“Belief at the beginning of any successful undertaking is the one ingredient that will ensure success” William James

1. “Belief at the beginning of any successful undertaking is the one ingredient that will ensure success”William James (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

2. Nursing Research Community College of Philadelphia Spring 2007 (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

3. What is Nursing Research? • Research is diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge • Nursing research must address questions relevant to the profession of nursing • Grow the body of literature / body of nursing knowledge related to our profession • What is related to our profession? (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

4. How do we know what we “know” as nurses? • How do we acquire knowledge? • Traditions • Authority • Borrowing • Trial and error • Personal experience • Role modeling and mentorship • Intuition • research (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

5. A knowledge base is necessary for the recognition of nursing as a science by health professionals, consumers, and society (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

6. One goal of nursing research • Development of evidence-based practice, with nurses using the current, best research findings in their delivery of care (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

7. Different types of research (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

8. Quantitative Research • Quantitative • Research that collects data in numeric form and emphasizes precise measurement of variables; often conducted in the form of rigorously controlled studies. (Melnyk & Fineout-Overholt, 2005) • An experiment to “prove” something • Formal, objective, systematic process in which numerical data are used to obtain information about the world • Used to describe variables, examine relationships among variables, and determine cause-and-effect interactions between variables (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

9. Lets talk about the quantitative research process, how quantitative research is used, and where you might use it in your practice (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

10. Qualitative Research • Qualitative • Research that involves the collection of data in a non-numeric form, such as personal interviews, usually with the intention of describing a phenomenon (Melnyk & Fineout-Overholt, 2005) • A systematic, interactive, subjective approach used to describe life experiences and give them meaning (Leininger, 1985; Munhall & Boyd, 1999) • A means to exploring the depth, richness, and complexity inherent in phenomena • Nurses began using this type of research in the 1970’s (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

11. Lets talk about Qualitative Research and how you can use it in your practice ! (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

12. Outcomes Research • Outcomes Research • The use of rigorous scientific methods to measure the effect of some intervention on some outcome(s). (Melnyk & Fineout-Overholt, 2005) • Focuses on the end results or patient care • Policy makers, insurers, consumers, public • Leapfrog group, etc… • University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

13. “Curiosity is the wick in the candle of learning.”William Arthur Ward (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

14. Evidence-Based Practice (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

15. Evidence-based practice is the conscientious use of current best evidence in making decisions about patient care (Sackett, Straus, Richardson, Rosenberg, & Hayes, 2000). It is a problem solving approach to clinical practice that integrates: • A systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question • One’s own clinical expertise • Patient preferences and values (Melnyk & Fineout-Overholt, 2005) (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

16. Why EBP????? • Better outcomes • Explosion of research / literature • One study stated it could take as long as 17 years to put research findings into practice • Practice becomes outdated to patients detriment • Placing babies on their back instead of belly • Beta blockers following MI (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

17. 5 Steps to EBP • Ask the burning clinical question • Collect the most relevant and best evidence • Critically appraise the evidence • Integrate all evidence with one’s clinical expertise, patient preferences, and values in making a practice decision or change • Evaluate the practice decision or change (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

18. Rating Level of Evidence • Level I • Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs), or evidence based clinical practice guidelines based on systematic review of RCTs • Level II • Evidence from at least one well-designed RCT (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

19. Level III • Level IV • Level V • Level VI • Level VII • Evidence from the opinion of authorities and or reports of expert committees • Lowest level of evidence (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

20. Where to find Evidence / EBP Guidelines? • The Cochrane Library • National Clearinghouse Guidelines • Registered Nurse Association of Ontario, www.rnao.org • John A. Hartford Institute for Geriatric Nursing • www.nursingsociety.org • Worldviews on Evidence Based Practice (Journal) • Schools and Universities • Pubmed • EBSCO host • Use your imagination !! Its out there, just got to find it !!!!!! (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

