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In pursuit of clinical excellence: the role of evidence

Gibb, Heather RN BA(Hons) PhD MPsych1,2

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International Journal of Evidence-Based Healthcare: September 2008 - Volume 6 - Issue 3 - p 277
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The tireless pursuit of clinical excellence demonstrated by health practitioners from all disciplines, across the world, never ceases to amaze me. This determination to ensure that the quality of healthcare is of the highest possible standard, despite the challenges and exigencies that plague its delivery, is truly a testimony to the strength and professionalism of those involved.

This volume of the journal draws together a range of perspectives and approaches in addressing the challenge of continuous quality improvement through the analysis and application of evidence to inform clinical decision-making. It could be described as a volume committed to ‘down to earth aspects’ of healthcare.

The systematic reviews in this volume include an analysis of evidence for patient simulation as an alternative to traditional clinical encounters, as the basis for student learning;1 the relative effectiveness of different fluid regimens in colostomy irrigation2 and an analysis of the relative effectiveness of a low toxicity treatment in osteoarthritis, through the use of ginger.3 A practice implementation project is outlined in the ‘Evidence Utilisation’ section regarding the use of physical restraint as a safety measure in residential aged care.4

In this same vein, two articles are included which relate to the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) software. It has long been argued that ‘a pluralistic approach when considering “what counts as evidence” for health care practices’ is required.5 Thus, the JBI-QARI software was designed within the Joanna Briggs Institute to provide a framework to manage, appraise, analyse and synthesise the findings of qualitative research as part of a systematic review. This resource therefore offers opportunity for synthesising experiences and perspectives in a systematic way to further inform clinical decision-making in practice.

The first of the papers related to JBI-QARI is a systematic review that examines the experiences of young people with chronic illness.6 The other paper reports on the researcher experience of using JBI-QARI to examine the views and experiences of older people in relation to falls.7 As the authors emphasise, the capacity to include reviews of qualitative data of this kind, ensures that care delivery is both evidence-based and consumer informed.

This edition of the journal highlights the importance of ensuring that quality improvement initiatives consider the best available evidence in line with the context of care, client preference and professional clinical expertise. It acknowledges that the pursuit of clinical excellence is the sum total of these individual but equally important elements and recognises the unique and inimitable relationship between those who provide and those who use health services.

Heather Gibb, RN BA(Hons) PhD MPsych1,2

1Director, National Evidence Based Aged Care Unit, The Joanna Briggs Institute and 2Affiliate Professor, The University of Adelaide, Adelaide, South Australia, Australia


1. Laschinger S, Medves J, Pulling C et al. Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction. Int J Evid Based Healthc 2008; 6: 278–302.
2. Lizarondo L, Gyi, AA, Schultz T. Fluid regimens for colostomy irrigation: a systematic review. Int J Evid Based Healthc 2008; 6: 303–10.
3. Leach M, Kumar S. The clinical effectiveness of ginger (Zingiber officinale) in adults with osteoarthritis. Int J Evid Based Healthc 2008; 6: 311–20.
4. Timmins J. Compliance with best practice: implementing the best available evidence in the use of physical restraint in residential aged care. Int J Evid Based Healthc 2008; 6: 345–50.
5. Pearson A. Evidence based nursing: quality through research. In: Nay R, Garratt S, eds. Nursing Older People: Issues and Innovations. Sydney: Maclennan & Petty, 1999; 338–52.
6. Venning A, Eliott J, Wilson A, Kettler, L. Understanding young peoples' experience of chronic illness: a systematic review. Int J Evid Based Healthc 2008; 6: 321–36.
7. McInnes E, Wimpenny P. Using Qualitative Assessment and Review Instrument (QARI) software to synthesise studies on older people's views and experiences of falls prevention. Int J Evid Based Healthc 2008; 6: 337–44.
International Journal of Evidence-Based Healthcare © 2008 The Joanna Briggs Institute