Is There Any Value in Nurses’ Developing Evidence-based Skills?

Introduction

The question ‘’Is there any value in nurses’ developing evidence-based skills’’ will be evaluated and critically appraised throughout this essay. This will be done so by using two different research articles, both articles are relevant to the topic.
The first research paper ‘’ Identifying barriers to EBP adoption: A focus group study’’ the author has chosen to use a qualitative approach (Tacli et al, 2015).

Qualitative research ensures nurses are able to provide patients with the best EBP Fain (2017).  Parahoo (2014) explains that qualitative research enables to understand each individuals’ experiences and also ensures to understand a patient’s own perspectives of the topic that is being researched. Galvin and Holloway (2017) also agree with parahoo as they explain that by using different approaches which may include group interviews or individual, this allows the researcher to speak to the individuals that are exploring thoughts and feelings and be able to engage with them.

The second research paper ‘’ a multi-institutional study of the perceived barriers and facilitators to implementing EBP’’ has been written in a quantitative approach (Duncombe, 2018). Parahoo (2014) explains that quantitative research uses statistical and objective measurements in which data is collected and is transferred into evidence. Gerrish and Lathlean (2015) expand and explain that quantitative research is complete in order to manage the original hypothesis, with the goal being able to produce a positive outcome. (Parahoo, 2014) the hypothesis is explained to identify what the research question is and this is done through experience and the cause of why this may be happening. The researcher also has a responsibly ensure this information is backed up credible research.

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All nurses should have skills that are both safe and effective to ensure all patients receive the correct and approached care (Brooker & Waugh, 2007). The NMC (2015) state that when providing patients with any information to patients it should always be evidence based. In agreement Holzemer (2010) explains it is important that nurses and all health professionals are able to carry out the best knowledge that have been found from research. Moule et al (2017) also back this information as they state that in order to deliver the best quality of care all nurses must stay up to date with their own knowledge and clinical skills. Leach (2006) states that as nurses are accountable for any decision making, EBP helps to reduce any confusion or worry a nurse may have when making a making a clinical decision. Parahoo (2014) agrees as they explain EBP helps the production of good quality care while also meetings the needs of each patients.

The Nursing and Midwifery Council (NMC, 2018) states that nurses are responsible for ensuring that their evidence-based knowledge and skills is always ongoing, this allows nurses to practice efficiently in such ways that have been found through research. This shows that following the findings and credible evidence, this enables staff whom work within the nursing sector to be able to perform the best EBP. Leah (2006) continues to explain that by inspiring nurses to practice EBP this will help with the reduction in patient’s complication. Nonetheless, to enable EBP to work its needed that nurses are competent and have an interest with engaging with further learning in order to broaden their skills and knowledge (Burke et al, 2004).

Critical appraisal will also be carried out to confirm whether or not the information from the articles is relevant. Critical appraisal is an evaluation to assess the outcome of the evidence and ensure that this information is methodically and trustworthy, and most important that it can be used in clinical practice (Gerrish & Lathlean, 2015). Moule et al (2017) also defines critical appraisal as a process that analyses the strengths and weaknesses of an article of research.

In order for the writer to ensure that each paper has used relevant and relevant information they have used Holland and Rees (2010) & CASP (2013) critical appraising tools. These tools are used to be able to understand the literature and the details that are within each of the articles. By using both of the tools this has helped he writer to be able to identify both strengths and weaknesses of the papers in a coherent way. The tools ensure the writer is able to look at the data analysis, data collection, and sample. These are all different aspects of the articles and finding this out will help with the answer of essay question “is there any value in nurses developing EBP skills?”.

Critical Appraisal of a Qualitative Research Paper.

The qualitative paper Tacia et al (2015) will be discussed and critically appraised and this will be done by using Holland and Rees framework (2010). This framework will help to critically analysis the research article effectively. The article carries out a direct focus with a detailed title ‘’Identifying barriers to evidence-based practice adoption: A focus group study’’ (Tacia et al 2015).  This makes It clear for the reader to understand what the article is about. Tecli et al (2015) aspire to understand the individuals outlook on the chosen topic while identifying any barriers, whilst understanding EBP. Parhoo (2014) explain that the aim of researcher is to also to be able to raise an understanding as to why the study is being developed and how relevant the chosen subject is this present day. Parhoo (2014) extend and state that the researcher has also to be able to identify any mistakes in practice and how these errors can be improved. The writer found that Tacli et al (2015) has not only outlined that main aim of the research but also outline the reason for the study and while doing so, identify how it is relevant to nurses.

The Holland and Rees framework (2010) describe the sample as a very important stage of the research, this stage can be critically analysed. Sampling is an important part of the research article as this can compromise the results (Polit & Beck 2006). Tacia et al (2015) choose a focus group design, this was used in order to gather information. There were three different focus groups in total and these where up of advance practice nurses, administrators/managers and staff nurses – all groups where involved in a nursing background. The participant that where choose was to be able to maximise views and opinions.

