“Belief at the beginning
of any successful
undertaking is the one
ingredient that will
ensure success”
William James
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Nursing Research
Community College of Philadelphia
Spring 2007
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
What is Nursing Research?


Research is diligent, systematic inquiry or
investigation to validate and refine existing
knowledge and generate new knowledge
Nursing research must address questions
relevant to the profession of nursing
Grow the body of literature / body of nursing
knowledge related to our profession
 What is related to our profession?

(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
How do we know what we “know” as
nurses?

How do we acquire knowledge?
Traditions
 Authority
 Borrowing
 Trial and error
 Personal experience
 Role modeling and mentorship
 Intuition
 research

(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
A knowledge base is
necessary for the
recognition of nursing as
a science by health
professionals, consumers,
and society
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
One goal of nursing research

Development of evidence-based practice, with
nurses using the current, best research findings
in their delivery of care
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Different types of
research
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Quantitative Research

Quantitative



Research that collects data in numeric form and emphasizes
precise measurement of variables; often conducted in the
form of rigorously controlled studies. (Melnyk & Fineout-Overholt, 2005)
An experiment to “prove” something
Formal, objective, systematic process in which
numerical data are used to obtain information about the
world

Used to describe variables, examine relationships among
variables, and determine cause-and-effect interactions
between variables
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Lets talk about the
quantitative research
process, how quantitative
research is used, and
where you might use it in
your practice
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Qualitative Research

Qualitative


Research that involves the collection of data in a nonnumeric form, such as personal interviews, usually with the
intention of describing a phenomenon (Melnyk & Fineout-Overholt, 2005)
A systematic, interactive, subjective approach used to
describe life experiences and give them meaning
(Leininger, 1985;
Munhall & Boyd, 1999)


A means to exploring the depth, richness, and
complexity inherent in phenomena
Nurses began using this type of research in the 1970’s
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Lets talk about
Qualitative Research and
how you can use it in your
practice !
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Outcomes Research

Outcomes Research


The use of rigorous scientific methods to measure
the effect of some intervention on some
outcome(s). (Melnyk & Fineout-Overholt, 2005)
Focuses on the end results or patient care
Policy makers, insurers, consumers, public
 Leapfrog group, etc…


University of Pennsylvania School of Nursing,
Center for Health Outcomes and Policy Research
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
“Curiosity is the wick in
the candle of learning.”
William Arthur Ward
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Evidence-Based
Practice
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)

Evidence-based practice is the conscientious use of
current best evidence in making decisions about patient
care (Sackett, Straus, Richardson, Rosenberg, & Hayes,
2000). It is a problem solving approach to clinical
practice that integrates:



A systematic search for and critical appraisal of the most
relevant evidence to answer a burning clinical question
One’s own clinical expertise
Patient preferences and values
(Melnyk & Fineout-Overholt, 2005)
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Why EBP?????


Better outcomes
Explosion of research / literature


One study stated it could take as long as 17 years to
put research findings into practice
Practice becomes outdated to patients detriment
Placing babies on their back instead of belly
 Beta blockers following MI

(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
5 Steps to EBP
1.
2.
3.
4.
5.
Ask the burning clinical question
Collect the most relevant and best evidence
Critically appraise the evidence
Integrate all evidence with one’s clinical
expertise, patient preferences, and values in
making a practice decision or change
Evaluate the practice decision or change
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Rating Level of Evidence

Level I


Evidence from a systematic review or meta-analysis
of all relevant randomized controlled trials (RCTs),
or evidence based clinical practice guidelines based
on systematic review of RCTs
Level II

Evidence from at least one well-designed RCT
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)





Level III
Level IV
Level V
Level VI
Level VII
Evidence from the opinion of authorities and or
reports of expert committees
 Lowest level of evidence

(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Where to find Evidence / EBP
Guidelines?





