1Name:University:Course:Tutor:Date: 13th February 2011. Evidenced Based Practice in Health and Social Care Introduction Evidence-based practice is a way that is followed in providing healthcare which isguided by thoughtful integration of the very best of the currently available knowledge with aclinical expertise. This approach of research in nursing practice allows the medicalpractitioner to have a critical assessment of the research adapt, the clinical guidelines as wellas other sources of information to enhance correct identification of the clinical problem andthus application of the most high quality interventions while re-evaluating the outcome forfurther improvements in the future. According to Cochrane collaboration evidence basedhealth care is a conscientious offing of the current best evidence to make decision about thecare given to the patients or in the delivery process of the health and social services (Titler, &Goode, 2001) The concept of evidence is used to refer to range of tangible information that isusable in identifying a problem and the necessity of responding to it forming an essentialrequirement for later evaluation purposes. The idea of current best evidence is informationthat is up to date and relevant therefore can be sued in carrying out of a valid research aboutvarious forma of health and social care, the possible harm from exposure to certain agents,accuracy of the diagnostic tests and finally the power of the predictability of the prognostic
2powers. This paper will offer a critical review of the evidence based practice as in concerns tothe field of health and social care in nursing profession (Mason & Chaffee, 2002) The term evidence based medicine was first sued in the 1980s and was used todescribe the approaches that were used to in determining the best practice and was altershifted to become evidence based practice especially after its importance in decisions makingwere recognized by clinicians and physicians. after that expert begun talking of the evidencebased health care as process in which research evidence was used to make decisionsregarding specific population or groups of patients hence assuming that the evidence was usedin context of the particular group or patients preferences, desires, clinical situation and finallyon the expertise of the clinicians. Experts as expect that the healthcare professionals are ableto read, critique as well as synthesize the research findings to help them in interpreting theexisting evidence based guideline soft e clinical practice. In recent years funding agencies have been increasing their pressure on the federal,state and local government to incase the effectiveness as well as the accountability of thepreventive and intervention programs. The rising demand for increased quality of health andsocial programs and evidence of such quality has fostered for increased interest in theevidence based programs. These programs judge to be evidence based if the evaluationresearch indicates that the program is producing positive and expected result, and that theresult can actually be attributed to the specific program but not on extraneous factor, if theevaluation is previewed by the experts while in the field and finally the programs must beendorsed by a respected research agency or federal agency which have listed it as one of theireffective programs (McCarthy, 2007).
3 The evidence based practice have been getting an increasing attention in the field ofhealth and social care and it focuses on the perspectives of the professionals in the midwifery,physiotherapy, social acre and nursing. This new approach is seen as an optimistic approachand has had wide acceptance as it demonstrates an organization attempts to bridge the existingresearch practice divide which include in the process of interpretation of research outcomes asconcerning the practice protocols, guidelines and standards. Nurses have often served instrumental roles in the process of ensuring as well asprovision of the evidence based practice through a continuous asking of question reading thebest evidence for the interventions, provisions of the best practice and finally on thepossibility of achieving the highest outcome both for the patient, family and nurse. Thereforethey have always been positioned to working with in collaboration with colleagues when itcomes to identification of clinical problems and in the use of the exiting evidence in pridingan improved practice. There are numerous opportunities that nurses can question in order toensure that the current nursing practices use the evidence based methods to improve and makeprovision of health and social acre more effective. The evidence based practice research has benefited the health and social care serviceproviders and agencies in various ways. Some of the benefits includes: helping nurses toprovide patient care that is based on research and knowledge rather than on normality,intuition, traditions, myths, advice of colleague, personal experiences outdated books andhunches. Other benefits include the better and improved patient outcomes, keeps the nursingpractice current and relevant, increases confidence when it comes to decision makingprocesses, ensures that policies ad procedures in the practice are current and includes thelatest research hence supporting the JCAHO –readiness and finally the integration of evidence
