RESEARCH PRIORITIES IN

NURSING RESEARCH AND

EVIDENCED BASED
NURSIING
INTRODUCTION
Today the catchphrase is evidenced based nursing to ensure high quality
nursing practice. To be competent nurses we must use evidenced based
nursing that means keeping up with VALID current research. Current
Medical and Nursing knowledge is changing fast in the world, i.e. the
Genome Project means new drugs/treatments. To allow high quality
nursing all nurses need to at least have a base knowledge of research to
decipher the research articles we come across to pick out the good from
the bad. It would not do to accept a article on face value just because it
has been printed in a journal. How many think  its OK to believe all you
see or read on TV or in print? I don't think many would. That's why
research is included in nursing courses.
Nursing research continues to develop at a rapid pace and will
undoubtedly flourish in the 21st century. Funding continues to grow.
Broadly speaking, priority for nursing research in the future will be the
promotion of excellence in nursing science. Toward this end, nurse
researchers and practicing nurses will be sharpening their research skills,
and using those skills to address emerging issues of importance to the
profession and its clientele.
DIRECTIONS FOR FUTURE RESEARCH
 HEIGHTEND FOCUS ON EBP

Concreted efforts to use research findings in practice are sure to continue

and nurses at all levels encouraged to engage in evidence based patient
care. In turn quality will be needed both in the quality of nursing studies
and in nurses skills in locating, understanding, critiquing, and using
relevant study results. Relatedly, there is an emerging interest in
translational research- research on how findings from studies can best be
translated into nursing practice.
  DEVELOPMENT OF A STRONGER EVIDENCE BASE
THROUGH MORE RIGOROUS METHODS AND MULTIPLE,
CONFIRMATORY STRATEGIES

Practicing nurses are unlikely to adopt an innovation based on weakly

designed or isolated studies. Strong research designs are essential and
confirmation is usually needed through the replication of studies with
different clients, in different clinical settings and at different times to
ensure that the findings are robust. Another confirmatory strategy is the
conduct of multisite studies by researchers in several locations.

GREATER EMPHASIS ON SYSTEMTIC INTEGRATIVE

REVIEWS

Systematic reviews are considered a corner stone of EBP and will

undoubtedly take on increased importance in nursing and in all health
disciplines. The emphasis in a systematic review is on amassing
comprehensive research information on the topic, weighing pieces of
evidence and integrating information to draw conclusion about the state
of evidence. Best practice clinical guidelines typically rely on such
systematic reviews.

EXPANDED LOCAL RESEARCH IN HEALTH CARE SETTINGS

In the current evidence based environment, there is likely to be increase

of small, localised research designed to solve immediate problems.
Mechanisms will need to be developed to ensure that evidence from
these small projects becomes available to others facing similar problems.

STRENGTHENING OF MULTIDISCIPLINARY COLLABORATION

Interdisciplinary collaboration of nurses with researchers in related fields

(as well as intradisciplinary collaboration among nurse researchers) is
likely to continue to expand in the 21st century as researchers address
fundamental problems at the behavioural and psychobiologic interface.
As one example, there are likely to be vast opportunities for nurses and
other health care researchers to integrate breakthrough in human
genetics into lifestyle and health care interventions. In turn such
collaborative efforts could lead to nurse researchers playing a more
prominent role in national and international health care policies.
EXPANDED DISSEMINATION OF RESEARCH FINDINGS

The internet and other means of electronic communication have large

impact on dissemination of research information which in turn helps to
promote EBP. Through such electronic location and retrieval of research
articles, on line publishing (eg. Online journal of Knowledge synthesis
for nursing, the online journal of clinical innovation), online resources
such as lippincott’s NursingCenter.com, e-mail, and electronic mailing
lists, information about innovations can be communicated more widely
and more quickly than ever before.

INCREASING THE VISIBILITY OF NURSING RESEARCH

The 21 st century is likely to witness efforts to increase the visibility of

nursing research. Most people are unaware that nurses are scholars and
researchers. Nurse researchers internationally must market themselves
and their research to professional organizations, governments, consumer
organizations and the corporate the world to increase support for their
research.

INCREASED FOCUS ON CULTURAL ISSUES AND HEALTH

DISPARITIES

The issue of health disparities has emerged as central concern in

nursing and other health disciplines, and this in turn has raised
consciousness about the ecological validity and cultural sensitivity
of health interventions. Ecological validity refers to the extent to
which study designs and findings have relevance and meaning in
variety of real world contexts. Research must be sensitive to health
believes, behaviours, epidemiology, and values of culture.
RESEARCH PRIORITIES

Since 1975, expert researchers, speciality groups, professional

organizations and funding agencies have identified nursing
research priorities. The research priorities were initially identified
by Lindeman. Those original research priorities included nursing
interventions related to stress, care of aged, pain and patient
education.

Many professional nursing organizations have websites that are

used to communicate their current research priorities. For example
American association of critical care nurses(AACN) determined
initial research priorities for this speciality in early 1980s and
revised these priorities in 1993 and 1999. The development of
research priorities for critical care nurses has been previously
examined from the perspective of both Australian and international
critical care nursing experts. A variety of techniques have been
 used to determine research priorities for critical care nursing,
however, a clear articulation of research priorities for Australian
critical care nurses, which are both timely and encompass all
aspects of critical care nursing practice, is lacking.

Research priorities previously determined in Australia and elsewhere

identify similar clinical research priorities such as nutritional support,
infection control, supporting respiratory and cardiac function, and follow-
up of critically ill patients. However, differences between the few
available studies exist, possibly because of the changing nature of critical
care nursing practice.
The most current AACN research priorities are:-

1.Effective and appropriate use of technology to achieve optimal patient

assessment, management, or outcomes.

2. Creating a healing, humane environment

3. processes and systems that foster optimal contribution of critical care

nurses.

