The following trends in health care will have a definite impact on future nursing research and EBP:
1. Heightened focus on EBP: Nurses will be encouraged to engage in EBP; therefore, improvements are needed in both the quality of nursing studies and in nurses’
skills in understanding, critiquing, and utilizing study results.
2. Stronger scientific knowledge base: Nurses should deliberately replicate, or repeat, studies with different populations, settings, and times to ensure that findings are solid.
3. Greater stress on integrative reviews of nursing knowl- edge: Nurses should amass comprehensive research in- formation on the topic, weigh pieces of evidence, and integrate information to draw conclusions about the state of knowledge.
4. Increased emphases on multidisciplinary collaboration:
Collaboration of nurses with researchers in related fields should lead nurses to a more prominent role in creating national and international health care policies.
5. Expanded dissemination of findings: The Internet and other modes of electronic communication, such as the Online Journal of Knowledge Synthesis for Nursing and the Online Journal of Clinical Innovation, will assist in promoting EBP.
6. Increased interest in outcomes research: Nurses will assess and document the effectiveness of health care
services that are both cost-effective and still achieve outcomes without compromising care (Polit & Beck, 2006).
By identifying clear, significant priorities for study, striv- ing for excellence in the evolving knowledge base, and con- firming study findings, nursing researchers are providing a creditable scientific position from which to address societal health care issues and guide nursing practice.
KEY CONCEPTS
• The science of nursing is established by the same systematic, investigative process used by all science- based disciplines, the research process.
• Knowledge and nursing science are predicated on many ways of knowing, such as tradition, systematic inquiry, esthetics, and empiricism, and are influ- enced by gender perspectives.
• The five steps of the research process are statement of the research problem, delineation of a conceptual framework and review of the literature, selection of a research design, analysis and interpretation of the findings, and communication of the results of the research study.
• Research, education, and practice constitute the required integrated approach to the daily practice of all nurses.
• Obtaining informed consent for clients participating in the research process requires that the researcher provide full disclosure of the nature of the study, the subject’s right to refuse participation, and the likely risks and benefits that would be incurred by the study.
• The various applications of nursing research to edu- cation and practice can significantly influence the quality and delivery of nursing care.
• The importance of nursing research will increase as the result of trends occurring in educational pro- grams, interdisciplinary collaboration, interrelation- ships between nursing practice and research, and nurse-client involvement in research activities.
• To bridge the gap between nursing research and nursing practice, several research utilization models DETERMINING EVIDENCE-BASED
NURSING PRACTICE
A nurse working on an oncology unit is interested in the relationship of oral contraceptives and the de- velopment of ovarian cancer.
• Step 1. Review and critique research reports related to oral contraceptives and the develop- ment of ovarian cancer.
• Step 2. Based on the critique of the literature on oral contraceptives and the development of ovarian cancer, identify the level and strength of the evidence: good, fair, or insufficient to support or reject a cause-and-effect interpreta- tion of the association.
• Step 3. Make specific recommendations regard- ing the use of oral contraceptives and the devel- opment of ovarian cancer based on the
critiqued research and the level and strength of the evidence found in the research.
Adapted from Brockopp, D., & Hastings-Tolsma, M. (2003).
Fundamentals of nursing research(3rd ed.). Sudbury, MA: Jones &
Bartlett.
have been developed to promote quality care (e.g., the WICHE, CURN, and OCRUN models).
• EBP promotes quality care that has been demon- strated to be effective.
• Researchers, educators, and practitioners need to work collaboratively to ensure that nursing estab- lishes an evidence base for nursing practice.
REVIEW QUESTIONS
1. Which of the following best describes the founda- tion of research?
a. Evidence b. Experience c. Critical thinking d. Scientific method
2. ‘‘The systematic collection of numerical informa- tion, often under conditions of considerable control, and the analysis of the information using statistical procedures’’ best defines:
a. Quantitative research b. Qualitative research c. Experimental research d. Evidence-based practice
3. Informed consent requires that the researcher com- municate which of the following to the participant?
Select all that apply.
a. The nature of the study
b. The subject’s right to refuse participation c. That the data will be shared with all health care
providers
d. The expected outcomes, risks and benefits, of the study
e. That the family and the prescribing practitioner determine the client’s rights to participate f. That the agency has the right to use the data
freely
4. Which of the following are obstacles to moving research rapidly into client care?
a. Inadequate scientific base
b. Unfavorable organizational climates c. Lack of access to a health care library d. Limited communication and collaboration
between researchers and practitioners 5. Number the following steps of evidence-based
reports in the appropriate order.
a. Level of evidence b. Ask the clinical question c. Analysis of scientific data d. Recommendations for practice
online companion
Visit the DeLaune and Ladner online companion resource atwww.delmar.cengage.comfor additional content and study aids. Click on Online Companions, then select the Nursing discipline.
—VINCENT VANGOGH
CHAPTER 4
Health Care Delivery, Quality, and the Continuum of Care
COMPETENCIES
1. Describe the current status of the U.S. health care delivery system.
2. Discuss the various health care settings through which health care services are delivered.
3. Identify the members of the health care team and respective roles.
4. Explain factors influencing health care delivery.
5. Explore the challenges that exist within the health care system.
6. Discuss nursing’s role in meeting the challenges within the health care system.
7. Describe the emerging trends and issues for the health care delivery system.
8. Define the continuum of care concept.
9. Identify the levels of preventive care.
10. Discuss the phases of health care delivery that promote continuity of care.
11. Discuss methods for improving quality of health care delivery.
12. Explain the relationship between consumer satisfaction and quality.
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