NURSING RESEARCH

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NURSING RESEARCH

• Analysis of Findings

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FINDINGS

• The findings of the study are the results,
  conclusions, interpretations, recommendations,
  generalizations, and implications for future
  research and nursing practice.

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RESULTS

• The data-bound section of the report where the
  researcher presents the quantitative data or
  numbers generated by the descriptive and
  inferential statistical tests (see handout).
• Should reflect the question and/or hypothesis
  tested (see handout).
• Example of results section - (see handout).

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RESULTS

• The following points should be addressed in the
  results section
• An objective response to the results in the
  discussion of the results.
• Interpretation of the results, with a careful
  reflection on all aspects of the study that
  preceded the results.
• The data presented are summarized.

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RESULTS

• The following points should be addressed in the
  results section
• The condensation of data is done both in the
  written text and through the use of tables and
  figures.
• Results for the descriptive and inferential
  statistics for each hypothesis or research
  question are presented.

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DISCUSSION OF RESULTS

• The following should be discussed in this
  section
• Both supported and nonsupported data.
• Limitations or weaknesses of a study.
• Support of the theoretical framework.
• Other relationships found through analysis.

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DISCUSSION OF RESULTS

• Confidence interval quantifies the uncertainty
  of a statistic or the probable value range within
  which a population parameter is expected to lie.
• Generalizability inferences that the data are
  representative of similar phenomena in a
  population beyond the studys sample.
• Recommendations the investigators suggestions
  for the studys application to practice, theory,
  and further research.
• Example of discussion of results (see handout).

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CRITIQUE OF RESULTS/DISCUSSION

• (see handout)

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NURSING RESEARCH

• USE OF RESEARCH IN PRACTICE

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EBP AND RESEARCH UTILIZATION

• Research utilization a process of using
  research findings to improve patient care (see
  handout).
• Research-based practice nursing practice that
  is based on research studies (reflected in
  standards or guidelines).

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EBP AND RESEARCH UTILIZATION

• Conduct of research the analysis of data
  collected from a homogeneous group of subjects
  who meet inclusion and exclusion criteria for the
  purpose of answering specific research questions
  or testing specified hypotheses.
• Dissemination of findings accomplished through
  research reports in journals and at scientific
  conferences.

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USE OF EVIDENCE IN PRACTICE

• Two forms of using research evidence in practice
  conceptual and decision driven.
• Conceptual driven forms of evidence in practice
  influence the thinking of the health care
  provider, not necessarily the action.

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USE OF EVIDENCE IN PRACTICE

• Decision driven forms of using evidence in
  practice encompass application of scientific
  knowledge as part of a new practice, policy,
  procedure, or intervention.

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MODELS OF EVIDENCE-BASED PRACTICE

• An example of a decision-driven model of using
  nursing research in practice is the Iowa Model of
  Research Based Practice to Promote Quality Care
  (see handout).
• Titler, M.G., Kleiber, C., Steelman, V., Goode,
  C., Rakel, B., Barry-Walder, J., Small, S.,
  Buckwalter, K. (1994). Infusing research into
  practice to promote quality care. Nursing
  Research, 43(5), 307-13.

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STEPS OF EVIDENCE-BASED PRACTICE

• Selection of a topic
• Problem-focused triggers those identified by
  staff through quality improvement, risk
  surveillance, benchmarking data, financial data,
  or recurrent clinical problems.
• Knowledge-focused triggers ideas generated when
  staff read research, listen to scientific papers
  at research conferences, or encounter EBP
  guidelines published by federal agencies or
  specialty organizations.

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STEPS OF EVIDENCE-BASED PRACTICE

• Forming a team
• May be an existing committee such as the quality
  improvement team, the practice council, or the
  research committee.
• Literature retrieval
• Read articles in the following order integrative
  review articles clinical articles theory
  articles EBP guidelines and evidence reports
  research articles including metaanalyses.

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STEPS OF EVIDENCE-BASED PRACTICE

• Schemas for grading the evidence
• No consensus in methods used for denoting type
  and quality of evidence.
• The group responsible for the review need to
  agree on a grading method.

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STEPS OF EVIDENCE-BASED PRACTICE

• Example of a grading method
• A scientific evidence provided by
  well-conducted, controlled trials with consistent
  statistically significant results.
• B scientific evidence provided by
  observational studies or by controlled trials
  with less consistent results.
• C expert opinion because available scientific
  evidence did not present consistent results or
  because controlled trials were lacking.

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STEPS OF EVIDENCE-BASED PRACTICE

• Critique of evidence-based practice guidelines
• Critical areas that should be assessed date of
  publication/release authors of guideline
  endorsement of the guideline includes a clear
  purpose and patient population focus types of
  evidence used in formulating guideline grading
  methods used for evidence retrieval methods used
  to acquire evidence well-referenced statements
  regarding practice comprehensive reference list
  review of guideline by experts use or testing in
  practice.

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STEPS OF EVIDENCE-BASED PRACTICE

• Critique of research
• Use of journal clubs to discuss critiques done by
  each member of the group.
• Use of a summary form helps identify
  commonalities across several studies with regards
  to study findings and the types of patients to
  which study findings can be applied (see
  handout).

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STEPS OF EVIDENCE-BASED PRACTICE

• Setting forth evidence-based practice
  recommendations
• Based on the critique of the EBP guidelines and
  synthesis of research, recommendations for
  practice are set forth.
• The type and strength of evidence used to support
  the practice needs to be clearly delineated.

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STEPS OF EVIDENCE-BASED PRACTICE

• Criteria for making a decision to change
  practice relevance of research findings for
  practice consistency of findings across studies
  a significant number of studies with similar
  samples consistency among evidence from
  research/nonresearch evidence feasibility for
  use in practice risk/benefit ratio is low/high.

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STEPS OF EVIDENCE-BASED PRACTICE

• Development of evidence-based practice
• When results of the critique and synthesis of
  evidence support current practice or suggest a
  change in practice, a written EBP protocol
  (standard, policy, procedure) is warranted.

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STEPS OF EVIDENCE-BASED PRACTICE

• Implementing the practice change
• Rogers model of diffusion of innovations (1995)
  is extremely useful in facilitating adoption of
  EBPs.
• According to this model, four areas must be
  addressed within a context of participative,
  planned change nature of the innovation
  communication process members involved social
  system involved.

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STEPS OF EVIDENCE-BASED PRACTICE

• Eleven steps of evaluation for evidence-based
  projects.

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CREATING A CULTURE OF EBP

• Access to information policies/procedures data
  base access on-line books and journals.
• Human resources
• Research committee research consultant MSNs.

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CREATING A CULTURE OF EBP

• Organizational climate
• Nurse executives set the tone for the
  organizational climate in relation to nursing
  research.

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FUTURE DIRECTIONS

• A national center for evidence-based practice and
  translational research is needed.