The Research Process
M1: Lesson 3 – Discussion
- Create an original posting with a minimum of 250-300 words.
- Back up your arguments with reliable evidence.
The Research Process
Instructions:
- Read an article published recently(less than 5 years) on a topic of your interest. (in nursing)
- Provide the citation and a written summary of your answers to the following questions:
- What is the research problem?
- What is the purpose statement?
- What were the initial hypotheses for this study?
- What was the study design?
- Where the hypotheses rejected or accepted?
- What was the overall conclusion of this study?Objectives To introduce you to:
1. key principles and processes of evidence based nursing including strategies and resources to promote evidence based practice.
2. Feel more comfortable with Evidence Based and Research concepts. 3. Understand key concepts in the research methodology . 4. Understand why EBP is essential for healthcare providers. 5. Find reliable resources for EBP.
From Expert Opinion to Best Practice Guidelines
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Healthcare delivery is filled with uncertainty and many questions arise due to rapid changes in clinical practice.
What are the “questions”
Which patient symptoms predict better or worse outcomes? Which treatment is most effective and will produce the best patient outcome? Which patient position is most effective after a hand burn injury?
Evidence based practice is one approach that may enable nurses to manage the explosion of new literature and technology. EBP provides opportunities for clinicians to ensure that clinical techniques and strategies they are using provide the best outcomes for patients and families in the form of Clinical Protocols, policies, standards and procedures. It also allows nurses to be the best advocates for patients when arguing for length of stay or equipment resources based on research
evidence.
From Concept Analysis to Quantitative and Qualitative Research for Evidence Based Care
Evidence-based practice facilitates the integration of internal evidence (i.e., quality and outcome data), external evidence (i.e., research) and practice across multiple settings to improve patient, families, provider, community, and system outcomes.
Research Research is an organized systematic inquire to find answers to questions. Research involves the process of collecting and analyzing information (data) in order to increase our understanding of the phenomenon with which we are concerned or interested. Research uses various approaches (qualitative and quantitative methods) to answer questions and solve problems.
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Scientific method
The Scientific Method involves a series of steps that are used to investigate.
The scientific method involves selecting and defining a problem, formulating research question(s) or hypotheses or both, reviewing the literature, collecting data, analyzing data, and reporting results. Unique to the scientific method are objectivity and the use of empirical data. Why must we understand research?
Knowledge obtained from sound research is transformed into clinical practice, leading to nursing practice that is evidence-based. To help make informed decisions. Research Methods
The systematic approach to collect and analyze data for acquiring trustworthy knowledge via reliable and valid procedures. Basic research, also called pure research, is concerned with generating new knowledge; applied research seeks solutions to immediate problems. Translational Research
Translational research: translates basic science discoveries into clinical applications, and/or uses clinical observations to generate new research topics.
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Why EBP?
Previous Recommendations Rational The Empirical Research Showed
that it was wrong
Put babies in the front when they go to sleep when they are sleeping
If they should vomit in their sleep, they may swallow the vomit into their lungs and develop pneumonia
Observational data have show that babies are more likely to die of Suden Infant Death Syndrome (SIDS) if they lie in their fronts
Bed rest after a myocardial infarct The heart needs resting after an insult in which some of the muscle dies
Randomized controlled trials showed that bed rest makes thromboembolism much more likely
Covering wounds after the removal of skin cancer
To prevent bacteria gaining access and therefore causing infection
A randomized controlled trial showed that leaving the skin wounds open does not increase the infection rate
Define EBP What is and What is Not?
The cookbook recipe theory of EBP Guidelines based on the best available evidence do not mean that the practitioner has an edict to practice in a single way. The EBP approach requires that health practitioners integrate and take in consideration three areas of knowledge when making clinical decisions: best research evidence , clinical expertise and patient values (Sackett, Straus, Richardson, Rosenberg & Haynes, 2000). Evidence-based nursing practice or the use of best practices – “integration of the best evidence available, nursing expertise, and the values and preferences of individuals, families and communities who are served” (Sigma Theta Tau International, 2004, p. 69) However, some practitioners have expressed apprehension about the use of evidence based practice, concerned that EBP is just “cookbook” medicine.
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Evidence-based practice is not clinical problem solving
While evidence-based practice is a mechanism for solving clinical problems and making decisions about interventions, it is distinct from traditional problem-solving approaches in health care. EBP is not a collection of statistical summaries, ignoring patient preferences and clinical expertise. EBP does more than just identify research, it integrates the best possible evidence with individualized patient care. Clinicians using evidence based practice do not simply “follow a recipe”, but use their own clinical experience and apply the evidence to the specific clinical situation.
Is evidence-based practice the same as guidelines?
No, guidelines are one way that EBP can help to get the best available evidence into clinical practice, but they are by no means the only way.
