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Preface

Background

Demographic, economic, political and environmental changes have been taking place at a phenomenal pace, nationally and internationally. Many of these changes affect people's needs for health care. At the same time, the demand for health care mounts from a more informed public having access to information from online sources and websites. Campaigns for safe and speedy intervention determine the treatments available and those yet to enter the health care system. The twin axes of patients' safety and the personalized treatment they need require nurses and health care professionals to be confident in the use of statistics, for example, in calculating dosages in oral, liquid, tablet, intravenous, intramuscular and subcutaneous forms. Nurses and health care professionals should be familiar with the meanings and significance of the numbers they encounter in the context of the care they provide.

While it is estimated that there are already approximately 35 million nurses and midwives worldwide contributing to the total health care workforce, there are increasing numbers of other persons seeking to acquire nursing skills at different levels and in a variety of settings, for example, in hospitals, in the community, in the workplace and in people's own homes. One approach to increasing the number of people entering nursing has been to expand the educational programmes. The Long‐Term Plan for the NHS (2019 ) backs six routes into nursing, including a degree course and a pilot accelerated postgraduate programme.

In the United Kingdom, professional regulatory bodies, such as the Nursing and Midwifery Council (2018 ) established evidence‐based proficiency standards of care to underpin pre‐registration nursing education and practice. The proficiency standards of care require, amongst other forms of knowledge and skills, an understanding of relevant research and statistics.

Changes in the Context of Health Care

The context of health care is changing, most notably between primary care/home/community‐based services and those provided in acute hospitals. Public expectation of wellness and patterns of disease have also changed, for example, patient referral with symptoms indicative of cancer is more rapid, leading to quicker diagnosis and treatment. At the same time, opportunities created by the development in pharmaceutical services and technological advances combine to increase the pace of change in nursing practice, pointing to the need for nurses to be prepared to respond in knowledgeable and practical ways, and to do so competently every time.

Technological Imperatives

Technological developments in nursing and health, for example, more efficient electronic imaging machines, e‐booking appointments with doctors in the community, patients' e‐records and complex calculations of dosage makes screening for diseases, diagnosis and monitoring much faster and more accurate. The use of hand‐held electronic devices provides an immediate record and instant feedback to the care team. Patients are likely to benefit from these improvements in the methods of data collection and use of technology by which diagnoses are made and, as a consequence, treatment and care will be more effective. Nurses and health care professionals need to know and understand the data they collect individually and collaboratively. Once they comprehend the data and they are converted into information for them, they must critically appraise the information and use it as the evidence base for their patients' care and treatment plans. Chapters 2 and 3 explain common methods of interpreting data sets with worked examples.

Team Working

Changes in organizational scale, structure and systems make it essential for nurses to work together in teams to provide an integrated care for patients. A Plan of Care, for example, for patients with diabetes, may include an evaluation response of their response to medication – insulin or tablets – according to their age, gender and ethnicity. It could be extended for purposes of research to a comparative analysis of whether tablets or injections are more effective in controlling the patients' diabetes.

Team working in nursing and health care demands close coordination and collaboration, especially as data are likely to be collected from different sources and to require competent computation and analysis in order to arrive at sound clinical judgements. For example, team members have a responsibility to ensure that data about patients' kidneys obtained by computerized tomography (CT) should be placed in the patients' records, even when the scan shows no abnormality.

Nurses working in specialist clinical areas such as heart, thoracic surgery, intensive care, renal endoscopy clinics and cancer centres/units use skills of a highly technical and statistical nature that are described in specialist medical language that carries precise meanings. Nurses in these settings access, interpret and manage health information, and are required to record clinical changes in patients' conditions. Basic statistical principles enable nurses and health care professionals to decide on suitable treatment.

In relation to midwifery, the Institute of Manpower Studies report series 242 by Wraight et al. (1993 ) found that over 40% of maternity services had recently introduced ‘team midwifery’. The practice of team midwifery is now commonplace and requires all midwives to use scientific evidence to underpin the care they provide to women and babies. For example, an understanding of the APGAR score of the baby at birth and in the immediate post‐delivery period is important to a team of midwives operating in the delivery room and the post‐natal area. A baby's APGAR score at birth and, in particular, when there is delay after birth in the baby achieving the maximum score of 10, will require accurate monitoring of heart, pulse and breathing rates. The APGAR scale is explained in Chapter 3 by the well‐known Ordinal Scale.

Modern Ways of Working to Make a Difference

Roles in modern nursing have become more diverse and specialized and carry more responsibility, such as those of the nurse consultant and advanced nurse practitioner. In addition to these senior roles, the organizational context involves an eclectic mix of nurses and health care professionals, assistant practitioners, nursing associates, nursing degree apprentices and practitioners returning to practice. These health practitioners drawn from a variety of educational backgrounds and social settings meet in practice to plan and deliver care that can be complex to organize. Its planning and delivery often require understanding and interpretation of statistical data to ensure care is suitable and safe for patients. The use of hand‐held electronic devices in care settings gives immediate record and feedback to members of the team involved in providing care but it is essential for all involved to understand how the data they collect will be processed for the patients' benefit.

Nurses and health care professionals working in the community and in primary care are expected to provide accurate and reliable health information to patients about health risks and the pattern of disease. As public health workers, they undertake community profiling, health needs assessment, and provide advice about a range of topics, including the control of communicable diseases and obesity.

The requirement of specially trained nurses to prescribe drugs (from the Nurses' Prescribing Formulary for patients) places additional demands for good statistical understanding and skills in order to accomplish the task of prescribing accurately and safely. As the role of prescribing expands in the future, and nurses start to administer a greater range of medicines (Department of Health 1999 ; Nurse Prescribers’ Advisory Group 2017–2019) the need for the use of quantitative methods in nursing will increase.

In the context of care for young children, nurses and other health care professionals know that mothers are likely to be anxious about whether the weight of their child is high, low or within the expected range. The ability of these nurses to understand the principles underlying weight calculations, the influence of the child's length and gender on the weight percentile, analysis of where the child is on percentile lines and what that means puts them in a good position to explain accurately and to reassure mothers. In Chapter 4, Section 4.6 we introduce the idea of centiles and use a growth chart as an example of centiles in practice, based on WHO child growth standards (United Kingdom World Health Organisation 2009 ).

This book on practical statistics for nurse and other health care professionals is an introductory text produced to assist with the growing demand for user‐friendly worked examples that are clear and easily understood, not only by students, but also by busy practitioners. We aim to provide an introduction to the statistical techniques that are in common use in order to provide a solid foundation for those who wish to develop their understanding and nursing proficiency with the possibility of pursuing an interest in research. A glossary of all the statistical symbols used throughout this book can be found in Appendix J.

We acknowledge the contribution made by Professor Lou Cohen through his guidance over the years and whose original style persists in this book.

Jim FowlerPhilip JarvisMel Chevannes