nursing research Evidence-Based Practice Discussion Questions PLEASE SUMMARIZE THESE TWO CHAPTERSAfter completing the assigned readings, respond to the mod
nursing research Evidence-Based Practice Discussion Questions PLEASE SUMMARIZE THESE TWO CHAPTERSAfter completing the assigned readings, respond to the module 1 discussion question(s). Each initial discussion posting must be between 250-350 words . Posts, especially the initial one must have reference(s) cited correctly both within the text and on the reference list. See posted Abbreviated APA Essentials. Chapter 1
Introduction to Nursing Research and
Evidence-Based Practice
Copyright © 2011 by Saunders, an imprint of Elsevier Inc.
1
What Is Research?
To search again
To examine carefully
Diligent and systematic inquiry
Discovery
Goal is to develop an empirical body of
knowledge for a discipline
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2
Definition of Nursing Research
A scientific process that validates and refines
existing knowledge and generates new
knowledge that directly and indirectly
influences nursing practice.
It is the key to building an evidence-based
practice for nursing.
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3
Using Research in Practice
Synthesis of knowledge (research, theory,
and clinical experiences)
Effect of philosophy
Making a change in practice
Evaluation of change for patient, provider,
and health care system
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4
Integrative Review of Research
Critique of studies on a selected topic or
practice problem
Development of evidence-based practice
guidelines:
➢
Example: safe administration of intramuscular
injections
• Summarize the findings.
• Draw conclusions about what is known or not known
about the topic.
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5
Evidence-Based Practice Guidelines
Conscientious integration of best research
evidence with clinical expertise and patient
values and needs in the delivery of highquality, cost-effective health care
Synthesis of knowledge for development of
guidelines, standards, protocols, or policies to
direct nursing interventions and practice
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6
Why Is Research Important for
Evidence-Based Practice?
Develops empirical knowledge base
Identifies best practices that are based on
clinical practices
Improves outcomes for:
➢
➢
➢
Patient and family
Nurse
Health care system
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7
Nursing Research Provides:
Description
Explanation
Prediction
Control
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8
Description
Identifying and understanding the nature of
nursing phenomena and the relationships
among the phenomena to:
➢
➢
➢
➢
Describe what exists in nursing practice.
Discover new information.
Promote understanding of situations.
Classify information for use in the discipline.
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9
Explanation
Clarifying the relationships among
phenomena and identifying the reasons why
certain events occur
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10
Prediction
Estimating and anticipating the outcomes in a
particular situation
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11
Control
Manipulating a situation so as to achieve a
particular outcome
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12
Research Participation at Various
Levels of Educational Preparation
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13
BSN Researcher Role
Identify research problems.
Assist with data collection.
Critique research studies.
Summarize research findings for use in
practice.
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14
History of Nursing Research
Nursing research has evolved slowly over the
years.
Nursing research began in the 19th century
with Florence Nightingale.
Clinical research is the current major focus of
nursing research and will continue to be so
throughout the 21st century.
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15
Florence Nightingale
Nightingale focused on the importance of a
healthy environment for patients.
Aspects of her research included:
➢
➢
➢
➢
Ventilation
Cleanliness
Purity of water
Healthy diet
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16
Nursing Research: 1900–1940s
American Journal of Nursing first published in
1900.
Case studies reported in the 1920s and
1930s.
Graduate programs in nursing began in the
1920s.
Research conducted by nurses in the 1940s.
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17
Nursing Research: 1950s
1950—American Nurses Association begins
5-year study of nursing functions and
activities.
1952—Nursing Research published
BSN and MS nursing programs add research
to their curricula.
1953—Institute for Research and Service in
Nursing Education established by Teacher’s
College, Columbia University.
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18
Nursing Research: 1960s
1963—International Journal of Nursing
Studies
1967—Image published by Sigma Theta Tau
(now titled The Journal of Nursing
Scholarship)
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19
Nursing Research: 1970s
1970—ANA Commission on Nursing
Research
1972—Council of Nurse Researchers
1978—Advances in Nursing Science
1978—Research in Nursing and Health
1979—Western Journal of Nursing Research
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20
Nursing Research: 1980s
1982–1983—Conduct and Utilization of
Research in Nursing project (CURN)
1983—Annual Review of Nursing Research
1985—National Center for Nursing Research
(NCNR)
1987—Scholarly Inquiry for Nursing Practice
1988—Applied Nursing Research and
Nursing Science Quarterly
1989—Agency for Health Care Policy and
Research (AHCPR)
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21
Nursing Research: 1990s
1992—Clinical Nursing Research
1993—National Institute of Nursing Research
(NINR)
1993—Journal of Nursing Measurement
1994—Qualitative Health Research
AHCPR renamed Agency for Healthcare
Research and Quality (AHRQ).
