Hlten514 b research

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HLTEN514BApply Research Skills Within a Contemporary Health Environment

www.tastafe.tas.edu.au


Topic 1 – An Overview

What is research?Where does knowledge come

from?Language of research

Types of researchApplication to practice


What is Research?“Systematic process using both inductive and deductive reasoning to confirm and refine existing knowledge and to build new knowledge” (Borbasi, Jackson & Langford, 2004, pp.68)


Where does knowledge come from?

• Over the years, knowledge has been gained from many sources

• Some reliable• Some not so reliable and bring risk


Sources of Knowledge

Tradition and Custom- Passed on from generation to generation- Reflects our culture and heritage

For example: As nurses we provide daily linen changes and bathing. Why?We traditionally take patients’ obs each shift. Why?



Authority- Reliance on individuals as ‘experts’- Information obtained from text books and

perhaps teachers?

How can you ensure this information is correct?



Trial and Error- Uses successive numbers of alternative

solutions.- Often used when we have no reference to

draw upon.

What are the weaknesses of this approach?



Personal Experience- First-hand knowledge- Often hard to translate or explain to others

who have no similar experience.

Novice Advanced Beginner CompetentProficient Expert



Intuition- ‘hunch’ or ‘gut feeling’- Closely tied to personal experience- Perceptual awareness


Sources of KnowledgeReasoning- Use of logical thought pattern- Inductive reasoning: starts with facts and builds a larger picture- Deductive reasoning: starts with the big picture and breaks down into smaller parts.


Why do we need to do it?– Critical appraisal– Provide quality care based on facts– Legal accountability for practice– Latest & best practice to improve outcomes– Link theory, education & practice – Cost effective care – Improve decision making, prioritising & organising nursing care


Evolution of nursing research

1854 Florence Nightingaleimplementing sanitary reforms – considered to be the first nursing study.

Slow start – next research 1940’s!60’s and 70’s advance degrees increased a push for PhD1970’s two new nursing journals – research explosion!1980’s in Aust and NZ – Nursing moved into tertiary education sector


Nursing Research

Some examples of nursing researchWound HealingPressure relieving devices for ulcersClient informationNutritional support for elderlyUrinary incontinenceHypothermia in ORPainAnd many more


The Language of Research

• Research has its own language• Some common terms are explained

in the following slides



Efficacy- The ability of an intervention to produce

beneficial results that it is intended to deliver within a research study.www.bidmc.org/YourHealth/HealthResearchJournals.aspx

Abstract- A brief, comprehensive summary of a study.(Elliott & Burr, 2000, pp.574)

http://www.bidmc.org/YourHealth/HealthResearchJournals.aspx



Validity- Is the research providing answers to the

research questions for which is was undertaken?

- If so, is it providing these answers using appropriate methods and procedures?

(Kumar, 1996, pp.137)



Reliability- Is the research tool reliable, i.e. consistent,

stable, predictable and accurate?(Kumar, 1996, p.140)

Bias- A distortion in the data analysis results.(Elliott & Burr, 2000, pp. 575)



Dissemination- The communication of research findings. E.g.

publication of research papers, presentations at conferences etc.

Hypothesis- A predication about the relationship between

two or more variables.

Variable- A defined concept(Elliott & Burr, 2000, pp. 575)



• Methodology

• Control

• Randomisation


Types of Research

There are three main types of research• Quantitative – objective, about

numbers• Qualitative – subjective, about

feelings and experiences• Mixed Method – a mixture of both the

above

• Each type has varying methods


Types of Research

Quantitative- A systematic process used to gather and

statistically analyse information that has been measured by an instrument and converted into numerical data.

