Nursing Research and Evidence-Based Practice

Week 1 discussion

Nursing Research and Evidence-Based Practice

In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.

Based on this evidence, you can formulate a question. In this Nursing Research and Evidence-Based Practice Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).

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To prepare:

Consider a recent clinical experience in which you were providing care for a patient.

Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?

What questions have you thought about in a particular area of care such as a procedure or policy?

Review Chapter 2, pages 36—39 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.

Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.

Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

By Day 3

Post an evaluation of the use, or lack thereof, of EBP in a recent clinical experience. Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.

Nursing Research and Evidence-Based Practice Week 2 discussion

Literature Searches

An important step in the EBP process is reviewing the current body of literature to better understand the subject or topic in which you are interested. By conducting a review of the literature, you are building foundational knowledge about the topic; later, you can use this background to build new insights. Developing a strong grasp of a topic can only be garnered by taking the time to thoroughly search for relevant information and resources.

For this Discussion, you will practice searching the literature to find evidence on a specific topic.

To prepare:

Choose a simple search term(s) relating to a topic of your PICOT question.

Review the information on the evidence hierarchy discussed in Chapter 2 of the course text, in the article, “Facilitating Access to Pre-Processed Research Evidence in Public Health,” and in the multimedia presentation “Hierarchy of Evidence Pyramid,” found in this week’s Learning Resources.

Review the information on the Walden Library’s website, “Levels of evidence.” Take a few minutes to explore the different types of databases available for each level of evidence and focus on the meaning of filtered and non-filtered resources.

Conduct a literature search in the Walden Library on your selected topic using the databases that you reviewed. Use at least one database for each of the three levels of filtered information and at least one unfiltered database. Record the number of hits that you find at each level of the hierarchy of evidence.

Select one article from the results at each level of the hierarchy. Compare the articles based on the quality and depth of information. What would be the value of each resource if you were determining an evidence-based practice?

By Day 3

Post a summary of your search. Describe what topic you selected, the search term(s) that you used, and the number of results found at each level of the hierarchy. Compare the types of information found in the articles from different levels and the value of the information from each level. Highlight a useful tip that you could share with your colleagues about conducting an effective literature search.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.

Nursing Research and Evidence-Based Practice Week 3 discussion

Theory, Research, and Evidence-Based Practice

As they explore the world around them, young children often want to know the “why” and “how” of the things they observe. This is similar to what researchers do when they approach a new problem. Researchers develop new theories or build on old ones to explain the “why” of the world around them. They use models and conceptual frameworks to help explain “how” the processes and events they observe occur. Together, theories and models provide an understanding of the world and allow researchers to explore it in meaningful ways.

Virtually all research questions can benefit from the use of an existing theory or model. Researchers should consider their research questions and select the most suitable theory or model, which then serves as a foundation for the research design. The selection of a theory or model is an important part of the research process.

In this Nursing Research and Evidence-Based Practice Discussion, you focus on the role of theory and models in research and evidence-based practice.

To prepare:

Review the information in Chapter 6 of the course text. Focus on the various conceptual theories and models that are currently used in nursing research.

Select one of the theories or models described that is of interest to you.

Using the Walden Library, search for and identify a research article that uses the theory or model you selected.

Reflect on how the theory or model provides structure to the research study described in the article.

Now, think about an issue in your practice area that you would be interested in exploring through research.

Review this week’s media presentation and consider strategies for locating and identifying a relevant theory or model for a research study.

By Day 3

Post a summary of the article that you located and explain how the theory or model that you selected was used in the research study. Assess the value of basing research on an established theory or model.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Nursing Research and Evidence-Based Practice Week 4 discussion

Ethical Dimensions of Research Studies

In the best-selling book, The Immortal Life of Henrietta Lacks (Skloot, 2010), the author highlights the true story of an African-American woman who died in 1951 from cervical cancer. What makes her story unique is that prior to her death, cells from her tumor were removed and successfully grown in a petri dish. This was the first time scientists were able to successfully replicate cells outside the body, and it is estimated that billions of Lacks’ cells have been used in medical research. However, Henrietta Lacks was never asked for permission to take a sample and her family was never made aware of the widespread use of her cells. Although the culturing of her cells has been pivotal for advancing research, strong ethical concerns later arose about using these cells without patient or family approval.

