Chapter 2 Lecture Notes PDF

**Chapter 2** **Theory, Research, and Evidence-Based Practice** Applied Research: research designed to directly influence or improve clinical practice Basic Research: designed to generate and refine theory; the findings are often not directly useful in practice Concept: abstract images (ideas) t...

**Chapter 2** **Theory, Research, and Evidence-Based Practice** Applied Research: research designed to directly influence or improve clinical practice Basic Research: designed to generate and refine theory; the findings are often not directly useful in practice Concept: abstract images (ideas) that are formed as impressions from the environment and organized into symbols of reality Conceptual Framework or Model: set of concepts, along with the statements that arrange the concepts into an understandable pattern Data: grouping of patient data or cues that points to the existence of a patient health problem Deductive Reasoning: cognitive process in which of examines a general idea and then considers specific actions or idea Evidence-Based Practice (EBP): nursing care provided that is supported by sound scientific rationale Evidence-Based Practice Guidelines: guidelines written by a panel of experts that synthesize information from multiple studies and recommend best practice to treat patients with a disease, a symptom, or a disability Inductive Reasoning: cognitive process in which one identifies a specific idea or action and then makes conclusions about general ideas Informed Consent: knowledgeable, voluntary permission obtained from a patient to perform a specific test or procedure Nursing Research: encompasses both research to improve the care of people in the clinical setting and to study people and the nursing profession, including education, policy development, ethics, and nursing history Nursing Theory: differentiates nursing from other disciplines and activities by serving the purposes of describing, explaining, predicting, and controlling desired outcomes of nursing care practices Research: process that uses observable and verifiable information (data), collected in a systematic manner, to describe, explain, or predict events Research Utilization (RU): is a process of transforming research knowledge into practice, with knowledge referring to both conducting and analyzing research. It enables nurses to improve patient care by informing practicing on interventions that may no longer be useful. Qualitative Research: method of research conducted to gain insight by discovering meanings Quality Improvement (QI): the commitment and approach used to continuously improve every process in every part of an organization, with the intent of meeting and exceeding customer expectations and outcomes -- also known as continuous quality improvement (CQI) or total Quality management (TQM) Scholarly Inquiry: the logical, organized process of searching for answers to questions via research, assessment of findings from literature searches, and examination of other knowledge sources Systematic Reviews: summarized findings from multiple studies of a specific clinical practice questions or topic that recommend practice changes and future directions for research; one of the strongest sources of evidence for evidence-based practice Theory: statement based on observed facts that explains or characterizes a process, an occurrence, or an event, but cannot be proved directly or absolutely as a fact **Nursing Social Policy Statement of Issues Nurses Address \#1** - Promotion of health and wellness Promotion of safety and quality of care Care, self-care processes, and care coordination Physical, emotional, and spiritual comfort, discomfort, and pain Adaptation to physiologic and pathophysiologic processes Emotions related to the experience of birth, growth and development, health, illness, disease, and death Meanings ascribed to health, illness, and other concepts **Nursing Social Policy Statement of Issues Nurses Address \#2** - Linguistic and cultural sensitivity Health literacy Decision making and the ability to make choices Relationships, role performance, and change processes within relationships Social policies and their effects on health Health care systems and their relationships to access, cost, and quality of health care The environment and the prevention of disease and injury **Source of Knowledge** - How do we know something? - Traditional---passed down from generation to generation Authoritative---comes from an expert, accepted as truth based on person's perceived expertise Scientific---obtained through the scientific method (research) **Types of Nursing Knowledge and Influences on Nursing Knowledge** **Historical Influences on Nursing Knowledge** - Nightingale influences - Demonstrating efficient and knowledgeable care Defining nursing practice as separate and distinct Differentiating between health and illness nursing Societal influences - Shift to planned educational curriculum Women entering the workforce due to war Shift of nursing to a science **Hitorical Influences** - **Nightingale Model:** Service oriented until 1950's - **- Societal Influence:** Nursing as Science after 1950's **- Institute of Medicine Report** ( 2011) **Framework of Nursing Theory** Theory: group of concepts that describe a pattern of reality - Can be tested, changed, or used to guide research Concepts: abstract impressions organized into symbols of reality; describe objects, properties, and events and relationships among them - Conceptual framework or model---a group of concepts that follow an understandable pattern Nursing theory is developed to describe nursing and