JOURNAL STUDY ON THE RESEARCH ARTICLE “SURVEY OF KNOWLEDGE PERCEPTIONON THE ACCESS TO EVIDENCE-BASED PRACTICE AND CLINICAL PRACTICE CHANGE AMONG MATERNAL AND INFANT HEALTH PRACTITIONERS ON SOUTH EAST ASIA”

The journal is a study of the knowledge and the perception of health care practitioners on evidence-based practice and clinical practice change among maternal and child health care practitioners in four countries in the Southeast Asian region. Among those that participated in the study were 660 respondents which were classified into six health professional groups working from 9 different hospitals that participated in the South East Asia Optimizing Reproductive and Child Health in Developing countries (SEA-ORCHID) in four participating countries; Malaysia, Indonesia, Thailand, and the Philippines. The aim of the study was to assess the health care professionals’ current knowledge of evidence-based practice, their information seeking behaviors, and their perception on the potential barriers and enablers to the change in clinical practice among Maternal and Child Health care practitioners.

The results of the study with regards to the knowledge of the concept of Evidence Based Practice were a far outcry from what is ideal. Although 58 percent of the total population has said they have heard the concept, the responses made by the health professionals point to a great lack of understanding of the concept. More professionals from Thailand and Malaysia were familiar of the concept of EBP than in the Philippines and Indonesia. And although a great 78 percent of the respondents opted to write their definition there was great variation to their answers.

As a brief background, evidence based practice of nursing according to the Sicily statement on Evidence-Based Practice (EBP), states that it “

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requires decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources

”1. To many older health care professionals, this concept is relatively new and complex. Throughout the years, the definition of Evidence-Based Nursing has evolved, and it has been most commonly confused with similar terms, such as Evidence-Based Medicine, Evidence-Based Outcome, etc. Evidence-Based Practice requires nurses, and even other health care professionals to be able to adapt to the changing times; we must, be able to assess, gain, and integrate new knowledge into the care of our patients and these must be solidly grounded on the most currently available preeminent, and proven literature. To quote the opening statement of the document lifted from Goethe (1833), “

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Knowing is not enough; we must apply. Willing is not enough, we must do

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As such, Evidence-Based Practice must underlie and emanate from every action and intervention we health care professionals perform. As such, the Sicily Statement on Evidence-Based Practice has found five steps to accomplish EBP first generally described in 1992. The steps are as follows:

1. Translation of uncertainty to an answerable question,
2. Systematic retrieval of best evidence available,
3. Critical appraisal of evidence for validity, clinical relevance and applicability,
4. Application of results in practice, and
5. Evaluation of performance.

It is then such an important concept, but how can such a pivotal concept simply be forgotten? The answer must lie on the fact that evidence based practice has never been widely introduced among the health professions only until recently. This is supported by the same results stated in the study conducted by the SEA-ORCHID group that in-service training in the hospitals where the respondents worked were primarily technical or professional, possibly with no regard to evidence based practice. What we need to do is intensify efforts to propagate the seeds of evidence based practice so that one day, every health care practitioner will be able to recognize the wonders and effectivity of this concept.

The Internet is being used as a source of information among health professionals and commoners. In fact, according to a study by Renahy et al (2008)2, Internet access rates have drastically increased in all industrialized countries in the last 15 years, with the United States having the biggest rise in access rates (70%). However, the question has never been the Internet interface itself, but its ability to be available to the health professional and to the greater extent, the general public. In the same study conducted by Renahy et al (2008) in France about health information seeking in the internet, close to 70 percent of the adult population has had internet access and that 49 percent of them have previously searched the Internet for medical information. Economic and social discrepancies seen in online health information seeking are furthermore reinforced by the same economic and social discrepancies in internet access. It also shows the trend that those who do have a recent problem are the ones who also consult the internet for health information. This study only further proves the power of the World Wide Web as a potent tool in education and research and in the never ending quest to find supporting literature for Evidence Based Practice.

Although the power of the Net to become a tool to change the way health professionals treat and give care has been established, it does not at all radically change the face of diagnosing and caring in the 21st century. It is largely due to the fact that not all people have the access to the Internet and that not all people have the technical know-how to be able to effectively use it. In a study made by Kontos et al. (2007)3, more barriers to the use of the internet have been cited, among them include time constraints, and family conflict over computer usage. This further supports the variations in the results of the study that in most parts of Indonesia, Malaysia and the Philippines, there is no available internet connection in a significant number of areas and that, in the above stated paragraphs, there is no real in-service training in the use of computers. Although the use of computers have been primarily to consult health information (57 percent), this seeming ignorance may have been the cause of why the internet has not been included in the most frequently used resources. Also, the users do not report frequent use of such important medical websites such as The Cochrane Library, and the World Health Organization’s Reproductive Health Library. Even the website Pubmed.nih.gov only ranked second to Google, the most used website for consultation purposes. This may be due to the self-instructed nature of their Internet know-how. What we need to do is improve upon our knowledge in technology so as not to be left behind with the advance of society. It is our responsibility as nurses to adapt with the changing times.

