Nursing Research and EvidenceBased Practice

Week 1

Week 1 Nursing Research and Evidence-Based

Practice

Table of Contents
Welcome................................................................................................................................................3
Weekly Learning Objectives ................................................................................................................3
Introduction...........................................................................................................................................3
Nursing Research.................................................................................................................................3
Evidence-Based Practice .....................................................................................................................3
Purpose of Research in Implementing an Evidenced-Based Nursing Practice ...............................4
Participation of Nurses in Research: Past to Present........................................................................6
Acquiring Knowledge in Nursing ........................................................................................................7
Acquiring Knowledge through Nursing Research .............................................................................9
Best Research Evidence for Practice................................................................................................11
Your Role in Nursing Research .........................................................................................................12
Summary .............................................................................................................................................12

Week 1 Nursing Research and Evidence-Based

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Welcome
Welcome to the first weeks presentation, Nursing Research and Evidence-Based Practice. This week
you will learn about nursing research, its significance in developing evidence-based practice for nursing
and the common research methodologies used in generating research evidence for practice.
Weekly Learning Objectives
By the end of this week, you will be able to:
Define research and nursing research
Describe the link between research and the development of evidence-based practice in nursing
Identify the professional nurses role in research
Identify the type of research conducted in nursing
Describe the ways of acquiring knowledge for nursing practice
Introduction
Nursing research requires a learner to learn new unique languages, integrate new rules, and use new
experiences to expand their perceptions and methods of reasoning.
Nursing Research
Research means a diligent, systematic inquiry or study that validates and refines existing knowledge
and develops new knowledge. It requires extensive planning, organization, and persistence.
Research in nursing requires the identification of relevant knowledge needed by nurses.
Research is necessary in nursing to develop and refine knowledge that nurses can use to improve
clinical practice. Practicing nurses need to be able to read research reports and synthesize research
findings to implement evidence-based interventions such as protocols and guidelines in practice to
promote positive outcomes for patients.
Nursing research is also required to gather knowledge about nursing education, nursing administration,
healthcare services, characteristics of nurses, and nursing roles.
Hence, nursing research is a scientific process that validates and refines existing knowledge and
generates new knowledge that directly and indirectly influences nursing practice.*
Nursing research plays a vital role in building an evidence-based practice for nursing.
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Evidence-Based Practice
Evidence-based practice evolves from the integration of the best research evidence with clinical
expertise and patient needs and values.*
Some of the major elements of evidence-based practice are:

Week 1 Nursing Research and Evidence-Based

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Best Research Evidence

"Best research evidence is the empirical knowledge generated from the synthesis of quality study
findings to address a practice problem."*
A researcher uses best research evidence to deduce and develop standardized guidelines, protocols,
or policies for clinical practice.
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Clinical Expertise
"Clinical expertise is the knowledge and skills of the healthcare professional providing care."*
The clinical expertise of nurses include their years of experience and their current knowledge of
research and clinical literature. Clinical expertise helps them in making sound clinical judgment in using
the best research evidence in practice.
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Patient Needs and Values

"With evidence-based practice, patients and their families are encouraged to take an active role in the
management of their health.*
A patient's needs might include the following:
Health promotion
Illness prevention
Acute or chronic illness management
Rehabilitation
The patients may also bring values or unique preferences, expectations, concerns, and cultural beliefs
to the clinical encounter.
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Purpose of Research in Implementing an Evidenced-Based Nursing Practice

