Understanding Research Methods For Evidence-Based ... - (Introduction To Research The Research Process and EBP)

CHAPTER 1
Introduction to research,
the research process
and EBP
LEARNING OBJECTIVES
1.1 What does ‘evidence-based practice’ mean?

1.2 Why are people apprehensive about evidence-based practice?
1.3 How do we get started with evidence-based practice?
Copyright © 2019. Wiley. All rights reserved.
Pdf_Folio:1
Greenhalgh, Trisha M.. Understanding Research Methods for Evidence-Based Practice in Health, 2nd Edition, Wiley, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/ecu/detail.action?docID=5880746.
Created from ecu on 2023-02-21 10:27:30.
© John Wiley & Sons Australia, Ltd. Not for resale or distribution. Any unauthorised distribution or use will result in legal action.
OPENING SCENARIO
Imagine you are taking the time to visit your grand-

father, Wilf, who has been living on his own for the
past two years, and recently began seeing a health
professional regarding his chronic hip and knee
pain. When you walk into his house, you see him in
the living room following along to a televised fitness
program — you ask: ‘Hey gramps, don’t you think
you should avoid exercise because of the pain from
your osteoarthritis?’. He sits you down and tells
you that, in short, he’s recently been exercising at
home and attending regular yoga classes alongside
his standard care to decrease the levels of pain
in his hips and knees. He continues to tell you
that he’s already feeling much better since he has
started exercising. At first, you are a bit sceptical of
this revelation, but it turns out that by doing these
activities, coupled with standard care, your grandfather will experience a reduction in his hip and knee
pain symptoms, while gaining confidence and decreasing depressive symptoms.1 In fact, this advice was
not given to your grandfather ‘on a whim’ or based on a simple research paper that guided the health
professional to advise your grandfather of this; it was a systematic review — the highest level of evidence.
(More on this in the chapter on levels of evidence.)
Now imagine that you are the health professional and Wilf is your client. Rather than just providing
‘standard’ practice, think about the ways in which you could provide evidence-based practice (EBP) —
a practice that is supported by scientific evidence, clinical expertise and client values — and how this
practice will have significantly better outcomes than ‘standard’ care for your clients. Isn’t this the care that
you would want to provide? I don’t know about you . . . but that’s the type of care that I would not only
prefer to provide as a health professional but also receive as a health consumer. This is just the start —
EBP becomes so much more exciting from here on in. The more you know, the more you want to know.
This is one of the most fascinating topics to learn about, because you can’t ‘undo’ your learning. If you
allow yourself the opportunity to become immersed in the topic, it will change your perception of nearly
everything you hear, read and do for the rest of your life!
............................................................................................................................................................................
DISCUSSION QUESTIONS
1. Have you visited a health professional in the past 12 months?
(a) If so, do you believe the health professional was an evidence-based practitioner?
(b) How can you be sure that you were receiving evidence-based care?
2. How would you distinguish evidence-based care from standard care?
1.1 The meaning of ‘evidence-based practice’

LEARNING OBJECTIVE 1.1 What does ‘evidence-based practice’ mean?
The aim of this chapter is for you to start to understand ‘research’, the ‘research process’ and ‘evidence-
based practice’ as fundamentally critical to you — not only as an individual, but also as a health consumer
and a health practitioner. This chapter will give you the opportunity to explore the importance of evidence-
based practice and open your mind to copious real-world examples that surround you on a daily basis,
which you might not even recognise as EBP.
EBP is much more than just reading papers. According to the most widely quoted definition, it is ‘the
conscientious, explicit and judicious use of current best evidence in making decisions about the care of
individual patients’.2 Professor Sackett continued to explain that EBP should be visualised as a three-
pronged and overlapping approach, also known as a triad approach: the best possible research evidence,
clinical expertise and patient values and preferences.3
Pdf_Folio:2
2 Understanding research methods for evidence-based practice in health

