Evidence-based practice (EBP)

Not all EBP projects result in statistically significant results. *Define clinical significance and **explain the difference between clinical and statistical significance. ***How can you use clinical significance to support positive outcomes in your project?

In nursing, most evidence-based practice (EBP) projects are carried out with an aim of obtaining accurate results. The results contribute to a new body of knowledge that is used to improve nursing practice (Giomuso et al., 2014; Melnyk et al., 2014; Spruce, 2015). The accuracy of most research findings is tested using statistical significance. Results are said to be statistically significant when the relationship between variables is not exclusively caused by chance (Heavey, 2019). In other words, statistical significance is used to demonstrate the likelihood of research results being true and that they are not due to normal variation. However, it is important to note that it is not all EBP projects that lead to statistically significance results (Heavey, 2019; Kim et al., 2020). This makes it necessary to evaluate the clinical significance of the findings of the researches involved in such projects.

EBP project results are said to be clinically significant if it is believed that they are substantial and that they can be used to guide nursing practice. In this regard, clinical significance can be defined as the extent to which research findings are considered to be meaningful for them to be applied to patient care (Brown, 2018; Kim et al., 2020). Thus, this parameter tries to validate the findings of a research based on its usefulness in clinical application. In EBP projects, clinical significance is determined using the actual effect or outcome of the proposed intervention. If the intervention does not result in positive changes such as improved patient outcomes, it can be said that it lacks clinical significance. Such interventions rarely lead to successive implementation of proposed projects meant for promotion of health and other important changes.

There is a clear-cut difference between clinical and statistical significance. Clinical significance involves validating the practical effect of a given intervention in real life (Brown, 2018). In contrast, statistical significance involves confirmation or rejection of research hypothesis using evidence (Kim et al., 2020). In most cases, the parameter generalizes research findings by way of demonstrating the impact of an intervention. It is also important to note that clinical significance can be used to tell the meaningfulness of a research finding (Brown, 2018). It is able to tell whether a given intervention can really work for the achievement of the desired change. However, statistical significance cannot do this. Even if a given hypothesis of a research is confirmed using statistical significance, it doesn’t mean that the findings will automatically lead to a positive impact (Heavey, 2019; Kim et al., 2020). Additionally, clinical evaluation is measured through subjective evaluation of the research findings (Brown, 2018; Kim et al., 2020). On the contrary, statistical significance is measured using probability values (p values) and confidence levels that quantify an intervention’s significance (Heavey, 2019). For instance, a p value of less than 0.05 demonstrates statistical significance. It means that the results at hand are not due to chance.

The current EBP project involves putting in place effective initiatives or measures that can led to prevention and control of diseases among marginalized groups. Clinical significance can be used to support the achievement of positive outcomes in this project. However, it is important to first determine the statistical significance of its results. This is due to the fact that clinical significance derives from subjective evaluation of the findings, and it cannot be justified using a single test (Brown, 2018). In the proposed project, if the establishment of more healthcare facilities, recruitment of enough healthcare personnel, and provision of health education in marginalized communities lead to an increase in the number of people receiving healthcare facilities, then statistical significance is achieved. On the other hand, clinical significance can be established by determining whether such measures can lead to increased access to quality healthcare services, and improved patient outcomes.

References:

Brown, S. J. (2018). Evidence-based nursing: The research-practice connection. Burlington, MA: Jones & Bartlett Learning.

Giomuso, C. B., Jones, L. M., Long, D., Chandler, T., Kresevic, D., & Pulphus, D. (2014). A successful approach to implementing evidence-based practice. MedSurg Nursing, 23 (4): pp. S4+. Retrieved from https://go.gale.com/ps/i.do?id=GALE%7CA382083709&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=10920811&p=AONE&sw=w&userGroupName=anon%7E25bb6818

Heavey, E. (2019). Statistics for nursing: A practical approach. Burlington, MA : Jones & Bartlett Learning.

Kim, M. J., Mallory, C., & Valerio, T. D. (2020). Statistics for evidence-based practice in nursing. Burlington, MA : Jones & Bartlett Learning.

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews Evid Based Nurs, 11 (1):5-15. doi: 10.1111/wvn.12021. Epub 2014 Jan 21. PMID: 24447399.

Spruce, L. (2015). Back to basics: implementing evidence-based practice. AORN J, 101 (1):106-12. doi: 10.1016/j.aorn.2014.08.009. PMID: 25537331.