Qorinah Estiningtyas Sakilah Adnani, SST, M.Keb, Ph.
D
[email protected]
Twitter @QorinAdnani
An activity that contributes to the understanding of a
phenomenon [Kuhn, 1962; Lakatos, 1978 modified ]
▪ phenomenon: a set of behaviors of some entity(ies) that is found
interesting by a community
▪ understanding: knowledge that allows prediction of the behavior
of some aspect of the phenomenon
▪ activities : appropriate efforts made to the production of
understanding (knowledge) → research methods and techniques
Kuhn, T.S. The Structure of Scientific Revolutions, 3rd Edition, University of Chicago Press, 1996
Lakatos, I. „The Methodology of Scientific Research Programmes“, John Worral and Gregory Currie, Eds.,
Cambridge, Cambridge University Press, 1978
Motivation for research:
▪ pure research:
enhance understanding of phenomena
▪ instrumentalist research:
a problem needs a solution
▪ applied research:
a solution needs application fields
Needs for research methodology
(as scientific /academic activity)
▪ (qualitatively) control research process
▪ validate research results
▪ compare research approaches
▪ respect rules of good scientific practice
Phenomenon
Find any problem(s) ?
State the problem
How much do you know ?
Read literature
Find the relation with problem(s)
Statement of the purpose of the study
Research Design
Narrowing problems into focused topic
What to put ?
Data collection
Appropriate design for the study purpose
Data Analysis
Appropriate calculations for the study purpose
Formulation of conclusions and implications
How the results succeed or fail to answer the problems
Communication of the results of the study
Dissemination of (new) information/knowledge to the community
COMMUNICATING
THE RESULTS OF THE STUDY
STAGE 3
IMPLEMENTING
STAGE 2
THE RESEARCH PROPOSAL
PLANNING
THE STUDY STAGE 1
JENIS DAN STRATA PENDIDIKAN TINGGI
Doktor
Dokt Sub
(S3) Fokus pada
or Terapan
spesialis 9
pengemban
(S3)
gan dan
Magister Spesial
Magis
(S2)
peningkata
ter is n keahlian
Terapan 8
(S2) kerja yang
spesifik
Profes
i
7
Sarja Diplo
na ma 4
(S1) (D4)
Diploma 3 6
Fokus pada (D3)
pengemban Diploma 2
gan (D2) 5
filosofis - Diploma 1
keilmuan (D1) LE 4
VE
Sekolah Menegah Atas/ Kejuruan/ Madrasah L
LS-2014-Profesi Alyah KK 3 8
NI
UU NO 4 TH 2019 TENTANG KEBIDANAN
Pendidikan Kebidanan terdiri
atas:
Pasal 4 a. pendidikan akademik;
b. pendidikan vokasi; dan
c. pendidikan profesi.
(1) Pendidikan akademik a terdiri atas:
a. program sarjana;
Pasal 5 b. program magister; dan
d. program doktor.
(2) Lulusan pendidikan akademik dapat melanjutkan program
pendidikan profesi.
(1) Pendidikan vokasi merupakan program diploma tiga
Pasal 6 kebidanan.
(2) Lulusan pendidikan vokasi yang akan menjadi Bidan lulusan
pendidikan profesi harus melanjutkan program pendidikan
setara sarjana ditambah pendidikan profesi.
Care Provider
Communicator
Community Leader
Manager
Reseacher
PERAN BIDAN
Praktek kedokteran berbasis bukti sudah
lama dikenal
Sejak jaman Ibnu Sina, seorang filsuf
yang juga tabib terkemuka,
mengemukakan prinsip-prinsip dasar
praktek pengobatan berbasis bukti
sebagai berikut
Ibn Sina
(981 – 1037)
The drug must have specific mode of action
It must be tested on a well defined single disease
The time of action must be observed
The effect of the drug must occur constantly and not transient
TESTING A DRUG ON A LION OR A HORSE MIGHT BE DIFFERENT
FROM ITS EFFECT ON MAN
The experiment must be done with the human body
Praktek pengobatan pada jaman dulu
(mungkin) dilakukan tanpa dasar ilmiah
yang tepat.
Dipraktekkan secara turun temurun,
sekalipun belum tentu benar bermanfaat,
bahkan mungkin berbahaya.
contoh :
mengeluarkan darah untuk penderita
panas demam
The cure for hot,
moist diseases
Panas badan
turun ….
