Practice-based Research in (allied) healthcare

Practice-based research in (allied) healthcare

Practice-based research in (allied) healthcare

Eveline Wouters Yvonne van Zaalen Janna Bruijning

Translation of the Dutch third, revised edition

bussum 2021

www.coutinho.nl/prhc You can use the online study materials that go with this book. This material consists of, among other things, knowledge clips, interviews, examples of different types of studies and assignments for the assessment of research literature.

© 2012/2021 Uitgeverij Coutinho bv All rights reserved.

No parts of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, storing in an information retrieval system or otherwise, without prior permission from the publisher, unless it is in accordance with the exemptions established in the Copyright Law of 1912. For reprographic reproduction as permitted on the basis of Article 16h of the Copyright Law of 1912, the legally required fee should be paid to Stichting Reprorecht (www.reprorecht.nl). Enquiries concerning the reader regulation should be made to Stichting UvO (publisher’s organisation for educational licenses, www.stichting-uvo.nl). For the use of copyright protected material in newspaper cuttings, contact Stichting PRO (publication and reproduction rights organisation, www.stichting-pro.nl).

First edition (Dutch) 2012 Third, revised edition (Dutch) 2021

Uitgeverij Coutinho PO Box 333 1400 AH Bussum info@coutinho.nl www.coutinho.nl

Cover: Ronald Boiten, Amersfoort Cover image: © Shutterstock Interior layout: az grafisch serviceburo bv, The Hague

Note from the publisher Every effort has been made to trace copyright holders. Persons or organisations wishing to assert specific rights are kindly requested to contact the publisher. The people in the photographs do not appear in the text and bear no relationship to that which is described therein, unless indicated otherwise.

ISBN: 978 90 469 0818 1 NUR: 882

Foreword

The health and social care sector is undergoing a transition whereby there is a growing emphasis on how people function in their everyday lives. Given that allied health sciences are focused specifically on people’s functioning in their daily environment, the importance of this field is growing as a result of this transition. Research can contribute to the further development of this type of care. Just like other medical and nursing caregivers, it is therefore important to properly train allied health science staff in the use of research methods. This book contributes much to that effort. Its authors opt for a practice-based approach: how can research be used to further develop and improve the field of allied health sciences in practice? They demonstrate how research can help answer the questions that caregivers face in their everyday practice. They also offer a thorough description of what research is and how it should be conducted. The book covers both the classical quantitative andqualitative researchmethods andother forms of research, suchas participatory action research and design-based research. More and more often, patients’ complex healthcare issues call for a multidisciplinary approach. This book helps base that approach on a solid foundation of multidisciplinary research. The book has been written for people who only want to read about research, for those who want to conduct research themselves and for those who want to distribute and implement the results of research. It contains valuable and useful information for each of these demographics. The book is as practical as it is thorough: it contains myriad concrete tips and guidelines on how to conduct research. Throughout one’s entire study and long after, this book will serve as a source of suggestions and ideas on how to critically assess, set up or distribute research and research results. Lastly, it is an inspirational book to page through. In other words, this book has many different ambitions. After reading it, I was pleasantly surprised to find that it realises each of these ambitions to the fullest. It will make a valuable contribution to practice-based research in the field of allied health sciences and therefore to the manner in which people function in their daily environment. Prof Dr Joost Dekker Professor of Allied Health Care, Amsterdam University Medical Centres

Preface

Our goal for this book is to offer students in the field of healthcare a guideline that will help them to enthusiastically take part in research and continue to develop their research skills throughout their entire lives. Although we continue to focus largely on students of allied health sciences, this book (i.e. the third revised edition in Dutch) has been expanded with examples and designs from a broader field of care. In addition to the known quantitative and qualitative research designs, we have added two new chapters written by specialists that focus on participatory action research (Chapter 8) and design research (Chapter 9). Chapter 8 was written by Mieke Cardol, Marieke Groot and Karin Neijenhuis (Rotterdam University of Applied Sciences), while Chapter 9 was written by Job van ’t Veer (NHL Stenden University of Applied Sciences). The other chapters of this book have also been extensively revised and expanded where necessary. More so than with previous editions, we hope to serve the field with research that contributes to substantiated innovation and improvement. Eindhoven/Utrecht, spring 2021 Eveline Wouters, Yvonne van Zaalen and Janna Bruijning

