NUR 432 Nursing Research verified questions and answers

Empirical Data Documented evidence (data) gathered through direct observation rather than a researcher's subjective belief. Nursing Research A systematic process of investigating problems to gain knowledge about improving care that nurses provide. Nursing Science The body of knowledge that is unique to the discipline of nursing. Qualitative research An approach for generating knowledge using methods of inquiry that emphasize subjectivity and the meaning of an experience for the individual. Ex. Interviews Quantitative research An approach for generating knowledge based on determining how much of a given behavior, characteristic or phenomenon is present. Ex. Measurements, testing hypotheses, and statistical analysis of data. Replication The ability of researchers to repeat a study using the same variables and methods or slight variations of them. This increases the extent to which the findings can be generalized, providing additional evidence of validity. Research Consumer A reader of nursing research whose objective is applying findings to nursing practice or using the findings to conduct further research Research team A group that collaborates to conduct a research project, from determining the initial research question through communicating the results. Rigor Striving for excellence in research, which involves discipline, scrupulous adherence to detail, and strict accuracy. Scientific Inquiry The process of critically analyzing data that have been gathered systematically about a particular phenomenon. Scientific Method A systematic research process that involves the following steps: Selecting and defining the problem Formulating research questions or hypotheses or both. Collecting data Analyzing data Reporting results Triangulation =Use of quantitative and qualitative methods to collect data about a particular phenomenon Ways of Knowing An assortment of methods used to acquire new knowledge, including tradition, authority, trial and error, intuition, logical reasoning, and use of the scientific method. Evidence Based Practice "Clinical decisions" and "actions based on research findings" mean that nurses engage in evidence based practice. Integrate research findings into clinical thinking and decision making Helps to improve the practice of nursing. Research and the Entry Level Nurse Reads, understands, interprets, and applies research findings. Understands the basics of EBP Works with others to identify potential nursing research problems that need to be investigated. Collaborates on research teams. Shares research findings with colleagues. Master's Degree in Nursing Evaluated research findings Develop and implement EBP guidelines Identify practice and systems problems requiring study. Collaborate and assist others in initiating research. Doctoral Degree in Nursing Focus more on evaluating research findings and starting advanced programs based on them. Focuses on incorporating research into practice National Institute of Nursing Research (NINR) Originally launched in 1986 as the National Center for Nursing Research (NCNR) and awarded institute status by NIH in 1993 Conducts program of grants and awards supporting nursing research and training Promotes health Furthers prevention and mitigation of the effects of disease The Quality and Safety Education for Nurses (QSEN) An initiative focused on developing the requisite knowledge, skills, and attitude (KSA) statements for each of the competencies for pre-licensure and graduate education. Can you identify the PICO Question : Research Population Intervention Comparisons Desired Outcome Identify the Research Population, Intervention, Comparisons, and Desired Outcome (i.e. the PICO Question) P — patient with hypertension I — implementing medication teaching C — compare patient outcomes for patient who receive teaching to those for a patient who does not O — increased adherence leads to decrease in blood pressure Chapter 2: Understanding the Research Process and Ethical Issues ... Anonymity A condition in which the identity of subjects remains unknown, even to the researcher, to protect subjects participating in a study and to promote objective truths. Applied research A type of study designed to gather knowledge that has direct clinical application. Basic research A type of study designed to develop the knowledge base and extend theory without direct focus on clinical application Confidentiality Protecting data that are gathered or learned from patients by not disclosing information without those patient's permission. Correlational research A type of non-experimental study designed to examine the relationship between and among variables. Cross sectional research A study that collects data at a particular point in time and does not require follow up. Descriptive research A type of non-experimental study designed to provided a knowledge base when little is known about a phenomenon; used to describe variables rather than to test a predictive relationship. Experimental research A study in which the researcher manipulates and controls one or more variables and observes the effect on (an) other variable(s) Human rights The presentation of subjects participating in a research study; includes the right to freedom from inquiry, the right to privacy and dignity, and the right to anonymity and confidentiality. Longitudinal research A study that follows a cohort of subjects and collects data over time. Non-experimental research A descriptive study that does not exhibit a great amount of control over variables Prospective research A