FIGURE 1.1 The triad approach
Best research
evidence
EBP
Clinical Patient
expertise values
Let’s take a moment to break down each of these areas so you fully grasp what is being considered when
explaining EBP.
1. The best possible research evidence. As you will learn in the chapter on levels of evidence, the higher
the level of evidence, the better the evidence is. Think of it this way: would you prefer implementing a
new exercise regime because your cousin told you it worked for her (Level 5 — anecdotal evidence), or
because a systematic review of over 450 000 people (Level 1 — systematic review) demonstrated that it
would have significant results? Therefore, when we are looking at ‘best possible research evidence’, it
is literally looking for the best options currently available (because you don’t want to use old evidence).
Typically, research evidence is updated at least every 3–5 years, depending on the topic, which means
you could continuously improve your practice.
2. Clinical expertise. This takes into consideration your experiences, both personal and professional, to
help guide you in how to best care for your clients. You might have previously attempted something
yourself — it could be as simple as using a saline rinse around allergy season to alleviate allergy
symptoms. You then have a client tell you how horrible their hayfever symptoms are each year when
the flowers start to bloom, but are not sure how to effectively manage this. In this situation, you might
explain to them that using a saline irrigation for allergic rhinitis works quite well because it thins the
mucus in the nasal cavity and removes some allergens,4 and that although the evidence is low, it’s cost-
effective, available without a prescription and a good alternative to steroid and antihistamine use. Later
on, that client might attempt this ‘remedy’ and then report the results back to you — you then begin to
build your ‘clinical expertise’ in this area.
3. Patient values and preferences. There are times when you might have researched the ‘best possible
treatment’ for your client. From clinical experience you are aware that it would work quite well, but
when you explain the treatment or procedure to the client, they might prefer an alternative treatment;
or their values or religious beliefs will not permit the treatment you have suggested. As you are treating
your clients, their values and preferences should be the first thing that you take into consideration, as
there is no point in continuously suggesting treatments they are not able or willing to engage with.
If you are a health practitioner working in rural or remote locations, you also need to consider whether
‘best practice’ is available — you might have to seek alternative treatments because the EBP is simply not
accessible in your location.
You might now be asking ‘What is research?’. Essentially, it is ‘focused, systematic enquiry aimed at
generating new knowledge’. Throughout this resource, it will be explained how this definition can help
you distinguish genuine research (which should inform your practice) from the poor-quality endeavours
of well-meaning amateurs (which you should politely ignore).
If you follow an evidence-based approach to clinical decision making, all sorts of issues relating to
your clients will prompt you to ask questions about scientific evidence (figure 1.2), seek answers to those
questions in a systematic way and alter your practice accordingly.
Pdf_Folio:3
CHAPTER 1 Introduction to research, the research process and EBP 3

FIGURE 1.2 Some things to consider when assessing clients
• Client preferences
• Symptoms
• Physical/diagnostic signs
• Age, sex and ethnic origin of the client
• Benefits versus risks
• Cost-effectiveness of the treatment
Sackett and Haynes summarised the five essential steps in the emerging science of EBP5 as:
1. to convert our information needs into answerable questions (i.e. to formulate the problem) (ASK)
2. to track down, with maximum efficiency, the best evidence with which to answer these questions —
which may come from the clinical examination, the diagnostic laboratory, the published literature or
other sources (ACQUIRE)
3. to appraise the evidence critically (i.e. weigh it up) to assess its validity (closeness to the truth) and
usefulness (clinical applicability) (APPRAISE)
4. to implement the results of this appraisal in our clinical practice (APPLY)
5. to assess our performance (EVALUATE).
Hence, EBP requires you not only to read papers but also to read the right papers at the right time, and
then to alter your behaviour accordingly (and, what is often more difficult, influence the behaviour of other
people) in the light of what you have found. At no time should one step be seen as more important than
another — all steps should hold equal importance. Yet if you have asked the wrong question or sought
answers from the wrong sources, you might as well not read any papers at all. Equally, all your training
in search techniques and critical appraisal will go to waste if you do not put at least as much effort into
implementing valid evidence and measuring progress towards your goals as you do into reading the paper.
Greenhalgh added to the steps above to create what she deemed a ‘context-sensitive checklist for
evidence-based practice’ to incorporate the client’s perspective, resulting in eight stages, as outlined in
figure 1.3.6
This resource has been strategically designed and written so that you can get the best possible overview
of evidence-based practice, especially for those who are new to the concept of EBP. Our goal is for you to
be able to have an understanding of EBP so that when you become a practitioner, you have the minimum
skills and knowledge to apply evidence and practice as an evidence-based practitioner.
FIGURE 1.3 Is my practice evidence-based? A context-sensitive checklist for individual clinical encounters
Have I identified and prioritised the clinical, psychological, social and other problem(s), taking into
account the patient’s perspective?
Have I performed a sufficiently competent and complete examination to establish the likelihood of
competing diagnoses?
Have I considered additional problems and risk factors that may need opportunistic attention?
Have I, where necessary, sought evidence (from systematic reviews, guidelines, clinical trials and
other sources) pertaining to the problems?
Have I assessed and taken into account the completeness, quality and strength of the evidence?
Have I applied valid and relevant evidence to this particular set of problems in a way that is both
scientifically justified and intuitively sensible?
Have I presented the pros and cons of different options to the patient in a way they can understand,
and incorporated the patient’s preferences into the final recommendation?
Have I arranged review, recall, referral or other further care as necessary?
Incidentally, if you want to explore the subject of EBP online, you will note that throughout this resource,
we provide you with a plethora of websites that can help guide you on the various topics. Please don’t feel
overwhelmed by the vast amount of literature available — most of the sites offer very similar material and
you certainly don’t need to visit them all . . . just visit them if you are interested in digging a little deeper
into each topic.
Pdf_Folio:4

