Nursing Research and EBP

What is Nursing Research?
*a systematic approach used to examine phenomena important to nursing and nurses

*a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice

Examples of Phenomena Important to Nursing
•Which is better – heparin flush or saline flush for peripheral IV catheters?
•Best practices for prevention of pressure ulcers
•Best practices for oral care on ICU patients
•Relationship of low staffing levels on rates of serious patient complications
•Predictors of job satisfaction among nurses
•Ethical conflicts of nurse practitioners working in managed care environments
•Impact of shift work on nurses’ quality of life
The Systematic Approach to Conducting Research
•Identify a problem/situation
•Define the purpose of the study
•Review related literature (literature review)
•Formulate a hypothesis and define the variables
•Select a research design
•Select the population, sample, and setting
•Conduct a pilot study (not always done)
•Collect data
•Analyze data
•Communicate the findings
•Institutional Review Board (IRB) approval
– Privacy
– Confidentiality
– Fair treatment
– Freedom from harm
•Informed Consent
– Risks/benefits of study
– Protection of anonymity/confidentiality
– Voluntary participation
– Compensation
– Alternative treatments
– How to contact the investigator
Unethical Research
•Nazi experiments
•Tuskegee Syphilis Study
•The Jewish Chronic Disease Hospital in NY
Quantitative
-Deductive
-Looking for cause & effect; correlations
-Usually have large samples
-Analyzes numerical data
-Data collection methods
•Surveys
•Questionnaires
•Experiments
•Secondary data analysis
Qualitative
-Inductive
-Looking to discover
-Usually have small samples
-Analyzes narrative data
-Data collection methods
•Interviewing
•Focus groups
Who conducts/funds the research?
•Cochrane Collaboration (systematic reviews)
•National Institute of Nursing Research (NINR)
•Agency for Healthcare Research and Quality (AHRQ)
•Foundations/Organizations:
-Robert Wood Johnson Foundation
-W. K. Kellogg Foundation
-Sigma Theta Tau International Honor Society of Nursing
Research Roles of
Associate Degree Nurses
•Help to identify clinical problems in nursing practice
•Assist in the collection of data within a structured framework
•In conjunction with nurses holding more advanced degrees, use research in clinical practice
What is Evidence-based Practice?
•”the process of systematically finding, appraising, and using research findings as a basis for making decisions about patient care” (Webb, 2011)
•”the conscientious use of current best evidence in making decisions about patient care” (Sackett et al., 2000)
•Uses research findings to develop:
-Best practices
-Clinical Practice Guidelines
Why Evidence-based Practice?
•Results in better patient outcomes
•Healthcare providers experience higher levels of satisfaction
•Third-party payers will provide reimbursement only for interventions that have been proven to be effective
Barriers to Evidence-based Practice
•Barriers
-Nurses lack the time to search the literature
-Nurses lack the knowledge to critically appraise research articles
-Resistance to change
-Peer pressure to continue traditional practices
•Can take as long as 17 years to translate research findings into practice (Balas & Boren, 2000)
Facilitators of Evidence-based Practice
•Facilitators
-The explosion of technology – easy access to research findings
-Evidence-based Practice workplace committees
-Workplace journal clubs
-More & more hospitals striving for Magnet status
Take Away Points
•Nursing research follows a systematic approach.
•Nursing research is conducted to build on existing knowledge or generate new knowledge.
•Institutional review boards (IRB) are in place to make sure the ethical rights of individuals participating in research studies are protected.
•There are 2 types of research designs:
-Quantitative
-Qualitative
•Research studies can be funded by government or private funds.
•The research role of ADN is to help identify nursing practice problems and to assist with data collection for research studies.
•Evidence-based practice uses current best evidence to improve patient care and outcomes
Definition of Nursing research
• Systematic inquiry or study to build knowledge in a discipline
• Results provide a foundation on which practice decisions and behaviors are laid
• Evidence provides support for the quality and cost-effectiveness of nursing interventions
• Evidence-based changes may occur at the individual level or at varied organizational or social levels
Evolution of Nursing Research
• Began with Florence Nightingale during the Crimean War
• 1900-1940 nursing education was the focus
-what type of person enters nursing
-how are nurses perceived by other groups
-teaching, curriculum, administration
• 1970s more doctorally prepared nurses conducting research studies focus on improvement of patient care
• 1980s many more qualified nursing researchers; widespread availability of computers; naturalistic paradigm; studies were qualitative rather than quantitative
• 1990s focus on health care delivery issues; cost, quality, access
• Today: incorporation of EBP, larger scale/international studies accessible via online forums
Research Priorities
• Goal is to put knowledge gained from research into health care delivery
• Two major sources of funding
-National Institute of Nursing Research (NINR)
-Agency for Healthcare Research and Quality (AHRQ)
National Institute of Nursing Research (NINR)
• Part of the National Institutes of Health (NIH)
• Supports research on the biologic and behavioral aspects of critical health problems that confront the nation
• Research encompasses “health promotion and disease prevention, quality of life, health disparities, and end-of-life”
• Potentially supported research topics
-determining disease risk and treatment through utilizing genetic information
-determining effective health-promotion strategies for individuals, families, and communitites
-discovering approaches that encourage people to effectively take responsibility for symptom management and health promotion
-assisting in identification and effective management of symptoms related to acute and chronic disease
-improving clinical settings in which care is provided
-improving the quality of care giving in settings such as long-term care facilities, the home, and the community
-understanding predisposition to disease, socioeconomic factors that influence health, and cultural health practices that either protect from or expose to risk for health problems
-improving symptom management for those at end-of-life
*** investigators bring their own unique creativity and expertise when proposing research in NINR priority research areas
• Annual round-table discussions to obtain feedback from the disciplines requiring continued or new research
