The Motivation of Advanced Practice Nurses to Explore
Research Motive in Practice
Nursing profession today has the essential elements of accountability and autonomy meaning that a nurse is responsible, professionally and legally for the nursing care provided. Nursing practice is liable for six kinds of legal authority, viz, ‘The federal or central law’, ’The law of the state’, The international code of physicians’, ‘Institutional rules and regulations’, ‘Standing orders of the chief’ and ‘Precedent court decisions’( Zwemer,1995). With increased patient awareness of the health care delivery situations, media flare up and public opinions, nursing practice has become more accountable today and there is a radical departure from the traditional practice which draws upon the personal experiences, case studies and research of the physician and not the health care delivery system as a whole entity. Autonomy means that a nurse is independent reasonably and self governing in making decisions in practice. The modern day nurse is a ‘client advocate who protects the human and legal rights of the patient under her care, based on his/her cultural and religious affiliations. The nurse is a ‘Care Giver’ helping the patients regain health through the process of healing. The nurse is the pivot of all communications in the health care delivery system (Potter, 2005). Thus, an advance practice nurse is motivated to explore research evidence in practice towards establishment of a 1.Evidence based Practice.2.Collaborative Practice.3.Nursing Research and 4.Patient satisfaction by research in the professional life.
Evidence based practice
Nurses are under increasing pressure to keep up to date and to base their decisions more firmly on evidences as opposed to anecdotal information of the past Evidence based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the case of individual patients (Baum, 2003). The practice of evidence-based medicine is the integration of individual clinical expertise with the best available external clinical evidence from systemic research. Individual clinical expertise is the proficiency and judgment that nurses acquire through clinical experience and practice. External clinical evidence is the relevant patient centered clinical research from the science of medicine. This includes the accuracy and precision of diagnostic tests, prognostic markers, therapeutic, rehabilitative and preventive regimens. External evidence sometimes replaces previously accepted treatments by virtue of accuracy and safety (Baum, 2003).
Evidence based practice takes patient’s perspective also into account. Hence, evidence based practice involves a big process of question building and this process of question building takes into account Clinical findings, Aeotiology, Diagnosis, Prognosis, Therapy and Prevention of diseases. This question building process gives the idea on the most important question, the question which is encountered very often in practice and the question’s relevance very often in practice and the question’s relevance to the patient situation. Of course, the best evidences are based on the conviction that a systematic documenting of a large number of high quality RCTs (Randomized with Concealment, Double blended, complete follow-up, intention to treat analysis) gives the least biased estimate. Thus, this becomes level 1 evidence and recommendations based on level 1 evidence are Grade A (Sackett, 1996).Various terminologies aid evidence based medical practice such as ‘Clinical practice guideline’ which assists the nurse practitioner and patient make decisions about appropriate health care and ‘Randomized controlled clinical trial’ where a group of patients is randomized into an experimental group and a control group. These groups are followed up for the variables and outcomes of interest (Baum, 2003).
The changing role of nurses as significant members of the health care team has brought about radical change in Health Care delivery system. The nurse-physician collaborative model is a model which shows a radical shift from the past. In such a model, the health care organizational structure is decentralized and the nurses and physicians function collaboratively to make clinical decisions (Potter, 2005).
Nursing Research Programs
The early twentieth century saw the affiliation of nursing education with Universities and this has widened the scope for nurses to take their nursing education to level of advanced research in nursing to improve nursing care and patient’s health (Potter, 2005).
