On Thursday I had the honour of meeting Christine Webb. Christine is the executive editor of Journal of Advanced Nursing, a prestigious international journal of nursing. Christine is also the professor of health studies at the University of Plymouth in the UK.
Christine was here to speak with staff at Otago Polytechnic about "growing a profession through research".
Her lecture discussed the various types of research. She suggested that we should not undervalue quantitative research in nursing, midwifery and allied health fields. She mentioned the preference that is often expressed in these areas for qualitative research and suggested that this is not always as well conducted or as rigorous as it could be. She spoke of the importance of looking at a phenomenon under study from more than one perspective, "triangulation". Christine also stressed the value of systematic review and suggested that this is something that we as educators could do to within our fields to support dissemination of evidence.
Christine discussed the importance of practice based on the best available evidence and spoke of research into evidence based practice which highlights the preference, in all health fields, for gaining knowledge and information from colleagues and other contacts. There is a tendency, when this is the case, for traditional practices to be promoted without good supporting evidence. This can lead to practices which have been proven to be ineffective, or even harmful, being continued in practice. She gave examples of this, for example pressure area care. This relates to my own research which found a similar preference amongst rural midwives, some of whom had small groups with whom they shared information and some of whom did not have this opportunity. The challenge is to get information about evidence for practice to these groups to support change in practice. However I do not believe it is enough to only get the information out there. In many instances I beleive it is important for some role modeling of the new practice to be available. For example one of the participants in my study commented that she would like to start using a sterile water block for lower back pain in labour. This is something that has been known about for some time but she has never seen it done in practice and so feels unable to take that step and try it in practice herself.
Christine suggested that one answer is for educators to get out into the workplace and make themselves known, being a resource for evidence for practice. I can see this is something that might help in some way but I think we need greater recognition of the importance of social networks and communities of practice (COP) to learning, we need to find innovative ways to utilise COP to disseminate information and evidence and we need to find way for role modeling innovations based on evidence. I see online resources as one way in which this might be achieved.
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Thanks for this post, Carolyn. It illustrates the importance of evidence-base practice really well. I have had a comment on my blog from someone who is very impressed with the concept of EBP. Whilst I understand her anxieties, I still think it is vital we look at latest evidence and routinely question what/how we are doing.
I think EBP is important because so much of the medical evidence which has directed practice "norms" is flawed. poor quality, not robust - and this has a very real impact on womens lives and well being. A lot of medical practice in the area of birth is not evidence based. It is important that women and midwives know that - without EBP the medicval profession goes largely unchecked. An informed midwifery profession can now say "actually there is not good evidence to support that practice". This is power.
Thanks for your comments. I do agree that EBP is very important and it is also important for us to know or be aware of situations where there is no good evidence to support a particular action. This does give us the ability to challenge ritualistic or traditional practices which may not be in the best interests or against the wishes of the woman.
The challenge is to be aware of evidence, we need to question everything we do. For example, it is many, many years since I was in nursing. When I was nursing we would do routine turning and massage of pressure areas. Since Christine mentioned this I have looked up the evidence on pressure area care and have discovered that massaging pressure areas is actually harmful and causes damage to the tissues. Had I been working in this area I would have been aware of this but, because I am working mostly with fit healthy women I was not familiar with this research. None the less I may be involved in caring for a woman who is unable to move, due to an epidural or spinal, and I may need to consider her skin integrity in this situation. I am also involved in teaching students about this aspect of care. So it is important for me to be aware of this.
If we are to rely on specialists for sharing and disseminating evidence, and I am including lecturers in this category, how do we know that the information they are sharing is evidence based?
I am giving you my commentator award:
http://tinyurl.com/65gkct
What an interesting thread to start thinking upon...the idea that evidence based practice can also be spread by use of social networking and communities of practice. I started thinking, after reading this, how much I have learned over the years as a midwife from other midwives and their stories. Then taking that further and seeing what the evidence says compared to what we experience in practice and sharing with our colleagues. This is a vein of thinking that is interesting because it incorporates the use of groups and communication of learning vs individual study and practice.
I am going to ponder more on this idea....
By the way I am linking your blog site to mine. I want to keep up with you. Your ideas are interesting. Thank you for sharing.
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