A Comprehensive Analysis of Evidence-Based Practice in Healthcare and Implications for Operating Department Practitioners
- March 30, 2024
Introduction
The evidence-based practices (EBP) were introduced almost three decades ago in the healthcare literature (Connor et al. 2023). Since then, they have been recognised by national and international healthcare organisations. EBP practices have been constantly associated with enhanced patient outcomes, improved patient safety, and many other positive treatment outcomes (Abu-Baker et al., 2021). This assignment aims to critically evaluate the importance of EBP in healthcare and its benefits in the operative department. This will be conducted through critical appraisal of evidence and evaluation of the relationship between knowledge, practice research, and education. A questioning approach will be implemented when examining the healthcare practice. Furthermore, a journal article by Wang et al., (2020) on the application of evidence-based nursing and its effect on reducing surgical incision infections and improving patient satisfaction with nursing will be utilised to demonstrate critical thinking and the evaluation of evidence-based sources.
Critical and Academic Discussion of Evidence-Based Practice
Evidence-based practice (EBP) can be defined as clinical proficiency and decision-making through the latest research and best available data associated with the preference of the patients and the professional judgment of healthcare professionals (Cardoso et al. 2021). The implementation of EBP promotes good quality care, improves patient outcomes, and reduces the costs needed for healthcare. EBP is essential for nurses as it standardises the nursing practice and improves their knowledge related to clinical decision-making (Abu-Baker et al., 2021). Despite the increasing use of EBP in healthcare organisations due to its efficiency and effectiveness, the implementation is still challenging due to gaps in training, experience, and practice. Cardoso et al. (2021) stated that the application of EBP is difficult and time-consuming and requires appropriate education. The lack of educational knowledge and staff training were perceived barriers to the implementation of EBP. The proper implementation of EBP requires a collaborative and cohesive multidisciplinary approach that is insufficient in this environment of competing interests. Moreover, the absence of a prominent governmental and public policy was also seen as a barrier and disadvantage in the execution of EBP (Lehane et al., 2018).
Operating department practitioners (ODPs) play a key role in providing quality care to patients through the implementation of best practices and evaluation of the safety of patients during the surgical period (Lowes et al. 2020). The Health and Care Professions Council (HCPC) standards state that ODPs should implement evidence-based practice and gather information to guarantee quality care and positive patient outcomes (HCPC, 2023). Care and treatment based on the best available evidence have been shown to provide a safe and advanced standard of care (Ramage and Foran, 2023).
The principal patterns of knowing in nursing were introduced by Carper in the 1970s (Rafii et al., 2021). These fundamental patterns were important for the encouragement of nurses and the understanding of complex nursing practices. Empirical knowing includes facts, models, theories, and themes. Ethical knowing focuses on the ethical principles of nursing practice and addresses the questions of who and what is responsible. Personal knowing includes having appropriate knowledge of a scenario, and the recognition of own reactions, strengths, flaws, and personal biases that may be compromising the quality of the nurse-patient interaction. Empathy, dynamic adaptation, and component understanding are the keys to achieving aesthetic knowing, often known as the art of nursing (Rafii et al., 2021). This critical knowledge and understanding are important for the implementation of EBP.
Searching for Evidence and The Importance of Critical Appraisal
The quality of evidence is determined by the hierarchy of study designs. The study designs hierarchy starts at the lowest level with expert opinion, translational and animal studies, and moves up to descriptive case reports or case series, analytic observational designs like cohort studies, randomised controlled trials, and, as the highest quality evidence, systematic reviews and meta-analyses (Wallace et al., 2022). For ODPs, this hierarchy of evidence in the medical literature is fundamental as it is relevant to important phases of evidence-based practice, such as effective literature searches and ranking the best designs for critical evaluation to answer clinical questions (Lowes et al. 2020).
Researchers have made incredible advances in comprehending the pathophysiology and developing treatment options, but there are currently no well-established methods for data collection and analysis. Quantitative and qualitative data collection techniques are the two most successful approaches. Qualitative research prioritises words and concepts, while quantitative research concentrates on figures and graphs. In general, quantitative methods use math, surveys, and practical experiments, while qualitative research typically draws from observations, interviews, and previously published studies (Sardana et al., 2023). Therefore, qualitative research is preferred when researchers wish to comprehend ideas such as experiences, perceptions, and thoughts. The mixed method approach is a third strategy in which researchers utilize both qualitative and quantitative data for a single study (Wasti et al., 2022).
