Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 6 Nursing Research and Evidence- Based Practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Definition—systematic inquiry or study conducted to generate new knowledge or to refine existing knowledge Nursing Research

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Research  Results provide a foundation for practice decisions and behaviors.  Results create a strong scientific base for nursing.  Results provide support for the quality and cost-effectiveness of interventions.  Application of results demonstrates professional accountability to insurers and health care consumers.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Evolution of Nursing Research  Florence Nightingale—Crimean War  Research focus, 1900 to 1940  Nursing education  Student characteristics  Student satisfaction  Research focus, 1950s to 1970s  Teaching  Administration  Curriculum Issues

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Evolution of Nursing Research  Research focus, 1980s  Clinical research  Transdisciplinary studies  Qualitative studies  Research focus, 1990s — health care delivery issues such as cost, quality, and access  Research focus of the 21st century — evidence base for practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Research Priorities  National Institute for Nursing Research (NINR)  Understand and ease the symptoms of acute and chronic illness.  Prevent or delay the onset of disease or disability, or slow its progression.  Find effective approaches to achieving and sustaining good health.  Improve clinical settings in which care is provided.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Research Priorities  NINR objectives address six broad areas  Chronic conditions — arthritis, diabetes, urinary incontinence, long-term care, and caregiving  Health promotion and risk behaviors — women’s health, adolescence, menopause, environmental health, exercise, nutrition, and smoking cessation

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. NINR Objectives  Cardiopulmonary health — prevention and care of persons with cardiac or respiratory conditions, including research in critical care, trauma, wound healing, and organ transplantation  Neurofunction and sensory conditions — pain management, sleep disorders, and symptom management in persons with cognitive and chronic neurologic conditions

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. NINR Objectives  Immune and neoplastic diseases — symptoms primarily associated with cancer and AIDS, such as fatigue, nausea, vomiting, and cachexia, and prevention research on risk factors  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

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Agency for Healthcare Quality and Research (AHRQ)  An agency of the U.S. Department of Health and Human Services that aims to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Agency for Healthcare Quality and Research (AHRQ)  The 1999 reauthorizing legislation expanded the role of the agency by directing ARHQ to Improve the quality of health care through scientific inquiry, dissemination of findings, and facilitation of public access to information Improve the quality of health care through scientific inquiry, dissemination of findings, and facilitation of public access to information Promote patient safety and reduce medical errors through scientific inquiry, building of partnerships with health care providers, and establishment of Centers for Education and Research on Therapeutics (CERTS) Promote patient safety and reduce medical errors through scientific inquiry, building of partnerships with health care providers, and establishment of Centers for Education and Research on Therapeutics (CERTS)

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Established an office for priority populations to ensure that the needs of low-income groups, minorities, women, children, the elderly, and individuals with special health care needs are addressed by the agency’s research efforts Established an office for priority populations to ensure that the needs of low-income groups, minorities, women, children, the elderly, and individuals with special health care needs are addressed by the agency’s research efforts Advanced the use of information technology for coordinating patient care and conducting quality and outcomes research Advanced the use of information technology for coordinating patient care and conducting quality and outcomes research Agency for Healthcare Quality and Research (AHRQ)

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Private Foundations  Robert Wood Johnson  W.K. Kellogg Foundation  Helene Fuld Trust

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Organizations Sigma Theta Tau International (STTI)Sigma Theta Tau International (STTI) Oncology Nurses Society (ONS)Oncology Nurses Society (ONS) American Nurses Foundation (ANF)American Nurses Foundation (ANF)

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Components of the Research Process  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

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Study Designs Plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific research questions Plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific research questions

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Quantitative Designs  Case study — provides an in-depth analysis of a single subject, group, institution, or social unit  Survey — used to collect large amounts of information with little expenditure of time and money  Needs assessment — used to determine what is most beneficial to an aggregate group

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Quantitative Designs  Methodologic — focuses on the development and testing of instruments to improve reliability and validity of instruments  Meta-analysis — an advanced process by which research on a specific topic is reviewed and findings of multiple studies are statistically analyzed and expressed quantitatively

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Quantitative Designs  Experimental — studies that include the manipulation of one or more independent variables, random assignment to a control or a treatment group, and observation of the outcome or effect that is presumably the result of the independent variable  Quasi-experimental — This design lacks one of the components of experimental design, i.e., randomization, control group, or manipulation of one or more variables.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Quantitative Designs  Secondary analysis — involves asking new questions on data collected previously. The data may have been generated from previous formal research or may have been gathered through any previous systematic collection of data.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Quantitative Designs  Triangulation — the use of various research methods or data collection techniques in the same study  Pilot studies — small-scale studies referred to as feasibility studies; purpose is to identify strengths and limitations of a larger planned study

