420 exam 1
Phase III: Comparative Evaluation/Decision Making includes four parts:
(1) substantiation of the evidence; (2) fit of the evidence with the healthcare setting; (3) feasibility of using research findings; and (4) concerns with current practice (see Fig. 13.2). Substantiating evidence is produced by systematic reviews and meta-analyses of relevant studies. However, individual quasi-experimental and experimental studies also can provide extremely strong evidence for making a change in an agency. To determine the fit of the evidence in the clinical agency, examine the characteristics of the setting to determine the forces that will facilitate or inhibit implementation of the evidence-based change. Stetler (2001) has noted that the feasibility of using research evidence in practice involves examining the three Rs related to making changes in practice: (1) potential risks; (2) resources needed; and (3) readiness of those involved. By conducting phase III, you can assess the overall benefits and risks of using the research evidence in a practice setting. If the benefits are much greater than the risks for the organization, individual nurse, or both, using the research-based intervention in practice is feasible. During the decision-making aspect of phase III, three decisions are possible: (1) to use the research evidence; (2) to consider using the evidence; and (3) not to use the research evidence (see Fig. 13.2). The decision to use research knowledge in practice depends mainly on the strength of the evidence. Another decision might be to consider use of the available research evidence in practice. When a change is complex and involves multiple disciplines, additional time is often needed to determine how the evidence might be used and what measures will be taken to coordinate the involvement of different healthcare professionals in the change. A final option might be not to use the research evidence in practice because the current evidence is not strong, or the risks or costs of change in current practice are too high in comparison with the benefits (Stetler, 2001).
Research evidence in nursing is synthesized using the following processes:
(1) systematic review; (2) meta-analysis; (3) meta-synthesis; and (4) mixed-methods systematic review. • A systematic review is a structured comprehensive synthesis of quantitative studies in a particular healthcare area to determine the best research evidence available for clinicians to use to promote an EBP. • Meta-analysis is a type of study that statistically combines or pools the results from previous studies into a single quantitative analysis to provide one of the highest levels of evidence for an intervention's efficacy. • Meta-synthesis involves the systematic compilation and integration of qualitative studies in an area to expand understanding and develop a unique interpretation of the findings. • A mixed-methods systematic review is the synthesis of findings from individual studies conducted with a variety of methods—quantitative, qualitative, and mixed methods—to determine the current knowledge in an area. • The levels of research evidence are a continuum, with the highest quality of research evidence at the top of the pyramid and the weakest research evidence at its base (see Fig. 1.3). Systematic research reviews and meta-analyses of quality experimental studies provide the best research evidence for practice. • Evidence-based guidelines are rigorous and explicit clinical guidelines that have been developed based on the best research evidence available in a particular area.
Bachelor of Science in Nursing (BSN)
)Read and critically appraise studies; use best research evidence in practice with guidance; assist with problem identification and data collection
Willowbrook study
1. 1956-1970 2. Examined the progression of hepatitis and tested vaccinations. 3. participants where mentally retarded. 4. Parents told that their children would get hepatitis anyways.
belmont report
1. Respect for persons 2. Beneficence 3. Justice informed consent assessment of risks and benefits selection of subjects 1979, respond to tuskegee study
freezing experiments
25 degrees of less, fatality occurs
Jewish Chronic Disease Hospital Study
Unethical study involving injection of cancer cells into subjects without their consent 1960s
conference proceedings
Collection of papers presented for review, which are later published, of a conference of major professional organizations
Doctor of Philosophy (PhD) in Nursing
Major role, such as primary investigator, in conducting research and contributing to the empirical knowledge generated in a selected area of study; obtain funding for research; coordinate research teams of BSN, MSN, and DNP nurses
Developing a clinical question in an area of interest and conducting an extensive search of evidence-based sources is an effective way to identify current evidence for use in practice. The clinical question often is developed using the PICO format, which includes the following elements:
P - population or participants of interest in your clinical setting I - intervention needed for practice C - comparisons of interventions to determine the best intervention for your practice O- outcomes needed for practice and ways to measure the outcomes in your practice
Doctor of Nursing Practice (DNP)
Participate in evidence-based guideline development; develop, implement, evaluate, and revise as needed protocols, policies, and evidence-based guidelines in practice; conduct clinical studies, usually in collaboration with other nurse researchers
The intent of Stetler's (2001) model is to make using research evidence in practice a conscious, critical thinking process that is initiated by the user. Thus Phase I:
Preparation, involves determining the purpose, focus, and potential outcomes of making an evidence-based change in a clinical agency. Once the agency, individuals, or committee have identified and approved the purpose of the evidence-based project, a detailed search of the literature is conducted to determine the strength of the evidence available for use in practice.
