CH 1: nursing research/role evidence-based practice

what is research

systematic inquiry

disciplined methods

answer question

solve problems

what is research goal

gain knowledge that benefit people

research adresses…

nursing practice

nursing education

nursing administration

pt outcome

health and quality of life

clinical nursing research

guide nursing practice

improve health / quality of life of patients

why does research matter to a nurse

evidence-based practice EBP

best available evidence when pt-care decision

help nurse determine whether interventions are

• clinically appropriate

• effective

• safe

• cost-effective

consumer of research

reads/evaluates research

• stay current

• findings affect practice

research-related activities

producer research

research-related activities

nurse…

• suggest ideas

• gather data/inf from participants

• educates pt

• search for research evidence about clinical problem

• participates in journal club

producer research

actively design and conduct research studies

current and future direction in nursing research

continued focus EBP

more research syntheses

pt-centeredness

applicability

local research and quality improvement

health disparities

clinical significance

continued focus EBP

locate → understand → critically appraise → use evidence

more research syntheses

systematic review

pt-centeredness

pt help establish research priorities

applicability

researchers are interested in wether research findings apply to…

• specific pt

• subgroup

• particular clinical situation

local research and quality improvement

small projects to solve local clinical problem

health disparities

researchers must consider differences in

• belief

• life experience

• barriers

• values

• culture background

• language

clinical significance

findings should make meaningful clinical differences for pt

nurse knowledge

tradition + authority/experts + clinical experience + trial/error + research

nursing

art + science

paradigms in nursing research

worldview

view and understanding how the world works

• positive: QUAN

• constructivists: naturalistic, QUAL

positive paradigm

reality exists independently of human observation

nature is olderly and reg

events/phenomia have causes

researchers strive objectivity

researchers should be systemic

determinism

phenomenon

determinisms

Phenomenon are not random, they have a antecedent causes

phenomenon

something researchers are interested in

quantitive research

positive paradigm

numeric inf, measure, statistical analysis, controlled research conditions

problem → plan → data collection → analysis → answer

empirical evidence/generalizability

empirical evidence

evidence rooted in objective reality gather through senses g

generalizability

ability to apply research finding to people who did not participate

constructive paradigm

reality depends on people experience/perspective

multiple realities

multiple realities

researchers goal is to understand

• experience

• perspective

• meaning

• context

qualitative research

quality/experience = words and meaning

researchers collect

• interview

• narrative

• description

• observation

deductive vs inductive

quantitative = deductive

qualitative = inductive

deductive

quantitative

general → specific

testing hypothesis

idea/theory and test whether evidence supports

inductive

qualitative

specific → general

research collect experience then look for patterns

• themes

• description

• explanation

• theory

purpose of nursin gresearch

identification

description

exploration

prediction/control

explanation

identification

what is this

QUAL

description

how common is it - QUAN

what are the characteristics - QUAL

exploration

what factors are associated with it - QUAN

what is the full nature of the experience - QUAL

prediction/control

if x occurs, what will happen to y - QUAN

explanation

what causes it - QUAN

what does it mean - QUAL

EBP categories of research questions

therapy/intervention

diagnosis/assessment

prognosis

etiology/harm

description

meaning/process

therapy/intervention

does intervention work

most direct evidence for chaning nursing practice

diagnosis/assessment

tool or procedure accuretely

prognosis

what will happen

long-term plan, pt education, risk counseling, symptom monitoring

etiology/harm

what caused it

help healthcare professional to develop prevention strategies

description

what is happening/how common is it

quantitative: prevalence, size, intensity, measurable characteristics

qualitative: dimensions, development, evolution

meaning/process

qualitative research

nurses care for whole person

EBP: 3 legged stool

best research evidence

pt preference/values

• nurse must consider what matters to the pt

clinical experience

• nurse education, continuing education, pt-care experience, clinical judgement

meta-analysis

used to statistically combine finding from multiple quantitative studies

number + statistics

metasynthesis

qualitative studies

interpret + amplify + integrate qualitative findings

meta-aggregation

synthesizing qualitative evidence

systematic review

summarize + evaluate research evidence from multiple studies addressing the research question

rigorous syntehsis

level of evidence - LOE scale

level I: therapy/intervention question, systematic review of randomized controlled trials

level II: indv randomized controlled trial

EBP 5 A’s

ask- clinical question

acquire- find evidence

appraise- determine whether evidence is trustworthy/useful

apply- appropriate evidence in practice

assess- evaluate results

PICO

help turn clinical problem into specific, searchable question

P-opulation/pt

I-ntervention/influence/exposure

C-omparison

O-utcome

population / pt

who are we studying

intervention / influence / exposure

what are we doing or examining

comparison

what are we comparing intervention/exposure to

outcome

what results do we care about

PIO

P-opulation

I-ntervention/Influence

O-utcome