This week’s readings describe historical examples of unethical research, such as a study of syphilis among African-American men in which treatment was withheld and a study in which live cancer cells were injected into elderly patients. Today, stricter controls that seek to protect study participants are placed on researchers, but breaches still occur. Careful attention must be given toward preventing unethical behavior. In this Nursing Research and Evidence-Based Practice Discussion, you explore ethical considerations and issues in research.

To prepare:

Select a current health-related case involving research ethics. (If none come to mind, browse the Internet to familiarize yourself with recent cases.)

As you review the case that you have selected, reflect on the ethical principles discussed in “What Are the Major Ethical Issues in Conducting Research?” article found in this week’s Learning Resources. Which principles were breached in the case you have identified?

By Day 3

Post a description of the case that you selected and the ethical issues involved. Analyze the ethical principles that were breached by the researchers or organizations in your selected case as well as the possible cause of the breach(es). Suggest how the research might have been conducted differently to avoid or minimize the ethical problems. Discuss how research can be done on sensitive issues while still protecting the rights of the research subjects.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Nursing Research and Evidence-Based Practice Week 5 discussion

Quantitative Research Designs

In order to find the best information on a topic, not only should you develop a question and search for resources, but you should also know how to analyze the value of the resources that you identify. There are different ways to evaluate resources, such as using the hierarchy of evidence, which you explored in Week 4 of this course. Another way to evaluate resources is to consider the appropriateness of the research design. Understanding how research designs contribute to the quality of a study is essential for being able to analyze resources when conducting a literature review or locating evidence for practice.

In this Nursing Research and Evidence-Based Practice Discussion, you consider the different research designs and evaluate how these designs have been used to research a specific topic. You also consider strategies for selecting an appropriate research design.

To prepare:

Review the information in the course texton quantitative research designs. Focus on the information in Box 9.1, “Guidelines for Critiquing Research Designs in Quantitative Studies” located on page 230 of the course text.

Select a topic from the list below and search the Walden Library to find two different quantitative research studies addressing that issue:

Caregiver stress

Anxiety in children

Sleep apnea

Depression in college freshmen

Rural health care issues

Post-traumatic stress syndrome

Traumatic brain injury in veterans

Health effects of environmental contaminants

Bipolar disorder

End-of-life ethical issues

Alternative medicine

For each of the sources that you select, identify the type of quantitative research design used, and evaluate whether it is the most appropriate approach to the research.

Consider the ramifications of choosing an inappropriate design for a research study.

By Day 3

Post the topic you selected, references for the two sources you identified, and the quantitative research design used in each. Critique the appropriateness of the design used and justify your comments with information from the Learning Resources. Discuss the ramifications of choosing an inappropriate design for a research study.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the following ways:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Nursing Research and Evidence-Based Practice Week 6 discussion

Validity in Quantitative Research Designs

Validity in research refers to the extent researchers can be confident that the cause and effect they identify in their research are in fact causal relationships. If there is low validity in a study, it usually means that the research design is flawed and the results will be of little or no value. Four different aspects of validity should be considered when reviewing a research design: statistical conclusion validity, internal validity, construct validity, and external validity. In this Discussion, you consider the importance of each of these aspects in judging the validity of quantitative research.

Nursing Research and Evidence-Based Practice To prepare:

Review the information in Chapter 10 of the course text on rigor and validity.

Read the method section of one of the following quasi-experimental studies (also located in this week’s Learning Resources). Identify at least one potential concern that could be raised about the study’s internal validity.

Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18–25.

Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of Nursing Care Quality, 24(4), 325–331.

Yuan, S., Chou, M., Hwu, L., Chang, Y., Hsu, W., & Kuo, H. (2009). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing, 18(10), 1,404–1,411.

Consider strategies that could be used to strengthen the study’s internal validity and how this would impact the three other types of validity.

Think about the consequences of an advanced practice nurse neglecting to consider the validity of a research study when reviewing the research for potential use in developing an evidence-based practice.

By Day 3

Post the title of the study that you selected and your analysis of the potential concerns that could be raised about the study’s internal validity. Propose recommendations to strengthen the internal validity and assess the effect your changes could have with regard to the other three types of validity. Discuss the dangers of failing to consider the validity of a research study.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues in one or more of the following ways:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Nursing Research and Evidence-Based Practice Week 7 discussion

Qualitative Research Designs

For the past 2 weeks, you have focused on the features and considerations of quantitative research designs. However, quantitative designs are not appropriate for all research questions. Perhaps you are concerned with how patients react when confronted with negative test results, or you wish to study how views on a certain health topic change over time. In each of these cases, the emphasis is more on understanding the thinking and experiences of an individual or group than on numerical measurements. For these types of questions, a qualitative or mixed methods research design is the most appropriate.

