Introduction to Nursing Research in an Evidence-Based Practice Environment
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NURSING RESEARCH IN PERSPECTIVE
In all parts of the world, nursing has experienced a profound culture change. Nurses are increasingly expected to understand and conduct research and to base their professional practice on research evidence—that is, to adopt an evidence-based practice (EBP) . EBP involves using the best evidence (as well as clinical judgment and patient preferences) in making patient care decisions, and “best evidence” typically comes from research conducted by nurses and other health care professionals. NURSING RESEARCH
What Is Nursing Research?
Research is systematic inquiry that uses disciplined methods to answer questions or solve problems. The ultimate goal of research is to develop and expand knowledge.
Nurses are increasingly engaged in disciplined studies that benefit nursing and its clients. Nursing research is systematic inquiry designed to generate trustworthy evidence about issues of importance to the nursing profession, including nursing practice, education, administration, and informatics. In this book, we emphasize clinical nursing research, that is, research to guide nursing practice and to improve the health and quality of life of nurses’ clients. NURSING RESEARCH
Nursing research has experienced remarkable growth in the past three decades, providing nurses with a growing evidence base from which to practice. Yet many questions endure and much remains to be done to incorporate research innovations into nursing practice.
Examples of Nursing Research Questions:
· How effective is pressurized irrigation, compared to a swabbing method, in cleansing wounds, in terms of time to wound healing, pain, patients’ satisfaction with comfort, and costs? (Mak et al., 2015)
· What are the experiences of women in Zimbabwe who are living with advanced HIV infection? (Gona & DeMarco, 2015) NURSING RESEARCH
The Importance of Research in Nursing
Research findings from rigorous studies provide especially strong evidence for informing nurses’ decisions and actions. Nurses are accepting the need to base specific nursing actions on research evidence indicating that the actions are clinically appropriate, cost-effective, and result in positive outcomes for clients.
In the United States, research plays an important role in nursing in terms of credentialing and status. The American Nurses Credentialing Center (ANCC)—an arm of the American Nurses Association and the largest and most prestigious credentialing organization in the United States—developed a Magnet Recognition Program to acknowledge health care organizations that provide high-quality nursing care. As Reigle and her colleagues (2008) noted, “the road to Magnet Recognition is paved with EBP” (p. 102) and the 2014 Magnet application manual incorporated revisions that strengthened evidence-based requirements (Drenkard, 2013). The good news is that there is growing confirmation that the focus on research and evidence-based practice may have important payoffs. For example, McHugh and co-researchers (2013) found that Magnet hospitals have lower risk-adjusted mortality and failure to rescue than non-Magnet hospitals, even when differences among the hospitals in nursing credentials and patient characteristics are taken into account. NURSING RESEARCH
Changes to nursing practice now occur regularly because of EBP efforts. Practice changes often are local initiatives that are not publicized, but broader clinical changes are also occurring based on accumulating research evidence about beneficial practice innovations. NURSING RESEARCH
Example of Evidence-Based Practice: Numerous clinical practice changes reflect the impact of research. For example, “kangaroo care” (the holding of diaper-clad infants skin to skin by parents) is now practiced in many neonatal intensive care units (NICUs), but this is a relatively new trend. As recently as the 1990s, only a minority of NICUs offered kangaroo care options. Expanded adoption of this practice reflects mounting evidence that early skin-to-skin contact has benefits without negative side effects (e.g., Ludington-Hoe, 2011; Moore et al., 2012). Some of that evidence came from rigorous studies conducted by nurse researchers in several countries (e.g., Chwo et al., 2002; Cong et al., 2009; Cong et al., 2011; Hake-Brooks & Anderson, 2008). Nurses continue to study the potential benefits of kangaroo care in important clinical trials (e.g., Campbell-Yeo et al., 2013).
The Consumer–Producer Continuum in Nursing Research
In our current environment, all nurses are likely to engage in activities along a continuum of research participation. At one end of the continuum are consumers of nursing research, who read research reports or research summaries to keep up-to-date on findings that might affect their practice. EBP depends on well-informed nursing research consumers. NURSING RESEARCH
At the other end of the continuum are the producers of nursing research: nurses who design and conduct research. At one time, most nurse researchers were academics who taught in schools of nursing, but research is increasingly being conducted by nurses in health care settings who want to find solutions to recurring problems in patient care.
