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Professional Nursing Practice Concepts and Perspectives
Seventh Edition Chapter 10 The Nurse’s Role in Evidence-Based Health Care
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Learning Objectives 10.1 Discuss the trend toward evidence-based practice in nursing Describe the nurse’s role in research Analyze ethical concerns in nursing research Differentiate approaches in nursing research Identify the criteria for using research in nursing practice Identify available resources for evidence-based practice in nursing.
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Hallmark Features A focus on foundational knowledge related to professional nursing Includes nursing history, nursing theory, ethics, and legal aspects, etc. An overview of professional nursing roles, issues, and changes in the profession Discusses nurses as healthcare providers, learners and teachers, and leaders
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Challenges and Opportunities
Gap between research and practice Implementing practice changes Providing high-quality care with accountability Confidence in decisions based on scientific evidence
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Learning Objective 10.1 Discuss the trend toward evidence-based practice in nursing.
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Evidence-Based Practice
Sound knowledge base is necessary for decision making in practice Knowledge sources Tradition Authority Experience and trial and error Logical reasoning and application of research
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Evidence-Based Practice
Empirical nursing knowledge Comes from scientific evidence developed through research Includes order and control and allows for generalization of results
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Evidence-Based Practice
Purpose of scientific research Description Exploration Explanation Prediction Control
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Evidence-Based Practice
Ways to access empirical knowledge Learn about research methods Use systematic reviews conducted by expert groups Agency for Healthcare Research and Quality Federal agency that provides evidence reports on numerous topics
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Learning Objective 10.2 Describe the nurse’s role in research.
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Research in Nursing Directed toward building knowledge about effects of nursing on human responses Aspects of human responses Physiological Psychological Spiritual Social Cultural Developmental Economic Implies 24-hour responsibility
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Research in Nursing Research enables the nurse to
Describe situations about which little is known Explain phenomena that have not been well understood Predict probable outcomes Control occurrence of undesired outcomes Initiate activities to promote desired outcomes Research guides nurses’ decisions and actions
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Research in Nursing Roles in research
ANA expects that the RN integrates evidence and research findings into practice Nurses in clinical practice can Identify the problems in need of investigation Support the research process Assist with data collection and analysis Preparation for research roles begins at undergraduate level
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Research in Nursing Historical perspective
Florence Nightingale demonstrated the importance of research in nursing care Isabel Stewart integrated research into the graduate nursing curriculum Published the first research journal in nursing, the Nursing Education Bulletin in the late 1920s Publication of many other research journals to communicate nurses’ research
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Research in Nursing National Institute of Nursing Research (NINR) established in 1986 Elevated to an institute at NIH in 1993 NINR’s five strategies to advance the science of health Enhance health promotion and disease prevention Improve quality of life Improve palliative and end-of-life care Enhance innovation in science and practice Develop next generation of nurse scientists
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Research in Nursing Sigma Theta Tau International (STTI)
Honor society for nursing Mission supports the learning, knowledge, and professional development of nurses to make a difference in health worldwide Offers a variety of research grants
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Learning Objective 10.3 Analyze ethical concerns in nursing research.
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Ethical Concerns Nurses advocate for clients’ rights
Participation in research must be voluntary Tuskegee study violated ethical principles Nurses must safeguard clients’ rights Not to be harmed Full disclosure Self-determination Privacy and confidentiality
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Learning Objective 10.4 Differentiate approaches in nursing research.
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Approaches in Nursing Research
Two major approaches to investigating phenomena Quantitative – uses precise measurement for data collection and analyzes numerical data Frequently associated with philosophical doctrine logical positivism Qualitative – narrative data that describe the phenomena in an in-depth and holistic fashion Flexible and less controlled
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Approaches in Nursing Research
Mixed methods - combines two or more methods in the same study Integrates qualitative and quantitative data Allows for a conclusion by integrating results Can be more expensive
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Steps in the Research Process
Steps in the conduct of research Identify the problem Search the existing literature Primary source Secondary source Identify specific research questions or hypotheses Appropriate study designed to answer questions or test hypotheses Operational definition of the variable
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Steps in the Research Process
Data collection done according to three categories Biophysiological measures Observation Self-report by study participants or subjects Analyze and interpret the data Conclusions must be supported by data
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Using Research in Practice
Critiquing research reports Polit and Beck: dimensions when conducting research critiques Substantive and theoretical Methodological Ethical Interpretive Presentation and stylistic
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Integration of Research into Practice
Research utilization The process in which study findings are used to initiate and support innovations in the delivery of nursing care WICHEN and CURN projects promote dissemination and utilization of nursing research
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Integration of Research into Practice
Four stages before adopting research-based ideas or practices Knowledge Persuasion Decision Implementation
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Inhibitors of Integrating Research
Barriers to evidence-based practice Clinician barriers include Lack of training Low level of comfort Lack of awareness of available research Perceived lack of decision making authority Perceived minimal benefits
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Inhibitors of Integrating Research
Environmental barriers include lack of Infrastructure support Access to evidence Lack of incentive Insufficient time Collaboration Staff support Management support
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Facilitators of Research Utilization
Facilitating factors Understanding that change comes from a systematic approach Administrative support Newsletters Research meetings Continuing education programs Computer networks Research study guides
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Learning Objective 10.5 Identify the criteria for using research in nursing practice.
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Criteria for Research Utilization
Replication Scientific merit Risk Clinical merit Clinical control Feasibility Cost Potential for clinical evaluation
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Learning Objective 10.6 Identify available resources for evidence-based practice in nursing.
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Integration of Research into Practice
Evidence-based practice Broader than research utilization Recognizes other sources of evidence Reliable data from Quality improvement programs Evaluation projects Consensus of experts Clinical experience
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Integration of Research into Practice
Hierarchy of evidence Stetler Hierarchy of Evidence Melynk and Fineout-Overholt’s Rating for Hierarchy of Evidence
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Integration of Research into Practice
Evidence should be ranked as excellent, good, fair, or poor on three criteria Effectiveness/usefulness Appropriateness/applicability Feasibility/cost-benefit
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Integration of Research into Practice
Nurse can reach one of several conclusions and decide To implement a protocol To not use evidence in practice Research-based protocols and procedures
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