Nursing Research and Evidence Based Practice
Nur 420
Lecture 3
Introduction
• development and utilization of nursing knowledge is essential for continued
improvement in patient care. Conducting
researches in nursing, as all other sciences, is
important to establish a knowledge-base for
practice, improvement, and development.
• “A systematic study of problems in patient care.”
• “A systematic detailed attempt to discover or confirm facts that relate to a specific problem to improve the practice and profession of nursing.”
• A study of the problems in practice relating to the effects of nursing.”
• A systematic search for knowledge about issues of importance to nursing.”
Nursing Research
Definitions
PURPOSES OF RESEARCH
• Identification
• Description
• Exploration
• Explanation
• Prediction and Control
Characteristics of a scientific research
:
• 1. Should include a problem that need a solution or a question that need an answer.
• 2. Should achieve a general objective rather than a personal objective.
• 3. It should follow the scientific approach that characterized by order and control.
• 4. It should add new information through:
• a. New facts that was not known before.
• b. Validates results of previous research.
• c. Tests theories.
• d. Explains findings of a previous research.
• e. Find out new relationships among present phenomena.
The Quantitative Research Process
CONCEPTUAL PHASE
1. FORMULATING AND DELIMITING THE PROBLEM
o Topic
o Research Problem
o Problem statement – articulates the problem to be addressed and indicates the need for a study
o Research Questions – are the specific queries researchers want to answer in addressing the research problem
o Research Hypothesis – predictions that are tested
empirically
Term Example
Topic Side effects of Chemotherapy
Research Problem
Nausea and vomiting are common side effects among patients on chemo; interventions have been
moderately successful. New interventions that can reduce or prevent these side effects need to be identified
Statement of purpose
Purpose is to test an intervention to reduce
chemotherapy-induced side effects – specifically to compare the effectiveness of patient-controlled and nurse-administered antiemetic therapy
Research question
What is the relative effectiveness of patient-
controlled antiemetic therapy versus nurse-controlled antiemetic therapy with regard to (a) medication
consumption, and (b) control of nausea and vomiting in patients on chemotherapy?
Hypothesis
There is no difference on the effectiveness between patient-controlled and nurse-controlled antiemetic therapy with regard to medication consumption and control of nausea and vomiting of patients on
chemotherapy.
CONCEPTUAL PHASE
1. FORMULATING AND DELIMITING THE PROBLEM o Evaluating research problems
o Significance of the problem – research problem should have the potential of contributing meaningfully to the nursing knowledge
o Researchability of the Problem o Time and timing
o Availability of study participants o Facilities and equipment’s
o Money
o Experience and interest of the researcher
CONCEPTUAL PHASE
2. REVIEWING THE LITERATURE
Done to familiarize researchers with the knowledge base
PURPOSES:
Orient of what is known and not known regarding the topic
Replication of study
Identifications of relevant theoretical and conceptual framework
Assistance in interpreting study findings and developing
implications and recommendations
SOURCES OF LITERATURE
• PRIMARY SOURCES
– Research reports/studies
• SECONDARY SOURCES
– Books
– Literature review summaries
THE DESIGN AND PLANNING PHASE
1. Selecting a research design
2. Identifying the population to be studied
3. Sampling plan
4. Methods to measure research variables
5. Finalizing the research study
RESEARCH DESIGN
Based on:
– Time Frame
– Control over independent variable
– Measurement of independent
and dependent variables
TIME FRAME
DESIGN FEATURES EXAMPLE
CROSS-SECTIONAL Data are collected at one point in time
Practical, easy to do, economical
Mindell and Jacobson (2000) assessed sleep patterns and the
prevalence of sleep disorders during pregnancy. They compared
women who were at 4 points in pregnancy: 8-12wks, 18-22wks,
25-28wks, 35-38wks. They concluded that sleep disturbance
is common in late pregnancy.
