About the authors viii
Chapter 1 Introduction to research, the research process and EBP 1
1.1 The meaning of ‘evidence-based practice’ 2
1.2 Research informs evidence-based practice 4
1.3 Apprehension towards research and evidence-based practice 5
Decision-making by anecdote 6
Decision-making by press cutting 6
Decision-making by expert opinion 7
Decision-making by cost minimisation 8
1.4 Before you start: formulate the problem 8
Summary 10
Key terms 10
Websites 10
Endnotes 10
Acknowledgement 11
Chapter 2 Asking questions and searching for evidence 13
2.1 Different types of searching for evidence 14
Informal 14
Focused looking for answers 15
Searching the literature 15
2.2 Differences between primary and secondary research 15
Narrative review 16
Integrative review 16
Scoping review 16
Systematic review (with or without meta-analysis/ meta-synthesis) 16
Rapid review 16
2.3 Effective search strings 16
Steps for effective searching 17
One-stop shopping: federated search engines 20
2.4 Other avenues for how to search for evidence 21
Searching for information using social media 22
Summary 24
Key terms 24
Websites 24
Endnotes 24
Acknowledgements 24
Chapter 3 Reviewing literature 25
3.1 Is a paper worth reading at all? 27
Question 1. Who wrote the paper? 27
Question 2. Is the title appropriate and illustrative, and is the abstract informative? 27
Question 3. What was the research design, and was it appropriate to the question? 28
Question 4. What was the research question, and why was the study needed? 28
Question 5. Do the results or findings answer the question? 28
3.2 Reviewing the methods of primary research papers 29
Sample and setting: who are the participants, and where is the study being carried out? 29
What data-collection methods were used? 30
How was the data analysed? 30
3.3 Reviewing the methods of secondary (review) papers 31
Question 1. What is the focused clinical question that the review addressed? 31
Question 2. Was a thorough search of the appropriate database(s) carried out, and were other potentially important sources explored? 31
Question 3. Who evaluated the studies, and how? 32
Question 4. How sensitive are the results to the way the review has been performed? 32
Question 5. Have the results been interpreted sensibly, and are they relevant to the broader aspects of the problem? 33
Meta-analyses and meta-syntheses 33
Summary 34
Key terms 34
Websites 34
Endnotes 35
Acknowledgements 36
Chapter 4 Qualitative research 37
4.1 Qualitative research explained 38
Saturation 39
4.2 The difference between qualitative and quantitative research 39
4.3 Qualitative methodologies and data collection strategies 41
Data collection strategies 42
4.4 Evaluating papers that describe qualitative research 43
Evaluating the rigour in qualitative research 43
Critical evaluation of a qualitative research study 44
Question 1. Did the paper describe an important clinical problem addressed via a clearly formulated question? 44
Question 2. Was a qualitative approach appropriate? 44
Question 3. How were (a) the setting and (b) the subjects selected? 44
Question 4. What was the researcher’s perspective, and has this been taken into account? 45
Question 5. What methods did the researcher use for collecting data, and are these described in enough detail? 45
Question 6. What methods did the researcher use to analyse the data, and what quality control measures were implemented? 45
Question 7. Are the results credible and, if so, are they clinically important? 46
Question 8. What conclusions were drawn, and are they justified by the results? 46
Question 9. Are the findings of the study transferable to other settings? 47
Summary 48
Key terms 48
Websites 48
Endnotes 49
Acknowledgement 50
Chapter 5 Quantitative research 51
5.1 Why and how quantitative research is done 53
5.2 Quantitative research designs 54
Intervention studies 54
Observational studies 55
5.3 Measurement 57
Variables — independent and dependent 58
Reliability and validity in measurement 59
Summary 62
Key terms 62
Websites 62
Endnotes 63
Acknowledgements 63
Chapter 6 Levels of evidence 65
6.1 Clinical questions in healthcare 66
Finding valid evidence 66
NHMRC and evidence-based practice 67
How researchers answer clinical questions 67
