Becoming an Effective Practitioner essay


Becomingan Effective Practitioner

Becomingan Effective Practitioner

Thedisparity in access to mental health care is one of the keychallenges that have been troubling the stakeholders in theAustralia’s health care sector. In most cases, patients in therural areas are disadvantaged since the resources allocated tosupport them are scarce. However, this challenge can be addressedeffectively by using evidence-based practices (EBP) to inform alldecisions that are made regarding the distribution of health careresources. The purpose of this paper is to examine how one can becomean effective practitioner by applying the EBP to inform mental healthcare decisions. This purpose will be accomplished by criticallyanalyzing a scientific study entitled “Service provision for olderpeople with mental health problems in a rural area of Australia”that focuses on the barriers that affected the process of deliveringeffective mental care to clients living in the rural areas inAustralia. The topic of mental health care among older adults livingin the rural areas is a worthwhile pursuit, given that over 8.3 % ofthe mentally ill seniors reside in the rural areas (Australian Bureauof Statistics, 2011, p. 1).


Evidencebased practice

Theconcept of evidence-based practice (EBP) is used in many fields ofprofession, but is more common in the health care sector. It is usedto refer to the integration of clinical expertise, empirical researchevidence patient values into the process of making decisions thatpertain to patient care (Bennett, 2000, p. 172). The health careprofessionals who adopt the concept of EBP are expected to utilizethe skills as well as the knowledge that they have gained duringtheir practice to inform the process of decision making. The healthcare professionals should be able to determine the reliability of theresearch method used to identify the empirical evidence, beforerelying on the scientific findings of a given study to inform theprocess of decision making (Thyer, 2004, p. 168).

TheEBP is a significant concept in the fields of health care and socialcare environments because it enables the health care providers todeliver quality care. This is because the use of scientific evidenceallows the health and social care professionals to incorporate thelatest techniques in their work (Mullen, 2004, p. 114). This makesEBP a significant concept in the modern environment, in which clientsdemand for quality services (Kirsten, 2009, p. 26 and Nahata, 2005,p. 89). Additionally, the use of scientific evidence help the socialand health care professionals to evaluate various research projectsconstantly in order to ensure that the evidence they use to informtheir health care decision making processes is the latest (Nahata,2005, p. 89). This enhances the adaptability, confidence, andcritical thinking skills of the health care providers.

Therationale for selecting Domain 2 of the NHS Outcomes Framework

Domain2 focuses on the improvement of quality of life of persons sufferingfrom long-term conditions. Under this domain, health careprofessionals are expected to enhance the patient’s quality of lifeby empowering them to manage their own conditions (Department ofHealth, 2014, p. 10). The duration of hospitalization is reduced byempowering the patients as well as their families to manage thecondition while at home (Department of Health, 2014, p. 10). Mostimportantly, domain 2 also emphasize on the significance of enhancingthe quality of life of the health providers.

Domain2 is relevant to the psychiatric field of nursing practice becauseboth of then focus on the treatment of long-term conditions,especially the mental illness. Psychiatric nurses provide care andconsultation to clients who are suffering from mental healthdisorders (Theophilos, 2004, p. 163). Some of the long-termconditions that psychiatric nurses are expected to treat includeschizophrenia, dementia, and bipolar disorder. These conditions aremore common among older adults than the young generation (Goldberg,2015, p. 71). This is in line with the provisions of domain 2 thatadvocates for the empowerment of clients and reduction in durationhospitalization.

Outlineof the research paper

Thearticle “Service provision for elderly people with mental healthproblems in a rural area of Australia” was authored by EimearMuir-Cochrane, Deb O’Kane, Candice Oster, Pat Barkway, and JeffreyFuller. The article was published in the journal of Aging and MentalHealth in 2014. The purpose of the research reported in the articlewas to explore the key barriers that prevent an effective delivery ofmental health care services to older adults in the rural areas ofAustralia. The article was selected because it focuses on factorsthat limit the effective delivery psychiatric health care. Therefore,the findings reported in the article are expected to contribute asignificant body of knowledge to the field of psychiatric nursing.

Theresearch paper relates to domain 2 of the NHS Outcomes Frameworkbecause it is based on the study of mental health condition, which isone of the long-term illnesses. The aim of domain 2 is to improve thequality of life of individuals suffering from the long-termconditions (Department of Health, 2014, p. 10). The barriers(including the separation of the mental and physical health caresystems) reduce the quality of life of the mentally ill ruraldwellers.

