Nursing research Evidence-Based Practice Discussion Questions

Nursing research Evidence-Based Practice Discussion Questions ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Nursing research Evidence-Based Practice Discussion Questions PLEASE SUMMARIZE THESE TWO CHAPTERS After completing the assigned readings, respond to the module 1 discussion question(s). Each initial discussion posting must be between 250-350 words . Posts, especially the initial one must have reference(s) cited correctly both within the text and on the reference list. See posted Abbreviated APA Essentials. Nursing research Evidence-Based Practice Discussion Questions burns___grove_chp_1.ppt burns___grove_chp_13__1_.ppt understanding_nursing_research_______susan_k._grove__4_.pdf Chapter 1 Introduction to Nursing Research and Evidence-Based Practice Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 1 What Is Research? ? ? ? ? ? To search again To examine carefully Diligent and systematic inquiry Discovery Goal is to develop an empirical body of knowledge for a discipline Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 2 Definition of Nursing Research ? ? A scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice. It is the key to building an evidence-based practice for nursing. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 3 Using Research in Practice ? ? ? ? Synthesis of knowledge (research, theory, and clinical experiences) Effect of philosophy Making a change in practice Evaluation of change for patient, provider, and health care system Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 4 Integrative Review of Research ? ? Critique of studies on a selected topic or practice problem Development of evidence-based practice guidelines: ? Example: safe administration of intramuscular injections • Summarize the findings. • Draw conclusions about what is known or not known about the topic. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 5 Evidence-Based Practice Guidelines ? ? Conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of highquality, cost-effective health care Synthesis of knowledge for development of guidelines, standards, protocols, or policies to direct nursing interventions and practice Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 6 Why Is Research Important for Evidence-Based Practice? ? ? ? Develops empirical knowledge base Identifies best practices that are based on clinical practices Improves outcomes for: ? ? ? Patient and family Nurse Health care system Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 7 Nursing Research Provides: ? ? ? ? Description Explanation Prediction Control Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 8 Description ? Identifying and understanding the nature of nursing phenomena and the relationships among the phenomena to: ? ? ? ? Describe what exists in nursing practice. Discover new information. Promote understanding of situations. Classify information for use in the discipline. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 9 Explanation ? Clarifying the relationships among phenomena and identifying the reasons why certain events occur Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 10 Prediction ? Estimating and anticipating the outcomes in a particular situation Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 11 Control ? Manipulating a situation so as to achieve a particular outcome Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 12 Research Participation at Various Levels of Educational Preparation Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 13 BSN Researcher Role ? ? ? ? Identify research problems. Assist with data collection.Nursing research Evidence-Based Practice Discussion Questions Critique research studies. Summarize research findings for use in practice. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 14 History of Nursing Research ? ? ? Nursing research has evolved slowly over the years. Nursing research began in the 19th century with Florence Nightingale. Clinical research is the current major focus of nursing research and will continue to be so throughout the 21st century. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 15 Florence Nightingale ? ? Nightingale focused on the importance of a healthy environment for patients. Aspects of her research included: ? ? ? ? Ventilation Cleanliness Purity of water Healthy diet Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 16 Nursing Research: 1900–1940s ? ? ? ? American Journal of Nursing first published in 1900. Case studies reported in the 1920s and 1930s. Graduate programs in nursing began in the 1920s. Research conducted by nurses in the 1940s. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 17 Nursing Research: 1950s ? ? ? ? 1950—American Nurses Association begins 5-year study of nursing functions and activities. 1952—Nursing Research published BSN and MS nursing programs add research to their curricula. 1953—Institute for Research and Service in Nursing Education established by Teacher’s College, Columbia University. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 18 Nursing Research: 1960s ? ? 1963—International Journal of Nursing Studies 1967—Image published by Sigma Theta Tau (now titled The Journal of Nursing Scholarship) Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 19 Nursing Research: 1970s ? ? ? ? ? 1970—ANA Commission on Nursing Research 1972—Council of Nurse Researchers 1978—Advances in Nursing Science 1978—Research in Nursing and Health 1979—Western Journal of Nursing Research Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 20 Nursing Research: 1980s ? ? ? ? ? ? 1982–1983—Conduct and Utilization of Research in Nursing project (CURN) 1983—Annual Review of Nursing Research 1985—National Center for Nursing Research (NCNR) 1987—Scholarly Inquiry for Nursing Practice 1988—Applied Nursing Research and Nursing Science Quarterly 1989—Agency for Health Care Policy and Research (AHCPR) Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 21 Nursing Research: 1990s ? ? ? ? ? ? 1992—Clinical Nursing Research 1993—National Institute of Nursing Research (NINR) 1993—Journal of Nursing Measurement 1994—Qualitative Health Research AHCPR renamed Agency for Healthcare Research and Quality (AHRQ). 