nursing research and evidence based practice

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Question description

1. Read textbook chapters 1, 3, 4 and 6 . After reading the assigned chapters and reviewing the posted content for this week, think about the importance of research and evidence based practice to the profession of nursing.

Think of your own clinical practice - how could research or evidence based practice (EBP) impact your nursing care or the patients you care for? Support your statements with information from the readings and reference.

2. Concepts are the building blocks of nursing research and often seen in the title of a nursing research study. From the following concepts (coping, hope, self-efficacy, health promotion, chronic sorrow, loss, transition, and uncertainty in illness) identify at least 2 concepts that are relevant to the type of patients and families that you care for in practice. Describe why they are important to your practice and/or personally of interest.

PS: This assignment is for discussion board, so there's no word count limitation. Less than 1 page is acceptable. The reviewing content are posted. Thanks.

Knowledge Development in Nursing Strategies for Knowledge Development Found in the Nursing Literature • • • • • • Qualitative Research Quantitative Research Borrowed Theory Borrowed Concept Analysis of a Theory or Concept Synthesis of a Theory or Concept Concepts are the Building Blocks of Knowledge • A concept is a term or label given to phenomenon or group of phenomena (aspects of reality that can be consciously sensed or experienced • Examples: Adherence, Self-Esteem, Hope, Social Support, Courage, Book Concepts • A concept has properties (For example, the properties of a “book”) • There are feelings, values and attitudes associated with the word and with the perception of the thing Concrete to Abstract Concepts • Directly Observable • Height, weight, temperature • Indirectly Observable • Hemoglobin level, cardiovascular fitness • Inferred from Multiple Direct and Indirect observations • Self-Esteem, self-efficacy, wellness Example of Concepts of Concern to Nursing • • • • • • • Coping Hope Loss Social Support Anxiety Fatigue Uncertainty in Illness • • • • • • • • Self-Efficacy Courage Resilience Grief Pain Therapeutic Touch Families Self-Care Concepts are Dynamic • The definition and description of a concept will vary from one theorist to another • The definition, description and meaning of a concept may change over time (Example: “Family” 1950 vs. 2006) • The concept label may change (Example: “Compliance” vs. “Adherence” Theory • Concepts are the building blocks of a theory • A theory is a set of interrelated concepts, definitions, and relational statements and, • Presents a systematic view of essential elements in a field of inquiry by specifying relationships among variables • Theories are dynamic Alexa Stuifbergen PhD, RN, FAAN Promoting Wellness for Women with MS Stuifbergen, Becker, Rogers, Timmerman, & Kullberg (1999) The Journal of Neuroscience Nursing, 31 (2), 73-79. Barriers Resources Health Promoting Behaviors Perceived Health and Well-Being SelfEfficacy Antecedents Health Behaviors Outcomes The Purpose of Theories • To guide practice, research, and education • Provides a language for talking about the nature of nursing practice • Enhances communication Relational Statements (Also Called Propositions) • Relational statements describe how one concept is related to another concept • Found in the theoretical literature • According to Bandura (1997), selfefficacy is the most predictive factor of perseverance in a new behavior Relational Statements can also be Found in Research Studies • There is an inverse relationship between level of disability and selfesteem. • There is a positive relationship between self-efficacy and adherence to wellness behaviors in non-insulin-dependent diabetics. Levels of Theory • Descriptive • Explanatory • Predictive Descriptive Theory • Beginning description in a new area of interest • Describes two or more concepts • Does not specify exactly how concepts are related • Qualitative research often is used to develop new knowledge Explanatory Theory • Explains specific relationships between concepts (positive or inverse) • There is a positive relationship between problem-focused coping and well being (Lazarus & Folkman, 1984) • There is an inverse relationship between level of disability and self-efficacy (Fraser, 2005) Predictive Theory • • • • Predicts relationships between concepts Well developed theory Researched extensively Self-efficacy is the most predictive factor of perseverance in a new behavior (Bandura, 1997) Models in the Nursing Literature Sense of Belonging Hagerty, Lynch-Sauer, Patusky, Bouwsema, and Collier (1992) Antecedents 1. Energy for involvement 2. Desire for meaningful involvement 3. Potential for shared or complimentary characteristics Sense of Belonging 1. Valued involvement 2. Fit Consequences 1. Involvement 2. Attribution of meaningfulness 3. Foundation for emotional and behavioral responses Model of Perceived Uncertainty in Illness (Mishel, 1988) Nola Pender’s Health Promotion Model
