3110 chapter 5

Clinical implications:

A research article includes a section that explains whether the findings from the study have clinical implications. The researcher explains the generalizability or how to apply findings in a practice setting for the type of subjects studied.

Confidentiality

guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.

peer-reviewed

is reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published.

scientific method

is the foundation of research and the most reliable and objective of all methods of gaining knowledge

Informed consent

means that research subjects (1) are given full and complete information about the purpose of a study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity.

research process

n orderly series of steps that allow a researcher to move from asking the research question to finding the answer. Usually the answer to the initial research question leads to new questions and other areas of study. The research process builds knowledge for use in similar situations. For example, a nurse researcher wants to know the best way to provide psychosocial support for patients with breast cancer. The research process ultimately provides knowledge that nurses from a variety of settings will use to provide evidence-based nursing care.

Quantitative nursing research

precisely measures and quantifies a study's variables. Two examples of quantitative research are (1) a study dealing with a new pain therapy that quantitatively measures participants' pain severity and (2) a study testing different forms of surgical dressings to measure the extent of wound healing. Quantitative research is the precise, systematic, objective examination of specific concepts. It focuses on numerical data, statistical analysis, and controls to eliminate bias in findings (Lobiondo-Wood and Haber, 2018). There are many quantitative methods. Some of the more commonly used quantitative methods include experimental, nonexperimental, survey, and evaluation research.

Qualitative nursing research

studies phenomena that are difficult to quantify or categorize, such as patients' perceptions of illness or quality of life. This research method describes information obtained in a nonnumeric form (e.g., data in the form of transcribed written transcripts from a series of interviews). Qualitative researchers aim to understand patients' experiences with health problems and the contexts in which the experiences occur. Patients tell their stories and share their experiences in these studies. The findings have depth because patients are usually descriptive in what they choose to share. Examples of qualitative studies include (1) patients' perceptions of nurses' caring in a palliative care unit, and (2) the perceptions of stress by family members of critically ill patients.

latent errors

the organization or steps of the process

experimental study

tightly controls conditions to eliminate bias with the goal of generalizing the results of the study to similar groups of subjects.

To determine its worth to practice, consider:

• What is the level of evidence? • How well was the study (if research) conducted? • How useful are the findings to practice?

Ask a Clinical Question in PICOT Format

(:

Evidence-based articles include the following elements:

-

There are seven steps of EBP, which are numbered from zero to six

0. Cultivate a spirit of inquiry within an EBP culture and environment. 1. Ask a clinical question in PICOT format. 2. Search for the most relevant and best evidence. 3. Critically appraise the evidence you gather. 4. Integrate the best evidence with your clinical expertise and patient preferences and values to make the best clinical decision. 5. Evaluate the outcomes of practice changes based on evidence. 6. Communicate the outcomes of EBP decision or changes.

Literature review or background.

A good author offers a detailed background of the level of science or clinical information about the topic. The literature review offers an argument about what led the author to conduct a study or report on a clinical topic. This section of an article is very valuable. Even if the article itself does not address your PICOT question the way you desire, the literature review may lead you to more useful articles and build your knowledge base in nursing. After reading a literature review, you should have a good idea of how past research led to the researcher's question. For example, one article Tom found described a study designed to test the effects of aseptic practices on CLABSI. This study reviewed literature that describes the nature of CLABSI and the patients most at risk, the type of factors shown previously in the literature to contribute to CLABSI, and previous interventions used to prevent CLABSI.

Abstract

An abstract is a brief summary that quickly tells you if the article is research or clinically based. An abstract summarizes the purpose of the article. It also includes the major themes or findings and the implications for nursing practice.

Cultivate a Spirit of Inquiry

Changes in health care are often made slowly because of multiple barriers that often prevent the implementation of EBP. When your care is not evidence based, your patients will sometimes experience poor outcomes. To be an effective change agent and foster optimal patient care, you need to have a never-ending spirit of inquiry. Constantly questioning current practices and believing in the value of EBP lead to the consistent use of EBP in clinical nursing practice. For an institution to be successful at implementing and sustaining EBP changes, there must be a culture that promotes and supports a spirit of inquiry

Results or conclusions:

Clinical and research articles have a summary section. In a clinical article the author explains the clinical implications for the topic presented. In a research article the author details the results of the study and explains whether a hypothesis is supported or how a research question is answered. This section includes a statistical analysis if it is a quantitative research study. A qualitative study summarizes the descriptive themes and ideas that arise from the researcher's analysis of data. Do not let the statistical analysis in an article overwhelm you. Read carefully and ask these questions: Does the researcher describe the results? Were the results significant? An effective author also discusses limitations to a study in this section. The information on limitations is valuable in helping you decide if you want to use the evidence with your patients. Have a faculty member or an expert nurse help you interpret statistical results.

Methods or design:

Explains how a research study was organized and conducted to answer the research question or test the hypothesis. This section explains the type of study that was conducted (e.g., RCT, case control study, or qualitative study) and the number of subjects or people who participated in the study. In health care research, subjects often include patients, family members, or health care staff. The methods section is sometimes confusing because it explains details about how the researcher designed the study to obtain the most accurate results possible. Use your faculty member as a resource to help interpret this section.

Purpose statement:

Explains the focus or intent of a study. It includes research questions or hypotheses—predictions made about the relationship or differences among study variables (concepts, characteristics, or traits that vary within or among subjects). An example of a research question is: Does the use of chlorhexidine 2% compared with povidone-iodine reduce CLABSI in patients with CVCs? Within this question the author is studying the variables (independent) of chlorhexidine and povidone-iodine solutions as they affect the outcome (dependent variable) of CLABSI in patients. In contrast, a hypothesis might state: Chlorhexidine 2% for site care reduces the incidence of CLABSI in patients with CVCs.

