Research and Evidence-Based Practice: For Nursing, Health and Social Care Students
178
Research and Evidence-Based Practice: For Nursing, Health and Social Care Students
178eBook
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Overview
Through clear explanations, key case studies, questions and activities, the book will help you to understand the principles of research and develop your own evidence-based practice. You will learn:
- Why research is carried out, what the aims are, and why it matters.
- How to search and review the literature and evaluate the quality of research
- How research projects are designed, how participants are recruited, how data is collected and analysed, and how research findings are communicated
- About the costs of research and how it is funded
- About the ethics of research in health and social care
- How to review evidence and how evidence is used to improve the quality of care
From reviews:
“I would definitely recommend this book to any student starting a research module or even to refresh your memories ready for your dissertations/literature reviews. The content included is everything I would want to know as a student starting a research module. The glossary at the back is great for understanding the research terminology, which can often feel like a brand new language when you first start reading research papers. There are also handy references which you can use to do further reading and enhance your critical discussion within your assignments.
The book lives up to its intention to act as a lead-in to the research topic and has a clear and concise style throughout, whilst explaining things in the amount of detail needed to fully understand them. A must read for any nursing or health and social care student!”
Review on studentnurseandbeyond.co.uk, March 2019
Essentials is a series of accessible, introductory textbooks for students in nursing, health and social care. New and forthcoming titles in the series:
- The Care Process
- Communication Skills
- Leadership
- Mental Health
- Promoting Health and Wellbeing
- Study Skills
Product Details
| ISBN-13: | 9781908625601 |
|---|---|
| Publisher: | Lantern Publishing |
| Publication date: | 01/25/2019 |
| Series: | Essentials |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 178 |
| File size: | 2 MB |
About the Author
Vanessa Heaslip is a Professor of Nursing and Healthcare Equity at the University of Salford, and a visiting Associate Professor in the Department of Social Work at Stavanger University, Norway. She has extensive experience in nursing and nurse education and is an experienced qualitative researcher. Her research interests focus on socially excluded groups whose voices are not traditionally heard in the academic or professional discourse, as well as experiences of marginalised communities who experience inequality of opportunity in accessing statutory services. Professor Heaslip has contributed to many books and has written journal articles, editorials and discussion papers. She is also on the editorial board of the Journal of Clinical Nursing and writes regular reviews for a variety of nursing and academic journals, based on her expertise in qualitative research, socially excluded groups, marginalised communities, equality and diversity.
Bruce Lindsay worked in health care for over thirty years after qualifying in children’s nursing and adult nursing in Sheffield. He was awarded a PhD for his research into the development of the care of children in acute hospitals. He was a Senior Lecturer and Deputy Director of the Nursing and Midwifery Research Unit at the School of Health Sciences, University of East Anglia, until 2012, and was a systematic reviewer for Cochrane for fifteen years. He is now a freelance music journalist and biographer.
Read an Excerpt
CHAPTER 1
Identifying the research aim
LEARNING OUTCOMES
When you have completed this chapter you should be able to:
1.1 Explore why society wants health and social care research
1.2 Discuss why researchers carry out research
1.3 Understand what is studied by researchers
1.4 Understand different aims of research.
1.1 Introduction
Every research project has an aim, which clearly presents the purpose of the research. A well-written research proposal will make this aim clear to potential sponsors or supervisors of the project. In the same way, a well-written research paper or report will make its aim clear to readers and potential users of the study's findings. But this overt, openly declared, aim may not be the only one.
In this chapter, we will look at three types of research aims. Firstly, we will consider the aims of health and social care research as a whole, including why health and social care research is carried out at all, and why it is seen as important for practice and worth spending so much money on every year. Secondly, we will consider why individual academics or professionals undertake research projects or, in some cases, devote their entire careers to research. Thirdly, we will discuss the aims that apply to individual research projects, including both the stated (explicit) aims and the unstated (implicit or hidden) aims. We will analyse the impact that unstated aims can have on research design; we will also consider why it is so important to take these hidden aims into account when we evaluate a research report.
1.2 Why does society want health and social care research?
1.2.1 Reflections from Dr Bruce Lindsay
From what I can remember, I was taught nothing about research when I was a student nurse. I have no recollection of lectures on reading research papers, understanding statistics, or critiquing research designs. My tutors, nurses and doctors alike, made few if any references to research findings during classes and my written assignments were not constrained by the need to include long lists of research papers. During practical classes and placements I was taught the 'right' way to perform a procedure, set up a dressings trolley or administer medications. No one ever explained why this was the 'right' way, except perhaps by referring to 'experience' or 'custom and practice'. I don't remember questioning my tutors, even when this approach to my education and to health care produced rather ridiculous practices, such as those described in Key Case 1.1 and Key Case 1.2.
