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142 Cards in this Set
- Front
- Back
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research
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systematic inquiry to develop trustworthy evidence about issues of importance to the nursing profession, including nursing practice, education, administration and information.
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EBP
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as the use of the best clincal eidence in making patient care deciions, and such evidence typically comes from resesarch conducted by nurses and other HC professionals.
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EBP
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actions are clinically appropriate cost effective and result in positive outcomes for clients.
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consumers of nursing research
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read reports to develop skills and to keep currently on new trends and findings
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Producers of nursing research
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actively participate in designing and implementing studies.
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priorpity of nursing research in future
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will promote excellence in nursing science.
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evidence hierarchies
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acknowledge that certain types of evidence are superior to others
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sources of evidence for nursing practice
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- Tradition
- Authority - clinical experience - trial & error - intuition - logic reasoning |
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logic reasoning
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- inductive reasoning: process of developing generalizations from specific observations
- deductive reasoning: process of developing specific predictions from generalized principles. |
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Paradigm
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world view
generalized perspective on the complexities of the real world |
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2 types of paradigm
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- Positive paradigm/Logical: mainly means QUANTITATIVE studies
- Naturalistic Paradigm/Constructive: QUALITaTIVE studies |
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Positive Paradigm
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emphasizes rational and the scientific.
- reality out there that can be studied and known. - phenomena (observable facts and events) are not haphazard or random, but have antecedent causes. - much time is spent in understanding the underlying causes of the phenomena - observable facts & events. - Seek objectivity |
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Naturalistic Paradigm
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- reality is not fixed but rather a constructive of the individuals participating in the research.
- reality exists within a context and there are many constructions. |
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Scientific method - positive p.
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orderly,
disciplined procedures used to acquire information Uses DEDUCTIVE reasoning to generate predictions that are tested in the real world. |
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Scientific method
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- predefined pathway of:
problem definition/pre-specification plan -selection of concepts on which to focus - solution of the problem |
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empirical data
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quantitative research gathers empirical information that is rooted in objective reality and gathered directly/indirectly thru' senses rather that personal belief or hunches.
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generalizability - important goal
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is the ability to go beyond the specifics of a research situation and generalize to others outside of the research group.
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psychological phenomena
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difficult to measure objectively since they are subjective, e.g. morale, self-esteem.
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human subjects
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complex & diverse
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quantitative studies
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focus is narrow & inflexible
- leads to a sedimented view of the world that does not fully capture the reality of the experience |
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Naturalistic methods
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explores issues of the human complexity by exploring it directly.
- humans are complex and have the ability to shape and create their own experiences and the idea that truth is a composite of realities. - they examine the human experience as it is lived thru' careful collection and analysis of qualitative materials that are NARRATIVE & SUBJECTIVE. |
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naturalistic methods
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flexible, evolving procedures used to capitalized on finding that emerge in the course of the study
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problems w/naturalistic method
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- use humans that are sensitive and intelligent but fallible tools.
- generalization of findings can be challenged since focus is on a limited number of subjects and THEIR experience. |
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basic research
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undertaken to extend the base of knowledge in a discipline
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applied research
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focuses is on finding solutions to existing problems
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quantitative studies have either of 2 focuses
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- causing probing: looking at underlying causes of the phenomena (evidence hierarchy focuses on this)
- describe the phenomena and how they are interrelated |
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differences between qualitative & quantitative research approaches
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qualitative - little is known about phenomena: "what is the phenomena", what is its name?
- quantitative: begin with a phenomena that has been previously studied or defined. - So identification typically preceed the inquiry. |
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discriptors of both phenomena
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Qualitative descriptors: describe the dimensions, variations, and importance of phenomena.
Quantitative descriptors: focus on size, prevalence, incidence and measurable attributes of the phenomena. |
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exploration of qualitative studies
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useful in exploring little understood phenomena, to shed light on various ways in which a phenomena is manifested and on underlying processes.
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exploration research
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often linked to theories, which represent a method of organizing and integrating ideas about phenomena and their interrelationship.
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most of the EBP
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fundamentally call for cause probing research.
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prognosis research
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asks if a disease or health condition causes subsequent outcomes.
looking and evaluating mortality & morbidity |
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etiology research
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seeks explanations about the underlying causes of health problems.
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intervention research
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focuses on whether an intervention causes improvements in the key outcomes.
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diagnosis & assessment research
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focuses on tools to screen, diagnoses and assess patients and to measure important clinical outcomes.
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chapter 2
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chapter 2
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Research Utilization
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sometimes used interchangeably with EBP but they are distinct.
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RU
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is the use of findings from research and applying it towards solving real world problems.
- genesis of the process is research based innovation or new evidence. |
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evidence hierarchy pyramid
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at the peak is:
- Systematic review of Randomized Clinical trails & Systematic review of non-Randomized clinical trails 2nd tier includes: Single RCT or Single nonRCT 3rd tier includes: Systematic review of correlational/observational studies 4th level: Single observable study Opinions of authorities & expert committees is at bottom. |
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evidence hierarchy
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rank according to strength of the evidence they provide
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systematic reviews - top of the hierarchy pyramid
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not just a literature review.
