Nursing Research and Evidence-Based Practice Essay

I did non understand why I had to reserve a look class when all I wanted to do was be a module keep in a critical c be unit. query? Evidence-based employment? Why atomic number 18 these topics in the c atomic number 18 for program? I progress up enough to do just learning all the content in my clinical courses. What do search and evidence have to do with growing my breast feeding abilities? I trust the faculty, the textbooks, and clinical experience to prepargon me for c argon for. Im al glance overy getting what I take in to know. That was my earlier attitude. nowadays that I am practicing, I have a unfermented clasp for nurse query and the evidence it provides for natural covering to perpetrate.I have an solo different way of addressing clinical distrusts. Im starting to ingest questions more or less how I can reform the explosive charge I give to uncomplainings and how I can be involved in my workplaces efforts to improve contend for the longan imouss it serves. I have discovered by earnest reading in my practice area that inquiry reports and enquiry summaries go for umteen implications that apply to practice in the critical help unit. QUESTIONS TO allot WHILE READING THIS CHAPTER 1 How can faculty encourage students to read look journals?2 How does look into affect breast feeding practice? 3 How can nurses motivate colleagues to base their practice on interrogation? paint TERMS Clinical nurse interrogationer (CNR) An innovative practice nurse who is doctorally prepared and directs and participates in clinical interrogation. Clinical nurse specia listing (CNS) An advanced practice nurse who provides direct get by to clients and participates in wellness culture and seek. Clinical practice guideline (CPG) an evidence-based guide to clinical practice unquestionable by experts in a particular ? eld for direct application in clinical environments.Control group Subjects in an experiment who do not receive th e observational treatment and whose performance provides a service line against which the effects of the treatment can be measured. When a true experimental design is not utilise, this group is usually called a comparison group. data collection The litigate of acquiring existing information or developing new information. 104 treat Research and Evidence-Based Practice CHAPTER 6 105 empiric Having a foundation based on data gathered by means of the senses (e. g. , observation or experience) rather than purely done and through theorizing or logic. ethnography A qualitative look for rule for the purpose of trustigating cultures that involves data collection, description, and analysis of data to develop a theory of cultural behavior. Evidence-based practice The process of dictatorialally ? nding, measure, and using seek ? ndings as the radical for clinical practice. Experimental design A design that includes randomization, a control group, and utilization between or amon g variables to examine probability and causality among selected variables for the purpose of predicting and imperative phenomena. Generalizability The inference that ?ndings can be generalized from the sample to the entire population. cave in Proposal developed to seek explore reenforcement from mystic or open agencies. Grounded theory A qualitative question design use to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process. Meta-analysis Quantitative merging of ? ndings from some(prenominal) studies to determine what is known about 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 nature and the commission of science that guides qualitative research. Needs assessment A study in which the researcher collects data for estimating the paupe rizations of a group, usually for resource allocation. Phenomenology A qualitative research design that uses inductive descriptive methodology to cover the lived experiences of study participants. Pilot study A pocketableer version of a proposed study conducted to develop or re? ne methodology, much(prenominal) as treatment, instruments, or data collection process to be used in a larger study.Qualitative research A systematic, subjective come up used to describe life experiences and give them meaning. Quantitative research A formal, objective, systematic process used to describe and test relationships and examine cause-and-effect interactions among variables. Quasi-experimental research A type of duodecimal research study design that lacks hotshot of the components (randomization, control group, manipulation of one or more variables) of an experimental design. randomisation The assignment of subjects to treatment conditions in a random manner (determined by chance alone).Secon dary analysis A research design in which data previously collected in anformer(a) study are analyzed. State-of-the-science summary A merging of ? ndings from several studies concerning the same topic. Examples include meta-analysis with a quantitative approach and integrative review with a descriptive approach. visual sense A nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants. Triangulation The use of a pastiche of methods to collect data on the same concept. LEARNING OUTCOMES afterward examine this chapter, the reader will be able to1 Summarize major points in the evolution of nursing research in relation to modern-day nursing. 2 Evaluate the in? uence of nursing research on genuine nursing and health care practices. 3 Differentiate among nursing research methods. 4 Evaluate the forest of research studies using effected criteria. 5 Participate in the research proc ess. 6 Use research ? ndings to improve nursing practice. 106 UNIT ONE The Development of Nursing CHAPTER OVERVIEW This chapter provides basic experience regarding the research process and the ultimate importance of evidence-based nursing practice.The intent is to hearten 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 important 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 macrocosm organizations that fund research is given, and their research priorities are listed. Major research designs are brie? y described, and examples of each are given. imbibes of all educational levels are encouraged to participate in and promote nursing research at varying degrees. The process of locating research and ev idence for practice is reviewed. Students are infixd to the research process and guided in the process of critically appraising published research and research syntheses. Ethical issues connect to research are examined, and historical examples of unethical research are given. The functions of the institutional review opera hatride (IRB) and the use of informed consent in protecting the rights of human subjects are emphasized.DEFINITION OF NURSING RESEARCH Research is a process of systematic inquiry or study to build experience in a discipline. The purpose of research is to develop an empirical body 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 create a strong scienti? c base for nursing practice, especially when deliberately and carefully evalua ted for application to speci?c clinical topics (Melnyk and Fineout-Overholt, 2005). In recent decades the nursing discipline has begun to pay more than greater attention to the necessity of participating in research. Nursing research is a