Evidence-based Nursing Practice - Essay Example

Research for Health Professionals: Nursing Health-Related Research and Reviewing the Literature Introduction: Nursing research reviews theissues of importance to the nursing profession that encompass nursing practice, education, administration, and informatics in a systematic manner that investigates the state-of-the-art knowledge that improves nursing practice (Sandelowski, 2004) to see whether the best and scientific care has been delivered. Healthcare Research: Although practice based, nursing has a theoretical component, and its ultimate benefit is manifest only when the theory is deployed in practice leading to practice improvement (Rauhala and Fagerstrom, 2004). The general purpose of such research is to answer questions or solve problems of relevance for the nursing profession. Therefore, basic research is undertaken to extend the base of knowledge in a discipline that helps to refine and redefine a theory (Pope & Mays, 2004). Critical Analysis Skills: Critical analysis is a multidimensional skill, a cognitive or mental process or set of procedures (Timmins, 2006). It involves reasoning and purposeful, systematic, reflective, rational, outcome-directed thinking based on a body of knowledge, as well as examination and analysis of all available information and ideas. Nursing practice mandates the use of high-level, systematic and organized critical thinking skills within the nursing process since it enhances clinical decision making, helping to identify patient needs and to determine the best nursing actions that will assist the patient in meeting those needs (Evans, 2003). Evidence-Based Practice: Nursing practice is increasingly dependent on evidence-based practice, where patient care decisions are made on the basis of the most updated and best clinical evidence. It is generally agreed that research findings from rigorous and relevant studies comprise the best type of evidence for modifying and reinforcing the nurses' decision-making processes, actions in the practice area, and interactions with clients. This indicates that nursing actions would increasingly be based on research evidences that would lead to clinically appropriate, cost-effective nursing actions with intent to producing more positive outcomes for the clients (Goldenberg, 2006). Research and Advancement in Nursing Practice: The advancement of the nursing profession would be heavily reliant on the integration of research, research outcomes, and education into the practice setting. Clinical nursing is and is expected to be enhanced by the products of research activities, development of theory and validation, identification of problems, and resolution of those based on science that is the derivative of research. This would, as expected, lead to the desired development of new nursing knowledge, advancement of health policies, and ultimately would culminate into enhancement of nursing profession (Sackett, Straus, , & Richardson, 2000). Key Elements of Literature Review: The "evidence" in the evidence-based practice is gained by systemically searching and analyzing reports of studies and research that are accessed through databases and libraries. In fact, the systemic review process is also a form of research where the reviewer develops a protocol for the review, asks legitimate questions, endeavors to glean the evidence, appraises it, and takes decisions whether the evidence is applicable in practice. In that sense, a research or literature review is not a summary of the study, rather it is a careful appraisal of its merits and flaws. A good critique objectively identifies both adequacy and inadequacy, and virtues as well as faults. This task involves a background literature review, formulating objectives and questions and describing inclusion criteria, a search strategy for the literature, assessment criteria, extraction and synthesis of data (Paterson, Thorne, Canam, & Jillings, 2001). Critical Analysis of the Literature Review In the paper, The Study of Nursing Documentation Complexities, published in International Journal of Nursing Practice in the year 2006, Cheevakasemsook, Chapman, Francis, & Davies explore the complexities in nursing documentation and related factors. The authors explore the historical information to establish the purposes and importance of nursing documentation and claim this to be one of the most important functions that the nurses do. The relevance of meticulous documentation in the current healthcare practice is nothing less since documentation ensures continuity of care, provides legal evidence of the care process, and is a means to ensure quality control. However, recent evidence demonstrates that these objectives have not been achieved due to complexities in this process. By both qualitative and quantitative methodologies, the authors explore the issues related to complexities in the nursing documentation and related factors. By multiple methods of inquiry, the authors could explore the reasons for complexities in nursing documentation. They have also undertaken an extensive literature review for framing the hypothesis, and the methodology of the research is also based on existing literature in this area. The three aspects that could be identified were disruption, incompleteness and inappropriate charting. Related factors that influenced documentation were limitations in incompetence; limitations in motivation and confidence; ineffective nursing procedures; and inadequate nursing audit, supervision, and staff development. They concluded from these findings that complexities in nursing documentation require extensive resolution, and they could frame suggestions for improving practice in this area (Cheevakasemsook, Chapman, Francis, and Davies, 2006). Documentation should relate outcomes to the nursing diagnoses and collaborative problems, describe the patient's responses to the interventions, indicate whether the outcomes were met, and include any additional pertinent data (Stockhausen & Conrick, 2002); (Roberts & Taylor, 2002). The section