Appraisal and Application of
FOR NURSES PRACTICE
THE PEDAGOGY Evidence-Based Practice for Nurses: Appraisal and Application of Research, Fourth Edi-tion, drives comprehension through various strategies that meet the learning needs of students while also generating enthusiasm about the topic. This interactive approach addresses different learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following:
Chapter Objectives These objectives provide instructors and students with a snapshot of the key information they will encounter in each chapter. They serve as a checklist to help guide and focus study.
Key Terms Found in a list at the beginning of each chapter and in bold within the chapter, these terms will create an expanded vocabulary in evidence-based practice.
At the end of this chapter, you will be able to:
‹ Define evidence-based practice (EBP) ‹ List sources of evidence for nursing practice
‹ Identify barriers to the adoption of EBP and pinpoint strategies to overcome them
‹ Explain how the process of diffusion facilitates moving evidence into nursing practice
‹ Define research ‹ Discuss the contribution of research to EBP
‹ Categorize types of research ‹ Distinguish between quantitative and qualitative research approaches
‹ Describe the sections found in research articles
‹ Describe the cycle of scientific development
‹ Identify historical occurrences that shaped the development of nursing as a science
‹ Identify factors that will continue to move nursing forward as a science
‹ Discuss what future trends may influence how nurses use evidence to improve the quality of patient care
‹ Identify five unethical studies involving the violation of the rights of human subjects
abstract applied research barriers basic research cycle of scientific
development deductive reasoning descriptive research discussion section early adopters empirical evidence evidence-based practice
(EBP) explanatory research
inductive reasoning innovation introduction Jewish Chronic Disease
Hospital study laggards list of references methods section model of diffusion of
innovations Nazi experiments Nuremberg Code predictive research pyramid of evidence
qualitative research quantitative research replication study research research utilization results section review of literature theoretical framework theory Tuskegee study Willowbrook studies
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Critical Thinking Exercises As an integral part of the learning process, the authors present scenarios and questions to spark insight into situations faced in practice.
Test Your Knowledge These questions serve as benchmarks for the knowledge acquired throughout the chapter.
After an outcome has been selected and measured, data are compiled and evaluated to draw conclusions. Demonstrating the effectiveness of an innovation is a challenge, and conclusions must not extend beyond the scope of the data. Evaluation is facilitated when appropriate outcomes and associated indicators are chosen. If the outcome is not clearly defined, then the measurements and subsequent evaluation will be flawed. For example, suppose that you are a member of an interdisciplinary team that has developed a nursing protocol that reduces the amount of time the patient remains on bed rest after a cardiac catheterization procedure from 6 hours to 4 hours. The outcome selected is absence of bleeding from the femoral arterial puncture site. No other indicators are measured. The results obtained after implementing the protocol revealed that there was an increase in bleeding at the femoral arterial site in the 4-hour bed rest patients compared to the 6-hour bed rest patients. Before concluding that a shorter bed rest time leads to an increase in femoral bleeding, a few additional questions need to be considered. First, was absence of bleed- ing defined in a measurable way? Because bleeding might be interpreted in several different ways, a precise definition of bleeding should have been provided to ensure consistency in reporting. Second, when should patients be assessed for absence of bleeding? Is the absence of bleeding to be assessed when the patient first ambulates or at a later time? Input from the staff prior to changing the nursing protocol could have clarified these questions, resulting in more reliable results.
Another consideration in outcome evaluation is to obtain data relative to current practice for comparison purposes. To document the need for a practice change and to support a new protocol, baseline data might need to be collected
tEst YOur knOWlEdgE 18-3
How did you do? 1. F; 2. T; 3. T; 4. T
After an outcome has been selected and measured, data are compiled and evaluated to draw conclusions. Evaluation is facilitated when appropriate outcomes and associated indicators are chosen— conversely, if the outcome is not clearly defined, then the measurements and subsequent evaluation will be flawed.
498 ChaptER 18 Evaluating Outcomes of Innovations
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treatment of human response, and advocacy in the care of individuals, fami- lies, communities, and populations” (ANA, 2003, p. 6). From the early days of the profession, students have been taught that a scientific attitude and method of work combined with “experience, trained senses, a mind trained to think, and the necessary characteristics of patience, accuracy, open-mindedness, truthfulness, persistence, and industry” (Harmer, 1933, p. 47) are essential components of good practice. Harmer goes on to say, “Each time this habit of looking, listening, feeling, or thinking is repeated it is strengthened until the habit of observation is firmly established” (p. 47). This still holds true today. Benner (1984) studied nurses in practice and concluded that to become an expert nurse one has to practice nursing a minimum of 5 years. There are no shortcuts to becoming an expert in one’s field. The development of knowledge and skill takes time and work. As nurses encounter new situations, learning takes place. Nursing knowledge develops and is refined as nurses practice (Waterman, Webb, & Williams, 1995). In this way, nurses adapt theories to fit their practices. Unfortunately, much that is learned about theory during practice remains with the nurse because nurses rarely share their practice expertise through conference presentations and publications. The discipline will be enriched when nurses engage more formally in disseminating their knowledge about theory in practice.
The Relationships Among Theory, Research, and Practice Practice relies on research and theory and also provides the questions that require more work by theorists and researchers. Each informs and supports the other in the application and development of nursing knowledge. When the relationships among theory, research, and practice are in harmony, the discipline is best served, ultimately resulting in better patient outcomes (Maas, 2006). The relationships are dynamic and flow in all directions.
CRiTiCAL THinking ExERCisE 5-2
A nurse on a surgical floor observes that several new approaches are being used to dress wounds. She observes that some methods appear to promote healing faster than others do. While reviewing the research literature, she is unable to locate any research about the dressings she is using. How might she go about testing her theory that some methods are better than others? Can this be done deductively, inductively, or using mixed methods? Are any theories presently available related to wound healing, and if so, where might she locate these? What concepts might be important in forming the question?
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