THE IMPORTANCE OF RESEARCH IN NURSING AND MIDWIFERY
Sample onlyOxford University Press ANZ3CHAPTER 1THE IMPORTANCE OFRESEARCH IN NURSINGAND MIDWIFERYSansnee Jirojwong and Anthony WelchCHAPTER LEARNING OBJECTIVESAfter reading this chapter you will be able to: recognise the importance of research and evidence-based practice innursing and midwifery differentiate major philosophical approaches in the conduct ofresearch and their use in nursing and midwifery services understand developments in nursing and midwifery research in thecontext of society, politics and historyKEY TERMSquantitativeresearchphenomenoninductive approachdeductive approachparadigmtheorypositivistnaturalistmodel understand the links between nursing and midwifery services,education and research recognise the importance of nursing research and its contribution aspart of interdisciplinary research and healthcare services.01 JIR RM2 28510 TXT SI.indd 31/08/14 10:05 AM
4Sample onlyOxford University Press ANZPART 1 GETTING STARTED IN RESEARCHIntroductionThere are various ways by which we as human beings come to know and understandour everyday world. Over the centuries different forms of knowledge have beendeveloped and valued by individuals and societies. As a young child we come to value theknowledge of our parents. We go to them for information and for guidance. As we moveinto our teens we begin to question what they know and start to seek out our own way ofunderstanding our world and what is important to us. At high school and university weenrol in different subjects to acquire particular forms of knowledge for our future careerpathway such as nursing, teaching, architecture or psychology. Within your nursingprogram you study different subject areas to gain particular forms of knowledge: science,to understand the molecular world of the cell; biology, to learn about the workings of thehuman body; psychology, to understand human behaviour and the way people think andinteract; and research, to learn how to determine what is the most appropriate form ofknowledge or the best evidence on which to make clinical decisions, for example aboutaseptic technique, pain management, caring for a person with a mental illness and theirfamily, or deciding whether breastfeeding or bottle feeding is best for a mother and hernew baby.Over the past six decades scientific knowledge and technology have expanded. Thehealth of populations has improved significantly, with an increase in life expectancyand a reduction of morbidity and mortality from infectious diseases (Beaglehole &Bonita 2004). Changes to nursing and midwifery services, education and research haveoccurred in many developed and developing countries such as the USA, UK, Australia,New Zealand, Thailand, Indonesia and Malaysia.In Australia, nurses and midwives achieved formal recognition as healthcareprofessionals in the early 1980s. This was the result of political, social and professionalforces such as scientific discoveries, the use of technologies in medicine and public healthservices, the expansion of Australian universities, the increasing number of nursing andmidwifery leaders with postgraduate qualifications in education, and the requirementof undergraduate education preparation for beginning nurse clinicians (Greenwood2000). Nursing and midwifery education is now located in the tertiary education sector.Knowledge of the practice of nursing and midwifery has expanded as the professionshave become increasingly cognisant of the need for clinical practice to be underpinnedby research. Clinical practice informed by research is increasingly demanded by thegeneral public, who expect practising nurses and midwives to provide care that isevidence-based (International Council of Nurses 2006; Nursing and Midwifery Boardof Australia 2010).The professions of nursing and midwifery will experience ongoing changes inresponse to an increasingly ageing population, rising healthcare costs and the use oftechnology in the healthcare sector. The shift towards empowering health consumersto be active participants in managing their health, and the increasing expectation ofthe consumer to self-manage, challenges nurses and midwives to be responsive andadaptable to these trends.In this chapter, the importance of nursing and midwifery research and evidencebased practice is emphasised. The identification of existing and emerging challenges innursing and midwifery are discussed from the perspectives of two major philosophicalapproaches, positivism and naturalism. Both approaches will be described in the contextof nursing and midwifery research. The future of research in nursing and midwifery01 JIR RM2 28510 TXT SI.indd 41/08/14 10:05 AM
