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Evidence Based Practice in Midwifery Education

Evidence based practice in nursing ( and by extension, midwifery) is defined as "the practice of nursing in which
the nurse makes clinical decisions on the basis of the best available current
research evidence, his or her own clinical expertise, and the needs and
preferences of the patient" (Mosby's Medical Dictionary, 8th edition. : 2009,
Elsevier). Clinical information and practice guidelines are rapidly
changing and it is incumbent on us as providers and preceptors to stay current.
Evidence based practice includes evidence gleaned from a wide variety of studies
including randomized controlled trials, qualitative studies, observational
studies and descriptive studies.

Preceptors are often concerned that they will not know
enough to be a preceptor or that they won't be able to answer all the student's
questions. Having a student will actually often show a preceptor how much
she/he really knows. And, besides, the key is to know how to look up
information and how to stay current once in practice - not to even try to have
all the answers! Students often bring the latest information on a topic into the
clinical setting and can be great resources for up to date perspectives on any
given topic. Students are also often very tech savvy and very happy to
help preceptors learn new tricks and sources for information.

role modeling forstudents. It is critically important that students
learn from preceptors how to blend clinical practice and the art of staying
current. Preceptors set a very powerful example when they can say
to a student "I don't know-let's look it up" or "Why don't
you go and look that up and then let me know what you find?" Students are
familiar with using search engines to look up the research on a given topic;
preceptorscan help them to think through how applicable the
research is and what to consider when deciding how to bring research into

Preceptorsfoster and
student's development of a systematic
approach to clinical reasoning. Evidence based practice encourages the use
of the most reliable research available to inform that clinical reasoning
process. When midwives are presented with an issue in clinical practice that
they are unsure of or need more information about ,the following
process can be used to address it with a student:

  1. ASK the question
  2. LOCATE the evidence
  3. APPRAISE the evidence
  4. ACT on the evidence

There are a wide variety of sources to go to for
evidence. Many preceptorswill have
access to the library at their institution or at the school the student
attends. Use that avenue to access professional journals
or literature surveillance newsletters. The Cochrane Library is a highly
regarded source for rigorously examined reviews on a variety of topics - 
http://www.cochrane.org/. Also check
the websites of professional organizations for their most recent guidelines or
publications. There are also several sources for reviews: Database
of Abstracts of Reviews of Effects (DARE) - http://nhscrd.york.ac.uk/, Up to Date, Dyna Med and many others. Look to
see what the library subscribes to. In addition, there are many
sites that provide excellent reviews and consumer education such as Childbirth
Connection (http://www.childbirthconnection.org/). There are also excellent blogs, such as
Netting the Evidence or Academic OB/Gyn that examine current research and
provide thoughtful and stimulating perspectives.

Evidence based midwifery practice brings together the
best available research with the clinical expertise of the midwife and the
preferences of the client and family. Students gain tremendously when they
learn from preceptors how to combine these critical
elements into excellent clinical practice.

American College of Nurse-Midwives
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