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Exploring evidence-based practice research

Chrisman, Jolinda ASN, RN; Jordan, Rita MSN, RN; Davis, Charlotte BSN, RN, CCRN; Williams, Wanda MSN, APRN

doi: 10.1097/01.NME.0000450295.93626.e7
Department: On the Horizon
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Jolinda Chrisman is a MICU Clinical Nurse at the VA Medical Center in Nashville, Tenn. Rita Jordan is a GEC Nurse Educator at VA Tennessee Valley Healthcare System in Murfreesboro, Tenn. Charlotte Davis is a CCU/CVICU Clinical Nurse at Heritage Medical Center in Shelbyville, Tenn., and a Clinical Nurse/Charge Nurse/CCRN Review Program Coordinator at Alvin C. York VA Medical Center in Murfreesboro, Tenn. She is also a Nursing made Incredibly Easy! Editorial Advisory Board Member. Wanda Williams is a Nurse Practitioner at Alvin C. York VA Medical Center in Murfreesboro, Tenn.

The authors have disclosed that they have no financial relationships related to this article.

Evidence-based practice (EBP) is the process of collecting, processing, and implementing research findings to improve clinical practice, the work environment, or patient outcomes. According to the American Nurses Association (ANA), nursing interventions should be practical, methodical decisions based on EBP research studies. Utilizing the EBP approach to nursing practice helps us provide the highest quality and most cost-efficient patient care possible. Here we'll discuss the key characteristics of EBP relating to nursing research.

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It's a trend!

Involving all disciplines, EBP is an approach to clinical practice that's been gaining ground since its formal introduction in 1992. Starting in medicine, it then spread to other fields, such as nursing, psychology, and education. Currently, 55% of all nursing practices are based on research findings. The ANA predicts that by 2020, 90% of all nursing practice will be based on EBP research findings.

When you incorporate up-to-date information from new EBP research, you'll be able to question current practices. You may ask questions such as, “Are my current nursing interventions the most effective or safest for my patients?” or “Could we utilize these new EBP interventions in my work area?” Nurses committed to EBP will compare current professional and clinical practices with new research facts and outcomes as they emerge.

To meet the 2020 goal, nurses must become proficient in evaluating various types of EBP research because they provide effective, proven rationales for nursing actions (see Learn the lingo!). As you incorporate this new knowledge into your clinical practice and work areas, you become a role model and a positive change agent. Share these discoveries with your healthcare team to improve the essential components of your role and work environment.

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Knowing where to look

Nurses can find EBP research published in scholarly single-blind or double-blind peer-reviewed journals. Many state and national nursing organizations, such as the ANA, conduct nursing research. The National Institute of Nursing Research is well-known for comprehensive research studies that build the scientific foundation of our nursing practices; enhance hospice and palliative care; and help guide the prevention, treatment, and innovative management of diseases.

Many universities, colleges, and formal nursing programs also conduct and publish research findings in their newsletters or scholarly journals, or on their websites. Remember to look for the latest research findings relevant to your job role.

Consider obtaining appropriate institutional approval and conducting a formal research project of your own if you identify areas for improvement within your job role or work environment (see Caution: permission required). EBP research can be conducted in any area of nursing, including hospice care, geriatric or long-term care settings, in-patient hospital units, home care, substance abuse programs, and risk management. Besides improving patient outcomes and the work environment, research can help you evaluate social interactions, improve patient safety, resolve environmental issues affecting health, enhance quality of life, develop theories, explore healthcare economic issues, and address benchmarking needs or barriers.

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Four key elements

When evaluating EBP nursing research studies, focus on these four criteria:

  • validity—the legitimacy, accuracy, and soundness of all aspects of the study
  • reliability—the extent to which a measurement's result is consistent
  • relevance—the logical connection between two ideas, tasks, or events
  • outcome—the conclusions reached through the process of research.

If a study's outcome doesn't demonstrate validity, reliability, or relevance, using it to make a change in current practices that have a proven history of effectiveness, efficiency, and positive outcomes may not be justified. But if the study's outcome is valid, reliable, and relevant to your work environment or patient population, you should consider incorporating the new information into current clinical practice. Failure to utilize EBP to guide nursing care increases the risk of poor outcomes.

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The dynamic duo

Quantitative and qualitative research are the two types of EBP research that nurses perform, evaluate, and utilize to guide nursing interventions and improve patient care (see Quantitative versus qualitative research). Research can be specifically quantitative or qualitative, or a combination of both. When a research project utilized both quantitative and qualitative data, it's commonly called a mixed–methods research study.

