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Nursing Research, Philosophy, and Professional Roles

Role models and philosophy in nursing research

  • Role models provide a template/framework for developing professional identity in novice nurses. They learn by interacting with expert nurses or following their examples. Examples include admired teachers, expert practitioners, researchers, and illustrious individuals who inspire students, practicing nurses, educators, and researchers.

  • Mentorship as an accentuated form of role-modeling:

    • The mentor serves as teacher, sponsor, facilitator, clinical guide, and preceptor for the mentee.

    • The mentee imitates and internalizes the mentor’s values, attitudes, and behaviors while gaining intuitive knowledge and personal experience.

    • Mentorship is important for building research competence in nursing; graduates may join research teams to be mentored in how to conduct research.

  • Education as a formal way of knowing:

    • Education involves graduate study or professional development activities; teaching-learning activities and evaluation methods are guided by learning objectives.

    • Graduate nursing curricula are developed according to standards established by professional organizations (e.g., the AACN). Members serve as a panel of authorities to define what programs should include.

    • Universities set policies determining when a student has completed the program.

  • Research and theory development are formal ways of knowing:

    • Studies address a knowledge gap (research problem) and are conducted with rigor (reliability and validity).

    • Guidelines for credibility of findings are described in CH 18 of the text.

    • A theory is a creative and rigorous structuring of ideas with defined concepts, existence statements, and relational statements that present a systematic view of a phenomenon; theories are tested by research and can be generated by qualitative research (see CH 8).

  • Summary: Nursing requires acquiring, incorporating, and assimilating a body of knowledge, guiding thinking and behavior of individuals and the profession; this knowledge base supports recognizing nursing as a science and a unique discipline (Smith, 2019).

  • Philosophy in nursing:

    • Philosophy provides a broad, global explanation of the world; it is the most abstract concept in the model and gives unity/meaning to nursing, shaping the framework for examining nursing and health (Thorne & Sawatzky, 2014).

    • How nurses conduct research and apply knowledge depends on their philosophy related to science (Durepos et al., 2018).

    • Philosophical questions include: Is there absolute truth or is truth relative? Is there one reality or multiple realities? Your philosophy acts as a lens that shapes what you see and how you interpret data.

    • Openness to different philosophies/perspectives is a critical skill as you advance in nursing education and research.

  • Philosophical positions commonly held in nursing:

    • Human beings are holistic, rational, and responsible.

    • Nightingale linked mind, body, and spirit to environmental factors influencing health; health-promoting interventions aim to improve quality of life (Smith, 2019).

    • Nurses care for patients within physical, emotional, and social contexts and value each person’s uniqueness (Bender, 2018).

    • Focus on meaning-making, choice, quality of life, and healing in living/dying (Roy, 2019).

    • Nursing’s metaparadigm consists of person, health, environment, and nursing—foundational constructs guiding practice and research (Bender, 2018).

Truth, perception, and the framework for evidence-based practice

  • Truth is often relative in nursing; reality varies with perception and bias (Wieringa, Engebretsen, Heggen, & Greenhalgh, 2018).

  • Example: Nurses accept patients’ worldviews and help them seek health from within those worldviews, which is a critical component of evidence-based practice (EBP).

  • A framework connects empirical knowledge, EBP, science, research, theory, and philosophy; this framework reminds clinicians of the importance of research in practice (Fig. 1.1).

Focus of research evidence in nursing

  • The empirical focus in nursing aims to describe, explain, predict, and control phenomena important to professional nursing.

  • The following sections outline types of knowledge needed for moving toward EBP.

Description

  • Description involves observing/documenting a phenomenon, providing a snapshot of reality (Adams & Lawrence, 2019; Melnyk & Fineout-Overholt, 2019).

  • Descriptive designs can be qualitative, quantitative, mixed methods, or outcomes studies; used to explore new concepts or understand variables in natural settings.

  • Purposes of descriptive research in nursing:

    • Explore and describe what exists in nursing practice.

    • Discover new information and meaning.

    • Promote understanding of situations.

    • Classify information for disciplinary use.

  • Examples from descriptive research:

    • Identification of individuals’ experiences related to health conditions and situations.

    • Exploration of health promotion/illness prevention strategies across populations.

    • Determination of disease incidence locally, nationally, and internationally.

    • Identification of symptom clusters for a disease.

  • Descriptive study example (Egypt, PICU): Elbilgahy, Hashem, and Alemam (2019) surveyed mothers of children in a pediatric ICU to assess satisfaction with care. Findings included:

    • Respiratory problems were the most frequent reason for PICU admission.

    • Mothers were most satisfied with the “care and cure” aspects and with staff attitudes.

    • Factors influencing satisfaction: maternal education level, length of hospital stay, communication, and parental participation in care; child diagnosis also affected satisfaction.

    • Conclusion: Training programs were needed to improve communication between the health team and mothers. (Sample: N=108; p. 26)

  • Descriptive research is valuable for describing existing conditions and informing improvements.

Explanation

  • Explanation clarifies relationships among concepts/variables to understand how they work together.

  • Explanatory research can use qualitative, quantitative, mixed methods, or outcomes research (Adams & Lawrence, 2019; Creswell & Clark, 2018; Creswell & Creswell, 2018; Hall & Roussel, 2017; Marshall & Rossman, 2016).

  • Evidence types for practice from explanation:

    • Link concepts to develop explanations, models, or theories of a phenomenon in nursing.

    • Determine assessment data (subjective health history and objective physical examination data) needed to address health needs.

