MODULE

LESSON

1 FUNDAMENTALS of NURSING
3 HOURS

“We're going to take the best care of our patients while giving them access to treatment
options they might not have had otherwise.”

-Lisa Marsh
Research Nurse

Evidence-based practice in nursing is an integration of research evidence, clinical

expertise and a patient's preferences. This problem-solving approach to clinical
practice encourages nurses to provide individualized patient care.
1. Describe why research is important in the nursing profession and discuss the need
for evidence-based practice.
2. Describe historic trends and future directions in nursing research
3. Describe alternative sources of evidence for nursing practice.

Can you imagine how would the nursing profession without research?

The nursing profession without vigorous research would cause a lot of clinical
malpractice in any nursing procedure, illiteracy in terms of healthcare, and lack of
knowledge in many aspects of medical and allied health. It's just way too difficult to
imagine if we practice nursing skills that are not evidence-based practice because of
negative and antipathetic outcomes that may occur if the knowledge we obtain was
not adequate enough.
In the future what possible evidence-based nursing practice you will share to your
nursing profession?
The possible evidence-based nursing practice that I will share with my nursing
profession hopefully is Antibiotic stewardship.

 Antibiotic stewardship aims to measure and improve how  antibiotics are

prescribed by clinicians and utilized by patients. The development of
antibiotic prescriptions and use is vital to efficaciously treat infections,
protect patients from harms caused by unnecessary antibiotic use, and
combat antibiotic  resistance.
This lesson will lead you to different topics related to evidence-based practice in
nursing. The overview of this lesson will enlighten you how important research in
any field of practice of nursing.

Evidence-Based practice in Nursing

Research-Related Roles and Responsibilities

Research
is a systematic inquiry that uses discipline methods to answer questions and solve
problems (Polit & Beck, 2010)
The ultimate goal of research is to develop, refine and expand a body of knowledge.

Nursing Research
Is a systematic inquiry designed to develop trustworthy evidence about issues of
importance to the nursing profession, including in nursing practice, education,
administration and informatics (Polit & Beck, 2010)

Clinical Nursing Research

Research designed to guide nursing practice and to improve the health and quality of
life of nurse’s clients
Evidence-Based practice
Defined as the use of the best clinical evidence in making patient care decisions, and
such evidence typically comes from research conducted by nurses and other health
care professionals

Example of EBP:
“Kangaroo Care”
The adoption of this practice reflects the mounting evidence that early skin-to-skin
contact has clinical benefits without any apparent negative side effects (Dodd, 2005;
Galligan, 2006; Polit & Beck, 2010)

Example of nursing research breakthroughs in 1960’s: (Polit & Beck, 2010)

Jeanne Quint Benoliel began a program of research that had a major impact on
medicine, medical sociology and nursing. Quint explored the subjective experiences
of patients after diagnosis with a life-threatening illness (1967). of particular note,
physician in the early 1960’s usually did not advise women that they had breast
cancer, even after mastectomy. Quint’s (1963) seminal study of the personal
experiences of women after radical mastectomy contributed to changes in
communication and information control by physicians and nurses.

Example of nursing research breakthroughs in 1970’s:(Polit & Beck, 2010)

Kathryn Barnard’s research led to breakthroughs in the ares of neonatal and child
development. Her research program focused on the identification and assessment of
children at risk of developmental and health problems, such as abused and
neglected children and failure-to-thrive children (Barnard, 1973; Barnard, Wenner,
Weber, Gray & Peterson, 1977). Her research contributed to early interventions for
children with disabilities, and also to the field of developmental psychology.

Example of nursing research breakthroughs in 1980’s: (Polit & Beck, 2010)

The team of researchers headed by Dorothy Brooten engaged in studies that lead to
the development and testing of a model of site transitional care. For example,
Brooten and her colleagues (1986, 1988) conducted studies of nurse specialist-
manage home follow-up services for very-low-birth-weight infants who were
discharged early from the hospital, and demonstrated a significant cost savings- with
comparable health outcomes. The site transitional care model, which was developed
in anticipation of government cost-cutting measures, has been used as a framework
for patients who are at health risk as a result of early discharge from hospitals, and
has been recognized by numerous health care disciplines.

