Evidence-Based Practice: Theory and Research in Nursing

Evidence-Based Practice: Theory and Research

Introduction to Nursing Theory

Nursing theory provides a structured framework for understanding and guiding nursing practice, education, and research. It helps nurses find meaning in their experiences, organize their thinking, and develop new insights into their work.

• Nursing Theory: An organized set of related ideas and concepts that answer questions such as "What is this?" and "How does it work?"

• Applications: Used to describe, explain, and predict human behavior in practice, education, and research.

• Essential Concepts: Person, Environment, Health, Nursing

Components of a Theory

Theories are built from several foundational components that guide their development and application.

• Assumptions: Accepted truths without proof

• Phenomena: Observable occurrences or events

• Concepts: Abstract ideas representing phenomena

• Definitions: Clarify the meaning of concepts (theoretical and operational)

• Statements/Propositions: Relationships between concepts

Paradigm, Framework, Model, and Theory

These terms describe different levels of abstraction in organizing nursing knowledge.

• Paradigm: A worldview or ideology

• Framework: Conceptual or theoretical structure

• Model: Symbolic representation of a framework or concepts

Developing Nursing Theories

The development of nursing theories involves logical reasoning and evidence collection. Ideas are explored, validated, and used to build theories.

• Inductive Reasoning: Drawing general conclusions from specific observations

• Deductive Reasoning: Applying general principles to specific cases

Benner’s Novice to Expert Model

Patricia Benner’s model describes the progression of nursing expertise through five stages, from novice to expert.

• Novice: No experience, relies on rules

• Advanced Beginner: Some practical experience, difficulty prioritizing

• Competent: Intentional planning, efficient care

• Proficient: Holistic decision-making, prioritizing comes easily

• Expert: Intuitive grasp, critical thinking for creative solutions

Important Nurse Theorists

Several nurse theorists have contributed foundational ideas to nursing theory.

• Florence Nightingale: Environment and health

• Virginia Henderson: Basic needs addressed by nurses

• Hildegard Peplau: Communication and patient relations

• Patricia Benner: Unique knowledge development

• Madeleine Leininger: Cultural caring and competence

• Jean Watson: Caring from a nursing perspective

Theories from Other Disciplines

Nursing incorporates theories from other fields to enhance care and understanding.

• Maslow's Hierarchy of Basic Human Needs: Prioritizes needs from physiological to self-actualization

• Validation Theory: Focuses on communication and validation

• Stress and Adaptation Theory: Explains responses to stress

• Developmental Theory: Describes stages of human development

• System Theory: Views individuals as part of interconnected systems

Nursing Research

What is Nursing Research?

Nursing research is a systematic, objective process for analyzing phenomena important to nursing. It encompasses clinical practice, education, and administration, aiming to enhance patient care quality.

• Professional Competence: Required by standards from organizations such as the American Nurses Association

• Ways to Gain Knowledge: Trial and error, authority, intuition, logical reasoning, scientific method

Educational Preparation for Nursing Research

Nursing research skills are developed through various educational pathways, from associate degrees to doctorates.

• Associate Degree: Basic research participation

• Baccalaureate Degree: Research design and implementation

• Master’s Degree: Advanced research and leadership

• Doctoral Degree: Independent research and theory development

Scientific Method in Nursing Research

The scientific method is used to systematically collect, observe, verify, explain, or predict events in nursing. The goal is to find solutions to problems and develop explanations (theories).

• Quantitative Research: Uses measurable data to test hypotheses

• Qualitative Research: Explores experiences and themes

Steps of the Research Process

The research process involves several key steps to ensure validity and reliability.

• Select and define the problem

• Select a research design

• Search for credible sources

• Formulate research question, hypothesis, or problem statement

• Collect and analyze data

• Use research findings

Rights of Research Participants

Protecting research participants is a priority in nursing research. Institutional Review Boards (IRBs) ensure ethical standards are met.

• Informed Consent

• Right to Refuse Participation

• Right to Not Be Harmed

• Right to Full Disclosure

• Right to Self Determination

• Right to Privacy and Confidentiality

Practicing with Best Evidence: PICOT Method

The PICOT method is used to formulate searchable questions for guiding literature searches and evidence-based practice.

• P: Patient or Problem

• I: Intervention

• C: Comparison Intervention

• O: Outcomes

• T: Time

Searching the Literature

Indexes and databases are used to find credible sources for nursing research. Analytic reading and research appraisal are essential for evaluating quality.

Database	Description
CINAHL	Covers nursing, allied health, biomedical, and consumer health journals
Cochrane Library	Collection of evidence-based reviews and clinical trials
Digital Commons Network	Free scholarly articles from peer-reviewed journals
Directory of Open Access Journals (DOAJ)	Free access to peer-reviewed journals
Google Scholar	Searches scholarly literature across disciplines
MEDLINE	Database of the U.S. National Library of Medicine
PLOS	Open access journals in science and medicine
PubMed	Free access to biomedical literature
PsycINFO 1987	Database of psychology and related fields
UpToDate	Evidence-based clinical decision support

Summary Table: Virginia Henderson's List of Basic Needs

Basic Need	Description
Breathe normally	Maintain adequate oxygenation
Eat and drink adequately	Maintain nutrition and hydration
Eliminate body wastes	Proper excretion
Move and maintain desirable posture	Physical mobility
Sleep and rest	Recovery and energy
Select suitable clothes	Dress and undress appropriately
Maintain body temperature	Adjust clothing and environment
Keep body clean and well groomed	Protect the integument
Avoid dangers in the environment	Prevent injury
Communicate with others	Express emotions, needs, fears, opinions
Work and accomplish	Sense of accomplishment
Play or participate in recreation	Enjoy leisure activities
Learn, discover, satisfy curiosity	Normal development and health

Summary Table: PICOT Example for Pressure Injury

P	I	C	O	T
Patients with pressure injury	Application of a hydrocolloid dressing	Compared with applying a gauze dressing	Healing of the pressure injury	After four incident reports

Summary Table: Selected Databases for Health Literature

Database	Description
CINAHL	Covers nursing, allied health, biomedical, and consumer health journals
Cochrane Library	Evidence-based reviews and clinical trials
Digital Commons Network	Free scholarly articles from peer-reviewed journals
Directory of Open Access Journals (DOAJ)	Free access to peer-reviewed journals
Google Scholar	Searches scholarly literature across disciplines
MEDLINE	Database of the U.S. National Library of Medicine
PLOS	Open access journals in science and medicine
PubMed	Free access to biomedical literature
PsycINFO 1987	Database of psychology and related fields
UpToDate	Evidence-based clinical decision support

Additional info:

• Inductive reasoning is used when a nurse draws a general conclusion from specific patient symptoms.

• Deductive reasoning applies known principles to specific patient cases.

• Evidence-based practice integrates the best available research with clinical expertise and patient values.