Nursing Research and Evidence-Based Practice Essay

I did not understand why I had to nonplus a seek class when all I wanted to do was be a staff nurse in a critical c be unit. interrogation? Evidence- base practice? wherefore ar these topics in the nurse program? I commit enough to do just learning all the electrical capacity in my clinical courses. What do inquiry and grounds have to do with grooming my help for abilities? I trust the faculty, the textbooks, and clinical experience to prep ar me for breast feeding. Im already getting what I destiny to know. That was my earlier attitude. Now that I am practicing, I have a untried appreciation for breast feeding inquiry and the evidence it provides for application to practice.I have an entirely different way of addressing clinical questions. Im starting to ask questions well-nigh how I can improve the handle I take to diligents and how I can be involved in my workplaces efforts to improve c argon for the patients it serves. I have discovered by purposeful reading i n my practice area that query reports and look into summaries contain umteen implications that apply to practice in the critical mission unit. QUESTIONS TO CONSIDER WHILE drill THIS CHAPTER 1 How can faculty encourage assimilators to read re take care journals?2 How does re look for affect nursing practice? 3 How can nurses motivate colleagues to base their practice on look into? KEY foothold clinical nurse researcher (CNR) An advanced practice nurse who is doctorally prepared and demands and participates in clinical research. Clinical nurse specialist (CNS) An advanced practice nurse who provides direct consider to clients and participates in health t individuallying and research. Clinical practice guideline (CPG) an evidence-based guide to clinical practice waxed by experts in a particular ? eld for direct application in clinical environments.Control group Subjects in an test who do not receive the experimental intercession and whose performance provides a basel ine against which the effects of the manipulation can be measured. When a true experimental fig is not utilise, this group is usually called a comparison group. Data collection The branch of acquiring existing information or developing new information. 104 nursing Research and Evidence-Based Practice CHAPTER 6 105 Empirical Having a free-baseation based on data gathered with the senses (e. g. , observation or experience) rather than purely through theorizing or logic.descriptive anthropology A qualitative research method for the purpose of investigating cultures that involves data collection, description, and analysis of data to develop a theory of cultural behavior. Evidence-based practice The mathematical process of systematically ? nding, appraise, and using research ? ndings as the bag for clinical practice. Experimental design A design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena. Generalizability The inference that ?ndings can be generalized from the test to the entire population. Grant Proposal developed to seek research stock certificateing from private or national agencies. Grounded theory A qualitative research design used to collect and analyze data with the mother of developing theories grounded in real-world observations. This method is used to ask a social process. Meta-analysis Quantitative merging of ? ndings from some(prenominal) studies to determine what is known approximately a phenomenon. Methodologic design A research design used to develop the validity and reliability of instruments that measure research concepts and variables.Naturalistic paradigm A holistic view of genius and the direction of science that guides qualitative research. Needs assessment A study in which the researcher collects data for estimating the ineluctably of a group, usually for resourc e allocation. Phenomenology A qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Pilot study A smaller version of a proposed study shell outed to develop or re? ne methodology, such as treatment, instruments, or data collection process to be used in a larger study.Qualitative research A systematic, subjective snuggle used to describe life experiences and give them meaning. Quantitative research A formal, objective, systematic process used to describe and test analogyships and examine cause-and-effect interactions among variables. Quasi-experimental research A eccentric person of valued research study design that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. Randomization The assignment of subjects to treatment conditions in a random manner (determined by chance alone).Secondary analysis A research design in which data previ ously collected in another study are analyzed. State-of-the-science succinct A merging of ? ndings from several studies appertaining the same topic. Examples include meta-analysis with a quantitative approach and integrative surveil with a descriptive approach. Survey A nonexperimental research design that instructiones on mystifying information regarding the status quo of a situation, often through direct questioning of participants. Triangulation The use of a variety of methods to collect data on the same concept. LEARNING OUTCOMES After studying this chapter, the reader will be able to1 add together major points in the evolution of nursing research in relation to contemporary nursing. 2 value the in? uence of nursing research on menstruum nursing and health care practices. 3 check among nursing research methods. 4 Evaluate the calibre of research studies using accomplished criteria. 5 enrol in the research process. 6 Use research ? ndings to improve nursing practice. 