NURS 350 Week 1 Discussion Research in Nursing
NURS 350 Week 1 Discussion Research in Nursing
NURS 350 Week 1 Discussion Research in Nursing
DQ1 How does the focus of research and evidence-based practice (EBP) differ? Discuss the application of research findings into evidence-based nursing practice.
DQ2 Provide a specific example of evidence-based practice used in your work facility or within the nursing profession. Were there any challenges or barriers to implementing the evidence-based practice? If so, how were they overcome?
esearch, evidence-based practice (EBP), and quality improvement support the three main goals of the Magnet Recognition Program® and the Magnet Model component of new knowledge, innovation, and improvements. The three main goals of the Magnet Recognition Program are to: 1) Promote quality in a setting that supports professional practice 2) Identify excellence in the delivery of nursing services to patients or residents 2) Disseminate best practices in nursing services.
The Magnet Model includes five components:
- transformational leadership
- structural empowerment
- exemplary professional practice
- new knowledge, innovation, and improvements
- empirical quality outcomes.
To achieve the goals of the Magnet Recognition Program and the “new knowledge innovation and improvements” component of the Magnet Model, nurses at all levels of healthcare organizations must be involved. Many nurses may be unaware of the importance of their contributions to developing new knowledge, innovations, and improvements and may not be able to differentiate among those processes. This article explains the basic differences among research, EBP, and quality improvement (QI.) (See PDF link: Comparing research, evidence-based practice, and quality improvement.)
Understanding research
The purpose of conducting research is to generate new knowledge or to validate existing knowledge based on a theory. Research studies involve systematic, scientific inquiry to answer specific research questions or test hypotheses using disciplined, rigorous methods. While research is about investigation, exploration, and discovery, it also requires an understanding of the philosophy of science. For research results to be considered reliable and valid, researchers must use the scientific method in orderly, sequential steps.
The process begins with burning (compelling) questions about a particular phenomenon, such as: What do we know about the phenomenon? What evidence has been developed and reported? What gaps exist in the knowledge base?
The first part of investigation involves a systematic, comprehensive review of the literature to answer those questions. Identified knowledge gaps typically provide the impetus for developing a specific research question (or questions), a hypothesis or hypotheses, or both. Next, a decision can be made on the underlying theory that will guide the study and aid selection of type of method to be used to explore the phenomenon.
The two main study methods are quantitative (numeric) and qualitative (verbal), although mixed methods using both are growing. Quantitative studies tend to explore relationships among a set of variables related to the phenomenon, whereas qualitative studies seek to understand the deeper meaning of the involved variables.
- Quantitative studies typically involve scientific methodology to determine appropriate sample size, various designs to control for potential errors during data collection, and rigorous statistical analysis of the data.
- Qualitative studies tend to explore life experiences to give them meaning.
In all research, discovery occurs as data are collected and analyzed and results and outcomes are interpreted.
A final important step in the research process is publication of study results with a description of how they contribute to the body of knowledge. Examples of potential nursing research include conducting a systematic review of studies on preventing catheter-associated urinary tract infections (CAUTI), a randomized controlled trial exploring new wound care methods, and a qualitative study to investigate the lived experiences of patients with a specific chronic disease.
Understanding EBP
Unlike research, EBP isn’t about developing new knowledge or validating existing knowledge. It’s about translating the evidence and applying it to clinical decision-making. The purpose of EBP is to use the best evidence available to make patient-care decisions. Most of the best evidence stems from research. But EBP goes beyond research use and includes clinical expertise as well as patient preferences and values. The use of EBP takes into consideration that sometimes the best evidence is that of opinion leaders and experts, even though no definitive knowledge from research results exists. Whereas research is about developing new knowledge, EBP involves innovation in terms of finding and translating the best evidence into clinical practice.
Steps in the EBP process
The EBP process has seven critical steps:
1. Cultivate a spirit of inquiry.
2. Ask a burning clinical question.
3. Collect the most relevant and best evidence.
4. Critically appraise the evidence.
5. Integrate evidence with clinical expertise, patient preferences, and values in making a practice decision or change.
6. Evaluate the practice decision or change.
7. Disseminate EBP results.
Cultivating a spirit of inquiry means that individually or collectively, nurses should always be asking questions about how to improve healthcare delivery. The burning clinical question commonly is triggered through either a problem focus or a knowledge focus. Problem-focused triggers may arise from identifying a clinical problem or from such areas as risk management, finance, or quality improvement. Knowledge-focused triggers may come from new research results or other literature findings, new philosophies of care, or new regulations.
Regardless of the origin, the next step in the EBP process is to review and appraise the literature. Whereas a literature review for research involves identifying gaps in knowledge, a literature review in EBP is done to find the best current evidence.
Hierarchy of evidence
In searching for the best available evidence, nurses must understand that a hierarchy exists with regard to the level and strength of evidence. All of the various hierarchies of evidence are similar to some degree.
- The highest (strongest) level of evidence typically comes from a systematic review, a meta-analysis, or an established evidence-based clinical practice guideline based on a systematic review.
- Other levels of evidence come from randomized controlled trials (RCTs), other types of quantitative studies, qualitative studies, and expert opinion and analyses.
Critical appraisal
Once the evidence is gathered, the researcher must critically appraise each study to ensure its credibility and clinical significance. Critical appraisal often is thought to be tedious and time-consuming. But it’s crucial to determine not only what was done and how, but how well it was done. An easy method for conducting critical appraisal is to answer these three key questions:
- What were the results of the study? (In other words, what is the evidence?)
- How valid are the results? (Can they be trusted?)
- Will the results be helpful in caring for other patients? (Are they transferable?)