EVIDENCE-BASED PRACTICE AND NURSING RESEARCH

Nursing research provides the foundation for evidence-based nursing practice

Evidence-based practice The process of systematically finding, appraising, and using research findings as the basis for clinical practice - for making decisions about patient care.

Development of Nursing Knowledge Evidence-Based Practice (research-based practice, best practice) Integration of best research evidence with clinical expertise and patient values

Evidence-Based Practice A move toward supporting practice with evidence began in the mid-1980s. Agency for Healthcare Research and Quality oversees publishing reviews of evidence and clinical guidelines and supports nursing research.

The practice of Evidence-Based Practice includes five fundamental steps Step 1: Formulating a well-built question Step 2: Identifying articles and other evidence-based resources that answer the question Step 3: Critically appraising the evidence to assess its validity Step 4: Applying the evidence Step 5: Re-evaluating the application of evidence and areas for improvement

DEFINITION OF NURSING RESEARCH Nursing research is a systematic approach used to examine phenomena important to nursing and nurses, that clinical practice be based on scientific knowledge. Research is a process of systematic inquiry or study to build knowledge in a discipline.

NURSING RESEARCH The purpose of research is to validate and refine existing knowledge and develop new knowledge. The results of research process: provide a foundation on which practice decisions and behaviors are laid create a strong scientific base for nursing practice and application of results demonstrates profes­sional accountability to insurers and health care consumers.

NURSING RESEARCH Nursing research aimed at impacting the direct provision of nursing and health care to recipients of nursing care, nursing research also is needed to generate knowledge in areas that affect nursing care processes indirectly.

EVIDENCE-BASED PRACTICE The introduction of evidence-based change into the direct provision of nursing care may occur at the individual level of a particular nurse or at varied organizational or social levels. Evidence generated by nursing research provides support for the quality and cost-effectiveness of nursing interventions.

RESEARCH PRIORITIES often set by groups that fund research, encourage nurse researchers to invest effort and money into those areas of research likely to generate the most benefit to recipients of care, the funding opportunities offered by such groups don't hurt the research enterprise either.

Sources of funding for nursing research The main outcome of research activity for a nurse is to eventually put the knowledge gained to work in health care delivery. In USA there are the National Institute for Nursing Research (NINR) and the Agency for Healthcare Research and Quality (AHRQ). Both of these organizations are funded by federal congressional appropriations. Private foundations and nursing organizations also provide funding for nursing research.

Research is a process that takes place in a series of steps: Formulating the research question or problem Defining the purpose of the study Reviewing related literature Formulating hypotheses and defining variables Selecting the research design Selecting the population, sample, and setting Conducting a pilot study Collecting the data Analyzing the data Communicating conclusions

Are plans that tell a researcher STUDY DESIGNS Are plans that tell a researcher how data are to be collected, from whom data are to be collected, how data will be analyzed to answer specific research questions.

Research studies are classified into two basic methods: Quantitative research is a formal, objective, systematic process in which numeric data are used. Qualitative research is a systematic approach used to describe and promote understanding of human experiences such as pain

NURSING RESEARCH DESIGNS The most common designs used in health care research are case study, survey, needs assessment, experimental, quasiexperimental, methodologic, meta-analysis, and secondary analysis.

Case study designs Are used to present an in-depth analysis of a single subject, group, institution, or other social unit. The purpose is to gain insight and provide background information for more controlled broader studies, develop explanations of human processes, and provide rich descriptive anecdotes

Extramural Priority Areas for Nursing research a. Chronic conditions—arthritis, diabetes, urinary incontinence, long-term care, and care giving b. Health promotion and risk behaviors—women's health, adolescence, menopause, environmental health, exercise, nutrition, and smoking cessation c. Cardiopulmonary health—prevention and care of persons with cardiac or respiratory conditions, including research in critical care, trauma, wound healing, and organ transplantation

Extramural Priority Areas for Nursing research d. Neurofunction and sensory conditions—pain management, sleep disorders, and symptom management in persons with cognitive impairment and chronic neurologic conditions e. Immune and neoplastic diseases(oncology)—symptoms primarily associated with cancer and acquired immune deficiency syndrome, such as fatigue, nausea and vomiting, and cachexia, as well as risk-factor prevention research f. Reproductive and infant health—prevention of premature labor, reduction of health-risk factors during pregnancy, delivery of prenatal care, care of neonates, infant growth and development, and fertility issues (From the National Institutes of Nursing Research (NINR)

NURSING RESEARCH Nursing research (links education, theory, nursing practice) provides the basic for expanding the unique body of scientific knowledge that forms the foundation of nursing practice. Research studies will emphasize clinical issues, problems, and outcomes. Priority will be given to research studies that focus on promoting health and developing cost-effective health care systems.

RESEARCH UTILIZATION Through Research Utilization, efforts and knowledge obtained from research is transformed into clinical practice, culminating in nursing practice that is evidence-based, to help understand the importance of evidence-based practice.

Nurse Researcher Roles Two nursing roles are specifically focused on research: the clinical nurse specialist (CNS) and the clinical nurse researcher (CNR).

CONSUMER OF RESEARCH Nurses at all levels of educational preparation have responsibility to participate in the research process. Nurses become knowledgeable consumers of research through educational processes and practical experience, must have a basic understanding of the research process and critical appraisal skills that provide a standard for evaluating the strengths and weaknesses of research studies before applying them in clinical practice.

CONSUMER OF RESEARCH A consumer of research uses and applies research in an active manner. The nurse must be knowledgeable consumer of research, one who can critique research and use existing standards to determine the merit and readiness of research for use in clinical practice.