3215: intro to EBP

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3215: intro to EBP
2013-12-04 14:11:39
3215 final

intro to EBP
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  1. what is research?
    • systemic inquiry using methods to solve problems or answer questions
    • - ultimate goal is to gain knowledge that would be useful for many people
  2. evidence based practice is used for what?
    is the use of the best evidence in making patient care decisions. Such evidence typically comes from research conducted by nurses and other health care professional
  3. nursing research
    Systematic inquiry to develop knowledge about issues of importance to the nursing profession
  4. The American Nurses Credentialing Center
    has developed a magnet recognition program to recognize health care organizations that provide high-quality nursing care
  5. continuum of participation
    from producers of research to skilled consumers of research findings who use research evidence in their practice
  6. Florence nightingale 1850s
    • analyses of factors affecting mortality during the crimean war. she focused on
    • - hygiene
    • - amputation procedures
    • - environment (temp & air flow)- etc.
  7. first journal on research (nursing research) emerged, 1950s
    there was an increase of advance practicing nurses and research funding
  8. national center for nursing research established at NIH, 1986
    Importance in the US was the establishment in 1896 of the National Center for Nursing Research (NCNR) at the National Institute of health. The purpose of NCNR was to promote and financially support research projects and training related to patient care.
  9. national institute of nursing research (NINR) established, 1993
    Help put nursing research more into the mainstream of research activities enjoyed by other health disciplines
  10. future direction for research
    • Heightened focus on evidence-based practice
    • Use of multiple confirmatory strategies (e.g., replication [repeating] and multisite studies
    • Greater stress on systematic reviews

    • Systematic reviews: rigorously integrate research information on topic so that conclusions about the state of evidence can be reached
    • - Expanded local research in health care settings (e.g., as part of Magnet process)
    • - More multidisciplinary collaboration
    • - Expanded dissemination of research findings
    • - Greater focus on cultural issues and health disparities
  11. NINR’s 2010 budget request identified three broad areas of research emphasis
    • Promoting health and preventing diseases
    • Symptom management, self-management, and caregiving
    • End-of-life research
  12. sources of evidence for nursing
    • tradition
    • authority
    • clinical experience
    • logical reasoning
    • assembled information
    • disciplined research
  13. source of evidence: tradition
    may undermine effective problem solving
  14. sources of evidence: authority
    a person with specialized expertise. limitations include: they are not infallible because knowledge may be base off personal experience and no evidence based
  15. source of evidence: clinical experience
    • trail and error plays a role
    • intuition plays a role
    • clinical experience is a functional source of knowledge; may be biased and narrow
    • trial and error involves trying successively until a solution to a problem is found; practical but methods can be haphazard and unusual
  16. deductive reasoning
    Deductive reasoning is a basic form of valid reasoning. Deductive reasoning, or deduction, starts out with a general statement, or hypothesis, and examines the possibilities to reach a specific, logical conclusion. The scientific method uses deduction to test hypotheses and theories.
  17. inductive reasoning
    inductive reasoning is the opposite of deductive reasoning. Inductive reasoning makes broad generalizations from specific observations. Even if all of the premises are true in a statement, inductive reasoning allows for the conclusion to be false. Here’s an example: "Harold is a grandfather. Harold is bald. Therefore, all grandfathers are bald."
  18. sources of evidence: assembled information
    inductive reasoning is the opposite of deductive reasoning. Inductive reasoning makes broad generalizations from specific observations. Even if all of the premises are true in a statement, inductive reasoning allows for the conclusion to be false. Here’s an example: "Harold is a grandfather. Harold is bald. Therefore, all grandfathers are bald."
  19. sources of evidence: assembled information
    some information can be used in practice, but provide no mechanism to actually guide improvement
  20. source of evidence: disciplined research
    considered best method of acquiring reliable knowledge
  21. paradigm
    a world view a general perspective on the complexities of the real word, with certain assumptions about reality
  22. key paradigms for nursing research
    • positivist paradigm
    • naturalistic paradigm
  23. Positivist paradigm
    • Dominated nursing research
    • Is a reflection of a boarder cultural movement (modernism) that emphasizes rational and the scientific
    • Measurable and one reality
  24. naturalistic paradigm
    • Reality is not a fixed entity but rather a construction of the people participating in the research; reality exist within a context, and many constructions are possible
    • Assumes that knowledge is maximized when the distance between the inquirer and participants in the study is minimized
    • Many different realities because everyone has different experiences
  25. positivist assumption
    • - Reality exists. [there is a reality that can be studied and known]
    • - There is a real world driven by natural causes.
    • - Believers assume that nature is ordered and regular, and that reality exists independent of human observation
    • - the inquirer is dependent from those being studied
  26. naturalist assumption
    • - reality s multiple and subjective, constructed by individuals
    • - the inquirer interacts with those being studied; findings reflect the interaction
  27. roles and values of positivist assumption
    • - values are held in check; objectivity is sought
    • - their approach involves the use of orderly, disciplined procedures with tight controls over the research situation
  28. roles and values of naturalist assumption
    subjectivity and values are inevitable, desirable
  29. post-positivist
    still believe in reality and seek to understand it, but they recognize they impossibility of total objectivity
  30. research methods
    • the techniques used to structure a study and to gather, analyse, and interpret information. this includes
    • - quantitative research
    • - qualitative research
  31. Quantitative research
    • most often allied with the positivist tradition
    • - Typically move in systematic [progress through a series of steps] fashion from the definition of a problem to the solution of the problem
    • - Gather empirical evidence - Evidence that is rooted in objective reality and gathered directly or indirectly through the sense rather than through personal beliefs or hunches- Important limitations
    • - They must attach numerical values that express quantity
    • - Complexities tend to be controlled and, if possible, eliminated rather than studied directly – this narrow focus can sometimes obscure insights
    • - Has been accused of a narrowness and inflexibility of vision that does not capture the full breath of human experience
  32. qualitative research
    • most often allied with the naturalist tradition
    • - Emphasize the inherent complexity of humans, their ability to shape and create their own experiences
    • - Heavily focused on understanding human experience as it is lived
    • - Believe that traditional scientific method is reductionist: it reduces human experience to only a few concepts under investigation, and those concepts are defined in advance by the researcher rather than emerging from the experiences of those under study
  33. key points about positivist
    - fixed design- discrete, specific concepts - deductive processes- control over context- verification of hunches- quantitative information - seeks generalizations
  34. key points about naturalist
    • - flexible design
    • - holistic
    • - inductive processes
    • - context
    • -bound
    • - emerging interpretation
    • - qualitative information
    • - seeks patterns
  35. purposes of nursing research
    • - Treatment, Therapy, Intervention 
    • - Diagnosis, Assessment 
    • - Prognosis - Harm and Etiology
    • - Meaning, Process
  36. Prognosis
    [looks at the outcomes, what are we expecting to be the outcomes?]- These studies provide valuable information for guiding patients to make beneficial lifestyle choices or to be vigilant for key symptoms