TIME FRAME
DESIGN FEATURES
LONGITUDINAL Data are collected at two or more points in time over an extended period
TREND STUDIES Investigations in which samples from a population are studied over time
Different samples are selected but drawn from the same population
Based on surveys
CONTROL OVER
INDEPENDENT VARIABLE
DESIGN FEATURES
EXPERIMENTAL Manipulation of independent variable
Control group
randomization
QUASI -EXPERIMENTAL Manipulation of independent variable
No control group
No randomization
NONEXPERIMENTAL No manipulation of independent variable
Is there an intervention
?
No Yes
NONEXPERIMENTAL ?Is there randomization
No Yes
QUASI-EXPERIMENTAL EXPERIMENTAL
MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES
DESIGN FEATURES EXAMPLE
RETROSPECTIVE Study begins with dependent variable and looks backward
for cause
Heitkemper, et. al. (2001), used a
Retrospective design in their study of factors contributing to the onset of irritable bowel
syndrome. They compared samples of women with and without IBS in terms of their
history of sexual and physical abuse and found that abusive experiences were more
prevalent among women with IBS.
DESIGN FEATURE EXAMPLE
PROSPECTIVE Study begins with independent
variable and looks forward for
the effect
Brook, et. al. (2000) conducted a prospective study to examine clinical and cost outcomes of early versus late tracheostomy in patients who require
prolonged mechanical ventilation. Early tracheostomy was found to be associated with shorter lengths of hospital stay and lower cost.
IDENTIFYING THE POPULATION TO BE STUDIED
• POPULATION – aggregate or totality of those conforming to a set of specifications.
– Nurses
– Students
– Children
– Etc.
DESIGNING THE SAMPLING PLAN
• SAMPLE – subset of a population
– Sampling techniques:
• Probability sampling
– Systematic sampling – Fish bowl method
• Nonprobability sampling
– Purposive/Judgmental sampling – Snow ball technique
– Convenience/accidental sampling
METHODS TO MEASURE RESEARCH VARIABLES
• Different methods of data collection
– Biophysiologic measurements – Self-reports
– Observation
– Use of a research instrument
• Questionnaires
• Survey forms
FINALIZING THE RESEARCH PLAN
• Pretesting of questionnaires
• Conducting a Pilot study
DESIGN AND PLANNING PHASE
6. Selecting a Research Design 7. Specifying the Population
8. Operationalizing the Variables
9. Conducting the Pilot Study/Making Revisions
EMPIRICAL PHASE
10. Selecting the Sample 11. Collecting the Data
12. Organizing Data for Analysis
(DATA ENCODING)
THE ANALYTIC PHASE
• DATA ANALYSIS
– Statistical analysis
• DATA INTERPRETATION – is the process of making sense of the results and examining their implications
• CONCLUSION AND RECOMMENDATION
DISSEMINATION PHASE
• RESEARCH REPORT
– Research Abstract
– Research published in journals
– Term papers, theses, dissertations
• UTILIZATION OF FINDINGS
– Application to nursing practice and nursing
education
REFERENCES
All of the literature used in writing the research article. Should contain mostly
recent and primary sources.
What is Evidence-Based Practice
?
Definitions
“Process by which nurses make clinical decisions using best available evidence, clinical expertise, & patient preferences in the context of available resources”
“’Evidence-based practice (EBP) – utilizes the best clinical evidence in making patient care decisions typically
from research. EBP translates knowledge into practice’’
Why Evidence-Based Practice in Nursing
• Potential to narrow the ‘research-practice gap’: adoption of research findings into practice
• Provides a means to answer problematic clinical practice issues
• Potential to improve individual bedside practice;
• Supports/improves clinical decision-making skills
Evidence Based Practice Process
• Identify a practice issue
• Formulate an answerable question
• Search for best evidence
• Critically evaluate the evidence and clinical relevance
• Make recommendations
• Apply to clinical practice
• Evaluate impact/effectiveness/ outcomes
BARRIERS TO EVIDENCE-BASED PRACTICE
• Overwhelming patient workloads
• Misperceptions about EBP and research
• Lack of time and resources to search for and appraise evidence
• Organizational constraints – lack of support
• Peer pressure to continue with practices that are steeped in tradition
– “we’ve always done it this way and we are not changing now”
