Tutorial presentation was about qualitative research a phenomenological c
phenomenological case study in one surgical unit. Journal
Essay must be in 1000 words and should defined all key terms used.
Reference a minimum of 8 scholarly academic journal article or texts related to evidence
based practice ( other than the required text book by Liamputtong, 2010).
Methods of Inquiry in making Evidence-Based Decisions
Evidence- based health care refers to the diligent use of present best evidence when
making decisions concerning individual patients’ care or when delivering health services. Present
best evidence is information that is up-to-date, and gathered from valid, relevant research about
the impacts of various health care forms, diagnostic tests’ accuracy, prognostic factors’
predictive power and the potential harm due to exposure to agents. Evidence- based medicine
refers to the integration of the best research evidence with patient values and clinical expertise.
Louey (2007) asserts that there is an intersection of client expectations and values, practitioner
expertise and current best evidence.
Decision making is not founded solely on current best evidence since none of the core
elements can stand alone. The key elements work closely by utilizing practitioner skills in
developing client- sensitive case plans which use interventions having an effectiveness history. If
relevant evidence is absent, the remaining two elements are given more weight. If there is a lack
of overwhelming evidence, then best evidence is weighted more heavily.
In medicine, evidence- based decision making involves asking questions, appraising and
finding relevant data, and utilizing that information as reliable estimates of harm and benefit.
This approach requires the integration of personal clinical expertise, with clinical evidence
gathered form systematic research. The process has five steps that can be followed by
practitioners, to ensure evidence- based decisions in their practice (Marshall, Kitson & Zeitz,
The first step involves converting the need for causation, therapy, prognosis, and
diagnosis and prevention information in to questions that are answerable. Second, the best
evidence that can answer a question is tracked down. Third, the evidence is critically appraised
for applicability (clinical practice usefulness), impact (effect size) and validity (how close to the
truth). Fourth, the critical appraisal is integrated with clinical expertise and patient’s unique
circumstances, values and biology. The last step involves evaluating the efficiency and
effectiveness in executing the first four steps so as to ensure improvement in forthcoming
practice (Sackett, 1996).
Experts report that clinical experiences, case reports and observational studies have low
quality evidence. Randomized controlled trials, if conducted well, provide high quality evidence,
and more so if used to inform systematic reviews. Clinical studies form the foundation for
systematic reviews with wary participant selection. Cochrane Collaboration focuses on ensuring
that qualitative studies have the ability to add to knowledge and inform gathered from
randomized controlled studies. Roberts & Yeager (2004) argues that numerical terms are used to
measure outcomes. Some of the qualitative measures include life quality and lifestyle changes,
where information is collected using questionnaires. Furthermore, narrative interviews where
respondents narrate their experiences can be used. Questions and semi- structured prompts are
used to explore the issues and information required for a study.
Nichols Model focuses on elaborating how evidence- based decision making can
achieved (Kitson, 2012). The steps included in the model begin with the assessment of an
activity, means of assessment, criteria, summary of evidence and used of results. Activities can
be assessed through several means such as rubrics, behavior, and participation, multiple
evaluators and post/ pre surveys. Direct or indirect assessment can be used, as well as the norm
or criterion referenced criteria. The use of results is considered as the most significant step.
Stakeholders involve in thoughtful collegial discussion and self- reflection. Future plans are
formulated to modify the existing processes and identify new activities that ensure continuous
Grading for Recommendations, Development and Evaluation refers to a system that is
used in developing recommendations from clinical trials (evidence). Marshall, Kitson and Zeitz
(2012), conducted a phenomenological case study in a surgical unit setting. The study aimed at
conceptualizing and comprehending patient’s opinion of patient- centered care, and linking it
with existing literature. The research was founded on the fact that there is no fixed definition of
patient- centered care. Most literature is grounded on definitions expressed by researchers and
health professionals. The qualitative research study was founded in phenomenology. Data was
collected by the use of interpersonal interviews. The ten participants were surgical ward patients
from a large South Australia metropolitan hospital. The research findings indicate that patients
are not familiar with the patient- centered care concept. However, they were able to define their
understanding of the term and their expectations from the care. Majority of the patients equated
the quality and type of care received with the health care providers providing it. Attentiveness,
involvement and connectedness are some of the prevalent themes that patients desire from their
care. The study concludes that it is extremely vital that patents are allowed to have a voice in
conceptualizing and defining patient- centered care. In addition, regular and further consultation
with patients to identify their priorities and needs is immensely essential. It guarantees a unified
tactic to patient- centered care (Griffith & Tengnah, 2012).
Implementing evidence- based health care in clinical practice requires the interplay of the
core elements; the nature and level of evidence, the environment or context surrounding the
research and the way or method of facilitating the process. These elements should be put in to
practice equally since current research does not define the most significant element (Roberts &
Implementing evidence-based health care in clinical practice requires some basic skills.
Practitioners should be able to think critically; possess a disciplined desire and ability to assess
information. Confirming and contradicting information should be sought for, objective
judgments made, and one’s thinking monitored. Moreover, there should be RCTs rapid critical
appraisal, and information literacy.
In conclusion, evidence- based practice approach can be termed as bottom- up method
which outlines how individual practitioners can integrate research in daily decision making
(Dobrow & Goel, 2004). The approach empowers clients and individual practitioners to
collaborate actively in treatment decision. Evidence- based practice ultimately involves cultural
change in an agency. This implies that the approach involves human service agencies’
administrators who have a role of creating an enquiry culture where practitioners have resources
and the time seek for relevant information. The contested value and nature of evidence is still a
central debate in using evidence- based policy making. The debate is doubtful to be resolved,
therefore, its existence is significant in developing and highlighting the influence and theory of
context in evidence- based policy making application. It is imperative to know the weaknesses
and strengths of evidence- based policy making since this aids its future development and
Dobrow, M.J. & Goel, V.U.(2004). ‘Evidence-based health policy:context and utilization’
Social Science and Medicine, Vol. 58, 207-217.
Griffith, R. &Tengnah, C. (2012). Consent to care: patients who demand or refuse treatment.
Br J Community Nurs, Vol. 2, (3), 139-142.
Louey, M. (2007). “Making an evidence based decision involves a process of inquiry.” Aust
Nurs J. Nov, Vol. 15 (5), 22.
Kitson, A. et al. (2012). “What are the core elements ofpatient-centeredcare? A narrative review
and synthesis of the literature from health policy, medicine and nursing.” J Adv. Nurs,
Vol. 2 (1), 1-18.
Marshall, A., Kitson, A. & Zeitz, K. (2012). “Patients views of patient-centered care: a
phenomenological case study in one surgical unit.” Journal of Advanced Nursing, Vol.
3 (2), 12-34.
Roberts, A. R. & Yeager, K.R. (2004). Evidence-based practice manual: Research and outcome
measures in health andhuman services. New York: Oxford University Press.
Roberts, A. R.& Yeager, K.R. (2004). Systematic reviews of evidence-based studies and
practice-basedresearch: How to search for, develop, and use them. New York: Oxford
Sackett, D. L. et al. (1996). Evidence based medicine: What it is and what it isn’t. British
Medical Journal, Vol.12, 71-72.