NRS 433 Topic 1 DQ 1 Describe the difference between a nursing practice problem and a medical practice problem.
NRS 433 Topic 1 DQ 1 Describe the difference between a nursing practice problem and a medical practice problem.
NRS 433 Topic Discussions
Topic 1 DQ 1
PICOT is utilized by the health care community to identify and study a nursing or medical practice problem. Consequently, PICOT examples that may provide insight into the use of the PICOT process, may not be relevant to nursing practice as they are based on a medical practice problem.
Describe the difference between a nursing practice problem and a medical practice problem. Provide one example of each. Discuss why is it important to ensure your PICOT is based on a nursing practice problem.
Evidence-based practice refers to using the available evidence for decision making and providing efficient and effective care for patients on a scientific basis (Scott, 2009). Systematic implementation of EBP can enhance healthcare safety and improve patient outcome. A nursing practice problem is an issue encountered during nursing practice, such as during assessment related to the patient’s response to a health problem they are experiencing or potential health problems and life processes. For instance, while assessing a patient, the nurse may notice that the patient coughs prior to swallowing food, displays laryngeal elevation and repeatedly reports “something stuck” in their throat. The nurse may conclude a nursing diagnosis based on these symptoms of impaired swallowing. Nursing practice problems also includes physical, emotional and mental experiences. They are made independently by nurses. Nursing practice problems provides a basis for help nurses to choose appropriate interventions thereby attaining a particular outcome.
On the other hand, a medical practice problem focuses on patient’s disease, medical condition or pathological state and treatment. They are made by physicians , physician assistant or advanced nurse practitioner. An example of a medical diagnosis includes atrial fibrillation, hypertension and hepatitis. While nursing problems may be subject to change, medical diagnosis does not change and remains imprinted on patient’s medical history forever.
PICOT should be based on a nursing problem in order to provide safe,quality care and improve patient outcomes. According to Helbing (2018), when formulating a PICOT question for evidence based practice project, nurse researcher must gather information and have an idea as to why the study should be performed. PICOT question helps to refine the research and identify gaps in the clinical situation in terms of missing evidence.
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Reference
Helbig, J. (2018). Nursing Research: Understanding Methods of Best Practice. Retrieved from https://Ic.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice
Scott, K., & McSherry, R. (2009). Evidence-based Nursing: clarifying the concepts for nurses in practice. Journal of clinical nursing, 18(8), 1085-1095
TOPIC 1 DQ 2
Nursing research is used to study a dilemma or a problem in nursing. Examine a problem you have seen in nursing. Provide an overview of the problem and discuss why the problem should be studied. Provide rational and support for your answer.
TOPIC 2 DQ 1
Qualitative data has been described as voluminous and sometimes overwhelming to the researcher. Discuss two strategies that would help a researcher manage and organize the data.
TOPIC 2 DQ 2
The three types of qualitative research are phenomenological, grounded theory, and ethnographic research. Compare the differences and similarities between two of the three types of qualitative studies and give an example of each.
Two types of qualitative research are phenomenology and grounded theory. Grand Canyon provides the following definitions of both:“Phenomenology provides an approach that allows researchers to better understand a person’s lived experiences to gain a deeper understanding of significant phenomena in life. Data is usually collected through extensive interviews and conversations with study subjects. Sample sizes are generally small when this methodology is used” (Grand Canyon University, 2018).
An example of phenomenology research could be described as a child with ADD or ADHD who repetitively has to be reminded to stay on task in school, quit talking, stay in your seat, and keeping their hands to themselves. Behaviors sometimes leading to extra attention being placed on them from teachers due to their frequent disruption in class, fellow students looking at them differently, and being portrayed as “trouble makers.” Behaviors and observations could lead to other mental health problems such as depression, anxiety, defiant obedience disorder. Interviewing a group of children with the diagnosis of ADD or ADHD, obtaining their thoughts and point of view of how they feel and perceive they are doing in school, if they are able to get along with others, and what their social interactions are.
Grounded theory is an approach that allows for researchers to consider phenomena of significance to nursing. The aim is to understand actions taken in an area by those who are involved in performing the actions”(Grand Canyon University, 2018). Using the same scenario from above, students with ADD or ADHD, interviewing students asking open-ended questions to find out why they were being disruptive in class, unable to stay in their seats, and unable to keep their hands to themselves.
“Grounded theory studies are generally focused on social processes or actions: they ask about what happens and how people interact. Grounded theory studies begin with open questions, and researchers presume that they may know little about the meanings that drive the actions of their participants”(Sbaraini, Carter, Evans, & Blinkhorn, (2011).
Phenomenology research aims to gain an understanding of a person’s lived experiences to gain a deeper understanding of the significance, whereas grounded theory aims to understand the actions taken by those performing them. Similarly, both methods are considering others significant experience in life.
“Grounded theory and phenomenology appear to be particularly susceptible to the blurring trend observed by Morse (1989). It is not uncommon for an investigator to purport to use one or the other while in fact combining elements of each. The two approaches certainly share a number of characteristics. Both focus on the richness of human experience, seek to understand a situation from subject’s own frame of reference, and use flexible data collection procedures. Nonetheless, they are based on different intellectual assumptions and, flowing from these, have clear differences in purpose and methodological prescriptions”(Baker, Wuest, & Stern, (1992).