1.2 Apprehension towards evidence-based practice
LEARNING OBJECTIVE 1.2 Why are people apprehensive about evidence-based practice?
Unfortunately, some people might be apprehensive or groan when mentioning evidence-based practice
because they have heard through the grapevine that it’s all about statistics and number crunching. Before
we go much further, let’s clarify something and pop that bubble! EBP is not ‘all about statistics’. Although
yes, statistics, numbers, equations, odds ratios, confidence intervals, etc. are all words you will hear in
EBP, understanding how to interpret and implement EBP is much more important at this point in time.
Numbers are great but, in reality, if you don’t understand what the numbers mean, then you are not really
able to implement EBP. Alternatively, if you don’t understand how the researchers completed the math
behind the numbers, you can’t double-check their work — which is sometimes equally as important. With
this in mind, Greenhalgh and Donald proposed an alternative definition of EBP, which demonstrates the
use of mathematics.
Evidence-based practice is the use of mathematical estimates of the risk of benefit and harm, derived
from high-quality research on population samples, to inform clinical decision making in the diagnosis,
investigation or management of individual patients.7
Students regularly allow the idea of ‘numbers’ and a ‘new language’ to blur their excitement for learning
about EBP — please don’t let this happen to you. Be open to learning about the topic, which will stick
with you for the rest of your life. The more open you are to learning about EBP, the better the practitioner
you will become!
The second reason that people often groan when you mention evidence-based practice is because there
are plenty of daunting new (and often long) words that look like a foreign language. While it is like a
new language, absolutely everything in EBP can be broken down into simple and manageable steps. For
example, students are often stumped by retrospective longitudinal cohort design (which you will learn
about in this resource), but once they break it down, it makes perfect sense:
• retrospective — in the past (think of the word ‘retro’)
• longitudinal — over a long period of time
• cohort — a group of people
• design — type of study.
Now that it’s broken down into manageable chunks, you instantly know that ‘retrospective longitudinal
cohort design’ means a type of study that was done over a long period, looking at a group of people in
the past. So, please don’t feel overwhelmed by the words — they all make sense, but some just need to be
broken down first.
Anyone who works face-to-face with clients knows that it is necessary to seek new information before
making a clinical decision. Health practitioners spend countless hours searching through libraries, books
and online to inform their practices. In general, we wouldn’t put a client on a new drug or through a
new treatment without evidence that it is likely to work — but, unfortunately, best practice is not always
followed. There have been a number of surveys on the behaviours of health professionals. In the United
States in the 1970s, only around 10–20 per cent of all health technologies then available (i.e. drugs,
procedures, operations, etc.) were evidence-based; in the 1990s, that figure improved to 21 per cent.8
Studies of the interventions offered to consecutive series of clients suggested that 60–90 per cent of clinical
decisions, depending on the specialty, were ‘evidence-based’.9 Unfortunately, due to various excuses and
limitations, we are still selling our clients short most of the time.
A large survey by an Australian team looked at 1000 clients treated for the 22 most commonly seen
conditions in a primary-care setting. The researchers found that while 90 per cent of clients received
evidence-based care for coronary heart disease, only 13 per cent did so for alcohol dependence.10
Furthermore, the extent to which any individual practitioner provided evidence-based care varied in the
sample from 32 per cent of the time to 86 per cent of the time. A more recent study found that one in
three hospitals are not meeting performance metrics. One of the leading reasons was failure to implement
EBP.11 Following this, a study suggested that medical error is now the third leading cause of death in the
United States.12 These findings suggest plenty of room for improvement; therefore, with a new wave of
practitioners, hopefully we can increase the application of EBP so that the majority of health consumers
are receiving evidence-based care.
Let’s look at the various approaches that many health professionals use to reach their decisions in
reality — all of which are examples of what EBP isn’t . . . therefore, please do not practise these!
Pdf_Folio:5

