NRS 110A Unit 2, new

Sources of knowledge

Traditional

Athorative

Scientific

Traditional sources of knowledge

passed down from nurse to nurse; stagnates; did things bc we always do it that way…

ex. Change beds, bed bath daily (no scientific research behind pt improvement)… use of time ( a nurse can be doing something else more usefully)

Authoritative sources of knowledge

more skilled/older nurses train new ones… if they do it this way they must be right; can be unchallenged (now its something that we always do… then becomes not science based)

Scientific sources of knowledge

EBP; based on evidence.

Research shows that it befits pts/nurse/facility/everyone

ex. Have to wear gloves all the time (didn’t used to), no benefit to changing beds everyday (more expensive, no benefit to health of PT)

• make sure what you’re doing is relevant 

Nursing theory

Inform nursing practice

Nursing theories help guide and define nursing care and provide a foundation for clinical decision-making

These theoretical models in nursing shape nursing research and create conceptual blueprints, ultimately determining the how and why that drives nurse-patient interactions

• theories use mostly in nursing shape nursing research, create conceptual blueprints, determinations how and why that drives Nurse pt interacting

• guide and define nursing care

Provide a framework for nursing practice and care

Theory

Composed of a group of concepts that describe a pattern of reality

• group of concepts that describe a pattern of reality; tested, changed, used to guide research

Three tiers of nursing theory

Grand theory

Middle range theories

Practice level theories

Grand theory

big umbrella; broadest,

wide range of perspective, (beyond bedside)

Middle range theories

phenomena driven (used mostly sometimes in qualitative research)

predict trends, testable

Practice level theories

practice /// stuff we use at bedside, guide treatment of nursing

interventions, specific, impact daily practices

Nursing metaparadigm

shapes approach of nursing, base our care off of (framework)

guides nursing practice

1. Person (pt/client)

2. Environment (around pt)

3. Health (of pt)

4. Nursing practice (impacts pt)

Nursing research

Systematic inquiry designed to generate trustworthy evidence about issues of importance to the nursing profession, including nursing practice, education, administration, and informatics (Polit & Beck, 2017).

1.     Aimed at guiding nursing practice

2.     Improving the quality of life for patients

narrows into nursing practice

Research

Systematic inquiry that uses disciplined methods to answer questions or solve problems (Polit & Beck, 2017).

Continuum of participation

Consumers - look/find/read about it (not person doing research) 

Producers -  (person doing research); looking at latest research; always learning

Continuum of participation: consumer of nursing research

a.     Contribute – to an idea for clinical study

b.     Gather – information for a study

c.     Advise – clients about participating research

d.     Seek – answer to a clinical problem by searching and approaching research evidence

e.     Discuss – the implications of a study in a journal club (with each other)

What is EBP

combinations of the best scientific evidence (latest and best), pt values (what’s best for them is what works), and clinical experience (experts in that area)

1. high quality care

2. Supported by best evidence

3. contributes to expand with more nursing research

4. gaining skills for implementation

crucial tool for delivering high quality care in nursing nursing specialties

apply data back to solutions that incorporate clinical expertise and research

Improve practice environment (stop doing useless practices), pt outcomes, reduce cost

→ Ask questions; is it best for pt? Is it cost effective? Is it the best way to do it?

care based on research and knowledge!

• build knowledge; standardize practice

value, access, appraise, apply evidence based knowledge

Clinical decision making should be based on best up to date knowledge/evidence

“Founder” of EBP (Earliest) — Florence Nightingale — enhancing pt outcomes

critical thinking is important! 

• interpreters analysis, judgment…

ex. No BRAT diet anymore; removing catheter timing; aspirin for fevers (no more)

questioning everything we do is important!!

Importance of EBP to nursing

Provides evidence for nurse’s decisions and actions

When we base nursing actions on research, nursing actions are:          

• promotes clinical appropriate care

• promotes cost effective pt care

• Results in positive outcomes for pts

• fosters shared decision making with the pt and family (super important; don’t set unrealistic standards)

Healthcare professionals role in EBP

Always be generating questions about patient safety and care.

• can it be better for us and pt

Must be able to include interprofessional teams and incorporate patient/family input.

Some nurses might find themselves as leaders who research and implement EBP.

• These leaders will seek best practices to improve patient care.

• These leaders help model and promote a culture that supports the use of collaborative EBP.

• Help to ensure that necessary resources are in place to facilitate and sustain the process

Steps of EBP

1. Ask a question

2. Research for evidence / collect the most relevant and best evidence

3. Appraise it / clinically appraise the evidence

4. Integrate it / integrate the evidence

5. Evaluate the evidence / evaluate the practice decision or change

6. Disseminate (share)

Step 1: Ask a question

Think of PICO-T

This is how we ask the question

PICO-T (STEP 1 ASK)

how we ask a question

• population (who or what), intervention (what’s happening; phenomenon of interest), comparison, outcome (what are you trying to improve,measure or effect), time

The question comes first! (Q-PICOT)

ex. (As listed above); pain meds — spend more time in PACU (pts, pain, music, meds by themselves, decrease pain); goal to give less meds; and still decrease pain (T: while in pacu)

• put it all in a sentence

STEP 2: RESEARCH FOR EVIDENCE/COLLECT THE MOST RELEVANT AND BEST EVIDENCE

Take your question and break it up into subjects 

• ex. Pacu pts, pain, music therapy

quantitative and qualitative — research needs to be peer reviewed,

within last 5 years 

levels of evidence: (LOW) expert opinion; case studies/authoritative and descriptive studies EBP; uncontrolled cohort studies; controlled cohort studies; randomized controlled trials; systematic reviews (do not use these for journal) (HIGH) (as you go higher, less bias)

STEP 3: APPRAISE IT/CLINICALLY APPRAISE THE EVIDENCE

look at clin/ical area of interest

Follow John Hopkins

Things to look for to get appraisal:

• type of study

• look at the population size

• look for biases

• Look at time frame 

• Look for peer review

  •  Reviewed by people in the same field

  • way for journal publications to verify and see what’s appropriate for the research being done and for the question

  • If wrong, gets sent back and can resubmit after fixing

  • date submitted, and date published (different) submit… reviewed…accept it

  • Go to actual website/publisher

• year published

STEP 4: INTEGRATE IT/EVIDENCE

Changes practices

What does PICO-T stand for?

