Mosby items and derived items 2011 2008

Chapter 6 Nursing Research and Evidence-Based Practice Mosby items and derived items © 2011,

Nursing Research Definition: systematic inquiry or study conducted to generate new knowledge or to refine existing knowledge Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 3

Nursing Research (Cont’d) Results provide foundation for practice decisions and behaviors Results create strong scientific base for nursing Results provide support for the quality and costeffectiveness of interventions Application of results demonstrates professional accountability to insurers and health care consumers Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 4

Evolution of Nursing Research Florence Nightingale: Crimean War Research focus, 1900 to 1940 Ø Ø Ø Nursing education Student characteristics Student satisfaction Research focus, 1950 s to 1970 s Ø Ø Ø Teaching Administration Curriculum issues Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 5

Evolution of Nursing Research (Cont’d) Research focus, 1980 s More qualified researchers Widespread availability of computers for data collection and analysis Ø Qualitative studies Ø Ø Research focus, 1990 s: health care delivery issues such as cost, quality, and access Research focus of 21 st century: evidence base for practice Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 6

NINR Research Foci Health promotion and disease prevention Quality of life Health disparities End

Agency for Healthcare Research and Quality (AHRQ) An agency of the U. S. Department of Health and Human Services that aims to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services www. ahrq. org Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 8

Agency for Healthcare Research and Quality (AHRQ) (Cont’d) • Established an office for priority populations to ensure that the needs of low-income groups, minorities, women, children, older adults, and individuals with special health care needs are addressed by the agency’s research efforts • Advanced use of information technology for coordinating patient care and conducting quality and outcomes research Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 9

Private Foundations Robert Wood Johnson W. K. Kellogg Foundation Helene Fuld Trust Mosby items

Nursing Organizations Sigma Theta Tau International (STTI) Oncology Nurses Society (ONS) American Nurses Foundation (ANF) Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 11

Components of the Research Process Ø Ø Ø Ø Ø Formulating the research question or problem Defining the purpose of the study Reviewing related literature Formulating hypotheses and defining variables Selecting the research design Selecting the population, sample, and setting Conducting a pilot study Collecting the data Analyzing the data Communicating conclusions Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 12

Study Designs Plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific research questions Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 13

Quantitative Designs Case study: provides an in-depth analysis of a single subject, group, institution, or social unit Ø Survey: used to collect large amounts of information with little expenditure of time and money Ø Needs assessment: determines what is most beneficial to an aggregate group Ø Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 14

Quantitative Designs (Cont’d) Methodologic: focuses on development and testing instruments to improve their reliability and validity Ø Meta-analysis: an advanced process by which research on a specific topic is reviewed and findings of multiple studies are statistically analyzed and expressed quantitatively Ø Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 15

Quantitative Designs (Cont’d) Experimental: studies that include the manipulation of one or more independent variables, random assignment to a control or a treatment group, and observation of the outcome or effect that is presumably the result of the independent variable Ø Quasi-experimental: lacks one of the components of experimental design, i. e. , randomization, control group, or manipulation of one or more variables Ø Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 16

Quantitative Designs (Cont’d) Triangulation: use of various research methods or data collection techniques in the same study Pilot studies: small-scale studies referred to as feasibility studies; purpose is to identify strengths and limitations of a larger planned study Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 17

Qualitative Designs Qualitative designs: a method of research designed for discovery rather than for verification Phenomenology: method used to study intangible experiences such as grief, hope, or risk taking. It is designed to provide an understanding of the patient’s “lived experience. ” Ø Ethnography: a method used to study phenomena from a cultural perspective Ø Grounded theory: a method designed to explore a social process Ø Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 18

Using Research in Practice • Research utilization: there is extensive concern that nurses have failed to realize the potential for using research findings as a basis for making decisions and developing interventions • Locating published research: focus on the usefulness of computerized databases such as CINAHL and MEDLINE and the Annual Review of Nursing Research • Critical appraisal of nursing research Ø Blind review Ø Abstract and findings may be the easiest sections of a research report for the novice to understand Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 19

Nurse Researcher Roles Clinical nurse specialist (CNS): master’s degree –prepared nurse who is an expert clinician with additional responsibility for education and research: assesses agency’s readiness for research utilization; works with staff to identify clinical problems; helps staff find, implement, and evaluate findings relevant to current practice Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 20

Nurse Researcher Roles (Cont’d) Clinical nurse researcher (CNR)—doctorally prepared with clinical and research experience Focuses on the conduct or facilitation of research Works with staff to identify research questions Designs studies Disseminates findings to staff, administrators, and legislators Ø Emerging roles • DNP and CNL Ø Ø Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 21

Types and Levels of Evidence Journal article describing a single study Systematic review methods (meta-analysis and meta-synthesis) Intervention guidelines Patient values and preferences Expert opinion Theory-based information Compiled databases Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 22

Critical Appraisal of Nursing Research Blind review Abstract and findings Mosby items and derived

Examples of Evidence-Based Practice Heparinized saline for flushing peripheral intravenous catheters Interventions such as exercise for cancerrelated fatigue Prevention and treatment of pressure ulcers Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 24

Ethical Issues Related to Research Institutional review: IRB or Human Subjects Committee required by institutions receiving federal funding Historical examples of unethical research Ø Ø Ø Nazi experiments Tuskegee syphilis study Jewish Chronic Disease Hospital in New York Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 25

Summary Educators must prepare students to appreciate and conduct research and evaluation at their level of preparation Health care administrators must foster research Consumers must be educated about the value of nursing research Policymakers must be informed about findings, so results can be translated into health policy Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 26

Assignment #3 See Portal for written details Assignment #3 will be submitted just like #2 Start Assignment #3 in the Library on Portal. I recommend the CINAHL database. The “help sheet” for each database is located below the individual database. Mosby items and derived items © 2011, 2008 by Mosby Inc. , an imprint of Elsevier Inc. 27