NHS services

There is an increasingly strong belief that NHS services should be of high quality and that
they adhere to evidence-based research to ensure best practice.There is a large body of
evidence espousing the benefits of evidence-based practice in health care delivery and
planning. To this end, a succession of policy documents, guidance and research on how this
may be achieved have emerged.It is therefore essential that staff working within NHS
imaging services have both an awareness of how to undertake evidence-based practice and
what resources are available to them to ensure their practice is based on best available up-
to-date evidence.
Your assignment must address all of the following points
? What is meant by the term “evidence-based practice “
? Specific government documentation supporting the need for evidence-basednpractice
? The implications of evidence-based practice for Radiographers and
imagingndepartments, in terms of:
o Management
o Service delivery
? Any associated advantages and / or disadvantages to both the NHS andnspecifically to
imaging departments.
? Radiography specific examples of evidence-based practice currently documentednwithin
the NHS or other healthcare settings.
? Examples of where it may be possible to improve the uptake of evidence-based practice in
imaging departments.
This assignment will be assessed according to:

  1. Your ability to collect information, present it logically and communicate clearly and
    professionally using appropriate language.
  2. Evidence of the use of appropriate and up to date literature, which has been critically
    evaluated and accurately referenced.
  3. Your ability to demonstrate an understanding of the issues surrounding evidencebased
    practice in healthcare delivery.
  4. Your ability to provide relevant supporting examples to all arguments presented.


The Importance of Evidence-based Practice in Imaging

There is an increasingly strong belief that NHS services should be of high quality and that they
should adhere to evidence-based research as the best practice. There is a large body of
information supporting the benefits of evidence-based practice in health care application and
planning. To this end, there are many policy documents that have emerged to guide medical
researchers. It is therefore necessary, that employees working within NHS imaging services are
aware of how to undertake evidence-based practice and what resources are available to them to
ensure their practice is based on the best available up-to-date evidence.
Evidence- based practice (EBP) in medicine advocates for the use of the best current evidence
while attending to the individual patients. It means the integration of individual clinical
proficiency and knowledge from the best external clinical evidence that is available from a
systematic research. The individual clinical expertise relates to the proficiency and the decision
making skills that individual medical practitioners acquire through their experience and practice
(Stout & Hayes, 2005). Development of clinical expertise is reflected through the effective and
efficient diagnosis and through the personal judgment in utilizing patients’ rights and preference
when making clinical decisions concerning their care. Using the best available external clinical
evidence refers to the clinically appropriate research on specific medical aspects as indicated in
the basic sciences of medicine. However, the external clinical research has to be patient-centered
more so in the accuracy of diagnostic tests and the safety of the procedure used.
The earlier definition indicated above was later developed after it was realized to contain some
limitations in practice. Some group of physicians from Canada noted that the definition did not
focus on traditional determinants of clinical decisions but instead emphasized on clinical


research. Therefore, this led to the contemporary definition of EBP as an integration of the best
research evidence with clinical expertise and patient values. The current definition focuses on the
patient’s condition, the patient’s goals and values, the best available research evidence and the
clinical expertise of the medical practitioner (Sackett et al., 1997). What this tries to highlight is
that a patient may not accept the interventions with strong research as suggested by a clinical
expert due to differences in beliefs and values. Likewise, the clinician may not be in a position to
access the best researched evidence due to financial limitations or lack of relevant resources. In
such a situation, the use of the best research evidence may be impractical to offer. There are also
some instances where the clinician may also realize that the best research was conducted under
different circumstances. The differences that may be noted in research include the use of a
different population that does not reflect the needs of the current patient, or other factors such as
age, medical conditions, culture, and gender.
Many social workers have endorsed the contemporary definition of EBP and have also applied it
in their various publications. They usually emphasize the client values and opinions as being an
important part of intervention planning. In addition, social workers argue that patients should be
fully involved in the intervention planning instead of being given a summary of what is
appropriate to the medical experts (Drisko & Grady, 2012). By actively involving clients in the
intervention planning, they get motivated and empowered and hence the process produces more
acceptable results. 
Evidence-based practice is an effective approach that improves the effect of practice in medicine,
social work, nursing, psychology, and other related fields. Obviously, medical practitioners have
used evidence during their practice for many years. In particular, they have used and credited