of the literature review in this study points out that there is much variation in the form and the content of the data recorded by the nurses. Frequently, the flow to the recorded data is not organized, and there is always a possibility that some pertinent and absolutely essential data would be missing (Schneider, Elliott, Beanland, LoBiondo-Wood, & Haber, 2003). The literature review also pointed towards the means to investigate the issues and factors involved in such complexities by means of in-depth interviewing; participant observation; nominal group processing; focus group meetings; time and motion studies of nursing activities; and auditing of completeness of nursing documentation. Hence the purpose statement of the authors is to elicit those complexities that may be similar or identical to the realities of the complexities in the international context. Both qualitative and quantitative inquiry through several methods as dictated by this review can thus be used to confirm the actual complexities in the specific nursing documentation system being researched. These findings may instigate further research to find a solution of these complexities that are hindering appropriate documentation, and may also assist in dealing with the issues that would improve the quality of care and documentation. Ethical Concepts in Health-Related Research The most important aspect of research is that it must be ethical, although the ethics of research are complex. The two things that are disputed by none are that, all research has ethical dimensions and all research must be ethical. The conduct of research with human beings has the potential of imposing strong moral obligations on nurse researchers especially in the light of genetic advances and the use of human biological materials in research. Once the ethics of the research have been approved by the review board or its equivalent in the institution, it is customary to select the participants (Limb, 2001). Rules derived from the principles of respect for persons translate into requirements to obtain informed consent under their free wills and to respect the privacy of the research subjects. The principles of beneficence require that the researcher use the best possible research design to maximize benefits and minimize harm (Taylor, Kermode, and Roberts, 2006). The ethical dimensions of the research process must ensure the protection of the participants by taking extreme caution in preserving confidentiality, anonymity, safety, and the right to withdraw from the research at any time. Schelbred and Nord published their study "Nurses' experiences of drug administration errors" in the Journal of Advanced Nursing in 2007. This paper reports a study that was approved by Regional Research Ethics Committee and describes the experiences of nurses who had committed serious medication errors. The implication of this approval is apparent from the previous paragraph where the power of the ethics committee is explicitly explained. This indicates that the research was under constant control and surveillance of the appropriate authority to make sure that the things are all right. Potential participants were given written information about the study. The authors also obtained written consent to participate. This conforms to the ethical paradigm of any research in that persons interested in participating in study should be given a detailed verbal and written description of the study and be informed specifically about what the participation in the study entails. In fact, a person's choice to participate in a study should have no effect on his/her future. In this study, the authors emphasized confidentiality of all information to be discussed before beginning the interviews. They also informed the interviewees of their rights not to answer any questions if they wished so, and how they are able to stop the interview at any point. These instructions are all included in the consent, and a copy of the signed consent would need to be given to the participants. The consent form must include details about the specifics of the study for the protection of the participants as well as the risks and benefits of participating in the study. The main point here is to protect the participants' welfare and rights, and to be able to do that, a full disclosure of the study's processes, purposes, and intents must be given while honoring the participants' rights of privacy, confidentiality, and anonymity. The last section in the present literature review indicates that the study followed the ethical norms and standards with allowance of total autonomy to the participants. This indicates that the study is ethically sound (Schelbred and Nord, 2007). Qualitative Research Design and Method Qualitative researchers emphasize the following six significant characteristics in their research. First, they believe in multiple realities concerning a single issue or research question. Secondly, the qualitative research method has a commitment to identifying an approach to understanding that supports the phenomenon being studied. This method also demonstrates a commitment to the participants' viewpoints. Thirdly, the inquiry in qualitative research is conducted in a way that limits disruption of the natural context of the phenomena of interest. Fourthly, qualitative method acknowledges the participation of the researcher in the research process, and the reporting of the research happens in a literary style with participant commentaries. In the fifth place, the fundamental beliefs of the qualitative studies are that multiple realities exist for a phenomenon, and they create meanings for the studied individuals, and the research directs attention to the human realities in place of concrete objective realities. Therefore, to understand a particular situation, the researcher tends to view the phenomenon from different perspectives, and thus it is discovery through multiple ways of understanding. In many cases, more than one data collection method may be necessary to fully comprehend a research