CHAPTER 38 1. Identify nurses’ research competencies according to educational preparation. 2. Describe the research process and key components of research studies. 3. Identify neonatal nurses as research consumers who implement research translational strategies through clinical evidence-based practice. 4. List questions to ask when critiquing research literature. 5. Be informed about the rights of research subjects and the ethical conduct of research. Research refers to systematic inquiry or investigation governed by scientific principles and conducted to expand knowledge and increase understanding. The research process describes a logical and orderly progression from development of a question through the conduct of a study, analysis of resultant findings, dissemination of conclusions, translation into practice, and implementation. The questions asked and the methodology that guide inquiry reflect underlying values and beliefs, worldview, or philosophy. Scientific method describes prescribed rules of logic and imposed controls, ensuring that the knowledge generated is truthful. Research generates empirical (i.e., experienced) knowledge. Although nursing, as a science-based profession, strongly subscribes to empirical research, the body of nursing knowledge is enriched by diversity in ways of knowing. Nonresearch bases for nursing knowledge—tradition, authority, trial and error, personal experience, intuition, and commonsense reasoning—have a powerful influence and are part of nursing tradition; however, nonresearch knowledge does not permit scientific predictability, nor does it provide for scientific rationale and justification for nursing actions. Within the nursing profession, research promotes health and well-being of patient populations through a variety of applications. Research improves practice by providing answers to clinical questions, evaluating the effectiveness of nursing interventions and programs of care, and expanding the body of nursing knowledge. Increasing emphasis on evidence-based practice, research-based practice, best practices, practice guidelines, and outcomes focus mandates that research occupy a central role in nursing. The American Nurses Association (ANA) research agenda addresses the value of nursing in improving safety, clinical effectiveness, and quality assurance, and promoting the health of populations (ANA, 2011). The ANA research agenda speaks to the value and impact of nursing contributions to safety, care quality, and clinical efficiency in supporting the health of populations (ANA, 2011; LoBiondo-Wood and Haber, 2010). All nurses have a role related to research (LoBiondo-Wood and Haber, 2010). Put simply, nurses “do” and/or “use” research. While not all nurses do research, every nurse is a consumer of research. Research findings are an essential component of evidence-based practice. At the time of this writing, a search in PubMed using the terms “evidence-based practice nursing” yielded 10,719 hits. The earliest of these articles dates from the 1980s. The past three decades are marked by mounting emphasis on empirical proof as the base for nursing care as well as on the evaluation and synthesis of knowledge supporting nursing actions. There is a significant need in nursing for well-constructed systematic and integrative reviews of the literature (McGrath, 2012). Pressure for evidence-based practice is also related to cost containment and demonstrating the value of nursing care as well as cost-effectiveness of nursing interventions. Although nurses in general increasingly subscribe to the principles of evidence-based practice, nursing leadership and organizational support play an essential role in the implementation of evidence-based practice (Ahrens and Johnson, 2013). Neonatal clinical nurse specialists, nurse managers, and nursing administration are critical, therefore, in moving research into practice. Evidence-based practice shares elements with conducting research (Raines, 2012) and requires knowledge of the “doing” of research to evaluate existing evidence (Table 38-1). TABLE 38-1 Processes of “Doing” and “Using” Research in Nursing Adapted from Raines, D.A. Quality improvement, evidence-based practice, and nursing research . . . Oh my! Neonatal Network, 31(4):262-264, 2012; and Melnyk, B.M. and Fineout-Overholt, E.: Making the case for evidence-based practice and cultivating a spirit of inquiry. In B.M. Melnyk and E. Fineout-Overholt (Eds.): Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, 2011, Wolters Kluwer, pp. 3-24. Independently planning and conducting research requires advanced knowledge. Assuming that any nurse can do research is like assuming any nurse can insert a peripherally inserted central catheter line. Both require specific education and skill development. The conduct of research requires expertise in research design and methods as well as statistical analysis. Research is differentially emphasized in the curriculum of nursing academic programs. Table 38-2 illustrates general research competencies based on educational preparation. The American Association of Colleges of Nursing specifies research competencies as essentials in baccalaureate, master’s, and advanced practice doctoral education (American Association of Colleges of Nursing, 2013) and emphasizes research and development of nursing science as the center of Ph.D. education in nursing (American Association of Colleges of Nursing, 2001). TABLE 38-2 Nursing Research Education AACN, American Association of Colleges of Nursing. * AACN Essentials: http://www.aacn.nche.edu/education-resources/essential-series † AACN Indicators of Quality in Research-Focused Doctoral Programs in Nursing: http://www.aacn.nche.edu/publications/position/quality-indicators ‡ Adapted from AACN Position Statement on Nursing Research, approved 1998, revised 2006: http://www.aacn.nche.edu/publications/position/nursing-research § Adapted from Ayers, D.M. and Coeling, H.: Incorporating research into associate degree nursing curricula. Journal of Nursing Education, 44(11), 2005, 515-518. ¶ AACN BSN Essentials: http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf ¶¶ AACN Masters Essentials: http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf ** DNP Essentials (advanced nursing practice): http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf Bridging the gap between doing and using research is the role of translational science. Though various terms are used, translational science, knowledge translation, and implementation science, in general all refer to moving science “from the bench to the bedside,” including both practice and policy (Curran et al., 