Evidence-Based Practice And Research In Nursing

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Evidence-Based Practice

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• Current Standard of professional performance (ANA)
• EBP- making clinical decisions based on simultaneous use of best evidence, clinical expertise, & client's values
• Steps identified
• Some contend that research given the most weight, over expert opinions, CLINICAL EXPERTISE, theory
• *This emphasisis because RESEARCH entails using formal and systematicprocesses to address problems and answer questions
• Others concerned about using research as 1° source of evidence

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Nursing Research

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• a systematic, objective process of analyzing phenomena of importance in nsg.
• Encompasses all clinical practice arenas, nsg. education, and nsg. administration
• ANA(2004) includes research as one of the standards of professional performance

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components of EBP

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1. Clinical expertise
2. Best Evidence
3. Patient Values & Preferences

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Nursing Journal

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1st published in 1952 to serve as a vehicle for communicating nurses' research findings

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National Institute of Nursing Research (NINR)

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• 1985, ANA lobbied intensely, US Congress passed a bill creating Nat. Center for Nsg. Research, as a part of Nat. Inst. of Health
• 1993, the center elevated to INSTITUTE status.
• NINR puts nsg. research on an equal footing w/ research done by other health-related profs. by supporting research training and research related to client care

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Quantitative research

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• Generalized to populations
• the systematic collection, statistical analysis, and interpretation of numerical data
  
• planned and fixed study process, careful attention to extraneous variables (any variable that could influence the results of the study other than the specific variables being studied for their influence) or contaminating factors in the study environment
• Linked to the philosophical perspective of LOGICAL POSITIVISM (maintains that the "truth" is absolute and can be discovered by careful measurement

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Quantitative research questions:

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1. What causes_____________?
2. Which tx for a condition is more effective?
3. What factors are assoc. w/ a specific condition or outcome?
4. If I know X, to what extent can I predict the occurrence of Y?

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Qualitative reseach

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• Focuses on lived experiences of people
• systematic collection and thematic analysis of NARRATIVE data (the research collects and analyzes words, rather than numbers)
• Explores human experiences
• Philosophical perspective, of NATURALISM (constructivism)- maintains that reality is relative or contextual and constructed by individuals who are experiencing a phenomenon
• characterized by flexible & evolving study processes and by minmized "distancing" between the researcher and study informant

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3 distinct QUALITATIVE traditions

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1. Phenomenology
2. Ethnography
3. Grounded theory

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Phenomenology

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focused on lived experiences

ex. Student Nurse's lack of sleep, weight gain/ loss

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Ethnography

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Cultural patterns of thoughts and behaviors

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Grounded theory

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focuses on social process

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additional qualitative types

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include historical and case study research

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Qualitative research questions

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1. What is the experience of receiving Dx X or undergoing tx Y? (phenomenology)
2. What are the typical behaviors of certain groups of clients (who may be defined by a Dx or membership in a cultural or ethnic group)? (ethnography)
3. How do individuals cope with X? (grounded theory)

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Characteristic/ Quantitative research

1. Reality
   
2. Data
   
3. Perspective
   
4. Approach to knowing
   
5. Research approach
   
6. Research conditions
   
7. Goal
   
8. Methods
   
9. Data analyses
   
10. Outcome
    
11. Findings/results
    

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Quantitative research

1. Stable
   
2. Numbers, "hard data"
   
3. Outsider
   
4. Reductionistic
   
5. Objective, structured, rational, empirical
   
6. Controlled, laboratory
   
7. Verification, test theory
   
8. Measurement
   
9. Deductive, statistics
   
10. Facts
    
11. Replicable, reliable, generalizable
    

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Characteristic/ Qualitative research

1. Reality
   
2. Data
   
3. Perspective
   
4. Approach to knowing
   
5. Research approach
   
6. Research conditions
   
7. Goal
   
8. Methods
   
9. Data analyses
   
10. Outcome
    
11. Findings/results
    

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Qualitative research

1. Personal, contextual
   
2. Words, "soft" data
   
3. Insider
   
4. Contextual, holistic
   
5. Subjective, artistic, intuitive
   
6. Naturalistic, fieldwork
   
7. Discovery, generate theory
   
8. Thick description
   
9. Inductive, intuitive, themes
   
10. Meaning, understanding
    
11. Valid, credible, transferable
    

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Associate degree nurse's (Ed. prep. for NSG Research)