FIGURE 5.2

FIGURE 5.2

Exploratory research:

Initial study designed to develop or refine the dimensions of phenomena (facts or events) or to develop or refine a hypothesis about the relationships among phenomena. Example: Pilot study testing the benefits of a new exercise program for older adults with dementia.

PICOT format to state a foreground question. Box 5.1 summarizes the five elements of a PICOT question

P = Patient population of interest Identify patients by age, gender, ethnicity, and disease or health problem. I = Intervention or area of interest Which intervention is worthwhile to use in practice (e.g., a treatment, diagnostic test, prognostic factor)? What area of interest influences a desired outcome (e.g., complementary therapy, motivational interviewing). C = Comparison intervention or area of interest What is the usual standard of care or current intervention used now in practice? O = Outcome What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, or patient perception)? T = Time What amount of time is needed for an intervention to achieve an outcome (e.g., the amount of time needed to change quality of life or patient behavior)?

Surveys

Quantitative research often uses surveys to obtain information regarding the frequency, distribution, and interrelation of variables among subjects in the study (Lobiondo-Wood and Haber, 2018). An example is a survey designed to measure nurses' perceptions of physicians' willingness to collaborate in practice. Surveys obtain information about practices, perceptions, education, experience, opinions, and other characteristics of people. The most basic function of a survey is description. Surveys gather a large amount of data to describe the population and the topic of study. It is important in survey research that the population sampled is large enough to keep sampling error at a minimum.

Historical research:

Studies designed to establish facts and relationships concerning past events. Example: Study examining the societal factors that led to the acceptance of advanced practice nurses by patients.

Experimental research:

Study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable. Example: RCT comparing chlorhexidine with Betadine in reducing the incidence of IV-site phlebitis.

Correlational research:

Study that explores the interrelationships among variables of interest without any active intervention by the researcher. Example: Study examining the relationship between RNs' educational levels and their satisfaction in the nursing role.

Descriptive research:

Study that measures characteristics of people, situations, or groups and the frequency with which certain events or characteristics occur. Example: Study to examine RNs' biases toward caring for obese patients.

Evaluation research:

Study that tests how well a program, practice, or policy is working. Example: Study measuring the outcomes of an informational campaign designed to improve parents' ability to follow immunization schedules for their children.

Manuscript narrative.

The "middle section," or narrative, of an article differs according to the type of evidence-based article it is (Melnyk and Fineout-Overholt, 2019). A clinical article describes a clinical topic, which often includes a description of a patient population, the nature of a certain disease or health alteration, how patients are affected, and the appropriate nursing therapies. An author sometimes writes a clinical article to explain how to use a therapy or new technology. A research article contains several subsections within the narrative, including the following:

Introduction

The introduction contains more information about the purpose of the article. There is usually brief supporting evidence as to why the topic is important. Together the abstract and introduction help you decide if you want to continue to read the entire article. You will know if the topic of the article is similar to your PICOT question or related closely enough to provide useful information. If you decide that an article will most likely help answer your question, continue to read the next elements of the article.

Analysis:

This section explains how the data collected in a study are analyzed. If quantitative data such as physical measurements and scores on surveys are collected, statistical results from the study are explained. Statistics can be confusing. Focus on learning whether the researcher found differences between groups or if an association was found between different variables. For example, if a researcher tests a new fall-prevention strategy, did the strategy reduce falls more so than the standard approach to care? The researcher statistically reports a "p value." The p value (usually set at 0.05) is a probability level that tells you whether the difference between two groups was likely related to the intervention or if it was simply a difference by chance (Lobiondo-Wood and Haber, 2018). When the statistic shows that the value was less than the p value (<0.05), the result was likely the result of the intervention (less than 5% probability caused by chance). If a study involved collection of qualitative information such as audiotaped interviews or open-ended surveys, the analysis describes the major themes from the data. This section helps to determine whether a study was conducted in a way that allows you to trust the results and use them to inform practice

Evaluation research

a form of quantitative research that determines how well a program, practice, procedure, or policy is working (Lobiondo-Wood and Haber, 2018). Evaluation research determines why a program (or some components of the program) is successful or unsuccessful. When programs are unsuccessful, evaluation research identifies problems with the program and opportunities for change or barriers to program implementation.

Performance improvement (PI)

a formal approach for the analysis of health care-related processes. It does not involve introduction of new practices, as is the case of EBP, but it can involve review of how interventions within a process function effectively. Health care organizations routinely promote efforts for improving patient care processes and outcomes, particularly with respect to reducing medical errors and enhancing patient safety. PI is the continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality services or processes

Evidence-based practice (EBP)

a problem-solving approach to clinical practice that combines the deliberate and systematic use of best evidence in combination with a clinician's expertise, patient preferences and values, and available health care resources in making decisions about patient care

active errors

acts that personnel perform

sentinel event

an unexpected occurrence involving death or serious physical or psychological injury of a patient.

Nonexperimental descriptive studies

describe, explain, or predict phenomena (an observable fact, event, or occurrence). Two examples include (1) a study examining factors that lead to an adolescent's decision to smoke cigarettes, and (2) a study determining factors that lead patients with dementia to fall in a hospital setting.

inductive reasoning

develop generalizations or theories from specific observations or interviews