Searching the evidence means getting through keywords, databases, Boolean operators and also developing the structured search strategy. ODPs apply these keywords to tighten the search range and check in the related database(s) that include, for example, PubMed or Cochrane Library, to make sure that the literature search is very detailed as well. Therefore, by using Boolean operators such as AND, OR, and NOT, refined search is carried out thus ensuring relevant articles are retrieved (Alharbi and Stevenson, 2020). A search strategy that is concise limits the search results and requires deeper investigation. Critical appraisal is of great significance given that it helps ODPs to distinguish research validity, reliability, thoroughness and timeliness. It enables them to evaluate methods, point out faults, and look at the applicability of the methods to the real life practice. Factors that can obstruct critical appraisal are difficulty in understanding methodology, unavailable literature, time restrictions and biases occurring in studies (Haddaway et al., 2020). Knowledge of both kinds of research (quantitative and qualitative) empowers ODPs to use evidence-based medicine in a perioperative setting while making an informed decision for the optimum health outcome of the patient (Lowes et al., 2020). This procedure not only improves patients’ overall outcomes, but also establishes ODPs as healthcare providers with the true knowledge based on scientific information.
Critical Appraisal of Research Article
Table 1 Critical Appraisal of Research Article by Wang et al., (2020)
| Critique Component | Description |
| Aim – what is the aim of the research, is it clear? Did the author(s) address this? | The aim of this research is to study the use of evidence based nursing in the operating room and its outcome in getting the surgical wound infections less and improving the patients’ satisfaction. The nature of the aim underscores this principle proposed by Peavey and Vander Wyst (2017) that clarification of the objectives of the research will help in the design of the research framework as well as the interpretation of the findings. Essentially, Erismann et al. (2021) explains the role of the well-defined research aim in developing the research methodology and the subsequent dissemination of research results to the relevant stakeholders. |
| Literature review – is this relevant to the study? Did it provide an overview of current evidence/research? | The literature review covers evidence-based medicine (EBM) and its possible effects on the outcome of surgery as well as patients’ satisfaction. It provides the highlights of the current-day studies and research and establish the fact that the use of EBN improves patient outcomes in different care settings. A properly strengthened literature review, as suggested by Portney (2020), would enable adoption of a broader range of research studies and frameworks, which, in turn, would help produce more valid and generalizable findings concerning the role of evidence-based principles in surgical settings. In the opinion of Lim et al. (2022), a good literature review is therefore able to provide the researcher with helpful insights on the topic, pin point research gaps, and to explain the research problem itself. |
| Selection and recruitment – how were participants/research selected? Did they follow any frameworks? | The participants were randomly chosen and then randomly assigned to either an observation or control group. The specificity of the choosing procedure is outlined, displaying that randomness will be used so that selection bias will be decreased. Randomized controlled trials (RCTs) usually follow strict criteria for selection, in order to make audience and investigator errors tendency to be minimum (Kaur and Li, 2024). The information of the participant features and the clear inclusion/exclusion principles necessary for evaluation the external validity and the generalizability of research findings is also essential (Keung et al., 2020). Randomization indeed plays the crucial role in clinical trials as Saturn et al., (2014) puts it. It ensures even distribution of known and unknown factors that could affect the result across the groups. This helps to improve the internal validity of the research. |
| Methodology – was the study methodology sound? Were participants/researchers ‘blind’? Consider sample sizes, were they adequate? | The purpose of this study is to examine whether or not therapies are effective by using randomised controlled trial (RCT) design which is the most relevant and appropriate approach. While in the other hand, it does not indicate definitely the blinding of both the researchers and the participants which is more likely to be source of bias. Lakens (2022) states that it is important to have a sufficient sample size in order to obtain statistically powerful results that are reliable conclusions of the research. Unconfounded blinding methods provide another reason to reduce bias and increase the internal validity of the randomized controlled trials (RCT) (Krauss, 2021). Lakens (2022) showcases the importance of blinding techniques and the computing of sample sizes in randomised controlled trials (RCTs) while highlighting how these processes minimize systematic mistakes and strengthen the reliability of research findings. |
| Data collection – how was the data collected? Inclusion/exclusion criteria | Data collection included deploying a structured questionnaire to gauge nursing satisfaction as well as utilising self-rating scales, such as SAS and SDS, to measure psychological sentiment. The study was extended with the assessment of pain intensity using the Visual Analog Scale (VAS), the introduction of a Questionnaire of Quality of Life (QLQ-C30), which revealed the patients’ post-operative condition. The accurate reporting of data collection methods is an indispensable ingredient for reproducing results and ensuring the authenticity of the study findings (Hardwicke et al., 2020). The utilization of standardized instruments and validated protocols for data collection improves the reliability and validity of data obtained (Taherdoost, 2021). As indicated by Krauss (2021), the strength and reliability of study findings rest upon the firmness of data collection methodology and use of the best equipment. Consequently, one of the most important parts of the proper research process includes clear reporting of data collection methods that would in turn demonstrate the strength of the research findings. Participants were enrolled if they were between the age of 20 and 65 and underwent elective surgery using general anesthesia with surgical incisions longer than 2 cm as inclusion criteria, excluding patients with surgical contra-indications, infectious diseases, severe hepatic or renal dysfunction, severe coagulation disorders, cognitive or communication disorders, diabetes with severe immunodeficiency, |
