Читать книгу Preparing for Professional Practice in Health and Social Care - Группа авторов - Страница 12

Acquiring knowledge and keeping it up to date requires an understanding about how practitioners gather and evaluate knowledge that apply to their area of practice. The most pervasive method of judging the relevance of information in today’s healthcare decision making is referred to as EBP (Sackett et al. 1996). This is commonly defined by linking the realms of best evidence, clinical expertise, and patient interest.

As an Allied Healthcare Professional it is essential that everything you do is based on best evidence. The aim of pre-registration graduate training is to start the process of developing evidence-based literate graduates. This is a process that will never end, since we are constantly looking to evidence what we do and to refine the skills we have been taught, and of course to build capacity within the professions to improve quality and effectiveness of practice. Simply using whatever research evidence you happen to obtain from reading the few journals that you subscribe to is not going to sufficiently meet your information needs or keep you updated (Hoffmann et al. 2013, p. 3).

So why is EBP so important? The easiest way to answer that question is to consider whether you would trust a doctor who prescribed you a drug without knowing whether it was effective or had gone through rigorous testing to ascertain its safety and reliability. For service users, they need to trust that our interventions will not cause harm and that we are using the best guidance and evidence. When the outcome of treatment is harmful in some way, the non-evidence-based approach strays into the realms of professional negligence if a treatment regimen was pursued contrary to the evidence. In a world where patients are better informed about standards of care, litigation in healthcare is becoming increasingly common. A second problem is bias. A non-evidence-based approach relies on the knowledge and experience of the individual, which is naturally subject to personal preference and prejudices, some of which will not be evidence-based.

EBP therefore has an issue with knowledge, how it is generated, and what type ‘counts’ (Rycroft-Malone et al. 2004). It discounts or significantly downgrades knowledge that is generated in ways other than those that adhere to a very positivist view of epistemology. In other words, knowledge that is demonstrated by testing established theory. Unfortunately, practice does not always fit into neat puzzle packages to which there are simple solutions. Knowledge that is propositional and derived solely from isolating causes and measuring their effect might not be sufficient to produce effective care. Professionals therefore have to have a way to judge and develop all types of knowledge used in care, to be effective. This gap in the process of decision-making requires an understanding of how knowledge is generated and how we are able to judge the relevance of information to a healthcare question. Reflection is key to interpreting the different types of knowledge applicable to each of the major domains of EBP. Change in one type of knowledge impacts the other.

It is essential that AHPs utilise critical appraisal skills to determine the quality of the research since often evidence is of a poor quality. The aim of a systematic review of the effectiveness of an intervention is to collate all the relevant trials on a given question. Systematic reviews represent the best evidence on the effects of interventions. Meta-analysis is the statistical technique for assembling the data from several studies in a review into a single numerical estimate. There is also a move to valuing systematic reviews of qualitative research as well as mixed-methods research.

Questions that need to be asked of evidence are:

Validity – can you trust it? Impact – are the results clinically important? Applicability – can you apply it to your service users?