Greenhalgh’s award-winning Understanding Research Methods for Evidence-Based Practice in Health is back. In this second edition, you will gain a complete overview of the most common topics covered in a standard 12-week evidence-based practice unit for Nursing and Allied Health courses. Throughout the text, you will find engaging and insightful content, which has a unique focus on consumers of research – keeping students focused on the skills most relevant to them.
Features include videos that help students connect the theoretical with the practical, interactivities and animations that help bring course concepts to life and knowledge check questions throughout the text that provide guidance for further study. This title enables students to master concepts and succeed in assessment by taking the roadblocks out of self-study, with features designed so they get the most out of learning.
Table of Contents:
About the authors vii
Chapter 1 Introduction to research, the research process and EBP 1
1.1 The meaning of ‘evidence-based practice’ 2
1.2 Apprehension towards evidence-based practice 5
Decision making by anecdote 6
Decision making by press cutting 6
Decision making by expert opinion 6
Decision making by cost minimisation 7
1.3 Before you start: formulate the problem 8
Chapter 2 Asking questions and searching for evidence 11
2.1 Different types of searching for evidence 12
Informal 12
Focused looking for answers 13
Searching the literature 13
2.2 Differences between primary and secondary research 13
2.3 Effective search strings 13
Steps for effective searching 14
One-stop shopping: federated search engines 16
2.4 Other avenues for how to search for evidence 17
Searching for information using social media 19
Chapter 3 Reviewing literature 21
3.1 Is a paper worth reading at all? 23
Question 1. Who wrote the paper? 23
Question 2. Is the title appropriate and illustrative, and is the abstract informative? 23
Question 3. What was the research design, and was it appropriate to the question? 24
Question 4. What was the research question, and why was the study needed? 24
Question 5. Do the results or findings answer the question? 24
3.2 Reviewing the methods of primary research papers 25
Sample and setting: who are the participants, and where is the study being carried out? 25
What data-collection methods were used? 26
How was the data analysed? 26
3.3 Reviewing the methods of secondary (review) papers 26
Question 1. What is the focused clinical question that the review addressed? 27
Question 2. Was a thorough search of the appropriate database(s) carried out, and were other potentially important sources explored? 27
Question 3. Who evaluated the studies, and how? 28
Question 4. How sensitive are the results to the way the review has been performed? 28
Question 5. Have the results been interpreted sensibly, and are they relevant to the broader aspects of the problem? 28
Meta-analyses and meta-syntheses 28
Chapter 4 Qualitative research 32
4.1 Qualitative research explained 33
4.2 The difference between qualitative and quantitative research 34
4.3 Qualitative methodologies and data collection strategies 35
Qualitative sampling 36
Data collection 36
4.4 Evaluating papers that describe qualitative research 37
Question 1. Did the paper describe an important clinical problem addressed via a clearly formulated question? 38
Question 2. Was a qualitative approach appropriate? 38
Question 3. How were (a) the setting and (b) the subjects selected? 38
Question 4. What was the researcher’s perspective, and has this been taken into account? 38
Question 5. What methods did the researcher use for collecting data, and are these described in enough detail? 39
Question 6. What methods did the researcher use to analyse the data, and what quality control measures were implemented? 39
Question 7. Are the results credible and, if so, are they clinically important? 40
Question 8. What conclusions were drawn, and are they justified by the results? 40
Question 9. Are the findings of the study transferable to other settings? 40
Chapter 5 Quantitative research 43
5.1 Why and how quantitative research is done 44
5.2 Quantitative research designs 46
Intervention studies 46
Observational studies 47
5.3 Measurement 48
Variables — independent and dependent 49
Reliability and validity in measurement 50
Chapter 6 Levels of evidence 55
6.1 Clinical questions in healthcare 56
Finding the best evidence 56
NHMRC and evidence-based practice 57
How researchers answer clinical questions 57
6.2 Matching clinical questions to NHMRC levels of evidence 58
NHMRC evidence levels for intervention studies 60
6.3 How bias threatens the validity of research evidence 63
6.4 Evaluating the evidence – quality of evidence and grades of recommendations for practice guidelines 65
6.5 Levels within levels 66
Chapter 7 Statistics for the non-statistician 73
7.1 Storing quantitative data in a data set 74
7.2 Descriptive statistics for summarising sample characteristics 75
Descriptive statistics for categorical variables 75
Descriptive statistics for continuous variables 76
7.3 The researchers ‘setting the scene’ 77
Have the researchers tested the assumption that their groups are comparable? 77
What assumptions apply to the shape of the data? 77
Have valid assumptions been made about the nature and direction of causality? 78
7.4 Probability and confidence 79
How are p values interpreted? 79
Confidence intervals 81
7.5 Clinical importance of treatment effects 81
Clinical importance 81
7.6 Summarising treatment effects from multiple studies of interventions in a systematic review 84
Chapter 8 Mixed methods research 88
8.1 An overview of mixed methods research 89
Why use mixed methods in nursing and health sciences research? 89
8.2 Different mixed methods designs 90
Convergent study 90
Sequential study 91
Multiphase (multilevel) study 91
Embedded study 92
8.3 Integration in mixed methods research 93
Integrating the research question 93
Research design 93
Sampling 93
Analysis 93
Interpretation 94
8.4 Mixed method design considerations 94
Weighting (dominance) 94
General challenges associated with mixed methods studies 94
Chapter 9 Sampling 97
9.1 Understanding the terminology around sampling 98
