Select a qualitative question you are interested in investigating. Discuss the basics of qualitative research: what are the char
Select a qualitative question you are interested in investigating. Discuss the basics of qualitative research: what are the characteristics, what is included, what are the 4 designs of the qualitative type research, which type would be appropriate for your qualitative research question and why?
EVIDENCE-BASED PRACTICE FOR NURSES Appraisal and Application of Research
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THE PEDAGOGY
Evidence-Based Practice for Nurses: Appraisal and Application of Research, Third Edition, drives comprehension through various strategies that meet the learning needs of students, while also generating enthusiasm about the topic. This interactive approach addresses different learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most
chapters include the following:
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Chapter Objectives These objectives provide instructors and students with a snapshot of the key information they will encounter in each chapter. They serve as a checklist to help guide and focus study.
Key Terms
Found in a list at the beginning of each chapter and in bold within the chapter, these terms will create an expanded vocabulary in evidence-based practice.
Critical Thinking Exercises An integral part of the learning process, critical- thinking scenarios and questions are presented by the authors to spark insight into situations you may face in practice.
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FYI
Quick tidbits and facts are pulled out in chapter margins to highlight important aspects of the chapter topic.
Test Your Knowledge
These questions serve as benchmarks for the knowledge you are acquiring as you move throughout the chapter.
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Rapid Review This succinct list at the end of the chapter compiles the most pertinent and key information for quick review and later reference.
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Apply What You Have Learned
With this outstanding feature, you will be challenged to apply your newly acquired knowledge to specific evidence-based practice scenarios and research studies.
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Case Examples Found in select chapters, these vignettes illustrate research questions and studies in actual clinical settings and provide critical-thinking challenges for students.
8
Keeping It Ethical
Relevant ethical content concludes each chapter to ensure ethics are kept at the forefront of every step of the nursing process.
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Library of Congre s s Cataloging-in-Publication Data Evidence-based practice for nurses : appraisal and application of research / [edited by] Nola A. Schmidt and Janet M. Brown. — 3rd.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-284-05330-2 (pbk.) I. Schmidt, Nola A., editor. II. Brown, Janet M. (Janet Marie), 1947– editor.
[DNLM: 1. Nursing Research—methods. 2. Evidence-Based Nursing. WY 20.5]
RT81.5
610.73072—dc23
2014017978
6048
Printed in the United States of America 18 17 16 15 14 10 9 8 7 6 5 4 3 2 1
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DEDICATION For Mom, whose love and support are endless.
—N. A. S.
To my husband, my children, and my granddaughters, who enrich my life in every way.
—J. M. B.
13
CONTENTS Contributors
Reviewers
Preface
Acknowledgments
UNIT 1 Introduction to Evidence-Based Practice
CHAPTER 1
What Is Evidence-Based Practice?
