Evaluating Research for Evidence-Based Nursing Practice

337 Pages·2008·4.66 MB·English

by  Jacqueline Fawcett

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Evaluating Research
for Evidence-Based
Nursing Practice
JACQUELINE FAWCETT, PHD, FAAN
JOAN GARITY, EDD, RN
College of Nursing and Health Sciences
University of Massachusetts, Boston
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Library of Congress Cataloging-in-Publication Data
Library of Congress Cataloging-in-Publication Data
Fawcett, Jacqueline.
Evaluating research for evidence-based nursing practice/Jacqueline Fawcett, Joan Garity.
p.; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-1489-5 (alk. paper)
1. Nursing—Research—Evaluation. 2. Evidence-based nursing. I. Garity, Joan. II. Title.
[DNLM: 1. Nursing Research—methods. 2. Evaluation Studies as Topic. 3. Evidence-Based Medicine. WY 20.5
F278e 2009]
RT81.5.F39 2009
610.73—dc22
2008016804
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Dedication
To my husband, John S. Fawcett,
for his love and his willingness to support
my passion for writing about the conceptual,
theoretical, and empirical components
of nursing research.
Jacqueline Fawcett
In memory of my parents, my first teachers,
who encouraged me to be a lifelong seeker of
knowledge and teaching-learning opportunities.
Joan Garity
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Preface
Nursing research is conducted to generate or test middle-range theories, which provide the
evidence used for all phases of the nursing practice process, including assessment, planning,
intervention, and evaluation. Although a considerable amount of research that is relevant for
nursing practice already exists, students and practicing nurses do not yet routinely evaluate
that research. We believe that the lack of attention to existing research stems from lack of
understanding of the criteria used to evaluate reports of research in a systematic manner.
This book presents a comprehensive framework of criteria for the evaluation of reports of
nursing research. The framework incorporates the components of conceptual-theoretical-
empirical (C-T-E) structures for nursing research, with emphasis on the middle-range theories
that are the product of all types of qualitative and quantitative research designs. We have
placed middle-range theories within the context of their parent conceptual models of nursing
and the empirical research methods used to generate and test the theories.
Although written specifically as a text for a baccalaureate-program nursing research course,
this book is appropriate for all nursing students and practicing nurses who want to learn how
to evaluate reports of nursing research for evidence-based practice. The book contents are the
result of our many discussions while revising and co-teaching an undergraduate nursing
research course at the University of Massachusetts, Boston. We wanted to demystify the
research process and infuse our students with a lifelong learning approach to evaluating and
utilizing nursing research. Demystifying research for undergraduate students, as many faculty
have discovered, is a major challenge. Students express their concerns about nursing research
with comments such as: “I get anxious just thinking about research.” “I’m not very good at
math, so I’m worried about how I will do with the statistics.” “Reading a research article hurts
my head.” “Will I really use this material in my nursing practice?”
Throughout the book, we have focused exclusively on the evaluation, rather than the con-
duct, of research. In doing so, we have found that the book contents eliminated many of our
students’ concerns about nursing research and facilitated their ability to understand and eval-
uate the conceptual, theoretical, and empirical components of published research reports.
We recommend that the book be read in the order in which the content is presented. The
book is divided into five parts. Part One introduces the reader to our view of the world of
nursing research, including the ideas that:
• research is equivalent to theory development,
• theory is equivalent to evidence, and
• practice is equivalent to research.
In Chapter 1, we provide definitions of research, theory, evidence, and evidence-based prac-
tice, and we explain why research is conducted, the links between research and theory and
theory and evidence, and the link between the nursing practice process and the nursing research
process. In addition, we discuss various sources of knowledge, various types of theories, and the
v
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vi Preface
type of evidence that each source of knowledge and each type of theory provides. In Chapter 2,
we introduce the idea of C-T-E structures for theory-generating research and theory-testing
nursing research. In Chapter 3, we describe the contents of typical research reports and explain
where to find each component of the C-T-E structure in them. In Chapter 4, we present our
comprehensive framework of criteria for evaluation of C-T-E structures for nursing research.
