Harvard style research paper nursing evidenced based practice

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Date: 13th February 2011.
Evidenced Based Practice in Health and Social Care
Introduction
Evidence-based practice is a way that is followed in providing healthcare which is
guided by thoughtful integration of the very best of the currently available knowledge with a
clinical expertise. This approach of research in nursing practice allows the medical
practitioner to have a critical assessment of the research adapt, the clinical guidelines as well
as other sources of information to enhance correct identification of the clinical problem and
thus application of the most high quality interventions while re-evaluating the outcome for
further improvements in the future. According to Cochrane collaboration evidence based
health care is a conscientious offing of the current best evidence to make decision about the
care given to the patients or in the delivery process of the health and social services (Titler, &
Goode, 2001) The concept of evidence is used to refer to range of tangible information that is
usable in identifying a problem and the necessity of responding to it forming an essential
requirement for later evaluation purposes. The idea of current best evidence is information
that is up to date and relevant therefore can be sued in carrying out of a valid research about
various forma of health and social care, the possible harm from exposure to certain agents,
accuracy of the diagnostic tests and finally the power of the predictability of the prognostic

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powers. This paper will offer a critical review of the evidence based practice as in concerns to
the field of health and social care in nursing profession (Mason & Chaffee, 2002)
The term evidence based medicine was first sued in the 1980s and was used to
describe the approaches that were used to in determining the best practice and was alter
shifted to become evidence based practice especially after its importance in decisions making
were recognized by clinicians and physicians. after that expert begun talking of the evidence
based health care as process in which research evidence was used to make decisions
regarding specific population or groups of patients hence assuming that the evidence was used
in context of the particular group or patients preferences, desires, clinical situation and finally
on the expertise of the clinicians. Experts as expect that the healthcare professionals are able
to read, critique as well as synthesize the research findings to help them in interpreting the
existing evidence based guideline soft e clinical practice.
In recent years funding agencies have been increasing their pressure on the federal,
state and local government to incase the effectiveness as well as the accountability of the
preventive and intervention programs. The rising demand for increased quality of health and
social programs and evidence of such quality has fostered for increased interest in the
evidence based programs. These programs judge to be evidence based if the evaluation
research indicates that the program is producing positive and expected result, and that the
result can actually be attributed to the specific program but not on extraneous factor, if the
evaluation is previewed by the experts while in the field and finally the programs must be
endorsed by a respected research agency or federal agency which have listed it as one of their
effective programs (McCarthy, 2007).

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The evidence based practice have been getting an increasing attention in the field of
health and social care and it focuses on the perspectives of the professionals in the midwifery,
physiotherapy, social acre and nursing. This new approach is seen as an optimistic approach
and has had wide acceptance as it demonstrates an organization attempts to bridge the existing
research practice divide which include in the process of interpretation of research outcomes as
concerning the practice protocols, guidelines and standards.
Nurses have often served instrumental roles in the process of ensuring as well as
provision of the evidence based practice through a continuous asking of question reading the
best evidence for the interventions, provisions of the best practice and finally on the
possibility of achieving the highest outcome both for the patient, family and nurse. Therefore
they have always been positioned to working with in collaboration with colleagues when it
comes to identification of clinical problems and in the use of the exiting evidence in priding
an improved practice. There are numerous opportunities that nurses can question in order to
ensure that the current nursing practices use the evidence based methods to improve and make
provision of health and social acre more effective.
The evidence based practice research has benefited the health and social care service
providers and agencies in various ways. Some of the benefits includes: helping nurses to
provide patient care that is based on research and knowledge rather than on normality,
intuition, traditions, myths, advice of colleague, personal experiences outdated books and
hunches. Other benefits include the better and improved patient outcomes, keeps the nursing
practice current and relevant, increases confidence when it comes to decision making
processes, ensures that policies ad procedures in the practice are current and includes the
latest research hence supporting the JCAHO –readiness and finally the integration of evidence