Master of Science in Nursing (MSN)
Critically appraise and synthesize studies to develop and revise protocols, algorithms, and policies for practice. Implement best research evidence in practice; collaborate in research projects and provide clinical expertise for research
angel of death
Dr. Mengele ran experiments on identical twins to see the differences between how they died
Through control, the researcher can reduce the influence of extraneous variables.
Extraneous variables exist in all studies and can interfere with obtaining a clear understanding of the relationships among the study variables. For example, if a study focused on the effect of relaxation therapy on the perception of incisional pain, the researchers would have to control the extraneous variables, such as the type of surgical incision and time, amount, and type of pain medication administered after surgery, to prevent their influence on the patienťs perception of pain. Selecting only patients with abdominal incisions who are hospitalized and receiving only one type of pain medication intravenously after surgery would control some of these extraneous variables.
Tuskegee Syphilis Study
Government study from 1932-1972 which investigated effects of untreated syphilis on African American males. Men were lied to and told they were being treated for "bad blood."
henrietta lacks
Her cervical cancer cells were harvested without her or her next of kin's permission or consent. Millions of her cells have been used in research today with no financial compensation to her family.
In Phase II: Validation, the research reports are critically appraised to determine their scientific soundness (Gray et al., 2017; Grove & Cipher, 2017; Melnyk & Fineout-Overholt, 2015).
If the studies are limited in number, weak, or both, the findings and conclusions are considered inadequate for use in practice, and the process stops. If a systematic review, meta-analysis, and/or meta- synthesis has been conducted in the area in which you want to make an evidence-based change, this greatly strengthens the quality of the research evidence. If the research knowledge base is strong in the selected area, the clinical agency or individual nurse must make a decision about using the evidence in practice. For example, the guideline related to IM injections (see Box 13.1) can be implemented by individual nurses to improve their practice outcomes.
Postdoctorate
Implement a funded program of research; lead and/or participate in nursing and interdisciplinary research teams; identified as experts in their areas of research; mentor PhD-prepared researchers
The EBP competency is defined as
"integrating the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care" (QSEN, 2017).
The word research means
"to search again" or "to examine carefully." More specifically, research is a diligent systematic inquiry or study that validates and refines existing knowledge and develops new knowledge. Diligent systematic study indicates planning, organization, and persistence. The ultimate goal of research is to develop an empirical body of knowledge for a discipline or profession, such as nursing.
The human rights that require protection in research are the rights to the following:
(1) self-determination; (2) privacy; (3) anonymity and confidentiality; (4) protection from discomfort and harm; and (5) fair selection and treatment. The American Nurses Association (ANA) Code of Ethics for Nurses (2015) reiterates these rights and provides nurses with guidelines for ethical conduct in nursing practice and research. This code focuses on protecting the rights of patients and research participants.
policies
a formal written statement detailing the particular action to be taken in a particular situation that is contractually binding
A nondirectional hypothesis states that
a relationship exists but does not predict the nature (positive or negative) of the relationship.
nursing research is
a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice. Nursing research is the key to building an EBP for our profession.
A pilot study is often
a smaller version of a proposed study, and researchers frequently conduct these to refine the study sampling process, intervention, or measurement of variables
standards
a statement, reached through conensus, which clearly identifies the desired outcomes. Usually used within audit as a measure of success
Qualitative research is
a systematic subjective approach used to describe life experiences and situations and give them meaning (Creswell & Poth, 2018). The philosophic base of qualitative research is interpretive, humanistic, and naturalistic and is concerned with understanding the meaning of social interactions and shared interpretations by those involved
Practice theories are
a type of middle range theories that are more specific. They are designed to propose specific approaches to particular nursing practice situations.
