Using Nursing Research in Practice



Using Nursing Research in Practice



Mary Mackenburg-Mohn, RN, PhD, CNP



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.


—MADELINE LEININGER


After completing this chapter, you should be able to:




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.




BOX 24-1


Analyzing a Research Article for Potential Use of Findings in Nursing Practice


1a. The Purpose of the study is:


1b. The importance of this study to nursing practice is:


2. The Research Question/Hypothesis is:


(If the question/hypothesis is not stated, it could be):


3a. The Independent Variable(s) is/are:


3b. The Dependent Variable(s) is/are:


(If there are no independent and dependent variables, the Research Variable[s] is/are):


3c. Definition(s) of the variable(s) of interest to me is/are:


4. The Conceptual Model/Theoretical Framework linked with this study is:


5a. The content areas in the Review of Related Literature are:


5b. The review does/does not evaluate both supporting and nonsupporting studies:


6a. The Research Design used for the study is:


6b. The design is/is not appropriate for the research question:


6c. The control(s) used in this study is/are:


6d. The Study Setting is:


7a. The Target Population is:


7b. The Sampling Method is:


7c. The Sampling Method is/is not appropriate for the design:


7d. The criteria for participants are:


7e. The sample included ________ participants.


7f. The sample is/is not representative of the population:


8a. The Study Instrument(s) is/are:


8b. Instrument validity and reliability information are presented and are of adequate levels for confidence in using the results:


9a. The Data Collection Method(s) is/are:


9b. The Data Collection Method(s) is/are (is not/are not) appropriate for this study:


10. Steps were taken to protect the Rights of Human Subjects:


11a. The Data Analysis Procedure(s) is/are:


11b. The Data Analysis Procedure(s) is/are appropriate for the level of data collected and the research question/hypothesis:


11c. The Research Question/Hypothesis is/is not supported:


12. The author(s) major Conclusions and/or Implications for Nursing Practice are:



BOX 24-2


How to Read a Nursing Research Article


A research article should answer the following:




















































What: Is the content of the article related to my question?
Read the problem statement, purpose, research question, and results/findings.  
Why: Why was the research done?
Read the problem statement or the review of literature.  
When: When was the study done? Is it classic, current, or outdated?
Do more recent findings provide a better answer?  
Read the date of publication.  
How: What research method was used? Is it a quantitative, qualitative, or mixed methods approach?
Read the method and design sections.  
Who: Who were the subjects? What was the sample?
Read the method section.  
Where: In what setting was the research done?
Read the method section.  
So What: Are the findings helpful to me and my problem?
Read the findings and discussion.  
Do Not: Do not automatically accept what you read; critically evaluate the content. You can only evaluate what is written and reported; do not assume anything about what is not written.

What to Do When: When the statistical procedures are beyond your level of understanding:



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.


Jan 10, 2017 | Posted by in NURSING | Comments Off on Using Nursing Research in Practice
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