(mungkin
karena syok
hipovolemik )
Menarik kesimpulan dari suatu fenomena
membutuhkan bukti yang kuat.
Bukti ini didapatkan dari hasil observasi
terhadap suatu fenomena
Mengukur kekuatan suatu bukti dilakukan
menurut metode tertentu, yang bersifat
obyektif.
Ukuran seperti baik, kurang baik bersifat
subyektif.
Metode A lebih baik dari metode B harus
dibuktikan dengan alat ukur yang bersifat
umum, yakni angka .
Menyanggah praktek
blood letting .
Kesimpulannya :
Secara umum pasien
yang mengalami
perdarahan kondisinya
lebih buruk daripada
yang tidak mengalami
perdarahan.
Observasi dilakukan minimal pada dua
kelompok yang diperbandingkan
Dari berbagai segi :
- Kondisi awal
- Jenis penyakit/masalah kesehatan
- Intervensi (jenis dan metodenya)
- Keberhasilan intervensi
- Efek samping
- Biaya
Prinsip ini diterapkan pada praktek
pengobatan modern, termasuk dalam
praktek kebidanan.
Di negara-negara maju, bidan tidak kalah
pintar dari dokter dalam mempelajari dan
menerapkan bukti-bukti ilmiah ini.
Clinical expertise
= keterampilan klinik
Research evidence
= bukti dari penelitian
Patient preference
= pilihan pasien atau klien
PERLU DICARI TITIK TEMU YANG
TERBAIK DAN DAPAT DITERIMA
SEMUA PIHAK
Keterampilan dasar untuk mencari, menelaah dan
menerapkan hasil penelitian ilmu dasar hingga
ilmu terapan dalam praktek kebidanan.
Membentuk kerangka pendidikan bidan yang
efektif dan efisien, baik di level diploma hingga
pasca sarjana
Mencetak bidan yang mampu belajar mandiri
Mendorong kebiasaan dan menciptakan rasa
kebutuhan untuk belajar seumur hidup.
Praktek kebidanan yang mengintegrasikan :
Bukti penelitian terbaik (dari yang ada)
berasal dari penelitian klinik, melibatkan pasien
yang sesungguhnya
Keterampilan klinik
terampil dalam mengambil manfaat dari
pengetahuan dan pengalaman, dalam menentukan
masalah setiap klien dengan kondisi uniknya
masing-masing
Menghargai nilai dan harapan yang diinginkan klien
sekalipun jenis masalah serupa, tetapi sifat individual
yang sangat unik, harus tetap menjadi bahan
pertimbangan,
Bukti –bukti penelitian, yang baik maupun
buruk harus diungkapkan dan diterangkan
secara jujur dan transparan
Setiap bukti penelitian memiliki urutan nilai
(hirarki) berdasarkan desain penelitiannya,
yang juga harus dipertimbangkan
Pengetahuan baru terus berkembang setiap
hari
Keterampilan klinik (diharapkan) bertambah
dengan pengalaman bekerja
Perlu dicari jalan tengah mencari
keseimbangan, karena pada kenyataannya
semakin banyak klien, semakin sedikit waktu
kita untuk belajar
Pelayanan “menurun”
Kinerja layanan kebidanaan dapat selalu
membaik dengan jalan :
1. Mempelajari bagaimana melaksanakan EBM
2. Mencari dan menerapkan EBM dan ringkasan2nya (bila
sudah ada)
3. Menerapkan strategi EBM untuk mengubah sikap dan
perilaku klinis kita dalam pelayanan kebidanan.
1. Pasien
2. Bidan
3. Layanan kesehatan
4. Seluruh masyarakat
Jenis jenis penelitian
penggunaan metode sifat Bidang ilmu
Your Text Here Your Text Here Your Text Here Your Text Here
You can simply You can simply You can simply You can simply
impress your impress your impress your impress your
audience and add a audience and add a audience and add a audience and add a
unique zing and unique zing and unique zing and unique zing and
appeal to your appeal to your appeal to your appeal to your
Presentations. You Presentations. Get a Presentations. Easy Presentations.
can simply impress modern PowerPoint to change colors,
your audience and Presentation that is photos and Text.
add a unique zing and beautifully designed.
appeal to your
Presentations.