Nola A. Schmidt and Janet M. Brown
1.1 EBP: What Is It?
1.2 What Is Nursing Research?
1.3 How Has Nursing Evolved as a Science?
1.4 What Lies Ahead?
1.5 Keeping It Ethical
CHAPTER 2
Using Evidence Through Collaboration to Promote Excellence in Nursing Practice
Emily Griffin and Marita G. Titler
2.1 The Five Levels of Collaboration
14
2.2 Keeping It Ethical
UNIT 2 Acquisition of Knowledge
CHAPTER 3
Identifying Research Questions
Susie Adams
3.1 How Clinical Problems Guide Research Questions
3.2 Developing Hypotheses
3.3 Formulating EBP Questions
3.4 Keeping It Ethical
CHAPTER 4
Finding Sources of Evidence
Patricia Mileham
4.1 Purpose of Finding Evidence
4.2 Types of Evidence
4.3 How Sources Are Organized
4.4 How to Search for Evidence
4.5 Keeping It Ethical
CHAPTER
15
5 Linking Theory, Research, and Practice
Elsabeth Jensen
5.1 How Are Theory, Research, and Practice Related?
5.2 Keeping It Ethical
UNIT 3 Persuasion
CHAPTER 6
Key Principles of Quantitative Designs
Rosalind M. Peters
6.1 Chart the Course: Selecting the Best Design
6.2 What Is Validity?
6.3 Categorizing Designs According to Time
6.4 Keeping It Ethical
CHAPTER 7
Quantitative Designs: Using Numbers to Provide Evidence
Rosalind M. Peters
7.1 Experimental Designs
7.2 Quasi-Experimental Designs
16
7.3 Nonexperimental Designs
7.4 Specific Uses for Quantitative Designs
7.5 Keeping It Ethical
CHAPTER 8
Epidemiologic Designs: Using Data to Understand Populations
Amy C. Cory
8.1 Epidemiology and Nursing
8.2 Infectious Diseases and Outbreak Investigations
8.3 Measures of Disease Frequency
8.4 Descriptive Epidemiology
8.5 Descriptive Study Designs
8.6 Analytic Study Designs
8.7 Screening
8.8 Evaluating Health Outcomes and Services
8.9 Keeping It Ethical
CHAPTER 9
Qualitative Designs: Using Words to Provide Evidence
Kristen L. Mauk
17
9.1 What Is Qualitative Research?
9.2 The Four Major Types of Qualitative Research
9.3 Keeping It Ethical
CHAPTER 10
Collecting Evidence
Jan Dougherty
10.1 Data Collection: Planning and Piloting
10.2 Collecting Quantitative Data
10.3 Validity and Reliability
10.4 Collecting Qualitative Data
10.5 Keeping It Ethical
CHAPTER 11
Using Samples to Provide Evidence
Ann H. White
11.1 Fundamentals of Sampling
11.2 Sampling Methods
11.3 Sample Size: Does It Matter?
11.4 Keeping It Ethical
18
CHAPTER 12
Other Sources of Evidence
Cynthia L. Russell
12.1 The Pyramid of Evidence: The 5 Ss
12.2 Using the Pyramid for Evidence-Based Practice
12.3 Keeping It Ethical
UNIT 4 Decision
CHAPTER 13
What Do the Quantitative Data Mean?
Rosalind M. Peters, Nola A. Schmidt, and Moira Fearncombe
13.1 Using Statistics to Describe the Sample
13.2 Using Frequencies to Describe Samples
13.3 Measures of Central Tendency
13.4 Distribution Patterns
13.5 Measures of Variability
13.6 Inferential Statistics: Can the Findings Be Applied to the Population?
13.7 Reducing Error When Deciding About Hypotheses
13.8 Using Statistical Tests to Make Inferences About Populations
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13.9 What Does All This Mean for EBP?
13.10 Keeping It Ethical
CHAPTER 14
What Do the Qualitative Data Mean?
Kristen L. Mauk
14.1 Qualitative Data Analysis
14.2 Qualitative Data Interpretation
14.3 Qualitative Data Evaluation
14.4 Keeping It Ethical
CHAPTER 15
Weighing In on the Evidence
Carol O. Long
15.1 Deciding What to Do
15.2 Appraising the Evidence
15.3 Clinical Practice Guidelines: Moving Ratings and Recommendations into Practice
15.4 Keeping It Ethical
UNIT 5 Implementation
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UNIT 5 Implementation
CHAPTER 16 Transitioning Evidence to Practice
Maria Young
16.1 Evidence-Based Practice Models to Overcome Barriers
16.2 Creating Change
16.3 Keeping It Ethical
CHAPTER 17
Developing Oneself as an Innovator
Diane McNally Forsyth
17.1 Who Is an Innovator?
17.2 Developing Oneself
17.3 Professionalism
17.4 Keeping It Ethical
UNIT 6 Confirmation
CHAPTER 18
Evaluating Outcomes of Innovations
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18.1 What Is an Outcome?
