Chapter 24 Nursing Research and Evidence-based practice

According to research findings, approximately how many years does it take to fully embed research findings into facility-wide client care

*** 20 yrs

The Code of Federal Regulations states that

*** subjects must never be asked to waive their rights or to release the investigation from liability or negligence

A primary responsibility of every nurse conducting research is

*** the distribution of the findings (evidence) that have application in the client-care setting

The strength and consistency of evidence are also ranked on a five-point scale ranging from A (best) to E (poorest)

***"B" or higher should be present before a nurse integrates the data into EBP

Nursing research can be defined

**** as a systematic process for answering questions through the discovery of new information with the ultimate goal of improving client care ***a complex process in which knowledge is transformed from the findings of one or more studies into possible nursing interventions, with the ultimate goal of being used in clinical practice

Recommendations by the IOM's report on the future of nursing and documents from major professional nursing organizations

**** point to the need to focus inquiry on and link research findings to clinical practice early in the education process ***if these practices are adopted by and incorporated into nursing education, the research-practice gap should shrink and eventually be eliminated

Examples of Qualitative Research Designs

****Phenomenology ***Ethnography ***Grounded theory ***Historical studies ***Case studies

Steps of Quantitative Research

****Research problem and purpose ***Literature review ***Study framework ***Research objectives, questions, or hypothesis (study variables) ***Assumptions ***Limitations ***Research design ***Population and sample ***Methods of measurement ***Data collection ***Data analyses ***Research outcomes ***Generate new research

Nursing research is a key element

****in defining nursing as a profession

The next section of the evidence report focuses on clinical practice and should

****include practice-focused guidelines or recommendations for specific clinical interventions ***this section often begins with a statement such as, "there is very good evidence that..." or "there is no evidence that..." ***the practices outlined should be specific and relevant to the care being given

A major goal of nursing research is

****to expand and clarify the body of knowledge unique to the discipline of nursing

Ethnography

***A qualitative research approach involving the study of cultural groups

PICO question

***A question in which P represents population or patient ; I stands for phenomenon of interest; and CO stands for comparative and outcome

Essential features of Evidence-Based Practice (EBP)

***EBP is problem-based and within the scope of the practitioner's experience ***EBP narrows the research-practice gap by combining research with existing knowledge ***EBP facilitates application of research into practice by including both primary and secondary research findings ***EBP is concerned with quality of service and is therefore a quality assurance activity ***EBP projects are team projects and therefore require team support and collaborative action ***EBP supports research projects and outcomes that are cost-effective

What elements contributed to Evidenced Based Practice (EBP) becoming the gold standard for nursing practice?

***Integration of individual clinical expertise and client preferences ***Using the best available information developed for systematic research

Other Sources

***National Guideline Clearinghouse (U.S Agency for Healthcare Research and Quality): A repository for clinical practice guidelines (http://www.guideline.gov) ***The Cochrane Collaboration (international): Develops and maintains systematic reviews State University of New York (SUNY) website: lists the best sites for information (http://www.cochrane.org/)

Helpful tactics to create an environment receptive to new research findings include

***Reading clinical journals regularly but also critically ***Attending clinically focused nursing conferences where the latest client-care interventions are presented and discussed ***Learning to look for evidence that clearly supports the effectiveness and feasibility of updating nursing interventions ***Seeking work environments that promote the use of research findings and evidence-based care ***Collaborating with a nurse researcher ***Learning to critically scrutinize the status quo ***Pursuing the possibility of proposing and implementing a project

The ANA supports nursing research with a variety of resources such as the

***Research Toolkit

Evidence-based practice (EBP)

***The selective and practical use of the best evidence, as demonstrated by research, to guide health-care implementation and decisions

Guidelines for critiquing the Ethical Features of Research

***Was the study approved by an IRB? ***Was informed consent obtained from every subject ***Is there information regarding anonymity or confidentiality ***Were vulnerable subjects used ***Does it appear that any coercion may have been used ***Is it evident that potential benefits of participation outweigh the possible risks ***Were participants invited to ask questions about the study and told how to contact the researcher, should the need arise ***Were participants informed how to obtain results of the study

