Readings 

Woo. (2019). Chapter 3, Chapter 4 p. 63- 68,

 chap.8
Eraydin & Avsar (2017).
Lintona & Farrell (2009)
Mizock, Russinova, & Millner (2014).
Required Reference for
Standards for Scholarly Writing of Research Reports: APA (2009).
Learning Objectives
 
 
  1 .To identify and explain key terms in research
 
     2. To describe the steps of the research process and the differences between the steps in qualitative and quantitative research

     3. To describe the role of theory in research and the critical appraisal of theory in research
  4. To identify the components of various formats for dissemination of research

  5. To  identify the problem for a BPG and to review the respective literature and select evidence based knowledge as per the RNAO
BPG champion webinars 1 and 2 

       for guideline implementation

    6. to identify the tools to ensure quality in a BPG 

    7. To identify the tools to

ensure quality in a BPG
    8. To discuss initial
strategies to implement a BPG

       9 To discuss the reasons that

BPG recommendations are adapted to the situational context  
 
 10. to identify stakeholders and their potential support and influence
 11. to discuss strategies to enhance stakeholder support and influence
 12. to identify organizational resources to implement a guideline recommendation
 
 
 
  
 
 
 
 
 
 

Key Concepts and Terms, Steps of the Research Process and Conceptual Frameworks
An Introduction to Key Terms in Research
Before advancing in the discussion of the research process, it is important to have a basic understanding of key research terms and their definitions.
Note the follwing terms and definitoins are not in your Loiselle text:
Ontological which refers to the philosophical question about what is nature of reality.
Epistemological which refers to the philosophical question about the nature of the relationship between the researcher and that being researched.
Axiological which refers to the philosophical question about the role that  values play in the research.
Polit, Beck & Hungler (2001). Essentials of Nursing Research: Methods, Appraisal, and Utilization 5th Edition p 13 Lippincott, Williams and Wilkins: Philadelphia

Interactive
Match the following terms with the definition
 Matching Exercise:
Matching Exercise 1

Matching Exercise:
Matching Exercise 2

Matching Exercise:
Matching Exercise 3

Think
Please respond to “Think about it” questions in the Discussion Board under Module 02.

Terms
Match the following terms with the definition

Matching Exercise:
Matching Exercise

Steps of the Research Process: The Process of Research

Research is a process.
There are procedures and protocols to follow, however in the development of the procedures and protocols there are numerous decisions. The research study is a result
of much discussion, many edits and exhaustive literature investigation. Hence, research is a process.
The core and essential steps of the research process are listed below and we will spend considerable time exploring each step in detail for both the qualitative and
quantitative paradigms.

Interactive
Please put these steps in their correct order:

Matching Exercise:
 Ordering Exercise

The manner by which each step of the research process is conducted varies between quantitative and qualitative research based upon the philosophical assumptions
inherent in each. At first glance it may look as though there is an error here as identification of the research question is listed twice, once at the beginning and then again
in step 4. Usually the researcher begins with a question in mind from clinical practice, education, theory or other areas of interest.
However, that question may have been addressed by researchers previously, or may be unanswerable as written. Research builds on existing knowledge, There may be a
little or a lot or a little in one aspect of the question and not in the other. So after an area of research interest or question has been identified, then the literature must be
reviewed and critiqued thoroughly to evaluate what is already understood and where the gaps are in knowledge of methodology or perhaps the population. Then, the
researcher revises the question such that it is supported by the literature. The literature review will build a case, an argument, a position for the question. It will
demonstrate that this particular research question needs to be asked.

