Module 1: Intro to Research and Evidence-Based Practice
Research
The systematic, rigorous, critical investigation that aims to answer
questions about nursing phenomena.
Evidence-Based
Practice
The collection, evaluation, and integration of valid research evidence,
combined with clinical expertise and an understanding of patient and
family values and preferences, to inform clinical decision making.
Steps of
Evidence-Based
Practice
(p. 14 in book)
Ask→ Gather → Assess and Appraise → Act → Evaluate
Quality
Improvement
The systematic use of data to monitor the outcomes of care processes as
well as the use of improvement methods to design and test changes in
practice for the purpose of continuously improving the quality and safety of
health care systems.
Critical Appraisal
Skills
Nurses must be knowledgeable consumers of research, who can evaluate
the strengths and weaknesses of research evidence and use existing
standards to determine the merit and readiness of research for use in
clinical practice.
Clinical
Guidelines
Systematically developed statements or recommendations that serve as a
guide for practitioners. There are two types of clinical guidelines that we
will discuss: consensus (expert-developed) guidelines and evidencebased guidelines.
Clinical Practice
Guidelines
Issued by third-party organizations, these guidelines define the role of
specific diagnostic and treatment modalities in the diagnosis and
management of patients. The statements contain recommendations that
are based on evidence from a rigorous systematic review and synthesis of
the published medical literature.
Consensus
Guidelines
An agreement among experts about a certain approach to diagnose or
treat a particular disease or condition.
NonResearch design in which an investigator observes a phenomenon without
experimental
manipulating the independent variable(s).
Research Design
Experimental
A research design that has the following properties: randomization,
Research Design control, and manipulation.
Systematic
Review
A summation and assessment of a group of research studies that test a
similar research question.
Meta-Analysis
A summary of a number of studies focused on one question or topic, and
uses specific statistical methodology to synthesize the findings in order to
draw conclusions about the area of focus.
Integrative
Review
A focused review and synthesis of research or theoretical literature in a
particular focus area, and includes specific steps of literature integration
and synthesis without statistical analysis. It can include both quantitative
and qualitative articles. At times reviews use the terms systematic review
and integrative review interchangeably.
Meta-Synthesis
and MetaSummary
The synthesis of a number of qualitative research studies on a focused
topic, using specific qualitative methodology.
Module 2
Chapter 2: Research Questions, Hypotheses, and Clinical Questions
Research question
3 Characteristics of a Good
Research Question
A key preliminary step wherein the foundation for a study
is developed from the research problem and results in the
research hypothesis.
A question that tests a measurable relationship to be
examined in a research study.
1. Clearly identifies the variables under
consideration
2. It specifies the population being studied
3. Testability - it implies the possibility of empirical
testing
Hypothesis
Predicts the outcome of the study.
Theory
A set of interrelated concepts, definitions, and
propositions that present a systematic view of phenomena
for the purpose of explaining and making predictions
about those phenomena. Hypotheses provide a bridge
between theory and the real world.
Nursing Theory
A creative and rigorous structuring of ideas that project a
tentative, purposeful, and systematic view of phenomena.
Through systematic inquiry, nurses develop knowledge
relevant to improving the care of patients.
Clinical question (will conduct a
literature search to answer
these questions) (p.49)
A question that arises from clinical situations - or - the first
step in the development of an EBP or QI project. Using
similar criteria related to framing a research question,
focused clinical questions form a basis for searching the
literature to identify supporting evidence from research.
