Nursing Research and Evidence Based Practice Dr. Belal Hijji, RN, PhD October 24, 2010

2 Learning Outcomes At the end of this lecture, students will be able to: Recognise the importance of nursing research and its relationship with evidence-based practice. Identify the major two approaches to nursing research. Discuss the role of the nurse as an advocate to the client who is a research participant Discuss the quantitative research process and, to some extent, the qualitative research tradition 2

3 Nursing Research & Evidence Based Practice At present, nurses are extensively involved in generating, publishing, and applying research in practice. Evidence-based practice is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research" (Sackett et al, 1996) The scope and standards of practice published by the ANA (2004) include research as one of the standards of professional performance (next slide) 3

4 ANA’s Standards of Professional Performance Pertaining to Research Standard 13: Research The registered nurse integrates research findings into practice Measurement Criteria The registered nurse: Utilises best available evidence, including research findings, to guide practice decisions. Actively participates in research activities at various Levels appropriate to his/ her level of education and Position. Such activities may include:  Identifying clinical problems specific to nursing research 4

5  Participating in data collection  Sharing research activities and/ or findings with peers  Conducting research  Critically analysing and interpreting research for application to practice Florence Nightingale demonstrated the importance of research to nursing practice. During the Crimean war she found A military hospital overcrowded, filthy, rat and flea infested, and lacking in food, drugs, and medical supplies. These conditions led to deaths among service men due to starvation and diseases. Nightingale systematically collected, organised, and reported data, and was able to institute sanitary reforms and reduce mortality rates. 5

6 Approaches to Nursing Research There are two major approaches to nursing research. These are: – Quantitative research: This type of research progresses through systematic, logical steps according to a specified plan to collect data that is analysed using statistical procedures. Examples of quantitative studies include: Knowledge and practice of blood transfusion: a survey of nurses in the north and middle regions of Jordan. Nurses’ practice of blood transfusion in the United Arab Emirates: an observational study 6

7 – Qualitative research: This type of research of research is usually associated with naturalistic inquiry, which explores the subjective and complex experiences of human beings. Qualitative researchers aim to understand the human experienced as it is lived, usually through careful collection and analysis of qualitative materials that are subjective. Examples of qualitative research studies include: The nature of coping and adjustment after a radical prostatectomy. High school students perceptions of nursing as a future career. 7

88 Protecting the Rights of Research Participants Because nursing research focuses on human beings, one of the roles that nurses enact is that of client advocate. This entails that clients are informed and understand the consequences of consenting as a research participants. Nurses in practice setting where research is conducted with human subjects and those who carry out research safeguard the following human rights: Right not to be harmed: The risk of harm can be physical, psychological, legal, financial, or social. For example, reporting a nurse who administered incorrect blood to a client during an observational study.

99 Right to full disclosure: Providing full information to a prospective research participant is a basic right. Covert research is unethical because it means deception by withholding information or giving false or misleading information. Right of self-determination: This means that prospective subjects must be free from constraints, coercion [ər- zhən, -shən], or any undue pressure. For example, students should not feel pressured to participate in a study carried out by a faculty member. Right of anonymity and confidentiality: Anonymity is ensured if the researcher cannot link a specific person to the information provided. Confidentiality means that the information provided by a research subject will not be made public or shared with others without his/ her consent

10 The Quantitative Research Process Research is a systematic inquiry that uses disciplined methods to answer questions or solve problems. The following are steps in quantitative research: Identify a research topic. This usually comes from experience or literature. A research topic should meet four criteria: significance, researchable, feasible, and interest to the researcher.  Significance: the research topic has the potential to contribute to nursing science by enhancing client care.  Researchable: means that the topic can be subjected to scientific investigation. Not all topics or problems are amenable to research. For example, should nurses be allowed to go on strike?