Example of nursing research breakthroughs in 1990’s: (Polit & Beck, 2010)

Many studies that Donaldson (2000) identified as breakthroughs in nursing research

were conducted in the 1990’s. this reflects, in part, the growth of research programs
in which teams of researchers engage in a series of related research on important
topics, rather than discrete and unconnected studies. As but one example, several
nurse researchers had breakthroughs during 1990’s in the area of
psychoneuroimmunology, which has been adopted as the model of mid-body
interactions. Swanson and Zeller, for example, conducted several studies relating to
human immunodeficiency virus (HIV) infection and neuropsychologic function
(Swanson, Cronin-Stubbs, Zeller, Keesler, & Bielauskas, 1993; Swanson, Zeller &
Spear, 1998) that have led to discoveries in environmental management as a means
of improving immune system status.

Example of landmark nursing studies of the 21st century: (Polit & Beck, 2010)

Celebrating its 2oth anniversary, NINR published a report in 2006 on 10 landmark

studies that had been supported with NINR funds. The 10 selected studies
encompassed a wide range of research, including a study on the relationship
between nurse staffing a patient well-being by Aiken and colleagues (2002); a test of
clinical intervention to improve metabolic outcomes for adolescents with type I
diabetes by Grey and colleagues (2001); and an evaluation of a multidisciplinary
project to reduce high blood pressure in inner-city hypertensive men by Hill and
colleagues (2003).

Researchers have a responsibility to communicate their research, to collaborate with

others where appropriate and to transfer and exploit knowledge for the benefit of
your employer, the economy and society as a whole. Researchers have
a responsibility to behave honestly and ethically in the course of their research.

Roles of nurses in research

1. Consumers or users. Nurses who read research reports to develop new skills and
to keep up to date on relevant findings that may affect their practice. Nurses are
expected to maintain this level of involvement in research, at a minimum.
2. Producers. Nurses who actively participate in designing and implementing studies.
At one time, most nurse researchers were academics who taught in schools of
nursing, but research is increasingly being conducted by practicing nurses who want
to find what works best for their clients.

Other research involvement of nurses:

 Participate in a journal club in a practice setting, which involves settings to
discuss and critique research articles
 Attend research presentations and professional conferences
 Solve clinical problems and make clinical decisions based on rigorous research
 Help to develop an idea for clinical study
 Review a proposed research plan and offer clinical expertise to improve the plan
 Assist researchers by recruiting potentials study participants or collecting
research information (e.g. distributing questionnaires to clients)
 Provide information and advice clients about participation in he study
 Discuss the applications and relevance of research findings with clients

Sources of evidence for nursing practice

1. Tradition and authority
2. Clinical experience , trial and error and intuition
3. Logical reasoning
4. Assembled information
5. Disciplined research

Six steps of evidence-based practice

1. Ask a clinical question.

2. Collect the most relevant and best evidence.
3. Critically appraise the evidence you gather.
4. Integrate all evidence with clinical expertise patient values and preferences in
making a practice decision or change.
5. Evaluate the practice decision or change.
6. Share the outcomes of evidence-based practice with others.

Responsibilities of the Research Team

 Principal Investigator (PI) The Principal Investigator has the

primary responsibility for ensuring the ethical conduct of the research study.
 Sub-Investigator (Sub-I) / Co-Investigator (Co-I)
 Regulatory Coordinator.
 Data Coordinator.
 Research Coordinator/ Research Nurse.
The European Charter sets out the following responsibilities for researchers
covering:

 Research freedom
 Ethical principles
 Professional responsibility
 Professional attitude
 Contractual and legal obligations
 accountability
 Good practice in research
 Dissemination, exploitation of results
 Public engagement
 Relationship with supervisors (and managers)
 Supervision and managerial duties
 Continuing professional development.

 As a research student you have responsibility for managing both yourself and

your work and within the research degree programme to: ensure you are
familiar with the University's requirements. satisfactorily complete formal
reviews of your progress. develop an appropriate range of research and other
skills.

 Research coordinators ensure study subjects meet the criteria set forth by the
organization they work for. They also address any concerns or problems the
subjects might have prior to and during the study.

Research Coordinator Duties and Responsibilities

The duties and tasks research coordinators are required to carry out will depend on
their place of employment and a variety of other factors, such as the amount of
experience they have. Despite these factors, the overwhelming majority of research
coordinators can be expected to do the following on a regular basis:

Control Research Budgets

Scientific and medical studies can be expensive, and most of the time, they must be
conducted on a budget. This budget is usually set forth by the company or school
responsible for the study, and the research coordinator is in charge of ensuring the
study does not exceed the budget.
Enter Study Data into a Database

As a study progresses, various individuals will collect important data from the test
subjects. This data will usually be studied by scientists, doctors, or other important
officials later on. It is the job of the research coordinator to enter this data into an
electronic database.