Population (who or what)

Intervention (what’s happening; phenomenon of interest)

Comparison

Outcome (what are you trying to improve, measure, or effect)

Time

*question comes first! (Q-PICO-T)

·       ex. (As listed above); pain meds — spend more time in PACU (pts, pain, music, meds by themselves, decrease pain); goal to give less meds; and still decrease pain (T: while in pacu)

• put it all in a sentence

PICOT mnemonic

P – person/population/problem (who/what)

I – intervention/phenomena of interest (how?)

C – comparison/condition/comparator/current practice

O – outcome of interest (what are you trying to improve, measure or effect?)

T – time that is needed for intervention to achieve an outcome

Example of a PICO (T) Question

Scenario: The main concern for most of your patients coming out of anesthesia in the PACU is pain. You want to explore nursing interventions you can use on top of medication administration to decrease pain. One coworker mentions trying to make the PACU feel less clinical by playing soft music to relax patients.

P: PACU patients

I:   Soft music as an adjunct to standard care

C: Standard care alone

O: Lower reported pain scores

• In PACU patients, will playing soft music in the PACU as an adjunct to standard care result in lower reported pain scores when compared to standard care alone

Qualitative research

touchy feely; experiences people have, feelings

Ask personal questions; open ended questions (elicit more of a response not just yes or no)

explore the feelings

data collection (observation interviews, document, recording)data reduction (selection focusing simplifying abstracting transforming) data display (matrices graphs, networks, charts) conclusion drawing (give meanings, confirming, verifying)

no structured classification

insight to gain meaning

analyzes words or narrative rather than numbers

Ex. Depression/copd…qualitative studies

Feelings and themes… not numbers and data

Qualitative research articles

• Seek to discover the why and how of a phenomenon of interest in a written format as opposed to numerical

• There is no structured classification system for different approaches to data collection.

• Collects data with one data collection point (cross-sectional)  or multiple data sites (longitudinal) 

will have in introduction, look for sources they site and look into them (if cannot find what you’re looking for)

Interviews, memos (shows that its qualitative)

— look at abstract of an article to know

Sometimes it's said if its qualitative; make sure not a mixed method (qual/quant)

Wide age range is good to have for studies

exclusion criteria in both

types ; qualitative and quantitative

Types of qualitative research

Phenomenology

Grounded theory

Ethnography

Narrative inquiry

Case study

Basic qualitative

Historical

What is quantitative research

Definition – The investigation of phenomena that lend themselves to precise measurement and quantification, often involving a rigorous and controlled design (Pilot & Beck, 2017).

Obtained through numerical comparisons and statistical inferences, data analysis. Researcher describe, predict, test hypotheses, classify features, and contrast models and figure to explain what is observed (Dang et al., 2022)

Research approach uses objective and precise collection to measure or quantify data.

Data can be collected through observation, surveys, interviews (closed-ended questions), documents, audiovisuals, and polls.

Scientific method

we have a question and were going to test it

·       variable - can be measured

·       Dependent - result of the study

·       independent - cause or condition 

·       hypothesis

·      data

·      instruments

Types of quantitative research

True experimental

• resistance of cause and effect between intervention and an outcome, 

• To examine cause-and-effect relationships between variables under highly controlled conditions; often conducted in a laboratory setting

Quasi-experimental

• estimate the casual relationship between an intervention and an outcome without randomization

• To examine cause-and-effect relationships between selected variables; often conducted in clinical settings to examine the effects of nursing interventions on patient outcomes

Non-experimental (observational)

• AIM: measures one or more variable as they naturally occur without manipulation

• FEATURES: may or may not have an intervention, no random assignment to a group, no control group

• STUDY METHODS: descriptive, correlational

True experimental

• AIM: establish existence of cause and effect relationship between intervention an outcome

• FEATURES: manipulation of a variable in the form of intervention, control group, random assignment to the intervention or control group

• STUDY METHODS: randomized controlled trial; post test-only with randomization; pre-and post test with randomization; Solomon 4 group

Quasi-Experimental

• AIM: Estimate the casual relationship between an intervention and an outcome without randomization

• FEATURES: an intervention; non random assignment to an intervention group; may lack a control group

• STUDY METHODS: Nonequivalent groups (not randomized), one group (not randomized), interrupted time-series

Nonexperimental

• AIM: measures one or more variable as they naturally occur without manipulation

• FEATURES: may or may not have an intervention, no random assignment to a group, no control group

• STUDY METHODS: descriptive, correlational

Step 3:Critically Appraise the Evidence

a.     Look at the population size

b.     Look for biases

c.     Look at the timeframe

d.     Look for peer-review

Peer-reviewed research

a.     Evaluation of scientific, academic, or professional work by others working in the same field.

b.     Locating a Peer-Reviewed Article

c.     When searching in a database, click the “peer-reviewed” box in the search engine

d.     Look at the website of the journal to see if it is peer-reviewed

e.     Look at the article to see if it is peer-revied

f.      Look at the submission date to see if there is a revision and an academic editor

g.     Go to the journal website to see if it is a peer-reviewed journal. 

h.     LCC Library