4 How Do Nurses Know What They Know? TraditionAuthorityClinical experience and intuitionLogical reasoningDisciplined researchSome of what students learn is based on scientific research, but much is not. It has been estimated that 86% of health care practice has not been scientifically validated.Tradition: Passage of knowledge from one generation to another…We’ve always done it that way…There is a growing concern that many nursing interventions are based on tradition, customs, and ‘unit culture’ rather than on sound evidenceAuthority: Nurses looked to physicians for a great deal of their practice knowledge. It has only been recently that nurses have begun to build a unique body of nursing knowledge. Questions to ask: How does the authority figure know? What evidence is there that the information being given is valid?Clinical experience and intuition—expert knowledge—individual observations and perceptions may or may not be valid and cannot be generalizedLogical reasoning—logical thought processes—combines experience, intellectual capacity, and formal systems of thought:Inductive reasoning—process of developing generalizations from specific observations.Deductive reasoning—process of developing specific predictions from general principles.Disciplined research—Most sophisticated means of acquiring evidence. Allows nurses to base their clinical practice on research based findings rather than tradition, authority or personal experience.
5 What is Nursing Research? A systematic inquiry designed to develop knowledge about issues important to the nursing profession
7 Nineteenth Century – After 1850 Beginning of nursing as a formal disciplineConcepts are congruent with current priorities of nursing researchBelieved systematic collection and exploration of data were necessary for nursingHer research led to a variety of health reforms during the Crimean WarConcepts: Promotion of health, Prevention of disease, care of the sick
8 Twentieth Century – Before 1950 Focus was mainly on nursing educationLeaders: Lavinia Dock, Anne Goodrich, Adelaide Nutting, Isabel Hampton Robb and Lillian WaldGathered documentation to establish nursing as a profession and reform nursing educationClinically-oriented research centered mainly on morbidity and mortality rates1920: First nursing research coursePhoto: Lillian Wald1st course: Isabel M. Stewart TC
9 Twentieth Century – After 1950 Groundwork is laid for nursing’s current level of research skillExpansion of nursing programs; graduate programs including research coursesResearch priority: Practice-oriented research1986: National Center for Nursing Formed (later became NINR)Expansion of master’s and doctoral programsNINR institute status at the NIH
10 Future Directions Continued expansion of nursing knowledge Numerous opportunities to study important research questionsFocus is on promoting health and ameliorating the side effects of illness and the consequences of treatmentGoal is to provide the foundation for evidence-based practiceExpansion of doctoral programs
11 NINR: Research ThemesChanging lifestyle behavior for better health (starting healthy behaviors)Managing the effects of chronic illness to improve quality of lifeIdentifying effective strategies to reduce health disparitiesHarnessing advanced technologies to serve human needsEnhancing end-of-life experience for patients and families
12 Purposes of Nursing Research Basic researchApplied researchGeneral purpose of nursing research is to answer questions or solve problems of relevance to the nursing profession.Basic research is concerned with generating new knowledge by generating new theories or testing theory—immediate application of results is not the goal (e.g. animal research)Applied research focuses on finding solutions to existing problems—generating knowledge that can be used immediately or in the near future—most nursing studies.
13 Methods for Nursing Research Scientific Method and Quantitative ResearchNaturalistic Method and Qualitative ResearchThe quantitative research methodology is based on the positivist paradigm which assume that there is an objective reality and that natural phenomena are regular and orderly. There is a reality out there that can be studied and known. This lends itself to the scientific method of study—which refers to a general set of orderly, disciplined procedures used to acquire information.Qualitative research is based on the naturalistic paradigm—the assumption that reality is not a fixed entity but is a construction of human minds and therefore ‘truth’ is a composite of multiple constructions of reality.Qualitative researchers emphasize understanding the human experience as it is lived through collection and analysis of subjective, narrative materials that take place in a natural setting. Naturalists believe that the scientific method is ‘reductionist’. That it reduces the human experience to only concepts that are under investigation, and those concepts have been previously defined by the researcher rather than emerging fro the experience of those under study.
