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More evidence? Yes, please

Posted by plosmedicine on 31 Mar 2009 at 00:20 GMT

Author: Annemarie Jutel
Position: Associate Professor
Institution: Otago Polytechnic, Dunedin, New Zealand
Additional Authors: David Menkes
Submitted Date: February 26, 2008
Published Date: February 26, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dr Goodell points out that nurse prescribers have training in several areas relevant to critical appraisal of clinical trial data. While this is true, it does not contradict our statement which applied generally to nursing (both prescribing and non-prescribing nurses) versus medical education. The key point is that even with such training, nurse prescribers are likely to share doctors’ vulnerability to misleading pharmaceutical promotion [1]. More data are required on nurse responses to such promotion; it will be of particular interest to examine whether the training required of nurse prescribers equips them to deal more effectively with this challenge. Optimism in this regard must be tempered, as it is for doctors, by recognition of the fact that commercial promotions often succeed despite dodgy statistical arguments [2].

In a more general sense, statistics seems unlikely to become a ‘core’ nursing expertise, fundamental to daily practice – indeed this may help explain why our and Dr Goodell’s students frequently complain about required ‘statistical rigor’. Only 18% of a sample of nurses in the United Kingdom felt that their education programme led them to feel confident “to a large extent” in their ability to use inferential statistics to interpret research, and fully 68% identified that statistical analyses “not being understandable” was a barrier to making use of research findings in practice [3]. Australian researchers found that only 17.6% of senior clinical nurses surveyed felt they had the necessary skills to evaluate quantitative/statistical research reports and only 21% indicated they do not have difficulty interpreting the statistics used in research [4]. These findings align with our anecdotal observations as educators of nursing students, and emphasize the importance of teaching critical appraisal primarily in relation to practical issues faced by nurses in their daily work. One such issue, prevalent in many settings, is commercial promotion and its impact on clinical practice.

[1] Mansfield PR (2007) Is it insulting to suggest that health professionals are influenced by drug companies? Available: http://www.healthyskeptic.... Accessed 26 February 2008
[2] Scott T, Stanford N, Thompson DR. Killing me softly: myth in pharmaceutical advertising. BMJ 2004;329;1484-1487
[3] Veeramah V. Utilization of research findings by graduate nurses and midwives. Journal of Advanced Nursing. 2004;47(2):183-91.
[4] Sherriff KL, Wallis M, Cahboyer W. Nurses' attitudes to and perceptions of knowledge and skills regarding evidence-based practice. International Journal of Nursing Practice. 2007;13:363-9.

Competing interests declared: We are the authors of this article