Tag Archives: research

EBP, Evidence based nursing, evidence based practice, research, Research student, Uncategorized

2019: It is…….

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I’m not a New Year’s resolution person.  I used to be and then I realized that I wanted to hit the restart button more often than every 365 days.  So…my aim for this blog remains pretty much unchanged:   Make research processes and ideas understandable for every RN.

DifficultToBeSimpleAlthough “to be simple is difficult,” that’s my goal. Ljourneyet me know what’s difficult for you in research, because it probably is for others as well.  Let’s work on the difficult together so that you can use the BEST Evidence in your practice.

The 2019 journey begins today, and tomorrow, and the tomorrows after that!

FOR MORE: Go to PubMed. Search for a topic of interest. Send me the article & we’ll critique together.

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DNP, EBP, Evidence based nursing, evidence based practice, PhD

DNP vs. PhD: If the shoe fits….

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For RNs wanting to pursue a doctorate, it is important to pick a degree that Glass slipperbest matches your anticipated  career path.   The shortest simplest explanation of the difference in these degrees is probably:

  1. PhD – If you want to be a nurse scientist & teach in a university & conduct  nursing research. 
  2. DNP – If you want to be an advanced practice nurse, who primarily uses research in leadership, QI, patient care, etc. along with measuring project outcomes.

An excellent, free full-text, critique can be found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547057/  

Of course, some DNPs teach in universities, particularly in DNP programs.  PhDs may otherwise be better prepared for faculty roles.  I encourage you to look carefully at the curriculum at the school where you hope to study and expectations of a university where you hope to teach.  Speak with faculty,  & choose wisely.

Clinical practice guidelines, Evidence based nursing, evidence based practice, reading research, research, Research class

It’s Up to you: Accept the Status Quo or Challenge it

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Yes.  Change can be painful.question

Yes. It is easier to do things the way we’ve always done them (and been seemingly successful).

Yet, most of us want to work more efficiently or improve our own or patients’ health.Tension

 So, there you have the problem: a tension between status quo and change. Perhaps taking the easy status quo is why ‘everyday nurses’ don’t read research.

Ralph (2017) writes encountering 3 common mindsets that keep nurses stuck in the rut of refusing to examine new research:

  1. I’m not a researcher.
  2. I don’t value research.
  3. I don’t have time to read research.

But, he argues, you have a choice: you can go with the status quo or challenge it (Ralph).  And (admit it), haven’t we all found that the status quo sometimes doesn’t work well so that we end up

  • choosing a “work around,” or
  • ignoring/avoiding the problem or
  • leaving the problem for someone else or
  • ….[well….,you pick an action.]

TensionHow to begin solving the problem of not reading research? Think of a super-interesting topic to you and make a quick trip to PubMed.com. Check out a few relevant abstracts and ask your librarian to get the articles for you. Read them in the nurses’ lounge so others can, too.

Let me know how your challenge to the status quo works out.

Bibliography: Fulltext available for download through https://www.researchgate.net/ of  Ralph, N. (2017 April). Editorial: Engaging with research & evidence is a nursing priority so why are ‘everyday’ nurses not reading the literature, ACORN 30(3):3-5. doi: 10.26550/303/3.5

Clinical practice guidelines, Data, EBP, Evidence based nursing, evidence based practice, Evidence hierarchy, NNT, research, Safety

More? Not always better! Check out NNT.

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EBPPractice based in evidence (EBP) means that you must critique/synthesize evidence and then apply it to particular setting and populations using your best judgement.  This means that you must discriminate about when (and when NOT) to apply the research.  Be sure to use best professional judgment to particularize your actions to the situation!

Add to your repertoire of EBP tools,  ratiothe Number Needed to Treat (NNT).   This is not mumbo -jumbo.   NNT explained here–short & sweet: http://www.thennt.com/thennt-explained/ 

FindingsCRITICAL THINKING:   Check out this or other analyses at the site.  How does the info on antihypertensives for mild hypertension answer the question of whether more is better?  Are there patients in whom you SHOULD treat mild HTN?  (“We report, you decide.”)   http://www.thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/

MORE INFO:  Check out what the data say about other risk/benefit treatments at http://www.thennt.com/ 

Data, quantitative research, reading research, research

Goldilocks and the 3 Levels of Data

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Actually when it comes to quantitative data, there are 4 levels, but who’s counting? (Besides Goldilocks.)