4.Effective approaches to symptom management

5. Prevention and management of complications

The American organization of nurses executives made their areas of

research priorities. The AONE's 2008-2010 Strategic Plan (approved by
the AONE Board of Directors in December 2007) guided the
development of the 2009 Education & Research Priorities.    These
priorities are intended to guide AONE's efforts to develop and promote
education and research projects that further AONE’s overall strategic
objectives.

1. Stewards of leadership: focus on conduct of research to develop an

evidenced based leadership capacity, where the leaders are expected
to use technology to complement patient care.
2. Patient care delivery models: Focus on development of new
management methods and techniques, improvement in health care
processes and outcomes across the continuum of health care
 agencies, efficient useof resources, improvement in outcomes of
technological systems and infrastructure to accommodate new
technology and expansion of leadership in managing technological
change.
3. Positive and healthy work environment for the 21 st century nurse
administrators and executives: Focuses on attracting and retaining
nurses in the profession, developing provider and patient safety guide
lines, promoting diversity in the work force.

National Institute Of Nursing Research also developed research

priorities.
1. End of life and palliative care research
2. Chronic illness experiences
3. Quality of life and quality of care
4. Health promotion and disease prevention research
5. Symptom management of illness and treatment
6. Tele health interventions and monitoring
7. Cultural and ethnic considerations of health and illness.
GOAL: Identify and support future areas of opportunities to
advance research of high quality, cost effective care and to make a
scientific base for nursing practice. Priorities related to this area
are;
1. Research in chronic illness and long term care
2. Health promotion and risk behaviours
3. Cardiopulmonary health and critical care
4. Neurofunction and sensory conditions
5. Immune responses and oncology
6. Reproductive and infant health

NATIONAL CENTER FOR NURSING RESEARCH set research

priorities.
The scientific program of the NCNR has two major components, namely,
the extramural program and the intramural program

Extramural Program identified research priorities include

Health Promotion and Disease Prevention. Health promotion research
focuses on nursing approaches to improving the general health of
individuals, families, and communities. Health
Promotion includes ways to promote wellness and to decrease the
vulnerability of individuals and families to illness and disability. Disease
prevention research, on the other hand, focuses on a particular illness,
injury, or disability and on ways to intercept the onset of such problems.
Acute and Chronic Illness. This program supports research on the human
responses to acute and chronic illness, injury, and disability. It addresses
biological and behavioral factors that contribute to these conditions, as
well as their interrelationships; ways to improve, mitigate, or remedy
these conditions; and ways to assist individuals to live with and cope with
such conditions.
Nursing Systems. Research in this area examines: the clinical practice
environment in which health care is provided; factors underlying the
process of nursing care; relationships among aspects of clinical practice;
and the influence of that practice on outcomes of care. It includes such
diverse investigations as promising approaches to strengthening quality of
care, nursing informatics, structuring nursing care delivery, technology
assessment, and ethical issues in clinical practice.

Intramural Program
The intramural program supports investigations by nurse scientists on the
NCNR staff. This program, which is relatively new, focuses in its initial
phase on one of the priorities identified by the NNRA
HIV Infection--Prevention and Care. Although the program is still small,
it has enhanced its resources and the significance of its work through
collaboration with several other NIH intramural programs, namely the
National Institute on Allergy and Infectious Diseases, the National Heart,
Lung, and Blood Institute, and the National Institute on Aging. Several
studies are in progress, including studies of nutritional requirements of
HIV/AIDS patients, health-related quality of life in HIV/AIDS patients,
and myopathy in HIV/AIDS patients.
CONFERENCES ON RESEARCH PRIORITIES IN
NURSING(CORP) set priorities conducted by NINR .
The areas are:-
 Low Birth weight: Mothers and Infants. Research related to: pre
conceptional and prenatal nursing care, with a focus on pre-venting
the delivery of preterm or growth-retarded infants; care of low birth
weight infants in the acute care setting, with a focus on prevention
of complications; and models of care delivery after discharge from
the institution.
 HIV Infection: Prevention and Care. Study of: ethical issues;
prevention of transmission; physiological and psychosocial
factors; and issues relating to delivery of care to people with HIV
infection or AIDS.
 Long-term Care for Older Adults. Research focuses on both the
older adult and the family, and includes: clinical problems
encountered in the long-term care of older adults in institutions or
in the community, and issues related to the delivery of long-term
care services, such as continuity of care and transitions across
clinical settings.
 Symptom Management: Pain. Research concentrates on the
development of effective assessment measures and intervention
strate-gies for pain and other symptoms associated with acute and
chronic illness, with an emphasis on bio-psycho-social parameters.
 Nursing Informatics: Enhancing Patient Care. This area of research
is designed to strengthen patient care. Priorities will be selected
from research into the collection, organization, processing, and
dissemination of information for clinical practice, including the
design and development of databases, classification systems,
computer models, and expert systems.
 Health Promotion for Older Children and Adolescents. This area
focuses on under-standing health behaviors in childhood and
adolescence, a critical developmental period, and on testing theory-
based interventions to facilitate health-enhancing behavior patterns
and to reduce health compromising ones.
 Technology Dependency across the Life-span. This research
addresses technology used to support or replace lost function of
body organs or systems when technology is an essential element in
the treatment of chronic disease. Included are the study of
individual and family responses, prevention of complications,
bioethical issues, and demand for resources.
 The world Health Organization (WHO) is encouraging the
identification of priorities for a common nursing research agenda
among countries. The six top priority areas identified by WHO
are:-

1. Evaluation of the effects of health care reform

2. Comparative analysis of supply and demand of the health
work force of different countries
3. Evaluation of health care organizations, work conditions,
technology and supervision on the motivation and
productivity of nursing personnel.
4. Analysis of feasibility, effectiveness of education and
quality of services provided by nurses
5. Action research on delivery modes and necessary context
for quality nursing care to vulnerable populations

