chapter 002
TRANSCRIPT
1Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Chapter 2
Evolution of Research in Building Evidence-based Nursing Practice
2Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Historical Development of Research in Nursing
Florence Nightingale Evolution of nursing research topics
throughout the 20th century and into the 21st century
Eventual movement toward Evidence-BasedPractice (EBP)
Are there any commonalities that you see among the types of research done over the past 150 years?
3Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Florence Nightingale
Data collection—gathered data on soldier morbidity and mortality rates
Statistical analysis Instigated attitudinal, organizational, and
social changes
4Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1900 to 1950
Research led to advances in nursing education
1940s—trend started that focused on organization/delivery of nursing services
5Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1950s and 1960s
ANA initiated research into nursing functions and activities; ANA sponsored research conferences
Educational studies Growing number of clinical studies focused
on quality care and the development of criteria to measure patient outcomes
6Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1970s
Focus on nursing process First Nursing Diagnosis Conference held
which has evolved into today’s NANDA-I Studies involving implementation and
outcomes of primary nursing care deliverymodels
Archie Cochrane’s Effectiveness and Efficiency: Random Reflections on HealthServices published
7Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 1980s and 1990s
Focus on conduct of clinical nursing WICHE and CURN projects launched to
promote the use of research-based nursing interventions in practice
NCNR created to support the conduct of basic and clinical nursing research and the dissemination of findings
Emergence of outcomes research Term evidence-based was first used by David
Eddy in 1990
8Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Nursing Research 21st Century
Central vision: Conducting quality studies using a variety of methodologies, synthesizing study findings into best research evidence, and using research evidence to guide practice
Strong focus on EBP Focus of healthcare research and funding has
expanded from illness treatment to include health promotion and illness prevention
Key organizations promoting use of research to provide EBP: AHRQ, NINR, and ANA
9Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Classification of Research Methods for this Course
Quantitative research Qualitative research Outcomes research Intervention research
10Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Scientific Method
Incorporates all procedures that scientists have used, currently use, or may use in the future to pursue knowledge
Would both quantitative and qualitative studies fall under this umbrella?
11Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Comparison of Quantitative and Qualitative Research
Quantitative research—a formal, objective, systematic process implemented to obtain numerical data for understanding aspects of the world (currently the predominantly used method of scientific investigation in nursing)
Qualitative research is a systematic, interactive, subjective, holistic approach used to describe life experiences and give them meaning
12Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Comparison of Quantitative and Qualitative Research (Cont’d)
The problem and purpose to be studied determines the type of research to be conducted
Would you use quantitative or qualitative research to study… whole person’s response to pain? effects of nutritional education on serum lipid
levels?
13Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Quantitative Research Describes and examines relationships and determines causality among
variables Useful for testing a theory by testing the validity of the relationships that
compose the theory Requires control to identify and limit the problem to be researched and
attempts to limit the effects of extraneous or other variables that are not the focus of the study
Requires the use of structured interviews, questionnaires, or observations; scales; or physiological measures that generate numerical data
Control, instruments, and statistical analyses are used to ensure that the research findings accurately reflect reality so that the study findings can be generalized; generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn
14Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Quantitative Research Methods
Descriptive: accurate portrayal or account of characteristics of a particular individual, situation, or group
Correlational: systematic investigation of relationships between or among two or more variables that have been identified in theories, observed in practice, or both (nature of relationshipNOT cause-and-effect)
Quasi-experimental: used to identify causal relationships, to examine the significance of causal relationships, to clarify why certain events happened, and for a combination of these objectives
Experimental: objective, systematic, controlled investigation conducted for the purpose of predicting and controlling phenomena (examines causality)
15Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Qualitative Research
Generates knowledge about meaning through discovery
Inductive and dialectic reasoning are predominant Researchers use observations, interviews, and focus
groups to gather data (interactions are guided but not controlled)
Qualitative data take the form of words and are analyzed according to the qualitative approach that is being used
Findings from a qualitative study are unique to that study, and it is not the researcher’s intent to generalize the findings to a larger population
16Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Qualitative Research Methods
Phenomenological research: humanistic study of phenomena Grounded theory research: emphasizes interaction,
observation, and development of relationships among concepts; useful for discovering what problems exist in a social setting and the processes people use to handle them
Ethnographic research: research attempts to tell the story of people’s daily lives while describing the culture in which they live
Exploratory-descriptive qualitative research: conducted to address an issue or problem in need of a solution and/or understanding
Historical research: narrative description or analysis of events that occurred in the remote or recent past
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Outcomes Research and Intervention Research
Outcomes research examines the results of care and measures the changes in health status of patients
Intervention research investigates the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in a natural setting
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Best Research Evidence for Practice
What is it? A summary of the highest-quality, current empirical knowledge in a specific area of health care that is developed from a synthesis of quality studies in that area
Who does it? At least two researchers, or even a team of expert researchers and healthcare providers
19Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Research Evidence Synthesization Processes
Systematic review: structured, comprehensive synthesis of the research literature
Meta-analysis: statistically pooling the results from previous studies (usually quasi-experimental or experimental types) into a single quantitative analysis that provides one of the highest levels of evidence about an intervention’s effectiveness
Meta-synthesis: systematic compiling and integration of qualitative study results to expand understanding and develop a unique interpretation of study findings in a selected area (focus is on interpretation rather than the combining of study results)
Mixed-methods systematic review: synthesizing both quantitative and qualitative studies
20Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Continuum of Research Evidence
21Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Continuum of Research Evidence (Cont’d)
Strongest/best research evidence: systematic research reviews and meta-analyses of high-quality experimental studies
Weakest evidence: expert opinions or opinions expressed in committee reports
Best research evidence generated from systematic reviews, meta-analyses, and integrative reviews is used most often to develop standardized or evidence-based guidelines for practice
22Copyright © 2013, 2009, 2005, 2001, 1997 by Saunders, an imprint of Elsevier Inc.
Evidence-Based Practice Guidelines
Rigorous, explicit clinical guidelines based on the best research evidence available in that area
Usually developed by a team or panel of expert researchers; expert clinicians; and sometimes consumers, policymakers, and economists
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Sources for Evidence Based Guidelines
National Guideline Clearinghouse (NGC) Cochrane Collaboration and Library The Joanna Briggs Institute Professional nursing organizations