10 6 UNIT ONE The tuition of Nursing CHAPTER OVERVIEW This chapter provides basic companionship regarding the research process and the ultimate immenseness of evidence-based nursing practice.The intent is to move an appreciation for nursing research and to show how it can improve nursing practice and how results can be translated into health policy. Nursing research is de? ned as a systematic approach used to examine phenomena heavy to nursing and nurses. A summary of major points in the evolution of nursing research in relation to contemporary nursing is presented. A description of private and public organizations that broth research is given, and their research priorities are listed. Major research designs are brie? y described, and examples of each are given.Nurses of all fosterageal levels are promote to participate in and promote nursing research at varying degrees. The process of locating research and evidence for practice is reviewed. Students are introduced to the resear ch process and guided in the process of critically appraising published research and research syntheses. Ethical issues related to research are examined, and historical examples of u give the axehical research are given. The functions of the institutional review board (IRB) and the use of informed consent in protecting the rights of gentleman subjects are emphasized.DEFINITION OF care for RESEARCH Research is a process of systematic inquiry or study to configuration knowledge in a discipline. The purpose of research is to develop an empirical ashes of knowledge for a discipline or profession. Speci? cally, research validates and re? nes existing knowledge and develops new knowledge (Burns and Grove, 2007). The results of research process provide a foundation on which practice decisions and behaviors are laid. Research results get to a strong scienti? c base for nursing practice, especially when deliberately and carefully evaluated for application to speci?c clinical topics (Mel nyk and Fineout-Overholt, 2005). In recent decades the nursing discipline has begun to pay much greater attention to the exigency of participating in research. Nursing research is a systematic approach used to examine phenomena key to nursing and nurses. Because nursing is a practice profession, it is important that clinical practice be based on scienti? c knowledge. Evidence generated by nursing research provides support for the whole step and cost- effectualness of nursing interventions. Thus recipients of healthcareand particularly nursing carereap bene? ts when nurses attend to research evidence and introduce alternate based on that evidence into nursing practice. The introduction of evidence-based change into the direct provision of nursing care may occur at the individual level of a particular nurse or at varied organizational or social levels. In addition to nursing research aimed at modify the direct provision of nursing and health care to recipients of nursing care, nu rsing research also is demand to generate knowledge in areas that affect nursing care processes indirectly.Research within the realms of nursing education, nursing administration, health services, characteristics of nurses, and nursing roles provides evidence for effectively changing these supporting areas of nursing knowledge (Burns and Grove, 2007). Today the importance of nursing research to the discipline is recognized. However, much nursing history underlies the current state of acceptance. EVOLUTION OF NURSING RESEARCH Nursing research began with the work of Florence Nightingale during the Crimean War.After Florence Nightingales work, the pattern that nursing research followed was closely related to the problems confronting nurses. For example, nursing education was the focus of more or less research studies between 1900 and 1940. As more nurses received their education Nursing Research and Evidence-Based Practice CHAPTER 6 107 in a university setting, studies regarding stud ent characteristics and satisfactions were conducted. As more nurses taked a college education, staf? ng patterns in hospitals changed because students were not as readily easy as when more students were enrolled in hospitalaf?liated diploma programs. During this period, researchers became interested in studying nurses. Questions such as what type of person enters nursing and how are nurses perceived by other groups guided research investigations. Teaching, administration, and curriculum were studies that prevail nursing research until the 1970s. By the 1970s more doctorally prepared nurses were conducting research, and there was a shift to studies that focussed on the improvement of patient care. The 1980s brought nursing research to a new stage of development. on that point were many more quali? ed nurse researchers than ever, goodspread availability of com portioners for collection and analysis of data, and a fruition that research is a vital part of professional nursing (Po lit and Beck, 2006). Nurse researchers began conducting studies based on the naturalistic paradigm. These studies were qualitative rather than quantitative. In addition, instead of conducting many small, unrelated research studies, teams of researchers, often interdisciplinary, began conducting programs of research to build bodies of knowledge related to speci?c topics, such as urinary incontinence, decubitus ulcers, pain, and quality of life. The 1990s brought increasing concern about health care reform, and now in the twenty-? rst century, research studies focus on important health care saving issues, such as cost, quality, and overture. Research ? ndings are being used increasingly as the basis for clinical decisions. Evidencebased practice (EBP) can be de? ned as the process of systematically ? nding, appraising, and using research ? ndings as a basis for making decisions about patient care. The rise of technology and the worldwide access and ?ow of information have transform ed the decision-making processes of practitioners. Helpful informational websites for busy practitioners are listed in Box 6-1. No durable do nurses simply compare outcomes of patient care with other