assent
agreement from a child
Generating an empirical knowledge base for implementation in practice requires the participation of
all nurses in a variety of research activities. Some nurses are developers of research and conduct studies to generate and refine the knowledge needed for nursing practice. Others are consumers of research and use research evidence to improve their nursing practice. The AACN (2006, 2017) and ANA (2010) have published statements about the roles of nurses in research. No matter their education or position, all nurses have roles in research; some ideas about those roles are presented in Table 1.4. The research role that a nurse assumes usually expands with his or her advanced education, clinical expertise, and career path. Nurses with a Bachelor of Science in Nursing (BSN) degree have knowledge of the research process and skills in reading and critically appraising studies. They assist with the implementation of evidence-based guidelines, protocols, algorithms, and policies in practice (Melnyk et al., 2017). In addition, these nurses might provide valuable assistance in identifying research problems and collecting data for studies. The QSEN (2017) competencies identify such knowledge and skills as being essential for prelicensure students. Table 1.4 Nurses' participation in research at various levels of educationNurses' educational preparationResearch expectations and competenciesBachelor of Science in Nursing (BSN)Read and critically appraise studies; use best research evidence in practice with guidance; assist with problem identification and data collectionMaster of Science in Nursing (MSN)Critically appraise and synthesize studies to develop and revise protocols, algorithms, and policies for practice. Implement best research evidence in practice; collaborate in research projects and provide clinical expertise for researchDoctor of Nursing Practice (DNP)Participate in evidence-based guideline development; develop, implement, evaluate, and revise as needed protocols, policies, and evidence-based guidelines in practice; conduct clinical studies, usually in collaboration with other nurse researchersDoctor of Philosophy (PhD) in NursingMajor role, such as primary investigator, in conducting research and contributing to the empirical knowledge generated in a selected area of study; obtain funding for research; coordinate research teams of BSN, MSN, and DNP nursesPostdoctorateImplement a funded program of research; lead and/or participate in nursing and interdisciplinary research teams; identified as experts in their areas of research; mentor PhD-prepared researchers Nurses with an MSN have undergone the educational preparation to critically appraise and synthesize findings from studies to revise or develop protocols, algorithms, or policies for use in practice. They also have the ability to identify and critically appraise the quality of evidence-based guidelines developed by national organizations. Advanced practice nurses (APNs)—nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives—and nurse administrators have the ability to lead healthcare teams in making essential changes in nursing practice and in the healthcare system based on current research evidence. Some MSN-prepared nurses conduct studies but usually do so in collaboration with other nurse scientists (see Table 1.4). The doctoral degrees in nursing can have a practice-focus (doctor of nursing practice [DNP]) or research-focus (doctor of philosophy [PhD]). Nurses with DNPs are educated to have the highest level of clinical expertise, with the ability to translate scientific knowledge for use in practice. Many APNs are obtaining a DNP degree to expand their knowledge base. The DNP-prepared nurses have advanced research and leadership knowledge to develop, implement, evaluate, and revise evidence-based guidelines, protocols, algorithms, and policies for practice (Butts & Rich, 2015). In addition, DNP-prepared nurses have the expertise to conduct and/or collaborate with clinical studies. PhD-prepared nurses assume a major role in the conduct of research and the generation of nursing knowledge in a selected area of interest. These nurse scientists often coordinate research teams that include DNP-, MSN-, and BSN-prepared nurses to facilitate the conduct of rigorous studies in a variety of healthcare agencies and universities. Nurses with postdoctoral education have the expertise to develop highly funded programs of research. They lead interdisciplinary teams of researchers and sometimes conduct studies in multiple settings. These scientists often are identified as experts in selected areas of research and provide mentoring for new PhD-prepared researchers (see Table 1.4).
A research framework is
an abstract and logical structure of meaning, such as a portion of a theory, which guides the development of the study and enables the researcher to link the findings to nursing's body of knowledge
protocols
an agreed framework outlining the care that will be provided to patients in a designated area of practice. They do not describe how a procedure is performed, by why, where when and by whom the care is given
The term critical appraisal or critique is
an examination of the quality of a study to determine the credibility and meaning of the findings for nursing.
Experimental research is
an objective, systematic, and highly controlled investigation conducted for the purposes of predicting and controlling phenomena in nursing practice. In an experimental study, causality between the independent (treatment) and dependent (outcome) variables is examined under highly controlled conditions (Shadish et al., 2002). Experimental research is the most powerful quantitative method because of the rigorous control of variables. The three main characteristics of experimental studies are the following: (1) controlled manipulation of at least one treatment variable (independent variable); (2) exposure of some of the study participants to the treatment (experimental group) and no exposure of the remaining participants (control group); and (3) random assignment of participants to the control or experimental group. The degree of control achieved in experimental studies varies according to the population studied, variables examined, and environment of the study. Randomly selecting participants and conducting the study in a laboratory or research facility strengthen the control in a study.
