N580 Midterm
nurses on the cutting edge - ANSpromote improvement in patient outcomes
accomplish this through: research, EBP, and QI
nurses achieve personal growth through and expand clinical decision-making skills through...
- ANSdevelopment of clinical questions
literature reviews
evaluation of evidence in literature
application of "best available evidence" in your practice
nurses as knowledgable consumers - ANSnurses must be knowledgable consumers of
research who can evaluate the strengths and weaknesses of research evidence and use
existing standards to determine the merit and readiness of research for use in clinical
practice
to use research for an EBP and to practice using the highest quality processes, you do not
have to conduct research; however, you do need to understand and appraise the steps of
the research process in order to read the research literature critically and use it to inform
clinical decisions
research definition - ANSa systematic investigation, including research development, testing
and evaluation, designed to develop or contribute to generalizable knowledge
quantitative and qualitative research
studies are guided by research questions
nurses employ the same methods used by other disciplines yet study questions are relevant
to nursing practice
quantitative vs. qualititative research - ANSquantitative: encompasses the study of research
questions and/or hypotheses that describe phenomena, test relationships, assess
differences, seek to explain cause-and-effect relationships between variables, and test for
intervention effectiveness--numeric data are summarized and analyzed using
statistics--techniques are systematic and methodology is controlled
qualititative: question is about understanding the meaning of a human experience such as
grief, hope, or loss--meaning of an experience is based on the view that meaning varies and
is subjective--context of experience also plays a role--generally conducted in natural settings
and uses data that are words or text rather than numeric to describe the experiences being
studied--guided by research questions and data are collected from a small number of
subjects, allowing an in-depth study of a phenomenon--subjective approach but systematic
in its method
QI definition - ANSsystematic use of data to monitor the outcomes of care processes and
improvement methods to design and test changes to continuously improve the quality and
safety of health care systems
uses currently available knowledge to improve health care delivery within the local setting
,QI elements - ANS1. conducting an assessment
2. setting specific goals for improvement
3. identifying ideas for changing current practice
4. deciding how improvements in care are measured
5. rapidly testing practice changes
6. measuring improvements in care
7. adopting practice change as new standard of care
want to create measurable change across quality domains through application of these 7
steps, often through the plan, do, study, act model
research vs. QI - ANSresearch studies generate new knowledge that is generalizable to
other populations and settings
QI projects use currently available knowledge to improve health care delivery within the local
setting
IRB should have a written policy and template for determining the difference between
humans subjects research and QI
research and EBP - ANSbest research evidence, clinical expertise, and patient values all
come together in EBP (see Venn diagram)
EBP allows one to systematically use the best available evidence from research with the
integration of individual clinical expertise as well as the patient's values and preferences to
make clinical decisions
developing EBP expertise - ANSconduct effective literature reviews
develop critical reading skill process
1. preliminary: skimming article abstracts, title
2. comprehensive: understanding the purpose of the study
3. analysis: examining the study components
4. synthesis: assessing the study's validity
levels of evidence - ANSsee pyramid
Level I: systematic review or meta-analysis of RCTs, evidence-based clinical practice
guidelines based on systematic reviews
Level II: well-designed RCT
Level III: controlled trial without randomization (quasi-experimental study)
Level IV: nonexperimental study (case-control, cohort studies)
Level V: systematic reviews of descriptive and qualitative studies (metasynthesis)
Level VI: qualitative studies or descriptive studies
Level VII: opinion of experts and authorities, expert committee reports or organizations, not
based on research
EBP steps - ANSask
gather evidence
assess, appraise, synthesize literature
act
evaluate
research article format - ANSabstract
,intro or background section: literature review, theoretical framework, hypothesis and/or
research question, purpose statement
methods: research design, sampling, instruments, data collection, data analysis plan
results
discussion (ties everything together): recommendations and implications
references
research journal article - ANSqualitative, quantitative, mixed methods
systematic review - ANSsummation and assessment of group of studies that test a similar
research question
meta-analysis - ANSsummary of a number of studies focused on one question or topic, and
uses a specific statistical methodology to synthesize the findings in order to draw
conclusions about the area of focus--systematic review that uses statistical techniques to
summarize and assess studies
integrative review - ANSfocused review and synthesis of research or theoretical literature in
a particular focus area, and includes specific steps of literature integration and synthesis
without statistical analysis; can include both quantitative and qualitative articles (sometimes
used interchangeably with systematic review)
meta-synthesis/meta-summary - ANSsynthesis of a number of qualitative research studies
on a focused topic using specific qualitative methodology
clinical guidelines - ANSevidence-based guidelines are those developed using research
findings
consensus or expert-based guidelines are developed by expert panels
guidelines have been developed to assist in bridging practice and research
provide clinicians with an algorithm for clinical management, or decision making, for specific
diseases (e.g., colon cancer) or treatments (e.g., pain management)
NIH strategic plan - ANS1. symptom science: promoting personalized health strategies
