Promoting real evidence-based practice using Critically Appraised Topics (CAT).

The subsequent blog in our Knowledge Mobilization series is written by Dr Andrew Finney, Senior Lecturer in Nursing at Keele University. This blog explores the usage of Critically Appraised Topics (CAT) in community nursing.

Dr Andrew Finney is a Senior Lecturer within the School of Nursing, Midwifery and Medicine at Keele University. Andrew holds the title of ‘Queen Nurse’ and as an instructional nurse is a mixed methodologist specializing in nurse-led interventions. Andrew has extensive experience in research methodology, epidemiology and qualitative research. His research focused totally on primary care nursing. Andrew has led the Keele CAT Group for Primary Care Nurses since 2015 and is currently expanding it nationally as a research engagement model for nurses that supports the Nurse Executives Strategic Research Agenda (2021).

I believe it’s secure to say that nurses generally avoid testing. Most frequently, we tolerated research lectures during training, and implemented research modules after registration only when crucial! I feel like that is another person’s role… “the ‘researcher’ role, not the nurse’s!”

Nonetheless, once we speak about evidence-based practice or evidence-based nursing, nurses naturally engage in research because there’s a way of ownership, it means something, it signifies that we all know that what we’re doing is true, up so far and we hope that is “best practice”. For those who ask nurses whether or not they are aware of clinical differences in what they do, or whether there’s clinical uncertainty about certain areas of practice, nurses are literally extremely aware of most of the research questions surrounding this topic.

One method to bring nurses to the forefront of recent research is to support them in identifying research questions and interesting them within the processes of finding, critiquing, and implementing best evidence through the usage of a critically assessed topic (CAT). CAT studies summarize the most effective available evidence to reply a clinical query ¹

The CAT method is predicated on a particular patient situation or problem and is subsequently of direct relevance to nurses who may previously have felt that EBP concepts were very distant from on a regular basis clinical practice ². The goal of CAT is to present research in an accessible way that allows nurses to read and adopt the outcomes so as to influence their practice.

At Keele University we’ve got focused on General Nursing (GPN) and invited all local (North Staffordshire and Stoke-on-Trent) GPNs and Advanced Nurse Practitioners (ANPs) to form a CAT group. The group could be hosted by Keele University in partnership with the then Clinical Commissioning Groups (CCG). The concept of a CAT group was presented to GPN and ANP and our group was formed.

We knew the group needed academic leadership and the support of Keele’s Health library, but most significantly they needed nurses. Questions needed to be directed by nurses. The CAT group meets every three months within the evening (during nurse’s working hours). The CAT questions for this meeting are agreed upon and shaped for the EBP process.

Once an issue has been identified inside the group, a clinical query arises that will be answered. The query used the PICO structure (population or patient; intervention; comparison; consequence) to discover search terms. The University Health Library formulates and implements a search technique to discover the most effective available evidence. The evidence is then assessed for validity and clinical relevance by the group using recognized assessment tools to supply a Clinical End result (CBL). The CBL is a transient summary of findings that is a component of a two-page report that features the query, results, and clinical significance that’s helpful and simple for clinicians to read. The ultimate CAT report is published on a dedicated website

(https://www.keele.ac.uk/iau/evidenceintopracticegroups/practicenursing/CAT). Depending on the findings, consideration is then given to the adoption and implementation of recent evidence in practice.

“In patients with vitamin B12 deficiency, it is run orally vitamin B12 supplementation as effective as intramuscular B12 injections?”​

It is not uncommon to manage vitamin B12 by intramuscular injection, but literature reviews suggest that oral vitamin B12 could also be as effective as intramuscular administration in some patients. Oral use of vitamin B12 can reduce nurse work time and is less invasive than intramuscular treatment.

On account of the COVID-19 pandemic, numerous patients might be prescribed oral vitamin B12 as an alternative of intramuscular vitamin B12 with the approval and objections of the Medication Optimization Team, which reduced the variety of patients seen through practices without consequences for patients. Patients with pernicious anemia, Crohn’s disease, or gastric bypass should proceed to receive vitamin B12 intramuscularly.

Academically, our nurses were fully engaged within the research process. GPNs developed their awareness and research skills through ‘bitesize’ teaching sessions adapted to the methods used inside the source evidence. Our nurses boldly query their practice and the practice of others, and have made many improvements in primary care nursing practice.

The CAT methodology is well transferable and replicable. CAT groups will be used for a particular discipline (e.g. GPN) or a particular condition (heart disease, diabetes, etc.).

If you desire to create your personal group, you may contact the creator of this blog. a.finney@keele.ac.uk

Bibliography

1. Finney et al (2016) Critically Appraised Topics (CATs): A way for integrating best evidence into general nursing practice. Nursing Practice, March 2016, 32-34
2. Foster et al (2001) Critically Appraised Topics (CAT): one approach to facilitating evidence-based physiotherapy practice. Physiotherapy, 87(4), 179-190.

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