Applied Nursing Research

***a journal with a specific intention of providing research directed toward the practicing clinical nurse

If the research question invites discovery of meanings, perceptions, and the collection of subjective data

***a qualitative design should be used

If the researcher is looking at variables that are independent or objective or that demonstrate cause and effect

***a quantitative design is most suitable

In its fullest meaning, nursing research involves

***a systematic quest for knowledge designed to address any questions and solve any problems relevant to the profession, issues related to nursing practice, nursing education, and nursing administration

Scientific inquiry is the tool of choice for

***achieving the goals of professional clarification, justification, extension, and collaboration

Informed consent is both

***an ethical and a legal requirement in the research process

If little is known about a specific subject

***an exploratory study may be the best method for uncovering new information ***in exploratory research, there is usually more interest in the qualitative characteristics of data; hypotheses are usually not required for these studies

Ethical issues are critical to all research

***and all researchers from all disciplines are bound by ethical principles that protect the rights of the public

Associate degree nurses

***are expected to demonstrate an awareness of the value of research in nursing by becoming knowledgeable consumers of research information and by helping identify problems within their scope of nursing practice that may warrant exploration

Integrative reviews in evidence reports should provide

***both the type of evidence included and the strengths and consistencies of the information

The trial and error process has been replaced

***by the scientific inquiry and the formal research process that not only increases new knowledge but also demonstrates what is best in nursing practice

The four major concepts of all nursing theories

***client (person), health, environment, and nursing should also be considered in identifying areas of interest that the nursing profession views as the core of its value system

Best practice is defined as

***clinical nursing actions that are based on the "best evidence" available from nursing research ***it has the goals of infusing practice with research-based knowledge and applying the most recent, relevant, and helpful nursing interventions into the nurse's day to day practice ***the purpose is to achieve client care outcomes that exceed the basic standards of care ***to be considered a best practice, there must be empirical data from multiple institutions that are using the practice and it must be published in a professional journal

Nurses may participate in research activities in a number of ways such as

***conducting reviews of literature ***to critique research studies for the possibility of application to practice, or use research findings in the development of policies, procedures and guidelines for the client care

Informed consent

***consent to participate in a study given by one who has full understanding of the study before the study begins ***based on the principle of the right of each individual to self-determination

Virginia Henderson, one of the early theorists

***defined the role of nursing as being to assist individuals (sick or well) with those activities contributing to health, or its recovery or to a peaceful death, that they performed unaided, when they have the necessary strength, will, or knowledge; to help individuals carry out prescribed therapy and to be independent of assistance as soon as possible

The mission of the IRB is to

***ensure that researchers do not engage in unethical behavior or conduct poorly designed research studies

The mission of EBP researchers is to

***evaluate and present the available evidence on a specific topic in a clear and unbiased way ***clinical recommendations evolving from this process present nurses with sound decisions based on evidence of best practice

Questioning the status quo is a key

***first step in the research process

The Population, Intervention, Comparison, and Outcome (PICO) question

***flows naturally from nursing's values

Evidence-based practice is more geared to the goal of

***generating high-quality research that can be used to build best practices

Academic and practice arenas are often

***in reality, two entirely different cultures

Strategies to help nurses conduct and use research for the improvement of nursing care

***incorporating research findings in textbooks, basic and continuing nursing education programs, and clinical policy and procedure manuals ***explicitly connecting research use to institutional goals and objectives ***developing joint committees between colleges of nursing and hospital nursing hospital departments ***inviting staff nurses to find and present summaries and abstracts during unit meetings and clinical case conferences, in an effort to increase the interest of colleagues working on their units

The implementation of research in practice will depend on

***inquisitiveness, development of cognitive skills, the ability to question one's own practice , and professional discipline

