Evidence-Based Care for Midwives: Clinical Effectiveness Made Easy PDF
Preview Evidence-Based Care for Midwives: Clinical Effectiveness Made Easy
EVIDENCE-BASED CARE FOR MIDWIVES CLINICAL EFFECTIVENESS MADE EASY Second Edition Donna Brayford Ruth Chambers Elizabeth Boath and David Rogers CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgment, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgments, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com #2008DonnaBrayford,RuthChambers,ElizabethBoathandDavidRogers DonnaBrayford,RuthChambers,ElizabethBoathandDavidRogershaveassertedtheirright undertheCopyright,DesignsandPatentsAct1998tobeidentifiedastheauthorsofthis work. BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary. ISBN:9781846191473 TypesetbyAdvanceTypesettingLtd,Oxford Contents Abouttheauthors v Preface vi Introduction 1 Overallaimoftheprogramme 1 Objectivesofthisbook 1 Self-assessmentofwhereyouarenowwithclinical effectivenessandclinicalgovernance 2 Whatareclinicaleffectivenessandevidence-based healthcare? 4 Whatistheevidenceforevidence-basedhealthcare? 5 Whymidwivesneedinformation 6 Aremidwivesreadyforevidence-basedhealthcare? 7 Learningbyportfolio 8 Electronicdatabases 10 Stage1:Askingtherightquestion 18 Questionsaboutcost-effectiveness 19 Framingquestions:someexamples 20 Examplesofquestionsyoumightposeasamidwife 23 Stage2:Undertakingaliteraturesearch 25 Thesearchstrategy:think,searchandappraise 25 Undertakeasearch 26 UsingtheCochraneLibrary 27 UsingtheMedlinedatabase 27 Thehierarchyofevidence 28 Examples 29 Searchingbyyourself 34 Stage3:Frameyourownquestionandsearchfortheevidence 38 Stage4:Appraisetheevidence 42 Themeaningofdifferentresearchmethodsandterms 42 Readingapaper 49 Criticalappraisalofapublishedpaperorreportofastudy 50 Examples 53 Criticalappraisalofaqualitativeresearchpaper 63 iv Contents Criticallyappraiseapublishedpaper 65 OurreviewofHannahM,HannahW,HewsonSetal. (2000) 68 Stage5:Applytheevidence 71 Diaryofyourprogressinsearchingforevidence 71 Actionplan 72 Barrierstochange 73 Stage6:Whatclinicalgovernancemeansandhowtoputit intopractice 76 Componentsofclinicalgovernance 76 Thechallengestodeliveringclinicalgovernance 78 Enhancingyourpersonalandprofessionaldevelopment 79 Howevidence-basedcare,clinicaleffectivenessandother componentsofclinicalgovernancefittogether: (cid:1) thepractitioner’sortheunit’sperspective 80 (cid:1) theprimarycareorganisation’sortrust’sperspective 91 (cid:1) ResearchGovernanceFrameworkforHealthandSocialCare 95 Stage7:Focusingonyourrevalidation–whereclinical governancefits 98 Movingfromappraisaltorevalidation 100 Whereclinicalgovernancefitswithrevalidation 102 Continuingprofessionaldevelopment(CPD) 104 Differentiatingappraisalandassessment 105 Preparingforappraisalandrevalidation 105 Compilinganeffectivepersonaldevelopmentplan(PDP) 109 Howtoidentifyyourdevelopmentandserviceneeds 110 Providingevidenceofyourcompetenceandperformance 120 Evaluateyournewlygainedknowledgeandskillsinclinical effectivenessandclinicalgovernance 135 Usefulpublicationsofevidencealreadyavailable 138 Organisations 139 Usefulwebsites 141 Furtherreading 143 References 145 Index 151 About the authors Donna Brayford is a community midwife and teenage pregnancy link midwife at the University Hospital of North Staffordshire. She has a passion to deliver high standards of care as a midwife and help others to practise in clinicallyeffectiveways. RuthChambershasbeenageneralpractitionerformorethan20years.She iscurrentlyaGP,aclinicalleadfortheRoyalCollegeofGeneralPractitioners and Professor of Primary Care Development at Staffordshire University. Her interest in clinical effectiveness and clinical audit grew from her three-year spellasChairmanofStaffordshireMedicalAuditAdvisoryGroupinthe1990s. Ruthhasrunseveralseriesofclinicaleffectivenessandclinicalgovernance workshops, teaching a mix of primary and community care health profes- sionalsclinicaleffectivenessskillsineasystepsandanunderstandingofclinical governance.Theexperiencesofthoseworkshopshaveinformedthisbook. Elizabeth Boath is a Reader in Health and Social Care and a Learning and Teaching Fellow at Staffordshire University. Liz had a special interest in the field of perinatal mental health. Her interest in clinical effectiveness and clinical governance emerged from her time as a research facilitator, during whichshefacilitatedandtaughtontheseriesofworkshopsusedtodevelopthis book. David Rogers is the clinical effectiveness librarian for the Bedside Clinical GuidelinesPartnership.Hehastaughtthousandsofhealthprofessionalshow to seek for the evidence base for their practice over the years. David also providestheevidenceforclinicalguidelinesusedby25hospitaltrustsacross theMidlandsandbeyond. Preface The best practice discussed in this book is not easily achieved in the current climate of our maternity health system. Midwives can be undermined by limitationsandconstraintsinfinancialresources,copingwithdailyincreasing workloads.Midwivesmaylackthetimetoactivelyparticipatein,conductand implement research, and to find and critically evaluate evidence which they canuseintheireverydaypractice.Insometruststheremaybeaninadequate