Nursing Research PDF

Student Learning Outcomes (SLOs):  By the end of the lecture, students should be able to: 1.Discuss the evolution of nursing research, and current healthcare trends. 2.Discuss the difference between theory, research, and practice. 3.Differentiate between basic and...

Student Learning Outcomes (SLOs):  By the end of the lecture, students should be able to: 1.Discuss the evolution of nursing research, and current healthcare trends. 2.Discuss the difference between theory, research, and practice. 3.Differentiate between basic and applied research. 4.Delineate sources for nursing research. 5.Define nursing research. 6.Discuss the goals of nursing research 7.Differentiate between logical reasoning types. 9.Classifications of research 10.Discuss the characteristics of scientific research The evolution of nursing research Evolution from Nightingale to the Present. Florence Nightingale’s work on sanitation in the 1800s was one of the early efforts at linking environmental variables to clinical outcomes. In fact, the seminal work of Nightingale regarding hygiene, especially hand washing, had a significant impact on the five pandemics from 1918 to 2020. In the early 1900s, the focal point of nursing research was on nursing education. In the 1940s, the concentration shifted to the availability of and demand for nurses in time of war. 3  A major milestone occurred in 1952 when the first edition of the journal Nursing Research was published. In 1955, the National Institutes of Health (NIH) established the Nursing Research Study Section.  At the same time in 1955, the American Nursing Foundation was established to promote nursing research (American Nurses Foundation, 2018). A 1983 study entitled Nursing and Nursing Education: Public Policy and Private Actions, published by the Institute of Medicine (IOM, 1983), recommended that nursing research be included in the mainstream of health-related research. With growing public support, the Health Research Extension Act of 1985 authorized the development of the National Center for Nursing Research (NCNR) at the NIH. The NIH Revitalization Act of 1993 elevated NCNR to an NIH Institute and established the National Institute of Nursing Research (NINR, n.d.). 5  In the late 1990s, a growing concern arose that many hospitals had adopted clinical pathways that was developed by multidisciplinary team. Also, multiple interventions have been identified that together enhance the clinical outcome; this practice has come to be known as bundling. A bundle is a group of interventions related to a disease or care process that, when executed together, results in better outcomes than when the interventions are implemented individually Blending evidence-based research and applying it to clinical practice and patient outcomes were goals of the work of the IOM (1999) in its landmark publication To Err Is Human: Building a Safer Health System 6  In 2004, the IOM expanded its original work to look at the work environment of nurses in its publication Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2004). This report further described the need for bundles of mutually reinforcing patient safety defenses as part of the effort to reduce errors and increase patient safety. It described “bundles of changes” that are needed within four aspects of care to strengthen patient safety: (1) Leadership and management, (2) The workforce, (3) The work process, (4) Organizational culture. 7  The IOM in 2010 suggested major challenges in providing health care with an emphasis on primary care versus specialty care in the community instead of acute care facilities (IOM, 2010). Patient-Centered Outcomes Research Institute (PCORI) is a result of the Affordable Care Act (ACA), which is a prime example of efforts to make the patient the center of care and to make the provision of outcomes specific to the patient (National Pharmaceutical Council, 2012). 8  Historical Background  In 1859, Miss Nightingale published her first classical book titled Notes On Nursing “What it is, and What it is Not” Nightingale to 1950s 1900 American Journal of Nursing Research on nursing education The Journal of Nursing Research 1952 Research in the 1960s More concern about lack of research in practice The International Journal of Nursing Studies Research in the 1970s Research on psychological and sociological backgrounds Research in the 1980s Evidence‐Based Medicine Specialized institutions in nursing research started e.g., NCNR at the NINR Research in the 1990s ‐ Present National Institute of Nursing Research More research on intervention More collaboration with other health care disciplines More randomized clinical trials Theory, Research, and Practice Parker and Smith (2010) define theories as “organizing structures of our reflections, observations, projections and inferences”. Fain (2009) defines research as “a systematic inquiry into a subject that uses various approaches (quantitative and qualitative methods) to answer questions and solve problems” Polit and Beck (2021) define research as “a systematic inquiry that uses disciplined methods to answer questions or solve problems” 10 Research methods flowchart 11  Sources for Nursing Research Academia A major thrust of research in education is the evaluation of programs, technologies, and instructional design. Healthcare Settings For healthcare settings to serve as a source for nursing practice, a process for research is necessary. 