Research

Systematic inquiry

develop knowledge about issue of importance to the nursing profession, including nursing practice, education administration and informatics

• Validate existing knowledge 

• Refine existing knowledge 

• Generate new knowledge

Systematic

• Characteristics of research

• Follow certain steps of processes

•  “methodological”

Controlled

• Characteristics of research

• Every step should be planned to prevent bias and minimize error

Controlled

• Characteristics of research

• Attempt to gain solution or intervention

Empirical

• Characteristics of research

• Data gathered can be verified or validated using five senses 

Investigation

• Characteristics of research

• Attempt to gain solution or intervention

EVIDENCE BASED PRACTICE

• problem solving approach to clinical decision making

• Best & latest evidence

  Uses and applies the best and latest evidence with internal evidence, external evidence and patient preferences and values

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  Uses multiple studies

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  Trigger

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  Gather best & latest critical evidences as solution 

  & recall ethical expertise

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  Consider patient preferences and values

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  EBP

External Evidences

• Evidences from researches outside the institution

• Other sources

Internal Evidences

• Practice initiative

• Practices that are done in one hospital or institution

• Clinical expertise/abilities

• Ability to assess or give interventions 

PATIENT PREFERENCES AND VALUES

Every steps should be planed

To prevent errors and minimizes bias

Research

Generates the evidence 

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based on one study

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gather research studies and applies  to practice 

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Research Utilization

Knowledge Triggers

EBP Triggers

• Gaps in knowledge → unanswered clinical questions.

• Updated guidelines, new tech, continuing education.

Benchmarking

EBP Triggers

• comparing institutional practice vs. best practice

• setting standard

Problem Triggers

EBP Triggers

• Facility-based problems → compromise care.

• Ex: Pressure ulcers persist despite turning Q2H.

• High infection rates, patient/staff complaints, sentinel events (unexpected events → death/injury not r/t illness).

• Inconsistent outcomes, questionable practices (e.g., IM aspiration).

External Evidence

Types of Evidence

• From rigorous research (outside institution).

• ✅ Strength: scientifically credible, generalizable.

• ❌ Limitation: may not fit local context.

Internal Evidence

Types of Evidence

• From practice initiatives, QI projects (within institution).

• ✅ Strength: real-time relevance, context-specific.

• ❌ Limitation: lacks generalizability.

Barriers to EBP

• Resistance to change.

• Lack of funds, time, or admin support.

• Rigid policies.

Step 0: Absorb

Steps in EBP (ABA ZACH PAPA ASAL)

• Foster spirit of inquiry, supportive culture, EBP mentors.

Step 1: Ask

Steps in EBP (ABA ZACH PAPA ASAL)

• Formulate clinical question

Criteria of good clinical question

• P – population

• I – intervention

• C – comparison

• O – outcome

• T – time

Step 2: Acquire

Steps in EBP (ABA ZACH PAPA ASAL)

• Gather best evidence

Systematic reviews

RCT

Quasi-experimental

Non-experimental

Qualitative

Expert opinion

Hierarchy of evidence

Step 3: Appraise

Steps in EBP (ABA ZACH PAPA ASAL)

• Critically evaluate: Quality, Quantity, Consistency.

Step 4: Apply

Steps in EBP (ABA ZACH PAPA ASAL)

• Implement in practice, consider expertise + patient values, pilot test first.

Step 5: Assess

Steps in EBP (ABA ZACH PAPA ASAL)

• Evaluate outcomes (positive → continue; negative → revise/restart)

Step 6: Allocate

Steps in EBP (ABA ZACH PAPA ASAL)

• Disseminate results (share with departments/others).

Goal of NRes

• Improve patient outcomes and quality of care (cost-effective).

• Promote EBP.

• Ensure nursing credibility.

• Strengthen accountability.

Environmental Theory - Florence Nightingale

History of EBP in Nursing

• 1st nursing research

American Journal of Nursing

History of EBP in Nursing

• 1st published nursing journal (case studies)

Nursing Research

History of EBP in Nursing

• 1952: 1st compilation of nursing studies

Nursing Studies Index - Virginia Henderson

History of EBP in Nursing

• First annotated nursing research index

• Also created 14 Basic Needs

Sigma Theta Tau

History of EBP in Nursing

• Honor society; sponsors conferences to present research.

Archie Cochrane

History of EBP in Nursing

• Coined “EBP” in medicine.

1st National Nursing Diagnosis Conference

History of EBP in Nursing

• 1973: Mary Ann Lavin, Kristine Gebbie

NANDA

History of EBP in Nursing

• 1982: formation of professional organization that develops and disseminates standardized nursing diagnoses (US + Canada)

NANDA-I

History of EBP in Nursing

• 1982: formation of professional organization that develops and disseminates standardized nursing diagnoses that is anchored in Gordon’s functional health patterns

21st century

History of EBP in Nursing

• EBP mainstream in nursing

Description

Purposes of Nursing Research

• quantify, classify, categorize.

Exploration

Purposes of Nursing Research

• qualitative, little-known topics.

Explanation

Purposes of Nursing Research

• causal relationships (“why?”)

Prediction and Control

Purposes of Nursing Research

• estimate outcomes, modify via intervention.

RA 9173, Sec. 3

Legal mandate of nursing research

• Nurses shall undertake nursing & health human resource development, training, and research.

Reasons for Research

• Spiraling cost of healthcare → need for cost-effective interventions.

• Increasing demand to adapt to Evidence-Based Practice (EBP).

• Improve patient care & outcomes.

• Ensure nursing credibility & accountability.

Ethics of a Proper Researchers

• Scientific objectivity

• Consent

• Integrity

• Equitable

• Noble - respects the rights of participants

• Truthfulness

• Importance to the nursing profession

• Courage to look for data

Nuremberg Code (1947, Germany)

Historical Ethical Codes in Research

• Origin: Nazi experiments on Jews during WWII.

• Focus: Human experimentation ethics.

• Legacy: Birth of informed consent.

• Key Principles:

  • VOLUNTARY consent

  • Minimization of harm

10 Standards of Nuremberg Code

• Consent – voluntary participation.

• Avoid harm/suffering.

• Benefit – outcomes must benefit society.

• Benefit > Risk – risks must never exceed importance of problem.

• Qualified researchers only.

• Adequate facilities – clean, safe.

• Preclinical studies first (animal/cell before human).

• Right to withdraw (freedom of participant).

• End study if unsafe.

• Prevent death/disability whenever possible.

Helsinki Declaration (1964, Finland)

Historical Ethical Codes in Research

• Issued by: World Medical Association (WMA).

• Focus: Medical research ethics.

• Key Principles:

  • INFORMED consent

  • Vulnerable populations

  • Ethics review

Principles of Helsinki Declaration

• Defend vulnerable populations.

• Ethics review required.

• Consent (informed).

• Low risk, high benefit.

• Access to post-trial intervention.

• Rights respected.

• Evidence-based science.

Belmont Report (1979)

Historical Ethical Codes in Research

• Created by USA National Commission

• Focus: General research ethics (all human subjects).

Belmont Report Main Principles

• Beneficence

• Respect for human dignity

  • Right to self-determination

  • Right to full-disclosure

• Justice

  • Privacy

  • Confidentiality

  • Anonymity