Is evidence-based practice the same as randomized controlled trials? No, although randomized controlled trials are the cornerstone of research investigating whether interventions work. However, not all questions are interventions, and the may require a different type of research design (qualitative research , case control studies, cross sectional studies and cohort studies).
Who is paying attention to EBP? IOM Study in 2001 called for a bridge to cross the “quality chasm” between research and practice Bridging the gap between knowledge and care
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Evidence Based Practice Definition
The Institute of Medicine defines evidence-based practice (EBP) as “the integration of best research, clinical expertise, and patient values in making decisions about the care of individualized patients” EBP is a problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences and a clinician’s expertise in making decisions about patient care (Melnyk & Fineout-Overholt, 2005)
“Integration of the best evidence available, nursing expertise, and the values and preferences of individuals, families and communities who are served” (Sigma Theta Tau International Evidence-Based Nursing Position Statement, 2005)
Reality
Can take up to 17 years before significant research findings are implemented into clinical practice (Nalas & Boren, 2000). Even once evidence is widespread, providers still made decisions based on habit rather than the evidence.
Why Practice EBP? Clinical intuition versus EBP
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The primary purpose of evidence-based interventions is to close the gap between research and clinical practice and to maximize functional outcome. EPB does not compel clinicians to ignore their experience and clinical intuition, or the patient’s needs. Instead, it requires clinicians to become more systematic and consistent in how they use information. Outcomes research has documented that patients who do receive evidence- based therapies have better outcomes than those who don’t. Although we need new evidence almost daily, we usually fail to get it.
So, why should we even consider evidence-based practice?
Nursing is an applied science and the practice of nursing should be grounded in science. EBP promotes an attitude of inquiry and get us thinking about questions: Why am I doing
this in this way? Is there evidence that can guide me to do this in a more effective way? Enhance Professional Environment: Nurses patient, the professional nurse, and the organization want to work in an environment where everyone is doing what has been proven effective for enhancement of patient outcomes.
However, what is the significance of EBP in your professional career? With EBP you will:
Questioning what you see in practice Seeking additional knowledge when care protocols seem less than effective
Reading and understanding research articles in clinical journals Participating in evidence-based quality improvement projects on your unit or in your agency
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Adopting evidence-based protocols when they are introduced into your work setting
Quality Care and Positive Patient Outcomes: You want the best for your patients by providing quality care.
Cost containment: organizations in which patient care is provided are always looking at the financial side of patient care. EBP plays an important role in ensuring that health resources are use wisely and that relevant evidence is considered when decisions are made about funding health services.
5 Steps to EBP
ASK: the burning clinical
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ASK: the burning clinical question Access: the most relevant and best evidence
Appraise: Critically appraise the evidence for its validity and usefulness Apply: Integrate all evidence with one’s clinical expertise, patient preferences, and values in making a practice decision or change Assess: Evaluate the practice decision or change
What are Evidence Based Best Practices? Can sometimes be used to describe guidelines or practices driven more by clinical wisdom, guild organizations, or other consensus approaches that do not include systematic use of available research evidence. Best practices may include environmental and relationship, clinical and programmatic factors that by themselves do not constitute a therapy or intervention
Examples of best practices professional Associations Click on one or more of the links below for examples Academic Center for Evidence-Based Practice (ACE) at the University of Texas Health Science Center at San Antonio
The Academic Center for Evidence-Based Practice (ACE) is dedicated to bridging research into practice. American Association of Oncology Nurse (ONS) This website provides detailed evidence information for current PEP nurse- sensitive patient outcomes or topic areas. Levels of evidence are provided for all the interventions identified. Currently, 16 conditions/topics pertinent to cancer nursing care are included on the website.
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Register Nurses Association of Ontario (RNAO) This site contains almost 50 guidelines, plus a Toolkit and Educator Resources to support implementation of guidelines. It is sponsored by the Registered Nurse Association of Ontario. The site includes many topics such as pain, diabetic foot ulcers, adult asthma, pressure ulcers, breastfeeding, delirium, end-of-life care, smoking cessation, post-partum depression, dyspnea, ostomy care, fall prevention, restraint use, establishing therapeutic relationships among others.
University of Iowa College of Nursing Hartford Center of Geriatric Nursing Excellence – Evidence-based Practice Guideline This academic center produces clinical practice guidelines specific to older adults, in addition to quick reference guides and consumer information sheets that accompany most of the guidelines. The most recently updated CPGs are: Hydration management (2011), Improving Medication Management in Older Adult Clients (2012), and Oral Hygiene Care for Functionally dependent and Cognitively Impaired Older Adults (2011). Joanna Briggs Best Critical Appraisal Tools
Summary information on best practice guidelines by the Joanna Briggs Institute of Australia. The appraisal tools are free and accesible . Nurse Family Partnership Intensive home visitation to promote health and welfare of parents and children. EBP supports improved pregnancy outcomes, improved child health and well being and increases economic self-sufficiency.
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