18.2 Choosing Outcomes
18.3 Evaluating the Outcomes
18.4 Keeping It Ethical
CHAPTER 19
Sharing the Insights with Others
Janet M. Brown and Nola A. Schmidt
19.1 Dissemination: What Is My Role?
19.2 The 3 Ps of Dissemination
19.3 Using Technology to Disseminate Knowledge
19.4 Making the Most of Conferences
19.5 Keeping It Ethical
Glossary
Index
22
CONTRIBUTORS Susie Adams, PhD, RN, PMHNP, FAANP
Professor and Director PMHNP Program School of Nursing
Vanderbilt University
Nashville, Tennessee
Janet M. Brown, PhD, RN
Dean and Professor
College of Nursing and Health Professions Valparaiso University
Valparaiso, Indiana
Amy C. Cory, PhD, RN, CPNP
Associate Professor
College of Nursing and Health Professions Valparaiso University
Valparaiso, Indiana
Jan Dougherty, MS, RN
Director
Family and Community Services Banner Alzheimer’s Institute Phoenix, Arizona
Moira Fearncombe
Associate Professor
The Illinois Institute of Art Schaumburg, Illinois
Diane McNally Forsyth, PhD, RN
Professor
Graduate Programs in Nursing Winona State University
Rochester, Minnesota
Emily Griffin, MSN, ARNP, FNP-C
Lecturer
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College of Nursing
University of Iowa
Iowa City, Iowa
Elsabeth Jensen, PhD, RN
Associate Professor and Graduate Program Director School of Nursing
Faculty of Health
York University
Toronto, Ontario
Carol O. Long, PhD, RN, FPCN
Geriatric and Palliative Care Educator and Researcher Capstone Healthcare Group
Adjunct Faculty
College of Nursing and Health Innovation Arizona State University
Phoenix, Arizona
Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, FAAN
Professor Kreft Endowed Chair for the Advancement of Nursing Science College of Nursing and Health Professions Valparaiso University
Valparaiso, Indiana
Patricia Mileham, MA Associate Professor of Library Services, Director of Public Service Christopher Center for Library & Information Resources Valparaiso University
Valparaiso, Indiana
Rosalind M. Peters, PhD, RN, FAAN
Associate Professor
College of Nursing
Wayne State University
Detroit, Michigan
Kathleen A. Rich, PhD, RN, CCNS-CSC, CNN
Cardiovascular Clinical Specialist Patient Care Services
Indiana University Health La Porte Hospital La Porte, Indiana
Cynthia L. Russell, PhD, RN, ACNS-BC, FAAN
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Professor
School of Nursing and Health Studies University of Missouri—Kansas City Kansas City, Missouri
Nola A. Schmidt, PhD, RN, CNE
Professor
College of Nursing and Health Professions Valparaiso University
Valparaiso, Indiana
Marita G. Titler, PhD, RN, FAAN
Associate Dean for Practice and Clinical Scholarship Rhetaugh G. Dumas Endowed Chair Division Chair Health Systems and Effectiveness Sciences University of Michigan School of Nursing Ann Arbor, Michigan
Ann H. White, PhD, MBA, RN, NE-BC
Dean
College of Nursing and Health Professions University of Southern Indiana Evansville, Indiana
Maria Young, PhD, RN, ACNS-BC
Cardiac Care Clinical Nurse Specialist Franciscan St. Elizabeth Health West Lafayette, Indiana
25
REVIEWERS Carol Beltz, MSN, RN
26
Lecturer
27
Kent State University
Kent, Ohio
Susan Weber Buchholz, PhD, ANP-BC
28
Professor
Department of Adult Health and Gerontological Nursing Rush University
Chicago, Illinois
Nathania A. Bush, MSN, APRN, BC
Assistant Professor of Nursing Morehead State University
Morehead, Kentucky
Janie Canty-Mitchell, PhD, RN
University of North Carolina—Wilmington Wilmington, North Carolina
Kim Clevenger, MSN, RN
Assistant Professor of Nursing Morehead State University
Morehead, Kentucky
Suzanne Edgett Collins, PhD, RN, MPH, JD
29
Associate Professor
30
Department of Nursing
31
University of Tampa
Tampa, Florida
Marianne Curia, PhD, MSN, RN
32
Assistant Professor
University of St. Francis College of Nursing and Allied Health Joliet, Illinois
Maureen B. Doyle, PhD, APRN
33
Assistant Professor
Fairleigh Dickinson University Henry P. Becton School of Nursing and Allied Health Teaneck, New Jersey
Catherine M. Jennings, RN, MSN, APN-C
34
Felician College
Lodi, New Jersey
Jane Kapustin, PhD, CRNP
University of Maryland—Baltimore Baltimore, Maryland
Cathy Leahy, MSN, MEd, RN
35
Department of Nursing
36
Xavier University
Cincinnati, Ohio
Cheryl Martin, PhD
37
BSN Programs Director
38
Associate Professor
39
University of Indianapolis
Indianapolis, Indiana
Mary A. Megel, PhD, RN
40
Associate Professor
41
College of Nursing
Family & Systems Department University of Nebraska Medical Center Omaha, Nebraska
Arlene Morris, EdD, RN, CNE
42
Associate Professor
43
Department of Nursing
Auburn University Montgomery School of Nursing Montgomery, Alabama
Iris Mullins, PhD, RN
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Assistant Professor
45
School of Nursing
New Mexico State University Las Cruces, New Mexico
Jenenne P. Nelson, PhD, RN, CNS
Associate Professor and Kaiser Permanente Professorship in Nursing Beth-El College of Nursing and Health Sciences Colorado Springs, Colorado
Katherine Peck, MSN, RN, CNS
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Instructor
New Mexico State University Las Cruces, New Mexico
Michael Perlow, DNS, RN
47
Murray State University
Murray, Kentucky
Ginger Raterink, DNSc, ANP-C
48
School of Nursing
49
University of Colorado
Denver, Colorado
Jacquelyn Reid, EdD
50
Associate Professor
51
School of Nursing
Indiana University Southeast New Albany, Indiana
Linda S. Rieg, PhD, RN
52
Associate Professor
53
Xavier University
Cincinnati, Ohio
Kandy K. Smith, DNS, RN
54
Associate Professor
55
College of Nursing
University of South Alabama Mobile, Alabama
Claudette Spalding, PhD, ARNP, CNAA Associate Dean for Graduate Education Associate Professor
Barry University School of Nursing Miami Shores, Florida
Nancy Wilk, DNS, WHNP
St. John Fisher College
Rochester, New York
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PREFACE
We are most pleased to offer the third edition of this text. For this revision, chapter authors have paid particular attention to updating information and references. Of special note is a new chapter about statistics used in epidemiology. We consider this an important addition because evidence-based practice (EBP) and epidemiology are closely aligned. As more nursing literature involves epidemiology, it is important for nurses to understand the methods used in order to interpret information and apply it to their practices.