Table of Contents

Introduction

15

Part I

Introduction to practice-based research

17

1

Research competence for a professional context

19 20 24 25 29 30 31 33 36 40

1.1 1.2 1.3 1.4 1.5

The research spectrum

Embedding practice-based research in higher vocational education What can you learn from practice-based research? Evidence-based practice in the healthcare sector 1.5.1 Step 1: Translating a (clinical) problem into an answerable question 1.5.2 Step 2: Efficiently searching for the best evidence 1.5.3 Step 3: Evaluating the relevance, quality and applicability of the evidence you found 1.5.4 Step 4: Applying the results in practice 1.5.5 Step 5: Regularly evaluating the process and the results Evidence-based practice, practice-based evidence and practice-based research The five steps of evidence-based practice

42

1.6

43 44

1.7

Summary

2

The ethics of research in (allied) healthcare

45 46 47 47 49 50 53 55

2.1 2.2

Historical background Ethical assessment of research

2.2.1 Medical Research Involving Human Subjects Act

2.2.2 Non-WMO-governed research

2.2.3 Additional laws and regulations governing research

2.2.4 Codes of conduct Reaching out to participants

2.3 2.4

The secure collection and storage of research data and personal data

61

2.5 2.6 2.7 2.8 2.9

Fraud and plagiarism

64 66 69 71 74 76 77 80 80 81 81 81 86 87 92 92 95 96 97

Intellectual property, publication rights and confidentiality

Publishing research

Assessment criteria for the ethical aspects of research

Back to the case

2.10 Summary

3

Critically reading research literature

3.1

General quality criteria

3.1.1 Research question and justification of the research design 3.1.2 Analysing strengths and weaknesses

3.1.3 Applicability

3.2 3.3

Quantitative descriptive research

Quantitative intervention research and the randomised controlled trial (RCT)

3.3.1 Quality criteria

3.3.2 Interpretation of the results Quantitative observational research 3.4.2 Case-control study 3.4.3 Quality criteria Diagnostic research 3.5.1 Quality criteria Qualitative research 3.6.1 Quality criteria 3.4.4 Interpretation of the results 3.5.2 Interpretation of the results 3.6.2 Interpretation of the results

3.4

3.4.1 Cohort study (prospective and retrospective)

100 101 101 104 106 109 111 112 113 113 115 116

3.5

3.6

3.7 3.8

Design research Systematic review

3.8.1 Quality criteria

3.8.2 Interpretation of the results

3.9

Summary

Part II The preparation

117

4

From preliminary investigation to research question

119

4.1

What research question do you want to dedicate (part of ) your life to?

120 121 122 123 124

4.2

The contents of a research project plan

4.2.1 The title

4.2.2 The introduction Identifying a practical problem

4.3 4.4

Clarifying the problem definition via a preliminary investigation Searching for relevant literature for your preliminary investigation

125

4.5

127 127 129 133 136 143 144 145 145 146 147 149 151 154 154 155 155

4.5.1 Where will you look?

4.5.2 How to look?

4.6

Formulating the research question 4.6.1 PICO, PICOT and DDO strategy 4.6.2 Main question and subquestions

4.7

Summary

5

The right research method (design)

5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9

Method of the research project plan Representing the method in your project plan

Choosing a research design Participants and test subjects

Data collection: (measuring) instruments and procedures

Data analysis

Time frame and budgeted costs Bibliography and appendices

Summary

Part III Conducting your own research

157

6

Quantitative research

159 160 162 163 165 167 168 169 170 170 172 174 176 176 180 181 181 182 183 184 184 185 185 187 187 189 192 193 195 197

6.1 6.2

When and why do you conduct quantitative research?

Methods/approach

6.2.1 Observation schedule

6.2.2 Survey

6.2.3 (Physical) measurements 6.2.4 Developing a measurement protocol

6.3 6.4

Collecting data Processing data

6.4.1 Determining reliability 6.4.2 Data analysis and statistics 6.4.3 From test to interpretation 6.4.4 Data analysis software

6.5 6.6

Presentation and justification of your findings

Summary

7

Qualitative research

7.1 7.2 7.3 7.4

When and why do you conduct qualitative research?

Qualitative research: interviews Qualitative research: focus groups

Other forms of qualitative research and combinations of methods

7.5

Conducting qualitative research

7.5.1 Further development of the method 7.5.2 Further preparation of the interviews

7.5.3 Practising interviews 7.5.4 Collecting data 7.5.5 Processing data

7.5.6 Reading through the transcripts 7.5.7 Analysing and coding data

7.6 7.7

Presentation of the results 

Summary

8

Participatory action research

199

8.1

What is participatory action research?

