Evidence-Informed Practice: Methodologies & Ethics

• Study notes on evidence-informed practice, research methodologies, ethics, and validity.

Evidence-Informed Practice (EIP) Steps

• EIP begins with selecting a topic by identifying a problem.
• A team is formed, and the research question is defined using the PICOT framework.
• Relevant evidence is gathered by finding studies and determining their types.
• The evidence is then graded based on a hierarchy.
• Research is critiqued to evaluate the quality of studies.
• The research is synthesized by comparing and contrasting findings.
• EIP recommendations are developed based on the synthesis.
• A decision is made on whether to implement a practice change.
• Evidence-informed practice guidelines or protocols are developed.
• The new practice change is implemented.

Hierarchy of Evidence

• Systematic Reviews & Meta-Analyses: Considered the best level of evidence.
• RCTs (Randomized Controlled Trials) are next.
• Controlled Cohort Studies follow RCTs in the hierarchy.
• Case-Control Studies.
• Descriptive & Qualitative Studies.
• Expert Opinions & Case Reports.
• Background Information & Theory: Considered the weakest level of evidence.

Ethics & Historical Studies

• Tuskegee Syphilis Study: Involved no consent and withholding treatment from participants.
• Auschwitz Sterilization Experiments: Were conducted using coercion and were unethical.
• Psychiatric Experiments featured unethical treatments in institutions.
• AIDS/AZT Africa study: Exploited vulnerable populations.
• First Nations Nutrition Studies: Were conducted on malnourished children.

Regulations & Policies

• CNA Code of Ethics: Provides professional ethical guidelines for nurses.
• Tri-Council Policy Statement (TCPS-2): Is a policy statement that has ethical conduct for research involving humans.
• REB Considerations: Include protection of vulnerable populations and Indigenous rights.

Research Article Structure (IMRaD)

• Introduction: Provides background information, states the purpose of the study, and presents the hypothesis.
• Methods: Describes the study design, sample, procedures, and data analysis techniques.
• Results: Presents the data findings, including statistics and tables.
• Discussion: Interprets the results, acknowledges limitations, and draws conclusions.

Types of Research Articles

• Theoretical: Explores abstract concepts without using empirical data.
• Methodological: Focuses on research methods and their application.
• Literature Review: Summarizes and synthesizes existing research on a specific topic.
• Empirical Research: Presents an original study with collected data.

Research Design & Validity

• Internal validity: The extent to which a study establishes a trustworthy cause-and-effect relationship between a treatment and an outcome.
• External validity: The extent to which the results of a study can be generalized to other situations and to other people.

Internal Validity Threats

• History: External events that occur during the study that could affect the results.
• Maturation: Natural changes in participants over time that influence outcomes.
• Testing: The act of pre-testing influencing subsequent outcomes.
• Instrumentation: Inconsistencies in measurement tools or procedures.
• Attrition (Mortality): Dropouts from the study affecting the results.
• Selection Bias: Issues arising from non-random sampling methods.

External Validity Threats

• Selection Effects: Occur when the sample is not representative of the population of interest.
• Reactive Effects: Participants behaving differently because they are aware they're being studied.
• Measurement Effects: Pre-tests influencing post-test results.

Research Methods

Experimental Designs

• True/Classic Experiment: Uses random assignment, a control group, and manipulation of variables.
• Solomon Four-Group Design: Controls for pre-test bias by using four groups: two with pre-tests and two without.
• After-Only Design: Involves no pre-test, just post-test measurement after the intervention.
• Quasi-Experimental: Does not use random assignment, making it weaker than true experiments.

Non-Experimental Designs

• Purpose: To observe, describe, and explore relationships without manipulation.
• Survey Designs: Collect data through questionnaires and interviews.
• Relationship/Difference Designs: Compares variables to find relationships or differences.
• Correlational Studies: Examines the relationships between variables, needs to be interpreted carefully.

Sampling & Hypothesis

• Independent Variable (IV): The factor that is manipulated by the researcher.
• Dependent Variable (DV): The outcome that is measured.

Research Hypothesis Types

• Directional: Predicts a specific relationship between variables.
• Non-Directional: Predicts a relationship exists but does not specify the direction.
• Statistical Hypothesis (Null): States that no relationship exists between the variables.

Cohort Studies

• Prospective Cohort Study: Follows a group over time, is generally stronger in design.
• Retrospective Cohort Study: Uses past data, is generally weaker in design.

Cohort studies - Advantages

• Are good for determining cause-and-effect relationships.
• Allows for examination of multiple outcomes.

Cohort studies - Disadvantages

• Can be expensive and time-consuming for prospective studies.
• Retrospective studies can suffer from recall bias.

Four Levels of Understanding

• Preliminary: Recognizing key ideas.
• Comprehensive: Summarizing content accurately.
• Analysis: Identifying patterns and contradictions.
• Synthesis: Combining insights to form new conclusions.

Research Paradigms

• Post-Positivism: Assumes an objective reality that can be studied using scientific methods.
• Constructivism: Assumes that there are multiple realities based on subjective interpretations.

Study notes covering evidence-informed practice steps, research methodologies, ethical considerations, and validity assessment. Includes forming teams, gathering evidence, grading research, and developing practice guidelines. Covers research synthesis and implementation of practice changes.