  1. Nominal  (categorical) data are names or categories: (gender, religious affiliation, days of the week, yes or no, and so on)
  2. Ordinal data are like the pain scale.  Each number is higher (or lower) than the next but the distances between numbers are not equal.  In others words 4 is not necessarily twice as much as 2; and 5 is not half of 10.
  3. Interval data are like degrees on a thermometer.  Equal distance between them, but no actual “0”.  0 degrees is just really, really cold.
  4. Ratio data are those  with real 0 and equal intervals (e.g., weight, annual salary, mg.)

(Of course if you want to collect QUALitative word data, that’s closest to categorical/nominal, but you don’t count ANYTHING.  More on that another time.)

CRITICAL THINKING:   Where are the levels in Goldilocks and the 3 levels of data at this link:  https://son.rochester.edu/research/research-fables/goldilocks.html ?? Would you measure soup, bed, chairs, bears, or other things differently?  Why was the baby bear screaming in fright?

Disseminating findings, EBP, evidence based practice, research

Creation & Use of Evidence: Different!

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The difference between research and evidence-based practice (EBP) can sometimes be confusing, but the contrast between them is sharp.  I think most of the confusion comes because those implementing both processes measure outcomes.  Here are differences:

  • RESEARCH :  The process of research (formulating an answerable question, designing project methods, collecting and analyzing the data, and interpreting themagnifyingGlassmeaning of results) is creating knowledge (AKA creating research evidence).  A research project that has been written up IS evidence that can be used in practice.  The process of research is guided by the scientific method.
  • EVIDENCE-BASED PRACTICE:   EBP is using existing knowledge (AKA using EBPresearch evidence) in practice.  While researchers create new knowledge,

The creation of evidence obviously precedes its application to practice.  Something must be made before it can be used.  Research obviously precedes the application of research findings to practice.  When those findings are applied to practice, then we say the practice is evidence-based.

A good analogy for how research & EBP differ & work together can be seen in autos.

CreateCar
Creating a car!

 

  • Designers & factory workers create new cars.

    UseCar
    Using a car!
  • Drivers use existing cars that they choose according to preferences and best judgments about safety.

 

 

CRITICAL THINKING:   1) Why is the common phrase “evidence-based research” unclear?  Should you use it?  Why or why not?  2) What is a clinical question you now face. (e.g., C.Diff spread; nurse morale on your unit; managing neuropathic pain) and think about how the Stetler EBP model at http://www.nccmt.ca/registry/resource/pdf/83.pdf  might help.  Because you will be measuring outcomes, then why is this still considered EBP.

evidence based practice, Evidence hierarchy

Dispelling the nice or naughty myth: retrospective observational study of Santa Claus.

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Naughty NiceGo to full article

Abstract

“OBJECTIVE:  To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day.

DESIGN:  Retrospective observational study.

SETTING:  Paediatric wards in England, Northern Ireland, Scotland, and Wales.

PARTICIPANTS:  186 members of staff who worked on the paediatric wards (n=186) during Christmas 2015.

MAIN OUTCOME MEASURES:  Presence or absence of Santa Claus on the paediatric ward GIFTSduring Christmas 2015. This was correlated with rates of absenteeism from primary school, conviction rates in young people (aged 10-17 years), distance from hospital to North Pole (closest city or town to the hospital in kilometres, as the reindeer flies), and contextual socioeconomic deprivation (index of multiple deprivation).

RESULTS:  Santa Claus visited most of the paediatric wards in all four countries: 89% in England, 100% in Northern Ireland, 93% in Scotland, and 92% in Wales. The odds of him not visiting, however, were significantly higher for paediatric wards in areas of higher socioeconomic deprivation in England (odds ratio 1.31 (95% confidence interval 1.04 to 1.71) in England, 1.23 (1.00 to 1.54) in the UK). In contrast, there was no correlation with school absenteeism, conviction rates, or distance to the North Pole.

CONCLUSION:  The results of this study dispel the traditional belief that Santa Claus rewards children based on how nice or naughty they have been in the previous year. Santa Claus is less likely to visit children in hospitals in the most deprived areas. Potential solutions include a review of Santa’s contract or employment of local Santas in poorly represented region.”  Park et al. (2016).BMJ. 2016 Dec 14;355:i6355. doi: 10.1136/bmj.i6355.

How would you translate this into practice?   Questions to help you with this endeavor:   Where does this retrospective, observational research fall on the evidence hierarchy?  EBNIs it quantitative or qualitative research?  Experimental or non-experimental research? How generalizable is this research? What are the risks,resources, and readiness of people in potentially using the findings (Stetler & Marram, 1996; Stetler, 2001)?   What might happen if you try to apply the abstract information to practice without reading the full article?  Do you think the project done in Europe is readily applicable to America?  What would be the next level of research that you might undertake to better confirm these findings?
Enjoy your holiday season! -Dr H