We are even more committed to the premise that baccalaureate-prepared nurses, given the emphasis on leadership, critical thinking, and communication in their curricula, are ideally positioned to advance best practices. Therefore, nursing faculty must create educational strategies for students that develop a lifelong commitment to critically examining nursing practice in light of scientific advances. Although many texts and references deal with the principles, methods, and appraisal of nursing research, few sources address the equally important aspect of integrating evidence into practice. Because there is a growing expectation by accrediting bodies that patient outcomes are addressed through best practice, it is imperative that books be available to prepare nurses for implementing best practices. This nursing research textbook provides substantive strategies to assist students with applying evidence at the point of care.
The American Association of Colleges of Nursing (AACN) charges nursing programs to prepare baccalaureate nurses with the basic understanding of the processes of nursing research. This book includes content related to methods, appraisal, and utilization, which is standard in many other texts. Furthermore, the AACN expects BSN-prepared nurses to apply research findings from nursing and other disciplines in their clinical practice. The framework for this text is the model of diffusion of innovations (Rogers, 2003), which gives readers a logical and useful means for creating an EBP. Readers are led step by step through the process of examining the nursing practice problem of medication errors using the innovation–decision process (IDP). It is recommended that faculty use this text with students to guide them through assignments that might effect actual change in patient care at a healthcare facility. Schmidt and Brown (2007) described this teaching strategy more fully. Because students typically express that research content is uninteresting and lacks application to real life, we have tried to create a textbook that is less foreboding and more enjoyable through the use of friendly language and assignments to make content more pertinent for students.
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The primary audience for this textbook is baccalaureate undergraduate nursing students and their faculty in an introductory nursing research course. All baccalaureate nursing programs offer an introductory research course, for which this text would be useful. Because the readership has grown, we recognize that nursing graduate programs are also using this textbook. The addition of the chapter about epidemiology may be especially pertinent to this audience.
In this third edition, input from students and feedback from faculty has been incorporated. We are most grateful for their time and thoughtful critique. This edition continues to follow the five steps of the IDP: knowledge, persuasion, decision, implementation, and confirmation. This organizational approach allows the research process to be linked with strategies that promote progression through the IDP. The chapters follow a consistent format: chapter objectives, key terms, major content, test your knowledge, case study, rapid review, and reference list. Critical thinking exercises and user-friendly tables and charts are interspersed throughout each chapter to allow readers to see essential information at a glance. Textbook users will be pleased to find that efforts to provide consistency between chapters have been made. The evidence hierarchy and questions to consider when appraising nursing studies are printed inside the back cover for easy reference. The chapter about qualitative methods was expanded to include more detail about the philosophic underpinning of various methods. Additionally, content about the role of technology in dissemination has also been enhanced.
The case study continues to be a significant feature of this textbook. More recent evidence has been provided to challenge students to make decisions about practice related to the elimination of medication errors. The case study unfolds in a manner that integrates chapter content with each step of the EBP process. Concrete strategies, in the form of exemplars and checklists, allow readers to master competencies needed to perform these activities in the clinical setting.
The unique feature of integrating ethical content throughout the chapters remains. Organizing content in this manner assists students to integrate ethical principles into each step of the research process.