Description involves identifying
and understanding the nature of nursing phenomena and, sometimes, the relationships among them (Chinn & Kramer, 2015). Through research, nurses describe what exists in nursing practice and discover new information. Descriptive research is also used to promote understanding of situations and classify information for use in the discipline. Some examples of clinically important research evidence that have been developed from research focused on description include the following: • Identification of the hope phenomenon and its dimensions or characteristics. • Identification and classification of nursing diagnoses. • Description of the responses of individuals to a variety of health conditions and aging. • Determination of the incidence of a disease locally (e.g., West Nile virus in Dallas, Texas), nationally, and internationally (e.g., Zika virus in the United States and other countries). An example of research conducted for the purpose of description was a qualitative study by Koehn, Ebright, and Draucker (2016, p. 567) "to explore nurses' decision-making processes regarding reporting errors." They found that: "Making an error is a complex dynamic process often situated in the context of a high-stress working environment. The nurses' most salient response to making an error was learning from the error so it would not happen again. Making an error is typically a highly distressing experience for nurses, and lack of institutional follow-up and support exacerbate this distress" (Koehn et al., 2016, p. 572). Koehn and colleagues (2016) provided a unique dynamic description of nurses' experiences after making a medical error. They recommended that future studies focus on developing strategies to facilitate reporting of errors and improving the learning and coping of nurses in the aftermath of an error. Research focused on identification and description is essential groundwork for studies to provide explanations, predictions, and control of nursing phenomena in practice.
Demographic variables are
attributes of subjects that are collected to describe the sample. The demographic variables are identified by the researcher when a proposal is developed for conducting a study. Some common demographic variables are age, education, gender, ethnic origin (race), marital status, income, job classification, and medical diagnosis
background for a problem
briefly identifies what we know about the problem area,
Null hypotheses
can be simple or complex and associative or causal but are always nondirectional because the null hypothesis states there is no relationship between variables or differences between groups statistical hypothesis
An explanation
clarifies the relationships among phenomena and identifies possible reasons why certain events occur. Research focused on explanation provides the following types of evidence essential for practice: • Understanding which factors are related to and the full nature of caring for a newborn in the family. • Examining the relationships among the assessment data and a nursing diagnosis. • Determining the relationships among health risks, health behaviors, and health status. For example, Newland, Lunsford, and Flach (2017) studied "the interaction of fatigue, physical activity, and health-related quality of life [HRQOL] in adults with multiple sclerosis (MS) and cardiovascular disease (CVD)." They found "the complex and interconnected nature of fatigue, which adversely impacts physical activity and HRQOL, is challenging for adults with MS and CVD in the community. Nurses and other healthcare team members may underestimate and/or poorly understand the need for adults with MS and CVD to engage in physical activity to improve HRQOL as part of self-management regimen" (Newland et al., 2017, p. 52). Future studies focused on interventions to manage fatigue, increase physical activity, and promote HRQOL have the potential to improve adults' self-management of their chronic illnesses.
kabakas
comfort
constructs
concepts have very general meanings that may be a label for a complex idea and are sometimes referred to as
policy
concise statement outlining the context, goal, or purpose of a specific procedure. A statement that is the guide to any decision making in relation to processes or activities that regularly take place or might be expected to occur
protected health information (PHI) as
data generated and collected for research that can be linked to an individual person. With the recent revision of the Common Rule, the relationship between it and HIPAA is less clear than it was. Some experts have suggested that privacy rules will be integrated into the Common Rule. Fig. 4.1 provides a diagram of the current roles of the Common Rule and Privacy Rule. The rules, identified in the boxes at the top of the figure, have different foci but are united in the goal of protecting the rights of human subjects (bottom of the figure).
The quantitative research methods are classified into four categories:
descriptive, correlational, quasi-experimental, and experimenta`
Ethnographic research was
developed by the discipline of anthropology for investigating cultures through an in-depth study of the members of the culture. Health practices vary among cultures, and these practices need to be recognized when delivering care to patients and families (Creswell & Poth, 2018; Marshall & Rossman, 2016).