| Ethical considerations – are there any ethical issues? | The study reports that ethical approval has been confirmed and participants have consented to the terms of the study. Ethical practice in research entails protecting the rights and safety of the participants, ensuring that their participation is consensual and ensuring that data privacy is observed (Brittain et al., 2020). Incorporating ethics clarifications in the reporting process will improve the reliability and credibility of research findings in general (Ibbet and Brittaine, 2020). Ethical guidelines which are discussed in the Declaration of Helsinki highlight the importance of making the participant completely aware of the risk-benefit ratios, alongside confidentiality protection (Kurihara et al., 2023). Therefore, adequate adherence to ethical principles is mandatory for avoiding improper conduct during research which may lead to the personal harm of participants. |
| Data analysis including statistics – how was the data analysed? Were appropriate methods used? | The collected data were statistically analyzed using SPSS version 18.0 software. Pairwise t-test was utilised to check intragroup before-after variation and independent t-test and chi-square were employed to contrast between-group and enumeration data respectively. The significance level was set at P < 0.05. These techniques are popularly used for processing quantitative data in clinical research, ensuring conformity to acceptable statistical analysis principle and interpretation threof. Reporting pertaining to statistical procedures used for obtaining the data can go a long way in getting more and more people to trust your findings and give you credit for that (Kekecs et al. 2023). Applying satisfactory statistical methods comes under the umbrella of scientific principles and adds up to the validity of the study results (Dodgy, 2017). Thus, steadfast adherence to reliable statistical methods is a key guideline in making sure that the study’s conclusions are robust and widely applicable. |
| Reliability and Validity – consider the points that could affect this | The investigation expresses medium reliability and validity, with the random allocation and standardized processes contributing to improved reliability, and the clear standards and validated instruments contributing to the validity. Though the imperfection of biases and the credibility of the information that the sample may lack could be responsible for the overall credibility and generalizability of the results. Collecting data with a high level of reliability and validity is an imperative step in the research process and relies on robust data collection techniques, validated instruments, and statistically robust analyses (Taherdoost, 2021). |
| Results – what are the overall results? How were they expressed? Are they valid? Are they reliable? Any bias to consider? | The study findings showed significantly fewer cases of surgical-related wound infections. It also reported reduced levels of negative psychological states in the observation group when compared to the control group. It is also important to note that both patients and nurses were satisfied with the quality of life and shorter hospital stays, which were observed in the observation group. The impacts were shown by the use of statistical comparisons, differences before and after, as well as self report measures. Although, the outcomes of this research seem to be trustworthy when standard assessment tools and statistical analysis are used, it is perhaps advisable to consider potential biases like selection bias and subjective reporting, which can have adverse effects on reliability. |
Discussion – overview of the research, is there anything you think should be included? Give consideration to whether the content of the research can be applied to your area of practice | The discussion highlights the results of the study whether EBN has been able to reduce the incidences and post-surgical complications and this has resulted in improved patient outcomes and satisfaction. In depth discussions should include study’s shortcomings, important implications, and directions for the future research to ensure that study outcome is viewed in a holistic context, and it further helps in clinical decision making (Shea et al., 2017). By determining to integrate critical reflection, the utility of research results is improved in real-world settings (Shea et al., 2017). The literature should not assume to be straightforward narration of the findings but instead must take the discussion a step further into implications for clinical practice, policy, and future research (Dawadi et al., 2021). |
Conclusion
In summary, healthcare cannot do without evidence based practices to ensure that services offered to patients are uniform and that the patients have the best experience and furthermore ensure that there is a reduction in cost. Identifying studies and critically reading them, are the key Anticipating abilities which ensures healthcare provider’s use of evidence-based practice is effective. ODPs who work in operating departments are an important part of the mechanism to incorporate evidence-based practice (EBP) to ascertain correct care provision and favorable patient outcomes. The assimilation of varying ways of knowing in nursing like empirical, ethical, personal and aesthetic knowing is a very basic requirement for effective and quality based EBP. The processes of finding evidence, critical appraisal, and the insight into both statistical and qualitative design are the steps that will guide ODPs and make proper decisions for their patients. Ethical principles should be followed by ODPs in data mining and analysis, and validity and trustworthiness of the overall study should also be taken into account to provide credible and applicable research results for better clinical practice. Evaluative discussions of research outcomes must also include study limitations, clinical implications, and suggestions for future research, as well so that the maximum amount of knowledge can be gained from the work.