    • Link assessment data to determine diagnoses (nursing and medical).

    • Link causative risk factors/etiologies to illness, morbidity, and mortality.

    • Determine relationships among health risks, health status, and healthcare costs.

Prediction

  • Prediction estimates the probability of a specific outcome in a given situation (Chinn & Kramer, 2018).

  • Predicting outcomes does not automatically allow modification/control of outcomes (Dane, 2018).

  • Predictive evidence in nursing includes:

    • Predicting disease risk in different populations.

    • Predicting the accuracy/precision of screening instruments (e.g., mammography).

    • Predicting long-term survival based on disease stage (e.g., 10-year survival after cancer).

    • Predicting the impact of nursing actions on outcomes.

    • Predicting health-promoting behaviors, illness prevention, and longevity.

    • Determining whether specific nursing actions will be acceptable to patients based on personality.

  • Example: Serum albumin as a predictor of morbidity/mortality in surgical/ICU patients.

    • Kendall, Abreu, and Cheng (2019) reviewed studies and identified a gap: whether post-admission albumin trends predict mortality in ICU sepsis patients.

    • Study design: retrospective medical record analysis of N=577 ICU patients with sepsis.

    • Five albumin variables were extracted per patient: admission albumin, minimum albumin, maximum albumin, serum albumin trend, and average albumin.

    • All variables predicted mortality with high sensitivity and specificity; the most predictive were serum albumin trend and minimum albumin.

    • Age was the only demographic variable contributing to mortality prediction.

Control

  • If an outcome can be predicted, researchers/nurses can attempt to control or manipulate the situation to achieve the desired outcome using best available evidence.

  • Areas important for generating EBP evidence:

    • Testing interventions to improve healthStatus for individuals, families, and communities.

    • Testing leadership strategies to improve healthcare delivery.

    • Determining the quality and cost-effectiveness of interventions.

    • Implementing evidence-based interventions to determine effectiveness in managing health needs and achieving quality outcomes.

    • Synthesizing research evidence for use in practice.

Example of applying an EBP guideline

  • Hartford Institute for Geriatric Nursing guideline: Managing oral hydration in dehydration-prone older adults (Mentes, 2008, 2012).

  • Target population: Older adults who are nil per os (NPO) prior to procedures, have fever, vomiting/diarrhea, or are at risk for dehydration based on a standardized assessment tool.

  • Guideline basis: Findings from >20 studies evaluated for quality and level of evidence.

  • Recommended nursing actions for older adults at risk of dehydration (e.g., dementia/incontinence):

    • Calculate a daily fluid goal: ext{fluid goal}.

    • Compare current intake to the fluid goal: ext{intake}
      ightarrow ext{fluid goal}.

    • Offer a variety of fluids routinely during rounds at designated times.

    • Schedule "happy hours" or "tea times" to increase fluid intake.

    • Monitor urine color and amount: ext{urine color/amount}.

  • Outcome: By implementing these actions, nurses can correct fluid deficits or prevent dehydration.

Your role in research

  • Many more studies and syntheses are needed to generate evidence for practice (Bourgault, 2018; Clanton, 2017; Melnyk & Fineout-Overholt, 2019).

  • Education levels correspond to different research roles:

    • BSN: Critically appraise existing studies and participate as data collectors; apply best evidence with guidance.

    • MSN: Critically appraise and synthesize studies to develop/revise protocols and policies; implement best evidence; collaborate on research.

    • DNP: Participate in evidence-based guideline development; develop/implement/evaluate/revise protocols and guidelines; conduct clinical studies, usually with other nurse researchers.

    • PhD: Assume major role as primary investigator; obtain initial funding; coordinate BSN/MSN/DNP researchers; contribute to empirical knowledge.

    • Postdoctoral: Implement funded programs of research; lead/participate in nursing and interdisciplinary teams; mentor PhD-prepared researchers.

  • Table 1.1: Nurses’ participation in research at various levels of education (summary of competencies)

    • BSN: Read and critically appraise studies; use best evidence in practice with guidance; assist with problem identification and data collection.

    • MSN: Critically appraise and synthesize studies to develop/revise protocols; implement best evidence; collaborate and provide clinical research expertise.

    • DNP: Participate in evidence-based guideline development; develop/implement/evaluate/revise protocols and guidelines; conduct clinical studies (often with collaborators).

    • PhD: Assume major role as primary investigator; obtain initial funding; coordinate research teams of BSN, MSN, and DNP nurses.

    • Postdoctoral: Implement a funded program of research; lead/participate in nursing and interdisciplinary teams; mentor PhD researchers.

    • Abbreviations: BSN = Bachelor of Science in Nursing; DNP = Doctorate of Nursing Practice; MSN = Master of Science in Nursing; PhD = Doctor of Philosophy; Postdoctoral = postdoctoral researcher.

Chapter wrap-up and key points

  • This chapter introduces the world of nursing research and the connections among EBP, research, theory, and science (Fig. 1.1).

  • As you study the following chapters, you will expand your ability to critically appraise studies, synthesize findings, and apply the best research evidence in clinical practice.

  • Nursing research offers opportunities for collaboration with expert nurse researchers and holds promise for the future of nursing practice.

  • Key points:

    • Nursing research is a scientific process that validates/refines existing knowledge and generates new knowledge that influences the delivery of EBP. \text{Nursing research} \,=\, \text{scientific process}.

    • The empirical world interacts with EBP, research, theory, science, knowledge, and philosophy; this framework moves from concrete practice to abstract philosophical views affecting nursing (Fig. 1.1).