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EVIDENCE-BASED
NURSING
The Research-Practice
Connection
FOURTH
EDITION
Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any
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The Research–Practice Connection, Fourth Edition is an independent publication and has not been authorized,
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Library of Congress Cataloging-in-Publication Data
Names: Brown, Sarah Jo, author.
Title: Evidence-based nursing : the research-practice connection / Sarah Jo
Brown.
Description: Fourth edition. | Burlington, Massachusetts : Jones & Bartlett
Learning, [2017] | Includes bibliographical references and index.
Identifiers: LCCN 2016030106 | ISBN 9781284099430 (pbk.)
Subjects: | MESH: Evidence-Based Nursing | Nursing Research
Classification: LCC RT81.5 | NLM WY 100.7 | DDC 610.73--dc23
LC record available at https://lccn.loc.gov/2016030106
6048
Printed in the United States of America
20 19 18 17 16 10 9 8 7 6 5 4 3 2 1
Contents
Lead-In xi
iii
iv CONTENTS
Glossary 373
Index 385
Lead-In
Aims
In the first part of the text, the focus is on how clinical knowledge is
produced—from original studies, to research summaries, to the translation
of research evidence into practice guidelines. Just enough of the basics of
conducting research are explained so you can understand research reports,
research reviews, and evidence-based guidelines published in clinical jour-
nals. Then in the second part of the book, the use of research in practice
settings is examined. This includes locating, appraising, and translating re-
search evidence into clinical protocols and standards of care.
Features of Note
■■ Emphasis on Using Research Evidence Systematic research reviews
and evidence-based clinical practice guidelines receive considerable
attention as the most ready-to-go forms of research evidence. Basing
care on one or even several individual studies is viewed as the fallback
xi
xii LEAD-IN
position—for reasons that are explained early on. In the second part
of the text there is a strong emphasis on developing skills in appraising
the quality and applicability of the various forms of research evidence.
■■ Easy to Read An online reviewer of the third edition said it was easy to
understand because it was written almost like a blog. Although some
persons may view these descriptions as an indication that the book is
not “academic,” I feel good about them because I have made consider-
able effort to write so that complex information is conveyed in a clear
and de-jargonized way. I hope you find it readable and clear—even
interesting.
■■ Format In Part I, a profile and discussion is provided for each exem-
plar research report you read; this material is presented in a consistent
WHY-HOW-WHAT format to assist you in breaking a research ar-
ticle down into its key parts.
■■ Exemplars As in previous editions, actual research reports are used to
illustrate the different types of research evidence. Careful reading of
these exemplars is essential to acquiring understanding of how nurs-
ing research is conducted and reported. Four exemplars are printed
in full, whereas the citation and abstract are provided for the other
three. We are unable to print these three in full here due to copyright
restrictions. The full reports should be easily obtained through col-
lege, university, and medical center libraries.
■■ Statistics You will note that there is not a chapter about statistics;
instead specific statistical tests and their interpretations are incorpo-
rated into the explanations of results of the exemplar reports. Stu-
dents have told me that learning about a statistical test in the context
of an actual study is quite helpful. The index indicates the page(s) on
which each statistic is explained.
■■ Gender References As with all texts that include examples with un-
known persons, there is the she-her/he-him conundrum. There are
various ways to deal with it, but I have chosen to sometimes refer to
the nurse as she and other times as he—the same with references to
an individual patient.
Sarah Jo Brown, PhD, RN
P A R T I
Nursing Research
2 Research Evidence
4 Qualitative Research
6 Correlational Research
7 Experimental Research
8 Cohort Research
9 Systematic Reviews
1
PART I Nursing Research
3
4 PART I Nursing Research
from research reports; and (3) skill in evaluating whether the research
evidence is trustworthy and applicable to your practice. The abstract
is just a sketch and lacks the details needed to acquire the needed
knowledge and skills.
• Why
Goal: • How Synopsis
Understand
research • What
• Credibility
Goal: • Clinical significance Decision re: Use
How to appraise
research • Applicability
evidence
• Clinical protocols
Goal: • EBP-QI projects Evaluate outcomes
How to use
evidence • Individual practice
The Research–Practice
Connection
Research to Practice
In the healthcare professions, research is conducted to develop, refine, and
expand clinical knowledge about how to promote wellness and care for
persons with illness. The development of clinical knowledge about a clini-
cal issue plays out over time proceeding from a single study about the is-
sue, to several similar and related studies, to a systematic summary of the
finding of the several studies, to a translation of the summary conclusions
into a clinical action or decision recommendation. Thus, research evidence
develops as a progression from knowledge that has limited certainty to
greater certainty and from limited usefulness to greater usefulness. Actu-
ally, clinical nursing knowledge is quite variable with some issues having
been examined by only one or two studies and other issues having been
7
8 CHAPTER 1 The Research–Practice Connection
PROTOCOLS
Evidence
To produce effective and useful clinical protocols, project teams combine
research evidence with other forms of evidence, including:
■■ Internal quality monitoring data
■■ Data from national databases
■■ Expert opinion
■■ Scientific principles
■■ Patient/family preferences
There is wide agreement among healthcare providers that research find-
ings are the most trustworthy sources of evidence and that clinical proto-
cols should be based on research evidence to the extent possible. However,
when research evidence is not available or does not address all aspects of
a clinical issue, the other forms of evidence come into play. In recognition
of the fact that multiple sources of knowledge and information are used to
develop clinical protocols, they are commonly called evidence-based pro-
tocols. Research evidence is an essential ingredient, although, as you will
learn, the strength of the research evidence will vary. From here forward
I will use the descriptor evidence-based, often abbreviated e-b, to describe
protocols and care actions that are based to a major degree, but maybe not
entirely, on research findings.