Although the future holds promises (the results of the study indicate the health care professional’s interest in attending workshops on Evidence based Practice [ranging from 83 percent to 88 percent]), may this study serve as a wake-up call to all nurses, to all academicians and to all nursing administrators. The times are changing, we are being left behind; we must embrace new concepts and move forward into a better tomorrow.



References:

1 - Martin Dawes, William Summerskill, Paul Glasziou, Antonino Cartabellotta, Janet Martin, Kevork Hopayian, Franz Porzsolt, Amanda Burls, and James Osborne, October 2004, Sicily Statement on Evidence Based Practice, lifted from the BioMed Central Journal, retrieved June 20, 2009 from www.pubmedcentral.nih.gov

2 - Emilie Renahy, Isabelle Parizot, and Pierre Chauvin, February 2008, Health information seeking on the Internet: a double divide? Results from a representative survey in the Paris metropolitan area, France, 2005–2006, lifted from the BioMedCentral Journal, retrieved June 20, 2009 from the www.pubmedcentral.nih.gov

3 - Emily Z Kontos, ScM, Gary G Bennett, PhD, and K Viswanath, PhD, October 2007, Barriers and Facilitators to Home Computer and Internet Use Among Urban Novice Computer Users of Low Socioeconomic Position, lifted from the Journal of Medical Internet Research, retrieved June 20, 2009 from the www.pubmedcentral.nih.gov

Comparing the Philippines' health care delivery with that of United States, Canada and other first world countries, it is quite obvious that our country is very much left behind. Modernization is one thing present in our times. There is a great difference with the practice and treatment given in our country with that of the powerful countries.

Evidence-based practice (EBP) involves complex and careful decision-making which is based not only on the available facts but also on patient conditions, beliefs, and preferences. It recognizes that care is different from one patient to another. It has become individualized to come up with the optimum care for patients. Evidence-based practice is a twist with the traditional health care practice.

The government leaders should address this issue so improvements may be done and we can keep moving forward.

Much of day-to-day clinical practice is based in traditional scientific authority and adherence to standard approaches, with problem-solving occurring through reflection on one's experience and knowledge of underlying biology, and information found by consulting textbooks or local experts (EBM Medicine Working Group, 1992).

Guidelines reflect the standard and accepted practices that have evolved and been reinforced over time through common use. In the early 1970's researchers began paying attention to variations in medical practice among physicians within the same geographic region, with comparable patient populations (Wennberg & Gittelsohn, 1973). It became clear that the traditional approaches and guidelines needed to be made more systematic, with empirical evidence used to estimate the benefits, harms, and costs of various health care strategies and form the basis for recommendations for appropriate care. Presumably, empirically-based recommendations would help practitioners avoid care that is too aggressive or too conservative.

Characteristics of evidence-based care:
• A systematic, information-driven approach to care
• Applies principles of outcomes research to practice
• Emphasizes population-based care
• Identifies people at risk, intervenes, measures outcomes, and continually strives to improve care.
• Requires practitioners to shift from consensus-based health care to evidence-based care.

Evidenced-based if integrated in our practice, it will enable us to continuously improve patient care. It involves identifying, assessing, and implementing strategies that are supported by scientific research as being effective in improving outcomes for patient care. As healthcare practitioners, we should use the best available information to guide our work with our patients, it enhanced our performance.
It will help us in making decisions about the care of individual clients and further improve the increase quality of patient care.

Evidenced-based nursing/evidence-based practice (EBN/EBP) is a nursing process that entails reviewing and instilling the most reliable and updated research in patient care. The goal of EBN is to provide the highest quality and most cost efficient nursing care possible. EBN is a process founded on the collection, interpretation, and integration of valid, important, and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments. EBN is not easily achieved and requires a conscious effort to practice and participate. In order to practice evidence based nursing one must understand the concept of research, know how to accurately evaluate research and decide which research is measurably valid and reliable.

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"Registered Nurses are expected to access, appraise, and incorporate evidence-based practice into their professional judgment and decision-making as well as to consider preferences and values of their patient population."

Associate degree graduates will demonstrate an awareness of the value or relevance of evidenced-based practice. Registered nurses help identify problem areas in nursing practice within an established structured format, assist in data-collection activities, and , in conjunction with the professional nurse, appropriately use research findings in practice (Geri LoBiondo-Wood, Judith Haber pg.9) Thus, incorporating EBP into their nursing careers.
"When enough research evidence is available, it is recommended that the evidence base for practice be based on the research." EBP is a growing trend in nursing. As more research is done in a specific area, the research evidence can be used to update and refine guidelines.

