Evidence-based Culture Research Articles

Reflections on caring as a virtue ethic within an evidence-based culture

Reflections on caring as a virtue ethic within an evidence-based culture

The Quality of Qualitative Research

QUALITY RESEARCH This book opens by encouraging readers to refrain from engaging too intensely in research methodology for fear that this might stifle creativity and paralyse the budding enthusiast. The book assumes readers will already be familiar with the philosophies and methods underpinning qualitative approaches. It is not a handbook of methods, though there is an excellent chapter on writing-up qualitative studies. Its strength lies in re-visiting the assumptions of qualitative approaches and giving new insights into issues such as reliability and generalisability in qualitative research. For this reason, it is not only valuable for anyone studying at a post-graduate level but practising researchers in health services who, in our evidence-based culture, struggle with the problem of the credibility of qualitative approaches. The book will also help those engaged in evaluation of services and those developing so-called ‘softer’ outcome measures of service delivery. There are summaries at the end of chapters and an appendix that includes learning exercises. Many of the points made are illustrated by examples from actual research projects. However, this is not a text I would recommend for the first time qualitative researcher. Despite its clear style, researchers who are more familiar with the qualitative approach will get the most out of this book.

Incompatible skills and ideologies: the impediment of gender attributions on nursing research.

The evidence-based care culture requires that ritualistic treatment interventions are subjected to scientific scrutiny, with the ultimate intention that clinical practice should have empirical rather than historical justification. Despite initiatives to increase research output, there is evidence for a continued research/practice rift. One explanation for this that has relevance for the present paper is the perceived conflict between the skills and ideologies associated with clinical nursing and research. More specifically, it would seem that the characteristics demanded by high quality nursing are diametrically opposed to those required by research, such that research activities may be perceived to be inappropriate within the traditional nursing role. Formal gender-role schemata may also contribute to the theory-practice gap, insofar as nursing embodies qualities that are essentially female-associated, while research requires attributes associated with masculinity. These conceptualizations are derived from two studies based on central trait theory, which involved participants in making assumptions about a range of qualities of hypothetical candidates for a nursing post, who were described either as a good researcher or a good clinician. The hypothetical candidates in the first study were female, but in the second were male; in both cases the participant raters were female. It is, however, conceivable that rater-gender impacts upon assumptions of personal and professional attributes of clinical and research nurses. In order to investigate this contention, the present paper manipulated the gender of the raters, whilst replicating the previous studies in every other way. Analysis of the data using a series of 3-way ANOVAS suggested that there were some significant effects of rater and candidate gender, as well as of clinical/research descriptors, especially in terms of ascribed kindness, compassion, ambition and success. The results are discussed in relation to gender role stereotypes and nursing research.

Clinical effectiveness and EBP3: application by health-care professionals

The move towards an evidence-based culture within the NHS has been encouraged by a number of policy-led initiatives in recent years. However, it is not clear whether these developments have impacted upon practice. The current study set out to examine the application of evidence-based practice in a large, representative sample.

Evidence-based educational commissioning and policy making: A case for the prospective use of a psychometric approach in defining the role and preparation of the nurse practitioner in Australia

The concept of evidence-based care and the profile of the nurse practitioner (NP) have together assumed mounting importance as possible solutions to the problem of meeting escalating demands for high quality health care with decreasing resources. With regard to the former, concerted efforts to ensure that clinical practice has its base in scientific evidence, have resulted in health care delivery that is increasingly informed by research rather than ritual and tradition. This success notwithstanding, health management and policy-making have remained grounded in assumption, principally because of the paucity of available research in these areas. With regard to the NP, there is little agreement regarding the boundaries of professional practice and preparatory education, both of which need to be defined to some degree at the local level, if the health needs of the indigenous population are to be met. If these two issues are integrated, the policies regarding the preparation and occupational scope of the NP could incorporate research-based decision-making, and thus could simultaneously develop the NP according to locally specified needs, as well as meeting the requirements of the evidence-based care culture. This paper discusses a psychometrically valid and reliable instrument that has the capacity to provide research data which can inform strategic thinking regarding the definition, education and operation of the NP at a variety of levels. The technique has been used extensively in the UK, repeatedly demonstrating its value in NP educational commissioning. While the instrument has not yet been used to inform NP education in Australia, it has been administered to a cohort of acute sector nurses in Victoria. It is argued that the relevance of the instrument to the Australian health system, coupled with its proven importance in the development of the NP in comparable health care cultures, makes this approach worthy of consideration for the preparation of the NP for a variety of Australian health contexts.

Evidence-based care in nursing: reforms versus research, rhetoric versus reality.

The new evidence-based health care culture, together with nurses' demands for enhanced professional status, has embedded within its strategy the imperative to develop a corpus of nursing-specific research. These apparently compatible aims were intended to meet the need for enhanced professional status while at the same time enabling clinical nursing practice to be justified on scientific grounds. While the dual reform agendas brought with them the resistance that always accompanies radical amendments to the status quo, they also seem to have created an unanticipated reciprocal antagonism which has impeded the development of nursing research. The policy changes that were necessary to meet the prerequisites for professional status have had a detrimental effect on the potential for generating an adequate body of nursing research. This second paper discusses some of the key reforms to nursing that have been implemented over the last decade and their impact on nursing's progress towards creating its own esoteric research knowledge base that could inform clinical care. It is suggested that policy and research may be diametrically opposed, and that nursing, if it is committed to professionalization, may have to reconsider its allegiance to the scientific research culture in favor of achieving some of the other objectives on its agenda.

Scientific basis of health services.

The Research and Development (R&D) programme in the National Health Service (NHS) is probably the first systematic attempt in any country to prioritize health care needs for R&D. The aims of the programme are described by its founding director, Sir Michael Peckham, in Research for health, and the essence of the enterprise is to identify pressing research questions requiring R&D solutions, rather than leaving the direction of research to investigators with vested interests. Although this needs-led approach to R&D funding is not without its critics, it is an essential component of an evidence-based medical culture which emphasizes the scientific basis of clinical practice. Indeed, the Scientific Basis of Health Services was the theme of a highprofile international conference held in London recently, which both affirmed the importance of developing a research base for the provision of health care and celebrated the considerable achievements of Peckham's NHS R&D programme. As well as emphasizing needs-led rather than investigator-led research, the R&D programme also underscores the importance of the sciences of implementation and evaluation. Applicants for funding in most of the initiatives in the programme have to consider not only the relevance of the research to the NHS, and the health gain that the results of research would bring, but also need to submit proposals relating to the dissemination and implementation of the research, and some thoughts about the way in which new research information can find its way into clinical practice. The mechanism for setting priorities for R&D in the NHS has recently been described. The Central Research and Development committee selects key topics, some of which are related to the health care priorities laid out in The health of the nation and expert advisory groups are set up to seek, through wide consultation, the most pressing research questions in the area of interest, and to advertise for and commission research into them. The priority topics so far identified include mental health, cardiovascular disease and stroke, maternal and child health, the primary:secondary care interface and physical and complex disabilities. In addition a health technology assessment programme continues to identify innovations in the delivery of health care,