Any research project not worth doing is not worth doing well.
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!
Add to your repertoire of EBP tools, the Number Needed to Treat (NNT). This is not mumbo -jumbo. NNT explained here–short & sweet: http://www.thennt.com/thennt-explained/
CRITICAL THINKING: Check out this or other analyses at the site. How does the info on antihypertensives for mild hypertension answer the question of whether more is better? Are there patients in whom you SHOULD treat mild HTN? (“We report, you decide.”) http://www.thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/
MORE INFO: Check out what the data say about other risk/benefit treatments at http://www.thennt.com/
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.)
CRITICAL THINKING: Where are the levels in Goldilocks and the 3 levels of data at this link: https://son.rochester.edu/research/research-fables/goldilocks.html ?? Would you measure soup, bed, chairs, bears, or other things differently? Why was the baby bear screaming in fright?
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) is creating 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.
- Drivers use 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.
WHAT IS RESEARCH? Take < three minutes to check out: https://www.youtube.com/watch?v=v50ct9xJVKE . Listen for what research is and 2 basic ways to approach the answers to a research question: “Why is the sky blue?”
CRITICAL THINKING: What is a recent problem you’ve experienced in clinical practice? Write out a positivist question and an interpretist research question related to that same clinical problem.
“OBJECTIVE: To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day.
DESIGN: Retrospective observational study.
SETTING: Paediatric wards in England, Northern Ireland, Scotland, and Wales.
PARTICIPANTS: 186 members of staff who worked on the paediatric wards (n=186) during Christmas 2015.
MAIN OUTCOME MEASURES: Presence or absence of Santa Claus on the paediatric ward during Christmas 2015. This was correlated with rates of absenteeism from primary school, conviction rates in young people (aged 10-17 years), distance from hospital to North Pole (closest city or town to the hospital in kilometres, as the reindeer flies), and contextual socioeconomic deprivation (index of multiple deprivation).
RESULTS: Santa Claus visited most of the paediatric wards in all four countries: 89% in England, 100% in Northern Ireland, 93% in Scotland, and 92% in Wales. The odds of him not visiting, however, were significantly higher for paediatric wards in areas of higher socioeconomic deprivation in England (odds ratio 1.31 (95% confidence interval 1.04 to 1.71) in England, 1.23 (1.00 to 1.54) in the UK). In contrast, there was no correlation with school absenteeism, conviction rates, or distance to the North Pole.
CONCLUSION: The results of this study dispel the traditional belief that Santa Claus rewards children based on how nice or naughty they have been in the previous year. Santa Claus is less likely to visit children in hospitals in the most deprived areas. Potential solutions include a review of Santa’s contract or employment of local Santas in poorly represented region.” Park et al. (2016).BMJ. 2016 Dec 14;355:i6355. doi: 10.1136/bmj.i6355.
It’s that time of year again! Enjoy this illustration of how to use one model in applying best, available evidence to practice. Have fun and a merry and bright season.
How strong is the evidence regarding our holiday Santa Claus (SC) practices? And what are the opportunities on this SC topic for new descriptive, correlation, or experimental research? Although existing evidence generally supports SC, in the end we may conclude, “the most real things in the world are those that neither children nor men can see” (Church, as cited in Newseum, n.d.).
If you want to know the answers, check out: Highfield, M.E.F. (2011). Here comes Santa Claus: What’s the evidence? Advanced Emergency Nursing Journal, 33(4), 354-6. doi: http://dx.doi.org.libproxy.csun.edu/10.1097/TME.0b013e318234ead3 Using bona fide published work, the article shows you how to evaluate the strength of evidence and how to apply it to practice. You can request a full-text for your personal use from your library or from the author via www.researchgate.net/home .
Critical thinking: Check out this related research study with fulltext available through PubMed: Black Pete…
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