Exploring the Concept of

Evidence-Based Practice
Dr Tina Harris
Lead Midwife for Education
Adapted from a presentation originally
developed by Dr Susan Dyson

Aims
By the end of the session you should be able
to:
Articulate the concept of evidence-based
practice
Appreciate the importance of using
evidence to underpin professional practice
Understand the principles for determining
what is best available evidence

Whats in a Word (or

phrase)
What do you understand about
evidence based practice (EBP)
- discuss with your neighbour

Evidence-based practice is..

The conscientious, explicit and
judicious use of current best
evidence in making decisions about
the care of individual patients. The
practice of evidence-based medicine
means integrating individual clinical
expertise with the best available
external evidence from systematic
research (Sackett et al, 1996:71-72)

Evidence-Based midwifery
Practice
involves integrating the best
available research evidence with
professional expertise while taking
account of patient preferences
is a complex undertaking that
involves identifying and appraising
different sources of evidence

Evidence for breast feeding

Best way to help a woman
successfully breast feeding
What is happening?
What needs to happen to resolve the
problem
What is the best way to do this

In more detail
We can extend the concept of EBP
from individuals to groups of
patients, health care services and
policy initiatives (Muir Gray, 2004)
Ongoing research adds to the `body`
of knowledge and ensures the
knowledge base for practice is
constantly evolving

EBP for midwives

The onus is on midwives to keep upto-date with research, both `generic`
and `applied`, so as to provide best
possible care
The evidence drawn on to underpin
practice should be in the public
domain, open to scrutiny, clinically
based, take account of women and
their families.

Research to underpin EBP

Research findings as evidence
- Systematic research process should ensure
confidence in research findings
- All research has limitations, so research
reports should be subject to `critical
scrutiny`
- Evidence drawn from one source is
insufficient as grounds for changing
practice
- Research findings often need considering
alongside professional expertise to identify
best practice

 Research findings may be applied

directly to practice in the form of
clinical protocols or practice
guidelines, be used persuasively to
present a case for changes in policy
or practice

Professional Expertise to
underpin EBP
Professional expertise or `practical`
knowledge (derived from professional
experience) can inform EBP, when used
alongside `technical` or `propositional`
knowledge (derived from research)
Midwives often draw on these sources of
knowledge more often than formal
sources, i.e. published research reports

Patient experience to underpin

EBP
Can be `individual` e.g. collected during
individual episodes of care
or `collective` e.g. collected during group
or community participation in health care
planning or service delivery
Users of health cares services are
becoming more involved in all aspects of
care using a variety of mechanisms to
inform preferences and/or opinions e.g.
user forums, satisfaction surveys, internet,
NHS organisations

Hierarchy of Evidence

1.
2.
3.
4.
5.

EBP draws on different types of evidence

What constitutes `best` available
evidence the so-called `hierarchy`
Systematic Review Multiple Randomised
Controlled Trials (RCTs)
RCT
Non RCT
Non Experimental
Descriptive studies, Expert Committees

Characteristics of all
research
All types of research are or aim to be:
Planned
Cautious
Systematic
Reliable
Ways of finding out or deepening
understanding

Examples of Research
Ethnicity Question and Antenatal
Screening (EQUANS)
A Department of Health funded study using
quantitative and qualitative methods to
find out about the efficacy of asking
pregnant women an ethnicity question as
a way of detecting risk of carrying genes
associated with Sickle Cell Disease (SCD)
Project Lead Dr Simon Dyson: Reader in
Applied Social Sciences
RCT and non-RCT

 Cultural diversity of pre-registration

nursing programmes
A Health Care Workforce Deanery (HWD)
funded study using qualitative and
quantitative methods to understand the
experiences of South Asian nursing
students on under-graduate nursing
programmes
Project Lead Dr Sue Dyson: Principal Lecturer
in Nursing
Non experimental

 Midwifery practice in the third stage of labour

A study which aimed to identify and explain the
variety of ways midwives manage the third stage
of labour.
Project Lead Dr Tina Harris: Principal Lecturer in
Midwifery
Non experimental

 The experience of obesity in

childbearing
Aim to explore with obese women their
experiences of childbearing to inform
future care of this client group.
Project lead Rowena Doughty

Non experimental

In summary
We should be able to articulate what
evidence-based practice is
We should understand something of the
importance of using evidence in
professional practice
We should understand the principles behind
determining what is best available
evidence

References
Spiby H and Munro J (2009) Evidence
based midwifery: applications in context.
Chichester:Wiley-Blackwell. Chapter 1.
Rees C (2011) Introduction to research
in midwifery. London:Churchill
Livingstone
Cluett R and Bluff R (2006) Principles
and practice of research in midwifery

References
Gerrish, K and Lacey, A (2006) The
Research Process in Nursing (5th Edn)
Blackwell Publishing. Oxford.
Sackett, D.L., Rosenburg, W.M., Muir Gray,
J.A., Haynes, R.B., Richardson, W.S., (1996)
Evidence-Based Medicine: what it is and
what it isnt. British Medical Journal
312: 71-72
Muir Gray, J.A. (2004) Evidence-based
policy making (editorial) British Medical
Journal 329: 988-989