nursing research lecture 1

• Research is systematic inquiry using disciplined methods to solve problems or answer questions
• Nursing research


  Systematic inquiry to develop knowledge about issues of importance to the nursing profession
• Roles of Nurses in Research

  • Producer of research
  • Intelligent consumer of research findings
• Evidence Based Practice (EBP)


  The use of the best clinical evidence in making patient care decisions
• Both the consumer and the producers play a key role in EBP
• Florence Nightingale pioneered research (handwashing reducing the spread of germs, and disease)
• The first journal on research (nursing research) emerged 1950s
• Clinical research becomes increasingly important 1970s
• The National Health Research Development Program (NHRDP) and the Medical Research Council of Canada (MRC) were established
• The Canadian health services research foundation and Canadian institutes of Health Research were established
• Future Directions for Nursing Research

  • Heightened focus on evidence-based practice
  • Increased use of multiple confirmatory strategies and replication
  • Greater stress on integrative reviews
  • Increased multidisciplinary collaboration
  • Expanded dissemination of research findings
  • Greater focus on outcomes research
• Sources of Evidence for Nursing Practice

  • Tradition
  • Authority
  • Clinical experience; trial and error; intuition
  • Logical reasoning (inductive and deductive)
  • Assembled information (e.g., quality improvement data)
  • Disciplined research
• Paradigm


  A worldview; a general perspective on the complexities of the real world, with certain assumptions
• Positivist paradigm


  • Quantitative - cling to more objective, fixed numbers
  • Reality exists there is a real world driven by natural causes
  • The inquirer is independent from those being studied
  • Values are held in check; objective is sought
  • Most often allied with the positivist tradition
  • Fixed design, discrete, specific concepts, deductive processes, control over context, verification of hunches, quantitative information, seeks generalizations
• Naturalistic paradigm


  • Qualitative - constructivism, things are built, more interested in the process or experience
  • Reality is multiple and subjective; constructed by individuals
  • The inquirer interacts with those being studied; findings reflect this interaction (bracketing; positionality; reflexivity)
  • Subjectivity and values are inevitable and desirable
  • Most often allied with the naturalistic tradition
  • Flexible design, holistic, inductive processes, context-bound, generation of interpretations, qualitative information, seeks patterns, similarities/differences
• Both the positivist and naturalistic paradigms are equally important
• The Purpose of Nursing Research


  • Identification
  • Description
  • Exploration
  • Explanation
  • Prediction
  • Control
• Evidence Based Practice


  Evidence based decision making should integrate best research evidence with clinical expertise, patient preferences, and local circumstances
• Research Utilization

  Using findings from studies in a practical application that is unrelated to the original research
• Studies identified knowledge-practice gaps (e.g., Ketefian 1975)
• RU projects sought to address the gap (1970s and 1980s)
• RU efforts began to be superseded by a call for EBP during 1990s
• Archie Cochrane

  Called for efforts to make research summaries about interventions available to health care providers
• David Sackett


  Developed a learning strategy called evidence-based medicine, with has broadened to the use of best evidence by all health care practitioners
• Evidence Hierarchies


  Involve ranking sources according to the strength of evidence they provide
• Systematic reviews are at the pinnacle of the evidence hierarchy
• Best Evidence


  Research findings that are methodologically appropriate, rigorous and clinically relevant for answering pressing questions
• Types of Best Evidence

  • Efficacy of nursing interventions
  • Safety of nursing interventions
  • Cost effectiveness of nursing interventions
  • Reliability of nursing assessment tests
  • Causes and consequences of health problems
  • Meaning and nature of patients experience
• Resources for EBP


  • Systematic reviews
  • Meta-analysis
  • Meta synthesis
  • Clinical practice guidelines
  • Care bundles
• Clinical Practice Guidelines

  Give specific recommendations for evidence-based decision-making
• Models for Evidence Based Nursing Practice

  • The settler model of research utilization to promote evidence-based practice
  • The Iowa model of evidence-based practice to promote quality care
  • Roger's diffusion of innovations theory
• Steps in EBP


  • Asking clinical questions that can be answered with research evidence
  • Searching for and retrieving relevant evidence
  • Appraising and synthesizing the evidence
  • Integrating the evidence with your own clinical expertise, patient preferences, and local context
  • Assessing the effectiveness of the decision, intervention, or advice
• PIO


  Population or patients, Intervention (influence or exposure), Outcome
• Quantitative terms


  • Respondent
  • Study participant
  • Concepts, constructs, variables
  • Data (numeric values)
  • Relationships
  • Reliability, validity
• Qualitative terms


  • Informant
  • Study participants
  • Phenomena, concepts
  • Data (narratives, stories)
  • Patterns of association
  • Trustworthiness
• Variable


  A characteristic or quality that takes on different values, that is, varies from one person to the next
• Types of variables


  • Continuous
  • Categorical
  • Attribute variable
  • Created variable
  • Independent variable
  • Dependent variable
• Conceptual Definition


  The abstract or theoretical meaning of a concept being studied
• Operational Definition


  The operations (measurements) a researcher must perform to collect the desired information
• Quantitative Data


  Information that can be counted or expressed numerically