NURS3030 Research Methodology PDF

NURS3030 – Research Methodology Prepared by Leemoy Weaver UWISON, Mona  Chapter 2 Fundamentals of Evidence- Based Nursing Practice Background of Evidence-Based Nursing Practice Research utilization (RU) – The use of study findings in a practical application unrelat...

NURS3030 – Research Methodology Prepared by Leemoy Weaver UWISON, Mona  Chapter 2 Fundamentals of Evidence- Based Nursing Practice Background of Evidence-Based Nursing Practice Research utilization (RU) – The use of study findings in a practical application unrelated to the original research Evidence-based practice (EBP) – Basing clinical decisions on research findings and other factors History of RU in Nursing Practice Studies identified knowledge–practice gaps (e.g., Ketefian, 1975). RU projects sought to address the gap (1970s and 1980s): – E.g., the Conduct and Utilization of Research in Nursing (CURN) project RU efforts began to be superseded by call for EBP, 1990s. Overview of the EBP Movement Archie Cochrane – Efforts led to the development of Cochrane Center in Oxford and the Cochrane Collaboration. – Proposed an evidence hierarchy for weighing evidence David Sackett – Evidence-based medicine pioneer at McMaster Medical School Evidence Hierarchies Involve ranking evidence sources according to the strength of evidence they provide Ranking may depend on the type of question being asked. Within any level, evidence quality can vary considerably. Example of an Evidence Hierarchy Best Evidence Refers to research findings that are methodologically appropriate, rigorous, and clinically relevant for answering pressing questions. EBP Challenges Research-related barriers – E.g., scarcity of strong research evidence Nurse-related barriers – E.g., inadequate skills in locating and appraising evidence Organizational barriers – E.g., lack of financial support and staff release time for EBP Question Is the following statement True or False? The strongest level of evidence is obtained from individual correlational studies. Answer False Rationale: The strongest level of evidence is obtained from systematic reviews of randomized clinical trials (RCTs). Resources for EBP Preappraised evidence has been selected from primary studies and evaluated for use by clinicians. – Systematic reviews integrate evidence about a topic in a rigorous, systematic way. – Clinical practice guidelines give specific recommendations for evidence-based decision making. Systematic Reviews Meta-analyses that integrate findings across quantitative studies statistically Meta-syntheses that integrate and amplify findings across qualitative studies Clinical Practice Guidelines There is no single guideline repository. When multiple guidelines exist, must identify ones based on strongest evidence Appraisal of Guidelines Research and Evaluation (AGREE) Models for Evidence-Based Nursing Practice Dozens of models exist. Three widely referenced models: – The Stetler model of research utilization to promote evidence-based practice – The Iowa model of evidence-based practice to promote quality care – Rogers’ Diffusion of Innovations Theory EBP in Individual Nursing Practice Nurses are called upon to make decisions or give advice daily. Many clinical scenarios provide opportunity for EBP, e.g. – Is there a reliable screening tool for assessing risk of Clostridium difficile among surgical patients? – Are there ways to reduce pain of children undergoing allergy scratch tests? Question Is the following statement True or False? Meta-analyses use statistics to integrate findings across quantitative studies. Answer True Rationale: Statistics are involved with meta-analyses to integrate findings across quantitative studies. Meta- syntheses integrate and amplify findings across qualitative studies. Major Steps in EBP 1. Ask questions that reflect uncertainties in clinical practice. 2. Search for and assemble evidence. 3. Appraise and synthesize evidence. 4. Integrate evidence with other sources. 5. Assess effectiveness of decision or advice. Asking Clinical Questions Components for quantitative evidence – Population – Intervention (exposure, issue) – Comparison* – Outcome – Time* *Not always specified Question Templates Templates can greatly facilitate wording of questions, e.g., an intervention question: In _____ (population), what is the effect of ________ (intervention), in comparison to _______ (comparison), on __________(outcome)? Question Which of the following would be the first step when personally investigating evidence for a specific nursing care problem? – A. Searching for possible evidence – B. Asking answerable clinical questions – C. Assessing effectiveness of decision – D. Assembling available evidence Answer B. Asking answerable clinical questions Rationale: The first step in individual EBP efforts is to ask questions that are answerable with research evidence. Searching for, assembling, appraising, and synthesizing would occur next in that order. Assessing effectiveness is the last step. Appraising the Evidence for EBP What is the quality of the evidence? What is the magnitude of effects? How precise are estimates of effects? Is there evidence of side effects? What are the costs? Is there relevance to my clinical situation? Integrating Evidence in EBP Research evidence needs to be integrated with – Your own clinical expertise and knowledge of clinical setting – Patient preferences and values – Evidence from qualitative research EBP in an Organizational Context Select a problem – Knowledge-focused triggers Begins with an innovation or research finding (e.g., might emerge in a journal club) – Problem-focused triggers Begins with a perplexing or troubling clinical situation EBP in an Organizational Context (cont.) Appraise implementation potential. – Transferability – Feasibility – Cost–benefit ratio Evidence appraisals and subsequent actions Implement and evaluate the innovation. Question Is the following statement True or False? Clinical practice guidelines put evidence into a usable form. Answer True Clinical practice guidelines give specific recommendations for evidence-based decision making, putting evidence into a usable form for implementation. End of Presentation