Nursing Education, Research, and Evidence-Based Practice Nursing education is controlled from within the profession through state boards of nursing

and national accrediting bodies. The traditional focus of nursing education was to teach the knowledge and skills that would enable a nurse to practice in the hospital setting.

Nursing curricula now have a greater focus on critical thinking and the application of nursing and supporting knowledge to health promotion, health maintenance, and health restoration as provided in both community and hospital setting.

The major goal of nursing research is to improved client care.

Nursing Education There are two types of entry-level generalist nurses:

o Registered Nurse (RN)o Licensed Practical or Vocational Nurse (LPN, LVN)

Responsibilities and licensure differ for these two levels. The majority of new RNs graduate from diploma, associate degree, or baccalaureate nursing

programs. There are also generic master’s and doctoral programs that lead to eligibility for RN

licensure. Graduates of these master’s programs are eligible to take the licensure examinations to

become an RN and may continue into specialty roles such as nurse practitioner or educator.. All RNs in the US take the same licensing examination. National Council Licensure

Examination (NCLEX-RN) is administered in each state. Nursing Licensure Examination All US nursing programs require approval by their state board of nursing. In addition to state approval, the National League for Nursing Accrediting Commission

(NLNAC) provides accreditation for all levels of nursing programs, and the Commission on Collegiate Nursing Education (CCNE) accredits baccalaureate and graduate degree nursing programs. Commission on Higher Education

Accredited programs meet standard requirements evaluated periodically through written self-studies and on-site visitation be examiners.

Types of Educational ProgramsEducational programs available for nurses include:

1. Practical or vocational a. Provided by community colleges, vocational schools, hospitals, or other independent

health agenciesb. Last 9 to 12 months and provide both classroom and clinical experiencec. Takes the NCLEX-PN to obtain a license as practical or vocational nursed. LPNs usually provide basic direct technical care to clients under the

supervision of the RN2. Registered nursing programs

a. Diploma programs – are hospital-based educational programs that provide a rich clinical experience for nursing students

b. Community College/Associate Degree Programs – the graduating student receives an associate degree in nursing (ADN) or an associate of arts (AA), associate of science (AS), or associate in applied science (AAS) degree with a major in nursing

c. Baccalaureate Degree Programs – are located in senior colleges and universities and are generally 4 years in length.

- Degree awarded is a bachelor of science in nursing (BSN)- Experience greater autonomy, responsibility, participation in institutional

decision making, and a career advancement.

3. Graduate nursing – applicants must be RN, hold a baccalaureate degree in nursing from approved college or university

a. Master’s Program – takes 1.5 to 2 years to complete. Degrees granted are the master of arts (MA), master in nursing (MN), master of science in nursing (MSN) and master of science (MS). Provide specialized knowledge and skills that enable nurses to assume advanced roles in practice, education, administration, and research.

b. Doctoral Programs – award the degrees of doctor of philosophy (PhD), doctor of nursing science (DNS or DNSc), or nursing doctorate (ND). Further prepare the nurse for advanced clinical practice, administration, education, and research.

4. Continuing education (CE) –refers to formalized experience designed to enlarge the knowledge or skills of practitioners, more specific and shorter, participants may receive certificates of completion or specialization. Designed for: a. To keep nurses abreast

5. In-service Education program – is administered by an employer; it is designed to upgrade the knowledge or skills of employees.

Entry to Practice

In 1985, ANA endorsed the BSN as the entry level for professional practice. According to ANA’s proposal, only the baccalaureate graduate would be licensed under the legal title registered nurse. The graduate with an associate degree in nursing would be considered a technical nurse or be licensed under the legal title associate nurse (AN).

Basic Educational Program in Nursing

Until 1983, there was only one basic educational program in nursing – the four-year collegiate degree program leading to the Bachelor of Science in Nursing. The basic three-year hospital-based program leading to the title Graduate in Nursing was phased out. It is to be noted, however, that revision of this program continues as seen fit by the Council of Deans, the Philippine Colleges of Nursing, the Commission on Higher Education, and nursing practitioners.

However, effective School Year 1998-1999, the curriculum for the common two-year Associate in Health Science Education (ASHE) was enforced.

The BSN Curriculum

The four-year Bachelor of Science in Nursing Program offers a competency-based community oriented curriculum to educate future nurse practitioners to assume their roles and responsibilities in the Philippine Health Care Delivery System. It aims to prepare nurses for entry level positions in any healthcare setting in the country, e.i., hospitals, clinics, healthcare centers, homes, and communities.

Overall, the BSN program intends to produce a professional nurse who demonstrates the following behaviours:

1. Caring behaviour (compassionate, competent and committed)2. Ability to practice legal, ethico-moral, social responsibilities/accountabilities3. Critical and creative thinking; and

4. Skill in practicing S-K-A and values for the promotion of health, prevention of illness, restoration of health, alleviation of suffering; assisting clients to face death with dignity and in peace.

Nursing Research and Evidence-Based Practice

What is Nursing Research?

"A scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice." (Grove & Burns, (1995). "Understanding Nursing Research". Philadelphia: Saunders.)

What is the Primary Goal of Nursing Research?

** To develop a specialized, scientifically based body of knowledge unique to nursing **

Other goals: develop and test nursing theories; understand nursing phenomena;

foster professional commitment & accountability;

help nurses make informed decisions in patient care;

validate the effectiveness of particular nursing measures;

help document nursing's unique role in the health care delivery system;

improve quality of care and care delivery;

provide a link between theory & practice;

advance nursing as a profession.

What are the various nursing roles in the Research Process for graduates with the ADN, BSN, MSN or PhD?

