Nursing Research:

1. Nursing Research: Building a Culture At NHRMC Lorna Bell-Kotwall, RN, PhD

2. “Nursing creates the culture of the healthcare organization. If nurses don’t drive change, it won’t happen, and if nurses don’t change, it doesn’t matter who else does”Timothy Porter-O’Grady, DM, APRN, FAAN

3. “Half of what you are taught in school will be proven wrong in 10 years, and the trouble is, none of your teachers know which half!” Harvard Medical School • “We double our medical information every 3-5 years. Do we change nursing practices every 3-5 years to match new/changing medical knowledge?”

4. Nursing Research • What • Definition • Nursing Process & Nursing Research: Similarities • Types, Qualities • Why • Standards ( professional, national, & accreditation) • Examples of best practice at NHRMC • Professional commitment • Your organization, research, & EBP • How • Using a Research/EBP Model: The Iowa Model • Principles of EBP • Comparing research, EBP, QI • Barriers to Implementing EBP • Research, EBP, & QI at NHRMC • How to get started: Use of PICO format • Where • Research in the Hospital • Nursing Research Committee

5. Nursing Research: Building a Culture What? Why? How? Where?

6. I.What? • Research is a systematic search for knowledge • Validate and refine current knowledge • Generate new knowledge • Problem solving approach to understand, describe, explain, predict, control • Ultimate goal to improve nursing practice

7. What does the literature say? State your problem How are you planning to study your population? What does your patient assessment tell you? What are the deficits/areas for nursing care? What is the plan for your nursing care? Nursing Research & Nursing Process: Are they similar?

8. How are you going to evaluate your study findings? How will you share your findings with others? (presentations, publications, research utilization) Ultimate goal: to promote quality of nursing practice How are you going to evaluate your nursing care? How will you share your info with others? (follow up with staff, shift report, huddles, rounding, staff meetings) Ultimate goal: to provide quality nursing care Nursing Research & Nursing Process: Are they similar?

9. Nursing Research & Nursing Process:Similarities • Both require background assessment • Both require determination of a problem • Both involve a plan for implementation • Both include an evaluation of findings • Follow up of information (patient and/or research study), communication of findings • Both have a goal of promoting optimal patient care

10. Types of Nursing Research • Quantitive; Measuring, frequently large numbers (sample size), collection of data, analysis, results conclusions, implications for nurses • Qualitative: More subjective methods, increased meaning & understanding, small groups, requires training, implications for nurses

11. Qualities of all types of Research • Aim is to increase/produce new knowledge • Results should be generalized to larger groups • Will have end point when desired sample is reached • Requires IRB approval and participant consent • Results are published universally to share with wide base of persons

12. II. Why ?? • Part of Nursing Standards in our local Professional Organization (NCBON), and our National Professional Association (ANA) • Pillar goals for all NHRMC employees, and NHRMC Nursing Performance standards • National accredition standards: JCAHO, NIH, IHI,CMS “require” evidence of best practices for funding incentives

13. II.More Reasons Why… • Current Standards require Healthcare providers to use research/evidence based principles in their practice. Some examples include: SCIP, AMI, CHF core measures programs. Other excellent examples of best practice includes all programs of excellence at NHRMC: Bariatric, Trauma, Cancer, Neonatology Registries.

14. II. More Reasons Why … • Professional Commitment: Basic care nurse or research/EBP Nurse? • What is the degree of your professional responsibility? Why is it important?

15. Do you provide basic nursing care or are you a research/EBP nurse? • Basic Nurse Qualities: • Provide quality nursing care • Pride in caring for Patients • Respect, moral integrity • Safety in Workplace • Function as part of multidisciplinary team

16. EBP/Research-oriented nurse • Control over nursing practice • Provide excellence in patient care • Encourage autonomy, responsibility, & accountability for nursing practice • Improve multidisciplinary relationship & gain mutual respect for discipline

17. Your Organization, Research and EBP • WHY??? • Recognition for contribution to research • Enhancement of patient care, competitiveness for market • Economical considerations, cost effective care • Promote collaboration with academic affiliations • Achievement of accreditation ( JCAHO, etc)

18. III. How ??Using a Research/EBP model • IOWA model: ( Maria Titler,1997) • Acts as a guide for differentiating between EBP, research, and steps to complete • Guides process of implementing findings to practice, (research utilization) and evaluating effect • Provides guidelines for problem solving and clinical decision making • Adaptable & simple to use : individual, committee, or by the organization ( over 900 requests for use; students- presentations, projects; organizations-research/EBP programs,

19. Iowa Model of EBP (Titler, 1997)

20. Principles of Evidence Based Practice • Process that requires the integration of the best research evidence, along with clinical expertise, moderated by patient values, needs, and preferences, in the delivery of quality, cost effective care.