As previously discussed, Tacli et al (2015) explains that the aim of the research is to be able to find out how important EBP is in the delivery of care, within the role of an advance practice nurse. Following that the writer disagrees with the sample that where chosen. The reasons being that only four out of eighteen participants interviewed where advanced practice nurses. Gerrish and Lathlean (2015) extends by explaining that in order for qualitative research to be successful, the sampling group that is selected need to beneficial. This is beneficial to the researcher as they are able to choose participants who have worked in the specialised field and who have an insight to the phenomenon. Following that the writer then believes that the participants that the research was aimed at, should have been to advanced nurse practitioners only as by including staff nurses and administrators this does not show a good association to the aim.

To select the individuals that where involved, it is stated that they were recruited with emails and flyers. This means that the sampling group was a probability sample as Tacia et al (2015) had reached out to them and had control over who he sent these emails and flyers to rather than is being randomized (Parahoo 2014).  Parahoo (2014) state that volunteer sampling is not a good source of sampling and can be very weak due the researcher having no control over the participant. However, Grove et al (2014) disagree with this as they state that by using voluntary approach, it may be beneficial as it will only attract participants who are interested in the specific topic.  The writer feels that while it has attracted people with interest to EBP it has not attracted enough advance practice nurses whom the study is aimed at.

Over all Tecia et al (2015) has choose eighteen participants in total to be involved in their research. While Polit and beck (2017) explain that they agree that this is an adequate number for the research to take place Creswell (2018) disagree, as they suggest that when it involves qualitative research the sample size should be 3-15 to be able to obtain the correct information. Parahoo (2014) also explain that when using the appropriate sampling size this will then achieve beneficial interviews that then allow the researcher to be able to gather all the evidence that is required and that is rich in detail. The writer then agrees that as the researcher has chosen the correct sample size this will allow the research study to take place and information will be easy to collect.

While collecting data Tacia et al (2015) opted for group interviews. Parahoo (2014) explains, methods of qualitative data collection differ, through the use of unstructured and semi structured approach for example interview and observations. These interviews took place in the same place and lasted around two hours. Aveyard (2017) explains how group interviews are beneficial. Thus then allowed the writer to believe that group interviews was a very beneficial way in order to allow the researcher to be involved and engage within the group and this is a good way of gathering information, as this can engage a more acutely conversation.

Tacia et al (2015) decided to use three main questions while using 12 probe questions in order to gather the correct information while using audio tape with the consent of all individuals within the group. Polite and beck (2013) explain that the use of audiotape is that it is dependant as it will monitor each conversation that took place rather than information being forgot about. Parahoo (2015) also explain that using open-ended questions is more time consuming and more effort when it comes to answering them, therefore the participants may pull back from answering and not provide superficial answers. The writer believes that if Tacli et al (2015) used closed questions this may be more beneficial and it may decrease weaknesses and allows more definite answers, thus then making the research study creditable. The positives of using this structure means that conversations between the participates could stimulate a much deeper exploration of the topic. However, as Tacia et al (2015) provided the question’s this limited what the focus group would discuss with regards to the topic.

During the critiquing this paper the writer identified that the site principle investigators whom was involved in the group interview had personally engaged and interacted with a few of the participants before hand, this could lead to a bias result. Gerrish and Lathlean (2015) acknowledge that when choosing participants that don’t have a connection to the researchers whom are carrying out the questions will result in a fairer result and have less complications. The writer feels that any interactions with the participants prior the study taking place may result in the study being ruined and not being able to collect the appropriate answers.

Critical Appraisal of a Quantitative Research Paper.

Quantitative research is a social science research that delivers their finding through gathering non-numerical data. It explores to answers questions about why or how a distinct phenomenon occurs (Nery, 2017).  Fain (2017) states that this type of research has been used in nursing in a broad and adequate way to explore evidence-based practice. Quantitative research is connected to provide data detailing links and understanding research paradigms that can be gathered slowly through the collection of data (Ellis,2016).

The Quantitative research paper Dunscombe, (2018) will be discussed and critically appraised and this will be done by using a critical appraisal took designed by CASP that is tilted ‘Systemic Review Checklist’ (CASP, 2013). This checklist helps the reader review the quantitative article and this will determine the effectiveness and condition of the article. The CASP checklist helps the reader to understand the validity of the article and also understand what the results are (CASP, 2013). The writer chooses this checklist due to is direct and simple style.

