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resulted in monumental advances in modern healthcare

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Biomedical, environmental, psychological, and sociological research has

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to expand a professions knowledge base. Currently research focusing on outcomes or evidence-based research has molded clinicians practice in hope of improving health outcomes for recipients.

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One major reason for conducting research is

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Forms the bridge between theory and practice and is sometimes referred to as a bench-side (as in lab bench) to bedside process. It forms the foundation for evidence based protocols and interventions that increase the quality of nursing care and improve patient outcomes.

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Transitional research

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When professional nurses choose to use treatment methods that are based on research. Untested treatment methods may seemingly improve or alter the outcome a patient experiences, but no confirmation exists the choosing the same treatment a second time would similarly improve outcome.

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How are nursing practice and patient outcomes enhanced?

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leads to improved care

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Research based nursing practice

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biopsychocoial fields, such as physiology, pharmacology, psychology, and sociology.

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The science of nursing draws heavily on other sciences in particular

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good research from poor research to know what to use in clinical practice. Therefore they must have a working knowledge of research methods and a beginning ability to read for application and to critique research.

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Nurse must be able to discriminate

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Defined as a formalized process of systematic investigation designed to test a research question or hypothesis and draw conclusions from collected data. Many similarities are found between the formalized research process and the nursing process format that is an integral part of the nursing education. Search for a valid answer to a question.

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Research

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Is defined as systematic inquiry into the problems encountered in nursing practice and into the modalities of patient care, such as support and comfort, prevention of trauma, promotion of recovery, health education, health appraisal, and coordination of healthcare.

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Nursing research

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solutions to research problems, to discover and interpret new facts and relationships, or both

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In addition, Waltz and Bausell included the precision of the research process to gain

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nursing and things that do nurses do that are different from the actions of other disciplines

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Nursing research concerns

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is an approach to healthcare that realized that pathophysiologic reasoning and personal experience are necessary, but not suffceint, for making decisions. This technique emphasizes decision making based on the best available evidence and the use of outcome studies to guide decisions.

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Evidence based practice (EBP)

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a firm foundation of high-grade scientific evidence rather than on experience or opinion

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Advocates of evidence based medicine argue that medical decisions should be based as much as possible on

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one of the pioneers of evidence-based medicine from McMaster University in Canada, defined it as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating clinical expertise with the best available external evidence fro systematic research"

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Dr. David Sackett

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Research, clinical experience, patient experience, and information from the local context

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British nursing leaders have identified four major sources for evidence based nursing

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practitioners are interested in seeking the truth. Nurses interested in improving the health of their clients engage in systematic inquiry designed to develop trustworthy evidence, which forms the basis of EBP.

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Nursing research is identical with that of any other discipline in which

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in relation to the goals of nursing

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Research affects the clinical practice of nurses in all areas, particularly

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develops knowledge about health and the promotion of health over the full lifespan, care of persons with health problems, and disabilities, and nursing actions to enhance the ability of individuals to respond to actual or potential health problems (ANA 1981)

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Historically, nursing has valued research that

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reviews of research or through the use of expert or consensus panels relevant to their areas.

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Specialist become familiar with research related to their disciplines by paying attention to

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generating fundamental knowledge to guide nursing practice. Progress in nursing education, practice, or administration requires systematic analyses of research applicable to a nurses area of expertise.

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The focus of nursing research must be on

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International, nonprofit organization aims to help people make well-informed decisions about healthcare. Through its website (www.cochrane.org) healthcare workers and others can access systematic reviews of relevant randomized controlled trials regarding healthcare interventions

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Cochrane Collaboration and Library

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nurse researchers are expanding the overall sum of nursing knowledge. Research can also yield benefits, in a cost-conscious healthcare arena, that may improve the economics of nursing care

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In addition to generating practice results

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the research model

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The scientific method, the problem-solving method, and the nursing process all use

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formal and informal classes, clinical experience, discussions with classmates or expert panels, scientific problem solving, continuing education courses, and research studies relevant to the area of interest.

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Ways of seeking and finding answers and acquiring knowledge in any field include

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-Identifying what one needs to know or is curious about -Deciding the approach to seeking the answer -Devising a plan -Implementing a plan -Assessing the evidence

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Methods of seeking knowledge of the following common characteristics

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The first step for the nurse is to access the problem, for the researcher it is recognize the general problem area. The next step for the practicing nurse is to making a nursing diagnosis, and defining the specific problem is the second step in the research process. The clinical nurse then proceeds with planning and intervention whereas the researcher proposes hypotheses, tests them through experimental and nonexperimental approaches and manages data. In the final step the clinician evaluates outcomes; the researcher analyzes the data collected and disseminates the findings in relation to the patterns uncovered.

