A beginners guide to evidence-based practice in health and social care

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German revision and practice book with audio disk. Fits around your leg above the knee. Small surface for accurate practice!. It prepares therapists to examine and treat patients with problems related to balance, mobility, and upper extremity function, based on the best available evidence supporting clinical practice. Work book with practice questions Collection only. Thank you for looking. A great read for pharmacy students. Also happy to take cash on collection to avoid delivery charges.

Great condition. Perfect for nursing students. Assassin's creed renaissance book by Oliver Bowden is a great book to read. Based on Assassin's creed 2. Like new. Not written or scrawled in. Started with a tweet. Was 7. Never read it. No post. When we are thinking about evidence based practice, we need to ensure that we use the strongest possible evidence to support our practice. If we do not seek out strong evidence, we risk being criticised for not using up-todate, robust evidence. Remember that the nature of evidence in health and social care changes very quickly and what was considered good evidence at one time can become quickly outdated.

However you must also remember that nothing is perfect and you may not always be able to find strong evidence. You should aim to base your practice on the best available evidence you can find. Direct research based evidence Direct research based evidence is evidence that relates directly to the health and social care practice situation you are involved with. In an ideal world, there would be direct evidence to underpin the care you deliver and this evidence would be based on direct observations or studies of people who are similar to those you look after.

Also in an ideal world, you would find that the evidence that exists relates directly to your clinical or professional setting so that you can be as sure as possible that it applies to your patient or client. An example would be that of hand cleansing. Research evidence relating to hand cleansing will be relevant to your practice irrespective of where and when it was undertaken, although you still need to assess the quality of the research undertaken which we will look at later in this book. A further example of direct evidence would be the impact of shift work on the quality of care. Thus any research which explores quality of care provision and its relationship to shift work is likely to be directly relevant to all disciplines.

This evidence can still be useful to you. We will refer to this as indirect research based evidence. The research might have been carried out on a different group of patients or clients or in a different country, so its relevance and application to your setting might be different. Example: An example of the use and relevance of indirect evidence could be research about how information giving reduces anxiety. You are working in general surgery. We will discuss ways of assessing the quality of the evidence further on in this book but for now it is important to note that you are likely to have to make a judgement about the applicability of the evidence you encounter to your professional practice.

However this research will be relevant to you in some way. This is why we refer to it as indirect evidence. Example: Imagine you are working with deprived children in an inner city from a particular cultural group. There is research evidence about the most effective way to promote uptake of day care provision that has been undertaken with a different cultural group but nothing that relates to the particular group of children you are working with. Again, this is where your clinical or professional judgement comes into play. You might find that this is the best available evidence and you need to determine how relevant it is to the group of children you are working with.

Example: Another example of indirect evidence is the use of antiseptic skin washing prior to surgery. Whilst there is evidence to suggest that use of a skin wash does reduce the amount of surface bacteria on the skin, there is, to date, no available evidence that this reduced skin bacterial count leads to reduced rates of infection following surgery.

A Beginner's Guide to Evidence-Based Practice in Health and Social Care

Given this information, do you feel that use of antiseptic skin washing prior to surgery fits into an evidence based approach? Would you choose to wash with the solution or not? You are probably thinking by now that much of the evidence you use in your clinical practice is indirect evidence — that is, even if it was obtained through direct observation or experiments on patient or clients, its focus was not on the practice setting you are working in and therefore the evidence does not apply to your practice directly and you have to make a judgement about its relevance to your practice area.

You will find that this is often the case. Evidence deduced from scientific knowledge Evidence deduced from scientific knowledge is where you take principles from the sciences and apply them to the practice setting. It might be that you find that there is no direct or indirect research evidence that is relevant to the area you are searching for information about. It will often be the case that there is not sufficient direct or indirect research evidence available to you about the specific question you are investigating. Does this mean that you cannot practice evidence based practice?

The answer is you can still find evidence to underpin your practice, even if it is not immediately obvious what information might be relevant to you. However, to do so, it will be necessary to look further afield for sources that might provide you with an evidence base for your practice. This is because professional practice encompasses a very wide range of activities and will therefore draw on a wide range of sources of evidence to justify practice. Your practice can be underpinned by evidence which is deduced from scientific knowledge rather than from observation on patient or clients themselves.

Evidence deduced from scientific knowledge is evidence which is obtained from scientific and social scientific explanations about how things work, but which have not been tested or observed scientifically empirically with patient or clients in the practice setting. By scientific knowledge we mean from the hard sciences, such as biology, physiology and also from social sciences such as sociology and psychology.

We know that alcohol intake during pregnancy is likely to lead to low birth weight babies. We also know that low birth weight babies are also more likely to spend time in the intensive care unit. We can deduce from this that alcohol consumption during pregnancy is likely to lead to increased risk of admission to intensive care for the new born child, however unless we find out about the alcohol consumption of mothers of babies in intensive care we cannot say for certain that alcohol consumption during pregnancy increases the chances of intensive care admission for the baby.

For this, we would need empirical evidence because you are testing or scientifically observing what actually happens in practice. We also know that low blood pressure readings are indicative of haemorrhage. Yet in order to really know how effective this practice is in the prevention and management of haemorrhage we would need to observe the effectiveness of this in practice.

Interestingly, Zeitz and McCutcheon undertook a literature search for the empirical rationale for the frequent blood pressure measurement following surgery. They found that despite the physiological rational for blood pressure monitoring, there was an absence of direct evidence to support frequent blood pressure measurement.

A Beginner's Guide to Evidence Based Practice in Health and Social Care - PDF Free Download

Philpin suggests that those very serious about evidence based practice would oppose this practice, arguing that it is a ritual for which there is no scientific rationale. However if we look to the wider psychological and sociological literature surrounding dignity, grief and coping with death of a loved one, we are likely to find justification and evidence to support this activity.

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What other specialist disciplines predominantly inform your professional practices? You are likely to find that your own area of practice is informed by a wide variety of disciplines and that research from within these disciplines will be relevant to your practice. You will use these to develop an understanding of the evidence base behind many of the activities you undertake.

You might therefore need to think quite broadly to find evidence to justify your practice. Can you identify areas of your own practice that may have an evidence base you can use? You will not always find direct or indirect research information on your topic — either a literature review or individual piece of research.

Imagine a line where traditional practices and ritual were at one end and a fully evidence based approach was at the other. However, unfortunately it is not as straightforward as this.

This assertion caused much outcry and since then medical practitioners have taken up the challenge to disprove this claim Ellis et al. We have not yet found any such studies of other professional groups, so the extent to which practice within health and social care is based on evidence of effectiveness is unknown.

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No evidence at all? Sometimes you may not find any research based information, or you might not be in a position to identify the best possible evidence.


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In this case you will rely on weaker sources, such as experience, advice from colleagues but you should be aware that these provide a weaker source of evidence.