The review of literature in quantitative research is conducted to
direct the planning and execution of a study. The major literature review is performed at the beginning of the research process (before the study is conducted). A limited review is conducted after the study is completed to identify studies published since the original literature review, especially if it has been 1 year or longer since the study began. Additional articles may be retrieved to find information relevant to interpreting the findings. The results of both reviews are included in the research report. The purpose of the literature review is similar for the different types of quantitative studies—descriptive, correlational, quasi-experimental, and experimental.
The researcher must
disclose essential information about the study to potential subjects in a way that can be understood. The second element is the extent to which the potential subject comprehends the information. The final elements are the competence of the potential subject and the person's voluntary agreement to take part in the study.
The Magnet Recognition Program®
emphasizes EBP as a way to improve the quality of patient care and revitalize the nursing environment. Clinical agencies seeking or maintaining Magnet status must document research-related outcomes, including nursing studies conducted and professional publications and presentations by nurses.
Prediction Through prediction, one can
estimate the probability of a specific outcome in a given situation (Chinn & Kramer, 2015). However, predicting an outcome does not necessarily enable one to modify or control the outcome. It is through prediction that the risk of illness or injury is identified and linked to possible screening methods to identify and prevent health problems. Knowledge generated from research focused on prediction is essential for EBP and includes the following: • Prediction of the risk for a disease or injury in different populations. • Prediction of behaviors that promote health and prevent illness. • Prediction of the nursing care required based on a patient's circumstances and values. Lee, Faucett, Gillen, Krause, and Landry (2013) conducted a quantitative study to examine the factors that were perceived by critical care nurses (CCNs) to predict the risk of musculoskeletal (MSK) injury from work. They found that a greater physical workload, greater job strain, more frequent patient-handling tasks, and lack of a lifting team or devices were predictive of the CCNs' perceptions of risk of MSK injury. They concluded that "Improving the physical and psychosocial work environment may make nursing jobs safer, reduce the risk of MSK injury, and improve nurses' perceptions of job safety" (Lee et al., 2013, p. 43). This predictive study isolated independent variables—physical workload, job strain, patient-handling tasks, and lack of lifting devices or teams—that were predictive of MSK injuries in CCNs. The variables identified in predictive studies require additional research to ensure that their manipulation or control results in quality outcomes for patients, healthcare professionals, and healthcare agencies.
The purpose of quasi-experimental research is to
examine causal relationships or determine the effect of one variable on another. These studies involve implementing an intervention and examining the effects of this intervention using selected methods of measurement (Shadish, Cook, & Campbell, 2002). For example, an intervention of a swimming exercise program might be implemented to improve the balance and muscle strength of older women with osteoarthritis. Quasi-experimental studies differ from experimental studies by the level of control achieved by the researchers. Quasi-experimental studies have less control over the implementation of the intervention, management of the setting, and/or selection of study participants than experimental studies. When studying human behavior, especially in clinical settings, researchers frequently are unable to select the participants randomly or control certain variables related to the intervention or setting. As a result, nurse researchers conduct more quasi-experimental studies than experimental studies. Control is discussed in more detail later in this chapter.
nother reason you may be conducting a review of the literature is to
examine the strength of the evidence and synthesize the evidence related to a practice problem. EBP guidelines are developed through the synthesis of the literature on the clinical problem. The purpose of this type of literature review is to identify all studies that included a particular intervention, critically appraise the quality of each study, synthesize the studies, and draw conclusions about the effectiveness of a particular intervention. When available, replication studies, systematic reviews, meta-analyses, meta-syntheses, and mixed-methods systematic reviews are important publications to include. It is also important to locate and include previous evidence-based papers that examined the evidence of a particular intervention because the conclusions of these authors are highly relevant. Other types of literature syntheses related to promoting evidence-based nursing practice are described in Chapter 13.
• Correlational research
examines relationships and is conducted to develop and refine explanatory knowledge for nursing practice.
Qualitative research
explored the holistic nature of people and phenomena, discovering meaning and gaining new insights into issues relevant to nursing.
• Descriptive research • •
explores new areas of research and describes situations as they exist in the world.
