Why would quantitative research be relevant in this scenario? Give reasons for your answer
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You work as a support worker in an aged care facility and you are part of a multidisciplinary team, which includes nurses, support workers and diversional therapists. In addition, there is a geriatrician that visits the centre once a fortnight as well as other allied health professionals that visit when needed, including a social worker and an occupational therapist. The organisation prides itself on using only EBP.
There is a weekly team meeting in which the team discusses the service users’ needs, any issues that they may be experiencing and any action that needs to be taken.
Mary is 78 years old. She was living at home, but after having several falls was assessed by the Aged Care Assessment Team (ACAT) as eligible for residential care. She has been at the facility for a few months. Her case is discussed at the meeting because the team is concerned that she may be experiencing symptoms of depression – she is not sleeping, her mood is low and she is not eating. It was agreed by several team members that counselling (especially cognitive therapies) can be helpful for older people experiencing depression.
The team agrees that it would be good to find the evidence to support this suggestion before any further action is taken.
QUESTIONS: (pleaseanswer all of the following)
Why would quantitative research be relevant in this scenario? Give reasons for your answer.
Using the PICO format, (PICO stands for Population (Participants), Intervention (or Exposure for observational studies), Comparator and Outcomes.
Describe the steps that need to be taken before you begin searching for the evidence.
Where would you look in order to find the evidence?
How would you recognise and appraise the evidence when you see it?
What steps need to be taken before applying the evidence?
How would you evaluate the application of evidence?
SAMPLE ANSWER
Why would quantitative research be relevant in this scenario? Give reasons for your answer.
Evidence based practices the integration of best clinical practice as evidenced by research in order to deliver quality and cost effective care. Quantitative research is relevant in this scenario because it aids the researcher to test objective hypothesis and theories by examining the relationship between variables (Age, depression and cognitive therapies). In addition, quantitative research aims at establishing significant relationships between the study variables. This method of research addresses the project problem by describing it, and is mainly based on objective observations and measurement. The study is concerned mainly with causation and correlation (Burns and Grove, 2013).
There are four main design of quantitative research namely correctional, descriptive, quasi-experimental and experimental. The most appropriate in this case study is experimental research because it is systematic and objective. This method is considered as a gold standard in researching best practice evidence. In this type of research design, the investigator uses two treatments (control and intervention) and randomly assigns the participants in either of the two groups. The study outcome is reached by comparing the differences in statistical findings, which aids in evaluating the effectiveness of the proposed evidence practice in addressing the research problem. One advantage of this study design is that study findings can be generalized (Polit and Hungler, 2013).
Using the PICO format, (PICO stands for Population (Participants), Intervention (or Exposure for observational studies), Comparator and Outcomes.
Describe the steps that need to be taken before you begin searching for the evidence.
The first step is identifying a research problem. This is the first step of evidence practice and should be done appropriately. To start with, the researcher should select parameters set by evidence based practice. The problem identified should be manageable. Once the topic is identified, it is important to state it as a question using the PICOT format. This helps one identify the main study concepts/keywords that should guide the research (Polit and Hungler, 2013).
In this case study, the PICO statement is as follows; In geriatric population (P), cognitive therapies (I) or standard care (C), is effective in treating depression (O), over a period of one year.
Using the key words identified, then a preliminary research should be conducted to check is there is adequate literature of the problem out there that meets the study needs and to also set the research context. Preliminary search for the information should be done in periodical databases, internet and lecture books. In some cases, one may want to adjust the focus of the study topic according to the information available (Wolters et al., 2014).
Where would you look in order to find the evidence?
Once the study problem is identified and written in PICOT format, the next step is to locate materials. This is important as it helps the investigator to learn known and what is unknown about the study topic, identify literature gaps, develop significance of the study and situate the project within the available research literature. There are a number of places to locate materials including books and electronic databases such as school online library, CINAHL, Cochrane, NCBI, Proquest, JSTOR, Web of science and EBSCOhost data bases. Data bases with peer reviewed journals are the best places to look for evidence as they contain current evidence based practice.
How would you recognize and appraise the evidence when you see it?
The next step is to critically appraise research evidence of the material located from the databases. Rapid appraisal is done to ensure that only relevant, reliable, valid and applicable literature applicable to the study is collected. The studies selected are the “keeper studies.” One barrier to effective implementation of evidence based practice is due to laborious critiquing process. However, using the rapid critical appraisal uses three major questions to evaluate the relevance of the study (Nieswiadomy, 2012).
