In the last few weeks, following the publication of the Francis report there has been a lot of discussion in the UK nursing press about why the nurses at Mid-Staffs did not whistle blow about the poor practice that was taking place in the hospital. We will probably never understand this completely but I think there are several things it is worth reflecting on. Firstly, even when nurses did report poor practice nothing seemed to happen. Managers did not seem to act on what was being reported to them. I do not think Mid-Staffs is unique in this regard. I have heard many friends and colleagues talk about how they have reported quite serious concerns to their managers and nothing has happened. The whole NHS needs to reflect on this. Secondly, whistle blowers have historically been treated badly and often lost their jobs which makes people think twice about doing so, even if they know they really should. This is another area where cultural change is needed.
One area nurses should be highlighting is where practices do not adhere to current clinical guidelines. Registered nurses are accountable for their actions and should practice in an evidence-based manner. In the UK nurses’ professional conduct must conform to the Nursing and Midwifery Council’s (NMC) Code of Professional Conduct (2008). (The Code is available from: http://www.nmc-uk.org/Nurses-and-midwives/The-code/.) Similar codes of conduct are in place in other countries.
The NMC code states that as a registered nurse, you must:
- deliver care based on the best available evidence or best practice
- ensure any advice you give is evidence-based if you are suggesting healthcare products or services
- have the knowledge and skills for safe and effective practice when working without direct supervision
- recognise and work within the limits of your competence
- keep your knowledge and skills up to date throughout your working life
- take part in appropriate learning and practice activities that maintain and develop your competence and performance
Evidence-based practice has been defined as an approach to providing care to patients that involves the use of clinical research combined with clinical experience, patient characteristics, and patient preferences to make clinical decisions regarding treatment and management (Joint Commission International 2010).
If we are going to carry out evidence-based nursing several skills are needed, including:
- literature searching
- a knowledge of research (to enable critique of research papers)
- ability to reflect on practice
- critical appraisal skills – to decide whether the:
- research in the paper is any good
- results are relevant to your practice
These are all skills that develop over time and for which the adage practice makes perfect applies. Your local librarian should be able to help you develop your literature searching skills. In relation to critical appraisal skills there are several tools available – see: http://www.casp-uk.net/ or http://bit.ly/W1TY0J. The questions you will need to ask will vary depending of the type of research carried out. Why not practice your critical appraisal skills by taking part in our Twitter Journal Club? See: https://blogs.bmj.com/ebn/ebn-twitter-journal-club/ for further details.
Some of the questions you need to be asking about research papers you read are:
- Have the authors included recent literature in the background/literature review sections of the paper?
- Has an appropriate methodology been used to address the research questions?
- Have the ethical issues raised by the study been adequately addressed?
- Are the limitations of the study addressed appropriately?
- What are the strengths and weaknesses of the paper?
- What are the implications for practice of the paper?
- What are the implications for future research?
Joint Commission International (2010) Approaches to Pain Management: An Essential Guide for Clinical Leaders 2nd edn, Joint Commission International, Oakbrook Terrace, Illinois.