Nursing Research & Evidence-Based Practice – Flashcards
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Nursing Research
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- Provides the scientific basis for the practice of the profession
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Focus of Nursing Research
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- Understanding & easement of symptom of acute & chronic illness - Prevention of disease/disability - Effective approaches to achieve & sustain optimal health - Improvement of clinical settings - Professional socialization - Educational processes
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*Baccalaureate Programs
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- Basic understanding of research processes - Apply research findings from nursing & other disciplines to clinical practice - Understand basic elements of EBP - Identify potential research problems - Participate in research
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*Masters Program
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- Evaluate research findings - Develop & implement EBP Guidelines - Identify practice & systems problems - Collaborate with scientists to initiate research
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Practice-Focused Doctoral Programs (DNP)
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- Prepares for the highest level of nursing practice - Evaluation and use of research rather than the conduct of research - Translate scientific knowledge into complex clinical interventions - Evaluate the translation of research into practice - Collaborate with scientists on hew health policy research opportunities
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Research-Focused Doctoral Programs (Ph.D.)
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- Pursue intellectual inquiry - Conduct independent research for the purpose of extending knowledge - Plan & launch an independent program of research
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Scientific Method
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- Foundation of Research - Most reliable & objective for gaining knowledge - Used to explain, predict, or control a nursing phenomenon - Systematic step-by-step process - Ensure that findings from a study are valid, reliable, generalizable, and to similar groups of people
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Limitation of Scientific Method
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- Traditional, scientific, quantitative research cannot solve all nursing research problems - Health care settings are not comparable to laboratories - Humans are too complex - Nursing also requires research that is "nonobjective" . Nursing research often is interested in the patient's lived experience.
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Problem solving
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- Using generic methods in an orderly manner for finding solutions to problems
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Problem Solving vs. Scientific Method
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- Problem solving is specific to a given situation - Problem solving is designed for immediate action -- Research is generalizable (transferable) to other situations. - Research deals with long-term solutions rather than immediate ones
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Nursing Research Cont'd
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- Systematic inquiry or study conducted to generate new knowledge or to refine existing knowledge
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Quantitative
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- Uses deductive reasoning - General to specific - Conclusions are drawn by logical inference from given premises - If it is applicable generally, then it will be applicable to one similar case - Using broad facts, principles, laws, or theories to address narrower yet related phenomenon
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Major Classes of Quantitative Research
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- Experimental research - Researchers actively introduce an intervention or treatment - Non-experimental research - Researchers collect data without intervening or introducing treatments
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Qualitative Research
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- Study of phenomena that are difficult to quantify or categorize - Inductive reasoning - Develop generalizations or theories - Information obtained from interviews or focus groups - Smaller sample size
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Inductive Reasoning
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- Process begins with a particular experience (experiment or research inquiry) and proceeds to generalizations - Smaller, narrower concepts/variables and formulate new propositions - leads to New facts, principles, laws, theories
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Types of Qualitative Research
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*- Ethnography (systematic study of people and culture) - Phenomenology (study of structures of consciousness as experienced from the first-person point of view) - Grounded theory (systematic methodology in the social sciences involving the construction of theory through the analysis of data)
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Institutional Review Board (IRB)
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- a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans
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*Informed consent means
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- Participants receive full and complete information - They can understand the information - They have free choice to participate - They understand how their confidentiality will be kept
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Evidence-Based Practice
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- Integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care - Safe, effective delivery of patient care requires the use of nursing practices consistent with the best available knowledge - This includes use of clinical expertise and patient preferences and values in addition to current best research evidence
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Evidence-Based Practice Cont'd
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- Using the best available research findings for making clinical decisions - Patient care guidelines that are based on synthesized research findings
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History of EBP in Nursing
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- First systematically introduced in nursing with the Conduct and Utilization of Research in Nursing (CURN) project in the late 1970's - Reviewed 10 common nursing procedures - The project developed research-based clinical protocols - implement to practice and measured outcomes
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Research utilization
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- involves critical analysis and evaluation of research findings and then determining how these findings fit into clinical practice. Research findings are the only source of evidence (NOT EBP)
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Quality improvement
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- focuses on systems, processes, satisfaction, and cost outcomes, usually within a specific organization
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EBP: What is it?
