Lecture 1

Question 1

what are the levels of the evidence hierarchy (from best to worst)

Answer 1

1. Systematic Review: or meta-analysis of randomized controlled trials (evidence informed clinical practice guidelines based on systematic reviews - critiques the findings of many RCTs)
2. Randomized Control Trials (RCTs): rigorous, eliminates bias/confounds; sees if intervention has a causative result
3. Controlled trial w/o randomization - quasi experimental study)
4. Case-control studies: looks at 2 diff groups at a point in time; more bias/confounds (case-control, correlational, cohort)
5. Systematic reviews of descriptive and qualitative studies (case studies and case reports - a report on a single case/person
6. editorials/expert opinion: single descriptive or qualitative study

Question 2

optimum decision eqtn

Answer 2

f(valuesSI)
where SI = f(E,C,F)

SI = successful implementation
E = evidence
C = context
F = facilitation (people/processes of change management)

Question 3

what do evidence pyramids not tell you

Answer 3

the worth of the study conducted

• A qualitative study could be revolutionary and extremely well conducted and tell you in detail about an extremely common phenomenon and give you an “a-ha” about its depth
• Vs. a quantitative study that could just be about if rats grow fast with a ton of confounds, no control, pretty shit, no actual contribution to the scientific community

Question 4

what is evidence informed practice

Answer 4

Consciously using the best evidence to deliver health care
- The best decision based on the evidence available; using guidelines, evidence, sub/obj data
- Incorporates research, clinical expertise/experience, available resources, and client values
- Distinct from Evidence-Based Practice: focuses more on the quantitative research practice behind the clinical decision
- This takes into account factors like indigenous knowledge, culture/religion
- Helps hold us accountable to society/patients -> we know why we do something
- We constantly evaluate/refine the nursing process
- When we use research, we critically analyze it and understand the studies going into it

Question 5

discenso model

Answer 5

Visualization of EIP

Question 6

sources of knowledge

Answer 6

1. Tradition/Authority: He told me to do it this way; it’s always been done this way
2. Clinical Experience/Intuition: Anecdotal evidence seasoned nurses get from experience
3. Trial and Error: Semi-scientific way of seeing what does and doesn’t work
4. Disciplined Research: Rigorous scientific research with an experimental process

Question 7

what is research

Answer 7

A systematic, formal, rigorous, and precise process employed to gain solutions to problems + discover/interpret new facts and relationships; from “recherche”, to search again
- Systematic investigation to answer questions/problem solve with various approaches

Question 8

what are the goals of research

Answer 8

Goals:
- To develop new knowledge used to inform practice (evidence-informed practice)
- Knowledge provides evidence that can be used to improve patient outcomes
“See what everybody else has seen, and to think what nobody else has thought”

Question 9

5 steps of evidence-based practice

Answer 9

1. What is the burning clinical question?: What do you need to know?
2. Collect the most relevant & best evidence:
   a. Use databases; JBI/Cochrane reviews or Medline/CINAHL databases
3. Critically appraise the evidence: Carefully, systematically assess the research
4. Integrate all the evidence: Apply it to the patient/clinical setting
5. Evaluate outcomes: Was the new information effective? Should you keep using it?

Question 10

what is the knowledge to action cycle

Answer 10

Graham et al., 2013
Centre Core: Knowledge Creation: Involves inquiry, synthesis, and developing into tools/products
Outer Rings: Action Cycle: All the steps of actually using the knowledge
- Identifying problems, Determining the Know/Do Gap, Select Relevant Knowledge
- Adapt it to the context -> FInd barriers/facilitators -> Tailor/Implement interventions
- Monitor Use of Knowledge -> Evaluate Outcomes -> Sustain Use of Knowledge

Question 11

nursing knowledge: levels of abstraction (from most abstract to most concrete

Answer 11

1. metaparadigm
2. philosophy
3. conceptual model
4. theory
5. empirical indicator

Question 12

what are 3 common paradigms

Answer 12

positivism (or post-positivism), constructivism, critical realism

Question 13

what is a metaparadigm

Answer 13

reflects diff ways of knowing and consists of different assumptions

Question 14

how do paradigms influence our research approach

Answer 14

3 paradigms influence how you may see the research and how you will likely approach it
Nothing is right or wrong, just diff perspectives when looking at the information

Question 15

historical development of nursing research

Answer 15

Historical Development: Began in the 19th Century with Florence Nightingale
- She emphasized the need for observation and statistics in the field
- Chief Nurse from 1854-1856; Crimean War -> 6months after arriving, mortality dropped from 42.7% to 2.2% as she observed trends in patients

Question 16

in 1952 what was established

Answer 16

Nursing Research Journal established in the USA; 50’s-60’s quantitative dominates
- Later, qualitative paradigms begin to grow in influence
- “What are people’s feelings about having chronic illnesses? Stories, experiences?”