4based practice in to the practice of nursing is very important for provision of high qualitypatient care and achievement of the ANCC Magnet Recognition Program designation((McCarthy, 2007). Evidence based practice in the filed of social care is defined as the conscious, explicitand judicious process of using the current best evidence in the making of decisions thatregards the welfare of the service user and careers.For the past decade health and social services providers have been under pressure to increaseaccountability in the provision of their service especially regarding methods of measuring theeffectiveness of health and social services for instance on what works the best and on theintroduction of diverse range of performance indicators in the field. Some of the question thatthat nurses and care givers ask themselves regarding the evidence based practice in the fieldoh health and social care include the types of methods of evidence based that promote the bestpractice while ensuring that patient get the best and improved health and social services thatfactor in their personal preference, cultural and social differences. Effectiveness of socialprovision services under that children are all securely attached to careers that are capableensuring provision of safe and effective care during the duration of their childhood and therelated indicator of performance in the reduction of to no more than sixteen percent ofchildren looked after who have two to tree annual placement (French, 2002). The concept of effectiveness in the involve the appropriateness and validity of themethods theater used by professionals in their daily work to ensuring that the basic aims ofthe organization and the overall abilities of the agencies in delivering services they required towhile the concept of performance is concerned with the ability of n agency to achievepredetermined targets that are viewed as the determinants of both quality and quantity of the
5services delivered. The three E’s i.e. effectiveness, efficiency and performance were theperformance indicators during the 1980’s. In the social and health service care the attention ofthe public was shifted towards the issue spreading child abuse and protection tragedies thatwere culminated in the enquiry of Cleveland case. This led to an increasing number ofquestion asked concerning the effectiveness of the process of assessment sexual abuses inchildren and the interventions that were targeted at the victims and the perpetrators. Social service departments as well as other social acre providers are being increasingexpected to be accountable for the effectiveness of the service that that are delivered both atthe organizational level as well as on the specific programs used in various interventions(Gray, 1997) Therefore information technology as played a critical role when it comes toproviding the means of which organizations and agencies utilize in monitoring the socialservice it provides and hence becoming capable of providing information that is used toachieve accountability. Focusing on the effectiveness has fostered the raising of fundamentalissues regarding the nature of the research of the social work. When on considers the evidence that emerges from the National Health Service, thereis a massive variations in the health service provided both for the cost between identicaltreatments and also in the duration and provision of the various form of treatments. Suchdifference can only be explained based o n the different medical or social needs as well as onthe questions raised on the electiveness of such treatments. Some of the initiative designed tohelp in improving the services provided by health providers include the creation of nationalinstitute for clinical excellence which is intended to improve service through the use of sharedknowledgebase as well as the set standards (Titler, & Goode, 2001)
6 In addition to that another impact of the effectiveness agenda in the provision of social and health service can be evident in the proliferation of the policy as well as guidance documents as well as the creation of specific initiatives intended to increaser guides in the field for instance the Centre for Evidence-Based Social Services (CEBSS). At a national level there has been development of detailed guidance as well as practice manual both for the social care staff and other professional regarding the procedures that are followed in the handling of cases of suspected child abuse but all these vary specifically on the extent in which they based on research or on other agency priorities. Finally the most concrete manifestation of the best practice in social care services is the Centre for Evidence-Based Social Services started in 1997 and based at Exeter University. The centre aims at ensuring that the decision take at every level of social service are based on trends and quality research and it conduct training on ways of achieving the stated aims. The Centre for Evidence-Based Social Services is partnership between the department of health and the social services department from corner to corner of England and at Exeter University. The organization has recently expanded to other areas and associations have various aims including the following:• To help in the translation of the results of the existing research in to the service and development of the practice.• Ensures that the findings derived from research are made available to the social service departments especially during the review and changing of the delivery systems• To promote collaboration with other stakeholders like degree and PQ to ensuring that the training conducted in social work incorporates the available knowledge from existing research
7• Improvement of general informational dissemination especially of research findings to the local policy makers, practitioners, managers, careers and service users• Commissioning of research on areas where information gaps are identified finally is to ensure working towards level where surface user and careers are included as the valuable sources of information especially when it comes on the service effectiveness projects. Untangling the Web-The impact of internet use on the social care and the physician-patient Relationship Methods The current study lies at the intersection process and outcome study, in the process of exploring the impacts of the internet use on the social care as well as the physician-patient relations. It processes insight into the operations by which individuals access and use online social care information. It borrows much from the web based qualitative approaches. Interviews were carried out to investigate people’s meanings that are attached to their internet use, in relation to their social as well as day-day life. To ensure that the engagement of the internet user is grasped with the online medium, it was as well much significant to meet the seekers of the information in their location of activity. The initial contact and recruitment of the interviewees were hence situated online. Email Interviews With the internet users looking for social care information online, the email interview was conducted. The recruitment of the interviewees was on UK websites for lawyers for low income people, social guidance counsellors, food providers and government officials, amongst others. The reason for focusing on such like web site was because they in most cases
