Nurse 1130
Potter & Perry:
Chapter 7 (pp. 74-88) - dirk
Chapter 13 (done from praxis)
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Ross and Kerr
Chapter 8 (119 -130) - dirk
Chapter 9 (136 -137) - dirk
Research as a basis for practice
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Evidence informed practice – allows professionals to make informed descisions (safety net)
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Nurses need to stay current with new evidence (research and nonreasearch based), and
evidence from clients themselves
Researching the evidence
Asking the clinical question
Problem focused trigger – a question you face while caring for a client or a trend you see on a nursing
unit (how can i reduce falls on my unit)
Knowledge focused trigger - a question seeking new information available on a topic (what is the best
way to improve pain management in clients with migraine headaches)
Format used to make sure questions are not too vague:
P = patient population of interest: what are the age, gender, ethnicity, and disease or health
problem of the client?
I = Intervention of interest: what is the best intervention (treatment, diagnosis test, prognosis
factor?)
C = Comparison of interest: What is the usual standard of care or current intervention used now
in practice?
O = Outcome: What result (e.g., change in client behaviour, physical finding) do you want to
achieve as a result of the intervention
Collect the best Evidence:
Choose from:
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Systematic reviews and meta-analysis
One well designed rct
Well designed control trials without randomization
Well designed case control studies
Systematic review of descriptive and qualitative studies
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Internal and organization: quality/risk management data
Opinion of authorities or expert committees
Critique the evidence:
Ask: do the articles offer evidence to explain or answer you PICO question? Do the articles show the
evidence is true and reliable? Can you use the evidence in practice?
Integrate the Evidence:
Once you decide that the evidence is strong and applicable to your clients and clinical situation,
incorporate the recommended evidence into practice; apply research into plan of care for client; use
evidence as rationale for an intervention you plan to try
Consider setting and if all staff supports the change and if the change fits with the scope of
practice in the clinical setting
Evaluate the Practical Decision
After apply the evidence in your practice, you need to evaluate it’s effectiveness
Support evidence informed practice
CNA recommend evidence informed decision making as an essential component of providing quality
nursing care that optimizes the outcomes for patients
Table 7-1: fundamental Patterns of Knowing in Nursing
Empirics: the science of knowledge development in nursing
Knowledge developed through systematic research to describe and explain phenomena
Esthetics: the art of nursing
Creativity, with an artistic or expressive component
Personal knowledge
Knowledge derived from the depth and power of the interpersonal relationship with the client
Ethics: the moral component
Knowledge that emerges from ethical dilemmas and is based on what ought to be done in
particular situations
Emancipatory knowing: the social, economic, and political component
Knowledge that allows change to occur
The Developmental Research in Nursing
Research is the primary means by which new knowledge is discovered and brought into practice to
improve the care that nurses provide to their clients. It is a systematic process in which questions that
generate knowledge are asked and answered. This knowledge becomes part of the scientific basis for
practice and may be used to validate interventions.
Nursing research is a systematic examination of phenomena important to the nursing discipline, as well
as to nurses, their clients, and families. Its purpose is to expand the knowledge base for practice by
answering nurses' questions. Nursing research addresses a range of issues related to actual and
potential client populations and to individual and family responses to health problems. Some research
tests nursing theories; other research generates theory from findings. This “back-and-forth” relationship
between theory and research is the way knowledge develops in any discipline
History of Nursing (super lame! I mean Florence Nightingale is totally weak sauce)
Summary: See box 7-5 Historical Milestones in the Development of Canadian Nursing Research (81) – if
you want to see it
Nursing research
Researchers who use the scientific method pose research questions and collect and analyze data to find
answers to the questions; focus is on deductive reasoning, in which a hypothesis is tested
experimentally to confirm or reject theoretical explanations
See table 7-2 for steps in planning Nursing research
The Qualitive (interpretive) Paradigm
Qualitative research avoids the empirical notion of the study of people as objects and strives instead to
understand human behaviour in the context of the people being studied
Six characteristics to all qualitative research
1. Belief in multiple realities
2. Commitment to identifying an approach to understanding the will support the phenomenon
studies
3. Commitment to the participant's point of view
4. Conduct of inquiry in a way that does not disturb the natural context of the phenomena of
interest
5. Acknowledged participation of the researcher in the research
6. Conveyance of the understanding of phenomena by reporting in a literary style rich with
participants’ commentary
Research Designs
Scientific nursing research
Is quantitative research – investigation of nursing phenomena that can be precisely measured and
quantified (pain severity, rates of wound healing)
Experimental research
Requirements:
Control group – not tested
Subjects - tested
Experimental variable - manipulated
Theory proposed, statistically tested hypotheses about actions of the variables to answer the research
question
Quasi-experimental research:
Groups are formed and the conditions are controlled but the subjects are not randomly assigned
to a control group
Descriptive Survey Designs
People in a group are compared with regard to two or more variables; purpose it to discover
relationships among variables in the population
3 key elements:
-randomized selection from population must be drawn
