Nursing Research and Evidence Based Practice Team Teaching

Introduction development and utilization of nursing knowledge is essential for continued improvement in patient care. Conducting researches in nursing, as all other sciences, is important to establish a knowledge-base for practice, improvement, and development.

Nursing Research Definitions

“A systematic study of problems in patient care.” “A systematic detailed attempt to discover or confirm facts that relate to a specific problem to improve the practice and profession of nursing.” A study of the problems in practice relating to the effects of nursing.” A systematic search for knowledge about issues of importance to nursing.”

Evolution of Nursing Research Education/Recruitment Administration/Staffing Practice Methodology/Theory based research

Current Trends Health Promotion Nursing Decision Making Effectiveness of Nursing Intervention in Selected Health Problems Prevention Case Studies/Qualitative Research Compliance

PURPOSES OF RESEARCH Identification Description Exploration Explanation Prediction and Control

Characteristics of a scientific research: The good scientific research should have the following characteristics: 1. Should include a problem that need a solution or a question that need an answer. 2. Should achieve a general objective rather than a personal objective. 3. It should follow the scientific approach that characterized by order and control. 4. It should add new information through: a. New facts that was not known before. b. Validates results of previous research. c. Tests theories. d. Explains findings of a previous research. e. Find out new relationships among present phenomena.

The Quantitative Research Process.

CONCEPTUAL PHASE FORMULATING AND DELIMITING THE PROBLEM Topic Research Problem Problem statement – articulates the problem to be addressed and indicates the need for a study Research Questions – are the specific queries researchers want to answer in addressing the research problem Research Hypothesis – predictions that are tested empirically

Side effects of Chemotherapy Term Example Topic Side effects of Chemotherapy Research Problem Nausea and vomiting are common side effects among patients on chemo; interventions have been moderately successful. New interventions that can reduce or prevent these side effects need to be identified Statement of purpose Purpose is to test an intervention to reduce chemotherapy-induced side effects – specifically to compare the effectiveness of patient-controlled and nurse-administered antiemetic therapy Research question What is the relative effectiveness of patient-controlled antiemetic therapy versus nurse-controlled antiemetic therapy with regard to (a) medication consumption, and (b) control of nausea and vomiting in patients on chemotherapy? Hypothesis There is no difference on the effectiveness between patient-controlled and nurse-controlled antiemetic therapy with regard to medication consumption and control of nausea and vomiting of patients on chemotherapy.

CONCEPTUAL PHASE FORMULATING AND DELIMITING THE PROBLEM Evaluating research problems Significance of the problem – research problem should have the potential of contributing meaningfully to the nursing knowledge Researchability of the Problem Time and timing Availability of study participants Facilities and equipments Money Experience and interest of the researcher

CONCEPTUAL PHASE 2. REVIEWING THE LITERATURE Done to familiarize researchers with the knowledge base PURPOSES: Orient of what is known and not known regarding the topic Replication of study Identifications of relevant theoretical and conceptual framework Assistance in interpreting study findings and developing implications and recommendations

SOURCES OF LITERATURE PRIMARY SOURCES SECONDARY SOURCES Research reports/studies SECONDARY SOURCES Books Literature review summaries

THE DESIGN AND PLANNING PHASE Selecting a research design Identifying the population to be studied Sampling plan Methods to measure research variables Finalizing the research study

RESEARCH DESIGN Based on: Time Frame Control over independent variable Measurement of independent and dependent variables

TIME FRAME DESIGN FEATURES EXAMPLE CROSS-SECTIONAL Data are collected at one point in time Practical, easy to do, economical Mindell and Jacobson (2000) assessed sleep patterns and the prevalence of sleep disorders during pregnancy. They compared women who were at 4 points in pregnancy: 8-12wks, 18-22wks, 25-28wks, 35-38wks. They concluded that sleep disturbance is common in late pregnancy.

