What is the goal of nursing research?

Is nursing research worthwhile if it is not applied in bedside care?

A generally agreed upon definition of evidence based practice (EBP) consists of clinical expertise, patient preferences, and care decisions based on proven research. Through a problem solving approach its goal is to increase the quality of care and patient outcomes. In the early years of EBP, discussion centered around what was considered evidence.

There were two sides in the discussion: one which defined evidence strictly as scientific data and results of clinical trials, and others who believed a broad definition of evidence would better serve the nursing profession. It has evolved beyond that beginning question. Evidence is scientific proof of what works best or what empirical evidence supports clinical decision making. For example does taking blood pressure and pulse every 4 hours even to the point of interrupting the patient’s sleep prevent or detect a changing medical condition? EBP encompasses the most current scientific findings, patient care data, values and preferences, as well as nurse expertise.

For evidence based practice to have a positive effect on care nursing scholars say its definition must include more than research findings and practice protocols. Nursing is comprised of more than those two factors. The intangibles factors of nursing do not make them invalid. Yet the intent of evidence based practice can elevate nursing. To what extent has it done that in the last decade and a half? Is evidence based practice a destination or a journey?(1)

Indeed it is difficult to effect change in any profession and nursing is no exception. How to bring research and knowledge to bedside care? Studies have shown that nurses view evidence based practice positively but there is still a disparity between the positive attitude and how often research is applied in practice. There are a number of reasons for this gap. Often an important reason for the research practice gap is the lack of time in the typical workday of a nurse. Current discussion seeks to give nurses the tools, confidence, and skills to apply EBP. Healthcare organizations can foster a positive attitude towards evidence based practice with support both in spirit and with tangible means.

If nurses know that management looks favorably on investigation and inquiry they will be more inclined to suggest improvements and innovations. If infrastructure is in place where nurses can readily access research that helps them in their clinical decision making EBP will occur more readily. If nurses are given paid time to access research, foster discussion, mentorship and to share experiences and ideas this would allow research to increase the quality of nursing.

It is about creating a culture in a medical center where research, clinical expertise, and patient preference help clinical decision making all within a caring environment. Studies have shown that nurses have increased job satisfaction when there is evidence based practice. This is due in part to increased autonomy in practice.

Proven strategies are needed to help nurses integrate evidenced based practice into nursing at the bedside. Interprofessional collaboration is one avenue to explore. If mentorship and training are available then that helps bring research into practice. Nursing associations can and have supported evidence based practice by building capacity and drafting valid guidelines.

Questions that can further the implementation of evidence based practice are as follows: How effective was the newly applied evidence based practice? What was the ease or difficulty in implementation of the research? Did the change result in any unintentional harm to the patient or system? Were the costs to implement sustainable in the long run. Was the EBP well accepted by staff?

Nurses can use these questions as a foundation in their journey to EBP: Which of my practices are based on evidence and which are not supported by evidence? What is the best way and time to reflect on my current clinical practices? Where can I locate the best evidence to answer the questions my reflection has produced? Who can help me advance my EBP knowledge, skills, and practice? How can I develop more skill in EBP and assist in its implementation with my peers?

One area in research currently being developed is improvement science or quality improvement research. This new area seeks to develop methods that evaluate the effectiveness of EBP, innovations and improvements by valid measurements.

The nurse’s expertise and clinical judgment skills will still be the deciding factor in patient care. The priority given to each component of EBP will depend on the patient situation. For example, if the presurgery protocol for a child calls for nil by mouth for 4 hours prior the nurse caring for that patient will use her judgment whether to wake the child if surgery is in the morning. He or she will consider many factors in the decision, such as whether the child would be anxious because he or she was woken, the weight and age of the child, whether there is likely to be a delay in the time of surgery etc. The protocol will be but one factor in her clinical decision for the child.

Expertise is not solely due to EBP; it is clinical judgment in action. It is not possible to reduce nursing to only measurable outcomes because nurses are skilled in seeing people and situations holistically and dealing with them in a personalized manner that must take into account the patient’s view of health care.

In answer to the opening question of this article, the point of nursing research is to provide a scientific foundation for reliable high quality care. EBP can help nurses to provide that care. Strategies need to be developed that increase the understanding of how knowledge is transferred and used. EBP can become more widely disseminated to close the practice theory gap but support needs to start at the organization level. For example, a nurse in a surgical unit notices that in a span of a few months patient acuity is higher, and in those few months there have been three or more cardiac arrests with four deaths. This nurse shows her supervisor a published report on rapid response teams and how their implementation has decreased in hospital cardiac arrests and unplanned ICU admissions. Her supervisor encourages her to find more evidence that supports this innovation with the view towards possible implementation in the near future. .(2)

It is this constant quest for improvement that is the hallmark of expert nursing

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