different kinds of evidence related to their medical fields. EBP puts emphasis on the need to rely
on large-scale research comparisons to find out the efficiency of various treatments against
untreated control groups (Cilika, 2005). This is done because a research that is well done can
indicate whether the treatment used caused any change. It is also important to note that EBP may
include non-experimental research since it may be unethical or impractical to administer
experiments to some populations.
The external evidence gathered by medical practitioners during EBP, does not make decisions
for the experts but assists them to determine the best action to take based on the prevailing
situations of their patients (Roberts & Yeager, 2004). The integration of all the elements of EBP
improves the clinical outcomes and the quality of life for the patients. However, this can only be
achieved if clinicians use their skills to search for efficient experiments that have used
appropriate and reliable methodology.
Radiographers use evidence in their daily practice but most of them have not yet embraced the
use of evidence-based practice (EBP). For many years, radiography has not been perceived by
many medical practitioners as a discipline that requires investigation (Kurmis, 2003). This has
contributed to the continued use of traditional skills by the radiographers, which has also been
spreading to other health professions.
Currently, there is increased pressure for radiographers in various parts of the world including
UK and Norway to be efficient and effective in their medical practice. As a result, radiographers
are required to acquire the latest evidence in their field in order to provide high quality services
to the patients (Decker & Iphofen, 2005). Normally, it takes around two years to translate
research findings into actual practice. This is what has led to the increased use of EBP in


radiography. For one to become a practitioner with necessary skills in evidence-based
radiography there is need to be competent in searching medical articles from the internet. In
addition, it requires individual commitment and a sense of purpose for the evidence-based
radiography. Through this practice, radiographers are able to demonstrate their skills in decision
The environment where radiographers operate from is changing in NHS and in other health
systems. This is particularly notable with the continued combination of medical images and
communication systems, and the computer-based integrated health care enterprise (IHE). In the
future these changes can be used to promote the radiographers’ interaction with the best available
information and the preferences and values aimed at improving the quality of service offered to
clients. It is understandable that medical practice is becoming busier for medical practitioners to
spend so much time reading and reflecting on past studies in search of relevant information
(Brealey, 2001). In this regard, there is need to have the skills to enable physicians peruse
literature more effectively and to understand the operations of modern communication systems.
EBP provides basic methods, tools, and principles that can help radiographers overcome this
challenge. As a result, this improves their management skills and service delivery to their clients.
Evidence-based practice differs from the ordinary practice in two crucial ways. First, the
fundamental of EBP is its explicitness where relevant literature is categorized according to type
such as diagnosis, reviews, and therapy. In an objective critical assessment, standard questions
are applied to establish the validity of the evidence (Dobson & Craig, 1998). Then, the strength
of the results is assessed through standard calculations. It is this explicitness that makes the
results of EBP transparent and reproductive. Second, the objective of EBP is to offer medical


practitioners with tools and regulations that would enable them to undertake their own
evaluations as part of their individual practice (Gibbs, 2003). As a result, practitioners formulate
solutions for individual patients and departmental challenges, using the best current evidence
found in research. This may however be different from the principles that have been followed in
the development of standard guidelines in radiography. In most cases, such guidelines depend on
the views of experts that are often outdated and not applicable to individual practice.
In evidence-based radiography (EBR), the radiographer should be conversant with all the
necessary steps in EBP. In the first step, the radiographer should identify the need for
information (Stuart & Lilienfeld, 2007). The second step involves formulating a question. Here
the radiographer should get data from the client and then developing a hypothesis to explain the
data (Smith & Taylor, 2007).  The question should not be ambiguous and hence should relate to
diagnosis or treatment. It should also highlight the benefits of interventions and the quality of
The third step of the EBP involves finding the current best evidence that can be applied to a
given condition. This process may either be quite quick, depending on the search method or it
can be time-consuming and frustrating for a radiographer. For the radiographer to be effective in
searching for evidence, there are two types of electronic databases that are available (Kurmis,
2003). The first is the bibliographic that allows the user to search for information using citations
from literature. This can be done using MEDLINE database. The second type is more refined
and as it uses quality-filtered publications, but there is still very limited information on


