Nursing Theory, Research & Evidence Based Practice PDF

RAK Medical & Health Sciences University RAK College of Nursing BSc Nursing I Semester Topic: Nursing Knowledge, Theory and Research Dr. Vimala Edwin MSN, Ph.D. Assistant Professor RAK Coll...

RAK Medical & Health Sciences University RAK College of Nursing BSc Nursing I Semester Topic: Nursing Knowledge, Theory and Research Dr. Vimala Edwin MSN, Ph.D. Assistant Professor RAK College of Nursing. Learning outcome At end of the session the student will be able to I. Define Nursing Knowledge II. Discuss the Sources , Types of knowledge and historical effects of nursing Knowledge III. Explain selected nursing theories. IV. Understanding the types and steps of nursing research Introduction Nursing is a unique healthcare discipline in which nurses provide a service based on knowledge and skill. Nursing has body of knowledge and application of that knowledge in nursing care interventions. (skill) There is a growing knowledge base developed specifically for nursing through theory development and research. 1.NURSING KNOWLEDGE Knowledge is an awareness of reality one obtains through learning or investigation. II. Sources of Knowledge- Knowledge comes from a variety of sources and may be i. Traditional ii. Authoritative iii. or Scientific. i. Traditional Knowledge Traditional knowledge is that part of nursing practice passed down from generation to generation. It is customary in acute care settings to change a patient’s bedclothes daily, whether soiled or not. There are no research data to support this, yet virtually millions of hospital beds are changed daily because this practice is accepted as a necessary component of quality patient care. Authoritative Knowledge Authoritative knowledge comes from an expert and is accepted as truth based Example, when a senior staff nurse teaches a new graduate nurse inserting an intravenous catheter. The senior nurse has gained knowledge through experience, and the new graduate nurse accepts it as truth based on the perceived authority of the experienced nurse. iii. Scientific Knowledge Scientific knowledge is that knowledge arrived at through the scientific method (suggesting through research). New ideas are tested and measured systematically using objective criteria. Nurses increasingly focus on scientific knowledge to provide care, commonly called (Evidence Based Practice)EBP. 3.Historical influences on Nursing Knowledge The development of nursing knowledge has been influenced by i) The early work of Florence Nightingale ii)Later Nursing researcher, theorists and Societal changes. i) Nightingale influenced nursing knowledge and practice by Demonstrating efficient and knowledgeable nursing care, Defining nursing practice as separate and distinct from medical practice, and Differentiating between health nursing and illness nursing. ii. Societal Influences on Nursing Knowledge During the first half of the 20th century, Nursing education began to focus more on education than hands-on training, Nursing research was conducted and published. The idea of nursing as a science became more generally accepted In the 21st century, according to the Institute of Medicine (IOM), The Future of Nursing which identifies research priorities for transforming nursing practice, nursing education, and nursing leadership. Provide a strong foundation for the development of a nursing workforce whose members are well educated and well prepared to practice Provide future health needs of patients, and to act as leading change and advancing health”  III. Nursing Theory Theory A theory is composed of a group of concepts that describe a pattern of reality. Concepts describe objects, and events and relationships among them. Conceptual framework or model. A group of concepts that follows an understandable pattern makes up a conceptual framework or model. Nursing theory How the nursing theories important for Nursing  Nursing theory Developed to describe nursing in clarity  Nursing theory differentiates nursing from other disciplines and activities Nursing theory provides knowledgeable reasons for nursing interventions (actions). It gives nurses the knowledge to act appropriately in nursing care situations, Types of theory A. General Systems Theory  Ludwig von Bertalanffy, developed the theory for universal application.  This theory describes how to break whole things into parts and then to learn how the parts work together in “systems.” (Eg)Hospital).  It emphasizes relationships between the whole and the parts and describes how parts function and behave. These concepts may be applied to different kinds of systems.  