References
Abu-Baker, N.N., AbuAlrub, S., Obeidat, R.F. and Assmairan, K., 2021. Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students. BMC nursing, 20, pp.1-8.
Alharbi, A. and Stevenson, M., 2020. Refining Boolean queries to identify relevant studies for systematic review updates. Journal of the American Medical Informatics Association, 27(11), pp.1658-1666.
Brittain, S., Ibbett, H., de Lange, E., Dorward, L., Hoyte, S., Marino, A., Milner‐Gulland, E.J., Newth, J., Rakotonarivo, S., Veríssimo, D. and Lewis, J., 2020. Ethical considerations when conservation research involves people. Conservation Biology, 34(4), pp.925-933.
Cardoso, D., Couto, F., Cardoso, A. F., Bobrowicz-Campos, E., Santos, L., Rodrigues, R., … & Apóstolo, J. (2021). The effectiveness of an evidence-based practice (EBP) educational program on undergraduate nursing students’ EBP knowledge and skills: A cluster randomized control trial. International Journal of Environmental Research and Public Health, 18(1), 293.
Connor, L., Dean, J., McNett, M., Tydings, D.M., Shrout, A., Gorsuch, P.F., Hole, A., Moore, L., Brown, R., Melnyk, B.M. and Gallagher‐Ford, L., (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: findings from a scoping review. Worldviews on Evidence‐Based Nursing, 20(1), pp.6-15.
Cypress, B.S., 2017. Rigor or reliability and validity in qualitative research: Perspectives, strategies, reconceptualization, and recommendations. Dimensions of critical care nursing, 36(4), pp.253-263.
Dawadi, S., Shrestha, S. and Giri, R.A., 2021. Mixed-methods research: A discussion on its types, challenges, and criticisms. Journal of Practical Studies in Education, 2(2), pp.25-36.
Erismann, S., Pesantes, M.A., Beran, D., Leuenberger, A., Farnham, A., Berger Gonzalez de White, M., Labhardt, N.D., Tediosi, F., Akweongo, P., Kuwawenaruwa, A. and Zinsstag, J., 2021. How to bring research evidence into policy? Synthesizing strategies of five research projects in low-and middle-income countries. Health Research Policy and Systems, 19, pp.1-13.
Haddaway, N.R., Bethel, A., Dicks, L.V., Koricheva, J., Macura, B., Petrokofsky, G., Pullin, A.S., Savilaakso, S. and Stewart, G.B., 2020. Eight problems with literature reviews and how to fix them. Nature Ecology & Evolution, 4(12), pp.1582-1589.
Hardwicke, T.E., Wallach, J.D., Kidwell, M.C., Bendixen, T., Crüwell, S. and Ioannidis, J.P., 2020. An empirical assessment of transparency and reproducibility-related research practices in the social sciences (2014–2017). Royal Society open science, 7(2), p.190806.
Ibbett, H. and Brittain, S., 2020. Conservation publications and their provisions to protect research participants. Conservation Biology, 34(1), pp.80-92.
Kaur, R. and Li, J., 2024. How to conduct a randomized controlled trial. Respiratory Care, 69(1), pp.128-138.
