This essay will consider the definition of nursing research, different types of research and design, and why research is important in nursing practice. It will also illustrate examples of research influencing practice, and make recommendations for current or future practice.
Nursing research can be defined as any scientific (i.e. systematic) enquiry into the effectiveness or value of nursing practice (Parahoo, 1997; Sullivan, 1998; Polit & Beck, 2004). It denotes any empirical evidence on which nursing care is based. This includes both quantitative and qualitative research evidence (Comack, 1996).
Qualitative research essentially entails analysis of individual subjective experience. It focuses on meanings and experiences as conveyed for example through philosophies such as grounded theory, phenomenology, discourse analysis, and experientialism (Coolican, 1994). Data collection is typically in the form of interviews, case studies, and systematic observation, while data analysis generally involves the identification of themes, for example through thematic analysis. Quantitative research relies on positivist philosophy, where only measurable phenomena are considered worthy of investigation. Randomised clinical trials (i.e. controlled experiments) are the preferred method of inquiry albeit questionnaire and archive-based surveys, in the form of retrospective or prospective designs, and other methodologies, may also be used. Data analysis is based on statistical tests (Howitt & Cramer, 2005).
Why is research important? Given the growing emphasis on evidence-based practice in nursing care across the Western world (Sullivan, 1998), there is a need for an ample body of accumulated empirical evidence to which nurses can refer in order to inform clinical practice (Polit & Beck, 2004). Any responsible and accountable vocation claiming to be a profession, and answerable to a professional body, requires an empirical evidence base. This is the only way that standards of practice can be evaluated and improved, for the benefit of the general public. The value of empirical evidence, as contrasted with casual observation and anecdotes, is that it is systematic and typically obtained under controlled conditions. Research enables nursing practice to keep pace with a rapidly changing world in which health care practices must continually improve to meet changing and ever more demanding patient expectations and requirements (Eastabrooks, 1998). Only through continued research activity can appropriate evidence-based ‘best practice’ guidelines be introduced to ensure the good quality nursing care (Ring et al, 2005).
Examples where research influences nursing practice aren’t difficult to find (Polit & Beck, 2004). A review of electronic databases such as Internurse, High-Wire Press, Science Direct, and Academic Search Premier, yields an abundance of quantitative and qualitative studies on nursing practice. Five varied examples are as follows, including both quantitative and qualitative research; Meyer et al (2002); Barr et al (2005); Hughes & Umeh (2005); Ring et al (2005), and Lee & Knight (2006).
Meyer et al (2002) conducted a randomised clinical trial contrasting the effectiveness of two different bandaging techniques nurses use for treating venous leg ulcers. The study showed that ulcers treated with higher compression bandaging didn’t heal any quicker than ulcers administered lower compression bandages.
Barr et al (2005) studied archived data of all self-harm patients who presented at A & E units over a given period, to ascertain the extent to which nurses carry out psychosocial assessment. It emerged that nurses do not always conducted psychological evaluations, as stipulated. However, patients were more likely to be assessed if they were considered ‘high risk’.
Hughes and Umeh (2005) studied stresses experienced by nurses at work. Extremely heavy and stressful workloads can impair the quality of nursing care, for example by increasing the frequency of sick leave. Certain nursing groups may be more susceptible to stress, with implications for clinical practice. This study was based on a questionnaire survey, administered to general and psychiatric nurses. Analysis revealed that general nurses experienced more stress than their psychiatric counterparts, notably in the absence of social support from colleagues, friends, and family.
Ring et al (2005) employed a qualitative design to evaluate the degree to which nurses adhere to best practice statements (BPS) in clinical practice. BPS reduce variations in the quality of care patients receive, and hence is a fundamental component of clinical practice. The methodology involved conducting semi-structured interviews with a small group of registered nurses involved in the formulation of BPS. Several themes emerged from the data, indicating considerable variation in the implementation of BPS.
Hareendran et al (2005) also used a qualitative method. This study aimed to establish the effect that venous leg ulcers may have on a patients’ quality of life. Patients suffering from venous ulcers attended semi-structured interviews and completed a questionnaire. Interview transcripts showed that ulcers caused uncomfortable symptoms (e.g. itching, pain, interrupted sleep) in the majority of patients. Furthermore, one-half of patients were dissatisfied with the quality of care they received.
Clearly, these examples illustrate how research evidence can influence clinical practice. For example, Meyer et al’s (2002) study could facilitate understanding of the impact of bandaging, and improve care delivery, such that ulcer patients aren’t unnecessarily inconvenienced by highly compressed bandaging which clearly isn’t going to speed up recovery. Hughes and Umeh’s (2005) study may lead to better redistribution of workloads, and more potent social support systems, thereby maintain the quality of care nurses dispense.
Despite the advantages, there are significant barriers to research utilisation. Consider the notion of best practice guidelines. These are standards firmly rooted in empirical research, consistent with ethos of evidence-based practice. However, nurses have identified considerable hindrances to such evidence-based practice (Polit & Beck, 2004), including a lack of resource, deficient training, a general apathy towards change amongst nursing staff, multidisciplinary issues that are difficult to resolve, and a lack of inspirational clinical leadership at local level (Ring et al, 2005). One way to resolve these hindrances is clearly by improving nurse training, for example, in how to translate raw research findings into practice, and/or liase with other health professionals in working out how best to implement a best-practice statement. Nurses can also be encouraged to form and/or join a journal club (Wikipedia, 2006). This is essentially a group of individuals who convene on a regular basis to review recent empirical findings and perhaps work out feasible modalities to translate evidence into practice.
Overall undertaking rigorous research and translating evidence into practice are indispensable elements in the development of any profession, and nursing practice is no exception. On a positive note there is continued (and growing emphasis) on evidence-based nursing practice, supported by both the Department of Health, and Nursing & Midwifery Practice Development Unit (NMPDU). Despite inconsistent implementation, nursing care is likely to continue to benefit from empirical research. However, on a less optimist note, a review of nursing research indicates a paucity of randomised clinical trials. The bulk of empirical evidence appears to be based on less rigorous research methodologies, making it difficult to establish causal relationships. For example, although qualitative evidence has revealed potential barriers to research utilisation, it isn’t certain there is a causal link between these factors. Future research needs to redress this imbalance.
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