Introducing Research and Evidence-Based Practice for Nursing and Healthcare Professionals

Jeremy Jolley

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000063318
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing

Research can seem difficult to get to grips with. However, at the heart of this new edition is the view that research is essentially a simple activity, the principles of which can be readily understood by students new to the subject.

Each chapter guides the reader to uncover the 'mysteries' of research, exposing each aspect in turn, while demonstrating how research in healthcare is a practical activity, orientated directly to patient care. Fully updated to refer to the latest sources and studies, the third edition includes:

a new chapter on systematic literature reviews;

a new chapter on research ethics;

a completely revised chapter on evidence-based practice which now focuses more tightly on the implementation of research and other forms of evidence.

This book is designed for all students of nursing and allied health professions at any level but who find themselves studying research for the first time. Research is illustrated through examples of activities familiar to students from their daily lives, which help build confidence in undertaking research and evidence-based practice.

Chapter 1

Research is simple

CHAPTER OBJECTIVES

The objectives for this chapter are to:

• suggest that research IS relevant to healthcare practice;

• show that research can be interesting and even fun;

• argue that although research looks complex, it is in fact readily understandable and you know a lot of it already.

Chapter outline

People often find it difficult to understand the real meaning of the terms ‘research’ and ‘evidence-based practice’. This chapter aims to make it possible for anyone to understand what these terms mean and why they are relevant to healthcare. In short, this chapter will help you make sense of what can sometimes seem a complex area of study. Research can seem to be complex, but this chapter will show you that research is really very simple. Indeed, this chapter will convince you that you already know about research.

What is research?

You are probably reading this because you have been asked to study research or evidence-based practice. Perhaps you have been asked to write your first research proposal. Research can seem complex, but it is actually little more than what you already do and what you already know. Fundamentally, research is simple, and this book aims to keep it that way.

Research is relevant to you and it is relevant to healthcare practice. In fact, research and practice are inseparable. Practice needs to be questioning, it needs to be seeking to find better ways to help people. Practice needs research. Indeed, research is similar to the questioning and investigative stance that clinical practitioners use all of the time. Think about it, when you first see a patient or client, you will want to talk with them, watch them and ask them questions. Your assessment of this patient isn’t haphazard or random; it is organised, it is systematic. This systematic approach to the gathering of information is not only similar to research, it is what defines research. Research is not just any haphazard collection of data; research is organised, thought-through and systematised – exactly like your assessment of a new patient. Furthermore, in your own practice you will use skills that are identical to the skills used in research. You will, for example, try to collect data that are rich enough (sufficient enough) for your purpose, and you will use data-collection methods that are purposeful and thought-through, just as in a research project. When you see a new patient, you use a face-to-face interview; you do not give them a questionnaire or get them involved in a focus group. So it is with research: research uses the most appropriate means of data collection, and that may be and often is exactly the technique you use when assessing a new patient.

Healthcare students do sometimes become confused about research. They find that they are unsure about what research is. Now we know why they are confused. Research is what practice is, and practice is what research is. No wonder students are confused, they are looking for something new to study when in fact they have been living and breathing it since the first day of their course. You already know about research; it is in every fibre of your enquiring mind and you can use it to contribute to nursing and make things better.

Let us be clear, you are studying research because you have a lively and intelligent mind; in fact, you have already acquired so much knowledge of research that you will not find your present studies difficult. Indeed, you already know most of the important principles of research.

Box 1.1 New words

Data (Datum) Values or factual information collected during research. Note that ‘data’ is plural, so that a researcher might say ‘these data are interesting’. The singular form is ‘datum’.

You may be concerned that you are not very good at mathematics; well, that’s no problem. Researchers need only to use computer applications that deal with numbers, as a word processor deals with words. Don’t worry if you are not good with numbers. Many researchers are not good with numbers either.

You may be thinking, ‘no, this isn’t me at all. I just want to know what needs to be done and how it’s done. I want to know the right way to do things and I want to be able to do everything in the time I have available within each shift’. You may be thinking, ‘what pleases me, is to be like the other nurses and to get jobs done efficiently’. To some extent, we all want to be an accepted member of our team. We all want to get everything finished on time. However, to grasp the fundamentals of research, we need to add something to our mindset; we want also to make things better, to be able to do a better job than we managed to do today. We need to accept responsibility for advancing nursing because that is what research is all about. Research is all about making a difference and improving our practice for the benefit of the patient.

Definitions of research

Scientific method

The scientific method is a sort of philosophical underpinning for everything we call science. It is very similar to clinical reasoning within the Nursing Process in nursing (Alfaro-LeFevra, 2013) and in other disciplines (Cooper and Frain, 2016) in that it is systematic and objective. It goes something like this:

1 the hunch (a gut feeling about a possible enquiry);

2 literature review to find out what is already known;

3 problem identification;

4 the hypothesis;

5 plan for research;

6 data collection;

7 data analysis;

8 discussion of results/evaluation.

Research

Research is any enquiry that is systematic in its approach and that seeks to ensure that the results of the enquiry cannot be criticised on the grounds of poor technique.

Evidence-based practice

Evidence-based practice is said to exist where there is a clear attempt to base clinical practice upon known evidence. Research evidence is usually the best form of evidence, but sometimes other forms of evidence are used.

Figure 1.1 shows the relationship between three important concepts. The purpose of science and of research is to produce practice that is based on evidence; that is, practice that is understood and is known to be effective.