1999—AACN position statement on nursing
research
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22
Nursing Research: 21st Century
2000—Healthy People 2010
2000—Biological Research for Nursing
2002—Joint Commission revised policies to
support evidence-based care.
2004—Worldviews on Evidence-Based
Nursing
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23
21st Century
2005—AHRQ guidelines and priorities
➢
2005—NINR priorities
➢
www.ahrq.gov
www.nih.gov/nin
2006—Revised AACN position statements on
nursing research
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24
Ways of Acquiring Knowledge
in Nursing
Traditions
Authority
Borrowing
Trial and error
Personal
experience
Role modeling
Intuition
Reasoning
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25
Practice Knowledge Base
Identify two common behaviors used in your
practice.
Indicate the knowledge base for these
behaviors.
Is your practice based mainly on research or
on other types of knowledge?
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26
Nursing Research Methods
Quantitative research
Qualitative research
Outcomes research
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27
Quantitative Research Methods
Descriptive research
Correlational research
Quasi-experimental research
Experimental research
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28
Quantitative Research Characteristics
Philosophical origin: logical positivism
Focus: concise, objective, reductionistic
Reasoning: logistic, deductive
Basis of knowing: cause-and-effect
relationships
Theoretical focus: tests theory
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29
Qualitative Research Methods
Phenomenological research
Ground theory research
Ethnographic research
Historical research
Focus groups
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30
Qualitative Research Characteristics
Philosophical origin: naturalistic, interpretive,
humanistic
Focus: broad, subjective, holistic
Reasoning: dialectic, inductive
Basis of knowing: meaning, discovery,
understanding
Theoretical focus: theory development
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31
Outcomes Research
Focus of outcomes:
➢
➢
➢
Patients and families
Providers (nurses, physicians)
Health care systems
Outcomes used change practice and develop
policy.
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32
Chapter 13
Building an Evidence-Based Nursing
Practice
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1
Evidence-Based Practice
Conscientious integration of best research
evidence with clinical expertise and patient
values and needs in delivery of quality costeffective health care
Has a broader focus than research use
Goal is implementation of quality costeffective care to promote positive outcomes
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2
Barriers to EBP
Practical
Conceptual
May create a “cookbook” approach to care
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3
Benefits to EBP
Improved patient outcomes for patients,
providers, and agencies
Leads to best treatment (Gold Standard) plan
An integral part of the Magnet Status process
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4
Evidence-Based Sources
Systematic reviews
Meta-analyses
Integrative reviews
Metasummaries
Metasyntheses
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5
Developing Evidence-Based Practice
for Nursing
Findings from a study are different from
research evidence.
Research evidence is a synthesis of quality,
relevant studies to form a body of empirical
knowledge for selected area of practice.
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6
Synthesis of Research Findings
Knowledge comes from quantitative,
qualitative, and outcomes research.
Content clustering: integration of findings
from scientifically sound research to
determine what is currently known or not
known
➢
Accomplished through:
• Integrative reviews
• Systematic reviews
• Meta-analyses, metasummaries, metasyntheses
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7
Integrative Reviews
Identifies, analyzes, and synthesizes results
from independent quantitative and qualitative
studies to determine current knowledge
Includes multiple types of research designs
and literature types
A complicated review, but gives breadth and
depth to conclusions
Annual Review of Nursing Research
publishes integrative reviews.
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8
Qualitative Research Contributions to
Integrative Reviews
Identifies and refines questions and
outcomes
Identifies types of participants and
interventions
Augments and provides data for research
synthesis
Highlights inadequacies in methods
Explains findings and interpretation of
findings
Helps make recommendations
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9
Systematic Reviews of Research
A narrowly focused synthesis of research
findings from quantitative studies
Looks at studies of similar methodology
Has same standards of clarity, rigor, and
replication as primary research studies
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10
Steps in Systematic Reviews
Formulate purpose and identify scope.
Develop specific questions or hypotheses.
Establish criteria for inclusion/exclusion of
studies.
Conduct extensive literature search of all
sources.
(Melnyk & Fineout-Overholt, 2005; Whittemore, 2005)
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11
Steps in Systematic Reviews (cont’d)
Develop questionnaire and contact authors to
gather data.
Critique studies for scientific merit and data
analysis.
Analyze and interpret data.
Report the review.
(Melnyk & Fineout-Overholt, 2005; Whittemore, 2005)
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12
Meta-analyses of the Research
Literature
Statistically pools results from previous
studies into single quantitative analysis
Allows for application of scientific criteria
➢
For example, sample size, level of significance,
variables
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13
Results of Meta-analysis
A large, diverse sample that is more
representative of target population
Determination of overall significance of
probability of pooled data
Indication of the efficacy of the intervention
from the average effect size determined from
several quality studies
Strength of relationship between variables
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14
Metasummaries in Qualitative
Research
Definition: a synthesis of multiple primary
qualitative studies to produce a narrative
about a selected phenomenon
Expands our knowledge base
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15
Metasynthesis of Qualitative
Research
Synthesizes qualitative research with a critical
analysis of primary studies and synthesis of
findings into a new theory
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16
Best Evidence for Use in Practice
The strength of the evidence is on a
continuum from high-quality results to lowerquality results.