Ensure State and Federal Compliance

Institutions and organizations must adhere to certain regulatory standards when

conducting a study of any sort. These standards ensure the study remains ethical and
those participating in the study remain safe. Research coordinators must know these
regulations and make certain they are followed.

Recruit Study Subjects

Without the right study subjects, virtually any study will fail. Research coordinators
ensure study subjects meet the criteria set forth by the organization they work for.
They also address any concerns or problems the subjects might have prior to and
during the study.

Communicate with Researchers

The research coordinator provides researchers with any important information or

developments that occur during the study. They may communicate regularly with
these researchers or convey the concerns of study subjects.

Research Coordinator Skills and Qualifications

Every company and organization will have different requirements in regards to the
skills needed to become a research coordinator, but there are some skills that are
needed to enter the field. Most research coordinators must have at least a
bachelor’s degree. They should also possess the following skills and qualifications if
they want to get hired:

 Clinical knowledge – a qualified research coordinator should have some

knowledge of biology, biochemistry, research techniques, psychology, and other
health and science disciplines
 Understanding of safety regulations – safety regulations are immensely
important, and if a company or organization does not follow them, they could
 be fined or face other serious consequences. Research coordinators should be
aware of these regulations and how they can impact the study
 Data entry – research coordinators should know how to enter large amounts
of data into a database. They may even be tasked with using software to
compile reports or graphs depicting the findings of the study
 Attention to detail – research coordinators should be capable of recognizing
small details, especially since they can have a major impact on the outcome of a
study. They should pay attention to any feedback provided by test subjects and
any irregular findings
 Communication skills – strong written and verbal communication skills are
needed to become a research coordinator. Research coordinators should also
feel comfortable sending emails and interacting with other coordinators and
researchers

Summary points:
 Nursing research is systematic inquiry to develop evidence on problems
importance to nurses
 Nurses in various settings are adopting evidence-based practice (EBP) that
incorporates research findings into their decisions and interactions with clients.
 Knowledge of nursing research enhances the professional practice of all nurses -
including both consumers of research ( who reads and evaluates studies) and
producers of research ( who designs and undertakes studies)
 Nursing research began with Florence Nightingale, but developed slowly until its
rapid acceleration in 1950’s. Since the 1980’s, the focus has been on clinical
nursing research- that is, no problems relating to clinical practice.

Enlist an evidence-based research in nursing and elaborate on how this will help you
in the future practice.
Provide the title, author, reference
For quiz:

1. In caring for patients, it is important for the nurse to realize that evidence-based
practice is
a. The only valid source of knowledge that should be used.
b. Secondary to traditional or standard care knowledge.
c. Dependent on patient values and expectations.
d. Not shown to provide better patient outcomes

2. The quality improvement committee has been alerted to an increased number of

falls in the
hospital. Most of these falls have occurred at night and have involved
patients who were trying to crawl over bedrails. A literature review brought
out that most falls occur because patients are trying to go to the bathroom.
The committee created a practice change that bedrails should be left in the
down position, and hourly nursing rounds should be conducted. What is the
committee's next step?
a. Evaluate the changes in 1 month.
b. Wait a month before implementing the changes.
c. Implement the changes as a pilot study.
d. Communicate to staff the results of this inquiry.

3. The hospital quality improvement committee has noted that the incidence of
needlestick injuries on a particular unit has increased. When faced with
issues, the committee applies the PDSA model, a formal model for exploring
and resolving quality concerns. Because the committee is multidisciplinary in
nature, and few members are nurses, it is imperative that the committee first
a. Plan.
b. Do.
c. Study.
d. Act.
4. In conducting a research study, the researcher must guarantee that any
information the subject
provides will not be reported in any manner that identifies the subject and
will not be accessible to people outside the research team. This concept is
known as
a. Anonymity.
b. Confidentiality.
c. Informed consent.
d. The research process.
5. The nurse has used her PICO ( Patient Problem or Population, Intervention,
Comparison or Control, Outcome) question to develop an evidence-based
change in protocol for a certain nursing procedure. However, to make these
changes throughout the entire institution would require more support staff
than is available at this time. What is the nurse's best option?
a. Drop the idea of making the change at this time.
b. Insist that management hire the needed staff to facilitate the change.
c. Seek employment in another institution that may have the staff needed.
d. Conduct a pilot study to develop evidence to support the change.