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5856 results in Facet Publishing

Page 290 of 293

  • 11 - Evaluating your performance

  • from Part 2 - Skills and resources for evidence-based information practice
    • By Andrew Booth, School of Health and Related Research (ScHARR), University of Sheffield
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 127-137

  • Summary

    Introduction

    The final stage of evidence-based practice is evaluating your own performance (Figure 11.1). This has two aspects: firstly, on a technical level:

  • • How have you performed with regard to the stages of evidence-based practice?

  • • Did I ask a specific focused question?

  • • Did I find efficiently the best evidence to answer my question?

  • • Did I evaluate the evidence reliably according to validity and usefulness?

  • • Did I apply the results of the research appropriately to a specific user or group of users?

    • Evaluating your performance in this context helps you become a better evidencebased practitioner.

    Secondly and more importantly, has the service that you introduced or modified as a result of undertaking the evidence-based process actually made the anticipated difference? Evaluating your performance in this context helps you become a better evidence-based practitioner. As Todd (2002) identifies: ‘evidence- based practice thus has two important dimensions. First, it focuses on the conscientious, explicit and carefully chosen use of current best research evidence in making decisions about the performance of the day-by-day role. Second, evidence-based practice is where day-by-day professional work is directed towards demonstrating the tangible impact and outcomes of sound decision making and implementation of organizational goals and objectives’.

    Evaluation will consider both direction and degree; did the intervention have the planned effect (as opposed to the opposite effect) and did the effect have the expected magnitude? It may also lead you to redefine the original problem (Figure 11.1).

    Because change strategies involve organizational and individual factors, differences between what you anticipate and what actually happens can have various causes:

  • • differences between the political, cultural or economic environment in the published study and that in which you are operating (applicability differences)

  • • differences between the technologies employed in the published study and those available to you locally (intervention differences)

  • • differences between the morale, motivation and commitment of staff in the published study compared with those locally (motivational differences).

  • 7 - Identifying sources of evidence

  • from Part 2 - Skills and resources for evidence-based information practice
    • By Alison Winning, Clinical Effectiveness Information Specialist, Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 71-88

  • Summary

    Introduction

    Evidence-based information practice is no different from any other evidence-based speciality in requiring a thorough search of information resources relevant to the topic in question, in order to identify evidence and, subsequently, put it into practice. The evidence base can be identified through published and unpublished literature with the main sources taking the form of bibliographic databases and journals.

    As a profession, librarians spend a large proportion of their time assisting users to identify appropriate information resources for their query. Subsequently they also devote a great deal of effort to training users in search methods and utilization of the resources to their greatest effect. How much time, and to what effect, do information professionals spend developing their skills in interrogating resources relevant to their own profession?

    The multifaceted nature of librarianship and information science (LIS) means that the evidence base is contained in multiple and varied information resources. However, only a handful of papers address methods for accessing and interrogating the library literature (Crumley and Koufogoiannakis, 2002; Eldredge, 2000; McKibbon et al., 1999; Yerkey and Glogowski, 1990). It remains unclear which sources are most useful in this quest and what their relative advantages and disadvantages might be. This lack of clarity may compound the fact that information professionals are not enthusiastic consumers of LIS research (see Chapter 5) (Booth, 2000; Turner, 2002).

    Scenario

    You are a children's librarian within a public library service and have been seconded for two days a week to work on a project investigating the use of ICT in reader development. The library service wishes to develop an interactive web-based package to support the reading development of children. The package will also support writing and computer literacy skills. One of your first tasks is to complete the project initiation document.

    Scenarios such as the one above will be familiar to many of you. As the librarian in the scenario you would perhaps want to consult the literature to identify similar initiatives to inform the development of your project and the writing of your document. To assist those of you seeking to develop an evidence-based approach to your practice this chapter identifies and presents a summary of information resources pertinent to evidence-based information practice.