- traditionally, were narrative (qualitative) intergration that merged and synthesized findings. - Narrative now being replaced by meta- analysis |
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meta analysis
Meta synthesis Critically apprised topics (CAT) |
is a technique for intergrating quantitative reseach findings from a study ar one piece of infromation. The findings from multiply studies on the same topic are combined and then all of the information is analyzed statistically in a manner similar to that of a usual study.
- individual studies are the unit of analysis and not study participants. - integrates a body of findings and of observing patterns that might not have been detected. - intergrates and amplify findings across qualitative studies. |
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pre-approved evidence
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is evidence that has been selected from primary studies and evaluated for use in clinical situations.
- systemic reviews are one such resource |
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Background questions
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foundational questions about a clinical issue - typically find answers in textbooks
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foreground questions
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can be answered based on current best research evidence on diagnosis, assessing or treating patients or an understanding the meaning, cause or prognosis of health problems.
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Models of EB Nursing Practice include:
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- Stetler model of RU to promote EBP
- Iowa Model - designed by nurses to promote quality care - Rogers Diffusion of Innovation Theory - Clinical practice guidelines |
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5 basic steps for individual EBP are:
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- framing an answerable question
- searching for relevant research based evidence - appraising & synthesizing the evidence - integrating evidence w/other factors - assessing effectiveness |
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One scheme for asking well worded clinical questions: is PICOT -
Quantitative |
PICOT:
P = POPULATION I = INTERVENTION C = COMPARSION O = OUTCOMES T = TIME (not always included) |
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One scheme for asking well worded clinical questions: qualitative studies
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- Population
- Situation (conditions, experience, circumstances of interest) |
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appraisal of the evidence involves:
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- validity of the study findings
- clinical importance - precision of estimates of effects - associated costs & risks - utility in a particular clinical situation |
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EBP in an organizational context. Many of same steps as individual EBP but are more formal and take organization and interpersonal factors into account. Triggers are:
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- knowledge focuses triggers: begins with an innovation or research finding
- problem focused triggers: begins with perplexing or troubling clinical situation. |
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AGREE
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APPRAISAL of Guidelines Research & Evaluation
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AGREE
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appraisal instrument to facilitate the evaluation of clinical practice guidelines.
- rating of quality based on 4 point scale: strongly agree, agree, disagree, strongly disagree for 23 quality dimensions organized into 6 domains. Domains include: scope of practice Rigor |
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Before EBP can be tested, implementation potential should be tested:
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- transferability
- feasibility - cost-benefit ratio - develop EB protocols - implement & evaluate the innovation |
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Once EBP protocol is developed and tested for implementation, next step is:
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pilot test of innovation and assessment of outcomes before widespread adoption.
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qualitative research
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rooted in research tradition that originate in other disciplines
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Three traditions of qualitative research are:
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- grounded theory: key social psychological and structural processes that occur in social settings
- phenomenology: lived experience - ethnography: meanings, patterns, lifeways of a culture |
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abstract
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brief synopsis
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bias
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distortion of results
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masking
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blinding - used to avoid bias
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reliability
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accuracy
reliability precision How reproducible is the data? |
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validity
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soundness of the data
more complex |
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reflexivity
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qualitative studies only
reflecting critically on self in an attempt to minimize biases |
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randomness
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assigning certain things in the study to chance
powerful tool in controlling bias |
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research control
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hold constant outside forces so relationship between independ and depend variables can be investigated.
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statistical significance
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high probability if being "real".
if p value is >0.5; results are considered NOT TO BE statistically relevant. |
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statistical tests
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used to test the hypothesis.
how believable is the data? |
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thick description
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rich & thorough description of the research setting so others can make inferences about contextual similarities
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generalizability
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quantitative studies
can the findings be applied to other settings and groups? |
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transferability
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qualitative studies only.
can data be transferable to other groups or settings. |
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inference
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drawing conclusions from limited data
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placebo
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sham drug
used to avoid influence of expectations of its efficacy |
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peer review
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usually 2 or more reviewers
don't know researcher's name or author's name |
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credibility
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aspect of trustworthiness
do the researcher's methods engender confidence in the results |
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reflexivity
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can also be used in quantitative studies.
self awareness and introspections can enhance quality of the data. |
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clinical trial
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medical & epidemiologic research term
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non-experimental inquiry
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observational study
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experimental research - quantitative
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an intervention is ACTIVELY introduced.
a study in which the researcher manipulates the independent variable. |
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non-experimental research - quantitative
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researchers are bystanders that collect data w/o introducing treatment or making changes
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constructs - qualitative
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phenomena
abstractions or mental representations inferred from situations or behaviors |
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theory
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knits together concepts/constructs into a coherent system to explain some aspect of the work
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quantitative
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conceptual model
deductive reasoning variables subjects |
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data
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pieces of information collected in a study
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hypotheses
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researchers expectations about relationships among study variables.
predicted relationships between variables |
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intervention protocol
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what is the interventions?
how often? who will get it? for how long? used in experimental research. |
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saturation
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qualitative studies
when data becomes redundant, repetitive such that no new information can be gleaned by further data collection. |
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operational definition of a concept
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specifies the operations that researchers must perform to collect the required information
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conceptual definition
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abstract or theoretical meanings of the concepts.
