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Data Management in Research, Quality Improvement (QI) and Evidence-Based Practice (EBP)
Have you ever considered the importance of research in nursing? How might research shape the delivery of healthcare? Research in nursing began with Florence Nightingale in 1850 and has continued to transform in complexity and scope every year since (Gray & Grove, 2020). The field and practice of nursing are greatly influenced by the implementation of evidence-based practice (EBP) and quality improvement (QI) initiatives, and in this first Discussion, you will analyze research to identify gaps in knowledge and practice.
For this Discussion, you will analyze three different articles: a research study, a published quality improvement article, and a completed evidence-based DNP project to answer the prompts provided.
Reference: Gray, J. R., & Grove, S. K. (2020).
Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
· Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021).
Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model & guidelines (4th ed.). Sigma Theta Tau International Honor Society of Nursing.
· Chapter 4, “The Practice Question Phase” (pp. 92–95)
· Salkind, N., & Frey, B. (2019).
Statistics for people who (think they) hate statistics (7th ed.). SAGE Publications.
· Chapter 8, “Hypotheticals and You: Testing Your Questions” (pp.168–169)
· Niedz, B. (2024).
Terminology [Video]. Walden University. Walden University Canvas.
BARBARA NIEDZ: Hi, all.
· 00:02
· Dr. Barbara Niedz here.
· 00:04
· And this is just a short video with just about 12 slides
· 00:08
· that will hopefully get things kicked off for 8211, Research
· 00:16
· for an Evidence-Based Practice.
· 00:18
· And this is week 1, just a few words about terminology.
· 00:24
· Here are a few objectives that we’re going
· 00:26
· to spend a few minutes on.
· 00:28
· We certainly want you to take a look
· 00:30
· at nursing research quality improvement
· 00:33
· and evidence-based practice project in this course.
· 00:39
· And certainly, there are similarities and differences
· 00:42
· between research quality improvement
· 00:45
· and a DNP project in terms of the question to be answered,
· 00:50
· the gaps in knowledge or in practice.
· 00:53
· And along those lines, I think it’s
· 00:57
· important to actually take a look at some of these research
· 01:00
· terms that we’ll be using throughout the course.
· 01:05
· And to get things started, types of hypotheses,
· 01:09
· levels of measurement, types of variables, the sample
· 01:13
· and population, and then, descriptive and inferential
· 01:18
· statistics.
· 01:19
· So I’m sure you’re aware that the focus on outcomes
· 01:23
· has been stellar in the past few years.
· 01:28
· And as a doctorally prepared nurse,
· 01:31
· you’ll really be at the forefront of change
· 01:34
· for the nursing profession.
· 01:36
· You need to understand how to use statistical analysis,
· 01:40
· whether it’s just being able to read a study
· 01:44
· or actually measuring differences in outcomes
· 01:47
· before and after an intervention.
· 01:51
· There are actually two different types of research
· 01:54
· that we’re going to talk about in this course, qualitative
· 01:57
· and quantitative research types.
· 02:00
· They’re both useful, they’re both important,
· 02:04
· and create for us an evidence-based practice.
· 02:11
· Quantitative research uses statistics
· 02:15
· and a rigorous research design to eliminate bias.
· 02:19
· Qualitative research uses words to extract meaning and themes
· 02:25
· from interviews, focus groups, conversations.
· 02:30
· Characteristically, the differences
· 02:33
· between quantitative and qualitative
· 02:38
· lie in the use of statistics versus the use of words.
· 02:43
· Both are a way to inform an evidence-based practice.
· 02:50
· And DNP projects can use both types of research methods,
· 02:57
· even though DNP projects are not research, per se.
· 03:03
· And that’s an important distinction.
· 03:06
· Outcomes of care.
· 03:08
· We talk about it all the time and we sort of
· 03:11
· throw that word out.
· 03:13
· Outcomes measure the quality of care, can help us do that,
· 03:17
· can be used for benchmarking against a standard,
· 03:21
· may be used in report cards that are sometimes
· 03:25
· accessed by purchasers and consumers
· 03:28
· alike to assess quality, are used to monitor and improve
· 03:34
· quality, and are essential to new payment
· 03:38
· approaches for hospitals and providers as well.
· 03:44
· Research versus quality improvement.
· 03:47
· While both can use statistics, and both
· 03:51
· may use qualitative methods, the intent of research
· 03:56
· is to close a knowledge gap, to discover new knowledge,
· 04:02
· whereas the intent of quality improvement
· 04:05
· is to close a practice gap and to improve outcomes.
· 04:10
· Both may influence outcomes, without a doubt.
· 04:15
· Both rely on previous research evidence,
· 04:18
· which is the most important kind of evidence
· 04:23
· that we have to support the endeavor.