1999—AACN position statement on nursing research Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 22 Nursing Research: 21st Century ? ? ? ? 2000—Healthy People 2010 2000—Biological Research for Nursing 2002—Joint Commission revised policies to support evidence-based care. 2004—Worldviews on Evidence-Based Nursing Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 23 21st Century ? 2005—AHRQ guidelines and priorities ? ? 2005—NINR priorities ? ? www.ahrq.gov www.nih.gov/nin 2006—Revised AACN position statements on nursing research Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 24 Ways of Acquiring Knowledge in Nursing ? ? ? ? Traditions Authority Borrowing Trial and error ? ? ? ? Personal experience Role modeling Intuition Reasoning Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 25 Practice Knowledge Base ? ? ? Identify two common behaviors used in your practice. Indicate the knowledge base for these behaviors. Is your practice based mainly on research or on other types of knowledge? Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 26 Nursing Research Methods ? ? ? Quantitative research Qualitative research Outcomes research Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 27 Quantitative Research Methods ? ? ? ? Descriptive research Correlational research Quasi-experimental research Experimental research Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 28 Quantitative Research Characteristics ? ? ? ? ? Philosophical origin: logical positivism Focus: concise, objective, reductionistic Reasoning: logistic, deductive Basis of knowing: cause-and-effect relationships Theoretical focus: tests theory Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 29 Qualitative Research Methods ? ? ? ? ? Phenomenological research Ground theory research Ethnographic research Historical research Focus groups Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 30 Qualitative Research Characteristics ? ? ? ? ? Philosophical origin: naturalistic, interpretive, humanistic Focus: broad, subjective, holistic Reasoning: dialectic, inductive Basis of knowing: meaning, discovery, understanding Theoretical focus: theory development Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 31 Outcomes Research ? Focus of outcomes: ? ? ? ? Patients and families Providers (nurses, physicians) Health care systems Outcomes used change practice and develop policy.Nursing research Evidence-Based Practice Discussion Questions Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 32 Chapter 13 Building an Evidence-Based Nursing Practice Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 1 Evidence-Based Practice ? ? ? Conscientious integration of best research evidence with clinical expertise and patient values and needs in delivery of quality costeffective health care Has a broader focus than research use Goal is implementation of quality costeffective care to promote positive outcomes Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 2 Barriers to EBP ? ? ? Practical Conceptual May create a “cookbook” approach to care Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 3 Benefits to EBP ? ? ? Improved patient outcomes for patients, providers, and agencies Leads to best treatment (Gold Standard) plan An integral part of the Magnet Status process Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 4 Evidence-Based Sources ? ? ? ? ? Systematic reviews Meta-analyses Integrative reviews Metasummaries Metasyntheses Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 5 Developing Evidence-Based Practice for Nursing ? ? Findings from a study are different from research evidence. Research evidence is a synthesis of quality, relevant studies to form a body of empirical knowledge for selected area of practice. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 6 Synthesis of Research Findings ? ? Knowledge comes from quantitative, qualitative, and outcomes research. Content clustering: integration of findings from scientifically sound research to determine what is currently known or not known ? Accomplished through: • Integrative reviews • Systematic reviews • Meta-analyses, metasummaries, metasyntheses Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 7 Integrative Reviews ? ? ? ? Identifies, analyzes, and synthesizes results from independent quantitative and qualitative studies to determine current knowledge Includes multiple types of research designs and literature types A complicated review, but gives breadth and depth to conclusions Annual Review of Nursing Research publishes integrative reviews. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 8 Qualitative Research Contributions to Integrative Reviews ? ? ? ? ? ? Identifies and refines questions and outcomes Identifies types of participants and interventions Augments and provides data for research synthesis Highlights inadequacies in methods Explains findings and interpretation of findings Helps make recommendations Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 9 Systematic Reviews of Research ? ? ? 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 Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 10 Steps in Systematic Reviews ? ? ? ? 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, 2005; Whittemore, 2005) Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 11 Steps in Systematic Reviews (cont’d) ? ? ? ? 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, 2005; Whittemore, 2005) Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 12 Meta-analyses of the Research Literature ? ? Statistically pools results from previous studies into single quantitative analysis Allows for application of scientific criteria ? For example, sample size, level of significance, variables Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 13 Results of Meta-analysis ? ? ? ? 