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Nursing Research

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Definition: systematic inquiry or study conducted to generate new knowledge or to refine existing knowledge

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Nursing Research Results

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Results provide foundation for practice decisions and behaviors Results create strong scientific base for nursing Results provide support for the quality and cost-effectiveness of interventions Application of results demonstrates professional accountability to insurers and health care consumers

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Florence Nightingale: Crimean War Research focus, 1900 to 1940

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Nursing education Student characteristics Student satisfaction

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Research focus, 1950s to 1970s

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foci on nurses Teaching Administration Curriculum issues 1970's-improvement of pt. care

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Research focus, 1980s

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Naturalistic paradigm More qualified researchers Widespread availability of computers for data collection and analysis Qualitative studies

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Research focus, 1990s

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Health care health care delivery issues such as cost, quality, and access

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Research focus of 21st century

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evidence base for practice

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NINR Research Foci

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Health promotion and disease prevention Quality of life Health disparities End of life

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Potential Funding Areas

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Determining disease risk and treatment through utilizing genetic information Determining effective health-promotion strategies for individuals, families, and communities Discovering approaches that encourage people to effectively take responsibility for symptom management and health promotion Assisting in identification and effective management of symptoms related to acute and chronic disease Improving clinical settings in which care is provided Improving quality of caregiving in long-term care facilities, the home, and the community Understanding predisposition to disease, socioeconomic factors that influence health, and cultural health practices that protect from or expose to risk for health problems Improving symptom management for those at end of life

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Agency for Healthcare Research and Quality (AHRQ)

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An agency of the U.S. Department of Health and Human Services that aims to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services

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The 1999 reauthorizing legislation expanded the role of the agency by directing AHRQ to:

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Improve quality of health care through scientific inquiry, dissemination of findings, and facilitation of public access to information Promote patient safety and reduce medical errors through scientific inquiry, building of partnerships with health care providers, and establishment of Centers for Education and Research on Therapeutics (CERTS) Established an office for priority populations to ensure that the needs of low-income groups, minorities, women, children, older adults, and individuals with special health care needs are addressed by the agency's research efforts Advanced use of information technology for coordinating patient care and conducting quality and outcomes research

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Private Foundations

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Robert Wood Johnson W.K. Kellogg Foundation Helene Fuld Trust

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Nursing Organizations

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Sigma Theta Tau International (STTI) Oncology Nurses Society (ONS) American Nurses Foundation (ANF)

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Components of the Research Process

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Formulating the research question or problem Defining the purpose of the study Reviewing related literature Formulating hypotheses and defining variables Selecting the research design Selecting the population, sample, and setting Conducting a pilot study Collecting the data Analyzing the data Communicating conclusions

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Study Designs

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Plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific research questions

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Quantitative Designs

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Case study: Survey: Needs assessment: Methodologic: Meta-analysis: Experimental: Quasi-experimental: Secondary analysis Triangulation: Pilot studies:

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Case study

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provides an in-depth analysis of a single subject, group, institution, or social unit

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Survey:

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used to collect large amounts of information with little expenditure of time and money

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Needs assessment:

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determines what is most beneficial to an aggregate group

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Methodologic:

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focuses on development and testing instruments to improve their reliability and validity

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Meta-analysis:

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an advanced process by which research on a specific topic is reviewed and findings of multiple studies are statistically analyzed and expressed quantitatively

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Experimental:

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studies that include the manipulation of one or more independent variables, random assignment to a control or a treatment group, and observation of the outcome or effect that is presumably the result of the independent variable

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Quasi-experimental:

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lacks one of the components of experimental design, i.e., randomization, control group, or manipulation of one or more variables

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Secondary analysis

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involves asking new questions on data collected previously. The data may have been generated from previous formal research or may have been gathered through any previous systematic collection of data.

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Triangulation:

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use of various research methods or data collection techniques in the same study

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Pilot studies:

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small-scale studies referred to as feasibility studies; purpose is to identify strengths and limitations of a larger planned study

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Qualitative Designs

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a method of research designed for discovery rather than for verification: Phenomenology Ethnography Grounded theory

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Phenomenology:

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method used to study intangible experiences such as grief, hope, or risk taking. It is designed to provide an understanding of the patient's "lived experience."

