Discuss_the_Contribution_That_Quantitative_Research_Can_Make_to_Evidence_Based_Practice

This essay will examine the contribution that quantitative research makes to evidence-based clinical practice. It will examine what such practice is and see what part quantitative research plays in determining how an individual patient is treated in a hospital near us, “our patient”. In deciding how to treat “our patient” we bring not only high level quantitative evidence based knowledge into play, but the substantial knowledge base of nursing in improving both the outcome and experience for “our patient”. Quantitative research refers to research using numerical data collection to support a question and the relationships involved with that question. The objective of quantitative research is to develop and employ mathematical models, theories or hypotheses related to that question. Quantitative research is often contrasted to qualitative research; which is rather the examination, analysis and interpretation of observations for the purpose of discovering underlying meanings and patterns of relationships, including classifications of types of questions in a manner that does not involve mathematical models. Qualitative research produces information only on the particular cases studied; other questions found during the study may or may not be extrapolated to apply to the wider population (Liamputtong, 2009). Evidence based practice in health care refers to the process that includes discovering the best research evidence in relation to the effectiveness or efficacy of various treatment options, while subsequently deciding the relevance and importance of options to the patient. This information is then considered and used in clinical practice while incorporating patient values and tailoring this to the patient’s individuality (Liamputtong, 2009). Evidence based practice research is represented as a five level hierarchy with the gold standard: level one being the systematic review of randomised controlled trials. The second tier of evidence is randomised controlled trials; followed by pseudo-randomised control trials and cohort studies. Case series, being expert opinion-based on laboratory research, are the lowest in the hierarchy of evidence at five (Liamputtong, 2009; Dale, 2005). Qualitative methodologies are not included within the five level hierarchy. This hierarchy has been transferred from medicine to nursing and has resulted in qualitative research being undervalued; despite this qualitative research is as necessary in the generation of research based nursing knowledge. The exclusion of the qualitative methodologies from the hierarchy implies that such methods are not considered relevant or best for generating evidence for practice because they are not scientific (Dale, 2005). Bias may be minimised or removed by randomly choosing participants for groups which receive different treatments. These are called randomised control trials. Such trials may run into ethical grey territory if the welfare of one of the groups is clearly being compromised. Also another significant criticism is that the trials focus is too narrow to be relevant in clinical practice where conditions are not as controlled (Hallberg, 2009). The nurse uses quantitative evidence to support practice decisions but needs to evaluate this evidence while considering the patients values, concerns and preferences as well as bringing previous experience and knowledge to mind. Therefore, although the available evidence is sound a different approach may be required and evidence may not prove useful. This is a legitimate element of evidence based practice so long as the decision was made in an informed and skilled manner and is justifiable (Dale, 2005). Systematic reviews are our best hope of distilling guidelines for use in clinical evidence-based practice. They endeavour to comprehensively identify and synthesise the available literature on a specific topic – the literature being treated itself like data (Liamputtong, 2009). These reviews may be flawed by the choice of research which is chosen; the effect of a different country, culture, health system, political system and cost of treatment. What is “best” in one part of the world may be an expensive and culturally insensitive treatment in another. As in the example the “Systematic review of the Effectiveness of Primary Care Nursing” a year’s funding and huge amount data collection and study reveals a “modest international evidence” that nurses in primary care settings can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. The Abdulwadud, Francis, Keleher, and Parker (2009) study concludes that “Gathering stronger data would contribute to an evidence base about the most effective and efficient use of nurses’ time and the most cost-effective ways for these nurses to work.”(p. 23). Therefore the 12 months of financial and other support from Australian Primary Health Care Research Institute, a great deal of effort from the researchers, has highlighted the need for more study and the article has not led to any specific “How to treat” guidelines despite summarising 31 “relevant papers” in attempt to distil them to add to our body of knowledge. In summary, the clinical practice of nursing needs research-based evidence that is drawn from not only the scientifically pure quantitative evidence presented in the five level hierarchy, but from a much wider, culturally adjusted, patient adjusted evidence base. Only then can the nurse in our local area apply this research to “our patient”. Only then, will quantitative research make its full contribution to clinical practice rather than having its contribution diluted by highlighting a need for further research. This further research may then lead to knowledge on which to base “how to treat” guidelines.   References: Abdulwadud, O., Francis, K., Keleher, A., Parker, R. (2009) Systematic review of the effectiveness of primary care nursing. International Journal of Nursing Practice. 15, 16-24. Dale, A. (2005) Evidence-based practice: compatibility with nursing. Nursing Standard. 19, 40, 48-53. Hallberg, I.R. (2009). Moving nursing research forward towards a stronger impact on health care practice' International Journal of Nursing Studies, 46, 407–412. Liamputtong, P. (Ed.). (2010). Research methods in health: foundations for evidence-based practice. South Melbourne: Oxford University Press