Florence Nightingale

***is viewed as the person who first elevated nursing to the status of a profession ***she recognized the positive impact of combining strong logical thinking and empirical research in developing a sound scientific base on which to build the practices of the nursing profession ***her strong advocacy for better care and improved environmental conditions lowered the mortality rate among wounded soldiers from 42 to 2 percent

One solution to speed up the process of incorporating EBP into client care was developed by the Agency for Healthcare Research and Quality (AHRQ)

***it created a framework that uses the following three steps: 1) knowledge creation 2) diffusion of the evidence 3) dissemination and adoption (institutionalizing) of the change ***this framework creates a multidisciplinary map for education and practice to establish parallel paths whose ultimate goal is improved client outcomes

Which of the following reflects the true scope of nursing research

***it includes investigation into administration ***it includes investigation into nursing education ***it includes investigation into nursing practice

Center for Research for Nursing (1983)

***its mission is to serve as a source of national data for the profession

The National Center for Nursing Research (NCNR) 1986

***its mission is to support clinical (applied) and basic research to create a scientific foundation of the care of individuals across the life span

Researchers must find ways of packaging the conclusions so that practicing nurses

***may easily understand and implement clinical solutions to the care issues they are facing

Research is the approach by which nursing knowledge may be judged

***much more reliable and transferable than that afforded by authority, tradition, or past experience ***research provides the crucial link between theory and practice

Using nursing research

***nurse investigators address issues related to cost, safety, quality, and accessibility of health care and look ahead to establish priorities and to define the future direction of the nursing profession

With the emphasis on the urgency for implementing EBP, critical and creative thinking have become even more important for the following reasons

***nurses must access, understand, evaluate, and disseminate a rapidly expanding body of nursing and other health-related information ***nurses must be able to recognize commonalities and uncover inconsistencies regarding the values of the profession, the values of the organization that employs them, the needs of clients for whom they advocate, and even the popular culture that exerts pressure on the public's ability to make safe choices ***nurses recognize that it takes critical and creative thought to support research into complex health-care issues and to promote successful implementation of changes in professional practice

The goal of nurses using EBP is to

***obtain the best information available and to integrate it into their day-to-day nursing practice; such practice includes the client's values and self-determination in providing care, as well as those of the client's family ***the ultimate goal of EBP is to improve the quality of care

Applying critical thinking to a problem

***often leads to visualization of a research project, the development of a plan, the implementation of that plan, and finally, sharing of the findings with others; this process follows a logical progression from abstract ideas to concrete actions

Primary research

***one recurring criticism of primary nursing research is that much of it is accomplished as single studies

Epidemiologist

***one who studies the distribution and determinants of health and illness and the application of findings as a means of promoting health and preventing illness

Research reported in the literature is a primary source of high quality information but not the only one

***other sources include expert opinion, collaborative consensus, published standards, historical data, local quality assurance studies, and institutional reports, including cost effectiveness and client and family preferences and input

Nursing's top 10 IOM priorities for research

***preventing and treating overweight and obesity in children and adolescents through school related interventions such as healthy meal programs, vending machines that sell healthy snacks, and physical activity ***developing more effective treatment strategies for atrial fibrillation by comparing treatments such as surgery, catheter ablation, lifestyle changes, and medication ***identifying risk factors and preventing falls in older adults through primary prevention methods such as exercise, balance training , and various clinical treatments ***evaluating the effectiveness of comprehensive home-care programs for children and adults with severe chronic disease, particularly in minority and ethnic populations that have been identified as having ongoing disparities ***comparing the effectiveness of hearing loss treatments for children and adults in minority and ethnic populations; evaluating various methods, including but not limited to, assistive listening devices, cochlear implants, electric-acoustic devices, rehabilitation methods, sign language, and total communication techniques ***preventing obesity, hypertension,diabetes, and heart disease in at risk groups such as the urban poor, Hispanic, and American Indian populations; comparing the effectiveness of strategies, including but not limited to, pharmacological interventions, improved community environment, making healthy foods available, or a combination of interventions ***reducing or eliminating healthcare associated infection (HAI) in adults and children by testing various techniques, particularly where invasive devices such as central lines,ventilators, and surgical procedures are used ***determining the best methods for early detection, prevention, treatment, and elimination of antibiotic-resistant organisms (MRSA) in both community and institutional settings ***determining the best treatments for early detection and management of dementia to be used by caregivers in the community setting ***publishing and distributing the findings of CER so that clients, physicians, nurses, and others can use the data to establish best practices

