RESEARCH--EXAM 1 Flashcards
o Systematic inquiry using disciplined methods to solve problems or answer questions
research
o Systematic inquiry to develop knowledge about issues of importance to the nursing profession
nursing research
♣ Use of best clinical evidence in making patient care decisions
evidence-based practice
♣ Things that impact evidence-based practice:
- Research methods
- Respect patient preferences
- Provider (the nurse) expertise
o Nursing decisions need to be based on ______
evidence
o requires research methods, and EBP
♣ Projects that are focused for one institution
quality improvement
♣ Established first nursing school
♣ Collected and evaluated data concerning healthcare decisions
• Used data to drive decisions!
o Florence Nightingale, 1850s
more broad
multisite studies
repeat search more than once
replication studies
ϖ Sources of Evidence for Nursing Practiceϖ Sources of Evidence for Nursing Practice
tradition authority clinical experience logical reasoning assembled information disciplined research
o gold standard
♣ Problem is that it is done on mainly high risk important issues
Disciplined research
♣ A world view; a general perspective on the world’s complexities
o Paradigm:
The two Paradigms
positivist assumption
constructivist assumption
♣ Reality exists
♣ There is a real world driven by natural causes
♣ There is truth out there just still looking for it
positivist assumption
♣ Reality is multiple and subjective, constructed by individuals
♣ There is not one answer out there but many, challenge is to appreciate there are lots of different ways of thinking about things
constructivist assumption
techniques used to structure and study and to gather, analyze, and interpret information
Research methods:
2 types of research methods
quantitative research & qualitative research
Quantitative research—most often allied with the
♣ positivist tradition
Qualitative research—most often allied with the
no numbers
constructivist tradition;
♣ Orderly procedures ♣ Prespecified plan ♣ Control over context ♣ Formal measurement ♣ Seeks generalizations (Description, Exploration, Prediction & control, Explanation)
quantitative
numbers
quantitative
♣ Dynamic design – depends on response of participants
♣ Holistic
♣ Context-bound
♣ Humans as instruments
• Understand all experiences are different
♣ Seeks patterns
qualitative
words, behaviors
qualitative
purposes of nursing research
identification and description explorations explanations prediction & control therapy, treatment or intervention diagnosis & assessment
o description focuses on the prevalence, size, and measurable aspects of phenomena
quantitative
o describes the nature, dimensions, and salience of phenomena
qualitative
- Begins with a phenomena of interest
- Examine the nature of phenomenon, manner in which it is manifested, and other factors to which it is related instead of describing it
o Including factors that may be causing it
explorations
______ methods can be used to explore the nature of little understood phenomena and to shed light on the ways in which a phenomenon is expressed
• Qualitative
• Seeks to understand the underlying causes or full nature of a phenomenon
explanation
• theories or prior findings are used deductively to generate hypothesized explanations that are then tested
quantitative
• – search for explanations about how or why a phenomenon exists or what a phenomenon means as a bias for developing a theory that is grounded in rich, in-depth, experiential evidence
qualitative
ex of prediction & control
- We can predict that a woman 40 years of age has a higher risk of delivering a down syndrome baby versus a woman 25 years of age
- We can partially control the outcome by educating women about the risks and offering amniocentesis to women older than 35 years of age
• In many ____ studies prediction and control are key goals
quantitative
o Seek to identify effective treatments for preventing health problems
• Therapy purpose studies
_____ plays a key role in EBP
• Intervention research
• Development of formal instruments to screen, diagnose, and assess patients and to measure clinical outcomes
diagnosis & assessment
o The use of study findings in a practical application unrelated to the original research
o Emphasis is on translating research findings into real-world applications
research utilization
starting point of research utilization
o = new evidence or a research-based innovation
CURN stands for?
o Conduct and Utilization of Research in Nursing Project (1970s)
♣ Aimed to increase nurses use of research findings by disseminating research findings facilitating organizational changes, and encouraging collaborative clinical research
CURN
begins with the research itself/emergence of new knowledge
research utilization
begins with a clinical question
EBP
♣ How can I put this innovation to good use in my clinical setting?
research utilization
♣ What does the evidence say is the best approach to solving this problem?
