Chapter 2: Theory, Research, and Evidence-Based Practice
A nurse studies the culture of native alaskans to determine how their diet affects their overall state of health. Which method of qualitative research is the nurse using?
Ethnography
When looking at a model for evidence-based practice, what is the final step of the process?
Evaluating practice change
A nurse researcher is examining the cause-and-effect relationship between the consumption of tap water containing minimal amounts of bleach, and the incidence of cancer in rats. The research is taking place in a lab setting. What type of quantitative research is being used based upon this description?
Experimental Research
A nurse is formulating a clinical question in PICOT format. What does the letter P represent?
Explicit descriptions of the population of interest
Who is considered to be the first nursing researcher?
Florence Nightingale
Who is considered to be the first theorist who conceptualized nursing in terms of manipulating the environment?
Florence Nightingale
Which theory emphasizes the relationships between the whole and the parts, and describes how parts function and behave?
General Systems Theory
A nursing theorist examines a hospital environment by studying each ward and how it works individually, then relates this information to the hospital as a whole working entity. This is an example of the use of which theory?
General systems theory
Interdisciplinary base for nursing theories
General systems theory Adaptation theory Developmental theory
A nurse developing a foreground question for nursing research using the PICO model. Which component would be represented by the statement, "a 45-year-old male with coronary heart disease and atrial fibrillation"?
P
Asking clinical questions in PICO format
P = patient, population, or problem of interest I = intervention of interest C = comparison of interest O = outcome of interest
A student nurse interacting with patients on a cardiac unit recognizes the four concepts in nursing theory that determine nursing practice. Of these four, which is most important?
Person
There are 4 common concepts in nursing theory. While all concepts are important, the focus of nursing is always on which of the following?
Person
Common concepts in nursing theories
Person (patient) Environment Health Nursing All of these concepts common to all nursing theories although they may be defined somewhat differently
A nurse manager schedules a clinic for the staff to adress common nursing interventions used in the facility and to explore how they can be performed more efficiently and effectively. The nurse managers actions to change clinical practice are an example of a situation described by which nursing theory?
Prescriptive theory
The nurse researcher would like to gather data about the attitudes of young adults on spirituality and health care. What is the most effective form of research on this topic?
Qualitative research
A nursing student is reading a research article from a nursing journal. The student is aware that the opening paragraph summarizing the article and the research findings is a good place to start. What part of the article is the nursing student reading?
Abstract
Components of a research journal
Abstract Introduction Method Results Discussion References
The nursing instructor asks a group of students to identify a theory that describes how humans adjust to life with other living things and with the environment. One of the students correctly identifies this as which theory?
Adaptation theory
The nurse working in research correctly identifies which of the following to be mandatory for the ethical conduction of research in a hospital setting?
Clients must grant informed consent if they are to participate
Information is collected for analysis in both quantitative and qualitative research. What is the information called?
Data
When conducting quantitative research, the researcher collects information to support a hypothesis. This information would be identified as:
Data
Phenomenology
Describe experiences as they are lived by the subjects being studied
A mother has brought her 6 year old into the clinic. The mother is concerned that her child does not seem to skip as well as the other children in her class. In planning assessments and care for this child, the nurse might choose which theory as a foundation for decision making?
Developmental theory
The nursing instructor asks a group of students to identify a theory that describes the maturation of humans through stages. One student correctly identifies this theory as what?
Developmental theory
A nurse is conducting quantitative research to examine the effects of following nursing protocols in the emergency department (ED) on patient outcomes. This is also known as what type of research?
Quasi-experimental
types of nursing knowledge
Science Philosophy Process
Following the identification of a researchable problem, what must the nurse do?
Select literature relevant to the problem
Sources of knowledge
Traditional, Authoritative, and Scientific
Ethics of Clinical Research Studies
Value Scientific validity Fair subject selection Favorable risk-benefit ratio Independent review Informed consent Respect for enrolled subjects
Authoritative
comes from an expert, accepted as truth based on persons perceived expertise
Steps in Implementing EBP
cultivate a spirit of inquiry ask the burning clinical question in PICOT format search for & collect the most relevant best practice critically appraise the evidence integrate the best evidence with ones clinical expertise & patient preferences & values in making a practice decision or change based on evidence disseminate the outcomes of the EBP decision or change
Quantitative research
descriptive, correlational, quasi-experimental, experimental
Ground theory
discovery of how people describe their own reality & how their beliefs are related to their actions in social situations; findings "grounded" in the data from subjects
variable
element that varies
Experimental
examine cause and effect relationships between variables under highly controlled conditions
Quasi-experimental
examine cause and effect relationships between variables; often conducted in clinical settings
Historical
examine events of the past to increase understanding of nursing profession today
Correlational
examine type & degree of relationships between two or more variables
Deductive Reasoning
examines general ideas and considers specific actions or ideas
Descriptive
explore events in real life situations, identifying relationships among events
One of the primary focuses of nursing research is to
generate knowledge to guide practice
Theory
group of concepts that describe a pattern of reality can be tested, changed, or used to guide research
data
information collected from subjects in the study
Quatitative
involves concepts of basic and applied research
Science
knowledge in & of nursing
knowledge base for nursing
nursing science, philosophy & ethics; biology & psychology; & the social, physical, economic, organizational, & technological sciences
Scientific
obtained through the scientific method (research)
developmental theory
orderly and predictable growth and development from conception to death; Erik Erikson & Abraham Maslow
Traditional
passed down from generation to generation
Qualitative Research Methods
phenomenology, grounded theory, ethnography, historical
A group of nurses is planning to investigate the effectiveness of turning immobilized stroke clients more frequently in order to prevent skin breakdown. The team has begun by formulating a PICO question. Which of the following will the "O" in the teams PICO question refer to?
