1. Excellence in Nursing Practice Through Research, EBP & Application to Bedside Patient Care Chesapeake Bay Society of PeriAnesthesia Nurses Saturday, February 8 th, 2014 Kim A. Noble, PhD., RN, CPAN © Copyright Kim A. Noble; use prohibited without permission

2. Part III: Research Design: Breaking Hard Into Easy Pieces Kim A. Noble, PhD., RN, CPAN knoble@aspan.org ©

3. Objectives Following participation in this lecture, the learner will: Deconstruct the elements of research; Compare forms of research design; Describe the literature critique based process with the use of critique tools; Brainstorm for the incorporation of Research in clinical practice. ©

4. The Future of Nursing… ©

5. Research Design: Overview A systematic approach to evidence critique Overview of Research Design: Systematic literature reviews: Guideline/PR EBP Experimental: RCT Cohort Case controlled; Descriptive Expert Opinion Quant –Vs- Qual ©

6. Research Design: Overview http://www.cebm.net/index.aspx?o=1039 © Dirty words: Error Bias Questions: Q1 Q2 Q3

7. Meta-Analysis Quantative data Quantative data obtained from completed research studies. Use of statistical analyses for single data set.Advantage: Large sampleDisadvantage: Potential mixture of different research design Metasynthesis for qualitative data Meta-Analysis: ©

8. Systematic Literature Review Reviews adhere to explicit and rigorous methods to identify, critically appraise & synthesize relevant primary/original research. Reviews adhere to explicit and rigorous methods to identify, critically appraise & synthesize relevant primary/original research. Goal: minimize bias; Goal: minimize bias; Different from EBP Different from EBP Similar to EBP Similar to EBP Systematic Literature Review Krainovich-Miller, 2007, 17 ©

9. Experimental Studies: RCT Three essential elements: Three essential elements: Randomization of subjects Randomization of subjects Researcher-controlled manipulation of treatment (independent variable) Researcher-controlled manipulation of treatment (independent variable) Researcher control of the Researcher control of the experimental situation. experimental situation. Use inclusion & exclusion criteria. Use inclusion & exclusion criteria. Goal: minimize bias. Goal: minimize bias. Randomized Controlled Trials © What is Randomization? What is Blinding? Treatment –Vs- Control

10. Quasi-Experimental Studies Not as strong; Not as controlled; Many Possible designs: No use of control groups; No use of randomization; Less control for inclusion; No blinding. ©

11. Observational Studies: Overview Types: Cohort studies Case-controlled studies ©

12. Cohort Studies What is a cohort??? What is a cohort??? Subjects with similar characteristic(s); Useful to determine history or incidence of disorder or exposure; Two types: Prospective (longitudinal) Retrospective (historic) Aid in studying causal associations ©

13. Case-Control Studies Cases’ already have disease/condition; Controls’ do not have disease/condition; Otherwise matched to control for bias Frequently used: electronic records; Rapid means of collecting incidence data; Sometimes called a retrospective study; Inexpensive, fast & no risk to sample. ©

14. Descriptive Studies Types: Case series/case report; Cross-sectional studies; Used to describe the characteristics of a population; Does not answer Who? What? Where? Why??. ©

15. Case Series/Case Reports Tracks patients given similar treatment: Prospective; Examines medical records for exposure and outcome: Retrospective; Detailed report of individual patient May identify new diseases & adverse effects. ©

16. Cross Sectional Studies A slice or snap-shot of target group; Frequency & characteristic(s) of disease/variables in a population at a given time; Often use survey research methods; Also called prevalence studies. ©

17. The Joanna Briggs Institute The JBI Evidence Based Practice Process ©

18. Practice Makes Perfect ©

19. © References Boswell, C. & Cannon, S. (2007). Introduction to Nursing Research: Incorporating Evidence-Based Practice, Sudbury, MA: Jones & Bartlett. Burns, N. & Grove, S. K. (2011). Understanding Nursing Research: Building Evidence-Based Practice, 5 th ed., Maryland Heights, MO: Elsevier, Saunders. Malloch, K. & Porter-O’Grady, T. (2006). Introduction to Evidence-Based Practice in Nursing and Health Care, Sudbury, MA: Jones & Bartlett. White, K. M. & Dudley-Brown, S. (2012). Translation of Evidence Into Nursing and Health Care Practice, New York: Springer.