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.
Preceptors provideimportant 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 toa 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 practice.
Preceptorsfoster and nurturethe 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:
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.