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outcome variable
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dependent variable
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fieldwork
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qualitative
naturalistic setting |
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variables
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concepts in quantitive research.
something that varies. |
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independent variable - presumed cause.
dependent variable |
presumed cause
presumed effect |
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relationship
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bond or connection between two variables.
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data
Data set |
pieces of information obtained in a study.
all the pieces of data gathered in a study. |
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research design
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overall plan for obtaining answers to the questions being studies and for handling various challenges to the worth of the study evidence.
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sample
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subset of the population being studied.
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sampling plan
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specifies in advance how the sample will be collected and how many subjects there will be.
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belmont report
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beneficence
respect for human dignity justice |
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beneficence
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performance of some good and the protection of participants from physical and psychological harm and exploitation.
minimize harm maximise benefit |
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respect for human dignity
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right of self determination: freedom to control their own activities, including vol. participation in the study.
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vulnerable subjects
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require additional protection. including children, not able to make truly informed decisions, prisoners (diminished autonomy), terminally ill and pregnant women - their circumstances heighten the risk of physical & psychological harm.
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Research ethics board or Institutional Review Board
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carry out external review of the ethical aspects of a study.
Is highly desirable and ofter required by universities and organizations from which participants are recruited. |
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research misconduct
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plagiarism
fabrication of results falsification of data |
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ethical conduct in research
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ethical conduct in research protects the rights of animals and human subjects but also maintains high standards of integrity
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full disclosure
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fully described the rights, costs and benefits of the study.
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human research
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should provide benefits for participants themselves, or for other individuals or society as a whole.
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Justice
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fair & equitable treatment
right to privacy |
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privacy
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can be maintained thru' anonymity
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risk benefit assessment
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benefits of study to individuals & society verses costs to individuals.
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certificate of confidentiality
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protects against forced disclosure of confidentiality
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problem statement
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problem identification
background problem scope consequences of the problem knowledge gaps possible solutions |
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statement of purpose
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overall study goal
key concepts (variables) study grp. or population whether study is experimental or non-experimental (quantit) underlying research traditions of qualitative studies |
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hypothesis
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statement of predicted relationships between 2 or more variables.
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research hypotheses
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predict existence of relationships
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null hypotheses
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expresses the absence of relationships
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directional hypotheses
nondirectional hypotheses |
predict direction of relationship.
predict the existence of a relationship w/o predicting the direction. |
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protection of study participants include
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risk assessment
informed consent implied consent confidentiality debriefing external reviews & protection of human rights treatment of vulnerable groups |
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relationships
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require at least 2 variables.
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hypothesis
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need to be worded in the present tense.
only see hypothesis in quantitative studies |
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hypothesis
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formally tested thru statistical analysis.
Statistical analysis does not provide proof, only supports inferences that a hypothesis is probably correct or not. |
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primary source
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original description of the study by original researcher.
Preferred source for literature reviews |
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ancestry
descendancy |
footnote chasing
find a pivotal study and move forward to see how many studies referenced this pivotal study |
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search strategies include
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Bibliographic database search
ancestry approach descendancy approach |
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wildcard character
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$ or *
search for multiply words with same root |
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boolean operators
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AND
OR e.g., Lung cancer AND smoking |
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databases for nurses
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CINAHL - cumulative index for nurses & allied health
MEDLINE - medical literature on line |
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CINAHL Database
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starts at 1982 to present.
focuses on English language nursing & allied health journals, as well as books, conferences,dissertations, etc |
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MEDLINE
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dates back to 1960's.
developed by US National Library of Medicine. Access thru' PubMed - free access (ncbi.nih.gov) |
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subject heading
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index system with subject codes
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literature review
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crucial early task
helps determine ways to contribute to existing EBP helps interpret findings |
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mapping
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is a feature on bibliographic databases that allow you to search for topics using your own keywords rather than needing to use an exact term as indicated in subject heading of database.
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population
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set of individuals or objects with a common characteristics
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Classical theories
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abstract generalization that systemically explains relationships among phenomena
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descriptive theories
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thoroughly describes a phenomena in detail
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Grand Theories
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attempts to explain large aspects of human experience
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middle range theory
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focuses on specific aspect of the human experience, e.g., stress
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Conceptual model of nursing
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Roys Adaption model
Neumans Newmans Orems Rogers Parse |
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Concepts central to models of nursing
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human beings
health environment nursing |
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Non nursing models used
frequently |
Bandura
Health Belief Model Theory of stress and coping Theory of Planned behavior Theory of transtheorectical model |
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Shared theories
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when a borrowed theory is tested and found to be empirically adequate in the health relevant situation of nursing
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shared theories
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self efficacy (social cognitive theory)
stages of changes (transtheorecitcal model) behavioral intentions ( planned behavior) |
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substantive theory
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conceptualization of the target phenomena
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