An Appraisal of a Piece of Research-based Evidence Relevant to Healthcare Practice. Since the 1970’s the term evidence-based health care has progressively been used more, the expansion of evidence-based health care has risen with the development of being able to access a range of information. Other factors that have contributed to the use of evidence based health care include; changing of public expectations, political consensus, cost pressures and professional accountability (Hamer Collinsons 2005, cited by Cutcliffe W. & J. Ward M, 2004). There are many different definitions to describe evidence-based practice (EBP), the best known definition was written by Sackett et al (1997, cited by Lindsay, B 2007) he states that EBP is the ‘Conscientious, explicit and judicious use of current best evidence about the care of individual patients.’ To paraphrase, EBP is an approach where a professional is able to use current evidence and research to backup and give an accurate reason for their care they provide for patients. As a student nurse, EBP is very significant in me being able to offer the best up to date care I possibly can for my patients, it also enables me to use existing evidence to support my practice and allows me to understand the reasons in which I perform certain aspects of my clinical practice, therefore I am accountable for all of my actions. EBP is an important factor in being able to work in a multidisciplinary team, without me participating in EBP it’s possible that I would become isolated from a multidisciplinary team and not offer the best care for my patients. If I was to locate research evidence on the hand hygiene practices; which is the topic addressed in the article, I would use a very precise search strategy to be able to gain appropriate research. First of all I would produce a clinical question, which is a useful means for excluding research which is not relevant to the situation within the article. I would construct this question by using the following headings: Situation, Intervention, Counter intervention and Outcome (Basset, C 2004). I would then choose keywords from my focused clinical question to help me find available research and articles. The key words that would be appropriate to use would be ‘hand washing’, ‘alcohol gel’, ‘infection control precautions’ and ‘nursing students’. I would use a limitation of when the date was published (1995-2008) to ensure the research I gather is up to date. I would then use these keywords and limitation to search numerous academic and professional journal databases such as CINAHAL, British Nursing index, Embase, Ovid journals and Medline. I may also use these keywords in a general search engine such as Google; in this case I would have to take in consideration the amount of information that would be available and the reliability of the information. The Article in which I am appraising is written by Barret and Randle J (2008) the main issue of this article is to investigate hand hygiene practices of nursing students within a clinical setting. The objectives of this article were to look into the factors that influence a student’s perception on their own and other health care workers hand hygiene compliance. In addition the article would also like to make recommendations for practice in the future and the hand hygiene training that is available on nursing courses. The study intends to achieve these outcomes by using a qualitative design and the method they have used is a semi-structured interview. ‘Qualitative research is used to gain insight into people's attitudes, behaviours, value systems, concerns, motivations, aspirations, culture or lifestyles’ (QRS International, 2007).Out of a range of methods Interviews are the most communally used data collection tool within qualitative research. A pilot study of the interview was undertaken first with two pre-registration students who were not included in the overall sample. Pilot studies are a vital component of...
Cited: by Burns, N & Grove, S) stated that ‘In qualitative research, the focus is on the quality of the information obtained from a person, situation or event sampled rather than the size of the sample.’ Consequently using a small sample size means that the results cannot be reprehensive of the whole population but by using a small sample it costs less and is quicker to achieve (Burns, N & Grove, S 2007).
The design of this study is a descriptive design; this type of design is aimed in gaining more information about characteristics within a certain area of a study. The purpose is to be able to provide a picture of a certain situation as it naturally happens (Burns N & Grove, S 2007). This design is very appropriate in achieving the aims of this study; it allows the researchers to gain information of perceptions of hand washing as it has happen in a clinical environment. This type of design generally ends with the development of a hypothesis which is different compared to the other types of designs which start off with a hypothesis that the researchers are trying to answer.
Ethics are a major difficulty that researchers have now got to face, it’s important that before any research takes place, all the ethical issues are considered and resolved. If the Ethics cannot be resolved, then the research should not take place. Ethics are regarded as ‘Moral philosophy, ethics search for a reasonable ground to our moral standards and what you think is right and wrong’ (Wiki answers, 2008).
