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Sr. Callista Roy, PhD, RN, FAAN


Sr. Callista Roy, PhD, RN, FAAN Professor and Nurse Theorist Boston College Connell School of Nursing Council Advancement Nursing Science . Washington , DC – PowerPoint PPT presentation

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Title: Sr. Callista Roy, PhD, RN, FAAN

Generating Cumulative Knowledge Evidence for
  • Sr. Callista Roy, PhD, RN, FAAN
  • Professor and Nurse Theorist Boston College
    Connell School of Nursing
  • Council Advancement Nursing Science
  • Washington , DC
  • September 14, 2012

Purpose-Discovery through Innovation
  • To purpose a pathway to cumulative knowledge as a
    basis for evidence for practice by
  • Synthesizing research based on one conceptual
  • Deriving middle-range theories based on the
    cumulative knowledge
  • Providing a broad definition for evidence for
    practice and demonstrate the evidence for the
    derived theories
  • Presenting an exemplar of how cumulative
    knowledge can create change for practice

Cumulative Knowledge
  • Annual Review of Nursing Researchstarted in
    1983, H. Werley
  • Publishes state of the science papersintegrated
    review on one topic
  • Metaanalysisusually of clinical trials
  • Critique of Use as EvidenceMove from
  • focus on empirics to focus on diverse
  • patterns of knowing and use of
  • theory-guided, evidence-based
  • holistic nursing practice

Fawcett, Watson, Neuman, Walker Fitzpatrick,
Cumulative Knowledge Based on One Theoretical
ModelRoy Adaptation Model
  • Have common concepts close to practice
  • Concepts cross clinical areas, based on adapting
    people and groups can be generalized
  • Large number of studies
  • Multiple methods
  • Measurements may be the same
  • Basis within heritage of nursing perspective

Results of Literature Review 1995-2010
  • 178 studies met research and links to model
  • 106 were referred journal publications and 72
    were dissertations
  • Articles published in 47 English-language
  • Dissertations completed at 32 different
    universities in the United States

Studies Organized by Method
  • Quantitative Studies (n127)
  • Descriptive (59)
  • Explaining, Predicting and Prescribing (43)
  • Interventions (25)
  • Qualitative Studies (n40)
  • Content Analysis (n8)
  • Grounded Theory (n4)
  • Ethnography (n3)
  • Phenomenology (n17)
  • Mixed Methods (n6)
  • Case Study (n2)

350 Research Studies in Data Base from 1970-2010
by 5-year Intervals
Process of Using Studies to Create MRT
  • 1. Observations (studies) are clustered together
  • 2. Similarities identified
  • 3. Major concepts identified-Critics, Conceptual
    clarity needed,RAM concepts developed over 42
    years of publications, with definitions/theoretica
    l basis
  • 4. Concepts interrelated in theoretical
    statements-RAM has set of generic propositions
  • 5. Even with 178 plus researchers, still
    commonalities for cumulative knowledge are great

Middle-range Theories
  • Significant milestone that marks considerable
    progress in knowledge development beginning
  • Have a transformational effect on entire
    discipline of nursing
  • Help to answer questions about overall mission,
    goals and nature of discipline of nursing and
    differentiate from other disciplines
  • Clear indication that nursing discipline has
    undergone a turning point toward producing more
    accessible and functional theories that guide
    productive research programs and provide theory
    and research-based evidence for practice

  • Meleis, 2007

Major Clusters of Studies-Developing Middle range
  • General coping
  • Coping with life events
  • Coping with loss
  • Coping with chronic health conditions
  • Coping with family health

Coping with Life Events Examples of
  • 1. Descriptive survey. 300 women identified
    common postpartum problems and adaptation
    strategies to cope with these problems during the
    first 2 to 8 weeks following delivery of full
    term healthy newborns (Martin, 1995)
  • 2. Multivariate to explain. Public data set used
    to test a model of decision-making responses
    related to Advance Directives (ADS) with 938
    aging subjects. Results were analyzed using
    causal modeling and path analysis (Zhang, 2004)

Examples of StudiesQuantitative and Qualitative
  • Intervention study. 105 preschool children having
    immunization injections. The aim was to examine
    the effects distraction and cutaneous stimulation
    on the pain of having the injection (Sparks,
  • Phenomenological study. Described the experience
    of five emergency nurses who routinely handle
    traumatic and violent events (Wright, 2007)