study the examines data collected in the present Retrospective research A study that examines data collected in the past Risk benefit ratio The relationship btw potential harm to subjects and potential positive outcomes of participating in a research study; an evaluation used by subjects to make voluntary informed consent. Vulnerable research participant Those persons who are relatively or absolutely incapable of protecting their own interests and unable to provide meaningful informed consent. Five Steps Associated with the Research Process Step 1: Selecting and defining the problem Step 2: Selecting a research design Step 3: Collecting data Step 4: Analyzing data Step 5: Using the research findings Types of Research: Basic versus applied research Basic research: Purpose is to obtain empirical data that can be used to develop, refine, or test a theory. Ex. To gain advanced knowledge in a given subject area (e.g. the brain) Applied research: Conducted to gain knowledge that can be used in practical setting Ex. Performed in actual practice conditions on subjects who represent the group to which results will be applied (e.g. finding the difference between upper arm BP and forearm BP) Types of Research: Experimental versus non-experimental Experimental research: Researcher manipulates and controls one or more variables and observes the effect of manipulation on other variables Non-experimental research: Studies that are more descriptive or exploratory and are interested in what already exists Classified as descriptive and/or correlational Descriptive: describes existing situation or event systematically Correlational: examines relationship between and among variables What are a few examples of unethical studies? Let's discuss.... Nazi medical experiments Tuskegee syphilis study Willowbrook study Jewish chronic disease hospital study Tuskegee Syphilis Study Conducted by U.S. Public Health Service on black sharecroppers and black men in Tuskegee, Alabama from 1932 to 1972 Subjects not informed they were part of study Portion of men given a known, noneffective drug Willowbrook Study Ran from 1950s to 1970 at Willowbrook State School and was focused on period of infectivity of infectious hepatitis Researchers injected mentally handicapped children with hepatitis B virus Willowbrook State School required parents to consent to their child's participation in the study Parents were told of injection, but were not informed of the serious consequences Believed they were conducting ethical "natural experiments" Crisis at Johns Hopkins University in 2001 Consent form failed to inform medication not approved from FDA Healthy, voluntarily enrolled subject died as result of hypotension and multiorgan failure Ethical Codes: Nuremberg Code Judges who presided over Nuremberg Trials instrumental in development of Nuremberg Code Protection of human participants Protection from risk or harm Right to withdraw from experimentation Adequate qualifications of those conducting research Basic principles of ethical behavior Ethical Codes: Declaration of Helsinki Developed by World Medical Association in 1964 Reiterates aspects of Nuremberg code and outlines two categories of research Research that has therapeutic value for subjects Research that does not have direct therapeutic value for subjects Subjects need to be informed of risks prior to enrollment Allows legal guardians to grant permission to enroll subjects Clinical Nursing Research Guidelines Developed by the American Nurses Association and the American Association of Colleges of Nursing Protects human rights Right to freedom from injury Right to privacy and dignity Right to anonymity and confidentiality Vulnerable research participants needing protection- Table 2-3 Clinical Nursing Research Guidelines (cont'd) Key elements of informed consent Provide potential subjects with sufficient information about study participation Assure them participation is voluntary Simple, understandable language Institutional Review Boards (IRBs) Evaluating evidence for protection of human rights National Institutes of Health requirements What is informed consent? Essential information for consent Comprehension of consent information Competence to give consent Voluntary consent What is included in the essential information for consent? Introduction of research activities Statement of research purpose Selection of research subjects Explanation of procedures Description of risks and discomforts Description of benefits Disclosure of alternatives Assurance of anonymity and confidentiality What is an Institutional Review Board (IRB)? 1974 National Research Act requires research study review Who serves on the board? Functions Protection of rights and welfare Voluntary informed consent Benefits exceed risks Chapter 3 Understanding Evidence-Based Practice ... What is Evidence-Based Practice (EBP)? Derived from principle that health-care professionals should center practice on scientific research findings Research Utilization vs. EBP Research Utilization: Research-generated knowledge is incorporated into practice Often thought of as a subset of EBP EBP: Integrates research utilization with clinical expertise "What is the best possible evidence available to solve a clinical problem?" Research Utilization Clarification Process by which knowledge generated from research becomes incorporated into clinical practices. The purpose is the application of available knowledge to improve patient outcomes. Compiles the results of several studies Most utilization efforts tend to be informal EBP Clarification Problem-solving approach that