Embedded Files
provide the best available evidence. Because of the explicit criteria used to select and grade studies, they are reproducible so that other researchers can reach the same conclusions (Krainovich-Miller, 2006; Pawson, 2006). ● A systematic review can be qualitative or quantitative; a quantitative review also is termed a meta-analysis. A qualitative systematic review does not use statistical methods to combine findings, whereas a meta-analysis does. An example of a qualitative sysEvidence-Based Policy Evidence-Based Regulation Evidence-Based Practice Evidence-Based Education Evidence-Based Health Care Nursing Medicine Allied Health Evidence-Based Health Care Nursing Medicine Allied Health FIGURE 1 Relationship of Evidence-Based Regulation to Evidence-Based Health Care As this figure shows, evidence-based regulation, practice, and education fall under the umbrella of evidence-based health care. Volume 1/Issue 1 32 Journal of Nursing Regulation tematic review that regulators might use to support regulations is the one conducted by Issenberg, McGaghie, Petrusa, Gordon, & Scalese (2005) on simulation strategies. ● An integrative review resembles a qualitative systematic review but uses a broader and sometimes less rigorous method to combine results from a body of studies (Krainovich-Miller, 2006). An example of an integrative review that might interest regulators addresses the use of a journal club as a medium to disseminate evidence (Rogers, 2009). ● Meta-analyses are less common. An example of a meta-analysis useful to policy makers is the one conducted by Rice and Stead (2004), which investigates interventions for smoking cessation. Challenges for Evidence-Based Nursing Regulation Many challenges exist for evidence-based nursing regulation. Pawson (2006, p. 87) states, “I argue unambiguously that the hierarchy of evidence descending from biomedical interventions, with RCTs [randomized controlled trials] sitting imperiously atop, has to be abandoned.” Few RCTs exist in nursing regulation, or in nursing generally. Indeed, Sanares-Carreon, Waters, & Heliker (2009) argue that for patient issues, a substantial number of nursing interventions cannot be validated using RCTs, and this applies to nursing regulation as well. The Evans hierarchy (Table 3) may be somewhat helpful, although this issue must be addressed. Similarly, Melnyk & Fineout-Overholt (2005) point out that qualitative and quantitative descriptive studies are especially important for answering questions that RCTs cannot address. Qualitative studies, for example, incorporate the patient’s voice into evidence-based practice. Therefore, researchers are beginning to establish frameworks or systems for ranking qualitative studies in terms of feasibility, appropriateness, meaningfulness, and effectiveness. Hammersley (2005) and Pawson (2006) make strong arguments that traditional evidence-based health care may fail to recognize the fallibility of scientific research. Hammersley further asserts that reliable evidence can derive from sources other than research and that using any evidence requires judgment—regarding not just its validity but also its implications for practice in particular contexts. Publication Gap Cooper, Betts, Trotter, Butler, & Gentry (2009) identify the socalled “publication gap,” which also can pose a challenge for nursing regulation. Nurse regulators often are too busy to write and submit their findings for publication. Researchers commonly do not submit their findings if they obtain negative or inconclusive results, a practice reinforced by some journals’ reluctance to publish them. (Interestingly, positive findings are more likely to be published in English-language journals, whereas negative findings are more likely to appear in other-language journals.) Nurse-Related Barriers Polit & Beck (2004) identify nurse-related barriers. One concern is nurses’ educational preparation in the area of research skills. Negative attitudes toward research also can be barriers for evidencebased regulation; studies have found that the more positive a nurse’s attitude, the more likely the nurse is to use research in practice. Challenges Within the Profession Challenges exist within the nursing profession itself. For example, few initiatives have taken place that encourage the collaboration and interaction of regulators and researchers. Likewise, mentors for evidence-based regulation are lacking. According to Ridenour (2009), a significant regulatory challenge is the difficulty of attaching a dollar value to public protection. Executive directors in BONs serve diverse stakeholders from nursing applicants to legislators, always with the mission of public protection. Compare this with the situation in the business world, where a tangible return on investment or customer loyalty typically can be measured. For regulators, the market is public protection—something that is not easy to measure. In addition, reTABLE 1 Definitions of Evidence-Based Regulation The definitions of evidence-based regulation given below are cited in Ridenour (2009) and adapted from global definitions. 1. The raw ingredient of evidence-based regulation is information. Good policy making depends on high-quality information derived from a variety of sources—expert knowledge, existing domestic and international research, statistics, stakeholder consultation, evaluation of previous policies, new research
Google Sites
Report abuse