The Cochrane Library
National Clearinghouse Guidelines
Registered Nurse Association of Ontario, www.rnao.org
John A. Hartford Institute for Geriatric Nursing
www.nursingsociety.org





Worldviews on Evidence Based Practice (Journal)
Schools and Universities
Pubmed
EBSCO host
Use your imagination !! Its out there, just got to find it !!!!!!
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Barriers to EBP







Lack of knowledge
Misperceptions, or negative views
Lack of belief that EBP improves outcomes
Too much information in journals
Lack of time and resources to search/appraise evidence
Overwhelming patient loads
Organizational constraints, lack of administrative
support
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Barriers Cont.



Demands from patients for a certain type of
care, e.g.. ABX for cold
Peer pressure to continue with old, or traditional
practice
Lack of EBP instruction in educational
programs
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Forming a good
question
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
PICO




P = Patient population or disease of interest (age,
gender, ethnicity, with a certain disorder – hepatitis)
I = Intervention or range of interventions of
interest (exposure to disease, prognostic
factor A, risk behavior)
C = Comparison, you want to compare the
intervention against (no disease, placebo or no
intervention, prognostic factor B, absence of risk
factor)
O = Outcome of interest (accuracy of diagnosis, rate
of occurrence of adverse outcome)
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)

In (P) immobile acute care patients, what is the
effect of (I) turning every 2 hours on (O)
prevention of pressure ulcers compared with (C)
not turning patients every 2 hours?
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
The Literature
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Review of the Literature



Research should be built on the work of others
The “Literature” is all the written sources relevant to your topic
Primary source


Secondary source





Written by the person who originated , or is responsible for generating,
the ideas published
Summarizes or quotes content from primary sources
Paraphrase the works of primary authors
Meta-analysis or systematic reviews
Your work should mostly contain primary sources. Citations
should be of primary sources not secondary sources
Generally, try to keep cited references to within 5 years
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Journals

Peer Reviewed Journal


Refereed Journal


Project critiqued by a team of reviewers that has
expertise in the subject
Uses referees or expert reviewers to determine
whether a manuscript will be accepted for
publication
Use Peer Reviewed / Refereed Journals for
your references!!!
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Your Literature Review


Goal should be to develop a search strategy
designed to retrieve as much of the relevant
literature as possible (Relevant to your topic)
Time frame:
Influenced by problem studied, sources available,
and goal of the researcher
 The more focused the question/study question the
shorter time for the literature review

(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
How to gather your literature !

Search Databases




CINAHL – Cumulative Index to Nursing and Allied Health Literature
Medline
Pubmed
Use “keyword”






Concepts relevant to your question/topic
Patient population
Interventions
Measures
Outcomes
Variations on the same topic/spelling, etc…
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)



Search for Authors who are frequently cited in
articles you have found interesting
Try “not” , “and” , “or”
Limit your search
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)

Save information about your search
Name of database
 Date search performed
 Search strategy
 Articles found

(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)


The review of the literature gives support to
your paper, presentation, case, etc…
The literature, “supports” the point you want to
make
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Conclusion

Researching / Finding the literature is
FUN !!

The Literature / Body of knowledge allows you
to advance your practice and improve patient
outcomes
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Finding Literature at CCP

Databases
EBSCO Host
 OVID
 PUBMED
 Others




National Guideline Clearinghouse
Cochrane Database
Demo
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Where to find Evidence / EBP
Guidelines?





The Cochrane Library
National Clearinghouse Guidelines
Registered Nurse Association of Ontario
John A. Hartford Institute for Geriatric Nursing
www.nursingsociety.org





Worldviews on Evidence Based Practice (Journal)
Schools and Universities
Pubmed
EBSCO host
Use your imagination !! Its out there, just got to find it !!!!!!
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
“My basic principle is that you don’t make
decisions because they are easy; you don’t
make them because they are cheap; you
don’t make them because they’re popular;
you make them because they’re right”
Fr. Theodore Hesburgh
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
Pressure Ulcers
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)
References
Burns, N., & Grove, S.K. (2001). The Practice of
Nursing Research (4th ed.). Philadelphia, PA: W.B.
Saunders Company.
Melnyk, B.M., & Fineout-Overholt, E. (2005).
Evidence-Based Practice in Nursing & Healthcare a
Guide to Best Practice. Philadelphia: Lippincott
Williams & Wilkins.
(Burns & Grove, 2001; Melnyk &
Fineout-Overholt, 2005)