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based practice in to the practice of nursing is very important for provision of high quality
patient care and achievement of the ANCC Magnet Recognition Program designation
((McCarthy, 2007).
Evidence based practice in the filed of social care is defined as the conscious, explicit
and judicious process of using the current best evidence in the making of decisions that
regards the welfare of the service user and careers.
For the past decade health and social services providers have been under pressure to increase
accountability in the provision of their service especially regarding methods of measuring the
effectiveness of health and social services for instance on what works the best and on the
introduction of diverse range of performance indicators in the field. Some of the question that
that nurses and care givers ask themselves regarding the evidence based practice in the field
oh health and social care include the types of methods of evidence based that promote the best
practice while ensuring that patient get the best and improved health and social services that
factor in their personal preference, cultural and social differences. Effectiveness of social
provision services under that children are all securely attached to careers that are capable
ensuring provision of safe and effective care during the duration of their childhood and the
related indicator of performance in the reduction of to no more than sixteen percent of
children looked after who have two to tree annual placement (French, 2002).
The concept of effectiveness in the involve the appropriateness and validity of the
methods theater used by professionals in their daily work to ensuring that the basic aims of
the organization and the overall abilities of the agencies in delivering services they required to
while the concept of performance is concerned with the ability of n agency to achieve
predetermined targets that are viewed as the determinants of both quality and quantity of the

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services delivered. The three E’s i.e. effectiveness, efficiency and performance were the
performance indicators during the 1980’s. In the social and health service care the attention of
the public was shifted towards the issue spreading child abuse and protection tragedies that
were culminated in the enquiry of Cleveland case. This led to an increasing number of
question asked concerning the effectiveness of the process of assessment sexual abuses in
children and the interventions that were targeted at the victims and the perpetrators.
Social service departments as well as other social acre providers are being increasing
expected to be accountable for the effectiveness of the service that that are delivered both at
the organizational level as well as on the specific programs used in various interventions
(Gray, 1997) Therefore information technology as played a critical role when it comes to
providing the means of which organizations and agencies utilize in monitoring the social
service it provides and hence becoming capable of providing information that is used to
achieve accountability. Focusing on the effectiveness has fostered the raising of fundamental
issues regarding the nature of the research of the social work.
When on considers the evidence that emerges from the National Health Service, there
is a massive variations in the health service provided both for the cost between identical
treatments and also in the duration and provision of the various form of treatments. Such
difference can only be explained based o n the different medical or social needs as well as on
the questions raised on the electiveness of such treatments. Some of the initiative designed to
help in improving the services provided by health providers include the creation of national
institute for clinical excellence which is intended to improve service through the use of shared
knowledgebase as well as the set standards (Titler, & Goode, 2001)

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In addition to that another impact of the effectiveness agenda in the provision of social
and health service can be evident in the proliferation of the policy as well as guidance
documents as well as the creation of specific initiatives intended to increaser guides in the
field for instance the Centre for Evidence-Based Social Services (CEBSS). At a national level
there has been development of detailed guidance as well as practice manual both for the social
care staff and other professional regarding the procedures that are followed in the handling of
cases of suspected child abuse but all these vary specifically on the extent in which they based
on research or on other agency priorities.
Finally the most concrete manifestation of the best practice in social care services is
the Centre for Evidence-Based Social Services started in 1997 and based at Exeter University.
The centre aims at ensuring that the decision take at every level of social service are based on
trends and quality research and it conduct training on ways of achieving the stated aims. The
Centre for Evidence-Based Social Services is partnership between the department of health
and the social services department from corner to corner of England and at Exeter University.
The organization has recently expanded to other areas and associations have various aims
including the following:
• To help in the translation of the results of the existing research in to the service and
development of the practice.
• Ensures that the findings derived from research are made available to the social service
departments especially during the review and changing of the delivery systems
• To promote collaboration with other stakeholders like degree and PQ to ensuring that the
training conducted in social work incorporates the available knowledge from existing research

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• Improvement of general informational dissemination especially of research findings to the
local policy makers, practitioners, managers, careers and service users
• Commissioning of research on areas where information gaps are identified finally is to ensure
working towards level where surface user and careers are included as the valuable sources of
information especially when it comes on the service effectiveness projects.
Untangling the Web-The impact of internet use on the social care and the physician-patient
Relationship
Methods
The current study lies at the intersection process and outcome study, in the process of
exploring the impacts of the internet use on the social care as well as the physician-patient
relations. It processes insight into the operations by which individuals access and use online
social care information. It borrows much from the web based qualitative approaches.
Interviews were carried out to investigate people’s meanings that are attached to their internet
use, in relation to their social as well as day-day life. To ensure that the engagement of the
internet user is grasped with the online medium, it was as well much significant to meet the
seekers of the information in their location of activity. The initial contact and recruitment of
the interviewees were hence situated online.
Email Interviews
With the internet users looking for social care information online, the email interview
was conducted. The recruitment of the interviewees was on UK websites for lawyers for low
income people, social guidance counsellors, food providers and government officials,
amongst others. The reason for focusing on such like web site was because they in most cases