Institutional Review Board (IRBs)

***primary responsibility is to safeguard, in every way, the rights of any individual participating in a research study ***are panels that review research proposals in detail to ensure that ethical standards are met in the protection of human rights

The research problem can be identified through the

***problem-solving process, the nursing process, or evidence-based practice process

Essential features of professional nursing and relationship to Evidence-Based Practice

***provision of a caring relationship that facilitates health and healing ***attention to the range of human experiences and responses to health and illness within physical and social environments ***integration of assessment data with knowledge gained from an appreciation of the patient or the group ***application of scientific knowledge to the processes of diagnosis and treatment through the use of judgement and critical thinking ***advancement of professional nursing knowledge through scholarly inquiry ***influence on social and public policy to promote social justice ***assurance of safe, quality, and evidence-based practice ***honoring client preferences and values in shared decision- making ***determining the applicability of evidence to an individual patient and his or her context ***gathering individual or local data and situating them with evidence from the research of groups ***using clinical expertise and appraisal of the best available evidence of effectiveness to select the most appropriate nursing intervention ***using the evidence syntheses to identify gaps in knowledge and the need for further research ***advocating for policy that assures equal access to effective treatment and the incorporation of patient values and preferences in policy decisions ***questioning traditional practices and using the best available evidence to drive safe, high quality care while discarding ineffective practices

Phenomenology

***qualitative research studies that examine lived experiences through descriptions of the meanings of such experiences by the individuals involved

Baccalaureate Degree Nursing Graduate

***reads, interprets, and evaluates research for applicability to nursing practice ***identifies nursing problems that need to be investigated and participates in the implementation of scientific studies ***uses nursing practice as a means of gathering data for refining and extending practice ***applies established findings of nursing and other health related research to practice ***shares research findings with colleagues

The last section of the evidence report is the report source

***reports should be specific and current and should come from high-quality, refereed professional journals

Research design

***serves as a fairly flexible set of guidelines that will provide the researcher with answers to the questions of injury

Systematic reviews present

***summaries of past research on a particular topic that are easy to read and understand

A challenge to the use of research in practice is that research in practice skills are often

***taught to nursing students in isolation from other nursing subjects

The purpose of nursing research is to

***test, refine, and advance the knowledge on which improved education, clinical judgement, and cost effective, safe, ethical nursing care rests

The professional responsibility of every nurse caring for clients requires

***that all nursing interventions be planned on the basis of reliable research findings

Nurses should look for several key elements in evidence reports when attempting to integrate EBP into their care

***the first part of the report should include a structured summary statement of the problem, practice, or disease that describes what is in the evidence report ***the second part should comprise a lengthy and detailed analysis of the published and unpublished data, including reviews of articles and reports, the populations included in the studies , and the nature of the nursing actions investigated; one of the most important elements in the second part of the evidence report is the ranking or grading of the quality of the evidence or level of recommendation for use

The ability to read, understand, and critique research articles is

***the first step in upgrading clinical practice

To choose a research design

***the nurse must first develop a vision of the overall plan for a study, including a general idea of the type of data needed to answer the research question ***the design is a critical link that connects the researcher's framework with the appropriate types of data

Qualitative designs

***the purpose of qualitative inquiry is to gain an understanding of how individuals construct meaning in their world, visualize a situation, and make sense of that situation ***qualitative designs are best suited to answer questions that interest nurses ***semistructured interviews using open-ended questions and observations are the most commonly used data collection methods in qualitative studies; knowledge generated by qualitative research answers questions related to the meaning and understanding of human experiences

