Evidence-Based Practice in Decision Making

This essay is about evidence-based practice in decision making. Study it to gain knowledge of how evidence-based practice is applied in research decision making.

Introduction to Evidence-Based Practice in Decision Making Essay

Evidence-based practice (EBP) is a worldwide experience that includes research evidence evaluation, patient preferences, and the environment of care delivery in order to improve best practice knowledge and the delivery of high-quality care by making educated judgments (Barker, 2010). Using recent literature, this article compares and evaluates one research aspect of two research studies by Mattheus-Kraemer et al. (2016) and Milano et al. (2018).

The critical evaluation instrument developed by Moule (2018) will be used to discuss the data gathering aspect that has been selected. The validity, dependability, and trustworthiness of the research publications will be discussed and critiqued using research literature. The location of the study article in the hierarchy of evidence, as well as its advantages, will be investigated.

Definition of Evidence-Based Practice

What is evidence-based practice?

Although there are several definitions for EBP, Sackett et al. (1996) is the most frequently recognized, defining it as “the deliberate, explicit, and prudent use of current and accessible information in decision making of individual treatment.” Nursing research is defined as a methodical investigation used to solve problems and generate solid evidence on matters relating to the nursing discipline, practice, information, and education (Polit and Beck, 2012).

Benefits of Evidence-Based Practice

What are the benefits of evidence-based practice?

Nurses’ previous decision-making expertise was based on their own experiences, trial and error, intuition, logical reasoning, and conventional procedures (Polit and Beck, 2010). Although Brooker and Waugh (2013) recognize this kind of knowledge transmission as important, they also raise concerns about the hazards to the nurse and the patient from incorrect information being conveyed, which may lead to prejudice.

Nurses have been a part of an endeavor that has evolved over the years as national and local legislation and policies have changed, keeping in mind that patients are becoming experts in their own diagnoses, which has an influence on the treatment they get (Stevens,2013; Ellis, 2016).

Because nursing has evolved from mandated responsibilities to a personalized approach to care, Emanuel et al. (2011) argue that evidence that is synthesized into recommendations has become increasingly important. According to Ellis (2016), nurses should not only act in the best interests of their patients, but they should also be able to defend their judgments about their care.

Moreover, owing to accountability in delivering the highest quality of care, nurses have a responsibility to comprehend research and guarantee the application of the best evidence available to their daily practice in order to provide credible advice and assist patients in making informed choices (NMC,2018). This emphasizes effective treatment delivery and improves the patient’s quality of life.

Healthcare practitioners, on the other hand, must be aware of research relevant to their own clinical competence and use it appropriately (Moule, 2018). EBP and studies have shown that the efficacy of simplified services supplied reduces costs (Barker et al., 2016). As a result, it is critical for nurses to stay current on policies, conduct research, and comprehend evidence utilizing a range of research methodologies in order to provide safe care using evidence-based practice and research (Ellis, 2016).

For research, both quantitative and qualitative methodologies are often employed (Gerrish and Lathlean, 2015). Qualitative research is a subjective, holistic technique of gathering data based on personal experiences. However, rather than using statistics, data is gathered using language. Quantitative research is defined as a systematic, impartial technique for testing hypotheses and displaying the results (LoBiondo-Wood and Harber, 2018). Polit and Beck (2012), on the other hand, suggest that quantitative research techniques are more efficient and trustworthy than qualitative research approaches.

Limitations of Evidence-Based Practice

What are the limitations of evidence-based practice?

Despite the fact that the advantages of EBP are widely recognized and employed in nursing practice, there remain limits and challenges to evidence-based care implementation. Clinical decision-making and expertise, according to Dicenso et al. (2008), are centralized to EBP. All of these techniques, however, must be used in conjunction with all other types of evidence when using recommendations in general. Evidence-based practice, according to O’Halloran et al (2010), has supplanted the use of professional judgment and judgment in the delivery of treatment.

Moreover, according to Moule (2018), implementing exclusively evidence-based practice might limit decision-making and autonomy, and there is no proof that evidence-based practice works. It also claims that the EBP techniques’ simplicity has resulted in a scarcity of resources.

Furthermore, lack of organizational support for staff, a lack of communication between healthcare professionals, a nurse’s lack of knowledge of research, language barrier, insufficient time to write a research paper, lack of training, insufficient staffing, and lack of knowledge of EBP have all hampered the application of EBP to care delivery (Shayan et al., 2019).