  • 15 - The contribution of evidence-based practice to educational activities

  • from Part 3 - Using the evidence base in practice
    • By Anne Brice, Head of Knowledge and Information Sciences, in the Public Health Resource Unit, Oxford, Cindy Carlson, Learning and Development Team at the Public Health Resource Unit in Oxford in September 2002
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 164-177

  • Summary

    Introduction

    This chapter examines issues relating to evaluation of educational interventions. It considers the types of questions that might be framed from an educational perspective, the sources that might supply answers to such questions, and the quality of the evidence base. Whether evidence from education research is put into practice, and barriers to acting on the evidence are also considered. Key studies from within the domain are used to illustrate issues and methods. Educational approaches within an information setting encompass everything from user education to staff development and training. A subsequent special topic examines the evidence base for the training of users in information skills.

    What is evidence-based education?

    What do we mean by evidence-based education, and what kinds of research might those involved in teaching and learning do? Much existing published research centres on education policy, and very little is actually evidence-based. In addition, much research has been carried out in the context of primary and secondary education, where much of the controversy and public interest lies. In fact, even here Davies et al. (2000) suggest that the evidence base is weak and that ‘there is often not a culture of teachers using research to inform their everyday school practice’. In this chapter we focus on research undertaken with regard to adult and lifelong learning. However we should acknowledge, albeit in passing, the considerable work that exists looking at evidence-based practice in relation to the contribution of the school librarian (Todd, 2001; Todd, 2002a; Todd, 2002b; Todd, 2003).

    Evidence-based education is ‘(t)he integration of professional wisdom with the best empirical evidence in making decisions about how to deliver instruction’. The authors of this definition argue that professional wisdom is important for helping to adapt empirical evidence to local situations, and that randomized control trials are the best way to establish empirical evidence.

    Fierce debate surrounds the relevance and appropriateness of research methodologies for educational interventions. Some see the gold standard of evidence in this context as multiple replications of small scale, randomized controlled trials of feasible interventions in real-life settings (Fitz-Gibbon, Tymms and Coe, 2000) while others strongly challenge this view (Morrison 2001; Hammersley 2001).

  • Special Topic (H) Determining the information needs of practising nurses postregistration in the UK from 1990 to 2003 (Evidence Digest)

  • from Part 3 - Using the evidence base in practice
    • By Jennie Kelson, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 272-278

  • Summary

    Why is it important?

    Studies investigating the information needs of healthcare professionals have tended to focus on medical staff (Bunyan and Lutz 1991; Roddham 1995). Nurses learnt on the wards, which discouraged the use of research in practice (Wakeham et al., 1992) and led to the belief that nurses had no need of libraries (Wakeham 1992).

    Since the early 1990s, the UK nursing profession has undergone radical changes that are expected to increase nurses’ requirement for information and libraries (Roddham 1995; Yeoh 2000). These include the introduction of a more scholarly base for nursing (UKCC 1986; UKCC 1999), increasing emphasis on continuing professional development (UKCC 1994), the growing evidence-based healthcare movement and the extended role of nurses (Yeoh 2000).

    Technological developments such as the internet and the NHSnet, and initiatives including the National electronic Library for Health (Yeoh 2000) and the increasing focus on electronic delivery of information are expected to impact on the information needs and information-seeking behaviour of practising nurses.

    What is required?

    Many NHS Trust libraries traditionally have provided services to a narrow range of clients, predominantly physicians and junior doctors in training (Capel 1998). Government initiatives to encourage NHS libraries to take on a multidisciplinary focus (Department of Health, 1997), coupled with the move of nursing education to the higher education sector (UKCC, 1986), have meant they are expected to provide services for different staff groups although they may have little experience or knowledge of their information needs.

    Marketing techniques and strategies can be used to evaluate existing services and to plan new services (Bunyan and Lutz 1991). Products and services to meet the needs of a particular client group can then be developed and promoted.

    The information needs of nurses are diverse, as the profession encompasses a variety of specialities including general, psychiatric, community, midwifery and children's nursing (Bawden and Robinson 1994). Nurses may work in acute care or within the community and, in addition to their role as carer, may undertake other roles including those of teacher, student, researcher or manager (Roddham 1995; Urquhart et al., 1997).