Developing solutions for individual patients is done at the fourth step of EBR where the overall
research-based evidence is critically assed to determine whether it is valid. This assists the
radiographer to make decisions where their literature can be relied in providing the patient with
the best services (Black, 1998). This calls for the radiographer to have evaluation and appraisal
skills if the information is to be of any value to the patient. In the final step, the radiographer
develops solutions for individual patients by integrating the evaluated results with the patient’s
values and preferences and reflects whether the evidence was helpful (Howard, McMillen, &
Pollio, 2003). It is critical to note that the external evidence should not replace the individual
skills from the radiographer. Instead, the radiographer should use his skills and expertise to
determine where the external evidence is useful to the patient.
Some of the advantages of the advantages of the evidence-based practice in radiography and
imaging departments include giving patients access to the latest care methods. In return, this
improves patient satisfaction and quality of service (Mantzoukas, 2008). The latest information
in medicine is mostly an improvement of the previous information and hence tends to produce
better results. By using EBR, radiographers are able to compare the previous studies conducted
in the field of radiography and compare the results of such studies with the current condition of
their patients (Jackson, 2007). Therefore, this eliminates chances of trying methods that may
lead to failure or making the patient’s health condition worse. In addition, EBR also enables the
management of the radiography and imaging departments to have confidence with their staff due
to the high chances of producing quality outcomes while treating patients. When the imaging
process is successful, the credit is not only given to the concerned radiographer, but also to the
management of that that department.


However, there are also some disadvantages that are associated with EBR. In some cases, the
radiographer spends a lot of time searching for the best available evidence research but at the end
fails to get any relevant evidence. This amounts to a waste of time when the client may still be
suffering. Again, the radiographer may search for evidence and only get evidence where the
patients of the subjects used in the research were of different age or gender with the current
patient. Such results may therefore not be helpful to the patient. In most instances, the process of
getting research evidence is tedious and time consuming (Jackson, 2007). Even after getting the
necessary research evidence, the radiographer must evaluate and appraise its applicability and
hence consuming more time with one patient. With the continuing changes in some diseases such
as cancer, radiographers may be attending to new types of cancer developments that have never
been addressed before (Simpson, Segall, & Williams, 2007).  The implication for this is that no
evidence research will be available and hence prompting the radiographers to use any acquired
Additionally, most health facilities advocate for the use of evidence-based practices by all their
practitioners. Although these practices work, most of the times they limit the practitioners from
coming up with new solutions especially for the unique patients (Gambrill, 2003). When all the
patients are treated using same interventions, the physician’s personal input becomes limited.
Most of the health facilities encourage the use of EBP in order to protect the overall business,
especially in matters of insurance cover (Nightingale & Hogg, 2003). As a result, radiographers
are unwilling to take risks of applying new techniques due to the fear of losing their medical
license or being sued. This prevents the radiographers from expanding their creativity through
the practical application of their skills and expertise, so that other future radiographers can also
be relying on their evidence.


Although there have been notable development in the medical technology, radiographers have
not made use of all the information they need in order to deliver a high quality and cost effective
care to their patients. What is challenging for this is for the clinicians to keep updated with the
changes in medical knowledge and how to learn and interpret it accordingly. For the
radiographers, limited skills of scientific literature can be a problem In addition, there may be
minimum training on how to combine research evidence with other types of information such as
the client’s values and preferences, in order to formulate valid information (Melnyk, & Fineout-
Overholt, 2005). Some other constraints include the limited use of electronic databases and
outdated textbooks and journals.
Health care services practitioners and consumers are in need of high quality outcomes brought
about by the evidence-based practice. The inclusion of EBP techniques in radiography and
imaging is a promising move that will contribute to the further evolution of radiography in terms
of training and practice. Evidence based radiography will uphold the use of research-based
evidence both in NHS and in other health care facilities and will develop radiography as a
discipline. EBR solves clinical problems by identifying the best available research that is
evaluated by the radiographer for its applicability to the client. Through EBR, radiographers are
empowered to assist individual patients by finding evidence-based solutions that address their
values. This information can also be used by radiographers to formulate local departmental
policies that can also be used by other radiographers in future. In general, EBR improves the
quality of service delivery by providing patients with the most effective solutions for their
problems. It also benefits the management of the radiography and imaging departments by
offering solutions for client’s problems and hence boosting the confidence towards their
employees and improves their organisation’s reputation. Although EBR may be time consuming


