Research/EBP

RESEARCH AND EBP

Chapter 2 Overview

  • Explores nursing knowledge, its sources, historical influences, research evolution, and methods.

OBJECTIVES

  • Explain the sources of nursing knowledge and historical influences on nursing knowledge.

  • Discuss the evolution of nursing research.

  • Compare and contrast quantitative and qualitative research methods.

  • Describe evidence-based practice in nursing, including the rationale for its use.

TYPES OF NURSING KNOWLEDGE AND INFLUENCES

Types of Nursing Knowledge

  1. Traditional Knowledge

    • Passed down from generation to generation.

  2. Authoritative Knowledge

    • Comes from experts and is considered truth based on their authority.

  3. Science

    • Knowledge that has been tested and validated through the scientific method.

  4. Philosophy

    • The study of wisdom and fundamental knowledge; explores processes used to construct life and understanding.

Influences on Nursing Knowledge

  • Historical Influences

    • Florence Nightingale as a source of authoritative knowledge.

    • Societal changes affecting traditional knowledge.

  • Societal Influences

    • Development of nursing schools that emphasize scientific methods and authoritative teaching.

FRAMEWORK OF NURSING THEORY

Definition of Theory

  • A theory is a group of concepts that describe a pattern of reality.

  • Theories can be tested, modified, or used to guide research and practice.

Concepts in Nursing

  • Concepts are abstract impressions organized into symbols of reality.

  • Conceptual Framework or Model:

    • Described as the blueprints of a house; the concepts in nursing act as the bricks and boards that shape nursing practice.

TYPES OF REASONING

  1. Deductive Reasoning

    • Begins with a general idea and examines specific actions or ideas.

  2. Inductive Reasoning

    • Builds from specific ideas or actions to develop conclusions about general ideas.

  • In the 21st century, emphasis has shifted towards evidence-based practice, which has evolved over the last 50 years, tracing back to Florence Nightingale's objective record-keeping and research methodologies.

  • By the 1950s to 60s, the reliance on evidence-based research surpassed traditional knowledge.

GOALS OF NURSING RESEARCH

  • Improve care for patients in clinical settings.

  • Study the interplay between nursing processes and individuals.

  • Promote education, policy development, ethics, and nursing history.

  • Foster greater autonomy and strength within the nursing profession.

  • Provide a foundation for evidence-based nursing practice.

NATIONAL INSTITUTE OF NURSING RESEARCH

GOALS OF RESEARCH

  • Build a scientific foundation for clinical practice.

  • Prevent disease and disability effectively.

  • Manage and eliminate symptoms associated with illness.

  • Enhance end-of-life and palliative care approaches.

METHODS OF NURSING RESEARCH

Quantitative Research

  • Involves numerical data ($n$ in quantitative = numbers).

  • Follows specific steps in the research process:

  1. Formulate a hypothesis.

  2. Prove or disprove the hypothesis through data collection.

Qualitative Research

  • Aims to gain insights by discovering meanings, focusing on narratives and words rather than numbers.

  • Based on the belief that reality varies based on individual perceptions and can change over time.

  • Example: Analyzing emotional needs of dying patients and families through qualitative narratives.

EVALUATING THE ETHICS OF CLINICAL RESEARCH STUDIES

Key ethical considerations include:

  • Value of the research.

  • Scientific validity.

  • Fair subject selection.

  • Favorable risk-benefit ratio.

  • Independent review processes.

  • Informed consent from participants.

  • Respect for all enrolled subjects.

TYPES OF QUANTITATIVE RESEARCH

  1. Descriptive Research

    • Describes concepts about events without prior evidence.

  2. Correlational Research

    • Examines relationships between two or more variables.

  3. Quasi-experimental Research

    • Studies cause and effect relationships between variables; useful for examining nursing interventions' effects on patient outcomes.

  4. Experimental Research

    • Investigates cause and effect under strictly controlled conditions such as laboratory settings.

STEPS OF QUANTITATIVE RESEARCH

(Refer to Table 2-4 in the original source)

  1. State the research problem.

  2. Define the purpose of the study.

  3. Review related literature.

  4. Formulate hypotheses and identify variables.

  5. Select the research design.

  6. Choose the population and sample.

  7. Collect data systematically.

  8. Analyze the collected data.

  9. Communicate findings and conclusions.

TERMS IN QUANTITATIVE RESEARCH

  • Variable:

    • Dependent variable: The outcome that is measured.

    • Independent variable: The factor that is manipulated or controlled.

  • Hypothesis: A statement about what the researcher expects to find.

  • Data: Information gathered during research.

  • Instruments: Tools or devices utilized for data collection.

EVIDENCE-BASED PRACTICE (EBP)

  • Definition: A problem-solving approach used in clinical decision-making that incorporates the best available evidence.

  • EBP integrates scientific knowledge with the art of nursing to achieve optimal patient outcomes.

  • May involve specific nursing interventions and established guidelines for caring for patients with certain ailments, treatments, or surgical procedures.

  • Usage of EBP requires thorough analysis and systematic review of relevant research findings.

Levels of Evidence

  • Lower levels of bias include systematic reviews and randomized controlled trials (RCTs).

  • Hierarchically categorized evidence:

    • Systematic reviews

    • Randomized controlled trials

    • Controlled Cohort Studies

    • Uncontrolled Cohort Studies

    • Case Studies and Case Series, Qualitative and Descriptive Studies, EBP Implementation and Quality Improvement Projects

    • Expert Opinion

STEPS IN IMPLEMENTING EBP

  1. Cultivate a spirit of inquiry.

  2. Formulate a burning clinical question using the PICOT format:

    • P = Patient, population, or problem of interest.

    • I = Intervention of interest.

    • C = Comparison of interest.

    • O = Outcome of interest.

    • T = Time.

  3. Research and collect the most relevant evidence.

  4. Critically appraise the evidence (includes rapid critical appraisal, evaluation, and synthesis).

  5. Integrate the best evidence with clinical expertise and patient preferences in practice decisions.

  6. Evaluate outcomes based on evidence from practice changes.

  7. Disseminate outcomes of EBP decisions or changes.

ASKING CLINICAL QUESTIONS IN PICOT FORMAT

  • P = Patient, population, or problem of interest.

  • I = Intervention of interest.

  • C = Comparison of interest.

  • O = Outcome of interest.

  • T = Time.

Example Study

  • Involves NICU babies aged 32-35 weeks. Participants were randomly assigned to either a music therapy group or a control group with no music therapy.

  • Music therapy was administered daily; weight, length, and the Newborn Happiness Assessment were evaluated after one week.

PICOT PRACTICE

  • Health question example regarding patient ambulation after surgery:

    • Question: Do patients who ambulate twice a day achieve better pain control compared to those who do not ambulate post-surgery?

    • P: Patients

    • I: Who ambulate twice daily

    • C: Patients who ambulate vs. those who do not

    • O: Achieve better pain control

    • T: After surgery

PICOT PRACTICE QUESTION FORMULATION

  • When formulating a clinical question using PICOT, determining the P involves focusing on the following:

    • A. Comparison to another similar protocol

    • B. Review of procedures

    • C. Identification of study purpose

    • D. Clear description of the population at interest

  • Correct Answer: D - it focuses on the patient population of interest.

COMPONENTS OF A RESEARCH JOURNAL

  1. Abstract: A summary of the study.

  2. Introduction: Background and significance of the research topic.

  3. Method: Detailed description of how the study was conducted.

  4. Results: Findings of the study.

  5. Discussion: Interpretation of the results.

  6. References: Citation of sources used in the study.