NURSING RESEARCH Recommended Review Preparations • ANA. Standards of Professional Performance Standard I.
Quality of Care The nurse systematically evaluates the quality and effectiveness of nursing practice. Standard II. Performance Appraisal The nurse evaluates his/her own nursing practice in relation to professional practice standards and relevant statutes and regulations. Standard III. Education The nurse acquires and maintains current knowledge in nursing practice. Standard V. Ethics The nurse's decisions and actions on behalf of clients are determined in an ethical manner. Standard VI. Collaboration The nurse collaborates with the client, significant others, other criminal justice system personnel, and health care providers in providing patient care. Standard VII. Research The nurse uses research findings in practice. Rationale Utilization and practice of research activities promotes the professional development and knowledge base. The nurse is expected to adhere to research method guidelines. Measurement Criteria 1. The nurse uses interventions substantiated by research as appropriate to the individual's position, education, and practice environment. 2. The nurse participates in research activities as appropriate to the individual's position, education, and practice environment. Such activities may include the following: a. Identifying clinical problems suitable for nursing research b. Participating in data collection. c. Participating in a unit, organization, or community research committee or program. d. Sharing research activities with others. e. Conducting research within the guidelines of the individual facility, statutes, and regulations. f. Critiquing research for application to practice. g. Using research findings in the development of policies, procedures, and guidelines for client care. Standard VIII. Resource Utilization The nurse considers factors related to safety, effectiveness, and cost in planning and delivering client care. • Roles and Functions of the Nurse 1. Caregiver 2. Agent of change 3. Leader 4. Manager
5. 6. 7. 8.
Communicator Advocate of client Research user or consumer Teacher
9. Case Manager 10. Counselor
• Expanded Career Roles for Nurses 1. Nurse Anesthesist 2. Nurse Midwife 3. Nurse Practitioner 4. Clinical Nurse Specialist/ Expert 5. Nurses Researcher- Nurse Researcher investigates nursing problems to improve nursing care and to refine and expand nursing knowledge. They are employed in academic institutions, teaching hospitals and research center such as the National Institute for Nursing Research. Nurse-researcher usually has an advanced education at the doctoral level.
6. Nurse Educator
• Criteria of a Profession A profession is generally distinguished from other kinds of occupation by: 1. Its requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed 2. An orientation of the individual toward service, either to a community or to organizations 3. Ongoing research 4. Code of ethics 5. Autonomy 6. Professional organizations
Development of Nursing Research • Importance of Nursing Research 1. Purpose: discovery and development of organized body of knowledge. 2. Research is of utmost importance to nursing profession. Research evidence determines nursing interventions that we are practicing is the optimum one 3. Research knowledge will help nurses to be effective, efficient and excellent. Definitions of Nursing Research 1. Research is a collection of data in a rigorously controlled situation for the purpose of prediction or explanation; a more formal systematic and intensive process of carrying on a scientific method of analysis. Purpose: discovery and development of organized body of knowledge. 2. Committee on research of the PNA-Research is an honest scientific investigation undertaken for the purpose of discovering new facts or establishing new relationships among facts already known which will contribute to the present body of knowledge and can lead to effective solution of the present problem. It involves careful or critical thinking to revise or to revalidate accepted conclusions and previously held concepts or established generations or principles. 3. Systematic inquiry using disciplined methods to solve problem 4. Includes the breadth and depth of the discipline of nursing ( preventive, therapeutic and rehabilitative) as well as the preparations of the practitioners and personnel involved in the total nursing sphere. 5. Polit and Beck (2004) - systematic inquiry designed to develop knowledge about issues of importance to the nursing profession, including nursing practice, education, administration and informatics. 6. Burns and Grove (2005) - have more narrowly defined nursing research as a “scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences clinical nursing practice. 7. Nieswiadomy – systematic objective process of analyzing phenomena of importance to nursing. Clinical nursing research indicates nursing research involving clients or studies that have the potential for affecting the care of clients, such as with the studies of animals or the so-called normal subjects. 8. Nursing research- Systematic inquiry to develop knowledge about issues of importance to the nursing profession 9. 10. Sources of nursing knowledge 1. Customs and tradition- “we’ve always done it that way”. Social and cultural practices have been the bases for nursing care in the country.
