53 a focus 5 research & ebp
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  • 1. 11/30/2010 Nursing Fundamentals Focus XII The Role of Research in the Development of Nursing Theory and PracticeModule for Chapter 2-Berman30-35; 41-42 Objectives: • Compare and contrast the seven ways of acquiring knowledge • Discuss the advantages and disadvantages of each • Examine 5 characteristics of the scientific method of acquiring knowledge and explain why it is important in nursing. • List the different types of research and describe the differences • Explain the importance of nursing research in the development of nursing theory • Identify some of the limitations of the scientific research process. Acquiring Knowledge • What is knowledge? • How is it acquired? • Is it based on research? 1
  • 2. 11/30/2010 Acquiring Knowledge• Knowledge – Essential information acquired in a variety of ways – Accurate reflection of reality – Incorporated and used to direct a person’s actions (Kaplan, 1964). Acquiring Knowledge• Quality of knowledge – Question the quality and credibility – Sources of knowledge – Nursing interventions: • Tradition • Research • Borrowed • Trial and error • Personal experience • Role modeling • Intuition • Reasoning Acquiring Knowledge• Traditions – “truths” or beliefs based on customs and trends – Transferred by: • written and oral communication • role modeling – Narrow and limit knowledge – Not tested for accuracy or efficiency 2
  • 3. 11/30/2010 Acquiring Knowledge• Authority – Person with power and expertise – Influences opinion and behavior – Given to a person because they are perceived to know more in a given area • Quoting someone – authors • Instructors • Clinical nursing experts – Maintain traditional ways of knowing Acquiring Knowledge• Borrowing – Appropriation and use of knowledge from other fields or disciplines to guide nursing practice. – Using medical model to guide their nursing practice • Diagnosis and treatment of the disease – Integrating information from other disciplines within the focus of nursing. • Blurred boundaries • May not answer the question generated in nursing Acquiring Knowledge• Trial and Error – Used in situations of uncertainty – Other sources of knowledge are not available – Knowledge is gained from experience – Documentation of effective and ineffective practices does not exist – May be detrimental to patient’s health – Time consuming 3
  • 4. 11/30/2010 Acquiring Knowledge• Personal Experience – Being personally involved in an event, a situation, or a circumstance – Gain skills and expertise by providing care – Nurse can cluster ideas into a meaningful whole • Read about it, told about it, observed it and now do it repeatedly• Novice to expert –Benner Acquiring Knowledge• Benner’s Novice to Expert – Novice • No experience • Preconceptions and expectations – Challenged, refined, confirmed, or refuted by clinical experiences – Advanced beginner • Just enough experience to recognize and intervene in recurrent situations – Competent Nurses • Generate and achieve long-range goals and plans • Conscious, deliberate actions that are efficient and organized Acquiring Knowledge• Benner’s Novice to Expert – Proficient nurse • Views patient as a whole and member of the family • Recognizes each patient and family responds differently to illness and health – Expert Nurse • Extensive background of experience • Able to identify accurately and intervene skillfully in a situation • Grasps a situation with intuition, speed and accuracy – Benner, 1984 – Qualitative Research 4
  • 5. 11/30/2010 Acquiring Knowledge Role Modeling• Role Modeling – Imitating behaviors of an expert – Admired teachers – Expert clinicians – Researchers – Inspirational people• Mentorship – Expert nurse serves as teacher, sponsor, guide, counselor Acquiring Knowledge• Intuition – Insight into or understanding of a situation or event as a whole that usually cannot be explained logically. – “gut feeling” “hunch” – Result of deep knowing Acquiring Knowledge• Reasoning – Processing and organizing of ideas in order to reach conclusions – Make sense of both their thoughts and experiences.• Logical thinking – Inductive reasoning – specific to general • Particular instances are observed and then combined into a larger whole or general statement – Deductive reasoning – general to specific 5
  • 6. 11/30/2010 Acquiring Knowledge Inductive Reasoning Deductive Reasoning • Particular Instances • Premise – statement of – A headache is an altered level proposed relationship between of health that is stressful two or more concepts – A terminal illness is an altered • Premises: level of health that is stressful. – All human beings experience • General Statement loss – Therefore it can be induced – All adolescents are human that all altered levels of health beings are stressful • Conclusion – Therefore it can be deduced that all adolescents experience loss. Benefits of Nursing Research• Improve client care• Expand the body of knowledge• Explore and describe new phenomena to enhance understanding• To generate a theory development• To provide sound rationales for nursing interventions• Clients who are subjects in a study – may receive care they would not have received – some receive stipends – enhanced self esteem from being apart of something that may help societyPages 307-308-Harkreader Risk of Nursing Research Physiological Factors Physical factors • fatigue and anxiety • Physical harm • related to: • Discomfort • self disclosure • Adverse effects • loss of privacy • time 6