RESEARCH PRIORITIES FOR THE FUTURE

1. Health promotion and disease prevention

2. Promotion of health of vulnerable and marginalised communities
3. Patient safety
4. Development of Evidence based practice
5. Promotion of health and well being of older people
6. Patient cantered care and care coordination
7. Palliative and end life care
8. Care implications of genetic testing
9. Development of nurse researchers
10.Nurse’s working environment
 EXAMPLES OF NURSING RESEARCH PRIORITIES

PAEDIATRIC NURSING

Establishing nursing research priorities on a paediatric haematology,

oncology, immunology and infectious diseases unit: Louise Soanes
yes platform+medline author author

Identification of four top priority areas of:

 symptom management,
 negotiation of care between the child and family,
 quality-of-life issues and retention of staff.
 The effect of daily ward routines and procedures and their child's
overall hospital experience,
 staff retention and morale
 MATERNITY AND GYNAECOLOGICAL NURSING
Priority area 1
Appropriate, timely and effective interventions

Research is needed to establish what is ‘appropriate care’ for individuals,

Their careers and families, including work to evaluate public health
interventions and the role of nursing and midwifery professionals in
reducing inequalities in health. Research is also needed to improve
understanding of the nature of clinical interventions and to evaluate
care-giving practices.
Exemplars:
• Evaluate psychosocial nursing and midwifery health interventions in
relation to patient/family and community-centred outcomes.
• Evaluate comprehensive assessment tools of physical, psychological
and social need linked to interventions and user/professional and
organisational outcomes.

Priority Area 2
Individualised services

The evidence base for information giving, therapeutic interactions and

decision making should be strengthened to develop effective
communication systems and professional information-giving skills.
Communication between nurses/midwives and patients/clients and carers
during interventions or the ‘clinical encounter’ is a specific priority.
Exemplars:
• Develop models of service users’ and carers’ participation in clinical
decision making and the clinical encounter, and evaluate in relation
to organisational culture, professional approaches and service user
outcomes.
• Evaluate nurse-led user-centred models of care delivery in a variety
of clinical and public health settings.
Priority Area 3
Continuity of care

Communication of patient-centred information was highlighted in

relation
to enhancing continuity of care. This requires the development and use
of information technology (IT) and communication strategies for the
transfer of information between service areas, supporting integrated
pathways of care.
Exemplars:
• Examine continuity of care models for vulnerable groups, especially
older people and those less likely to access services, such as
adolescents, in relation to patient/user, staff and organisational
outcomes.
• Identify efficient practices and methods of transferring confidential
information (including patient information) between professionals,
service areas/units and agencies.
Priority Area 4
Staff capacity and quality

Priorities for research relating to staff capacity and quality include;

recruitment and retention; defining professional roles and clarifying
optimal skill mix; quality concerns, such as establishing who are the
‘right’
people (professionals/volunteers/ carers) to deliver aspects of care
(health interventions/essential care); and uncovering the reasons for
variations in nursing and midwifery practice, with specific client
groups or
in areas of care perceived to be outside a person’s professional remit.
Exemplars:
• Systematically review evidence on skill mix, role diversification,
career pathways and working lives.
• Evaluate workforce retention strategies and employment practice.
• Generate success criteria for new service design, changing role
boundaries, team working and reconfigured services within
organisational uncertainty.
• Evaluate health interventions with vulnerable/hard-to-reach groups.

Priority Area 5
User involvement and participation

Research is required that supports the strategic commissioning of

conceptual, methodological and evaluative work into active user
 participation in delivery of care, training and education of staff,
standard
setting and quality monitoring.
Exemplars:
• Methodological development of user-centred-outcome studies that
take account of the context, content and process of the
intervention.
• Evaluate nursing and midwifery interventions in relation to identified
outcomes across psychosocial and health domains.
• Develop capacity and skills to strengthen user participation in
nursing and midwifery research and evaluate the impact in terms of
changes in practice at individual, family or community levels.

MEDICAL SURGICAL NURSING

Nursing research priorities in critical care set by AACN are:
Medication Management

 The efficacy of aerosolized surfactants, analgesics, and antidiuretics

 Drug administration in the stomach should be further compared to
drug administration in the duodenum and jejunum
 Further study on drug binding to feeding tubes
 Increased pharmacokinetic and pharmacologic clinical data in
pediatric patients
 New routes of administration such as transmucosal and transdermal
 Medication safety
 Glycemic control and insulin therapy management, on a broader
patient population
 Procedural sedation

Hemodynamic Monitoring

 Determine the effect on clinical outcomes and cost of using continuous

cardiac output in critically ill patients
 Describe the effect of routine nursing procedures on all tissue
oxygenation variables in critically ill patients
 Determine the effects of early mobilization programs (eg, fast track)
on tissue oxygenation variables in specific populations of patients
 Determine interventions to support, improve, or restore tissue
oxygenation and enhance physiological adaptation to nursing care
 Investigate methods to decrease oxygen demand and prevent oxygen
deficiency (eg, use of analgesics, paralytics, and sedatives), especially
for patients with marginal or inadequate SPO2
 Determine the effects of tissue oxygenation of alternative therapies
such as relaxation and meditation exercises, biofeedback, animal
assisted therapy, and other diversional therapies
 Replicate studies on how often the accuracy of interpreting v waves
(eg, patients with mitral regurgitation, poor left ventricular
compliance, dilated hearts)
 Validate currently used method of correcting for PEEP
 Devise reliable methods that use waveform analysis to validate
placement of the PA catheter tip in lung zone 3
 Methods to improve accuracy of hemodynamic measurements in the
clinical setting
 How much blood should be discarded before blood is obtained from
the catheter for determination of PTT in adults and children

