They couldhave used a more appropriate comparison for example 2 countries with similar demographicswhich have similar guidelines, population and health care systems could havebeen compared instead of two countries that are so different. (Office for National Statistics, 2016). Prevalencereported in national surveys often vary by country, levels and patterns ofdrinking. According to (Social Care Information Centre, 2012) In the UK 40% of womenreport any use throughout the pregnancy. 22% drank in the last week and 9%drank more than 2 units on the heaviest drinking. A comparison is made with theUSA where 1.
4% report binge drinking 7.6% of women report use. (Morbidity andMortality Weekly Report, 2012).
Althoughit is good that comparisons to different countries have been made the culturetowards drinking whilst pregnant may be vastly different due to differentreligious beliefs also the amount of people they asked was not specified in thearticle so they could vary massively. Women may not give an honest answer whenasked if they are drinking these factors combined could make the statistics inaccuratealthough the researcher did mention this factor within the article so this hasbeen taken into consideration. The articlecontinues to mention that despite the recommendations made by different sourcesa substantial number of women continue to consume some alcohol duringpregnancy. The researcher fails to quantify what “some” is regarding that statement.Theintroduction also goes on to discuss that the National Institute of Health andClinical Excellence (NICE) have guidelines that state that women are advisednot to drink alcohol around conception and the first 3 months of pregnancy, andto avoid intoxication or binge drinking which is defined as more than 5standard drinks around 7.5 units of alcohol during pregnancy (NICE, 2010). This is a differentguideline to the DH one and this may lead to not only pregnant women becomingconfused it may lead to healthcare practitioners to be confused as there is 2reliable sources giving different information on how many units of alcohol aresafe to use during pregnancy. NICE, 2010 doesnot clarify what constitutes as a “standard” drink which can also be confusing.
The articlealso acknowledges that alcohol consumption patterns and drinking cultures areaffected by, political, economic and social factors such as the laws governingthe sale for example in the UK it is against the law to purchase alcohol if youare under 18 however the article fails to mention that alcohol could be obtainedby people under age illegally so it cannot always be a certain that peopleunder 18 cannot obtain and drink alcohol (GOV.UK)the article acknowledgesthat quantities of alcohol can be difficult for a person to measure due to varyingglass sizes and different units for different types/strengths of alcoholicbeverages, a lack of knowledge on units may also contribute to inaccurate statisticsand information. (White et al.,2003,2005). The introduction also goes on to state the UKDepartment of Health (DH) recommend that women should avoid drinking alcohol duringpregnancy but for those choosing to drink limit their consumption to 1-2 units onceor twice per week. it is not made clear weather once a week is okay or twice aweek it only gives a vague indication which can be confusing for expectantmothers. It is unknown if drinking 1-2 units twice a week will affect the foetusand cause issues like foetal alcohol syndrome which can cause many issues witha child’s development in the future (Abel,E.
L). Theintroduction of article 1 shows guidelines of recommended drinking during pregnancyin different countries it states that most countries have modified their recommendationsin line with abstinence during pregnancy (Internationalcentre for alcohol policies 2009) this information comes from A reliablesource but it does not state what the modifications are or if they are enforcedin law or just guidelines that a woman may choose to follow. The abstract shown indications that drinkingpre-conception and/or during the first trimester was more likely if the womenwere multiparous and of white ethnicity but it did not show how it came to thatconclusion. The abstract also indicates that researchers gained consent fromthe participants in the study it stated in the conclusion that pregnant womenattending their first antenatal appointment were willing to complete brief alcoholscreening questionnaires. Overall theabstract of article 1 was difficult to understand in some areas as they did notspecify how they came to the conclusions that they did. They did not giveexplanations on how they chose the setting or how they recruited the participants.they also didn’t specify the criteria which needs to be met to be part of theresearch.
Although, the method used to test participants was specified but Itwas not explained.The keyconclusions were defined in the abstract however they were not described indetail and only given a minimum amount of information.The abstractof the article also shows the findings of this research article this states theactual number of participants in the study and what percentage of womenreported drinking alcohol despite being aware they are pregnant. The findingsof the research within the abstract were difficult to understand as the scoresand how they were obtained were not highlighted or discussed. The abstract didnot specify which researcher conducted the tests and asked the questions thismay have an impact on the study if participants do not know who is asking themquestions (Alder and Clark, 2011).
The abstractstates the setting of the study but it doesn’t explain why that setting waschosen and if it has a diverse range of patients. In theabstract it doesn’t state what the inclusion/ exclusion criteria was it onlystates that women who were 10-12 weeks pregnant and attending their firstantenatal appointment were included. This indicates that the sampling method isconvenience sampling according to Aveyardand Sharp 2013. Convenience sampling is a sample taken from participantswho are local and convenient to the study. convenience samples usually usequestionnaires to obtain information for their study and that conforms withthis article as a cross sectional survey is used to obtain the information fromthe participants as this is stated in the abstract of the article. within the abstractthe study design is highlighted and a sample size is also given however thismay not be the number of participants that took part in the study. To make theabstract more reader friendly and to avoid confusion within the article theactual number of participants that took part could be highlighted.