and frustrating to the nurses, it is still one of the best approaches in providing the best imaging
services will lead to patient satisfaction. In this regard, NSH and other health care facilities
should strive to promote the use of EBR in their radiography and imaging departments for
quality improvement in patient care. Certainly, practical radiography research needs to be
developed by NHS with more people being encouraged to study EBR as this will contribute
towards professional development of radiography.


List of References

Black, D. (1998). The limitations of evidence. J R Coll Physicians Lond; 32: 23

Brealey, S. (2001). What is evidence-based medicine? An emerging science not fashionable
rhetoric. Radiography, 7 (5), 249-254.

Cilika, D. (2005). Education for Evidence-Based Practice. Journal of Professional Nursing, 21
(2), 345-350.

Decker, S., & Iphofen, R. (2005). Developing the profession of radiography: Making use of oral
history. Radiography, 11 (8), 262-271.

Dobson, K., & Craig, K.  (1998).  Empirically supported therapies:  Best practice in professional
psychology.  Thousand Oaks, CA: Sage.

Drisko, J. & Grady, M. (2012).  Evidence-based practice in clinical social work.  New York: 

Gambrill, E.  (2003).  Evidence-based practice: Implications for knowledge development and use
in social work.  In A. Rosen & E. Proctor (Eds.), Developing practice guidelines for
social work intervention (pp. 37-58).  New York:  Columbia University Press.

Gibbs, L.  (2003).  Evidence-based practice for the helping professions.  New York: Wadsworth.

Howard, M., McMillen, C., & Pollio, D.  (2003).  Teaching evidence-based practice: Toward a
new paradigm for social work  education.  Research on Social Work Practice, 13, 234-


Jackson, C. (2007). Assessment of clinical competence in therapeutic radiography: A study of
skills, characteristics and indicators for future career development. Radiography, 13 (5),

Kurmis, A. (2003). Contributing to research: the basic elements of scientific manuscript.
Radiography, 9 (2), 277-282.

Mantzoukas, S. (2008). A review of evidence-based practice, nursing research and reflection:
Levelling the hierarchy. Journal of Clinical Nursing, 17(2), 214-223.

Melnyk, B., & Fineout Overholt, E. (2005). Evidence- Based Practice in Nursing &
Healthcare: A guide to best practice. London: Lippincott William & Wilkins.

Nightingale, J., & Hogg, P. (2003). Clinical practice at an advanced level: an introduction.
Radiography, 9 (3), 77-83.

Roberts, A., & Yeager, K. (Eds.). (2004). Evidence-based practice manual:  Research and
outcome measures in health and human services.  New York: Oxford University Press.

Sackett, D., Richardson, W., Rosenberg, W., & Haynes, R.  (1997).  Evidence-based medicine: 
How to practice and teach EBM.  New York:  Churchill Livingstone.

Simpson, G., Segall, A., & Williams, J.  (2007).  Social work education and clinical learning: 
Reply to Goldstein and Thyer. Clinical Social Work Journal, (35), 33-36.


Smith, S., Daunic, A., & Taylor, G.  (2007).  Treatment fidelity in applied educational research:
Expanding the adoption and application of measures to ensure evidence-based practice.
Education & Treatment of Children, 30(4), pp. 121-134. 

Stout, C., & Hayes, R. (Eds.). (2005). The evidence-based practice: Methods, models, and tools
for mental health professionals.  Hoboken, NJ: Wiley.

Stuart, R., & Lilienfeld, S.  (2007). The evidence missing from evidence-based practice.
American Psychologist, 62(6), pp. 615-616.