A nurse would require a solid research base to implement and document the effectiveness of an
intervention for a particular patient problem and to promote positive outcomes. In the clinical practice,
you may need to critically appraise, synthesize, and apply research evidence that provides description,
explanation, prediction, and control of phenomena to accomplish these goals.
Description
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Description involves identifying and understanding the nature of nursing phenomena and, sometimes,
the relationships among them.*
Some key points to focus on are:
Recognition of the responses to a variety of health conditions
Recognition of the symptoms for a particular disease
Description of the health promotion and illness prevention strategies used
Determination of the incidence of a disease locally, nationally, and internationally
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Explanation
Explanation clearly states the relationships among phenomena and identifies the reasons for certain
events to occur.
Some key points to focus on are:
Determination of the assessment data, both subjective data from the health history and
objective data from physical exam, which need to be gathered to address a patient's health
need
The link of assessment data to a diagnosis
The link of causative risk factors or etiologies to illness, morbidity, and mortality
Determination of the relationships among health risks, health behaviors, and health status
Prediction
Through prediction, one can estimate the probability of a specific outcome in a given situation.*
Some key points to focus on are:
Prediction of risk for a disease
Prediction of behaviors that promote health and prevent illness
Prediction of healthcare required based on a patient's need and values
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Control
Control is the ability to write a prescription to produce the desired results.
Some key points to focus on are:
Testing interventions to improve the health status of individuals, families, and communities
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Testing interventions to improve healthcare delivery

*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Participation of Nurses in Research: Past to Present

Over the last 160 years, the participation of nurses in research has changed drastically and holds great
promise for the twenty-first century.
Screen 8:
Florence Nightingale
In 1859, Nightingale's research initially focused on the importance of a healthy environment in the
physical and mental well-being of the patients. She studied the following aspects of the environment:
Ventilation
Cleanliness
Purity of water
Diet to determine the patients' health
However, her most noted research is her collection and analysis of soldier morbidity and mortality data
during the Crimean War.
Nursing Research: 1900s through 1970s
During the late 1920s and 1930s, the American Journal of Nursing began to publish case studies in its
journals. A case study involves an in-depth analysis and a systematic description of one patient or a
group of similar patients to promote understanding of healthcare interventions.
During the 1940s, the increase in research activity prompted the publication of the first research journal
in 1952 called the Nursing Research. Nursing schools began introducing research and the steps of the
research process at the baccalaureate level, during the 1950s and 1960s.
An increasing number of clinical studies focused on quality care and the development of criteria to
measure patient outcomes during the 1960s. And, in the late 1960s and 1970s, nurses were involved in
the development of models, conceptual frameworks, and theories to guide nursing practice. In 1972,
Professor Archie Cochrane originated the concept of evidence-based practice through his book entitled,
Effectiveness and Efficiency: Random Reflections on Health Services.
Nursing Research: 1980s and 1990s
During the 1980s, the main focus was on the conduct of clinical research. Many clinical journals began
publishing a number of studies. Some of them were:
Scholarly Inquiry for Nursing Practice, 1987
Applied Nursing Research and Nursing Science Quarterly, 1988
Conduct and Utilization of Research in Nursing (CURN), 1982 and 1983
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Annual Review of Nursing Research, 1983

Clinical Nursing Research, 1992
Journal of Nursing Measurement, 1993
Qualitative Health Research, 1994
National Center for Nursing Research (NCNR), 1985

During the 1980s and 1990s, outcomes research emerged as an important methodology for
documenting the effectiveness of healthcare services. In 1989 the Agency for Health Care Policy and
Research (AHCPR) was established to facilitate the conduct of outcomes research. Several of these
evidence-based guidelines were published in the 1990s and provided standards for practice in nursing
and medicine.
Nursing Research: Twenty-First Century
The development of a scientific knowledge base that enables nurses to implement an evidence-based
practice is the vision for nursing in the twenty-first century.
The NINR is focused on encouraging a variety of methodologies such as quantitative, qualitative, and
outcomes research, to be used to generate essential knowledge for nursing practice and in seeking
expanded funding for nursing research.
The AHRQ is focused on supporting research designed to improve the quality of healthcare, reduce
cost, improve patient safety, decrease medical errors, and broaden access to essential services.
The American Association of Colleges of Nursing (AACN) is focused on promoting the quality of
nursing education and in providing future direction for the discipline in moving toward evidence-based
practice.
In order to ensure an effective research enterprise in nursing, the discipline must:
Create a research culture
Provide high-quality educational programs to prepare a workforce of nurse scientists
Develop a sound research infrastructure
Obtain sufficient funding for essential research
Acquiring Knowledge in Nursing
Knowledge is essential information acquired in a variety of ways, expected to be an accurate
reflection of reality, and incorporated and used to direct a person's actions.*
Acquiring knowledge in nursing is of key importance as it helps in providing quality care to patients.
Some modes of acquiring knowledge in nursing are:
Traditions
Authority
Borrowing
Trial and error
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Personal experience
Role modeling
Intuition
Reasoning

