Introduction to Nursing
Research and EvidenceBased Practice
THE PENNSYLVANIA STATE UNIVERSITY COLLEGE OF NURSING
NURSING 200W
What is nursing research?
•To search again
•To examine carefully
•Diligent and systematic inquiry
•Discovery – a “spirit of inquiry”
•Goal is to develop an empirical (scientific) body of knowledge for a
discipline which is essential
for evidence-based practice!
Why is research important for evidencebased practice?
•Develops empirical knowledge base
•Identifies best practices that are based on clinical practices AND
research
•Improves outcomes for:
• Patient and family
• Nurse
• Health care system
What role does research have in implementing
an evidenced-based nursing practice?
Description
• Identify and understand topics where little is
known
Explanation
• Explains the interaction between concepts
What role does research have in implementing
an evidenced-based nursing practice?
Prediction
• Estimate likelihood that an outcome will occur
Control
• Experimental designs; maintaining consistency
between variables
Test Your Knowledge Question
Identifying and understanding the nature of nursing phenomena and
the relationships among the phenomena are examples of
__________?
A.
B.
C.
D.
Description
Explanation
Prediction
Control
Test Your Knowledge Question: Answer
A. Description deals with identifying and understanding the nature of
phenomena and the relationship among the phenomena
B. Explanation—Clarifying the relationships among phenomena and
identifying the reasons why certain events occur
C. Prediction—Estimating and anticipating the outcomes in a particular
situation
D. Control—Manipulating a situation so as to achieve a particular outcome
ANSWER A!
What is the history of nursing research?
•Nursing research has evolved slowly over the years
•Nursing research began in the 19th century with Florence
Nightingale in the Crimean War
•Clinical research is the current major focus of nursing research and
will continue to be so throughout the 21st century
How is nursing knowledge acquired?
•Traditions – changing bed linens daily
•Authority – charge nurse on a unit
•Borrowing – knowledge from other disciplines
•Trial and Error
•Personal Experience – Benner’s Model of novice to
•Role Modeling – clinical preceptor or mentor
•Intuition – source of knowledge cannot be fully explained, “gut feeling”
•Reasoning – inductive or deductive
How and why do researchers utilize
empirical knowledge?
•Empirical knowledge is gained by employing the following research
methods:
• Quantitative research = numbers
• Qualitative research = language
• Outcomes research = system level quality and effectiveness
•Empirical knowledge is essential for the delivery of high-quality,
safe patient and family nursing care (QSEN competencies)
Quantitative Research
•Formal, objective process
•Involves measurement & numerical data
•Philosophy is based on logical positivism, where:
◦ Truth is absolute
◦ A single reality exists
◦ Deductive reasoning is used
•Purposes include test hypotheses, determine cause & effect, and/or
identify relationships among variables
What are some types of quantitative
research?
•Descriptive: measures what is.
• Correlational: how concepts relate to each other.
• Quasi-experimental and Experimental: Manipulate or control one
aspect of a situation to examine the effect.
Qualitative Research
•Systematic, subjective approach
•Involves non-numeric data
•Philosophy is based on holistic, interpretive stance, which states
that:
◦ Truth is dynamic
◦ Multiple realities exist
◦ Inductive reasoning is used
•Purpose is to investigate human experiences and interactions.
What are some types of qualitative
research?
•Phenomenological: describe an experience
•Grounded theory: formulate and test a theory
•Ethnographic: in depth study of a culture
•Exploratory-descriptive: describe a topic and promote understanding
•Historical research: an analysis of events to provide understanding
Test Your Knowledge Question
The beginning nurse researcher would like to investigate credible
resources for implementing protocols in clinical practice. Which of
the following would be considered empirical sources of nursing
knowledge?
A. Reasoning, authority, and tradition
B. Quantitative, qualitative, and outcomes research
C. Care maps and protocols
D. Role modeling and trial and error
Test Your Knowledge Question: Answer
Answer: B!
Quantitative, qualitative, and outcomes research methods are used
to generate empirical knowledge for nursing practice. These research
methods are essential to generate evidence.
A and D are examples of sources of knowledge.
C refers to clinical practice guidelines.
What is the focus of outcomes research?
Patients and
Families
Healthcare
Providers
Practice
Changes
Healthcare
Systems
Policy
Development
Test Your Knowledge Question
The nurse researcher is investigating outcomes research on nursing
interventions. Which of the following examples would constitute
outcomes research?
A. A comparison of two patient groups
B. Patient responses to nursing intervention
C. Patient tested before and after intervention
D. A patient’s perception of the intervention
Test Your Knowledge Question: Answer
Answer: B!