General System Theory (conceptual frame work) Input Through put Output Adequate Provide Quality number of efficient Patient care Health Team Health care Members(Docto Services rs, Nurses, In the health Pharmacist, etc) care.Finance, organization Technology Feed Back B. Adaptation Theory Adaptation theory defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Adaptation is a continuously occurring process that effects change and involves interaction and response. Human adaptation occurs on three levels: The internal (self), The social (others), and the physical Sister Callista Roy: Adaptation Model of Nursing The Adaptation Model of Nursing was developed by Sister Callista Roy in 1974 Central Theme Humans needs are created within interrelated adaptive modes: A. Physiological B. Self-concept C. Role function D. and Interdependence. Sister Callista Roy outlined four modes of adaptation that contribute to a person’s healing: continued… A. The physiologic mode is associated with the physical need of the person Eg) 1) Oxygenation, 2) nutrition, B. The Self Concept Mode The self-concept mode is defined as the individual’s beliefs and feelings about themself or others Eg) Positive body image C. The Role Function Mode The role function mode covers the individual’s role in society for social integrity. Eg) mother, father, teacher, etc., Eg) Responsibility to fulfill roles D. The Interdependence Mode The interdependence mode includes relationships and inter action with others. For the individual, this mode focuses on interactions related to care, respect, giving and receiving value. It creates sense of confidence  Adaptation theory continued…  Application to Clinical Practice  In Adaptation Model, nurses are facilitators of adaptation.  Nurses assess the patient’s behaviors for adaptation, promote positive adaptation by enhancing environment interactions and helping patients react positively to stimuli.  Increasing adaptation during health and disease improves the interaction between the environment and human systems and thus improves health Common Concepts in Nursing Theories Four concepts common in nursing theory that influence and determine nursing practice are (1) The person (patient) (2) The environment (3) Health, and (4) Nursing. Of the four concepts, the most important is that of the person. FIGURE 5-1. Four concepts common to all nursing theories are person, environment, health, and nursing.  c.Florence Nightingale Theory(1860) Central Theme Meeting the personal needs of the patient within the environment Application to the clinical practice Concern for the environment of the patient, including cleanliness, ventilation, temperature, light, diet, and noise  d. Virginia Henderson Theory (1955) Central theme The patient is an individual who requires help to reach independence. The theory focuses on the importance of increasing the patient's independence to hasten their progress in the hospital. Henderson's theory emphasizes the basic human needs and how nurses can assist in meeting those needs e. Dorothea Orem self care theory (1971) Central theme: Self-care(Hygiene) is a human need, self-care deficits require nursing actions. Application to clinical practice Nursing is a human service, and nurses design interventions to provide or to manage self-care actions for supporting health or recovering from illness or injury.  III. Nursing Research 1. Research most simply defined means to examine carefully or to search again. Research is systematic review that uses disciplined method to answer the questions and solve the problems (Polit, 2018) 2. Methods of conducting nursing research A. Quantitative B. and qualitative A. Quantitative research Quantitative research methods emphasize objective measurements and the numerical analysis of data collected through questionnaires. Questions Yes No Nursing students perception (Score 1) (Score 0) about nursing Listening to the patient. Discuss the case of a patient with a doctor..Measure the patient's vital signs  Qualitative research- Is a method of research conducted to gain insight by discovering meanings. Qualitative research is the process of collecting, analyzing, and interpreting non-numerical data. Eg) What is your opinion about Nursing profession? Nursing means compassion, kind and care giver 3. Important Terms related to Quantitative Research a. Variable b. Independent variable c. Dependent variable d. Hypothesis e. Data f. Instruments Important Terms related to Quantitative Research …. a. Variable: A variable is a characteristic that has different values that can be measured  It is called a variable because the value may vary from one individual to another. Examples of variables. Height, weight, age, place of living, grades obtained at school and type of housing Independent variable: The variable that is used to describe/ measure the factor that is assumed to cause the problem is called an independent variable. Cause/influence is the independent variable Eg) Smoking enhances the risk of lung cancer. Proper Hand hygiene decreases prevention of infection Smoking, proper hand hygiene are Independent variable c. Dependent variable: The variable being studied, determined as a result of a study. Effect is the depended variable Lung cancer, prevention of infection are Depended variable d. Hypothesis: Statement of relationships between the independent and dependent variables that the researcher expects to find Eg)Proper hand hygiene decreases health care-associated infection:  Data: Information the researcher collects from subjects in the study  Eg) Information regarding hand hygiene  Instruments: questionnaire used to collect and record the data,.  