Qualitative Research Process

1. Identify the research question
2. Conduct a thorough literature review
3. Describe the conceptual framework which will frame the research Conceptualization of the topic may be limited, if it exists at all as the topic is usually a poorly known
area
4. Identify the research problem, clarify and finalize the question (s).The research question may be broad and be described in terms of a purpose only. There are no
hypothesis (es) or predictions of relationships
5. Design the study according to the most appropriate paradigm and design type
6. Identify the target population and the sample; sample sizes are small
7. Identify all methods and procedures
8. Conduct the data collection. The data collection is iterative, through an interview process, loosely structured, narrative and observational.
9. Analyze the data. Analysis is conducted by the identification of narrative themes. It seeks subjectivity, confirmation, and validation from the participants
10. Write the research report. Findings are disseminated in raw verbatim passages
11. Disseminate the research findings. They may form future hypotheses to be tested quantitatively, and are critiqued in terms of transferability and credibility

Pause and Reflect

1. How does this qualitative process differ from the quantitative process?
Enter your thoughts and compare your responses to your colleagues.

Quantitative Research Process

1. Identify the research question.
2. Conduct a thorough literature review. The literature review includes all concepts identified in the question.
3. Describe the conceptual framework which will frame the research. The conceptual base to form the question is clearly described. The conceptual framework
provides direction and indication of the relationships of the variables in the question.
 4. Identify the research problem, clarify the research question (s); and hypothesis(es) The research question is precisely worded so that it may be objectively and
accurately measured. Each word and the position of each word within the question directs the study design, population, and analysis Hypothesis (es) are predicted
and articulated and are based upon the concept of statistical significance.
5. Design the study according to the most appropriate paradigm and design type. The design includes the research setting, the instruments to measure the variables.
6. Identify the target population and the sample, the feasibility of collecting the sample, the sample size.
7. Identify all methods and procedures.
8. Conduct the data collection. Data collection is numeric.
9. Analyze the data.  Analysis is conducted through appropriate statistical tests.
10. Write the research report. Results are interpreted within the statistical significance are critiqued based upon generalizability, reliability and validity
11. Disseminate the research findings.

Pause and Reflect

2. How does the quantitative process differ from the qualitative process and also where are both similar?
Share and compare your thoughts here with your colleagues!
 

Theoretical or Conceptual Frameworks

Theory
Research has as its foundation a theory or conceptual framework. The research question or purpose is grounded in philosophical assumptions about what constitutes
“truth” and relationships about its key concepts. Research studies all have theoretical or conceptual underpinnings. The theory or conceptualization may not be always
explicitly stated. It may be subsumed in the nature of the question. An example of this might be "What is the effect of preoperative prophylactic treatment with Ampicillin on
the post operative staphylococcus infection in a patient versus no preoperative prophylactic treatment with Ampicillin?" Although not explicitly stated, this question is
founded on the germ theory and possibly the antigen antibody theories.  In some studies, the theory for the research is described in the section entitled: Theoretical or
Conceptual Framework. In other studies, theory is identified briefly in the Introduction or Literature Review section of an article.
What is a theory? A theory is a set of abstract generalizations or concepts that present a systematic explanation about how phenomena are interrelated.

Pause and Reflect

3. Give some examples of theory within nursing and within other professions or disciplines. What theories do nurses commonly use to guide practice and research?
Nurses also use theories from other professions and disciplines to guide practice and research. What are some examples of theories from other professions that
nurses use to guide practice and research?

The Role of Theory in Research

Theory serves several purposes in research. It allows the researchers to interpret and synthesize findings in a coherent structure. It provides direction for the research
question by predicting relationships between concepts. It guides the data collection process. There is an interrelationship between theory and research. It is an ongoing,
cyclical process in which the theory directs the research question (deductive reasoning) and the findings or observations from the research further influences theoretical
development (inductive reasoning), which then gives rise to the subsequent research question… and so on… 

Test Yourself

Test your knowledge!

Provide your definition of inductive reasoning and compare it with the answer provided:
Mouse Over to see the Correct answer
 
Provide your definition of deductive reasoning and compare it with the answer provided:
Mourse Over to see the Correct answer
 

Theory Guiding Research

Theory guiding quantitative research: an example
Chan (2001) conducted a study on the effect of Heparin injection duration on the injection site pain and bruising. The conceptual framework, that guided the study, stated
that site, volume, syringe size, needle gauge and injection duration all influence the injection site pain and bruising. Then, the researcher designed a study to test
systematically the influence of one variable, the duration of injection, on the injection site pain and bruising.  The researcher tested the hypothesis deduced from the
theory. (Speed does count!)

