PowerPoint Presentation

Nursing Research

ObjectivesReview week 1Identify seven steps to evidence-base practiceResearch terminologiesIdentify dependent and independent variablesLevels of evidence and strengthsLiterature reviewOverview of research process

Review of week 1Define research :SystematicLogicalEmpiricalValidates and generates new knowledge

Define evidence-based practice:Confirmed evidence (research & quality)Decision makingNursing expertiseDelivery of holistic patient care

Evidence-based practice research-based, decision making process used to guide the delivery of holistic patient care.3ConnectionNursing Decision-making Confirmation (research and quality Improvement)

Nursing Expertise Holistic Patient Care

Purpose of ResearchThe 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 ResearchTwo primary sourcesAcademic evaluation of programs, technologies, and instructional designHealthcare settings variable demands at bedside and multiple co-morbidities can make replication difficultNurses identified as champions within evidence-based practiceTypes of ResearchBasic research is research to gain knowledge for knowledges sake

Applied research directly impacts practice

Most nursing research is applied research

Basic Vs Applied ResearchBasic 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

What is theory? A set of concepts (idea) , definitions, that shows a systematic view of a phenomena for the purpose of explaining and making predicitions about those phenomena.

8Applied 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 Theory becomes evidence to guide practice Research is equal to theory developmentNursing is in the intersection of the diagram12Obstacles to Using ResearchEducational preparationBeliefs/AttitudesSupport/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 1st Nursing research journal

14Nursing 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 questionsBackground questions

Foreground questionsBackground questions: Foundation based. Can be found in a textbook. It provides biological, psychological & sociological aspects of care.Foreground questions: seek evidence to answer a need for clinical information related to an intervention or therapy (diagnosing, treating or to assist patients to understand their prognosis.Give examples of both.16Question Formation5 components of evidence-based question:P Patient/ populationI - Intervention or interestC ComparisonO OutcomeT Time PICOT formation is used to frame questions17This 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%, elderlyIntervention - Avapro (Irbesartan)Comparison if any none, standard of careOutcome 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 AHRQChronic IllnessQuality and cost effectiveness of careHealth promotion and disease preventionManagement of symptomsAdaptation to new technologiesHealth disparitiesPalliative care at the end of life

Sources include academia and healthcare settings21What 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 improvementChanges must be made based on evidenceEBP utilizes the PICOT formatEBP uses critical appraisal of all available researchEBP formulates recommendationsEBP is the underpinning for safe and effective health care Types of EvidenceCase studiesCase seriesCase reportsEditorialsIdeasOpinionsExpert Opinions

Have the students turn to page 12 for types of evidence24More types of EvidenceObservationsConsensusQualitative researchQuantitative researchMixed methodsTranslational researchconsensus25

Clinical pathwaysBundling Best practice Agency for Healthcare Research and Quality (AHRQ)Clinical pathways plan of care developed by multidisciplinary team outling a sequence of care to a predicative group of patientsBundling group of interventions related to a care or disease process. When implemented produces positive outcomesBest practices nursing actions that produce the most desirable patient outcome27Steps to EBP

0. Cultivate a spirit of inquiryAsk the burning clinical questionCollect the most relevant and best evidenceCritically appraise the evidenceIntegrate all evidence with ones clinical expertise, patient preferences, and values in making a practice decision or changeEvaluate the practice decision or changeDisseminate the outcomes of EBP or changeTerminologiesPopulationSample Sample sizeSamplingRandomizationRandom sampling

Terminologies contd.Variable Dependent variableIndependent variableHypothesisResearch designHawthorne effect

Independent and Dependent variablesExample 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

Class activity32Level 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 studyLevel 7 - Expert opinion

Literature Review

Written analytical summary of research finding on a topic of interestComprehensive compilation of what is known about a phenomenonClear identification of the topic of interest importantPurpose of Lit. ReviewIdentifies a research problem and how it can be studiedHelps clarify and determine the importanceIdentifies what is knownIdentifies gaps in the knowledgeProvides examplesPurpose of Lit. ReviewProvides evidence of the importance of the problemIdentifies theoretical frameworks and conceptual modelsIdentifies experts in the fieldIdentifies research designs and methodologiesProvides a context for analysis

Conducting a SearchSeek the help of a professional librarianResearch idea Brainstorm about an ideaOther articles can provide suggestions for the next stepResearch questionHelps to be curious about topicReading is great source for ideasDoes not have to be etched in stone

Database or Search engineSearch engines Take you to the informationHelp you retrieve accessible informationDatabaseOrganized body of related information Arranged for speed of access and retrievalStorage location like a libraryTwo types bibliographic and full text

Basics of SearchingIdentify concepts from the research question to focus the searchDetermine any synonyms for identified concepts (search terms)Combine search strategiesAND = reduces the number of citationsOR = less restrictiveKey InformationTextbooks can be helpful to provide a foundationDetermine the gaps in the literature and authors of major articlesMore precise the search = fewer number of resourcesMore general the search = greater number of resourcesEvaluating the LiteratureBelieve that you have analytical skills to base the evaluation uponLook at the discussion section of article to see the limitations identified for the studyDriving force is to determine if the study supports the question identified and if any gaps are seenParts of a Lit. ReviewPurpose of the studySample size and selectionDesign of the studyData collection proceduresAnalysis of the dataConclusionLit. Review Cont.Articles Authors credentials, citation informationPurpose Helps to group similar type studies, organizes the material for later summarizingSample Selection process, size of the sampleMethod Implementation of study, inclusion criteria, instruments or surveys used, data collection procedures, data analysisMajor Findings Gaps noted, limitations, next step in the research processWriting the Lit. reviewNot a summary of articlesSynthesis of information about the topicPurpose convince the reader about the need to do the studyFormat can varyOutlines are helpful to manage the amount of data to be organized

Take a break.Next slide will be chapter 4: Ethics of Nursing research.45Overview of the Research ProcessAbstractIntroductionIdentification of a research problemPurposeLiterature reviewTheoretical FrameworkHypothesis/research question

Have an article to review with class46Research process Cont.Research designSamplingData collection methodsResultsDiscussionSummaryHomeworkRead Chapters 4 & 5Answer the questions at the end of each chapter

Tuskegee Experiment