VOL: 97, ISSUE: 23, PAGE NO: 36
Robert McSherry, MSc, RGN, DipN, PGCE, RT, is principal lecturer in practice development, school of health, University of Teesside
Wilfred McSherry, MPhil, BSc, RGN, PGCE (FE), NT, PGCRM, is lecturer in acute care of the adult, school of nursing, faculty of health, University of HullNurses want to provide the best possible standard of care for their patients but there are several other reasons why they must ensure that their practice is based on appropriate evidence (Box 1). To practice evidence-based nursing you do not need to be a researcher or an academic but you do need to be aware of research and be able to assess the evidence in a critical way.
Nurses want to provide the best possible standard of care for their patients but there are several other reasons why they must ensure that their practice is based on appropriate evidence (Box 1). To practice evidence-based nursing you do not need to be a researcher or an academic but you do need to be aware of research and be able to assess the evidence in a critical way.
The value of critiquing
The importance of critical appraisal and its application to health care practice is well documented in the literature (Crombie, 1996; McSherry and Haddock, 1999).
Crombie (1996) and Sackett et al (1997) suggest that critical appraisal involves considering the relevance of a research question, evaluating the evidence collected to answer that question and then assessing the effectiveness of the conclusion and any recommendations given. Put simply, it is about systematically reviewing and questioning each stage of the research process: from the title and abstract to the recommendations. You should keep the following questions in mind (Crombie, 1996):
- Is the research relevant?
- Why was it done?
- How was it performed?
- What did it show?
- What is the implication for your practice?
To demonstrate the critiquing process, consider the following scenario. As a senior nurse you have been informed that your hospital/nursing home/community trust wants a strategy to improve the standard of nursing records.
Fig 1 shows a simple 10-step guide aimed at improving the standards of nursing record-keeping. Steps 1-6 support the implementation processes and steps 7-10 the evaluation process.
Step 1. Relevance Establish whether there is a need to review current standards of nursing record-keeping. This can be done only by informing and involving staff, which includes telling them why the concern has come to light, for example, after a request from management. By taking your time over this step the rest may be made easier.
Step 2. Staff ownership Encourage participation in developing a simple but reliable action plan that is shared, owned and most importantly agreed by all (where possible). If staff are in favour the project should have shared ownership. Then the allocation of key roles and responsibilities can be instigated.
Step 3. Literature searching Several organisations may be willing to offer support and aid you in improving the standard of nursing record-keeping, as Step 4 confirms.
Step 4. Involve outside agencies It is important to explore all possible avenues to enhance the quality of your work (see Fig 1).
Step 5. Critiquing the literature Having obtained the necessary information it is important that it is reviewed for appropriateness. Consider whether the information is useful and meets your unique set of clinical needs.
Step 6. Examining the existing standards Check the guidelines offered in the literature to establish which standards on nursing records best meet your ward, team or individual needs. Step 7. Putting the standards into practice Having examined the available standards for nursing record-keeping you may be able to incorporate them into your practice without any changes or just a slight modification. You must ensure that approval is obtained from the author(s) and that you do not breach copyright legislation.
Step 8. Pilot study Having established your standards on how the nursing records should be written (for example, dated, timed, written in black ink, signed), it is essential that the newly devised standards are implemented and evaluated after an agreed period of time (the pilot). The pilot will ensure that the standards are achievable and that the initiative/innovation is suitable for your individual, team, ward or department. This is where the quantitative approach to research will help - obtaining numbers or figures to demonstrate achievement of the set standards.
The evaluation of set standards requires the devising of an auditing strategy.
Step 9. Dissemination of information Once audited, your findings can then be reported. After discussion, recommendations can be made with regard to the results.
Step 10. Evaluation of the research process
Every two months two members of the nursing staff from a different ward evaluate a set of 10 randomly selected nursing records and assess the level of compliance against the set standards template. The data is recorded separately for each set of notes, resulting in an annual sample selection of 60 sets of nursing records.
A summary report including all 10 sets of evaluated nursing records is presented to the ward manager, outlining any action that needs to be taken. The annual results are collated and a report is presented to the ward on overall progress in the standards of record-keeping.
The need to base practice on the best possible evidence is essential if nurses are to meet the challenges of providing quality care. This case study illustrates a flexible and systematic framework directed towards improving the standards of nursing records.
It would be unwise and time-consuming to do a literature search without first establishing the motivation and commitment of staff to the project. By posing a research question or rationale for reviewing the standards of nursing records in your clinical area, the entire process of literature searching becomes easier and less time-consuming because you may already have an idea of the style of nursing records to be introduced and evaluated. Having an understanding of the various approaches to research is essential to improving standards.
- The full version of this article is available on our website: www.nursingtimes.net
- See also Fit for Practice, p45