Nursing Research

Objectives
Review week 1
Identify seven steps to evidence-base practice
Research terminologies
Identify dependent and independent variables
Levels of evidence and strengths
Literature review
Overview of research process




Review of week 1

Define research :
Systematic
Logical
Empirical
Validates and generates new knowledge


Define evidence-based practice:
Confirmed evidence (research & quality)
Decision making
Nursing expertise
Delivery of holistic patient care







Connection
Nursing Decision-making
Confirmation
(research and quality
Improvement)

















Nursing Expertise Holistic Patient
Care
















Purpose of Research
The purpose of nursing research is to build a
body of knowledge for the improvement of
patient outcome

Models and frameworks provide opportunities
for new nursing knowledge generation



Sources of Nursing Research
Two primary sources
Academic evaluation of programs, technologies,
and instructional design
Healthcare settings variable demands at bedside
and multiple co-morbidities can make replication
difficult
Nurses identified as champions within
evidence-based practice
Types of Research
Basic research is research to gain knowledge
for knowledges sake

Applied research directly impacts practice

Most nursing research is applied research

Basic Vs Applied Research
Basic or Pure Research:

Pursuit of knowledge or finding truth

Generates, refines or tests theory

Often uses laboratory setting

Findings may not be directly useful in
practice

May be used later in development of
treatment/drug/theory



Applied or Practical Research

Knowledge intended to directly influence
clinical practice

Conducted in actual practice conditions

Solve problems, make decisions,
predict/control outcomes

Evaluate interventions

Test/validate theories

Evaluate Basic research knowledge for
usefulness
Research

Inquiry
Quality


Policy, Procedure
Protocol

Quality Assurance Process
Defining the
problem
Determining a
improvement plan
Confirming the
outcomes of the
improvement plan
Modifying any
policy, procedure,
or protocol in
place
Communicating
the results and
next steps

Theory
Practice Research
Obstacles to Using Research


Educational preparation
Beliefs/Attitudes
Support/Resources

Nursing History
Began with Nightingale and Crimean
War- mid 1800s; connection of the
environment to clinical outcomes
Early 1900s focus of nursing research
was on nursing education, staffing issues
1952 publication of the 1
st
Nursing
research journal

Nursing History Contd.
1955 National Institute of Health established
the nursing Research Study section

1983 - ANA Center for Research for Nursing

1993 National Institute of Nursing Research


Clinical questions
Background questions

Foreground questions
Question Formation
5 components of evidence-based question:
P Patient/ population
I - Intervention or interest
C Comparison
O Outcome
T Time
This is a new patient who recently moved to the
area to be closer to her son and his family.
Pauline is 73 years old and has a history of
congestive heart failure and a left ventricular
ejection fraction of 40%.
She has been hospitalized twice within the last 9
months for worsening of heart failure. She is
extremely diligent about taking her medications
(enalapril, aspirin and simvastatin) and wants
desperately to stay out of the hospital. She lives
alone with several cats and a canary.
She comes to you with an advertisement for
Avapro (Irbesartan) and wants to know if this
would help her. You are not certain of the
evidence supporting this drug. You decide to
research this question before discussing this with
her during the next visit.

Patient/problem heart failure, ejaction fraction
40%, elderly
Intervention - Avapro (Irbesartan)
Comparison if any none, standard of care
Outcome primary: reduce need for
hospitalization ,
secondary : reduce mortality

Clinical Question


In elderly patients with heart failure and an
ejection fraction of 40%, is irbesartan effective
in reducing the need for rehospitalization?
Sources for Nursing Research as
outlined by the AHRQ
Chronic Illness
Quality and cost effectiveness of care
Health promotion and disease prevention
Management of symptoms
Adaptation to new technologies
Health disparities
Palliative care at the end of life

What is evidence?
Definition: A process to prove or disprove
something; making information clear;
foundation for values, beliefs, and/or ideas

Foundation for sound nursing and health care

Evidence base practice = research + quality
improvement
Changes must be made based on evidence
EBP utilizes the PICOT format
EBP uses critical appraisal of all available
research
EBP formulates recommendations
EBP is the underpinning for safe and effective
health care
Types of Evidence
Case studies
Case series
Case reports
Editorials
Ideas
Opinions
Expert Opinions