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Practicing Nurse vs. Researcher

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formulate and answer questions they encounter in the clinical setting

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Staff nurses can use the nursing process framework to

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research subject or a data collector for another person's research project. Of course, nurses can conduct research in their practice area, with guidance from others skilled in research methods.

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Another way to become involved in research is to be a

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Florence Nightingale documented the care of soldiers in the Crimean War. Nightingales careful satisitical records are a model for nurses and social scientists.

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Nursing research has been an integral part of the profession since

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identified several historical events that have been key to developments in nursing research. Between 1900 and 1940 research in nursing centered on education, methods of teaching and methods of evaluating how nurses learned.

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LoBiondo-Woood and Haber (2005), Nieswiadomy (2008), ad Polit and Beck (2008)

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began publishing the results of studies by indiviudals and schools of nursing.

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Journal nursing research

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1960's

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When did federal funding for graduate study and research expand?

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provided support for nurses to obtain doctorates (PhDs) in allied fields such as anthropology and psychology because few nursing PhD programs existed at that time

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The federally funded Nurse Scientist Training Program

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Is a leading examples of a current nurse scholar who received such a doctoral degree (anthropology)

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Dr. Madeleine leininger

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With the development of conceptual frameworks (an early stage of theory development wherein interrelated concepts help shape the proposed research) and the use of the scientific method in nursing practice.

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How was the nursing profession strengthened?

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research investigations. Such research endeavors led to improvements in the quality and specificity of nursing care.

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Nursing organizations established priorities for

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Canadian nursing research journal titled Nursing Papers (later renamed the Canadian Journal of Nursing Research). Three more journals of nursing research were born in 1970s: Advances in Nursing Science, Research in Nursing and Health, and Western Journal of Nursing Research.

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In 1969, Dr. Moyra Allen of McGill University started the first

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further research in areas of health promotion, illness prevention, cost effective healthcare, and nursing care for high-risk patients

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In 1981 the ANA commission on nursing research recommended

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urged the federal government to increase the level of funding for nursing research. As a result the National Institute of Research (NIR) was established under the National Institute of Health (NIH). The institutes purpose was to place nursing securely in the sphere of scientific investigation and to supply research and training in patient care, health promotion, and disease prevention as well as the mitigation of efforts of acute and chronic conditions.

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In 1983, a study by the Institute of Medicine (IOM)

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identified 11 research priorities for nursing research: -Promote health -Minimize or prevent behaviorally and environmentally induced health problems -Minimize the negative effects of new health techniques -Ensure that the care needs of particularly vulnerable -Classify nursing practice phenomena -Ensure that principles of ethics guide nursing research -Develop instruments to measure nursing outcomes -Develop integrative methodologies for the holistic study -Design and evaluate alternative models for delivering healthcare -Evaluate the effectiveness of alternative approaches to nursing education for the kind of practice that requires broad knowledge -Identify and analyze historical and contemporary factors

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In 1985, the ANA Cabinet in nursing research

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identified future directions as the need to focus on EPB linked to translational research expansion of local research in healthcare settings, and strengthening of multidisciplinary collaborations

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Polit and Beck (2008)

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physiologic, psychological, sociologic, cultural, and economic factors that affect a person

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When nurses conduct research they tend to focus on

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-The focus of nursing research must be on a variance that makes a difference in improving patient care -Nursing research has the potential for contributing to the development of theory and the body of scientific nursing knowledge -A research problem is a nursing research problem when nurses have access to and control over the phenomena being studied -A nurse interested in research must have an inquisitive, curious, and questioning mind.

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Diers 1979 listed four properties of nursing research and how to maintain a holistic perspective

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Quantitative and Qualitative research

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What are two broad approaches to research?

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Involves the systematic collection of numeric information (referred to as data) usually under conditions of considerable control and the analysis of that information using statistical procedures. This type of research seeks to test theories and hypotheses.

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Quantitative research

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Involves the systematic collection and analysis of more subjective narrative materials (also known as data) using procedures in which there tends to be a minimum of researcher-imposed control.

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Qualitative research

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use deductive reasoning.