Evidence-based guidelines are essential in
developing evidence-based practice for
nursing.
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17
Continuum of Strength of Research
Evidence
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18
Strength of Evidence
Strongest evidence
1.
2.
3.
Meta-analysis
Integrative reviews
Experimental studies
Weakest evidence
1.
2.
3.
4.
Descriptive surveys
Qualitative studies
Correlational studies
Quasi-experimental
studies
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19
Stetler Model of Research Utilization
Phase I: Preparation
Phase II: Validation
Phase III: Comparative Evaluation/Decision
Making
Phase IV: Translation/Application
Phase V: Evaluation
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20
Iowa Model of Evidence-Based
Practice
Provides direction for development of
evidence-based practice in an agency
Looks at triggers for change, such as:
➢
➢
➢
➢
Risk management data
Financial data
Organizational standards
Philosophy of care
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21
Iowa Model of Evidence-Based
Practice (cont’d)
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22
Application of the Iowa Model
What are effective strategies for
implementation?
What are outcomes from using the research
findings?
Do the data support the change?
Is the proposed change an agency priority?
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23
Scientific Merit Critique
According to the Iowa model, research should
be examined for:
Conceptualization and internal consistency of the
study
2. Methodological rigor of the design, sample
methods, data, and analysis
3. Generalizability of the findings
4. Number of replications
1.
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24
Determining Agency Compatibility
with the Change in Practice
Who needs to approve the change in the
agency?
What steps are needed to get the change
approved in the institution?
Do physicians support the change?
Do nurses support the change?
Who are the leaders and will they support the
change?
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25
Instituting the Change in Practice
Will the implementation take a long time?
What support is needed to make the change?
Are there barriers to instituting change in the
agency?
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26
Utilization Barriers
Administration barriers
➢
➢
➢
Research not valued
Limited change in agency or change not based on
research
Limited resources to make research-based
change
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27
Utilization Barriers (cont’d)
Clinician barriers
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➢
➢
➢
Do not read research reports
Lack education about research process
Do not believe research findings
Do not know how to implement findings
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28
Monitoring Outcomes
After the change is effected, the outcomes
must be monitored for effectiveness.
Change should be documented regarding
improved quality of care, decreased costs,
saved nursing time, and improved access to
care.
Feedback is needed.
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29
The Cochran Collaboration
P – Population or participant of interest
I – Intervention needed for practice
C – Comparison of interventions to determine
best practice
O – Outcomes needed for practice
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30
Development of Evidence-Based
Guidelines
AHRQ helps with guidelines through
development of an expert panel.
The group designates the scope of the
guidelines.
They synthesize the findings to develop
recommendations for practice.
Guidelines developed are presented at
meetings and published.
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31
Examples of AHRQ Practice
Guidelines
Pain management
Decubiti prediction/prevention
Cataract treatment in adults
Depression treatment
Screening, diagnosis, management of sickle
cell disease in newborns and infants
Otitis media treatment in children
Availability of cardiac rehabilitation services
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32
Access to Evidence-Based Guidelines
Agency for Healthcare Research and Quality
(AHRQ)
National Guideline Clearinghouse (NGC)
Academic Center for Evidence-Based
Nursing
American College of Physicians
American Academy of Pediatrics
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33
Implementing a Model of EvidenceBased Practice
Identify practice problem.
Search for best research evidence.
Determine quality of guideline by assessing:
➢
➢
➢
➢
➢
Authors
Significance of problem
Strength of evidence
Link to national standards
Cost-effectiveness of guideline
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34
Translational Research
An evolving concept defined by the NIH as
the translation of basic scientific discoveries
into practical application
Encouraged by nursing and medicine to
increase the implementation of evidencebased interventions in practice and determine
if these interventions are effective
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35
Understanding Nursing Research
Building an Evidence-Based Practice
SIXTH EDITION
Susan K. Grove, PhD, RN, ANP-BC, GNP-BC
Professor Emerita, College of Nursing, The University of Texas at Arlington, Arlington, Texas
Adult Nurse Practitioner, Family Practice, Grand Prairie, Texas
Jennifer R. Gray, PhD, RN, FAAN
George W. and Hazel M. Jay Professor, College of Nursing, Associate Dean, College of Nursing,
The University of Texas at Arlington, Arlington, Texas
Nancy Burns, PhD, RN, FCN, FAAN
Professor Emerita, College of Nursing, The University of Texas at Arlington, Arlington, Texas
Faith Community Nurse, St. Matthew Cumberland Presbyterian C…
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