considers clinical experience Combines research evidence, knowledge, and theory Allows patient values to be heard Utilizes research, but also integrates clinical expertise with the best available evidence. The best clinical evidence can never replace clinical expertise. When nurses use research findings and the best available evidence as their foundation for clinical decsion making, the outcome is EBP Commonalities in Models for promoting integration of Nursing research Identify the clinical problem Assembling the research literature Critiquing the research literature Assess the applicability Planning an innovation based on the research literature Implementing the innovation Evaluation the innovation Settler Model The issue is a catalyst to starting research or researching literature The Stetler model of Research Utilization consists of five phases that guide: Phase 1. the selection of research evidence; Phase 2. formal utilization critique of studies; Phase 3. consideration of research findings in the context of other forms of evidence, fit to the setting that is considering implementation, alignment with current practice and feasibility of adoption; Phase 4. the type of use decision and specifics of implementation; and Phase 5. dynamic evaluation, the details of which depend on the use decision. Iowa Model Starts with a trigger Then it is problem focused Then research problem highlights the importance of considering the entire healthcare system from the provider, to the patient, to the infrastructure, using research within these contexts to guide practice decisions. The first step in the Iowa Model of EBP is to identify either a problem-focused trigger or a knowledge-focused trigger that will initiate the need for change. A problem-focused trigger could be a clinical problem, or a risk management issue; knowledge triggers might be new research findings or a new practice guideline. Grovess Model Practice Problem Search for best evidence based on guidelines Reasons for Research-Practice Gap Practicing nurses may delay using research findings if they: do not know about current research findings are unclear about risks involved do not develop opportunities for acceptance of innovation Nurse researchers may contribute to research-practice gap if they: use a different language than nurse clinicians in reports do not report findings in clinically meaningful way Limitations of EBP Shortage of coherent, consistent scientific evidence Difficulties in applying any evidence to care for individual patients Barriers to any practice of high-quality medicine The need to develop skills in researching and appraising research Limited time in practice to master skills Resources scarce Steps to EBP 1.) Selecting a topic Knowledge-focused trigger Generated when staff encounter EBP guidelines either by reading in journal, attending conferences, or through federal guideline Problem-focused trigger Identified by staff in context of clinical practice by examining data (quality improvement, risk surveillance, benchmarking) or a recurrent clinical problem "Why do we do it this way?" or "Is there a better way to do this?" Steps to EBP 2.) Asking a clinical question using PICOT Asking a clinical question- Table 3.3 PICOT approach Patient population or patient condition Intervention or issue of interest Comparison of interest (may not be relevant to every clinical question) Desired outcomes Time frame (may not be relevant to every clinical question) Steps to EBP 3.) Forming a team Members should be: familiar with problem stakeholders in delivery of care from different health-care professions May also include administrators who will help implement EBP Steps to EBP 4.) Systematic review of literature Knowledge is more than just one finding Use scientific approach to summarize, appraise, and communicate results of several studies Steps to EBP 5.) Tracking down the best evidence Start searching broadly Identify indexes, journals, databases, and other sources worth pursuing Textbooks not helpful in this review Work with librarian to develop search strategy Collaborate with other nurse colleagues Steps to EBP 6.) Identifying electronic databases & other resources to use based on research topic Basic/background information Short critiques or recent studies/reviews Common well-studies topics Practice guidelines/algorithms Uncommon/specific/current topics MEDLINE, CINAHL, Cochrane Library Steps to EBP 7.) Other Resources Journal Club InfoPOEMS National Guideline Clearinghouse Clinical Key AHRQ Steps to EBP 8.) Developing a search strategy Inclusion and exclusion criteria Search for key terms or phrases associated with patient population and intervention Use concept map to expand keywords Subject headings and title search Boolean operators Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Steps to EBP 9.) Appraising the evidence critically Extract pertinent data from each original research study and assemble systematically Arrange in matrix table Collaborate with more experienced researchers Steps to EBP 10.) Hierarchy of Evidence Systematic reviews and randomized clinical trials (RCTs) are ranked as strongest evidence (level I) Expert opinion of authorities and/or reports from expert committees ranked as weakest evidence (level VII) Hierarchy of Best Evidence Systematic review of experimental studies Meta analysis of randomized clinical trials (RCT) and quasi experimental studies Individual RCT Quasi experimental study Meta analysis of correlational studies and descriptive studies Meta synthesis of qualitative studies Correlational study Qualitative or