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Comment: Strong evidence harder to produce in lean times

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For some years now, the emphasis in nursing has been on practising evidence-based care wherever this is possible, although we still have a way to go before we catch up with medicine in this regard.

Oxford’s Centre for Evidence-based Medicine, for example, suggests a system for ranking evidence, ranging from level A (consistent randomised controlled trial) to level D (expert opinion without explicit critical appraisal). In nursing research, by contrast, the three choices upon which to base our care are: evidence based on current research; evidence based on old research; or what is considered best practice.

In the previous issue of the Continence Journal (NT Supplement, 16 October, p48), I presented the findings of a group of continence advisers who attempted to establish whether there is evidence available to support current clinical practice in the management of urinary catheter drainage systems, and whether it is based on sound research or is merely established best practice.

A review of the research literature regarding urinary drainage bags revealed very little and, in some areas of care, there was no current research upon which to base practice. Indeed, most of the manufacturers of catheters and urine drainage bags use the Drug Tariff as a reference when advising that the bag should be changed every five to seven days.

Lengthy investigations, however, did not reveal the research upon which this recommendation is based. Both the chief medical officer and the chief nurse for England were asked several times for the evidence for this recommendation but nothing was forthcoming.

Should continence nurse specialists and the manufacturers of continence aids continue to accept a recommendation that is based purely on ‘expert opinion’? Or should they demand that new research be carried out based on the gold standard of randomised controlled trials?

The challenge for continence care will be to decide whether it is possible to carry out research in a climate of job cuts and uncertainty over service development. In future, continence nurses may find the challenge of conducting original research increasingly difficult as they juggle competing demands on their time.

Sarah Jones, MSc, FETC, RGN, is continence adviser, West Kent PCT, Tonbridge, Kent.

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