Introduction to Nursing Research and Evidence Based Practice

Introduction to Nursing Research and Evidence. Based Practice THE PENNSYLVANIA STATE UNIVERSITY COLLEGE OF NURSING 200 W

What is nursing research? • To search again • To examine carefully • Diligent and systematic inquiry • Discovery – a “spirit of inquiry” • Goal is to develop an empirical (scientific) body of knowledge for a discipline which is essential for evidence-based practice!

Why is research important for evidencebased practice? • Develops empirical knowledge base • Identifies best practices that are based on clinical practices AND research • Improves outcomes for: • Patient and family • Nurse • Health care system

What role does research have in implementing an evidenced-based nursing practice?   Description • Identify and understand topics where little is known Explanation • Explains the interaction between concepts

What role does research have in implementing an evidenced-based nursing practice?   Prediction • Estimate likelihood that an outcome will occur Control • Experimental designs; maintaining consistency between variables

Test Your Knowledge Question Identifying and understanding the nature of nursing phenomena and the relationships among the phenomena are examples of _____? A. B. C. D. Description  Explanation  Prediction  Control 

Test Your Knowledge Question: Answer A. Description deals with identifying and understanding the nature of phenomena and the relationship among the phenomena B. Explanation—Clarifying the relationships among phenomena and identifying the reasons why certain events occur C. Prediction—Estimating and anticipating the outcomes in a particular situation D. Control—Manipulating a situation so as to achieve a particular outcome ANSWER A!

What is the history of nursing research? • Nursing research has evolved slowly over the years • Nursing research began in the 19 th century with Florence Nightingale in the Crimean War • Clinical research is the current major focus of nursing research and will continue to be so throughout the 21 st century

How is nursing knowledge acquired? • Traditions – changing bed linens daily • Authority – charge nurse on a unit • Borrowing – knowledge from other disciplines  • Trial and Error • Personal Experience – Benner’s Model of novice to • Role Modeling – clinical preceptor or mentor • Intuition – source of knowledge cannot be fully explained, “gut feeling” • Reasoning – inductive or deductive

How and why do researchers utilize empirical knowledge? • Empirical knowledge is gained by employing the following research methods: • Quantitative research = numbers • Qualitative research = language • Outcomes research = system level quality and effectiveness • Empirical knowledge is essential for the delivery of high-quality, safe patient and family nursing care (QSEN competencies)

Quantitative Research • Formal, objective process • Involves measurement & numerical data • Philosophy is based on logical positivism, where: ◦ Truth is absolute ◦ A single reality exists ◦ Deductive reasoning is used • Purposes include test hypotheses, determine cause & effect, and/or identify relationships among variables

What are some types of quantitative research? • Descriptive: measures what is. • Correlational: how concepts relate to each other. • Quasi-experimental and Experimental: Manipulate or control one aspect of a situation to examine the effect.

Qualitative Research • Systematic, subjective approach • Involves non-numeric data • Philosophy is based on holistic, interpretive stance, which states that: ◦ Truth is dynamic ◦ Multiple realities exist ◦ Inductive reasoning is used • Purpose is to investigate human experiences and interactions.

What are some types of qualitative research? • Phenomenological: describe an experience • Grounded theory: formulate and test a theory • Ethnographic: in depth study of a culture • Exploratory-descriptive: describe a topic and promote understanding • Historical research: an analysis of events to provide understanding

Test Your Knowledge Question The beginning nurse researcher would like to investigate credible resources for implementing protocols in clinical practice. Which of the following would be considered empirical sources of nursing knowledge? A. Reasoning, authority, and tradition B. Quantitative, qualitative, and outcomes research C. Care maps and protocols D. Role modeling and trial and error

Test Your Knowledge Question: Answer: B! Quantitative, qualitative, and outcomes research methods are used to generate empirical knowledge for nursing practice. These research methods are essential to generate evidence. A and D are examples of sources of knowledge. C refers to clinical practice guidelines.