Creating Healing Environments

 What organizational models facilitate clinical team collaboration and

communication? Does open versus closed ICU make a difference?
 Does practice based on the AACN Synergy model affect patient and
organizational outcomes?
 What impact does integrating the AACN Standards for Establishing
and Sustaining Healthy Work Environments have on decreasing
medical errors, decreasing staff stress and turnover, and increasing the
quality of care provided?
 What are the most effective methods to promote the value of family
centered care among nurses and other health core providers?
 Can early family interventions minimize problems in adjustment?
 When a patient’s family is involved in care, is there a difference in the
patient’s outcome?
 What sensitizes nurses to families’ needs and what are the most
effective ways to help nurses develop the skills needed to meet those
needs?
 Multisite, randomized, controlled trials are needed to test
interventions that promote proximity of critically ill patients and their
family members
 Studies to test strategies for assisting nurses to develop positive
attitudes and increase their knowledge about providing family centered
care including visiting
 Additional research on animal visits in the critical care areas. In
particular the effect of assisted animal therapy on ventilatory weaning,
pain medication requirements, length of stay, body image, functional
improvement measures and patient education retention.
 Additional study on pain assessment, particularly in patients unable to
give a verbal report
 The safety and effectiveness of pharmacological and non-
pharmacological pain control therapies

Palliative Care and End-of-Life Issues

 Research investigating family bereavement interventions should

examine outcomes such as grief resolution and satisfaction with health
care providers and institutions
 Studies for evaluating various methods for teaching end-of-life
communication and collaboration to health care professionals
 Qualitative studies that capture the interactive and relational
dimensions of end-of-life communication
Mechanical Ventilation

 Additional research studies on what constitutes adequate oral hygiene

in relation to decreasing VAP
 The impact of continuous airway subglottic tubes on VAP
 Additional study on the prevention, assessment and treatment of
delirium
 The optimal time for transitioning from ET to tracheostomy
 Studies to challenge or support the practice of routine replacement of
inner cannulas.
 How to best care for tracheostomy stomas?
 Studies evaluating the differences between set-PEEP and auto-PEEP
in promoting oxygenation without further lung injury or compromising
delivered tidal volumes.
 Research to describe the understanding of and application of lung
protective strategies and modes of ventilation by the people caring for
the mechanically ventilated patient
 Studies that explore methods of assessing weaning readiness and
which predictors are the best
 Research on weaning predictors and forecasting outcomes so that
clinicians know when to proceed and when to stop
 Studies that assess the impact of protocols and critical pathways on
patient outcomes and total cost of care should continue to determine
the safest, most effective , and least costly methods for administering
sedation
 More studies in the area of EEG monitoring and bispectral index on
paralyzed and sedated patients

Monitoring Neuroscience Patients

 Development of objective, validated bedside assessments of cough

strength and effects of high frequency ventilation on brain tissue
oxygenation
 The validity and reliability of sedation scales in patients with altered
level of consciousness and the optimal agent to use for sedation during
weaning
 The optimal timing of intubation for neuroscience patients
 Further testing of ICP versus CCP as treatment goals
 Clinical studies identifying correlations among waveform findings,
interventions/treatments, nursing care and outcomes
 Is there value in collecting routine cultures of the CSF in patients with
external ventricular drains?
 Is it safe to give heparin to a patient with an intraventricular catheter?
 The duration for leaving a EVD in place
 What type of dressing is safest for the patient?
 What is the best timing for EVD insertion?
 Complication rates seen in institutions and the utility of lumbar
draining as a treatment option
 Study to establish the clinical usefulness of information obtained in
cerebral blood flow monitoring
 Using EEG data in identifying patients at risk for delirium
 Whether and to what degree do EEG-derived parameters improve
clinical outcomes

Non Invasive Monitoring

 Studies on the value of continuous 12-lead ECG monitoring in

different populations of patients
 A study that describes current nursing practice related to the placement
of electrodes and the selection of leads and the rational for the choices
 Studies to determine the efficacy of respiratory waveforms
 Research to describe the specific patient outcomes that have been
improved by the use of the pulse oximeter
 Temperature management
Research Priorities in Respiratory Nursing
1.Health Promotion and Disease Prevention
2. Therapeutic Strategies: Acute Care
Weaning from Mechanical Ventilation
High-technology Home Care
Oxygen Delivery Systems
End-of-life Decision Making
1. Therapeutic Strategies: Chronic Care
Asthma
COPD
Lung Cancer
Lung Transplantation
Sleep Apnea
Tuberculosis/HIV Infection
Bronchopulmonary Dysplasia
Cystic Fibrosis
1. Pulmonary Rehabilitation
2. Cost-related Research/Health Care Delivery
Tobacco Use
1. Research aimed at preventing tobacco use among children and
adolescents is a major priority. Cessation programs for adolescents
must be designed and tested. Policy-related studies that examine
mechanisms to decrease youth access to tobacco are needed.
2. Effective cessation methods have yet to be adequately tested
among socioeconomically disadvantaged, underserved, and
culturally diverse smokers. Studies of clinician-based interventions,
especially in combination with nicotine replacement therapy,
among patients with lung disease are needed.
3. Research to evaluate programs designed to restrict the international
spread of tobacco are necessary and especially timely due to the
rapid increase in smoking in underdeveloped countries.
Prevention of Pulmonary Complications