4 Components of a Clinical
Question (PICO)
(provides framework to help
nurses develop an effective
electronic literature search)
(p. 49)
1. Population - The individual patient or group of
patients with a particular condition or health care
problem
2. Intervention - The particular aspect of health care
that is of interest to the nurse (e.g. a therapeutic
[inhaler or nebulizer for treatment of asthma], a
preventative [pneumonia vaccine], a diagnostic
[measurement of blood pressure], or an
organizational [implementation of a bar coding
system to reduce medication errors] intervention)
3. Comparison - Standard care or no intervention
(e.g. no antibiotic comparison to ibuprofen for
children with otitis media); a comparison of two
treatment settings (e.g. rehabilitation center vs.
home care)
4. Outcome - More effective outcome (e.g. improved
glycemic control, decreased hospitalizations,
decreased medication errors)
Hypothesis (complex, research,
statistical)
A prediction about the relationship between two or more
variables.
Statistical: States that there is no relationship between
the independent and dependent variables. The statistical
hypothesis is also known as the null hypothesis.
Complex: Number of variables
Research: A statement about the expected relationship
between the variables; also known as the scientific
hypothesis
Directional hypothesis
Provides a direction of the relationship -- greater than,
less than, positive, negative.
Non directional hypothesis
States a relationship, but no direction.
Independent variable
The variable that has the presumed effect on the
dependent variable. In experimental research studies, the
researcher manipulates the independent variable. In
nonexperimental research, the independent variable is not
manipulated and is assumed to have occurred naturally
before or during the study.
Dependent variable
Varies with a change in the independent variable. The
dependent variable is not manipulated. It is observed and
assumed to vary with changes in the independent
variable. It is the dependent variable that the researcher is
interested in understanding, explaining, or predicting.
Population
A well-defined set that has certain characteristics and is
either clearly identified or implied in the research
question.
Purpose
The purpose of the study encompasses the aims or
objectives the investigator hopes to achieve with the
research (purpose, aims, and objectives are
synonymous). Verbs such as discover, explore, or
describe suggest investigation of an infrequently
researched topic that might appropriately be guided by
research questions rather than hypotheses. In contrast,
verb statements indicating that the purpose is to test the
effectiveness of an intervention or compare two
alternative nursing strategies suggest a hypothesis-testing
study for which there is an established knowledge base of
the topic.
Testability
Measureable by either qualitative or quantitative
methods.
Chapter 4: Theoretical Frameworks for Research
Two Major Components of
Theories
Concepts and Constructs -- convey they essential elements or
ideas of a theory
Concept
Image or symbolic representation of an abstract idea; the key
identified element of a phenomenon that is necessary to
understand it. Concepts can be concrete or abstract. A concrete
concept can be easily identified, quantified, or measured,
whereas an abstract concept is more difficult to quantify or
measure. For example, weight, blood pressure, and body temp
are concrete concepts. Hope, uncertainty, and spiritual pain are
more abstract concepts. In a study, resiliency is a relatively
abstract concept.
Construct
A complex concept - combination of two or more concepts;
constructs usually comprise more than one concept and are built
or “constructed” to fit a purpose. Health promotion, maternalinfant bonding, health-seeking behaviors, and health-related
quality of life are examples of constructs.
Model
A graphic or symbolic representation of a phenomenon. A
graphic model is empirical and can be readily represented. A
model of an eye or a heart is an example. A symbolic or
theoretical model depicts a phenomenon that is not directly
observable and is expressed in language or symbols. Written
music or Einstein’s theory of relativity are examples of symbolic
models. Theories used by nurses or developed by nurses often
include symbolic models. Models are very helpful in allowing the
reader to visualize key concepts/constructs and their identified
interrelationships.
Nursing Theories
(situation-specific, middle
range, grand)
Grand Nursing Theories: Sometimes referred to as nursing
conceptual models and include the theories/models that were
developed to describe the discipline of nursing as a whole. This
most abstract level of theory has established a knowledge base
for the discipline of nursing.
Middle Range: Limited number of concepts. More focused. Are
more easily tested through research and more readily used as
frameworks for research studies.
Situation-Specific Nursing or Practice Theories: Narrow in
scope, explain a small aspect of phenomena and processes of
interest to nurses, and are usually limited to specific populations
or fields of practice. Provide closer links to research and practice.