2. Assembled information (e.g., quality improvement data) 3. Scientific research – the most objective and the source of nursing knowledge 4. Trial and error – “if it works, we’ll use it”. If one approach did not work one will be use until
one process is effective that until then the process will be stop.
5. Logical reasoning (inductive & deductive) 6. Experts or authorities- experts and authorities in the given field often provide knowledge for
other people. Features of Scientific ResearchS 7. Reliability/Generalizations- mean that the research findings can be applied to a situation or population larger than the one studied 8. Order 9. Control- means the impositions of conditions in research, to minimize bias and maximize the precision and validity of data gathered. 10. Empiricism-objective methods of seeking information
11. Systematic- refers to process that a researcher moves in a systematic fashion from identifying a
problem to conclusions and recommendations • Purposes of nursing research 1. Identification 2. Description 3. Exploration 4. Explanation 5. Prediction 6. Control 1. 2. 3. 4. 5. 6. • discover new facts about known phenomena Find answer to the problem that is only partially solved by existing methods and information. improve existing techniques and develop new instruments or products discover previously unrecognized substances or elements discover pathways of action of known substances and elements classify or arrange in order related and valid generalizations into systematized science
Goals for conducting nursing research 1. Promotion of evidence-based practice Two models for evidenced- based practice The Stetler Model of research utilization to promote evidence-based practice Five sequential phases of settler model - Phase I: Preparation - Phase II:Validation - Phase III: Comparative Evaluation and Decision Making - Phase IV: Translation/Application - Phase V: Evaluation
The Iowa Model of evidence-based practice to promote quality care Steps of individual EVP - Framing an answerable clinical question - Searching for relevant research-based evidence - Appraising and synthesizing the evidence - Integrating evidence with other factors - Assessing effectiveness
Appraisal of evidenced - Validity of study findings - Clinical importance of findings - Precision of estimates of effects - Associated costs and risks - Utility in a particular clinical situation Increased Future Directions for multidisciplinary collaboration Greater focus on outcomes research Use of multiple, confirmatory strategies Expanded dissemination of research findings Increased visibility of nursing research Promote evidenced –based practice means that nurses make clinical decisions based on the best research evidenced, their clinical expertise, and the health care preferences of their clients or patients. ensure credibility of the nursing professions provide accountability for nursing practice document the cost effectiveness of nursing care Paradigm- A world view; a general perspective on the complexities of the real world, with certain assumptions about reality Key paradigms for nursing research: – Positivist paradigm – Naturalistic paradigm Nature of reality • Positivist assumption: Reality exists; there is a real world driven by natural causes • Naturalistic assumption: Reality is multiple and subjective, constructed by individuals Relation of Inquirer to those being studied • Positivist assumption: The inquirer is independent of those being studied 1. 2. 3. 4. 5.
