Chapter 06

Chapter 6
Nursing Research and
Evidence-Based Practice
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 Definition: systematic inquiry or study conducted
to generate new knowledge or to refine existing
knowledge
 Results provide foundation for practice decisions
and behaviors
 Results create strong scientific base for nursing
Nursing Research
2

 Results provide support for the quality and cost-
effectiveness of interventions
 Application of results demonstrates professional
accountability to insurers and health care
consumers
 Generate knowledge in areas that indirectly
affect nursing care process
Nursing Research (cont'd)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 3

 Florence Nightingale: Crimean War
 Research focus, 1900 to 1940
 Nursing education
 Student characteristics
 Student satisfaction
 Research focus, 1950s to 1970s
 Teaching
 Administration
 Curriculum issues
Evolution of Nursing Research

 Research focus, 1980s
 More qualified researchers
 Widespread availability of computers for data
collection and analysis
 Qualitative studies
 Research focus, 1990s: health care delivery
issues such as cost, quality, and access
 Research focus of 21st century: evidence base
for practice
Evolution of Nursing Research
(cont'd)

 Health promotion and disease prevention
 Quality of life
 Health disparities
 End of life
NINR Research Foci

 Determining disease risk and treatment through
using 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
Potential Funding Areas

 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 of health problems
 Improving symptom management for those at end of life
Potential Funding Areas (cont'd)

 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
Agency for Healthcare
Research and Quality (AHRQ)

 The 1999 reauthorizing legislation expanded the role
of the agency by directing AHRQ to:
• 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)
Agency for Healthcare Research
and Quality (AHRQ) (cont'd)

• 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
11Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Agency for Healthcare Research
and Quality (AHRQ) (cont'd)

 Robert Wood Johnson
 W.K. Kellogg Foundation
 Helene Fuld Trust
Private Foundations

 Sigma Theta Tau International (STTI)
 Oncology Nurses Society (ONS)
 American Nurses Foundation (ANF)
 American Nurses Association (ANA)
Nursing Organizations That Fund
Research

 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
Components of the
Research Process

 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
Study Designs

 Case study: provides an in-depth analysis of a single
subject, group, institution, or social unit
 Survey: used to collect large amounts of information
with little expenditure of time and money
 Needs assessment: determines what is most
beneficial to an aggregate group
Quantitative Designs

 Methodologic: focuses on development and testing
instruments to improve their reliability and validity
 Meta-analysis: an advanced process by which
research on a specific topic is reviewed and findings
of multiple studies are statistically analyzed and
expressed quantitatively
Quantitative Designs (cont'd)

 Experimental: 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
 Quasi-experimental: lacks one of the components of
experimental design (i.e., randomization, control
group, or manipulation of one or more variables)

 Secondary analysis: 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.

 Triangulation: use of various research methods
or data collection techniques in the same study
 Pilot studies: small-scale studies referred to as
feasibility studies; purpose is to identify
strengths and limitations of a larger planned
study

 Qualitative designs: a method of research
designed for discovery rather than for
verification
 Phenomenology: 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.”
 Ethnography: a method used to study phenomena
from a cultural perspective
 Grounded theory: a method designed to explore a
social process
Qualitative Designs

1. A researcher is using data collected by the
government on the use of prescription drugs by
older adults. The new research question, “Why do
older adults adhere to a prescription drug
regimen?” was based on data from the previous
study. The researcher is participating in which
type of research?
A. Meta-analysis
B. Secondary data analysis
C. Quasi-experimental
D. Pilot study

2. The advantage of meta-analysis is that multiple
studies are statistically analyzed, enhancing the
power of the results. The disadvantage is that:
A Generalizability is limited
B. Confidence is small
C. The findings are only as reliable and valid as the original
studies
D. The results are expressed qualitatively

Using Research in Practice
• Research use: 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
• Locating published research: focus on the usefulness of
computerized databases such as CINAHL and
MEDLINE and the Annual Review of Nursing Research
• Critical appraisal of nursing research
 Blind review
 Abstract and findings may be the easiest sections of a research
report for the novice to understand
24

Advancing Evidence-Based
Practice
 Assessment of barriers to EBP
 Corrections of misperceptions about EBP goals and
processes
 Questioning current clinical practice

 Clinical nurse specialist (CNS): 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
Nurse Researcher Roles

 Clinical nurse researcher (CNR)—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
Nurse Researcher Roles (cont'd)

 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
Types and Levels of Evidence

Critical Appraisal of Nursing
Research
Blind review
Abstract and findings

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

 Clinical practice guidelines: 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
Examples of
Evidence-Based Practice (cont'd)

 Institutional review: IRB or human subjects
committee required by institutions receiving
federal funding
 Historical examples of unethical research
 Nazi experiments
 Tuskegee syphilis study
 Jewish Chronic Disease Hospital in New York
Ethical Issues Related to Research

 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 into health policy
Summary

Chapter 06

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (14)

Similar to Chapter 06

Similar to Chapter 06 (20)

More from stanbridge

More from stanbridge (20)

Chapter 06

Editor's Notes