Quantitative research is a
formal, objective, systematic process in which numerical data are used to obtain information about the world. The quantitative approach toward scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, and predictions. Quantitative researchers hold the position that "truth" is absolute and that a single reality can be defined by careful measurement. To find truth, the researcher must be objective, which means that values, feelings, and personal perceptions should not enter into the measurement of reality. Quantitative research is conducted to test theory by describing variables (descriptive research), examining relationships among variables (correlational research), and determining cause and effect interactions between variables (quasi-experimental and experimental research; Shadish, Cook, & Campbell, 2002). The methods of measurement commonly used in quantitative research include scales, questionnaires, and physiological measures (see Table 1.3). The data collected are numbers that are analyzed with statistical techniques to determine results (Grove & Cipher, 2017). Quantitative researchers strive to extend their findings beyond the situation studied. With extensive research in an area, findings might be generalized to different populations and settings. Chapter 2 describes the types of quantitative research and the quantitative research process.
pendorse
health promotion
HeLa cells
helps with polio, measles, mumps, n1v, ebola, chromosomes, hpv and cancer treatment
The Belmont Report
identified ethical principles to guide selecting subjects, informing them of the risks and benefits of a study and documenting their consent.
The Quality and Safety Education for Nurses (QSEN) initiative
identified the requisite knowledge, skills, and attitude statements for each of the competencies for prelicensure and graduate education.
problem statement
identifies the specific gap in the knowledge needed for practice.
research on terminally ill
increased risk of harm with decreased benefits.
A positive relationship
indicates that the variables vary together; that is, both variables increase or decrease together. For example, research has shown that the more minutes people exercise each week, the greater their bone density. A negative relationship indicates that the variables vary in opposite directions; thus as one variable increases, the other will decrease. For example, research has shown as the number of smoking pack-years (number of years smoked multiplied by the number of packs smoked per day) increases, people's life spans decrease. The primary intent of correlational studies is to explain the nature of relationships in the real world, not to determine cause and effect. However, the relationships identified with correlational studies are the means for generating hypotheses to guide quasi-experimental and experimental studies that do focus on examining cause and effect relationships (see Fig. 2.1).
significance of a research problem
indicates the importance of the problem to nursing and health care and to the health of individuals, families, and communities
• Phenomenological research is an
inductive holistic approach used to describe an experience as it is lived by individuals, such as the lived experience of losing a child.
• Grounded theory research is an
inductive research technique used to formulate, test, and refine a theory about a particular phenomenon (Charmaz, 2014). Grounded theory research initially was described by Glaser and Strauss (1967) in their development of a theory about grieving.
Phase IV: Translation/Application
involves planning for and actually using the research evidence in practice. The translation phase involves determining exactly what knowledge will be used and how that knowledge will be applied to practice. The use of the research evidence can be cognitive, instrumental, or symbolic. With cognitive application, the research base is a means of modifying a way of thinking or one's appreciation of an issue (Stetler, 2001). For example, cognitive application may improve the nurse's understanding of a situation, allow analysis of practice dynamics, or improve problem-solving skills for clinical problems. Instrumental application involves using research evidence to support the need for change in nursing interventions or practice protocols. Symbolic or political utilization occurs when information is used to support or change a current policy. The application phase includes the following steps for planned change: (1) assess the situation to be changed; (2) develop a plan for change; and (3) implement the plan. During the application phase, the protocols, policies, and/or algorithms developed with research knowledge are implemented in practice.
Correlational research
involves the systematic investigation of relationships between or among variables. When conducting this type of study, researchers measure selected variables in a sample and then use correlational statistics to determine the relationships among the study variables. Using correlational analysis, the researcher is able to determine the degree or strength and type (positive or negative) of a relationship between two variables. The strength of a relationship varies, ranging from − 1 (perfect negative correlation) to + 1 (perfect positive correlation), with 0 indicating no relationship (Grove & Cipher, 2017).
