1. Exploring the Concept of Evidence-Based Practice Dr Tina Harris Lead Midwife for Education Adapted from a presentation originally developed by Dr Susan Dyson

2. Aims By the end of the session you should be able to: Articulate the concept of evidence-based practice Appreciate the importance of using evidence to underpin professional practice Understand the principles for determining what is best available evidence

3. What’s in a Word (or phrase) What do you understand about evidence – based practice (EBP) - discuss with your neighbour

4. Evidence-based practice is.. “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external evidence from systematic research” (Sackett et al, 1996:71- 72)

5. Evidence-Based midwifery Practice …involves integrating the best available research evidence with professional expertise while taking account of patient preferences …is a complex undertaking that involves identifying and appraising different sources of evidence

6. Evidence for breast feeding Best way to help a woman successfully breast feeding – What is happening? – What needs to happen to resolve the problem – What is the best way to do this

7. In more detail… We can extend the concept of EBP from individuals to groups of patients, health care services and policy initiatives (Muir Gray, 2004) Ongoing research adds to the `body` of knowledge and ensures the knowledge base for practice is constantly evolving

8. EBP for midwives The onus is on midwives to keep up-to-date with research, both `generic` and `applied`, so as to provide best possible care The evidence drawn on to underpin practice should be in the public domain, open to scrutiny, clinically based, take account of women and their families.

9. Research to underpin EBP Research findings as evidence - Systematic research process should ensure confidence in research findings -All research has limitations, so research reports should be subject to `critical scrutiny` -Evidence drawn from one source is insufficient as grounds for changing practice -Research findings often need considering alongside professional expertise to identify best practice

10. Research findings may be applied directly to practice in the form of clinical protocols or practice guidelines, be used persuasively to present a case for changes in policy or practice

11. Professional Expertise to underpin EBP Professional expertise or `practical` knowledge (derived from professional experience) can inform EBP, when used alongside `technical` or `propositional` knowledge (derived from research) Midwives often draw on these sources of knowledge more often than formal sources, i.e. published research reports

12. Patient experience to underpin EBP Can be `individual` e.g. collected during individual episodes of care or `collective` e.g. collected during group or community participation in health care planning or service delivery Users of health cares services are becoming more involved in all aspects of care using a variety of mechanisms to inform preferences and/or opinions e.g. user forums, satisfaction surveys, internet, NHS organisations

13. Hierarchy of Evidence EBP draws on different types of evidence What constitutes `best` available evidence – the so- called `hierarchy` 1.Systematic Review Multiple Randomised Controlled Trials (RCTs) 2.RCT 3.Non RCT 4.Non Experimental 5.Descriptive studies, Expert Committees

14. Characteristics of all research All types of research are or aim to be: Planned Cautious Systematic Reliable Ways of finding out or deepening understanding

15. Examples of Research Ethnicity Question and Antenatal Screening (EQUANS) A Department of Health funded study using quantitative and qualitative methods to find out about the efficacy of asking pregnant women an ethnicity question as a way of detecting risk of carrying genes associated with Sickle Cell Disease (SCD) Project Lead Dr Simon Dyson: Reader in Applied Social Sciences RCT and non-RCT

16. Cultural diversity of pre-registration nursing programmes A Health Care Workforce Deanery (HWD) funded study using qualitative and quantitative methods to understand the experiences of South Asian nursing students on under-graduate nursing programmes Project Lead Dr Sue Dyson: Principal Lecturer in Nursing Non experimental

17. Midwifery practice in the third stage of labour A study which aimed to identify and explain the variety of ways midwives manage the third stage of labour. Project Lead Dr Tina Harris: Principal Lecturer in Midwifery Non experimental

18. The experience of obesity in childbearing – Aim to explore with obese women their experiences of childbearing to inform future care of this client group. – Project lead Rowena Doughty – Non experimental

19. In summary… We should be able to articulate what evidence-based practice is We should understand something of the importance of using evidence in professional practice We should understand the principles behind determining what is best available evidence

20. References – Spiby H and Munro J (2009) Evidence based midwifery: applications in context. Chichester:Wiley-Blackwell. Chapter 1. – Rees C (2011) Introduction to research in midwifery. London:Churchill Livingstone – Cluett R and Bluff R (2006) Principles and practice of research in midwifery

21. References Gerrish, K and Lacey, A (2006) The Research Process in Nursing (5 th Edn) Blackwell Publishing. Oxford. Sackett, D.L., Rosenburg, W.M., Muir Gray, J.A., Haynes, R.B., Richardson, W.S., (1996) Evidence- Based Medicine: what it is and what it isn’t. British Medical Journal 312: 71-72 Muir Gray, J.A. (2004) Evidence-based policy making (editorial) British Medical Journal 329: 988-989