CHAPTER 46 Research and Evidence-Based Practice

Patricia Kunz Howard, PhD, RN, CEN

MAJOR TOPICS

Purpose

Improvement in Nursing Care by Establishing Scientific Basis for Practice

Validation of Scope of Emergency Nursing Practice

Facilitation of Evaluating Emergency Nursing Practice

Basis for Accountability

Documentation of Emergency Nursing Contributions to Health Care

Assessment of Outcomes of Emergency Nursing Care

Validation and Refinement of Existing Emergency Nursing Knowledge

Generation of New Knowledge Related to Nursing Care of Emergency Patients

Description and Promotion of Understanding Human Experiences

Nursing Education and Research Functions

Educational Institutions Incorporate Various Research Activities into Their Programs to Familiarize Nurses with the Research Process and Related Responsibilities

The American Nurses Association (1994) Delineated the Following Educational Preparation for Nurses Involved in Research

Research Projects

Clinical Problem Solving

Research Study

Research Methodologies

Quantitative

Qualitative

Triangulation (Blended Methods)

Research Process Steps

Question or Problem Formulation (for Quantitative)

Problem Statement

Literature Review

Hypothesis Formulation

Definition of Terms

Methodology

Data Analysis

Findings/Results, Conclusions, Recommendations

Communication of Findings

Research Ethics

Human Subjects and Ethical Guidelines

Animal Subjects and Ethical Guidelines

Scientific Fraud and Misconduct

Application to Clinical Practice

Do Study Findings Address Current Clinical Problems?

Is There Relevance to Clinical Practice?

Does Study Include an Appropriate Subject Population?

Were Subjects’ Rights Protected?

Was Study Ethical, Legal, and Feasible?

Was a Critical Review of the Literature Done?

Is Study’s Setting Similar to or Different from Intended Practice Setting?

Is Sample Similar to Intended Population to Which You Hope to Apply Findings?

Are the Research Instruments or Tools Used Reliable and Valid?

Are Findings Consistent with Practice?

Do Other Studies Report Similar or Different Findings?

Critiquing Research

Quantitative Research Studies

Qualitative Research Studies

Using Evidence-Based Practice

Components of Evidence-Based Practice

Essential Steps of Evidence-Based Practice

Nursing research and evidence-based practice are an integral aspect of emergency nursing practice every single day. Research is essential to ensure that the care provided will result in the best clinical outcomes that are possible for the patient. A compelling need to provide the best nursing care causes nurses to seek out evidence that supports best practice.

Research is a process of systematic inquiry; a question exists, investigation occurs, and conclusions are reached. Using evidence-based practice, emergency nurses look at what is known about a specific clinical condition or circumstance, evaluate the evidence, and derive best practices from the interpretations.

I. PURPOSE

A. Improvement in Nursing Care by Establishing Scientific Basis for Practice

B. Validation of Scope of Emergency Nursing Practice

C. Facilitation of Evaluating Emergency Nursing Practice

D. Basis for Accountability

E. Documentation of Emergency Nursing Contributions to Health Care

F. Assessment of Outcomes of Emergency Nursing Care

G. Validation and Refinement of Existing Emergency Nursing Knowledge

H. Generation of New Knowledge Related to Nursing Care of Emergency Patients

I. Description and Promotion of Understanding Human Experiences

II. NURSING EDUCATION AND RESEARCH FUNCTIONS

A. Educational Institutions Incorporate Various Research Activities into Their Programs to Familiarize Nurses with the Research Process and Related Responsibilities

B. The American Nurses Association (1994) Delineated the Following Educational Preparation for Nurses Involved in Research:

1. Associate degree in nursing

a. Helps to identify clinical problems in nursing practice

b. Assists in collection of data within a structured format

c. In conjunction with nurses possessing more advanced credentials, appropriately uses research findings in clinical practice

2. Baccalaureate degree in nursing

a. Reads, interprets, and evaluates research for applicability to nursing practice

b. Identifies clinical problems requiring investigation

c. Assists experienced investigators gain access to clinical sites

d. Influences the selection of appropriate methods of data collection

e. Collects data and implements nursing research findings

f. Applies established findings of nursing and other health-related research to nursing practice