Analysisof the study

Thestudy reported in the article “Service provision for elderly peoplewith mental health problems in a rural area of Australia” will beanalyzed using the CASP (CASP 2016) checklist for qualitative studiesas follows

Statementof aim

Theauthors had a clear statement of aim. The aim of the study wasthought to be significant because of the high rate of increase in thepopulation of mentally ill Australians living outside the majorcities. For example, it is estimated that about 12 % of allAustralians suffer from mental conditions, but 8.3 % of them live inthe rural areas (Australian Bureau of Statistics, 2011, p. 1). Thismakes the aim of the study relevant.


Theresearchers used the qualitative methodology to pursue the purpose oftheir study. The methodology was appropriate for the study becausethe qualitative approach is mainly used to provide the description ofa complex phenomenon, illuminate the experience of a given event, ortrack a unique event (Sofaer, 2000, p. 1102).

Appropriatenessof the research design

Theresearchers justified their decision to use the qualitative design bystating that it is suited to applied research projects that have alimited framework, specific questions, and a pre-designed sampleMuir-Cochrane, 2014, p. 161). One of the key strengths associatedwith the use of a qualitative design is the fact that it allows anin-depth analysis of the underlying issue (Turner, 2010, 750).Reliance on human experience is one of the strengths of thequalitative design, which make the findings of the study morecompelling and reliable than a study that is based on a quantitativedesign (Turner, 2010, 750).

However,the qualitative design has some weaknesses that might have limitedthe credibility of the findings. For example, the qualitative designrequires the presence of the researcher or a direct contact betweenthe respondents and the researchers, which creates room for theresearcher to influence the type of data that needs to be collected(Rajendra, 2015, p. 1). In overall, the research design wasappropriate to the aim, in spite of the few weaknesses associatedwith the use of a qualitative methodology.

Appropriatenessof the recruitment strategy

Apurposive sampling was used to recruit participants in the study. Oneof the key strengths of the purposeful sampling approach is the factthat it allows researchers to select participants whom they believehave the data that is required to achieve the aim of a given study(Teddlie, 2007, p. 83). For example, the purposeful sampling allowedthe researchers to recruit the senior clinical service providers whohad been offering mental care to clients residing in the rural areas(Muir-Cochrane, 2014, p. 760).

However,the use of a purposeful sampling technique introduces bias into thestudy, which is a major weakness that limits the credibility as wellas the reliability of the findings (Suri, 2011, p. 65). For example,by selecting 19 clinical service providers, the researchers failed togive other health and social care providers who have been working inthe rural areas an equal chance to take part in the study (Dattalo,2010, p. 1).


Boththe method and the form of the data are well explained in thearticle. They used the semi-structured method to collect data, whichwas stored in the form of an audiotape. Some of the key strengths ofthe structured interview include the ease of collecting data and thefact that it ensures that all required items are covered during theinterview (Phellas, 2011, p. 182). However, a structured interviewlimits the capacity of the researchers to conduct a furtherexploration and clarify participant’s responses by askingadditional questions.

Relationshipbetween the study participants and researchers

Theauthors did not give a vivid explanation of the relationship thatthey had with the participants. However, it is clear that the authorshad no direct relationship with the participants. This is because theauthors requested the agencies to suggest 19 potential participants(Muir-Cochrane, 2014, p. 760). This implies that the authors did nothave a direct contact with the participants prior to the study. Thelack of a direct contact reduced the possibility of bias in theprocesses of formulation of questions and data collection.


Ethicalissues were observed during the study in several ways. For example,the authors obtained permission from the University’s researchboard and the human research ethics committee (Muir-Cochrane, 2014,p. 760). The main role of the research board is to ensure that theresearch is not a duplicate of the work that has already been done byother researchers (Doyle, 2010, p. 48).


Theauthors used the framework approach to analyze the data (Gale, 2013,p. 117). The process of analysis was adequately described where theauthors started with the familiarization with transcripts andinterviews, followed by the identification of the thematic framework,indexing, charting, mapping and interpretation (Muir-Cochrane, 2014,p. 761).

Statementof findings

Theauthors made a clear statement of findings. They stated that theprovision of health care for mentally ill Australians residing in therural areas was inadequate. They added this inadequacy was mainlycontributed by a combination of extrinsic and intrinsic barriers.These barriers include a perception that the separation between themental and the physical systems was a strategy to discriminateagainst the mentally ill patients.

Valueof the research

Theresearch is valuable because it provides a new body of informationabout the barriers that have limited the delivery of adequate mentalcare services to rural residents with mental conditions. Therefore,the findings of the study can be used to enhance efficiency in healthcare delivery. However, the authors did not explain how the findingscan be transferred to other populations, besides the older adults.