units in the B O X 61 Helpful Websites l f l b i National road map Clearinghouseresource for evidence-based clinical practice guidelines www. guidelines. gov US Department of Veterans Affairs Clinical Practice Guidelines www. healthquality. va. gov AHRQ Healthcare Innovations commutationinnovations and tools to improve health care www.innovations. ahrq. gov/index. aspx The Evidence-Based Medicine Education Center of Excellenceextensive list of databases, journals, and textbooks http//library. ncahec. net/ebm/pages/resources. htm U. S. National Institute for Health Consensus statements http//consensus. nih. gov Centre for Evidence-Based Nursing, based at University of YorkUnited Kingdom www. york. ac. uk/healthsciences/centres/evidence/cebn. htm The Joanna Briggs Institute, based at Ro yal Adelaide Hospital and the University of Adelaide, Australiamultiple evidence resources for practice www.joannabriggs. edu. au Cochrane Centerresource for evidence-based clinical practice guidelines www. cochrane. org 108 UNIT ONE The Development of Nursing same hospital. Nurses and other health care professionals are more likely to look for solutions, choices, and outcomes for patients that represent the best available knowledge internationally (Hamer and Collinson, 2005). RESEARCH PRIORITIES Why set priorities for research in the nursing discipline? Can nurses do research in areas that collar personal areas of interest? The answer to the second question is, yes, certainly.But nursing exists to provide high-quality nursing care to individuals in need of health-promoting, health-sustaining, and health-restoring strategies. The main outcome of research activity for a nurse is to eventually put the knowledge gained to work in health care delivery. Research priorities, often set by groups that fund research, encourage nurse researchers to invest effort and money into those areas of research likely to generate the most bene? t to recipients of care. Of course the support opportunities offered by such groups do not hurt the research enterprise either. Research costs money.Thus nurses engaged in research often match personal interests with funding opportunities that are available during the planning phase for a proposed investigation. Two major sources of funding for nursing research are the National Institute of Nursing Research (NINR) and the Agency for Healthcare Research and shade (AHRQ) (formerly known as the Agency for Health Care Policy and Research AHCPR and reauthorized as AHRQ by Congress in 1999). two of these organizations are funded by federal congressional appropriations. Private foundations and nursing organizations also provide funding for nursing research.National Institute of Nursing Research As part of the National Institutes of Health (NIH) , the NINR supports research on the biologic and behavioral aspects of critical health problems that confront the nation. The NINRs research focus encompasses health forward motion and disease prevention, quality of life, health disparities, and end-of-life (NINR Strategic Plan 2006-2010, 2006). A small sampling of potentially back up research topics includes those aimed at ? find out disease risk and treatment through utilizing genetic information ? Determining effective health-publicity strategies for individuals, families, and communities ?Discovering approaches that encourage people to effectively take responsibility for symptom management and health promotion ? Assisting in identi? cation and effective management of symptoms related to acute and chronic disease ? Improving clinical settings in which care is provided ? Improving the quality of care giving in settings such as long-term care facilities, the home, and the community ? Understanding predisposition to disease, soci oeconomic factors that in? uence health, and cultural health practices that either protect from or expose to risk for health problems ?Improving symptom management for those at end of life The areas of research emphasis published by the NINR are useful guides for investigators developing proposals but are not considered to be prescriptive in nature. Investigators bring to bear their own unique expertise and creativity when proposing research in harmony with NINR priority research areas. Annually the NINR conducts a roundtable discussion with multiple nursing organizations to obtain the feedback of the disciplines regarding the need for continued or new research Nursing Research and Evidence-Based Practice CHAPTER 6109 emphases. instruction obtained is used in setting future research agendas and making decisions about funding of proposals submitted by researchers (Of? ce of Science Policy and Public Liaison, NINR, 2009). The NINR website details current announcements regarding resea rch priorities (www. ninr. nih. gov/ResearchAndFunding). Agency for Healthcare Research and Quality The AHRQ broadly de? nes its mission as improving the quality, safety, ef? ciency, and effectiveness of health care for all Americans (AHRQ, 2009a). As an authority of the U. S.Department of Health and Human Services, the AHRQs health-related aims are to reduce the risk of harm by promoting delivery of the best possible health care, improve health care outcomes by encouraging the use of evidence to make informed health care decisions, transform research into practice to facilitate wider access to effective health care services, and reduce unnecessary costs (AHRQ, 2009a). Since the inception of the agency in 1989, strategic goals have centered on supporting improvements in health outcomes, strengthening measurement of health care quality indicators, and fostering access to and cost-effectiveness of health care.The 1999 reauthorizing legislation expanded the role of the agency by direc ting the AHRQ to ? better the quality of health care through scienti? c inquiry, dissemination of ? ndings, and facilitation of public