CHAPTER 2

8 CHAPTER 2 / Evidence-Based Practice and Research in Nursing

EVIDENCE-BASED PRACTICE AND RESEARCH IN

NURSING
LEARNING OUTCOME 1 SUGGESTIONS FOR CLASSROOM ACTIVITIES
Explain the relationship between research and evidence-based practice nurs- • Hold a discussion with students about clinical
research they might want to conduct to provide
ing. evidence for care they provide to clients.
• Assign students to find an evidence-based
Concepts for Lecture nursing practice journal article that applies to
a clinical practice area of interest.
1. Current standards of professional performance for nurses include
using evidence and research findings in practice. Additionally, nurs-
es today are actively involved in generating and publishing evidence
in order to improve client care and expand nursing’s knowledge
base. These activities support the current emphasis on practice that is
based on evidence and that all nurses need to be able to locate, un-
derstand, and evaluate both research findings and non-research-
based evidence.

LEARNING OUTCOME 2 SUGGESTIONS FOR CLASSROOM ACTIVITIES

Apply the steps of change used in implementing evidence-based practice. • Lead the students through the steps for imple-
menting change using a concept they are familiar
with, which may be a nursing practice they have
Concepts for Lecture performed in clinical or something they are fa-
miliar with from attending nursing school. For
1. Cultivate a spirit of inquiry. Nurses need to be curious and willing to example, they may opt to discuss the change in
investigate how various practices compare and which might be best practice model related to changing the testing
process in this class based on best evidence they
for a specific client.
can find in nursing journals.
2. Ask clinical questions. For consistency and efficiency, nurses should
state the question in a standard format.
3. Search for best evidence. Nurses should identify relevant evidence
in the literature.
4. Critically appraise the evidence. Several toolkits or schema are
available to assist the nurse in determining the most valid, reliable,
and applicable evidence. In some cases, relevant studies may already
have been synthesized.
5. Integrate the evidence with clinical expertise and client/family pref-
erences and values. Each nurse must determine how the evidence
fits with the clinical condition of the client, available resources, insti-
tutional policies, and the client’s wishes.
6. Implement and evaluate the outcomes of the intervention. The nurse
gathers all relevant data that may indicate whether or not the intervention
was successful. If the outcomes varied from those reported in the evi-
dence, this evaluation can help determine the reasons for the variable re-
sponses and will contribute to improving the evidence available for
future situations.

© 2016, Pearson Education Inc. 8

 CHAPTER 2 / Evidence-Based Practice and Research in Nursing 9

LEARNING OUTCOME 3
Describe limitations in relying on research as the primary source of evidence
for practice.

Concepts for Lecture

1. Some scholars describe that although evidence includes theories,
opinions of recognized experts, clinical expertise, clinical experienc-
es, and findings from client assessments, findings from research
studies are often given the most weight in the decision-making pro-
cess. This emphasis is because research entails using formal and sys-
tematic processes to address problems and answer questions.
2. Other scholars express concerns about the emphasis on research as the
source of evidence because research is performed under controlled cir-
cumstances that differ from the real world, research suggests only one
best solution limiting creativity, EBP ignores the significance of life
events to an individual, not all published research is robust and flawless,
EBP does not promote cost-effective care, and implementing EBP may
not consider organizational culture and resources.

LEARNING OUTCOME 4 SUGGESTIONS FOR CLASSROOM ACTIVITIES

Differentiate the quantitative approach from the qualitative approach in nurs- • Have the students find one example of a quanti-
tative and one example of a qualitative nursing
ing research. research study and write a paper comparing and
contrasting the type of research question, meth-
Concepts for Lecture ods, and analysis used.

1. The two major approaches in nursing research to investigate diverse

phenomena are quantitative and qualitative research.
2. Quantitative research progresses through systematic, logical steps SUGGESTIONS FOR CLINICAL ACTIVITIES
according to a specific plan under conditions of control with data an- • Have the students make a list of appropriate
research questions that could be addressed by
alyzed using statistical procedures. Quantitative research is most fre- quantitative and qualitative research methods
quently associated with a philosophical doctrine of logical from their current clinical practice.
positivism, which maintains that “truth” is absolute and can be dis-
covered by careful measurement. It is often viewed as “hard” sci-
ence and uses deductive reasoning and the measurable attributes of
human experience.
3. Qualitative research is rooted in the philosophical perspective of
naturalism, which maintains that reality is relative or contextual and
constructed by individuals who are experiencing a phenomenon.
This philosophical perspective is reflected in the human sciences
such as anthropology, sociology, and existential psychology. Quali-
tative research seeks to understand the human experience as it is
lived through careful collection and analysis of materials that are
narrative and subjective. Using the inductive method, data are ana-
lyzed by identifying themes and patterns to develop a theory or
framework that helps explain the processes under observation.
Each type of research is appropriate for specific types of re-
search questions. SUGGESTIONS FOR CLASSROOM ACTIVITIES
• Have the students find one quantitative and one
qualitative study in a nursing research journal
LEARNING OUTCOME 5 and identify the steps in the research process.