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 Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 14 Metasummaries in Qualitative Research ? ? Definition: a synthesis of multiple primary qualitative studies to produce a narrative about a selected phenomenon Expands our knowledge base Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 15 Metasynthesis of Qualitative Research ? Synthesizes qualitative research with a critical analysis of primary studies and synthesis of findings into a new theory Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 16 Best Evidence for Use in Practice ? ? The strength of the evidence is on a continuum from high-quality results to lowerquality results. Evidence-based guidelines are essential in developing evidence-based practice for nursing. Nursing research Evidence-Based Practice Discussion Questions Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 17 Continuum of Strength of Research Evidence Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 18 Strength of Evidence ? Strongest evidence 1. 2. 3. Meta-analysis Integrative reviews Experimental studies ? Weakest evidence 1. 2. 3. 4. Descriptive surveys Qualitative studies Correlational studies Quasi-experimental studies Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 19 Stetler Model of Research Utilization ? ? ? ? ? Phase I: Preparation Phase II: Validation Phase III: Comparative Evaluation/Decision Making Phase IV: Translation/Application Phase V: Evaluation Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 20 Iowa Model of Evidence-Based Practice ? ? Provides direction for development of evidence-based practice in an agency Looks at triggers for change, such as: ? ? ? ? Risk management data Financial data Organizational standards Philosophy of care Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 21 Iowa Model of Evidence-Based Practice (cont’d) Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 22 Application of the Iowa Model ? ? ? ? What are effective strategies for implementation? What are outcomes from using the research findings? Do the data support the change? Is the proposed change an agency priority? Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 23 Scientific Merit Critique ? According to the Iowa model, research should be examined for: Conceptualization and internal consistency of the study 2. Methodological rigor of the design, sample methods, data, and analysis 3. Generalizability of the findings 4. Number of replications 1. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 24 Determining Agency Compatibility with the Change in Practice ? ? ? ? ? Who needs to approve the change in the agency? What steps are needed to get the change approved in the institution? Do physicians support the change? Do nurses support the change? Who are the leaders and will they support the change? Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 25 Instituting the Change in Practice ? ? ? Will the implementation take a long time? What support is needed to make the change? Are there barriers to instituting change in the agency? Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 26 Utilization Barriers ? Administration barriers ? ? ? Research not valued Limited change in agency or change not based on research Limited resources to make research-based change Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 27 Utilization Barriers (cont’d) ? Clinician barriers ? ? ? ? Do not read research reports Lack education about research process Do not believe research findings Do not know how to implement findings Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 28 Monitoring Outcomes ? ? ? After the change is effected, the outcomes must be monitored for effectiveness. Change should be documented regarding improved quality of care, decreased costs, saved nursing time, and improved access to care. Feedback is needed. Nursing research Evidence-Based Practice Discussion Questions Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 29 The Cochran Collaboration ? ? ? ? P – Population or participant of interest I – Intervention needed for practice C – Comparison of interventions to determine best practice O – Outcomes needed for practice Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 30 Development of Evidence-Based Guidelines ? ? ? ? AHRQ helps with guidelines through development of an expert panel. The group designates the scope of the guidelines. They synthesize the findings to develop recommendations for practice. Guidelines developed are presented at meetings and published. Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 31 Examples of AHRQ Practice Guidelines ? ? ? ? ? ? ? Pain management Decubiti prediction/prevention Cataract treatment in adults Depression treatment Screening, diagnosis, management of sickle cell disease in newborns and infants Otitis media treatment in children Availability of cardiac rehabilitation services Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 32 Access to Evidence-Based Guidelines ? ? ? ? ? Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse (NGC) Academic Center for Evidence-Based Nursing American College of Physicians American Academy of Pediatrics Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 33 Implementing a Model of EvidenceBased Practice ? ? ? Identify practice problem. Search for best research evidence. Determine quality of guideline by assessing: ? ? ? ? ? Authors Significance of problem Strength of evidence Link to national standards Cost-effectiveness of guideline Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 34 Translational Research ? ? An evolving concept defined by the NIH as the translation of basic scientific discoveries into practical application Encouraged by nursing and medicine to increase the implementation of evidencebased interventions in practice and determine if these interventions are effective Copyright © 2011 by Saunders, an imprint of Elsevier Inc. 35 Understanding Nursing Research Building an Evidence-Based Practice SIXTH EDITION Susan K. Grove, PhD, RN, ANP-BC, GNP-BC Professor Emerita, College of Nursing, The University of Texas at Arlington, Arlington, Texas Adult Nurse Practitioner, Family Practice, Grand Prairie, Texas Jennifer R. Gray, PhD, RN, FAAN George W. and Hazel M. Jay Professor, College of Nursing, Associate Dean, College of Nursing, The University of Texas at Arlington, Arlington, Texas Nancy Burns, PhD, RN, FCN, FAAN Professor Emerita, College of Nursing, The University of Texas at Arlington, Arlington, Texas Faith Community Nurse, St. Matthew Cumberland Presbyterian C … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10