Sample onlyOxford University Press ANZCHAPTER 1 THE IMPORTANCE OF RESEARCH IN NURSING AND MIDWIFERY5and of evidence-based practice will be presented in the context of ongoing changes inAustralian social, political and professional environments.The place of research in generating knowledgeLet us reflect on how health knowledge has been generated in traditional societies.People observed that certain behaviours would have certain outcomes. Women who werecarers would encourage sick people to rest and drink plenty of fluid because they sawthat the recovery process was faster when the sick attempted to do something ratherthan do nothing. The use of trial and error as an approach to problem-solving wasthe most common means of identifying what worked and what did not. Communitiesand individuals depended on cultural beliefs, social customs, traditional healers andacknowledged experts as the main sources of knowledge for decisions about health andquality of life. Over time, trial and error has been replaced with a more effective way ofgenerating knowledge and applying it systematically.As nurses and midwives, we have improved our practices as new knowledge ofwhat is more effective has become available through research and questioning therelevance of convention, custom and tradition, through the opinion of experts, throughobservations and through the experience of trial and error in contemporary healthcaredelivery (Burns & Grove 2009). Examples are early ambulation among post-operativepatients, and the use of pets in providing emotional support for residents in long-termcare. Planned investigations help consumers of research—nurses, midwives, researchersand educators—to apply research results to their work environment. The result has beenimproved practice.We all use research results in one form or another. For example, clinical guidelinesbased on the synthesis of research results are used in our daily working life. We care forpatients and their families who vary in their knowledge of their illness and their abilityto manage it. As health professionals it is our business to ensure that our patients havethe most up-to-date and appropriate knowledge with which to make informed decisionsabout their care and management. To be effective in improving health outcomes forpatients and their families, we need knowledge that is evidence-based. As nurses andmidwives, we also need to be competent in evaluating the strengths and weaknesses ofresearch studies, and the applicability of their findings to our work environment.The importance of evidence-based nursing andmidwifery practicesAs mentioned earlier, health professionals such as nurses and midwives use differentsources of information for the delivery of services. In the 1960s Archie Cochranefound that much of clinical practice in health services lacked evidence of effectiveness,resulting in wastage of healthcare resources and sub-optimal outcomes. Cochrane wasa strong advocate of randomised controlled trials (RCTs) (Cochrane 1972; CochraneCollaboration 2010). In 1976 the first systematic review of controlled trials in perinatalmedicine commenced in the UK. The Cochrane Centre opened in Oxford in 1992with registration of the Pregnancy and Childbirth Group and its Subfertility Group.In 1993 at a conference in New York, the concept of the Cochrane Collaborationwas presented by the New York Academy of Sciences. Since that time there has beenrapid and extensive adoption of the concept. By August 2013 there were more thanSANSNEE JIROJWONG AND ANTHONY WELCH01 JIR RM2 28510 TXT SI.indd 51/08/14 10:05 AM
6Sample onlyOxford University Press ANZPART 1 GETTING STARTED IN RESEARCH5600 completed Cochrane reviews and 2300 protocols (see the approach used for thisresearch in Chapter 15), which are available to healthcare workers and consumers.Sackett and his colleagues (1996), pioneers of the Cochrane Collaboration andthe Centre for Review and Dissemination, defined evidence-based medicine as ‘aconscientious, explicit and judicious use of current best evidence in the decision-makingabout the care of individual patients’ (p. 2). In 2000, the definition was expanded furtherto include patient values and clinical expertise. The evidence needs to be generatedby systematic investigation. Patients’ illness condition, rights and preferences areconsidered when making clinical decisions about their treatment. Clinicians use theirpersonal expertise and the best available evidence in the delivery of care. The definitionof evidence-based medicine is also applied to evidence-based nursing (EBN) andmidwifery (EBMid) (see Chapters 2 and 15).Since the early 1990s evidence-based nursing and midwifery practices have beenactively promoted by York University and McMaster University (Craig & Smyth 2007).Over these two decades, there has been a growth of publications of EBN and EBMidpractices by different organisations including the International Council of Nurses, theAustralian Nursing and Midwifery Council, and the Joanna Briggs Institute (JBI) (seeGreenwood 2000; Usher & Fitzgerald 2008). These publications are as brief as a onepage summary or as long as a comprehensive document of more than 40 pages. Thelength and format of these publications accommodate the needs of consumers who maywish to access such evidence.TIPS AND SKILLSAntiretroviral treatment (ART) improves the health and prolongs the lives of personswith HIV. Long-term ART treatment is crucial for the health and well-being ofindividuals and reducing the risk of HIV transmission. The World Health