Conceptual definition vs
operational definition
Conceptual Definition: Much like a dictionary definition, a
conceptual definition conveys the general meaning of the
concept. However, it goes beyond general language meaning
found in the dictionary by defining or explaining the concept as it
is rooted in theoretical literature.
Operational Definition: Specifies how the concept will be
measured. Defines what instruments will be used to assess the
presence of the concept and will be used to describe the amount
or degree to which the concept exists (e.g. operational definition
for time = hours, minutes, seconds)
Conceptual
framework/theoretical
framework
These two terms are used interchangeably. The
conceptual/theoretical framework refers to a structure that
provides guidance for research or practice. The framework
identifies the key concepts and describes their relationships to
each other and to the phenomena (variables) of concern to
nursing. It serves as the foundation on which a study can be
developed or as a map to aid in the design of the study.
Deductive vs inductive
(p.74-75)
Inductive: Generalizations are developed from specific
observations. Theory generation uses inductive reasoning. We
make many observations, discern a pattern, make a
generalization, and infer an explanation or a theory.
Deductive: The scientific method uses deduction to test
hypotheses and theories. In deductive reasoning, we hold a
theory and based on it we make a prediction of the
consequences. That is, we predict what the observations should
be if the theory were correct. We go from the general -- the
theory -- to the specific -- the observations
Module 3
Chapter 5: Introduction to Qualitative Research
Qualitative
research
The study of research questions about human experiences. Help formulate
an understanding of a phenomenon.Explanatory, descriptive, and inductive
in nature.
Context
dependent
An observation as defined by its circumstance or context.
Ex: The experience of having a baby is not the same for any two women,
and is definitely different for a disabled mother. Thus, qualitative
researchers believe that reality is socially constructed and context
dependent.
Context
independent
The opposite of context dependent. (Ex: You would be able to give a
description of a basketball because just the word alone would bring these
ideas to mind).
Data saturation
A point when data collection can cease. It occurs when the information
being shared with the researcher becomes repetitive. Ideas conveyed by
the participant have been shared before by other participants; inclusion of
new participants does not result in new ideas.
Grand tour
question
A broad overview question.Types of interview questions in qualitative
studies that seek “the big picture.”
Inclusion and
exclusion
criteria
Exclusion criteria: Those characteristic that restrict
Inductive vs
deductive
Naturalistic
setting
An environment of familiar “day to day” surroundings. Commonly used for
data collection in qualitative studies.
Paradigm
Pattern; it has been applied to science to describe the way people in
society think about the world. All research is based on paradigm.
Theme
In the data analysis of qualitative studies, the goal is to find commonalities
and differences in the interviews, and then group these into broader, more
abstract, overarching categories of meaning called themes.
Chapter 6 and 7: Qualitative Approaches to Research and Appraising Qualitative Research
4 Approaches to Qualitative
Research
1.
2.
3.
4.
Phenomenological Method
Grounded Theory Method
Ethnographic Method
Case Study Method
Phenomenological Method
Process of learning and constructing the meaning of human
experience through intensive dialogue with persons who are
living the experience.The researcher’s goal is to understand
the experience as it is lived by the participant.
Phenomena and
Phenomenology
Phenomena: Those things that are perceived by our senses
(e.g. pain, losing a loved one).
Phenomenology: A qualitative research approach that aims
to describe experience as it is loved through, before it is
conceptualized.
Lived experience
The focus of the phenomenological method. In
phenomenological research, a term used to refer to the focus
on living through events and circumstances (prelingual),
rather than thinking about these events and circumstances
(conceptualized experience).
Bracketing
When using the phenomenological method, the researcher’s
perspective is bracketed. This means that the researcher
identifies their own personal biases about the phenomenon
of interest to clarify how personal experience and beliefs may
color what is heard and reported. Further, the
phenomenological researcher is expected to set aside their
personal biases--to bracket them--when engaged with the
participants.
.