Comparison of Matthaeus-Kraemer et al’s, (2016) Research Article and Milano et al’s, (2018) Research Article

The study by Matthaeus-Kraemer et al. (2016) aimed to identify the barriers to time management and early detection of severe sepsis in hospital wards, while the study by Milano et al (2018). The goal of this study is to determine the link between sepsis bundle adherence and patient death, as well as the impact of infection source and declaration location on higher mortality.

Matthaeus-Kraemer et al. (2016) utilized focus group talks data collecting to perform a qualitative study, whereas Milano et al. (2018) used clinical record data collection to conduct a quantitative retrospective observational study. It’s worth noting that although both studies have a similar study subject and issue, the data gathering methodologies vary.

A qualitative focus group study is a broad and open conversation aimed at gathering a group’s experiences, emotions, opinions, and ideas in order to better understand a certain subject or problem (Goodman and Evans, 2015). Retrospective observational studies, on the other hand, investigate a present problem while collecting data from the past to assess medical occurrences and repercussions (Song and Chung, 2011; Hasson et al., 2015).

Data collection, according to Barker (2010), is the method and instrument for obtaining information and measuring variables in order to test hypotheses, assess results, and answer questions. Furthermore, it plays a critical role in the assessment, implementation, and design of public health initiatives (World Health Organization, 2017).

According to Rees et al. (2015), the hierarchy of evidence is the classification of research evidence into distinct categories based on the strength and degree to which results are free of bias. Healthcare practitioners must comprehend and be able to organize existing research findings into a hierarchy in order to communicate clearly in daily practice while educating colleagues, counseling patients, and, most crucially, formulating practice recommendations (Petrisor and Bhandari,2007).

Moreover, according to Inghram-Bloomfield (2016), understanding the hierarchy of evidence will increase a nurse’s ability to appraise the strength and weaknesses of research findings and their applicability to practice. The hierarchy of evidence has been criticized for excluding certain evidence and undervaluing qualitative research and other forms of participatory evidence (Rees et al., 2015). It is important to note that the hierarchy of evidence was created to assist in determining the validity of evidence by evaluating the treatment and clinical intervention outcome (Moule, 2018).

However, Gerrish and Lathlean (2015) argue that it is not appropriate for providing information in developing understanding in relation to patients and other practitioners, in which case qualitative evidence is more appropriate. Milano et al (2018) retrospective observational study is ranked on level 4 of the Murad et al (2016) hierarchy of evidence design as a ‘case-control study’ only above reports, indicating a lack of validity. However, the limitation of this evidence pyramid is that it does not consider qualitative research and experiences.

The qualitative study by Matthaeus-Kraemer et al. (2016) is placed on level six out of seven in Polit and Beck’s (2012) hierarchy of evidence design, indicating that it lacks reliability. However, Milano et al.’s (2018) retrospective study is placed on level four out of seven as a single observational study’ in this same pyramid of evidence. Similarly, Moule (2018) explains the efficacy of research evidence by ranking Milano et al’s study as a ‘case-control or observational study’ on level 3 above Matthaeus-Kraemer et al’s qualitative study on level 4.

This suggests that, while being low on the hierarchy, Milano et al (2018) is seen as more trustworthy than Matthaeus-Kraemer et al. (2016) qualitative research (Polit and Beck, 2012). Although retrospective observational research is somewhat credible because of its rating, there is a danger of bias that impacts the quality of information when it is remembered (Jirowong and Pepper,2013).

Noyes’ (2010) hierarchy of evidence for experience and views in service delivery suggests that qualitative research is more important than quantitative research, ranking Matthaeus-Kraemer et al.’s (2016) qualitative study higher in the third level and Milano et al.’s (2018) quantitative study sixth. Because one hierarchy of evidence cannot be used in relation to all research when providing care, researching, and using the best evidence, all levels of evidence should be considered and understood to be able to determine the validity, reliability, and credibility of evidence (Burns et al.,2012).

Appraisal of the Chosen Element for Data Collection Using Moule’s (2018) Critical Appraisal Tool

Critical appraisal is a method of systematically evaluating research for value, reliability, and relevance before drawing conclusions (Barker and Kane, 2016). Nurses may utilize critical evaluation methods to make important decisions in practice by examining the study’s validity, outcomes, and utility. 2017 (Al-Jundi and Sakka). The data collecting approach will be evaluated in reference to the papers by Matthaeus-Kraemer et al. (2016) and Milano et al. (2016) using Moule’s critical evaluation methodology (2018).

The following are the framework’s questions.

