Introduction to Nursing Research

Introduction to Nursing Research in an Evidence-Based Practice Environment

• Nursing research is a systematic inquiry using disciplined methods to answer questions or solve problems related to nursing practice.
• It aims to develop trustworthy evidence about issues important to nurses and their clients.
• Clinical nursing research specifically guides nursing practice.

What Is Nursing Research?

• Research is a systematic inquiry using disciplined methods to answer questions or solve problems.
• Nursing research focuses on creating trustworthy evidence concerning important issues for nurses and their clients.
• Clinical nursing research is designed to influence and improve nursing practice.

The Importance of Research to Evidence-Based Nursing

• Evidence-based practice (EBP) uses the best clinical evidence to make patient care decisions.
• EBP forms the basis of many recent clinical practice changes.
• EBP produces decisions that are clinically appropriate, cost-effective, and result in positive client outcomes.

Evidence in EIPH

• Evidence-Informed Public Health (EIPH) integrates science-based interventions with community preferences to improve population health.
• EIPH considers community health issues, local contexts, and public health expertise along with the available resources.

Typical Roles of Nurses in Research

• Nurses contribute ideas for clinical inquiries.
• They assist in collecting research information.
• Nurses provide advice to clients about study participation.
• They search for research evidence.
• They discuss research implications with their colleagues.

Nursing Research: Past and Present

• Florence Nightingale pioneered nursing research in the 1850s.
• The 1950s saw the first nursing research journal, which helped advance nursing research's development.
• Clinical research gained importance in the 1980s.
• The National Center for Nursing Research was established at NIH in 1986.
• The National Institute of Nursing Research (NINR) was established in 1993.
• The NINR budget was just under $150 million in 2016.

Future Directions for Nursing Research

• The focus on evidence-based practice will remain important.
• Implementing confirmatory strategies for stronger evidence will continue.
• Emphasizing systematic reviews will uphold research rigor.
• Expanding local research in healthcare settings will be crucial (e.g., Magnet schools).
• Research findings will be disseminated widely.
• Addressing cultural issues and healthcare disparities will be key areas of focus.
• Patient input and clinical significance will be prioritized.

Sources of Evidence for Nursing Practice

• Tradition and authority
• Clinical experience and trial and error
• Assembled information (e.g., benchmarking data, quality improvement data, and risk data)
• Disciplined research (evidence-based findings) is the preferred method.

Paradigms and Methods for Nursing Research

• A paradigm is a worldview or perspective on the complexities of the world.
• Key paradigms for nursing research include the positivist paradigm and the constructivist paradigm.

Positive Versus Constructivist Paradigms

• Positivist paradigm: reality exists, is driven by natural causes, and researchers are independent from those researched; values and biases should be avoided.
• Constructivist paradigm: reality is multiple and subjective; researchers interact with those researched; values and biases are inevitable and desirable.

Research Methods

• Research methods are the techniques used to structure, gather, analyze, and interpret information in a study.
• Quantitative research aligns with the positivist paradigm.
• Qualitative research aligns with the constructivist paradigm.

Quantitative Versus Qualitative Research

• Quantitative research uses orderly procedures and has a systematic plan.
• It controls over context and uses formal measurement.
• It gathers empirical evidence and pursues generalizations.
• Qualitative research employs a dynamic design that is holistic and context-bound.
• Humans are considered instruments and qualitative information is gathered.
• Qualitative research seeks patterns.

Research Purposes Linked to EBP

• Therapy, treatment, or intervention
• Diagnosis and assessment
• Prognosis
• Etiology (causation) and harm
• Meaning and processes

Specific Purposes of Nursing Research

• Quantitative research can be used for identification, description, explanation, prediction, and control.
• Qualitative research is also used for identification, description, explanation, and exploration.

Evidence-Based Practice

• Evidence-based decision-making in nursing integrates best research evidence with clinical expertise, patient preferences, and local circumstances.
• It emphasizes personalizing best evidence for a particular patient.
• It emphasizes the importance of using all available research and clinical evidence in making clinical decisions.

Research Utilization

• Utilizing research findings in a practical application unrelated to the original research.
• Translating new knowledge into real-world applications
• Bridging the gap between research and clinical practice

History of RU in Nursing Practice

• Nursing research explored and identified knowledge-practice gaps.
• Research utilization projects addressed those observed gaps in the 1970s and 1980s, such as the Conduct and Utilization of Research in Nursing (CURN) Project.
• The emphasis on evidence-based practice (EBP) replaced research utilization in the 1990s.

Overview of the EBP Movement

• Archie Cochrane emphasized the importance of summarizing research for health care providers.
• Cochrane led to the Cochrane Collaboration and the development of the Cochrane Center located in Oxford.
• David Sackett also emphasized evidence-based medicine (EBM), which broadened approaches for best evidence use by all health care practitioners.