12  What Is Nursing research? Nursing research: is a systematic inquiry designed to develop knowledge about issues of importance to the nursing profession including Practice, education, Administration, and informatics Clinical Nursing Research: Research designed to generate knowledge to guide nursing practice and improve the health and quality of life of clients Research is important because nurses are expected to adopt an evidence-based practice This will enable them to describe and explain phenomena and control undesirable outcomes  Goals of Nursing Research The goal of the research is to develop, refine, and expand a body of knowledge Benefit the profession and its patients and contribute to improvements in the entire health care system. Consumer–Producer Continuum: Two points: one end is the consumer and the other is the producers Consumers of nursing research read research reports to develop new skills and to keep up to date on relevant findings that may affect their practice Producers of nursing research: nurses who actively participate in designing and implementing research studies. Research utilization—the use of research findings in a practice setting— depends on intelligent nursing research consumers.  Logical reasoning Inductive and deductive reasoning Inductive and deductive reasoning are important critical thinking skills. They help the nurse use clinical judgment when implementing the nursing process. Inductive reasoning involves noticing cues, making generalizations, and creating hypotheses. Is the process of developing generalizations from specific observations ○ Cues are data that fall outside of expected findings that give the nurse a hint or indication of a patient’s potential problem or condition. ○ A generalization is a judgment formed from a set of facts, cues, and observations and is similar to gathering cues ○ A hypothesis is a proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring. If a “why” is identified, then a solution can begin to be explored. Example: A nurse assesses a patient and finds the surgical incision site is red, warm, and tender to the touch. The nurse recognizes these cues form a pattern of signs of infection and creates a hypothesis that the incision has become infected. The provider is notified of the patient’s change in condition, and a new prescription is received for an antibiotic. This is an example of the use of inductive reasoning in nursing practice. 2. Deductive Reasoning: Is the process of developing specific predictions from general principles( that is referred to as “top-down thinking.” ) Relies on using a general standard or rule to create a strategy. Nurses use standards set by their state’s Nurse Practice Act, the American Nursing Association, professional organizations, and their employer to make decisions about patient care and solve problems. Example: Based on research findings, hospital leaders determine patients recover more quickly if they receive adequate rest. The hospital creates a policy for quiet zones at night by initiating no overhead paging, promoting low-speaking voices by staff, and reducing lighting in the hallways. The nurse further implements this policy by organizing care for patients that promotes periods of uninterrupted rest at night. This is an example of deductive thinking because the intervention is applied to all patients regardless if they have difficulty sleeping or not. Assumptions: Refers to a basic principle that is believed to be true without proof or verification Assumptions are not statistically tested in research Based on the belief , the researcher attempts to discover the correlation.“ Childhood obesity is more private schools as compared to Government schools”. Benchmarking: Data provide information on such issues as the rates of using various procedures.(e.g., rates of cesarean deliveries) or rates of infection (e.g., nosocomial pneumonia rates), and can serve as a guide in evaluating clinical practices Quality improvement and risk data: EXAMPLES WEQAYA. such as medication error reports and evidence on the incidence and prevalence of skin breakdown, which can be used to assess practices and determine the need for practice changes  Sources of Evidence for Nursing Practice Tradition Authority Clinical experience, trial and error, intuition Logical reasoning (inductive and deductive) What Is a Paradigm? A world view; a general perspective on the complexities of the real world, with certain assumptions about reality Key paradigms for nursing research: Positivist paradigm Naturalistic paradigm , What Is the Nature of Reality? Positivist assumption: Reality exists; there is a real-world driven by natural causes.( QAUNTITVE) Naturalistic assumption: Reality is multiple and subjective, constructed by individuals. ( QAULATITVE )  How Is Knowledge Obtained? Positivist Constructivist Fixed design Flexible design Discrete, specific concepts Holistic Deductive processes Inductive processes Control over context Context-bound Quantitative information Qualitative information Seeks generalizations Seeks patterns  Classifications of Research  According to Time Frame  According to the level of investigation 1. Longitudinal 1. Exploratory 2. Cross-sectional 2. Descriptive  According to Motive Or Objective 3. Experimental 1. Basic research  According to approach 2. Applied research 1. Experimental  According to TimeLine 2. Non-experimental 1. Retrospective  According to Measurement & Data Analysis 2. Prospective 1. Quantitative  According to Research Environment 2. Qualitative 1. Field 2. Laboratory  Characteristics of Scientific Research  According to the Scientific Method, Research is a process of collecting, analysing and interpreting information to answer questions.  For a process to be called research, the process must have certain characteristics. It must be controlled, rigorous, systematic, valid & verifiable, empirical, critical, Generalizable and Theory Development 1. Controlled  In real life there are many factors that affect an outcome.  The concept of control implies that, in exploring causality in relation to two variables (factors), you set up your study in a way that minimizes the effects of other factors affecting the relationship. 2. Rigorous  you must be careful in ensuring that the procedures followed to find answers to questions are relevant, appropriate and justified. 3. Systematic  This implies that the procedure adopted to undertake an investigation follows a certain logical sequence. 