199 200 201 202 202 202 204 206 206 207 207 209 210

8.1.1 Developing PAR

8.1.2 The unique position of PAR

8.2

Conducting PAR

8.2.1 Research questions 8.2.2 Phases of research

8.2.3 Diversity in research methods

8.2.4 Quality

8.3

Equality and shared ownership 8.3.1 Researchers 8.3.2 Practical partners

8.3.3 Students Sharing results Ethical dilemmas

8.4 8.5

212 8.5.1 Differences in power or hierarchy in the collaboration 213 8.5.2 The blurring of the lines between researcher and co-researcher 214 8.5.3 Whose are the results and who decides what counts as a result? 215 8.5.4 Resources 216 8.6 Summary 217 221 9.1.1 An open and creative perspective of the problem situation 221 9.1.2 Don’t do anything for us without us 221 9.1.3 Doing is the new thinking 222 9.1.4 Paying attention to the broader (healthcare) context 223 9.1.5 Validation 224 9.2 The phases of design-based research 224 9.2.1 Discover 225 9.2.2 Define 227 9.2.3 Develop 229 9.2.4 Deliver 231 9.3 Performing design research 234 9.3.1 Preparation 234 9.3.2 Performance 235 9.4 Reporting on design-based research 236 9.5 Summary 239 Design research 219 9.1 The specific mindsets of the design researcher

9

10

Literature review

241

10.1 When and why do you conduct a literature review?

242 244

10.2 Development of the method

10.2.1 Where to look? 245 10.2.2 How to develop a good and efficient search strategy? 245 10.2.3 What does the selection process look like? 246 10.2.4 Appraising the quality of studies 248 10.2.5 Data extraction 248 10.2.6 Data synthesis and interpretation 249 10.3 Presentation and justification of your findings 252 10.4 Summary 257

Part IV The presentation

259

11

Impact on society

261 262 264 265 266 267 269 277 280 281 281 282 283

11.1 Impact of the research results

11.2 Network analysis 11.3 A suitable title  11.4 Written presentation

11.4.1 How to write a policy document? 11.4.2 How to write an article or project report?

11.4.3 Scientific writing style

11.5 Verbal presentation

11.5.1 Connection to the audience

11.5.2 Contents and structure of the presentation 11.5.3 The actual presentation: presentation techniques

11.6 Summary

Tips for correctly referring to sources

285

References

293

Index

301

About the authors

313

Inleiding

Introduction

Although many students do not go on to become researchers after graduating, they will face issues in their daily professional practice that will require answers in the short or long term. Finding these answers calls for research. This research contributes to the development of the professional practice. However, research skills cannot simply be acquired by completing a “Research methods” module during your studies; they must be developed. All development takes time. Practice-based research in (allied) healthcare serves as a guideline throughout your entire study. As a student, this book will gradually introduce you to the building blocks you need to conduct your own research. It will also teach you to appreciate and critically assess existing research. This ensures that research becomes a part of your daily practice and of your studies and it paves the way for future improvements to the field of practice. It deepens and adds nuance to the choices you make in practice. Asking questions, being critical and utilising evidence-based methods together with people from other fields of expertise. This also means knowledge of more and different research designs. All chapters follow the student over the course of their journey through the world of research: from a passive and critical reader to an active performer of research and a translator of research results into practice. Part IV of this book is specially dedicated to this so-called impact. This completes the circle: on the one hand, the research is inspired by practical needs; on the other hand, guidelines are offered to ensure the field of practice benefits optimally from the results of the research. We have tailored the structure of the book accordingly to ensure it serves as both a student’s journey and a true innovation cycle. The structure of this book This book intends to guide you as a student in the field of healthcare from the start of your studies to your eventual role as a practitioner with well-developed research skills and the means to change their care practice for the better. The book is divided into four parts. In part I, we cover the “why” of research in (allied) healthcare and the value of evidence-based practice (Chapter 1), the ethics of research (Chapter 2) and the ability to critically read research literature (Chapter 3). In part II, we explore the process of preparing your own

15

Practice-based research in (allied) healthcare

research: how to translate a practical problem into a good research question (Chapter 4) and how to write a project plan (Chapter 5). In part III, we then delve deeper into how students conduct research: we take a step-by-step look at the practical issues youmay encounter, up to and including analysing and presenting the results. Chapter 6 covers quantitative designs, Chapter 7 is about qualitative research, Chapter 8 is about participatory action research, Chapter 9 covers design research and Chapter 10 covers literature reviews. In every chapter of part III, we consider what a student needs to conduct their own practical research; where relevant, we refer to in-depth literature. Finally, Chapter 11 (part IV) focuses on the practical impact of research: what does impact mean and what presentation forms and methods are there that contribute to the impact of research? Online study materials You can find the online study materials that go with this book at www.coutinho.nl/prhc . This material consists of, among other things, knowledge clips, interviews, examples of different types of studies and assignments for the assessment of research literature.