The first question reflects the validity of the study findings. This question helps identify of the research method used is rigorous enough to render the results that are as accurate as possible. It explores questions if the study used randomization when assigning subjects to intervention or control group and if the study used reliable and valid instruments to measure and analyzes the study outcomes (Polit and Hungler, 2013).
The second question evaluates the relevance and effectiveness of the study findings. This assesses if the intervention was effective, its impact on the study outcomes and likelihood of generating similar results if the study is replicated. It involves assessing if the research approach fits the study purpose and evaluates the reliability of the study findings. The next question explores on the applicability to the study materials on investigators research and if the intervention benefits outweigh the study feasibility, cost-effectiveness, patient values, risks and preferences (Wong, 2014).
What steps need to be taken before applying the evidence?
The first three steps that have been aforementioned are important is indicating if evidence based practice is effective or not. This includes identifying the nature of the problem, developing PICOT statement, locating literature, critical appraisal of the literature and literature synthesis. Research evidence only is not adequate enough to justify for its integration into practice. The implementation of evidence based practice should be guided by the clinical expertise based on patient’s clinical assessments, preferences and values. There is no magic formula on how to weight these core elements, and mostly implementation process is usually guided by healthcare facility institution values and patient variables (Polit and Hungler, 2013).
For instance, if the strong body of evidence indicates that depression in geriatric population is reduced if they receive sessions of cognitive therapies before discharge, then the hospital is likely to hire a therapist to offer the proposed therapy. However, some constraints such as financial constraints or resistance to change can hinder successful implementation of the evidence based practice (Nieswiadomy, 2012).
Before implementing the evidence based practice, it is important to design an implementation plan as well as the evaluation plan, and develop translational strategies that will facilitate the adoption of evidence practice as a new practice. Some of these strategies would include use of opinions from leaders and project. After the implementation of the Evidence based practice, the team members should gather baseline data of the implementation process and the outcomes indicators. Key action in this step is sharing identifying of flaws in the new practice and in identifying effective recommendations for the new practice. To sustain the change, it is important to monitor the change continuously (Polit and Hungler, 2013).
Considering the merits of evidence based practice, it is obvious that evidence based practice should be the norm. Unfortunately, this is not the case. There several barriers that impede effective implementation of evidence based practice. This includes negative attitudes from the staff, organization’s culture and lack of support by the administration. Most of organizations lack systems in place to facilitate implementation. The use of EBP champions, educational materials, refresher trainings, policies, effective communication and leadership support (Wong, 2014).
How would you evaluate the application of evidence?
After the evidence based practice is implemented, it is important to evaluate the changes of the evidence based intervention so that the negative effects can be removed and the positive effects supported. Studies indicate that just because the intervention was successful in pilot study it will yield the same exact effects in the clinical settings. It is important to monitor the effects of the proposed evidence change on quality and clinical outcomes so as to spot and eliminate flaws in the implementation process (Hoffmann, Bennett, and Del Mar, 2013).
In this case study, the outcome evaluation can be psychosocial such as improved quality of life, reduced depression, anxiety and patient perception of care; physiologic such as functional impairment. Evaluation of the process can be done through audit, self reflection of peer assessment. Depending on the type of outcome, it is possible to evaluate the effectiveness of the intervention at local, regional and national (Nieswiadomy, 2012).
References
Burns, N. and Grove, S.K. (2013). The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence. Maryland Heights, Missouri: Saunders Elsevier.
Hoffmann, T., Bennett, S. and Del Mar, C. (2013). Evidence‑Based Practice across the Health Professions. Chatswood, Sydney: Churchill Livingstone, Elsevier.
Nieswiadomy, R.M. (2012). Foundations of Nursing Research. Boston: Pearson.
Polit, D.F. and Hungler, B.P. (2013). Essentials of Nursing Research: Methods, Appraisal, and Utilization (8th Edition ed.). Philadelphia:
Wolters Kluwer/Lippincott Williams and Wilkins Shaughnessy, J.J., Zechmeister, E.B. and Zechmeister, J.S. (2014). Research Methods in Psychology. Retrieved from http://www.mhhe.com/socscience/psychology/shaugh/index.html
Wong, G. (2014). Research Questions. In V. Wright‑St Clair, D. Reid, S. Shaw and J. Ramsbotham (Eds.), Evidence‑based Health Practice. South Melbourne: Oxford University Press
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