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Nursing Fundamentals Focus XII

The Role of Research in the Development of Nursing Theory and Practice

Module for Chapter 2-Berman

30-35; 41-42

• Compare and contrast the seven ways of acquiring knowledge

• Discuss the advantages and disadvantages of each• Examine 5 characteristics of the scientific method of

acquiring knowledge and explain why it is important in nursing.

• List the different types of research and describe the differences

• Explain the importance of nursing research in the development of nursing theory

• Identify some of the limitations of the scientific research process.

Objectives:

• What is knowledge?• How is it acquired?• Is it based on research?

Acquiring Knowledge

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• Knowledge– Essential information acquired in a variety of

ways– Accurate reflection of reality– Incorporated and used to direct a person’s

actions (Kaplan, 1964).

Acquiring Knowledge

• Quality of knowledge– Question the quality and credibility– Sources of knowledge– Nursing interventions:

• Tradition• Research• Borrowed• Trial and error• Personal experience• Role modeling• Intuition• Reasoning

Acquiring Knowledge

• Traditions– “truths” or beliefs based on customs and trends– Transferred by:

• written and oral communication • role modeling

– Narrow and limit knowledge– Not tested for accuracy or efficiency

Acquiring Knowledge

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• Authority– Person with power and expertise– Influences opinion and behavior– Given to a person because they are perceived to

know more in a given area• Quoting someone – authors• Instructors• Clinical nursing experts

– Maintain traditional ways of knowing

Acquiring Knowledge

• Borrowing– Appropriation and use of knowledge from other

fields or disciplines to guide nursing practice.– Using medical model to guide their nursing

practice• Diagnosis and treatment of the disease

– Integrating information from other disciplines within the focus of nursing.

• Blurred boundaries• May not answer the question generated in nursing

Acquiring Knowledge

• Trial and Error– Used in situations of uncertainty– Other sources of knowledge are not available– Knowledge is gained from experience– Documentation of effective and ineffective

practices does not exist– May be detrimental to patient’s health– Time consuming

Acquiring Knowledge

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• Personal Experience– Being personally involved in an event, a

situation, or a circumstance– Gain skills and expertise by providing care– Nurse can cluster ideas into a meaningful whole

• Read about it, told about it, observed it and now do it repeatedly

• Novice to expert –Benner

Acquiring Knowledge

• Benner’s Novice to Expert – Novice

• No experience• Preconceptions and expectations

– Challenged, refined, confirmed, or refuted by clinical experiences

– Advanced beginner• Just enough experience to recognize and intervene

in recurrent situations

– Competent Nurses• Generate and achieve long-range goals and plans• Conscious, deliberate actions that are efficient and

organized

Acquiring Knowledge

• Benner’s Novice to Expert– Proficient nurse

• Views patient as a whole and member of the family• Recognizes each patient and family responds

differently to illness and health

– Expert Nurse• Extensive background of experience • Able to identify accurately and intervene skillfully

in a situation• Grasps a situation with intuition, speed and accuracy

– Benner, 1984 – Qualitative Research

Acquiring Knowledge

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• Role Modeling– Imitating behaviors of an expert– Admired teachers– Expert clinicians– Researchers– Inspirational people

• Mentorship– Expert nurse serves as teacher, sponsor, guide,

counselor

Role ModelingAcquiring Knowledge

• Intuition– Insight into or understanding of a situation or

event as a whole that usually cannot be explained logically.

– “gut feeling” “hunch”– Result of deep knowing

Acquiring Knowledge

• Reasoning– Processing and organizing of ideas in order to

reach conclusions– Make sense of both their thoughts and

experiences. • Logical thinking

– Inductive reasoning – specific to general• Particular instances are observed and then combined

into a larger whole or general statement

– Deductive reasoning – general to specific

Acquiring Knowledge

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Acquiring Knowledge

Inductive Reasoning• Particular Instances

– A headache is an altered level of health that is stressful

– A terminal illness is an altered level of health that is stressful.

• General Statement– Therefore it can be induced

that all altered levels of health are stressful

Deductive Reasoning• Premise – statement of

proposed relationship between two or more concepts

• Premises:– All human beings experience

loss– All adolescents are human

beings

• Conclusion– Therefore it can be deduced

that all adolescents experience loss.

