, INTRODUCTION TO
Nursing
Research
Incorporating Evidence-Based Practice
FIFTH EDITION
,© MATJAZ SLANIC/iStock/Getty Images Plus
The Pedagogy
Introduction to Nursing Research: Incorporating Evidence-Based Practice, Fifth
Edition fosters comprehension through various strategies that address the learning
essentials of students while also creating interest in the topic. This collaborative ap-
proach converges distinctive learning styles, making this the critical text to ensure
mastery of strategic concepts. The pedagogical aids that appear in most chapters
incorporate the following:
© MATJAZ SLANIC/iStock/Getty Images Plus
CHAPTER 1
Connection Between
Research and
Evidence-Based Practice
Carol Boswell and Sharon Cannon
Objectives
CHAPTER OBJECTIVES Chapter objectives provide
At the conclusion of this chapter, the learner will be able to: instructors and students with a
1. Translate the essentials for research to ratify evidence-based practice.
2. Define evidence-based practice. snapshot of the key information
3. Indicate impediments to evidence-based research.
4. Distinguish the nurse’s role in evidence-based practice.
5. Interpret how evidence-based practice affects nursing practice.
they will encounter in each
chapter. They serve as a checklist
KEY TERMS to help guide and focus study.
Evidence-based practice (EBP) Research
Obstacle Research process
PICOT Research utilization
Key Terms
▸ Introduction Found in a list at the beginning
The overarching principle for healthcare practice is the provision of quality nurs- of each chapter, these terms
ing care to all clients without consideration of social, financial, cultural, or other
individual characteristics. As the nurse initiates contact with the client, the cli- create an expanded vocabulary.
ent should be confident that the care provided by that nurse is based on the most
current, up-to-date health information available. Having established the currency
of the health information to be utilized, the nurse and client must also agree that
1
, Providing a Line of Reasoning for EBP and Evidence-Based Research 5
advocate for safe and quality health care for all generations and cultures. The incor-
poration of EBP, research, and QI provides the fortification and reinforcement of the
evidence needed to provide effective and efficient health care in multiple settings.
Welton and Harper (2016) champion the idea that the costing of nursing is difficult
on a per-patient basis due to the challenge of measuring quality. This process of
identifying means to showcase the quality efforts of nursing on a per-patient basis is
imperative to advancing the profession of nursing within the current healthcare arena.
These three new developments (ACA, the Carnegie Foundation recommenda-
tion, and the IOM report) require nurses to examine their knowledge; skills; and,
most important, their values about EBP and research. Each of these three develop-
ments has provided further clarification of the expectations for safe, effective care
to every individual encountering healthcare issues. Looking at how to best address
the burdensome aspects of health care through effective utilization of key providers
allows for the successful management of health challenges.
Think Outside the Box THINK OUTSIDE THE BOX
Students can work on these critical thinking
Consider the following four routine activities done by nurses during a typical clinical
day: bowel sounds, turning every 2 hours, nothing by mouth for 8 hours prior to surgery,
and normal oral temperature levels. Carefully consider what evidence was used in your
assignments individually or in a group while institution as the foundation for these tasks. Are the skills for the tasks in your practice
setting based on research, personal preferences, clinical guidelines, or traditions?
reading through the text.
The practicing nurse has to value the ideas of the EBP process, research, and
QI to facilitate its complete incorporation and implementation. Nurses must under-
stand the value of integrating carefully analyzed results from research, QI, and other
sources with personal experiences and client values when determining the treat-
ment plan that best addresses a situation’s identified challenges. Even when health-
care providers utilize the most advantageous evidence accessible, each engagement
with an individual continues to be distinctive. The treatments and outcomes will
change based on the uniqueness of the client’s values, preferences, interests, and/or
diagnoses. According to Fonteyn (2005), nurses who are involved with EBP tend to
demonstrate increased critical thinking skills along with implementation of research
outcomes. Saunders and Vehviläinen-Julkunen (2016) ascertained that “nurses
worldwide state they are familiar with, have positive attitudes toward, and believe
in the value of EBP in improving care quality and patient outcomes, nurses per-
ceive their own EBP knowledge and skills insufficient for employing EBP, and do not
use best evidence in practice” (p. 129). Nurses are taught, encouraged, and expected
to think critically. This process of critical thinking corresponds to the use of EBP
on clinical units and in primary care settings. Critical thinking embraces the need
for health care to be based on a foundation of proven research and other tested data
while including the client’s perspective. The use of unconfirmed reports, hearsay,
and unfounded information, combined with a lack of client input, does not fit with
the provision of sound, quality nursing care at this point in time. The evolution of
EBP has moved the focus of client-centered care to the forefront of nursing care.