EBP
o Basing clinical decisions on research findings and other factors (patient preferences & experience of healthcare provider)
o Efforts to personalize evidence to fit a specific patient’s needs and a particular clinical situation
EBP
- Series of online libraries containing only systematic reviews
- Huge database of summarized literature
- Aim is to help providers make good health care decisions by preparing and disseminating systematic reviews of the effects of health care interventions
Cochrane Collaboration
Dr. Archie Cochrane proposed an ____ _____ for weighing evidence/making decisions
evidence hierarchy
♣ Evidence-based medicine pioneer at McMaster Medical School
o David Sackett
o Involve ranking evidence sources according to the strength of evidence they provide
o Ranking may depend on the type of question being asked
evidence hierarchy
how does an evidence hierarchy look?
o Picture inside front cover – focus on inside
o Refers to research findings that are methodologically appropriate, rigorous, and clinically relevant for answering pressing questions
best evidence
♣ Questions not only on the about the efficacy, safety, and cost effectiveness of nursing interventions but also about the reliability of nursing assessment tests, the causes and consequences of health problems, and the meaning and nature of patients’ experiences
best evidence
ϖ Challenges in Implementing EBP
research-related barriers
nurse-related barriers
organizational barriers
ex of research-related barriers
♣ Scarcity of strong research evidence
ex of nurse-related barriers
♣ Inadequate skills in locating and appraising evidence
♣ Doesn’t know how to find & assess the literature
ex of organizational barriers
♣ Lack of financial support and staff release time for EBP
♣ Has been selected from primary studies and evaluated for use by clinicians
(AKA summarized sources)
preappraised evidence
2 examples of preappraised evidence
systematic review
clinical practice guidelines
o Integrate evidence about a topic in rigorous, systematic way
systematic review
o Give specific recommendations for evidence-based decision making
o Developed when a small group of experts analyze existing literature and propose guidelines
• Clinical practice guidelines
examples of summarized evidence
Systematic Reviews
♣ Integrate findings across quantitative studies statistically
♣ Treats the findings from the study as one piece of information
♣ Findings from multiple studies on the same topic are combined and then all of the information is analyzed statistically in a manner similar to that in a usual study
♣ Individual studies are the unit of analysis instead of study participants
♣ Provides an objective method of integrating a body of findings and of observing patterns that might not have been detected
o Meta-analyses
♣ Integrate and amplify findings across qualitative studies
♣ Less about reducing information and more about interpreting it
o Meta-syntheses
Three widely referenced models for Evidence-Based Nursing Practice
♣ ACE Star Model of Knowledge Transformation
♣ The Stetler model of research utilization to promote EBP
♣ The Iowa model of EBP to promote quality care
ϖ Major Steps in EBP
ask questions
search for
integrate
assess effectiveness
P
population
I
intervention
C
comparison
O
outcome
T
time
o Research evidence needs to be integrated with
♣ Your own clinical expertise and knowledge
ϖ Appraising the Evidence for EBP
what is the quality of the evidence?
what is the evidence/magnitude of effects?
how precise are estimates of effects?
is there evidence of side effects/benefits?
What are the costs of applying/not applying the evidence?
Is there relevance to my clinical situation?
♣ Identification of a clinical practice problem in need of a solution
♣ May arise in the course of clinical practice or in the context of quality assessment or quality improvement efforts
♣ Likely to be clinically relevant and to have staff support if the problem is one that numerous nurses have encountered
o Problem focused triggers
♣ Readings in the research literature
♣ Clinical relevance and applicability of the research might need to be assessed
o Efforts designed to result in a formal policy or protocol affecting the practice of many nurses
o Knowledge focused triggers
♣ Determines the implementation potential of an innovation in a particular setting
♣ Several issues should be considered; esp. the transferability of the innovation, feasibility of implementing it, and the cost-benefit ratio
o Implementation Potential/Environmental Readiness
quantitative examples
subject constructs variables numerical data cause-effect deductive reasoning
qualitative examples
informant more broad phenomena narrative descriptions patterns of association inductive reasoning
types of places the information is gathered
research settings
specific location for the research
research sites
• Offer a larger and often more diverse sample of participants
♣ Multisite Studies
♣ Abstractions of particular aspects of human behavior of characteristics (e.g., pain, weight)
o Concepts
♣ Slightly more complex abstractions, composed of concepts (e.g., self care)
o Constructs
♣ Knit concepts into a coherent system that purports to explain phenomena
♣ Explanation of some aspect of reality
o Theories
♣ researchers start with a theory and using deductive reasoning make predictions about if that theory were true
Quantitative theory