· 04:26
· Research outcomes are to show what is known,
· 04:33
· and quality improvement–
· 04:37
· the outcome of a quality improvement project
· 04:40
· is to improve the outcomes of care.
· 04:45
· Now, there are a number of types of Doctor of Nursing practice
· 04:51
· projects.
· 04:53
· Every program requires some kind of a doctor
· 04:57
· of nursing practice project at the end
· 05:01
· as a capstone experience.
· 05:06
· At Walden, it’s very important to note
· 05:09
· that there are three types of projects quality
· 05:13
· improvement, clinical practice guidelines, and staff education.
· 05:18
· Whichever you choose, as you progress in the program,
· 05:22
· you are going to find lots of resources in our classrooms
· 05:28
· and process guides to help you along the way.
· 05:32
· We have great resources, including
· 05:35
· the book that is introduced as a requirement in this course.
· 05:40
· The book by Dang and other authors from 2022
· 05:48
· has just an abundance of tools that we use in the DNP project
· 05:53
· and that you’re going to find useful when you are a doctorally
· 05:57
· prepared nurse.
· 05:59
· And most importantly, please remember
· 06:01
· that all three types of DNP projects use statistics.
· 06:08
· Very important concept that I want to leave you with.
· 06:13
· I’m telling you, the language is important.
· 06:15
· And so let’s get into it a little bit more.
· 06:19
· Remember, research is out to resolve a gap in knowledge.
· 06:27
· Something’s missing that we don’t really know.
· 06:30
· And quality improvement DNP projects
· 06:35
· are essentially out to close a gap in practice
· 06:42
· and improve outcomes at the back end.
· 06:46
· Now, published research may very well have research questions
· 06:51
· and may be phrased in a question with a question mark
· 06:56
· at the end of it, whereas hypotheses are typically
· 07:01
· seen in PhD dissertations.
· 07:05
· They might be implicit in a published study,
· 07:09
· and they are declarative statements
· 07:13
· that you can see that juxtapose relationships, associations,
· 07:20
· differences in the means, et cetera.
· 07:24
· A practice-focused question can be very much related
· 07:31
· to a clinical issue, a leadership and management issue.
· 07:35
· It can be related to some operational or administrative
· 07:40
· issue in organizations, whether they
· 07:43
· be hospitals or outpatient primary care sites,
· 07:47
· or any number of different types of venue.
· 07:52
· One of the big differences between research and quality
· 07:57
· improvement is important–
· 07:59
· it’s an important distinction, and it
· 08:02
· gets at this issue of generalizability
· 08:05
· versus applicability at the site.
· 08:08
· Both research and quality improvement
· 08:12
· may use sampling techniques, because in many cases,
· 08:17
· it’s just impractical to be able to take a look
· 08:21
· at the entire population.
· 08:23
· And the idea behind a rigorous research design
· 08:28
· that I mentioned earlier is that you really
· 08:31
· want to have a sample that’s big enough
· 08:33
· to make generalizable conclusions from that sample
· 08:39
· to the population.
· 08:41
· It’s not always possible in a quality improvement project
· 08:45
· to be able to do that, to get a sample size that is that large.
· 08:51
· But you certainly want to be able to show
· 08:55
· that interventions can be applicable at a given site.
· 08:59
· Now, there are three articles in week 1,
· 09:05
· and I want you to take a look at them.
· 09:07
· For example, the published work on the impact of tailored
· 09:15
· interventions for patient safety to reduce fall rates
· 09:20
· is a piece that is published in Med Surg Nursing in 2023,
· 09:26
· and it asked a clinical question,
· 09:29
· will the implementation of tailored interventions
· 09:33
· for patient safety reduce fall rates over four weeks?
· 09:38
· And similarly, there is a research study
· 09:45
· on falls, a multi-hospital survey
· 09:48
· on effective interventions to essentially discover
· 09:53
· new knowledge on what works in hospitals to prevent falls.
· 10:00
· And there was a main research question.
· 10:04
· What are highly effective interventions
· 10:08
· to prevent fall injuries as perceived by RN staff
· 10:13
· for adult inpatients in acute hospital settings?
· 10:19
· And finally, there is a dissertation,
· 10:24
· the development and evaluation of a nurse
· 10:27
· practitioner-directed intentional rounding strategy
· 10:32
· and its impact on decreasing falls.
· 10:36
· And in this particular project, this
· 10:40
· was a DNP project published in ProQuest dissertations.
· 10:46
· The project aimed to compare the impact of intentional rounding
· 10:52
· and unstructured rounding on the risk of
· 10:57
· falls in a long-term care facility.
· 11:01
· So all three of these published papers
· 11:05
· use some kind of a statistical analysis to answer a question,
· 11:11
· whether it’s a research question and hypothesis,
· 11:15
· or whether it’s a practice-focused question.
