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Chapter 2

Evolution of Research in Building Evidence-based Nursing Practice

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Historical Development of Research in Nursing

Florence Nightingale Evolution of nursing research topics

throughout the 20th century and into the 21st century

Eventual movement toward Evidence-BasedPractice (EBP)

Are there any commonalities that you see among the types of research done over the past 150 years?

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Florence Nightingale

Data collection—gathered data on soldier morbidity and mortality rates

Statistical analysis Instigated attitudinal, organizational, and

social changes

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Nursing Research 1900 to 1950

Research led to advances in nursing education

1940s—trend started that focused on organization/delivery of nursing services

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Nursing Research 1950s and 1960s

ANA initiated research into nursing functions and activities; ANA sponsored research conferences

Educational studies Growing number of clinical studies focused

on quality care and the development of criteria to measure patient outcomes

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Nursing Research 1970s

Focus on nursing process First Nursing Diagnosis Conference held

which has evolved into today’s NANDA-I Studies involving implementation and

outcomes of primary nursing care deliverymodels

Archie Cochrane’s Effectiveness and Efficiency: Random Reflections on HealthServices published

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Nursing Research 1980s and 1990s

Focus on conduct of clinical nursing WICHE and CURN projects launched to

promote the use of research-based nursing interventions in practice

NCNR created to support the conduct of basic and clinical nursing research and the dissemination of findings

Emergence of outcomes research Term evidence-based was first used by David

Eddy in 1990

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Nursing Research 21st Century

Central vision: Conducting quality studies using a variety of methodologies, synthesizing study findings into best research evidence, and using research evidence to guide practice

Strong focus on EBP Focus of healthcare research and funding has

expanded from illness treatment to include health promotion and illness prevention

Key organizations promoting use of research to provide EBP: AHRQ, NINR, and ANA

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Classification of Research Methods for this Course

Quantitative research Qualitative research Outcomes research Intervention research

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Scientific Method

Incorporates all procedures that scientists have used, currently use, or may use in the future to pursue knowledge

Would both quantitative and qualitative studies fall under this umbrella?

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Comparison of Quantitative and Qualitative Research

Quantitative research—a formal, objective, systematic process implemented to obtain numerical data for understanding aspects of the world (currently the predominantly used method of scientific investigation in nursing)

Qualitative research is a systematic, interactive, subjective, holistic approach used to describe life experiences and give them meaning

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Comparison of Quantitative and Qualitative Research (Cont’d)

The problem and purpose to be studied determines the type of research to be conducted

Would you use quantitative or qualitative research to study… whole person’s response to pain? effects of nutritional education on serum lipid

levels?

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Quantitative Research Describes and examines relationships and determines causality among

variables Useful for testing a theory by testing the validity of the relationships that

compose the theory Requires control to identify and limit the problem to be researched and

attempts to limit the effects of extraneous or other variables that are not the focus of the study

Requires the use of structured interviews, questionnaires, or observations; scales; or physiological measures that generate numerical data

Control, instruments, and statistical analyses are used to ensure that the research findings accurately reflect reality so that the study findings can be generalized; generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn

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Quantitative Research Methods

Descriptive: accurate portrayal or account of characteristics of a particular individual, situation, or group

Correlational: systematic investigation of relationships between or among two or more variables that have been identified in theories, observed in practice, or both (nature of relationshipNOT cause-and-effect)

Quasi-experimental: used to identify causal relationships, to examine the significance of causal relationships, to clarify why certain events happened, and for a combination of these objectives

Experimental: objective, systematic, controlled investigation conducted for the purpose of predicting and controlling phenomena (examines causality)

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Qualitative Research

Generates knowledge about meaning through discovery

Inductive and dialectic reasoning are predominant Researchers use observations, interviews, and focus

groups to gather data (interactions are guided but not controlled)

Qualitative data take the form of words and are analyzed according to the qualitative approach that is being used

Findings from a qualitative study are unique to that study, and it is not the researcher’s intent to generalize the findings to a larger population

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Qualitative Research Methods

Phenomenological research: humanistic study of phenomena Grounded theory research: emphasizes interaction,

observation, and development of relationships among concepts; useful for discovering what problems exist in a social setting and the processes people use to handle them

Ethnographic research: research attempts to tell the story of people’s daily lives while describing the culture in which they live

Exploratory-descriptive qualitative research: conducted to address an issue or problem in need of a solution and/or understanding

Historical research: narrative description or analysis of events that occurred in the remote or recent past

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Outcomes Research and Intervention Research

Outcomes research examines the results of care and measures the changes in health status of patients

Intervention research investigates the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in a natural setting

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Best Research Evidence for Practice

What is it? A summary of the highest-quality, current empirical knowledge in a specific area of health care that is developed from a synthesis of quality studies in that area

Who does it? At least two researchers, or even a team of expert researchers and healthcare providers

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Research Evidence Synthesization Processes

Systematic review: structured, comprehensive synthesis of the research literature

Meta-analysis: statistically pooling the results from previous studies (usually quasi-experimental or experimental types) into a single quantitative analysis that provides one of the highest levels of evidence about an intervention’s effectiveness

Meta-synthesis: systematic compiling and integration of qualitative study results to expand understanding and develop a unique interpretation of study findings in a selected area (focus is on interpretation rather than the combining of study results)

Mixed-methods systematic review: synthesizing both quantitative and qualitative studies

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Continuum of Research Evidence

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Continuum of Research Evidence (Cont’d)

Strongest/best research evidence: systematic research reviews and meta-analyses of high-quality experimental studies

Weakest evidence: expert opinions or opinions expressed in committee reports

Best research evidence generated from systematic reviews, meta-analyses, and integrative reviews is used most often to develop standardized or evidence-based guidelines for practice

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Evidence-Based Practice Guidelines

Rigorous, explicit clinical guidelines based on the best research evidence available in that area

Usually developed by a team or panel of expert researchers; expert clinicians; and sometimes consumers, policymakers, and economists

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Sources for Evidence Based Guidelines

National Guideline Clearinghouse (NGC) Cochrane Collaboration and Library The Joanna Briggs Institute Professional nursing organizations