Throughout Dunscombe, (2018) article the author cited copious amounts of studies that states relevant factors towards evidence-based practice within nursing. However, the writer feels some studies were out of date as to ensure all information is up to date and relevant, articles should try not be cited that are more than 5 years stated by Grove, Gray and Burns (2015). Although there is no set rule for this, the references cited should be current (Grove, Gray and Burns 2015).

The first part that Dunscombe, (2018) discusses was their sampling. In order to carry out his research on EBP, 100 registered nurses were recruited this is the form of random sampling. They were all asked to take part in self-administered survey, the nurses had different nursing backgrounds. There were four different backgrounds of nursing that where choose, and they had all been employed for over a year. The 100 participants were used as a sample-size, Polit and Beck (2014) agree with this as their recommendation would be to use larger sample size to ensure population value is representive. However, the adverse circumstances where that only 61 responded out of the 100.

The results of Dunscombe, (2018) where presented clearly to the reader using the format of 5 different tables, which were filled with data that was retrieved throughout the survey. Creswell and Clark, (2011) states that visual tables and charts are a good way for researcher to present their data, as it is easy to read and understand. Dunscombe, (2018) has used their results and presented these results in an organised table by using headings, columns and rows. The tables then went on and explained the details in more descriptive way. Dunscombe, (2018) used questionnaires that where made up of 32 questions and 4 sections. The question’s consisted of questions to analyse the barriers of EBP that nurses experience. Alongside the question’s a pilot study was also carried out with a small group of participates who were asked not share the information with any of the others in order to prevent conflict of interest. The reason for this was to assess the use of the data and be able to identify the strengths and weaknesses, therefore drawing attention to the researchers of what needed improvement or more work. Modifications where created during this pilot study and then given out to the registered nurses to complete with their own working hours. As nurses where asked to complete during working hours this would perhaps be the explanation for the non-responding due time management. Polit and Beck (2014) support arguments for and against the use of questionnaires, stating that the method may be efficient but is not always applicable to all groups who are involved.

Duncombe (2018) had been granted approval before starting the research from an ethics committee. The ethics committee look out for the researcher as well as the participants, they also focus on the risks and benefits of the way the research is being carry out. Aveyard et al (2017) state that is it compulsory to receive an approval as well as gaining the permission for participation. In order to prevent any harm or risks to anyone involved ethical principles should be followed. In order for the individuals whom are involved within the research, they must state that they have the capacity to do so and they also must retain the knowledge to the chosen subject in order to be involved within the research (Schneider et al 2007). Duncombe (2018) ensured that confidentiality was followed throughout the process and gained consent from all participants. Before giving consent, the participants received both written and verbal communication and confidentiality was followed as after the questionnaires was completed, they were placed in a data collection box which was locked and secure, keeping in line with the ethics committees guidelines.

Conclusion

The writer feels that throughout both research articles both Duncombe (2018) and Tacia et al (2015) have both focused on the question ‘Is there any value in nurses’ developing evidence-based skills’ Both of the research articles analyse the barriers and the implementations of EBP, as well as addressing evidence-based practice. Both papers used two different approaches, one qualitative approach and the second quantitative approach. The two papers both described that evidence-based practice is essential so that patient centred care is carried out to high standard.

The first paper the writer critically appraised was Tacia et al (2015). This research paper identified 6 main barriers which was highlighted within the 3 focus groups that where used. The writer feels that they were well explained. Tacia et al (2015) research identifies the understanding of EBP and what the challenges where when nurses tried to implement EBP, however along with this there is also suggestions of how this could be improved.

The second paper the writer critically appraised was Duncombe (2018). Duncombe (2018) research suggested that nurses require more training in relation to EBP in order to provide high standard quality care. However, it was also identified that it is not only the nurse’s job to practice EBP however a combined effort from all medical staff, this suggests that there is more need to prioritise EBP. The paper used 100 nurse as their sample and the writer feels that if it could have been carried out with a higher number of samples then this may have varied results and a higher rate may have responded as Polit and Beck (2014) state that in order to create significant results, using a larger amount of sample will help with this and determines the results. Ethical committee covered all the needs of both the percipients and researcher safeguarding them both and gaining consent before the research began.

Overall both papers pinpoint EBP. Duncombe (2018) and Tacia et al (2015) both used appropriate sample groups when doing so and by critical appraisal this has shown that there has been both strengths and weaknesses in both studies. Not only is this topic a contemporary to nursing issues it is also applicable to the writer themselves as a third-year nursing student. By identifying why EBP is so important and why it is such a large topic within nursing, the writer will be able to focus on this and recognise EBP. This will help the writer to ensure that she is also able to implement positive factors and educate other medical staff with regards to EBP. This will help the writer to be able to deliver a high standard of care working as a newly qualified nurse to prevent patients being at risk. It is essential that a nurse practitioner is able to take reasonability for their own clinical skills being up to date and their practice is evidence-based.

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