. In the past, we have been ill equipped to do so, and, given the packed nature of healthcare pre-registration education, research often takes a back seat. As we said above, very few clinicians go on to be full-time researchers, but all of us are research users, even when we are not aware of it. Being a knowledgeable, aware consumer of research findings is integral to competent practice.

Apart from using research in our own clinical practice, we have a further ethical obligation concerning use of research, and one which exceeds the responsibility of members of the general public. For example, HCPs need to be sufficiently knowledgeable about research to help patients who may become involved in research projects run by other members of the clinical team to make reasonable, informed choices about, for example, participation in such a study. Similarly, patients may ask our views about treatment which is currently practiced, and we are unable to offer such advice without an informed understanding of the evidence base. This, in turn, comes from an understanding of the research approaches which have been used to generate this evidence.

Surprisingly, even in everyday life, away from clinical practice, our role as an HCP gives us a greater ethical obligation to understand the evidence behind healthcare interventions, because our role may give us a certain amount of authority when we communicate (even very informally) with others about healthcare matters and healthcare research. Accordingly, we have a special responsibility to ensure that we know what we are talking about. This implies, once again, a knowledge of research methods.

Which brings us to our final point in this section. Very little healthcare has been subject to robust clinical research. This leaves us, we believe, with two important responsibilities. First, we should be basing our care as far as possible on the best available evidence. This implies an ability to search for, appraise and implement that evidence. Appraisal requires a basic understanding of the merits of the studies we read, and a knowledge of research methods is essential to that understanding. Second, the knowledge base needs building, so involvement, at whatever level, in research to build it is as part of our ethical responsibility as HCPs in just the same way as use of current best evidence.

Perhaps the key questions at the heart of evidence-based practice in the health professions are as follows:

What works?

What works best?

How does it work?

Research provides a starting point in answering these questions.

Using this book to get involved in healthcare research

We want this book to be a practical guide. Part of being practical is being as easy to access as possible. This leaves us with a problem. We have tried to make each chapter as stand-alone as possible, but at the same time we wanted to avoid repetition, so we do not go over every piece of background information necessary in each chapter. This means there will inevitably be some shifting around for you between chapters, and we hope you will dip in and out to follow up things we have not been able to cover over and over again as they occur in different contexts. To help you do this, we are going to avoid giving you the tr...

Table of contents

• Cover
• Title Page
• Copyright
• List of Common Research Terms
• SECTION 1: CONTEXTUAL MATERIALS
• SECTION 2: QUALITATIVE APPROACHES
• SECTION 3: QUANTITATIVE APPROACHES
• SECTION 4: APPRAISAL, DISSEMINATION AND IMPLEMENTATION
• Appendix 1: Research Log
• Appendix 2: List of Useful Websites (In Order of Citation)
• Index