Part Two focuses on the conceptual and theoretical components of C-T-E structures for nurs-
ing research. In Chapter 5, we introduce readers to the criteria to evaluate the conceptual model
used by the researcher to guide a theory-generating or theory-testing study. In Chapter 6, we
identify and describe the criteria used to evaluate the middle-range theory that was generated or
tested. Tables containing summaries of several conceptual models of nursing and nursing grand
theories, as well as research focus guidelines and research methods guidelines for those concep-
tual models and grand theories are in the Chapter 5 files on the CD that comes with this book.
Tables containing lists of middle-range theories developed by nurses and members of other
disciplines are in the Chapter 6 files on the CD.
Part Three addresses the empirical research methods component of C-T-E structures for
nursing research. The six chapters address the criterion for evaluation of the five elements of
empirical research methods: research design (Chapter 7), samples (Chapter 8), research instru-
ments and experimental conditions (Chapter 9), procedures for data collection and protection
of research participants (Chapters 10 and 11, respectively), and data analysis techniques
(Chapter 12). A special feature of Part Three is the discussion of both qualitative and quanti-
tative research in each chapter and the categorization of research as descriptive, correlational,
or experimental. Due to our special concerns about the ethical aspects of research, Chapter 11
highlights the parallels between the research-relevant content of the American Nurses’
Association Code of Ethics and research ethics codes, including the Nuremberg Code, the
Declaration of Helsinki, and the Belmont Report, as well as the research implications of the
Patient’s Bill of Rights.
Part Four returns attention to the theoretical and conceptual components of C-T-E structures
and completes discussion of the framework for evaluation of C-T-E structures. In Chapter 13, we
discuss the criterion used to evaluate research findings. In Chapter 14, we present the criterion
used to evaluate the utility of the middle-range theory for practice. A highlight of Chapter 14 is
a decision tree that illustrates the options for use of a theory in practice, including whether the
middle-range theory requires additional study, should be used in practice, could be tried in prac-
tice, or should not be used. In Chapter 15, we identify the criterion used to evaluate the utility
and soundness of the conceptual model that guided the research.
The single chapter in Part Five of the book focuses on integration of research and practice.
Specifically, in Chapter 16 we discuss strategies that all nurses can use to bring evidence-based
practice to life by integrating nursing research and nursing practice.
Throughout the book, we emphasize three questions about information contained in pub-
lished research reports:
Whereis the information?
Whatis the information?
How goodis the information?
We provide numerous examples drawn from existing research reports to facilitate readers’
understanding of the where, what, and how good of information. The examples we selected
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Preface vii
encompass a large number of qualitative and quantitative research designs. Many of these
examples are given in the chapters, and additional examples are given in detailed tables that
are found on the CD that comes with this book. The tables for Chapters 8 through 15 pro-
vide information on every research design introduced in Chapter 7. Other files found on the
CD include an example of a complete research report (Chapter 3), directories for research
instruments (Chapter 9), templates for evidence-based practice papers for practice tools and
intervention protocols (Chapter 14), and a searchable bibliography of nursing conceptual
model-based research with instructions for searching that literature. In addition, the CD
includes a complete list of all references cited in the book. The reference list is also printed at
the end of the book.
In addition, the CD includes learning activities, practice examination questions, and
PowerPoint slides for each chapter. We designed learning activities and practice examination
questions that should help readers to understand how to apply the content of each chapter in
diverse ways. The PowerPoint slides for each chapter can be used as the basis for personal notes
about chapter content.
We designed the book contents and the CD files to help the students, faculty, and practic-
ing nurses who will use this book to better incorporate the evaluation of nursing research into
their varied practice settings. We are mindful, given the present faculty shortage, that faculty
with diverse educational backgrounds may be asked to teach nursing research to diverse
students in a variety of settings. We have endeavored to include enough information so that
faculty will be able to competently help students learn how to evaluate reports of nursing
research using only this one book.