Articles adapted from the Nuremberg Code

***the voluntary consent of human subjects is absolutely necessary ***the experiment should yield fruitful results for the good of society ***the experiment should be so designed and based on results of animal experimentation and knowledge of... the disease or problem under study that the anticipated results will justify performance of the experiment ***the experiment should be conducted where there is a priori reason to believe that death or... injury will occur ***the degree of risk...should never exceed that determined...by the importance of the problem to be solved by the experiment ***proper preparations should be made....to protect the experimental subject against even remote possibilities of injury, disability, or death ***only scientifically qualified people must conduct the experiment; the highest degree of skill and care should be required through all stages of the experiment ***during the course of the experiment, the subject should be at liberty to bring the experiment to an end ***during the course of the experiment, the scientist....must be prepared to terminate the experiment at any stage

Which of the following is an expected fundamental competency in nursing

***to be able to use EBP in daily provision of care

Nursing research can also be used

***to shape health policy in direct client care, within an organization, and at local, state, and federal levels

Critical discernment requires the nurse

***to understand the research process and to sift through and carefully assess all available and credible research findings

Quantitative Designs

***use approaches that seek to verify data through prescriptive testing, correlation, and sometimes description ***these designs imply varying degrees of control over the research material or subjects; control of the research design can range from very tight to somewhat loose ***the design in quantitative research becomes the means used for hypothesis testing; the design also optimizes control over the variables to be tested and provides the structure and strategy for answering the research question ***more highly controlled quantitative designs try to demonstrate causal relationships, and more flexible designs address relationships between and among variables ***in quantitative experimental design, a comparison of two or more groups is required; the independent variable is the one managed or manipulated by the researcher; the dependent variable depends on, or is altered as a direct result of, the researcher's manipulation

Experiential learning, also called the trial and error process

***was used for many years in developing the knowledge, skills, and techniques nurses used in the promotion of health and healing

In qualitative research, an important concept is process consent

***which requires that the researcher renegotiate the consent if any unanticipated events occur

Master's Degree in Nursing

1. Analyzes and reformulates nursing practice problems so that scientific knowledge and scientific methods can be used to find solutions 2. Enhances quality and clinical relevance of nursing research by providing expertise in clinical problems and by providing knowledge about the way in which these clinical services are delivered 3. Facilitates investigation of problems in clinical settings by contributing to a climate supportive of investigative activities, collaborating with others in investigations, enhancing nurses' access to clients and data 4. Investigates for the purpose of monitoring the quality of nursing practice in a clinical setting 5. Assists others in applying scientific knowledge in nursing practice

Graduate of a Research-Oriented Doctoral Program

1. Develops theoretical explanation phenomenon relevant to nursing by empirical research and analytic processes 2. Uses analytical and empirical methods to discover ways to modify or extend existing scientific knowledge so that it is relevant to nursing 3. Develops methods for scientific inquiry of phenomena relevant to nursing

The nurse can evaluate the evidence report by asking three questions

1. Is this the best available evidence? - best sources include peer-reviewed journals and reports no more than 3 to 5 years old 2. Will the recommendations work for my practice given the client population and problems? - if the study population is of young adult white men and the nurse's primary work population is elderly women, the data generated may not apply 3. Do the recommendations fit well with the preferences and values of the clients I commonly work with? -if the values of the nurse's primary group vary greatly from those of the study group, it is likely the recommendations may not work well

Doctorate Degree in Nursing or a related discipline

1. Provides leadership for the integration of scientific knowledge for the advancement of practice 2. Conducts investigations to evaluate the contributions of nursing activities to the well-being of clients 3. Develops methods to monitor the quality of nursing practice in a clinical setting and to evaluate contributions of nursing activities to the well-being of clients

Key elements of informed consent

1. Researcher is identified and credentials presented 2. Subject selection process is explained 3. Purpose of the research is described 4. Study procedures are discussed 5. Potential risks are identified 6. Potential benefits are described 7. Compensation, if any, is discussed 8. Alternative procedures, if any, are disclosed 9. Assurances regarding anonymity or confidentiality are explained 10. The right to refuse participation or withdraw from the study at any time is assured 11. An offer to answer all questions honestly is made 12. The means of obtaining the study results is described