ADN graduates:

have awareness of the value of nursing research

BSN graduates:

understand each step of the research process; interpret, evaluate, determine the credibility of research findings; integrate research into clinical practice; participate in studies

MSN graduates:

are active members of the research team, they are clinical experts

PhD graduates:

appraise, design and conduct research; they develop theoretical explanations of nursing phenomena; and they disseminate findings (presentations, publications)

Remember: Nursing research is important to ALL nurses!

Features of Qualitative & Quantitative Research

Qualitative Quantitative

The aim is a complete, detailed description.

The aim is to classify features, count them, and construct statistical models in an attempt to explain what is observed.

Researcher is the data gathering instrument.

Researcher uses tools, such as questionnaires or equipment to collect numerical data.

Data is in the form of words, pictures or objects.

Data is in the form of numbers and statistics.

Subjective - individuals� interpretation of events is important ,e.g., uses participant observation, in-depth interviews etc.

Objective � seeks precise measurement & analysis of target concepts, e.g., uses surveys, questionnaires etc.

Qualitative data is more 'rich', time consuming, and less able to be generalized. 

Quantitative data is more efficient, able to test hypotheses, but may miss contextual detail.

Researcher tends to become subjectively immersed in the subject matter.

Researcher tends to remain objectively separated from the subject matter.

 (the two quotes are from Miles & Huberman (1994, p. 40). Qualitative Data Analysis)

Main Points

Qualitative research involves analysis of data such as words (e.g., from interviews), pictures (e.g., video), or objects (e.g., an artifact).

Quantitative research involves analysis of numerical data.

What is Evidence-based Nursing Practice?

Evidence-based practice (EBP) in nursing is a process of locating, appraising, and applying the best evidence from the nursing and medical literature to improve the quality of clinical practice.

EBN is a type of evidence-based medicine. It involves identifying solid research findings and implementing them in nursing practices, in order to increase the quality of patient care. The goal of EBN is to provide the highest quality and most cost-efficient nursing care possible. EBN is a process founded on the collection, interpretation, and integration of valid, important, and applicable research. Some define EBN tightly, considering only the application of the findings of randomized clinical trials, while others also include the use of case reports and expert opinions. In order to practice evidence based nursing, practitioners must understand the concept of research and know how to accurately evaluate this research. These skills are taught in modern nursing education and also as part of professional training.

It involves: 1. Formulating a clear question based on a clinical problem; 2. searching the literature for the best available evidence;3. evaluating the strength of that evidence in terms of validity and generalisability;4. implementing useful findings in clinical practice based on valid evidence; evidence is used alongside clinical expertise and the patients' perspective to plan care;5. evaluating performance through a process of self reflection, audit, or peer assessment.

Protecting the Rights of Human Subject

Because nursing research usually focuses on humans, a major nursing responsibility is to be aware of and to advocate on the behalf of client’s right

All clients must be informed and understand the consequences of consenting to serve as research participants.

1. Right Not to Be HarmedThe risk of harm to a research subject is exposure to the possibility of injury going beyond everyday situations. The risk can be physical, emotional, legal, financial or social.

2. Right to Full DisclosureFull disclosure, the act of making clear the client’s role in a research situation, is a basic right. It means that deception, either by withholding information about client’s participation in a study or by giving the client false or misleading information about what participating in the study will involve, must no occur.

3. Right of Self-determinationMany dependents clients feel pressured to participate in studies. The right of self-determination means that participants should feel from constraints, coercion, or any undue influence to participate in a study.

4. Right of Privacy and ConfidentialityPrivacy enables a client to participate without worrying about later embarrassment. Confidentiality means that any information a participant relates will not be made public or available to others without the client’s consent. Use codenames.. pseudonyms.

CARING

The art of knowing in nursing theory, more formerly known as the "Fundamental Patterns of Knowing in Nursing," describes four basic concepts, or patterns of knowledge, as they relate to their advanced application in clinical practice. This model of nursing theory permits nurse practitioners to enhance patient care and recovery by applying real life experience, knowledge and cognitive reasoning that extends beyond the scientific methodology of empirical knowledge.

Carper (1975) identified four ways of knowing in nursing that came to be known as the epistemology of nursing in the United States. The four ways of knowing include Empirics, the science of nursing; Ethics, the moral directives of nursing; Personal, the special way nurses have of being with their patients; and Esthetics, the creativity that nurses bring to their practice.

Kramer and Chinn (1988) enhanced Carper’s work by adding the creative, expressive, and assessment dimensions to the ways of knowing.

Empirical Knowledge Generally referred to as the "science of nursing," empirical knowledge represents the scientific essentials of nursing. This pattern of knowledge is founded in evidence-based research and objective experience.

Aesthetic Knowledge Often called the "art of nursing," aesthetic knowledge is subjective and intuition-based. It calls for recognizing and appreciating the unique qualities of individual patients, as well as responding with compassion and understanding to help patients and their families navigate the recovery process.

Personal Knowledge As the term implies, personal knowledge is defined by first-hand experience and self-awareness. Personal knowledge enables the nurse practitioner to relate to the patient with empathy in an authentic manner.

Ethical Knowledge This pattern of knowledge refers to operating within a framework of ethical standards in order to recognize or judge what is correct or just when there is no "textbook answer." This means drawing on knowledge and experience to identify and address legal, moral and social issues with integrity and professionalism.

Evolution in Practice In an article published in the Journal of Advanced Nursing in 1998, expert Helen Heath wrote that Carper's art of knowing in nursing theory transformed practical nursing from a dependence on empirical theory to reflective practice based on experience. However, this system continues to evolve clinical practice methods today. For instance, Lorraine Holtslander of the University of Saskatchewan College of Nursing suggests that applying these patterns of knowledge as a guide to "hope research" may help to better address the needs of bereaved caregivers as they cope with loss and grief.