Evidence Based Practice Essay
Evidence Based Practice
To achieve a high quality of healthcare and to keep up with the increasing pace of clinical advances in the field of midwifery, using women’s experiences and statistics within evidence based practice is probably the best research evidence. Evidence based practice is ‘The conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health (and social) care decisions’. (Sackett et al 2000). The main aims of this assignment are to outline what qualitative and quantitative data are, how they are used in evidence based practice and to outline the key differences between these two methods. Two research papers, on qualitative and one quantitative will also be compared with respect to the key methodological differences used within the papers.
Qualitative research looks to explore a particular subject or question more in depth and is often used to research into a topic where there is unknown information. This type of research is more useful when answers are needed to what, how and why and when in-depth questions need to be answered and they cannot be done numerically. The researcher is looking to develop an in-depth understanding of this topic. Qualitative research uses small sample groups and the methods of collecting the information are often open ended questions in the form of in-depth interviews and focus groups. The participants used have generally had exposure to the phenomenon in the particular study. Qualitative research is less numerically measurable and results are often exposed as themes or trends presented in a narrative. Qualitative research’s aim is subjective.
Quantitative research looks to measure data within a study. It is only used when this data can be collected numerically. The sample size with this research is large and the researcher has no involvement with the participant making the research objective. Quantitative research uses structured closed question design and the results are expressed as numbers and statistics in graphs and tables.
Within each research problem there is a process which is followed. The research process starts with a general problem, topic or issue. Within quantitative research the aims or objectives are generally associated between the relationships of two or more variables. In qualitative research the aim is usually to gather a better understanding of the experiences of the subject area, a deeper knowledge so to speak. The research design with qualitative research is non structured, flexible and always non experimental designs. To select the participants within the research a technique called sampling is used. The qualitative sample size is often smaller and non-probability or a non-random sampling approach is used whereas with quantitative a larger more representative sample is used and the probability or the random technique is favoured.
The findings are collected in a process called data collection with qualitative research they are typically textual unstructured interviews and open ended questions and with quantitative research the collection is systematic and structured often questionnaires or surveys with closed questions. The data is analysed using thematic analysis techniques for qualitative research and statistical analysis for quantitative research. The results or findings are then presented for qualitative research in a narrative form that is typically supported with direct quotes to illustrate the main points and themes from the data sources and with quantitative research statistics and graphs are presented in tables and graphs.
The qualitative research paper is titled ‘Nobody actually tells you: a study of infant feeding’ and it is researching the infant feeding decision making process. The sampling size of the study is 21 and the women have been purposively sampled from a group of women known to have low breast feeding rates. These women were low class, low educational level, living in Tower Hamlets and Hackney in the United Kingdom and expecting their first baby. The women were told the research was about choices women make whilst looking after their first baby but the agenda was later declared. The research design used was a semi structured interview which was developed from four piloted interviews. The women had a choice of where the interview took place, all but three were interviewed in the home and a partner or relative could be present.
The women were interviewed on two occasions, once early in pregnancy and then again in six to ten weeks after birth, using the grounded theory which understands and interprets peoples experiences, developing a theory that has been grounded from the data. The framework method of data analysis was applied systematically using categories and themes identified by reading the transcripts. Nineteen women were reinterviewed at 6-10 weeks as two women had moved away, then the nineteen women remaining were sent a synopsis of their individual case analysis, feedback was received from elven women. The transcripts were analysed and cross checked using data from different sources with the results of the research presented in table form, one with the feeding outcomes and also a box with reasons for women being silent and not seeking help with postnatal difficulties. Also direct quotes from the women are presented in the research outlining some of the main themes of the subject discussed.
The quantitative paper is about looking at preconception risks presented when there is a negative pregnancy test. It is a care programme which has been set up to help women who want to become pregnant by giving advice to the women who present with these certain risk factors. The potential to assist women is known as the hypothesis, the risk factors are known as the independent variables with pregnancy being the dependent variable. An experimental method was used with randomised controlled trial which is where the participants are allocated by random allocation into two or more groups. The study was longitudinal because the data was collected over time approximately two years and two months. From the 1570 pregnancy tests 1106 were negative to which 262 women were approached. A registered nurse approached the women who had produced the negative pregnancy tests; the nurse was experienced in family planning and contacted the women within certain hours. The preconception risk assessment was then offered to 170 women. With a flip of a coin done so by the registered nurse the participants were randomly assigned to an intervention group or a usual care group.
The women within the usual care group and the clinician for this group received no feedback. Whereas the women in the intervention group were told of the risks identified and were given an appointment with a clinician. Preconception Risk Surveys (PRS) were given out to all women by a research assistant who was blinded to the group assignment. The PRS was defined as a screening tool to assess being ready for pregnancy and to identify any medical and psychosocial risk factors. The survey took approximately twenty-five minutes to complete. The women in the usual care group were offered appointments for a family planning visit to discuss the risks and the women in the intervention group received a booklet. Each woman was contacted via a telephone call a year on to ask whether the clinicians had tackled the risks identified and whether the women had become pregnant.
The rates of intervention between these two groups were compared and these differences were first analysed using intent to treat design. Subgroup analysis was also conducted which was only done on the women who had visited at least once during the follow up year. The results were presented in numerical tables and pie charts. When the groups were compared when there was at least one risk addressed there were no significant differences. But for the usual care and intervention groups combined the risk categories varied considerably combined with the chance of a risk being addressed.
It can be concluded that evidence based practice is an important tool to use when there is a need to achieve a high quality of health care. Evidence based practice enables the researcher to get what they require using the current and best evidence available. Depending on what information is required and from what sample size and the questions needed to be asked then depends on what research method is used, be it qualitative or quantitative research. One criticism of the qualitative research paper could be the sample size used, there were only twenty one women used over a period of time with two dropping out so if any more had dropped out there would have been a low transferability. Also from this small sample it could be difficult to be systematic comparisons as well as some of the feedback could be the researcher’s interpretation.
The paper did bring out key points amongst women but it’s the analysing of this data that could be difficult as women use different languages and with the open ended questions asked there will be a lot of talk to bring together into set themes although some common themes were found. In the quantitative research paper there was a very large sample used with different variable which didn’t have a great impact on the end results. In the majority of women the risks were not addressed so if there was further research in the future this should demonstrate some ways to help and motivate both clinicians and women to address the preconception risks and interventions should be initiated to lower the risk status.