Benefits of Nursing Research• Improve client care• Expand the body of knowledge• Explore and describe new phenomena to enhance

understanding• To generate a theory development• To provide sound rationales for nursing interventions• Clients who are subjects in a study

– may receive care they would not have received– some receive stipends– enhanced self esteem from being apart of something

that may help societyPages 307-308-Harkreader

Risk of Nursing Research

Physiological Factors

• fatigue and anxiety • related to:• self disclosure• loss of privacy • time

Physical factors

• Physical harm• Discomfort• Adverse effects

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• Sociological factors– loss of time– financial costs– transportation expenditures that may not

be reimbursed

Page 308 - Harkreader

Risk of Nursing Research

Ethics of Nursing Research

Risk/Benefit Ratio –• Competent investigator to conduct the research

• Safeguards the subjects

• Risk: • Probability harm may occur• Weigh severity and magnitude of harm

• Benefit:

• Positive value related to health and welfare of subject and others

Page 308-309 - Harkreader

• Review Board -– Institutional Review Board (IRB)

• committee whose duties include making sure that proposed research meets the federal guidelines for ethical research.

• the committee is mandatory in institutions receiving federal funds for research

• Page 308-309 - Harkreader

Ethics of Nursing Research

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• Informed Consent – Subjects must be competent, informed, freely

able give consent.

– Primary Ethical Principles of the Belmont Report (the National Research Act) 1978.

• Respect for persons, beneficence and justice

Page 308-309 - Harkreader

Ethics of Nursing Research

Protecting Rights of Human Subjects• Right Not to Be Harmed

– Nurse acts as advocate for client

• Right to Full Disclosure– Informed and aware of

consequences

• Right of Self-Determination

• Right of Privacy and Confidentiality

Page 33 - Berman

Ethics of Nursing Research

Ethical Dilemmas:

•Use of vulnerable participants:

• infants, children, pregnant women,

• terminally ill, prisoners, mentally ill……

•Knowledge gained from research is more important and beneficial than the rights of subjects or ethical principles.

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Ethical Dilemmas in Nursing Research

• Research Question:– Do maternity clients discharged 24 hours after

childbirth experience less complications if visited by a home health nurse?

• Ethical Dilemma– Some clients are visited and others not for a

control group– Is the group not being visited at risk?– How can this be prevented?

Ethical Dilemmas

• Research Question:– How do clients cope with the new diagnosis of

an impending terminal illness?• Ethical Dilemma

– Clients diagnosed with a terminal illness are very vulnerable.

– Intrusive questions may need to be asked causing increased anxiety and psychological trauma

– The insights gained will help other patients with a terminal illness

– Is it fair to ask such questions?Pg 309 - Harkreader

Types of Research

Types of Research• Exploratory• Evaluation• Descriptive• Experimental• Historical

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Experimental• A study in which the researcher manipulates a

treatment or interventions• Subjects are randomly assigned to either a control or an

experimental group • The researcher has control over the research situation.

• Quasi-experimental– Type of study in which the researcher manipulates a treatment

or intervention– unable to randomize subjects or lacks a control group

• Nonexperimental– researcher collects data without the introduction of a treatment

or intervention.

Types of Nonexperimental Research

•Correlational• examines relationships between variables to see if when one

changes, if the other changes without active intervention

•Descriptive• is used to obtain information concerning the current status of the

phenomena • describes "what exists" with respect to variables or conditions in a

situation.

•Case study• detailed investigation on group, institution or individual to

understand which variables are important to the subjects,history, care or development

• Historical– Reporting events and/or conditions that

occurred in the past• Needs assessment

– collect data to estimate needs of community• Survey

– studies to examine opinion, attitudes, behavior

• Page 311-Harkreader

Types of Nonexperimental Research

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Anatomy of a Research Study•Abstract

• A snapshot or a short summary that contains succinct information about the purpose of the study, the number of subjects and methodology used to select subjects, the type of study and the major results.

•Review of the literature• Reviews the current literature and theoretical background that brought

the investigator to identify or refine the research problem, substantiate a rationale and develop their study

•Development of the theoretical construct• A structure that aids in developing relationships among the variables in the study.

• It helps in the explanation of all the information included in the study.

• The framework allows the research to tie the research to the body of nursing knowledge .

• See fig 15.2. Theoretical framework in study is Roy Model. Pg. 315/316-Harkreader.

• Identification of the variables• The concepts under investigation

• Table 15.3 – pg. 313

• Clarification of operational definitions: precise meanings of the concepts being used in study, defined in a manner that specifies how the concept will be used in the study

• Formulation of the research question: the hypothesis the prediction of the relationship of the variables being studied

Anatomy of a Research Study

Anatomy of a Research Study•Research design

• researchers strategy for testing a hypothesis.