descriptive study Expert opinion Ethical Concerns Around EBP Present research findings with patients and families as part of decision-making process Note whether great deal of evidence or limited evidence supports guideline Feel free to express your informed views regarding meaning of findings Ways of Research Cross-sectional Longitudinal Prospective: watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s) Retrospective: looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. Qualitative Secondary analysis Chapter 4: Selecting and Defining a Problem ... Phase 1 of Research Process:Problem Statement First and most important step in research process Provides direction for research design Characteristics of problem statement Must be researchable Create operational definitions Ethical or philosophical problems not researchable, but debating them may lead to researchable problems Significant enough to warrant research Should have potential for extending scientific body of knowledge Sources of Research Problems Nursing practice Derived from clinical practice or investigator's own experience Literature review Examining literature to generate ideas for possible areas of research/ GAPS Theory Testing Less likely to involve clinical problem and are usually concerned with explanations of phenomena Replication Determines whether previous study can be repeated Selection of Research Problems Identify general problem area related to area of expertise Narrow general problem area to specific, researchable problem Problems that are too general: Require reviewing unrelated articles, resulting in more research hours Lead to studies with too many variables with results that may be difficult to interpret Research Problem Statement Clear concise declarative statement of what is purported to be an area where knowledge is needed to advance the evidence based practice of nursing Should consider: Ethical issues Significance to nursing Researcher qualifications Feasibility Problem Statement Consider its feasibility Consider feasibility of study Is the problem appropriate for study? Are there subjects available for the study? What are the time and money constraints? What are the researchers' areas of expertise? What resources are available? What ethical considerations exist? Purpose Statement Identifies why the problem is being studied Specifies overall goal and intent of research Seen more commonly in journal articles Should include following information: What researcher intends to do Setting where research will take place Subjects participating in study A "To" statement about why the study will be conducted Identifies population Identifies variables Operational definitions are clear-cut statements of how variables are measured. These definitions are important if quantitative research is to be meaningful. Review of Related Literature Definition - identification and analysis of the relevant publications related to the research problem area Purpose - helps to determine what is known, what are the gap in knowledge Scope - depth and breadth appropriate to problem area, should be targeted to the problem area and research problem, not a compendium of all that is known on the subject, but rather a focused and outlined synthesis based on research problem statement and purpose Sections of a Literature Review Introduction Problem Significance Identification of relevant focus areas Discussion of theoretical literature Discussion of empirical literature Both include discussions of how variables have been conceptually and operationally defined Synthesized summary Known Gap (not known) that leads to purpose and RQ or H Review of Related Literature Literature review involves identification and analysis of relevant publications Main purpose to discover what is already known Avoid temptation to include everything Important considerations How many years back should you go? What literature should you search? How many articles and books do you need? Do you go beyond library resources for information? Sources of Information Nursing journals Refereed journals Empirical literature Theoretical Literature Primary versus secondary sources Primary sources is written by person who developed theory or conducted the research Secondary source is a brief description of a study, written by a person other than original researcher Sources of Information (cont'd) Electronic databases Bibliographic files accessed by computer and available online. Indexes Used to find journal sources of data-based and conceptual articles Abstracts Summaries of articles that appear in other journals Consult with research librarian/ Table 4.5 Analyzing, Organizing, and Reporting Identify major ideas that are related to the problem statement List concepts either in descending order of importance or in terms of logical presentation Prepare an outline using the major concepts as major headings Divide each major heading into logical subheadings, if applicable Summarize major findings of each study Analyzing, Organizing, and Reporting Write introductory paragraph explaining significance of two or three major concepts. Summarize findings for each group of studies. Compile entire literature review and scan it for coherence, continuity, and smoothness. Research Review vs Research Critique Review Summative Reports the findings and characteristics of the study without evaluation Quantitative or qualitative No conclusions as to value of study to EBP Critique Evaluative Discusses strengths and weaknesses as applied to use in EBP Quantitative or qualitative Comes to a conclusion as o the value of the study to EBP