The 4 main ethical principles within research are: Non-maleficence, Beneficence, Respect for autonomy and Justice. (Burnard, P &Chapman, C 1993) In the study I am appraising the researchers have aimed to achieve these principles, they state in their design of the study that all students were guaranteed anonymity, confidentiality and informed that if they wanted to withdraw from the study, they were able to do so at anytime, this therefore covers the respect, anatomy and justice aspect of the ethical principles. All participants were given written and oral information about the aims of the study and written consent was also obtained. The research was also approved by the Medical School Ethics Committee, the purpose of ethical committees are to ensure that any research undertaken involving people, is not likely to cause any harm or distress to the participants. The overall study has no problems with causing harm to anyone, and the outcome for this research is likely to reduce the amount of harm caused by healthcare associated infections therefore having an overall benefit. By being able to understand the perceptions of hand hygiene compliance, interventions can be concluded from the research and then can be put into place. In conclusion all the ethics involved in this study were addressed appropriately and therefore I would say that this clinical research is ethical.
The fact that both the researchers were nurses can be a good aspect in the study; it means that the researchers were able to have a wide range of understanding of the clinical environment that nurses work in. Consequently this may possibly have an influence on the interpretation of the data received; this could be suggested as a form of bias within the study design. If bias occurs in a study it can distort the findings from what the results would have been without the bias (Burns, N & Grove, S 2007). The design of this study itself has tried to reduce bias occurring as much as possible, the interviews were undertaken within a study environment not a clinical environment, this had an advantage as other professionals within a clinical environment would not be able to influence on what a student would say or wouldn’t impact what a student would be comfortable in saying. The interviews were also audio-taped this means that when the researchers where analysing the results and writing them up they were able to be as accurate as possible and this also prevents manipulation of the results by the researchers.
The interviews resulted in many findings, the transcripts that were written by the researchers were analysed many times and the findings were separated into different categories. This was a very good way of analysing the findings as you could clearly make conclusions on the main factors that affect the perceptions of hand hygiene in nursing students. A range of answers were placed under a main heading in which they were related to. The participants who made comments were not named but numbered instead, therefore keeping confidentiality of the participants. Although there were ten interviews that took place, from looking at the findings you can notice that not all of these participants’ answers’ were used, therefore creating a flaw within the findings. In the article there is no statement to explain why everyone’s answers were not used, a possible reason could be that they didn’t fit under the headings but in this case they still should have been mentioned as they are just as valid as other comments and are an important contribution to the research, this has an effect on reliability.
The discussion resulted in the researchers linking their findings to several other studies that stated similar opinions. The researchers have linked the finding that nursing students are more likely to wear gloves to keep their hands clean rather than washing, to a lot of literature research based on how wearing gloves does not act as a shield to the micro-organisms that can be passed on within a clinical environment. They have also suggested that students adopt the behaviour and attitudes of their mentors and other health care workers. This discussion links into the conclusion that hand hygiene is a complex issue because there are so many factors that influence compliance. The conclusion also suggests ways in which improvements can be made, they make suggestions that practice development and assertiveness training should be given to nursing students.
Improving hand hygiene in care settings is very significant in preventing the spread of healthcare- associated infections as stated in this study. Within my practice, applying these results from this study is important; being aware of my own hand hygiene compliance is a factor I must consider. From this study, I am able to understand the different factors that do affect hand hygiene compliance which I didn’t know before I read this study. Therefore when I am in practice I will make sure that I can prevent these factors from affecting my hand hygiene compliance as much as possible. I will also take into consideration the point suggested that students can feel powerless to challenge health care practices, if I have a suggestion or a problem I will try my best to bring this up with my mentor. I believe if I was able to apply this study to my practice it would be a soft change with a substantial result to patients, and it would enable me to offer the best care I can to all of my patients.
In conclusion findings for this study are reliable and valid; the researchers put a lot of thought into their study design and prevented bias from taking place as much as possible, therefore making the results more accurate. Although the sample size was small, improvements could have made if more time was available. With more time it would be possible that further nursing students could have been interviewed to gain additional results for comparison. Due to a small sample it makes it hard to apply the general findings to an overall group. The main limitation to this research study is the fact that there isn’t really much evidence on the topic studied and therefore needs to be expanded. To further this research, an observation of hand hygiene compliance within health care settings would be a research method that could be considered to expand the results. If this was to be undertaken, the results could show factors that affect hand hygiene compliance which may have not of been mentioned in the interviews. Observation would be a useful method in seeing hand hygiene compliance happening in a natural setting and to notice factors that affect compliance which participants may not be aware of.
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