Theory guiding qualitative research: an example

Eaves (2000) interviewed rural African American elders to explore their experiences with stroke. Based on extensive interviews, Eaves developed a descriptive theory of
the stages elders pass through during their recovery from a CVA.  This is an example of grounded theory where theory development takes place inductively, theory is
developed based on the data

Theory in Quantitative Research

Here are two questions for you to think about. Please respond and share your thoughts with your colleagues in the discussion board!
1. What theories do nurses commonly use to guide practice and research?
2. Nurses also use theories from other professions and disciplines to guide practice and research. What are some examples of theories from other professions that
nurses use to guide practice and research?

Critiquing Theoretical Frameworks in Research Studies

Qualitative Research
Prior to a critique of theory in qualitative research, it is important to remember that theory may not have provided a conceptual base for the study itself but rather the
study may prompt theory to arise from the data.
The reader of the research study (the nurse who uses the research findings to guide practice) examines the emerging theory to see if it is clearly presented, is logical and
is supported by the data. Rather than at the beginning of the research article, the emergent theory may be included in the discussion of the findings. Theory should be
supported with narrative data evidence that provides credibility to the findings.
An example of theory emerging from qualitative research is available here for you. This is from a grounded theory article by
Delaney, K. & Johnson, M. (2006). Keeping the Unit Safe: Mapping Psychiatric nursing Skills. Journal of American Psychiatric Nurses Association,12 (4) 198-207. 
Download the article from the online library at Ryerson, read it and then answer the following interpretation and application questions.  These are typical of examination
questions in this course so practice here!

Test Yourself
 

1. The article by Delaney and Johnson (2006) is a qualitative study. The type of qualitative study is a grounded theory study because its purpose is
a. to describe a safe psychiatric unit
b. to construct a substantive theory of de-escalation process on a psychiatric unit
c. to prevent patient aggression
d. to test the theory on de-escalation

Verify Answer

2. In the emergent theory from Delaney and Johnson's work (2006), the following factors which inform nursing interventions were: :an awareness of their own
reactions, an awareness of the patient, a critical analysis of the situation, and balancing of the milieu situation against the patient's presenting behavior" ( p 204).
These factors are the building blocks of theory otherwise known as

a. concepts
b. ideas
c. interventions
d. interventions

Verify Answer
 3. If Delaney and Johnson wished to build upon their 2006 grounded theory work and actually test the theory the type of study design they would need to
create would be:
a. phenomenology
b. another grounded theory
c. critical social theory
d. quantitative

Verify Answer

4. Delaney and Johnson's (2006) grounded theory study analyzed theory from what type of data?

a. numeric
b. statistics
c. narratives
d. existing literature

Verify Answer

5. Delaney and Johnson's (2006) grounded theory study used prolonged engagement with the participants to facilitate the process for the development of
themes The study design had the hallmark characteristic of qualitative studies which is:

a. reductionistic
b. emergent
c. positivistic
d. deductive

Verify Answer
Quantitative Research
Prior to a critique of theory in quantitative research it is important to remember that theory in this paradigm is usually made visible. The conceptualization of studies is
made visible by the articulation of definitions. The conceptual definition is a clear statement that defines the concept of interest. For example the conceptual definition of
pain might be: a bio-psycho-social response to unpleasant stimuli. The operational definition is the procedure or operation by which the concept will be measured. How will
the researcher measure pain? She might use a patient rated pain scale (0-10) to operationalize the concept of pain.
In quantitative research, the theory is the foundation of the study. The reader of the research study (the nurse who uses the research findings to guide practice) examines
the study to see if :
1. the theory is explicitly stated,
2. a satisfactory overview of the theory is given, 
3. there is a logical flow from the framework to the research problem and hypotheses, 
4. the conceptual definitions are clearly stated, 
5. the theory guided the study methods,  and 
6. the researcher returned to the theory in the discussion section of the article to discuss the findings.