Decision making by anecdote
When Trisha Greenhalgh was a medical student, she was able to join a distinguished professor on his daily
ward rounds. On seeing a new client, he would ask about their symptoms, turn to the massed ranks of
juniors around the bed, and relate the story of a similar client encountered a few years previously. ‘Ah, yes.
I remember we gave her such-and-such and she was fine after that’. He was cynical, often rightly, about
new drugs and technologies, and his clinical acumen was second to none. Nevertheless, it had taken him
40 years to accumulate his expertise and the largest medical textbook of all — the collection of cases that
were outside his personal experience — was forever closed to him.
Anecdote (storytelling) has an important place in clinical practice.13 It is common practice for students
and practitioners to listen to professors, tutors and clients and memorise their stories or scripts in the
form of what was wrong with particular clients, and their outcomes to use later. Health professionals
glean crucial information from clients’ illness narratives — most crucially, perhaps, what being ill means
to the client. Experienced health professionals take account of the accumulated ‘illness scripts’ of all
their previous clients when managing subsequent clients — but that doesn’t mean simply doing the
same for client B as you did for client A if your treatment worked, and doing precisely the opposite if
it didn’t!
We would not be human if we ignored our personal clinical experiences, but we would be better to base
our decisions on the collective experience of thousands of health professionals treating millions of clients,
rather than on what we as individuals have seen and felt.
Decision making by press cutting

Imagine simply trawling the internet, magazines, newspapers and information presented throughout all
forms of media and simply ‘cutting and pasting’ then creating, for lack of a better analogy, a scrapbook
of treatments, cures, etc. — continuously altering your practice in line with the various conclusions. For
example, ‘probiotics improve your mood’,14 and advocating that all clients take probiotics. The advice was
in print, and it was recent, so it must surely replace what was previous practice.
This approach to clinical decision making is, unfortunately, still very common. How many doctors do
you know who justify their approach to a particular clinical problem by citing the results section of a single
published study, even though they might fail to tell you:
• the methods used to obtain those results
• whether the trial was randomised and controlled
• the number, age, sex and disease severity of the clients involved
• how many withdrew from (‘dropped out of’) the study and why
• by what criteria clients were judged ‘cured’
• if the findings of the study appeared to contradict those of other researchers; whether any attempt was
made to validate (confirm) and replicate (repeat) them
• whether the statistical tests that allegedly proved the authors’ point were appropriately chosen and
correctly performed (see the chapter on statistics for the non-statistician)
• whether the client’s perspective has been systematically sought and incorporated via a shared decision-
making tool.
Therefore, health practitioners who like to cite the results of medical research studies have a respon-
sibility to ensure that they first go through a checklist like this before simply making decisions by press
cutting.
Decision making by expert opinion

In extreme cases, an ‘expert opinion’ may consist simply of the lifelong bad habits and personal press
cuttings of an ageing health professional, which could simply multiply the misguided views of any one
of them. Table 1.1 gives examples of practices that were at one time widely accepted as good clinical
practice, but that have subsequently been discredited by high-quality clinical trials. Serious harm can be
done by applying guidelines that are not evidence-based. It is a major achievement of the EBP movement
that almost no guideline these days is produced solely by expert opinion!
Pdf_Folio:6