Theobjective hasn’t got much detail on how they are going to perform the testshowever it does cover what the aim of this study is and what they are going todo to gain the results. The objective is clear and easy for the reader tounderstand. The abstractof article 1 explains the objective of the study which is to assess the prevalence and pattern of alcoholconsumption pre- conception and/or during the first trimester using the AlcoholUse Disorders Identification Test (AUDIT), Alcohol Use Disorders IdentificationTest – Consumption (AUDIT-C) and T-ACE (Tolerance, Annoyance, Cut Down andEye-Opener) alcohol screening questionnaires, and determine thesocio-demographic predictors of drinking in this time period.
Research article 1 There are two main types of research Qualative studiesand Quantative studies. As stated by Aveyardand Sharp (2013) Qualative studies do not usually quantify or measure thestudy using numbers as they do in Quantative research. In Qualative studies they aim to explore anissue in depth. Qualative studies are often carried out in an area where littleis known. The main principle of Qualative study is to explore the meaning ofthe subject and develop an in depth understanding of the research topic asexperienced by the participants of the study. Rather than the evidence beingstatistics and data based it is more descriptive and interpretive ofparticipant’s feelings and experiences. Qualative research is most useful whenquestions cannot be answered numerically when you are asking “how? Why? Orwhat?” Rahul Mhaskar et al believes that criticalappraisal tools help to distinguish reliable research from unreliable research.
Critical appraisal tools use certain criteria and ask questions about theresearch to see what is included in the research and if they have justifiedtheir findings. the critical appraisal tool assists in deciphering the researchand points out the good and bad points about the methods used in the researchsuch as sampling numbers, how the research took place and whether the researchis biased or not. However not all research is reliable because many studiesare biased and don’t give a true reflection on the subject because they haveused flawed methods or manipulated the data to create the outcome theypreferred. critical appraisal is vital in health andsocial care. Critical appraisal helps healthcare professionals decide whetherthe research is dependable and reliable there is enough evidence to back it up.If the decision is made that the research is reliable, using the practitionersjudgement/ experience as evidence based practice explains the ideas may be putinto practice. (McLeod, S.A.
(2007) As described by Burl2009 critical appraisal is “the process of carefully and systematicallyexamining research to judge its trustworthiness, and its value and relevance ina particular context.” It is an essential part of evidence based practicebecause it allows health care professionals to find and use research and evidencereliably and efficiently. Research involves gathering data then collating andanalysing it to produce information that could be useful in practice.
Using evidencewithout professional judgement can lead to “average run of the mill “care andusing professional judgement without relevant evidence can lead to thecontinuation of outdated practice. Both evidence and clinical judgment shouldwork together to create the best outcomes for the patient. According toTanner (2006:204) professionaljudgement is described as “an interpretation or conclusion about a patient’sneeds, concerns or health problems and/or the decision to take action (or not,use or modify standard approaches or improvise new ones as deemed appropriateby the patient’s response.”Evidencebased practice is vital in health and social care because it applies researchand healthcare practitioners’ experience/ judgement to create the best outcomefor the patient.
Sometimes evidence based practice is mistaken for a researchonly approach but this is not the case because the research should be effectivein practice. Sackett et al statesthat “our own professional or clinical judgement is vital for assisting withproviding an evidence based approach to care”. Sackett describes how evidence can inform decisions about practice, butit can’t replace the expertise and judgment of health care professionalsbecause they know the patient and what will work for that individual ratherthan a “one size fits all” approach. (p.
4). Sackett et al. (2000) believed that there is a strong linkbetween evidence based practice and the decisions that we make in everydaypractice, they state that decisions should be clearly stated and well thoughtthrough and that evidence should be used sensibly and carefully. Sackett et al. (2000) also emphasisesthe role of personal judgement and patient preference within the idea ofevidence based practice they argue that the idea of evidence alone is notenough it should be supported by the judgment and previous experiences of thepractitioner and the preferences of the patient. According toAveyard and Sharp (2013) Evidencebased practice is “practice that is supported by a clear up to date rationale, consideringthe patient’s own preferences and using your own judgement.
If we practise anevidence based approach, then we are set to give the best possible care.” This essaywill explore evidence based practice in a health and social care setting why itis important, and how it is applied in practice. The essay will also identify criticalappraisal what it is, why it is important and how it links to evidence basedpractice. The essay will also discuss Two research articles one qualative andone quantative which will be critically appraised and analysed using criticalappraisal tools. The research articles that will be critiqued are Alcohol consumption during pregnancy:cross-sectional survey Lesley smith et al (this will be referred to in thetext as article 1). Also, women focused smoking cessation programming:a qualative study Nadia Minian et al (this will be referred to in the textas article 2).
The critical appraisaltools which will be used to critically appraise article 1 will be The Joanna Briggs institute Checklist forAnalytical Cross-Sectional Studies. The critical appraisal tools that willbe used for article 2 will be The JoannaBriggs Institute Checklist for Qualative research. These critical appraisaltools will be used because they are the most detailed and come from a reliablesource.