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address themselves to the public with a multiple to the public in general with multiple social
issues. There are even in most cases related topics developed on the similar website. Lawyers
for low income as well as food providers for instance provides various general poverty level,
while general social care website becomes an important place to government and non
governmental organization involvement, and also attracts various profiles of social care
information seekers.
These websites were identified through systematic internet research, by the use of 20
search engines as well as directories. The initial search came up with 920 websites. By the use
of frequency criteria, as well as presence, 4o websites were selected. Then, they were
conducted and invited for the invited to contribute to the research at hand. Amongst them, 10
websites responded positively and the research was advertised either as a web link on one of
there pages, or as message in groups of discussions. The researcher posted it, after being
permitted by the website administrator. Other ten were later added fin light of evidence about
their appropriate content their frequent by the first interviewer.
The advertisement was made to direct internet users to the website of the research
where the study goals, methods and privacy were all explained. On top of responding to an
online questioner, the internet users were also invited to participate in the interviews by first
cond8ucting the research through email, phone or even by the use of conventional mail. As a
matter of fact, only two interviewees used phone while none used conventional mails. The
initial exchange of around three emails before the base was set, the basis for the undertaking
full email interviews, though the participants were all given at any junction of even meeting
face-to-face, or even undertake an interview through exposure.

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The demographic data like the respondent’s age, employment, gender, education,
social status, health status, as well as income, were all collected to serve the purpose of
statistical controls. Respondents also were asked, if they have ever worked or ever stayed in
a social care related units. In addition, they were questioned about their views in non
traditional social care services.
Email Qualitative Research
Email interview is just asynchronous online method of interviewing, based generally
on several email exchange between the participants and the researcher (Bampton &Cowton,
2002). Such like interviews allows greater flexibility for the interviewee, who might answer at
his/her own convenience. Though it lacks the immediacy as compared to face-face
interviews, once the basis has been set up, email communications helps in the attainment of
conventional interviews and creates personal as well as thoughtful communications. In
addition, email interviews allows repeated interactions as time goes by, this has been proved
to be much significance for the deeper understanding of everyone’s dimension of the
participants’ doctors relationship, (Mann &Stewart, 2000).
About 20-30 emails had been already exchanged between the each respondent and the
researcher. The time of interview time relying on the speed that was adopted by the
interviewees for replying the email. The interviewee age varied from 20 to 60 years. The
respondents’ respondent to questions like what was their level of social help? They were also
asked about the source of their social care? Another question was about their social problem
that needs social care?
The gender imbalance especially interviewees, especially in favour of females can be
attributed to several reasons. One of them being the specificity of the mode of interview;

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given the gendered use as well as the social purposes of email communication; the initial
email contacts might have installed an intimacy level, which in one way or the other might
have locked the door out for male audience. Another reason might be the focus on social care
issues like lawyers for low income individuals and the general social care websites. Though
such like websites are addressed to the public in general and purpose male’s social problem
topics, the dimension of gender of these social issues as well as their related website has to be
recognized, (Saltonstall, 1993). Another reason that can explain is that, females are socially
constructed as the social gatekeepers of the family, and the society as a whole. Although
according to the survey knowledge, findings proving that online social information seekers
are mainly females. However the gender imbalance raises the question of whether the
differentiated presence as well as the gendered use of the internet regarding social
information, dimensions that need to researched on din another research.
The email interviews were semi-structured, such like interviewing form being
characterized by its openness and it’s enabling the interviewer to ensure that all themes rose
as well as narratives provided by interviewees. The guide of the interview focuses on the three
main issues namely; the traits, context as well as the implications of the internet for social
information reasons. Though initially, this method was being considered as secondary source
of data collection, the relations that interviewees have with their doctors, in real sense
constituted the major theme. One after the other, topics was all discussed. The process of
exchanging questions, and answers having no pre-judged other than just following a style that
is far much conversational style.

