1. Introduction to Nursing Research and Evidence-Based Practice
The Pennsylvania state university college of nursing
Nursing 200w

2. What is nursing research?
To search again
To examine carefully
Diligent and systematic inquiry
Discovery – a “spirit of inquiry”
Goal is to develop an empirical (scientific) body of knowledge for a discipline which is essential
for evidence-based practice!

4. Why is research important for evidence-based practice?
Develops empirical knowledge base
Identifies best practices that are based on clinical practices AND research
Improves outcomes for:
Patient and family
Nurse
Health care system

5. Description Explanation
What role does research have in implementing an evidenced-based nursing practice? 
Description
Identify and understand topics where little is known
Explanation
Explains the interaction between concepts

6. What role does research have in implementing an evidenced-based nursing practice? 
Prediction
Estimate likelihood that an outcome will occur
Control
Experimental designs; maintaining consistency between variables

7. Test Your Knowledge Question
Identifying and understanding the nature of nursing phenomena and the relationships among the phenomena are examples of __________?
Description 
Explanation 
Prediction 
Control 

8. Test Your Knowledge Question: Answer
Description deals with identifying and understanding the nature of phenomena and the relationship among the phenomena
Explanation—Clarifying the relationships among phenomena and identifying the reasons why certain events occur
Prediction—Estimating and anticipating the outcomes in a particular situation
Control—Manipulating a situation so as to achieve a particular outcome
ANSWER A!

9. What is the history of nursing research?
Nursing research has evolved slowly over the years
Nursing research began in the 19th century with Florence Nightingale in the Crimean War
Clinical research is the current major focus of nursing research and will continue to be so throughout the 21st century

10. How is nursing knowledge acquired?
Traditions – changing bed linens daily
Authority – charge nurse on a unit
Borrowing – knowledge from other disciplines 
Trial and Error
Personal Experience – Benner’s Model of novice to
Role Modeling – clinical preceptor or mentor
Intuition – source of knowledge cannot be fully explained, “gut feeling”
Reasoning – inductive or deductive

11. How and why do researchers utilize empirical knowledge?
Empirical knowledge is gained by employing the following research methods:
Quantitative research = numbers
Qualitative research = language
Outcomes research = system level quality and effectiveness
Empirical knowledge is essential for the delivery of high-quality, safe patient and family nursing care (QSEN competencies)

12. Quantitative Research
Formal, objective process
Involves measurement & numerical data
Philosophy is based on logical positivism, where:
Truth is absolute
A single reality exists
Deductive reasoning is used
Purposes include test hypotheses, determine cause & effect, and/or identify relationships among variables

13. What are some types of quantitative research?
Descriptive: measures what is.
Correlational: how concepts relate to each other.
Quasi-experimental and Experimental: Manipulate or control one aspect of a situation to examine the effect.

14. Qualitative Research Systematic, subjective approach
Involves non-numeric data
Philosophy is based on holistic, interpretive stance, which states that:
Truth is dynamic
Multiple realities exist
Inductive reasoning is used
Purpose is to investigate human experiences and interactions.

15. What are some types of qualitative research?
Phenomenological: describe an experience
Grounded theory: formulate and test a theory
Ethnographic: in depth study of a culture
Exploratory-descriptive: describe a topic and promote understanding
Historical research: an analysis of events to provide understanding

17. Test Your Knowledge Question
The beginning nurse researcher would like to investigate credible resources for implementing protocols in clinical practice. Which of the following would be considered empirical sources of nursing knowledge?
Reasoning, authority, and tradition
Quantitative, qualitative, and outcomes research
Care maps and protocols
Role modeling and trial and error

18. Test Your Knowledge Question: Answer
Answer: B!
Quantitative, qualitative, and outcomes research methods are used to generate empirical knowledge for nursing practice. These research methods are essential to generate evidence.
A and D are examples of sources of knowledge.
C refers to clinical practice guidelines.

