Traditions, personal experience, and trial and error are formal ways of acquiring knowledge.

Research Chapter 1 - Introduction to Nursing Research and Its Importance in Building an Evidence-Based Practice

Mentioned in lecture From textbook From lecture PPT

Learning Objectives 1. Define research, nursing research, and evidence-based practice. p2- a. Research - diligent systematic inquiry or study that validates and refines existing knowledge and develops new knowledge. b. Nursing research - scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice - generates knowledge about nursing education, nursing administration, healthcare services, characteristics of nurses and nursing roles. c. Evidence Based Practice - evolves from the integration of best research evidence with our clinical expertise and our patients circumstances and values to provide quality health outcomes. 2. Discuss the past and present activities influencing research in nursing. a. See below - in text on p6. 3. Apply the ways of acquiring nursing knowledge—tradition,authority, borrowing, trial and error, personal experience, role modeling, intuition, reasoning, and research—to the interventions implemented in your practice. a. See below - in text on p11. 4. Describe the common types of research—quantitative, qualitative, mixed methods, and outcomes—conducted to generate evidence for nursing practice. a. See below - in text on p 5. Describe the purposes of research in implementing an evidence-based nursing practice. 6. Discuss your role in research as a professional nurse p20. a. All nurses have roles in research that usually expand with his or her advanced education, clinical expertise and career path. BSN graduates should have knowledge of the research process and skills in reading and critically appraising studies and assist with implementation of evidence based guidelines, protocols, algorithms and policies in practice. May provide valuable assistance in identifying research problems and collecting data for studies. 7. Describe the following strategies for synthesizing healthcare research: systematic review, meta-analysis, meta-synthesis, and mixed-methodssystematic review. a. Systematic review b. Meta-analysis c. meta -synthesis d. Mixed-methods systematic review 8. Examine the levels of research evidence available to nurses for practice.

What Is Nursing Research? p ● ˜To search again ● ˜To examine carefully ● ˜Diligent and systematic inquiryvalidates and refines existing knowledge ● ˜Discovery ● ˜Goal is to develop an empirical body of knowledge for a discipline

What Is Evidence-Based Practice? p

Example given in lecture - a nurse with experience in the cardiac ICU (Clinical Expertise) receives a patient who has had a heart attack. The nurse knows that following a heart-healthy cardiac diet is imperative for the patient’s recovery (Best Research Evidence). The nurse also knows the patient is a Southern American who has a traditional southern diet (Patient Values and Preferences). All elements are needed to form an effective care plan.

● Best research evidence - empirical knowledge generated from the synthesis of quality health studies to address a clinical problem. ● Clinical expertise - knowledge and skills of the healthcare professional providing care. ● Patient circumstances - include the individual’s clinical state, which might focus on health promo, illness prevention, acute or chronic illness management, rehabilitation, and/or a peaceful death, and the clinical setting.

Why Is Research Important for Evidence-Based Practice? ˜ ● ˜Develops empirical knowledge base ● ˜Identifies best practices that are based on clinical practices ● ˜Improves outcomes for: ○ Patient and family ○ Nurseproductivity and performance ○ Healthcare system

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Nursing Research: 21st Century 2000— Healthy People 2010 - increased visibility and focus on research, resulting in many organizations adding research to their mission statement and made it a primary element in their organizational objectives 2000— Biological Research for Nursing

2002—Joint Commission revised policies to support evidence-based care 2004— Worldviews on Evidence-Based Nursing 2010— Healthy People 2020 2016 — NINR mission statement and strategic plan updated 2017 — AACN leading initiatives of research

Knowledge p ● Essential information acquired in a variety of ways and expected to be an accurate reflection of a reality used to direct a person’s actions ● Nursing has historically acquired knowledge through: ○ Traditions - truths or beliefs built on customs and trends. In nursing, done via role modeling and written and oral communication positively influence practice bc developed from effective past experiences OR narrow and limit knowledge sought for nursing practice when traditions upheld that are not efficient or effective. ○ Authority - person with expertise and power(given to them because it is thought they know more in a given area than others)able to influence opinion and behavior have to be careful to follow and share EBP because they are influencing the actions of others. ○ Borrowing - uses information borrowed from other disciplinessuch as medicine, sociology, physiology, and education. Two ways: taking information from another discipline and using it in nursing (even though it was not integrated with nursing) or integrating knowledge from another discipline within the focus of nursing - latter is most useful). ○ Trial and error - used in situations of uncertainty in which other sources of knowledge are unavailable, is an approach with uncertain outcomes. Involves no formal documentation of effective and ineffective nursing actions, which limits usefulness because it is often not shared with others, resulting in continuation of ineffective interventions. ○ Personal experience - gaining knowledge by being personally involved in an event, situation, or circumstance. Ex - skills are gained and expertise developed providing care via clinicals). Amount of personal experience affects the complexity of a nurse’s knowledge base. ■ Benner’s phases of how knowledge is acquired in nursingthrough personal experience (or how expertise is developed) : ● Novice nurses - no personal experience, but have some preconceptions and expectations about clinical practice learned during education that are challenged, refined, confirmed or refuted by personal experience in a clinical setting. ● Advanced beginner nurses - has just enough experience to recognize and intervene in recurrent situations ● Competent nurses - able to generate plans and achieve long range goals bc of years of personal experience