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Qualitative Designs  Qualitative designs—a method of research designed for discovery rather than for verification  Phenomenology — a method used to study intangible experiences such as grief, hope, or risk taking. It is designed to provide an understanding of the patient’s “lived experience.”  Ethnography — a method used to study phenomena from a cultural perspective  Grounded theory — a method designed to explore a social process

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Barriers to research utilization  Studies are not focused on clinical problems.  Studies are not replicated.  Findings are not stated in terms understood by nurses. Research utilization—Currently, there is extensive concern that nurses have failed to realize the potential for using research findings as a basis for making decisions and developing nursing interventions. Using Research in Practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Using Research in Practice  Barriers related to nurses  Nurses do not value research.  Nurses are unaware of or are unwilling to read research reports.  Nurses lack the ability to access research findings.  Nurses do not know how to apply research findings in practice.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Barriers related to health care organizations  Desire for stability  Time and monetary cost of development and implementation  Competing goals such as cost containment and regulatory compliance  Lack of systematic reward system for nurses who engage in research Using Research in Practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Using Research in Practice  Brown’s model for achieving research-based practice  Appraisal of the findings of a single study  Appraisal of collective evidence from two or more studies  Appraisal of a state-of-the-science summary

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  WICHE (Western Interstate Commission for Higher Education) Project  6-year project funded by the Division of Nursing in the mid 1970s for the critical appraisal and implementation of research findings in practice Using Research in Practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Using Research in Practice  CURN (Conduct and Utilization of Research in Nursing) Project  Best-known nursing utilization research project  Five-year project funded by the Division of Nursing in the late 1970s for the critical appraisal and implementation of research findings in practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Heparinized saline for flushing peripheral intravenous catheters Heparinized saline for flushing peripheral intravenous catheters Interventions such as exercise for cancer-related fatigue Interventions such as exercise for cancer-related fatigue Prevention and treatment of pressure ulcers Prevention and treatment of pressure ulcers Examples of Evidence-Based Practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Examples of Evidence-Based Practice  Clinical practice guidelines—developed by AHCPR (Agency for Healthcare Policy and Research) in 1992  Acute pain care management in infants, children, and adolescents  Prediction and prevention of pressure ulcers in adults  Identification and treatment of urinary incontinence in adults

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Strategies to Promote Research Strategies for administratorsStrategies for administrators –Foster a climate of intellectual curiosity. –Encourage individual staff. –Offer financial and resource support for research utilization. –Include research utilization as a criterion for performance evaluation. –Seek opportunities for institutional research utilization and evidence-based practice projects.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Strategies for Practicing Nurses – Read widely and critically. – Attend professional conferences. – Expect evidence that a procedure is effective. – Seek environments that support research utilization. – Become involved in a journal club. – Participate in institutional research utilization and evidence- based practice projects.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nurse Researcher Roles  Clinical nurse specialist (CNS) — master’s degree–prepared nurse who is an expert clinician with additional responsibility for education and research: assesses the agency’s readiness for research utilization; works with staff to identify clinical problems; and helps staff find, implement, and evaluate findings relevant to current practice

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nurse Researcher Roles  Clinical nurse researcher (CNR)—doctorally prepared nurses with clinical and research experience  Focuses on the conduct or facilitation of research  Works with staff to identify research questions  Designs studies  Disseminates findings to staff, administrators, and legislators

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Using Research in Practice  Locating published research  Focus on the usefulness of computerized databases such as CINAHL and MEDLINE  Annual Review of Nursing Research  Critical appraisal of nursing research  Blind review  Abstract and findings may be the easiest sections of a research report for the novice to understand.

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Ethical Issues Related to Research  Institutional review — IRB or Human Subjects Committee required by institutions receiving federal funding  Historical examples of unethical research  Nazi experiments  Tuskegee syphilis study  Jewish Chronic Disease Hospital in New York

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Summary  Educators must prepare students to appreciate and conduct research and evaluation at their level of preparation.  Health care administrators must foster research.  Consumers must be educated about the value of nursing research.  Policy makers must be informed about findings, so that results can be translated into health policy.