Nurses are challenged to expand their "comfort zone" by offering creative approaches to old and new health problems and designing new and innovative programs.

In order to be the best possible patient advocate, a nurse must be willing to continually evaluate and change his or her practice methods. Health care is constantly changing. New information on how to provide better care for patients is discovered every day; and old practices are being improved. research is done to prove their effectiveness.

REFERENCES:
1. LoBiondo-Wood, G., & Haber, J. (2006). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St. Louis, Missouri: Mosby Elsevier.
2. Nursing Scope & Standard of Practice 2004 Edition
3. Lanchanee-Kania, Donna, ANP, Best, Patricia J.M., MD, Mcdonah, Margret R., FNP, Ghosh, Amit K., MD. Evidence-Based Practice and the Nurse Practitioner. The Nurse Practitioner. Vol. 31, No 10, p 46-54.

Although the rise and expansion of evidence-based practice has been spectacular, it has been accompanied by considerable criticisms from medicine and other fields. Supporters and advocates of evidence-based practice claim that the approach results in the best practice and the best use of resources. In contrast, opponents have countered claims that evidence-based practice is a covert method of rationing resources, is overly simplistic and contains professional autonomy (Trinder, 2000)


On a positive note, evidence-based practices, are often developed in the form of clinical practice manuals that are quite specific. They generally specify the length of treatment and the specific topics and approaches to be used. Most evidence-based practices are based on a specific theoretical approach, such as motivational enhancement, contingency management, or cognitive behavioral methods.
One difference between clinical practice guidelines and evidence-based practices is that practice guidelines are not based on a single theoretical framework. Rather, practice guidelines are drawn from a wide variety of research literature, representing an eclectic collection of “things that work.” Evidence-based practices are generally based on one theoretical approach and provide detailed descriptions of how to carry out the approach. (The Iowa Consortium, For substance abuse research and Evaluation, Evidence-Based Practices,2003)


References:

Liz Trinder, Shirley Reynolds, Evidence- Based Health Care A Critical Appraisal (2000) , retrieved from http://books.google.com.ph/books?id=JWyuvdiP4QgC&printsec=frontcover&dq=related:LCCN99059641&source=gbs_similarbooks_s&cad=1



The Iowa Consortium, For substance abuse research and Evaluation, Evidence-Based Practices:
An Implementation Guide for Community-Based
Substance Abuse Treatment Agencies ( 2003) http://www.uiowa.edu/~iowapic/files/EBP%20Guide%20-%20Revised%205-03.pdf

Different strategies are done to promote efficient clinical care delivered to maternal and infant patients. Some countries are focused on training health care providers like midwives and others are into studying evidence-based practice of practitioners. Training of midwives was under the supervision of male obstetrician in western part of the world started during the seventeenth century. A century after, new schools of midwifery emerged in the light to reduce maternal and infant mortality rate (De Brouwere, 2007)[1].

The study conducted by Martis, et al (2008) identified the necessity to improve IT access to health care information to health care providers, so that they can use these information in their field, thereby promoting effective evidence-based practice.

There are also some researches done in the United States and Netherland showed that there are at least 30-40% of patients who did not receive the appropriate care according to scientific evidence. Meanwhile, there are 20% or greater of the care rendered is unnecessary or potentially hazardous to patients [2]. In the study done by Grol and Wensing (2004), the data showed that lack of awareness, motivation, lack of familiarity, and perceived external factors are some of the reasons that were identified as barriers to adopting clinical practice guidelines.

Rychetnik, L. & Wise, M. (2004) proposed six examples of health promotion policy goal that were identified to have great utility in the type of evidence promoted in evidence-based practice. (1) Increase the proportion of health sector funding for primary prevention and health promotion, (2) Implement interventions that are proven effective and safe, (3) Implement programs that are efficient, feasible and politically acceptable, (4) Address the social, economic and environmental determinants of health and inequities in health, (5) conduct joint or collaborative programs between the health sector and other sectors of government, and with non-government sectors, and (6) Encourage other sectors to adopt policies and programs that reinforce health and sector-funded programs or that directly address socio-economic determinants of health [3]. Evidence-based practice not only can save time, but it also has moral and safety implications [4].