○ Outcomes research - focuses on examining the results of care and determining changes in health status for the patient and family. ■ Areas included in outcomes research are: patient responses to nursing and medical interventions, functional maintenance or improvement of physical, mental and social functioning for the patient, financial outcomes achieved with the provision of healthcare services, and patient satisfaction with health outcomes, care received and healthcare providers. ■ Nursing sensitive outcome - individual, family, or community state, behavior or perception measured along a continuum in response to nursing interventions. ● Nursing Outcomes Classification (NOC) developed to standardize terminology for nursing-sensitive outcomes and is used across specialties in a variety of practice settings to capture changes in patient status after an intervention. ■ Determines the quality, safety, adn cost-effectivenessof nursing care and provides a basis for improvement in the future. ● ˜Empirical knowledge is essential for the delivery of high-quality, safe patient, and family nursing care.

Lecture question - the beginning nurse researcher would like to investigate credible resources for implementing protocols in clinical practice. Which of the following would be considered empirical sources of nursing knowledge? 1) Reasoning, authority and tradition 2) Quantitative, qualitative and outcomes research 3) Care maps and protocols 4) Role modeling and trial and error

Lecture question - the nurse researcher is investigating outcomes research on nursing interventions. Which of the following examples would constitute outcomes research? 1) A comparison of two patient groups 2) Patient responses to nursing interventions 3) Patient tested before and after intervention 4) A patient’s perception of the intervention

Quantitative Research Characteristics p ● Conducted to test theory by describing variables, examining relationships among variables, and determining cause and effect relationships among variables ● Methods used commonly - scales, questionnaires, physiological measures ● Data are numbers analyzed with statistical techniques to determine results ● Researchers strive to extend findings beyond the situation studied - a single study may be generalized to different populations and settings.

● ˜Philosophical origin: logical positivism(strict rules of logic, truth, laws and prediction - “truth” is absolute and a single reality can be defined by careful measurement without values, feelings, and personal perceptions being considered). ● ˜Focus:concise,objective, reductionistic ● ˜Reasoning: logistic, deductive ● ˜Basis of knowing: cause and effect relationships ● ˜Theoretical focus: tests theory

What Are the Categories of Quantitative Research? p1 8 ● ˜Descriptive Research -looks at new areas of research and describes situations as they exist in the world ● ˜Correlational Research- looks at relationships and is conducted to find explanatory knowledge of the nursing practice ● ˜Quasi-experimental Research and Experimental Research- determine effectiveness of nursing interventions in predicting and controlling a desired outcome ˜ Qualitative Research Characteristics p ● ˜Systematic, subjective approach used to describe life experiences and situations and give them meaning ● Concerned with understanding the meaning of social interactions and shared interpretations by those involved ● Truth is complex and dynamic and can only be found by studying people as they interact with and in their socio historical settings ● More effective method of investigating emotional responses and personal experiences than quantitative research ● Data is in the form of words collected through interviews, observations, focus groups and analyzed for meaning ● ˜Philosophical origin: naturalistic, interpretive, humanistic ● ˜Focus: broad, subjective, holistic ● ˜Reasoning: dialectic, inductive ● ˜Basis of knowing: meaning, discovery, understanding ● ˜Theoretical focus: theory development

What Are Some Categories of Qualitative Research? p1 6 ● ˜Phenomenological -inductive, holistic approach used to describe an experience as it is lived by individuals,such as the lived experience of losing a child ● ˜Grounded theory -inductive research technique used to formulate, test, and refine a theory about a particular phenomenon -initially described by Glaser and Strauss in 1967 in their development of a theory about grieving ● ˜Ethnographic -developed by the discipline of anthropology for investigating cultures through in-depth study of the members of the cultures because health practices vary among cultures and these practices need to recognized when delivering care to patients and families

Identify the Research Population, Intervention, Comparisons, and Desired Outcome (the PICO Question) Not in chapter 1, but will be discussing in class, so introduced in lecture this week. ● P—patient with hypertension ● I—implementing medication teaching ● C—compare patient outcomes for patient who receive teaching to those for a patient who does not ● O—increased adherence leads to decrease in blood pressure

What resources might assist you in finding practice guidelines and more information on best practices?

What are the methods of acquiring knowledge?

What are the four types of nursing knowledge?

What are the five sources of knowledge in nursing research?

How is knowledge acquired in nursing?