21. Barriers to EBP • Lack of knowledge • Misperceptions, or negative views • Lack of belief that EBP improves outcomes • Too much information in journals • Lack of time and resources to search/appraise evidence • Overwhelming patient loads • Organizational constraints, lack of administrative support (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

22. Barriers Cont. • Demands from patients for a certain type of care, e.g.. ABX for cold • Peer pressure to continue with old, or traditional practice • Lack of EBP instruction in educational programs (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

23. Forming a good question (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

24. PICO • P = Patient population or disease of interest (age, gender, ethnicity, with a certain disorder – hepatitis) • I = Intervention or range of interventions of interest (exposure to disease, prognostic factor A, risk behavior) • C = Comparison, you want to compare the intervention against (no disease, placebo or no intervention, prognostic factor B, absence of risk factor) • O = Outcomeof interest (accuracy of diagnosis, rate of occurrence of adverse outcome) (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

25. In (P) immobile acute care patients, what is the effect of (I) turning every 2 hours on (O) prevention of pressure ulcers compared with (C) not turning patients every 2 hours? (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

26. The Literature (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

27. Review of the Literature • Research should be built on the work of others • The “Literature” is all the written sources relevant to your topic • Primary source • Written by the person who originated , or is responsible for generating, the ideas published • Secondary source • Summarizes or quotes content from primary sources • Paraphrase the works of primary authors • Meta-analysis or systematic reviews • Your work should mostly contain primary sources. Citations should be of primary sources not secondary sources • Generally, try to keep cited references to within 5 years (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

28. Journals • Peer Reviewed Journal • Project critiqued by a team of reviewers that has expertise in the subject • Refereed Journal • Uses referees or expert reviewers to determine whether a manuscript will be accepted for publication • Use Peer Reviewed / Refereed Journals for your references!!! (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

29. Your Literature Review • Goal should be to develop a search strategy designed to retrieve as much of the relevant literature as possible (Relevant to your topic) • Time frame: • Influenced by problem studied, sources available, and goal of the researcher • The more focused the question/study question the shorter time for the literature review (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

30. How to gather your literature ! • Search Databases • CINAHL – Cumulative Index to Nursing and Allied Health Literature • Medline • Pubmed • Use “keyword” • Concepts relevant to your question/topic • Patient population • Interventions • Measures • Outcomes • Variations on the same topic/spelling, etc… (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

31. Search for Authors who are frequently cited in articles you have found interesting • Try “not” , “and” , “or” • Limit your search (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

32. Save information about your search • Name of database • Date search performed • Search strategy • Articles found (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

33. The review of the literature gives support to your paper, presentation, case, etc… • The literature, “supports” the point you want to make (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

34. Conclusion • Researching / Finding the literature is FUN !! • The Literature / Body of knowledge allows you to advance your practice and improve patient outcomes (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

35. Finding Literature at CCP • Databases • EBSCO Host • OVID • PUBMED • Others • National Guideline Clearinghouse • Cochrane Database • Demo (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

36. Where to find Evidence / EBP Guidelines? • The Cochrane Library • National Clearinghouse Guidelines • Registered Nurse Association of Ontario • John A. Hartford Institute for Geriatric Nursing • www.nursingsociety.org • Worldviews on Evidence Based Practice (Journal) • Schools and Universities • Pubmed • EBSCO host • Use your imagination !! Its out there, just got to find it !!!!!! (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

37. “My basic principle is that you don’t make decisions because they are easy; you don’t make them because they are cheap; you don’t make them because they’re popular; you make them because they’re right”Fr. Theodore Hesburgh (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

38. Pressure Ulcers (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)

39. References Burns, N., & Grove, S.K. (2001). The Practice of Nursing Research (4th ed.). Philadelphia, PA: W.B. Saunders Company. Melnyk, B.M., & Fineout-Overholt, E. (2005). Evidence-Based Practice in Nursing & Healthcare a Guide to Best Practice. Philadelphia: Lippincott Williams & Wilkins. (Burns & Grove, 2001; Melnyk & Fineout-Overholt, 2005)