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Ethnography:

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a method used to study phenomena from a cultural perspective

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Grounded theory:

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a method designed to explore a social process

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Using Research in Practice

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Research utilization Locating published research Critical appraisal of nursing research

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Research utilization

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there is extensive concern that nurses have failed to realize the potential for using research findings as a basis for making decisions and developing interventions

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Locating published research

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focus on the usefulness of computerized databases such as CINAHL and MEDLINE and the Annual Review of Nursing Research

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Critical appraisal of nursing research

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Blind review Abstract and findings may be the easiest sections of a research report for the novice to understand

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Advancing Evidence-Based Practice

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Assessment of barriers to EBP Corrections of misperceptions about EBP goals and processes Questioning current clinical practice

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Nurse Researcher Roles

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Clinical nurse specialist (CNS) Clinical nurse researcher (CNR)

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Clinical nurse specialist (CNS)

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master's degree-prepared nurse who is an expert clinician with additional responsibility for education and research: assesses agency's readiness for research utilization; works with staff to identify clinical problems; helps staff find, implement, and evaluate findings relevant to current practice

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Clinical nurse researcher (CNR)

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doctorally prepared with clinical and research experience Focuses on the conduct or facilitation of research Works with staff to identify research questions Designs studies Disseminates findings to staff, administrators, and legislators Emerging roles DNP and CNL

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Types and Levels of Evidence

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Journal article describing a single study Systematic review methods (meta-analysis and meta-synthesis) Intervention guidelines Patient values and preferences Expert opinion Theory-based information Compiled databases

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Critical Appraisal of Nursing Research

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Blind review Abstract and findings

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Examples of Evidence-Based Practice

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Heparinized saline for flushing peripheral intravenous catheters Interventions such as exercise for cancer-related fatigue Prevention and treatment of pressure ulcers

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Clinical practice guidelines

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developed by AHCPR (Agency for Health Care Policy and Research) in 1992 -Acute pain care management in infants, children, and adolescents -Prediction and prevention of pressure ulcers in adults -Identification and treatment of urinary incontinence in adults

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Ethical Issues Related to Research

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...

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Institutional review

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IRB or Human Subjects Committee required by institutions receiving federal funding

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Historical examples of unethical research

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Nazi experiments Tuskegee syphilis study Jewish Chronic Disease Hospital in New York

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Summary

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-Educators must prepare students to appreciate and conduct research and evaluation at their level of preparation -Health care administrators must foster research -Consumers must be educated about the value of nursing research -Policymakers must be informed about findings, so results can be translated

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Clinical nurse researcher (CNR)

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An advanced practice nurse who is doctorally prepared and directs and participates in clinical research.

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Clinical nurse specialist (CNS)

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An advanced practice nurse who provides direct care to clients and participates in health education and research.

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Clinical practice guideline (CPG)

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an evidence-based guide to clinical practice developed by experts in a particular field for direct application in clinical environments.

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Control group

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Subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. When a true experimental design is not used, this group is usually called a comparison group.

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Data collection

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The process of acquiring existing information or developing new information.

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Empirical

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Having a foundation based on data gathered through the senses (e.g., observation or experience) rather than purely through theorizing or logic.

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Ethnography

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A qualitative research method for the purpose of investigating cultures that involves data collection, description, and analysis of data to develop a theory of cultural behavior.

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Evidence-based practice

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The process of systematically finding, appraising, and using research findings as the basis for clinical practice.

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Experimental design

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A design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena.

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Generalizability

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The inference that findings can be generalized from the sample to the entire population.

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Grant

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Proposal developed to seek research funding from private or public agencies.

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Grounded theory

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A qualitative research design used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process.

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Randomization

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The assignment of subjects to treatment conditions in a random manner (determined by chance alone).

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Secondary analysis

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A research design in which data previously collected in another study are analyzed.

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State-of-the-science summary

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A merging of findings from several studies concerning the same topic. Examples include meta-analysis with a quantitative approach and integrative review with a descriptive approach.

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Survey

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A nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants.

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Triangulation

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The use of a variety of methods to collect data on the same concept.

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Purpose and Results of Nursing Research

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The purpose of nursing research is to generate knowledge that may support current practice or lead to refinement of practice. Historically, nurses did not question many activities that were taken for granted, such as the following: Schedules for changing IV sites or wound dressings End-of-shift report procedures Handwashing procedures More recently, nurses have started to question these kinds of activities through research that leads to evidence-based practice changes that benefit nurses and patients.

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Nursing Research in the 20th Century

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For most of the 20th century, nursing research focused on nursing education and nurses. This time has been referred to as the period when nurses were studying themselves. In the latter third of the 20th century, nurses started exploring research topics of relevance to patient care and health care systems. During this time, nurses began to conduct research studies using the naturalistic, or qualitative, paradigm.

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Nursing Research in the 21st Century

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In this century, nurse researchers are exploring a vast array of topics in basic research and clinical research. Some researchers work in laboratories to improve patient outcomes by studying various biologic and physiologic properties of the following: Cells Body fluids Animals Other researchers in the clinical area work with people (individuals, families, groups, populations) and organizations.

