Obtaining research information from publications and an introduction to basic critiquing skills
Having dealt with the basic skills of writing and presenting work for academic assignments, this part is about how to obtain and understand the research based evidence you need to support the factual information you are using in your work.
Professional publications are awash with research studies but the focus and quality of these vary considerably and it is important that you have a basic understanding of what constitutes research and how this should be reported.
This article is not about how to conduct research or in any way a guide to research methodology or analysis, but a reading list is included at the end which should help you explore these areas further.
What constitutes evidence?
As you progress in your course and start to develop your clinical skills, there should be an increasing interface between what you are learning in the academic environment and the relationship of this to midwifery and obstetric care of the woman and her family during pregnancy, birth and afterwards. Over the last 40+ years (Chalmers 1989) there has been an increasing emphasis on the need for clinical care to be underpinned or informed by actions that have been proved to be effective – this is referred to as the ‘evidence base’. Alongside this there has also been recognition that women and their partners should be more involved in their care and increasing efforts have been made to offer choices based on the best available evidence: this is referred to as ‘informed choice’ (DH 1993).
A reliable resource for studies that have been reviewed for their contribution to the evidence base for care is the Cochrane Collaboration (www.cochrane.org). The origins of this began in 1993 following a publication about the need to underpin care with evidence entitled ‘Effective care in pregnancy and childbirth’ (Chalmers et al 1989). This developed into the Cochrane Collaboration which is now an international network of more than 28,000 people from over 100 countries who have the skills to review a wide range of research topics. The aim is to inform health care providers, policy-makers and service users as well as their advocates and carers, about the choices available to them so that they can make informed decisions about health care, based on the best available research evidence. The reviews are constantly being updated and new titles added with over 4,600 so far, published online in the Cochrane Library.
Research forms the core of these activities and a robust system of r eview, comparison and critique has been developed in order to make the most of the research findings. The majority of the research reviewed in this way involves the collection of information that can be counted or described in numerical form. This is referred to as ‘quantitative research’ and includes research that comparesthe outcomes of interventions, treatments and drugs as well as descriptions of the frequency of health related events. Where several studies have been conducted on a similar topic, the effect of the findings can be maximised by undertaking what is called a ‘systematic review’. All the studies relevant to the point of enquiry are identified, the findings of those considered robust enough to qualify are combined and advanced statistical tests applied (metaanalysis), to arrive at an outcome that describes the level of effectiveness for the given intervention or treatment. Where the reviews are undertaken by the Cochrane Collaboration these are presented in what is called the Cochrane Library. There is a section devoted to pregnancy and childbirth and a separate one for neonatal. Information is given about how the review was conducted, this is referred to as an ‘abstract’ of the research, and each review is also summarised in a very readable version called the ‘plain language summary’; these are very helpful until you become more familiar with research papers and how to read them.
Shortly after the formation of the Cochrane Collaboration, a government body was established in England and Wales which aimed to identify what was effective in health care and incorporate this into general health care provision (DH 1999). The National Institute of Health and Clinical Excellence (NICE) was set up to review the evidence available to support the clinical care provided by the NHS and economic resources that would be needed to do this. In terms of pregnancy, birth and afterwards, there are now guidelines in place that cover a range of health aspects which are based on evidence and are subject to regular updating. The evidence is scored according to its reliability, and where such research evidence is missing, guidance is developed based on a consensus view from a panel of experts for what is considered to be the best practice. Therefore these guidance documents are an excellent resource for determining what is considered appropriate evidence in mainstream clinical care.
Alongside the structure of the systematic review, individual research studies continue to be of interest and may be of use in practice but without the ordered approach of the systematic review, it is important that these are assessed individually to establish that they are reliable, accurate and are appropriate to apply to clinical care. For the majority of publications, articles only get published after they have been through a process of peer review. This means that the publication has a team of reviewers who are deemed competent to assess the research and decide whether it is fit for publication. There are criticisms of this process (Wickham 2011) and the publications from MIDIRS (Midwifery Digest, Essentially MIDIRS and Essence) do not submit original papers for peer review because it is considered there is sufficient expertise in-house to assess each submission, and where this is not the case guidance is sought on an individual basis.