The Nuts and Bolts of Orthopaedic Nursing Research Dawn Denny, PhD, RN, ONC Disclosures Conflict of Interest I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect significantly my views on the subject on which I am presenting. Learner Outcome Approach orthopaedic nursing research in the professional work environment or practice setting with greater confidence Create appropriate practice generated research questions Objectives 1. Discuss the role of evidence-based decision-making in orthopaedic nursing practice 2. Apply the evidence-based practice process to orthopaedic nursing practice 1
Polling Question 1 Which best describes evidence-based practice (EBP) in your work environment? A. EBP has not yet been discussed. B. EBP has been discussed, but actual implementation into the clinical setting has not yet occurred. C. EBP is considered a good thing, but actual implementation of best practice is inconsistent. D. EBP has been integrated into the culture in my work setting. Background/Rationale Driving Forces behind Evidence Based Practice (EBP) Focuses on safety and improved patient outcomes Health care clinicians should have is the ability to employ evidencebased practice (National Academy of Science, 2003) Source: Retrieved from http://www.nationalacademies.org/hm d/reports/1999/to-err-is-human- Building-A-Safer-Health-System.aspx Definition of Research Research Approaches The diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge (Grove, Burns, & Gray, 2013, p. 1). Nursing research: Systematic inquiry relevant to the nursing profession Qualitative Experiences Quantitative Variables EBP 2
Research and the Scope of Practice for Orthopaedic Nurses The Orthopaedic Nurse applies research and evidence-based practice in the various clinical practice settings (Harvey et al., 2013, p. 144) Tips for Getting Started 1. Start reading research reports 2. Mark up your copy Highlighted significant statements Source: Pixabay.com [Public Domain]. Retrieved from https://pixabay.com Question marks by statements that do not fit with previous statements in the article What credentials are needed to implement evidence-based practice in the clinical setting? What is Meant by Evidence? Foundation on which beliefs and proofs are established. A pathway to clear and organized proof on a given topic (Boswell & Cannon, 2014, p. 445) Source: Rocketclips, Inc., via Dreamstime.com. Used with permission. Retrieved March 29, 2016 from http://www.dreamstime.com/rocketclips_info.) A Passion for Improving Patient Outcomes 3
Sources of Evidence Evidence from Research Individual Studies Summaries of Studies Evidence Based Guidelines Evidence Based Protocols Building Practice Knowledge through Evidence Findings from Individual Studies Systematic Research Reviews Evidence- Based Guidelines Quality Data Patient Values Nurse Experience Evidence- Based Protocols Clinical Practice Guidelines Expert opinion Example Evidence-Based Guidelines The NAON Clinical Practice Guideline for Surgical Site Infection Prevention. http://www.orthonurse.org/p/pr/vi/prodid= 121 Evidence-Based Decision Making: What is it? 4 Apply Evidence to Practice 1 3 2 Appraise the Evidence Search for Evidence Ask Clinical Question (Brown, 2018) 4
Why is Evidence-Based Decision- Making Important? Instills confidence in the quality of care provided to patients among: Patients Healthcare professionals The agency 3 rd party payers Accrediting agencies (Brown, 2018) Polling Question 2 An evidence-based protocol provides a recipe for care that should be provided to patients? (True/False) A. True B. False Evidence-Based Protocols A set of care actions for a patient population that has been endorsed by the hospital, agency, clinic, or healthcare facility (Brown, 2014, p. 10) Closing the Practice-Research Gap Patient care decisions based on research evidence Evidence-based protocols help to bridge gaps Protocols Recipes Evidence from Research Evidence- Based Protocol Evidence -Based Practice 5
Polling Question 3 How would you respond if a nurse colleague asked you to assist in the planning a research project in your unit? A. Decline B. Reluctantly accept with reservations C. Accept with anticipation D. Accept and suggest a clinical problem that needs attention Step One Formulate a clinical question and search the literature regarding a problem to be solved. Asking Clinical Questions I Wonder Asking what could be done better in the delivery of patient care Source: [Public Domain]. Retrieved from http://foresthillsnortherntechnology.wikispaces.com/blogging+in+the+class room I read a research article and the study found. Have you noticed that. (Brown, 2018) At NAON Congress I went to a session where they said. 6
Use PICO to Form the Clinical Question The question: Must be researchable through data collection and analysis PICO to Focus a Evidence-Based Project Patient Population what age, illness, or risk factors? Intervention intervention or issue Comparison Group compare intervention with usual care Avoid ethical questions Source: [Public Domain]. Retrieved from http://ccar.wikispaces.com/t3+activities Outcomes outcomes needed for practice Timing in terms of clinical status, duration, and frequency (recommended, not required) (Boswell & Cannon, 2014) (Sackett, Straus, Richardson, Rosenberg, & Haines as cited by Brown, 2018) Practice Clinical Question 1 What nonpharmacological measures (I) should nurses use to reduce pain, discomfort, and agitation (O) in older adults with dementia (P) during, and after ambulation following hip fracture surgery (T)? Practice Clinical Question 2 Was music or aromatherapy more effective (I and C) in controlling pain during and after ambulation (T) in older adults following total hip replacement(p)? 7