21. Evidence Based Practice within A Context of Caring:( Melnyk & Fineout-Overholt, 2005) A model for practice requires the integration of: 1. Evidence: • Research/Evidence based theories, & opinion leaders/expert panels • Assessment of the patients History & Physical Exam, & Availability of healthcare resources 2. Clinical Expertise 3. Patient preferences and values Which results in: ***Evidence-based Clinical Decision making, and Quality Patient Outcomes

22. Comparison of Research, EBP, & Quality Improvement • Research: Process, & product, global, discovery of knowledge, only complete when considered with DISSEMINATION and UTILIZATION • EBP: Process, use of research in conjunction with other factors for optimal patient outcome • QI: Process: narrow, specific, goal to improve aspect of practice, optimal outcome for pop’n

23. Barriers to Implementing • It takes up to 17 years to implement research and proven best practices into the clinical setting ( NINR, 2009) Why? • Only 15% of clinicians are using current best practices ( Melnyk, 2010) Why? • Lack of knowledge, misperceptions or negative views about research/EBP • Staff not committed to belief in better benefits ( more positive outcomes) • Threat of having to tackle journal sources • Overwhelming patient loads • Organizational constraints (Support and resources) • Demands from pts for certain type of treatment • Inadequate content & behavioral skills re:EBP in educational & orientation programs • Traditional characteristics of practicing nurses( basic nurse)

24. Research, EBP, Quality Improvement, & NHRMC Nurses -Current QI( PI, QA) projects: see Nursing Department, Nursing Congress, Professional development website for examples and application documents, -Become familiar with use of PDSA Model for Improvement ( See Nursing Congress: Professional Development website), Net learning Module ***Become active, and participate: Unit, ( ie. Unit based Journal Clubs, Unit Based practice, policy & procedure development, Hospital Committees & Professional Association

25. How to get started with a Research/EBP project: Use of Pico Worksheet Define your clinical problem using the PICO components described below: P - Patient/disease-describe patients chief complaint,(primary problem, disease, co-existing conditions), most important characteristics I - Intervention –what do you plan to do for the patient C - Comparative intervention (optional) What have others done? Is there an alternative? ( compare effect of 2 drugs, 2 nursing procedures) O – Outcome- what you plan to accomplish, improve (should be measurable: ie improve function or test score, relieve or eliminate symptoms, reduce adverse events, improve satisfaction scores)

26. Using the PICO Format Example from the Clinical Scenario: P - adults experiencing (moderate) depressionI - St. John's Wort ( specifically stated, no alternative))C - antidepressantsO - relief of symptoms . Write out your clinical Question using the PICO components. • This format can also help you to do a search of all relevant terms. By writing out a question, you help clarify exactly what you need to answer. The results of your search will only be as good as the initial question that you ask. • An example of a research question from our Clinical Scenario: For adult patients with moderate depression, is St. John's Wort (hypericum) more effective for symptom relief than antidepressants? • Literature Sources. Visit SEAHEC Digital Library for assistance http://library.ncahec.net/main.cfm

27. IV. Where?? Research in the Hospital • Role of the IRB Visit the Website for further information: http://www.nhrmc.org/body.cfm?id=4398&fr=true • Multidisciplinary Symposiums • Nursing Congress • Practice, Professional Development, Outcomes Improvement, Retention, Finance • Nursing Grand Rounds • Poster Symposiums, Annual Research Day • New Nursing Research Committee

28. Nursing Research Committee • Purpose: To engage nurses at all levels in the research process, and participate in educational research activities: • Research Journal Clubs; sharing with Nurse Managers • Participate in poster symposiums • Develop research proposal • Mentor all nurses who want to do research • Goals for 2010: • All members complete research projects, IRB approval • Promote increased use of clinical ladders-research focus • Nursing research website, net learning module • Lunch N Learn Research series for RNs