16

Part I Introduction to practice-based research

  1

Research competence for a professional context

Children from socioeconomically disadvantaged neighbourhoods often too fat Whereas barely two percent of ten-year-olds are overweight in one area of Amsterdam, nearly forty percent of ten-year-old children are obese less than a kilometre away. “This fattening environment is not good for anyone, but it is especially harmful to poor and poorly educated people.” (…) Both areas are residential neighbourhoods that border a park. There are a few schools, two supermarkets and some retail stores. Overtoomse Veld is home to five snack bars while Willemspark has four, but Willemspark has more small restaurants. This means the massive differences in weight cannot be attributed solely to structure and availability. (…) Source: Versprille & Brester (2017) When you open a paper or turn on the TV, you are often confronted with a problem that pertains to your own professional practice. Such problems should raise some questions in you. When considering the problem of obesity in poor neighbourhoods that are home to many poorly educated people, you could e.g. ask yourself: “Why is it that there are far more obese children in neighbour hoods in Amsterdam with many poor and poorly educated residents than in neighbourhoods with many rich and highly educated residents?” Practice-based research allows you to specifically examine problems from practice (practical problems) and come up with relevant solutions to the problems in question. Doing so requires an investigative and reflective attitude . By looking at the world around you with an open and critical look, identifying areas of improvement, asking questions, wanting to know and understand more, looking for explanations and answers, questioning the obvious, wanting to contribute to improvement and innovation, and sharing knowledge and ideas, you can achieve lifelong personal and professional development and contribute to the innovation in your field. Vice versa, conducting practice-based research can contribute to the development of an investigative attitude.

19

1 Research competence for a professional context

1.1

The research spectrum Before taking a closer look at how to conduct practice-based research , we first want to take a moment to consider the characteristics of practice-based research compared to more theory-based forms of research (also known as fundamental research, see Table 1.1). The basic principles of theory- and practice-based research are the same. When conducting either type of research, you are expected tomeet the scientific criteria and you choose what researchmethods and techniques to use depending onwhat is customary in the specific field of research you operate in. Furthermore, both types of research are designed to generate knowledge that is transferable to other contexts than those that were initially studied. However, there are several specific characteristics that are particularly applicable to practice-based research. The Validatiecommissie Kwaliteitszorg Onderzoek (Validation Committee for Research Quality Assurance) (2009) writes the following: Practice-based research is defined as research that is rooted in the professional practice and contributes to the improvement of and innovation in said professional practice. This is done by generating knowledge and insights, but also by delivering applicable products and designs and concrete solutions to practical problems. Furthermore, this research is generally multi-, inter- and/or transdisciplinary in nature and embedded in myriad internal and external organisational ties, with retention of the scientific reliability and validity of the research itself. The research is closely connected to the field of education via its contribution to educational activities, the professionalisation of lecturers and innovation of the curriculum. In light of the relevance of the research to, and impact on, the professional practice, education and society as whole, the resulting knowledge is disseminated via myriad channels and to various target groups. Although it is difficult to clearly distinguish between theory-based and practice based research, the two do have a different focus. Practice-based research can be described as research for which the research question is derived from professional practice (at the very least, it is important that practical issues from the professional field are recognised or acknowledged and that the researchers work together with people from the field of practice to answer the research question) and the results can contribute directly to that professional practice (e.g. in the formof new knowledge, insights, guidelines, protocols, interventions, measuring instruments and practically useful, creative and innovative solutions (Forum, 2011)). From the onset, the researcher and the representatives from the field of practice share responsibility for the research process and the results of the research to ensure that not only scientific knowledge but also the knowledge,

20

1.1 The research spectrum

experience and expertise of practical professionals and other stakeholders can be combined. Furthermore, this ensures the results of the research can be utilised in practice more easily and faster (Wetenschappelijke Raad voor het Regeringsbeleid, 2013). Practice-based research often involves transdisciplinary and inter professional collaboration . This means that professionals and other stake holders with various backgrounds work together on a joint solution (direction). For example, practice-based research conducted in the field of healthcare and wellbeing often involves collaboration between various healthcare and wellbeing professionals, researchers, lecturers, producers of medical aids, suppliers, professional associations, civilians, patients and sometimes even the parents or family members and informal carers of patients. Those who will ultimately benefit from the research results are included in the research process and play a clear role in it; i.e. it concerns research conducted as part of a network for and with other relevant stakeholders. The research is certainly not centred solely around the development of new knowledge, but also on the development of new products or services throughout the entire practical chain. These aspects are often less prevalent in theory-based research , where there is a greater focus on the development of new theories (scientific modelling).

