1. Evidence-Based Practice and Nursing Research Chapter 6

2. 6-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Research  Nursing research makes a difference to the care of clients, advances the discipline of nursing, and helps develop nursing knowledge.

3. 6-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Historical Development of Nursing Research  1936 First research grant awarded by Sigma Theta Tau.  1952 Nursing Research became official research journal of American Nurses Association.  1955 American Nurses Foundation formed.

4. 6-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Historical Development of Nursing Research  1963 Surgeon General’s Consultant Group on nursing research.  1965 First research conference to stimulate clinical studies focusing on quality of care.  1970s Establishment of three nursing research journals.

5. 6-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Organizations that Support Nursing Research  American Nurses Association  American Nurses Foundation  National Institute for Aging

6. 6-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. National Institute of Nursing Research (NINR)  Fundamental organization for coordinating and supporting the research efforts within the nursing profession  Established in 1993  Formerly National Center for Nursing Research (1985)

7. 6-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Historical Development of Nursing Research  Three major areas of nursing research funding for the 21st Century: Health Promotion/Disease Prevention Acute and Chronic Illness Nursing System

8. 6-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Development of Nursing Knowledge  Evidence-Based Practice (research- based practice, best practice) Integration of best research evidence with clinical expertise and patient values

9. 6-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evidence-Based Practice  A move toward supporting practice with evidence began in the mid-1980s.  Agency for Healthcare Research and Quality oversees publishing reviews of evidence and clinical guidelines and supports nursing research.

10. 6-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evidence-Based Practice  Level of Evidence Four levels of evidence designate the amount of research support generated to support a particular strategy in care. Best Practice Information Sheets allow reviewers to evaluate and draw conclusions based on the prescribed level of evidence.

11. 6-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Research Designs, Methods, and Methodologies in Nursing  The two main research paradigms in nursing are quantitative and qualitative.

12. 6-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Research Designs, Methods, and Methodologies in Nursing  Quantitative Research Design Draws conclusions about some procedure. Uses statistical methods. Uses deductive reasoning, logic, and measurable aspects of experience.

13. 6-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research Design Methods  Descriptive, exploratory, survey  Historical review  Cross-sectional, longitudinal  Retrospective, prospective  Correlational  Quasi-experimental, experimental

14. 6-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Descriptive Studies Describe a phenomenon of interest (clinical observation).

15. 6-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Exploratory Studies Describe in detail the phenomena and try to identify contributing factors.

16. 6-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Survey Method Surveying a group of individuals for responses to certain questions.

17. 6-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  A nurse researcher gives directions to research assistants when she is training to implement her survey method of research.

18. 6-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Historical Research Systematic data collection relating to past events. Places concepts in perspective. Establishes parameters for continued research in a specialized area.

19. 6-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Cross-Section Studies Data collected at one specific measurement point about a single event. A relatively large number of individuals is sampled in a short period of time.

20. 6-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Longitudinal Studies Data collection on the same subjects studied over time. Data is collected on a number of variables.

21. 6-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Retrospective Studies Review existing data from medical records/hospital charts. A carefully conducted retrospective study can provide the research questions for a prospective study.

22. 6-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Prospective Studies Actively follow subjects over the period of the study. The researcher is able to control all information collected.

23. 6-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Correlational Designs Investigate the correlation (relationship) of one variable to another. Useful for studying the relationships among large numbers of variables associated with “human research.”

24. 6-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Quasi-Experimental Design A modified experiment exposing all subjects to the independent variable. Less robust than a true experimental design.

25. 6-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quantitative Research  Experimental design Tests an “independent variable” against a “dependent variable.” Subjects are randomized to a treatment group or a control group. “Gold standard” in research design.

26. 6-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Research Designs, Methods, and Methodologies in Nursing  Qualitative Research Design The systematic collection and consideration of data relating to humans’ interactions in and with the world. Frequently involves interview data. Provides a more holistic approach that is conducted in natural settings.

27. 6-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Methods of Qualitative Research  Biographical  Case Study Method  Ethnography  Ethnomethodology  Grounded Theory  Phenomenology

28. 6-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Qualitative Research  Biographical Method Involves writing about people’s lives. Sources of data include historical documents: artifacts, diaries, letters, personal stories, related historical facts. Data analysis involves sorting and relating all the information gathered.

29. 6-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Qualitative Research  Case Study Method May refer to a single case, subject, group, or institution. Multidimensional approach using a variety of data-collection strategies.

30. 6-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Qualitative Research  Ethnography Longitudinal, descriptive research approach used by anthropologists to describe behaviors of a culture. Data sources include observation of participant behavior, interviews, artifacts.

31. 6-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Qualitative Research  Ethnomethodology Interpretive descriptions of how people make sense of their social world.

32. 6-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Qualitative Research  Grounded Theory Field research used in hospitals, nursing homes, clinics. Investigates social and decision-making processes of clients. Involves theoretical sampling until data saturation is reached.

33. 6-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Qualitative Research  Phenomenology Approach uses a variety of distinctive, yet related, philosophical approaches. Begins in profound reflection on the phenomenon to be studied. Multiple sources of data collection. Requires intense reflection to understand its meaning.

34. 6-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Literature Review  The process by which published and unpublished materials are selected to develop support for the research project. Computerized literature search Conference abstracts Published and unpublished materials

35. 6-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Developing a Research Proposal  Identification of the research question  Statement of the problem  Research design  Implications for nursing

36. 6-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Writing and Publishing Research Studies  Identification of the most appropriate journal for disseminating the results of the study.  Specific criteria for publication includes submission of an abstract and manuscript.

37. 6-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementing Research into Nursing Practice  Publication of findings  Forums for presenting findings  Applying legal and ethical principles  Gaining support from management  Making changes in nursing practice

38. 6-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Legal Aspects of Research  Protection of subjects in all research studies is mandatory.  Informed consent is the primary method for ensuring subjects are protected.

39. 6-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Legal Aspects of Research  The subject’s rights that are protected in informed consent are: Protection from harm Full disclosure of information Freedom to participate or not Privacy and confidentiality respected

40. 6-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Legal Aspects of Research  The Institutional Review Board provides a structure for research to be implemented in both a legal and an ethical environment.

41. 6-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Legal Aspects of Research  Informed Consent for Vulnerable Clients Confused elderly, unconscious, underage clients Consent by proxy

42. 6-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Research in the Year 2003 and Beyond  Future changes in nursing research include collaboration and development of teams of researchers using distance learning technology.