Patient satisfaction with nursing care is an indicator of quality care. A study to discover patients' perceptions of the nursing care they receive in a hospital setting using the Grounded theory method in eight medical-surgical patients recently discharged from an academic medical centre in the south-eastern United States of America has identified four categories of patient perceptions of their nursing care, namely, Seeing the individual patient, Explaining, Responding and Watching over. Seeing the individual explains the unique nature of the nursing care experience for each patient. 'Explaining' denotes the informal but essential explanations given by nurses. 'Responding' denotes the character and timeliness of nursing staff's responses to patient requests or symptoms. 'Watching over' represents the surveillance activities of nursing staff (Schmidt, 2003).The study has also identified four dimensions of patient perceptions namely, the medical-technical competence of the caregivers; the physical-technical conditions of the care organization; the degree of identity-orientation in the attitudes and actions of the caregivers and the socio-cultural atmosphere of the care organization (Wilde_et.al,1993). Thus, patient satisfaction is an important aspect of nurse care today and a nurse has to update herself by a research process to achieve maximum results.Utilization of Action Research to stimulate and evaluate nursing practice is being explored recently as evidenced by published literature. Action research with qualitative inquiry seems to be the need of the hour in nursing practice today (Baldwin et.al, 2001).This process should progress in a cautious pragmatic style based on rigorous, systematic and visible methods of data collection, analysis and verification of findings (Julienne Meyer, 1997). Action Research is more suited to nursing because of its similarity to the nursing process of planning, acting, observing, reflecting and replanning (Bellman, 1996). Action Research does not require expert researchers and hence, appropriate for nurses, where, the nurses define the problem themselves (Birkett, 1995). Action research is simple in structure and gives scope for changes (Titchen and Binnie, 1993) and hence, empowering. Further, Action Research is viewed as a tool to the implementation of innovations in health care where the diffusion of innovations is an essential component of the modernization of health care and it is best suited to the study of innovation diffusion where there is a need for high level of adaptation (Waterman et.al, 2007). Action research has been effectively redefined to fit into nursing practice with various models of action research. This includes the 'insider' and 'outsider' models of action research, the ‘double-act' and 'collaborative group' partnerships (Angie Titchen, 1993).
Thus, today nursing is a profession rather than a vocation. An advance practice nurse is motivated to explore research evidence in practice. The profession has extended education avenues, a body of knowledge leading to defined skills, an ability to provide specific service, professional autonomy to make decisions governed by a code of ethics (Potter, 2005). Utilization of techniques like action research helps nurses to evaluate their professional practice and an evidence based practice establishes professional authority.
- Angie Titchen (1993). Research partnerships: collaborative action research in nursing. Journal of Advanced Nursing. 18(6); 858-865.
- Ann J. Zwemer (1995) “Professional Adjustments and Ethics for Nurses in India”. 6th edn, B.1 Publications, India,.
- Bellman, L.M. (1996). Changing nursing practice through reflection on the Roper, Logan and Tierney model: the enhancement approach to action research. Journal of Advanced Nursing.24; 129-138.
- Birkett, M. (1995). Is audit action research? Physiotherapy. 81(4); 190-194.
- Heather Waterman (2007). The Role of Action Research in the Investigation and Diffusion of Innovations in Health Care: The PRIDE Project. Qualitative Health Research, 17(3); 373-381.
- Heather Waterman, Christine Webb and Anne Williams (1995). Changing Nursing and Nursing Change: a dialectical analysis of an action research project. Educational Action Research, 3(1); 55 - 70.
- Julienne Meyer (1997). Action research in health-care practice: Nature, present concerns and future possibilities. Nursing Times Research, 2(3): 175-184.
- Loretta M. Bellman (1996). Changing nursing practice through reflection on the Roper, Logan and Tierney model: the enhancement approach to action research. Journal of Advanced Nursing. 24(1); 129-138.
- Neil H.Baum (2003).Support your decisions with Evidence based Medicine, “Urology Times” Feb 1, 2003.
- Nichols R, Meyer J, Batehup L, Waterman H (1997) Promoting action research in Healthcare settings. Nursing Standard. 11(40); 36-38.
- Patricia A Potter and Anne Griffin Perry (2005). Fundamentals of Nursing, 6th edition, Mosby.
- Schmidt LA. (2003). Patients' perceptions of nursing care in the hospital setting.J Adv Nurs. 44(4):393-9.
- Sackett (1996) “Evidence based medicine: what it is and what it isn't”, BMJ; 312: 71-72.
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