Literature Review of Ritualistic Care in Practice

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Dana Louise Ward 28/02/2005

Literature Review of Ritualistic Care in Practice

The purpose of this essay is to validate the use of evidence based practice via constructing a literature review of ritualistic care in practice.  Literature may be obtained from various sources for example books, Internet, articles, and research.  

The most up to date literature is found in the form of relevant and valid nursing research.  Research is important source of information for the nursing profession because it is critical and valid to the development and refinement of knowledge in order to enhance practice.  Nursing research can be defined as the systematic objective process of analysing phenomena of importance to nursing (Earlene, 2001).  Many articles indicate that a gap exists between research/theory and practice.  This is due to a number of different factors such as lack of research, lack of access to research, barriers placed by staff etc.  To reduce this gap the approach of evidence-based practice has been introduced (Rolfe 1998, Upton 1999).  Evidence based practice can be defined “as an approach to problem-solving in clinical practice” (Roseburg and Donald 1995) or the” systematic interconnecting of scientifically generated evidence with the tacit knowledge of the expert practitioner to achieve a change in a particular practice for the benefit of a well defined client/patient group” (French, 1999).  Within literature multiple definitions of the term evidence based practise exist as they do for many other nursing terms (Upton, 1999).

Evidence based practice originated from evidence based medicine which was defined by Sackett (1996, pg 71) as the “ conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” the term was developed to teach medical students.  Evidence based medicine then developed into evidence based heath care, which is an even broader term than evidence based medicine and can be defined as the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services.  Evidence based practice is even more wide-ranging term.

        The major justification for evidence-based practice within nursing is to improve patient care.  Other benefits of evidence-based practice include demonstration of effectiveness, justify skill mix, problem solving, identifying needs, provides a rationale for practice, provides consistent information, enhances professional status and to show purchases the use of evidence based practice (le May, 1999).  

 Strategies to enhance evidence-based practice include research-based articles, the internet, computer, conferences, journal clubs, motivation, research centres, workshops, databases, lectures, meetings, funding for courses, study days, articles, books, more good quality valid research, in all areas of practice, as well as additional understanding of evidence based practice.

Obstacles which may hinder the utilization of research / change / utilization within practice may includes time, resources, pressure of work, to much change, nursing colleagues being uncooperative, medical staff blocking implementation, implementation may require resourcing, other professions may think research is sub-standard, inability to access research, insufficient skills in critical appraisal, language of research make it inaccessible, lack of motivation, fear, resistance to change, ritualised practice, beliefs that research wont make a difference, research data is not relevant, current practice is ok as it is, (le May, 1999).  With regard to the topic chosen, some obstacles, which may hinder change, included people’s beliefs that the old way it is the best way, or this is the way it has always been done.  However ritualised practice/care is believed to be an obstacle in itself.   Parker (1999) believes that the persistence of ritualistic care is due to the lack of familiarity with research.                              

  Ritualistic action can be defined as carrying out a task without thinking it through in a problem-solving logical way, therefore ritualistic practice could be interpreted as carrying out a care/practice without thinking it through in a problem-solving logical way (Philipin, 2002).   Ritual practice has been described as irrational unscientific, unsafe, and repetitive (Philipin 2002, Geffrey 1997, Biley 1997).  Although there is view points which, regard rituals as valuable such as the anthropologists.  The negative side of ritualistic care is talked about more, and usually brings areas of practice/care into light, what need additional valid up to date research.

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 In Wash and Ford (1989) classic text they called for a “drive for the replacement of ritualised practice”. Later in 1994, Ford and Walsh stated that lack of an in-depth theoretical framework leaves nursing vulnerable to ritualistic practice.  

Strange (2002) perceives ritual practice as economically unproductive and primitive.  Therefore presenting a disapproving view of ritualistic practice/care.  

This negative approach to ritualistic practice is thought to have originated from the fact that we are a technical society and so turn from primitive practice and the fact that irrational is often linked with emotion, which is not scientific.

Negative ...

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