  • 7. 11/30/2010 Risk of Nursing Research • Sociological factors – loss of time – financial costs – transportation expenditures that may not be reimbursed Page 308 - Harkreader Ethics of Nursing ResearchRisk/Benefit Ratio – • Competent investigator to conduct the research • Safeguards the subjects• Risk: • Probability harm may occur • Weigh severity and magnitude of harm• Benefit: • Positive value related to health and welfare of subject and othersPage 308-309 - Harkreader Ethics of Nursing Research • Review Board - – Institutional Review Board (IRB) • committee whose duties include making sure that proposed research meets the federal guidelines for ethical research. • the committee is mandatory in institutions receiving federal funds for research • Page 308-309 - Harkreader 7
  • 8. 11/30/2010 Ethics of Nursing Research• Informed Consent – Subjects must be competent, informed, freely able give consent. – Primary Ethical Principles of the Belmont Report (the National Research Act) 1978. • Respect for persons, beneficence and justice Page 308-309 - HarkreaderProtecting Rights of Human Subjects• Right Not to Be Harmed – Nurse acts as advocate for client• Right to Full Disclosure – Informed and aware of consequences• Right of Self- Determination• Right of Privacy and ConfidentialityPage 33 - Berman Ethics of Nursing ResearchEthical Dilemmas:•Use of vulnerable participants: • infants, children, pregnant women, • terminally ill, prisoners, mentally ill……•Knowledge gained from research is more important andbeneficial than the rights of subjects or ethicalprinciples. 8
  • 9. 11/30/2010 EthicalEthical Dilemmas Dilemmas in Nursing Research • Research Question: – Do maternity clients discharged 24 hours after childbirth experience less complications if visited by a home health nurse? • Ethical Dilemma – Some clients are visited and others not for a control group – Is the group not being visited at risk? – How can this be prevented? • Research Question: – How do clients cope with the new diagnosis of an impending terminal illness? • Ethical Dilemma – Clients diagnosed with a terminal illness are very vulnerable. – Intrusive questions may need to be asked causing increased anxiety and psychological trauma – The insights gained will help other patients with a terminal illness – Is it fair to ask such questions? Pg 309 - Harkreader Types of ResearchTypes of Research• Exploratory• Evaluation• Descriptive• Experimental• Historical 9
  • 10. 11/30/2010 Experimental • A study in which the researcher manipulates a treatment or interventions • Subjects are randomly assigned to either a control or an experimental group • The researcher has control over the research situation. • Quasi-experimental – Type of study in which the researcher manipulates a treatment or intervention – unable to randomize subjects or lacks a control group • Nonexperimental – researcher collects data without the introduction of a treatment or intervention. Types of Nonexperimental Research•Correlational • examines relationships between variables to see if when one changes, if the other changes without active intervention•Descriptive • is used to obtain information concerning the current status of the phenomena • describes "what exists" with respect to variables or conditions in a situation.•Case study • detailed investigation on group, institution or individual to understand which variables are important to the subjects, history, care or development Types of Nonexperimental Research • Historical – Reporting events and/or conditions that occurred in the past • Needs assessment – collect data to estimate needs of community • Survey – studies to examine opinion, attitudes, behavior • Page 311-Harkreader 10
  • 11. 11/30/2010 Anatomy of a Research Study•Abstract • A snapshot or a short summary that contains succinct information about the purpose of the study, the number of subjects and methodology used to select subjects, the type of study and the major results.•Review of the literature • Reviews the current literature and theoretical background that brought the investigator to identify or refine the research problem, substantiate a rationale and develop their study•Development of the theoretical construct • A structure that aids in developing relationships among the variables in the study. • It helps in the explanation of all the information included in the study. • The framework allows the research to tie the research to the body of nursing knowledge . • See fig 15.2. Theoretical framework in study is Roy Model. Pg. 315/316- Harkreader. Anatomy of a Research Study • Identification of the variables • The concepts under investigation • Table 15.3 – pg. 313 • Clarification of operational definitions: precise meanings of the concepts being used in study, defined in a manner that specifies how the concept will be used in the study • Formulation of the research question: the hypothesis the prediction of the relationship of the variables being studied Anatomy of a Research Study•Research design • researchers strategy for testing a hypothesis. • Quantitative • uses variables analyzed as numbers • Qualitative • type that uses ideas that are analyzed as words•Collection of data • investigator collects information needed to answer the research question.•Methods • describes how the researcher sought to answer the research questions, sample size, how the sample was collected and instruments used to collect data. Page 311-314 11