Table 1.1 Spectrum of characteristics of theory-based and practice-based research

Theory-based research

Practice-based research

Methodologically thorough

Practically relevant

Focus in consideration

Centred around knowing/ theory, transferability and new knowledge (modelling)

Centred around applications and improvements for the practical context (short-cycle, practically useful products and methods)

Orientation

Valid, transparent, plausible

Useful, participatory, innovative

Quality requirements

Research and analyse

Advise and intervene

Methodologies

National (or global)

Regional (or specific context)

Scope

Scientific journals and presentations at conventions

Continuous impact on research, education and practice/society via different forms and products Researchers, lecturers, practical professionals, civilians, patients/patient associations, policymakers, businesses, etc. (in cocreation) University of applied sciences (and, to a growing extent, vocational education institutions)

Knowledge sharing and impact

Researchers, knowledge partners

Stakeholders

University and research institute

Knowledge institution

21

1 Research competence for a professional context

Examples of theory-based and practice-based research Theory-based research can involve, for example, a study of the development of immunity to COVID-19 and the role that antibodies (as a response to infection) play in this process. Defence against corona quickly disappears from the blood (…) Antibodies against the new coronavirus will disappear from the blood after a few months. This raises questions about the feasibility of herd immunity and the effectiveness of vaccines. The body’s defence against the new coronavirus wears down quickly. The antibodies that people produce when they are infected with the SARS-CoV-2 virus can disappear from their blood in just a few months’ time, which may make these patients vulnerable to infection with COVID-19 all over again. That is the result of a British study conducted among 65 COVID-19 patients in the Guy’s and St Thomas’ Hospital in London. The manuscript in which the results are described appeared online this past weekend, although it has not yet been published in a scientific journal. This marks the first time that the development of immunity in COVID-19 patients has been studied over a longer period of time. (…) Source: Voormolen (2020) Blended physiotherapy for physical recovery of patients with COVID‑19 COVID-19 has a significant impact on the patients it affects, who may experience a major loss of muscle strength and physical condition. A research group from Utrecht University of Applied Sciences is developing blended physiotherapy to assist these patients with their physical recovery. With blended physiotherapy, some of the care is offered remotely with the help of eHealth. “A significant percentage of patients recovering from COVID-19 has care needs for which a physiotherapist is the go-to caregiver. (…) We are looking for ways to help this group of people return to their former level of physical strength and condition as quickly and effectively as possible. What are their care needs and how can physiotherapists offer the necessary care in their practices, in the patients’ homes and remotely? (…) We are collaborating with physiotherapists, patients and eHealth providers to ensure a proper coordination between the needs of users and the technical possibilities of developers.” (…) Source: Utrecht University of Applied Sciences (2020) Practice-based research can centre around, for example, how healthcare professionals can provide care to these people – both at home and remotely – in a socially distant society.

22

1.1 The research spectrum

The divide between the different types of research and their characteristics is thin, however. For example, it is not true that practice-based research is the exclusive domain of higher education, that it cannot have a national (or even international) focus, that it cannot result in new theories or that themethodology used is weaker. Likewise, it would be false to assume that universities never consider the practical implications of their research. There is a large degree of overlap between both types of research. It goes without saying that there is also a wide variety of goals and approaches within the field of practice-based research. Some research questions pertain to the direct professional practice (substantive questions), while other questions focus more on, for example, the professionalisation of the job (work-related questions). ■ What exercise therapy is most effective for stabilising the muscles in the shoulder girdle? ■ What test offers a complete overview of the communicative abilities of a stroke patient? ■ What lifestyle advice is important for (parents of) toddlers with a high risk of myopia (near-sightedness)? ■ How do pregnant women feel about monitoring their baby’s health via at-home CTG (cardiotocography)? ■ What factors play a role in the decision to admit people suffering from dementia in a care home? Examples of substantive questions

■ What knowledge do parents possess of dental care for infants?

■ How can the design of a wearable instrument (e.g. a wrist band that uses sensors to gather personal data) be improved?

Examples of work-related questions

■ To what extent has the use of the International Classification of Functioning, Disability and Health (ICF) affected professional conduct in the field of podiatry? ■ Does using digital read-out technology reduce the costs of manufacturing a lower-leg prosthesis? ■ To what extent do healthcare professionals apply the principles of evidence-based practice (EBP) in their everyday conduct? ■ What is needed to implement the use of eHealth for heart failure in home care practice? ■ What factors affect an obstetrician’s decision to perform an episiotomy during a birth? ■ How can the learning curve for the successful administration of an IV be improved?