For this Discussion, you focus on the different types of qualitative research designs, when they are used, and why they are important.

To prepare:

Reflect on the comments made by Dr. Mauk in this week’s media presentation on the value of qualitative research in nursing.

Locate the journal Qualitative Health Research in the Sage Premier database in the Walden Library.

From this journal, select an article of interest to you that was published within the last 3 years.

Review the information on different qualitative research designs in Chapter 21 of your course text.

Determine what qualitative research design was used in your selected article and evaluate whether it was the best choice.

Consider ethical issues involved in the study and how the researchers addressed them.

Think about how using a quantitative design would have affected the type of data gathered.

By Day 3

Post an APA citation for the article that you selected and provide a brief summary of the content and the qualitative research design used. Evaluate the appropriateness of the design, and explain how ethical issues in the study were addressed. Analyze how the study would have been different if a quantitative design had been used.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ Nursing Research and Evidence-Based Practice postings by providing additional insights or contrasting perspectives based on readings and evidence.

Nursing Research and Evidence-Based Practice Week 8 discussion

Planning for Data Collection

Data collection is an important part of both quantitative and qualitative research. Although the actual approach to gathering information may vary, for either research design, researchers need to plan in advance how the data will be gathered, reported, and stored, and they need to ensure that their methods are both reliable and valid. As nurses review research when considering a new evidence-based practice, it is important to be familiar with sound collection practices in order to ascertain the credibility of the data presented.

Consider the following scenario:

Nurses and other health care professionals are often interested in assessing patient satisfaction with health care services. Imagine that you are a nurse working in a suburban primary care setting that serves 10,000 patients annually. Your organization is very interested in understanding the patient’s point of view to help determine areas of care that can be improved. With this focus in mind, consider how you would create a survey to assess patient satisfaction with the services your organization provides. You may wish to consider variables such as the ease of accessing care, patient wait time, friendliness of the staff, or the likelihood that a patient would recommend your organization to others.

For this Nursing Research and Evidence-Based Practice Discussion, you generate questions and an overall plan for data collection that would be appropriate for a patient satisfaction survey in relation to the above scenario.

To prepare:

Consider the guidelines for generating questions presented in this week’s Learning Resources.

Review the scenario and formulate at least five questions that you could use to evaluate patient satisfaction.

Reflect on the different methods or instruments that can be used for gathering data described in Chapter 13 and Chapter 22 of the course text. Which methods or instruments would work well for the scenario?

Determine an appropriate sample size for the scenario.

By Day 3

Post the questions that you created for gathering information about patient satisfaction based on the above scenario. Explain which method or instrument you would use to gather data. Describe the sample size appropriate for the population and how you would select participants. Provide a rationale for your choices, and explain how you can ensure high standard of reliability and validity.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from the readings or after synthesizing multiple postings.

Nursing Research and Evidence-Based Practice Week 9 discussion

Data Analysis—Small Group Discussion

As a nurse engaged in evidence-based practice, it is important to recognize how statistics and other data analysis tools are used to generate and assess evidence. Most nurses need only a foundational understanding of statistical tools and terminology to understand the majority of research studies. As a nurse, you should be able to recognize the most commonly used statistical tests, how and when they are used, and how significance is determined.

In this Nursing Research and Evidence-Based Practice Discussion, you examine different types of statistics and statistical tests, when and why these particular tests would be selected for use, and, most importantly, what the results indicate. To this end, you will be assigned to a group by Day 1 of this week. Each group will be assigned one of the five chapters listed in this week’s Learning Resources and will develop a study sheet on their chapter that will be shared with the other groups.

To prepare:

Review the information in your assigned chapter.

As a group, develop a 1-page study sheet that includes the following:

The key concepts of the chapter: Focus on the basic concepts that are important for nurses to understand as they review research studies.

A description of the statistical methods covered in the chapter, what they measure, and under what circumstances they are used. Identify examples of how the statistical methods have been used in research studies.

