Nursing Research Based Practice
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Nursing research is a systematic enquiry that seeks to add new nursing knowledge to benefit patients, families and communities. It encompasses all aspects of health that are of interest to nursing, including promotion of health, prevention of illness, care of people of all ages during illness and recovery (or) towards a peaceful and dignified death (ICN 2009)
Research based practice is arguably the hallmark of professional nursing and is essential for high quality clinical and cost effective nursing care (ICN 2009)
Paradigm was coined by KUHN (1970). A paradigm is a world view, a general perspective on the complexities of the real world.
Disciplined inquiry in the field of nursing is being conducted mainly within two broad paradigms, both of which have legitimacy for nursing research.
The research question is the first and foremost initial step in the research process, because it defines the expected outcomes and drives the project design. So it should be clear and concise once the research question is formulated, the next is defining the terms and concepts used in the research process. A literature review is needed to clarify issues, gives an understanding to the researcher how others have formulated similar research questions and defines concepts.
There are ethical implications at every stage of the research process, including the choiceof topic to research, the selection of the design and the publication of the findings. There are 6 etical principles (ICN 2003) the health care professionals can use to guard their patients (or) clients from harm.
These includes :
b) Non- maleficience
The above mentioned six ethical principles have been synthesised into 4 rights of subjects considering participation in research. These are
The right not be harmed
The right of full disclosure
The right of self-determination
The right to privacy, anonymity and confidentiality (ICN 2003)
In qualitative studies, the researchers are unaware of the interview is likely to untwist. Therefore, informed consent is a must.
Richards and Schwartz (2002) listed four potential risks to research participants in qualitative studies. These are
Anxiety and distress, exploitation misreprentation and identification of the participants in published papers.
However in qualitative studies, there are greater chances of sharing confidentiality.
According to Smith (1992) suggests:
Researches who interview people and perhaps particularly women, need an awareness and a sensitivity to the fact that, although a subject may have agreed to take part in a study, it cannot be known for certain, what that interview will uncover (or) give rise to.
It could be argued that to be allowed a private view of another person’s past ( on opinions (on pain is a privilege.
Data collection needs a planned process for the researcher to determine the steps of how and what sequence data will be collected from a single subject.
Data collection is the process of selecting subjects and gathering data from these subjects (BURNS AND GROVE 2001)
Data can be collected by observation, testing, measuring, questioning and recording.
The 4 major task performed in process of data collections are:
Selecting the data
Collecting the data in a consistent way
Maintaining research controls
Solving problems that threaten to disrupt the study.
QUALITATIVE RESEARCH METHODOLOGY :
According to Leininger 1985, Munhall and Boyd, 1999, qualitative research is a systematic, interactive, subjective approach used to describe life experiences and give them meaning.
The reason for choosing qualitative promoting better understanding of human experiences such as pain, caring and comfort.
Since human feelings and emotions cannot be measured in a numerical value, qualitative research has been more effective method. In addition, this method also focuses on discovery and understanding of the whole, an approach that is consistent with the holistic philosophy of nursing (Munhall and Boyd 1999)
The term methodology denotes the choices a researcher makes regarding the cases to study, ways of data collection and method of analysing the data, in planning and executing the research study (Silverman 2010).
There are 4 approaches in qualitative research; it includes ethnography, phenomenology, discourse analysis and grounded theory.
For the purpose of this assignment, phenomenology is considered as it directly deals with life experiences of people. It begins with gathering examples of everyday experiences describing and reflecting on them.
Phenomenology as a research approach in the interpretivist tradition has its reoots in philosophy and was conceived by the German philosopher Husserl, at the beginning of the 20th century to investigate consiciousnes as experienced by the subject (Baker etal, 1992)
Phenomenology is concerned with the lived experience of its respondents (parahoo 2006 p68).
The main feature of Husserlian Phenomenology is the motion of ‘Bracketing’.
The 2 types of phenomenolgogy are
Descriptive (or) Husserlian developed by Husserl (1859-1938) aimed at uncovering and describing the essence of the phenomena of interest (Priest 2004)
Interpretive (or) Heideggerian phenomenology was developed by Heidegger (1889-1976) aimed at the interpretation of phenomena to uncover hidden meanings (priest 2004)
The researcher uses descriptions and (or) interpretation of everyday life experiences as sources of qualitative evidence.
The use of phenomenological studies in nursing have manifold.
Topics have included the lived experience of caring for a partner with Alzheimers disease ( Todres & Galvin 2006) experience s of care in relation to the physical environment of an oncology centre (Edvardssonetal 2006) experiencing aphasia and the struggle to regain the ability to communicate (Nystrom 2006) and the lived experience of waiting for colorectal surgery (moene et al 2006)
“Discovery interview” a methodology adopted by UK’s National Health Services Modernisation agency is using phenomenological attention to life world descriptions in health care.
In phenomenology the basis for sampling is the participant have experienced the phenomenon under investigation and are willing and able to articulate there experience of the (Corben 199, strcubert and carpenter 1999).
Purposive sampling is used in this type of qualitative research. Snow ball sampling can be best described as a form of purposive sampling.