The research purpose
is a clear concise statement of the specific goal or focus of a study. The purpose includes the variables or concepts, the population, and sometimes the setting for the study
institutional review board
is a committee that reviews research to ensure that the investigator is conducting the research ethically Each IRB has at least five members of varying backgrounds—cultural, economic, educational, gender, racial—to promote complete, scholarly, and fair review of research commonly conducted in an institution (DHHS, 2017a). At least one member has scientific expertise, and at least one member is a community member without scientific training. The same member or another member is not affiliated with the institution in any way. The members are sensitive to the attitudes of the community it serves and are educated about the federal regulations, institutional policies, and standards of professional conduct by which studies are to be evaluated. If an institution regularly reviews studies with subjects who may be vulnerable to coercion or undue influence, one or more members of the IRB should have experience working with persons who are similar to potential subjects. IRB members must not have a conflicting interest related to a study conducted in an institution. For example, if a member of the IRB proposes a study to be conducted in the institution, the member could not be involved in the deliberations and decision about the study other than to provide information (DHHS, 2017a). To be recognized as an IRB for an institution seeking federal funding, the IRB must register with the Office of Human Research Protection (OHRP; DHHS, n.d.) and obtain a federal-wide assurance (FWA; Grady, 2015). An FWA is documentation of the IRB's adoption of an ethical standard, such as the Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979), and agreement (assurance) to comply with the Common Rule. To receive an FWA, an IRB must have written policies for membership and processes and maintain records of all studies reviewed and the subsequent decisions (DHHS, 2017a).
periodical
journal published at regular intervals
The right to fair selection and treatment is based on the ethical principle of
justice
. Coercion occurs when
one person intentionally presents an overt threat of harm or an excessive reward to another to obtain compliance. Some subjects are coerced (forced) to participate in research because they fear harm or discomfort if they do not participate. For example, some patients, when asked by their healthcare provider to participate in a study, may fear that their medical and nursing care will be negatively affected if they do not agree to be research participants.
monograph
one-time publication
articleq
paperon a specific topic
academic journals
periodicals about scholarly topics, with articles typically edited and written by professors and/or other university-affiliated researchers
clinical journals
periodicals that include research reports and non-research articles about practice problems and professional issues
Vulnerable populations are defined as
persons who are susceptible to undue influence or coercion, such as children, prisoners, and persons who are economically or educationally disadvantaged (DHHS, 2017a). Persons who have impaired decision making were also identified as being vulnerable.Also pregnant women.
The qualitative research methods included in this text are
phenomenological, grounded theory, ethnographic research, and exploratory-descriptive
The qualitative research methods included in this text are
phenomenological, grounded theory, ethnographic research, and exploratory-descriptive (see Box 1.1).
In research, discomfort and harm can be
physical, emotional, social, or economic or any combination of these four types (Weijer, 2000).
broad consent
potential subject gives researchers permission to store, maintain, and use IPI for other studies (DHHS, 2017a). Broad consent does require that researchers protect confidentiality of the identity of the subjects. In addition, broad consent applies to identifiable biospecimens collected for other studies or clinical care.
irb
protect the human rights of subjects in proposed studies
Exploratory-descriptive
qualitative research is conducted to address an issue or problem in need of a solution and/or understanding. Qualitative nurse researcher
grey literature
refers to studies that have limited distributions, such as theses and dissertations, unpublished research reports, articles in obscure journals, articles in some online journals, conference papers and abstracts, conference proceedings, research reports to funding agencies, and technical reports
Limitations are
restrictions in a study methodology and/or framework that may decrease the credibility and generalizability of the findings.
A directional hypothesis
states the nature (positive or negative) of the interaction between two or more variable
• Quasi-experimental and experimental
studies determine the effectiveness of nursing interventions in predicting and controlling the outcomes desired for patients and families.
covert data collection,
subjects are unaware that research data are being collected (Reynolds, 1979). For example, during the Jewish Chronic Disease Hospital Study, most of the patients and their physicians were unaware of the study. The subjects were informed that they were receiving an injection of cells, but the word cancer was omitted
guidelines
systematically derived statements that help practitioners to make decisions about care in specific clinical circumstances. These should be research or evidence based
deception,
the actual misinforming of subjects for research purposes, can also violate a subject's right to self-determination. A classic example of deception is seen in the Milgram study (1963), in which the subjects thought they were administering electric shocks to another person, but the person was really a professional actor who pretended to feel the shocks. Deception should be used only when absolutely necessary to study topics with a potential to make significant contributions to science (Boynton, Portnoy, & Johnson, 2013). To be acceptable, the use of deception should not be expected to cause any long-lasting harm. Also, the researchers should explain the deception to the subjects as soon as possible. Based on the revision of the Common Rule, deception may only be used ethically in a study when the researcher informs potential subjects that they will be unaware of or deliberately misguided about the true purpose of the study, and they agree to participate despite this condition (
In qualitative research reports, the introduction will be similar to the same section in the quantitative study report because the researchers document
the background and significance of the research problem. Researchers often include citations to support the need to study the selected topic (Creswell & Poth, 2018). However, additional review of the literature may not be cited for two reasons. One reason is that qualitative studies are often conducted on topics about which we know very little, so little literature is available to review. The other reason is that some qualitative researchers deliberately do not review the literature deeply before conducting the study; because they do not want their expectations about the topic to bias their data collection, data analysis, and findings
A concept is
the basic element of a theory. Each concept in a theory needs to be defined by the theorist. The definition of a concept might be detailed and complete, or it might be vague and incomplete and require further development (Chinn & Kramer, 2015). Theories with clearly identified and defined concepts provide a stronger basis for a research framework.