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Three types of quantitative research

Quantitative research consists of information expressed in numbers, variables, and percentages. It seeks to confirm that all problems, dilemmas, or hypotheses have clear, concrete, and objective solutions that can be expressed in a numerical format. This type of research focuses on specific, narrow questions in a double-blind study, usually with a large random group and variables. The data collected can be analyzed with the help of statistics in an unbiased manner with the objective to explain, describe, or predict.

Quantitative research contains the following elements:

  • a hypothesis
  • a random or specific study group with a common similarity
  • variables (any element or behavior that can affect or change the outcomes of a study, such as a medication, treatment, or nursing intervention)
  • outcomes.

Quantitative research is usually conducted in a controlled environment, such as a lab or healthcare unit. It can be categorized as follows.

  • Correlational research is the methodical investigation of relationships or interactions between two or more variables without determining the cause-and-effect relationship the variables may have on each other. An example is studying two chemotherapy medications for compatibility without studying how the medications can have adverse interactions with food or other common medications.
  • Quasi-experimental research explores a cause-and-effect relationship among variables. It also evaluates the underlying cause of a problem and studies the effects of variables (such as a nursing intervention) to evaluate their effect on the problem.
  • Descriptive research offers an accurate representation of the characteristics of a particular individual, situation, or group. Descriptive research is a way of discovering new meaning, describing numerically something that currently exists, determining the frequency with which something occurs, and categorizing information.
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Five types of qualitative research

The goal of qualitative research is to generate new insight or knowledge, or to validate existing knowledge. Qualitative research data are usually driven by the participants' thoughts, reactions, perceptions, and experiences. This type of research focuses on systems, steps, rituals, processes, best practices, observations, or personal experiences, and may or may not have an outcome. Qualitative research can be used to gain a better understanding of a topic, inform the reader about how to perform a task, or gain a new perspective on a topic. It's helpful to explain sensitive, unique, and difficult-to-understand information that can't be conveyed quantitatively.

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Table

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Qualitative research may consist of the following elements:

  • a hypothesis or theory
  • an observation through experience or interactive study
  • practice-based interventions
  • implementation strategies
  • casual or formal approaches
  • approaches to adaptation or variation
  • how-to guidance
  • unanticipated adverse reactions if applicable
  • relevant background or circumstantial factors.

The five types of qualitative nursing research are as follows.

  • Ethnography involves the analysis or observation of a culture or social group's customs, rituals, and behaviors, and their understanding of disease and illness within that culture. It requires methodical collection, detailed descriptions, and analysis of the information to help refine or develop cultural theories. Ethnographic studies allow the reader to understand a subject group's way of life and the cultural forces that shape the group's rituals, behaviors, thoughts, or feelings. The research may have a specific or global focus; for example, the group's interaction among themselves or with others, or social norms or taboos.
  • Grounded theory is often referred to as “theory building” because concepts, problems, and theories are continuously reevaluated. It's designed to discover what problems exist in a specific social environment and how these problems are resolved. It involves devising a theory, testing the theory, and refining the theory until the core problem or solution is identified. This type of research often includes personal or professional first-hand experiences. A common core question within grounded theory is, “What's the basic problem and how are we going to resolve or improve it?” An example is a patient describing how he or she copes with existing or new health conditions. Another example: A nurse describes the methodical steps that have improved a patient's experience or health, or resolves the knowledge deficits of other healthcare personnel.
  • Symbolic interactionism focuses on patterns of communication, interpretation of that communication, and understanding how this communication forces adjustments between individuals who react to their interpretation of their world or social group. This type of research reflects the theory that people behave or react in response to what they believe is true or correct, and not just based on what's objectively true. Teenagers who are overwhelmed with information on the health risks of smoking are one example: Despite this information, they may still smoke because they believe it will help them fit in with their peer group.
  • Historical research involves understanding and gathering information on the history of a topic, group, or culture. This type of research allows the reader to systematically evaluate historical information via a detailed analysis of past occurrences and guides the reader to what's been proven to be beneficial or ineffective in certain situations in the past. Armed with this knowledge, nurses can develop a plan to improve results or outcomes for their patients, work environment, or clinical practice. An example of this type of research is Florence Nightingale's discovery that unsanitary wound care and infrequent hand washing led to poor patient outcomes and that sanitary wound care with good hand washing improved patient outcomes.
  • Phenomenology utilizes personal experiences to gain insight, empathy, or knowledge about a specific topic, situation, or “phenomenon.” With this type of research, the investigator attempts to describe or understand a person's or group's perception, perspective, and understanding of a phenomenon and tries to answer the question, “What's it like to experience a given situation?” By understanding how patients view or experience events, nurses can formulate new treatment plans to enhance the healthcare experience or resolve knowledge deficits. By looking at multiple perspectives on the same situation, a researcher can make generalizations about what something is like from an insider's point of view. This research is typically focused on specific topics, such as a patient's response to illness, physical disability, healthcare procedures, or healthcare work environments.
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Become an EBP cheerleader