23

1 Research competence for a professional context

The angle and approach of practice-based research depends greatly on the research question (see Chapter 4). Furthermore, the “products” that the research is to result in are partly determined by the nature of the professional practice (Losse, 2018). After all, specific professional fields naturally have a greater or lesser focus on certain products and services: analysis (e.g. laboratory staff ), giving advice (e.g. communication consultants), creating a design (e.g. engineers), manufacturing a product (e.g. dental prosthetists) and/or performing actions (e.g. nurses). Embedding practice-based research in higher vocational education Since 1986, universities of applied sciences are legally obligated to conduct practice based research. In 1999, universities of applied sciences gave substance to their research task by establishing chairs and knowledge groups in which lecturers and researchers (often in the form of lecturer-researchers) conducted practice-based research. These days, practice-based research is strongly embedded and greatly professionalised in higher education institutions. Practice-based research by chairs receives broad appreciation and projects are often born out of a varied and active network that includes educational institutions and many other stakeholders from the professional practice. In order to tie in well with the field’s practical needs, practice-based research often has a short lead time. With their practice-based research, chairs give an important impulse of innovation to that professional practice and to the field of education. This is clearly illustrated in Figure 1.1, in which these three components come together to form a triangle that leads to innovation and practical improvements.

1.2

Education

Innovation and practical improvements

Research

(Professional) practice

The triangle of education, research and (professional) practice leads to innovation and practical improvements

Figure 1.1

24

1.3 What can you learn from practice-based research?

Following the successful introduction of chairs at universities of applied sciences, vocational education institutions also have a growing need to develop and share knowledge pertaining to their own professional practice. Since 2012, the first practorates have been established to strengthen the interaction between vocational education and (professional and educational) innovation. The contents and approach of the practorates differ, although they share their focus on sharing knowledge and conducting practical research (Platform Talent voor Technologie, n.d.). The MBO Raad (Dutch council for vocational education and training, n.d.) views conducting research as a means to better assess the consequences of one’s own actions and (consequently) improve the quality and professionalismof lecturers as reflective practitioners and offer students up-to date vocational education. At the moment, work is being done to develop a research culture, strengthen research networks (e.g. through collaboration with chairs in higher vocational education) and gather data, with the freedom to utilise different types of research and innovative forms of knowledge development that are best suited to vocational education. Students are being involved more and more in the activities of practorates. What can you learn from practice-based research? In 2009, the Netherlands Association of Universities of Applied Sciences (Vereniging Hogescholen, then HBO-raad) published a memorandum entitled Kwaliteit als opdracht , in which it was stated that all undergraduate students must acquire research competence for a professional context : “In our modern society, it is crucial that higher education undergraduate students possess research competence for a professional context that leads to reflection, evidence based practice and innovation.” This contributes to the better performance of the professions for which they are trained. According to Andriessen (2016), research competence for a professional context consists of three components: ■ Working from an inquiry stance. Students are curious, thoughtful and critical and they are willing to share information. They must be able to reflect on their own actions in their professional practice, identify areas of improvement, attempt to explain their observations using their foundation of knowledge and find starting points fromwhich to improve their approach. The keyword here is “reflection”. ■ Being able to apply the research results of other studies. Students can find their way around relevant scientific and professional literature pertaining to their field, assess its worth and utilise it. This is a prerequisite in order to operate in accordance with the principles of evidence-based practice. ■ Being able to conduct research (activities). This does not necessarily have to result in generalisable new knowledge that is applicable in and transferable

1.3

25

1 Research competence for a professional context

to other contexts. When students conduct research, their data collection and analysis activities must meet the same quality requirements that apply to the professional field. This allows students to contribute to the development of new procedures and products that innovate their professional practice. An environment in which practice-based research is conducted contributes to a culture in which reflection and (attention for) research competence for a professional context can develop more effectively. Furthermore, (higher education) undergraduate and master’s students often participate in research projects that are conducted by chairs. Expanding, deepening and sharing knowledge By taking part in practice-based research, you not only acquire research competence for a professional context but will also achieve other goals that benefit your personal development. Studying a topic gives you more knowledge about that topic ( deepening knowledge ). In the process of conducting practice based research, you will also be confronted with aspects related to the topic at hand that you may not have been aware of before ( expanding knowledge ). The process of deepening and expanding your knowledge occurs primarily at the start of your research. During the execution of a research project, you also improve your professional skills , such as your personal conversation skills, ethical conduct or practical diagnostic or therapeutic skills through your interaction with the test subjects. Lastly, you will learn to share the knowledge you develop with other professionals during and after the completion of your research ( sharing knowledge ). To illustrate this, we will present several examples of goals that are achieved as a result of (participating in) practice-based research. The following example illustrates that deepening knowledge is important in order to become a true expert and facilitate your further professional development. Deepening knowledge While coming up with your research topic, you can further clarify your research question by exploring the existing theory on the subject. As part of your research, you strive to fill in the blanks in the existing knowledge. To do so, you read extensively about the topic at hand. You will gradually learn far more about this topic than what you learned thus far in your studies. Furthermore, you discover that you want to learn even more about this topic after your studies; you want to become a true expert!