We hope that all readers of this book will embrace evaluating C-T-E structures for theory-
generating and theory-testing research. We also hope that readers will become expert evaluators
of research reports and, given the sound foundation provided by this book, be better
prepared to pursue graduate education and learn how to conduct rigorous nursing conceptual
model–based, theory-generating and theory-testing research that will enhance the health-
related quality of life of all people who come to nurses for care.
The writing of this book was enlightening. Despite many years of experience conducting
our own research, we learned a great deal about research as we wrote each chapter. Our pas-
sion for research and our conviction that research is conducted for the sake of theory develop-
ment only increased as we wrote successive drafts of the chapters. A particular challenge was
to convey our idea of C-T-E structures for research in a way that readers would understand.
Our students’ comments and their performance on course examinations indicate that we have
been successful; we hope that all of our readers will agree.
The mountains depicted on the cover of this book symbolize nurses’ efforts to understand
and promote research and evidence-based practice, as well as our own efforts to write a book
that can serve as a comprehensive reference for evaluation of C-T-E structures for research. We
acknowledge the continuous support and encouragement that we received from many col-
leagues and friends from inception to completion of our book. We are indebted to our stu-
dents and colleagues at the University of Massachusetts, Boston for their support, intellectual
challenges, and constructive criticism. We would like to especially acknowledge the contribu-
tions to our thinking about nursing research offered by our colleague Susan DeSanto-Madeya,
the contributions to our understanding of statistics by our colleagues Laura Milliken and
Jie Chen, and the contributions to ways to teach nursing research offered by our colleague
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viii Preface
Sheila Cannon. We gratefully acknowledge the opportunity given to us by Cynthia Aber, our
Nursing Department Chairperson, to teach an undergraduate nursing research course. We also
acknowledge the assistance of Amanda Hall of Waldoboro, Maine, who helped us compile the
conceptual models of nursing bibliographies. We are indebted to Joanne P. DaCunha of
F. A. Davis Company for her encouragement and the time spent discussing the content and
design of this book, to Barbara Tchabovsky for her superb editing of every chapter, and to
Padraic J. Maroney for all he did to facilitate production of the book.
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Reviewers
Robert Atkins,PhD,MSN,BSN,BA Maryellen McBride,PhD(c),ARNP,BC,
Assistant Professor CARN
Rutgers University Assistant Professor
Newark, New Jersey Washburn University
Topeka, Kansas
Martha C.Baker,PhD,RN,APRN-BC
Director, BSN Program Mary Ellen Mitchell-Rosen,BSN,MSN,RN
Southwest Baptist University Assistant Professor
Springfield, Missouri Nova Southeastern University
Fort Lauderdale, Florida
Elizabeth W.Black,MSN,CSN
Assistant Professor Mario R.Ortiz,RN,PhD,CNS
Gwynedd-Mercy College Assistant Professor
Gwynedd Valley, Pennsylvania Purdue University
Westville, Indiana
Lucille C.Gambardella,PhD,RN,CS,
APRN-BC,CNE Mary E.Partusch,PhD,RN
Chair and Professor, Department of Nursing Professor
Wesley College Nebraska Methodist College
Dover, Delaware Omaha, Nebraska
Nancy C.Goddard,RN,MN,PhD Christine E.Pilon-Kacir,PhD,RN
Nursing Instructor Professor
Red Deer College Winona State University
Red Deer, Alberta, Canada Rochester, Minnesota
Adjunct Assistant Professor
Janice Putnam,RN,PhD
University of Alberta
Alberta, Canada Associate Professor
University of Central Missouri
Kristen Gulbransen,RN,BScN,MN
Warrensburg, Missouri
Nursing Educator
Debra L.Renna,MSN,CCRN
Red Deer College
Red Deer, Alberta, Canada Instructor
Keiser University
Susan M.Hinck,PhD,RN
Fort Lauderdale, Florida
Associate Professor
Charlene M.Romer,RN,PhD
Missouri State University
Springfield, Missouri Associate Professor
Clayton State University
Violet Malinski,BS,MA,PhD
Morrow, Georgia
Associate Professor and Graduate Program
Director
Hunter Bellevue School of Nursing
New York, New York
ix