11  Feasibility: Means availability of time, material, and human resources needed to investigate a topic. For example, Hijji (2010) investigated the actual practice of blood transfusion among 50 nurses in Abu Dhabi, United Arab Emirates (UAE). However, it was not possible to observe 200 nurses because of lack of time and other constraints.  Interest: The researcher spends huge amount of time and energy while conducting a study. Therefore, he should be genuinely interested in his work as an element of success. Identify the aims and objectives of the study: For the above mentioned study, the aims and objectives were as follows (next slide)

12  The aim of the observations was to document nurses' actual practice of blood transfusion of children and adult patients. The objectives were to assess nurses' practice: 1.Before blood bag collection 2. After blood delivery to the clinical area but before the initiation of a transfusion and 3. Within 15 minutes of setting up a transfusion. Review the literature: This is an important and useful step as it would enable the researcher to determine what is known and what is unknown about the topic. A literature review provides the foundation on which to build new knowledge; it may provide information about available instrument; and may identify problems to be avoided.

13 Select a research design: The research design tells us about the overall plan for investigating the research topic. It provides information about study setting, the sample, the type of data to be collected. For the above mentioned study the design was descriptive observational that involved a random sample of 50 nurses from a total of 140 nurses (population) from 2 public hospitals in Abu Dhabi. Conduct a pilot study: This is a small-scale study conducted on a few participants to assess the adequacy and feasibility of the data collection plan. It can identify problems that may arise in the main study and eliminate them. An example is provided next.

14 No item to document the checks nurses performed at nurses' station "Performed checks at nurses' station" was added Baseline vital signs were not specific BP, pulse, and temperature were specified Problems identified following the first pilot study

15 Collect the data: The research process relies on empirical data collected from the observable world. Data can collected via questionnaires, observations, or interviews. Analyse the data: In this stage, the collected data are organised, coded and analysed. Quantitative data are analysed using a computer software called the Statistical Package for Social Scientist (SPSS). Data analysis could involve descriptive statistics (see below). Statistics (Score out of 25) N68 Mean Median Mode 10.00

16 Communicate the results: It is the researcher’s professional responsibility to share the results generated through his research with others, through publication, conferences, or informally with concerned institution. For example, the results of the survey of nurses’ knowledge and practice of blood transfusion in the middle and northern regions of Jordan were presented to the hospitals that supported the study.

17 The Quantitative Research Process Qualitative research is associated with a number of overlapping philosophies and methodologies such as naturalism, interpretivism, and ethnography. Hammersley & Atkinson (1983) define naturalism: – Naturalism proposes that the social world should be studied in its ‘natural’ state, undisturbed by the researcher. Hence, ‘natural’, not ‘artificial’ settings like experiments or formal interviews, should be the primary source of data. Furthermore, the research must be carried out in ways that are sensitive to the nature of the setting. Interpretivism incorporates naturalism and emphasise the point that researchers can only understand the social world through their senses and a process of subjective interpretation.

18 Qualitative approach can enable researchers to explore issues in depth. For example, Hijji (2001) wanted to understand the barriers that prohibit high school students from entering nursing education programmes. Unstructured data collection methods such as participant observation and semi-structured interviews are used in qualitative studies. Qualitative researchers often draw on the grounded theory when undertaking their studies. This ensures that the theories that researchers develop are grounded in the data obtained

19 References American Nurses Association (ANA) Scope and Standards of Nursing Practice (2004) Hammersley, M. and Atkinson, P. (1983). Ethnography: Principles in Practice. London, Routledge. Hijji, B. (2001). High school students’ perceptions of nursing as a future career. A pilot qualitative research study. Hijji, B. et al. (2010). Nurses’ practice of blood transfusion in the United Arab Emirates: An observational study. Journal of Clinical Nursing. Sackett, W.M.C. Rosenberg, J.A.M. Gray, R.B. Haynes and W.S. Richardson (1996) Evidence based medicine: what it is and what it isn't? British Medical Journal 312, pp. 71–72.