As a staff nurse, I was never called on to back up my actions with reference to research evidence and my early years as a clinical teacher were also almost totally research-free. This is not to say that no health and social care research was being done. The Royal College of Nursing had commissioned some major research projects in the mid-1970s, for example. But this rarely seemed to have any impact on my work in a series of provincial hospitals. The amount of health and social care research being undertaken started to expand more rapidly in the 1980s and 1990s, but as late as 1998 Margaret Ogier remained pessimistic about its impact on nursing: '... it is doubtful that research findings are being widely used to inform everyday practice ...' (Ogier, 1998, p. 5).
1.2.2 Reflections from Dr Vanessa Heaslip
As one of the Project 2000 student nurses whose nurse education was based at a university, during my training (1993–1996) there was beginning to be more emphasis on utilising evidence within our practice. We were introduced to, and learnt to really value, books such as the Royal Marsden Manual of Clinical Nursing Procedures, which presented a variety of clinical procedures. During my training and the early days of my career, I was conscious of the need to provide an evidence-based rationale for my decision making. There were also times when I was driven more by the evidence and subsequently had to adapt my practice to fit both the patient and the clinical context (see Key Case 1.3).
In the above reflections, we have shown the gradual move towards an 'evidence-based' approach that has occurred in health and social care practice over the last few decades. This has made it even more crucial for practitioners to understand how to make use of research.
Whether you are already qualified, or still studying to become a health or social care practitioner, you therefore need to develop some skills in reading and critiquing research evidence. Much of our teaching for undergraduate and pre-registration students is about research, or it makes use of research findings. Students are expected to refer to research findings and other evidence in their assignments; and practice assessments require students not only to perform skilfully in practice but also to support their actions by referring to evidence. For all these reasons, today's health and social care professionals are expected to be 'research aware' (Moule & Goodman, 2009, p. 1). This means that you need to be able to:
* Search for and identify evidence
* Have an understanding of research and the research process and use this understanding to read and critically analyse the evidence
* Translate your understanding of what you have read into the professional practice context.
Although research is not the only source of evidence, it is an extremely influential one. Governments, international organisations, professional bodies, charities and individual patients and clients expect care to be evidence-based and expect much of the evidence to come from research. There are many complex reasons behind this move away from accepted custom and practice towards a demand for research evidence, which are beyond the scope of this book. However, we think the most important reasons are that:
* The public no longer trusts health and social care professionals to do what is best and this distrust has been fuelled by very high-profile media reports of cases of poor-quality care
* Professionals are conscious of the risk of being sued and want clear evidence for their practice
* Emerging health and social care professions want to create their own evidence for their profession, to develop and contribute to their profession's knowledge base
* Governments demand clear evidence before funding expensive new treatments or care strategies.
If health and social care research (in its many different forms) has a single over-arching aim, it is therefore to create evidence. However, while there is undoubtedly some truth in this statement, it is too simplistic to be of any real use in understanding individual research projects. For this reason, we also need to consider the aims of those who do research, those who pay for it and those who seek to apply it to practice. We will consider these in the next few chapters.
1.3 Why do researchers do research?
If society demands health and social care research, then society also needs people to carry it out. These people are called 'researchers', but it is a mistake to think of researchers as a single group, with similar backgrounds, skills and intentions. People do research for many different reasons.
1.3.1 Who does research?
Health and social care research is done by people from many different backgrounds. Social scientists, statisticians, behavioural scientists, historians, health professionals and social care professionals all regularly undertake health and social care research. Some will be career researchers, devoting their entire working lives to researching various aspects of health and social care. At the other extreme, many health and social care professionals will undertake one or two small-scale research projects while they are students. They never again take part in actual research but will still use research findings to inform their practice.
The typical health and social care researcher probably sits somewhere between these two extremes, combining research with practice and/or teaching. In our case, we spend about half our time teaching and half on research. Other researchers may work mostly in practice, doing occasional research projects and some teaching. People also have many different reasons for doing research.
Many researchers like to think that their work will make the world a better place. Without wishing to sound too cynical, some research projects may indeed end up 'making the world a better place' but that is unlikely to be a researcher's primary reason for undertaking it in the first place. Other, more mundane, and less altruistic, reasons usually lie behind an individual's decision to undertake a particular research project. Here are some examples:
* We're fascinated by a particular topic or subject, such as the cardiovascular system, or viruses, or the reasons why people take drugs or become criminals
* We have a theory we would like to test out, such as a possible link between eating fruit and the ability to play chess
* Our employment contract ends in a few months and we need to get a research grant in order to extend our contract for another year or two
* Our job requires us to publish at least two research papers each year
* We want to develop our reputation in our chosen field of health or social care
* We want to generate new understanding and new professional knowledge.
