Understanding Nursing Research: Using Research in Evidence-Based Practice

1. Understanding Nursing Research: Using Research in Evidence-Based Practice Chapter 1: Evidence-Based Nursing: Using Research in Practice

2. Overview of course • The outcome of the course is to become critical and intelligent users of nursing research in clinical care. • The course will use clinical vignettes, some in-class data, and current published research for learning.

3. Why use research in practice? • In order to be scientifically sound and to continuously improve, clinical practice should be based on evidence. • Evidence-based practice is practice based on research evidence or findings. • Evidence-based nursing is a process to make informed clinical decisions.

4. What makes research difficult to use? • A unique language • Concepts that are unfamiliar • A process that can seem isolated from real patient care • Can be time-consuming

5. What often happens when nurses try to use research without understanding the language and process of research? • They become frustrated. • They misunderstand the implications of research findings. • They stop using research. • Patient care suffers.

6. How to become critical and intelligent users of research Learn how to read and understand research in order to answer five questions: • What is the answer to my practice question—what did the study conclude? • Why did the author(s) reach these conclusions—what did they actually find? • To what types of patients do these research conclusions apply—who was in the study? • How were these patients studied—why was the study done that way? • Why ask that question—what do we already know?

7. What are some clinical questions? • Do you know whether to use humor when working with an anxious patient? • Do you know what to assess (pain, fatigue, number of sticks, vein condition) in order to decide whether to establish a venous port for blood draws in a patient who needs blood drawn repeatedly and regularly? • Do you know how young children perceive the x-ray machine?

8. History of Nursing Research • 1860—Florence Nightingale produces Notes in Nursing • 1900–1940—Research focused on preparation of nurses • 1940–1950—Research focused on characteristics of RNs and nursing education • 1960—Research focused on theoretical foundations • 1970—Research focused on clinical practice • 1980—Establishment of National Center of Nursing Research (in 1993 became National Institute of Nursing Research)

9. Question Is the following statement True or False? The National Center of Nursing Research became the National Institute of Nursing Research in 1993 and placed nursing research of equal importance with other disciplines.

10. Answer True. The National Institute of Nursing Research was established in 1993 and set the science of nursing research at an equal standard to medicine and other disciplines.

11. Question Is the following statement True or False? The first nurse researcher was Florence Nightingale with her studies of the environment.

12. Answer True. During the Crimean War, Florence Nightingale worked as a nursing researcher recording notes about the environment of the hospital.

13. What is research today? • Utilizes both Qualitative and Quantitative Research • Focuses on Outcome Research • Looks at best practice and leads to Evidence-Based Practice

14. How do we find answers to questions such as these? • Ask someone….Authority • Look it up in a book….Authority • Follow our instincts….Intuition • Do what seems right….Intuition • Think about how we would feel….Past experience • Remember a similar situation….Past experience

15. How do we find answers to clinical questions such as these? • Look on the World Wide Web….Seek research • Look in journals for research about the question….Read research • There are a number of ways of seeking answers to clinical questions, so why use research?

16. We use research because… • Often there are conflicting answers from past experience, authorities, and intuition. • Research is the most systematic approach to knowledge development.

17. Before we use research… • We must look at the state of current nursing knowledge. • We must find pertinent reports of research that address the clinical question of concern. • We should know where to look for reports of research.

18. Three major sources for identifying reports of research • Printed indexes • The Internet • Electronic databases

19. Printed indexes: • Written lists of professional articles • Organized and categorized by: Topic Author • Used before there were electronic databases; research before 1982 is categorized • May be a good source of key words for researchers • Key words are terms that describe the topic in which you are interested.

20. The Internet: • The network that connects computers throughout the world • Accessed using “search engines”—programs used to search the Internet • Searches often lead to Web sites relevant to nursing research such as: • http://www.nih.gov/ninr • http://www.cdc.gov

21. Electronic databases • Computer databases that provide categorized bibliographic citations of scholarly work • Categorized by author, topic, key words, title, journal • Available in most academic libraries either on CD-ROM or online • Examples: PubMed CINAHL COCHRANE

22. Question Which sample title reflects a research report? • “Five steps to improving your care of the patient with diabetes” • “The role of exercise in maintaining glycemic control” • “Comparison of two approaches to diabetes education in adolescents” • “The adolescent with diabetes—what is the most useful advice?”

23. Answer C. “Comparison of two approaches to diabetes education in adolescents” Any of the titles MAY reflect a research report, but only the third title suggests and describes research report. The two group comparison suggests that outcomes were measured on two different diabetes education programs.

24. What is nursing research? • The systematic gathering of information to gain, expand, or validate knowledge about health and responses to health problems • Systematic = planned and organized • Knowledge = what is understood and recognized about a subject

25. A report of research is NOT: • A description of a procedure or intervention that mentions a research study • A literature review about a topic that cites a number of research studies

26. A research report IS: • A published report that identifies a problem or question • A published report that describes a planned and organized set of actions to gather information about the problem or question • A published report that describes new information to address a gap in knowledge

27. A systematic review: • Is similar to a traditional research report because it addresses a gap in knowledge and uses a systematic approach to gather information about the gap, BUT… • Is different from a traditional research report because it summarizes existing research (which includes 2 to n number of studies), creating a synthesis of the findings rather than gathering new information about the gap or problem

28. Levels of Evidence

29. Research Questions Applied to Systematic Reviews

30. So if the title does not tell us whether or not the publication is a research report, how do we know? • Specify “research” when doing an electronic database search. • Read the abstract to see if it describes a problem that reflects a gap in knowledge and a systematic approach to gathering information about the problem.

31. An abstract is: • A brief summary of the article • A condensed version of the research report • Often available online as part of a citation • Can help you quickly identify articles relevant to your search topic

32. Question This part of a research report or article summarizes the text in a condensed version, usually a paragraph. • Abstract • Purpose Statement • References • Title

33. Answer • Abstract An abstract provides a brief summary of the entire article. This summary is available as part of the citation in most databases.

34. Abstracts can be helpful in identifying appropriate research to acquire and read. They cannot and should not be depended upon to provide a level of understanding of the research study that would support clinical decision making.

35. Questions?