♣ : theory is often the product of research, researchers use information from study participants inductively to develop a theory rooted in their experiences
Qualitative theory
o Characteristic or quality that takes on different values, i.e., that varies from one person to the next
variable
ex of variables
♣ Blood type, weight, length of hospital stay, method of pain measurement
variables are used in
quantitative research
types of variables
continous
categorical
independent variable
dependent variable
♣ Range of values on a continuum
• Height, test score
o Continuous variable
♣ Grouped variable
♣ Choice of statistical analysis is more limited
• Female, male
• Type of pain management method
grouped variable
♣ Presumed cause or direction of effect of a dependent variable
♣ Variable influenced by dependent variable, can be cause or effect
independent variable
think of the IV as the _____ bc it influences the outcome of the dependent variable
intervention
♣ Presumed effect of response to an independent variable
o Dependent (outcome) variable
o no independent/dependent variables just “research variables”
Descriptive quantitative research
o Independent and Dependent variables can also be used to indicate ______ ___ ______ rather than cause and effect
direction of influence
♣ Abstract or theoretical meaning of a concept being studied
♣ Dictionary definition
♣ E.g. pain definition
o Conceptual definition
♣ Operations (measurements) a researcher must perform to measure the concept and collect the desired information
♣ How you are going to measure that concept
♣ E.g. faces pain scale to measure pain level
o Operational definition
o Pieces of information researchers collect in a study
data
o Bond or connection between variables/two or more phenomena
relationships
- (causal) relationship (e.g. lung CA and smoking)
* Only determined by experimental research or a whole lot of observational research
♣ Cause-and-effect
- (functional) relationship (e.g., gender and life expectancy)
- e.g. Risk factors – association btw risk factors and dx
♣ Associative
ϖ Major Classes of Quantitative Research
experimental research
non experimental research
♣ Researchers actively introduce an intervention or treatment – most often to address therapy questions
experimental research
experimental research
is called ____ ____ in medical research
clinical trials
• Introducing an intervention, doing something to the group
experimental research
♣ Researchers are bystanders and collect data without intervening or introducing treatments
non experimental research
non experimental research is called ___ ____ in medical research
observational research
♣ May study different groups but study what is existing, they do not introduce anything different or have the groups doing anything – they may compare them
non experimental research
♣ Seeks to understand key social psychological processes that occur in a social setting
♣ Sociological perspective
♣ The social and psychological phases that characterize a particular event or episode
grounded theory research
♣ Focuses on the lived experiences of humans
♣ Some try and describe the experiences and some try and interpret
♣ Approach to thinking about what life experiences of people are like and what they mean
phenomenological research
♣ Focuses on the patterns, lifeways, and experiences of a cultural group in a holistic fashion
♣ How different cultural groups make sense of their lives
♣ Strive to learn from members of a cultural group, to understand their world view, and to describe their customs and norms
♣ Not necessarily a specific ethnic group but a group of people who share the same values, etc. (e.g. nightshift workers)
♣ Typically engage in extensive fieldwork often participating to the extent possible in the life of the culture under study
ethnographic research
- Follow a format similar to journal articles
* 10-20 minutes to describe key features of the study
oral reports
• Simultaneously present visual displays summarizing their studies while conference attendees walk around the room looking at these displays
poster sessions
♣ Papers often subjected to peer review
• Reviewed by other researchers, nurses
Peer reviews are often blind
journal articles
what does it mean when it says peer reviewed articles are blind?
reviewers are not told names of authors and vice versa
content of research journal articles Acronym
IMRAD
what does IMRAD stand for?
introduction method results abstract discussion
o Brief description of the study placed at the beginning of the article
o Answers questions like “What were the research questions?, What methods were used to address the questions?
abstract
• sets the stage for presenting what the researcher did & learned; immediately after abstract
o Background, make a case for why this is an important topic to read about, gaps in the literature, what theoretical frameworks are used
o Always ends with the research question, hypothesis, aim, or goal of the study
intro
o Plan, procedures for how to collect the data, who is going to be in the study, what tool is going to be used to collect data on, how it is going to be evaluated
method
o Facts, results of data analysis, means, statistical differences, etc.
o Presents the findings
results
o What the researcher believes about the facts; was the sample size too small, etc.
o This is what needs to be done next, recommendations for future practice, research, and educations
o Conclusion about the meaning and implications of the findings
discussion