· 11:20
· So let me just say that research is the highest form of evidence.
· 11:24
· And this is borne out in Dang et al 2022.
· 11:27
· Absolutely at the top of the pyramid.
· 11:32
· Quality improvement, clinical practice guidelines,
· 11:35
· and any staff education must be based
· 11:37
· on existing knowledge and research,
· 11:40
· the highest form of evidence.
· 11:42
· Quantitative research requires rigorous design to minimize bias
· 11:47
· and to be able to draw from the sample
· 11:51
· to the population, the ability to make inferences
· 11:55
· to the population.
· 11:57
· Qualitative research also requires rigorous design
· 12:01
· to extract meaning and intent and to better understand
· 12:06
· the human experience.
· 12:08
· Now, one of the nice things about statistics
· 12:11
· is that they do provide us with objective tools to summarize,
· 12:17
· to present, to assess, to answer questions,
· 12:21
· and to support your conclusions.
· 12:23
· There’s some limitations, though.
· 12:26
· There is really a heavy reliance on good research design
· 12:30
· and on valid methods for data collection,
· 12:32
· and it is subject to bias.
· 12:35
· And one of the problems that we often have,
· 12:38
· especially with DNP projects, is that sample size is often small.
· 12:44
· So you might hear us talk as we go
· 12:47
· through this course about variables.
· 12:50
· And these can be independent variables, which is typically
· 12:56
· some aspect of your intervention,
· 12:59
· and dependent variables, which is that outcome that we’re
· 13:03
· so interested in.
· 13:04
· And variables can come in two different shapes,
· 13:09
· categorical variables, like nominal level data
· 13:13
· and ordinal level data, both categorical,
· 13:18
· or it can be continuous data.
· 13:21
· And as we move forward in this course with other slide
· 13:24
· decks and more attention to the statistics themselves,
· 13:29
· you’re going to see continuous data made up of interval level
· 13:33
· or ratio level data.
· 13:35
· Very, very useful for making comparisons.
· 13:38
· Descriptive data, we use measures of central tendency
· 13:43
· and dispersion.
· 13:45
· And again, we’re going to spend a whole week on this.
· 13:47
· And then, inferential we’ll spend several weeks on,
· 13:50
· which enables comparisons and determines
· 13:55
· the extent to which there are relationships between variables.
· 13:59
· So parting thought this week, probability theory
· 14:03
· is really the basis for many of the statistical analysis
· 14:09
· that we use in research and in quality improvement
· 14:13
· and in DNP projects.
· 14:16
· It’s about making a prediction from the sample
· 14:18
· to the population.
· 14:20
· And what are the chances?
· 14:22
· Is this something that’s due to chance, or random,
· 14:26
· or is this something that is predictable?
· 14:28
· So with that couple of questions that are essentially questions,
· 14:34
· I’m going to leave you this week and we’ll
· 14:36
· pick it up again next time.
·
·
Document:
Terminology (PowerPoint presentation)
Download Terminology (PowerPoint presentation)
Required Readings for Topic: Falls
Required Readings for Topic: Falls
· Bangura, F. (2024).
Development and evaluation of a nurse practitioner–directed intentional rounding strategy, and its impact on decreasing falls in a veterans long-term care facilityLinks to an external site.
(Publication No. 30991997) [Doctoral dissertation, Wilmington University]. ProQuest Dissertations and Theses Global.
· Khoja, A., & Moosa, L. (2023).
Impact of tailored interventions for patient safety (TIPS) to reduce fall ratesLinks to an external site..
MEDSURG Nursing, 32(2), 89–93.
· Tzeng, H.-M., & Yin, C.-Y. (2017).
A multihospital survey on effective interventions to prevent hospital falls in adultsLinks to an external site..
Nursing Economics, 35(6), 304–313.
To prepare:
· Read and view the Learning Resources, focusing especially on pages 92–95 of Dang et al. (2021).
· Choose one of the topics (from the “Falls” topic list) in the resources and read the three articles presented.
· View the video on Terminology.
By Day 3 Of Week 1
Post a response including the following:
· Identify the gap in knowledge (in the research article) and the gap in practice (in the QI study) presented in the articles provided. Explain how the practice-focused question emerged in the DNP EBP project. Use Table 4.6 on page 95 in Dang et al. (2021).
· Evaluate the provided research study, the quality improvement study, and the DNP EBP project. Compare and contrast (a) the gap and (b) the research question or practice-focused question.
By Day 6 of week 1
Read a selection of your colleagues’ posts and
respond to
at least two of your colleagues
on two different days by expanding upon their reflections, making connections to your perceptions, and offering additional insights.