Coping with Life Events Concepts
  • 1. Developmental, expected
  • postpartum, menopause, advanced
  • directives, immunizations
  • 2. Situational Events, unexpected, specific
  • verbal abuse or observing trauma-nurses date
  • Challenges of health changes
  • mother and child, e.g. NICU, cerebral palsy,

Statements from Studies that Relate Coping
Strategies to Outcomes
  • 1. Cognator processes of taking direct action,
    planning ahead, handling systematically and use
    of resources and experience can affect adaptive
    responses in self-esteem, role transition,
    sensation, and health attitudes.
  • 2. In new role development or an unexpected role
    event expanding input can lead to effective role
    transition or role effectiveness.
  • 3.When life event or health challenges involve
    too many or unfamiliar challenges selective
    attention can help integrate the experience.
  • 4. For nurses facing specific event challenges
    problem-focused behaviors, use of knowledge and
    skill and humor can lead to role effectiveness,
    teamwork, and protected mental health.
  • 5. Time perspective can be useful in resolving
    moral distress.

  • 6. Use of personal and spiritual self,
    particularly seeing moral ends can protect mental
  • 7. Relating to others during developmental
    challenges is used for help, support and
    emotional sharing.
  • 8. Relating to others during life challenges is
    used for support and empathy.
  • 9. Relating to others in health challenges is
    needed but may be lacking, leaving the person
    with a duty to be strong.
  • 10. The use of a common language between those
    dealing with health challenges and the nurse can
    lessen anxiety and fear.
  • 11. The pooled effect of contextual stimuli such
    as context, age, and socioeconomic status and
    residual stimuli such as childhood abuse and
    witness of violence affect the mental health
    outcomes of abuse.
  • 12. The unique bonding and connecting of mothers
    of ill children does not eliminate the craving
    for normalacy

Middle Range Theory of Coping with Life Events,
Developmental Events
Middle Range Theory of Coping with Life Events,
Situational Events
Views of Evidence for Practice
  • 1. Sometimes evidence means, reduced to
    biomedical, empirical and positivistic variables
    and criteria
  • 2. Critical dialogue about eclectic views of
    evidence that may incorporate more components
    more congruent with nursing science and emanate
    from how nursing knowledge and knowing how been
  • 3. Included widening meaning of evidence to make
    it more pluralistic, to incorporate humanistic
    experience as evidence of models of care used
  • 4. We have not explored criteria for judging
    evidence within this frameworkno definite ideas

  • Meleis, 2007

Level 1 EBP High Potential for Implementation
in Practice
  • Proposition supported by more than one study
  • Unequivocal support of hypothesis
  • Low risk
  • High clinical need
  • Level 2 EBP Needs Further Clinical Evaluation
    Before Implementation
  • Proposition supported
  • Generalizability not clear
  • Risk not clear
  • High clinical need
  • Level 3 EBP Needs Further Testing Before

Translational Research
  • National Institutes of Health made translational
    research a priority
  • Clinical and Translational Science Award (CTSA)
    program began in 2006 in 2008 were 60 such
    centers in 2012 expect 60
  • T1 means bench to bedside e.g. harnessing
    knowledge from basic sciences to produce new
    drugs, devices, and treatment s
  • T2 seeks to close the gap and improve quality by
    improving access, reorganizing and coordinating
    system care, helping clinicians and patients to
    exchange behaviors, make more informed choices,
    providing reminders and point of-care decision
    support tools, and strengthening
    patient-clinician relationship
  • Take clinical studies into everyday clinical
    practice and health decision making
    Wolfe, 2011

Coping is Significant for Health
Recommendations for Practice
  • Intervention We propose that a major
    responsibility for every nurse in practice is to
    coach each patient in the use of ones own coping
    strategies when to use one and when another
    what coping strategies works best for them in a
    given situation and what situations call for
    learning new strategies
  • Change for Practice Add a nurse-discharge
    planner for every inpatient unit. This nurse
    would not be concerned primarily with finding
    long-term placements for patients across many
    settings. Rather the nurse in this re-defined
    role would work with the primary care nurses on a
    given unit from the time the patient is admitted
    to plan for coordinating the patients ability to
    cope with their developmental and situational
    life events across settings.

Pathway to Cumulative Knowledge as Evidence
for Practice, the Basis of Change
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