1. Studies are needed to identify risk factors for atelectasis, ARDS,

and pneumonia in high-risk populations (e.g., immune
compromised, neurologic dysfunction, trauma, elderly, pediatric,
and neonatal disease). Studies are also needed to identify methods
of minimizing the risk of nosocomial pneumonia in patients who
receive tube feedings, have cuffed tubes, or are at risk for aspiration
during feeding.
2. Given the trend of outpatient surgery, early discharge, and
provision of high technological care in the home, studies are needed
to identify optimum ways to assist caregivers to prevent and
manage pulmonary complications in outpatient/home settings.
 3. Studies are needed to identify how to prevent and treat
postoperative pulmonary complications in acute care settings where
time for patient education is limited and early discharge is
common. Areas for investigation include ways to prevent
complications, ensure appropriate pain management, and convey
essential information in a time- and staff-limited environment.
4. Studies are needed to describe outcomes of current protocols for
management of community-acquired pneumonia, with emphasis on
consequences for the patient (symptoms, health-related quality of
life), caregiver burden, and health care system (resource
utilization).
THERAPEUTIC STRATEGIES: ACUTE CARE
1. Studies are needed that test ways to facilitate the weaning process,
with emphasis on patient factors, ventilator mode, and clinician
decision making.
2. Studies are needed to identify subsets of patients unlikely to wean
due to physiologic or psychologic factors (e.g., acute left
ventricular dysfunction, nutritional status, or high anxiety level).
Specialized techniques may be beneficial in patients with high
anxiety levels (e.g., relaxation training, music therapy), and should
receive broader testing.
3. Studies are needed to test cost-effective strategies that can be
implemented by health team members to speed weaning, e.g.,
dedicated assessment teams, protocolized weaning, or transfer to
units or facilities that specialize in this care.
4. Given many references to the "art" of weaning, studies are needed
to describe subtle predictors of weaning readiness.

Research Priorities for Emergency Nursing 

Identification of research priorities the Institute for Emergency
Nursing Research (IENR), which represents the collective research
expertise of ENA.
 Emergency Nursing Professional Practice Issues:  Examples of
research areas include nurse orientation, continuing education, and
assurance of competence of emergency nursing practices as well as
emergency department staffing patterns and the impact of the
staffing on patient outcomes.
  The Joint Commission’s National Patient Safety Goals: Examples
of research areas include improving the accuracy of patient
identification, the effectiveness of communication among
caregivers, the safety of using medications, and recognition and
response to changes in a patient’s condition; as well as reducing the
risk of health care-associated infections, patient harm resulting
from falls, influenza and pneumococcal disease; and health care
associated pressure ulcers. 

 Research priorities in mental health nursing.

Pullen L etal.
Six categories emerged from the data analysis are identified as research
priorities: support, holism, mental health nursing practice, quality care
outcomes, mental health etiology, and mental health delivery systems. As
mental health nursing embraces evidenced-based practice, the need for
clear research priorities is imperative for knowledge development in the
field.
Davidson P etal.
The top four categories are discussed under the headings: Preparation of
Helpers, the Service System, Caregiver Needs, and Clients With Major
Behavior Problems. This timely study offers explicit direction for
psychiatric and mental health nursing practice and research, and for the
development of social policy.
RESEARCH PRIORITIES IN COMMUNITY HEALTH NURSING
Studies that focused on the public health nursing workforce (n=96
studies) addressed public health nursing practice (80%), competencies
(10%), workforce profile (5%), recruitment and retention (2%), and
information systems (2%). Public health nursing educational research
(n=43 studies) was conducted primarily in academic settings (58%).

Research also is needed in the areas of public health nursing informatics,

community strategies, methods of including communities in
interventions, international health care systems, violence, family
caregiving, mental health, obesity, disaster preparedness, and decreasing
disparities in the elderly, people with disabilities, medically underserved
individuals, and sexual minority individuals. Public health nursing
research is also needed concerning health policy, public health nursing
workforce issues, and public health nursing education. The two major
priorities identified are:

1. Population-Focused Outcomes
2. Public Health Nursing Workforce
 EVIDENCED BASED NURSING PRACTICE
Evidence-Based Nursing involves identifying solid research findings
and implementing them in nursing practices, in order to increase the
quality of patient care. The goal of EBN is to provide the highest quality
and most cost-efficient nursing care possible. In order to practice
evidence based nursing, practitioners must understand the concept of
research and know how to accurately evaluate this research. These skills
are taught in modern nursing education and also as part of professional
training

DEFINITIONS

EVIDENCE BASED PRACTICE:

”Evidence based practice involves making clinical decisions on the basis

of best possible evidence.” (POLIT AND BECK).

“Evidence-based practice is the conscious and judicious use of

best evidence in the care of patients and delivery of health care
services.”(TITLER et.al)

Evidence Based Nursing

"Evidence-based nursing (EBN) means using the best available evidence
from research, along with patient preferences and clinical experience,
when making nursing decisions." (Cullum N)

Purpose and Objectives

Evidence based practice seeks to replace practice as usual, with practice
guided by rigorous outcome-oriented research, ideally randomized
controlled trials.
It also seeks to make practice a less subjective enterprise, and to raise it to
a higher level of accountability.
It is associated with efforts to identify best practices in nursing and other
disciplines. (Baumann SL, 2010)
Evidence based nursing aims:
 to provide the highest quality and most cost-efficient nursing
care possible. 
  to advance quality of care provided by nurses.
 to increases satisfaction of patients
 to focus on nursing practice away from habits and tradition to
evidence and research.
BENEFITS OF EVIDENCE BASED NURSING
no do thi!
Nurses are responsible for the care they provide to their patients.
Evidence-based practice in nursing means making decisions about patient
care on the basis of current best available evidence. It helps the nurse
provide high-quality care to her patients based on research and
knowledge.
Efficiency
Evidence-based practice increases the efficiency of nurses. Making
decisions based on knowledge that is backed by research makes it
easier for a nurse to choose what care to provide to her patient as
opposed to trying something that may or may not be beneficial to her
patient. This saves her time, which she can devote to patients who
need more intensive care from her.
Better Patient Outcome
Nurses regularly make decisions on what care to provide for their
patients. These decisions can impact the patients' health negatively or
positively. The patient will likely experience a better outcome when
the care is based on researched and proven methods.
For nurses to apply evidence-based practice in the care they provide,
they have to stay informed on any new discoveries that have been
made. This encourages them to read materials that cover nursing
research thus keeping their practice current.
Decision Making
Using evidence-based practice to provide care to patients increases the
nurse's confidence. This is because she knows that she is basing her
decisions about patient care on valid information that has been
thoroughly researched.
Magnet Status
Incorporating evidence-based practice into the nursing care at a
hospital may help the hospital achieve Magnet status. The Magnet
 Recognition Program recognizes quality patient care, nursing
excellence and innovations in nursing practice. Being a magnet
facility, assures patients that they are getting excellent nursing service.
MODELS FOR EVIDENCE –BASED PRACTICE:

A number of models of research utilization have been

developed by nurse researchers in the United States, Canada, U.K. These
models offer guidelines for designing and implementing research
utilization and evidence based practice projects. Some models focus on
use of research from the perspective of an individual clinician, some
focus on the utilization from an organizational perspective where as
others have multiple perspectives. Models includes

1. STETLER MODEL OF RESEARCH UTILIZATION

This model was first developed in 1976 and refined in 1994

and was designed with the assumption that the research utilization
could be undertaken not only by the organizations but also by
individual clinicians and managers. It was a model designed to
promote and facilitate critical thinking about the application of
research findings in practice. It involves 5 phases –

a) preparation :

 Nurse would define the underlying purpose of the project.

 Search for and select sources of research evidence.

 Consider external factors that can influence potential

application and internal factors that can diminish objectivity.

 Affirm the clinical significance of solving the perceived

problem.

b) Validation :

-The second phase involves a critique of each source of evidence and

check whether it is sufficiently sound for practical application.

-The process stops at this point if the evidence sources are rejected.

C) Comparative evaluation and decision making.

 It involves synthesis of findings and these findings are
used to determine the desirability and feasibility of applying findings
from validated sources to nursing practice. The end result of comparative
evaluation is to make a decision about using the study findings. If the
decision is negative no further steps are necessary.

d) Translation and application

It involves how findings will be used and then

implementing a plan.

e) Evaluation

In this final phase application would be evaluated.

Although this model was designed as a tool for individual practioners, it
has also been the basis of formal research utilization and evidence based
practice projects by group of nurses.

IOWA MODEL

IOWA model of evidence based practice is an organizational,

collaborative model developed by the university of IOWA hospital and
University of IOWA College of nursing. This model was revised in 2001
and renamed as Iowa model of evidence based practice to promote quality
care.

According to current version of Iowa model a formal project starts with

a ‘trigger’-an impetus to explore possible changes to practice.

The start point of EBP can be either a

 Knowledge focused trigger

Awareness of innovative research findings

 Problem focused trigger

Clinical /organizational problem

E.g. If ‘pain management for a specific patient population ‘the area of

focus for EBP. Here

 Knowledge focused trigger –is the emergent knowledge related

to developments in pain management.
  Problem focused trigger-is the current practices of pain
management that needs improvement.

IOWA model has 4 phases-

 Evidence triggered.

 Evidence supported

 Evidence observed

 Evidence based phase

THE OTTAWA MODEL OF RESEARCH USE (OMRU)

This model is developed by Logan and Graham consists of 6 key

components interrelated through the process of evaluation.6 components
includes

 Practice environment

 Potential research adopter

 Evidence based innovation

 Strategies for transferring innovation into practice

 Adoption of evidence

 Health and other outcomes.

Systematic assessment, monitoring and evaluation are central to ERMU

and applied to each of 6 components before during and after any effort to
transfer research findings.

THE ROSSWURM MODEL-

It was developed and tested by ROSSWURM and

LARRABEE at the West Virginia university school of
nursing. The process guide the practitioners through the
process of EBP, beginning with the assessment of the need
for change and ending with integration of an evidence based
practice. According to this model EBP involves 6 steps:
  Assess the need for change.

 Define the problem identified.

 Synthesis of best evidence.

 Design a change in practice.

 Implement and evaluate the change.

 Integrate and maintain the change in practice.

This model may be applicable for various health care setting.

SOURCES OF EVIDENCE FOR NURSING PRACTICE

Nurses make clinical decisions based on large repertoire of knowledge

and information. Information sources for clinical practice vary in
dependability and validity. Increasingly there are discussions of
evidence hierarchies that acknowledge that certain types of evidence
and knowledge are superior to others.

TRADITION AND AUTHORITY

Many questions are answered and decisions made based on customs

and tradition. Within each culture certain truths are accepted as given.
For example as citizens of democratic societies, most of us accept ,
without proof that democracy is the highest form of government. This
type of knowledge often is so much as a part of our heritage, that few
of us seek verification. Tradition is efficient as an information source:
Each individual is not required a new in an attempt to understand the
world or certain aspects of it. Tradition posses some problems because
many traditions are not evaluated for their validity. Many nursing
interventions are based on traditions, customs and unit culture rather
than on sound evidence.

Another common source of information is an authority, a person with

specialised expertise and recognition for that expertise. We trust on the
judgement of the people who are authoritative on an issue by virtue of
specialised training or experience. Authority is also having
shortcomings if their expertise based primarily on personal experience
like tradition; their knowledge often goes unchallenged.

CLINICAL EXPERIENCE, TRIAL AND ERROR, AND

INTUITION

Clinical experience is a familiar and functional source of knowledge.

The ability to generalize regularities and to make predictions based on
observations is an important characteristic of the human mind. The
personal experience limited as a knowledge source for practice because
each nurses experience is typically narrow to be generally useful.
Second limitation is that the same objective event is often experienced
or perceived differently by two nurses.

In trial and error approach alternatives are tried successively until a

solution to a problem found. For example many patients dislike the
taste of potassium chloride solution, Nurses try to disguise the taste of
the medication in various ways until one method meets the approval of
the patient. This method offer practical means of securing knowledge,
but it is fallible. The solution obtained may be idiosyncratic and the
evidence obtained is often unrecorded, hence inaccessible in
subsequent clinical situations.

