Nursing Research Notes

Nursing Research Notes

Learning Outcomes

  • By the end of today’s class, students will be able to:

    • Differentiate between Evidence-Based Practice (EBP) and Evidence-Informed Practice (EIP) and explain when each approach is most appropriate in clinical settings.

    • Identify and describe key types of evidence used in Canadian nursing practice:

    • Quantitative

    • Qualitative

    • Contextual

    • Experiential

    • Apply evidence-informed decision-making to real patient scenarios, incorporating cultural safety, patient preferences, and contextual factors.

Evidence-Based Practice (EBP)

  • Definition: Evidence-based practice adopts a ‘cookbook’ approach to applying evidence into practice. This means it results in no flexibility in applying findings to patient care.

    • Source: Nevo & Slonim‐Nevo, 2011.

  • Hierarchy of Evidence: EBP utilizes a formal hierarchy of evidence which ranks certain forms of research evidence higher than others, for example:

    • Higher ranks: Systematic reviews, Randomized Controlled Trials (RCTs)

    • Lower ranks: Qualitative research, Observational studies

Evidence-Informed Practice (EIP)

  • Definition: Evidence-informed practice recognizes practitioners as critical thinkers and encourages creativity in clinical decision-making based on the current state and circumstances.

    • Source: McSherry 2007; Nevo & Slonim‐Nevo, 2011.

  • Model: Unlike EBP, EIP supports an integrative model of practice considering all forms of research evidence:

    • Systematic reviews

    • RCTs

    • Qualitative research

    • Quantitative research

    • Mixed methods

  • Preference: EIP prefers evidence that provides the best answer to the clinical question.

    • Source: Epstein, 2009.

Decision Making in Care

  • Differences between EBP and EIP:

    • EBP:

    • Assumes decisions are made solely on research evidence.

    • Believes only research-derived evidence has value, ignoring tacit evidence (experience, instinct).

    • Does not account for resources, cultural, religious, and social norms influencing decisions.

    • Risks being influenced by poor-quality or misinterpreted evidence (See BBC story for an illustration).

    • EIP:

    • Employs the purposeful and systematic use of the best available evidence to inform various aspects of decision-making, including practice and policy development.

    • Policies are informed by a broader range of evidence beyond strict research metrics.

    • Decisions consider a range of influences, including political ideology, social norms, economic variables, and practical feasibility.

Comparisons between EBP and EIP

Category

EBP

EIP

Definition

Uses the strongest, highest-quality research evidence.

Integrates research, expertise, patient values, and culture.

Approach

Standardized, protocol-driven.

Flexible, adaptive, patient-centred.

When Used

Strong evidence exists; safety relies on consistency.

When evidence must be adapted to patient context.

Best Situations

High-risk, acute, regulated procedures.

Chronic disease, communication barriers, cultural needs.

Flexibility

Low - deviation may compromise safety.

High - nurse adapts safely to real-life context.

Evidence Sources

Quantitative: RCTs, reviews, guidelines.

Qualitative, experiential, contextual evidence.

Cultural Safety

Not automatically included.

Central - integrates beliefs, values, and language.

Examples

- Infection control (BCCDC)

- Cultural diet teaching

- Insulin titration

- Modified mobility plans

Goal

Standardization, safety, accuracy.

Personalization, cultural safety, shared decision-making.

Importance of Evidence

  • To bring a high standard of research evidence into the decision-making process while considering contextual and experiential factors that influence care.

  • Aim: Deliver appropriate care efficiently to individual patients and ensure ethical practice by doing the right things the right way.

Challenges for Practitioners

  • Critical appraisal skills are essential for determining high-quality evidence.

  • Need for effective synthesis of emerging evidence for accessibility and usability.

  • Requires ongoing knowledge update in the field to adapt to role changes.

  • Study outcomes may vary depending on study design and sample, emphasizing combined trials in meta-analysis to clarify treatment effects.

Understanding Evidence

  • Definition of Evidence: Evidence refers to information or facts systemically obtained to inform decisions or judgments, per CDC (2011).

  • In nursing, care involves a wide range of observations and interventions drawn from various disciplines (e.g., psychology, sociology, public health).

  • Sources of synthesized evidence are evolving and increasingly accessible.

Types of Evidence

  • Best Available Research Evidence: High-quality, rigorously obtained data.

  • Contextual Evidence: Measurable factors in the community influencing strategy success, using:

    • Census data

    • Surveys

    • Community assessments

    • Focus groups

    • Interviews

  • Experiential Evidence: Intentionally and systematically elicited from diverse stakeholders in response to specific decision-making situations.

