Nursing Research and Evidence-Based Practice Study Notes

Chapter 6: Nursing Research and Evidence-Based Practice

  • Definition of Nursing Research:
    • Systematic inquiry or study aimed at building knowledge or refining existing knowledge.
    • Results provide a foundation for practice decisions and behaviors.
    • Establishes a strong scientific basis for nursing, focusing on quality and cost-effectiveness of interventions.
    • Facilitates evidence-based changes in nursing care.

Evolution of Nursing Research

  • Florence Nightingale's Contribution during the Crimean War:

    • Focus on the role of research in nursing, initiating organized research efforts in the early 1900s.

  • Research Focus (1900-1940):

    • Areas of focus included nursing education, student characteristics, and student satisfaction.

  • Research Focus (1950-1970s):

    • Emphasis on teaching methodologies, administration, and curriculum issues.

  • Research Focus (1970s):

    • Concentrated on the improvement of patient care and outcomes.

  • Research Focus (1980s):

    • Increase in the number of qualified researchers.
    • Rise of computers for data collection and analysis.
    • Introduction of qualitative studies into the nursing research field.

  • Research Focus (1990s):

    • Shift to health care delivery issues, emphasizing cost, quality, and access to services.

  • Research Focus (Twenty-First Century):

    • Predominantly centered around Evidence-Based Practice (EBP).

Evidence-Based Practice (EBP)

  • Definition:
    • The systematic process of finding, appraising, and using research findings to inform decisions about patient care.

NINR Research Foci

  • Symptom Science:

    • Focuses on promoting personalized health strategies.

  • Wellness:

    • Emphasizes health promotion and illness prevention.

  • Self-Management:

    • Works to improve the quality of life for individuals living with chronic illnesses.

  • End of Life and Palliative Care:

    • Enhances care with an emphasis on compassion and support.

Agency for Healthcare Research and Quality (AHRQ)

  • Overview:

    • An agency of the U.S. Department of Health and Human Services.
    • Objectives include improving health care outcomes and quality, reducing costs, enhancing patient safety, and expanding access to effective services.

  • AIMS of AHRQ:

    • Reduce risks of harm by implementing best practices in health care.
    • Promote the translation of research evidence into practical application to enhance service access.
    • Aim to lower unnecessary healthcare costs.

  • 1999 Reauthorizing Legislation:

    • Expanded the agency's role to improve the quality of health care through scientific inquiry and public accessibility to findings.
    • Promoted patient safety and reduced medical errors via strategic partnerships and centers for research training.

  • Inclusion of Priority Populations:

    • Established an office to focus on low-income groups, minorities, women, children, the elderly, and those with special health care needs, ensuring their unique needs are addressed.
    • Improved information technology use for coordinating patient care and enhancing outcomes research.

Funding Sources for Nursing Research

  • Private Foundations:

    • Robert Wood Johnson Foundation.
    • W.K. Kellogg Foundation.

  • Nursing Organizations:

    • Sigma Theta Tau International (STTI).
    • Oncology Nurses Society (ONS).
    • American Nurses Foundation (ANF).
    • American Nurses Association (ANA).

Components of the Research Process

  • Steps Involved:
    1. Formulating the research question or problem.
    2. Defining the purpose of the study.
    3. Conducting a literature review related to the topic.
    4. Formulating hypotheses and defining variables.
    5. Choosing the appropriate research design.
    6. Selecting the population, sample, and setting for the study.
    7. Conducting a pilot study for initial assessment.
    8. Collecting data systematically.
    9. Analyzing the collected data.
    10. Communicating the conclusions drawn from the research.

Quantitative Research Designs

  • Case Study:

    • Provides an in-depth analysis of a single subject, group, institution, or social unit.

  • Survey:

    • Utilized for collecting large amounts of information in a time-efficient and cost-effective manner.

  • Needs Assessment:

    • Aims to determine what is most beneficial to a specific aggregate group.

Specialized Quantitative Designs

  • Methodologic Designs:

    • Focus on developing and testing instruments to enhance reliability and validity.

  • Meta-Analysis:

    • An advanced method where research on a specific topic is aggregated, and findings from multiple studies are statistically analyzed and summarized.

  • Experimental Designs:

    • Involve manipulation of one or more independent variables, random assignment, and observation of outcomes attributed to the manipulated variables.

  • Quasi-Experimental Designs:

    • Lack one component of the experimental design, such as randomization, control group, or variable manipulation.

  • Secondary Analysis:

    • Involves formulating new questions based on previously collected data, whether from formal research or systematic data collection.

  • Triangulation:

    • Employs various data collection techniques to strengthen research findings.

  • Pilot Studies:

    • Conducted as small-scale feasibility studies to test methods prior to comprehensive research.

Qualitative Research Designs

  • Purpose:

    • Designed to explore and develop understanding rather than to verify established knowledge.

  • Phenomenology:

    • A method focusing on understanding intangible experiences such as grief, hope, or risk-taking by examining lived experiences.

  • Ethnography:

    • Examines phenomena from a cultural viewpoint, understanding behaviors and beliefs within a cultural context.

  • Grounded Theory:

    • A method aimed at exploring social processes and developing theories grounded in empirical data.

Application of Research Methods

  • Example Scenario:
    • A researcher utilizes previously collected government data on prescription drug use among older adults to address a new question: “Why do older adults adhere to a prescription drug regimen?”
    • This scenario exemplifies participation in Secondary Data Analysis.

Critical Thinking Questions

  • Which nursing organizations provide funding for research?:
    • Includes the Institute of Medicine, Oncology Nurses Association, American Cancer Society, and Agency for Healthcare Research and Quality.

Nurse Researcher Roles

  • Clinical Nurse Specialist (CNS):

    • A master’s degree-prepared nurse who serves as a clinician and is responsible for education and research.
    • Evaluates the readiness of the agency for research utilization and collaborates with staff to identify clinical problems and implement relevant findings.

  • Clinical Research Nurse (CRN):

    • Typically holds a doctorate with clinical and research expertise.
    • Chiefly focuses on the safety and care of research participants, safeguarding informed consent, adhering to protocols, ensuring data integrity, and managing follow-ups.
    • Emerging Roles: Include Clinical Nurse Leader (CNL) focusing on quality improvement and Doctor of Nursing Practice (DNP) concentrating on EBP applications.

Challenges in Utilizing Research

  • Research Use:

    • Research indicates that nurses frequently do not utilize research findings to inform decisions and design interventions.

  • Resources for Using Research in Practice:

    • Databases are available to locate published research.
    • Clinical Practice Guidelines provide structured recommendations.
    • The Internet serves as a vast resource for accessing research information.