Lisa Gorski - Phillipss Manual of I.V. Therapeutics Evidence-Based Practice for Infusion Therapy

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For My Other Loren

Who would have thought our professional paths would cross

at occupational therapy? I am so glad they did.

CB

The introduction of evidence-based medicine by David Sackett and other researchers in the 1990s (Sackett, 1997) initiated a radical shift in the approach to instruction in research methods and the application of research findings to health-care practice. Until then, practitioners learned about research through standard academic research methods courses in which they were taught to read and critique journal articles using the well-established criteria of reliability and validity. They were then expected to use those skills to keep up with the research literature relevant to their area of practice and apply the results to patient care. Unfortunately, for the most part, they didnt.

Sackett and his colleagues determined that the traditional approach to applying research to practice was ineffective, and they proposed a radically different approachwhat we now recognize as evidence-based practice. What was so different? Sackett and colleagues recognized that research was relevant and useful to the practitioner only to the extent that it addressed a clinical question of importance to practice and provided a useful guide to clinical decision making. From this perspective, reading journal articles just to keep current and without a particular question in mind was unfocused and unproductive.

The alternative method they proposed taught practitioners to use research evidence as one of three integral components of clinical reasoning and decision making. This method is reflected in the now-familiar definition of evidence-based practice: integration of the clinicians expertise and the best available scientific evidence with the clients preferences and values to determine an appropriate course of action in a clinical encounter.

To support the use of evidence-based practice as an integral part of clinical reasoning, a different method of instruction was developed, which is exemplified in The Evidence-Based Practitioner: Applying Research to Meet Client Needs. Evidence-based practice (EBP) is a process to be learned, not a content area to be mastered the way we learn to identify the bones of the body or the details of a particular assessment. Although it does require learning about research methods and design, measurement, and statistics, this knowledge is mastered in the context of appraising evidence in relation to a particular clinical question regarding a particular clinical scenario. The EBP process involves a specific set of steps to formulate an answerable question and then to search, select, appraise, and apply the evidence to answer the clinical decision at hand. Ideally, students will have multiple opportunities to practice these steps so that, ultimately, the process can be initiated and carried out smoothly and efficiently in occupational therapy practice.

One of the valuable features of this text is that it is designed to be used with team-based learning. This approach supports another important element of Sacketts (Sackett, 1997) and others original recommendations for how to conduct EBP: that is, the importance of distributing the work and learning from one anothers insights. Team-based learning models a method that can be carried forward into the real world to continue to implement EBP in practice.

Heres what this can look like: Each of the five practitioners in a group prepares and shares an appraisal of one key study that addresses a clinical question of importance to the group. In less than an hour of discussion, the group synthesizes the findings and reaches a decision on the best answer (known as the clinical bottom line in EBP) to a clinical question at hand. One busy practitioner working alone might find that amount of work daunting. In addition, they would miss the crucial insights that other group participants provide.

Theres another important advantage to team-based EBP: its much more fun. Group members energize one another, and examining the evidence becomes an interesting exploration and lively discussion of how best to balance strengths and limitations, clinical relevance and feasibility, and similarities and differences in the evidence. The outcome of that lively discussion will help ensure that your clinical decisions are guided by the best evidence available to help your clients.

In The Evidence-Based Practitioner: Applying Research to Meet Client Needs, Catana Brown provides occupational therapy, physical therapy, and speech-language pathology students with a clear and concise overview of research designs, methodology, use of statistical analysis, and levels of evidence, as well as the tools with which to evaluate and apply evidence. Interesting and engaging features such as From the Evidence lead the readers through the steps to becoming effective consumers of evidence. Exercises and Critical Thinking Questions motivate learners to explore how this knowledge can be applied to their clinical practice.