Or maybe we really do want to make the world a better place!
1.3.2 Does the reason matter?
When you are a practising health or social care professional, you need a source of high-quality, reliable evidence. So does it matter why the research was carried out, as long as the findings are useful? We suggest that it does, because different reasons for doing research have an impact on what is studied, why it's studied and how it's studied. The availability of research is directly linked to the reasons why research is done.
In a perfect world, we would know everything. In an almost perfect world, researchers would study those subjects that would be of most benefit to the well-being of individuals and society at large. They would be able to fund all the necessary research and they would have the skills and resources to carry out their research effectively. In a less than perfect world (like this one) other issues arise.
For example:
* Researchers' personal interests do not always match the issues that are of most potential benefit to society
* Researchers don't always have the skills to undertake research in the way they would wish
* Funding organisations have their own agendas and may not wish to fund research in certain subjects, however important others might believe them to be
* Health and social care questions can be extremely complex and we do not yet have a sufficient range of research methodologies available to answer them all.
Many researchers strive to undertake projects that offer maximum potential benefit for patients or clients but, once real-world issues are taken into account, few researchers actually develop research activities that achieve this aim.
1.4 What will be studied?
Just as there are many reasons for doing research, there are also many reasons why some subjects are heavily researched and some (which are apparently equally important) receive little attention. Decisions about which aspects of health and social care to study are particularly affected by issues such as:
* Changing public, political or professional ideas about the relative importance of particular subjects
* Emerging threats to current health and social care provision
* New sources of research funding that become available for research into specific topics
* New roles for health and social care professionals.
1.4.1 Changing ideas
In the mid-1980s, British health professionals, politicians and members of the public viewed Acquired Immune Deficiency Syndrome and Human Immunodeficiency Virus (AIDS/HIV) as a major threat to health. Its apparently sudden appearance in western societies and its devastating effect on health meant that many people saw it as the single biggest health threat we faced. Research projects developed across the world, including many in the UK, and the British government allocated large sums of money to fund research. By the mid-1990s, AIDS/HIV was no longer viewed with such alarm by the British public. It therefore became far less politically important and, even though it remained a major international threat to health, research into AIDS/ HIV fell sharply.
1.4.2 Emerging health threats
New threats have since appeared, overtaking AIDS/HIV in the minds of the public. Since the mid-2000s, we have seen the emergence of major public health concerns regarding nutrition, obesity, dementia and frailty (in response to the increased number of older people requiring health and social care), as well as concerns about antimicrobial resistance (due to bacteria becoming resistant to treatment). In response to this, the 2018 research priorities for the National Institute for Health Research (NIHR, 2018a) are dementia and antimicrobial resistance, as well as areas identified by Priority Setting Partnerships. These partnerships enable clinicians to work alongside patients and carers to identify areas where there is currently a lack of evidence regarding specific treatments and from this to jointly develop a list of ten priority areas. This list informs researchers and research funders about the concerns of both clinicians and the public and helps ensure that any research undertaken or funded will have a big impact and be meaningful to society as a whole.
1.4.3 New sources of funding
Changing ideas and new threats can alter the ways in which research funds are allocated. Occasionally a new (rather than reallocated) source of research funds appears and this changes the way in which money is awarded and shifts ideas about which research projects are appropriate. The emergence of the National Lottery is a good example of a major new source of funding for research. Money from the Lottery is awarded through bodies such as the Big Lottery Fund (BLF) and the Heritage Lottery Fund (HLF). Much of the BLF is used to fund research into health and social care, whilst the focus of the HLF is to make a difference to heritage, people and communities, including health and social care projects linked to heritage. Since their inception, both BLF and HLF have awarded thousands of grants. During 2016–17 the BLF funded 13,000 National Lottery grants, totalling in excess of £712 million (Big Lottery Fund, 2017); whilst during 2017–18 the HLF will be spending a projected £300 million on research grants (Heritage Lottery Fund, 2017).
