will guide and enhance what is gathered through the therapeutic nurse–patient relationship. While research plays an important factor in supporting the decision‐making process without acknowledging the credibility of the research, the question of whether the findings can be trusted needs to be addressed. Two ways to determine this refer to critical appraisal and hierarchy of evidence.
Poorly conducted research seriously compromises the integrity of the research process; therefore, critical appraisal of the quality of clinical research is central to inform decision‐making in healthcare. Critical appraisal is the process of carefully and systematically examining research evidence to judge its trustworthiness, its value and relevance in a particular context (Caldwell et al. 2011). It allows clinicians to use research evidence reliably and efficiently. Critical appraisal is intended to enhance the healthcare professionals’ skill to determine whether the research evidence is true and relevant to their patients (Burls 2009). Critiquing tools such as Caldwell et al.’s (2011) Critical Appraisal Skills Programme (2011) and Joanna Briggs Institute’s Critical appraisal tools (2017) are commonly used within nursing to critically appraise research.
Figure 6.1 Hierarchy of evidence.
Source: Based on Evans (2003).
Particularly, in medicine, there is a requirement to seek the best available evidence, and in order to understand this, knowledge of the hierarchy of evidence is required. Figure 6.1 illustrates how the hierarchy of evidence refers to a ranking system whereby a range of different methodologies are graded according to the validity of their findings (Evans 2003).
A number of hierarchies of evidence have been developed to enable different research methods to be ranked according to the validity of their findings. However, most have focused on the evaluation of the effectiveness of interventions.
Conclusion
This chapter has considered the importance of gathering relevant information so as to ensure the delivery of evidence‐based patient‐centred care. The therapeutic nurse–patient relationship has been acknowledged, indicating this is pivotal to patient‐centred care. It has been acknowledged that the nursing associate will gather information to inform nursing practice from a variety of sources; however, it would seem that the effectiveness of this information gathering is somewhat reliant on the emotional intelligence skills of the nursing associate as well as underpinning an appreciation of the research process. Previous experience and expertise appear to develop these skills, as the less experienced nursing associate may not be as in tune with the patient in order to pick up the non‐verbal cues of the patient, having not been exposed to similar clinical situations previously.
References
1 Benner, P. (1984) Novice to expert: excellence and power in clinical nursing practice, California: Addison Wesley.
2 Bundgaard, K., Nielson, K.B., Delmar, C. and Sørensen, E.E. (2012) What to know and how to get to know? A fieldwork study outlining the understanding of knowing the patient in facilities for short term care, Journal of Advanced Nursing, 68(10): 2280–2288.
3 Burls, A. (2009) What is critical appraisal?, Oxford, UK: University of Oxford.
4 Caldwell, K., Henshaw, L. and Taylor, G. (2011) Developing a framework for critiquing health research: an early evaluation, Nurse Education Today, 31(8): e1–e7. doi: 0.1016/j.nedt.2010.11.025.
5 Carper, B. (1978) Fundamental patterns of knowing in nursing, Advances in Nursing Science, 1(1): 13–23.
6 Currid, T. and Pennington, J. (2010) Continuing professional development: therapeutic use of self, British Journal of Wellbeing, 1(3): 35–42.
7 den Hertog, R. and Niessen, T. (2019) The role of patient preferences in nursing decision‐making in evidence‐based practice: excellent nurses communication tools, Journal of Advanced Nursing, 75(9): 1987–1995. doi: 10.1111/jan.14083.
8 Dewing, J., McCormack, B. and Titchen, A. (2014) Practice development workbook: for nursing, health and social care, Hoboken, NJ: Wiley Blackwell, Chapter 2.
9 Eraut, M. (2000) Non‐formal learning and tacit knowledge in professional work. British Journal of Educational Psychology, 70: 113–136.
10 Evans, D. (2003) Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions, Journal of Clinical Nursing, 12(1): 77–84. doi: 10.1046/j.1365‐2702.2003.00662.x.
11 Feo, R., Conroy, T., Marshall, RJ., Rasmussen, P., Wiechula, R. and Kitson, AL. (2017) Using holistic interpretive synthesis to create practice relevant guidance for person‐centred fundamental care delivered by nurses, Nursing Inquiry, 24(2): e121152. doi: 10.111/nin.12152.
12 Feo, R., Rasmussen, P., Wiechula, R., Conroy, T. and Kitson, A. (2016) Developing effective and caring nurse‐patient relationships, Nursing Standard, 31(28): 54–63. doi: 10.778/ns.2017.e.10735.
13 Freshwater, D. (2007) The therapeutic use of self, in Freshwater, D. (ed.), Therapeutic nursing: improving patient care through self‐awareness and reflection, London: Sage.
14 Freshwater, D. and Stickley, T. (2004) The heart of the art: emotional intelligence in nurse education. Nursing Inquiry, 11(2): 91–98.
15 Gobet, F. and Chassy, P. (2008) Towards an alternative to Benner’s theory of expert intuition in nursing: a discussion paper, International Journal of Nursing Studies, 45(1): 129–139.
16 Health Education England. (2019) Nursing associate and new support role in health care, Health Education England. [online] Available: https://www.hee.nhs.uk/our‐work/nursing‐associates. Accessed September 2019.
17 James, I., Andershed, B., Gustavsson, B. and Ternestedt, B.‐M. (2010) Emotional knowing in nursing practice: in the encounter between life and death, International Journal of Qualitative Studies of Health and Well‐being, 5(5367): 1–15.
18 Johns, C. (2000) Becoming a reflective practitioner, London: Blackwell Science Ltd.
19 Kitson, A., Harvey, G. and McCormack, B. (1998) Enabling the implementation of evidence based practice: a conceptual framework. Quality in Healthcare, 7: 149–158.
20 Koutsopoulou, S., Papathanassoglou, E.D.E., Katapodi, M.C. and Patiraki, E.I. (2010) A critical review of the evidence for nurses as information providers to cancer patients, Journal of Clinical Nursing, 19(5–6): 749–765.
21 Leary, A., White, J. and Yarnell, L. (2014) The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK, European Journal of Oncology Nursing, 18(1): 23–28.
22 Mayer, J.D. and Salovey, P. (1997) What is emotional intelligence? in Salovey, P. & Sluyter, D.J. (eds.) Emotional development and emotional intelligence. Educational implications. New York, NY: Basic Books, 3–34.
23 Mayer, J.D., Salovey, P., Caruso, D.R. and Sitarenious, G. (2001) Emotional intelligence as a standard intelligence, Emotion, 3(1): 232–242.
24 McCormack, B. and McCance, T. (2010) Person‐centred nursing: theory and practice, London:
