Evidence-Based

Practice and Research

in Nursing
Jayson S. Austria, RN 12/23/2016
Outline
 Learning Outcomes
 Introduction
 Evidence-Based Practice
 Nursing Research
Learning Outcomes
 Explain the relationship between research and
evidence-based nursing practice.
 Apply the steps of change used in
implementing evidence-based practice.
 Describe limitations in relying on research as the
primary source of evidence for practice.
 Differentiate the quantitative approach from
the qualitative approach in nursing research.
Cont.
 Outline the steps of the research process.
 Describe research-related roles and
responsibilities for nurses.
 Describe the nurse’s role in protecting the rights
of human participants in research.
INTRODUCTION
 All nurses are expected to use evidence and research
to determine proper nursing actions, to engage in
research activities as appropriate to their abilities, and
to share knowledge with other nurses.
 All nurses need a basic understanding of the research
process and its relationship to evidence-based
practice.
EVIDENCE-BASED PRACTICE
 Evidence-based nursing, occurs when the nurse can
“integrate best current evidence with clinical expertise
and patient/family preferences and values for delivery
of optimal health care” (Cronenwett et al., 2007).
Cont.
Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010:
 Cultivate a spirit of inquiry.
 Ask clinical questions: PICOT
 Search for the best evidence.
 Integrate the evidence with clinical expertise and
client/family preferences and values.
 Implement and evaluate the outcomes of the
intervention.
Cont.
 Some scholars contend that, while evidence includes
theories, opinions of recognized experts, clinical
expertise, clinical experiences, and findings from client
assessments, findings from research studies are often
given the most weight in the decision-making process.
 Research entails using formal and systematic
processes to address problems and answer questions.
 Resulting findings should be accurate, dependable,
and free from bias.
Reasons for concerns
about reliance solely on research for EBP
1. Research is often done under very controlled circumstances,
which is very different from the real world of health care
delivery.
2. Research evidence suggests that there is one best solution to
a problem for all clients and this limited perspective stifles
creativity.
3. Not all published research is robust and flawless.
4. EBP should promote cost-effective care, but cost is often not
included in traditional research studies.
NURSING RESEARCH
 Approaches to Nursing Research
 Overview of the Research Process
 Research-Related Roles and Responsibilities for
Nurses
NURSING RESEARCH
 1854, Florence Nightingale demonstrated how
research findings could be used to improve nursing
care.
 By systematically collecting, organizing, and reporting
data, Nightingale was able to institute sanitary reforms
and significantly reduce mortality rates from
contagious diseases and infection.
 All nurses, however, have a responsibility to identify
nursing issues that require research and to participate
in research studies to the extent they are able.
 Research-Related Role Expectations for Nurses
with Different Levels of Educational Preparation
Educational Preparation Identified Expectations
Baccalaureate degree Basic understanding of the research process.
Able to understand and apply research findings from nursing
and other disciplines in clinical practice.
Understand the basic elements of evidence-based practice.
Work with others to identify potential research problems.
Collaborate on research teams.
Master’s degree Evaluate research findings.
Implement evidence-based practice guidelines.
Form and lead research teams in work settings and
professional groups.
Identify practice and systems problems that require study.
Work with scientists to initiate research.
 Research-Related Role Expectations for Nurses
with Different Levels of Educational Preparation
Educational Preparation Identified Expectations
Practice-focused doctoral Focus on the evaluation and use of research rather than the
(DNP) degree conduct of research.
Translate scientific knowledge into complex clinical
interventions tailored to meet individual, family,
and community health and illness needs.
Use leadership skills to evaluate the translation of research
into practice.
Collaborate with scientists on new health policy research
opportunities that evolve from the translation
and evaluation processes.
Research-focused Conduct independent research.
doctoral Seek needed support for the initial phases of a research
(PhD) degree program.
Involve others in research projects.
Postdoctoral preparation Establish and pursue a focused research agenda.
Approaches to Nursing Research
 Quantitative research
 Qualitative research
A quantitative approach to research is useful for
research questions such as these:
 What causes ___________?
 Which treatment for a condition is more effective?
 What factors are associated with a specific condition
or outcome?
 If I know X, to what extent can I predict the
occurrence of Y?
QUALITATIVE RESEARCH
 systematic collection and thematic analysis of
narrative data
 research collects and analyzes words, rather
than numbers
 rooted in the philosophical perspective of
naturalism (sometimes referred to as
constructivism),reality is relative or contextual
and constructed by individuals who are
experiencing a phenomenon.
Cont.
 qualitative approach to research is
characterized by flexible and evolving study
processes and by minimized “distancing”
between the researcher and study informant.
 a holistic perspective and results in a report that
may read like a story.
 three distinct qualitative traditions
phenomenology, ethnography, or grounded
theory.
Cont.
 Phenomenology: lived experiences,
 Ethnography: cultural patterns of thoughts and
behaviors
 Grounded theory: social processes.
 Additional qualitative types include historical
and case study research.
A qualitative approach to research is useful for
research questions such as these:
 What is the experience of receiving diagnosis X or
undergoing treatment Y? (phenomenology)
 What are typical behaviors of certain groups of clients
(who may be defined by a diagnosis or membership in
a cultural or ethnic group)? (ethnography)
 How do individuals cope with X? (grounded theory)
 Comparison of Quantitative and
Qualitative Research Approaches
Characteristic Quantitative Research Qualitative Research
Reality Stable Personal, contextual
Data Numbers, “hard” data Words, “soft” data
Perspective Outsider Insider
Approach to Reductionistic Contextual, holistic
knowing
Research approach Objective, structured, rational, Subjective, artistic, intuitive
empirical
Research conditions Controlled, laboratory Naturalistic, fieldwork
Goal Verification, test theory Discovery, generate theory
Methods Measurement Thick description
Data analyses Deductive, statistics Inductive, intuitive, themes
Outcome Facts Meaning, understanding
Findings/results Replicable, reliable, generalizable Valid, credible, transferable
Overview of the Research Process
 FORMULATING THE RESEARCH PROBLEM AND PURPOSE
 DETERMINING STUDY METHODS
 COLLECTING RESEARCH DATA
 ANALYZING RESEARCH DATA
 COMMUNICATING RESEARCH FINDINGS
 USING RESEARCH FINDINGS IN PRACTICE
FORMULATING THE RESEARCH PROBLEM
AND PURPOSE
 The researcher’s first task is to narrow a broad
area of interest into a more specific problem
that indicates the issue of concern behind the
study.
 Ideas for research problems may arise from
recurrent problems encountered in practice,
questions that are difficult to resolve because of
contradictions in the literature, or areas in which
minimal or no research has been done.
Cont.
 A research problem should be significant to
nursing and offer the potential to improve client
care.
 The problem must also be feasible to study in
light of the resources (including time and skill)
that are available to conduct the study.
 Research problem also must be something that
can be answered by scientific investigation.
Cont.
 A research problem should be of interest to the
researcher because the researcher’s
enthusiasm and commitment to the problem
can be a factor in the successful completion of
the study.
 The researcher must also decide on the
purpose of the study or on the nature of
information that it will provide.
Cont.
 A study’s purpose statement is characterized by
an action verb that indicates whether the study
will provide descriptive information, explanatory
information, cause-and-effect information, or
information that will allow prediction and
control.
 A study’s purpose statement has important
implications for how the study will be
conducted and how the data collected will be
analyzed.
One strategy for stating the problem you wish to
explore is to use the PICO format:
 P – Patient, population, or problem of interest
 I – Intervention or therapy to consider for the
subject of interest
 C – Comparison of interventions, such as no
treatment
 O – Outcome of the intervention.
 PICOD by adding study Design, PICOS by adding Setting or
PICOC adding Context, and PICOT by adding Timeframe.
Cont.
 Formulating the research problem and purpose
is facilitated by conducting a review of the
relevant literature.
 This literature review helps the researcher
become familiar with the current state of
knowledge in regard to the problem area and
build on that knowledge when designing the
current study.
Cont.
 Reviewing the literature can also help the
researcher identify strategies that have been
used successfully (and unsuccessfully) in the
past to investigate the problem and to measure
the variables of interest.
 Dependent variable: behavior, characteristic, or
outcome that the researcher wishes to explain or
predict.
 Independent variable: presumed cause of or
influence on the dependent variable.
Cont.
 In some studies, the researcher may develop a
hypothesis or a predictive statement about the
relationship between two or more variables.
DETERMINING STUDY METHODS
 The methodological elements of the research
process deal with how the study is organized,
who or what will be the sources of information
for the study, and data collection details such
as what data will be collected, how data will
be collected, and the timing of data collection.
Cont.
 The first methodological decision made by a
researcher is whether the study will use a
quantitative or qualitative research approach.
 This decision has implications for subsequent
methodological decisions about research
design, sampling, and data collection, as well
as data analysis.
Cont.
 Research design refers to the overall structure
or blueprint or general layout of a study.
 The research design indicates how many times
data will be collected in a study, the timing of
data collection relative to other study events,
the types of relationships between variables
that are being examined, the number of groups
being compared in the study, and how
extraneous variables will be controlled so that
study findings are more reliable and accurate.
Cont.
 There are two major types of research designs:
experimental design and nonexperimental design
 experimental design, the researcher controls the
independent variable by administering an
experimental treatment to some participants while
withholding it from others.
 Experimental designs are used to determine cause-
and-effect relationships.
Cont.
 nonexperimental design, there is no manipulation of
the independent variable; in fact, there may be no
identifiable independent and dependent variables in
the study.
 Nonexperimental designs are used for descriptive
research studies.
Cont.
 Sample or sources of information
 for a study may be humans, events, behaviors,
documents, or biologic specimens.
 Samples are carefully selected so that they are
as accurate a representation as possible of the
target population, or the universe of elements
to which the researcher wishes to be able to
apply the study’s findings.
Cont.
 The sample is a carefully chosen segment of the target
population.
 Nurse researchers use a wide variety of data
collection strategies, including questionnaires,
interviews, observation, record reviews, and
biophysical measures.
Cont.
 Data collection decisions spell out how any
intervention that is going to be administered to study
participants will be implemented.
 Data collection decisions interface closely with
sampling decisions.
 For example, if a researcher is going to distribute a
questionnaire to collect data, study participants must
be able to read it!
Cont.
 One quality control strategy in research is to
conduct a pilot study.
 A pilot study is a “dress rehearsal” before the
actual study begins.
 Pilot studies are helpful for detecting problems
such as instructions or questionnaire items that
can be misunderstood and for providing a
chance to correct these problems before
formal data collection procedures get under
way.
COLLECTING RESEARCH DATA
 During the actual data collection phase of a
research study, all of the methodological decisions
that have been made are implemented.
 Researchers expend great effort to ensure that
data collection occurs in a consistent manner
throughout the course of the study.
 Detailed data collection protocols or instructions
and careful training of research assistants are
strategies that can be used to ensure the
consistency and integrity of data collection
procedures.
Cont.
 Reliability refers to the consistency of measures.
 Validity refers to the completeness and
conceptual accuracy of measures
 The way in which reliability and validity are
established depends on the data collection
procedure being used and the nature of the
data being collected.
 Conducting a pilot test allows a researcher to
do a preliminary estimate of reliability and
validity.
ANALYZING RESEARCH DATA
 During the data analysis stage of the research process,
the collected data are organized and analyzed to
answer the research question(s) or test the study’s
hypothesis.
 If a study has used a quantitative approach, data
analysis involves the application of a variety of
statistical procedures.
 Descriptive statistics are procedures that organize and
summarize large volumes of data including measures
of central tendency and measures of variability
Cont.
 Measures of central tendency provide a single
numerical value that denotes the “average”
 value for a variable.
 Measures of variability describe how values for
a variable are dispersed or spread out.
Cont.
 The use of inferential statistics allows
researchers to test hypotheses about
relationships between variables or differences
between groups.
 Inferential statistics are particularly useful when
a researcher wants to establish the
effectiveness of an intervention.
Cont.
 If results are statistically significant, it means that
they are not likely to have occurred only by
chance.
 The notion of statistical significance is linked to
probability.
 By convention, probability (a p value) of less than
.05 is considered to indicate statistical significance.
 A p value of .05 means that the observed statistical
results are likely to occur solely by chance only 5%
of the time.
Cont.
 The CI indicates the range within which the true
value lies, with a specific level of confidence.
 For example, if a study indicates that something
occurs, on average, 2.5 times more often in one
group than in another, with a 95% CI of 1.9–3.2,
this means that there is a 95% likelihood that it
occurs between 1.9 and 3.2 times more often.
Cont.
 As long as zero does not fall within the CI, the
findings are statistically significant.
 It is important to keep in mind that just because
results are statistically significant does not
automatically mean that they are clinically
significant.
Cont.
 If a research study uses a qualitative approach,
data analysis involves searching for themes and
patterns.
 This procedure is sometimes referred to as
content analysis because the content of
narrative materials is being analyzed.
 Qualitative researchers may synthesize their
findings to develop a theory or conceptual
framework of the phenomenon being studied
COMMUNICATING RESEARCH FINDINGS
 Research findings must be made public if they
are to become accessible and used to guide
practice decisions.
 Research findings can be communicated
through publication in journals or at
conferences.
 Even small-scale research projects that are
carried out in a clinical setting should be
communicated.
USING RESEARCH FINDINGS IN PRACTICE
 Before a study’s findings are used to guide
practice, they should undergo three types of
evaluation: scientific validation, comparative
analysis, and cost–benefit appraisal.
 Scientific validation is a thorough critique of a
study for its conceptual and methodological
integrity.
 This means scrutinizing how the study was
conceptualized, designed, and conducted in
order to make a judgment about the overall
quality of its findings.
Cont.
 Comparative analysis involves assessing study
findings for their implementation potential.
 Three factors are considered: (1) how the study’s
findings compare to findings from other studies
about the problem; (2) how the study’s findings will
transfer from the research conditions to the clinical
practice conditions in which they will be used; and
(3) practical or feasibility considerations that need
to be addressed when applying the findings in
practice.
Cont.
 Cost–benefit analysis involves consideration of
the potential risks and benefits of both
implementing a change based on a study’s
findings and not implementing a change.
 Both immediate and delayed potential costs
and benefits to clients, nursing staff, and the
organization as a whole should be considered.
Research-Related Roles
and Responsibilities for Nurses
 RESEARCH CONSUMER
LOCATING RESEARCH LITERATURE
CRITIQUING RESEARCH REPORTS
 RESEARCH TEAM MEMBER
PROTECTING THE RIGHTS OF STUDY PARTICIPANTS
Research-Related Roles
and Responsibilities for Nurses
 In today’s EBP environment, all nurses,
regardless of their educational preparation,
need to be able to assume two research-
related roles: that of research consumer and
research team member.
RESEARCH CONSUMER
 Being a research consumer means routinely
searching and reading the current research
literature in order to stay current with new
insights in client experiences and nursing and
medical interventions.
 Two skills are fundamental to this role: locating
relevant literature and critiquing research
reports.
LOCATING RESEARCH LITERATURE
CRITIQUING RESEARCH REPORTS
 In addition to locating research literature about
current clinical topics and identified clinical
problems, nurses must be able to critique or
critically read and evaluate research articles.
 A research critique enables the nurse, as a
research consumer, to determine whether the
findings of a study are of sufficient quality to be
used to influence practice decisions.
Cont.
 A research critique involves dissecting a study to determine
its strengths and weaknesses, statistical and clinical
significance, and the generalizability and applicability of its
results.
 Conducting an effective critique of a research study entails
reading it several times.
 First, scan the article from start to finish getting a general
sense of how the study was conducted.
 Next, focus on the results and discussion sections of the
article.
 A key question that guides the research critique process is
“Do the study findings and the researcher’s interpretation of
these findings make sense in view of how the study was
conducted?”
Characteristics of an Ideal Study
RESEARCH TEAM MEMBER
 This role is particularly important in hospitals that
are seeking or wishing to maintain magnet
recognition status.
 Nurses in hospitals with this designation are
expected to be involved in research and EBP
activities on an ongoing basis.
Cont.
 Identifying clinically relevant problems that need to be
studied
 Reviewing the literature to provide background
information for a study
 Recruiting study participants
 Securing clients’ consent to participate in a study
 Designing data collection instruments
 Pilot-testing data collection procedures
 Collecting research data
 Monitoring for adverse effects of study participation
 Implementing research interventions
 Assisting with interpretation of study findings.
PROTECTING THE RIGHTS OF STUDY
PARTICIPANTS
 Because nursing research usually involves humans,
a major nursing responsibility is to be aware of and
to advocate on behalf of clients’ rights.
 Before any research on humans can be started,
the researcher must obtain approval from the
relevant committee designated to protect human
subjects’ rights.
 This includes research that does not require direct
involvement of the person, only access to data
about the client. This committee is often called the
Institutional Review Board (IRB
Cont.
Cont.
 All nurses who practice in settings where
research is being conducted with human
subjects or who participate in such research
play an important role in safeguarding the
rights discussed next.
Cont.
 RIGHT NOT TO BE HARMED
 RIGHT TO FULL DISCLOSURE
 RIGHT TO SELF-DETERMINATION
 RIGHT TO PRIVACY
Reference
 Berman, S., Snyder, S. J., & Frandsen, G. (2016).
Kozier & Erb’s Fundamentals of Nursing:
Concepts, Process, and Practice (10th Ed.).
Boston:Pearson. pp. 26-36.