Note Nursing research does not have to be grounded in nursing theory in order for it to be considered nursing research. It does ned to be grounded in theory that is
applicable to the key concepts of interest and/or design.

Reading Research Reports  

After research has been conducted, the researcher’s next requirement is to disseminate or share the
findings
A common form of dissemination is through a conference with a poster or oral presentation. Depending upon the forum, a specified length of time will be allowed for the
presentation and the research and its results are synthesized to ‘fit’ the time constraints of a presentation and the audience needs. The other format for dissemination is
the written report such as a journal article or possibly a chapter in a text. As with oral reports written reports will have defined length of pages or words and will also be
directed to a specific audience. In both the oral and the written reports, academic integrity as specified by the scholarly format and standards will be specified and must be
followed. Typically it is APA 5 th however each journal will specify its own publication modifications on this style. The have publication rights to do this and it may meet
other standards regarding journal space etc. The researcher must follow those guidelines. Not following them will result in the publication rejection or possibly charges of
plagiarism.
 

The Dissemination of Research Findings

Research findings are only useful if they are shared or dissmeniated to others who may have an interest or need for the results. There are several different ways to
disseminate research findings. Each has its own advantage and disadvantage and most researchers use all methods at one time or another depending on the purpose of
the report and the target audience. 

Types of Research Reports

There are several different types of research reports, each serving a different purpose.
 Theses and Dissertations completely describe the study conducted as a requirement for most master and doctoral degrees. They are lengthy, highly detailed
accounts of each component of the research.
Books provide chapter summaries of current research in a given topic.
Presentations at conferences provide an oral or poster format description of the summary of the study or one component of the study.
Individual oral presentations are usually 10-20 minutes long and as such highlight only the key points of the research. The selection of essential information from the
study to present is critical as the author is conveying information with strict time limitations.
Team oral presentations are usually a one hour session and up to four speakers present for about 15 minutes each on different components of a specific topic.
Poster presentations are a formatted visual display of a study summary or key findings. The author may have a specified time limit to meet and respond to interested
observers or the poster may be up over a period of time and the author may not necessarily be present for all observers.
Key note speaker at professional conferences sets the theme for the conference; provides an overview of the literature and research on the given topic and presents
key questions or future directions for the audience to consider.
The advantage of conferences is the opportunity to quickly disseminate knowledge and dialogue between the consumer of the research and the author. Abstract or
presentations are published in conference proceedings.

NB: All oral, poster and PowerPoint presentations must meet rules of academic integrity for publishing requirements e.g. APA 5th format for referencing. This is inclusive of
all power point or overhead presentations you may do for a class presentation as a student.
You may think that all of this pertains to other nurse academics but not to you. However, you are also a professional and hava a curriculum vitea! This is your formal
record of your professional and academic life or work.  Most of you will have a curriculum vitae (CV) or resume. Although you may not now be preparing a CV for grant
submission you may be applying for a job or other academic endeavors. (Part of the grant writing process and occasionally submission process for presentations for
research dollars, includes the submission of an updated CV.) Your CV needs to include all publications inclusive of presentations that you have authored or
co-authored. So every time you present or publish add it to your CV immediately!
 

