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Chapter 1
Evidence-Based Nursing: Using Research in Practice
LEARNING OUTCOME
The student will describe evidence that can serve as the basis for nursing practice.
M.D. is a 17-year-old adolescent
who is a senior at a local public high school. She has had weight issues
for the last 6 years and is considered to be medically obese. She has
become concerned about the inability to lose weight, health problems
related to obesity, and her self-esteem. She has discussed her concerns
with the school nurse and is anxious to take action. The school nurse
recognizes that M.D. needs both education and support in achieving her
ideal weight. The RN completes a literature search and finds two articles
that appear to relate to M.D. and her weight. The first is titled “Sleep,
Hunger, Satiety, Food Cravings, & Caloric Intake in Adolescents”
(Landis, Parker, & Dunbar, 2009), and the second is titled “The
Relationships Among Self-Esteem, Stress, Coping, Eating Behavior, and
Depressive Mood in Adolescents” (Martyn-Nemeth, Penckofer, Gulanick,
Velsor-Friedrich, & Bryant, 2009). You can find these articles in
Appendices A.1 and A.2 of this text.
CHAPTER OVERVIEW
Chapter 1 discusses the relevance of nursing research to nursing practice. The chapter begins with a clinical case about a 17-year-old adolescent who is obese. She discusses her concerns with the school nurse who know she needs support to achieve a healthy body weight. The case raises a clinical question about appropriate education and support to prepare the adolescent for a healthy way to lose weight. Use of research to address this question is discussed and used as an example. The chapter identifies the five questions that nurses might have about a research report and how these are used to organize the chapters of the book. The five questions are:
1. What is the answer to my practice question—what did the study conclude?
2. Why did the author(s) reach these conclusions—what did they actually find?
3. To what types of patients do these research conclusions apply—who was in the study?
4. How were these people studied—why was the study performed that way?
5. Why ask that question—what do we already know?
The organization of the text, starting with the conclusions of a research report and moving forward to the introduction of a research report, is described.
1. Understanding research is essential to answering clinical questions and to providing high-quality care.
2. Evidence-based nursing helps nurses utilize research to make informed decisions regarding patient care.
3. Nursing research began with Florence Nightingale.
4. Nursing research now focuses on outcomes research and the National Institute for Nursing Research has been established as a source of funding and support.
5. Reading research is not the only way to find answers to clinical questions; other ways include use of experts or authorities, past experience, and intuition.
6. Effective clinical questions for evidence-based nursing include a concern that someone else has studied, a concern that can be measured or described, and a concern that is relevant to nursing. The question also addresses Who, Where, What, and When in terms of the clinical concern—CORE CONCEPT.
7. Evidence-based practice is the process of conscious and intentful use of research and theory-based information to answer questions and make clinical decisions. Reading and using research is part of evidence-based practice.
8. Nursing research is the systematic gathering of information to gain, expand, or validate knowledge about health and responses to health problems. Evidence-based nursing uses research-based evidence to plan and implement quality care—CORE CONCEPT.
9. Reports of research can be found through:
a. Printed indexes
b. The Internet—relevant World Wide Web sites for nursing are listed in Table 1.1
c. Electronic databases
1) Commonly used electronic databases are CINAHL, MEDLINE, and PubMed.
2) Key words are used to search electronic databases. Key words are descriptive terms regarding a research question.
10. Abstracts of research can be very helpful in narrowing down or focusing on the appropriate research to acquire and read. Abstracts cannot and should not be depended on to provide a level of understanding of the research that would support clinical decision making—CORE CONCEPT.
11. Abstracts are useful for identifying whether a study is relevant to a particular clinical question and whether the study sample is similar enough in order to be useful to the clinical sample of interest to the nurse.
12. Systematic reviews are a written compilation of research relevant to a research question. The COCHRANE database is a source for systematic reviews. The Joanna Briggs Collaboration promotes evidence-based health care through reviews of research and the development of Best Practice Evidence-Based sheets.
IN-CLASS PRACTICE RESEARCH STUDY
Included in Appendix C is an
in-class survey that students could take during the first class meeting.
Some of the information on the survey is exactly the type of information
used to develop the “Fictional Article” (Appendix B) used as an
example throughout the text. There is some additional information asked
that may be used for different in-class activities. You can easily enter
the data into any database or statistical package. If you choose to
use the survey and enter the data, it could be used as an example throughout
class. However, even hand tabulation of the data would not be difficult
for small classes.
IN-CLASS ACTIVITIES OR CHAT ROOM DISCUSSION QUESTIONS
1. Discussion Questions: Begin class with a discussion of the last research study that students have read:
a. Why did you read it?
b. What did you find/What do you remember from it?
c. What parts did you read?
2. Critical Thinking Exercises: Ask students to identify a clinical question they have wondered about. If they do not have one, pose the question: Would daily hygiene care, traditionally called A.M. care, be better scheduled in the evenings in order to prepare patients for a restful sleep?
a. Discuss how they might go about getting the answer to the question.
b. Discuss the relative strengths and drawbacks to each of the four approaches to answering clinical questions that are described in the chapter: research, authority, experience, and intuition.
c. How would they summarize
and present their findings to other staff nurses?
ONLINE ACTIVITIES
1. Critical Thinking Exercises:
a. Present a clinical question and ask students to provide an answer and identify their source for that answer. Possible questions include:
1) What information is most important to a newly diagnosed patient with diabetes: etiology, prognosis, treatment, or self-care requirements?
2) What are the optimal intervals for tube feedings to maximize absorption and use of nutritional supplements?
b. Tally whether answers were found using research, authority, past experience, or intuition.
2. Written Assignment:
a. Ask students to perform a database search for a research citation about a clinical question, such as the effects of chocolate on depression. Have them submit their search results from one established electronic database, such as CINAHL.
b. Note: A search of CINAHL in June 2010 yielded three specific citations for chocolate and depression:
1) Macht, M., & Mueller, J. (2007). Interactive effects of emotional and restrained eating on responses to chocolate and affect. Journal of Nervous & Mental Disease, 195(12), 1024–1026.
2) Rose, N., Koperski, S., & Golomb, B. (2010). Mood food: Chocolate and depressive symptoms in a cross-sectional analysis. Archives of Internal Medicine, 170(8), 699–703.
3) Strandberg, T., Strandberg,
A., Pitkälä, K., Salomaa, V., Tilvis, R., & Miettinen, T. (2008).
Chocolate, well-being and health among elderly men. European Journal
of Clinical Nutrition, 62(2), 247–253.
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