• Naturalistic assumption: The inquirer interacts with those being studied; findings reflect the interaction Roles of Values in Inquiry • Positivist assumption: Values are held in check; objectivity is sought • Naturalistic assumption: Subjective values are inevitable, desirable How knowledge is obtained? Positivist Fixed design Discrete, specific concepts Deductive processes Control over context Verification of hunches Quantitative information Seeks generalizations Naturalistic Flexible design Holistic Inductive processes Context-bound Emerging interpretations Qualitative information Seeks patterns
General Classification of research according to purpose: 1. Basic Research - pure research - conducted to develop, test and refine theories and generate new knowledge - “seek knowledge for knowledge’s seek” - is concerned with generating new knowledge Ex. Isaac Newton Law of Gravity and Inertia 2. Applied Research - is concerned with using knowledge to solve immediate problems - Directed toward generating new knowledge that can be used in the near future. It is often conducted to seek solutions to existing problem - received funding than basic research Ex. study the various methods of cleft lip and palate surgery and the effectiveness of this methods Classification of research according to design: 1. Quantitative research- is concerned with objectivity, tight controls over the research situation, and the ability to generalized findings. - scientific research - hard science 2. Qualitative research is concerned with the subjective meaning of an experience to the individual. - not scientific - soft science Comparison of Quantitative and Qualitative research Qualitative Subjective data Discovery Whole is greater than the parts Multiple truths Small sample sizes Participants/informants/respondents Results presented as narrative data Researcher part of the study Quantitative Objective data Explanation Parts are equal to the whole One truth Large sample sizes Subjects Results presented as statistics Researcher separate from the study
3. Experimental research design 4. Non- Experimental research design Outcomes research- research that focuses on measurable outcomes of interventions with certain patients populations. - include a wide range of patients population Classification of research according to the level of investigation a. Exploratory research- is conducted when little is known about the phenomenon of interest. A flexible approach rather than a structured approach. Hypotheses are generally not appropriate for these types of studies. b. Descriptive research- phenomena are described or the relationship between variables is examined. It is conducted when enough information exists to examine relationships between variables, descriptive studies maybe conducted in which hypothesis are tested. c. Explanatory research- search for causal explanations and are much more rigorous than exploratory or descriptive studies. This type of research is usually experimental. Classification of Research According to Duration/ Time Element of the study 1. Longitudinal study- follows subject over a period of time in the future. Cohort study- a special type of longitudinal study wherein a person or persons who have been born under a particular period of time are being studied. a. Developmental studies b. prospective studies- the independent variable or presumed cause is identified at the present time, and then subjects are followed in the future to observed the dependent variable. “what is” 2. Cross-sectional study – examines subject at one point in time. a. Historical studies -the dependent variable is determined in the present and attempt is made to determine the independent variable that occurred in the past. Data are collected after the fact. b. ex post facto study c. retrospective studies – “what was” Classification of research according to number of variables used in the study: 1. one variable study/ univariate study 2. two variable studies/ bivariate studies 3. multiple variables study/ multivariate study Combining qualitative and quantitative methods Combining both qualitative and quantitative methods increases the researcher’s ability to rule out the rival explanations for phenomena. Field and Morse asserted that the strongest research findings are found in studies that use both methods. Triangulation- is a technique simultaneously using the two methods in research • Roles of nurses in research 1. Advocate of client or respondents during study 2. Major/ principal Investigator 3. Evaluator of a research findings 4. Research problem identifier 5. Informants/respondents/subjects/ participants or sample population 6. Consumer of research findings 7. Associate or member of research team
Nurses role in using research • Read widely and critically • Attend professional conferences • Learn to expect evidence that a procedure is effective • Become involved in a journal club • Pursue and participate in RU/EBP projects Barriers to Using Research in Nursing Practice • Research-related barriers • Nurse-related barriers • Organizational barriers • Barriers related to the nursing profession
History of nursing research-Increasing research in nursing is contributing to nursing practice. In the 1940’s nursing research is at the very early stage of development. In the 1950s increase in the federal funding and professional support helped established centers for nursing research. Most early research was directed to the study of nursing education. In the 1960s, studies were often related to the nature of the knowledge base underlying nursing practice. Since the 1970s, the nursing research has focused on practice-related issues. - Mid 1800’s Florence nightingale recommended clinical nursing research but this type of research is scarce until 1970’s - Replication studies are needed in nursing. Replication studies involve repeating a study with all the essential element of the original study held intact. - in the Philippines, nursing research prior to and during the ‘60s was mostly in nursing administration 51%, and nursing education (33%), while patient care and related studies received minimal attention, with only 13% and 3% respectively. The teaching of research in the undergraduate level was integrated in the curriculum in the midsixties. It was aimed at familiarizing the students with skills in scientific investigations, developing a positive attitude toward research, and enhancing interest in their own studies. At this time the only research university in the Philippines is DLSU and the country is lagging behind from other Asian countries in the race of producing research studies.