TABLE 1.1 Examples of harmful practices once strongly supported by ‘expert opinion’
Approximate Clinical practice accepted by Practice shown

time period experts of the day to be harmful in Impact on clinical practice
a
From 500 BC Bloodletting (for just about any 1830s Bloodletting ceased
acute illness) around 1910
Early 1900s Complete immobilisation in the 1930s Although very hot dressings
form of splints and braces on and physical therapy (what we
the affected limbs for infantile now know as physiotherapy)
paralysis (Polio) was deemed to be effective,
it was not fully implemented
for the treatment of polio until
the 1950s
1957 Thalidomide for ‘morning 1960 The teratogenic effects of

sickness’ in early pregnancy, this drug were so dramatic
which led to the birth of over that thalidomide was rapidly
8000 severely malformed withdrawn when the first case
babies worldwide report appeared
From at least 1900 Bed rest for acute low 1986 Many doctors still advise people
back pain with back pain to ‘rest up’
1960s Benzodiazepines (e.g. 1975 Benzodiazepine prescribing

diazepam) for mild anxiety for these indications fell in
and insomnia, initially the 1990s
marketed as ‘non-addictive’
but subsequently shown to
cause severe dependence and
withdrawal symptoms
1970s Intravenous lignocaine in acute 1974 Lignocaine continued to

myocardial infarction, with a be given routinely until the
view to preventing arrhythmias, mid-1980s
subsequently shown to have
no overall benefit and in some
cases to cause fatal arrhythmias
Late 1990s Cox-2 inhibitors (a new class of 2004 Cox-2 inhibitors for pain were
non-steroidal anti-inflammatory quickly withdrawn following
drug), introduced for the some high-profile legal cases
treatment of arthritis, were later in the United States, although
shown to increase the risk of new uses for cancer treatment
heart attack and stroke (where risks may be outweighed
by benefits) are now being
explored
a
Interestingly, bloodletting was probably the first practice for which a randomised controlled trial was suggested.
Decision making by cost minimisation

The popular press tends to be horrified when they learn that a treatment has been withheld from a client for
reasons of cost. Managers, politicians and, increasingly, health professionals can count on being pilloried
when a child with a rare cancer is not sent to a specialist unit in the United States or a frail elderly woman
is denied a drug to stop her visual loss from macular degeneration. Yet, in the real world, all healthcare
is provided from a limited budget, and it is increasingly recognised that clinical decisions must take into
account the economic costs of a given intervention. Clinical decision making purely on the grounds of cost
(‘cost minimisation’ — purchasing the cheapest option with no regard to how effective it is) is generally
ethically unjustified, and we are right to object vocally when this occurs.
Expensive interventions should not, however, be justified simply because they are new, or because they
ought to work in theory, or because the only alternative is to do nothing — but because they are very likely
to save life or significantly improve its quality.
Pdf_Folio:7

1.3 Before you start: formulate the problem
LEARNING OBJECTIVE 1.3 How do we get started with evidence-based practice?
If midwifery students are asked what they know about childbirth and pain management, they can talk at
length about the different pain management techniques, how they measure pain by having a conversation
with the woman in labour, what the textbooks define as pain — the list goes on. They are truly aware of
the concept of ‘pain’ and its management during the labouring process.
However, when the students are asked a practical question such as ‘Mrs Janes wants the most effective,
non-invasive and non-pharmacological pain management technique — what would you advise her as her
options?’, they appear startled. One student replies ‘Mrs Janes can have absolutely anything she wants
to manage her pain!’ — a great response, but it doesn’t provide the best possible evidence to Mrs Janes,
especially if she’s asking direct questions. The response could be relaxation techniques,15 massage and
reflexology,16 aromatherapy,17 and so on — but the student would need to revise the evidence. They may
sympathise with Mrs Janes’s predicament, but they often draw a blank as to where to draw on information
such as this, which could possibly be the one thing that Mrs Janes needs or wants to know.
Experienced health professionals might think they can answer Mrs Janes’s question from their own
personal experience, but few of them would be right. Even if they were right on this occasion, they would
still need an overall system for converting all of the information about a client (age, ethnicity, subjective
pain scale, etc.), the particular values and preferences (utilities) of the client, and other things that could be
relevant (a hunch, a half-remembered article, the opinion of a more experienced colleague or a paragraph
discovered by chance while flicking through a textbook) into a succinct summary. The summary would
need to cover what the problem is, and what specific additional items of information we need to solve that
problem and come up with a desired outcome.
Sackett et al., in a book subsequently revised by Straus,18 explained that the parts of a good clinical
question should include three components.
• First, define precisely whom the question is about (i.e. ask ‘How would I describe a group of clients
similar to this one?’).
• Next, define which manoeuvre (treatment, intervention, etc.) you are considering in this client, and, if
necessary, a comparison manoeuvre (e.g. placebo or current standard therapy).
• Finally, define the desired (or undesired) outcome (e.g. reduced mortality, better quality of life, and
overall cost savings to the health service).
Thus, in Mrs Janes’s case, we might ask, ‘In a thirty-year-old Caucasian woman with a high pain
threshold, two previous labouring/birthing experiences, no coexisting illness, and no significant past
medical history, whose blood pressure is currently X/Y, would the benefits of suggesting massage and
reflexology provide her with the desired outcome of an effective, non-invasive and non-pharmacological
pain management technique to decrease pain during labour?’ Note that in framing the specific question, we
have already established that Mrs Janes has previously experienced labour and birth twice. Knowing this,
we recognise that she may have also previously experienced invasive or pharmacological interventions and
is aware of the discomfort of labouring and birthing.
Remember that Mrs Janes’s alternative to an effective, non-invasive and non-pharmacological pain
management technique is potentially invasive and may have side effects — on not only Mrs Janes, but
also the birthing process and/or the baby about to be born. Not all of the alternative approaches would help
Mrs Janes or be acceptable to her, but it would be quite appropriate to seek evidence as to whether they
might help her — especially if she was asking to try one or more of these remedies.
Before you start, give one last thought to your client in labour. In order to determine her personal
priorities (how much does she value a 10 per cent reduction in her pain to still experience the labour and
birthing process compared to the inability to feel below her belly button?), you will need to approach Mrs
Janes, not anybody else in that labouring room, and start the dialogue towards providing evidence-based
care.
Pdf_Folio:8