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Quantitative researchers tend to

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use dynamic, individual aspects of the human experience in a holistic approach

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Qualitative researchers tend to

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the development of a research idea

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Practical experience, scientific literature and untested theories or theories with limited testing influence

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help you formulate good clinical foreground questions. PICO will also help you determine key words that can help narrow your literature search and find the information you need.

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PICO model is a widely used mnemonic in EBP that will

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Are those that are specific to a particular patient.

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Foreground questions

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of concern in the care of a given patient. POnce the question has been identified the nursing literature within must identify all relevant evidence supporting an answer to the question.

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The first step involves the identification of the clinical question

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profoundly influence the onset of some diseases, the progression of many and the management of nearly all

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Evidence-based studies on how we think, feel or behave

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identification and research based practice

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Taking the opportunity to question and investigate can lead to

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Is the process of selecting published materials that have relevance to the potential research. Doing such a review helps the researcher find out what is already known about the subject and prevents duplication of effort if the subject is already well studied. In addition, it helps illuminate what gaps in knowledge exist in the subject area and can point the way for new research directions.

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Literature review

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it allows the participant to tell his or her story with minimal interruption by the research

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Research interviews can help researchers understand peoples responses to illness or a particular diagnosis because

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speculate about a problem area, particularly if the literature is in conflict or is inconsistent with their own practice.

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Critical appraisal of the scientific literature may lead nurses to

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systematic and exhaustive.

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Literature review must be

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It gives clues on how to study the problem (the methods) and suggests instruments that might help

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A complete review also help develop the conceptual frame of reference for the study

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they provide sources for original articles

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Bibliographies in books and reference lists in articles are valuable because

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the enormous volume of literature in the health sciences. Indexes such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL) PubMed Medline, Cochrane Library, Thomson Reuters Web of Science and Google Scholar are valuable. Such data sources are primarily available online through university libraries and may be available in print, consult a librarian for details.

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Indexes are the gateway to

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Is a set of interrelated constructs or propositions that attempt to present or explain some phenomenon systematically.

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Theory

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systematically the logical relationship between variables. Each nursing model depends on the individual researchers philosophy of human behavior and how that philosophy meshes with other ways of looking at science.

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The nursing model or theory should be a guide to identify and study

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Is a key step in the research process identifies the direction that a research project will take. The problem statement should be clear and unambiguous, express a relationship between two or more variables, identify the population to be studied and encourage empiric testing. It introduced early in the research and should reflect a well-defined specific focus.

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Problem statement

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has no right answer

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The study of values

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or properties that vary from each other, are the focus of the study. For example a researcher studying postoperative patients might be interested in preoperative preparation in relation to the outcome of respiratory function. Variables can be dependent or independent, according to their role in a particular study.

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Variables

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Has the presumed effect on the dependent variable. It may be manipulated if the researcher is doing an experimental study; in a nonexperimental study, it is assumed to have occurred naturally before or during the study.

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Independent variable

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Is what you believe might be influenced or modified by the independent variable or it is the consequence of presumed effect that varies as changes occur in the independent variable. The dependent variable is the one that the researcher is interested in understanding and explaining.

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Dependent variable

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Testability. If the question is posed in such a way that there is a relationship between an independent and a dependent variable and that relationship can be measured, it is likely that the question can be researched

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What is the final consideration when evaluating a research problem?

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Is the overall plan for the collection and analysis of the data. The study's design is crucial. If the design can limit the number of research problems before the study, the outcome may be more useful. If an instrument is to be used in a study or a new instrument needs to be developed, a consultant in methods (a methodologist) can alleviate some reliability and validity problems by helping the novice researcher select or develop the instrument.

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Research design

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institutional review boards (IRBs) before implementation

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Research involving human subjects also needs approval by

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raw form of the answer

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Data are not the final results. They are a

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objectively and subjectively

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Researchers look for patterns of information and they may analyze this information

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the responsibility of researchers in interpretation. Researchers return to their original question or problem statement and should be able to answer it with the analysis and interpretation of the results.

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The results must make sense and be consistent with the data this is part of

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It is a good way to disseminate and expand one's knowledge. A bonus of presenting the results at meetings or publishing them may be the researcher will meet other nurses with similar interests

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Networking

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Held at rotating sites in the western United States, and the Sigma Theta Tau State of the Science Congress on nursing Research. Nurses from all educational backgrounds and experiences benefits from attendance at these types of meetings.

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Western Institute of Nursing (WIN)

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nursing professionals ascertain the best evidence provided by research to inform their practice.