The Research Journal Article

The most common form of research report, a part from textbooks, that you will use as a student will be the journal article in peer reviewed journals. As this source will be
fundamental to all of your academic life it is important for you to understand how to read and critically appraise this type of work. Journal articles either summarize a
research study or focus on a key component of the study.
All manuscripts for submission to a peer review journal to become an article in publication must follow an accepted format as specified by the journal publisher in
manuscript guidelines. The format usually includes elements of the following headings:
an abstract: one paragraph summary; word limit is specified; usually 200 words
an introduction: the focus of research; research statement, questions and/or hypotheses; review of the literature; theoretical framework; significance and the need for
study
the method: study participants; research design; consent, measures and data collection; study procedures
the results: sample, findings, statistical tests; value, significance, summarize key findings of the study
the discussion: limitations of the study; interpretation of results, implications of the findings for practice and research
The summary or conclusion: the summary synthesizes the key aspects of the article; the conclusion draws the position statement of the paper to logical ending
references: formatted as per the journal requirements e.g. APA 5th edition

There may be variations on the above elements depending upon the nature of the topic, however it will be structured to lead the reader through the flow of thought, it will
have subheadings to introduce and organize new components of the paper and it will always adhere to strict publishing guidelines and referencing requirements.
TIPS for writing your own paper! When you, as a student, write a paper for any academic course, the same academic standards will apply. Remember to include
subheadings in your papers! If you are worried about page length and that subheadings require more space, remember that succinct writing always strengthens a paper.
So reread your paper several times and edit for word and page length.  Remove redundancies such as repetitive phrases and excessive adjectives. Most papers  can be
edited down in length, by removig tangential thoughts and developing ideas clearly

Evidence Based Practice and Best Practice Guidelines

Reading research articles takes time, practice and experience to synthesize its essence.. Most articles, indeed most academic work, require multiple readings and a brief
point form synopsis to ensure accuracy and thoroughness of comprehension for the novice academic and researcher. Why?
The writing style is very compact. The author has been given a specific word length for the manuscript by the publisher, so each word matters. Meaning must be conveyed
in a concise and precise manner. It seems to the beginner consumer of research that the language is full of jargon. The terminology is highly specific to that discipline or
profession. It is also written objectively, in the third rather than the first or second person.
Again, these are the academic standards for scholarly papers that all academics (including students) strive to achieve.
The article usually includes statistical information. Again, the terms and meaning are often unfamiliar to someone without statistical expertise. Interpretation of the data is
confusing at best. Reliance on the author’s interpretations often occurs with minimal critique and analysis by the reader
References for this Module
Delaney, K. & Johnson, M. (2006). Keeping the Unit Safe: Mapping Psychiatric nursing Skills. Journal of American Psychiatric Nurses Association,12 (4) 198-207. 
Loiselle, C. G., Profetto-McGrath, J. Polit, P., D., & Tatano Beck C. (2011). Canadian Essentials of Nursing Research (3rd Ed.)(Chapters 2,3,4). Philadelphia:
Lippincott Williams & Wilkins.
 

Evidence Based Practice and Best Practice Guidelines

 
Research has been critiqued and synthesized for clinicians in formats that are feasible for daily use. This is moving evidence in to practice or evidence based practice
(EBP).
Nursing, via RNAO with Ontario Ministry funding, has invested much time and resource to inform nursing practice of the evidence by the creation of Best Practice
Guidelines.
This week , begin the RNAO BPG champion webinars to further understand the  actual implementation process of BPGs in practice.
 
But first, lets visit a little more about EBP and how research will inform it. 
 

Why Evidence Based Practice?

 
There are several reasons to pursue evidence based practice as the standard of care as opposed to other forms of knowing truth such as tradition, hierarchy or trial and
error
First it can provide a measure for cost / benefit analysis. It facilitates the delivery of the “best” possible patient care. It ensures professional accountability and continuity
of careacross professionals. It also enhances job satisfaction by fulfilling the professional role.
 
 There are five prongs to evidence:
1. a question or practice issue or concern arises
2. there is a search for evidence through the literature
3. the literature is reviewed through a critical appraisal to ascertain the evidence
4. the implementation of “best” practice is incorporated
5. the outcome is evaluated

 
Evidence may be grounded in theory such as the germ theory; suicide theories: theories of coping etc. Some theories are tested repeatedly, others are tested partially and
still some are completely untested.