Intuition is a type of knowledge that cannot be explained on the basis

of reasoning or prior instruction. Although intuition undoubtedly play a
role in nursing practice- as they do in the conduct of research.

LOGICAL REASONING

Solutions to many problems are developed by logical thought

processes. Logical reasoning as problem solving method combines
experience, intellectual faculties and formal systems of thought.
Inductive reasoning and deductive reasoning are useful as a means of
understanding and organizing phenomena. Reasoning is limited
because the validity of reasoning depends on the accuracy of
information with which one starts.

ASSEMBLED INFORMATION
 In making clinical decisions, health care professionals also rely on
information that has been assembled for a variety of purposes. For
example, local, national and international bench marking data provide
information on such issues that rates of using various procedures(rates
of caesarean deliveries) or rates of infection(nosocomial pneumonia
rates) and can serve as a guide to evaluate the clinical practice. Quality
improvement and risk data, such as medication error reports and
evidence on the incidence and prevalence of skin break down can be
used to assess the practice and determine the need for practice
changes. Cost data – That is information on the costs associated with
policies , policies, or practices.

DISCIPLINED RESEARCH

Research conducted within a disciplined format is the most

sophisticated method of acquiring knowledge that humans have
developed.

Resources to facilitate evidence-based nursing

During the last decade, major initiatives have been introduced to help
clinicians become evidence-based practitioners. The following is a brief
description of some of these efforts:
Evidence-Based Journals
Rather than publishing original research, the objective of these journals is
to summarise those studies that are valid and clinically useful. Currently,
these journals consist of
ACP Journal Club,
Evidence-Based Medicine,
Evidence-Based Cardiovascular Medicine,
Evidence-Based Health Policy and Management,
Evidence-Based Mental Health
Evidence-Based Nursing.
The specific purposes of this journal are: to identify, using predefined
criteria, the best quantitative and qualitative original and review articles
on the meaning, cause, course, assessment, prevention, treatment, or
economics of health problems managed by nurses and on quality
assurance; to summarise this literature in the form of "structured
abstracts" that describe the question, methods, results, and evidence-based
conclusions of studies in a reproducible and accurate fashion; and to
provide brief commentaries written by practising nurses on the context of
each article, its methods, and clinical applications that its findings
warrant.
Systematic reviews
A systematic review is a method of summarising the findings of all
methodologically sound studies addressing the same research question. In
a systematic review, eligible research studies are viewed as a population
to be systematically sampled and surveyed. Individual study
characteristics and results are then abstracted, quantified, coded, and
assembled into a database that, if appropriate, is statistically analysed
much like other quantitative data. The statistical combination of the
results of more than one study, or meta-analysis, effectively increases the
sample size and results in a more precise estimate of effect than can be
obtained from any of the individual studies used in the meta-analysis.
The Cochrane Collaboration is an international organisation that aims to
help people make informed decisions about health by preparing,
maintaining, and ensuring the accessibility of rigorous, systematic, and
up-to-date reviews (including meta-analyses where appropriate) of the
benefits and risks of health care interventions. The Cochrane Library is
the product of the Collaboration's work and includes reports and protocols
of over 1000 systematic reviews produced within the Collaboration,
abstracts of over 1800 reviews summarised and critically appraised by the
Centre for Reviews and Dissemination at the University of York, UK, and
citations for over 200,000 randomized controlled trials.
Centres for Evidence-Based Nursing
In the past few years, a number of countries, including the UK, Canada,
Germany, New Zealand, Australia and others, have created Centres for
Evidence-Based Nursing. While the specific goals of these centres vary,
most seek to educate nurses through workshops or through formal courses
to be evidence-based nurses in practice, education and research; to
conduct original research and systematic reviews; and to design and
evaluate strategies for disseminating research findings to nurses. The
EPCs review all relevant scientific literature on clinical, behavioural, and
organization and financing topics to produce evidence reports, technical
reviews (covering nonclinical methodological topics), and technology
assessments.
These reports, reviews, and technology assessments are based on
rigorous, comprehensive syntheses and analyses of the scientific literature
on topics relevant to clinical, social science/behavioural, economic, and
other health care organization and delivery issues. EPC reports and
assessments emphasize explicit and detailed documentation of methods,
rationale, and assumptions. These scientific syntheses may include meta-
analyses and cost analyses. All EPCs collaborate with other medical and
research organizations so that a broad range of experts is included in the
development process.
The resulting evidence reports and technology assessments are used by
Federal and State agencies, private sector professional societies, health
delivery systems, providers, payers, and others committed to evidence-
based health care.
In addition, the EPCs will:
 Provide technical assistance to professional organizations,
employers, providers, policymakers, etc. to facilitate translation of
the reports into quality improvement tools, evidence-based
curricula, and reimbursement policies.
 Undertake methods research.
 Update prior evidence reports.

The current EPCs are located at:

 Blue Cross and Blue Shield Association, Technology Evaluation
Center. .
 Duke University.
 ECRI Institute.
 Johns Hopkins University.
 McMaster University.
 Minnesota Evidence-based Practice Center.
 Oregon Evidence-based Practice Center.
 RTI International—University of North Carolina.
 Southern California.
 Tufts—New England Medical Center.
 University of Alberta.
 University of Connecticut.
 University of Ottawa.
 Vanderbilt University.
BARRIERS TO EVIDENCE-BASED PRACTICE

An idea of the Barriers to EBP in nursing is useful because they

should be taken in to account in the planning and implementation of
efforts to integrate research into practice. These barriers can be
broadly divided into.

A. Research Related Barriers

For many nursing problems, the state of art of research knowledge
is fairly primitive. Results reported in the literature may not merit
translation into practice. So for many nursing problems, a solid
base of valid and trustworthy study results have not been
developed. Many studies cannot be replicated. Single studies rarely
provide and adequate basis for making changes in nursing practice.
Some nursing studies may not be published to utilize the findings.
If published complex statistical information and dense research
jargon makes findings in accessible to practitioners.