  • 13 - Six domains of evidence-based information practice

  • from Part 3 - Using the evidence base in practice
    • By Andrew Booth, School of Health and Related Research (ScHARR), University of Sheffield, Anne Brice, Head of Knowledge and Information Sciences, in the Public Health Resource Unit, Oxford
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 144-147

  • Summary

    In a pivotal address at the 2001 first Evidence Based Librarianship Conference in Sheffield, UK, Crumley and Koufogiannakis (2002) proposed that the discipline of evidence-based information practice could be organized within the following six domains, based upon the major areas dealt with in daily practice for librarians:

  • • Reference/enquiries – providing services and access to information that meets the needs of library users

  • • Education – finding teaching methods and strategies to educate users about library resources and how to improve their research skills

  • • Collections – building a high-quality collection of print and electronic materials that is useful, cost-effective and meets user needs

  • • Management – managing people and resources within an organization

  • • Information access and retrieval – creating better systems and methods for information retrieval and access

  • • Marketing/promotion – promoting the profession, the library and its services to both users and non-users.

    • They went on to observe the usefulness of this approach as a contribution to the evidence-based practice process: ‘As with EBHC, matching librarianship questions with one of the above domains can help librarians decide where to search and the appropriate search terms they should use to answer that type of question. This also allows librarians to focus upon what they are really asking, rather than permitting the question to snowball in many different directions’.

    Structure of ‘domain chapters’

    We have decided to use this structure to present a brief overview of the main types of study, with illustrative examples, in each domain. Although this prototypic taxonomy is by no means perfect – staff development probably merits a category in its own right and the evidence base for knowledge management will imminently command its own category – like the originators themselves we believe it to be a useful parallel to the evidence-based healthcare paradigm.

    Each principal chapter in Part 3 follows a similar pattern – after a brief introduction and consideration of the definition of the domain it proceeds to look at the most relevant sources of evidence and the general quantity and quality of research. It then examines principal examples of evidence-based practice designs such as systematic reviews and randomized controlled trials before considering designs with special importance to that domain.

  • 17 - Towards evidence-based management

  • from Part 3 - Using the evidence base in practice
    • By Andrew Booth, School of Health and Related Research (ScHARR), University of Sheffield
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 200-209

  • Summary

    Introduction

    This chapter characterizes management in terms of its main functions before identifying common types of question and approaches used to resolve them. From here the chapter considers sources to yield answers to such questions. Key management studies are identified and assessed together with implications for practice. The chapter concludes by identifying research priorities with most promise for management. This chapter is followed by two special topics examining the evidence relating to the measurement of service impact and charging for services.

    What is evidence-based management?

    In the fourth of their domains, Management, Crumley and Koufogiannakis (2002) include ‘managing people and resources within an organization’. Stewart (2001) adopts a broad definition of ‘evidence-based management’ as: ‘The conscientious, explicit and judicious use of current best evidence in making decisions’.

    Claiming that it is ‘more difficult to practise evidence-based management than evidence-based medicine’ she asserts that if managers were required to search and appraise evidence for themselves, opportunities for evidence-based practice would be very rare indeed. Barriers are more to do with the slim likelihood that managers will acquire skills in searching and appraising the literature than the paucity of management evidence.

    Asking the question

    Management research is a relatively young field, far less developed in terms of question formulation than healthcare. There tends to be low consensus concerning key research questions in management research. Studies in the field rarely address identical problems, share a research agenda, or more importantly, ask the same questions. As a result the extent to which meta-analysis, or its qualitative equivalent, meta-ethnography, can be used to group and synthesize findings has been questioned within management research. Replication studies are extraordinarily difficult to find within management research. Consequently, management research often addresses questions at a broad, overarching, organizational level rather than examining the causes of particular problems or specific policies (Tranfield et al., 2002).

    Finding the evidence

    Management, as a domain, simultaneously lies within the information literature and yet subsumes it. Layzell Ward (2002) observes that: ‘One of the surprising aspects of this year's review has been an increase in the quantity and quality of writing about the management of services within the sector. This review contains more citations than before – and still a higher number of interesting items were rejected. This is in contrast to the general literature of management where fewer interesting papers were retrieved’.

  • 4 - How good is the evidence base?