Traditions
Through the means of writing, oral communication, and role modeling, nursing traditions have been
transferred to the present from the past, and they continue to influence the practice of nursing.
The main advantage of traditions is that they were developed from effective past experiences. The
main disadvantage of traditions is that it narrows and limits the knowledge sought for nursing practice.
Authority
An authority refers to a person, who has expertise and is given the power to influence opinion and
behavior. It is important that nurses with authority act based on research evidence than on customs and
traditions.
Borrowing
Borrowing in nursing involves the appropriation and use of knowledge from other fields or disciplines to
guide nursing practice. The two ways in which nursing has borrowed are:
Taking information from other disciplines and applying it directly to nursing practice, without
integrating it into the unique focus of nursing
Integrating information from other disciplines within the focus of nursing
Trial and Error
Trial and error is used in a situation of uncertainty in which other sources of knowledge are unavailable
and the outcome is also unknown. Nurses need to use trial and error in providing nursing care, as each
patient responds uniquely to a situation. Some of the disadvantages of using this mode are that:
It is time-consuming
It is risky
It is learned only through experience since the knowledge for using this strategy is often not
shared with others
Personal Experience
Knowledge gained by being personally involved in an event, situation, or circumstance is called
personal experience. The different levels of experience in the development of clinical knowledge and
expertise are:
NoviceA nurse with no personal experience

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Advanced beginnerA nurse, who has just enough experience to recognize and intervene in
recurrent situations
CompetentA nurse who is able to generate and achieve long-range goals and plans because
of years of personal experience
ProficientA nurse who recognizes that each patient and family responds differently to illness
and health
ExpertA nurse who has an extensive background of experience and is able to identify
accurately and intervene skillfully in a situation

Role Modeling
Learning gained by imitating the behaviors of an expert is called role modeling. An intense form of role
modeling is mentorship in which the expert nurse serves as a teacher, sponsor, guide, and counselor
for the novice nurse.
Intuition
"Intuition is an insight into or understanding of a situation or event as a whole that usually cannot be
explained logically.*
Some nurses can intuitively assess the patient's condition and contact the physician for medical
intervention.
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Reasoning
The processing and organizing of ideas in order to reach conclusions is called reasoning. There are two
types of reasoning:
Inductive reasoningIt moves from specific to general
Deductive reasoningIt moves from general to specific
Acquiring Knowledge through Nursing Research
A variety of research methods are needed to generate knowledge. These methods are essential to
generate research evidence for specific goals of the nursing profession:
Promoting an understanding of a patient's experiences with health and illness
Implementing effective nursing interventions to promote patient health
Providing high-quality, cost-effective care
Quantitative research
Some of the characteristics of quantitative research are:
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It has a logical positivism as its philosophical origin, as it operates strictly on the rules of logic,
truth, laws, and predictions
Its focus is concise, objective, and reductionistic
Its reasoning is always logistic and deductive
It uses the cause-and-effect relationships as its basis of knowing
Its theoretical focus is on theory testing

The quantitative research methods are classified into the following categories:
Descriptive research - It explores new areas of research and describes situations as they exist
in the world
Correlational research - It examines relationships and is conducted to develop and refine
explanatory knowledge for nursing practice
Quasi-experimental or Experimental research - It determines the effectiveness of nursing
interventions in predicting and controlling the outcomes desired for patients and families