Fineout-Overholt and Melnyk (2005) state that continuous opportunities for
learning EBP must be given to providers to enhance and sharpen EBP skills for
Summary Points 25
Summary Points
1. Current national legislation and reports continue to have an impact on the
importance of EBP and research utilization.
2. A core body of nursing knowledge stems from the process in which research
is incorporated into practice; this strategy has been called best practice, qual-
ity of care, and EBP.
3. EBP is a process of utilizing confirmed evidence (research and quality im-
provement), decision making, and nursing expertise to guide the delivery of
holistic patient care.
4. The PICOT acronym offers a structure for rendering dynamic, clinical ques-
tions to construct scientific questions.
5. Obstacles to research utilization are education, beliefs/attitudes, support/re-
sources, lack of time, and lack of mentoring.
6. Generating evidence augments the core of nursing knowledge, which ad-
vances nursing as a profession.
7. The combination of nursing practice and research is central to advancing EBP.
8. Safe, effective patient care is not an extravagance but rather an obligation.
Red Flags
At the end of every chapter, these bullet points
RED FLAGS alert students to areas in research that may raise
■ Within the documentation of a research project, specific decisions concerning the concern.
planning and implementation of the process must be defended by rationales. In
EBP, randomized controlled trials are viewed as one of the most powerful types of
evidence. As a result, some research characteristics are viewed as stronger designs
(quantitative, experimental, and randomized sampling) than other facets of the pro-
cess. In this text, the categorization of a red flag will reflect features of the research
project that need to be examined carefully to determine the quality of the process
employed. These areas are not strictly forbidden within research but rather are points
that need to be taken into consideration. Within the documentation, these aspects
should be corroborated by rationales reflecting the thought process utilized for
those pieces.
■ When an individual is appraising an article for inclusion in an EBP situation and/or
policy and procedure rationale, the presence of red flags should be seen as a gate-
way to consider the justification for the decisions made by the research team. If the
research team has provided sufficient justification for each of the research decisions, a
study characterized by red flags can still be a strong study. The documentation of the
research report by a researcher is a process of validation and justification of the vari-
ous judgments made during the planning, implementation, and analysis processes.
The researcher has the responsibility to document the validation for the decisions
incorporated into the study such as ethics, sampling, design, and data collection.
■ Red flags are areas within the documentation of the study that raise concerns. These
areas are not items that should never be done but rather are items that should be
supported by sound, clear rationales as to why the researcher used the research
components.
Nursing
Research
Incorporating Evidence-Based Practice
FIFTH EDITION
,© MATJAZ SLANIC/iStock/Getty Images Plus
The Pedagogy
Introduction to Nursing Research: Incorporating Evidence-Based Practice, Fifth
Edition fosters comprehension through various strategies that address the learning
essentials of students while also creating interest in the topic. This collaborative ap-
proach converges distinctive learning styles, making this the critical text to ensure
mastery of strategic concepts. The pedagogical aids that appear in most chapters
incorporate the following:
© MATJAZ SLANIC/iStock/Getty Images Plus
CHAPTER 1
Connection Between
Research and
Evidence-Based Practice
Carol Boswell and Sharon Cannon
Objectives
CHAPTER OBJECTIVES Chapter objectives provide
At the conclusion of this chapter, the learner will be able to: instructors and students with a
1. Translate the essentials for research to ratify evidence-based practice.
2. Define evidence-based practice. snapshot of the key information
3. Indicate impediments to evidence-based research.
4. Distinguish the nurse’s role in evidence-based practice.
5. Interpret how evidence-based practice affects nursing practice.
they will encounter in each
chapter. They serve as a checklist
KEY TERMS to help guide and focus study.
Evidence-based practice (EBP) Research
Obstacle Research process
PICOT Research utilization
Key Terms
▸ Introduction Found in a list at the beginning
The overarching principle for healthcare practice is the provision of quality nurs- of each chapter, these terms
ing care to all clients without consideration of social, financial, cultural, or other
individual characteristics. As the nurse initiates contact with the client, the cli- create an expanded vocabulary.
ent should be confident that the care provided by that nurse is based on the most
current, up-to-date health information available. Having established the currency
of the health information to be utilized, the nurse and client must also agree that
1
, Providing a Line of Reasoning for EBP and Evidence-Based Research 5
advocate for safe and quality health care for all generations and cultures. The incor-
poration of EBP, research, and QI provides the fortification and reinforcement of the
evidence needed to provide effective and efficient health care in multiple settings.
Welton and Harper (2016) champion the idea that the costing of nursing is difficult
on a per-patient basis due to the challenge of measuring quality. This process of
identifying means to showcase the quality efforts of nursing on a per-patient basis is
imperative to advancing the profession of nursing within the current healthcare arena.