The Relationship of Research to Evidence

You have studied the qualitative and quantitative research paradigms as well as mixed methods. You are now aware of the quantitative perspective that evidence rests in
the numeric, calculations of statistical significance. It is referred to as the empirical or positivistic ‘truth’. It may be experimental, quasi experimental or non experimental
such as descriptive, or correlational. The ‘gold standard of the quantitative experimental design is the randomized control trial. The qualitative paradigm discovers ‘truth’
 through narrative themes in designs such as phenomenology, grounded theory, ethnography, historical research, and critical social theory.

Core Elements of Nursing Best Practice

Nursing embraces three components of best practice
1. Patient’s wishes
2. “best” evidence
3. Clinician’s expertise

Patient’s Wishes
 
Despite the “evidence” in the research literature the patient may want a different approach.
 
 

Historical Roots
Evidence Based Nursing Practice has its roots in Evidence Based Medicine (EBM) from the 1980’s. EBM is based on rules of evidence that lowers value placed on expert
opinion and increases value placed on data based studies and  clinical research in order to make clinical decisions and educate medical practitioners (MDs). A primary
source for the creation and promotion of EBM is the Cochrane Collaboration, founded in the 1970’s. Cochrane was a 1970’s, British Dr.(physician-epidemiologist), who
was interested in delineating costs and benefits of treatments. EBM has evolved from its origins to be “an enterprise that rivals the Human Genome Project in its potential
implications for modern medicine” ( Naylor, 1995).
 

Evaluation of Evidence
EBM has a emphasis on interventions. To evaluate the evidence a comprehensive search is conducted to find ALL relevant research. You probably can recall the literature
search that you did last fall for your literature review papers and how time consuming that process was. So imagine searching for all relevant academic research on a
topic. The most valued research reports in EBM is the RCT It is the gold standard.
EBM is “evidence based medicine… de-emphasizes intuition, unsystematic clinical experience, and patho physiologic rationale as sufficient grounds for clinical decision
making and stresses the examination of evidence from clinical research” (Evidence Based Medicine Working Group, 1992)
An expanded EBM definition by Sackett and colleagues (1996) is “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of
individual patient. The practice of EBM means integrating individual expertise with the best available external clinical evidence from systematic research”(Sackett et al,
1996).
A broader definition of EBP is “the synthesis of knowledge from research, retrospective or concurrent chart review, quality improvement and risk data, international,
national, and local standards, cost effectiveness analysis, benchmarking data, patient preferences, and clinical expertise” (Goode & Piedalue, 1999)
Evidence Based Nursing Practice (EBP) is the systematic observation of patients to determine disease and treatment efficacy. An excellent example of this in our nursing
history is Florence Nightingale and her work on sepsis and handwashing.
The Canadian Nurses Association have a Position Statement (2002) on EBP “share responsibility to facilitate EBP”.
Evidence Based Nursing began in the 1990’s and challenges the RCT as the only source of nursing knowledge. What other methods do nurses use to come to “know”?
Nurses include the wishes of the patient so EBP includes the patient’s wishes in decision making regarding interventions.
EBHC is Evidence Based Health Care and links patient wishes and resource allocation to EBP.
Evidence Based Nursing is “the conscientious, explicit, and judicious use of theory-derived, research based information in making decisions about care delivery to
individuals or groups of patients and in consideration of individuals needs and preferences” (Ingersoll, 2000).
Additional nursing definitions include “de-emphasizes ritual, isolated, & unsystematic clinical experiences, ungrounded opinions & tradition as a basis for nursing practices
& stresses instead the use of research findings & as appropriate quality improvement data, other operational & evaluative data, the consensus of recognized experts &
affirmed experience to substantiate practice” (Setler et al., 1998a)
 
Or
….information based on historical or scientific evaluation of a practice that is accessible to decision-makers in the health care system. (National Forum on Health, 1998.)
Clinical Practice Guidelines are not quite the same as EBP
Clinical practice guidelines are systematically developed statements to assist the practitioner and patient make decisions about appropriate health care for specific
circumstances (Lohr & Field, 1992.) 
 