Justificationfor robustness of the findings

Thefindings reported in the article are robust enough to be used tochange the practice in the field of psychiatric care. For example,the fact that many mentally ill patients in the rural areas lackaccess to care due to the perception that they are discriminatedagainst can addressed by combining the physical and mental healthcare system. This will change the perception and make the mentallyill clients believe that they are being treated equally.

Contributionof the findings to professional development

Thefindings indicated that the lack of access to health care make themental conditions worse, especially when patients take long beforefinding the medical assistance. As a professional health careprovider, these findings suggest that all measures should be taken toreduce inequality in the distribution of the health care resources.


Theevidence-based practice enhances the quality of care and patientoutcome by enabling the social and health care providers to use thelatest scientific evidence to inform the process of making healthcare decisions. From this study, the geographical distance and theseparation between the physical and mental care systems are the keybarriers that limit the accessibility of mental care in the ruralareas. The authors used the qualitative methodology to pursue thepurpose of the study and a structured interview to collect the datain the form of audio-tape.

Tworecommendations can be made based on these findings and conclusion.First, a random sampling should be used in the future studies inorder to determine if the previous findings were affected by bias.Secondly, the future studies should be based on data collected fromrural clients or a combination of the rural clients and clinicalproviders. This will ensure that barriers to effective delivery ofcare are discussed from the perspectives of both the clients andproviders.

Listof references

AustralianBureau of Statistics, 2011. Australian social trends. AustralianBureau of Statistics.[Online]. Available at: &lt[Accessed 18 May 2016].

Bennett,S. and Bennett, W., 2000. The process f evidence-based practice inoccupational therapy: Informing clinical decisions. AustralianOccupational Therapy Journal,74, p. 171-180.

CASP,2016. 10 questions to help you make sense of qualitative research.CASP.[Online]. Available at:&lt[Accessed 18 May 2016].

Dattalo,P., 2010. Ethical dilemmas in sampling. Journalof Social Work Values and Ethics,7 (1), 1-12. Phellas, N., Bloch, A., and Seale, C., 2011.Structured methods: Interviews, questionnaires and observation.Sociologyof Health &amp Illness,30 (7), p. 992–1006.

Departmentof Health, 2014. TheNHS Outcomes Framework 2015/2016.London: NSH Group.

Doyle,E., Mullins, M. and Cunningham, M., 2010. Research ethics in abusiness school context: The establishment of a review committee andthe primary issues of concern. Journalof Academic Ethics,8, p. 43-66.

Gale,K., Cameron, E., and Redwood, S., 2013. Using the framework methodfor the analysis of qualitative data in multidisciplinary healthresearch. BMCMed Res Methodology,13, p. 117-130.

Goldberg,E., Gladman, R., Whittamore, H., Hardood, H. and Janes, G., 2012. Theprevalence of mental health problems among older adults admitted asan emergency to a general hospital. Ageand Ageing,41, p. 80-86.

Kirsten,A. and Clark, M., 2009. The impact of health information technologyon the quality of medical and health care: A systematic review.HealthInformation Management,38 (3), p. 26-37.

Muir-Cochrane,E., O’Kane, D., Barkway, P., Oster, C. &amp Fuller, J., 2014.Service provision for older people with mental health problems in arural area of Australia. Agingand Mental Health,18 (6), p. 759-766.

Mullen,J. and Streiner, L., 2004. The evidence for and againstevidence-based practice. BriefTreatment and Crisis Intervention,4 (2), p. 111-121.

Nahata,B., Ostaszewski, K. and Sahoo, P., 2005. Rising health careexpenditures: A demand-side analysis. Journalof Insurance Issues,25 (1), p. 88-102.

Rajendra,N., 2015. Dealingwith bias in qualitative research: A balancing act for researchers.Tanjong Malim: University of Pendidikan Sultan Idris.

Sofaer,S., 2000. Qualitative methods: What are they and why use them? HealthService Research,34 (5), p. 1101-1118.

Suri,H., 2011. Purposeful sampling in qualitative research synthesis.QualitativeResearch Journal,11 (2), p. 63-75.

Teddlie,C. and Yu, F., 2007. Mixed methods sampling: A typology withexamples. Journalof Mixed Methods,1, p. 77-100.

Theophilos,T., Green, R., and Cashin, A., 2015. Nurse practitioner mental healthcare in the primary context: A Californian case study. HealthCare,3, p. 162-171.

Thyer,A., 2004. What is evidence-based practice? BriefTreatment and Crisis Intervention,4 (2), p. 167-176.

Turner,W., 2010. Qualitative interview design: A practical guide for noviceinvestigators. TheQualitative Report,15 (3), p. 754-760.