According to struton et al 2004 he defines snowball sampling as “ a process of reference from one person to the next”, the idea being that the researcher is able to identify individuals who are considered credible by other participants.
Reflection is a key instrument needed for effective and person-centered professional practice.
Reflection is a way of examining your experience in order to look for the possibility of other explanation and alternative approaches in doing things.
Reflection is the examination of personal thoughts and actions.
Reflection has been defined variously as
Accessing previous experience helping to develop TACIT AND INTUITIVE KNOWLEDGE (John and Freshwater, 2005)
A transirmative process that changes individuals and their actions ( Ghaye and Lillyman, 2010)
A way to teach awareness of how and why things have occurred (Johns 2010)
An active, persistent and careful consideration of any belief (or) supposed form of knowledge in the light of the groundsthat support it and the further conclusions to which it tends (Dewey 1933).
The main aim of reflection is to develop professional actions that are paralleled with personal belief and values
TYPES OF REFLECTION
There are 2 forms of reflection
Reflection-on-action and reflection-in-action
The former is the commonest form. It includes the events that have occurred in the past and playback in the mind. But it aims at strengthening of values and to act effective and different in the future. In the literature on reflection (grant and Greene 2001; Revans 1998, thre is a focus on identifying negative aspects of personal behaviour with a view to improving professional competence.
Reflection in action, which is something related to an experienced professional. According to Schon, it means examining your own behaviour and that of others while in a situation (Schon 1995; Schon 1987). As the term suggests, it occurs in the midst of action . It involves rapid analysis and quicker decisions when needed.
The term “Reflective practice” was coined by Donald Schon (1983, 1987). He argued that reflection is a strategy whereby professionals become aware of their implicit knowledge base. There are 10 principles outlined by Ghaye (1998) to become a reflective practioner.
1. Reflective practice needs to be understood as a discourse (Fair clough 1998)
2. Reflective practice is fuelled and energised by experience (Bond and Miller 1996, Bond etal 1997, weil and McGill 1990).
3. Reflective practice is a process that involves a reflective turn (Ghaye 1998)
4. RP is concerned with learning how to account for ourlselves. This means learning how to describe, explain and teaching. (Ghaye).
5. RP should be understood as a dispositions to inquiry. (Ghaye 1998)
6. Reflective practice is interest saving when we reflect, we are engaging ina process of knowledge creations.
7. Reflective practice is enact by those who are critical thinkers (Barnett 1997)
8. RP is a way of decoding a symbotic landscape
9. RP sits at the interface between motions of practice and theory.
10. RP is a post modernist way of thinking (Burr 1995, Fosnot 1996)
On Reflection (Hilary KORNBLITH) Oxford university press. UK 2012 1st Edition P26
BENEFITS OF REFLECTION
Reflection plays a vital role in self-assessment. We engage ourselves for assessing through reflection
Engaging in experimental research helps to determine the reliability of reflection.
Reflective practice in nursing is vital due to plethora of reasons. To begin with “nurses are responsible for providing care to the best of their ability to patients and their families (NMC,2002 UKCC, 1992). Adequate knowledge skills and appropriate behaviour is focused, so that nurses are able to meet the demands at work. Secondly, reflective practive is one among the requirements by the nursing board. This is part of the requirement to update professional skills. Keeping a portfolio offers a chance for on-going development.
Thirdly effective communication and gaining feedback by colleagues, patients and families can help nurses to achieve goal of reflective practice.
Reflection is a continuous process in which nurses has great interest as it influence nursing practice and education. Due to current financial constraints and work pressure, health services are affected in many countries.
Various learning opportunities have affected in terms like provision of clinical supervision for nurses, time for informally reflecting with colleagues, defending the relevance of reflective education for the development of clinical judgement, along side the juggernant which is evidence bases practice education (Bulman C and Schutz.S 2012).
CORE CONCEPTS OF CNS
Clinical nurse specialist practice will encompass a major clinical focus (NCNM 2008).
The national council for the professional development of nursing and midwifery was established in 1999. The council published frameworks for the establishment of CNS/CMS post inclusive of outlining the roles, responsibilities, core concepts, competencies and criteria’s.
The major clinical focus of the specialist practice includes assessment, planning, delivery and evaluation of the care given to patients and their families in hospital, community and outpatient settings.
Addtionallly CNS provides expertise in a
Speciality area by developing standards of practice
Review treatment programmes and adjust as necessary
Create and uphold policies, procedure and standards
Gather patient information via interviews and medical records to improve services.
Create treatment plans and provide guidance on other provides plans.
Work in tandem with other provides and health care professionals on a number of issues, including procedure.
Educate and mentor other nurses.
Assess the quality of programs by designing evaluation standards
Supervise nurses as it relates to patient care.
INTRO FOR CNS
A CNS is a venerable one-man show with 5 major responsibilities such as : clinical focus, research, teaching, consulting and management.
Optimizing patient care by working with nursing staff. This includes evaluating current practices, reviewing alternatives, consultations with patient care managers and providing education to staff.
Make decision on where to allocate staff and resources.
Develop specialised treatment plans after patient examinations.
Educating patients and families on how to best manage their conditions.
Incorporate practices to promote staff teamwork.
Analyse patient data and outcomes
Participate with colleagues on new research.