Chapter 27 Utilizing Research: Putting Evidence Into Nursing Practice

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Chapter 27Utilizing Research Putting Evidence
Into Nursing Practice
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Research Utilization Versus Evidence-Based
Practice

• Research utilization (RU)
• The use of study findings in a practical
  application unrelated to the original research
• Evidence based practice (EBP)
• Basing clinical decisions on best possible
  evidenceespecially high-quality research

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Figure 27-1 Schema of How RU and EBP are
Interrelated
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Research Utilization Rogers Diffusion of
Innovations Theory

• Knowledge diffusion is an evolutionary process,
  the key elements of which are
• The innovation (e.g., new knowledge, idea) itself
• Communication channelsmedia through which
  information is transmitted

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Research Utilization Rogers Diffusion of
Innovations Theory (contd)

• Timethe period over which diffusion occurs
• Social systemthe context within which the
  innovation arises

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Five Stages of Rogers Innovation-Adoption Process

• Knowledge stage
• Persuasion stage
• Decision stage
• Implementation stage
• Confirmation stage

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Barriers to Using Research in Nursing Practice

• Research-related barriers
• Nurse-related barriers
• Organizational barriers
• Barriers related to the nursing profession

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Tips to Researchers to Promote Use of Research in
Clinical Practice

• Do high quality research
• Replicate
• Collaborate with clinicians
• Disseminate aggressively
• Disseminate broadly
• Communicate clearly

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Tips to Researchers to Promote Use of Research in
Clinical Practice (contd)

• Present findings amenable to meta-analysis
• Suggest clinical implications
• Prepare integrative research reviews

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Strategies for Nurses to Play a Role in RU/EBP

• Read widely and critically
• Attend professional conferences
• Learn to expect evidence that a procedure is
  effective
• Become involved in a journal club
• Pursue and participate in RU/EBP projects

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Strategies for Administrators to Promote RU/EBP

• Foster a climate of intellectual curiosity
• Offer emotional or moral support
• Offer financial or resource support for
  utilization
• Reward effects for using research
• Seek opportunities for institutional RU or EBP
  projects

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Strategies for Educators to Promote RU/EBP

• Incorporate research findings into the curriculum
• Encourage research and research use
• Place demands on researchers

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Two Models for Evidence-Based Nursing Practice

• The Stetler Model of research utilization to
  promote evidence-based practice
• The IOWA Model of evidence-based practice to
  promote quality care

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Five Sequential Phases of the Stetler Model

• Phase I Preparation
• Phase II Validation
• Phase III Comparative Evaluation and Decision
  Making
• Phase IV Translation/Application
• Phase V Evaluation

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IOWA Model of Evidence-Based Practice to Promote
Quality Care

• The Iowa Model outlines a series of activities
  with three critical decision points
• Decide whether problem is a sufficient priority
  for the organization exploring possible changes
• Decide whether there is a sufficient research
  base
• Decide whether change is appropriate for adoption
  in practice

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Major Activities/Steps in Using Research in
Nursing Practice

• Select a topic or problem
• Knowledge-focused triggers
• Problem-focused triggers
• Assemble and evaluate evidence
• Use integrative reviews
• Search for other evidence
• Evaluate evidence

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Major Activities/Steps in Using Research in
Nursing Practice

• Assess implementation potential
• Assess transferability of innovation
• Evaluate feasibility of adopting innovation in
  new setting
• Assess costs and benefits of innovation
• Develop, implement, and evaluate the innovation

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Research Integration and Synthesis

• Forms of integrative reviews
• Narrative, qualitative integration (traditional
  review of quantitative or qualitative results)
• Meta-analysis (statistical integration of
  results)
• Meta-synthesis (theoretical integration of
  qualitative findings)

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Steps in Conducting an Integrative Review

• Define research problem or hypotheses to be
  tested
• Select sample of studies to be included in the
  review
• Extract and record data from research reports

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Steps in Conducting an Integrative Review (contd)

• Determine quality of the evidence (e.g., quality
  ratings to weight findings)
• Analyze the data (i.e., cumulative findings)
• Write up integrative review

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Six-level Evidence Hierarchy (Stetler)

• Levels of evidence (from strongest to weakest)
• Meta-analyses of controlled studies
• Individual experimental studies
• Quasi-experimental studies
• Nonexperimental studies
• Program evaluations, RU studies, quality
  improvement projects, case reports
• Opinions of respected authorities and expert
  committees