Nursing Science Exam 1

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a coherent body of knowledge composed of research findings and tested theories for a specific discipline; both a product (end point) and a process (means by which you reach an end point)

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science

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- Objective reality, independent of human observation
- Control of the environment
- Data are empirical, rooted in objectivity
- Deductive process

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Positivist Paradigm

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Karl Popper

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Positivist Paradigm

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- Reality is multiple and subjective
- Emphasis on human or “lived” experience
- Data are words – narratives, subjective
- Inductive process

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Naturalist Paradigm

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(Thomas Kuhn, Max Weber)

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Naturalist Paradigm

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based on logical positivism; data are numeric/objective/empiric; process is deductive
- Build body of knowledge that describes, explains, predicts, prescribes
- Formal, objective, systematic process
- Data objective (5 senses)
- Findings statistically analyzed
- Emphasis on control/randomization
- Humans are a composite of many body systems

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Quantitative Methods

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based on naturalism; data are words; subjective; process is inductive
- Describe and promote understanding of human experiences
- Formal, subjective, system, process
- Data are words – narratives
- Narratives analyzed for common themes
- Often provide starting point
- Lay groundwork for quantitative

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Qualitative Methods

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Limitations of Quantitative Methods

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- Human beings are complex, and are more than the sum of their parts
- Not all questions in nursing can be empirically tested

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Limitations of Qualitative Methods

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- Small sample sizes
- Concern about generalizability

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Continuum of Research (levels)

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- Description (qualitative and quantitative) lowest level
- Explanation (quantitative)
- Prediction (quantitative)
- Prescription (quantitative) highest level

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most sophisticated method in nursing for acquiring knowledge; accepted process for obtaining knowledge

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Research or scientific inquiry

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Ways of Acquiring Knowledge in Nursing:

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Tradition
Borrowing
Trial & error
Personal experience
Authority
Research or scientific inquiry:

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– the broader study of nurses and the nursing profession, including historic, ethical, and political studies

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research in nursing

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Theory supported by research findings (evidence) becomes the foundation of theory-based clinical practice in nursing
- Theories must be tested to determine accuracy

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Evidence-Based Practice (EBP)

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“the conscientious, explicit and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups. . .and in consideration of individual needs and preferences” Ingersoll (2000)

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EBP

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EBP: Three components

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- research-based information
- clinical expertise of the nurse
- patient preferences

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5 phases of Stetler Model

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Preparation
Validation
Decision making
Apply the evidence
Evaluate the the outcomes

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EBP models

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Stetler, ARCC, mentorship

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Focuses on: individual or group of practitioners

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Stetler model

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- Advance practice nurse with skill in EBP facilitates improvements in care via EBP
- Has been expanded by Melnyk and Fineout-Overholt

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mentorship model

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- Clarify the purpose
- Identify the sources of research evidence
- Initiative the search for the relevant research evidence

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preparation phase

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- Analyze the evidence
- Sufficient
- Credible

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validation phase

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- Organize the evidence
- Determine the meaning for practice
- Decide what evidence to implement

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decision making

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- Implement the change
- Not as easy as it sounds

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applying the evidence

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- Evaluate the outcome
- Degree to which it was implemented
- Were the desired outcomes met

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evaluate the outcomes

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what does ARCC stand for?

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Advancing Research and Clinical Practice Through Close Collaboration

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steps in the EBP process

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- Ask the burning clinical question
- Collect the most relevant and best evidence
- Critically appraise the evidence
- Integrate all evidence with one’s clinical expertise, patient preferences, and values in making a practice decision or change
- Evaluate the practice decision or change

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Systematic reviews/meta-analysis of all RCTs

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Level I of EBP Hierarchy of evidence

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Evidence obtained from at least 1 RCT

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Level II of EBP hierarchy of evidence

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Evidence from CT without randomization

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Level III of EBP hierarchy of evidence

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Evidence from case-control & cohort studies

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Level IV of EBP hierarchy of evidence

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Evidence from systematic reviews of descriptive/qualitative studies

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Level V of EBP hierarchy of evidence

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Evidence from 1 descriptive/qual study

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Level VI of EBP hierarchy of evidence

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Evidence from the opinion of authorities or expert committees

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Level VII of EBP hierarchy of evidence

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generates new knowledge

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research question

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make decisions about patient care based on the best current evidence gathered using a systematic problem-solving approach

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EBP question

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what does PICO stand for?

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P: patient population or patient condition
I: intervention
C: comparison
O: outcome

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Barriers to the use of research

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- Research findings not disseminated
- Some clinicians don’t read research or know how to evaluate it
- Some don’t value research or don’t think they have the time
- Some are aware of findings but don’t feel they have power or authority to make a change
- Bringing change is not easy

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Specific practice recommendations that are based on a rigorous review of the best
evidence on a specific topic

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Evidence-Based Clinical Practice Guidelines

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Why is research important to nursing?

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- It is evidence upon which we base our practice
- Keeps practice current

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Characteristics of a Good Problem Statement Will identify what?

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1.Variables to be studied

2. Population to be studied

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the question to be answered in the study

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Research Question/problem statement

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lays out how the researcher intends to go about answering the question

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Purpose statement