3. Master’s degree in nursing

a. Active research team member, assuming role of clinical expert collaborating with experienced investigators in proposal development, data collection, data analysis, and interpretation

b. Appraises the clinical relevance of research findings

c. Creates a climate in the practice setting that supports scholarly inquiry, scientific integrity, and scientific investigation of clinical nursing problems

d. Provides leadership for integrating findings in clinical nursing practice

4. Doctoral education

a. Contributes to nursing knowledge through the conduct of research aimed at theory generation, theory testing, or new clinical knowledge

b. Designs studies independently as well as collaborates with other clinicians and researchers conducting studies

c. Responsible for acquiring funding for research from public or private sources

d. Disseminates research activities to the scientific community, clinicians, and as appropriate policymakers and lay public

III. RESEARCH PROJECTS

A. Clinical Problem Solving

1. Uses trial and error method

2. Generally involves one problem or a set of problems

3. Is not theory based

4. Generally does not use high-level statistical analysis

5. Is not concerned with issues of validity or reliability

6. Provides possible solutions to specific problems

B. Research Study

1. Uses formal plan to study problem

2. Looks for several solutions simultaneously

3. Is based on theory or generates a theory

4. Uses statistical analysis for quantitative research and uses words or themes as basis for analysis with qualitative research

5. Is concerned with issues of reliability and validity in quantitative research and auditability, credibility, and fittingness in qualitative research

6. May suggest solutions with wide applications for quantitative research or describe and give meaning to life experiences for qualitative research

IV. RESEARCH METHODOLOGIES

A. Quantitative (Table 46-1)

1. Described as a formal, objective, and systemic process: deductive process

2. Uses numeric data to quantify findings

3. Used to describe variables, examine relationships among variables, and determine cause-and-effect interactions between variables

4. Is most frequently used method of research studies

5. Identification of dependent and independent variables

a. Dependent variables: what the researcher is interested in exploring, understanding, and measuring; it is the answer or outcome response

b. Independent variables: what the researcher believes to be the cause of or influence on dependent variables; variable manipulated by the researcher; it is the treatment or intervention

1) Example: “What effect is there on turnover among emergency nurses who work in level I trauma centers versus those who work in freestanding urgent care centers?”

a) Dependent variable: turnover rates of emergency nurses

b) Independent variable: type of emergency setting (level I trauma or freestanding urgent care centers)

Table 46-1 COMPARISON OF FOUR QUANTITATIVE RESEARCH METHODS

B. Qualitative (Table 46-2)

1. Described as a systematic, interactive, and subjective approach

2. Uses words, not numbers, to give meaning to data

3. Used to describe life experiences and give them meaning

4. Is used less frequently than quantitative research, often generates rich, meaningful data

5. Inductive methods

Table 46-2 COMPARISON OF THREE QUALITATIVE RESEARCH METHODS

C. Triangulation (Blended Methods)

1. Can be employed in both quantitative and qualitative studies; may combine two types of the same methodology or may be a blending of both methodologies

2. Allows limitations of two methodologies to be overcome by comparing findings from different perspectives

3. May be used to overcome weaknesses in a specific method of data collection by using many strategies to avoid potential deficiencies of a single methodology or theory

V. RESEARCH PROCESS STEPS

A. Question or Problem Formulation (for Quantitative)

1. Definition of problem

a. Can be declarative or interrogative

b. Yields facts, not opinions

c. Is current and pertains to present and future of nursing

d. Is relevant to issues facing nursing today

e. Is clear, concise, and cogent

f. Provides direction for rest of research project

2. Research question

a. Directs research

b. Includes one topic per question

c. Provides basis for study and narrows focus

d. Example: “What effect does performing a brief intervention have on the number of emergency department visits for alcohol-related injuries?”

B. Problem Statement

1. Definition

a. Introduction of research topic

b. Explanation of importance of problem

c. What the investigator hopes to investigate

d. Full exposure of idea that needs to be studied

e. Logical ordering of thoughts about problem

2. Elements of problem statement

a. Initial literature search

1) Substantiates rationale for development and narrowing of problem

2) Provides references that support researcher’s justification for studying problem

b. Rationale for developing research question includes

1) Why there is a need for this particular research topic

2) Why an answer for this question is so imperative

3) How the findings will be applied to practice

3. Theoretical or conceptual framework

a. Both describe framework for study

b. Theoretical frameworks are composed of a set of concepts in which the relationships among concepts are described

c. Conceptual frameworks are the building blocks of theoretical frameworks; they may include multiple concepts related to a common theme (e.g., child maltreatment, anger) and tend to be more global and less testable than theoretical frameworks

d. Not all research studies have a fully developed conceptual or theoretical framework (e.g., descriptive or exploratory research studies)

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