1.4.4 New roles
The creation of new, or substantially different, roles and responsibilities for health and social care professionals also creates new research priorities and opportunities. Over the last twenty years, we have seen the development and expansion of nurse practitioner and nurse consultant roles, as well as the development of paramedics and emergency care practitioners. More recently, there has been an increased focus on the development of clinical academic careers, enabling clinically based practitioners to develop knowledge and expertise in research which can be used to generate new evidence as well as enabling the NHS to develop the research leaders of the future. Within social care, there have been similar developments as new ways of managing and delivering social care have been implemented, which have in turn affected the ways in which social care practitioners work.
1.5 Who makes the decisions?
At an individual level, researchers have professional and academic backgrounds, personal experiences and skills, and preferences for particular paradigms or methodologies. Each researcher will therefore tend to focus on specific subjects, issues or questions and will tend to approach them in a rather limited range of ways. We know few, if any, researchers who are equally comfortable carrying out randomised controlled trials of drugs and phenomenological studies of people's experiences of residential home care, for example.
Also, researchers in academic institutions are affected by the research aims of their own institution. Most university departments hope to develop a reputation in a particular field and will therefore actively encourage their staff to carry out research in that field. For instance, a social work department may decide to focus on the study of children and families rather than the study of older people, or a medical school might decide to study infectious disease or public health, rather than malignant disease or congenital problems.
(Continues…)
Excerpted from "Research and Evidence-Based Practice"
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Copyright © 2019 Vanessa Heaslip and Bruce Lindsay.
Excerpted by permission of Lantern Publishing Limited.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
About the authors; Introduction
Part One: Understanding research
1. Identifying the research aim
1.1 Introduction
1.2 Why does society want health and social care research?
1.3 Why do researchers do research?
1.4 What will be studied?
1.5 Who makes the decisions?
1.6 What do we want to find out?
1.7 Achieving success
2. Reviewing the literature
2.1 Introduction
2.2 Why does a researcher need to know what's already available?
2.3 Understanding the context
2.4 Understanding the existing evidence
2.5 Can I justify my project?
2.6 Carrying out the literature review
2.7 Developing a search strategy
2.8 Searching databases
2.9 What else should be searched?
2.10 Evaluating quality
2.11 Conclusion
3. Designing a study
3.1 Introduction
3.2 The three levels
3.3 Making sense of the levels
3.4 Paradigms
3.5 Methodologies
3.6 Method
3.7 Tools
3.8 The research hierarchies
3.9 External influences
3.10 Making the final choice
4. Can it be done? Funding and ethics
4.1 Introduction
4.2 Who funds research?
4.3 How much does research cost?
4.4 Ethical issues in health and social care research
4.5 Gaining ethical approval
4.6 Public engagement in research
4.7 Reading research - identifying ethical issues
5. Recruitment and data collection
5.1 Introduction
5.2 Recruitment issues
5.3 Participants or subjects?
5.4 Developing inclusion and exclusion criteria
5.5 Selection and sampling
5.6 Sampling
5.7 How big should the sample be?
5.8 Attrition
5.9 Obtaining consent
5.10 Giving rewards
5.11 Data collection
5.12 Data collection tools
5.13 Issues in data collection
5.14 Confidentiality and anonymity
5.15 Conclusion
6. Data analysis
6.1 Introduction
6.2 Quantitative and qualitative analysis: the same but different?
6.3 Quantitative analysis
6.4 Measurement scales
6.5 Types of statistical analysis
6.6 Major methods of quantitative analysis
6.7 Conclusion
7. What do we know now? Communicating research findings
7.1 Introduction
7.2 What can research tell us?
7.3 Limits to research accuracy
7.4 Building a body of research
7.5 Disseminating research
7.6 Conclusion
Part Two: Evidence-based practice
8. Reviewing the evidence
8.1 Introduction
8.2 Reliable, valid, relevant and applicable?
8.3 Relevance and applicability
8.4 Research synthesis
8.5 Evidence from other sources
8.6 Role of the service user
8.7 Conclusion
9. Putting the evidence into practice
9.1 Introduction
9.2 The relationship between evidence and practice
9.3 Top-down or bottom-up?
9.4 Changing personal practice
9.5 Practitioner inquiry
9.6 Action research
9.7 Conclusion
10. Audit and evaluation
10.1 Introduction
10.2 Audit and evaluation: what are they?
10.3 Differentiating between audit, evaluation and research
10.4 When to audit or evaluate
10.5 What standards matter?
10.6 Involving services users in audit and evaluation
10.7 Conclusion
11. 'Closing the circle': issues for the future
11.1 Introduction
11.2 The speed of change
11.3 New and forthcoming developments
11.4 Predicting, creating and dealing with change: the place of research
11.5 The international nature of health and social care
11.6 Who will be the health and social care researchers of the future?
11.7 Conclusion
Glossary; References; Index