Qorinah Estiningtyas Sakilah Adnani, SST, M.Keb, Ph.

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qorinah.adnani@unpad.ac.id
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

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2009).

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 ‘…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

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and improved, and we can keep striving forward for

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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