SUMMARY
Evidence-based practice is much more than ‘reading an academic article’. It includes, at a very minimum,
the best possible research evidence available, clinical expertise as well as understanding the client’s values
and preferences. EBP is not about learning a technique, skill and treatment methodology once and applying
it for the rest of your career; it should be a continuous loop of learning and improvement by using the Ask,
Acquire, Appraise, Apply and Evaluate model. Although some students (and even health practitioners)
attempt to avoid learning about EBP because they believe that it’s all math-driven and hard to understand,
it’s much more than just numbers. Once you learn the techniques, you will begin to see evidence-based
information all around you and will continue to apply EBP throughout your life as both a health consumer
and eventually a health practitioner. When the best question is formulated, it becomes much easier to find
the best evidence to answer the question.
KEY TERMS
evidence-based care Care that is based on evidence-based practice (supported by scientific evidence,
clinical expertise and client values).
evidence-based practice (EBP) A practice that is supported by scientific evidence, clinical expertise
and client values.
knowledge An accepted body of facts or ideas that is acquired through the use of the senses, reasons
or through research methods.
retrospective longitudinal cohort design A type of study conducted over a long period, looking at a
group of people in the past.
WEBSITES
1 Centre for Research in Evidence-based Practice (CREBP): https://bond.edu.au/researchers/research-
strengths/university-research-centres/centre-research-evidence-based-practice
2 Centre for Evidence-based Medicine: www.cebm.net
3 ‘What is evidence-based medicine?’, British Medical Journal: www.bmj.com/content/312/7023/71
4 HPNA Position statements ‘Evidence-Based Practice’, Hospice and Palliative Nurses Association
(US): https://advancingexpertcare.org/position-statements
Joanna Briggs Institute: www.joannabriggs.org
5
Australasian Cochrane Centre: http://aus.cochrane.org
6
‘Evidence-based information’, QUT Library: www.library.qut.edu.au/search/howtofind/evidencebased
7
‘Answering Clinical Questions’, University of Western Australia: www.meddent.uwa.edu.au/
8
teaching/acq
9 ‘Evidence based practice’, University of Tasmania: https://utas.libguides.com/ebp
10 ‘Introduction to evidence-based practice’, Duke University Medical Center Library and the Health
Sciences Library at the University of North Carolina: https://guides.mclibrary.duke.edu/ebmtutorial
ENDNOTES
1. M. Hurley et al., ‘Hip and knee osteoarthritis: a mixed methods review,’ Cochrane Database of Systematic Reviews 4 (2018).
doi:10.1002/14651858.CD010842.pub2.
2. D. L. Sackett et al., ‘Evidence-based practice: what it is and what it isn’t,’ BMJ: British Medical Journal 312, no. 7023
(1996): 71.
3. Sackett, ‘Evidence-based practice,’ 71.
4. K. Head et al., ‘Saline irrigation for allergic rhinitis,’ Cochrane Database of Systematic Reviews 6 (2018).
doi:10.1002/14651858.CD012597.pub2.
5. D. L. Sackett and R. B. Haynes, ‘On the need for evidence-based practice,’ Evidence-based Practice 1, no. 1 (1995): 4–5.
6. T. Greenhalgh, ‘Is my practice evidence-based?,’ BMJ: British Medical Journal 313, no. 7063 (1996): 957.
7. T. Greenhalgh, How to read a paper: the basics of evidence-based medicine (Oxford: Blackwell-Wiley, 2006).
8. M. Dubinsky and J. H. Ferguson, ‘Analysis of the national institutes of health medicare coverage assessment,’ International
Journal of Technology Assessment in Health Care 6, no. 3 (1990): 480–8.
9. D. L. Sackett et al., ‘Inpatient general practice is evidence-based,’ The Lancet 346, no. 8972 (1995): 407–10.
Pdf_Folio:9