Associate Degree Nursing Graduate

1. demonstrates awareness of the value or relevance of research in nursing 2. assists in identifying problem areas in nursing practice 3. assists in collection of data within an established structured format

Research design

A blueprint for conducting a research study

Nuremberg code

A code of conduct that serves as one of the recognized guides in the ethical conduct

Collaboration

A collaborative venture among those with a common goal

Hypothesis

A formal statement of the expected relationship between variables in a selected population

Theoretical framework

A framework based on propositional statements derived from one theory or interrelated theories

Conceptual framework

A framework of concepts that demonstrate their relationships in a logical manner. Although less well developed than a theoretical framework, this framework may be used as a guide for a study.

Scientific inquiry

A logical, orderly means of collecting data for the generation and testing of ideas

Comparative Effectiveness Research (CER)

A method to determine the priority of research topics developed by the IOM, based on client outcomes both in and outside the institutional setting.

Institutional Review Board (IRB)

A panel established at an agency, such as a hospital or university, to review all proposed research studies and to set standards for research involving human subjects

Nursing research

A process that permits nurses to ask questions directed at gaining new knowledge to improve the profession, including elements of client care

Research process

A process that requires the comprehension of a unique language and involves the ability to apply a variety of research processes

Experimental research design

A quantitative research design that meets all of the following criteria: an experimental variable that is manipulated, at least one experimental and one comparison group, and random assignments of participants to either the experimental or the comparison group.

Causal relationship

A relationship between variables in which the presence or absence of one variable (known as the cause) will determine the presence or absence of other variable (known as the effect)

Primary research source

A report or account of a research study written by the researcher(s) conducting the study. In historical research, a primary source might be an original letter, diary, or other authenticated document.

Replication study

A research study designed to repeat or duplicate earlier research A different sample or setting may be used while the essential elements of the original study are kept intact

Nonprobability sampling

A sampling process in which a sample is selected from elements of a population through methods that are not random Convenience, quota, and purposive sampling are examples

Random sample

A selection process that ensures that each member of a population has an equal probability of being selected

Conceptual model

A set of abstract and general concepts that are assembled to address a phenomenon of interest. Sometimes referred to as theoretical framework or conceptual framework.

Sample

A subset of a population selected to participate in a study as representative of that population

Quantitative research design

A systematic and objective process used to describe and test relationships and evaluate causal interactions among variables

Qualitative research design

A systematic but subjective research approach implemented to describe life experiences and give them meaning

Quasi-experimental design

A type of experimental design in which there is either no comparison group or no random assignment of participants

Process consent

A version of informed consent that supports renegotiation when a situation originally consented to undergoes change.

Five point scale

A. There is type 1 evidence or consistent findings from multiple studies of types II, III, or IV B. There is type II, III, or IV evidence, and the findings are generally consistent C. There is type II, III, or IV evidence, but the findings are inconsistent D. There is little or no evidence, or there is type V evidence only E. Panel consensus: practice recommendations are based on the opinions of experts in the field

Review of literature

An exploration of available information to determine what is known and what remains unknown about a subject.

Case study

An in-depth qualitative study of a selected phenomenon involving a person, a group of people, or an institution

Grounded theory

An inductive approach to research using a systematic set of procedures to develop a theory that is then supported by, or grounded in, the data

Bias

An influence that produces a distortion in the results of a research study

Barriers to Research in Practice

An isolated skill: research skills are often taught to nursing students in isolation from other nursing subjects. Lack of understanding: researchers don't understand from nurse's viewpoint; nurses may not be skilled in conducting skilled nursing research. Entrenched practices: nursing traditions that were widely accepted as fact that they are never questions and evade scrutiny of testing. Lack of incentive: due to budget constraints, hospitals/other agencies have not offered much to nurses in the way of encouragement/rewards to encourage research finding in an effort to improve practice. Resistance from managers: view the environment of updates/change as unfavorable to maintaining a committed and cohesive staff and a threat to the constancy necessary for safe/expeditious client care.