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EBP is an outcome of translational research. In this process

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To provide patients with the highest quality individualized care based upon thorough assessment and history taking, sound research evidence, clinical proficiency and information from the patient on values and care preference to ensure favorable outcomes.

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What is the goal of EBP

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human rights or subject rights. In the past, research has been conducted without proper consent or any consent from the participants. There has been an evolution of ethical principles in nursing, as in all research projects.

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Ethical and legal issues related to research process continues to arise. The primary issue is that of

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-Self-determination -Privacy and dignity -Anonymity and confidentiality -Fair treatment -Protection from discomfort and harm

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What are the 5 rights outlined by the ANA human rights guideline?

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Any agency applying for funding for any project involving biomedical or behavioral research on humans to submit assurances that it has an IRB to look over the research and protect the rights of human subjects.

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1974 National Research Act required

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Because the tribunal had no measuring against which to test the defendants a set of basic principles of ethical, moral, and legal concepts for the conduct of acceptable experiments had to be written.

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Why are IRBs necessary?

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addresses the rights of research subjects. Voluntary consent the right to withdraw from investigations at any time without penalty, the protection from physical and mental suffering, injury, disability, and death, and a balance between benefits and risks are paramount.

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The first statement of the Nuremberg code developed in 1949

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See page 128

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Nursing researchers must provide the following information to human subjects

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A position founded on the assumption that researchers were concerned about the participants well-being and wished to protect them.

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Informed consent

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guides in maintaining the right of research participants when the specific goals of research projects are determined

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The ethical principles of autonomy, beneficence, and justice serve as

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is the protection of the subject so that not even the researcher can link the subject to the information provided.

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Anonymity

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Ensures that the subjects' identities will not be linked with the information they provide and will not be publicly divulged.

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Confidentiality

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Health Insurance Portability and Accountability Act (HIPAA). A key federal regulation covered under HIPAA is the privacy rule that outlines the handling of protected health information (PHI) by certain healthcare groups.

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Furthermore, in 1996 the U.S federal government enacted the

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nurses actually have a great deal to contribute by observing patient responses to treatments and techniques

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Some nurses think mistakenly that they have little to contribute to research when in fact

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they can do their own research, act as consultants to novice researchers and collaborate with other healthcare professionals on more complex patient situations

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The education of nurses who are in advance practice usually emphasize clinically relevant research. In their practice arena,

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guidelines for the investigative function of nurses. These standards give information about how different educational levels may enhance the research contributions that nurses can make.

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The ANAs commission of nursing education has developed

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practice nurses translate clinical problems into research projects

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The problem solving methods that nurses use can help

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define and seek solutions to various problems. Nurses interested in research use of observation skills discussions with colleagues and personal clinical experience can learn to organize priorities and offer patients the most efficient and timely care.

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Patient care informed by research findings allows nurses to

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various conditions (variables) that affect the situation

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Nurse researchers broaden the area of study and try to discover

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the breadth of evidence needed for EBP. The agency for Health Care Policy and Research (AHCPR) was established in December 1989 under public law.

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No one discipline can provide

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a part of the US department of health and human services, was reauthorized on December 6, 1999 as the agency for healthcare research and quality (AHRQ) and functions as the lead agency charged with supporting research designed to improve the quality, safety, efficeincy and effectiveness of healthcare for all americans.

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What is the AHCPR

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quality and reduce cost, demonstrating that solid scientific research can identify how to target and design cost-reduction efforts without jeopardizing quality and how to improve quality without increasing costs

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The adoption of AHRQ recommendations has enabled the public and private sectors to improve

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usually does not involve student nurses and novice nurses. Even with limited direct participation in research, novice nurses should be consumers of research. They can read research literature applicable to the practice setting and attempt to evaluate it or use it in clinical practice after collaboration with more expert practitioners

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Direct research except in the role of data collection or administration of medications and treatments as a protocol in a research project

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keep learning and being aware that every day, new practices could be employed with knowledge gained through research and new evidence.

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Knowing that the answers are not always known, the nurse is wise to

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appraise, synthesize, and use the best evidence for nursing care

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Practitioners need skills and resources to

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directly applicable to their situation

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Nurses should view the contents of published studies with some degree of skepticism before adopting them to the clinical setting in which they function, as the research may not be

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appropriate approaches to patient care sitations

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In conjunction with research findings a planned program of evaluation and implementation will help nurses find

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