10 CHAPTER 1 The Research–Practice Connection
Evidence-Based Practice
When research findings are used to develop a protocol and the protocol
is followed in daily practice, everyone involved (patients, healthcare pro-
fessionals, the caregiving organization, third-party payers, and accrediting
agencies) can have confidence that patients are receiving high-quality care.
This is the case because the recommended actions have been scientifically
studied, and people with expertise in the field have considered their appli-
cation. In addition, the consistency of care achieved with standardized e-b
protocols reduces variability and omissions in care, which enhance even
further the likelihood of good patient outcomes.
Evidence- Evidence-
Research
Based Based
Evidence
Protocol Practice
Scenario Suppose you are providing care to a patient 2 days after he had a
lumbar spinal fusion and you observe that he does not seem as comfortable
Evidence-Based Practice 11
Protocols Þ Recipes
So, now you know a bit about how research evidence contributes to good
patient care. In the rest of Part I of this text, I will walk you through the
methods used to develop clinical practice knowledge. In later chapters of
Part II, I will turn your thinking once again to e-b protocols and to how
you as an individual can locate research evidence when there is no protocol
for a clinical condition or situation.
As a Staff Nurse
After you have been in the staff nurse role for a while, you may be asked to
participate in a project to develop or update a care protocol or procedure.
Often, your organization will be adapting an evidence-based guideline that
was issued by a professional association, leading healthcare system, or gov-
ernment organization. Other times, an evidence-based guideline will not
be available, but a research summary relative to the clinical issue will have
been published, and its conclusions will be used in developing the protocol.
To contribute to a protocol project, you will need to know how to read and
understand research articles published in professional nursing journals and
on trustworthy healthcare Internet sites.
Scenario You are working in a pediatric, urgent care clinic and are asked
to be a member of a work group revising the protocol for evaluating and
treating children with fever who are suspected of a having a urinary tract
infection. You may be asked to read, appraise, and report to the group
about an evidence-based clinical guideline produced by a leading pediatric
12 CHAPTER 1 The Research–Practice Connection
major source of funding for nursing research. Many other countries have
similar organizations.
In the mid-1970s, visionary nurse leaders realized that even though
clinical research was producing new knowledge indicating which nursing
methods were effective and which were not, practicing nurses were not
aware of the research. As a result, several projects were started to increase
the utilization of research-supported actions by practicing nurses. These
projects gathered together the research that had been conducted on issues
such as preoperative teaching, constipation in nursing home residents,
management of urinary drainage systems, and preventing decubitus ulcers.
Studies were critiqued, evidence-based guidelines were developed, and con-
siderable attention was paid to how the guidelines were introduced into
nursing departments (Horsley, Crane, & Bingle, 1978; Krueger, Nelson, &
Wolanin, 1978). These projects stimulated interest in the use of nursing
research in practice throughout the United States; at the same time, nurses
in other countries were also coming to the same recognition. By the 1980s
and 1990s, many research utilization projects using diverse approaches to
making nurses aware of research findings were under way.
During this time, interest in using research findings in practice was also
proceeding in medicine. In the United Kingdom, the Cochrane Collabora-
tion at Oxford University was formed in 1992 to produce rigorous re-
search summaries with the goal of making it easier for clinicians to learn
what various studies found regarding the effectiveness of particular health-
care interventions. At the McMaster Medical School in Montreal, Canada,
a faculty group started the evidence-based practice movement. This move-
ment brought to the forefront the responsibility of the individual clinicians
to seek out the best evidence available when making clinical decisions in
everyday practice. The evidence-based practice (EBP) movement in medi-
cine flowed over into nursing and reenergized the use of research by nurses.
Three other things were happening in the late 1990s and early 2000s:
■■ Considerably more clinical nursing research was being conducted.
■■ The EBP movement was proceeding in a somewhat multidisciplinary
way.
■■ National governments in the United States, the United Kingdom,
Canada, and many other countries funded efforts to promote the
translation of research into practice.
Today, high-quality evidence-based clinical practice guidelines and re-
search summaries are being produced by healthcare organizations around
14 CHAPTER 1 The Research–Practice Connection
the world, and nursing staffs are increasingly developing clinical protocols
based on those guidelines and summaries. Also, individual clinicians are
increasingly seeking out the best available evidence to use as a guide for
the care they provide to patients. The most recent development is an area
of research called implementation research or translational research. These
studies examine how to implement evidence-based innovations in various
practice settings so the changes are taken up by direct care providers and
become part of routine care.
References
Horsley, J. A., Crane, J., & Bingle, J. (1978). Research utilization as an organiza-
tional process. Journal of Nursing Administration, 8, 4–6.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for
the 21st century. Washington, DC: National Academy of Sciences. Retrieved
from http://www.nap.edu/html/quality_chasm/reportbrief.pdf
Krueger, J. C., Nelson, A. H., & Wolanin, M. O. (1978). Nursing research: Develop-
ment, collaboration, and utilization. Germantown, MD: Aspen.
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