Research Methodology - NURS3030 Chapter 2

Research Methodology - NURS3030

• Course prepared by Leemoy Weaver, UWISON, Mona

Chapter 2 - Fundamentals of Evidence-Based Nursing Practice

• Evidence-based nursing practice (EBP) involves basing clinical decisions on research findings and other factors.
• Research utilization (RU) is the use of study findings in a practical application, regardless of the original research.

Background of Evidence-Based Nursing Practice

• Research utilization (RU) emerged from recognizing knowledge-practice gaps, as identified in studies like Ketefian (1975).
• RU projects, such as the Conduct and Utilization of Research in Nursing (CURN) project, addressed these gaps in the 1970s and 1980s.
• RU efforts were later superseded by the call for evidence-based practice (EBP) in the 1990s.

Overview of the EBP Movement

• Archie Cochrane's work led to the establishment of the Cochrane Center in Oxford and the Cochrane Collaboration.
• Cochrane proposed an evidence hierarchy for evaluating the weight of evidence.
• David Sackett was a pioneer in evidence-based medicine at McMaster Medical School.

Evidence Hierarchies

• Evidence sources are ranked based on the strength of evidence they provide.
• Ranking can vary depending on the specific question being asked.
• Evidence quality can vary considerably within a given level.

Example of an Evidence Hierarchy

• The hierarchy is presented as a pyramid shape, with systematic reviews at the top, followed by randomized controlled trials, non-randomized trials, cohort studies, and case-control studies. Lower levels include cross-sectional studies, qualitative studies, and expert opinions, case reports and other less rigorous types of studies.
• Each level provides differing levels of evidence and implications.

Best Evidence

• Best evidence refers to research rigorously collected, methodologically sound, and clinically relevant to address important questions.

EBP Challenges

• Research-related barriers, such as a shortage of strong research evidence
• Nurse-related barriers, such as inadequate skills in locating and appraising evidence
• Organizational barriers, such as lack of financial support and time for EBP implementation.

Question: True or False?

• The strongest level of evidence is obtained from individual correlational studies.
• False. The strongest level of evidence comes from systematic reviews of randomized clinical trials (RCTs).

Resources for EBP

• Pre-appraised evidence has been selected from and evaluated for use by healthcare professionals.
• Systematic reviews, done rigorously and systematically, integrate evidence on a particular issue.
• Clinical practice guidelines offer specifics on how evidence-based decisions should be made.

Systematic Reviews

• Meta-analyses statistically combine results from quantitative studies.
• Meta-syntheses combine qualitative studies.

Clinical Practice Guidelines

• No single, universal repository of guidelines exists..
• When several guidelines exist, using the strongest evidence is crucial.
• AGREE (Appraisal of Guidelines Research and Evaluation) is a guideline for evaluating how good the guidelines are

Models for Evidence-Based Nursing Practice

• Several models are available.
• The Stetler model utilizes research to promote EBP.
• The Iowa model uses EBP for enhancing quality care.
• Rogers' Diffusion of Innovations Theory is another crucial model.

EBP in Individual Nursing Practice

• Nurses utilize EBP daily to make decisions and provide advice on diverse clinical scenarios.
• This includes questions like if there are reliable screening tools for Clostridium difficile risk among surgical patients or ways to reduce pain in children undergoing allergy tests.

Question: True or False?

• Meta-analyses use statistics to integrate findings from quantitative studies.
• True.

Major Steps in EBP

• 1. Ask clinical questions that address uncertainties.
• 2. Search for and compile evidence.
• 3. Appraise and analyze evidence.
• 4. Integrate with other sources of information.
• 5. Evaluate the effectiveness of the decision/advice.

Asking Clinical Questions

• Components for quantitative evidence include:
  • Population
  • Intervention
  • Comparison
  • Outcome
  • Time (though not always specified)

Question Templates

• Templates can improve question formulation for clinical practice. Example: "In [population], what is the effect of [intervention], compared to [comparison], on [outcome]?"

Question:

• Which of the following is the first step in evaluating a nursing problem using EBP?
  • Searching for possible evidence
  • Asking answerable clinical questions
  • Assessing the effectiveness of the decision
  • Assembling existing evidence
• Answer: Asking answerable clinical questions.

Appraising the Evidence for EBP

• Key considerations for appraising evidence include:
  • Evidence quality
  • Magnitude of effects
  • Precision of effect estimates
  • Side effects
  • Costs
  • Relevance to the clinical situation.

Integrating Evidence in EBP

• Integrate research with clinical expertise and clinical setting knowledge.
• Incorporate patient preferences and values.
• Consider evidence from qualitative research.

EBP in an Organizational Context

• Knowledge-focused triggers originate from new innovations or research.
• Problem-focused triggers stem from troubling clinical situations.

EBP in an Organizational Context (cont.)

• Assess implementation potential (e.g., transferability, feasibility, cost-benefit).
• Implement and evaluate innovations.

Question: True or False?

• Clinical practice guidelines organize evidence into a usable form.
• True. Clinical practice guidelines provide specific recommendations for evidence-based decision-making, presenting the evidence in a usable format for implementation.

End of Presentation