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1. aware of importance
   
2. help Identify problem areas in nsg
   
3. help collect data
   

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Research Process

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• Formulating the research problem and purpose
  
• Determining study methods
  
• Collecting Research Data
  
• Analyzing Research Data
  
• Communicating Research Findings
  
• Using Research Findings in Practice
  

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(Formulating the research )PICO

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P-Patient, population, or Problem of interest

I- Intervention or therapy to consider for subject of interest

C- Comparison of interventions, such as no tx

O- Outcome of Intervention

*PICOD=Design

*PICOS=Setting

*PICOT=Timeframe

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Dependent variable

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a behavior, characteristic, or outcome that the researcher wishes to explain or predict

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Independent variable

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is the presumed cause of or influence on the dependent variable

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Hypothesis

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a predictive statement about the relationship between 2 or more variables

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Methodology

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thought of as the study's logistics or mechanics

-elements- how study is organized

-who/ what will be the source of info.

-what data will be collected

etc.

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Research design

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Overall structure, blueprint, layout of the study

• how many times data will be collected
  
• # of groups being compared in study
  
• timing of data collection relative to other studies
  

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Reliability

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the consistency of measures

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Validity

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the completeness and conceptual accuracy of measures

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CINAHL

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Cumulative Index of Nursing Health Literature

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Descriptive Statistics: Measures of Central Tendency

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Mean- the arithmetic average for a set of scores. Mean is calculated by summing all scores and dividing by the # of scores

Median- the middle value in a distribution of scores or the value above and below which 50% of the scores lie

Mode- the most common or frequently occurring value in a data set

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Descriptive Statistics: Measures ofVariability

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Range- the difference or span between the lowest and highest value for a variable

Standard deviation- the average amount by which a single score in a distribution deviates or differs from the mean score

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Commonly used Inferential Statistics

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Independent t-test- used to compare the mean performance of 2 independent groups (ex. men and women)

Dependent (or paired) t- test- used to compare the mean performance of 2 dependent or related groups (such as a before and after test given to the same individuals)

Analysis of Variance(ANOVA)- used to compare the mean performance of 3 or more groups

Pearson's product-moment correlation coefficient (Pearson's r)- used to describe and test the relationship between two continuous variables (ex. age and weight)

Chi-squared- used to compare the distribution of a condition across 2 or more groups.

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Scientific validation

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a thorough critique of a study for its conceptual and methodological integrity.

Scrutinizing the overall quality of its findings

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Comparative analysis

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Assessing study findings for their implementation potential. 3 factors: 1-how the study's findings compare to the findings from other studies about the problems; 2- how the study's findings will transfer from the research conditions to the clinical practice conditions in which they will be used; 3- practical or feasibility considerations that need to be addressed when applying the findings in practice

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Cost-benefit analysis

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involves consideration of the potential risks and benefits of both implementing a change based on a study's findings and not implementing a change

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Nurse's working directly with clients can make particularly valuable contributions to research projects

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• Identifying clinically relevant problems that need to be studied
• Reviewing the literature to provide background information for a study
• Recruiting study participants
• Securing clients' consent to participate in a study
• Designing data collection instruments
• Pilot-testing data collection instruments
• Collecting research data
• Monitoring for adverse effects of study participation
• Implementing research interventions
• Assisting with interpretations of study findings

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Institutional Review Board (IRB)

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Relevant committee designated to protect human subjects' rights.

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Rights of Study Participants

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Right NOT to be Harmed

Right to FULL Disclosure

Right to SELF-DETERMINATION

Right to PRIVACY

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Elements of Informed Consent

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1. Subject status
   
2. Study purpose
   
3. Sponsorship
   
4. Subject selection
   
5. Study procedures, type of data to be collected
   
6. Nature of Commitment
   
7. Potential Risks and costs associated w/ participation
   
8. Potential benefits associated with participation
   
9. Protection of Privacy
10. Voluntary Consent
11. Alternatives
12. Right to decline to participate or withdraw from study, nonprejudicial treatment
13. Comprehension of information
14. Contact information: whom to contact with questions or complaints about the study