CHAPTER 2 THEORY RESEARCH AND EVIDENCEBASED PRACTICE 1

CHAPTER 2 THEORY, RESEARCH AND EVIDENCE-BASED PRACTICE. 1

THE SCIENCE OF NURSING Nursing is a unique healthcare discipline in which nurses provide a service based on knowledge and skill. Nursing has two essential elements: 1) A body of knowledge (Science) 2) The application of that knowledge in nursing care interventions (Art) 3) Used together, this is the essence of critical thinking 2 Copyright © 2015 Wolters Kluwer • All Rights Reserved

SOURCES OF KNOWLEDGE Traditional—passed down from generation to generation Ex. Changing bed clothes Authoritative—comes from an expert, accepted as truth based on person’s perceived expertise Ex. Teaching IV insertion technique Scientific—obtained through the scientific method Ex. Research Copyright © 2015 Wolters Kluwer • All Rights Reserved 3

TYPES OF NURSING KNOWLEDGE Science—knowledge in and of nursing Philosophy—the study of wisdom, fundamental knowledge, and processes used to construct life Process—a series of actions, changes, or functions intended to bring desired result- conceptual frameworks and theories (nursing process) 4 Copyright © 2015 Wolters Kluwer • All Rights Reserved

INFLUENCES ON NURSING KNOWLEDGE Historical influences Florence Nightingale Differentiated between health nursing and illness nursing Defined nursing practice as separate and distinct from medical practice Schools of nursing Societal influences WWI & WWII Schools of nursing – Part II 5 Copyright © 2015 Wolters Kluwer • All Rights Reserved

FRAMEWORK OF NURSING THEORY Theory: group of concepts that describe a pattern of reality Can be tested, changed, or used to guide research Concepts: abstract impressions organized into symbols of reality Conceptual framework or model 6 Copyright © 2015 Wolters Kluwer • All Rights Reserved

FRAMEWORK OF NURSING THEORY Ø Nursing Theory is developed to describe nursing. Ø Differentiates nursing from other disciplines and activities Ø Serves the purpose of Describing Explaining Predicting Controlling desired outcomes of nursing care practice 7 Copyright © 2015 Wolters Kluwer • All Rights Reserved

TYPES OF REASONING Deductive reasoning —examines general ideas and considers specific actions or ideas Inductive reasoning —builds from specific ideas or actions to conclusions about general ideas Copyright © 2015 Wolters Kluwer • All Rights Reserved 8

INTERDISCIPLINARY BASE FOR NURSING THEORIES General systems theory —theory for universal application; break whole things into parts to see how they work together in systems Think of our solar system: 9 Copyright © 2015 Wolters Kluwer • All Rights Reserved

INTERDISCIPLINARY BASE FOR NURSING THEORIES Adaptation theory —adjustment of living matter to other living things and environment Think of adaption Developmental theory —orderly and predictable growth and development from conception to death Ex. Erickson and Maslow 10 Copyright © 2015 Wolters Kluwer • All Rights Reserved

BENEFITS OF NURSING THEORY ü Directs nurses toward common goal, with the ultimate outcome being improved patient care. ü Provides rational and knowledgeable reasons for nursing actions ü Gives nurses knowledge base necessary for appropriate actions ü Helps resolve current nursing issues ü Prepares nurses to question assumptions and values ü Serves research, education, and practice 11 Copyright © 2015 Wolters Kluwer • All Rights Reserved

GOAL OF THEORETICAL FRAMEWORKS Holistic patient care Individualized care to meet needs of patients Promotion of health Prevention or treatment of illness 12 Copyright © 2015 Wolters Kluwer • All Rights Reserved

THE MOST IMPORTANT CONCEPT OF NURSING THEORY–THE PERSON 13 Copyright © 2015 Wolters Kluwer • All Rights Reserved

FLORENCE NIGHTINGALE (1860) Meeting the personal needs of the patient within the environment. Concern for the environment of the patient, including cleanliness, ventilation, temperature, light, diet, and noise 14 Copyright © 2015 Wolters Kluwer • All Rights Reserved

GOALS OF RESEARCH Develop explanations (in theories) Find solutions to problems 15 Copyright © 2015 Wolters Kluwer • All Rights Reserved

GOALS OF NURSING RESEARCH Improve care of people in clinical setting. Study people and the nursing process. Education Policy development Ethics Nursing history Develop greater autonomy and strength as a profession. Provide evidence-based nursing practice. 16 Copyright © 2015 Wolters Kluwer • All Rights Reserved

METHODS OF NURSING RESEARCH Quantitative (think numbers or quantity) Involves concepts of basic and applied research Qualitative (think quality) Conducted to gain insight by discovering meanings Based on belief that reality is based on perceptions that differ for each person and change over time 17 Copyright © 2015 Wolters Kluwer • All Rights Reserved

STEPS OF QUANTITATIVE RESEARCH 1. State the research problem. 2. Define purpose of the study. 3. Review related literature. 4. Formulate hypotheses and variables. 5. Select research design. 6. Select population and sample. 7. Collect data. 8. Analyze data. 9. Communicate findings and conclusions. 18 Copyright © 2015 Wolters Kluwer • All Rights Reserved

TERMS IN QUANTITATIVE RESEARCH Variable- varies and has different values- measurable Dependent variable- variable being studied- determined as a result of a study Independent variable- causes or conditions that are manipulated or identified to determine the effects on the dependent variable Hypothesis- statement of what the researcher expects to find Data- info the researcher collects from subjects in the study (expressed in numbers) Instruments- devices used to collect and record data Copyright © 2015 Wolters Kluwer • All Rights Reserved 19

PROTECTING THE RIGHTS OF RESEARCH SUBJECTS Informed consent: Ø The patient’s right to consent knowledgeably to participate in a study without coercion (consent can be withdrawn at anytime) Ø The right to refuse to participate in a study without jeopardizing the care that he or she will receive Ø The right to confidentiality Ø The right to be protected from harm 20 Copyright © 2015 Wolters Kluwer • All Rights Reserved

PROTECTING THE RIGHTS OF RESEARCH SUBJECTS Federal regulations Requires that institutes receiving federal funding or conducting studies of drugs or medical devised regulated by the FDA (food and drug administration) establish institutional review boards. Institutional Review Boards (IRBs) Review all studies conducted in the institution to determine the risk status of all studies and to ensure that ethical principles are followed. 21 Copyright © 2015 Wolters Kluwer • All Rights Reserved

EVIDENCE-BASED PRACTICE (EBP) Problem-solving approach to making clinical decisions using the best evidence available Blends both the science and the art of nursing so that the best patient outcomes are achieved (critical thinking) May consist of specific nursing interventions or may use guidelines established for the care of patients with certain illnesses, treatments, or surgical procedures While EBP is best, it is not always practical to implement it in actual practice 22 Copyright © 2015 Wolters Kluwer • All Rights Reserved

STEPS IN IMPLEMENTING EBP Step 1: Ask a question about a clinical area of interest or an intervention. Step 2: Collect the most relevant and best evidence. Step 3: Critically appraise the evidence. Step 4: Integrate the evidence with clinical expertise, patient preferences, and values in making a decision to change. Step 5: Evaluate the practice decision or change. (Do you see ADPIE? ? ) Copyright © 2015 Wolters Kluwer • All Rights Reserved 23

ASKING CLINICAL QUESTIONS IN PICO FORMAT P = patient, population, or problem of interest I = intervention of interest C = comparison of interest O = outcome of interest (You need to know this… Copyright © 2015 Wolters Kluwer • All Rights Reserved ) 24