2. wellness: promoting health and preventing disease
3. self-management: improving QOL for individuals with chronic illness
4. end of life and palliative care: science of compassion
integrate behavioral and biological sciences
cross-cutting areas are vital to the advancement of nursing science
1. promoting innovation: technology to improve health
2. 21st century nurse scientists: innovative strategies for research careers
PICO question - ANSproblem/patient population
intervention
comparison
outcome
nursing research is significant to the profession of nursing because it promotes... -
ANSgeneration of a specialized body of nursing knowledge for use in nursing practice
, action that demonstrates the role of a knowledgable consumer of nursing research -
ANSevaluating the credibility of research findings
primary value of evidence-based practice in nursing - ANSincorporating research findings
with clinical expertise when individualizing patient care
the research question and study purpose are located in the... - ANSintroduction
critical step for the QI process in health care settings - ANSadopting a practice change as a
new standard of care
the review of literature is important to the research process because... - ANSit guides all
steps of the research process
most relevant and frequently used source of nursing literature - ANSCINAHL
how far back should a literature search for an academic paper or project go? - ANS3-5 years
website that is an important source for clinical evidence but limited as a provider of primary
documents for literature reviews - ANSCochrane Library (see pp. 52 & 56 for tables)
where do research problems come from? - ANSdirect clinical experience
critical appraisal from the scientific literature
theories and conceptual models
direct clinical experience - ANSday-to-day interactions lead to questions: do patients being
discharged from a hospital have special learning needs?
literature search is needed to help you find out what has been done, and to refine or focus in
on the specific problem you will address
critical appraisal from the scientific literature - ANSliterature can serve as a starting point
a reader may begin to question practices or findings because of flaws in logic or
methodology, due to personal anecdotal experience or the source of the study
you may find conflicting findings in literature or identify gaps in literature
previous studies may have recommended replication or extension/refinement of a study
theories and conceptual models - ANStheory: provides explanation of how certain concepts
or abstract ideas are related to each other and serves as a basis for explaining events or
predicting future events
conceptual model: not in itself testable, but rather focuses attention on certain concepts and
their relationships, and places these within a context of the discipline
normally need many theories to explain a conceptual model
defining the problem area - ANSstart with broad area of interest
ask what about this topic specifically interests me, what is it I really want to know
continue to ask yourself these questions until you have focused your thoughts into a specific
statement that you can write out
nurses on the cutting edge - ANSpromote improvement in patient outcomes
accomplish this through: research, EBP, and QI
nurses achieve personal growth through and expand clinical decision-making skills through...
- ANSdevelopment of clinical questions
literature reviews
evaluation of evidence in literature
application of "best available evidence" in your practice
nurses as knowledgable consumers - ANSnurses must be knowledgable consumers of
research who can evaluate the strengths and weaknesses of research evidence and use
existing standards to determine the merit and readiness of research for use in clinical
practice
to use research for an EBP and to practice using the highest quality processes, you do not
have to conduct research; however, you do need to understand and appraise the steps of
the research process in order to read the research literature critically and use it to inform
clinical decisions
research definition - ANSa systematic investigation, including research development, testing
and evaluation, designed to develop or contribute to generalizable knowledge
quantitative and qualitative research
studies are guided by research questions
nurses employ the same methods used by other disciplines yet study questions are relevant
to nursing practice
quantitative vs. qualititative research - ANSquantitative: encompasses the study of research
questions and/or hypotheses that describe phenomena, test relationships, assess
differences, seek to explain cause-and-effect relationships between variables, and test for
intervention effectiveness--numeric data are summarized and analyzed using
statistics--techniques are systematic and methodology is controlled
qualititative: question is about understanding the meaning of a human experience such as
grief, hope, or loss--meaning of an experience is based on the view that meaning varies and
is subjective--context of experience also plays a role--generally conducted in natural settings
and uses data that are words or text rather than numeric to describe the experiences being
studied--guided by research questions and data are collected from a small number of
subjects, allowing an in-depth study of a phenomenon--subjective approach but systematic
in its method
QI definition - ANSsystematic use of data to monitor the outcomes of care processes and
improvement methods to design and test changes to continuously improve the quality and
safety of health care systems
uses currently available knowledge to improve health care delivery within the local setting
,QI elements - ANS1. conducting an assessment
2. setting specific goals for improvement
3. identifying ideas for changing current practice
4. deciding how improvements in care are measured
5. rapidly testing practice changes
6. measuring improvements in care
7. adopting practice change as new standard of care
want to create measurable change across quality domains through application of these 7
steps, often through the plan, do, study, act model
research vs. QI - ANSresearch studies generate new knowledge that is generalizable to
other populations and settings
QI projects use currently available knowledge to improve health care delivery within the local