Organizationrecommends that the ART treatment needs to be initiated in hospitals with maintenance in peripheral health facilities such as community-based organisations orhome-based services (WHO 2013).Quantitative research:A systematic investigationwith a rigorous andcontrolled design, usingprecise measurementsand obtaining quantifiableinformation to answer aresearch question.01 JIR RM2 28510 TXT SI.indd 6Levels of evidence are classified according to the validity and reliability of research(NHMRC 2009). Comprehensive criteria used to assess the quality of quantitativeresearch have been well developed (see Chapter 15). Analysis and synthesis ofexperimental research are considered to be level I evidence. It should be noted that theAustralian National Health and Medical Research Council (NHMRC) does not allocateany level to the opinions of experts (see Table 1.1).Table 1.1Levels of evidence according to the type of interventionLevelInterventionIA systematic review of Level II studiesIIA randomised controlled trialIII-1A pseudo-randomised controlled trial (i.e. alternate allocation of some othermethod)1/08/14 10:05 AM
Sample onlyOxford University Press ANZCHAPTER 1 THE IMPORTANCE OF RESEARCH IN NURSING AND MIDWIFERYIII-2A comparative study with concurrent controls: Non-randomised, experimental trial Cohort study Case-control study Interrupted time series with a control groupIII-3A comparative study without concurrent controls: Historical control study Two or more single-arm studies Interrupted time series without a parallel control groupIVCase studies with either post-test or pre-test/post-test outcomes7Source: NHMRC 2009However, Polit and Beck (2010, p. 37) have included levels V, VI and VII: Level V: Systematic review of descriptive, qualitative or physiologic studiesLevel VI: Single descriptive, qualitative or physiological studyLevel VII: Opinions of authorities or expert committees.Compared to quantitative research, qualitative research has been classified at levels Vand VI evidence, based on qualitative evaluation of reliability and validity. Currently theCochrane Qualitative Research Methods Group is calling for researchers to registertheir evaluation evidence from the perspective of qualitative research. Resources forconducting qualitative syntheses are also made available by various organisations throughthe Cochrane Collaboration website (2013).The purposes of researchWhat is research? We do research because we are curious and interested in solvingproblems. ‘Research is a systematic investigation which aims to discover new knowledgeor to validate and refine existing knowledge’ (Burns & Grove 2009, p. 2). The professionsof nursing and midwifery are committed to generating new knowledge that informs theirpractice and validates best practice for healthcare delivery.Nurses and midwives are in a good position to generate research questions becausethey provide direct and continuous care to individuals, families and communities. Newknowledge can be generated through our observations. For example, a nurse in Sydneywas the first to observe an increase in congenital malformations in newborn childrenof mothers who had been treated with thalidomide during pregnancy. Subsequentinvestigations confirmed that this was a worldwide phenomenon (McBride 1962;Smithells & Newman 2009).Nursing and midwifery care vary across a broad range of contexts from healthpromotion, illness prevention, acute and chronic care settings and school health, toterminally ill persons who are receiving palliative care at home or in a hospice. Our clientscan also be a community, such as people in rural and remote areas or disadvantagedpeople.Like other professionals, nurses and midwives need to be aware of new knowledgeabout emerging trends and innovations in healthcare delivery that are informed byresearch. It is quite common to find a single issue investigated by many researchers. Ofthese, few projects may have findings that corroborate each other, while the findings ofPhenomenon: Anyobservable thing oroccurrence that isworth noting; plural,phenomena.SANSNEE JIROJWONG AND ANTHONY WELCH01 JIR RM2 28510 TXT SI.indd 71/08/14 10:05 AM
8Sample onlyOxford University Press ANZPART 1 GETTING STARTED IN RESEARCHother projects may contradict each other. The question that needs to be asked is, whichstudy gives the most credible findings and provides the best outcomes that we can use?The process used to critically analyse a large number of research studies concerned withexploring the same issue is called a systematic review (Cochrane Collaboration 2010;Craig & Smyth 2007; see Chapter 15).Knowledge development is an ongoing process. It occurs in response to a continualadvance in technology and the changing healthcare needs of clients and society. As part ofa multidisciplinary healthcare team, it is important to be aware that knowledge in nursingand midwifery can be improved or confirmed through the synthesis of knowledge fromresearch into other health disciplines.THINKING DEEPLYPatient informationNurses observe that a few post-operative patients require pain relief medication morethan