Ethnography/Ethnographic
Method
A qualitative research approach designed to produce cultural
theory. Focus is on cultural or social groups and systems.
Goal is to understand the emic view (insider’s view).
Questions are around “lifeways” or patterns of behavior in a
social group or culture. Data collected using documents,
interviews and observation and include key informants. Data
analysis begins with searching for domains. Nurses use the
method to study cultural variations in health and patient
groups as subcultures within larger social contexts.
Grounded Theory Method
An inductive approach that uses a systematic set of
procedures to arrive at a theory about basic social
processes.Grounded theory describes a research approach
to construct theory where no theory exists, or in situations
where existing theory fails to provide evidence to explain a
set of circumstances.
Grounded Theory
Theory that is constructed inductively from a base of
observations if the world as it is lived by a selected group of
people.
Theoretical Sampling
A tool used in the grounded theory method of qualitative
research that allows data collection and analysis to occur
simultaneously. Hunches about emerging patterns in the
data are noted in memos that the researcher uses to direct
activities in fieldwork. Used to select experiences that will
help the researcher to test hunches and ideas and to gather
complete information about developing concepts.
Constant comparative method
A process of continuously comparing data as they are
acquired during research with the grounded theory method.
Case Study Method
Studying the peculiarities and commonalities of a specific
case, irrespective of the actual strategies for data collection
and analysis that are used to explore research questions.
Include quantitative or qualitative data but are defined by
their focus on uncovering an individual case and, in some
instances, identifying patterns in variables that are consistent
across a set of case studies.
Emic vs Etic views
Emic Views: A native’s or insider’s view of the world.
Etic Views: An outsider’s view of another’s world.
Mixed Methods Research
The use of both qualitative and quantitative methods in one
study.
Community-Based
Participatory research
A research method that systematically accesses the voice of
a community to plan context-appropriate action. Change or
action is the intended end product.
Saturation
See data saturation
Ways to Synthesize
Qualitative Research
Meta-analysis and meta-summary
Meta-summary
Qualitative meta-summary is a quantitatively oriented
aggregation of qualitative findings that are topical or thematic
summaries or surveys of data.
Meta-synthesis (p. 117)
Qualitative meta-synthesis is an interpretive integration of
qualitative findings that are interpretative syntheses of data,
including phenomenologies, ethnographies, grounded
theories, and other integrated and coherent descriptions of
phenomena, events, or cases that are the hallmarks of
qualitative research. They offer a description or explanation
of a target event or experience, instead of a summary of
unlinked features.
Issues in Qualitative Research
(p. 118)
1. Ethics - Protection of human subjects is a critical
aspect of all scientific investigation
a. Naturalistic Setting - The need to gain
informed consent
b. Emergent Nature of Design - Planning for
questioning and observation emerges over
the time of the study. Thus it is difficult to
inform the participant precisely of all potential
threats before he or she agrees to participate.
c. Research-Participants Interaction Relationships developed between the
researcher and participant may blur the focus
of the interaction.
d. Researcher as Instrument - The researcher is
the study instrument, collecting data and
interpreting the participant’s reality.
2. Credibility, Auditability, and Fittingness - Quantitative
studies are concerned with reliability and validity of
instruments, as well as internal and external validity
criteria as measures of scientific rigor. The rigor of
qualitative methodology is judged by unique criteria
appropriate to the research approach.
Criteria for Appraisal of
Scientific Rigor (in qualitative
research)
1. Auditability
2. Fittingness
3. Credibility
Auditability
Accountability as judged by the adequacy of information
leading the reader from the research question and raw data
through various steps of analysis to the interpretation of
findings. For instance, you should be able to follow the
reasoning of the researcher step by step through explicit
examples of data, interpretations, and syntheses.
Fittingness
Faithfulness to participants’ everyday reality, described in
enough detail so that others can evaluate importance for
practice, research, and theory development. For instance,
you will know enough about the human experience being
reported that you can decide whether it “rings true” and is
useful for guiding your practice.
