What is nursing research?

1
Why Nursing Research Is Important and Will
Benefit From European Collaboration
Nicky Cullum Centre for Evidence Based Nursing,
University of York, UK
2
What Is Nursing Research?

• systematic enquiry
• seeks to add new nursing knowledge to benefit
  patients, families and communities
• encompasses all aspects of health that are of
  interest to nursing
• knowledge generated should be used to inform
  nursing practice
• International Council of Nursing

3
Do We Need Nursing Research?

• Demand for R and D is difficult to measure
• Policy expectation (EBP)
• Identification of clinical uncertainty and a
  research gap develops a research agenda, e.g., in
  UK
• via open consultation (Health Technology
  Assessment Programme)
• as gaps in evidence (NICE, Cochrane Reviews)
• If we believe that nurses can impact on patient
  and population health, then nursing research must
  also

4
What Kinds of Clinical Uncertainty Do Nurses Face?
5
The Studies

• Subjects health visitors, practice nurses,
  district nurses, nurse practitioners, acute
  surgical, medical and coronary care nurses.
• Mixed method, multi-site case study design, 3
  geographical areas over one year (1999-2000
  2001-2)
• In depth interviews (n180)
• Observation data (600 hours)
• Q methodological statistical modelling (n224)
• Local information resource audit (circa 1500
  source documents)

6
Decisions by Nurses

• Intervention (therapy/prevention)
• Targeting (who to give to?)
• Timing (when to give?)
• Communication (how to communicate what to
  communicate)
• Service organisation, delivery, management
• Experiential
• One choice every 10 minutes in acute care

7
The Questions Nurses Ask.

• For how long should a patient continue to take a
  ß-blocker post MI?
• What is the evidence to suggest MMR is a safe
  vaccine?
• What are the benefits of breastfeeding a child
  after the first year of life?

8

• At what age should parents start weaning their
  children?
• What is the best treatment to prevent recurrence
  of venous leg ulcers in a middle aged woman with
  poor compliance?
• What is the most appropriate pain relief regime
  for a terminally ill patient with bone pain?
• What is the most effective pressure relieving
  mattress for elderly orthopaedic patients?

9
(No Transcript)
10
(No Transcript)
11
Nursing Needs

• Systematic reviews
• Quantitative research incl. epidemiology
• Qualitative research
• Mixed methods
• Research about service delivery and organisation
• Theoretical scholarly work

12
(No Transcript)
13
Systematic Reviews For Nursing Practice

• 1998
• Exhaustive searching identified 36 systematic
  reviews relevant to nursing
• 19/36 met 3 quality criteria (clear question,
  comprehensive search, appropriate data synthesis)
• 4/36 met 2
• 8/36 met 1
• 5 met 0

• 2005
• Searched Cochrane Library with search term nurs
• 703 completed reviews in Cochrane Database
• 194 systematic reviews abstracted by Evidence
  Based Nursing since 1998 (these met quality
  criteria AND had an important message)

14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
The Case of Pressure Ulcers

• Search for RCTs and systematic reviews in
  Cochrane Library gets 448 hits including
• 386 RCTs
• 5 completed Cochrane Reviews
• 15 non Cochrane Reviews
• 41 RCTs of support surfaces for prevention
• What does this mountain of information tell us?

24
We still DONT KNOW

• how best to detect those at risk
• what to sit them on
• what to lie them on
• what to feed them
• how regularly to move them
• what position to move them to

25
RCTs in pressure ulcers
26
Methods for Nursing Research

• Depends on the research question
• We need to avoid polarisation (quantitative vs.
  qualitative)
• Increasing use of mixed methods
• More systematic reviews and RCTs
• Epidemiology
• Health economics

27
Why Collaborate?

• Interdisciplinary collaboration (we need health
  economics, epidemiology, statistics, sociology,
  psychology to answer questions that matter)
• Inter-professional collaboration (many topics
  span boundaries e.g., prescribing, primary care)

28
Why is a European Collaboration a good idea?

• Efficiency!
• Share resources
• Enhance wider relevance of research
• Enhance generalisability of findings
• Complementarity
• Research Capacity Building
• Quicker results leading to more rapid patient
  benefit

29
but we must take care!

• Create opportunities and facilitate relationships
  but do not force marriages
• The most fruitful collaborations may not be
  between nurse researchers may be between nurse
  researchers and clinical nurses nurse
  researchers and other disciplines