The best research evidence is
the empirical knowledge generated from the synthesis of quality health studies to address a clinical problem. Teams of expert researchers, healthcare professionals, and sometimes policy makers and consumers synthesize the best research evidence in different areas to develop national standardized guidelines for clinical practice. For example, a team of experts conducted, critically appraised, and synthesized research related to the chronic health problem of high blood pressure (BP) to develop an EBP guideline for practice that is discussed later in this section.
Descriptive research is
the exploration and description of phenomena in real-life situations. It provides an accurate account of characteristics of particular individuals, situations, or groups using numbers (Kerlinger & Lee, 2000). Descriptive studies are usually conducted with large numbers of subjects or study participants, in natural settings, with no manipulation of the situation. Through descriptive studies, researchers discover new meaning, describe what exists, determine the frequency with which something occurs, and categorize information in real-world settings. The outcomes of descriptive research include the identification and description of concepts, identification of possible relationships among concepts, and development of hypotheses that provide a basis for future quantitative research.
A generalization is
the extension of the conclusions made based on the research findings from the sample studied to a larger population. The study conclusions provide a basis for the implications of the findings for practice and identify areas for further research (see Chapter 11). Study outcomes are usually presented in the discussion section of the research report.
Pediatric Research Equity Act (PREA)
to motivate drug manufacturers to include pediatric subjects in drug trials and provide pediatric dosing when new drugs are released for use. Physicians have voiced concerns that pediatric drug research lags far behind adult studies and could result in harm, or at least loss of potential benefits for children
Control If one can predict the outcome of a situation, the next step is to control or manipulate the situation
to produce the desired outcome. In health care, control is the ability to write a prescription to produce the desired results. Using the best research evidence, nurses could prescribe specific interventions to meet the needs of patients and their families (Melnyk et al., 2017; Straus et al., 2011). The results of multiple studies in the following areas have enabled nurses to deliver care that increases control over the outcomes desired for practice: • Testing the effectiveness of interventions to improve the health status of individuals and families. • Synthesis of research for development into EBP guidelines. • Determining the effectiveness of EBP guidelines in your clinical agency. As discussed earlier, extensive studies have been conducted with regard to the safe administration of IM injections and synthesized into EBP guidelines. The EBP guideline for IM injections includes the following: (1) the appropriate needle size and length to use for administering different types of medications; (2) the safest injection site (ventrogluteal) for many medications; and (3) the best injection technique to deliver a medication, minimize patient discomfort, and prevent physical damage (Cocoman & Murray, 2008; Nicoll & Hesby, 2002; Ogston-Tuck, 2014). Research has continued regarding aspiration during an IM injection with Sisson (2015) recommending no aspiration and Thomas et al. (2016) recommending aspiration. Thus RNs should use a decision-making process to determine whether to aspirate or not based on the situation. Using the evidence-based knowledge for administering IM injections helps control the following outcomes: (1) adequate administration of medication to promote patient health; (2) minimal patient discomfort; and (3) no physical damage to the patient. However, Greenway (2014) has recently reviewed the literature and found that many nurses were using traditional knowledge rather than EBP guidelines when giving IM injections. EBP guidelines significantly improve the quality of IM injections and decrease the incidence of pain and muscle and sciatic nerve damage (Stringer, 2010). Broadly, the nursing profession is accountable to society for providing quality, safe, and cost-effective care for patients and families. The extensive number of clinical studies conducted in the last 50 years has greatly expanded the scientific knowledge available to you for describing, explaining, predicting, and controlling phenomena within your nursing practice.
Nightingale (1859) is recognized as the first nurse researcher,
with her initial studies focused on the importance of a healthy environment in promoting patients' physical and mental well-being. She studied ventilation, cleanliness, purity of water, and diet to determine their influence on patients' health