systematic approach used to examine phenomena important to nursing and nurses. Because nursing is a practice profession, it is important that clinical practice be based on scienti? c knowledge. Evidence tryd by nursing research provides support for the quality and cost- rough-and-readyness of nursing interventions. Thus recipients of healthcareand peculiarly nursing carereap bene? ts when nurses attend to research evidence and introduce vary based on that evidence into nursing practice. The introduction of evidence-based change into the direct provision of nursing care may occur at the single level of a particular nurse or at varied organizational or social levels. In addition to nursing research aimed at affecting the direct provision of nur sing and health care to recipients of nursing care, nursing research as well is needed to generate knowledge in areas that affect nursing care processes indirectly.Research indoors 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. organic 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 businesss confronting nurses. For example, nursing education was the focus of most research studies between 1900 and 1940. As more nurses received their education Nursing Research and Evidence-Based Practice CHAPTER 6 107 in a university set(p)ting, studies regarding student characteristics and satisfactions were conducted. As more nurses pursued a college education, staf? ng patterns in hospitals changed because students were not as readily operational 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 dominated nursing research until the 1970s. By the 1970s more doctorally prepared nurses were conducting research, and there was a prowl to studies that focused on the improvement of patient care. The 1980s brought nursing research to a new stage of development.There were many more quali? ed nurse researchers than ever, widespread availability of computers for collection and analysis of data, and a identi fication that research is a vital part of professional nursing (Polit and Beck, 2006). Nurse researchers began conducting studies based on the naturalistic paradigm. These studies were qualitative rather than quantitative. In addition, preferably 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 nineties brought increasing concern about health care reform, and now in the twenty-? rst century, research studies focus on important health care preservation issues, such as cost, quality, and accession. Research ? ndings are being used more and more 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 qualification decisions about patient c are. The rise of technology and the worldwide access and ?ow of information have transformed the decision-making processes of practitioners. Helpful informational websites for busy practitioners are listed in Box 6-1. No longer 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 Guideline Clearinghouseresource for evidence-based clinical practice guidelines www. guidelines. gov US part of Veterans Affairs Clinical Practice Guidelines www. healthquality. va. gov AHRQ wellnesscare Innovations Exchangeinnovations 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 Royal 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 establish 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 match 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 at last put the kno wledge 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 reinforcement opportunities ecstasyed by such groups do not lessened the research enterprise either. Research be 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 business office for Healthcare Research and eccentric (AHRQ) (formerly known as the Agency for Health Care Policy and Research AHCPR and reauthorized as AHRQ by Congress in 1999). Both of these organizations are funded by federal congressional appropriations. secret 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 promotion and disease prevention, quality of life, health disparities, and end-of-life (NINR strategic Plan 2006-2010, 2006). A small sampling of potentially support research topics includes those aimed at ? Determining disease risk and treatment through utilizing catching information ? Determining effective health-promotion 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 a s long-term care facilities, the home, and the community ? Understanding sensitivity to disease, socioeconomic 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 simply are not considered to be prescriptive in nature. Investigators bring to bear their own unique expertise and creative thinking 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 move or new research Nursing Research and Evidence-Based Practice CHAPTER 6109 emphases. Information obtained is used in setting future research agendas and making decisions about funding of proposals submitted by researchers (Of? ce of Sci ence Policy and universe Liaison, NINR, 2009). The NINR website details current announcements regarding research 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 forte of health care for all Americans (AHRQ, 2009a). As an agency 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 encourage 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, strengthen measurement of health care quality indicators, and fostering access to and cost-effective ness of health care.The 1999 reauthorizing legislation expanded the role of the agency by directing the AHRQ to ? alter 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 tally that the needs of low-income groups, minorities, women, children, the elderly, and individuals with special health care needs are address 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 through 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, partly 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. Another recent addition to AHRQs initiatives is the Healthcare Innovations Exchange (2009b), which provides a public source of informatio n about innovations taking place in health care delivery. Submitted innovations are reviewed 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 designing some information speci? cally for dissemination to the lay public (AHRQ, 2009a). 110 UNIT ONE The Development of Nursing Private Foundations national funding is available through the NIH and the AHRQ. However, because obtaining money for research is becoming increasingly competitive, voluntary 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 lib raries. In addition, grant-seeking enterprises often purchase subscriptions 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 enroll is established in research design and implementation. After several age 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 add-on 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 informatio n about the many foundations and organizations interested in funding research 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 rational ? 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 state 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 re searcher chooses the method based on the research question and the current level of knowledge about the phenomena and the problem to be studied. Quantitative research is a formal, objective, systematic process in which numeric