  • If the appropriate method of data collection was used
  • If the data was gathered by appropriate people
  • If the participants were protected from physical and psychological harm
  • If the researcher’s role and relationship was considered

Focus group discussion was employed by Matthaeus-Kraemer et al. (2016), which is a common method in qualitative healthcare research (Tausch and Menold, 2016). The study design was completed using semi-structured interviews with open-ended conversations; nevertheless, this method cannot be supported. By addressing crucial subjects, the semi-structured method allows for an in-depth narrative of participants’ experiences, opinions, and beliefs ( Polit and Beck, 2010).

One of the methodologies’ limitations is the difficulty in engaging participants in dialogues when sensitive issues are presented, which might impact the data acquired (DeJonckheree and Vaughn,2019). The focus group discussion was guided by a subject guide created utilizing a concept mapping technique, which promoted conversation around the article’s primary topics, allowing for an organized debate and analysis of the data obtained (Matthaeus-Kraemer et al., 2016; Burgress-Allen and Smith, 2010).

Evidence-Based Practice in Decision Making

An Example of a Concept Map

Concept mapping is a mixed-method research approach that entails the structure and induction of group data collecting, allowing for the collation of several participant ideas via the use of quantitative methods to produce hypotheses and new concepts (Wheeldon,2010; Dejonchkheree and Vaughn,2019). Moreover, this enables for the comparison of focus groups and group consistency; nevertheless, this may limit the questions addressed, debates held, and contributions made (Goodman and Evan, 2015). The location, technique, and duration of the discussion were all included in the appendix and body of the literature, demonstrating the research’s openness (Whiting,2008).

Additionally, using transcribed audio recordings of talks in combination with semi-structured interviews might improve the validity of results, but it can also cause anxiety and self-consciousness in participants, leading to biased responses (Williamson et al., 2015). Matthaeus-Kraemer et al. (2016)’s data collecting strategy worked well since it allowed for a variety of viewpoints to be voiced on themes that were important to the participants (Cridland et al,2015).

Milano et al. (2018), on the other hand, employed a retrospective observational strategy to gather data from patient medical records. Medical records are documentation regarded as trustworthy and dependable by healthcare practitioners and are widely utilized in retrospective clinical data collecting (Engel et al., 2009). However, inadequate records, lost patient records, non-documentation of reports, and other factors might lead to data misinterpretation (Sarkar and Seshadri, 2014).

The use of statistics to quantify data obtained is a strength of this research, allowing for statistical description and analysis, which is the study’s goal (Moule, 2018). Furthermore, the study’s bundle adherence measure was operationally defined and modified from earlier studies, enhancing the research’s quality and implying past validity (Reber and Gersch, 2015). When examined critically, the data collection methods used by Matthaeus-Kraemer et al.(2016) and Milano et al.(2018) were found to be appropriate, despite some limitations.

Milano et al. (2018) used trained utilization-review nurses as abstractors to obtain data from medical records in a quantitative investigation. Data abstractors should have expertise in gathering data from medical records, professional healthcare knowledge, credentials, and experience relevant to the research, according to Gregory and Radovinsky (2012).

The trained review nurses that gathered data for this study are trained and have a previous awareness of the study, as well as the ability to recognize the required factors in the clinical record (Gregory and Radovinsky, 2012). This allows for consistency and optimization of collected data, increasing the research’s dependability and validity (Reisch et al. 2001).

Furthermore, the data abstractors were blinded to the research results, which is standard practice in clinical record review and helps to avoid bias (Patanwala, 2017). However, there may be prejudice as a result of administrative task pressure (Milano et al.2018). Despite the possibility of bias, Milano et al (2018) said in their research that steps such as the use of timestamps and the recalculation of bundle compliance and intervals were used to limit the potential of bias impacting findings and conclusions.

Mattheus-Kraemer et al. (2016), on the other hand, utilized moderators in each focus group who were two trained personnel that included doctors and a social scientist from the MEDUSA project. Research facilitators are vital while collecting data in qualitative research, according to Nyumba et al. (2018). Morrison-Beedy (2001) also recommends that when choosing a moderator, qualifications, competence, understanding of the study issue, and familiarity with the research topic be taken into account.

Similarly, Ellis (2016) contends that a researcher’s skills and experience must be related to the study issue in order for the research to be credible. It is important to note that the moderators used to collect data in Mattheus-Kraemer et al’s (2016) study are trained physicians and social scientists who have participated in similar studies, implying that they are reliable and knowledgeable about the subject and can guide discussion and provide support to participants.

In this research, the moderators helped in the direction of the open-ended debate and guaranteed that every participant was included by utilizing the subject guide, which would increase data collection, credibility, and dependability ( Cranley et al., 2017; Nyumba et al., 2018). However, there is a possibility of personal bias since moderators might intimidate participants’ answers or debates by the way the topics for discussion are phrased (Seale, 2012). Milano et al.(2018) and Mattheus- Kraemer et al. (2016) utilized utilization review nurses to obtain information, and they were suitable since they had a relevant background and expertise of the study issue.