Levels of Evidence
Evidence is evaluated from the lowest level of rigor to the highest level of rigor:
6. experience
5. expert opinion: consensus, reports
4. program evaluations
3. non experimental: observational,
2. quasi-experimental.
1. experimental: randomized clinical trials, meta-analysis, analytic studies  = EBM
Note in the Suicide prevention BPG there were few level 1 and 2 evidences, ‘levels’ of evidence challenged by the development team and expanded philosophy to be
inclusive of types of evidences  
 

 
 

Pause and Reflect

4. Why is an objective versus a subjective writing style the preferred academic format?

Historical Roots
Evidence Based Nursing Practice has its roots in Evidence Based Medicine (EBM) from the 1980’s. EBM is based on rules of evidence that lowers value placed on expert
opinion and increases value placed on data based studies and  clinical research in order to make clinical decisions and educate medical practitioners (MDs). A primary
source for the creation and promotion of EBM is the Cochrane Collaboration, founded in the 1970’s. Cochrane was a 1970’s, British Dr.(physician-epidemiologist), who
was interested in delineating costs and benefits of treatments. EBM has evolved from its origins to be “an enterprise that rivals the Human Genome Project in its potential
implications for modern medicine” ( Naylor, 1995).
 

Evaluation of Evidence
EBM has a emphasis on interventions. To evaluate the evidence a comprehensive search is conducted to find ALL relevant research. You probably can recall the literature
search that you did last fall for your literature review papers and how time consuming that process was. So imagine searching for all relevant academic research on a
topic. The most valued research reports in EBM is the RCT It is the gold standard.
EBM is “evidence based medicine… de-emphasizes intuition, unsystematic clinical experience, and patho physiologic rationale as sufficient grounds for clinical decision
making and stresses the examination of evidence from clinical research” (Evidence Based Medicine Working Group, 1992)
An expanded EBM definition by Sackett and colleagues (1996) is “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of
individual patient. The practice of EBM means integrating individual expertise with the best available external clinical evidence from systematic research”(Sackett et al,
1996).
A broader definition of EBP is “the synthesis of knowledge from research, retrospective or concurrent chart review, quality improvement and risk data, international,
national, and local standards, cost effectiveness analysis, benchmarking data, patient preferences, and clinical expertise” (Goode & Piedalue, 1999)
Evidence Based Nursing Practice (EBP) is the systematic observation of patients to determine disease and treatment efficacy. An excellent example of this in our nursing
history is Florence Nightingale and her work on sepsis and handwashing.
The Canadian Nurses Association have a Position Statement (2002) on EBP “share responsibility to facilitate EBP”.
Evidence Based Nursing began in the 1990’s and challenges the RCT as the only source of nursing knowledge. What other methods do nurses use to come to “know”?
Nurses include the wishes of the patient so EBP includes the patient’s wishes in decision making regarding interventions.
EBHC is Evidence Based Health Care and links patient wishes and resource allocation to EBP.
Evidence Based Nursing is “the conscientious, explicit, and judicious use of theory-derived, research based information in making decisions about care delivery to
individuals or groups of patients and in consideration of individuals needs and preferences” (Ingersoll, 2000).
Additional nursing definitions include “de-emphasizes ritual, isolated, & unsystematic clinical experiences, ungrounded opinions & tradition as a basis for nursing practices
& stresses instead the use of research findings & as appropriate quality improvement data, other operational & evaluative data, the consensus of recognized experts &
affirmed experience to substantiate practice” (Setler et al., 1998a)
Or
….information based on historical or scientific evaluation of a practice that is accessible to decision-makers in the health care system. (National Forum on Health, 1998.)
Clinical Practice Guidelines are not quite the same as EBP
Clinical practice guidelines are systematically developed statements to assist the practitioner and patient make decisions about appropriate health care for specific
circumstances (Lohr & Field, 1992.)