Theoretical population (or target population) 98
Study population (or accessible population) 98
Sampling 99
Sample 99
Sampling frame 99
9.2 Types of sampling 99
Probability sampling 99
Non-probability sampling 100
Sampling methods 100
9.3 Sampling error 102
9.4 Calculating sample size 102
Quantitative research 102
Qualitative research 103
Chapter 10 Ethics 106
10.1 Ethical principles 107
Autonomy: patients/clients are free to determine their own actions 107
Beneficence: acting to benefit human kind 108
Justice: obligation to treat fairly 108
Non-maleficence: avoiding or minimising harm 108
Respect for human dignity 108
Confidentiality: maintenance of privileged information, including the right to privacy and anonymity 109
Veracity: obligation to tell the truth 109
10.2 The role and function of human research ethics committees 109
10.3 Judging the ethical aspects of a published journal article 111
Chapter 11 Getting evidence into practice 114
11.1 Adoption of evidence-based practice (EBP) 115
Individual barriers 115
Organisational barriers 116
11.2 Encouraging individuals to implement evidence-based practice 116
11.3 Organisational support of evidence-based practice 117
Integrated care pathways 117
Clinical practice guidelines 118
11.4 The client perspective in evidence-based practice 119
Patient-reported outcome measures (PROMs) 119
Shared decision-making 119
Option grids 120
Chapter 12 Challenges to evidence-based practice 124
12.1 When evidence-based practice is done badly 126
12.2 When evidence-based practice is done well 126
Guidelines devalue professional expertise 126
The guidelines are too narrow (or too broad) 127
The guidelines are out of date 127
The client’s perspective is ignored 127
There are too many guidelines 128
Practical and logistical problems 128
The evidence is confusing 128
12.3 Achieving evidence-based practice 129
Index 133
About the Author :
Dr Trisha Greenhalgh is a Professor of Primary Care Health Sciences at the University of Oxford and a practising GP. She completed a BA in Social and Political Sciences at the University of Cambridge in 1980 and a medical degree at the University of Oxford in 1983. Trisha's research aims to apply the traditional aspects of medicine while embracing the opportunities of contemporary science to improve health outcomes for patients. She is the author of more than 240 peer-reviewed publications as well as a number of scholarly textbooks. Trisha has received numerous accolades for her work, including twice winning the Royal College of General Practitioners Research Paper of the Year Award, and receiving the Baxter Award from the European Health Management Association. In 2001, she was awarded an OBE for services to evidence-based medical care.
Dr John Bidewell is a Lecturer in Research Methods at the School of Science and Health at Western Sydney University. From an early career in school teaching, John moved into psychology, acquiring three degrees while always maintaining an interest in education. Opportunities arose in applied social research and data analysis, leading John in that direction. For many years, he provided technical and inspirational support to academic and student researchers, covering every stage of the research process from concept to publication, and especially data analysis and interpretation, at Western Sydney University's nursing and midwifery school. John has provided consultancy services in research and statistics to business, industry and governments, and has taught research methods and statistics to nursing, business and allied health students at undergraduate and postgraduate levels.
Dr Elaine Crisp is a Registered Nurse (RN) and Lecturer at the School of Nursing at the University of Tasmania, where she coordinates both the Bachelor of Nursing (BN) course and the Translational Research unit within the BN. This dual role enables her to ensure the BN highlights the connection between research and clinical practice. She has also taught research methods to nursing and allied health students at the postgraduate level, encouraging clinicians to understand and use research evidence in their everyday practice. Elaine worked as an RN in aged care and in the perioperative area before commencing her PhD, which combined her love of history and nursing. Her major research interests are nursing and welfare history, aged and dementia care, and nurse education.
Amanda E Lambros is a Professional Speaker, Author and Clinical Counsellor as well as a past Clinical Fellow. She has completed a Bachelor of Health Sciences at the University of Western Ontario (2001), a Postgraduate Diploma of Ethics (2002), a Master of Forensic Sexology (2004) and a Master of Counselling (2014). Amanda has developed, coordinated and taught evidence-informed health practice to thousands of Interprofessional First Year Health Sciences students throughout her career. Amanda's private practice focuses on relationships, mental health, and grief and loss. Providing her clients with the most up-to-date and evidence-based care is imperative to her, and she has a strong focus on EBP, ethics and communication. Amanda has received numerous accolades for her work, including NifNex 100 Most Influential Business Owners, a Telstra Business Award nomination and a Telstra Business Woman of the Year nomination.
Dr Jane Warland is an Associate Professor at the School of Nursing and Midwifery at the University of South Australia (UniSA). She worked as a midwife from 1988 to 2007, and gained her PhD from the University of Adelaide in 2007. Jane was appointed as an academic staff member to the School of Nursing and Midwifery in February 2008, and teaches a foundational research course in the undergraduate midwifery program. Her own program of research is STELLAR (stillbirth, teaching, epidemiology, loss, learning, awareness and risks). Jane has a track record in research using qualitative, quantitative and mixed methods. She has a strong interest in research ethics and served two terms as a member of the UniSA Human Research Ethics Committee. Jane has written numerous book chapters about research — she has more than 90 publications, including books, chapters and peer-reviewed journal articles.