preventing skin breakdown
Methods of Nursing Research
quantitative and qualitative
Hypothesis
statement of relationship between dependent & independent variables that researcher expects to find
Philosophy
study of wisdom, fundamental knowledge, and the processes used to develop and construct our perceptions of life -implies system of values and beliefs -nurses develop informed philosophic beliefs about humans, health, teaching, & learning and quality patient care
General Systems Theory
theory for universal application; break whole things into parts to see how they work together in systems
instruments
tools used to collect, record, and measure data
Ethnography
used to examine issues of a culture of interest to nursing
dependent variable
variable being studied, dependent on the intervention
independent variable
variable that is manipulated or determines effects on the dependent variable
Quantitative Research
variable, dependent variable, independent variable, hypothesis, data, instruments
protection of rights of human subjects
-human subjects participating in research have rights -must be informed about any benefits or risks of participation in a research study -informed consent -can withdraw from research at any time
Evidence-Based Practice (EBP)
-problem solving approach to making clinical decisions using the best evidence available -blends both the science & art of nursing so that the best patient outcomes are achieved -takes into consideration not only the evidence from research but also patient preferences & the clinical experience of the nurse -may consist of specific nursing interventions or may use guidelines established for the care of patients with certain illnesses, treatments or surgical procedures -the use of EBP mandates the analysis & systematic review of research findings
Process
-series of actions, changes, or functions -use of assessments & feedback -conceptual frameworks and theories become basis of actions
A nurse is using General systems theory to describe the role of nursing to provide health promotion and patient teaching. Which statements reflect key points of this theory? Select all that apply:
-the whole system is always greater than the sum of its parts -boundaries separate systems from each other and their environments -to survive, open systems maintain balance through feedback
Steps of Quantitative Research
1) State the research problem 2) Define the purpose of the study 3) Review related literature 4) Formulate hypotheses and variables 5) Select the research design 6) Select the population and sample 7) Collect the data 8) Analyze the data 9)Communicate findings and conclusions
How would a student nurse define a conceptual framework?
A group of interrelated objects that follow a pattern
National Institute of nursing research (Goals of research)
-build the scientific foundation for clinical practice -prevent disease and disability -manage and eliminate symptoms caused by illness -enhance end-of-life and palliative care
Goals of Nursing Research
- Improve care of people in clinical setting - Study people and the nursing process (Education, policy development, ethics, nursing history) - Develop greater autonomy and strength as a profession - Provide evidence based nursing practice
A nurse is using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model PET as a clinical decision making tool when delivering care to patients. Which steps reflect the intended use of this tool? Select all that apply:
-A nurse recruits an interprofessional team to develop and refine an EBP question -A nurse searches the internet to find the latest treatments for type 2 diabetes -A nurse questions the protocol for assessing postoperative patients in the ICU
Johns Hopkins Nursing EBP Model
-Clinical decision making specifically for the needs of the practicing nurse -user friendly tools -Three step process 1. practice question 2. evidence 3. translation
Nursing Theories
-Directs nurses toward common goal leads to improved patient care -provides rational and knowledgeable reasons for nursing actions -gives nurses knowledge base necessary for appropriate actions -helps resolve current nursing issues -prepares nurses to question assumptions and values -serves research, education, and practice
Quality Improvement (QI)
-Systematic & continuous actions that lead to measurable improvement in healthcare services & the health status of targeting patient groups -Quality often measured by extent to which patient needs & expectations are met -Any system can be improved even if it seems to be working well
Qualitative
-conducted to gain insight by discovering meanings -based on belief that reality is based on perceptions that differ for each person and change over time
For which research activity is a phenomenological research method most appropriate?
Attempting to understand non-English speaking immigrants experiences of being hospital clients
A male client 79 years of age who is postoperative Day 3 following hip replacement surgery has been approached by a nurse researcher and asked to participate in a research study. This study will test a new rehabilitation strategy. What aspect of the nursing research process addresses the clients understanding of the potential risks and benefits of this study?
Going through informed consent process with the client
A charge nurse meets with staff to outline a plan to provide transcultural nursing care for patients in their healthcare facility. Which theorist promoted this type of caring as the central theme of nursing care, knowledge, and practice?
Madeline Leininger
What is the central theme of florence nightingales nursing theory?
Meeting the personal needs of the client within the environment
What is the best explanation for the way evidence-based practice (EBP) has changed the way nursing care is delivered?
Nursing care now uses EBP as a means of ensuring quality care
Which of the following represents the basic framework of the research process?
Nursing process
Nurses in an ICU noticed that their clients required fewer interventions for pain when the ICU was quiet. They then asked a researcher to design a study about the effects of noise on the pain levels of hospitalized clients. How does this demonstrate the ultimate goal of expanding the nursing body of knowledge?
Nursing research helps improve ways to promote and maintain health
The most important concept of nursing theory
The person
Which statement best explains the importance of theoretic frameworks?
Theoretic frameworks advance nursing knowledge and practice
The nursing instructor is explaining sources of knowledge to a group of nursing students. She says, "Some knowledge is passed from one generation to another." One of the students correctly describes this source as being what?
Traditional Knowledge
A student nurse asks an experienced nurse why it is necessary to change the patients bed everyday. The nurse answers: "I guess we have just always done it that way." This answer is an example of what type of knowledge?
Traditional knowledge
Concepts
abstract impressions organized into symbols of reality conceptual framework or model
Adaptation Theory
adjustment of living matter to other living things and environment; how. do humans adapt
Nursing knowledge
awareness of reality acquired through learning or investigation
Inductive Reasoning
builds from specific ideas or actions to conclusions about general ideas