  • 12. 11/30/2010 Anatomy of a Research Study • Data analysis – what statistical tests were used to analyze data? • Results – describes results of study – addresses research question/s • Interpretation of the findings – researchers interpretation of the study – the relationship of the findings to the theoretical framework – implications for further study Nursing Research Journals Evidence Based NursingJournal of Nursing Measurement Clinical Nursing ResearchWestern Journal of NursingResearch Nurse ResearcherScholarly Inquiry for Nursing Applied Nursing ResearchPractice Research in Nursing and HealthAdvances in Nursing Science Nursing Science QuarterlyOncology Nursing Forum Journal of Nursing ScholarshipNursing Research Annual Review of Nursing Research Nursing Computer Search Databases• Computer search databases identify databases of interests of nurses. • Computer Index to Nursing and Allied Health Literature CINAHL • MEDICUS INTERNATIONAL NURSING INDEX MEDLINE• Many of the helpful nursing literature can be accessed athttp://www.nursingcenter.com/home/index.aspTable 15.2, page 312 12
  • 13. 11/30/2010 Evidence Based NursingWhats Evidence Based Nursing (EBN)?• Evidence Based Nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences.Three areas of research competence are:• interpreting and using research• evaluating practice• conducting research319-320 Evidence-based NursingEvidence-based Nursing Practice (EBP) • Use of some form of substantiation in making clinical decisions. • Solves problems encountered by nurses by carrying out four steps: I. Clearly identify the issue or problem based on accurate analysis of current nursing knowledge and practice II. Search the literature for relevant research III. Evaluate the research evidence using established criteria regarding scientific merit IV. Choose interventions and justify the selection with the most valid evidence Evidenced Based NursingTo carry out EBP the following factors must be considered:• sufficient research must have been published on the specific topic• the nurse must have skill in accessing and critically analyzing research• the nurses practice must allow her/him to implement changes based on EBN319-320 13
  • 14. 11/30/2010 Evidenced Based Nursing• Agency for Healthcare Research and Quality’s Effective Health Care Program – 3 approaches to publishing research on the comparative effectiveness of different treatments and clinical practices – 1. Review and synthesize knowledge – 2. Promote and generate knowledge – 3. Compile findings in practice and translate knowledge Nursing Research• Use of research finding in practice• AACN – 2006 – Position statement on nursing research that delineates expectations of graduates at each level of nursing education• ANA Standard’s of Professional Performance – 2004 – Standard 13: Research • The registered nurse integrates research findings into practice. (Pg 30- Berman) Nursing Research• Use of research finding in practice• AACN – 2006 – Position statement on nursing research that delineates expectations of graduates at each level of nursing education• ANA Standard’s of Professional Performance – 2004 – Standard 13: Research • The registered nurse integrates research findings into practice. (Pg 30- Berman) 14
  • 15. 11/30/2010 Nursing Research Critique• Evaluates the scientific merit of the study• Decides how the results may be useful in practice.• Intensive scrutiny – Strengths and weaknesses – Statistical and clinical significance – Generalizability of the results Nursing Research Critique• Evaluates the scientific merit of the study• Decides how the results may be useful in practice.• Intensive scrutiny – Strengths and weaknesses – Statistical and clinical significance – Generalizability of the results Nursing Research Critique• Polit and Beck – 2005 – Elements to be considered in a critique of quantitative research • Substantive and theoretical dimensions – Significance of problem – Appropriateness of conceptualizations – Theoretical framework of the study – Congruence of research question and methods used • Methodologic dimensions – Appropriateness of design – Size and sampling validity and reliability of the instruments 15
  • 16. 11/30/2010 Nursing Research Critique• Ethical dimensions – Human rights protected – Any ethical compromise occurred• Interpretive dimensions – Accuracy of the discussion, conclusions, and implication of the results – Implication and limitations reviewed – Replication or generalizability of findings• Presentation and stylistic dimensions – Manner in which results are communicated 16