Credibility
Truth of findings as judged by participants and others within
the discipline. For instance, you may find the researcher
returning to the participants to share interpretation of findings
and query accuracy from the perspective of the persons
living the experience.
Module 4
Chapter 3: Gathering and Appraising the Literature
Boolean operator
(p.59)
Words used to define the relationship between words or group of words
during a literature search. Ex. AND, OR, NOT, NEAR
Citation
management
software
Software that forms citations and creates references pages for you
Controlled
vocabulary
Most databases have a section for controlled vocabulary you can search
through, these are terms/keywords to help you conduct an efficient
search for the correct articles. You can use these keywords to see how
the terms of your question match up, and then add them to your search.
Electronic
database
From an EBP perspective, you need to retrieve all the studies available
on your topic/clinical question. To understand the literature in a specific
area requires a review of all relevant studies.
Grey literature
(p.55)
Information produced by government, industry, health care organizations,
and professional organizations in the form of committee reports and
policy documents. Ex. a dissertation
Literature review
(Narrative
Review)
Systematic and critical appraisal of the most important literature on a
topic. Also called: introduction, background, conceptual framework,
theoretical framework.
Pre-appraised
synopsis
(p.52)
-Secondary source!
-an expert's comment about someone else's research.
-These usually include a commentary regarding the strengths and
applicability of the evidence to a patient population
Primary and
secondary
sources
(p. 47)
Primary: research articles, theoretical documents, or other documents
used by the author who is conducting the study, developing a theory or
writing an autobiography
Secondary: Published articles or books written by persons other than the
individual who conducted the research study or developed the theory
Peer reviewed
journals
(p.55)
-Should be your primary sources for theoretical, clinical, or research
articles.
-Has a panel of internal and external reviewers that review the submitted
manuscript.
Web browser
(p.56)
Internet explorer, mozilla, firefox, chrome, safari, etc.
Chapter 11
AGREE II
(p.220)
One of the most widely used instruments to evaluate the applicability of
guidelines to practice
Clinical
practice
guidelines
(p.219)
Systematically developed statements or recommendations that link research
and practice and serve as a guide for practitioners. Can be evidence-based
or expert-based
Evidencebased practice
guidelines
Practice guidelines developed using a scientific process
Expert-based
practice
guidelines
Not all areas of clinical practice have a sufficient research base, that’s
where expert based guidelines come in. These guidelines depend on having
a group of experts who meet and use opinions of experts along with
whatever research evidence is available to date.
Effect size
A meta-analysis takes the effect size from each of the studies reviewed to
obtain an estimate of the population (or the whole) to create a single effect
size of all the studies. In a meta-analysis, the effect size is an estimate of
how large of a difference there is between intervention and control groups in
the summarized studies.
Forest plot
(blobbogram)
Graph (used in meta-analysis) that depicts the study results.
LINK THAT BREAKS DOWN HOW TO READ:
https://s4be.cochrane.org/blog/2016/07/11/tutorial-read-forest-plot/
Integrative
review
Critical reviews of an area of research without a statistical analysis or a
theory synthesis. The most broad category of reviews.
Meta-analysis
Also referred to as a systematic review, but the only studies that are metaanalyses are those that reviewed studies using statistical methods.
Systematic
review
Simply put, a systematic review refers to the entire process of
selecting, evaluating, and synthesizing all available evidence, while
the term meta-analysis refers to the statistical approach to combining
the data derived from a systematic-review.
Assessment of research studies found in the literature based on a clearly
focused question that uses explicit criteria to identify, select, critically
appraise and analyze relevant data.
MetaSynthesis
Metasynthesis—the systematic review and integration of findings
from qualitative studies—is an emerging technique in medical
research that can use many different methods.
Integrates qualitative research findings on a topic and is based on
comparative analysis and interpretive synthesis