Question 17

who is isabel stewart

Answer 17

Proponent for research; to be a true applied science, we must use rigorous research and experimentation, similar to others who are advancing their fields.
- Advocated for objective, scientific, and subjective, qualitative observation

Question 18

what was the importance of graduate programs where was the first

Answer 18

First graduate/PhD program was in Alberta -> important because graduate programs allow us to advance the field

Question 19

what is inductive reasoning

Answer 19

develops generalizations from specific observations

Question 20

what is deductive reasoning

Answer 20

develops specific predictions from general principles

Question 21

what are research chair holders

Answer 21

Faculty whose positions are supported by targeted funding from a funding agency or benefactor in order to focus on their research

Question 22

what are funding agencies

Answer 22

CIHR (Canadian Institutes of Health Research), SSHRC (Social Science and Humanities Research Council), NSERC (Natural Sciences and Engineering Research Council of Canada) -> major funding agencies in Canada; Tri-Council Funding

Question 23

what are benefactors

Answer 23

Ex., the Sally Smith Research Chair in Nursing -> Joan Tranmer

Question 24

what is international reach

Answer 24

Global Research Community is feasible, connected by network, websites
- Allows cross-cultural, cross-national study implementation -> richly diverse perspectives
- International Council of Nursing (ICN): dedicated to global nursing research

Question 25

what is the term future directions

Answer 25

What are the next important issues to study for improvement?
- Community-based care (esp. elderly), Health care disparities (SDoH), Health Promotion/Risk reduction, Complex client care, chronic illness, high aging population, quality/accountability
- Technology in health care -> ex., Vocera smartbadges

Question 26

importance of nursing research

Answer 26

• Gives us a larger knowledge base
• Through which we apply critical thinking -> is it relevant, useful, feasible, applicable
• Therefore affecting patient care -> practices, education, theory

Question 27

relevant CNO competencies to research

Answer 27

• Clinician: Being able to use client-centred and evidence-informed care
• Scholar: Are you able to use and complete research to make informed decisions?

Question 28

what is the purpose of research

Answer 28

Identify/Describe Phenomena -> Explore Body of Knowledge -> Explain -> Predict/Control Outcomes

Question 29

process of research

Answer 29

Question -> Search literature/reviews for knowledge gaps -> Make a Research Question
Use quantitative, qualitative methods to research it -> Collect and analyze the data, interpret it
Communicate the findings -> Apply to practice if able

Question 30

describe how nursing is a science and a art

Answer 30

• Science: Systematic inquiry; use of evidence for practice; critical appraisal/practice implication
• Art: Reflective practice/experience to create knowledge; learn by thinking on experiences

Question 31

describe the phrase consuming/producing continuum

Answer 31

You are somewhere along a continuum of consuming research knowledge or producing it
- Journal Clubs, Reviewing proposed research, attending presentations, collaborating in the development, discussing implications of findings, ethics review committees, client recruitment for studies, evaluating research for use in practice, collecting research information

Question 32

quantitative research

Answer 32

how prevalent is the phenomenon?
how often does the phenomenon occur?
what factors are related to the phenomenon?
what are the antecedents of the pnenomenom?
what is the underlying cause of the phenomenon?
does the theory explain the pnenomenon?
what will happen if we alter a phenomenon or introduce an intervention?
if phenomenon X occurs, will phenomenon Y follow?
can the occurrence of the phenomenon be prevented or controlled?

Question 33

types of Q’s for qualitative research

Answer 33

what is this phenomenon?
what is its name?
what are the dimensions or characteristics of the phenomenon?
what is important about the phenomenon?
what is the full nature of the phenomenon?
what is really going on here?

Question 34

steps in the quantitative research process and journal format

Answer 34

1. identify the research purpose and question
2. review the literature to see what is known about the concepts of interest
3. identify a framework that best explains how the concepts relate to one another
4. decide on the most suitable and rigorous study design
5. select a sample and measure the concepts of interest
6. analyze the data and report whether your hypotheses are likely to be true/false

Question 35

5 steps to evidence informed practice

Answer 35

A more involved guide
1. What is your clinical question and is it answerable?
2. Identify and gather the necessary evidence:
a. You need background information and foundational knowledge to understand literature
i. QCAT OMNI -> Cochrane/JBI Reviews, Medline/CINAHL (journal) databases
ii. Book Collections: Books@Ovid, Stat!Ref
b. Generate keywords and bibliographies of relevant material
3. Critically appraise and synthesize the literature; incl., books, review articles from experts
a. Review Articles: Sums up the current state of research on a given topic
i. Everything relevant to a topic and synthesized for a reader
ii. Could be done systematically (set process of questions) or not
iii. Different from peer-reviewed journal articles
b. Research Articles: Describes a particular research project
i. Specific methods, results, significance of findings, qualitative/quantitative
4. Act to change practice using evidence, clinical expertise, and patient preference
5. Evaluate the use of the research evidence and your process for improvement

Question 36

alternative evidence pyramid

Answer 36

1. Systems
2. Summaries -> Textbook summaries
3. Synopses of Syntheses
4. Syntheses -> i.e., PoC tools (BMJ, Dynamed), systematic reviews (JBI, Cochrane)
5. Synopses of Studies
6. Studies -> Original research, less practical (Medline/CINAHL Journal Articles)

Question 37

steps in the qualitative research process

Answer 37

1. identify the research Q and purpose
2. select a small group of ppl who have experienced the phenomenon of interest
3. conduct interviews about the phenomenon of interest or observe the group experiencing the phenomenon
4. analyze the data collected and look for recurring themes
5. review the literature
6. conduct further interviews/observations until no new themes occur - saturation
   review of literature
7. summarize the findings and describe the human experience

Question 38

what is PICO and what are PICO Questions

Answer 38

PICO Stands for: It is a formula used to create Clinical Questions
- Patient: Who are the relevant patient groups you’re observing?
- Ex., Elderly People 65+ with Advanced Cancer
- Intervention: What strategies are you using to manage the condition?
- Ex., Shared Decision Making/Advanced Directives
- Comparison/Control: What are you comparing your selected strategy to? Can be nothing
- Ex., (Nothing)
- Outcome: What are the consequences relevant to the patient you’re looking for?
- Ex., Improved Family relations
- (Time/Type): What time periods or study types are you considering?