Nursing Research Chap2

7/30/2019 Nursing Research Chap2

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NURSING RESEARCH:

CHAPTER 2Translating research into Nursing Practice:

EVIDENCE-BASED NURSING


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DEFINITION OF EBP:

EBP- conscientious use of currentbest evidence in making clinical

decisions about patient care.

NURSES & OTHER HCP must be:1. Lifelong learners- who have the skills to

search for, understand & evaluate new

information about patient care.2. Capacity to be flexible

3. Adapt to change


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Evidence based decision making

should integrate best research

evidence with:1. Clinical expertise

2. Patient preferences & circumstances

3. Awareness of the clinical setting &

resource constraints

Key ingredient- effort to personalize

the evidence to fit a specific patients

needs & a particular clinical situation.


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RESEARCH UTILIZATION &

EBP RESEARCH UTILIZATION- narrower

Use of findings from a disciplined study or

set of studies in a practical application

that is unrelated to the original research. Emphasis- translating empirically

derived knowledge into real world

applications. Genesis of the process- research

based innovation/ new knowledge.


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EBP (evidence-based

practice) broader.; incorporates research

findings with other factors

RU- begins with how can i put this

innovation to good use in clinicalsetting.

EBP- clinical question ( what does the

evidence say is the best approach tosolving this problem)


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RU CONTINUUM

Start point- emergence of newknowledge & new ideas

One end- discrete clearly identifiableattempts to base specific actions on

research findings. 3 distinct types of RU:

1. INDIRECT RU- changes in nurses thinking.

2. DIRECT RU- direct use of findings in giving

patient care.3. PERSUASIVE RU- use of findings to

persuade others to make changes inpolicies or practices relevant to nursingcare.


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HISTORY OF RU IN NSG.

PRACTICE 1980s- several changes in nursing

education & research prompted by the

desire to develop a knowledge base

for nursing practice. Nursing education- courses on

research methods.

Nursing research- shift focus towardclinical nursing problems


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CONCERNS ABOUT THE LIMITED

USE OF RESEARCH FINDINGS:

1. Nurses are often unaware ofresearch findings

2. Nurses did not incorporate results

into their practice CURN PROJECT (Conduct and

Utilization of Research in Nursing)

A 5 year development project awarded toMichigan Nurses Association by the

Division of Nursing in 1970.


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MAJOR OBJECTIVE OF

CURN: Use of research findings in Nurses

daily practice by:

1. Disseminating current research findings

2. Facilitating organizational changesneeded to implement innovations

3. Encouraging collaborative clinical

research.

RU- organizational process

Nurses- essential to OP


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CONCLUSION:

RU was feasible only if:

1. research is relevant to practice

2. Results are broadly disseminated

1990s- call for RU began to besuperseded by the push for EBP.


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EBP IN NURSING

ADVOCATES CRITICS

1. Offers a solution to improving

health care quality in our

current cost-constrained

environment.RATIONAL APPROACH- best

possible care with most cost-

effective use of resources.

1. Worries that advantages f EBP

are exaggerated & that :

1. Individual clinical

judgments2. Patient inputs

Are devalued.

2. Provides an importantframework for self-directed lifelong

learning essential in era of rapid

clinical advances & information

explosion.

2. Insufficient attention is beingpaid to the role of qualitative

research.


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OVERVIEW OF THE EBP

MOVEMENT COCHRANE COLLABORATION- one of the

cornerstones of EBP; Founded in UK based on the work of Archie

Cochrane--- british epidemiologist

Early 1970s Drew attention to the dearth of solid evidence

about the effects of health care.

Called efforts to make research summaries ofclinical trials available to physicians & other HCP.

1993- development of Cochrane center inoxford

COCHRANE COLLABORATION-international collaboration


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AIM OF CC

Help providers make good decisions about healthcare by: Preparing;

Maintaining;

And disseminating

Systemic reviews of the effects of health careinterventions.

EVIDENCE BASED MEDICINE- developedfrom a group from Mcmaster Medical School inCanada

Clinical learning strategy David Sackett- pioneer of EBM; means

integrating individual clinical expertise with thebest available external evidence from systemicresearch.


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TYPES OF EVIDENCE &

EVIDENCE HIERARCHIES General agreement- findings from

rigorous research are paramount.

RANDOMIZED CLINICAL TRIAL

(RCT)- well suited for drawingconclusions about the effects of health

care intervention.


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Resistance to EBP by nurses

due to:1. Bias in ranking sources of evidence

primarily in terms of questions about

effective treatments.

2. Thought that evidence fromqualitative & non-RCT studies would

be ignored.

3. Accdg. To Closs & Cheater- derivedfrom viewing it as an unwelcome

extension of the positivist tradition.


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7 level hierarchy

Comes from the systematic reviews thatintegrate findings from multiple RCT studiesusing rigorous & methodical procedures.

The worth of the evidence can vary

considerably. Evidence hierarchy is not universally

appropriate.

Appropriate with regard to questions about

the effects of clinical interventions ortreatments.

Best evidence- refers generally to findingsthat are methodologically appropriate,

rigorous and clinically relevant for answering


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Other sources:

1. Benchmarking data

2. Chart review

3. Quality improvement and risk data

4. Clinical expertise

One benefit of EBP movement is that

when clinical questions arise for which

there is no satisfactory evidence, anew research agenda can result.


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BY: PETIT

NACARIO, SN

THANK YOU!

Nursing Research Chap2

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