access to information. ? Promote patient safety and reduce medical errors through scienti? c inquiry, building partnerships with health care providers, and establishment of centers for education and research on therapeutics (CERTs). ? Advance the use of information technology for coordinating patient care and conducting quality and outcomes research.? Establish an of? ce on priority populations to ensure that the needs of low-income groups, minorities, women, children, the elderly, and individuals with special health care needs are addressed by the agencys research efforts. The research-related activities of the AHRQ are quite varied, but a recent shift emphasizes a more deliberate translation of research evidence into practice. In a process similar to that used by the NIH, investigators are invited to submit research proposals for possible funding t hrough grant announcements.A listing of current areas of the agencys research interests can be found online at www. ahrq. gov/fund/portfolio. htm. The AHRQ actively promotes EBP, partially through the establishment of 14 EBP centers (EPCs) in the United States and Canada. EPCs conduct research on assigned clinical care topics and generate reports on the effectiveness of health care methodologies. Health care providers may then use the evidence in developing site-speci? c guidelines that direct clinical practice. AHRQ also actively maintains the National Guideline Clearinghouse (www.guidelines. gov), an website that makes available to health care professionals a wide array of clinical practice guidelines that may be considered in health care decision making. some other recent addition to AHRQs initiatives is the Healthcare Innovations Exchange (2009b), which provides a public source of information about innovations taking place in health care delivery. Submitted innovations are revi ewed for the quality of achieved outcomes, providing evidence as a foundation for decision making by others who may be searching for or considering similar innovations.Although most AHRQ activities are intended to support health care professionals and institutions, the agency supports health care recipients by innovation some information speci? cally for dissemination to the lay public (AHRQ, 2009a). 110 UNIT ONE The Development of Nursing Private Foundations Federal funding is available through the NIH and the AHRQ. However, because obtaining money for research is becoming increasingly competitive, conscious foundations and private and community-based organizations should be investigated as possible funding sources.Many foundations and corporate direct-giving programs are interested in funding health care projects and research. Computer databases and guides to funding are available in local anaesthetic libraries. In addition, grant-seeking enterprises often purchase subscription s that allow computer access to enhanced listings of funding foundations that include information about the types of projects those foundations typically fund. Though subscriptions are expensive, costs are often balanced by the ef? ciency with which suitable funding prospects are identi? ed.An example of such a service is Prospect Research Online (www. iwave. com). Private foundations, such as the Robert Wood Johnson Foundation (2009a, 2009b) or the W. K. Kellogg Foundation (2009), offer program funding for health-related research. Investigators should be encouraged to pursue funding for small projects through local sources or private foundations until a track record is established in research design and implementation. After several years of experience in the research arena, investigators are more likely to be successful in securing funding through federal sources, such as the NIH.Nursing Organizations Sigma Theta Tau International (STTI), the American Nurses Association (ANA), and the Oncology Nurses Society (ONS), are a few of the nursing organizations that fund research studies. STTI makes research grant awards to increase scienti? c knowledge related to nursing practice. STTI supports creative interdisciplinary research and places importance on identifying best practices and benchmark innovations. Awards are made at the international and local chapter levels. The ANA awards small grants through the American Nurses Foundation.Specialty nursing organizations offer grants to support research related to their specialty. For example, the ONS awards grants that focus on issues related to oncology. To summarize, multiple potential sources of funding are available for research projects. The individual or group wishing to conduct research will need to carefully develop a proposal, search for a possible funding source, and submit the proposal. Libraries and the Internet provide ample information about the many foundations and organizations interested in funding res earch endeavors.Most research institutions establish of? ces that help in the search and procurement of funding. Thus researchers are supported in their work of knowledge building. COMPONENTS OF THE RESEARCH PROCESS The research process involves conceptualizing a research study, planning and implementing that study, and communicating the ? ndings. The process involves a logical ? ow as each step builds on the previous steps. These steps should be included in published research reports so that the reader has a basis for understanding and critiquing the study (Box 6-2). STUDY DESIGNSStudy designs are 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 speci? c research questions. Research studies are classi? ed into two basic methods quantitative and qualitative, two distinctly different approaches to conducting research. The researcher chooses the method based on the research question and the current l evel of knowledge about the phenomena and the problem to be studied. Quantitative research is a formal, objective, systematic process in which numeric