Qualitative research
Some of the characteristics of qualitative research are:
It has a naturalistic, interpretive, humanistic philosophical origin, as it is concerned with
understanding the meaning of social interactions by those involved
Its focus is broad, subjective, and holistic
Its reasoning is always dialectic and inductive
It uses meaning, discovery, and understanding as its basis of knowing
Its theoretical focus is on theory development
The qualitative research methods are classified into four categories:
Phenomenological researchIt is an inductive descriptive approach used to describe an
experience
Grounded theory researchIt is an inductive research technique that is used to formulate,
test, and refine a theory about a particular phenomenon
Ethnographic researchIt investigates cultures through an in-depth study of the members of
the culture
Historical researchIt is a narrative description or analysis of events that occurred in the
remote or recent past
Outcomes research
Outcomes research focuses on examining the result of care or determining the changes in health status
for the patient. The four essential areas that require examination are:
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Patient responses
Functional maintenance or improvement of physical functioning
Financial outcomes
Patient satisfaction

Best Research Evidence for Practice

Best research evidence:
Is used in evidence-based practice to support clinical decisions in practice
Is a summary of the highest quality
Provides current empirical knowledge in a specific area of healthcare that is developed from a
synthesis of quality studies such as quantitative, qualitative, and outcomes in that area
The main concepts of best research evidence for practice are:
Strategies Used to Synthesize Research Evidence
Research evidence in nursing and healthcare is synthesized by the following processes:
Systematic review - It is used to determine the best research evidence available for expert
clinicians to use and promote an evidence-based practice by using a structured, comprehensive
synthesis of quantitative and outcomes studies in a particular healthcare area
Meta-analysis - It is a type of study that provides one of the highest levels of evidence for an
intervention's efficacy, by statistically pooling the results from previous studies into a single
quantitative analysis
Integrative review - It determines the current knowledge of research in a particular area, by
identifying, analyzing, and synthesizing the research findings from independent quantitative,
outcomes, and qualitative studies
Metasummary - It helps in developing a description of current knowledge in an area, by
synthesizing or summing the findings across qualitative reports
Metasynthesis - It provides a fully integrated, novel description, or explanation of a target event
or experience
Levels of Research Evidence
The quality and quantity of the studies that have been conducted in the area determines the strength or
validity of the best research evidence in that area. "The levels of the research evidence are a
continuum, with the highest quality of research evidence at one end and weakest research evidence at
the other.*
*Source: Burns, N. & Grove, S. (2011). Understanding Nursing Research: Building an Evidence-based Practice (5th ed.). Philadelphia, PA:
W.B. Saunders.

Introduction to Evidence-Based Guidelines

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Evidence-based guidelines are rigorous, explicit clinical guidelines developed on the best research
evidence available in that area. Some of the sources for evidence-based guidelines are:
National Guideline Clearinghouse (NGC)
Cochrane Collaboration and Library
Oncology Nursing Society
National Association of Neonatal Nurses
Your Role in Nursing Research
There are three main roles that a nurse plays in research. They are as follows:
Developers of research - They conduct studies to generate and refine the knowledge needed
for nursing practice
Consumers of research - They use research evidence to improve their nursing practice
Critical appraisal of research They carefully examine all the aspects of a study to judge its
strengths, limitations, meaning, and significance
The participation of nurses in research is based on their educational preparation. They have been
categorized as follows:
Bachelor of Science in Nursing (BSN) - They search the databases and Internet sites for
evidence-based guidelines, protocols, and policies, in order to identify the best research
evidence for use in practice
Master of Science in Nursing (MSN) - They revise or develop protocols for use in practice by
critically appraising and synthesizing the findings from studies
Doctorate degree - They have the ability to translate scientific knowledge into complex
guidelines and protocols for practice
Post-doctorate - They play a major role in the conduct of research and in the generation of
nursing knowledge in a selected area of interest
Summary
By now, you should be able to:
Define research and nursing research
Describe the link between research and the development of evidence-based practice in nursing
Identify the professional nurses role in research
Identify the type of research conducted in nursing
Describe the ways of acquiring knowledge for nursing practice

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