Resources Free Health Science Databases PubMed MedlinePlus Trip National Guideline Clearinghouse Cochrane Collaboration Professional Nursing Organizations Librarian Support for Evidence- Based Practice Ask your Librarian to help: Locate & delivery of full-text Locate evidence-based guidelines Develop your clinical question Find electronic resources And much more! (Eresuma & Lake, 2016) What Types of Evidence Should I Search for? Start by searching for: Evidence-practice guidelines Meta-analysis, systematic reviews, integrative reviews Individual research study reports Search: How Do We Start the Search of the Literature? Select your search terms Example Pain Music Fractures Source: [Creative Commons]. Retrieved from http://nunesjanilton.blogspot.com/2011/05/liberdade-de-escolha.html 8
PubMed Search Basic Search Strategy Boolean operators between terms AND [default] OR NOT Use of filters (time, sex, language, etc.) Source: [Public Domain] Retrieved from https://commons.wikimedia.org/wiki/file:sy stem-search.svg Using AND in the Search Music Results Pain Fractures Using OR in the Search Using NOT in the Search Music Results Music Results Pain Fractures Pain Fractures Pain NOT music NOT fractures 9
Search Recommendations Age Gender Procedure Search Filters The best way to learn is to TRY!!! Need help? Consult your librarian Polling Question 4 In the research context, population refers to: A. The patient group to whom study findings are intended to apply B. The patient group who agrees to participate in the study C. The patient group who receives the experimental treatment D. The patient group from whom complete data is collected Step Two Appraise the quality of search results for quality. 10
Appraisal of Evidence Questions to ask Can the results or recommendations be trusted? Are the results clinically significant? Do they apply to patient care? Relevance and fit to a particular situation (Brown, 2018) Research Study Designs 1. Intervention study: data collected in controlled setting Experimental Outcomes between study group and control group are compared Study Group Study Group Control Group Control Group Research Study Designs 2. Observational study: data collected in natural environment ( Bias) Types Prospective study to determine what will happen Step Three Retrospective study to determine what has happened Design the Project to Answer the Clinical Question. Implement the Evidence-Based Change 11
Study Design Step Four Design a study based on the clinical question Method should be appropriate for the question Variables Dependent the measurable outcome Independent accounted for (manipulated) Measure Outcome Variable and Compare Results to the Variable Prior to Implementation of the Protocol Polling Question 5 What advice would you give a nurse who wants to incorporate research evidence into her nursing practice? A. Only clinical trials can be trusted for use in evidence-based practice. B. To begin, select a moral issue you are concerned about from your practice. C. Searches of evidence must be completed by a qualified librarian. D. Participating in Journal Club may help you get started. Obstacles to Evidence-Based Practice Applying research to practice is complex Education Beliefs/attitudes Support/resources (Brown, 2018) 12
Conclusion Utilizing evidence-based decision-making is crucial in orthopaedic nursing practice in order to improve patient outcomes. A passion for improving patient outcomes is the only qualification necessary to begin participating in research in your workplace Thank-you Dawn L. Denny, PhD, RN, ONC Assistant Professor College of Nursing & Professional Disciplines University of North Dakota Grand Forks, ND Dawn.Denny@UND.edu References Boswell, C., & Cannon, C. (2014). Introduction to nursing research: Incorporating evidence-based practice. Burlington, MA: Jones & Bartlett. Brown, S. J. (2014). Evidence-based nursing: The research-practice connection (3 rd ed.). Burlington, MA: Jones & Barlett. Brown, S. J. (2018). Evidence-based nursing: The research-practice connection (4 th ed.). Burlington, MA: Jones & Barlett. Eresuma, E., & Lake, E. (2016). How do I find evidence? Find the librarian stat!. Orthopaedic Nursing, 35(6), 421-423. Grove, S. K., Burns, N., & Gray J. R. (2013). The practice of nursing research: Appraisal, synthesis, and generation of evidence (7 th ed.). St. Louis: Elsevier. References Harvey, C., David, J., Eckhouse, D. R., Kurkowski, T., Mains, C., & Roberts, D. (2013). The National Association of Orthopaedic Nurses (NAON) scopes and standards of practice 3 rd edition. Orthopaedic Nursing, 32(3), 139-152. Lewenson, S. B., & Truglio-Londrigan, M. (2008). Decision-making in nursing: Thoughtful approaches for practice. Sudbury, MA: Jones & Bartlett. National Academy of Science. (2003). Health profession education: A bridge to quality. Washington, DC: National Academies Press. Pintz, C. (1998). Evidence-based decision-making. In S. B. Lewenson and M. Truglio-Londrigan (Eds.), Decision-making in nursing: Thoughtful approaches for practice (pp. 145-157). Sudbury, MS: Jones & Barlett. 13
References McCaffrey, R., & Locsin, R. (2006). The effect of music on pain and acute confusion in older adults undergoing hip and knee surgery. Holistic Nursing Practice, 20(5), 218-224. Pintz, C. (1998). Evidence-based decision-making. In S. B. Lewenson and M. Truglio-Londrigan (Eds.), Decision-making in nursing: Thoughtful approaches for practice (pp. 145-157). Sudbury, MS: Jones & Barlett. 14