Eg)  Which of the following hand hygiene actions prevents transmission of germs to the patient? a. Before touching a patient Yes No b. Immediately after a risk of body fluid exposure Yes No c. After exposure to the immediate surroundings of a patient Yes No d. Immediately before a clean/aseptic procedure Yes No 4. Types of quantitative research a. Descriptive Research To explore and describe events in real- life situations. Often used to generate new knowledge about topics with little or no prior research. Your survey might be with a set of prepared questions intended to obtain quick information from the subjects. Eg) Knowledge of nursing students on the prevention of healthcare associated infections b. Correlational Research To examine the relationships between two or more variables without the researcher controlling or manipulation. Eg) Hand hygiene reduces health care-associated infection Low intake of food causes underweight. Smoking enhances the risk of lung cancer. C. Experimental Research: (Randomized Controlled Trials)  An experiment is a scientific investigation that makes observations and collects data according to clear criteria. To examine cause-and-effect relationships between variables under highly controlled conditions; often conducted in a laboratory setting C. Experimental Research: continued….. A true experimental design has there characteristics:  Intervention-the experimenter does something to some participants by manipulating the independent variable. They are called experimental group  Control-a control group that does not receive the intervention  Randomization-the experimenter assigns participants to a control or experimental condition on a random basis True experimental design D. Experimental Research continued…. Example) To study the effectiveness of music therapy in relieving pain among adult patients The patients are randomly assigned with experimental(Intervention) group(receive music therapy) and a control group that receive no music therapy. d. Quasi-Experimental study – Some times researchers are not able to randomly assign subjects to groups, or for various reasons, no comparison group is available for an experimental study. Quasi experimental designs are those in which there is either no comparison group or subjects are not randomly assigned to groups Eg) Effects of Music Engagement on Responses to Painful Stimulation An educational intervention to improve hand hygiene compliance 5. Steps of the quantitative research process a. State the research problem(Identifying the problem). b. Define the purpose of the study. c. Review related literature- provides information about what is already known d. Formulate hypotheses and variables. e. Select the research design. provides a “road map” for all aspects of the study f. Select the population and sample. The population is the group to be studied. The sample refers to specific people or events in the population from which data will be collected. g. Collect the data. h. Analyze the data. Statistical procedures are used to analyze the data i. Communicate findings through publications and presentations 6. Protection of the Rights of Human Subjects Research studies have met appropriate scientific and ethical criteria before their implementation Protecting patient rights. Informed consent, the patient’s right to consent knowledgeably to participate in a study without compulsion  Example: Research article(not included for exam)  Knowledge and behaviour of nursing students on the prevention of healthcare associated infections. (Brosio F1, Kuhdari P1, Stefanati A1, Sulcaj N1, Lupi S1, Guidi E1, Bergamini M1, Gabutti G1)  METHODS:  339 students attending all the three years of course of the same academic year were enrolled.  questionnaire was administered in order to investigate the knowledge about three specific areas: infections associated with healthcare practices (HAI), standard precautions (SP) and hand hygiene (HH).  RESULTS:  A sufficient level of knowledge by all the three groups of students was observed only in the Standard Precaution area.  The level of knowledge about healthcare associated infections (HAI) was inadequate.  Abstract(not included for exam) A qualitative study on the role of patient–nurse communication in acute cardiac care Background: This study aimed to illuminate the meaning of the patient–nurse communication during a hospital stay as narrated by patients after a myocardial infarction, MI.(Heart attack)  Methods: Narrative interviews from 10 patients were analyzed,  Results:. Nurses’ presence and availability for non-verbal and verbal communication created a trustful relationship where new knowledge was acquired and motivational strength for life-style changes was mobilized. References Taylor, C. R., Lynn, P., & Bartlett, J. (2023). Fundamentals of Nursing. The art and science of person- centered care. 10th Ed. Wolters Kluwer. Craven F.R, Hirnle,J.C, Henshaw.M.C. 1. Journal Reference  Brosio, F., Kuhdari, P., Stefanati, A., Sulcaj, N., Lupi, S., Guidi, E., … Gabutti, G. (2017). Knowledge and behaviour of nursing students on the prevention of healthcare associated infections. Journal of Preventive Medicine and Hygiene, 58(2), E99–E104. 3. Maria Liljeroos, Ingrid M Snellman, Mirjam H Ekstedt (2011).A qualitative study on the role of patient–nurse communication in acute cardiac care,Journal of Nursing Education and PracticeVol 1, No.1 2017.