Add Text Add Text Add Text Add Text
Cross
Sectional
Case Control Cohort study
Case
T i m e l i n e
Report
Case `Series Clinical Trial
General Overview
Diagnostic test Harm
Therapeutic or cost-effective
Intervention
prognosis
others
Research is an essential component of
midwifery, and midwives must take
ownership of how their profession will
evolve further (Steen and Roberts 2011:
168).
Research can be an overwhelming process to
understand and undertake. ‘Midwives are so often
scared off by the term research – remembering dry
lectures in the classroom that involved complicated
words and statistical measures that were not
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remotely related to them’ (Crozier and Macdonald
D D
2009).
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D
‘…midwifery must have its own body of
professional knowledge, developed by
midwives for midwives, to be used by
midwives. Therefore, it is imperative that a
prevailing research culture is fostered within
the profession’. (Hicks 1996: 4)
There are still many unanswered questions about
midwifery practice, which continually arise due to
changes in other areas that generate questions,
such as women’s expectations and differing
organisation of midwifery services. This is why
midwives need to constantly reflect on and review
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their practice, so that knowledge can be developed
D D
and improved, and we can keep striving forward for
D
excellence in care for women and babies.
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Implications of research for midwifery practice
Publication of work impacts on the
midwifery knowledge base, and can
affect and influence clinical practice
and further work. More midwifery
research is being published, especially
as there are more midwives in clinical
and academic environments that have
studied at postgraduate level and
achieved PhDs. The Internet is also
having a huge impact on how
midwifery research is being
disseminated in relation to findings
and further enhancing evidence.
Contoh:
http://www.ncbi.nlm.nih.gov/sites/entrez
Search Cascade
Learning through playing
Try all “buttons”
Make lots of
mistakes”
Have fun !!!
Check the
question type Check the
emphasis
AND means both
terms required
* Means any
other letters
IN CAPITALS
weight gain AND pregnancy - has both terms
Pregnancy Weight gain
AND = both terms
OR = either term
NOT = not this term
(ADJacent, NEAR, … = AND + close)
* George Boole (a man) is claimed to have invented “logic”
Embase
Medline
Cochrane Trials Registry
Medline = Pubmed, Webspirs, OVID, …
Search on Title only
Eg [ti]
(Others are [au] - author; [so], [yr], …)
‘Related Articles’ button
(PubMed)
previously identified study (PubMed)
Look for the MeSH terms
MeSH browser
Decide the TYPE of question (Rx, Dx, Px, …)
Chose the right database for the type of question,
e.g.,
▪ Intervention: Cochrane Library, PubMed, …
▪ Diagnostic: Common Diagnostic Strategies (in BE), or
PubMed: Clinical Queries
▪ Prognosis, Etiology: PubMed: Clinical Queries
The EBM Way
What are the “gaps” between research and
practice?
Why do such “gaps” exist?
How can we close a specific gap?
How can we close all gaps?
What are the “gaps” between research and
practice are you involved in?
WHAT DO WE KNOW
Why Gaps exist ?
PAPERS ……. JOURNALS ……
TEXTBOOKS………
Evidence Based Practice ………..
OH NO …. ???
Knowledge gain
1. Traditions, role modelling
2. Authority, mentorship
3. Personal Experience
4. Trial and Error
Research
Assess Ask clinical
your patient questions
Acquire the Appraise
best evidence the evidence
Apply
evidence to
patient care
DAILY PROBLEMS IN MEDICAL PRACTICE
LITERATURE SEARCH
ARTICLE FOUND
APPRAISE CRITICALLY
EVIDENCE-BASED PRACTICE
Critical Appraisal of Topic
1.The validity of the
study ➢ Appropriateness
➢ Bias
2.The accuracy of ➢ Sensitivity
Specificity
the test
➢
➢ OTHERS
The decision
3.Applicability
➢
Hierarchy of evidence
Quality Type of evidence
1a (best) Systematic review of randomized controlled trials
1b Individual randomized controlled trials with narrow confidence
interval
1c All or none case series (when all patients died before a new
therapy was introduced, but patients receiving the new therapy
now survive)
2a Systematic review of cohort studies
2b Individual cohort study or randomized controlled trials with <80%
follow up
2c Outcome research; ecological studies
3a Systematic review of case-control studies
3b Individual case-control study
4 Case series
5 (worst) Expert opinion
All evidence is not created equal.
Evidence alone never makes clinical
decisions.
Values always influence decisions.
Diagnosis
Terapi
Prognosis