TIME FRAME DESIGN FEATURES LONGITUDINAL Data are collected at two or more points in time over an extended period TREND STUDIES Investigations in which samples from a population are studied over time Different samples are selected but drawn from the same population Based on surveys

CONTROL OVER INDEPENDENT VARIABLE DESIGN FEATURES EXPERIMENTAL Manipulation of independent variable Control group randomization QUASI -EXPERIMENTAL No control group No randomization NONEXPERIMENTAL No manipulation of independent variable

Is there an intervention? No Yes NONEXPERIMENTAL Is there randomization? No Yes QUASI-EXPERIMENTAL EXPERIMENTAL

MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES DESIGN FEATURES EXAMPLE RETROSPECTIVE Study begins with dependent variable and looks backward for cause Heitkemper, et. al. (2001), used a Retrospective design in their study of factors contributing to the onset of irritable bowel syndrome. They compared samples of women with and without IBS in terms of their history of sexual and physical abuse and found that abusive experiences were more prevalent among women with IBS.

MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES DESIGN FEATURE EXAMPLE PROSPECTIVE Study begins with independent variable and looks forward for the effect Brook, et. al. (2000) conducted a prospective study to examine clinical and cost outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. Early tracheostomy was found to be associated with shorter lengths of hospital stay and lower cost.

IDENTIFYING THE POPULATION TO BE STUDIED POPULATION – aggregate or totality of those conforming to a set of specifications. Nurses Students Children Etc.

DESIGNING THE SAMPLING PLAN SAMPLE – subset of a population Sampling techniques: Probability sampling Systematic sampling Fish bowl method Nonprobability sampling Purposive/Judgmental sampling Snow ball technique Convenience/accidental sampling

METHODS TO MEASURE RESEARCH VARIABLES Different methods of data collection Biophysiologic measurements Self-reports Observation Use of a research instrument Questionnaires Survey forms

FINALIZING THE RESEARCH PLAN Pretesting of questionnaires Conducting a Pilot study

DESIGN AND PLANNING PHASE 6. Selecting a Research Design 7. Specifying the Population 8. Operationalizing the Variables 9. Conducting the Pilot Study/Making Revisions

EMPIRICAL PHASE 10. Selecting the Sample 11. Collecting the Data 12. Organizing Data for Analysis (DATA ENCODING)

THE ANALYTIC PHASE DATA ANALYSIS Statistical analysis DATA INTERPRETATION – is the process of making sense of the results and examining their implications CONCLUSION AND RECOMMENDATION

DISSEMINATION PHASE RESEARCH REPORT UTILIZATION OF FINDINGS Research Abstract Research published in journals Term papers, theses, dissertations UTILIZATION OF FINDINGS Application to nursing practice and nursing education

REFERENCES All of the literature used in writing the research article. Should contain mostly recent and primary sources.

What is Evidence-Based Practice?

Definitions “Process by which nurses make clinical decisions using best available evidence, clinical expertise, & patient preferences in the context of available resources” “’Evidence-based practice (EBP) – utilizes the best clinical evidence in making patient care decisions typically from research. EBP translates knowledge into practice’’

WHAT IS EVIDENCE-BASED PRACTICE? Conscientious use of current best evidence to make decisions about patient care A problem-solving approach to clinical practice Based on: 1. systematic search for and appraisal of most relevant evidence to answer questions 2. one’s clinical experience and expertise 3. patient preference and values

Why Evidence-Based Practice in Nursing Potential to narrow the ‘research-practice gap’: adoption of research findings into practice Impacted by perception that published research is not relevant to practice Provides a means to answer problematic clinical practice issues Potential to improve individual bedside practice; supports/improves clinical decision-making skills

Evidence Based Practice Process Identify a practice issue Formulate an answerable question Search for best evidence Critically evaluate the evidence and clinical relevance Make recommendations Apply to clinical practice Evaluate impact/effectiveness/ outcomes

EVIDENCE-BASED PRACTICE The process of doing the “right thing” Standards of care Baseline description of quality practice Clinical guidelines Broad-based recommendations Critical pathways Identify key/critical activities that must occur in predictable fashion Protocols Detailed procedures on how to proceed with evaluation and treatment

BARRIERS TO EVIDENCE-BASED PRACTICE Overwhelming patient workloads Misperceptions about EBP and research Lack of time and resources to search for and appraise evidence Organizational constraints – lack of support Peer pressure to continue with practices that are steeped in tradition – “we’ve always done it this way and we are not changing now”

BARRIERS TO EVIDENCE-BASED PRACTICE Knowledge… lack of knowledge/awareness .… unfamiliar with guidelines and guideline accessibility Attitudes …. lack of confidence in the guideline developer, lack of motivation to perform the guideline recommendations Behaviors …. inability to incorporate patient preferences into the clinical decision making process