  • from Part 1 - The context for evidence-based information practice
    • By Jonathan Eldredge, Assistant Professor in the School of Medicine and Coordinator of Academic and Clinical Services in the Health Sciences Library and Informatics Center at the University of New Mexico
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 36-48

  • Summary

    Introduction

    Identifying research evidence relevant to answering EBIP questions poses an initial challenge. How good is the evidence base? How well does it answer our EBIP questions? Once we have identified and obtained this research then we have to evaluate its relevance and quality, a second major challenge (Chapter 9).

    This chapter identifies the types of research that may be used to answer important questions for our practice and outlines how an understanding of research types helps in matching an appropriate research type to a specific question. The chapter ends with an appraisal of the overall evidence base.

    Identifying the evidence base

    The evidence base for information practice is located within three main search domains: (1) the library and informatics literature; (2) the so-called ‘grey literature’ for our field; and, (3) the literatures outside our field with functional relevance to the question such as the literatures of the social, behavioural, education or management sciences.

    The library and informatics literature

    Issues of index coverage

    The first of these, the library and informatics literature, poses several unexpected challenges for the searcher. To illustrate from within the health sector, the major journals in our field include Health Information and Libraries Journal, Journal of the Medical Library Association and Medical Reference Services Quarterly. Less prominent journals include Bibliotheca Medica Canadiana; Hypothesis and Journal of Hospital Libraries. While PubMed is available to all searchers, commercial databases are likely to be too expensive for some professionals to access. The databases selected in any search for the contents of the major journals will yield different retrieval. Tables 4.1–4.3 illustrate uneven coverage amongst three databases. From Table 4.1 one notes that PubMed appeared to offer the most complete access, for the years 2001 or 2002, to the contents of Journal of the Medical Library Association (JMLA): (51 [2001] and 66 [2002] references compared to the Library Literature database's 32 and 42 respectively). For 1998, however, Library Literature provided access to 93 versus PubMed's 74 references to the same journal. Within the field, Library Literature is used extensively when searching for the evidence needed to make decisions. Yet, for the years 1998–2002, Library Literature did not index any contents for Health Information and Libraries Journal or its predecessor Health Libraries Review.

  • 12 - Disseminating the lessons of evidence-based practice

  • from Part 2 - Skills and resources for evidence-based information practice
    • By Ellen Crumley, Clinical Librarian with the Department of Pediatrics at the University of Alberta, Canada, Denise Koufogiannakis, Collections Manager at the John W. Scott Health Sciences Library, University of Alberta, Canada
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 138-143

  • Summary

    Introduction

    Dissemination of research results is vital to the progress of the profession as well as helping to improve practice. It involves not only making your research available, but also ensuring that it is accessible to others and presented in a manner that is easy to understand. In addition, it is important to use a variety of techniques for delivering information in order to provide evidence (or to conduct research where no data are available) for what we do as librarians and to help others understand how we define our role.

    In this chapter, we explore the evidence for dissemination and the different methods by which research and knowledge can be circulated. We also provide an overview of how distribution is used by librarians and investigate innovative ways to make your research known. Two types of disseminators, those who conduct research and those who use research findings in their practice, are examined throughout the chapter.

    Scenario

    As a special librarian, you work with a business research group consisting of a statistician, a research assistant and an MBA. Your role includes conducting environmental scans, facilitating access to online resources and performing comprehensive literature searches. You are also being asked to order documents for employees and other time-consuming tasks which could be done by other staff. You report to the vice president of the organization, who understands little about your role, yet she speaks on your behalf at board meetings. Since you see your boss infrequently, you prepare carefully for your meetings. You wish to communicate your needs and wants better, using evidence. You also want to find effective ways to get vital information to your supervisor. As a solo librarian, you also worry that you are isolated from other librarians and want to find ways to keep up with issues of relevance to your profession while at the same time gaining the support of your colleagues.

    Effective dissemination

    Dissemination continues to be a hot topic in recent literature. In order to be effective, research needs to be user-friendly, that is, understandable by those to whom we report, as well as to our colleagues. Many libraries are run by non-librarians and many librarians report to a person in another discipline who may not clearly understand their role and function within the organization.