2011). Translation, the in-between step, is a science unto itself, with theory and methods guiding how and why knowledge is transmitted into practice. Translational science, the underpinning of evidence-based practice, examines the nature of evidence and its evaluation, synthesis of evidence, informatics, the study of knowledge-to-action gaps, factors promoting and hindering knowledge transfer, methods of knowledge transfer, and evaluation of effects (Curran et al., 2011). Whether doing or using research, nurses assume several roles related to research ethics. Nurses independently conducting research comply with regulations governing human research subject participation. Nurses also may serve as staff on research projects conducted by others. Finally, nurses care for patients and their families who are involved in research. In all of these roles, nurses promote safety and protection of rights. In an American Association of Critical-Care Nurses draft resource document, Richmond and Ulrich (2012) outlined the ethical requirements related to the scientific value, integrity, and validity of the specific research project, benefits of the research outweighing the risks, informed consent processes, and respect for research participants. Neonatal intensive care unit (NICU) nurses face particular research ethics challenges given the vulnerable nature of infants and their parents (Franck, 2005). The nursing process and research process both represent an organized approach to critical thinking and share several similarities (Table 38-3). In essence, every patient is an “n of 1” research study. Regardless of the topic investigated, a research study contains several key elements (Houser and Bokovoy, 2006; LoBiondo-Wood and Haber, 2010): TABLE 38-3 Similarities of the Research Process and the Nursing Process Adapted from Gillis, A. and Jackson, W.: Research for nurses: Methods and interpretation. Philadelphia, 2002, F.A. Davis. 2. Each element of a research project fits the stated questions or hypotheses. 3. Analysis and study results direct relate to stated aims, questions, or hypotheses. B. Background: Framework is derived from a review of the literature that establishes what is currently known regarding the study topic and identifies the gaps in knowledge that the study will address. 2. A conceptual framework is a description of concepts, defined for the purposes of the research, and their relationships. C. Method: In some readings, the term method is used to define what was done to collect the data (e.g., observation, questionnaire, interview, physiologic measure); however, here method is defined as the entire description of how the study is conducted. a. Descriptive (sometimes divided into descriptive and exploratory). (1) Designs involve depicting the study sample “as is.” (2) Provide information to help understand the variables of interest in defined sample. b. Experimental. (2) Intervention studies are by nature experimental. c. The design determines the number of subject groups, the timing of data collection, and control of extraneous variables that may produce bias. d. These design choices contribute to scientific validity of the study and are related to how subjects are selected, the control of extraneous variables, how the independent variables are applied. e. Designs are described according to internal and external validity. Designs offer differing strengths and weaknesses relative to internal and external validity (Table 38-4). (2) External validity refers to the generalizability of results to a wider population. TABLE 38-4 Levels of Bias Control in Research Design
Foundations of Neonatal Research
RESEARCH AND GENERATION OF NURSING KNOWLEDGE
Research
Evidence-Based Practice
Formulate a question or hypothesis
Specify a clinical problem
Choose study design
Conduct literature review
Plan study methods and procedures
Gather evidence
Collect data
Critically appraise evidence
Analyze data and generate findings
Develop practice guideline
Disseminate results
Apply the practice change
Translate findings into practice
Evaluate patient/family outcomes and share results
Program
Educational Preparation*,†,‡,§
ADN
Appreciate the importance of research in nursing and assist in problem identification and data collection.‡
Identify problems, collect data, apply research findings in care delivery.§
B.S.N.
AACN B.S.N. Essential III. Translation of current evidence into practice.
Basic understanding of research process and translation to practice, appraise sources of information, participate in translation of evidence into practice, collaborate in collection and dissemination of evidence, understand nursing quality and safety measures.¶
Master’s
AACN Master’s Essential IV. Translation and integration of scholarship into practice.
Integration and translation of multiple information sources to improve practice and subsequent outcomes for patient aggregates, ethical protections for research participants, articulate evidence base for practice, work collaboratively to improve outcomes and promote policy change through generation, dissemination, and implementation of knowledge, apply practice guidelines, rigorous examination of database evidence to guide nursing practice.¶¶
DNP
AACN DNP Essential III. Clinical scholarship and analytical methods.
Determine best evidence for practice through critical appraisal, design and implement outcome evaluation of practice, design and conduct quality improvement processes, develop evidence-based practice guidelines, work collaboratively as a practice specialist to generate knowledge, dissemination to improve outcomes.**
Ph.D.
Develop the science of nursing. Research intensive, develop in-depth knowledge in substantive area, knowledge of the philosophy of science, integrative scientific perspective, generate knowledge, conduct original research, research ethics, leadership in the conduct of research, communication and dissemination of findings.†
RESEARCH PROCESS AND COMPONENTS OF A RESEARCH STUDY
Nursing Process
Research Process
Client assessment
Identification of problem
Nursing diagnosis
Questions or hypotheses
Plan of care
Method
Evaluation
Findings
Revision of plan
Implications and dissemination
Level
Designs
Independent Variable Control*
Control Group
Outcomes Present at Enrollment
A
Randomized concurrent controlled trial
Quasi-randomized concurrent trial
Randomized pre–post design
Yes
Yes (concurrent)
No
B
Cohort concurrent study
Pre–post study
No
Yes (may or may not be concurrent)
No
C
Ex post facto study
Case–control study
No
Yes (may or may not be concurrent)
Yes
D
Descriptive
No
No
Yes or no 
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