• Quantitative

• uses variables analyzed as numbers

• Qualitative

• type that uses ideas that are analyzed as words

•Collection of data• investigator collects information needed to answer the research

question.

•Methods

• describes how the researcher sought to answer the research questions, sample size, how the sample was collected and instruments used to collect data.

Page 311-314

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• Data analysis– what statistical tests were used to analyze data?

• Results– describes results of study– addresses research question/s

• Interpretation of the findings– researchers interpretation of the study– the relationship of the findings to the theoretical

framework– implications for further study

Anatomy of a Research Study

Nursing Research Journals

Evidence Based Nursing

Clinical Nursing Research

Nurse Researcher

Applied Nursing Research

Research in Nursing and Health

Nursing Science Quarterly

Journal of Nursing Scholarship

Annual Review of Nursing Research

Journal of Nursing Measurement

Western Journal of Nursing Research

Scholarly Inquiry for Nursing Practice

Advances in Nursing Science

Oncology Nursing Forum

Nursing Research

Nursing Computer Search Databases

• Computer search databases identify databases of interests of nurses.

• Computer Index to Nursing and Allied Health Literature CINAHL

• MEDICUS INTERNATIONAL NURSING INDEX MEDLINE

• Many of the helpful nursing literature can be accessed at

http://www.nursingcenter.com/home/index.asp

Table 15.2, page 312

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Evidence Based Nursing

What's Evidence Based Nursing (EBN)?• Evidence Based Nursing is the process by which nurses

make clinical decisions using the best available research evidence, their clinical expertise and patient preferences.

Three areas of research competence are: • interpreting and using research• evaluating practice• conducting research

319-320

Evidence-based Nursing

Evidence-based Nursing Practice (EBP)• Use of some form of substantiation in making clinical

decisions. • Solves problems encountered by nurses by carrying

out four steps:I. Clearly identify the issue or problem based on

accurate analysis of current nursing knowledge and practice

II. Search the literature for relevant researchIII. Evaluate the research evidence using

established criteria regarding scientific merit IV. Choose interventions and justify the selection

with the most valid evidence

Evidenced Based Nursing

To carry out EBP the following factors must be considered:

• sufficient research must have been published on the

specific topic

• the nurse must have skill in accessing and critically

analyzing research

• the nurse's practice must allow her/him to implement

changes based on EBN

319-320

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• Agency for Healthcare Research and Quality’s Effective Health Care Program– 3 approaches to publishing research on the

comparative effectiveness of different treatments and clinical practices

– 1. Review and synthesize knowledge– 2. Promote and generate knowledge – 3. Compile findings in practice and translate

knowledge

Evidenced Based Nursing

• Use of research finding in practice• AACN – 2006

– Position statement on nursing research that delineates expectations of graduates at each level of nursing education

• ANA Standard’s of Professional Performance – 2004– Standard 13: Research

• The registered nurse integrates research findings into practice. (Pg 30- Berman)

Nursing Research

• Use of research finding in practice• AACN – 2006

– Position statement on nursing research that delineates expectations of graduates at each level of nursing education

• ANA Standard’s of Professional Performance – 2004– Standard 13: Research

• The registered nurse integrates research findings into practice. (Pg 30- Berman)

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• Evaluates the scientific merit of the study• Decides how the results may be useful in

practice. • Intensive scrutiny

– Strengths and weaknesses– Statistical and clinical significance– Generalizability of the results

Nursing Research Critique

• Evaluates the scientific merit of the study• Decides how the results may be useful in

practice. • Intensive scrutiny

– Strengths and weaknesses– Statistical and clinical significance– Generalizability of the results

Nursing Research Critique

• Polit and Beck – 2005– Elements to be considered in a critique of

quantitative research• Substantive and theoretical dimensions

– Significance of problem– Appropriateness of conceptualizations– Theoretical framework of the study– Congruence of research question and methods used

• Methodologic dimensions– Appropriateness of design– Size and sampling validity and reliability of the

instruments

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• Ethical dimensions– Human rights protected– Any ethical compromise occurred

• Interpretive dimensions– Accuracy of the discussion, conclusions, and

implication of the results– Implication and limitations reviewed– Replication or generalizability of findings

• Presentation and stylistic dimensions– Manner in which results are communicated

Nursing Research Critique