Kekecs, Z., Palfi, B., Szaszi, B., Szecsi, P., Zrubka, M., Kovacs, M., Bakos, B.E., Cousineau, D., Tressoldi, P., Schmidt, K. and Grassi, M., 2023. Raising the value of research studies in psychological science by increasing the credibility of research reports: the transparent Psi project. Royal Society Open Science, 10(2), p.191375.
Keung, E.Z., McElroy, L.M., Ladner, D.P. and Grubbs, E.G., 2020. Defining the study cohort: inclusion and exclusion criteria. Clinical Trials, pp.47-58.
Krauss, A., 2021. Assessing the overall validity of randomised controlled trials. International Studies in the Philosophy of Science, 34(3), pp.159-182.
Kurihara, C., Inoue, K., Kai, H., Suzuki, K., Saeki, H., Funabashi, Y., Kishi, N., Kuge, A., Murakami, T., Saito, Y. and Uchida, E., 2023. Our “WMA Declaration of Helsinki”: Opinions and Proposals from Patient and Public for Research Ethics. In Ethical Innovation for Global Health: Pandemic, Democracy and Ethics in Research (pp. 243-269). Singapore: Springer Nature Singapore.
Lakens, D., 2022. Sample size justification. Collabra: psychology, 8(1), p.33267.
Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., O’Connor, M., Corrigan, M., Burke, F., Hayes, M. and Lynch, H., 2018. Evidence-based practice education for healthcare professions: an expert view. BMJ evidence-based medicine.
Lim, W.M., Kumar, S. and Ali, F., 2022. Advancing knowledge through literature reviews:‘what’,‘why’, and ‘how to contribute’. The Service Industries Journal, 42(7-8), pp.481-513.
Lowes, R., Duxbury, A. and Garth, A., 2020. The evolving roles of Operating Department Practitioners in contemporary healthcare: A service evaluation. Journal of Perioperative Practice, 30(3), pp.46-56.
Operating department practitioners (2023) HCPC. Available at: https://www.hcpc-uk.org/standards/standards-of-proficiency/operating-department-practitioners/ (Accessed: March 14, 2024).
Peavey, E. and Vander Wyst, K.B., 2017. Evidence-based design and research-informed design: What’s the difference? Conceptual definitions and comparative analysis. HERD: Health Environments Research & Design Journal, 10(5), pp.143-156.
Portney, L.G., 2020. Foundations of clinical research: applications to evidence-based practice. FA Davis.
Rafii, F., Nasrabadi, A.N. and Tehrani, F.J., 2021. How nurses apply patterns of knowing in clinical practice: a grounded theory study. Ethiopian journal of health sciences, 31(1).
Ramage, B. and Foran, P., (2023). Evidence-based practice in perioperative nursing: Barriers and facilitators to compliance. Journal of Perioperative Nursing, 36(2), p.6.
Sardana, N., Shekoohi, S., Cornett, E.M. and Kaye, A.D., 2023. Qualitative and quantitative research methods. In Substance Use and Addiction Research (pp. 65-69). Academic Press.
Saturni, S., Bellini, F., Braido, F., Paggiaro, P., Sanduzzi, A., Scichilone, N., Santus, P.A., Morandi, L. and Papi, A., 2014. Randomized Controlled Trials and real life studies. Approaches and methodologies: a clinical point of view. Pulmonary pharmacology & therapeutics, 27(2), pp.129-138.
Shea, B.J., Reeves, B.C., Wells, G., Thuku, M., Hamel, C., Moran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E. and Henry, D.A., 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. bmj, 358.
Taherdoost, H., 2021. Data collection methods and tools for research; a step-by-step guide to choose data collection technique for academic and business research projects. International Journal of Academic Research in Management (IJARM), 10(1), pp.10-38.
Wallace, S.S., Barak, G., Truong, G. and Parker, M.W., 2022. Hierarchy of evidence within the medical literature. Hospital Pediatrics, 12(8), pp.745-750.
Wang, Y., Wei, S. and Zhang, D., (2020). The application of evidence-based nursing and its effect on reducing surgical incision infections and improving patient satisfaction with nursing. Int J Clin Exp Med, 13(2), pp.909-916.
Wasti, S.P., Simkhada, P., van Teijlingen, E.R., Sathian, B. and Banerjee, I., 2022. The growing importance of mixed-methods research in health. Nepal journal of epidemiology, 12(1), p.1175.