    • Methods include reflective questioning, communities of practice, expert panels, and consensus processes.

Levels of Evidence

Level

Description

I

Systematic review or meta-analysis of RCTs; Evidence-informed clinical practice guidelines based on systematic reviews.

II

A well-designed RCT.

III

Controlled trial without randomization (quasiexperimental study).

IV

Single nonexperimental study (case-control, correlational, cohort studies).

V

Systematic reviews of descriptive and qualitative studies.

VI

Single descriptive or qualitative study.

VII

Opinions of authorities and/or expert committee reports.

Quantitative Evidence

  • Definition: The science of nursing; measurable and objective; utilized for prediction.

    • Focused aspects include:

    • Infection rates

    • Efficacy

    • Averages

  • Examples:

    1. Infection rates fell from 4.1% to 2.3% post-guideline implementation.

    2. 78% of patients reported moderate to severe postoperative pain.

    3. Long-term care (LTC) residents averaged 1.4 falls/month pre-rounding.

    4. O₂ saturation increased from 89% to 94% after inhaler education.

    5. 90% of cardiology patients completed follow-up.

    6. Call bell use reduced by 32% with hourly rounding.

Qualitative Evidence

  • Definition: The art of nursing; focuses on lived experiences, providing contextual understanding for patient and practitioner interactions.

  • Characteristics: Reveals unique understandings not quantifiable by numbers.

  • Examples:

    1. Punjabi-speaking patients may avoid reporting pain due to cultural beliefs.

    2. Immigrant patients may hesitate to ask questions during discharge teaching.

    3. Families mention patients becoming agitated when voices are raised.

    4. Stroke patients express feeling safer with nurse presence during mobilization.

    5. LTC residents prefer evening baths due to established habits.

    6. Newcomer mothers fear inhalers might damage lungs.

Case Study: Integrating Evidence Types

  • Scenario: Mr. K., 72-year-old immigrant with COPD, refuses maintenance inhaler believing it weakens lungs.

  • Relevant Evidence:

    • Quantitative: Daily inhaler use can reduce exacerbations by up to 30%.

    • Qualitative: Patient fears lung ‘dependency’ on inhalers.

    • Contextual: Mr. K. has limited English and is unfamiliar with the healthcare system.

    • Experiential: Nurses observe that newcomers often link inhalers to severe illness.

The Role of Nursing Science (NRC)

  • Produces information to:

    • Assess healthcare systems and environments.

    • Improve outcomes for patients, families, and communities.

    • Shape healthcare policy.

Integrating Evidence with Cultural Safety

  • Components to consider:

    • Clinical evidence.

    • Patient values and beliefs alongside:

    • Cultural context.

    • Interprofessional collaboration.

Evidence-Informed Practice (EIP) Model

  • Components:

    • Clinical experience

    • Best scientific evidence

    • Patient values

Application of Research in Clinical Practice

  • Encourages the use of research examples from clinical settings that illustrate the application of research to patient care.

Quiz Questions

  1. Which of the following best describes Evidence-Informed Practice (EIP)?

    • A. Strictly follows research hierarchy without flexibility

    • B. Integrates research evidence, clinical expertise, patient values, and context

    • C. Only uses qualitative research findings

    • D. Avoids practitioner judgment entirely

    • Correct Answer: B

  2. A nurse modifies a mobility plan because the patient's cultural beliefs discourage early ambulation. This is an example of:

    • A. Evidence-Based Practice

    • B. Evidence-Informed Practice

    • C. Quantitative Research

    • D. Expert Opinion Only

    • Correct Answer: B

  3. Which of the following is an example of contextual evidence?

    • A. Patient interview describing fear of medication

    • B. Census data showing 60% of community residents speak English as a second language

    • C. Infection rate decreasing after a new protocol

    • D. Nurse’s experience with managing COPD patients

    • Correct Answer: B

  4. A study measuring post-op pain scores using a numeric scale represents:

    • A. Qualitative evidence

    • B. Quantitative evidence

    • C. Experiential evidence

    • D. Contextual evidence

    • Correct Answer: B

  5. Which type of evidence is MOST helpful when exploring cultural beliefs affecting patient decisions?

    • A. Randomized controlled trials

    • B. Qualitative research

    • C. Meta-analyses

    • D. Laboratory experiments

    • Correct Answer: B

Quiz Answer Key & Rationales

  • The answer key with rationales for each question has not been provided explicitly in the transcript but may be inferred from the content of the notes above.