4. Valid and Verifiable  This concept implies that whatever you conclude on the basis of your findings is correct and can be verified by you and others 5. Empirical  This means that any conclusions drawn are based upon hard evidence gathered from information collected from real-life experiences or observations.  The scientific method searches for evidence (empirical: real) through observations, verified through our sense organs: sight, taste, touch, smell, and hearing 6. Critical  Critical scrutiny of the procedures used and the methods employed is crucial to a research enquiry  The process of investigation must be foolproof and free from drawbacks  The process adopted and the procedures used must be able to withstand critical scrutiny 7. Theory Development  Scientific generalizations are enhanced by the development of theories  Theories represent a method of organizing integrating and deriving abstract views about the manner of relationships that exist between phenomena or variables Basic versus Applied Research Basic research can be defined as research to gain knowledge for knowledge’s sake. Basic research is also called bench research, such as laboratory experiments intended to elucidate cell structure. for example, a researcher addresses how a new drug being tested affects a cell’s structure. Applied research has a direct impact on practice and modifies current practice. Cherry (2018) suggests that applied research solves practical problems. Most nursing research is applied research that assists in decision making related to nursing care. This type of research can also include the development of new approaches for care. 25  Modification, development, and evaluation of nursing care through best practice form the heart of EBP. Applied research builds a body of knowledge for nursing practice and guides the nurse in providing patient care. An example of applied research in nursing would be a study that generates new information about the use of soap and water versus hand cleansing gels in preparation for a sterile dressing. 26  Research methods Are techniques used by researchers to structure a study and to gather and analyze information relevant to the research question, they include: I. Quantitative Research:  Uses deductive reasoning to generate hunches that are tested in the real world  Moves from the definition of a problem, selection of concepts on which to focus, collection of information, and solution of the problem  Quantitative researchers use methods to control the study which means  Impose conditions on the research situation to minimize bias and maximize validity  Quantitative researchers gather empirical evidence “gathered through senses”  Usually, this information is numeric and analyzed with statistical procedures  The quality of quantitative research is assessed by the generalizability of the research . Quantitative” research.Early forms of research originated in the natural sciences such as biology, chemistry, physics, nursing etc.  it was concerned with investigating things which we could observe and measure in some way.  Such observations and measurements can be made objectively and repeated by other researchers II. Qualitative Research:  Naturalistic investigations place a heavy emphasis on understanding the human experience as it is lived, usually through the careful collection and analysis of qualitative materials that are narrative and subjective.  Naturalistic researchers tend to emphasize the dynamic, holistic, and individual aspects of human experience and attempt to capture those aspects  Naturalistic inquiry always takes place in the field  The subjective nature of the naturalistic inquiry sometimes causes concerns about the conclusions  qualitative” research.Research which attempts to increase our understanding of why things are the way they are in our social world and why people act the ways they do.  It used by researchers working in the social sciences: psychology, sociology, anthropology etc.  They were interested in studying human behaviors and the social world inhabited by human beings by trying to explain human behaviors in simply subjectively measurable terms.  Most naturalistic studies involve a relatively small group of people under study.  Test Your Knowledge In the early 1900s, the focal point of nursing research was on ○ Nursing education ○ Adult Nursing ○ Community development ○ Nursing homes Patient-Centered Outcomes Research Institute (PCORI) is a result of the Affordable Care Act (ACA), which is a prime example of efforts to make ○ Nursing research ○ patient the center ○ Bundel of care ○ Patients’ safety The IOM in 2010 suggested major challenges in providing health care with an emphasis on ○ Collaborative care ○ primary care ○ Palliative care ○ Nursing care Concept that Refers to a basic principle that is believed to be true without proof or verification ○ Reasoning ○ Benchmarking: ○ Quality improvement ○ Assumptions Professional care models give nurses: ○ a. accountability. ○ b. authority. ○ c. responsibility. ○ d. all of these.  Test Your Knowledge Potential areas of nursing research identified by the National Institute of Nursing Research include: ○ a. stem cell research. ○ b. application of pharmaceuticals in clinical practice. ○ c. chronic illness, health promotion, disease prevention, and end-of life care. ○ d. healthcare literacy. In which year was the first issue of Nursing Research published? ○ a. 1858 ○ b. 1952 ○ c. 1985 ○ d. 1992 The Nursing Studies Index, the first annotated index of nursing research, was the work of: ○ a. Florence Nightingale. ○ b. Virginia Henderson. ○ c. Marita Titler. ○ d. Dorothea Orem. Clinical pathways are developed by: ○ b. physician teams. ○ c. educator teams. ○ d. multidisciplinary teams. ○ nursing teams A bundle is a group of interventions related to a disease or care process that: ○ a. results in better outcomes when the interventions are implemented together. ○ b. results in diverse outcomes when the interventions are implemented individually. ○ c. results in confusing information about a single disease or care process. ○ d. provides insufficient evidence to alter clinical practice related to individualized interventions.