26

1.3 What can you learn from practice-based research?

While working on an (interprofessional) research or innovation project, you may also discover how expanding your knowledge can lead to the better execution of your own professional practice. Expanding knowledge While working on their final thesis project, students of the Dental Hygiene, Dental Prosthetics and Speech-Language Therapy programmes work together to answer questions from healthcare professionals in care homes about the care for and advice to residents who are experiencing difficulties with eating and dental hygiene. By combining their various professional perspectives to answer these questions, the students also learn how they can benefit from each other’s expertise and when they should collaborate with other fields in the performance of their own profession. The following example illustrates how you will not only improve your research competence for a professional context while working on a research project, but also your professional skills. Developing multiple skills Podiatry student Tijmen finds it difficult to assess the pronation of a patient’s feet during walking. To his relief, this topic was not covered in his exam. During his final thesis project, however, his fellow students and he are tasked with assessing the pronation of the feet of all test subjects. He is very worried about this while preparing for the project. He decides to talk to his client about it. They explain to him that a high degree of inter-observer reliability (see Section 3.5.2) is very important for the project. This means there will be plenty of time to practise how to assess the pronation of a patient’s feet and coordinate the assessments of the different student-researchers. By the end of the project, Tijmen has not only further developed his research skills but also improved his ability to assess the pronation of a patient’s foot.

The following example illustrates how you not only develop specific professional skills while working on a research project, but also learn to apply the theory.

27

1 Research competence for a professional context

Theory and practice in one Four Speech-Language Therapy students decide to gather normative data on the language development in infants and toddlers as part of their final thesis project. The client, a producer of test materials, wants the students to conduct a test using a predetermined protocol. Prior to the start of the project, the students take a course to learn how to conduct the test, assign a score and interpret the results. Before the students actually begin gathering the test data, they practise a few times. Halfway through the project, they meet with their supervisor for an interim evaluation. The students explain how they are getting better and better at predicting how children of a certain age will react to the test items. The stages of language development that they have thus far learned about in their textbooks are becoming reality through their work with young children. The students find that their experience helps them to recognise children with disadvantages or developmental problems more easily. A little bit different every time By the end of their project, a group of physiotherapy students reports the following: “We learned what a shoulder looks like from a book. During our project, we found that ‘the ideal shoulder’ looks a little bit different every time.” The following example illustrates how you may sometimes learn more about a certain topic than your lecturer while conducting your own research – and especially while working on your final thesis project. In this manner, you can help keep the education up-to-date and contribute to the innovation in your professional practice. By sharing knowledge, you expand your own and each other’s expertise. Sharing knowledge Although Yasmine and Irene felt nervous about presenting their final thesis project about the experiences of patients during an oedema treatment, they loved seeing how much the invited practice professionals appreciated the recommendations they developed over the course of their research. While answering the questions, they found that they had mastered the subject matter and actually knew more than their lecturer about certain topics. They felt very proud when their lecturer told them she would incorporate their findings in her lectures. Lastly, they learned a lot from watching the presentations given by their fellow students. Practical research sometimes allows you to adjust the views on what is normal that you developed during your studies.

28

1.4 Evidence-based practice in the healthcare sector

When you embark on your professional career, you bring the competences that you develop while conducting practice-based research with you. In your future work as a healthcare professional, you will have to study research results and implement them in your own activities, critically assess your own actions and evaluate the care you provide via practical research. You may also take part in studies conducted by other researchers or decide you want to learn more about research in order to set up your own practice-based research project. These things all contribute to your lifelong learning and your ongoing personal and professional development. This is an important hallmark of a good professional. Evidence-based practice in the healthcare sector Taking part in (practice-based) research contributes to the development of your research competence for a professional context, which in turn helps you perform your job well. Furthermore, practice-based research is necessary for the improvement of the quality of care and the innovation of the professional practice. However, it is not only important for you to learn and experience what practice-based research entails; you must also learn how to integrate the relevant findings from your research into your daily professional practice. That is what the term “ evidence-based practice ” ( EBP ) is all about. There are many different definitions of EBP. In line with Offringa, Verhoef and Munten (2016, p. 21) we use the following description: Evidence-based practice is the careful, explicit and judicious use of the current best evidence in order to make decisions with individual clients (and/or their relatives) about the necessary or desired care or treatment. The practice of evidence-based practice implies the integration of the practitioner’s individual knowledge and experience and the client’s individual values and knowledge-based experience with the best evidence. When you consider this definition, you will see that there are three aspects involved in making a decision, whereby the context in which the decision making process occurs must always be taken into consideration. The three elements of EBP are: ■ evidence: the (current) best available evidence ( evidence is not the same as proof ; only when evidence is so strong that there can hardly be any doubt regarding its correctness can it really be compared to proof (Offringa, Assendelft & Scholten, 2008)); ■ the value(s) and preferences of the individual patient or client (and/or their relatives); ■ the care professional’s knowledge and experience (clinical expertise).

