Evidence-Based Practice in Continence Care. Assoc Prof Winsome St John RN PhD Research Centre for Clinical Practice Innovation School of Nursing and Midwifery, Griffith University, Gold Coast. Quick review of evidence based practice Debates in evidence based practice
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Assoc Prof Winsome St John RN PhD
Research Centre for Clinical Practice Innovation
School of Nursing and Midwifery, Griffith University, Gold Coast
Actually, we don’t really base all of the things we do on good scientific evidence
Evidence shows that some things we have ‘always done’ can even cause harm.
The conscientious, explicit and judicious use of current best evidence in making the decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. (Sackett et al, 1996, p. 249-254)
The systematic interconnecting of scientifically generated evidence with the tacit knowledge of the expert practitioner to achieve a change in a particular practice for the benefit of a well defined client / patient group. French, 1999, p. 74
Providing care based on research / evidence will enable us to:
NHMRC 2008 Evidence Hierarchy: designations of ‘levels of evidence’ according to type of research question
evidence about the extent to which an activity or intervention is practical.
evidence about the extent to which an activity or intervention is Ethical or culturally apt.
evidence about the personal opinions, experiences, values, thoughts, beliefs or interpretations of clients and their families or significant others.
evidence about the effects of a specific intervention on specific outcomes.
“… a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research” (Cochrane, 2005).
A systematic review
Exercises, Biofeedback & Electrical Stimulation
Bladder retraining & Voiding
Faecal Incontinence & Constipation
Haddow, G., Watts, R., Robertson, J. (2005). The effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth (Technical Report)
The Australian Centre for Rural and Remote Evidence Based Practice. (Completed). Instruments for the Assessment of Faecal Incontinence for Community-dwelling Older Persons. Toowoomba Health Service District, Toowoomba, Queensland, Australia
A systematic review of psychometric evidence and expert opinion regarding the assessment of faecal incontinence in older community-dwelling adults. The University of Queensland/Blue Care Research and Practice Development Centre.
Hodgkinson, B. Hegney, D. Josephs, K. and Leira, E.A (Review in progress). Systematic review of the effect of educational interventions of urinary and faecal incontinence for health care staff/carers/clients on level of knowledge, frequency of incontinence episodes and hours spent on the management of incontinence episodes. The University of Queensland/Blue Care Research and Practice Development Centre.
Multi-Disciplinary, Allied Health, Nursing
Referral guidelines: Female Urinary Incontinence
Usefulness = Relevance X Validity
Work it takes to find out
J of Fam Pract 1994 38, 505-513
Experience of and responses to incontinence, therapy, treatment, advertising, product use, etc.
Processes for providing continence care, purchasing, etc.
Inequities in continence care provision / service provision
Socio-cultural impacts of incontinence, buying patterns, etc.
Issues generating conflicting perspectivesKnowledge that would contribute to improving continence practice:
Different sources are required for different types of evidence
The Database of Abstracts of Reviews of Effectiveness (DARE)
The outcome of refining and applying knowledge better care is for people with incontinence
Sackett DC, Rosenberg WMC, Gray JAM, Haynes RB & Richsrdson WS. (1996) Evidence-based medicine: What it is and What isn’t it. British Journal of Medicine, 312, 71-2.
Popay J, Rogers A, Williams G. (1998). Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res, 8(3), 341-351.
I Evidence obtained from a systematic review of all relevant randomised controlled (RCT) trials
II Evidence obtained from at least one properly designed randomised controlled trial
III.1 Evidence obtained from well-designed controlled trials without randomisation
III.2 Evidence obtained from well-designed cohort or case-control analytic studies preferably from more than one centre or research group
III.3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments
IV Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees