Information for practice thinking

Information for practice thinking

A quick, essential read

It is important to have a read through the Practice for Information Thinking section below, before writing your assignment. This will make you think about where you go to get clinical information and whether it is reliable and quality information.....just some food for thought!!!

Remember: Not all published information is good!!

Information for practice thinking:

Information authority and presentation: their contribution to evaluating the veracity of information

Welcome to the Information for Practice Thinking resource. This resource will focus on the authority and presentation of information and how this can be used to help judge the veracityof information that may be used to guide clinical decisions. This resource has been developed to assist you with developing Assessment 1 and also contains important content that will assist you in further developing your knowledge and skills in clinical decision-making and information use.

Introduction

The focus of this module is to examine the role information authority and presentation play in determining the veracity of information that might be used to guide clinical decisions. Nurses often experience uncertainty in their clinical practice and require additional information to make a sound clinical judgement. In the clinical context, when situations of clinical uncertainty arise, nurses will most commonly ask a colleague for information (verbal testimony) despite the availability of clinical practice guidelines and other institutional documents. It is important, therefore, to apply strategies in the evaluation of all sources of information, including the verbal testimony of our colleagues.

While this resource focuses on evaluating the authority of information and its presentation, it should be recognised that this is just one characteristic that should be considered when evaluating the overall veracity of the information before us.

Information for clinical decision-making can come from a variety of sources, including peer-reviewed, published information. However, most common information in clinical practice comes in the form of verbal information from others but may also be sourced from.

Topic 1: Presentation of Information

Textual information that is presented clearly and with attention to detail is often positively received. When I first started working in nurse education emphasis was placed on the importance of presenting textual material to the extent that photocopies of journal article could not be distributed until any black marks left by the copier were removed and the document reproduced so that it had just the text and a clean white border. Obviously, this makes not one bit of difference to the quality of the content because the text remains the same. However, a clean copy is more appealing and can enhance the (mis)perception that the information is of a high quality. Any well-presented document has the potential to impress just as poorly presented information is more likely to be disregarded.

Attention to detail and accurate presentation of textual data is also of importance. For example, if you are reading material that has numerous spelling, grammatical or punctuation errors then it is natural to make the assumption that this information might not be highly accurate. You could be forgiven to think that if the author hasnt bothered to pay attention to these fundamental aspects of conveying written information they might not have paid attention to the accuracy of the content they are putting forward.

So, does that mean that information that is beautifully presented is accurate? No. But when it appears that time and effort has gone into careful presentation of information we are less likely to be critical of the content. Nevertheless, we still need to consider critically the content that is being put forward and not make an assumption about the veracity of information just because it appears nicely presented.

1.1: Presentation of information on the Internet

Since 1989 when the World Wide Web became available, electronic access to information has increased the quantity, speed and ease with which information can be accessed. While this applies in a general sense, it is no less true when we consider the amount of information available to help healthcare professionals in their clinical practice. However, does having all this information at our fingertips necessarily equate with increased access to quality information?

We need to be careful of information provided on the Web because it is largely uncensored. It is important to think about how information is presented using this media and how this impacts perceptions of accuracy and credibility. Sometimes websites are presented in ways that appeal to certain groups of people. At times emotive and provocative statements will be used to grab the readers attention. It may be that the information is presented in a way that suggests but does not clearly establish the authority of the information put forward. Remember that information obtained through the Internet is not subject to a quality control process. Anyone can put anything up there and use very clever language and visual presentation to try and convince you of the authority of their information.

Topic 2: Authority of Information

The authority of the information source is an aspect of information veracity that is commonly considered by clinicians when they evaluate the quality of information received. The concept of information authority applies equally to that obtained verbally as well as via print or electronic media.

2.1: Authority of verbal testimony

Reliance on verbal information from colleagues is common in clinical practice and the perceived authority of the individual providing the information often is more highly regarded than the perceived authority of the information itself. When considering the authority of individuals providing the information key issues that are most commonly considered are position and length of experience. Research by Marshall (2008) suggests that positional authority is highly valued by many clinicians but does not exclusively equate with information accuracy or the clinical credibility of the individual. Nurses have reported that they will consider a colleagues experience and position within the workplace when selecting which individuals to seek information from. Interestingly, those nurses who are more experienced also recognise that equal levels of experience and position do not necessarily produce equally credible clinicians. So on one level experience and position provide a starting point from which additional criteria about an individuals expertise are then evaluated.

2.2: Authority of websites

As discussed previously the World Wide Web provides access to an enormous amount of information none of which is required to be censored before being made publically available. For some years the credibility of health-related information available on the Web has been widely discussed. In March 9, 2002 issue of the British Medical Journal has several articles discussing issues related to information obtained on the Web.

Read: Kunst H, Groot D, Latthe, PM, Latthe M, Khan KS (2002) Accuracy of information onapparently credible websites: a survey of five common health topics. British Medical Journal324: 581-582.

These authors demonstrate that commonly credibility of websites cannot reliably be determined by considering the source, currency of information and information hierarchy. These findings suggest that most tools used to evaluate website credibility that incorporate such characteristics might not be as beneficial as previously anticipated. Clearly, additional more advanced strategies are needed to evaluate website information and it is inadvisable to rely solely on information obtained through this medium.

2.3: Authority of Published Journals and Journal Articles

It is published - it must be good. There is an assumption that because an article appears in a publication its quality is of an acceptable standard. The belief that only quality articles make it to publication probably stems from the knowledge that most articles undergo a peer-review process before publication. The peer-review process does help with accurate and useful information being made available to healthcare professionals however it does not necessarily ensure or guarantee the quality of such publications.

Read

Mulligan A (2004) Is peer-review in crisis? Perspectives in Publishing 2:106

The knowledge that publication of inaccurate information can and does occur has prompted the development of guidelines for good practice in publication. For example, in the United Kingdom, the Committee on Publication Ethics (COPE) was founded in 1997 to find practical ways of promoting good practice in publication and has made available the Guidelines on Good Publication (http://www.publicationethics.org.uk/). In February 2008 the importance of good publication practices was recognised when more than 2000 journals, the full collection of Health Sciences and Science & Technology journals published by Elsevier (http://www.elsevier.com/) was added to the list of COPE members. Elsevier is a leading publisher of nursing and medical journals so this represents an important step in ensuring the quality of information provided and from which clinical practice decisions can be made.

Well-established journals deservedly have a reputation for publishing quality work. Themore prestigious the journal generally the more difficult it is to get a paper accepted for publication. However, the quality of the publication is not the only criteria considered when deciding on whether to publish an authors piece of work. In some instances, methodologically flawed studies might get accepted for publication because of current interest in the topic. An example is the publication, in the New England Journal of Medicine, of an article about the benefits of daily interruption to sedation (Kress et al 2000). An extension of this study has been published in the American Journal of Respiratory and Critical Care Medicine (2003) and reports the long-term psychological effects of sedation interruption. In many cases clinical practice has changed in response to these articles yet a critical review of this paper by Professor Sharon McKinley (Professor of Critical Care Nursing, University of Technology, Sydney) suggests methodological limitations in this published work.

This example illustrates the importance of critiquing published articles rather than relying on an assumption that because it is published, the quality must be good. Articles that have some methodological flaws will always continue to be published, even in the most prestigious journals because they continue to make important contributions to knowledge development.

2.4: Authority of Institutional Documents

Institutional and governmental documents form a large part of the available information we have to guide our clinical practice. In some cases, this information is both useful and easily accessible which makes it an excellent resource for making clinical decisions. However, institutional documents are sometimes neither useful nor accessible. Consider the setting where all institutional documents are available online only but there are only two computer terminals in the clinical area. This can potentially impact (negatively) on access. Other issues include how well the institutional document reflects the current best practice. Clinicians have commented that while policies/procedures/guidelines get updated, sometimes it is literally just changing the date to make it look current.

The veracity of information within institutional documents is often challenging when you consider using this information to guide your clinical practice. There is an expectation that patients receive the best possible care relative to their clinical presentation and preferences but if this is in conflict with current institutional policies/procedures this can make decision-makingsomewhat more complex. One of the greatest challenges facing nurses is how to deal with conflicting information.

Written by A Marshall, revised by K Curtis and E Leonard