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What is clinical research?

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The National Institutes of Health (NIH) Director's Panel on Clinical Research (CRP) executive summary (dated December 1997), outlines a three-part definition of clinical research: Patient-oriented research in which researchers directly interact with human research participants Epidemiologic and behavioral studies Outcomes research and health services research

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What is basic research?

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Basic research is designed to gain a more comprehensive knowledge or understanding of the following: Human anatomy, physiology, and biology Mechanisms and processes of disease Researchers conducting basic research may work solely in a laboratory rather than with human research participants. Close

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Who Sets Research Priorities?

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Research priorities are most often set by the groups that fund research. These groups include governmental funding through congressional appropriations, private foundations, and nursing organizations. Each of these groups has specific priorities that are determined by other factors, such as the following: Boards of directors Members Areas of focus Federal congressional mandates Research priorities encourage nurses to invest effort into areas of research that are most likely to generate the most benefit to the recipients of nursing care.

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Funding Research

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Although some small research projects can be undertaken with only personal funding, most research requires financial support. Money typically is needed to cover the following types of costs: Paying personnel employed by the project Purchasing or developing data collection materials, such as buying or copying paper-based instruments or obtaining biologic samples Paying for data analyses, such as sophisticated examination of blood or body fluid samples Funding travel to present the study's results to various groups Several groups have research priorities and fund nursing research that match those areas of interest. Let's look at some of those groups.

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National Institute of Nursing Research (NINR)

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The National Institute of Nursing Research (NINR), a section of the National Institutes of Health (NIH), is recognized as the premier organization for funding nursing research. NINR's mission is to promote and improve the health of individuals, families, communities, and populations.

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To accomplish its mission, NINR supports clinical research, basic research, and research training on issues related to health and illness across the lifespan, from prenatal care to the elderly. The focus of research funded by NINR includes the following:

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Health promotion and disease prevention Quality of life Health disparities End-of-life

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Agency for Healthcare Research and Quality (AHRQ)

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The Agency for Healthcare Research and Quality (AHRQ) is the health services research arm of the U.S. Department of Health and Human Services. Its mission—to improve the quality, safety, efficiency, and effectiveness of health care for all Americans—complements the biomedical research mission of the NIH.

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The AHRQ funds research studies focused on the following topics:

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-Quality improvement and patient safety -Outcomes and effectiveness of care -Clinical practice and technology assessment -Health care organization and delivery systems -Primary care (including preventive services) -Health care costs and sources of payment

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Private Foundations

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Private foundations are an important source of funding for health care projects and research. Two of the largest private foundations are the Robert Wood Johnson Foundation and the W.K. Kellogg Foundation.

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Organizations

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Several nursing organizations fund research studies. The focus of the organization determines the type of funding available. Some organizations are more general in scope (such as Sigma Theta Tau International and the American Nurses Foundation) and some are specialized (such as the Oncology Nursing Society, the Association of Women's Health, Obstetric and Neonatal Nurses, or any other specialty organization). Most nursing organizations provide limited funding for a project, often $10,000 or less. These organizations, therefore, are most appropriate for funding small, targeted, and/or pilot studies.

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Components of the Research Process There are four steps in the research process:

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1. Conceptualization—Identify what needs to be done 2.Planning—Decide how to proceed 3. Implementation—Put your plan into action 4. Communication—Make sure others know about it

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Quantitative Designs

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Quantitative research is a formal, objective, systematic process that defines, measures, and reports on relationships or variables using statistical analyses. Quantitative studies include the following features: Focus on "why" questions Production of generalizable knowledge Precise use of data collection instruments Formalized and strict protocols for collecting data Investigation of a very specific and narrow area of inquiry Often use large samples

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Qualitative Designs

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Qualitative research is a formal, systematic approach for exploring and describing persons' experiences and the meanings attached to those experiences. Qualitative studies include the following features: Focus on "how" questions Enhances in-depth understanding of specific situation or context Data collection open to modification during the study Exploration of unknown or little known areas Often uses small samples

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Institutional Review Board

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Universities and most major health care institutions establish an institutional review board (IRB) or Human Subjects Committee to review proposals for research studies. This committee is charged with protecting the rights of persons who participate in research. For example, IRB members are responsible for assuring that minimal regulatory review requirements are met and that these requirements are properly documented in the IRB's minutes. IRBs are charged with reviewing the following specific areas: Right to privacy and confidentiality Equitable selection of participants Potential for risks in relation to benefits In addition to reviewing the research proposal for these specific topics, IRBs also review the content of consent forms. Persons participating in medical research studies must sign consent forms as evidence that they received specific information about the study and their rights as participants.

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