14 Importance of Nursing Research Evidence-Based Nursing PracticeCredibility of the Nursing ProfessionAccountability for Nursing PracticeDocumentation of Cost-Effectiveness of Nursing CareThe major reason for conducting nursing research is to foster optimum care for our patients. Evidence-based practice may be defined as the use of the best clinical evidence in making patient care decisions.In the past, nursing has frequently been thought of as a vocation rather than a profession. The struggle for nurses to gain professional status has been a long and difficult one. One of the criteria for a profession is the existence of a body of knowledge that is distinct from that of other disciplines. Nursing has traditionally borrowed knowledge from the natural and social sciences, and only in recent years have nurses concentrated on establishing a unique body of knowledge that would allow nursing to be clearly defined as a distinct profession. The most valid means of developing this knowledge is through nursing research.Accountability for nursing practice—to be accountable for their practice, nurses must have sound rationale for their actions, based on knowledge that is gained through scientific research. Nurses have the responsibility of keeping their knowledge base current, and one of the best sources of current knowledge is research literature. The ability to critique research articles and determine findings that are appropriate for practice is a skill that is needed by all nurses.Now, more than ever, nurses need to document the social relevance and effectiveness of their practice, not only to the profession but to nursing care consumers, health care administrators, third-party payers and government agencies.
15 Research UtilityGeneral consensus that the research role of the baccalaureate graduate calls for the skill of critical appraisalThe nurse must be a knowledgeable consumer of researchAlso, to be able to critique research and use existing standards to determine the readiness and merit of that research for use in clinical practice
16 Consuming Nursing Research: Be Informed Use critical thinkingUnderstand the steps in the research processFirst slide, then….Why do we do this … it is to decide how, when, and if to apply a study or studies to your practice so that your practice is evidence based.
17 Evidence-Based Practice Integrates individual clinical expertise and the best evidence to guide (mutual) decision making and patient preference.Sackett, 2000It is the careful and judicious use of research literature in making patient care decisions.It allows one to systematically use the best available evidence along with the individual’s clinical expertise as well as the patient’s values and preferences in making clinical decisions.
18 Steps to Develop Evidence-Based Interventions First step: Be able to critically read the literatureResearch articlesClinical articlesClinical guidelines
19 Research Article vs. Clinical Article Follows the steps of the research processNot a “how to,” but answers a question with all the components of research clearly presentedAu: Please note parallelisms in slides 2, 3, and 4. Would suggest combining 2 & 3 under research and then Clinical would be parallel. -MK
20 Assess Strength of Evidence Level I Meta-analysis or systematic review of RCTs/experimental studiesLevel II RCTs or experimental studiesLevel III Quasi-experimental studiesLevel IV Nonexperimental studiesLevel V Case reports, program evaluation, qualitative researchLevel VI Opinion of respected authoritiesYou need to decide which level of evidence a research article provides.The model presented is useful for determining which level evidence a study provides.It represents a hierarchy for judging the strength of a study’s design, which influences the confidence the consumer has in determining whether the conclusions the investigator has drawn are valid.