More types of Evidence
Observations
Consensus
Qualitative research
Quantitative research
Mixed methods
Translational research
Clinical pathways
Bundling
Best practice
Agency for Healthcare Research and Quality
(AHRQ)
Steps to EBP

0. Cultivate a spirit of inquiry
1. Ask the burning clinical question
2. Collect the most relevant and best evidence
3. Critically appraise the evidence
4. Integrate all evidence with ones clinical
expertise, patient preferences, and values in
making a practice decision or change
5. Evaluate the practice decision or change
6. Disseminate the outcomes of EBP or change
Terminologies

Population
Sample
Sample size
Sampling
Randomization
Random sampling

Terminologies contd.
Variable
Dependent variable
Independent variable
Hypothesis
Research design
Hawthorne effect


Independent and Dependent variables
Example 1:
The use of cathode ray terminals (CRTs)
increases the incidence of birth defects.
a) independent variable ?
CRTs (presumed cause or effect)
b) dependent variable?
Birth defects (presumed outcome)

Example 2:
Individuals with birth defects have a higher
incidence of interdependence dependence
conflicts than individuals without birth defects.
a) Independent variable?
Birth defects (presumed cause or effects)
b) Dependent variable ?
Independence/dependence conflicts

Level 1 - Systematic review & meta-analysis of
randomized controlled trials; clinical guidelines
based on systematic reviews or meta-analyses

Level 2 - One or more randomized controlled trials

Level 3 - Controlled trial (no randomization)

Level 4 - Case-control or cohort study

Level 5 - Systematic review of descriptive &
qualitative studies

Level 6 - Single descriptive or qualitative study
Level 7 - Expert opinion

Literature Review

Written analytical summary of research
finding on a topic of interest
Comprehensive compilation of what is
known about a phenomenon
Clear identification of the topic of
interest important
Purpose of Lit. Review


Identifies a research problem and how it can
be studied
Helps clarify and determine the importance
Identifies what is known
Identifies gaps in the knowledge
Provides examples
Purpose of Lit. Review
Provides evidence of the importance of the
problem
Identifies theoretical frameworks and
conceptual models
Identifies experts in the field
Identifies research designs and methodologies
Provides a context for analysis

Conducting a Search
Seek the help of a professional librarian
Research idea
Brainstorm about an idea
Other articles can provide suggestions for the next step
Research question
Helps to be curious about topic
Reading is great source for ideas
Does not have to be etched in stone

Database or Search engine
Search engines
Take you to the information
Help you retrieve accessible information
Database
Organized body of related information
Arranged for speed of access and retrieval
Storage location like a library
Two types bibliographic and full text

Basics of Searching
Identify concepts from the research question
to focus the search
Determine any synonyms for identified
concepts (search terms)
Combine search strategies
AND = reduces the number of citations
OR = less restrictive
Key Information
Textbooks can be helpful to provide a
foundation
Determine the gaps in the literature and
authors of major articles
More precise the search = fewer number of
resources
More general the search = greater number of
resources
Evaluating the Literature
Believe that you have analytical skills to base
the evaluation upon
Look at the discussion section of article to see
the limitations identified for the study
Driving force is to determine if the study
supports the question identified and if any
gaps are seen
Parts of a Lit. Review
Purpose of the study
Sample size and selection
Design of the study
Data collection procedures
Analysis of the data
Conclusion
Lit. Review Cont.
Articles Authors credentials, citation information
Purpose Helps to group similar type studies,
organizes the material for later summarizing
Sample Selection process, size of the sample
Method Implementation of study, inclusion criteria,
instruments or surveys used, data collection
procedures, data analysis
Major Findings Gaps noted, limitations, next step in
the research process
Writing the Lit. review
Not a summary of articles
Synthesis of information about the topic
Purpose convince the reader about the need
to do the study
Format can vary
Outlines are helpful to manage the amount of
data to be organized

Overview of the Research Process
Abstract
Introduction
Identification of a research problem
Purpose
Literature review
Theoretical Framework
Hypothesis/research question

Research process Cont.
Research design
Sampling
Data collection methods
Results
Discussion
Summary
Homework
Read Chapters 4 & 5
Answer the questions at the end of each
chapter


Tuskegee Experiment