8address themselves to the public with a multiple to the public in general with multiple socialissues. There are even in most cases related topics developed on the similar website. Lawyersfor low income as well as food providers for instance provides various general poverty level,while general social care website becomes an important place to government and nongovernmental organization involvement, and also attracts various profiles of social careinformation seekers. These websites were identified through systematic internet research, by the use of 20search engines as well as directories. The initial search came up with 920 websites. By the useof frequency criteria, as well as presence, 4o websites were selected. Then, they wereconducted and invited for the invited to contribute to the research at hand. Amongst them, 10websites responded positively and the research was advertised either as a web link on one ofthere pages, or as message in groups of discussions. The researcher posted it, after beingpermitted by the website administrator. Other ten were later added fin light of evidence abouttheir appropriate content their frequent by the first interviewer. The advertisement was made to direct internet users to the website of the researchwhere the study goals, methods and privacy were all explained. On top of responding to anonline questioner, the internet users were also invited to participate in the interviews by firstcond8ucting the research through email, phone or even by the use of conventional mail. As amatter of fact, only two interviewees used phone while none used conventional mails. Theinitial exchange of around three emails before the base was set, the basis for the undertakingfull email interviews, though the participants were all given at any junction of even meetingface-to-face, or even undertake an interview through exposure.
9 The demographic data like the respondent’s age, employment, gender, education,social status, health status, as well as income, were all collected to serve the purpose ofstatistical controls. Respondents also were asked, if they have ever worked or ever stayed ina social care related units. In addition, they were questioned about their views in nontraditional social care services. Email Qualitative Research Email interview is just asynchronous online method of interviewing, based generallyon several email exchange between the participants and the researcher (Bampton &Cowton,2002). Such like interviews allows greater flexibility for the interviewee, who might answer athis/her own convenience. Though it lacks the immediacy as compared to face-faceinterviews, once the basis has been set up, email communications helps in the attainment ofconventional interviews and creates personal as well as thoughtful communications. Inaddition, email interviews allows repeated interactions as time goes by, this has been provedto be much significance for the deeper understanding of everyone’s dimension of theparticipants’ doctors relationship, (Mann &Stewart, 2000). About 20-30 emails had been already exchanged between the each respondent and theresearcher. The time of interview time relying on the speed that was adopted by theinterviewees for replying the email. The interviewee age varied from 20 to 60 years. Therespondents’ respondent to questions like what was their level of social help? They were alsoasked about the source of their social care? Another question was about their social problemthat needs social care? The gender imbalance especially interviewees, especially in favour of females can beattributed to several reasons. One of them being the specificity of the mode of interview;
10given the gendered use as well as the social purposes of email communication; the initialemail contacts might have installed an intimacy level, which in one way or the other mighthave locked the door out for male audience. Another reason might be the focus on social careissues like lawyers for low income individuals and the general social care websites. Thoughsuch like websites are addressed to the public in general and purpose male’s social problemtopics, the dimension of gender of these social issues as well as their related website has to berecognized, (Saltonstall, 1993). Another reason that can explain is that, females are sociallyconstructed as the social gatekeepers of the family, and the society as a whole. Althoughaccording to the survey knowledge, findings proving that online social information seekersare mainly females. However the gender imbalance raises the question of whether thedifferentiated presence as well as the gendered use of the internet regarding socialinformation, dimensions that need to researched on din another research. The email interviews were semi-structured, such like interviewing form beingcharacterized by its openness and it’s enabling the interviewer to ensure that all themes roseas well as narratives provided by interviewees. The guide of the interview focuses on the threemain issues namely; the traits, context as well as the implications of the internet for socialinformation reasons. Though initially, this method was being considered as secondary sourceof data collection, the relations that interviewees have with their doctors, in real senseconstituted the major theme. One after the other, topics was all discussed. The process ofexchanging questions, and answers having no pre-judged other than just following a style thatis far much conversational style.