Levels of Evidence
Evidence is evaluated from the lowest level of rigor to the highest level of rigor:
6. experience
5. expert opinion: consensus, reports
4. program evaluations
3. non experimental: observational,
2. quasi-experimental.
1. experimental: randomized clinical trials, meta-analysis, analytic studies  = EBM
Note in the Suicide prevention BPG there were few level 1 and 2 evidences, ‘levels’ of evidence challenged by the development team and expanded philosophy to be
inclusive of types of evidences
 Pause and Reflect
1. Suggest examples from your practice setting of evidence from each or any of the six levels of rigor.

Why Evidence Based Practice?

There are several reasons to pursue evidence based practice as the standard of care as opposed to other forms of knowing truth such as tradition, hierarchy or trial and
error.
There are several reasons to pursue evidence based practice as the standard of care as opposed to other forms of knowing truth such as tradition, hierarchy or trial and
error
First it can provide a measure for cost / benefit analysis. It facilitates the delivery of the “best” possible patient care. It ensures professional accountability and continuity
of careacross professionals. It also enhances job satisfaction by fulfilling the professional role.

2. How has evidence based practice influenced your nursing practice?

There are five prongs to evidence:

1.  
2. there is a search for evidence through the literature the literature is reviewed through a critical appraisal to ascertain the evidence
3. the implementation of “best” practice is incorporated the outcome is evaluated

 
3. Recall the literature review you conducted last fall. Think back to the practice issue you identified, the search you conducted, the review or appraisal of the 2 or 3
articles you retrieved. Now, from that work suggest to us an area of practice that you would or would not change based upon the evidence you found!!!  You may have
to pull out those papers for this one!

There is a Relationship of Theory to Evidence

Evidence may be grounded in theory such as the germ theory; suicide theories: theories of coping etc. Some theories are tested repeatedly, others are tested partially and
still some are completely untested.
The Relationship of Research to Evidence
You have studied the qualitative and quantitative research paradigms as well as mixed methods. You are now aware of the quantitative perspective that evidence rests in
the numeric, calculations of statistical significance. It is referred to as the empirical or positivistic ‘truth’. It may be experimental, quasi experimental or non experimental
such as descriptive, or correlational. The ‘gold standard of the quantitative experimental design is the randomized control trial. The qualitative paradigm discovers ‘truth’
 through narrative themes in designs such as phenomenology, grounded theory, ethnography, historical research, and critical social theory.

Core Elements of Nursing Best Practice

Nursing embraces three components of best practice
1. patient's wishes 
2. “best” evidence"
3. Clinician’s expertise 

Patients Wishes
Despite the “evidence” in the research literature the patient may want a different approach.
Think about it
4.  Can you suggest clinical scenarios when this may occur?
Clinical expertise
Not all situations are grounded in evidence and even with evidence situations differ or have unique attributes. The clinician determines best practice based upon:
1. experience
2. reading the literature
3. education
4. clinical supervision

Group Discussions on Research Articles

Discussion

Research Article 1:
Eraydin,
S., & Avsar, G. (2017). The effect
of foot exercises on wound healing in type 2 diabetic patients with a foot ulcer a randomized control study. Journal of
Wound Ostomy Continence Nursing. 00(0):1-8. DOI:
10.1097/WON.000000000000040
Question 1.
Did this study describe a theory? If so, what one, if not, why not? Discuss.

Research Article 2.
Lintona, J., & Farrell, M. (2009).  Nurses’ perceptions of leadership in an adult
intensive care unit: A phenomenology study. Intensive and Critical Care Nursing 25,
64–71.
Mizock, l., Russinova, Z., & Millner, U.
(2014). Acceptance of mental illness: Core components of a multifaceted
construct. Psychological Services, 11,(1),
97–104. 
Question 1.
Did each study describe a theory? If so, what one, if not, why not? Discuss.