Florence Nightingale, besides being the founder of modern nursing, was also the founder of nursing research. She identified problem, collected data, analyzed the data and came to a conclusion. Nightingale used the results of her data analysis to convince the Secretary of the Army to change the way soldiers were being cared for. These changes resulted in a decrease in mortality and morbidity for the soldiers in the Crimean War.
Since nursing is an emerging profession, research in nursing focused on providing support for nursing’s status as a profession. Besides the conducting research on nursing education, studies were done that focused on the organization and delivery of nursing services, the kinds and numbers of nursing personnel, staffing patterns, patient classification systems, patient and personnel satisfaction and unit arrangements.
Research on the role of the nurse evolved into a five year study on nursing functions and activities reported in the ANA publication: Twenty Thousand Nurses Tell Their Story. Studies on the most effective ways to educate nurses were also done at this time. Mildred Montag, developed and evaluated the two year technical nurse program whose purpose was to alleviate the nursing shortage of that era. These graduates eventually attained equality with graduates of other program levels.
Nursing research in the 1970’s emphasized the nursing process, differentiation of levels of practice, and nursing care delivery models. Primary nursing care, which replaced team nursing was considered the nursing care delivery model. There were primary nurses who were responsible for patients 24 hours a day who worked with associate nurses who would care for the patient when the primary nurse had the day off. The associate nurse could call the primary nurse at any time with questions regarding the patient. The 1970’s showed an increase in nurse scientist activities with the development of nursing conceptual frameworks and theories to guide practice. Imogene King, Hildegard Peplau, etc. were some of the early theorists. Evidence based practice was first introduced by Professor Archie Cochrane . He advocated the provision of health care based on research to improve the quality of outcomes. The Cochrane Center was established in 19992 and the Cochrane Collaboration in 1993
In order to generate empirical knowledge through research, the CURN (Conduct and Utilization of Research in Nursing) and WICHE (Western Interstate Commission for Higher Education) actualized research-based nursing education. Nurse researchers with the assistance of federal funding designed and implemented strategies for nursing research utilization. Greater funding for nursing research was a priority and federal research dollars started flow to nurse researchers. In 1985, the National Center for Nursing Research was created. Other agencies followed in its stead.
In the 21st century, emphasis was on providing quality nursing care through evidence based and outcomes research. The aim was to provide quality, comprehensive, patient care.
Quantitative research in narrow in scope and deems that reality is objectiveQuantitative research is much broader in scope, subjective and relies on the human experience. Outcomes research examines the results of care and measures the changes in the health status of patients.Intervention research determines how effective nursing interventions are in achieving patient care outcomes. Method of quantitative research include:Descriptive-provides an accurate portrayal of a phenomenonCorrelational-investigates relationships b/w variablesQuasi-experimental-identify causal relationships; examine the significance of causal relationships, clarify why certain events happened, combination of the othersQualitative MethodsPhenomenological-humanistic study of phenomena: lived experienceGrounded theory: Formulates, tests,and redevelops propositions until a theory evolvesEthnographic research: in-depth investigation of culturesHistorical research: narrative description of things that occurred in the remote or recent past.Philosophical Inquiry: Clarify meanings, make values manifest, identify ethics, study the nature of knowledgeCritical social theory: focus on understanding of how people communicate and develop symbolic meanings for society.
Evidence based nursing practice has developed alongside evidence based medicine and public health. Nurses who are in control of their own practice, critically read research articles to enable them to make decisions about is best practice.
Lesson One: Evolution of EBP in Nursing
Historical Development of Research in Nursing Florence Nightingale Early 1900s 1950’s , 1960’s 1970’s 1980’s, 1990’s Twenty-first century
Florence Nightingale Utilized statistics to support problem Investigated environmental impact on patient care Reduced soldier’s mortality rate in Crimean War Instituted change
1950’s to 1960’s ANA: Research on what nurses do Specialty nursing research Nursing education studies Establishment of nursing research departments in universities Clinical studies increase
1970’s Nursing process Nursing Diagnosis Evaluation of teaching methods Evaluation of different levels of nursing practice Primary care nursing Theories and Frameworks
1980’s, 1990’s A variety of clinical journals emerge Research based nursing interventions created WICHE CURN Increased advanced education
21st Century Quality Studies Nursing Evidence Based Practice Focus: Health promotion and illness prevention
Types of Research in Nursing Quantitative Qualitative Outcomes Intervention
Best Research Evidence for Practice Best research to support clinical decisions in practice Summary of the highest quality, current empirical knowledge Developed from a synthesis of quality studies