1. Nursing Research and Evidence Based Practice
Lecture 3

2. Introduction
development and utilization of nursing knowledge is essential for continued improvement in patient care. Conducting researches in nursing, as all other sciences, is important to establish a knowledge-base for practice, improvement, and development.

3. Nursing Research Definitions
“A systematic study of problems in patient care.”
“A systematic detailed attempt to discover or confirm facts that relate to a specific problem to improve the practice and profession of nursing.”
A study of the problems in practice relating to the effects of nursing.”
A systematic search for knowledge about issues of importance to nursing.”

4. PURPOSES OF RESEARCH Identification Description Exploration
Explanation
Prediction and Control

5. Characteristics of a scientific research:
1. Should include a problem that need a solution or a question that need an answer.
2. Should achieve a general objective rather than a personal objective.
3. It should follow the scientific approach that characterized by order and control.
4. It should add new information through:
a. New facts that was not known before.
b. Validates results of previous research.
c. Tests theories.
d. Explains findings of a previous research.
e. Find out new relationships among present phenomena.

6. The Quantitative Research Process

7. CONCEPTUAL PHASE FORMULATING AND DELIMITING THE PROBLEM Topic
Research Problem
Problem statement – articulates the problem to be addressed and indicates the need for a study
Research Questions – are the specific queries researchers want to answer in addressing the research problem
Research Hypothesis – predictions that are tested empirically

8. Side effects of Chemotherapy
Term
Example
Topic
Side effects of Chemotherapy
Research Problem
Nausea and vomiting are common side effects among patients on chemo; interventions have been moderately successful. New interventions that can reduce or prevent these side effects need to be identified
Statement of purpose
Purpose is to test an intervention to reduce chemotherapy-induced side effects – specifically to compare the effectiveness of patient-controlled and nurse-administered antiemetic therapy
Research question
What is the relative effectiveness of patient-controlled antiemetic therapy versus nurse-controlled antiemetic therapy with regard to (a) medication consumption, and (b) control of nausea and vomiting in patients on chemotherapy?
Hypothesis
There is no difference on the effectiveness between patient-controlled and nurse-controlled antiemetic therapy with regard to medication consumption and control of nausea and vomiting of patients on chemotherapy.

9. CONCEPTUAL PHASE FORMULATING AND DELIMITING THE PROBLEM
Evaluating research problems
Significance of the problem – research problem should have the potential of contributing meaningfully to the nursing knowledge
Researchability of the Problem
Time and timing
Availability of study participants
Facilities and equipment’s
Money
Experience and interest of the researcher

10. CONCEPTUAL PHASE 2. REVIEWING THE LITERATURE
Done to familiarize researchers with the knowledge base
PURPOSES:
Orient of what is known and not known regarding the topic
Replication of study
Identifications of relevant theoretical and conceptual framework
Assistance in interpreting study findings and developing implications and recommendations

11. SOURCES OF LITERATURE PRIMARY SOURCES SECONDARY SOURCES
Research reports/studies
SECONDARY SOURCES
Books
Literature review summaries

12. THE DESIGN AND PLANNING PHASE
Selecting a research design
Identifying the population to be studied
Sampling plan
Methods to measure research variables
Finalizing the research study

13. RESEARCH DESIGN Based on: Time Frame Control over independent variable
Measurement of independent and dependent variables

14. TIME FRAME DESIGN FEATURES EXAMPLE CROSS-SECTIONAL
Data are collected at one point in time
Practical, easy to do, economical
Mindell and Jacobson (2000) assessed sleep patterns and the prevalence of sleep disorders during pregnancy. They compared women who were at 4 points in pregnancy: 8-12wks, 18-22wks, 25-28wks, 35-38wks. They concluded that sleep disturbance is common in late pregnancy.