Box 1.2 New words

Robust

A word that means ‘solid’ or ‘unshakable’ and that is applied to research studies that are difficult to criticise. Qualitative studies often use the word ‘trustworthiness’ instead.

Quantitative research

This is research that we most clearly associate with traditional science. Quantitative research usually deals with numbers rather than text, and as the term suggests, deals with the ‘quantity’ of something. For example, we might measure patients’ anxiety by asking them to complete allocate a number from 1–5 to indicate how anxious they are.

Qualitative research

This is research that deals mostly with language or text. As the name suggests, it is concerned with the quality of something. For example, we might interview patients about their anxiety. This would allow patients to talk about their lived experience of anxiety, what that experience meant to them and how it affected their daily lives.

So, what is research? All research is nothing more than systematic enquiry. Quantitative research is an endeavour to discover new information, in a manner that is structured, systematic and objective, while using techniques (methodologies) that are robust. Qualitative research is also systematic (it has a defined method or ‘plan’) but allows for the interpretation of data in a manner that may be subjective, but which is open to audit. All researchers want to produce research of good quality (research that is robust or trustworthy). If the methodology is questionable, so will be the results. The definition of research given here applies to all research, from that which takes place in laboratories, to that which focuses on human experiences. All research is just a systematic enquiry.

Figure 1.1 The relationship between the scientific method, research and evidence-based Practice

The ‘salt bath’ and poor methodology

Healthcare practitioners are good at using sound principles for the collection of data. However, occasionally those sound principles have not been well applied. The history of the salt bath is interesting because it warns us to be on our guard against poor methodologies.

Through most of the twentieth century, salt baths were used to help heal wounds. Patients could often be found relaxing in baths to which had been added a variable amount of table salt (Austin, 1988). It had long been argued that salt baths were more or less essential for wound healing to take place.

Now, let us prove that salt baths do work. Let’s do an experiment. The next time you cut your finger, put it into a cup of water with salt in it (it doesn’t matter how much salt). Do this three times a day (because ‘three times a day’ sounds therapeutic). Your finger will get better. So, salt baths work; we have proved it.

Of course, you will have seen that our methodology is less than robust. The chances are that your finger would have got better without the salt-water treatment. Wounds have a tendency to get better all on their own. The problem here is that we did not set up a ‘control’. If we had tested, say, 50 cut fingers given no treatment and 50 cut fingers given a saline bath, then we would have found that being dipped in saline three times a day made no difference whatsoever to the healing rate or the incidence of successful healing.

However, before we criticise practitioners in the past for their lack of research (see Walsh and Ford, 1989), we should bear in mind that healthcare is a big discipline containing a great deal of expertise. We are all human, and it is difficult to question practices that are long established and widely accepted. When you next go to work, take a look at what you find yourself doing and ask ‘What exactly is the evidence that this works?’

Research: a two-headed beast

It will probably not surprise you that there is more than one form of research. You are probably aware that a survey, for example, is not the same thing as an experiment. Research does come in several different forms. For the moment, however, it would be useful to introduce the two main research variants. Arguably, every research study will fit into one or other of these two variants:

• Quantitative research: this deals in quantities of things. The data from quantitative studies exist usually in the form of numbers, which can then be quantified (added up) and subjected to statistical analysis. Quantitative research is often used to ‘demonstrate’ the truth in a hypothesis, that is, to demonstrate that something we think is true, is actually true.

• Qualitative research: this deals in the quality of things. However, this definition is not very helpful. In practice, this category of research deals in data that exist as words and concepts rather than as numbers. Qualitative research is often used to ‘explore’ human experience, especially where the researcher simply doesn’t know enough about that experience, even to know what questions to ask, so prompts such as ‘tell me about your experience of [whatever]’ are often used.

These two categories almost represent fields of research, with researchers often spending their whole career in one field or the other. This can lead to researchers valuing one approach over the other. However, it is possible to make use of both quantitative and qualitative forms of research and even of mixing the two approaches together within the same study (Curry and Nunez-Smith, 2014). In any case, healthcare practice needs both forms of research, and we should try to value what each can provide. Often, we need to ‘test something out’, we have an idea about improving practice, and we want to see if it works. Often, quantitative research works best for this. However, we also need to know how what we do is ‘experienced’ by patients and clients. Such a question is often best dealt with using qualitative research. In time, the results from qualitative research and our better understanding of what patients and clients experience, will lead us to examine specific aspects of that experience and this can often be done using quantitative research designs. In this way, both quantitative and qualitative approaches to research are not only useful but complement each other.

Box 1.3 Examples from the research literature

Mohammadpour et al. (2014) looked at patients with Acute Coronary Syndrome, which causes chest pain due to a reduced blood supply to the myocardium. The researchers wanted to identify whether the application of heat for chest pain was or was not effective. This is a question that lends itself to a quantitative approach and so a quantitative, randomised, double-blind, placebo-controlled clinical trial was used. Patients were randomly assigned to either a group where heat was applied to the chest during episodes of chest pain or to a group where a placebo ‘heat’ pack (heated to 37°C) was used. The study was ‘blinded...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• Preface
• 1 Research is simple
• 2 Reviewing the literature: getting started
• 3 Reviewing the literature systematically: the Systematic Literature Review
• 4 Evidence-based practice
• 5 Research ethics
• 6 Data and how data is collected
• 7 Research methods and design
• 8 Quantitative analysis
• 9 Qualitative research
• 10 Qualitative research in practice
• Appendix
• Glossary
• Index