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Analysis
The most appropriate application to the interview data according to, (Boyatzis, 1998,
Flick, 1998) is thematic analysis. The application consists of encoding qualitative information
through creation of several themes that usually organises a number of themes that have the
capability of organizing qualitative observation as well as describing the data into coherent as
well as meaningful ideas and constructs, which forms the foundation for the interpretation for
such like data. At first, themes were organized following the interview guide before being
elaborated into further subdivided themes that offers the coding foundation, under which
further themes that were created inductively were also integrated, (Flick, 1998).
Normally, formal informed consent is much important for all qualitative research
methods in social care practices apart from participant observation, no matter the sampling
method that was used in the identification of potential participants and the strategies used
during their recruitment. The number of project-specific factors at ultimately upon a provably
ethics committee, determines whether informed consent is written or oral. At the recruitment
stage, obtaining informed consent for qualitative research involves clearly explaining the
project to potential study participants.
Ethical Issues for the Conduct
The best protection of the subject interest and well-being is the protection of their
identity. If revealing the behavior or the responds harm them then adherence to this norm is
important. The two principles involved include anonymity and confidentiality.
The research subject is perceived anonymous when the researcher can’t associate a
given data with the individual. Anonymity highlights several potential difficulties. The studies
that involve field observation methods usually ensure that the research subjects are not

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known. Researchers might also expand access to nonpublic reports from both governmental
and non-governmental organizations agencies in which the names of individuals have been
uninvolved. An example is a web based survey in which no log in or other identifying data is
needed. The subjects anonymously fill the questionnaires that are then tabulated. Promising
anonymity makes it difficult to keep record of which sampled subjects have been interviewed.
Sometimes the value of anonymity is worth paying. Other methods of information collection
make it impossible to assure anonymity for the respondents. Confidentiality comes in when
the researcher links the data with the individual but promises not to do so in public. In a study
of self-reported drug use, the researcher is in a position to make it open the use of illegal
drugs by a given subject but the subject is guaranteed that it will not happen. Research using
police or court reports that contains individuals’ names might protect the confidentiality by
not including any leading information. All names and addresses data gathering forms should
be interchanged by identification numbers and master identification files made to link
numbers to names to allow latter corrections missing information, (LoBiondo-Wood, &
Haber, 2006).
Confidentiality comes in when the researcher links the data with the individual but
promises not to do so in public. In a study of social care practice, the researcher is in a
position to make it open so that it can be used by a given subject for the benefit of the
respondent, but the subject is guaranteed that it will not happen. Research using reports that
contains individuals’ names might protect the confidentiality by not including any leading
information. All names and addresses data gathering forms should be interchanged by
identification numbers and master identification files made to link numbers to names to allow
latter corrections missing information.

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Impacts
Many studies have exploited the complicated effects and contradictory roles of the
internet in changing the social care delivery as well as physical-physician relations. The
increase in internet-social “care consumers”, (Akerkar, 2004), suggested that, there has been a
shift of power within the social care relationships. To the advantage, the web social care
information, has led to an emerging consumerist model in which patients might more
effectively partner with their physicians in managing and being more responsible for their
own care. In the literature, the internet has been depicted in literature as being very rich in
information for patients and physicians a like. On the other hand, literature explains that
internet has side effects on social care practice provision, as providers try to meet patients,
current and evolving expectations, (Coiera & Eiser 1996). Physicians have now started
encountering patients who expect them to interpret their web-acquired information, (Kassirer,
2000). As an effect, the manner in which online social care information is presented and
looked upon in the social care encounter can influence both the course of the physician-
patient relation, and possibly, the clinical outcomes. According to (Gerber, 2001), more
research ought to be done to examine the real nature of the impact of the information obtained
through the internet on social care decision-making processes.
The social care information on the web has made patients more informed, hence better
social care outcomes, as well as more appropriate use of social care resources, (Gerber, &
Eiser 2001. On line resources are being utilized to encourage patients to partner with their
physicians in new and innovative way. It has been found that, patients who use internet social
care information are becoming more likely to comply with prescribed treatment plans. Some