Reference:
Baker, C., Wuest, J., & Stern, P. N. (1992). Method slurring: the grounded theory/phenomenology example. Journal of Advanced Nursing, 17(11), 1355–1360. doi: 10.1111/j.1365-2648.1992.tb01859.x
Grand Canyon University (Ed). (2018). Nursing research: Understanding methods for best practice.Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1ch.2
Sbaraini, A., Carter, S. M., Evans, R. W., & Blinkhorn, A. (2011, September 9). How to do a grounded theory study: a worked example of a study of dental practices. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184112/
TOPIC 3 DQ 1
Provide examples of experimental and nonexperimental research design. Contrast the levels of control applied to each.
TOPIC 3 DQ 2
Describe sampling theory and provide examples to illustrate your definition. Discuss generalizability as it applies to nursing research.
Re: Topic 3 DQ 2
Sampling theory is a study of relationships existing between a population and samples drawn from the population, Also it is the hypothesis that is pertinent just too arbitrary examples. For this reason, the population or a universe might be characterized as a total of things having a typical characteristic or attributes. At the end of the day, a universe is the complete gathering of things about which information is looked for.
Sampling theory was developed to determine the most effective way to acquire a sample that accurately reflects the population under study. Key concepts of sampling theory include populations, target population, sampling or eligibility criteria, accessible population, elements, representativeness, sampling frames, and sampling plans or methods. (Burns & Groves, 2015). A sampling plan or method outlines strategies used to obtain a sample for a study. As a design, a sampling plan is not specific to a study. The plan is designed to increase representativeness and decrease systematic variation or bias. The sampling plan may use probability (random) or nonprobability (nonrandom) sampling methods. When critically appraising a study, identify the study sampling plan as either probability or nonprobability, and determine the specific method used to select a sample. NRS 433 Topic Discussions
The research design, populations, and setting are important components that help answer the research questions and inform nurses if findings will be relevant to their practice. For nurses to be consumers of research, being able to critique the theory that is being tested, determine if the design is appropriate to answer the question and decide if the sample supports generalization, adds to knowledge translation and depth of research. To help determine when the research can be applied to their practice, they need to be able to assess these components for applicability to their practice and setting.
References
Burns, N., Grove, S. (2011). Understanding Nursing Research, 5th Edition. [Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978-1-4377-0750-2/
TOPIC 3 DQ 2
Describe sampling theory and provide examples to illustrate your definition. Discuss generalizability as it applies to nursing research.
TOPIC 4 DQ 1
Compare independent variables, dependent variables, and extraneous variables. Describe two ways that researchers attempt to control extraneous variables. Support your answer with peer-reviewed articles.
TOPIC 4 DQ 2
Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.
“According to nurse.com there are 4 levels of evidence. Level A is the strongest and Level C is the weakest with a new level added in 2013, Level ML, multilevel, was added to identify clinical practice guidelines that contain recommendations based on more than one level of evidence”(https://www.nurse.com/evidence-based-practice). NRS 433 Topic DiscussionsLevel A, the strongest of the levels, consist of evidence obtained from randomized control trials, systemic review or meta- analysis, and clinical practice guidelines.
Level A has gone through a filtering process and gathered the most accurate data from research to provide evidence-based practice. Therefore, nursing and medical practice greatly benefits from research from this level in providing the most up to date, accurate care to patients. An example would be doctors not injecting epinephrine into fingers due to research from 1950, that was later discredited stating procaine added to epinephrine was the cause of ischemia not epinephrine. “Further analysis found that the addition of procaine to the epinephrine injection was the cause of the ischemia. The procaine used in these injections included toxic acidic batches that were recalled in 1948. In addition, several cohort studies found no complications from the use of epinephrine in the fingers and hand. The results from these cohort studies increased the level of evidence. Based on the best available evidence from these studies, the hypothesis that epinephrine injection will harm fingers was rejected”(Burns, Rohrich, & Chung, (2011).
Level B consist of evidence obtained from well-designed control trials without randomization, clinical cohort study, case-controlled study, uncontrolled study, epidemiological study, and qualitative/quantitative study. Evidence from this level is still of more accurate research, but not as good as in level A. An example of this would be plastic surgery for silicone breast implants causing lymphoma, but after more research, there was not sufficient evidence to prove the fact. Providers providing care with evidence based practice from level B are using more research based practice with safer practices.
Level C, the weakest of the levels, is consisted of evidence from consensus viewpoint and expert opinion meta synthesis.
Nursing practice provided as a result of research from level C could result in biased, unsafe care. An example would be a provider giving his professional opinion that it is safe to bend and twist six weeks after lumbar surgery. Given this one provider’s opinion is not enough evidence to determine whether it is safe or not for the patient to do those things without more research.
Level ML(multilevel) was added in 2013. It consist of clinical practice guidelines, recommendations based on evidence obtained from more than one level of evidence
Reference:
Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011, July). The levels of evidence and their role in evidence-based medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/
(n.d.). What is Evidence-Based Practice in Nursing? Retrieved from https://www.nurse.com/evidence-based-practice
TOPIC 5 DQ 1
The theoretical foundations of qualitative and quantitative methods are very different, but many researchers believe both methods should be used in the research study to increase validity and reliability. What advantages or disadvantages do you see in using both types of methods in a nursing study? Support your answer with current evidence-based literature.
TOPIC 5 DQ 2
According to the textbook, nurses in various settings are adopting a research-based (or evidence-based) practice that incorporates research findings into their decisions and interactions with clients. How do you see this being applied in your workplace?