Encourage your healthcare team members to utilize and participate in EBP research studies when opportunities arise. This broadens our knowledge base and allows us to validate our clinical and operational practices. There are numerous ways that you can become an EBP cheerleader in your work area and encourage your healthcare team to be EBP leaders. For example:

  • consider starting a nursing journal club. Each member can bring a new, relevant EBP study to share with the group at each weekly or monthly meeting.
  • consult with your healthcare and administrative team about forming an EBP committee within your unit or facility. The group can explore new EBP data that may be beneficial in more than one area or unit of your healthcare facility.
  • interactively participate in grand rounds with your physicians and other healthcare team members on a regular basis. Engage your colleagues and educate them on new EBP practices, studies, or interventions that may benefit their work environment or patients.

The management team should set the example by supporting and acknowledging nurses who participate in, publish, or otherwise share new EBP research data that may benefit nurses and patients in their facilities and the community. As the field of nursing continues to evolve, we must become proficient in evaluating, participating in, and sharing EBP research with our healthcare team to improve our clinical practice and our patients' outcomes. To read more about EBP research, visit http://nursingplanet.com/Nursing_Research/.

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Caution: permission required

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Don't approach patients, families, or coworkers about participating in a research study until you've provided your healthcare facility with a clear research plan, including a hypothesis, objectives, and known variables. After presenting the research plan, obtain permission according to your healthcare facility's policy.

To proceed with research, you must typically obtain permission from your healthcare facility, governing bodies, management teams, ethical standards boards, patients, families, and coworkers, if applicable. Patients recruited for the research should be given full disclosure of all the known variables so they can make informed decisions that are consistent with their ethical values and beliefs.

It's important for all members of the research team to be socially and ethically considerate of all participants in a research study. Never pressure, coerce, or exert direct or indirect pressure on any potential participant in a research study.

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Learn the lingo!

Research studies often contain language that may be unfamiliar to nurses. Don't be intimidated! You can easily learn the basic lingo that's commonly found in research studies, such as:

  • abstract: a brief summary or overview of the research study.
  • case study: a collection of detailed information about a person or specific group.
  • causality: the relationship between the cause and effect of a situation or event.
  • consent: an agreement given by a competent person to participate in a research study.
  • control group: randomly selected participants from the research group who won't receive the experimental treatment or variable. Those in the control group will be compared with those receiving the treatment or variable under investigation to establish the effectiveness or ineffectiveness of the variable/treatment.
  • double-blind study: a research study conducted in which neither the investigators nor the participants know specific details of the study, such as whether a placebo or trial medication is being administered.
  • experimental research group: randomly selected participants from the research group who will receive the experimental treatment, medication, or variable.
  • hypothesis: an educated guess about the expected outcome of a study.
  • mean: the average score between two variables or outcomes.
  • single-blind study: a research study conducted in which the investigators know specific details of the study but the participants don't.
  • variable: an intervention, action, or medication that's being studied to observe its effect on the research group. For example, a group of oncology patients may receive a new cancer medication to study its effectiveness on reducing tumor cell growth. In this scenario, the new medication is the intervention or variable.
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memory jogger

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When conducting research, think DIDACTIC.

Develop a hypothesis

Identify common variables

Design (pick a specific research design)

Acquire pertinent data such as past medical records

Communicate your research goals with the healthcare team

Talk with the research study participants (goals, risks, and benefits)

Implement your plan after you obtain the participants' written consent

Collect the data and write your conclusion

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Learn more about it

Denzin NK, Lincoln YS. The SAGE Handbook of Qualitative Research. 4th ed. Thousand Oaks, CA: Sage Publications; 2011.
    Grove SK, Burns N. The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. 6th ed. St. Louis, MO: Elsevier Saunders; 2008.
      Hack L, Gwyer J. Evidence into Practice: Integrating Judgment, Values, and Research. Philadelphia, PA: F.A. Davis Co.; 2013:118–130.
        Melnyk BM, Fineout-Overholt E, Gallagher-Ford L, Kaplan L. The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators. J Nurs Adm. 2012;42(9):410–417.
          Munhall PL. Nursing Research: A Qualitative Perspective. 5th ed. Sudbury, MA: Jones & Bartlett Learning; 2010.
            Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
              Wolcott HF. Writing Up Qualitative Research. 3rd ed. Newbury Park, CA: Sage Publications; 2008.
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