Theory, Research, and Evidence-Based Practice in Health and Nursing

Chapter 2: Theory, Research, and Evidence-Based Practice

Nursing Social Policy Statement: Issues Addressed by Nurses

Nurses play a critical role in promoting health, wellness, and quality care. Their responsibilities encompass a wide range of issues that impact patient outcomes and the healthcare system.

• Promotion of Health and Wellness: Nurses educate and support patients in maintaining and improving their health.

• Promotion of Safety and Quality of Care: Ensuring safe practices and high standards in patient care.

• Care Coordination: Managing self-care processes and coordinating care among providers.

• Physical, Emotional, and Spiritual Comfort: Addressing discomfort and pain holistically.

• Adaptation to Physiologic and Pathophysiologic Processes: Helping patients adjust to changes in health status.

• Emotional Responses: Supporting patients through birth, growth, illness, disease, and death.

• Health Literacy and Decision Making: Promoting understanding and informed choices.

• Linguistic and Cultural Sensitivity: Providing care that respects diverse backgrounds.

• Relationships and Role Performance: Assisting patients with changes in relationships and roles.

• Social Policies and Health Care Systems: Understanding how policies affect access, cost, and quality.

• Environmental Health: Preventing disease and injury through environmental awareness.

Sources of Knowledge in Health and Nursing

Knowledge in health and nursing is derived from various sources, each with distinct characteristics and limitations.

• Traditional Knowledge: Passed down through generations; often subjective and context-specific.

• Authoritative Knowledge: Based on expert opinion; accepted due to perceived expertise.

• Scientific Knowledge: Obtained through systematic research and the scientific method.

Example: Traditional remedies may be practical but lack scientific validation, whereas scientific knowledge is based on evidence and reproducibility.

Historical Influences on Nursing Knowledge

The development of nursing knowledge has been shaped by historical events and societal changes.

• Nightingale Influences: Florence Nightingale emphasized efficient, knowledgeable care and defined nursing as distinct from medicine.

• Societal Influences: Educational reforms, women entering the workforce, and the evolution of nursing into a science.

Framework of Nursing Theory

Theories provide a structured way to understand and guide nursing practice. They are composed of concepts and models that describe reality.

• Theory: A group of concepts describing a pattern of reality; can be tested and used for research.

• Concepts: Abstract ideas organized into symbols; describe objects, properties, events, and relationships.

• Conceptual Framework/Model: A group of concepts following an understandable pattern.

• Methods of Theory Development: Deductive reasoning (from general to specific) and inductive reasoning (from specific to general).

Types of Reasoning

• Deductive Reasoning: Examines general ideas and applies them to specific cases.

• Inductive Reasoning: Builds generalizations from specific observations.

Example: Testing a theory by applying it to a specific patient scenario uses deductive reasoning.

Interdisciplinary Base for Nursing Theories

Nursing theories draw from multiple disciplines to provide comprehensive care.

• General Systems Theory: Analyzes systems by breaking them into parts and understanding their interactions.

• Adaptation Theory: Focuses on how living organisms adjust to their environment.

• Developmental Theory: Describes orderly and predictable growth from conception to death.

Goals of Theoretical Frameworks

Theoretical frameworks in nursing aim to provide holistic and individualized care.

• Holistic Patient Care: Addressing physical, emotional, social, and spiritual needs.

• Individualized Care: Tailoring interventions to meet unique patient needs.

• Promotion of Health: Encouraging healthy behaviors and prevention.

• Prevention/Treatment of Illness: Using evidence-based strategies to prevent and manage disease.

Common Concepts in Nursing Theories

• The Person (Patient): Central focus of care.

• The Environment: All external factors affecting health.

• Health: The state of well-being.

• Nursing: Actions and processes involved in care.

Example: The person receiving care is the central theme in most nursing theories.

Research in Health and Nursing

Research is essential for advancing knowledge and improving patient care.

• Scientific Inquiry: Uses observable, verifiable data to describe, explain, or predict events.