facilityforpersonalandprofessionaldevelopment,withstudyleaveandfunding regularlycancelledduetostaffshortages.Thisthenrestrictsmidwives’prac- tice,toallowthemtoimplementchangesbasedonevidence.But,despitethese organisationalpressures,weasmidwivesmustbededicatedtoprovidingsafe care for individual women and their babies, and moving maternity care forward. Hopefullythelearningandstrategiescoveredinthisbookwillassistyouin bringing your everyday work up to the high standards of care that match evidence-basedbestpractice,andgettingreadyforrevalidation.Asyoudoso you should document the standards of your everyday work so that you can demonstrate that you are competent and performing well at your annual appraisals.Thenitwillbeasmallsteptoproduceevidenceofyourmidwifery practice for the revalidation of your professional qualifications in the near future. DonnaBrayford Communitymidwife January2008 Introduction Clinical effectiveness and clinical governance are about knowing what you should be doing and being able to put that knowledge into midwifery practice Overall aim of the programme To increase awareness of, and skills in, the adoption of an evidence-based approachtothepracticeanddeliveryofhealthcare. Objectives of this book Thisprogrammeisforallmidwivestolearnhowto: (cid:1) asktherightquestion–itmustbeimportanttoyouandyourcolleagues (cid:1) lookfortheevidenceanddoaliteraturesearch (cid:1) receiveandincorporateconstructivecriticismfromcolleaguesabouttheir developingquestionsandsearchforevidence (cid:1) selectthebestevidence–whattodowherenostrongevidenceexists (cid:1) evaluateandinterprettheevidence,suchasreadandextractinformation fromareport (cid:1) applytheevidenceasappropriateinapractice,unitordepartment (cid:1) actontheevidencetoimprovethepracticeofclinicaleffectiveness (cid:1) promoteacultureofclinicalgovernance. 2 Evidence-basedcareformidwives Self-assessment of where you are now with clinical effectiveness and clinical governance Before you start working through the clinical effectiveness and clinical governance programme, assess your baseline knowledge and attitudes. You shouldcompleteasimilarself-assessmentwhenyouhaveworkedthroughthe book,sothatyoucancompareyouranswerstoseehowyourknowledgeand skills have increased. Please circle as many answers as apply, or fill in the informationrequested. 1 How confident do you feel that you are capable of practising clinical effectivenesstobeableto: askarelevantquestion? Very Somewhat Notatall undertakeasearchoftheliterature? Very Somewhat Notatall findreadilyavailableevidence? Very Somewhat Notatall weighupavailableevidence? Very Somewhat Notatall decideifchangesinpracticearewarranted? Very Somewhat Notatall makechangesinpracticeasappropriate? Very Somewhat Notatall 2Haveyoueversearchedtheliteratureyourselfforananswer toaquestion? Yes/No If‘Yes’: (cid:1) whichdatabase(s)haveyouused? Medline Cochrane OMNI Other(what?) (cid:1) wheredidyousearchtheliterature? Medicallibrary Atwork Athome Other(where?) (cid:1) didyouhaveanyhelpinsearchingtheliterature? None Healthcarelibrarian Friend/family Workcolleague Other(who?) 3Haveyoueveraskedsomeoneelsetosearchtheliteratureforyou? Yes/No If‘Yes’: (cid:1) whodidthesearchforyou? (cid:1) whydidn’tyoudothesearchyourself? Lackoftime Lackofskill Lackofaccess Otherreason todatabases Introduction 3 4 Can you complete the following list from your own knowledge, describing the features of different types or levels of evidence in decreasing order of robustnessfromverystrongevidencetononeatall? Type Features I Strongevidencefromatleastonesystematicreviewofmultiple,well-designed, randomisedcontrolledtrials II III IV V Opinionsofrespectedauthorities,descriptivestudies,reportsofexperts 5Ifyouhavepreviouslysearched fortheevidenceto answeraquestionyou hadposed,whatdidyoudowiththeresultofyoursearch?(Circleallthatapply.) (cid:1) Discusseditwithcolleaguesatwork (cid:1) Discusseditwithfriendsorfamily (cid:1) Madechange(s)toanaspectofwork (cid:1) Decidedagainstmakinganychange(s)toanyaspectofwork (cid:1) Otheroutcome–what? 6Towhatextentisevidence-basedhealthcarecentraltoyourownpractice? (Circleallthatapply.) (cid:1) Ihavenoideawhethermyeverydaypracticeisevidence-basedmostofthetime (cid:1) I assumethat myeveryday practice is evidence-basedwheneverpossible,but I’venoevidenceforthatassumption (cid:1) Iensurethatmyeverydaypracticeisevidence-basedbyregularlycomparing mypracticeagainstpublishedstandardsofbestpracticeandmakingappropri- atechanges 7Howmanyoftheseprinciplesofgoodpracticeinclinicalgovernancedoyou generallyincludeaspartofyourqualityimprovementwork?(Circleallthat apply.) (cid:1) Iactivelypromoteorparticipateinmultidisciplinaryworking (cid:1) Iaddressnational,local,organisationalorprofessionalprioritiesinmywork (cid:1) Itrytoachievepartnershipworking,e.g.betweenagencies,betweenmanage- ment/clinicians (cid:1) Iincorporateinputfrompatientsinmywork(e.g.users,carers,thepublic)in training,planning,monitoringordeliveryofhealthcare (cid:1) IlookforpotentialtoachievehealthgainsinthewayIorganisemywork (cid:1) Myeverydayworkisbasedonevidence-basedpractice,policyormanagement (cid:1) IcandemonstratethestandardsofcareorservicesthatIormyteamachieve
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