Agency for Healthcare Research and Quality (AHRQ)
• Mission is defines as “improving the quality, safety, efficiency, and effectiveness of health care for all Americans”
• Goals centered around supporting improvements in health outcomes, strengthening measurement of health care quality indicators, and foster access to and cost-effectiveness of health care
• Expanded roles as of 1999
-improve the quality of health care through scientific inquiry, dissemination of findings and facilitation of public access to information
-promote patient safety and reduce medical errors through scientific inquiry, building partnerships with health care providers, and establishment of centers for education and research on the therapeutics (CERTs)
-advance the use of information technology for coordinating patient care and conducting quality and outcomes research
-establish an office on priority populations to ensure that the needs of low-income groups, minorities, women, children, the elderly, and individuals with special health care needs are addressed by the agency’s research efforts
Private Foundations
• Obtaining money for research is becoming increasingly competitive
• Foundations and corporate direct-giving programs are interested in funding health care projects and research
• Computer databases and guides to funding available at libraries
• Computer access to enhanced listings of funding foundations via subscription
-often expensive
-costs often balanced by efficiency with procuring funds
• Private foundations
-Robert Wood Johnson Foundation
-W.K. Kellogg foundation
-offer program funding for health-related research
• Investigators should pursue funding through local sources and private foundations until they have established a track record
Nursing Organizations
• STTI- Sigma Theta Tau International
-supports creative inter-disciplinary research and places importance on identifying “best practices” and benchmark innovations
• ANA- American Nurses Association
-awards small grants through American Nurses Foundation
• ONS- Oncology Nurses Society
-awards grants that focus on issues related to oncology
• Libraries and internet provide ample information about the many foundations and organizations interested in funding research endeavors
• Most research institutions establish offices that help in the search and procurement of funding
Components of the Research Process
• Conceptualizing a research study
• Planning and implementing this study
• Communicating the findings
• Each step builds on the previous step
• Systematic process
Study Designs
• Plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific research questions
• Two basic methods; Quantitative and Qualitative
• The researcher chooses the method base on the research question and the current level of knowledge about the phenomena and the problem to be studied
• Quantitative research is a formal, objective, systematic process in which numeric data are used
• Qualitative research is a systematic approach used to describe and promote understanding of human experiences related to health
-provides a dimension of understanding to nursing science that adds to traditional quantitative methodology
Quantitative Designs
• QUANT- QUANTITY-NUMBERS
• Traditionally has been present in nursing research studies
• Intent is to apply or generalize knowledge from a smaller sample of subjects to a larger population
• Produce knowledge about very precise topics, creating a need for multiple studies over multiple years before conclusive knowledge is yielded
• Types of quantitative designs
-survey
-needs assessment
-experimental
-quasi-experimental
-methodologic
-meta-analysis
-secondary analysis
Survey
Used in research studies designed to obtain information regarding the prevalence, distribution, and interrelationships of variables within a population. Good to use when collecting demographic info, social characteristics, behavioral patterns, and information bases.
Needs Assessment
Used to determine what is the most beneficial to a specific aggregate group. Can be used by organizations communities, or groups to establish priorities for their respective client groups.
Methodologic
Focuses on the development of data collection instruments, such as surveys or questionnaires. Goal is to improve the reliability and validity of instruments. This work is time consuming and tedious, but necessary to the implementation of research studies. Once quality instruments are developed they can be used in multiple research studies.
Meta-analysis
An advanced process whereby multiple research studies on a specific topic are reviewed and the findings of these multiple studies are statistically analyzed. Synthesizes quantitative data from multiple studies thus enlarging the power of the results and allowing more confident generalizations than a single study.
Experimental Study
Having several subtypes, includes the manipulation of one or more independent variables, random assignment to either a control or treatment group, and observation of the outcome or effect that is presumably a result of the independent variable. Rigor and control of extraneous variables allow researchers to establish cause-and-effect relationships, testing casual relationships.
Quasi-experimental Design
Lacks one of the required components of the experimental design; when randomization, a control group, or the manipulation of one or more variables is not possible this is a good design. Several subtypes exist
Secondary Analysis
Involves asking new questions of data collected previously. The data must have been generated from previous formal research studies or may have resulted from any prior systematic collection of data.
Qualitative Designs
• Method designed for discovery rather than verification
• Used to explore little known or ambiguous phenomena
• Interviewing is the main technique
• Time consuming
-one-on-one interviews take time; must be recorded, typed, transcribed, analyzed
• Costly
• Uses small samples; generalizations cannot be made from findings
-researcher should give thorough description of the sample and setting so that findings could be expected to occur in similar individuals in similar settings
• Three main types
-phenomenology
-ethnography
-grounded theory
Phenomenology
Designed to provide understanding of the participants’ “lived experience.” Phenomenology is a valuable approach for studying intangible experience such as grief, hope, and risk taking
Ethnography
A method used to study phenomena from a cultural perspective. Ethnographers spend time in the cultural setting with the research participants to observe and better understand their experiences
Grounded Theory
Designed to explore and describe a social process. It is a method used to explore a process that people use to deal with problematic areas of their lives, such as coping with terminal illness or adjusting to bereavement.