Outline the steps of the research process.

1. The steps in quantitative research include stating a research question
SUGGESTIONS FOR CLINICAL ACTIVITIES
or problem; defining the purpose or rationale; reviewing the litera-
• Arrange for the students to attend a research
conference.

© 2016, Pearson Education Inc.

10 CHAPTER 2 / Evidence-Based Practice and Research in Nursing

ture; formulating the hypothesis and defining variables; selecting a

research design to test the hypothesis; selecting the population, sam-
ple, and setting; conducting a pilot study; collecting the data; analyz-
ing the data; and communicating conclusions or implications.
2. Steps in qualitative research differ in many ways. For example, depend-
ent and independent variables are not used and variables are not manipu-
lated to test a hypothesis. Because the intent of qualitative research is to
thoroughly describe and explain a phenomenon, the researcher collects
narrative data through interviews or observations, transcribes the data,
organizes data around a theme or pattern, and develops a theory. Some
common qualitative research traditions include ethnography, phenome-
nology, and grounded theory.

LEARNING OUTCOME 6 SUGGESTIONS FOR CLASSROOM ACTIVITIES

Describe research-related roles and responsibilities for nurses. • Provide students with a research report and cri-
tique the report in class discussion using the
PICO format. Ask students to decide if the re-
Concepts for Lecture search report would influence them to change
their practice.
1. Roles and responsibilities for nurses related to research include re-
search consumer and research team member.
2. As a research consumer nurses will locate research literature using
the PICO format:
• P—patient, population, or problem of interest
• I—intervention or therapy to consider for the subject of interest
• C—comparison of interventions, such as no treatment
• O—outcome of the intervention
3. As a research consumer, nurses will critique research reports, or critical-
ly read and evaluate research articles. A research critique enables the
nurse to determine whether the findings of a study are of sufficient quali-
ty to be used to influence practice decisions. A research critique involves
dissecting a study to determine its strengths and weaknesses, statistical
and clinical significance, and the generalizability and applicability of its
results.

LEARNING OUTCOME 7 SUGGESTIONS FOR CLASSROOM ACTIVITIES

Describe the nurse’s role in protecting the rights of human participants in • Invite a nurse researcher to discuss protection of
the rights of human subjects in the studies the re-
research. searcher has completed.
• Obtain copies of several consent forms used in
Concepts for Lecture nursing research studies, and have the students
review these for inclusion of all of the rights of
1. All clients must be informed of and understand the consequences of research subjects.
consenting to participate in a research study. They must be able to
assess the risks and potential benefits to either themselves or to the
development of knowledge.
For years, adults have been the focus of medical research; how- SUGGESTIONS FOR CLINICAL ACTIVITIES
ever, the American Academy of Pediatrics has identified the need to
• Ask a member of the institutional review board
conduct pediatric research so that children can benefit from advances to discuss the board’s roles and obligations and
in medical science. Because of their vulnerability, extra precaution how rights of human subjects are protected.
must be taken to ensure that children’s rights are upheld and that
they are not harmed; therefore, pediatric expertise is needed on re-
view panels.
All nurses who practice in settings where research is conducted, or
who participate in research, share a role in safeguarding the following
rights: the right not to be harmed, the right to full disclosure, the right of
self-determination, and the right of privacy and confidentiality.
The risk of harm is exposure to the possibility of injury going
beyond everyday situations. These risks may be physical, emotional,

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 CHAPTER 2 / Evidence-Based Practice and Research in Nursing 11

legal, financial, or social. The right to full disclosure is the act of

making clear the client’s role in a research situation; deception either
by withholding information or by giving false or misleading infor-
mation must not occur. The right of self-determination means that
participants should feel free from constraints, coercion, or any undue
influence to participate in a study. Hidden inducements must be
strictly avoided. The right of privacy means that anonymity of the
study participant is ensured, and confidentiality means that any in-
formation a participant relates will not be made public or available to
others without the participant’s consent. This may require the use of
pseudonyms, code numbers, and reporting only aggregate or group
data in published research.

© 2016, Pearson Education Inc.