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Dr.

Sahar Hassan
Introduction to Nursing Research

Dr. Sahar Hassan

Dr. Sahar Hassan


Dr. Sahar Hassan
What is research?

Dr. Sahar Hassan


What is research?
A systematic inquiry that uses
disciplined methods to answer
questions and solve problems.
The ultimate goal of research is to:
develop,
refine,
expand a body of knowledge
Dr. Sahar Hassan
Research & the Consumer
Science produces knowledge
This knowledge provides society with
more choicesor does it control our
choices?
Can be used to manipulate
Can imply info which isnt necessarily
fact

Dr. Sahar Hassan


What do I believe???
One study says to do one thing;
another study says that I should do the
opposite!
What do you do?

Dr. Sahar Hassan


Read the study?
Do you simply accept the findings
because they are scientific?
How do you know which studies are
credible?
This course will help!

Dr. Sahar Hassan


Why get excited about research?
The essence of all How can?
research= curiosity
Why is?
(a desire to find out
how & why things What is the best way
happen) to?
What causes?
What are the effects
of?

Dr. Sahar Hassan


What is a scientific Inquiry?

Observable, verifiable data collected to:


Describe
Explain
Predict events

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Scientific Method

Select/define a problem
Formulate research question/hypothesis
Collect data
Analyze data
Report results

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2 main methods of research:

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Quantitative Research
Formal, objective, systematic process using
measurement
hypothesis testing
data analysis
Traditional approaches such as:
Experiments
Questionnaires
Surveys
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Qualitative Research
Evaluate subjective life experiences & give
meaning to them
Focuses on understanding phenomena from an
individuals perspective
Approaches:
Observation
In-depth interviews
Case studies
Narrative analyses
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Triangulation
Using both quantitative & qualitative
methods to collect data
May combine various research designs/data
collection techniques in the same study
combine psychosocial surveys, interviews,
observations
Two approaches are complimentary & can
give an accurate reflection of reality.

Dr. Sahar Hassan


What is nursing research?

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Nursing research
Is systematic inquiry designed to develop
trustworthy evidence about issues of
importance to the nursing profession,
including nursing practice, education,
administration, & informatics.

Dr. Sahar Hassan


Nursing Research
Application of scientific method to areas
of interest to nursing
Primarily involves studying people
People do not behave consistently as do
objects/chemicals in a laboratory!
This adds special challenges!

Dr. Sahar Hassan


Clinical nursing research
Research designed to guide nursing practice &
to improve the health & quality of life of
nurses clients.
Typically begins with questions stemming
from practice-related problems/problems
such as ones you may have already face
during your clinical training

Dr. Sahar Hassan


Roles of Nurses in Research
With the current emphasis on EBP, it is every
nurses responsibility to engage in one or
more roles along a continuum of research
participation.
In the old days, most nurse researchers were
academics who taught in schools of nursing
Research now is increasingly being conducted
by practicing nurses who want to find what
works best for their clients.

Dr. Sahar Hassan


Continuum of Nursing Research

Consumers of producers of
Nsg research Nsg research

Users (consumers) of nursing research:


nurses who read research reports to develop new skills & to
keep up to date on relevant findings that may affect their
practice.
Producers of nursing research:
nurses who actively participate in designing & implementing
studies
How nurses can participate in this continuum?
Dr. Sahar Hassan
Continuum of participation
Consumers of research:
Read & evaluate
Participate in the research process,
utilize findings
Conduct research

Dr. Sahar Hassan


Importance of Nursing Research
Nurses ask questions aimed at gaining new knowledge
to improve patient care
Research-based (evidence based) practice =
integrating research findings into clinical decision
making
Accountability for care-related decisions; research
expands nursing practice
Reinforce identity of nursing as a profession
knowing/ understanding pts. health care experience

Dr. Sahar Hassan


Nursing Research: history
The Early Years: From Nightingale to the 1970s
In her landmark publication: Notes on Nursing (1859), Florence
Nightingale, described her early interest in environmental factors
that promote physical and emotional well-being
Based on her skillful analysis of factors affecting soldier mortality &
morbidity during the Crimean War, she successful effected some
changes in nursing care & in public health.
For many years after Nightingales work, the nursing literature
contained little research.
Studies began to be published in the early 1900s, mostly concerning
nurses education.
Later on, with university-based education, many studies came out
concerning nursing students, their characteristics, problems, &
satisfactions

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Sources of evidence for nursing practice
1)Traditional basis: Certain beliefs & practices
accepted as truth
Rituals, unverified rules
Anecdotes, isolated experiences
Customs, opinions, unit cultures (routine)
Physicians authority

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Sources of evidence for nursing practice

2) Clinical experience, trial & error, intuition:


based on observations, hunches,
Personal experience & intuition both limitations
as a source of evidence for practice
Alternatives are tried successively until a solution
to a problem is found

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Sources of evidence for nursing practice
3) Logical Reasoning: Experience, intellectual faculties, &
formal systems of thought. 2 types of reasoning:
a) Inductive reasoning : generalizations from
specific observations.
E.g., a nurse may observe the anxious behavior of (specific)
hospitalized children and conclude that (in general)
childrens separation from their parents is stressful.
b) Deductive reasoning : developing specific
predictions from general principles.
E.g. if we assume that separation anxiety occurs in
hospitalized children (in general), then we might predict that
(specific) children in a local hospital whose parents do not
room-in will manifest symptoms of stress.

