Introduction to EBP and the Role of Research
What is Nursing Research?
According to your text, “Nursing research is a systematic process of inquiry that uses rigorous guidelines to produce unbiased, trustworthy answers to questions about nursing practice” (Houser, 2018, p. 5). Nursing research strives to understand phenomena that impact health, seeks solutions to problems, tests approaches to improving nursing care, and generates new knowledge to further our profession.
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Evolution of Nursing Research
Nursing research has a long history beginning with Florence Nightingale, a British nurse who championed the use of scientific inquiry to guide nursing practice during the Crimean War. Nightingale employed statistical methods to show that better food, hygiene, and sanitation could reduce morbidity and mortality among the soldiers. Nightingale is recognized as one of the first nurses to utilize evidence as a base for her practice. In addition, she popularized the use of the polar area diagram, a form of pie chart, to depict her statistics; as a result, Nightingale was inducted into the Statistical Society of London.
Several decades passed before nursing would create a significant body of research. Today, the National Institute of Nursing Research (NINR) promotes the health of all Americans through nursing research funding and training. The NINR is a leader in promoting high priority areas of science.
Nurses may assume a variety of roles related to nursing research. Some nurses are consumers of research findings and utilize them to improve nursing practice where they work. Others share research knowledge with colleagues and participate in research-related activities or research projects, and yet another group act as principle investigators to produce research and publish the findings.
Many colleges and universities employ faculty who are engaged in nursing research. Regional, national, and international nursing organizations offer membership to nurses who wish to share their interest in research, including Sigma Theta Tau International, the Western Institute of Nursing, and the Eastern, Southern, and Midwest Nursing Research Societies. Introduction to Evidence-Based Practice in Nursing.
Evidence-Based Practice
Research yields evidence upon which nurses may base their practice (i.e., evidence-based practice). Evidence-based practice is “The use of the best scientific evidence, integrated with clinical experience and incorporating patient values and preferences in the practice of professional nursing care” (Houser, 2018, p. 12). The movement to base practice on evidence began in the early 1990s and has become a worldwide standard not only for nursing but also for many other health disciplines. Introduction to Evidence-Based Practice in Nursing.
Levels of Evidence
Level of Rating Type of Study
Level I
Multiple randomized controlled trials (RCTs) reported as meta-analysis, systematic review, or metasynthesis, with results that consistently support a specific intervention or treatment
Randomized trials with large sample sizes and large effect sizes
Level II
Evidence from well-designed controlled studies, either randomized or nonrandomized, with results that consistently support a specific intervention or treatment
Level III
Evidence from studies of intact groups
Ex-post-facto and causal-comparative studies
Case-control or cohort studies
Evidence obtained from time series with and without an intervention
Single experimental or quasi-experimental studies with dramatic effect sizes
Level IV
Evidence from integrative reviews
Systematic reviews of qualitative or descriptive studies
Theory-based evidence and expert opinion
Peer-reviewed professional organization standards with supporting clinical studies
Review and rating of the evidence should result in recommendations for practice, with the strength of these recommendations being commensurate with the level of evidence and the quality of the study. Introduction to Evidence-Based Practice in Nursing.
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Sources of Evidence
Decision making does not always rely on research or scientific investigation. The evidence pyramid reveals the sources of evidence that nurses use to make decisions and to solve problems.
Routine, day-to-day decisions involved in traditional problem solving rely on experience, expert advice, and standards of care, but what about those situations where the answer to your question is not obvious or well-understood? Maybe you and your colleagues have little experience with the situation, or you recognize that current practice is not working. Now, you are faced with a significant problem where trial and error or untested ideas prove unreliable. Instead, you turn to research-based evidence for guidance.Introduction to Evidence-Based Practice in Nursing.
Exercise: Levels of Evidence
Determine the definition of each of the levels of evidence.
Level I
Multiple randomized controlled trials (RCTs) reported as meta-analysis, systematic review, or metasynthesis, with results that consistently support a specific intervention or treatment
Randomized trials with large sample sizes and large effect sizes
Level II
Evidence from well-designed controlled studies, either randomized or nonrandomized, with results that consistently support a specific intervention or treatment
Level III
Evidence from studies of intact groups
Ex-post-facto and causal-comparative studies
Case-control or cohort studies
Evidence obtained from time series with and without an intervention
Single experimental or quasi-experimental studies with dramatic effect sizes
Level IV
Evidence from integrative reviews
Systematic reviews of qualitative or descriptive studies
Theory-based evidence and expert opinion
Peer-reviewed professional organization standards with supporting clinical studies
Finding Research-Based Evidence—Writing Searchable Questions
As you engage in nursing practice, you may find yourself reflecting on a situation where evidence is needed to practice safe, effective, and efficient nursing. Evidence can form the basis of best practices for:
the nursing care process, including assessment, diagnosis, planning, implementation, and evaluation;
policies and procedures that are tested and found to be effective;
patient-care management tools, such as care maps and critical pathways; and
the care of the individual patient.
As you consider the who, what, where, when, why, and how of the situation, you begin to formulate a clinical question that addresses these queries. Introduction to Evidence-Based Practice in Nursing.
The PICO(T) format is a way to develop a clinical question that lends itself to searching for evidence. PICO(T) is an acronym for
P = population of interest
I = intervention of interest
C = comparison of interest
O = outcome of interest
T = time
All of the PICO(T) elements may not be present in every clinical question. For example, the T (time) may not be relevant or there may be no C (comparison of interest). Introduction to Evidence-Based Practice in Nursing.
In quantitative research that has an experimental design, you will find interventions (I), and perhaps comparisons, (C) that are independent variables. The outcomes (O) are dependent variables. Variables will be discussed in more detail later in the course.
Once you have formulated your clinical question and determined the PICO(T) elements, the next step is to identify key terms that reflect the elements. The key terms are the actual words or phrases that you will use to search the indices, databases, and search engines. The goal is to select key terms that will likely match those terms that the authors assigned to relevant research reports. Introduction to Evidence-Based Practice in Nursing.
The following diagram illustrates how the search for evidence mirrors the research process. Notice that the place where both processes connect is at the key terms.