An explanation of the key statistical tests and how they measure significance (if applicable).

Note: This should be a collaborative effort, with each member of the group making contributions to the design and content of the study sheet. Use the Groups link on the left navigation bar to collaborate with your group. When you have developed your 1-page study sheet, select one member to post it to the Week 9 Discussion Forum so that the rest of your colleagues can access it.

By Day 5

Post your group’s study sheet. Discuss why it is important for nurses to understand the basics of these statistical methods.

Read a selection of your colleagues’ responses.

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By Day 6

Respond to at least two other groups on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ Nursing Research and Evidence-Based Practice postings, synthesizing the information to provide new perspectives.

Nursing Research and Evidence-Based Practice Week 10 discussion

Weighing the Evidence

When conducting original research, the final step researchers must complete is weighing the evidence and interpreting the meanings of their data, statistics, and analyses. This is the culmination of the research process in which all of the research methods and designs can be synthesized into a meaningful conclusion. In this stage, researchers should formulate explanations for what their data indicates, determine whether the data answers their initial research question, identify areas of uncertainty, and consider directions for further research.

In this Nursing Research and Evidence-Based Practice Discussion, you focus on one of the research articles that you identified for Part 2 of the Course Project (Literature Review). You then explore the process of how the researchers generated conclusions based on their data, consider other possible interpretations of their data, and formulate ideas for further research.

To prepare:

Review this week’s Learning Resources, focusing on how researchers find meaning in their data and generate sound conclusions. Pay particular attention to Table 2 in the article, “Study Design in Medical Research.”

Revisit the 5 articles that you identified in Part 2 of the Course Project. Select one to consider for the purpose of this Discussion.

Read sections of the chosen article where the data is presented, analyzed, and interpreted for meaning. What reasoning process did the researchers use to formulate their conclusions? What explanation did they give to support their conclusions? Were there any weaknesses in their analysis or conclusions?

Consider possible alternate conclusions that the researchers could have drawn based on their data.

Examine the findings that the article presents and consider how well they addressed the researcher’s initial question(s). What additional research could be done to build on these findings and gain a fuller understanding of the question?

By Day 3

Post an APA citation and brief summary of the research article that you selected. Describe the data and the results of any statistical tests or analyses presented in the article. Explain how the researchers formulated their conclusion, any weaknesses in their analysis or conclusions, and offer at least one alternate interpretation of their data. Propose at least one additional research study that could be done to further investigate this research topic.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Expand on your colleagues’ Nursing Research and Evidence-Based Practice postings by providing additional insights or contrasting perspectives based on readings and evidence.

Nursing Research and Evidence-Based Practice Week 11 discussion

Creating a Culture of Evidence-Based Practice

An abundance of evidence can be found on almost any medical issue or health topic. Often, the availability of information is not the concern, but rather nurses struggle with how to convey the evidence to others and change practices to better reflect the evidence. Deep-rooted organizational cultures and policies can make some resistant to change, even to changes that can vastly improve the quality, effectiveness, and efficiency of health care. However, there are many strategies that nurses can employ to bring about changes to practice.

In this Nursing Research and Evidence-Based Practice Discussion, you focus on how to create an organizational culture that supports evidence-based practice.

To prepare:

Review the information in this week’s Learning Resources. Examine the various suggestions for promoting an organizational culture that embraces the use of EBP.

Reflect on your own organization’s (or one in which you have worked) support of evidence-based practice. Examine how culture and policies impact the adoption of changes to practice based on evidence. What barriers exist?

Consider the models and suggestions for promoting evidence-based practice featured in this week’s Learning Resources. Identify models and suggestions that would work well in your organization.

Reflect on the significance of evidence-based practice in health care. What responsibility do nurses have to promote EBP and change practices to better reflect evidence and research findings?

Reflect on how nurses can disseminate findings from evidence-based practice research.

By Day 3

Post an evaluation of your organization’s use of EBP and how it is furthered or hindered by organizational culture and policies. Describe how you could disseminate the findings. Propose a strategy for strengthening the culture of EBP within the organization. Discuss a nurse’s responsibility to further the use of EBP, providing a rationale supported by specific information from the Learning Resources. Nursing Research and Evidence-Based Practice

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ Nursing Research and Evidence-Based Practice postings by providing additional insights or contrasting perspectives based on readings and evidence.

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