1.4

29

1 Research competence for a professional context

Best available evidence

Context

EBP (Shared decision making)

Healthcare professional’s knowledge and experience

Patient’s value(s) and preferences

The three elements of evidence-based practice (EBP)

Figure 1.2

Using the principles of EBP means using the best available evidence to base the decisions on that you make in your professional conduct with (individual) clients. Equally as important are the manner in which this is integrated with your own clinical expertise as a care professional and the personal wishes of the patient or other stakeholders. Together, these elements determine the decisions that are made regarding the nature of the care, taking into account the specific context (see Figure 1.2). The five steps of evidence-based practice The EBP methodology consists of the (systematic) application of five steps. 1 translating a (clinical) problem into an answerable question (ask); 2 efficiently searching for the best evidence (acquire); 3 evaluating the relevance, quality and applicability of the evidence you found (appraise); 4 applying the result in practice (shared decision-making based on the three elements from Figure 1.2) (apply); 5 regularly monitoring and analysing the process and the results (assess). These steps are taken one after the other over and over again, which is why they are often depicted in a circle shape (see Figure 1.3). When you utilise EBP, you are constantly reflecting on the choices you make and the actions you take, which results in lifelong learning. By sharing this process with colleagues, you not only contribute to keeping your own knowledge and skills up-to-date, but also help improve your professional practice.

1.5

30

1.5 The five steps of evidence-based practice

(Frequent) evaluation

Formulation of question

Practical application (shared decision making based on three elements)

Development of search strategy

Evaluation of evidence

The cycle of evidence-based practice

Figure 1.3

The individual steps of EBP are covered in greater detail next.

1.5.1

Step 1: Translating a (clinical) problem into an answerable question

To find an answer to a practical problem, you must first clarify the (clinical) problem and then translate it into an answerable question . Such a question may concern various parts of a care programme, e.g. the experience of patients during a connective tissue treatment, diagnostic tests to diagnose periodontal disease (inflammation of the gums) or the effectiveness of lifestyle recommendations to treat the symptoms of dry eyes. The questions can be general in nature, for example: “What physiotherapeutic interventions are possible for people with arthrosis of the knee?” However, they can also concern the care for or treatment of an individual patient. These questions are oftenmore specific in nature and have more context. That means there are often more dilemmas to consider when answering the question. Finding the answer to such a question therefore contributes significantly to improving the care in practice.

31

1 Research competence for a professional context

Clear solution for Simon In late August, two weeks before her due date, my pregnant colleague’s water broke. She had some doubts about the clarity of the amniotic fluid. This was her first pregnancy, so she had no experience with this. To top it off, it was the middle of the night. What to do now? Just to be safe, she decided to call the obstetrician’s emergency number. When she described what her amniotic fluid looked like, the obstetrician had her own doubts and wanted to come over. My colleague had a far better idea: she took a picture of her amniotic fluid and sent it to the obstetrician via WhatsApp. (…) After a little while, it became clear that my colleague’s amniotic fluid was clear and there was no foetal distress to worry about. My colleague was able to give birth to Simon in the comfort of her own home. The moral of the story: we do not yet make enough use in the care sector of the available solutions that have become commonplace in our private lives. It’s all about your mindset! Source: Wouters (2013) In “Clear solution for Simon”, an everyday solution is found for the obstetrician’s time-consuming activity (clinical problem). You may wonder whether the quality of a picture taken with a smartphone is good enough to accurately assess the situation. If it is not possible to properly assess the clarity of amniotic fluid in this manner, this may result in a wrong decision. That, in turn, may lead to unnecessary stress and to an unsafe situation during the home delivery. In order to make a well-informed decision in a similar situation in the future, you will look for “evidence” as part of the EBP cycle. It is important to first think carefully about what your aim is and consider what specific question you want to answer in this case (delineating your research question ). A more general aim might be to provide insight into the available diagnostics regarding this issue. A possible question would be: “What diagnostic tests are available to assess the clarity of amniotic fluid during a home delivery?” A more specific aim might be to find an answer for the case that inspired the question in the first place. In that case, you might ask the following question: “To what extent do images of amniotic fluid made with and sent via a smartphone provide the obstetrician with enough information to make a reliable and correct indication regarding whether or not to take action?” It is important to include all relevant elements that factor into answering the question in the question itself. Section 4.6 offers a detailed description of the approach and tools that can help you come up with a clearly delineated question.

32

Made with FlippingBook - Online catalogs