These three new developments (ACA, the Carnegie Foundation recommenda-
tion, and the IOM report) require nurses to examine their knowledge; skills; and,
most important, their values about EBP and research. Each of these three develop-
ments has provided further clarification of the expectations for safe, effective care
to every individual encountering healthcare issues. Looking at how to best address
the burdensome aspects of health care through effective utilization of key providers
allows for the successful management of health challenges.
Think Outside the Box THINK OUTSIDE THE BOX
Students can work on these critical thinking
Consider the following four routine activities done by nurses during a typical clinical
day: bowel sounds, turning every 2 hours, nothing by mouth for 8 hours prior to surgery,
and normal oral temperature levels. Carefully consider what evidence was used in your
assignments individually or in a group while institution as the foundation for these tasks. Are the skills for the tasks in your practice
setting based on research, personal preferences, clinical guidelines, or traditions?
reading through the text.
The practicing nurse has to value the ideas of the EBP process, research, and
QI to facilitate its complete incorporation and implementation. Nurses must under-
stand the value of integrating carefully analyzed results from research, QI, and other
sources with personal experiences and client values when determining the treat-
ment plan that best addresses a situation’s identified challenges. Even when health-
care providers utilize the most advantageous evidence accessible, each engagement
with an individual continues to be distinctive. The treatments and outcomes will
change based on the uniqueness of the client’s values, preferences, interests, and/or
diagnoses. According to Fonteyn (2005), nurses who are involved with EBP tend to
demonstrate increased critical thinking skills along with implementation of research
outcomes. Saunders and Vehviläinen-Julkunen (2016) ascertained that “nurses
worldwide state they are familiar with, have positive attitudes toward, and believe
in the value of EBP in improving care quality and patient outcomes, nurses per-
ceive their own EBP knowledge and skills insufficient for employing EBP, and do not
use best evidence in practice” (p. 129). Nurses are taught, encouraged, and expected
to think critically. This process of critical thinking corresponds to the use of EBP
on clinical units and in primary care settings. Critical thinking embraces the need
for health care to be based on a foundation of proven research and other tested data
while including the client’s perspective. The use of unconfirmed reports, hearsay,
and unfounded information, combined with a lack of client input, does not fit with
the provision of sound, quality nursing care at this point in time. The evolution of
EBP has moved the focus of client-centered care to the forefront of nursing care.
Fineout-Overholt and Melnyk (2005) state that continuous opportunities for
learning EBP must be given to providers to enhance and sharpen EBP skills for
Summary Points 25
Summary Points
1. Current national legislation and reports continue to have an impact on the
importance of EBP and research utilization.
2. A core body of nursing knowledge stems from the process in which research
is incorporated into practice; this strategy has been called best practice, qual-
ity of care, and EBP.
3. EBP is a process of utilizing confirmed evidence (research and quality im-
provement), decision making, and nursing expertise to guide the delivery of
holistic patient care.
4. The PICOT acronym offers a structure for rendering dynamic, clinical ques-
tions to construct scientific questions.
5. Obstacles to research utilization are education, beliefs/attitudes, support/re-
sources, lack of time, and lack of mentoring.
6. Generating evidence augments the core of nursing knowledge, which ad-
vances nursing as a profession.
7. The combination of nursing practice and research is central to advancing EBP.
8. Safe, effective patient care is not an extravagance but rather an obligation.
Red Flags
At the end of every chapter, these bullet points
RED FLAGS alert students to areas in research that may raise
■ Within the documentation of a research project, specific decisions concerning the concern.
planning and implementation of the process must be defended by rationales. In
EBP, randomized controlled trials are viewed as one of the most powerful types of
evidence. As a result, some research characteristics are viewed as stronger designs
(quantitative, experimental, and randomized sampling) than other facets of the pro-
cess. In this text, the categorization of a red flag will reflect features of the research
project that need to be examined carefully to determine the quality of the process
employed. These areas are not strictly forbidden within research but rather are points
that need to be taken into consideration. Within the documentation, these aspects
should be corroborated by rationales reflecting the thought process utilized for
those pieces.
■ When an individual is appraising an article for inclusion in an EBP situation and/or
policy and procedure rationale, the presence of red flags should be seen as a gate-
way to consider the justification for the decisions made by the research team. If the
research team has provided sufficient justification for each of the research decisions, a
study characterized by red flags can still be a strong study. The documentation of the
research report by a researcher is a process of validation and justification of the vari-
ous judgments made during the planning, implementation, and analysis processes.
The researcher has the responsibility to document the validation for the decisions
incorporated into the study such as ethics, sampling, design, and data collection.
■ Red flags are areas within the documentation of the study that raise concerns. These
areas are not items that should never be done but rather are items that should be
supported by sound, clear rationales as to why the researcher used the research
components.