11 Analysis The most appropriate application to the interview data according to, (Boyatzis, 1998,Flick, 1998) is thematic analysis. The application consists of encoding qualitative informationthrough creation of several themes that usually organises a number of themes that have thecapability of organizing qualitative observation as well as describing the data into coherent aswell as meaningful ideas and constructs, which forms the foundation for the interpretation forsuch like data. At first, themes were organized following the interview guide before beingelaborated into further subdivided themes that offers the coding foundation, under whichfurther themes that were created inductively were also integrated, (Flick, 1998). Normally, formal informed consent is much important for all qualitative researchmethods in social care practices apart from participant observation, no matter the samplingmethod that was used in the identification of potential participants and the strategies usedduring their recruitment. The number of project-specific factors at ultimately upon a provablyethics committee, determines whether informed consent is written or oral. At the recruitmentstage, obtaining informed consent for qualitative research involves clearly explaining theproject to potential study participants. Ethical Issues for the Conduct The best protection of the subject interest and well-being is the protection of theiridentity. If revealing the behavior or the responds harm them then adherence to this norm isimportant. The two principles involved include anonymity and confidentiality. The research subject is perceived anonymous when the researcher can’t associate agiven data with the individual. Anonymity highlights several potential difficulties. The studiesthat involve field observation methods usually ensure that the research subjects are not
12known. Researchers might also expand access to nonpublic reports from both governmentaland non-governmental organizations agencies in which the names of individuals have beenuninvolved. An example is a web based survey in which no log in or other identifying data isneeded. The subjects anonymously fill the questionnaires that are then tabulated. Promisinganonymity makes it difficult to keep record of which sampled subjects have been interviewed.Sometimes the value of anonymity is worth paying. Other methods of information collectionmake it impossible to assure anonymity for the respondents. Confidentiality comes in whenthe researcher links the data with the individual but promises not to do so in public. In a studyof self-reported drug use, the researcher is in a position to make it open the use of illegaldrugs by a given subject but the subject is guaranteed that it will not happen. Research usingpolice or court reports that contains individuals’ names might protect the confidentiality bynot including any leading information. All names and addresses data gathering forms shouldbe interchanged by identification numbers and master identification files made to linknumbers to names to allow latter corrections missing information, (LoBiondo-Wood, &Haber, 2006). Confidentiality comes in when the researcher links the data with the individual butpromises not to do so in public. In a study of social care practice, the researcher is in aposition to make it open so that it can be used by a given subject for the benefit of therespondent, but the subject is guaranteed that it will not happen. Research using reports thatcontains individuals’ names might protect the confidentiality by not including any leadinginformation. All names and addresses data gathering forms should be interchanged byidentification numbers and master identification files made to link numbers to names to allowlatter corrections missing information.
13 Impacts Many studies have exploited the complicated effects and contradictory roles of theinternet in changing the social care delivery as well as physical-physician relations. Theincrease in internet-social “care consumers”, (Akerkar, 2004), suggested that, there has been ashift of power within the social care relationships. To the advantage, the web social careinformation, has led to an emerging consumerist model in which patients might moreeffectively partner with their physicians in managing and being more responsible for theirown care. In the literature, the internet has been depicted in literature as being very rich ininformation for patients and physicians a like. On the other hand, literature explains thatinternet has side effects on social care practice provision, as providers try to meet patients,current and evolving expectations, (Coiera & Eiser 1996). Physicians have now startedencountering patients who expect them to interpret their web-acquired information, (Kassirer,2000). As an effect, the manner in which online social care information is presented andlooked upon in the social care encounter can influence both the course of the physician-patient relation, and possibly, the clinical outcomes. According to (Gerber, 2001), moreresearch ought to be done to examine the real nature of the impact of the information obtainedthrough the internet on social care decision-making processes. The social care information on the web has made patients more informed, hence bettersocial care outcomes, as well as more appropriate use of social care resources, (Gerber, &Eiser 2001. On line resources are being utilized to encourage patients to partner with theirphysicians in new and innovative way. It has been found that, patients who use internet socialcare information are becoming more likely to comply with prescribed treatment plans. Some
