Nursing Research in an Evidence-Based Practice Environment

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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.

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 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)

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.

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.

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.

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 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.
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.
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.
  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.
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