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social care related websites offer email advice don a fee for service basis while others for
instance British Medical Journal provides free access to information’s.
In addition, internet social information has offered opportunities for the improvement
of physician –patient relations. Through sharing the burden of responsibility for knowledge as
well as enhancing information in general. There has been an emerging pattern of cooperation
as well as team work which the internet0-based patient education might be beneficial
mutually, (Pemberton & Goldblat 1998). The internet can empower patients and increase and
raise their social problems control sense. This has been achieved through the provision of
attitudes, knowledge as well as self-awareness necessary to make informed decision. Some
social care professional have postulated that, such like empowerments alerts patients to
significant symptoms at an earlier stage and encourage them to look for care.
According to Eysenbach & Diepgen 1998, the internet has ensured that the relationship
between the patient and the physician has been transformed making sure that patients have been
empowered through medical information. Internet has ensured that the physician rare no longer
the sole holder of the medical information as it has helped it to be shared online. This sharing f
the information has turned the relationship of both patient and the physician to be more intimate.
However, though the patients hold more information about the medical service, the physician has
to ensure that they give their insight and their experience on the matter to ensure that the
information relayed to the patients is correct. They should ensure that accurate and precise
representation of data on the internet for proper interpretation (Eysenbach & Diepgen 1998).
Internet has emerged as the newest method according to Robinson et al. 1998, of the
patient source of medical knowledge. For example, in a country like United State of America,
about half the adult access the internet for medical information. This makes internet a very

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important patient-physician interaction site that should be taken with a lot of seriousness.
Therefore, internet has brought a great impact especially in the medical decision making process.
This is due to the increased knowledge of the patient prior to visiting the health care centres. The
knowledge gathered by the patient about the medication and the prescription of drugs, ensures
that patients influence the decision made in the medical process. This is because the patients’
posses’ knowledge of the prescription and the preferences prior visiting the health care clinic
(Robinson et al. 1998).
The internet has ensured that the patients are able to receive good health care services and
good relationship with their doctors. This has been made possible by ensuring that the doctor can
give the patient information of how to use certain medication and in turn, doctors is capable of
getting feedback from the patient without necessarily visiting the patients (Eysenbach & Diepgen
1998).
Disadvantages of internet on patient-physician relationship
Primarily, the internet may not always be the cause of good relationship between the
patient and the physician. It may also have a negative impact on the way the two parties relate.
First, the physician may feel overwhelmed by the idea that the patient are in position to question
their medical services through the information that they have about the medication. They may
feel threatened by question that emanate from this knowledge according to Robinson et al. 1998.
This relationship may turn sore as the physician may feel that their knowledge advantage is
decreasing leading to them being unprotected towards knowledgeable patients. This will have a
negative impact on the relationship the parties were enjoying before the era of internet. In
addition, may physician who are a little bit older and are not well conversant with computer may

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feel that the patient are more proficient with computer than they are. This make them feel
outdated in the service delivery making their relation with the patient sour.
Response towards the internet
According to the article by the Department of Family Medicine called ‘The E-Patient’, it
supported the internet usage to improve the relationship of the physicians and the patient.
However, it proposes the accuracy of the information should be paramount to ensure that the
patients are collectely informed about the medication to suppress collisions. They also advocate
for the physicians to be trained to ensure that are able to give information online to ensure that
they do not feel outdated due to technology (Robinson et al. 1998).
Critique
The internet information quality can highly vary; this limits its use as viable source of
information. Depending on its source, social care information might either be misleading or
misinterpreted. This might lead to comprising social behaviors as well as social care results.
Such misinformation might result to inappropriate request clinical interventions, or
unnecessary anxiety or even preventable morbidity or say mortality, as an effect, high quality
information is rendered useless if patients are overwhelmed, (Kiley, 2002).
Another thing is, some social-economic groups might be limited in accessing the
internet. It is true that, seeking information on social care on the internet is affected by social
economic groups, for instance younger, healthier and educated. These having low literacy and
are living in areas with no power, might be disadvantages in accessing the internet.
To solve such like problems, resources and creative strategies need to be directed
towards providing connectivity and access to information technology and power to
economically depressed areas. This will ensure all individuals are active participants in the

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information age. In addition, there should be a body of social care professionals to asses the
information concerning social care practices that are posted on the internet. This will at least
reduce the social care information variability.
The critiques of the article have mentioned that the hypothesis used in coining that the
older physician may not be proficient in the computer is not effective. They also cited that the
internet might not pose much of the problems, as most of those who use it are enlightened
individuals who are capable of disseminating medical data on the internet with ease.
Impact of Location of the research
The location of where the information affects the recommendation to be made. This is
because, the final recommendation will depend on the data collected. Therefore, if the
information is gotten from an area with more internet access, it may give a wrong overall picture.
Otherwise, regardless of lack of the internet in some places especially in the third world
countries, internet poses good penetration in such areas. In future, it will be very helpful as the
source of medical information to the patients

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