6.2 How bias threatens the validity of research evidence 68
6.3 Matching clinical questions to NHMRC levels of evidence 70
NHMRC evidence levels for intervention studies 72
6.4 Evaluating the evidence — quality of evidence and grades of recommendations for practice guidelines 75
6.5 Levels beyond levels 76
Summary 79
Key terms 79
Websites 80
Endnotes 80
Acknowledgements 81
Chapter 7 Statistics for the non-statistician 83
7.1 Storing quantitative data in a data set 84
7.2 Descriptive statistics for summarising sample characteristics 85
Descriptive statistics for categorical variables 85
Descriptive statistics for continuous variables 86
7.3 The researchers ‘setting the scene’ 87
Have the researchers tested the assumption that their groups are comparable? 87
What assumptions apply to the shape of the data? 87
Have valid assumptions been made about the nature and direction of causality? 89
7.4 Probability and confidence 90
How are p values interpreted? 90
Confidence intervals 92
7.5 Clinical importance of treatment effects 92
Clinical importance 93
7.6 Summarising treatment effects from multiple studies of interventions in a systematic review 96
Summary 98
Key terms 98
Websites 99
Endnotes 99
Acknowledgements 99
Chapter 8 Mixed methods research 101
8.1 An overview of mixed methods research 102
Why use mixed methods in nursing and health sciences research? 102
8.2 Different mixed methods designs 103
Convergent study 103
Sequential study 104
Multiphase (multilevel) study 104
Embedded study 105
8.3 Integration in mixed methods research 106
Integrating the research question 106
Research design 106
Sampling 106
Analysis 106
Interpretation 107
8.4 Mixed methods design considerations 107
Weighting (dominance) 107
General challenges associated with mixed methods studies 107
Summary 108
Key terms 108
Websites 108
Endnotes 108
Acknowledgements 109
Chapter 9 Sampling 111
9.1 Understanding the terminology around populations and sampling 112
Theoretical population (or target population) 113
Study population (or accessible population) 113
Sample 113
Sampling 113
Sampling frame 113
9.2 Types of sampling 114
Probability sampling 114
Sampling methods 115
9.3 Sampling error 116
Two types of sampling error 117
9.4 Calculating sample size 117
Quantitative research 117
Power analysis 117
Qualitative research 119
Summary 120
Key terms 120
Websites 121
Endnotes 121
Acknowledgements 121
Chapter 10 Ethics 123
10.1 Ethical principles 124
Autonomy: patients/clients are free to determine their own actions 124
Beneficence: acting to benefit human kind 125
Justice: obligation to treat fairly 125
Non-maleficence: avoiding or minimising harm 125
Respect for human dignity 125
Confidentiality: maintenance of privileged information, including the right to privacy and anonymity 126
Veracity: obligation to tell the truth 126
10.2 The role and function of human research ethics committees 126
10.3 Indigenous research 128
10.4 Judging the ethical aspects of a published journal article 129
Summary 130
Key terms 130
Websites 130
Endnotes 130
Acknowledgements 131
Chapter 11 Getting evidence into practice 133
11.1 Adoption of evidence-based practice (EBP) 134
Individual barriers 134
Organisational barriers 135
11.2 Encouraging individuals to implement evidence-based practice 135
11.3 Organisational support of evidencebased practice 136
Integrated care pathways 136
Clinical practice guidelines 137
11.4 The client perspective in evidencebased practice 138
Patient-reported outcome measures (PROMs) 138
Shared decision-making 138
Option grids 139
Summary 141
Key terms 141
Websites 141
Endnotes 141
Acknowledgements 142
Chapter 12 Challenges to evidence-based practice 143
12.1 When evidence-based practice is done badly 145
12.2 When evidence-based practice is done well 146
Guidelines devalue professional expertise 146
The guidelines are too narrow (or too broad) 146
The guidelines are out of date 147
The client’s perspective is ignored 147
There are too many guidelines 147
Practical and logistical problems 147
The evidence is confusing 147
Evaluating clinical practice guidelines 148
12.3 Achieving evidence-based practice 149
Summary 151
Key terms 151
Websites 151
Endnotes 151
Acknowledgements 153
Index 155