-large population to keep sampling errors to a minimum
- measurement tools (questionnaires, interviews) must yield accurate results
Explatory Descriptive Designs
Provide in depth descriptions of populations or variables no previously studied; the results provide
description of the variable or population; no relationships among variables are posited at this stage,
although the results might indicate that relationships should be examined in subsequent research
Qualitative Nursing Research
Poses questions about nursing phenomena that cannot be quantified and measured (experience of
nursing)
Ethnography
Obersvation and behaviour in social settings
Phenomenology
Focus on the lived experience of a specific phenomenon from the perspective of the people
who are in the situation
Grounded Theory
Generating hypotheses and theories about social processes inductively from the data
Ethical Issues in Research
See Box 7-6 Guiding Ethical Principles for Research in Canada
Ross and Kerr
Chapter 8 (119 -130) - dirk
Theoretical Issues in Nursing
The Context of Early Nursing Theorizing
- Nurses work relatively invisible until wartimes
- During the knowledge explosion of the 1950-1960’s, there was a motivation to theorize and
conceptualize scientific basis of practice and to have nursing distinguish itself from other health
practices
Definitions of Nursing
Early definitional theories take form - theoretical frameworks to organize the concepts that were
central to nursing practice and around which nursing educational curricula might be built
- By calling their conceptual frameworks “nursing theories,” early scholars simultaneously created
a context in which nursing knowledge could be advanced and a language that legitimized
nursing within the scientific community
- Because nursing theories were not amendable to traditional proofs and did not articulate causal
relationships in the manner of more scientific theories, nursing theories were never well
accepted
Early Theoretical Challenges
Current nursing process is based on “conceptual framework” of the 1970’s;
The older conceptual framework based on the 1970’s, was found to be too rigid and does not account
for “critical thinking, clinical judgement and multiple ways of knowing”
The Metaparadigm concepts in nursing theory
Early models used to help nurses systematically gather, organize, and interpret a vast body of
knowledge and possible information that could be relevant to any individual client.
Changes in models:
Inclusion of client’s relation with the world around them, and changes in what health is defined as
(changes to more current idea) needed to be included so models can be more encompassing
Nursing models come closer to what we use today: the nursing process
Table 8.2 The Nursing Megaparagdigm in Selected Conceptual Models
(examples of older models that didn’t quite work)
An Era of Model Building
Need to create models in which all aspects of the human person were understood to be in constant
interaction
Fourth major model emerges
See Perry and Potter pp68-71. The Major theoretical model from unit 2 in NURS 1130 – it does a better
job of separating the creators of the models and what theory style they belong to as well.
The fourth major theory is the simultaneity theories of Rodgers, Parse and Watson (PnP p.71)
The Model Debates
From the 60-80’s, around twenty different theoretical models came about. They were used and tested
but for the most part they were too rigid and systematic and did not allow for critical thinking. Distaste
for nursing theory came about – backlash
The Changing Theoretical Climate
Shift from infinite individualization the client to the client’s being similar – thus formation of NANDA and
its fixed diagnosis in the 1970’s (a move to standardize the nursing practice)
Notions of different ways of knowing in nursing comes to fruition, no longer is the scientific method held
in high esteem; alternative conceptualizations of nursing’s metapardigm concepts represent distinct
ways of approaching complexities in the nursing practice
Nursing’s ongoing Paradigm disputes
Nursing still needed to learn how to organize and make sense of all the possible bodies of knowledge
that might help them respond intelligently to the unique context of any individual clinical encounter
The different theories of nursing are categorized (differences between simultaneity and totality,
reductionist thinking and holism, modernism and postmodernism) everything except the simultaneity
models are discounted as legitimate contributors to the science of nursing
Forging new theoretical directions
“In an era prior to complexity science and postmodern thinking, the early theorists were trying to
capture and guide the intricate reasoning processes with which general substantive knowledge about
such things as disease, bodies, culture and societies could be transformed into a comprehensive,
individualized plan for each client in need of nursing care”
- Unfortunately most theories fell short of the goal
- New theories are still on the rise trying to incorporate different aspects of “what it means to be
a human being” (intellectual, spiritual, and embodied phenomenon)
Note form Dirk (not really part of the course, just an idea or a rant): one has to wonder
at what point Ockham’s razor should be applied to the creation of models/theories for
nursing – sometimes the best way to the truth is the easiest explanation. Nursing
models tend to confound the problem by adding more and more information in an
effort to explain an issue/problem. This may not be the best way to go about it. People
are indeed different and individuals but they are not as different as a theorist or model
maker would have us believe. Sometimes scholars of the theorist and model persuasion
create something in an effort to just have something published, nevermind actually
trying to improve a certain state of chaos. A lot of time, people are are unhealthy, sick,
or unhappy and depressed for the same reasons – “if it walks like a duck, quacks like a
duck, looks like a duck, it must be a duck”
Chapter 9 (136 -137) - dirk
Research and Practice: Bridging the Gap
The purpose of research based nursing practice
Research is the means by which vital nursing knowledge is generated and validated
- Research utilization – use of research as a means of verifying or a basis for changing nursing
practice
- Good clinical judgments can be made only when nurses possess the necessary facts