Evidence-Based Practice in a Hospital Environment Pamela K Ginex EdD, RN, OCN Nurse Researcher, Center for Evidence-Based Practice and Research Memorial Sloan-Kettering Cancer Center Evidence-Based Practice: What is it?   The conscientious, explicit, and judicious use of current best evidence in making decisions regarding patient care. Practice based on research evidence is more likely to achieve quality patient outcomes. Why Evidence-Based Practice?    Despite an aggressive research agenda, the majority of findings from research are not integrated into practice. It takes approximately 17 years to incorporate findings from research into practice. Without current best evidence, practice becomes rapidly out-of-date to the detriment of patients Thinking Outside the Box    Does what we are doing make theoretical sense? Why are we still doing it? We work in dichotomous silos    Discipline-to-discipline Department-to-department Do not positively impact patient outcomes What is an Evidence-Based Culture?  An EBP culture is    a practice environment that values and provides highlevel evidence-based care based on an organizational commitment to evidence-based nursing practice; and a practice environment that includes partnerships with other disciplines, as needed. Not a destination, but an ongoing journey The Nursing Process and Evidence-Based Practice      Assessment Diagnosis Planning Implementation Evaluation Assessment NURSING PROCESS Assessment ACTIONS EVIDENCE BASED PRACTICE Collects patient data Asking the question ACTIONS Clearly identifies specific patient problems/needs Diagnosis NURSING PROCESS Diagnosis ACTIONS EVIDENCE BASED PRACTICE Analyses assessment Search for evidence data and determines diagnosis ACTIONS Collects information relevant to the identified problem Planning NURSING PROCESS Planning ACTIONS Develops a plan of care EVIDENCE BASED PRACTICE Analyzing the evidence ACTIONS Critically appraises the published literature Implementation NURSING PROCESS Implementation ACTIONS EVIDENCE BASED PRACTICE Initiates the Applying the interventions evidence to practice identified in the plan of care ACTIONS Integrates evidence with clinical expertise Evaluation NURSING PROCESS Evaluation ACTIONS Evaluates the patient’s progress toward attainment of outcomes EVIDENCE BASED PRACTICE Evaluating the effectiveness ACTIONS Evaluates the effectiveness of the integration of evidence EBP Process  Ask the question   Question, background, objectives Search for evidence    Literature search engines Evidence-based practice web sites Experts in the field EBP Process  Analyze the evidence     Apply the evidence to practice     Selection of evidence (critiquing the literature) Levels of evidence Summary of findings Applicability to practice Feasibility Recommendations for practice Evaluate the evidence Asking the Question    Frame the question Describe the background related to the issue What are the specific objectives you want to accomplish? Searching the Evidence   What search strategy should be used to obtain the information? Describe the database/s utilized     Literature Search Engines Evidence-Based Web Sites Organization Web Sites Electronic Journals Analyzing the Evidence     What search criteria were used in the analysis? How were articles selected? What was the level of evidence? What were the main results? Providing Research Evidence for Best Practice Level Definition Level I Evidence from a systematic review or metaanalysis of all relevant randomized control trials (RCT) or evidence-based clinical practice guidelines based on systematic reviews of RCTs Level II Evidence obtained from at least one well designed RCT Level III Evidence obtained from well designed controlled trials without randomization Providing Research Evidence for Best Practice Level Definition Level IV Evidence from well designed case control and cohort studies Level V Evidence from systematic reviews of descriptive and qualitative studies Level VI Evidence from a single descriptive or qualitative study Level VII Evidence from the opinion of authorities and/or reports of expert committees Applying Evidence to Practice  What conclusions can be made as the evidence is applied to nursing practice? Evaluating Practice    What recommendations can be made to evaluate patient outcomes? What metrics are necessary to measure patient outcomes? Need to “close the loop” – evaluate patient outcomes, not just “collect data” Outcomes of Evidence Based Practice    Justification for standards of care Evidence of practice standards for patients, regulatory agencies, third party payors Improved patient outcomes Moving Toward an EvidenceBased Approach to Practice      Practice areas are unique Many standards of practice are shared There needs to be representation from all areas Policy review and all new policies need an evidencebased approach A major organizational commitment and culture change Template for EBP presentations  Use the following slides for your EBP presentation to your peers Question Simply state your question Specific Objectives One or two specific objectives Search Strategies     (example – describe your specific strategy) MEDLINE CINAHL Cochrane Collaboration Sources of Evidence from Literature Search Engines  ____ studies were chosen for review based on the research evidence provided  Briefly describe each study Summary of Evidence  Summarize key points from your review