Considering these issues, some tips for researchers in promoting

the Use of research findings if researchers address pressing clinical
questions.

 Collaborate with Clinicians- practicing nurses will be more willing

to use research findings if researchers address pressing clinical
questions.
 Do high-quality research – the quality of nursing studies has
improved dramatically in the past two decades, but progress
remains to be made to endure valid and transferable findings.
 Replicate- use of research results can rarely be justified based on
single study, so researchers must make a real commitment to
replicating studies and publishing the results.
 Communicate clearly- a genral aim should be to write research
reports that are user friendly with a minimum of research jargons.
 Present findings amenable to meta analyses-integrative reviews are
essential to EBP and such reviews are increasingly statistical
methods of integration. Report results in a manner that facilitate
meta analysis.
 Suggest clinical implications- if an implication section with
suggestions for clinical practice become a standard feature of result
reports, then the burden of using research in EBP would be lighter
for nurse clinicians.
 Disseminate aggressively- if researchers fail to communicate
results of a study to other nurses, it is obvious that the results will
never be use by practicing nurses.
 Disseminate broadly- It is especially important from a utilization
stand-point for researchers to report their results in specialty
journals which are more likely to be read by plasticizing nurses
than nursing research journals. Researchers should also take steps
to disseminate study findings at conferences, workshops etc.
attended by nurse clinicians.
 Prepare integrative research reviews: there is an urgent need for
high quality integrative reviews of research. Such reviews can play
a valuable role for practicing nurses who usually do not have the
time to do extensive literature reviews and who may have some
difficulty in critically evaluate individual studies. Integrative
reviews are a core feature of the EBP process.
 B. Nurse related Barriers
Studies have found that many clinical nurses have characteristics that
constraint the use of research evidence in practice. The main issues
are:

 Educational preparations
 Research preparations
 Attitude towards research
 Resistance to change
Some of the strategies to utilize research evidence are:

 Read widely and critically- Professionally countable nurses should

update important developments and should read journals relating to
their specialty, including research reports in them.
 Attend professional conferences- many nursing conference include
presentations of studies that have clinical relevance. Conference
attendees get opportunities to meet researchers and explore.
Practice implications.
  Learn to except evidence that a procedure that a procedure is
effective- Nurse need to develop expectations that the decisions
they make in their clinical practice are based on sound rationales
 Become involved in journal clubs-many organization sponsor
journal clubs that review research articles that have relevance in
practice.
 Pursue and participant in EBP: sometimes ideas for EBP come
from staff nurses. Nurses who include in research-related activities
develop more positive attitudes towards research and better
research skills.
C. Organizational Barriers.
Many of the major impediments tousing research in practice stem
from the organizations that train and employ nurses. Organizations
to greater extend than individuals resist change, unless there is a
strong perception that there is something fundamentally wrong. To
challenge tradition and accepted practices, a spirit of intellectual
curiosity and openness must prevail.

EBP will become part of organizational norms only if there is a

commitment on the part of managers and administrators. Strong
leadership in healthcare organizations is essential to make EBP
happen.

To promote the use of research evidence, administrators adopt the

following strategies:

 Foster a climate of intellectual curiosity- open communication is

important in persuading staff nurses that their experiences and
problems are important and that administration is willing by
helping to develop journal clubs and by serving as role models.
 Offer financial/resource support for utilization- Ebp require some
resources typically. If the administration expects nurses to engage
in such activities on their own and at their own expense, the
message is that EBP is unimportant to those managing the
organization.
 Reward efforts for using research- Include research utilization as a
criterion for evaluating nurses’ performance and offer rewards to
those who involve in EBP.
 Seek opportunities for institutional EBP- organizational effort and
commitment are essential for EBP projects.

Some barriers that contribute to the gap between research and practice
are more global than those discussed earlier and can be described as
the state of nursing profession. They include:

 Lack of interaction &collaboration among clinicians & researchers

 Shortage of appropriate role models
 Lack of perception as independent professionals
 Burden for changes in nursing profession on nurse educators.
Educators could help to promote the use of research evidence
through the following strategies.
 Incorporate research-findings into the curriculum- Research
findings should be integrated throughout the curriculum and when
possible, the efficacy of specific procedures should be documented
by referring to relevant studies.
 Encourage research & research studies- Either by acting as role
models to students(by discussing their own research or by
demonstrating positive attitudes towards research and its use in
nursing.
 Lace demand on researchers- faculty reviewers of research
proposals should demand the demonstration of study’s potential for
clinical use and specific plan for dissemination or utilization.

CONCLUSION

RESEARCH prioritization is a dynamic process. It is usually done at

different hierarchical levels of the health research system i.e., national,
institutional, departmental, or programme. It needs to be reviewed and
updated after a certain period of time. It should be part of the planning
exercise and its effectiveness and applicability are determined, to a large
extent, by its integration into the planning context. Research priorities
need to be established because research planning also confronts a scarcity
of human and financial resources. Another reason is that determinants and
pattern of diseases or conditions and their effect on the population at large
are constantly changing. This leads to inequality in the health status of the
people. This entails reconsideration of balance and relevance of health
research areas in the context of allocation and management of finite
resources for research. The whole process of research prioritization must
therefore be inherently linked to the functions of the national health
system. In other words, research prioritization must be undertaken
within the framework of the overall national policies and goals,
national health policies and national health research policies. Actually,
research prioritization is one of the key nodal points in the research
cycle i.e., research planning, research priority setting, strategies and
implementation of research priorities, research utilization, research
monitoring and evaluation (part of the research information system)
and overall research management. The final aim of research
prioritization is “how best well balanced research can support and
complement the health system to achieve the national goals for health”.
This way a forward-looking research system can be established firmly.
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Websites:

 www.aacn . com
 www.aone.com
 www.WHO.com
 www.nih/gov.com