Jill J. Webb, PhD, MSN, RN, CS and Rosemary A. McLaughlin, PhD, MSN, RN-NIC After studying this chapter, the reader will be able to: 1. Summarize major points in the evolution of nursing research in relation to contemporary nursing. 2. Evaluate the influence of nursing research on current nursing and health care practices. 3. Differentiate among nursing research methods. 4. Evaluate the quality of research studies using established criteria. 5. Participate in the research process. Clinical nurse researcher (CNR) An advanced practice nurse who is doctorally prepared and directs and participates in clinical research. Clinical nurse specialist (CNS) An advanced practice nurse who provides direct care to clients and participates in health education and research. Clinical practice guideline (CPG) An evidence-based guide to clinical practice developed by experts in a particular field for direct application in clinical environments. Subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. When a true experimental design is not used, this group is called a comparison group. The process of acquiring existing information or developing new information. Having a foundation based on data gathered through the senses (e.g., observation or experience) rather than purely through theorizing or logic. A qualitative research method for the purpose of investigating cultures that involves data collection, description, and analysis of data to develop a theory of cultural behavior. The process of systematically finding, appraising, and using research findings as the basis for clinical practice. A design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena. The inference that findings can be generalized from the sample to the entire population. Proposal developed to seek research funding from private or public agencies. A qualitative research design used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process. Quantitative merging of findings from several studies to determine what is known about a phenomenon. A research design used to develop the validity and reliability of instruments that measure research concepts and variables. A holistic view of nature and the direction of science that guides qualitative research. A study in which the researcher collects data for estimating the needs of a group, usually for resource allocation. A qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. A smaller version of a proposed study conducted to develop or refine methodology, such as treatment, instruments, or data collection process to be used in a larger study. A systematic, subjective approach used to describe life experiences and give them meaning. A formal, objective, systematic process used to describe and test relationships and examine cause-and-effect interactions among variables. A type of quantitative research study design that lacks one of the components of an experimental design (i.e., randomization, control group, manipulation of one or more variables). The assignment of subjects to treatment conditions in a random manner (determined by chance alone). A research design in which data previously collected in another study are analyzed. A merging of findings from several studies concerning the same topic. Examples include meta-analysis with a quantitative approach and integrative review with a descriptive approach. A nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants. The use of a variety of methods to collect data on the same concept. Research is a process of systematic inquiry or study to build knowledge in a discipline. The purpose of research is to develop an empirical body of knowledge for a discipline or profession. Specifically, research validates and refines existing knowledge and develops new knowledge (Burns and Grove, 2010). The results of research process provide a foundation on which practice decisions and behaviors are laid. Research results create a strong scientific base for nursing practice, especially when deliberately and carefully evaluated for application to specific clinical topics (Melnyk and Fineout-Overholt, 2011). In recent decades, the nursing discipline has begun to pay greater attention to the necessity of participating in research. In addition to nursing research aimed at affecting the direct provision of nursing and health care to recipients of nursing care, nursing research also is needed to generate knowledge in areas that indirectly affect nursing care processes. Research within the realms of nursing education, nursing administration, health services, characteristics of nurses, and nursing roles provides evidence for effectively changing these supporting areas of nursing knowledge (Burns and Grove, 2010). Today, the importance of nursing research to the discipline is recognized. However, much nursing history underlies the current state of acceptance. Nursing research began with the work of Florence Nightingale during the Crimean War. After Florence Nightingale’s work, the pattern that nursing research followed was closely related to the problems confronting nurses. For example, nursing education was the focus of most research studies between 1900 and 1940. As more nurses received their education in a university setting, studies regarding student characteristics and satisfactions were conducted. As more nurses pursued a college education, staffing patterns in hospitals changed because students were less available compared to when students were enrolled in hospital-affiliated diploma programs. During this period, researchers became interested in studying nurses. Questions such as what type of person enters nursing and how are nurses perceived by other groups guided research investigations. Teaching, administration, and curriculum were studies that dominated nursing research until the 1970s. By the 1970s, more doctorally prepared nurses were conducting research, and there was a shift to studies that focused on the improvement of patient care. The 1980s brought nursing research to a new stage of development. There were many more qualified nurse researchers, widespread availability of computers for collection and analysis of data, and a realization that research is a vital part of professional nursing (Polit and Beck, 2012). Nurse researchers began conducting studies based on the naturalistic paradigm. These studies were qualitative rather than quantitative. In addition, instead of conducting many small, unrelated research studies, teams of researchers, often interdisciplinary, began conducting programs of research to build bodies of knowledge related to specific topics, such as urinary incontinence, decubitus ulcers, pain, and quality of life. The 1990s brought increasing concern about health care reform, and now, in the twenty-first century, research studies focus on important health care delivery issues, such as cost, quality, and access. With the developing educational emphasis on the doctorate in nursing practice degree, research emphasis on such patient care foci is likely to gain momentum, especially in view of the quality gaps highlighted by recent reports from the Institute of Medicine (IOM, 2001). Increasingly research findings are being used as the basis for clinical decisions. Evidence-based practice (EBP) can be defined as the process of systematically finding, appraising, and using research findings as a basis for making decisions about patient care. The rise of technology and the worldwide access and flow of information have transformed the decision-making processes of practitioners. Helpful informational websites for busy practitioners are listed in Box 6-1. No longer do nurses and