- Considered by many to be the truest form of research

Qualitative- Reality is subjective, multifaceted rather than a

single, fixed, objective, actuality.- Investigates feelings and experiences


Mixed Method Research

• Combination of quantitative and qualitative date collection methods

• Seeks to build on the strengths and weakness of both methods

• Gaining in popularity• It’s use is widely debated

(Andrew S, and Halcomb E 2008 “Mixed Method Research” in Borbasi S, Jackson D and Langford R Navigating the Maze of Nursing Research 2e. Mosby Elsevier)


What is Evidence Based Practice?• Basing (in the case of nursing)

clinical practice, on solid evidence found through a deliberate collection of research on any given topic.

• Policy and procedure should be based on evidence gained through reliable and valid research, not on trial and error, cultural practice or any other method through which knowledge is gained.


Evidenced Based Practice - EBP

- Applying the most current research based evidence in making decisions about patient care.

- Conscientious integration of best research, clinical expertise, patient values, preferences and needs to provide quality, cost effective health care.

- Allows a streamlined and structured way of keeping abreast of new research developments without the overload.


Evidenced Based Practice - EBP

• Clinical Expertise• Expert Panels,

Leaders

Best available Evidence

Patient preferences & values

Evidence Based Clinical Decision Making

= Practice


Evidence Based Practice - EBP

Benefits of EBPPatients & consumersNursesHealth care organisationsCommunity

Provide care that is supported by facts, than myths, rituals or habitsLegally accountable for practice


Evidence Based Practice

• There are centres that collect, collaborate and disseminate research findings

• The task is too large for an individual on many topics

• Facilities then adopt EBP in to policy and procedure

• Can take many years from research to changing practice



Five steps to EBP1. Ask the question2. Collect best & relevant evidence3. Critically appraise the evidence4. Integrate that evidence with clinical

expertise, patient values & preferences in making change or decisions

5. Evaluate the decisions or change

Melnyk & Fineout-Overholt, 2005, pg 9



Evidence can be foundCINAHL (Cumulative Index to Nursing & the Allied Health Literature) MedlineThe Cochrane LibraryMeditextConference PapersJoanna Briggs Institute (JBI)


How is research utilised in practice

Research based policy, procedure and clinical practice guidelines

Barriers to implementation of EBPResistance to changeInsufficient time and resources to implement change to practiceLack of supportive infrastructureLack of research skills – inability to critique


Research and the EN

“a professional nurse interprets, evaluates and determines the credibility of research findings …..(in order to) promote the integration of research and clinical practice”.

(Beanland & Scneider, 2000, pp.7)


Research and the EN

• All nurses must base their practice on the best available evidence

• ANMC competencies refer to practice based on evidence

• Requirement of annual PD


References

(Andrew S, and Halcomb E 2008 “Mixed Method Research” in Borbasi S, Jackson D and Langford R Navigating the Maze of Nursing Research 2e. Mosby Elsevier)

Beanland, C., Schneider, Z., LoBiondo-Wood, G., Haber, J. (1999). Nursing Research: Methods, Critical Appraisal and Utilisation. Artamon: Mosby.

Borbasi, S., Jackson, D., Langford, R. (2004). Navigating the Maze of Nursing Research. Marrickville: Mosby.

Burns, N., & Grove, S. (1995). Understanding Nursing Research. Pennsylvania: W.B. Saunders Company.


References

Crotty, M. (1998). The Foundations of Social Research: Meaning and Perspective in the Research Process. St Leonards: Allen & Unwin.

Daly, J., Kellehear, A., Gliksman, M. (1997). The Public Health Researcher: A Methodological Guide. South Melbourne: Oxford University Press.

Elliott, D., & Burr, G. (2000). Study Guide to Accompany Nursing Research: Methods, Critical Appraisal and Utilisation. Marrickville: Mosby.


References

Kumar, R. (1996). Research Methodology: A step-by-step guide for beginners. South Melbourne: Addison Wesley Longman.

Peace, S. (1990). Researching Social Gerontology: Concepts, Methods and Issues. SAGE Publications: London.

Punch, K. (1998). Introduction to Social Research: Quantitative & Qualitative Approaches. SAGE Publications: London.


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Hlten514 b research

Health & Medicine

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