Some of the essential areas that require investigation through outcomes
research include: (1) patient responses to nursing and medical interventions; (2)
functional maintenance or improvement of physical, mental, and social
functioning for the patient; (3) financial outcomes achieved with the provision of
health care services; and (4) patient satisfaction with the health outcomes, care
received, and health care providers (Doran, 2011).
A. This is an example of a quantitative approach
C. An example of a Pre and Post test design
D. This is an example of a qualitative approach
Why utilize evidence-based practice
guidelines?
•Provide high-quality, cost-effective health care
•Allow for synthesis of knowledge needed for interventions and
practice including development of the following:
• Guidelines
• Standards
• Protocols
• Policies
What skills do baccalaureate prepared
nurses need?
•Are knowledgeable about the research process and have skills in
reading and critically appraising studies.
•The QSEN competencies identify such knowledge and skills as being
essential for pre-licensure students.
•Should be prepared to actively participate in Evidence Based
Practice.
Building an EvidenceBased Nursing Practice
How is evidence-based practice defined?
•Integration of all of the following to promote high-quality,
cost-effective patient care with good outcomes:
• Best research evidence
• Clinical expertise
• Patient values and needs
What is not evidence-based practice?
•Evidence-based practice is not always incorporated due to the
following barriers:
◦ Practicality of implementing changes
◦ ‘Cookie-cutter’ or ‘cookbook’ approach to care
Why do we use evidence-based practice?
•EBP is used because of benefits such as improved patient, family and
caregiver outcomes. EBP can also improve provider (i.e., nurse,
physician, etc.) and hospital outcomes.
•EBP leads to the ‘gold standard’ or best treatments
What are sources for evidence-based
practice?
Systematic reviews
Meta-analyses
Integrative reviews
Meta-syntheses
What are systematic reviews?
•A narrowly focused synthesis of research findings from quantitative
studies
•Looks at studies of similar methodology
•Has same standards of clarity, rigor, and replication as primary
research studies
Steps in a Systematic Review
•Formulate purpose and identify scope.
•Develop specific questions or hypotheses.
•Establish criteria for inclusion/exclusion of studies.
•Conduct extensive literature search of all sources.
(Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)
Steps in a Systematic Review
•Develop questionnaire and contact authors to gather data.
•Critique studies for scientific merit and data analysis.
•Analyze and interpret data.
•Report the review.
(Melnyk & Fineout-Overholt, 2010; Whittemore, 2005)
What is a meta-analysis?
•Statistically pools results from previous studies into single
quantitative analysis
•Allows for application of scientific criteria
• For example, sample size, level of significance, variables, etc.
What results are reported in a metaanalysis?
•A large, diverse sample that is more representative of target
population
•Determination of overall significance of probability of pooled data
•Indication of the efficacy of the intervention from the average effect
size determined from several quality studies
•Strength of relationship between variables
What is the best evidence for use in
practice?
•The strength of the evidence is on a continuum from high-quality
results to lower quality results.
•Evidence-based guidelines are essential in developing evidencebased practice for nursing.
What is strong versus weak evidence?
STRONGEST
1. Meta-analysis
2. Integrative reviews
3. Experimental studies
WEAKEST
1. Descriptive surveys
2. Qualitative studies
3. Correlational studies
4. Quasi-experimental studies
Pulling it All Together
AN EXAMPLE OF BUILDING A PICO(S) QUESTION
What are the steps to evidence-based
practice?
As a new nursing researcher you would like to learn more
about the research process and identify credible resources.
You decide to examine the problem of medication
adherence and the use of a medication reconciliation
process for patients who are newly diagnosed with
hypertension.
Steps of EBP
Step 0: Cultivate a spirit of inquiry.
Step 1: Ask a clinical question in PICOT format.
Step 2: Search for the BEST evidence
Step 3: Critically appraise the evidence
Step 4: Integrate the evidence with clinical expertise and patient preferences
and values
Step 5: Evaluate the outcomes of practice decisions based on the evidence
Step 6: Disseminate the EBP results
Developing the PICO Question
P—Population -patient with hypertension
I—Intervention - implementing medication teaching
C—Comparison -compare patient outcomes for patient who receive teaching to
those for a patient who does not
O—Outcomes - increased adherence leads to decrease in blood pressure
(T) - Time (may not always be a part of the study) OR
(S) – Setting (may not always be part of the study)
Developing the PICO Question
This is an example of an intervention type PICO question:
In patients with hypertension how does medication teaching
compared to no medication teaching increase medication
adherence and lowered BP?
Questions? Comments?
THE END!