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Evidence in practice and working ethically

Research involves the systematic investigation to discover facts or relationships and reach conclusions using scientifically sound methods.

Evidence based practice involves using the best available evidence and integrating this into your day-to-day practice. This evidence may be from guidelines, research evidence or other quality improvement information gathered about the care provided in your situation e.g. audit.

Stages of Evidence Based Practice

Developing your practice and the care that you provide involves working through a series of stages and there are many models that are used in practice, including the one suggested by the Centre for Evidence Based Medicine which has 5 stages.

The Centre for Evidence Based Medicine describes Evidence Based Practice as having 5 stages:

1. Asking focused question that is answerable

2. Finding the Evidence

3. Critical Appraisal: testing evidence for validity, clinical relevance, and applicability

4. Making a Decision and applying the results in practice

5. Evaluating Performance and auditing evidence-based decisions

Go to their 'What is Evidence' page and read about these stages and look at the tools that are provided.

Link to page: http://www.cebm.net/category/ebm-resources/tools/

Implementing Evidence Based Practice

After discussion and agreement with your mentor, select one of the people you care for and investigate how you could improve an aspect of their care by using the available evidence, using the model suggest based practice on  their 'What is Evidence'  page.

Link to page: http://www.cebm.net/ocebm-levels-of-evidence/

You should be able to see how a structured approach facilitates improving the quality and outcomes of care. While you are not expected to implement the model, you are expected to provide a practice based example illustrating the use of this model.

Working ethically

There are a range of issues that you need to think about to ensure that you are working ethically. The activities below help you to think about ethics in relation to practice, clinical governance and research. You already have some understanding of these issues from your undergraduate experience. In order to broaden your knowledge of these issues, you may want to do some or all of the activities below.

1. Ethics in relation to practice

Recap on what your professional body says about working ethically.

Nursing and Midwifery Council http://www.nmc-uk.org/

Health Professions Council http://www.hpc-uk.org/

2. Research

Find out about your local research and development office ethics committee.

You should record:

  • the key points  for your practice
  • how they influence the way that you work clinically
  • their influence how you would carry out evaluation or research activities

Social Networking Questions

You have now looked at the processes involved in using the evidence base and started to think about how this fits with your practice.  Find out about your Professional Regulator's policy (Nursing and Midwifery Council or the Health Professions Council) about social networking and list the benefits and risks of sharing information this way.

Nursing and Midwifery Council page:  nmc guidance on social networking

Health Professions Council page: http://www.hpc-uk.org/mediaandevents/socialmedia/

Networks supporting Evidence-Based Practice

You should identify a group of people that you care for who have a specific diagnosis and investigate the related clinical effectiveness literature. Share your findings with your colleagues. As with all aspects of your work and learning, you should remember your responsibilities in relation to confidentiality in your discussions.

The following resources will help you find the information that you need:

Evidence into Practice provides a wide range of resources to help improve healthcare quality in Scotland. Many of the resources have a clinical focus and include guidelines, systematic reviews and summaries of primary research.

Point of Care

TRIP database aims to help health professionals find the best available evidence to answer their clinical questions

http://www.tripdatabase.com/

Managed Clinical Networks are designed to impact on care by integrating services and supporting collaboration. There is a wide range of MCNS in Scotland and these are listed on the MCN webpage

Managed Clinical Networks information

Knowledge Network Communities of Practice are websites which increase access to expertise, examples of good practice and to help develop professional development.

http://www.knowledge.scot.nhs.uk/home/communities.aspx

Healthcare Improvement Scotland is the special Health Board who lead improving the quality of care and treatment delivered by NHSScotland. The website gives you access to the latest evidence, publications and resources.

http://www.healthcareimprovementscotland.org/home.aspx

Web resources

These websites are useful for reviewing the most up to date evidence for a range of topics. Why not browse and see if the resources below can support your clinical practice now or in the future.  Remember to add them to the favourites on your computer or record them in another way that will be useful to you.

You can now register for e-mail alerts about new articles on your interests or are in your favourite journals through the ZETOC service available via The Knowledge Network.

Clinical Evidence:http://www.clinicalevidence.com/x/index.html

The Knowledge Network: http://www.knowledge.scot.nhs.uk/home.aspx

NHS Clinical Knowledge Summaries