  • Special Topic (E) Should I charge and, if so, what should I charge for? (Evidence Briefing)

  • from Part 3 - Using the evidence base in practice
    • By Lynette Cawthra, Information and Library Service Manager at the King's Fund
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 223-230

  • Summary

    What are my objectives in charging?

    ‘Before introducing charges for any service it is essential to consider where the service sits within your long-term objectives and priorities and establish that: there is a need for the service; there is a willingness to pay; and you have the appropriate resources and skills to take it forward’ (Webb, 2003). You must decide what your objectives are in charging. For instance:

  • • are you trying to produce value-for-money outcomes? (Cooper, 1997)

  • • are you attempting to make a profit, recover costs or control excessive use? Libraries are often more concerned to recover costs than to make money, e.g. ‘cost-minus pricing’, providing subsidized services below costs (Snyder and Davenport, 1997)

  • • is the charged-for service peripheral (e.g. a service to ‘non-core’ users) or integral to what the library offers (e.g. passing on costs to internal users)?

    • Answers to such questions will generate very different pricing strategies (Ward et al., 2002).

    Libraries should establish a pricing mechanism only after determining the implications of such a policy on performance and utilization of library services (elasticity analysis) (Olaisen, 1992).

    What are my motives?

    Possible reasons for charging include:

  • • to generate revenue

  • • to recover costs, in whole or in part

  • • to benefit from users’ ability and willingness to pay

  • • to control usage (Snyder and Davenport, 1997) e.g. by ‘non-core’ users

  • • conversely, as outreach to ‘non-core’ users (Ward et al., 2002)

  • • to bring a service in line with ‘competitor services’ (Ward, 1997)

  • • to provide ‘value-added’ services e.g. a new or upgraded service. If a service benefits only a small proportion of library users, they may be expected to pay (Snyder and Davenport, 1997)

  • • to create a measure of value, aiming to demonstrate – e.g. to funding bodies – that information (and by extension the information expert! (Webb, 2003, 5)) is viewed as a valuable commodity

  • • as the only way to afford some services at all (Snyder and Davenport, 1997).

    • What services might I charge for?

    Table E.1 suggests possible services that might be charged for:

    You should not introduce charges randomly for existing, unchanged, previously free services (Webb, 2003). Previous demand from existing users does not necessarily convert into sales. You may need to look more broadly and recruit new clients (Webb, 1994).

Evidence-based Practice for Information Professionals
  • A Handbook
  • Edited by Andrew Booth, Anne Brice
  • Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004
  • Evidence-based practice is a paradigm that originated within healthcare but is rapidly migrating to other fields. It involves applying the results from rigorous research studies to professional practice in order to improve the quality of services to clients. Familiarity with these methods has caused an increasing number of information professionals to turn a critical eye to their own practice. Is it possible to adapt this model to librarianship and information work? To what extent are its skills and techniques transferable to the various areas of professional practice? Is it desirable for information professionals to integrate research findings into their day-to-day decision-making? These and other related issues are discussed in this book, the first to examine this key topic in depth. It is divided into three parts: The Context for Evidence-based Information Practice; Skills And Resources for Evidence-based Information Practice; and Using the Evidence Base in Practice. This last part explores each of the six domains of evidence-based librarianship identified in research, to demonstrate the application of evidence-based information practice in a practical decision-making context. These chapters with their associated Special Topics present concise summaries of evidence-based information practice within generic areas of work, together with practical examples of the application of evidence-based principles and methods. This book is of wide interest to all new and established information professionals, both those in fields such as healthcare where the evidence-based paradigm is already impacting on their work, and those in other fields encountering it for the first time. It is a core text in departments of library and information work.

  • 18 - Evidence-based perspectives on information access and retrieval

  • from Part 3 - Using the evidence base in practice
    • By Andrew Booth, School of Health and Related Research (ScHARR), University of Sheffield
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 231-246

  • Summary

    Introduction

    Information access and retrieval has generated significant research output over recent decades. This chapter examines issues in evaluating information retrieval systems and techniques. It then identifies issues involved in practical use of such systems. Sources from the information science and computing literature feature in addressing such issues. Illustrative studies are assessed for quantity and quality. The chapter concludes by describing priorities for future research. The chapter is followed by two special topics examining the research evidence on searching aptitudes and characteristics, and the merits of different interfaces.