21 Assessing StrengthQuality: Extent to which a study’s design, implementation, and analysis minimizes biasQuantity: Number of studies that have evaluated the research question, including sample size across studiesConsistency: Degree to which studies have similar and different designs yet the same research question and similar findingsGrading the strength of a body of evidence should incorporate three domains: quality, quantity, and consistency
23 Abstract Short comprehensive synopsis or summary of a study Located at the beginning of a studyQuickly focuses the reader on the main points of the study50 to 250 wordsShould accurately represent the study’s methods and results
24 VariableA characteristic or quality that takes on different values, i.e., that varies from one person to the nextBlood typeWeightLength of stay in hospital
25 Types of Variables Continuous (age, height) Discrete (number of children)Categorical (blood type)Dichotomous (gender)Attribute variable vs. Active variableContinuous variables take on a wide range of values and can assume an infinite number of variables between points.A discrete variable has a finite number of values between any two points.Categorical values take on a handful of discrete non-quantitative values.Dichotomous variables take on only two variables.Attribute variables refer to characteristics of research subjects (age, weight, health beliefs).Active variables are created by the researcher (salt intake, method of pain management)
26 Types of Variables (cont’d) Independent variable—the presumed cause (of a dependent variable)Dependent variable—the presumed effect (of an independent variable)Example: Smoking (IV) Lung cancer (DV)Questions:Does assertiveness training improve the effectiveness of psychiatric nurses.IV: assertiveness trainingDV: effectivenessAre the number of prenatal visits of pregnant women associated with labor and delivery outcomes?IV: number of prenatal visitsDV: labor and delivery outcomesVariable: body temperatureIV: Does infant’s body temperature upon admission to the nursery affect respiratory status?DV: What is the affect on radiant heatlamps on infant’s body temperature during short procedures?
27 Definitions of Concepts and Variables Conceptual definitionthe abstract or theoretical meaning of a concept being studiedOperational definitionthe operations (measurements) a researcher must perform to collect the desired informationSuggest operational definitions for the following terms:PainStressObesity
28 Identification of a Research Purpose/Question Research problemAn unexplained, perplexing, or troubling conditionProblem statementA statement describing the research problem and indicating the need for a studyBoth qualitative and quantitative researchers identify a research problem with a broad topic of interest. The purpose of the research is to solve the problem or to contribute to its solution by accumulating relevant information.A problem statement articulates the problem to be addressed and indicates the need for a study.
29 Research Question/Hypotheses Research questionsThe specific questions the researcher wants to answer in addressing the research problemHypothesesThe researcher’s predictions about relationships among variablesResearch questions are the specific queries researchers want to answer in address the research problem. Research questions guide the types of data to be collected in a study.Hypotheses are the specific predictions regarding answers to the research questions that can be tested empirically.
30 Research Design and Data Quantitative Studies—Researchers identify variables of interest, develop operational definitions, then collect relevant data from subjects. The actual values of the study variables constitute data for the projectQualitative Studies—Researcher primarily collects narrative dataData are pieces of information obtained in the course of the investigation
33 Major Methodologic Challenge Designing studies that are:Reliable and valid (quantitative studies)Trustworthy (qualitative studies)
34 Criteria for Evaluating Quantitative Research ReliabilityThe accuracy & consistency of obtained informationValidityThe soundness of the evidence—whether findings are convincing, well-groundedFor quantitative studies:Reliability refers to the accuracy and consistency of information obtained in a study. Can results be repeated?Validity refers to the quality of evidence. For example, does a nursing intervention really bring about improvements in patient outcomes, or were other factors responsible?
35 Dimensions of Trustworthiness in Qualitative Studies CredibilityConfirmabilityDependabilityTrustworthiness encompasses several different dimensions:Dependability refers to evidence that is consistent and stableConfirmability is the degree to which study results are derived from characteristics of participants and the study context, not from researcher bias.Credibility—researcher must engender confidence in truth of the data and in the researchers’ interpretations of the data.
36 Results Analysis Discussion Recommendations/Implications Communication Analysis – This is where the author describes the procedures used to analyze the data and what the findings wereDiscussion – researcher ties together all of the pieces – how does this study relate to other similar studies and how does it differ.Recommendations/Implications: What are the implications of the study’s findings for practice, education and research.Communication: article, paper, posterImportant to determine if the results are generalizable
37 Generalizability and Transferability Generalizability (Quantitative research): The extent to which study findings are valid for other groups not in the studyTransferability (Qualitative research): The extent to which qualitative findings can be transferred to other settings