Research Utilization Versus
Evidence-Based Practice
Research utilization(RU)
The use of study findings in a
practicalapplication unrelated to the original
research
Evidence-based practice(EBP)
Basing clinical
decisions on best possible evidence—especially high-quality research
Figure
18-1
Schema of How RU and EBP Are
Interrelated
Types
of Research Utilization
•
Instrumental(direct) utilization
•
Conceptual(indirect) utilization
•
Persuasive utilization
Stages
of Adoption of an Innovation
•
Awareness
•
Persuasion
• Occasional use
•
Regular use
Key
Proponents of the Evidence-based
Practice Movement
•
Archie Cochrane
– Efforts led to development of Cochrane
Center in Oxford and theCochraneCollaboration
– Proposed an
evidence hierarchy for weighing
evidence
• David Sackett
– EBP
pioneer at McMaster Medical School
Six-Level
Evidence Hierarchy (Stetler)
Levels of evidence (from
strongest to weakest):
•
Meta-analyses of controlled studies
•
Individual experimental studies
• Quasi-experimental studies
• Nonexperimental studies
•
Program evaluations, RU
studies, quality improvement projects, case reports
• Opinions of respected authorities and expertcommittees
Barriers
to RU and EBP in Nursing
•
Research-related barriers
•
Nurse-related barriers
•
Organizational barriers
• Barriers related to the nursing profession
Strategies
for Nurses to Play a Role in
RU/EBP
•
Read widely and critically
• Attend professional conferences
• Learn to expect evidence indicatingthat a procedure is effective
•
Become involved in ajournal
club
•
Pursue and participate in
RU/EBPprojects
Three
Models for Evidence-Based Nursing
Practice
• TheStetler Model of research utilization to promote evidence-based practice
•
TheIOWA Model of
evidence-basedpractice to promote quality care
•
TheOttawa Model of Research Use
(OMRU)
Major Activities/Steps in Using
Research
in Nursing Practice
•
Select a topic or problem
– Knowledge-focused
triggers
– Problem-focused
triggers
•
Assemble and evaluate evidence
– Use
integrative reviews
– Search
for other evidence
– Evaluate
evidence
Major Activities/Steps in Using
Research
in Nursing Practice(cont’d)
•
Assess implementation potential
– Assess
transferability of innovation
– Evaluate
feasibility of adopting innovation in new setting
– Assess
costs and benefits of innovation
• Develop, implement, and evaluate the innovation
Research
Integration and Synthesis
Forms of integrative
reviews:
– Narrative,
qualitative integration
(traditional review of
quantitative or qualitative results)
– Meta-analysis(statistical integrationof results)
– Meta-synthesis(theoreticalintegration of qualitative findings)
Steps in Conducting an Integrative
Review
•
Define research problem or
hypotheses to be tested
• Select sample of studies to be included in the review
•
Extract and record data from
research reports
Steps
in Conducting an Integrative Review
(continued)
• Determine quality of the evidence (e.g., quality ratings to weight
findings)
•
Analyze the data (i.e.,
cumulative findings)
– In meta-analysis, calculate aneffect size
• Write up integrative review