Reference:
1. De Brouwere, V. (2007).The Comparative Study of Maternal Mortality over Time: The Role of the Professionalisation of Childbirth. Social History of Medicine. Retrieved on October 9, 2007 from http://shm.oxfordjournals.org/cgi/content/abstract/20/3/541

2. Grol, R. & Wensing, M. (2004).What drives change? Barriers to and incentives for achieving evidence-based practice. Medical Journal of Australia. Retrieved on http://www.mja.com.au/public/issues/180_06_150304/gro10753_fm.html

3. Rychetnik, L. & Wise, M. (2004). Advocating evidence-based health promotion: reflections and a way forward. Health Promotion International, 19. Retrieved from http://heapro.oxfordjournals.org/cgi/content/full/19/2/247?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=evidence-based+practice&searchid=1&FIRSTINDEX=10&resourcetype=HWCIT

4. Bot, M. et al.(2006, May 25). Evidence-based guidelines, time-based health outcomes, and the Matthew effect. The European Journal of Public Health. Retrieved on October 23, 2006 from http://eurpub.oxfordjournals.org/cgi/reprint/17/3/314?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=evidence-based+practice&searchid=1&FIRSTINDEX=10&resourcetype=HWCIT

Evidence base practice is a problem solving approach that incorporates the best available scientific evidence, clinicians expertise and patients preference and values.

Barriers of Evidence Based Practice

Limited time to access,critique and apply the data.

Nurses who believe in the value of ebp to improve patient care and outcome often do not have the knowledge to use ebp

Lack of confidence or skill to use ebp and a feeling the the articles are hard to read and apply to practice


i think EBP should not be used as a primary tool but rather an aid or an enhancement while doing interventions with clients,

reasons

85% of current practices are not scientifically validated.

its like your playing ratio and proportions or statistics/probabilities.
every situation is different, every patient is unique.

references

Vratny A.(2007) A conceptual model for growing evidence base practice.

Shirley, M.R.(2006) Evidence based practice: how leaders can facilitate innovation.

Fineout-Overholt, E(2005) strategies for advance evidence based practice in clinical settings,

A new paradigm for medical practice is emerging. Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research. Evidence-based medicine requires new skills of the physician, including efficient literature-searching, and the application of formal rules of evidence in evaluating the clinical literature. (Guyatt, 1991)

As confirmed by the study, Evidence-based practice aids health professionals to improve the quality of care given to patients. But as revealed by the results of their study, only 58% have heard about it, 66% are using it in the Philippines, 38% of the nurses and 40% of midwives utilized it. I think these are not very good fractions considering only 9% brought about clinical practice change. And what is the goal of this evidence-based practice, it is indeed clinical practice change, for health professionals to access knowledge, to have the ability to interpret health care information and to gain strategies to apply care. Therefore, what is needed here is to encourage utilization of this Evidence-based practice to improve our health care system. It is no wonder why our health care system in the country is not that good, it is for this reason that there are available resources and yet we don’t make use of it. Yes there are barriers to availing these resources but what if instead of using the available funds in other not-so-important projects use it in subscription to this kind of information, we can then anticipate improvement in our health care system.

REFERENCE:
Guyatt GH. (1991) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine, ACP J Club. 1991;114(suppl 2):A-16

The specific goals of creating an Evidence Based Nursing Practice may vary from one country to another but most seek to educate nurses through workshops or through formal courses to be evidence-based nurses in practice, education and research, to conduct original research and systematic reviews and to design and evaluate strategies for disseminating research findings to nurses.

Evidence Based Nursing Practice as defined by the Centre for Evidence-based Medicine is a “systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances.” As further discussed by this analysis, the guidelines set can be used to reduce inappropriate variations in practice and to promote the delivery of high quality, evidence-based health care. Guidelines should be based on the best available research evidence, should be developed with representation from as many interested parties as possible, should be tested by professionals uninvolved in their development and in the healthcare setting for feasibility, and should be reviewed regularly and modified to incorporate new knowledge.

The increased emphasis on graduate education for nurses can lead to many important research questions related to the practice of nursing. There is a strong motivation among nurses to apply the findings of research to their practice through evidence-based nursing. To complement these developments, a variety of resources have emerged to help nurses become evidence-based practitioners.

References

1. Dicenso, A. & Ciliska, D. (2009). Evidenced Based Nursing. http://www.cebm.utoronto.ca/syllabi/nur/
2. http://www.biomed.lib.umn.edu/learn/ebp/

Evidence-based practice (EBP) refers to a decision-making process which integrates the best available research, clinician expertise, and client characteristics. EBP is an approach to treatment rather than a specific treatment.

In contrary, in spite of the enthusiasm for EBP evinced over the last decade or two, some authors have redefined EBP in ways that contradict, or at least add other factors to, the original emphasis on empirical research foundations. For example, EBP may be defined as treatment choices based not only on outcome research but also on practice wisdom (the experience of the clinician) and on family values (the preferences and assumptions of a client and his or her family or subculture).

Reference:
http://en.wikipedia.org/wiki/Evidence_based_practice