15. Different samples are selected but drawn from the same population
TIME FRAME
DESIGN
FEATURES
LONGITUDINAL
Data are collected at two or more points in time over an extended period
TREND STUDIES
Investigations in which samples from a population are studied over time
Different samples are selected but drawn from the same population
Based on surveys

16. CONTROL OVER INDEPENDENT VARIABLE
DESIGN
FEATURES
EXPERIMENTAL
Manipulation of independent variable
Control group
randomization
QUASI -EXPERIMENTAL
No control group
No randomization
NONEXPERIMENTAL
No manipulation of independent variable

17. Is there an intervention?No
Yes
NONEXPERIMENTAL
Is there randomization? No
Yes
QUASI-EXPERIMENTAL
EXPERIMENTAL

18. MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES
DESIGN
FEATURES
EXAMPLE
RETROSPECTIVE
Study begins with dependent variable and looks backward for cause
Heitkemper, et. al. (2001), used a Retrospective design in their study of factors contributing to the onset of irritable bowel syndrome. They compared samples of women with and without IBS in terms of their history of sexual and physical abuse and found that abusive experiences were more prevalent among women with IBS.
DESIGN
FEATURE
EXAMPLE
PROSPECTIVE
Study begins with independent variable and looks forward for the effect
Brook, et. al. (2000) conducted a prospective study to examine clinical and cost outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. Early tracheostomy was found to be associated with shorter lengths of hospital stay and lower cost.

19. IDENTIFYING THE POPULATION TO BE STUDIED
POPULATION – aggregate or totality of those conforming to a set of specifications.
Nurses
Students
Children
Etc.

20. DESIGNING THE SAMPLING PLAN
SAMPLE – subset of a population
Sampling techniques:
Probability sampling
Systematic sampling
Fish bowl method
Nonprobability sampling
Purposive/Judgmental sampling
Snow ball technique
Convenience/accidental sampling

21. METHODS TO MEASURE RESEARCH VARIABLES
Different methods of data collection
Biophysiologic measurements
Self-reports
Observation
Use of a research instrument
Questionnaires
Survey forms

22. FINALIZING THE RESEARCH PLAN
Pretesting of questionnaires
Conducting a Pilot study

23. DESIGN AND PLANNING PHASE
6. Selecting a Research Design
7. Specifying the Population
8. Operationalizing the Variables
9. Conducting the Pilot Study/Making Revisions

24. EMPIRICAL PHASE 10. Selecting the Sample 11. Collecting the Data
12. Organizing Data for Analysis
(DATA ENCODING)

25. THE ANALYTIC PHASE DATA ANALYSIS
Statistical analysis
DATA INTERPRETATION – is the process of making sense of the results and examining their implications
CONCLUSION AND RECOMMENDATION

26. DISSEMINATION PHASE RESEARCH REPORT UTILIZATION OF FINDINGS
Research Abstract
Research published in journals
Term papers, theses, dissertations
UTILIZATION OF FINDINGS
Application to nursing practice and nursing education

27. REFERENCES
All of the literature used in writing the research article. Should contain mostly recent and primary sources.

28. What is Evidence-Based Practice?

29. Definitions
“Process by which nurses make clinical decisions using best available evidence, clinical expertise, & patient preferences in the context of available resources”
“’Evidence-based practice (EBP) – utilizes the best clinical evidence in making patient care decisions typically from research. EBP translates knowledge into practice’’

30. Why Evidence-Based Practice in Nursing
Potential to narrow the ‘research-practice gap’: adoption of research findings into practice
Provides a means to answer problematic clinical practice issues
Potential to improve individual bedside practice;
Supports/improves clinical decision-making skills

31. Evidence Based Practice Process
Identify a practice issue
Formulate an answerable question
Search for best evidence
Critically evaluate the evidence and clinical relevance
Make recommendations
Apply to clinical practice
Evaluate impact/effectiveness/ outcomes

32. BARRIERS TO EVIDENCE-BASED PRACTICE
Overwhelming patient workloads
Misperceptions about EBP and research
Lack of time and resources to search for and appraise evidence
Organizational constraints – lack of support
Peer pressure to continue with practices that are steeped in tradition – “we’ve always done it this way and we are not changing now”