1. 1Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Chapter 2
Evolution of Research in Building
Evidence-based Nursing Practice

2. 2Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Historical Development of
Research in Nursing
 Florence Nightingale
 Evolution of nursing research topics
throughout the 20th century and into the 21st
century
 Eventual movement toward Evidence-Based
Practice (EBP)
Are there any commonalities that you see
among the types of research done over the
past 150 years?

3. 3Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Florence Nightingale
 Data collection—gathered data on soldier
morbidity and mortality rates
 Statistical analysis
 Instigated attitudinal, organizational, and
social changes

4. 4Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1900 to 1950
 Research led to advances in nursing
education
 1940s—trend started that focused on
organization/delivery of nursing services

5. 5Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1950s and
1960s
 ANA initiated research into nursing functions
and activities; ANA sponsored research
conferences
 Educational studies
 Growing number of clinical studies focused
on quality care and the development of
criteria to measure patient outcomes

6. 6Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1970s
 Focus on nursing process
 First Nursing Diagnosis Conference held
which has evolved into today’s NANDA-I
 Studies involving implementation and
outcomes of primary nursing care delivery
models
 Archie Cochrane’s Effectiveness and
Efficiency: Random Reflections on Health
Services published

7. 7Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1980s and
1990s
 Focus on conduct of clinical nursing
 WICHE and CURN projects launched to
promote the use of research-based nursing
interventions in practice
 NCNR created to support the conduct of
basic and clinical nursing research and the
dissemination of findings
 Emergence of outcomes research
 Term evidence-based was first used by David
Eddy in 1990

8. 8Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 21st Century
 Central vision: Conducting quality studies using a
variety of methodologies, synthesizing study findings
into best research evidence, and using research
evidence to guide practice
 Strong focus on EBP
 Focus of healthcare research and funding has
expanded from illness treatment to include health
promotion and illness prevention
 Key organizations promoting use of research to
provide EBP: AHRQ, NINR, and ANA

9. 9Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Classification of Research
Methods for this Course
 Quantitative research
 Qualitative research
 Outcomes research
 Intervention research

10. 10Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Scientific Method
 Incorporates all procedures that scientists
have used, currently use, or may use in the
future to pursue knowledge
Would both quantitative and qualitative
studies fall under this umbrella?

11. 11Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Comparison of Quantitative and
Qualitative Research
 Quantitative research—a formal, objective,
systematic process implemented to obtain
numerical data for understanding aspects of
the world (currently the predominantly used
method of scientific investigation in nursing)
 Qualitative research is a systematic,
interactive, subjective, holistic approach used
to describe life experiences and give them
meaning

12. 12Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Comparison of Quantitative and
Qualitative Research (Cont’d)
 The problem and purpose to be studied
determines the type of research to be
conducted
 Would you use quantitative or qualitative
research to study…
 whole person’s response to pain?
 effects of nutritional education on serum lipid
levels?

13. 13Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Quantitative Research
 Describes and examines relationships and determines causality among
variables
 Useful for testing a theory by testing the validity of the relationships that
compose the theory
 Requires control to identify and limit the problem to be researched and
attempts to limit the effects of extraneous or other variables that are not
the focus of the study
 Requires the use of structured interviews, questionnaires, or
observations; scales; or physiological measures that generate
numerical data
 Control, instruments, and statistical analyses are used to ensure that
the research findings accurately reflect reality so that the study findings
can be generalized; generalization involves the application of trends or
general tendencies (which are identified by studying a sample) to the
population from which the research sample was drawn

14. 14Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Quantitative Research Methods
 Descriptive: accurate portrayal or account of characteristics of a
particular individual, situation, or group
 Correlational: systematic investigation of relationships between
or among two or more variables that have been identified in
theories, observed in practice, or both (nature of relationship
NOT cause-and-effect)
 Quasi-experimental: used to identify causal relationships, to
examine the significance of causal relationships, to clarify why
certain events happened, and for a combination of these
objectives
 Experimental: objective, systematic, controlled investigation
conducted for the purpose of predicting and controlling
phenomena (examines causality)

15. 15Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Qualitative Research
 Generates knowledge about meaning through
discovery
 Inductive and dialectic reasoning are predominant
 Researchers use observations, interviews, and focus
groups to gather data (interactions are guided but not
controlled)
 Qualitative data take the form of words and are
analyzed according to the qualitative approach that is
being used
 Findings from a qualitative study are unique to that
study, and it is not the researcher’s intent to
generalize the findings to a larger population

16. 16Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Qualitative Research Methods
 Phenomenological research: humanistic study of phenomena
 Grounded theory research: emphasizes interaction,
observation, and development of relationships among concepts;
useful for discovering what problems exist in a social setting and
the processes people use to handle them
 Ethnographic research: research attempts to tell the story of
people’s daily lives while describing the culture in which they live
 Exploratory-descriptive qualitative research: conducted to
address an issue or problem in need of a solution and/or
understanding
 Historical research: narrative description or analysis of events
that occurred in the remote or recent past

17. 17Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Outcomes Research and
Intervention Research
 Outcomes research examines the results of
care and measures the changes in health
status of patients
 Intervention research investigates the
effectiveness of a nursing intervention in
achieving the desired outcome or outcomes
in a natural setting

18. 18Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Best Research Evidence for
Practice
 What is it? A summary of the highest-quality,
current empirical knowledge in a specific area
of health care that is developed from a
synthesis of quality studies in that area
 Who does it? At least two researchers, or
even a team of expert researchers and
healthcare providers

19. 19Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Research Evidence
Synthesization Processes
 Systematic review: structured, comprehensive synthesis of the
research literature
 Meta-analysis: statistically pooling the results from previous
studies (usually quasi-experimental or experimental types) into
a single quantitative analysis that provides one of the highest
levels of evidence about an intervention’s effectiveness
 Meta-synthesis: systematic compiling and integration of
qualitative study results to expand understanding and develop a
unique interpretation of study findings in a selected area (focus
is on interpretation rather than the combining of study results)
 Mixed-methods systematic review: synthesizing both
quantitative and qualitative studies

20. 20Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Continuum of Research Evidence

21. 21Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Continuum of Research Evidence
(Cont’d)
 Strongest/best research evidence: systematic
research reviews and meta-analyses of high-
quality experimental studies
 Weakest evidence: expert opinions or
opinions expressed in committee reports
 Best research evidence generated from
systematic reviews, meta-analyses, and
integrative reviews is used most often to
develop standardized or evidence-based
guidelines for practice

22. 22Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Evidence-Based Practice
Guidelines
 Rigorous, explicit clinical guidelines based on
the best research evidence available in that
area
 Usually developed by a team or panel of
expert researchers; expert clinicians; and
sometimes consumers, policymakers, and
economists

23. 23Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Sources for Evidence Based
Guidelines
 National Guideline Clearinghouse (NGC)
 Cochrane Collaboration and Library
 The Joanna Briggs Institute
 Professional nursing organizations