NUR 350  There are two main types of research – quantitative and qualitative ◦ Quantitative – uses numbers, data to answer a question ◦ Qualitative- uses thoughts and experiences to explore a topic  We’ll discuss each in more detail in a few weeks but for now we’ll review the overall steps involved in each  Number of steps can differ but: ◦ Research always proceeds in an orderly fashion ◦ Research always starts with the identification of the problem and ends with the utilization of the findings           Identify the problem/determine purpose of study Review of the literature/develop framework Formulate hypothesis/research question Define study variables/terms Select research design Identify the population Select the sample Collect data Analyze the results Interpret and communicate the findings  ???????    Start with broad topic area Narrow to specific problem statement Get study problem from ◦ ◦ ◦ ◦ Personal experiences Literature sources Prior research Theory testing  State problem as a question Include population and variables Determine the Purpose  Studies may have one or both   ◦ Difference between purpose and problem ◦ Problem tells what is studied ◦ Purpose tells why study is done       Finds out what exists on the topic Helps look at theory/framework Helps address the study methods Search a variety of sources ◦ ◦ ◦ ◦ Indexes Abstracts Dissertations Computer searches ◦ ◦ ◦ ◦ ◦ Research helps test, develop, refine theories Process assists in selection of study variables Directs the hypothesis and interprets findings Answers the “so what” question(s) Adds to our nursing body of knowledge Continue until time to collect data Develop a Theoretical/Conceptual Framework       Hypothesis predicts relationships between variables Hypothesis provides predicted answer to question Hypothesis contains two types of variables ◦ Independent variable ◦ Dependent variable Hypothesis is testable empirically Types of hypothesis vary Hypothesis mostly in quantitative studies ◦ Directional ◦ Non-directional ◦ The Null hypothesis   They must be clear to the researcher and reader The definitions may be ◦ Dictionary ◦ Theoretical ◦ Operational  The operational definition helps with study replication   Helps determine how study is planned Varies with the type of study conducted ◦ Quantitative vs. Qualitative ◦ Experimental vs. Non-experimental ◦ Experimental may be divided    True experimental Quasi-experimental Pre-experimental Population ◦ Target ◦ Accessible Generalization Select the Sample  A subgroup of the population  It represents the population  It helps with generalization Types of samples  ◦ Probability Samples ◦ Non-probability Samples Voluntary aspect of participation Permission secured and rights protected Data  Pieces of information or facts  Data collection procedures are followed  Questions asked are ◦ ◦ ◦ ◦ ◦ What data? How is it collected? Who collects the data? Where is it collected? When will it be collected? Organize the Data for Analysis  This step is planned from the beginning  It uses the help of a statistician  Decisions are made about missing data    The process is easier now Data is placed into computerized statistical packages Results are analyzed instantaneously Interpret the Findings  Do the data support the research hypothesis?  Do the data not support the research hypothesis?  Problems encountered are discussed  Limitations of the study are presented  Results are compared with other studies  Implications are identified  Recommendations are proposed Communicate the Findings  A very critical component of the process  A variety of ways are used ◦ Journals ◦ Presentations ◦ Posters Utilize the Findings  Recommendations need considerations  Integration into practice are critical components  Researcher may act as a consultant for using findings  Researcher must disseminate findings in many ways    Inductive or open to new ideas and theories Concerned with in-depth descriptions of people or events 4 common approaches ◦ ◦ ◦ ◦ Phenomenology Grounded theory Ethnography Historical        Identify the phenomenon to study Select the research design Review the literature Select the sample Collect the data Analyze the data Communicate the study results    General to more focused Broad statements Purpose statement  Depends on the phenomenon being studied     Debate on when to do this May bias the study results Preferred at the end of the study Tells how results fit with the body of knowledge    Smaller in size No set rules Saturation is more important Also need to gain entry to the research site ◦ IRB approval ◦ Key informants   Begins when the data is collected Content analysis procedures (software programs)

Tutor Answer

School: Purdue University



Nursing Research and Evidence Based Practice




Evidence-based practice is the thoughtful and explicit use of contemporary evidence to
make decisions regarding the care and well-being of patients. In the profession of nursing,
practice based on research and evidence is more efficient at achieving excellent patient
outcomes. This is because; treating patients without basing practice on current evidence means
that they get out...

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