• Goals: Develop explanations (theories) and find solutions to problems.

Goals of Nursing Research

• Improve Clinical Care: Enhance patient outcomes in practice settings.

• Study Nursing Processes: Analyze and refine care methods.

• Education, Policy, Ethics, History: Advance the profession through research.

• Evidence-Based Practice: Provide care based on scientific evidence.

National Institute of Nursing Research Goals

• Build Scientific Foundation: Support clinical practice with research.

• Prevent Disease and Disability: Focus on prevention strategies.

• Manage and Eliminate Symptoms: Improve quality of life for patients.

• Enhance End-of-Life Care: Support palliative and hospice care.

Methods of Nursing Research

• Quantitative Research: Uses numerical data and statistical analysis; includes basic and applied research.

• Qualitative Research: Explores meanings and perceptions; reality is subjective and varies by individual.

• Basic Research: Generates and refines theory; not always directly applicable.

• Applied Research: Directly influences clinical practice.

Terms in Quantitative Research

• Variable: Any factor that can change.

• Dependent Variable: The outcome measured.

• Independent Variable: The factor manipulated.

• Hypothesis: A testable prediction.

• Data: Information collected for analysis.

• Instruments: Tools used to collect data.

Types of Quantitative Research

• Descriptive: Observes and describes phenomena.

• Correlational: Examines relationships between variables.

• Quasi-Experimental: Tests interventions without full randomization.

• Experimental: Uses randomization and control groups to test interventions.

Steps of Quantitative Research

1. State the research problem

2. Define purpose of the study

3. Review related literature

4. Formulate hypotheses and variables

5. Select research design

6. Select population and sample

7. Collect data

8. Analyze data

9. Communicate findings and conclusions

Qualitative Research Methods

• Phenomenology: Studies lived experiences.

• Grounded Theory: Develops theory from data about social processes.

• Ethnography: Studies cultures and groups.

• Historical: Examines past events.

Evaluating the Ethics of Clinical Research Studies

Ethical evaluation ensures research is conducted responsibly and safely.

• Value: Research must have social or scientific value.

• Scientific Validity: Methods must be rigorous and reliable.

• Fair Subject Selection: Participants chosen equitably.

• Favorable Risk–Benefit Ratio: Benefits must outweigh risks.

• Independent Review: External oversight to ensure ethics.

• Informed Consent: Participants must understand and agree to the study.

• Respect for Subjects: Protecting rights and well-being.

Evidence-Based Practice (EBP)

EBP integrates the best available evidence with clinical expertise and patient values to achieve optimal outcomes.

• Problem-Solving Approach: Uses research findings to guide decisions.

• Blends Science and Art: Combines empirical evidence with clinical judgment.

• Mandates Systematic Review: Requires analysis of research before implementation.

Reading and Critiquing a Research Article

• Review article elements

• Determine level and quality of evidence

• Assess applicability to practice

Asking Clinical Questions in PICOT Format

Letter	Meaning
P	Patient, Population, or Problem of Interest
I	Intervention of Interest
C	Comparison of Interest
O	Outcome of Interest
T	Time

Steps in Implementing EBP

1. Formulate clinical questions

2. Search for and collect evidence

3. Critically appraise evidence (validity, reliability, applicability)

4. Integrate evidence with clinical expertise and patient/family preferences

5. Evaluate outcomes of practice decisions

6. Disseminate outcomes

Quality Improvement in Health Care

Quality improvement involves systematic actions to enhance health care services and patient outcomes.

• Systematic and Continuous Actions: Ongoing efforts to improve care.

• Patient Access: Ensuring patients can obtain needed services.

• Evidence-Based Care Provision: Using proven methods to deliver care.

• Patient Engagement: Supporting active participation in care.

• Care Coordination: Integrating services across providers.

• Cultural Competence: Communicating effectively with diverse populations.

Additional info: These concepts are foundational for personal-health courses, as they emphasize the importance of evidence-based practice, research, and theory in promoting health, preventing disease, and improving patient outcomes.