Evidence Hierarchies

• Evidence hierarchies rank evidence sources based on their strength.
• Ranking depends on the type of question being asked.
• Evidence quality can vary considerably within each level.
• Systematic reviews comprise the strongest level of evidence.

Best Evidence

• Methodologically sound, rigorous, and clinically relevant research findings are considered best evidence.
• Such findings cover efficacy, safety, and cost-effectiveness of nursing interventions, reliability of assessment tests, reasons for health problems, and nuances of patient experiences.

EBP Barriers

• The quality and nature of research (e.g., scarcity of robust research evidence)
• Nurse characteristics (e.g., insufficient skills in locating and appraising evidence)
• Organizational factors (e.g., lack of funding or time for evidence-based practice)

Asking Clinical Questions: PIO

• Population or patients: Defining the characteristics of patients or individuals.
• Intervention or exposure: Identifying the specific interventions or exposures of interest or the potentially harmful exposures of concern.
• Outcome: Determining the desired outcomes or consequences of an action or intervention.

Question Templates

• Using templates can make constructing questions easier, such as using a template for an intervention question: In (population), what is the effect of (intervention) in comparison to (comparison) on (outcome)?

Appraising the Evidence for EBP

• Evaluating the quality of evidence
• Determining the magnitude of effects
• Assessing the precision of effect estimates
• Investigating evidence of side effects
• Evaluating the financial costs of applying the evidence
• Ascertaining if the evidence is clinically relevant

Integrating Evidence in EBP

• Integrating research evidence with clinical expertise.
• Evaluating evidence in relation to clinical settings.
• Constituting patient preferences and values.
• Considering evidence from qualitative studies.

EBP in an Organizational Context

• Selecting a problem that needs to be addressed.
  • Knowledge-focused triggers (new research).
  • Problem-focused triggers (clinical issues).
• Appraising potential implementation.
  • Transferability
  • Feasibility
  • Cost-benefit
• Basing actions on evidence appraisals.
• Implementing and evaluating the innovation.

Implementing and Evaluating Innovation

• Developing an evaluation plan.
• Measuring client outcomes (before and after implementation).
• Training relevant staff in the use of the new guideline.
• Trying the innovation on one or more units.
• Evaluating the pilot project in terms of process and outcomes.

Qualitative Research: Disciplinary Traditions

• Grounded theory research: Seeking to understand key social and psychological processes.
• Phenomenological research: Focusing on the lived experiences of humans.
• Ethnographic research: Examining patterns and lifeways within a cultural group.

Phases in a Quantitative Study

• Conceptual phase
• Design and planning phase
• Empirical phase
• Analytic phase
• Dissemination phase

Major Steps in a Quantitative Study: Phases 1-5

• Conceptual Phase: Problem formulation, literature review, clinical fieldwork, establishing framework for study and creating hypotheses.
• Design and Planning Phase: Selecting research design, developing intervention protocols, identifying and defining populations, establishing sampling plans, and outlining methods for data collection with ethical considerations.
• Empirical Phase: Collecting data from participants.
• Analytic Phase: Analyzing the collected data using statistical methods. Interpreting the results.
• Dissemination Phase: Communicating findings (e.g., via research reports/journal articles). Putting the evidence into practice.

Selected Key Research Terms

• Quantitative research terms: Subject, study participant, investigator, researcher, constructs, variables, data (numerical), relationships (cause and effect), deductive reasoning.
• Qualitative research terms: Study participant, informant, researcher, phenomena, concepts, data (narrative), patterns of association, inductive reasoning.

Data

• Data in research are collected pieces of information.
• In quantitative research data is typically numerical.
• In qualitative data typically comprises narrative information.

Variables

• Variables represent characteristics or qualities that change or vary from person to person.
• Examples of variables include blood type, weight, length of hospital stay, gender, etc..
• Independent variables are considered the presumed causes.
• Dependent variables represent the presumed effects.

Relationships

• A relationship is a bond or connection between variables.
• Relationships can be characterized as cause/effect or associative based on the specific variables involved.
• Qualitative studies may specifically look for patterns of association and underlying meanings.

Major Classes of Quantitative Research

• Experimental research involves the active introduction of an intervention or treatment to ascertain its effect.
• This is often referred to as clinical trials in medical research or randomized clinical trials in other fields.
• Nonexperimental research gathers data without implementing any interventions to study existing correlations and relationships rather than manipulating interventions.

Faces and Places of Research

• Study subject or participant: people who are studied.
• Study site location(s) such as a region, hospital, or community.
• Multisite studies can broaden sample size and enhance the generalizability of findings.