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- EBP is a framework for clinical practice that incorporates the conscientious, explicit, and judicious use of the current best evidence in making decisions about care - EBP is the integration of best research evidence with clinical expertise and patient values
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Relevance of EBP in Nursing
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- helps resolve problems in the clinical setting - results in better patient outcomes - contributes to the science of nursing through the introduction of innovation to practice - keeps practice current and relevant by helping nurses deliver care based upon current best research - Decreases variations in nursing care and increases confidence in decision-making - Supports Joint Commission-readiness since policies and procedures are current and include the latest research - Essential for high quality patient care and achievement of Magnet status
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Barriers to EBP in Nursing
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- Lack of value for research in practice - Difficulty in changing practice - Lack of administrative support - Lack of knowledgeable mentors - Insufficient time - Lack of education about the research process - Lack of awareness about research or evidence-based practice - Research reports/articles not readily available - Difficulty accessing research reports and articles - No time on the job to read research - Complexity of research reports - Lack of knowledge about evidence-based practice - Lack of knowledge about the critique of articles
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Strategies to promote EBP
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- educate yourself - share with peers and support other nurses - develop a Center for Evidence-Based Practice - administrative support with time and funds for resources - access to electronic resources in the workplace - enhance job descriptions to include criteria related to evidence-based practice - offer incentives - opportunities for collaboration with researchers and experts
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PICO(T)
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P - Patient, Population, or Problem I - Intervention or Exposure or Topic of Interest C - Comparison or Alternate Intervention O - Outcome (T) - Time or timeframe
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Classification Systems
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- Meta-analysis or systematic reviews - Well-designed randomized controlled trials *- Well-designed non-randomized controlled trials (quasi-experimental) - Observational studies with controls - Systemic review of descriptive or qualitative studies - Single descriptive or qualitative studies - Opinions of authorities, expert committees
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Clinical Guidelines Resources
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- National Library of Medicine - Cochrane Library - National Guideline Clearinghouse - Joanna Briggs Institute - Agency for Healthcare Research and Quality - Centre for Health Evidence
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Appraisal of Guidelines for Research and Evaluation (AGREE II)
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- Scope and Purpose - Stakeholder Involvement - Rigor of Development - Clarity and Presentation - Application - Editorial Independence
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Scope and Purpose
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- Overall objectives of the guideline are specifically described - The Health questions covered by the guideline are specifically described - The population to whom the guideline is meant to apply are specifically described
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Stakeholder Involvement
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- Guideline development group includes individuals from all relevant professions - The views and preferences of the target population have been sought - Target users of the guideline are clearly defined
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Rigor of development
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- Systematic methods were used to search for evidence - The criteria for selecting the evidence are clearly described - The strengths and limitations of the body of evidence are clearly described - The methods used for formulating the recommendations are clearly described - The health benefits, side effects, and risks have been considered in formulating recommendations - There is an explicit link between the recommendations and the supporting evidence - The guideline has been externally reviewed by experts prior to publication - A procedure for updating the guideline is provided
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Clarity and presentation
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- Recommendations are specific and unambiguous - Different options for management of the condition or health issue are clearly presented - Key recommendations are easily identifiable
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Application
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- The guideline describes facilitators and barriers to its application - The guideline provides advice and/or tools on how the recommendations can be put into practice - The potential resource implications of applying the recommendations have been considered - Guideline presents monitoring and/or auditing criteria
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Editorial independence
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- The views of the funding body have not influenced the content of the guideline - Competing interests of guideline development group members have been recorded and addressed
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*Models of EBP Nursing
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- (ACE) Star Model of Knowledge Transformation - The Iowa Model of Evidence-Based Practice - Agency for Healthcare Research and Quality Model - Johns Hopkins Nursing Evidence-Based Practice Model
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ACE Star Model of Knowledge Transformation
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Five Steps - Knowledge discovery - Evidence summary - Translation into practice recommendation - Integration into practice - Evaluation
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Iowa Model of Evidence-Based Practice to Promote Quality Care
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Three critical decision points - Decide whether problem is a sufficient priority for the organization exploring possible changes - Decide whether there is a sufficient research base - Decide whether change is appropriate for adoption in practice
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Iowa Model of Evidence-Based Practice
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- 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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Johns Hopkins Nursing Evidence-Based Practice Model
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- Recognizes the different sources of evidence - Research Evidence Appraisal - Non-research Evidence Appraisal - Strength of evidence - Levels 1,2,3 & quality rating of low-good-high
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Agency for Healthcare Research & Quality Model
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- Three major stages of knowledge transfer - Knowledge creation and distillation - Diffusion and dissemination - Organizational adoption & implementation