differentiates it from other disciplines and activities Theories are derived through two principal methods - Deductive reasoning - Inductive reasoning **Types of Reasoning** **Interdisciplinary Base for Nursing Theories** General systems theory---theory for universal application; break whole things into parts to see how they work together in systems Adaptation theory---adjustment of living matter to other living things and environment Developmental theory---growth and development of humans as orderly and predictable from conception to death - Erikson - Maslow A diagram of a pyramid of needs Description automatically generated **Benefits of Nursing Theory** - Directs Nurses towards common goal - Gives nurse knowledge base necessary for appropriate actions - Leads to improved patient care - Helps resolve current nursing issues - Serves research, education, and practice - Provides rational and knowledgeable reasons for nursing actions - Prepares nurses to question assumptions and values **Goal of Theoretical Frameworks** - Individualized care to meet needs of patients Promotion of health Prevention or treatment of illness **Common Concepts in Nursing Theories** - The person (patient) The environment Health Nursing The most important concept of nursing theory is the patient. **Research** Scientific inquiry: process that uses observable and verifiable information (data), collected in a systemic manner, to describe, explain, or predict events Conducted to validate and refine current knowledge or to develop new knowledge **Evolution of Nursing Research** - 1859 Florence Nightingale -- Objective records 1952 *Nursing Research Published* 1970's Clinical Research 1980's National Center for Nursing Research 2016 Strategic Plan - Symptom science Wellness Self-management End of Life **Goals of Research** **Goals of Nursing Research** Improve care of people in clinical setting Study people and the nursing process - Education Policy development Ethics Nursing history Provide evidence-based nursing practice **National Institute of Nursing Research goals of Research** **Methods of Nursing Research** Quantitative - \- Involves concepts of basic and applied research Qualitative - \- Conducted to gain insight by discovering meanings \- Based on belief that reality is based on perceptions that differ for each person and change over time Applied research: designed to directly influence or improve clinical practice **Terms in Quantitative Research** - Variable - Dependent variable Independent variable Hypothesis Data Instruments **Types of Quantitative Research** - Descriptive Correlational Quasi-experimental Experimental **Steps of Quantitative Research** - State the research problem Define purpose of the study Review related literature Formulate hypotheses and variables Select research design Select population and sample Collect data Analyze data Communicate findings and conclusions **Qualitative Research Methods** - Phenomenology Grounded theory Ethnography Historical **Evaluating the Ethics of Clinical Research Studies** - Value Scientific validity Fair subject selection Favorable risk--benefit ratio Independent review Informed consent Respect for enrolled subjects Impediments to Nursing research **Evidence-Based Research** - Problem-solving approach to making clinical decisions using the best evidence available Blends both the science and the art of nursing so that the best patient outcomes are achieved May consist of specific nursing interventions or may use guidelines established for the care of patients with certain illnesses, treatments, or surgical procedures The use of EBP mandates the analysis and systematic review of research findings **Why Is EBP Important?** - **Improves** **quality** **of** **care** Meets needs of nurses and patients Reduces delays in implementation of change Keeps knowledge up-to-date AACN Practice Alert **EBP at ASN Level** - Assist in implementation of changes May be asked to assist in gathering information Support process change Stay knowledgeable!! **Steps In Implementing EBP** - Cultivate a spirit of inquiry. Formulate the burning clinical questions (PICOT) Search for and collect the best evidence Critically appraise the evidence (validity, reliability, applicability) Integrate the evidence with clinical expertise and patient/family preferences to make the best clinical decision Evaluate the outcomes of the practice decision or change based on evidence Disseminate the outcomes of the EBP decision or change **Asking Clinical Questions In Picot Format** - P = patient, population, or problem of interest I = intervention of interest C = comparison of interest O = outcome of interest T = time **Components Of a Research Article** Question \#1 Tell whether the following statement is true or false. Traditional and authoritative knowledge are practical to implement, but are often based on subjective data, limiting their usefulness in a wide variety of settings. A. True B. B. False Question \#2 Tell whether the following statement is true or false. A nurse who tests a nursing theory by examining the theory itself and then considering the specific actions or ideas is using deductive reasoning. A. True B. False Question \#3 Which of the following is the central theme in theoretical frameworks of nursing? A. The person receiving the care B. The health care environment C. The nursing care plan D. The person providing the care Question \#4 Tell whether the following statement is true or false. The basis of phenomenology is the discovery of how people describe their own reality and how their beliefs are related to their actions in a social scene. A. True B. False