other patients. They start talking to patients in order to understand why. Onepossibility is patients’ fear of surgery and the post-operative situation. The nursesknow that fear can be reduced by providing patients and their family with knowledgeabout the operation and what is to be expected post-operatively.To investigate the problem, two approaches to research can be used: quantitativeresearch and qualitative research. The choice of approach depends on the philosophicalorientation of the nurses and the question to be answered. Aspects of both approachesare often used to explore the same problem. Qualitative research is based on enquiryinto human quality of life and human action and therefore should consider allcircumstances in which that quality of life and action of the individual and family occur.What is important is researcher commitment to explore these phenomena (Law 2007;Rée & Urmson 2004). Open-ended questions (qualitative) provide an opportunity toexplore a broad sweep of questions such as, what does it mean to care for anotherwho is in pain? The knowledge generated from such a study can provide informationthat can be tested by quantitative research strategies. Both approaches are legitimatemeans by which new knowledge can be generated (Law 2007; Thompson 2003).Quantitative and qualitative research have arisen from worldviews on how knowledgecan be generated. Characteristics of both research methods are summarised in Table 1.2.The philosophical approach of quantitative research is that knowledge is good, that itaccumulates through time and that it builds on previous knowledge. If the knowledgeis true, it needs to stand the scrutiny of time or be tested in different environmentsand groups of people. An event cannot occur without preceding events, so it has tooccur as the result of previous events. A particular event needs to be precisely observedor measured without any interference from other events. The hypotheses about theoccurrence of an event can be tested in different environments and different groups ofpeople. Hypotheses can never be proved absolutely because no event in the world can beproved, since there could be alternative hypotheses not considered (Susser 1986).01 JIR RM2 28510 TXT SI.indd 81/08/14 10:05 AM
Sample onlyOxford University Press ANZCHAPTER 1 THE IMPORTANCE OF RESEARCH IN NURSING AND MIDWIFERY9THINKING DEEPLYSystematic researchPeople in European countries always see white swans. It would be incorrect to statethat ‘All swans are white’ as there are black swans in Australia. A better way to makesuch a statement is, ‘Not all swans are white’ and test this statement in differentlocations. Researchers or testers can falsify their statement and have more and moreconfidence that a swan is likely to be white. When they come across a black swan, thenthe statement is accepted as true.This indicates that researchers are unable to check an event that occurs all overthe world. The best they can propose is to ‘falsify’ that the event is not true.You can apply this situation to many health issues. For example, we may assumethat patients with terminal illness may want to know the prognosis so they can plantheir life or activities. This may not be true in certain cultures as there may be acultural belief that the psychological health of patients with terminal illness shouldbe maintained by not letting them know about imminent death. This knowledge willnot be confirmed if no systematic investigations or research are conducted amongdifferent cultural groups.Implications for evidence-based practiceQUANTITATIVE RESEARCH—THE CONCEPTBased on observations described in Thinking deeply on p. 8, a team of nurses planto assess the influence of fear and social support on some patients’ perceived painso that their care can be improved. If they can provide evidence that fear has moreimpact on the level of pain than social support, interventions can be made in orderto reduce fear before the operation. If social support has more impact, supportersof patients may need to be included in the pre-operative care so that their supportcan be enhanced, potentially reducing the patients’ pain. The literature providesinformation that fear, social support and pain can be investigated and measured.Based on the team’s philosophical approach, quantitative research is likely tobe used.The use of quantitative research to explore human behaviours has been criticisedbecause it includes phenomena that have been predetermined by researchers and separatedfrom their overall context, and because the control applied in quantitative research doesnot allow the
2000). Nursing and midwifery education is now located in the tertiary education sector. Knowledge of the practice of nursing and midwifery has expanded as the professions have become increasingly cognisant of the need for clinical practice to be underpinned by research. Clinical practice informed by research is increasingly demanded by the
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
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Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.
