Paradigms for nursing

research and Evidence

Based-Practice (EBP)
 Research
What does research mean? Nursing research?
a detailed study of a subject, especially in order to discover (new) information or reach a (new) understanding.
Nursing research is research that provides evidence used to support nursing practices.

From your clinical experiences, would you think about a nursing research
question you would like an answer for?
◦ e.g. Does the administration of pain medication at time of surgical incision reduce the need for
pain medication twenty-four hours after surgery?
◦ Should we use hypothermia units to lower temperatures in febrile patients?
Why research is important for nursing discipline?
Purpose of nursing research
◦ Basic research: is a type of research, and it is driven purely by curiosity and
a desire to expand our knowledge

◦ Applied research: is one type of research that is used to answer a specific

question that has direct applications.
“The evolution of nursing as a professional discipline
necessitated the establishment of a scientific research base to
increase disciplinary credibility” (Weaver & Olson, 2006).
What are the current trends and future directions?
◦ EBP
◦ Replication
◦ Innovation
◦ Systematic review
◦ Interdisciplinary collaboration
◦ Dissemination of research findings
◦ Health disparities
◦ Patient preferences
Sources of evidence for nursing practice
◦ Clinical experience
◦ Trial and error
◦ Authority
◦ Tradition
◦ Assembled information
◦ Logical reasoning
◦ Research
 Paradigm
What is paradigm?
It is based on ontological, epistemological, and methodological assumptions.
“A set of common beliefs and agreements shared between scientists about how
problems should be understood and addressed” (Kuhan, 1962).
“What we see- the facts-is largely determined by what we are looking for, by our
beliefs, expectations, orientations, by out theories” (Pedhazur & Schmelking,
1991).
P
 Positivist‫الفلسفة الوضعية‬ Post-positivist Interpretive ‫تفسيري‬ Critical social theory ‫النظرية‬
‫االجتماعية الحرجة‬
Empirical paradigm
Ontology‫علم‬ -The reality is out there, but -Reality is out there -Reality is not fixed. – Focus on oppression and
‫الوجود‬ independent of human and there is need to Reality is subjective and distributing power and
(entities) observation. understand it. constructed by individuals. resources.
-Truth is universal and has - Truth is an probable -Human is inseparate from -Truth is influenced by social,
an absolute entity entity. environment. political, cultural, gender and
-Pure objectivity. -Pure objectivity is -Relativism. economic factors.
-Nature is ordered and impossible…sought - Subjectivity is inevitable. -Realism.
regular. through replication
-Naïve realism. -Critical realism.
-Determinism. -Cause-effects
Epistemology -Researchers hold personal - Researcher is -Researcher and Researcher and participants
‫نظرية المعرفة‬ beliefs and biases. independent of participants are connected. are connected.
(process) -Use tight control of the participants.
research situation

Methodology‫ا‬ -Deductive reasoning -Deductive reasoning -Inductive reasoning -Inductive reasoning

‫لمنهجية‬ (hypothesis testing). (hypothesis testing). (hypothesis generation). (hypothesis generation).
-Defined concepts and -Defined concepts and -Holistic. -Holistic.
variables. variables -Insights from participants’ -Insights from participants’
-Control of contextual -Control of contextual experiences. experiences.
variables. Variables. Flexible design. Flexible design.
-Experiment (manipulation Representative Not representative sample. Not representative sample.
and observation). sample.
Do you think that research from a single paradigm is enough to meet nursing
practice demands?
Does nursing discipline require to choose one paradigm?
“developing knowledge may be enhanced through the use of integrative strategies
that maintain the theoretical perspectives of individual research paradigms”
(Weaver & Olson, 2006).
 Evidence-based practice:
“The process of shared decision-making between practitioner, patient, and others
significant to them based on research evidence, the patient’s experiences and preferences,
clinical expertise or know-how, and other available robust sources of information” (Sigma
Theta Tau, 2008).
Is Research Utilization (RU) is exactly similar to EBP? Or is RU a sub-
set of EBP?
RU is closely related to evidence based practice (EBP) in the sense that EBP is research utilization that includes other influences or
considerations specific to the problem at hand

What is Knowledge Translation (KT)?

“Best evidence refers to research findings that are methodologically
appropriate, rigorous, and clinically relevant for answering persistent
questions”
 Systematic review

Single RCT

Single non-randomized trial

(Quasi-experimental)

Single prospective/cohort study

Single case-control study

Single cross sectional study

Single in-depth qualitative study

Expert Opinion, case report

Issues in the literature related to EBP movement:
1. Difficulty defining the concept of evidence based on competing paradigms.
2. The nature of the evidence hierarchy.
o Advocate for “theory-guided, evidence-based nursing practice”
o Use four patterns of knowing (empirics, esthetics, personal knowledge, and ethics) to
generate evidence relevant to nursing practice.
o “RCT is considered the superior form of evidence……oversimplification of the complexity
of clinical nursing practice and aligning nursing with a similar path as medicine”.
o “EBP does indeed consist of a hierarchy of evidence that leads to valuing of some forms of
evidence (i.e., empirical evidence) over other forms, but they raise a significant question for
consideration, that being whether this is a good or a bad thing”
(Earle‐Foley, 2011).
3. Whether EBP is even a realistic or attainable goal within the
discipline of nursing.

If both quantitative and qualitative are equal evidence “then we must

consider whether nurses have adequate knowledge and skills to locate,
critically appraise, and then incorporate the ‘best’ evidence into clinical
practice”
◦ “Is it acceptable within the EBP movement for nurses to rely on other
sources such as intuition, authority, tradition, and common sense?”
(Earle‐Foley, 2011).
EBP challenges:
◦ Quality and nature of the research
◦ Characteristics of nurses
◦ Organizational factors

How individual nurse can adopt EBP?

 Different levels of explanation:
◦ Identification (e.g. studying adults’ experiences with osteoarthritis who had
undergone total knee joint arthroplasty. In this stud, the researcher identified the
process of adjustment).
◦ Description (e.g. describing the prevalence of cancer among Saudi women or the
describing the pain of postoperative head cancer patients who developed speech
impairment)
◦ Exploration (e.g. exploring whether the length of time patients spent on cardiac
surgery waiting list influenced their psychosomatic conditions or exploring refugee
mothers’ perception of healthy lifestyle).
Different levels of explanation:
◦ Explanation ( e.g. testing theoretical model that explains exercise behavior
in older adults or developing framework for understanding women’s
journey after separation from an abusive partner)
◦ Prediction and control (identify predictors of successful weaning from
mechanical ventilation)