What is the focus of outcomes research? Patients and Families Healthcare Providers Practice Changes Healthcare Systems Policy Development

Test Your Knowledge Question The nurse researcher is investigating outcomes research on nursing interventions. Which of the following examples would constitute outcomes research? A. A comparison of two patient groups B. Patient responses to nursing intervention C. Patient tested before and after intervention D. A patient’s perception of the intervention

Test Your Knowledge Question: Answer: B! Some of the essential areas that require investigation through outcomes research include: (1) patient responses to nursing and medical interventions; (2) functional maintenance or improvement of physical, mental, and social functioning for the patient; (3) financial outcomes achieved with the provision of health care services; and (4) patient satisfaction with the health outcomes, care received, and health care providers (Doran, 2011). A. This is an example of a quantitative approach C. An example of a Pre and Post test design D. This is an example of a qualitative approach

Why utilize evidence-based practice guidelines? • Provide high-quality, cost-effective health care • Allow for synthesis of knowledge needed for interventions and practice including development of the following: • Guidelines • Standards • Protocols • Policies

What skills do baccalaureate prepared nurses need? • Are knowledgeable about the research process and have skills in reading and critically appraising studies. • The QSEN competencies identify such knowledge and skills as being essential for pre-licensure students. • Should be prepared to actively participate in Evidence Based Practice.

Building an Evidence. Based Nursing Practice

How is evidence-based practice defined? • Integration of all of the following to promote high-quality, cost-effective patient care with good outcomes: • Best research evidence • Clinical expertise • Patient values and needs

What is not evidence-based practice? • Evidence-based practice is not always incorporated due to the following barriers: ◦ Practicality of implementing changes ◦ ‘Cookie-cutter’ or ‘cookbook’ approach to care

Why do we use evidence-based practice? • EBP is used because of benefits such as improved patient, family and caregiver outcomes. EBP can also improve provider (i. e. , nurse, physician, etc. ) and hospital outcomes. • EBP leads to the ‘gold standard’ or best treatments

What are sources for evidence-based practice? Systematic reviews Meta-analyses Integrative reviews Meta-syntheses

What are systematic reviews? • A narrowly focused synthesis of research findings from quantitative studies • Looks at studies of similar methodology • Has same standards of clarity, rigor, and replication as primary research studies

Steps in a Systematic Review • Formulate purpose and identify scope. • Develop specific questions or hypotheses. • Establish criteria for inclusion/exclusion of studies. • Conduct extensive literature search of all sources. (Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)

Steps in a Systematic Review • Develop questionnaire and contact authors to gather data. • Critique studies for scientific merit and data analysis. • Analyze and interpret data. • Report the review. (Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)

What is a meta-analysis? • Statistically pools results from previous studies into single quantitative analysis • Allows for application of scientific criteria • For example, sample size, level of significance, variables, etc.

What results are reported in a metaanalysis? • A large, diverse sample that is more representative of target population • Determination of overall significance of probability of pooled data • Indication of the efficacy of the intervention from the average effect size determined from several quality studies • Strength of relationship between variables

What is the best evidence for use in practice? • The strength of the evidence is on a continuum from high-quality results to lower quality results. • Evidence-based guidelines are essential in developing evidencebased practice for nursing.

What is strong versus weak evidence? STRONGEST 1. Meta-analysis 2. Integrative reviews 3. Experimental studies WEAKEST 1. Descriptive surveys 2. Qualitative studies 3. Correlational studies 4. Quasi-experimental studies

Pulling it All Together AN EXAMPLE OF BUILDING A PICO(S) QUESTION

What are the steps to evidence-based practice? As a new nursing researcher you would like to learn more about the research process and identify credible resources. You decide to examine the problem of medication adherence and the use of a medication reconciliation process for patients who are newly diagnosed with hypertension.

Steps of EBP Step 0: Cultivate a spirit of inquiry. Step 1: Ask a clinical question in PICOT format. Step 2: Search for the BEST evidence Step 3: Critically appraise the evidence Step 4: Integrate the evidence with clinical expertise and patient preferences and values Step 5: Evaluate the outcomes of practice decisions based on the evidence Step 6: Disseminate the EBP results

Developing the PICO Question P—Population -patient with hypertension I—Intervention - implementing medication teaching C—Comparison -compare patient outcomes for patient who receive teaching to those for a patient who does not O—Outcomes - increased adherence leads to decrease in blood pressure (T) - Time (may not always be a part of the study) OR (S) – Setting (may not always be part of the study)

Developing the PICO Question This is an example of an intervention type PICO question: In patients with hypertension how does medication teaching compared to no medication teaching increase medication adherence and lowered BP?

Questions? Comments? THE END!