As a learning strategy, chapters are subdivided so that content is presented in manageable “bites.” Students commented that they liked this feature. As in the second edition, chapters begin with a complete list of all objectives addressed in the chapter. Objectives are repeated for each subsection and are followed by content, and the chapter ends with a section called Test Your Knowledge. Multiple- choice and true-or-false questions, with an answer key, reinforce the objectives and content. Chapters also include critical thinking exercises that challenge readers to make decisions based on the content. Users will find significant alterations to the digital resources available to readers.
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New challenges arose while we wrote this third edition. Publishers are becoming less inclined to allow their materials to be reproduced. Therefore, we are disappointed that we can no longer offer the full-text reference articles within this text’s digital resources. In response to this challenge, the Apply What You Have Learned exercise for Chapter 4 was significantly transformed. Directions have been provided for students so that they can search for the articles themselves, thereby reinforcing behaviors that will be required of baccalaureate-prepared nurses, who need to keep up with the ever-changing healthcare environment. We are pleased with the result because this alteration has actually strengthened the exercise. For readers’ convenience, following is a table containing the evidence used throughout the Apply What You Have Learned exercises.
Articles to Search in CINAHL
Citation Chapter(s) Search Terms (Limiters)
Anthony, K., Wiencek, C., Bauer, C., Daly, B., & Anthony, M. K. (2010). No interruptions please. Impact of a no interruption zone on medication safety in intensive care units. Critical Care Nurse, 30(3), 21–29.
6, 7, 10, 11, 13, 15
Anthony (author) “no interruptions” (all fields)
Ausserhofer, D., Schubert, M., Desmedt, M., Blegen, M. A., DeGeest, S., & Schwendimann, R. (2013). The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey. International Journal of Nursing Studies, 50, 240–252.
8, 11, 13, 15 Ausserhofer (author) Schubert (author) “safety climate” (title)
Biron, A. D., Loiselle, C. G., & Lavoie-Tremblay, M. (2009). Work interruptions and their contribution to medication errors: An evidence review. World Views on Evidence- Based Nursing, 6, 70–86.
12, 13, 15 Biron (author) “evidence review” (all fields)
Cohen, H., & Shastay, D. (2008). Getting to the root of medication errors. Nursing, 38(12), 39–49.
4 Cohen (author) Shastay (author) 2008 (publication date)
59
Flanagan, J. M., Carroll, D. L., & Hamilton, G. A. (2010). The long- term lived experience of patients with implantable cardioverter defibrillators. MEDSURG Nursing, 19, 113–119.
1 “lived experience” (title) “implantable cardioverter defibrillators” (title)
Flynn, L., Liang, Y., Dickson, G. L., Xie, M., & Suh, D. (2013). Nurses’ practice environments, error interpretation practices, and inpatient medication errors. Journal of Nursing Scholarship, 44(2), 180–186.
10, 11, 13, 15 Flynn (author) Liang (author) “Journal of Nursing Scholarship” (publication name)
Kliger, J., Blegen, M. A., Gootee, D., & O’Neil, E. (2009). Empowering frontline nurses: A structured intervention enables nurses to improve medication administration accuracy. The Joint Commission Journal on Quality and Patient Safety, 35, 604–612.
4, 6, 7, 10, 11, 13, 15
Kliger (author) Gootee (author)
Pipe, T. B., Kelly, A., LeBrun, G., Schmidt, D., Atherton, P., & Robinson, C. (2008). A prospective descriptive study exploring hope, spiritual well-being, and quality of life in hospitalized patients. MEDSURG Nursing, 17, 247–257.
1 Pipe (author) hope (all fields) “spiritual well-being” (all fields)
Rich, V. L. (2005). How we think about medication errors: A model and a charge for nurses. American Journal of Nursing, 105(3 Suppl.), 10–11.
5, 10, 11, 12, 13, 15
Rich (author) “model” (title) “American Journal of Nursing” (publication name)
Schwappach, D. L. B., Hochreutener, M. A., & Wernli, M. (2010). Oncology nurses’ perceptions about involving patients in the prevention of chemotherapy administration errors. Oncology Nursing Forum, 37, E84–E91.
9, 11, 14, 15 Schwappach (author) “oncology“ (all fields) “qualitative“ (all fields)
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Tomietto, M., Sartor, A., Mazzocoli, E., & Palese, A. (2012). Paradoxical effects of a hospital-based, multi-intervention programme aimed at reducing medication round interr
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