Dr. Sahar Hassan


Sources of evidence for nursing
practice
4) Assembled Information: local, national, and
international bench-marking data provide
information on such issues as the rates of using
various procedures
5) Disciplined Research: most sophisticated
method of acquiring knowledge.
More reliable than other methods of
knowledge acquisition
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Why do nursing research?

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2 main purposes for research
1) To achieve varying levels of explanation

2) To link to Evidence-based practice (EBP)

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Specific Purposes of Nursing Research
Quantitative Qualitative
Identification X
Description X X
Exploration X X
Prediction and control X
Explanation X X

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Evidence-Based Nursing Practice

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Definitions
Evidence-based nursing (EBN) is an approach to
health care practice that enables nurses to
provide the highest quality care based on the
best evidence available to meet the needs of
their patients.

The integration of the best research evidence


with clinical expertise & patient values.

Dr. Sahar Hassan


Why Practice EBN?
Standard of Care
Assures patient receives most up-to-date care
possible
Assists practitioner in dealing with increasing volume
of medical literature
Allows patient & practitioner to work together to
make informed decisions

Dr. Sahar Hassan


Overview of the EBP Movement
Archie Cochrane
Efforts led to the development of Cochrane Center
in Oxford and the Cochrane Collaboration.
Proposed an evidence hierarchy for weighing
evidence

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Evidence Hierarchies
Involve ranking evidence sources according to the
strength of evidence they provide

Ranking may depend on the type of question


being asked.

Within any level, evidence quality can vary


considerably.

Dr. Sahar Hassan


Levels of Evidence Hierarchy
(Stetler et al.)
Level I: Meta-analysis of multiple RCTs
(gold standard)
Level II: Individual RCTs
Level III: Quasi-experimental
Level IV: Non-experimental; qualitative
Level V: Program evaluation; case reports
Level VI: Opinion of respected authorities

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Example of an Evidence Hierarchy

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Levels of Evidence

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Best Evidence
Refers to research findings that are:
methodologically appropriate,
rigorous,
clinically relevant for answering pressing
questions

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EBP Challenges
Research-related barriers
E.g., scarcity of strong research evidence
Nurse-related barriers
E.g., inadequate skills in locating and appraising
evidence
Organizational barriers
E.g., lack of financial support and staff release
time for EBP

Dr. Sahar Hassan


Resources for EBP
Preappraised evidence has been selected
from primary studies and evaluated for use by
clinicians.
Systematic reviews integrate evidence about a
topic in a rigorous, systematic way.
Clinical practice guidelines give specific
recommendations for evidence-based decision
making.

Dr. Sahar Hassan


How to start an evidence-based
practice?

The start point in EBP is a clinical question:

What does the evidence say is the best


approach to solving this problem?

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Major Steps in EBP
1. Ask questions that reflect uncertainties in
clinical practice.
2. Search for and assemble evidence (discovery
3. Appraise and synthesize evidence
4. Integrate evidence with other sources
(translation)
5. Assess effectiveness of decision or advice
(evaluate impact/effectiveness/ outcomes)
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Asking Clinical Questions
Components for quantitative evidence
Population
Intervention (exposure, issue)
Comparison*
Outcome
Time*
*Not always specified

Dr. Sahar Hassan


Question Templates
Templates can greatly facilitate wording of
questions, e.g., an intervention question:

In _____ (population), what is the effect of


________ (intervention), in comparison to
_______ (comparison), on
__________(outcome)?

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Appraising the Evidence for EBP
What is the quality of the evidence?
What is the magnitude of effects?
How precise are estimates of effects?
Is there evidence of side effects?
What are the costs?
Is there relevance to my clinical situation?

Dr. Sahar Hassan


EBP in an Organizational Context
Nurses may be able to implement evidence-
based strategies on their own (e.g. providing
advice about using compression stockings on an
upcoming flight)
In other situations, a decision is needed at the
organizational level, or
Among a team of nurses working together to
solve a recurrent clinical problem

Dr. Sahar Hassan


Where to find evidence-based clinical
guidelines?
Too many sources and impossible to list
In the US: nursing & other health care guidelines are
maintained by the National Guideline Clearinghouse
(www.guideline.gov).

In Canada: the Registered Nurses Association of Ontario


(RNAO) (www.rnao.org/bestpractices) maintains
information about clinical practice guidelines.

In the UK: 2 sources for clinical guidelines are the


Translating Research Into Practice (TRIP) database & the
National Institute for Clinical Excellence. (NICE)

Dr. Sahar Hassan