The new challenge is for nurses to use research methods that can clearly explicate the essential nature, meanings and components of nursing so that nurse clinicians can use this knowledge in a deliberate and meaningful way.
The Need for Nursing Practice Based on Research
In the recent past, there has been a continuing increase in costs associated with the delivery and receipt of health care in the United States. At the same time, there has been more and more scrutiny of how those health care dollars are spent. The decision of which health care treatments receive funding from health care insurance is now based primarily on documentation of favorable patient outcomes. In addition, patients want to know that the dollars they spend on health care will help them to get well and feel better—they want to purchase something that works for them. As providers of today’s health care, nurses must be able to demonstrate that the nursing care they provide is cost-effective and improves the health of patients.
Although in the past nursing care was largely based on traditional knowledge, given the current health care environment, today’s nurses must base their practice on nursing care that has been documented as being beneficial to patients. Such practice is based on sound scientific research in which nursing care has been able to demonstrate cost-effective, predictable, and measurable practice outcomes. In this chapter, two methods of incorporating nursing research findings into nursing practice are discussed: nursing research utilization and evidence-based practice.
What Is Nursing Research Utilization?
The ability to transfer research into clinical practice is essential for ensuring quality in nursing. The process of research utilization involves transferring research findings to clinical nursing practice. In the process of research utilization, the emphasis is on using existing data (findings or evidence) from previous nursing research studies to evaluate a current nursing practice. A major component of the process is reviewing completed nursing research studies that have been published in the literature. In contrast, conducting new research involves the collection of new data to answer a specific clinical practice question. Nursing research utilization is a step-by-step process incorporating critical thinking and decision making to ensure that a change in practice has a sound basis in nursing science.
What Are the Steps for Nursing Research Utilization?
Step 1: Preutilization.
The first step in the application of nursing research to nursing practice is the recognition that some aspect of nursing practice could be done in a safer, more efficient, more beneficial, or simply a different way. This begins an exploratory phase in which nursing colleagues in the practice setting are consulted regarding their opinions about the need to find a new approach for some aspect of nursing practice. An early question should be: “Is the current practice research-based?” When current practice is research-based, the next question should be “Is the research on which the practice is based current?” (e.g., the specific details of taking temperatures with mercury thermometers became outdated when digital thermometers were used exclusively in practice).
A second phase of step 1 is consensus building, which is used to identify the specific practice to be changed. In this phase, the incorporation of the principles of change theory will increase the possibility of success. (See Chapter 10 for information about the challenges of change.) In any practice setting in which there are several nurses, a change will be more acceptable if those affected are included in the decisions related to the change. Clear communication and teamwork are essential elements of this process. Group consensus is crucial for the successful application of research findings.
The third and final phase of step 1 delineates the aspect of nursing practice that will be changed into a concise statement of the practice problem. This statement will answer the question, “In our current nursing practice, what do we want to change, improve, or make more efficient?” The narrower and more specific the statement of the practice problem, the easier your task will be in Step 2.
Step 2: Assessing.
The second step in research utilization is the identification and critical evaluation of published research that is related to the practice problem you have identified (Figure 24-1). Nursing literature is searched to identify those studies that deal with your practice problem. Although some studies may have explored the exact practice problem that you are examining, it is likely that most research will have approached the problem from a different point of view. Your task will be to analyze and critically evaluate the research reports to determine which findings are adaptable to your practice problem and context. Organizing and summarizing the adaptable findings into an outline format will provide you with your primary working document for the remainder of the use plan (Box 24-1). Box 24-2 contains suggestions on reading a nursing research article.
The use of the Internet and electronic databases has made a thorough search of the current literature easier. However, the enormous volume of materials now available also increases the complexity of a review of literature. For example, the keywords used in a search can either return no articles or hundreds of articles. When you are conducting an electronic search, a valuable technique is to begin searching within the most recent year and then move back one year at a time until an adequate research base is identified. Limiting your searches to the use of nursing-oriented database may also help you find pertinent literature. The Cumulative Index to Nursing and Allied Health Literature (CINAHL) is an excellent place to start your search.
There are times, however, when an electronic search is not adequate. Keep in mind that many of the classic research studies were published before electronic formats were widely used and may not be available online. Also, there may be valuable studies that are available in hard copy only. Because of these limitations of electronic sources, you may need to make a trip to the stacks in the library, if you are looking for historical research. See Box 24-3 for hints on conducting a literature search.