Variable

Any trait of an individual, object, or situation that is susceptible to change and that may be manipulated or measures in quantitative research

Rosswurn and Larrabee Model for Application of Nursing Research

Assess the need for practice changes ***involve all nurses that have a stake in the intervention or change ***identify problems associated with the current practice ***compare available information Link the problem intervention or change ***identify possible interventions ***develop outcome indicators Produce best evidence for consideration ***conduct a review of existing literature ***compare and contrast the evidence found ***determine feasibility ( including cost in dollars and time) ***consider benefits and risks Design a proposed practice change ***define the anticipated change ***identify necessary resources **develop a plan based on desired outcomes Implement and evaluate the proposed change ***conduct a pilot study **assess the process and the outcomes ***make a decision to alter, accept, or reject the proposed change Support the change with ongoing evaluations of the outcomes ***communicate the desired change to those involved ***conduct in-service education sessions ***revise standards of practice (policy/procedures) reflecting the change ***monitor the ongoing process and results

Nurses can locate evidence reports from numerous sources

Clinical journals ****Evidence-Based Nursing (http://ebn.bmj.com/) ***Online Journal of Clinical Innovations (http://www.nursingworld.com) ***Reformatted STTI Online Journal for Knowledge Synthesis in Nursing (http://nursing society.org/Publications/Newsletter/) (Must be a member to access)

Best practices

Clinical nursing actions that are based on the "best evidence" available from nursing research.

In what ways can nurses participate in research and the development of best practices

Conducting reviews of nursing literature Critiquing research studies for the possibility of application to practice Using research findings in the development of policies, procedures and guidelines for patient care

What requires the nurse to understand the research process and to sift through and carefully assess all available and credible research findings then analyze and judge the recommendations for using the best practice techniques based on best evidence

Critical discernment

What do you call nursing practices and traditions that remain so widely accepted as a fact that they are never questioned and therefore evade the scrutiny of testing

Entrenched practices

Quantitative Research Designs

Experimental designs ***Pretest/post test control group ***Post-test only control group ***Solomon four group Quasi-experimental designs ***nonequivalent control group ***time series *** Pre-experimental designs ***one group pretest/post-test Nonexperimental designs ***comparative studies ***correlational studies ***developmental studies ***evaluation studies Meta-analysis studies ***methodological studies ***needs-assessment studies ***secondary analysis studies Survey studies ***one-shot case study

Five types of evidence can be present in an evidence report, ranked from I (strongest) to V (weakest)

I. Meta-analysis of multiple well designed, controlled studies that examines and synthesizes many studies to find similar results II. At least one well-designed experimental study with a random sample, control group, and intervention III. Well designed, quasi-experimental studies, such as nonrandomized controlled, single-group pretest or post-test, cohort studies, or time series studies IV. Well-designed nonexperimental studies, such as comparative and correlational descriptive studies and controlled case studies V. Case reports and clinical examples

Empirical evidence

Objective data gathered through the use of the human senses

Historical study

Qualitative research involving the systematic collection and synthesis of data regarding people and events of the past.

Ethical standards

Standards determined by principles of moral values and moral conduct.

Validity

The ability of an instrument to measure the variables that it is intended to measure

Metaparadigm

The broadest perspective of a discipline giving an overview of the key theoretical models

Correlation

The degree of association between variables

Reliability

The dependability or degree of consistency with which an instrument measures what it is intended to measure

Exploratory study

The descriptive examination of available data to become as familiar as possible with information

Nurses with a baccalaureate education are expected

to be intelligent consumers of research by understanding each step of the research process to interpret, evaluate, and determine the credibility of research findings to be able to distinguish between findings that are merely interesting and findings supported by enough data to be included in the nurse's practice to participate in one or more phases of research projects to be alert to and uphold the ethical principles of any research involving human participants and oversee the protection of individual rights as specified in the ANA Code of Ethics