The protection of participants from injury should be addressed while doing research, according to Gerrish and Lathlean(2015), since it is the researcher’s responsibility. Moule(2018) further contends that permission must be obtained before any study is conducted and that anonymity between participants and researchers, as well as confidentiality, must be preserved.

While Matthaeus-Kraemer et al. (2016) obtained prior consent from participants, maintained confidentiality before and after collecting audio-recorded data, and maintained anonymity between participants and moderators, Milano et al. (2018) obtained ethical committee consent before conducting the study. Consent, confidentiality, participant safety, and participant choice are among the characteristics that must be fulfilled while doing research under the UK policy framework for health and social care researchers (NHS Health Research Authority, 2017).

In addition to obtaining informed permission from participants, ensuring confidentiality, and clarifying the ability of participants to withdraw at any moment in healthcare research, the dignity and rights of a patient must be protected (GMC,2013). Despite the fact that Milano et al.(2018) received clearance from the DHS institutional review board, there was no verification of patients’ consent for their medical records. When using clinical record review, this has been an ethical issue because there is no prior consent for the use of data for research when keeping medical records (Sarkar and Seshadri, 2014).

Furthermore, data collected may be misused, and sensitive information about patients may be disclosed to people who are not directly involved in their care, resulting in a breach of confidentiality (McCarthy, 2008). Matthaeus-Kraemer et al.(2016) and Milano et al.(2018) both received ethical approval, indicating that the research was ethically sound and that steps were taken to protect participants from harm. When it comes to ethical validity, however, there may be some limitations.

Milano et al.(2018) and Matthaeus-Kraemer et al.(2018) did not discuss the researcher’s role or relationship with the participants. Furthermore, in both studies, the researchers did not have direct contact with the participants and instead relied on data abstractors and moderators to collect data. The role of the researcher and the specifics of how the research will be conducted must be discussed with participants, according to the NHS Health Research Authority(2017). However, in a quantitative study, the researcher’s role in data collection is practically non-existent (Simon, 2011).

Furthermore, because there was no researcher-participant interaction in the Milano et al.(2018) study, there was no need to consider the relationship. Matthaeus-Kraemer et al. (2016), on the other hand, needed to consider the researcher’s role and relationship with the participants because interactions between the researcher and participants allow for participant comfort and engagement in conversations (Ellis,2016).

In addition, Sutton and Austin(2015) argued that researchers have a role to play in gaining access to participants’ thoughts and feelings, which can provide them with more insight and understanding of the data collected when they are present. However, because of the researcher’s hierarchy, the presence and relationship between participants and researchers can lead to professional bias, which results in participants responding in a way that pleases the researcher (Raheim et al., 2016).

Although Matthaeus-Kraemer et al. (2016) were not present during the focus group discussions, the moderators used were anonymous to the participants, enhancing the research’s strength and lowering the risk of bias (Fink, 2000; Sutton and Austin, 2015).


Evidence-Based Practice in Decision Making

A Nurse Preparing for research

In order to maintain patient safety, nurses must apply the best evidence based on research to everyday practice and decision-making on patient care. The research used a variety of data collection methods, but when evaluated critically, both proved to be reliable, credible, and valid. Understanding the hierarchy of evidence and where research fits into it can help you make better decisions and connect research findings to practice.


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Frequently Asked Questions (FAQs).

1. What is meant by evidence-based practices?

Although there are several definitions for EBP, Sackett et al. (1996) is the most frequently recognized, defining it as “the deliberate, explicit, and prudent use of current and accessible information in decision making of individual treatment.”

2. How do you define nursing research?

Nursing research is defined as a methodical investigation used to solve problems and generate solid evidence on matters relating to the nursing discipline, practice, information, and education (Polit and Beck, 2012).

3. What are the benefits of evidence-based practice in healthcare?

Healthcare practitioners, on the other hand, must be aware of research relevant to their own clinical competence and use it appropriately (Moule, 2018). EBP and studies have shown that the efficacy of simplified services supplied reduces costs (Barker et al., 2016). As a result, it is critical for nurses to stay current on policies, conduct research, and comprehend evidence utilizing a range of research methodologies in order to provide safe care using evidence-based practice and research (Ellis, 2016).

4. What is the hierarchy of research evidence?

According to Rees et al. (2015), the hierarchy of evidence is the classification of research evidence into distinct categories based on the strength and degree to which results are free of bias.

Evidence-Based Practice in Decision Making