14 social care related websites offer email advice don a fee for service basis while others for instance British Medical Journal provides free access to information’s. In addition, internet social information has offered opportunities for the improvement of physician –patient relations. Through sharing the burden of responsibility for knowledge as well as enhancing information in general. There has been an emerging pattern of cooperation as well as team work which the internet0-based patient education might be beneficial mutually, (Pemberton & Goldblat 1998). The internet can empower patients and increase and raise their social problems control sense. This has been achieved through the provision of attitudes, knowledge as well as self-awareness necessary to make informed decision. Some social care professional have postulated that, such like empowerments alerts patients to significant symptoms at an earlier stage and encourage them to look for care. According to Eysenbach & Diepgen 1998, the internet has ensured that the relationshipbetween the patient and the physician has been transformed making sure that patients have beenempowered through medical information. Internet has ensured that the physician rare no longerthe sole holder of the medical information as it has helped it to be shared online. This sharing fthe information has turned the relationship of both patient and the physician to be more intimate.However, though the patients hold more information about the medical service, the physician hasto ensure that they give their insight and their experience on the matter to ensure that theinformation relayed to the patients is correct. They should ensure that accurate and preciserepresentation of data on the internet for proper interpretation (Eysenbach & Diepgen 1998). Internet has emerged as the newest method according to Robinson et al. 1998, of thepatient source of medical knowledge. For example, in a country like United State of America,about half the adult access the internet for medical information. This makes internet a very
15important patient-physician interaction site that should be taken with a lot of seriousness.Therefore, internet has brought a great impact especially in the medical decision making process.This is due to the increased knowledge of the patient prior to visiting the health care centres. Theknowledge gathered by the patient about the medication and the prescription of drugs, ensuresthat patients influence the decision made in the medical process. This is because the patients’posses’ knowledge of the prescription and the preferences prior visiting the health care clinic(Robinson et al. 1998). The internet has ensured that the patients are able to receive good health care services andgood relationship with their doctors. This has been made possible by ensuring that the doctor cangive the patient information of how to use certain medication and in turn, doctors is capable ofgetting feedback from the patient without necessarily visiting the patients (Eysenbach & Diepgen1998). Disadvantages of internet on patient-physician relationship Primarily, the internet may not always be the cause of good relationship between thepatient and the physician. It may also have a negative impact on the way the two parties relate.First, the physician may feel overwhelmed by the idea that the patient are in position to questiontheir medical services through the information that they have about the medication. They mayfeel threatened by question that emanate from this knowledge according to Robinson et al. 1998.This relationship may turn sore as the physician may feel that their knowledge advantage isdecreasing leading to them being unprotected towards knowledgeable patients. This will have anegative impact on the relationship the parties were enjoying before the era of internet. Inaddition, may physician who are a little bit older and are not well conversant with computer may
16feel that the patient are more proficient with computer than they are. This make them feeloutdated in the service delivery making their relation with the patient sour. Response towards the internet According to the article by the Department of Family Medicine called ‘The E-Patient’, itsupported the internet usage to improve the relationship of the physicians and the patient.However, it proposes the accuracy of the information should be paramount to ensure that thepatients are collectely informed about the medication to suppress collisions. They also advocatefor the physicians to be trained to ensure that are able to give information online to ensure thatthey do not feel outdated due to technology (Robinson et al. 1998). Critique The internet information quality can highly vary; this limits its use as viable source of information. Depending on its source, social care information might either be misleading or misinterpreted. This might lead to comprising social behaviors as well as social care results. Such misinformation might result to inappropriate request clinical interventions, or unnecessary anxiety or even preventable morbidity or say mortality, as an effect, high quality information is rendered useless if patients are overwhelmed, (Kiley, 2002). Another thing is, some social-economic groups might be limited in accessing the internet. It is true that, seeking information on social care on the internet is affected by social economic groups, for instance younger, healthier and educated. These having low literacy and are living in areas with no power, might be disadvantages in accessing the internet. To solve such like problems, resources and creative strategies need to be directed towards providing connectivity and access to information technology and power to economically depressed areas. This will ensure all individuals are active participants in the
17 information age. In addition, there should be a body of social care professionals to asses the information concerning social care practices that are posted on the internet. This will at least reduce the social care information variability. The critiques of the article have mentioned that the hypothesis used in coining that theolder physician may not be proficient in the computer is not effective. They also cited that theinternet might not pose much of the problems, as most of those who use it are enlightenedindividuals who are capable of disseminating medical data on the internet with ease. Impact of Location of the research The location of where the information affects the recommendation to be made. This isbecause, the final recommendation will depend on the data collected. Therefore, if theinformation is gotten from an area with more internet access, it may give a wrong overall picture.Otherwise, regardless of lack of the internet in some places especially in the third worldcountries, internet poses good penetration in such areas. In future, it will be very helpful as thesource of medical information to the patients
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