19. What is the focus of outcomes research?
Patients and Families
Healthcare Providers
Healthcare Systems
Practice Changes
Policy Development

20. Test Your Knowledge Question
The nurse researcher is investigating outcomes research on nursing interventions. Which of the following examples would constitute outcomes research?
A comparison of two patient groups
Patient responses to nursing intervention
Patient tested before and after intervention
A patient’s perception of the intervention

21. Test Your Knowledge Question: Answer
Answer: B!
Some of the essential areas that require investigation through outcomes research include: (1) patient responses to nursing and medical interventions; (2) functional maintenance or improvement of physical, mental, and social functioning for the patient; (3) financial outcomes achieved with the provision of health care services; and (4) patient satisfaction with the health outcomes, care received, and health care providers (Doran, 2011).
A. This is an example of a quantitative approach
C. An example of a Pre and Post test design
D. This is an example of a qualitative approach

22. Why utilize evidence-based practice guidelines?
Provide high-quality, cost-effective health care
Allow for synthesis of knowledge needed for interventions and practice including development of the following:
Guidelines
Standards
Protocols
Policies

23. What skills do baccalaureate prepared nurses need?
Are knowledgeable about the research process and have skills in reading and critically appraising studies.
The QSEN competencies identify such knowledge and skills as being essential for pre-licensure students.
Should be prepared to actively participate in Evidence Based Practice.

25. Building an Evidence-Based Nursing Practice

26. How is evidence-based practice defined?
Integration of all of the following to promote high-quality, cost-effective patient care with good outcomes:
Best research evidence
Clinical expertise
Patient values and needs

27. What is not evidence-based practice?
Evidence-based practice is not always incorporated due to the following barriers:
Practicality of implementing changes
‘Cookie-cutter’ or ‘cookbook’ approach to care

28. Why do we use evidence-based practice?
EBP is used because of benefits such as improved patient, family and caregiver outcomes. EBP can also improve provider (i.e., nurse, physician, etc.) and hospital outcomes.
EBP leads to the ‘gold standard’ or best treatments

29. What are sources for evidence-based practice?
Systematic reviews
Meta-analyses
Integrative reviews
Meta-syntheses

30. What are systematic reviews?
A narrowly focused synthesis of research findings from quantitative studies
Looks at studies of similar methodology
Has same standards of clarity, rigor, and replication as primary research studies

31. Steps in a Systematic Review
Formulate purpose and identify scope.
Develop specific questions or hypotheses.
Establish criteria for inclusion/exclusion of studies.
Conduct extensive literature search of all sources.
(Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)

32. Steps in a Systematic Review
Develop questionnaire and contact authors to gather data.
Critique studies for scientific merit and data analysis.
Analyze and interpret data.
Report the review.
(Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)

33. What is a meta-analysis?
Statistically pools results from previous studies into single quantitative analysis
Allows for application of scientific criteria
For example, sample size, level of significance, variables, etc.

34. What results are reported in a meta-analysis?
A large, diverse sample that is more representative of target population
Determination of overall significance of probability of pooled data
Indication of the efficacy of the intervention from the average effect size determined from several quality studies
Strength of relationship between variables

35. What is the best evidence for use in practice?
The strength of the evidence is on a continuum from high-quality results to lower quality results.
Evidence-based guidelines are essential in developing evidence- based practice for nursing.

37. What is strong versus weak evidence?
strongest
weakest
Meta-analysis
Integrative reviews
Experimental studies
Descriptive surveys
Qualitative studies
Correlational studies
Quasi-experimental studies

39. Pulling it All Together
An example of building a pico(S) question

40. What are the steps to evidence-based practice?
As a new nursing researcher you would like to learn more about the research process and identify credible resources. You decide to examine the problem of medication adherence and the use of a medication reconciliation process for patients who are newly diagnosed with hypertension.

41. Steps of EBP Step 0: Cultivate a spirit of inquiry.
Step 1: Ask a clinical question in PICOT format.
Step 2: Search for the BEST evidence
Step 3: Critically appraise the evidence
Step 4: Integrate the evidence with clinical expertise and patient preferences and values
Step 5: Evaluate the outcomes of practice decisions based on the evidence
Step 6: Disseminate the EBP results

42. Developing the PICO Question
P—Population -patient with hypertension
I—Intervention - implementing medication teaching
C—Comparison -compare patient outcomes for patient who receive teaching to those for a patient who does not
O—Outcomes - increased adherence leads to decrease in blood pressure
(T) - Time (may not always be a part of the study) OR
(S) – Setting (may not always be part of the study)

43. Developing the PICO Question
This is an example of an intervention type PICO question:
In patients with hypertension how does medication teaching compared to no medication teaching increase medication adherence and lowered BP?

44. Questions? Comments?
The end!