setting
IRB should have a written policy and template for determining the difference between
humans subjects research and QI
research and EBP - ANSbest research evidence, clinical expertise, and patient values all
come together in EBP (see Venn diagram)
EBP allows one to systematically use the best available evidence from research with the
integration of individual clinical expertise as well as the patient's values and preferences to
make clinical decisions
developing EBP expertise - ANSconduct effective literature reviews
develop critical reading skill process
1. preliminary: skimming article abstracts, title
2. comprehensive: understanding the purpose of the study
3. analysis: examining the study components
4. synthesis: assessing the study's validity
levels of evidence - ANSsee pyramid
Level I: systematic review or meta-analysis of RCTs, evidence-based clinical practice
guidelines based on systematic reviews
Level II: well-designed RCT
Level III: controlled trial without randomization (quasi-experimental study)
Level IV: nonexperimental study (case-control, cohort studies)
Level V: systematic reviews of descriptive and qualitative studies (metasynthesis)
Level VI: qualitative studies or descriptive studies
Level VII: opinion of experts and authorities, expert committee reports or organizations, not
based on research
EBP steps - ANSask
gather evidence
assess, appraise, synthesize literature
act
evaluate
research article format - ANSabstract
,intro or background section: literature review, theoretical framework, hypothesis and/or
research question, purpose statement
methods: research design, sampling, instruments, data collection, data analysis plan
results
discussion (ties everything together): recommendations and implications
references
research journal article - ANSqualitative, quantitative, mixed methods
systematic review - ANSsummation and assessment of group of studies that test a similar
research question
meta-analysis - ANSsummary of a number of studies focused on one question or topic, and
uses a specific statistical methodology to synthesize the findings in order to draw
conclusions about the area of focus--systematic review that uses statistical techniques to
summarize and assess studies
integrative review - ANSfocused review and synthesis of research or theoretical literature in
a particular focus area, and includes specific steps of literature integration and synthesis
without statistical analysis; can include both quantitative and qualitative articles (sometimes
used interchangeably with systematic review)
meta-synthesis/meta-summary - ANSsynthesis of a number of qualitative research studies
on a focused topic using specific qualitative methodology
clinical guidelines - ANSevidence-based guidelines are those developed using research
findings
consensus or expert-based guidelines are developed by expert panels
guidelines have been developed to assist in bridging practice and research
provide clinicians with an algorithm for clinical management, or decision making, for specific
diseases (e.g., colon cancer) or treatments (e.g., pain management)
NIH strategic plan - ANS1. symptom science: promoting personalized health strategies
2. wellness: promoting health and preventing disease
3. self-management: improving QOL for individuals with chronic illness
4. end of life and palliative care: science of compassion
integrate behavioral and biological sciences
cross-cutting areas are vital to the advancement of nursing science
1. promoting innovation: technology to improve health
2. 21st century nurse scientists: innovative strategies for research careers
PICO question - ANSproblem/patient population
intervention
comparison
outcome
nursing research is significant to the profession of nursing because it promotes... -
ANSgeneration of a specialized body of nursing knowledge for use in nursing practice
, action that demonstrates the role of a knowledgable consumer of nursing research -
ANSevaluating the credibility of research findings
primary value of evidence-based practice in nursing - ANSincorporating research findings
with clinical expertise when individualizing patient care
the research question and study purpose are located in the... - ANSintroduction
critical step for the QI process in health care settings - ANSadopting a practice change as a
new standard of care
the review of literature is important to the research process because... - ANSit guides all
steps of the research process
most relevant and frequently used source of nursing literature - ANSCINAHL
how far back should a literature search for an academic paper or project go? - ANS3-5 years
website that is an important source for clinical evidence but limited as a provider of primary
documents for literature reviews - ANSCochrane Library (see pp. 52 & 56 for tables)
where do research problems come from? - ANSdirect clinical experience
critical appraisal from the scientific literature
theories and conceptual models
direct clinical experience - ANSday-to-day interactions lead to questions: do patients being
discharged from a hospital have special learning needs?
literature search is needed to help you find out what has been done, and to refine or focus in
on the specific problem you will address
critical appraisal from the scientific literature - ANSliterature can serve as a starting point
a reader may begin to question practices or findings because of flaws in logic or
methodology, due to personal anecdotal experience or the source of the study
you may find conflicting findings in literature or identify gaps in literature
previous studies may have recommended replication or extension/refinement of a study
theories and conceptual models - ANStheory: provides explanation of how certain concepts
or abstract ideas are related to each other and serves as a basis for explaining events or
predicting future events
conceptual model: not in itself testable, but rather focuses attention on certain concepts and
their relationships, and places these within a context of the discipline
normally need many theories to explain a conceptual model
defining the problem area - ANSstart with broad area of interest
ask what about this topic specifically interests me, what is it I really want to know
continue to ask yourself these questions until you have focused your thoughts into a specific
statement that you can write out