Between these end points on the continuum lie a variety of research activities that are undertaken by nurses. Even if you never personally undertake a study, you may (1) contribute to an idea or a plan for a clinical study; (2) gather data for a study; (3) advise clients about participating in research; (4) solve a clinical problem by searching for research evidence; or (5) discuss the implications of a new study in a journal club in your practice setting, which involves meetings (in groups or online) to discuss research articles. In all possible research-related activities, nurses who have some research skills are better able than those without them to make a contribution to nursing and to EBP. An understanding of nursing research can improve the depth and breadth of every nurse’s professional practice. NURSING RESEARCH
Nursing Research in Historical Perspective
Table 1.1 summarizes some of the key events in the historical evolution of nursing research. (An expanded summary of the history of nursing research appears in the Supplement to this chapter on ).
TABLE 1.1: Historical Landmarks in Nursing Research
|1859||Nightingale’s Notes on Nursing is published.|
|1900||American Journal of Nursing begins publication.|
|1923||Columbia University establishes first doctoral program for nurses.|
|Goldmark Report with recommendations for nursing education is published.|
|1936||Sigma Theta Tau awards first nursing research grant in the United States.|
|1948||Brown publishes report on inadequacies of nursing education.|
|1952||The journal Nursing Research begins publication. NURSING RESEARCH|
|1955||Inception of the American Nurses Foundation to sponsor nursing research.|
|1957||Establishment of nursing research center at Walter Reed Army Institute of Research.|
|1963||International Journal of Nursing Studies begins publication.|
|1965||American Nurses Association (ANA) sponsors nursing research conferences.|
|1969||Canadian Journal of Nursing Research begins publication.|
|1972||ANA establishes a Commission on Research and Council of Nurse Researchers.|
|1976||Stetler and Marram publish guidelines on assessing research for use in practice.|
|Journal of Advanced Nursing begins publication.|
|1982||Conduct and Utilization of Research in Nursing (CURN) project publishes report.|
|1983||Annual Review of Nursing Research begins publication. NURSING RESEARCH|
|1985||ANA Cabinet on Nursing Research establishes research priorities.|
|1986||National Center for Nursing Research (NCNR) is established within U.S. National Institutes of Health.|
|1988||Conference on Research Priorities is convened by NCNR.|
|1989||U.S. Agency for Health Care Policy and Research (AHCPR) is established.|
|1993||NCNR becomes a full institute, the National Institute of Nursing Research (NINR).|
|The Cochrane Collaboration is established.|
|Magnet Recognition Program makes first awards.|
|1995||Joanna Briggs Institute, an international EBP collaborative, is established in Australia.|
|1997||Canadian Health Services Research Foundation is established with federal funding.|
|1999||AHCPR is renamed Agency for Healthcare Research and Quality (AHRQ).|
|2000||NINR’s annual funding exceeds $100 million. NURSING RESEARCH|
|The Canadian Institute of Health Research is launched.|
|Council for the Advancement of Nursing Science (CANS) is established.|
|2006||NINR issues strategic plan for 2006–2010.|
|2011||NINR celebrates 25th anniversary and issues a new strategic plan.|
|2014||NINR budget exceeds $140 million.|
Most people would agree that research in nursing began with Florence Nightingale in the 1850s. Her most well-known research contribution involved an analysis of factors affecting soldier mortality and morbidity during the Crimean War. Based on skillful analyses, she was successful in effecting changes in nursing care and, more generally, in public health. After Nightingale’s work, research was absent from the nursing literature until the early 1900s, but most early studies concerned nurses’ education rather than clinical issues. NURSING RESEARCH
In the 1950s, research by nurses began to accelerate. For example, a nursing research center was established at the Walter Reed Army Institute of Research. Also, the American Nurses Foundation, which is devoted to the promotion of nursing research, was founded. The surge in the number of studies conducted in the 1950s created the need for a new journal; Nursing Research came into being in 1952. As shown in Table 1.1 , dissemination opportunities in professional journals grew steadily thereafter NURSING RESEARCH
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