10. W. B. Runciman et al., ‘CareTrack: assessing the appropriateness of health care delivery in Australia,’ Medical Journal of
Australia 197, no. 10 (2012): 549.
11. B. Melnyk, ‘Are you getting the best health care? Evidence says: maybe not,’ The Conversation, June 9, 2016,
https://theconversation.com/are-you-getting-the-best-health-care-evidence-says-maybe-not-59206.
12. M. A. Makary and M. Daniel, ‘Medical error — the third leading cause of death in the US,’ BMJ: British Medical Journal 353
(2016): i2139.
13. J. Macnaughton, ‘Anecdote in clinical practice,’ in Narrative based practice: dialogue and discourse in clinical practice, ed.
T. Greenhalgh and B. Hurwitz (London: BMJ Publications, 1998).
14. L. Steenbergen et al., ‘A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad
mood,’ Brain, Behavior, and Immunity (2015): 258–64. doi:10.1016/j.bbi.2015.04.003.
15. C. A. Smith et al., ‘Relaxation techniques for pain management in labour,’ Cochrane Database of Systematic Reviews 3
(2018). doi:10.1002/14651858.CD009514.pub2.
16. C. A. Smith et al., ‘Massage, reflexology and other manual methods for pain management in labour,’ Cochrane Database of
Systematic Reviews 3 (2018). doi:10.1002/14651858.CD009290.pub3.
17. C. A. Smith, C. T. Collins, and C. A. Crowther, ‘Aromatherapy for pain management in labour,’ Cochrane Database of
Systematic Reviews 7 (2011). doi:10.1002/14651858.CD009215.
18. S. E. Straus et al., Evidence-based practice: how to practice and teach EBP, 4 ed. (Edinburgh: Churchill Livingstone, 2010).
ACKNOWLEDGEMENTS
Adapting author for this Australian edition: Amanda Lambros
Photo: © Halfpoint / Shutterstock.com
Pdf_Folio:10


Understanding Research Methods For Evidence-Based ... - (Introduction To Research The Research Process and EBP)

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Understanding Research Methods For Evidence-Based ... - (Introduction To Research The Research Process and EBP)

Uploaded by

Copyright:

Available Formats

CHAPTER 1

1.1 What does ‘evidence-based practice’ mean?

Imagine you are taking the time to visit your grand-

1.1 The meaning of ‘evidence-based practice’

2 Understanding research methods for evidence-based practice in health

CHAPTER 1 Introduction to research, the research process and EBP 3

4 Understanding research methods for evidence-based practice in health

CHAPTER 1 Introduction to research, the research process and EBP 5

Decision making by press cutting

Decision making by expert opinion

6 Understanding research methods for evidence-based practice in health

Approximate Clinical practice accepted by Practice shown

1957 Thalidomide for ‘morning 1960 The teratogenic effects of

1960s Benzodiazepines (e.g. 1975 Benzodiazepine prescribing

1970s Intravenous lignocaine in acute 1974 Lignocaine continued to

Decision making by cost minimisation

CHAPTER 1 Introduction to research, the research process and EBP 7

8 Understanding research methods for evidence-based practice in health

CHAPTER 1 Introduction to research, the research process and EBP 9

10 Understanding research methods for evidence-based practice in health

You might also like