Last week’s blog focused on the strongest types of evidence that you might find when trying to solve a clinical problem. These are: #1 Systematic reviews, Meta-analyses, or Evidence-based clinical practice guidelines based on systematic review of RCTs; & #2 Randomized controlled trials. (For levels of evidence from strongest to weakest, see blog “I like my coffee (and my evidence) strong!”)
So after the two strongest levels of evidence what is the next strongest? #3 level is controlled trials without randomization. (Sometimes called quasi-experimental studies.)
Here’s an example of a controlled trial without randomization: I take two groups of mice and test two types of cheese to find out which one mice like best. I do NOT randomly assign the mice to groups. The experimental group #1 loved Swiss cheese, & the control group #2 refused to eat the cheddar. I assume confidently that mice LOVE Swiss cheese…
You can be a part of documenting such stories, including your own. Can I pique your interest with these examples about historical research?
1. Artifacts:Example = http://acif.org/The American Collectors of Infant Feeders:
The American Collectors of Infant Feeders is a non-profit organization whose primary purpose is to gather and publish information pertaining to the feeding of infants throughout history. The collecting of infant feeders and related items is promoted.
2. Interviews:Example = http://www.oralhistory.org/ Want to do interviews of interesting faculty, students, leaders, “ordinary” nurses? Check out the Oral History Association In addition to fostering communication among its members, the OHA encourages standards of excellence in the collection, preservation, dissemination and uses of oral testimony.
3. Stories from the “ordinary:” Example: http://www.murphsplace.com/mother/main.htmlMy Mother’s War – “Helen T.Burrey was an American nurse who served as a Red Cross Nurse during World War I. She documented her experience in both a journal and a scrapbook which has been treasured by her daughter, Mary Murphy. Ms Murphy has placed many of these items on the Internet for people to access and it provides a first-hand account of that experience. Additionally she has a variety of links to other WWI resources.” (quoted from AAHN Resources online)
4. Ethnic studies:Example=https://libguides.rowan.edu/blacknurses Black Nurses in History “This is a ‘bibliography and guide to web resources’ from the UMDNJ and Coriell Research Library. Included are Mamie O. Hail, Mary Eliza Mahoney, Jessie Sleet Scales, Mary Seacole, Mabel Keaton Staupers, Susie King Taylor, Sojourner Truth, Harriet Tubman.” (quoted from AAHN Resources online)
Critical thinking: Don’t forget to save your own materials. Your life is history! What in your life is most interesting? Have you written it down or dictated it into your iphone voice memo? There is GREAT interest in “ordinary” men and women. Many times items are tossed because they are “just letters” or “only old records,” or “stuff.” Just Don’t Do It.
Every once in a while, it feels good to add a snooty foreign word or phrase to your writing. I mean, what would the writing world be without a little je ne sais quoi? However, there are rules about how to treat these words and phrases on first reference, and that’s what today’s post is about. (After all, teaching language and style rules is Grammar Party’s modus operandi.)
Section 7.49 of the sixteenth edition of The Chicago Manual of Style states, “Italics are used for isolated words and phrases in a foreign language if they are likely to be unfamiliar to readers. If a foreign word becomes familiar through repeated use throughout a work, it need be italicized only on its first occurrence. If it appears only rarely, however, italics may be retained.”
The question is: How do you know if a foreign word or phrase will be…
Practice based in evidence (EBP) means that you must critique/synthesize evidence and then apply it to particular setting and populations using your best judgement. This means that you must discriminate about when (and when NOT) to apply the research. Be sure to use best professional judgment to particularize your actions to the situation!
Actually when it comes to quantitative data, there are 4 levels, but who’s counting? (Besides Goldilocks.)
Nominal (categorical) data are names or categories: (gender, religious affiliation, days of the week, yes or no, and so on)
Ordinal data are like the pain scale. Each number is higher (or lower) than the next but the distances between numbers are not equal. In others words 4 is not necessarily twice as much as 2; and 5 is not half of 10.
Interval data are like degrees on a thermometer. Equal distance between them, but no actual “0”. 0 degrees is just really, really cold.
Ratio data are those with real 0 and equal intervals (e.g., weight, annual salary, mg.)
(Of course if you want to collect QUALitative word data, that’s closest to categorical/nominal, but you don’t count ANYTHING. More on that another time.)
The difference between research and evidence-based practice (EBP) can sometimes be confusing, but the contrast between them is sharp. I think most of the confusion comes because those implementing both processes measure outcomes. Here are differences:
RESEARCH :The process of research (formulating an answerable question, designing project methods, collecting and analyzing the data, and interpreting themeaning of results) iscreating knowledge(AKA creating research evidence).A research project that has been written up IS evidence that can be used in practice. The process of research is guided by the scientific method.
EVIDENCE-BASED PRACTICE: EBP is using existing knowledge (AKA using research evidence) in practice. While researchers create new knowledge,
The creation of evidence obviously precedes its application to practice. Something must be made before it can be used. Research obviously precedes the application of research findings to practice. When those findings are applied to practice, then we say the practice is evidence-based.
A good analogy for how research & EBP differ & work together can be seen in autos.
Designers & factory workers create new cars.
Driversuse existing cars that they choose according to preferences and best judgments about safety.
CRITICAL THINKING: 1) Why is the common phrase “evidence-based research” unclear? Should you use it? Why or why not? 2) What is a clinical question you now face. (e.g., C.Diff spread; nurse morale on your unit; managing neuropathic pain) and think about how the Stetler EBP model at http://www.nccmt.ca/registry/resource/pdf/83.pdf might help. Because you will be measuring outcomes, then why is this still considered EBP.