Evidence-based practice [EBP]:
• identifies research that is of direct relevance to workers and service users
• provides a set of simple rules for evaluating research evidence
• emphasises the responsibility of managers and supervisors to use their professional judgement, personal experience and also external evidence in making decisions
• refers explicitly to the welfare of service users
• expects decision making to made explicit and thus open to question and examination
• accepts that there are different types of evidence and that some are better than others and assumes that
• most workers need to be taught how to interpret and use research findings most workers (including managers) need help to use research to inform practice throughout their careers
• research findings must be disseminated to workers more efficiently
• evidence-based practice is a developing area for social care
difficulties surrounding the concept of EBP:
- conceptual problems:
• incomplete or reductionist approach to practice, producing partial or misleading understandings of situations in the real world
• can the evidence be trusted?
• are objective data possible and are practitioners (especially researchers) truly independent? The nature of interpretation can sometimes be questionable
• is evidence gathered from large populations applicable to individuals?
• there are some difficulties in defining what constitutes evidence
-pragmatic problems:
• is the evidence always available?
• sometimes there is too much evidence, is of poor quality, is of limited relevance
• can the results of EBP always be translated into practice?
• it is not always the case that applying the right and discarding the wrong information will lead to lasting changes in practice
• good ideas and sound interventions can be rejected not because they are ineffective but because enough evidence can’t be found to support them
• evidence based doesn’t always take account of other forms of knowledge and ways of knowing such as practice wisdom, theory and the views of service users
• practitioners don’t have time to read all relevant research findings for themselves
problems:
• different research questions need different research methods to address them
• a broad definition of evidence needs to take account of practice wisdom, theoretical perspectives and the views of service users
• practice is informed by rather than based upon evidence
influences upon the interpretation of research :
• departmental influences on the availability and use of research findings
• existing reading habits and preferences
• familiarity with research publications
• existing levels of knowledge of research terms
• attitudes to evidence-based care
• suggestions for priorities by statutory bodies
practical ways to support research-mindedness and EBP:
• explore and question plans and decisions; support ‘research champions’;
• encourage discussion; link to staff development and appraisal systems;
•modelling; allocate resources for journals and books; encourage use of web-based information searches; help promote critical appraisal skills
Organisational implications of EBP:
There is a need for:
• a well-qualified workforce and an emphasis on learning
• regular updating of knowledge and experience
• supervision system which draws regularly on research and encourages practitioners to question their practice on the basis of research
• senior departmental managers to act in the same way as they expect practitioners to act when making key decisions and allocating resources
• professional groups and individual practitioners to take more personal responsibility for being ware of research into service effectiveness
• better collaboration between health care service providers and local and regional universities and research institutes
managers and EBP:
• managers need to handle the development of research-mindedness and EBP in their units sensitively, to avoid increased stress
• managers and their organisations have a role in making research data accessible and actively used
• research-mindedness can occur more often when it is taken up by peers who can influence each other
• managers can be most effective in supporting such development if they build on existing interest and enlist those already involved in research to help those occupying the middle ground to take up new practices
• there are several practical steps managers can take to support research-mindedness and EBP
• focus on the people for, innovation and context of in which change is happening
• there are implications for organisations, senior managers and wider professional bodies and academia in bringing about the widespread cultural change required for EBP to become accepted practice.
REFERENCE
Shemmings, D. and Shemmings, Y. (2003) Supporting evidence-based practice and research mindedness, in Seden, J. and Reynolds, J., Managing Care in Practice, Open University. London: Routledge.