    What is evidence-based information access and retrieval?

    In their fifth domain, Information Access and Retrieval, Crumley and Koufogiannakis (2002) consider ‘creating better systems and methods for information retrieval and access’. Information retrieval (IR) is: ‘the science and practice of identification and efficient use of recorded media. Although … traditionally concentrated on the retrieval of text from the … literature, the domain over which IR can be applied effectively has broadened considerably …’. (Hersh et al., nd).

    Asking the question

    Budd and Miller (1999) highlight three particular questions from this domain:

  • • How does technology affect the information-seeking behaviour of users?

  • • Do we think differently when using a print source and an electronic source?

  • • How should we evaluate information technology?

    • Evaluation of information technologies provides a particular challenge to evidencebased information practice. Frequently, innovative technologies are adopted uncritically as a ‘good thing’ and evaluation viewed as an unwelcome ‘brake’ to technological advance.

    Marcum (2003) identifies several key questions for the digital library:

  • 1 How are digital resource users best served? What resources will they want? How will they want to use them? And, what services will most enhance use?

  • 2 What elements are required for a coherent preservation strategy covering resources both digital and traditional?

  • 3 What kinds of education will ‘librarians’ of the future need?

    • The developing information environment and changing expectations and demands of library users have blurred the distinction between collection management and information access and retrieval, where digital libraries are concerned. Indeed, the third question, from the education domain, suggests that a holistic approach to question identification and subsequent resolution may be preferable. Such an interpretation is supported by Marcum's observation that we need to learn a lot more than we now know about the use of digital resources, their preservation, and the training needed for operating the library of the future.

  • 2 - A brief history of evidence-based practice

  • from Part 1 - The context for evidence-based information practice
    • By Anne Brice, Head of Knowledge and Information Sciences, in the Public Health Resource Unit, Oxford, Alison Hill, Programme Director of the South East Region Public Health Observatory
  • Edited by Andrew Booth, Anne Brice
  • Book:
    Evidence-based Practice for Information Professionals
    Published by:
    Facet
    Published online:
    08 June 2018
    Print publication:
    15 March 2004, pp 13-23

  • Summary

    Introduction

    This chapter reviews the growth of evidence-based practice. It does not offer a comprehensive history of the relationship between research and practice, but highlights the main landmarks and initiatives, initially in healthcare, but also in such areas of practice as education, social care, and policy. It describes the significant effect the evidence-based healthcare movement has had on the role and practice of librarians, focusing on the UK in particular.

    Although single events may appear to be major catalysts of change, in retrospect any trend is a composite of diverse and complex social, political and technological change. The current context as it affects further development of evidence- based practice will be discussed.

    Definitions and debates

    There are many definitions of evidence-based practice in the literature (Critical Appraisal Skills Programme, 2003). The one that we feel best encapsulates the core concepts of evidence-based clinical practice states that it is ‘an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best’ (Gray, 2001).

    The evidence-based movement was based on the concept that practice should be based on up-to-date, valid and reliable research. It is difficult to argue with such a simple and direct message. The term ‘evidence-based’ was adopted deliberately to challenge prevailing practice at the time and to provoke practitioners into proving that they were up-to-date with research evidence, and incorporating that evidence into their practice (Gray, 2001). The term is now accepted and in universal usage, but at the start it met with negative reactions from the medical establishment, and generated ridicule and controversy (Feinstein and Horwitz, 1997; Grahame-Smith, 1995; Isaacs and Fitzgerald, 1999; Lancet Editorial, 1995; Molesworth, 1998; Sackett, 1995). Criticism ranged from evidence-based medicine being ‘old hat’ to it being a dangerous innovation, a threat to clinical autonomy, aimed at rationing healthcare and suppressing clinical freedom through ‘cook book’ medicine (Sackett et al., 1996).

Page 290 of 293