other health care professionals simply compare outcomes of patient care between units in the same hospital; solutions, choices, and outcomes are sought on an international level. As part of the National Institutes of Health (NIH), the NINR supports research on the biologic and behavioral aspects of critical health problems that confront the nation. The NINR’s focus is designed to advance the “science of health” by encompassing health promotion and disease prevention; improving quality of life through symptom management, palliative care, and end-of-life care; enhancing innovations in science and practice; and developing a new generation of nurse scientists (NINR Strategic Plan, 2011). A small sampling of potentially supported research topics includes those aimed at the following: • Determining disease risk and treatment through utilizing genetic information • Determining effective health-promotion and disease prevention strategies for individuals, families, and communities • Discovering approaches that encourage people to self-manage their chronic illness • Assisting in identification and effective management of symptoms and system clusters related to acute and chronic disease • Developing and applying knowledge to enhance the development of health information technology such as the electronic health record • Creating communication strategies that promote health and improve health literacy • Improving the understanding of the complex issues and choices underlying palliative and end-of-life care • Encouraging the next generation of nurse scientists through support, training, and rapid educational advancement Annually the NINR conducts a roundtable discussion with multiple nursing organizations to obtain the feedback of the disciplines regarding the need for continued or new research emphases. Information obtained is used in setting future research agendas and making decisions about funding of proposals submitted by researchers (Office of Science Policy and Public Liaison, NINR, 2009). The NINR website details current announcements regarding research priorities (www.ninr.nih.gov/ResearchAndFunding). The AHRQ broadly defines its mission as improving “the quality, safety, efficiency, and effectiveness of health care for all Americans” (AHRQ, 2011a). As an agency of the U.S. Department of Health and Human Services, the AHRQ’s health-related aims are to reduce the risk of harm by promoting delivery of the best possible health care, improve health care outcomes by encouraging the use of evidence to make informed health care decisions, transform research into practice to facilitate wider access to effective health care services, and reduce unnecessary costs (AHRQ, 2011a). Since the inception of the agency in 1989, strategic goals have centered on supporting improvements in health outcomes, strengthening measurement of health care quality indicators, and fostering access to and cost-effectiveness of health care. The 1999 reauthorizing legislation expanded the role of the agency by directing the AHRQ to: • Improve the quality of health care through scientific inquiry, dissemination of findings, and facilitation of public access to information. • Promote patient safety and reduce medical errors through scientific inquiry, building partnerships with health care providers, and establishing centers for education and research on therapeutics (CERTs). • Advance the use of information technology for coordinating patient care and conducting quality and outcomes research. • Establish an office on priority populations to ensure that the needs of low-income groups, minorities, women, children, older adults, and individuals with special health care needs are addressed by the agency’s research efforts. The research-related activities of the AHRQ are quite varied, but a recent shift emphasizes a more deliberate translation of research evidence into practice. In a process similar to that used by the NIH, investigators are invited to submit research proposals for possible funding through grant announcements. A listing of current areas of the agency’s research interests can be found online at www.ahrq.gov/fund/portfolio.htm. The AHRQ actively promotes EBP, partially through the establishment of 14 EBP centers (EBPCs) in the United States and Canada. EPCs conduct research on assigned clinical care topics and generate reports on the effectiveness of health care methodologies. Health care providers may then use the evidence in developing site-specific guidelines that direct clinical practice. AHRQ also actively maintains the National Guideline Clearinghouse (www.guidelines.gov), a website that makes available to health care professionals a wide array of clinical practice guidelines that may be considered in health care decision making. Another recent addition to AHRQ’s initiatives is the Healthcare Innovations Exchange (AHRQ, 2011b), which provides a public source of information about innovations taking place in health care delivery. Submitted innovations are reviewed for the quality of achieved outcomes, providing evidence as a foundation for decision making by others who may be searching for or considering similar innovations. Although most AHRQ activities are intended to support health care professionals and institutions, the agency supports health care recipients by designing some information specifically for dissemination to the lay public (AHRQ, 2011a). Federal funding is available through the NIH and the AHRQ. However, because obtaining money for research is becoming increasingly competitive, voluntary foundations and private and community-based organizations should be investigated as possible funding sources. Many foundations and corporate direct-giving programs are interested in funding health care projects and research. Computer databases and guides to funding are available in local libraries. In addition, grant-seeking enterprises often purchase subscriptions that allow computer access to enhanced listings of funding foundations that include information about the types of projects those foundations typically fund. Though subscriptions are expensive, costs are often balanced by the efficiency with which suitable funding prospects are identified. An example of such a service is Prospect Research Online (2011) (www.iwave.com). Private foundations, such as the Robert Wood Johnson Foundation (2011a,b) or the W.K. Kellogg Foundation (2011), offer program funding for health-related research. Investigators are encouraged to pursue funding for small projects through local sources or private foundations until a track record is established in research design and implementation. After several years of experience in the research arena, investigators are more likely to be successful in securing funding through federal sources such as the NIH. The research process involves conceptualizing a research study, planning and implementing that study, and communicating the findings. The process involves a logical flow as each step builds on the previous steps. These steps should be included in published research reports so that the reader has a basis for understanding and critiquing the study (Box 6-2). BOX 6-2 COMPONENTS OF THE RESEARCH PROCESS Research is a process that takes place in a series of steps:
Nursing Research and Evidence-Based Practice
Definition of Nursing Research
Evolution of Nursing Research
Research Priorities
National Institute of Nursing Research
Agency for Healthcare Research and Quality
Private Foundations
Components of the Research Process
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Nursing Research and Evidence-Based Practice
