Nurses must know the difference between Quality Improvement, Evidence-Based Practice, and Original Research Evidence because they must know what they are reading how each one can best be utilized to improve patient care, quality of care, the profession as a whole, and finally the overall field of medicine. Each concept can be best applied in many different fields of nursing. Nurses working in the varying positions can each have a long-lasting impact if they know each research concept and how best to apply the data supplied by those concepts.
Keywords: Quality Improvement, QI, Evidence-Based Practice, EBP, Original Research
Nursing is a multi-faceted profession, one that contains abilities that lay far beyond what the layman believes a nurse to be trained and educated to do One of the facets that belong in the nursing repertoire is understanding research. A nurse must understand research but a nurse must also know the differences between the varying types of research there is. Understanding the differences in research widens the scope of medical comprehension for the nurse but it also has a direct impact on the nurses’ patients, colleagues, and the institution in which they are employed.
Significance and Background
When nursing began it was not what it is today. Nurses were responsible for taking care of the sick or injured. Rolling bandages and changing the dressings on wounds may have been what nurses started out doing but the profession has expanded and has become a necessary and very important part of the medical field. Now, nurses are the eyes and ears for doctors. They spend time getting to know their patients, and there are instances of nurses catching things that doctors miss, saving the lives of their patients. They are the front line, every day, working to save lives and prevent the spread of disease.
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Nurses must be able to understand research and be able to interpret the varying types of research so that the information gathered and learned can be applied in a clinical setting in order to increase their abilities and the to improve the care their patients receive. The ever increasing medical education of nurses goes hand-in-hand with medical research. No matter ones profession in the medical field, continuing education is not only necessary it is paramount to the applicability of the latest medical findings.
Quality improvement or QI is when a nurse uses data to evaluate and monitor the outcome of care provided to a patient (or patients) while additionally using said data to improve upon varying methods of care and testing the changes in order to improve the care patients receive as well as improving the overall health care system. The main understanding of what QI is, is in the very name itself, quality improvement. The quality of care being received by patients and the quality of that care’s impact on the overall medical field is something that must be continuously improved upon. If data shows there is a need for improvement, nurses are able to make necessary adjustments or they are able to recommend the necessary adjustments in order for quality to improve. Quality of care has a large and lasting impact across the board in regards to health care.
Quality improvement is not the same as other types of research in the fact that it only examines the data that results from care processes, and not the care itself. Quality improvement would examine the data resulting in care changes, for example, it would examine the data collected surrounding getting appendectomy patients to ambulate after surgery within a certain time frame, differing from the time frame ambulation was previously. It would then examine that data to determine of moving ambulation up was helping the patients in comparison to a later ambulation time frame model.
Evidence-Based practice or EBP is research that combines clinical expertise, patient values, and research evidence into making decisions surrounding the process of patient care. This type of research would utilize validity, reliability, relevance and the outcomes of the variables they utilize to made decisions. In addition, EBP would also utilize quantitative research as well as qualitative research into their decision making processes. EBP requires evidence in order to make changes in the practice of the medical field.
Evidence-Based Practice, for example, would look at the clinical studies of those who were made to ambulate after having an appendectomy sooner than they had previously. In addition, they would also take into consideration the values of the patients, whether or not the early ambulation is too mentally taxing for the patients. Research evidence would also be incorporated into the examination of the change and into the applicability of the changes on a wider scale. EBP examines several variables before introducing any changes into the health care field. EPB is moderately-high in regards to use in a clinical setting (Squires, et al., 2011).
EBP could be used and is used to make changes in the quality of care a patient can receive or in the health care system as a whole, however, it is not the same as Quality Improvement (QI). Quality Improvement can be done on a micro level, such as at a hospital or a health care facility. Data can be collected and analyzed and changes can be put into place regarding the quality of care patients are receiving. EBP is harder to use on a micro-scale, it is still possible but it is utilized more for larger, broader changes such as changes on a state wide level or changes across an entire field in the health care field.
Original Research Evidence
Original research evidence is evidence that gathered from those groups of researchers or individual researchers who have developed a unique hypothesis and tested their hypothesis resulting in data that can be used to gain a better understanding of a topic, improve the care people receive, or to make changes to the health care field. Original research does not include research that is repeating research done by others. It also does not include research that incorporates information gathered from other research.
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An example of original research would be research surrounding the number of pregnant women who receive an in-utero diagnosis of hydronephrosis in their fetus compared to hydronephrosis that goes undiagnosed in-utero and is not diagnosed until after birth. As long as the researcher did not utilize data from other research studies, and the study has not been conducted prior to their conducting the study it would be considered original research. Original research is something that is conducted by those who specifically perform research or those in the medical field who are seeking to determine if their own hypothesis is valid or invalid. It is much harder for a non-researcher medical professional to conduct original research.
In order for original research to be deemed of value in order for the data to be utilized, the research must be peer-reviewed. Peer-review can mean the replicating of the study by outside researchers. However, if the data used is the data collected by the replication of the original study it is no longer original research. Original research must be peer-reviewed and preferably published in a reputable medical journal. If neither of this can be said of the original research, the research should be avoided in regards to the utilization of data gathered by said research in order to implement any changes either on a micro-scale or macro-scale.
Nurses work in a variety of settings. Each research concept can be utilized in the variety of settings, in fact, the variety of research concepts strengthen the role nurses have in the medical field. Evidence-Based Practice, for example, would be great utilized in regards to administration and overall policies regarding patient care. Quality Improvement would be best used in regards to direct patient care and even in situations that involve the work place for the nursing staff directly. Original research would be best utilized in terms of research itself and the academia facet of nursing.
Each concept is different, but each concept shares a common goal. That common goal is to improve the overall healthcare field and improve the abilities of the nurses, no matter what sector of nursing the nurse is employed in. Nursing and the entire medical field is moved into the future by constant evaluation and improvement of existing guidelines, practices, policies, etc. If changes did not occur, nursing, as well as, the medical field would stagnate and the patients would suffer from that stagnation.
Keep in mind, had research not been conducted and implemented, the medical field would have never understood that medical instruments and hands must be sanitized before moving to a new patient. The medical field learned from observations made during the American Civil War that led to the changes being made. It was a major step in sanitary medical practices that the medical field needed to become better at their jobs but also it would improve the quality of care received by the patients. Modernization is something that every field must embrace in order to improve and remain relevant. Nursing in a digital world is the next frontier (Abbott & Shaw, 2016).
Understanding the differences in Quality Improvement, Evidence-Based Practice, and Original Research Evidence is necessary in order to understand what one is looking at. Beyond that, the applications of each concept can be specific and aid in differing ways in regards to the position a nurse holds. Academia is very different than clinical work. Each concept is useful and important. Understanding the differences in research widens the scope of medical comprehension for the nurse but it also has a direct impact on the nurses’ patients, colleagues, and the institution in which they are employed.
- Abbott, M.B., & Shaw, P. (2016). Virtual Nursing Avatars: Nurse Roles and Evolving Concepts of Care. OJIN: The Online Journal of Issues in Nursing, 21,3, doi: 10.3912/OJIN.Vol2No03PPT39,05
- Squires, J.E., Hutchinson, A.M., Bostrom, A.M., O’Rourke, H.M., Cobban, S.J., & Estabrooks, C.A. (2011). To What Extent Do Nurses Use Research in Clinical Practice? A Systematic Review. Implementation Science, 6, 21. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068972/
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