question. Finally, qualitative research methods are selected based on the phenomenon of interest. This involves initial study of the phenomenon and then deciding whether to initiate a qualitative study. All qualitative approaches share a similar goal in that they seek to arrive at an understanding of a particular phenomenon from the context of those experiencing the phenomenon, and objectivity serves no purpose. The researcher is the observer, interviewer, and the interpreter of various aspects of a qualitative study. The rigor in a qualitative research is associated with openness, scrupulous adherence to the philosophical perspective, thoroughness in collecting data, and consideration of all the data in the subjective phase of theory development (Polit & Beck, 2004). In the article, "Safer injections, fewer infections: injection safety in rural north India", the authors, Kermode, Holmes, Langkham, Thomas, and Gifford, investigated the complex reasons of structural, economic, and socio-cultural factors for nurses' unsafe injection practices that is a potential predisposing precipitating factor for potentially preventable blood-borne viral disease, and the main objective of the authors is to identify appropriate intervention strategies. The method of the research article clearly describes the study design. In this case, it was a qualitative study design involving multiple methods that comprised of participant observation and in-depth interviews. The reader has no problem in understanding how this study was conducted and is able to evaluate the methods and determine its reliability and validity. The authors describe in detail the methods of data collection and analysis in a very explicit manner so that these could be reproducible in an identical setting. The method section has been divided into subsections and includes detailed description about the participants, their inclusion and exclusion criteria as relevant to the study design. In the data collection and analysis section, the authors acknowledge that a trained nurse was an involved observer. This meets the criterion for a qualitative study since researcher bias in reporting data would be a factor in this study. In this section, the authors also describe that the participation was mostly in the form of observation, interaction, or assistance. This section also comprises detailed description of the participants, apparatus, and procedures. Information under the subsections was relevant without any questions remaining. The authors articulated the subject who was not willing to participate in the study. They also clearly indicated the number of participants, their characteristics, and the selection process. However, their representativeness was not clear and may not be accepted by all. The demographic information was tabulated in table 3 in a concise manner. The apparatus and function used in the study were described with the experiment explained. Finally, the authors fully described the instruments and the analysis, enabling the reader to fully understand the researchers' intent to measure, and this has increased the internal validity of the study. The method also summarizes all instructions given to the participants including the formation of groups and findings from each group (Kermode, Holmes, Langkham, Thomas, and Gifford, 2005). Conclusion Critical analysis skills are very important for nurses. The present nursing practice is evidence-based, where evidence is to be extracted from research. Evidence-based practice is considered to be standards of practice, and for the nurse to be able to improve the quality of care of the patients, it is important to update the knowledge in order to exercise self-development. It appears that exposure to relevant nursing research is important. Research articles are sources of evidence, but the nurse must know how to apply critical analysis skills in studying a research article. Any research article has a structure, and being conversant with that structure is important to extract evidence. The theoretical paradigm of nursing research is based on literature review, ethical principles, and methodology, may it be qualitative or quantitative. In this work, literature review, ethics, and methodology of three research articles have been done from that point of view, and this has provided this writer a new insight to study research articles so future practice becomes more evidence based and improved, enhancing quality of care in practice. Reference List Cheevakasemsook, A., Chapman, Y., Francis, K., and Davies, C., (2006). The study of nursing documentation complexities. International Journal of Nursing Practice 12(6): 366-74. Evans, D. (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12, 77-84. Goldenberg, M. J. (2006). On evidence and evidence-based medicine: Lessons from the philosophy of science. Social Science & Medicine, 62, 2621-2631. Kermode, M., Holmes, W., Langkham, B., Thomas, MS., and Gifford, S., (2005). Safer injections, fewer infections: injection safety in rural north India. Tropical Medicine and International Health, May 2005; 10(5): 423-32. Limb, M. (2001). Reading and understanding research reports. In Implementing research in the clinical setting. London: Whurr Publishers Ltd. Paterson, B. L., Thorne, S. E., Canam, C., & Jillings, C. (2001). Meta-study of qualitative health research: A practical guide to meta-analysis and meta-synthesis. Thousand Oaks, CA: Sage. Polit, D. F., & Beck, C. T. (2004). Nursing research: principles & methods (7 ed.). Philadelphia: Lippincott Williams & Wilkins. Pope, C., & Mays, N. (2004). Qualitative research in health care. London: BMJ. Rauhala A, Fagerstrom L., (2004). Determining optimal nursing intensity: the RAFAELA method. Journal of Advanced Nursing; 45: 351-59. Roberts, K., & Taylor, B. (2002). Nursing research processes: an Australian perspective (2 ed.). Southbank: Nelson Australia. Sackett, D. L., Straus, S. E., & Richardson, W. S. (2000). Evidence-based medicine: How to practice and teach. EBM. 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