Research can be described as a method of investigating a chosen area to illicit new information on the topic or to build on previous knowledge. In nursing research the aim of this research is to provide clients, their carers and their families with the best possible care in all aspects of their treatment to promote wellbeing (Burns and Grove 2001).
“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;72)
Nurses are at the frontline of healthcare and have most one to one contact time with clients; therefore it is essential that the foundation of their practice be formed from reliable evidence (Parahoo 2006). Evidence based practice sets out to integrate the best possible evidence, nursing knowledge and patient views into practice. It is vital that nursing staff be knowledgeable of the latest findings in nursing research and are able to access and opt for the most suitable evidence to inform and implement into their practice. (Gerrish 2006) suggest that evidence based practice consists of research, patient experience and clinical expertise.
It is important to address which research findings nurses should consult to inform their clinical practice in order for them to deliver adequate care to their patients. There are many different types of evidence available to practitioners; Gray Muir (1997) as cited in Gerrish (2006) outlines a hierarchy of evidence and indicates which types are more superior. Placed at the top of the hierarchy are systematic reviews and multiple randomised controlled trials (RCTs). A systematic review is essentially a study done on prior research; this is then deemed as secondary research (Parahoo 2006). The aim of this type of review is to carry out an extensive and thorough search of material already available on this topic. The most fitting material in relation to the topic is chosen, this is then evaluated, the findings are then collaborated and summarised to answer the original question. This process should be performed in a clear manner so that it would be possible for others to carry out this research. In second place on the hierarchy is randomised controlled trials, third; non-randomised controlled trials, fourth; non-experimental studies and fifth; descriptive studies/expert committees. This hierarchy is more suited to quantitative research and is deemed inappropriate if outcomes are not measurable (Gerrish 2006).
There are many organisations that provide information on research and guidance to how it should be implemented into clinical practice. The National Institute for Health and Clinical Excellence (NICE) offer clinicians guidelines and criteria to follow with the aim of developing nursing care to the benefit of the clients health (NICE). The Cochrane Collaboration supply research material which is available to everyone. Their aim as an organisation is to provide health care workers, clients and their carers with information on the most current and reliable evidence used within health care settings.
There are several different barriers to implementing evidence into clinical practice; Gerrish (2006) suggests that these barriers can be set into four categories; the nature of the evidence, communication of the evidence, knowledge and skill of the nurse and organisational barriers. Barriers with regard to the nature of the evidence may include research questions unsuitable to clinical practice. In relation to communication of evidence the language used in the research may be deemed as inaccessible due to complex terminology. It has been identified that barriers concerning the nurses skill include troubles identifying or appraising evidence and also lack of confidence of the individual in using resources to access the research. Organisational barriers seem to indicate that lack of support from senior staff in providing information and time to implement changes are the main cause for concern.
Parahoo (2006) suggests that there are four main components in the research process. Identification and formulation of the research question is the first stage in the process, this is where the researcher determines what is being researched and a question is created. Previous literature researched in the chosen field may be consulted by the researcher to help define concepts. The final question must be clearly set out. The second stage of the process is the collection of data, in this part of the process several decisions will have to be made before data is collected. The design of the study, methods used within it and sometimes piloting need to be decided upon. The population that will be participating needs to be defined at this point consent may need to be sought from ethical committees. Once these arrangements are in place the data can be collected. The third stage in this process is the analysis of data, at this stage the researcher would analyse, translate and display their findings. It is important to note that before the data was collected the researcher would have decided on how the analysis would be conducted. After analysis the researcher would typically translate findings, examine the limitations and make suggestion as to how to implement into practice. Recommendations may be made for additional research needed. The final stage in research process is the dissemination of findings. An organisation that might be responsible for this area would be NICE, the barriers to the implementation of evidence are outlined above.
There are many ethical issues involved in the research process; the author of this essay intends to discuss some of these implications. Beneficence is an important ethical issue, it is essential that the study should be of the benefit of its participants and in the best interests of the overall public. Confidentiality is another ethical issue within the research process, any information gathered should be respected. Consultation to the participant’s wishes should be sought throughout the process and care must be taken by the researcher when publishing results so not to unintentionally expose the identity or information of its participants.Conclusion
The author of this essay has explored the relationship between evidence and the clinical setting. Research, evidence based practice and the research process was considered. Barriers to implementing evidence based practice and the strategies/organisations used to avoid these barriers were discussed. Critiques of two research articles are included in this essay; these critiques aim to illustrate the author’s understanding of the research process and knowledge of the various types of research and the methods used.