NursingResearchT1Q2

After reviewing the course textbook (attached), summarize the history of nursing research. Discuss the importance of nursing research as it relates to applying evidence in practice (evidence-based practice).

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.
Please, use at least y citation from the attached book, as a proof I already reviewed it.

24250061 – Grand Canyon University ©

1. History and Process of Nursing Research, Evidence-
Based Nursing Practice, and Quantitative and
Qualitative Research Process

“If we knew what we were doing, it would not be called
research, would it?” —Albert Einstein (WorkingMinds.com,

n.d., para. 53).

By June Helbig

Essential Questions

What is the history of human subject testing, and what has been its
impact on current practices and informed consent?
Why is it important for nurses to use evidence-based practices?
Why is it important for nurses to perform research and contribute to
generalizable knowledge?

Introduction
Nurses strive to provide the best possible care to diverse clients under consistently
changing conditions. From the medications administered to the type of dressing used
to heal a wound, nurses apply procedures that have been tested through research
and deemed appropriate according to evidence-based standards of practice. Through
foundational knowledge related to research methods, translation of research data is
used to improve nursing practice and, ultimately, patient outcomes. Therefore,
nurses must become familiar with the specific language of scientific research and the
research process.

Many historical events have shaped research practices, and guidelines have been
developed to protect human subjects from inadvertent harm. Many nurses and
physicians conduct research studies, but to do so, they must adhere to research
practices that address ethical considerations for participants, ensure the integrity of
the research process, and safeguard the public. This chapter outlines the historical
events that have shaped modern research, providing a framework to introduce
novice researchers to the foundations of research design and implementation.

History of Research
As health care professionals, nurses seek to provide their patients with the best
possible health care. To determine which approaches to care result in the best

24250061 – Grand Canyon University ©

possible care, the effectiveness of each approach specific to a chosen population
must be investigated. The pursuit of knowledge is the basis for research. Researchers
seek to find answers to various scientific questions, but there are the boundaries
associated with the pursuit of knowledge.

Nazi Medical Experiments (1933-1945)

During World War II, German physicians conducted unethical experiments on
thousands of human prisoners at the Nazi concentration camps. These experiments
were performed without consent and many times without anesthesia. The most
notorious of these experiments occurred at the hands of Dr. Josef Mengele. Mengele
worked at the Auschwitz concentration camp, called the killing center. Auschwitz, the
largest of the concentration camps, was operational from 1940-1945. It was the site
of medical experiments and various forms of research that were performed on
infants, twins, and dwarfs. Forced sterilization and castration of adults occurred as
well (U.S. Holocaust Memorial Museum [USHMM], n.d.-a.).

According to the United States Holocaust Memorial Museum (USHMM, n.d.-b), there
were three categories of unethical medical experimentation, including “facilitating the
survival of Axis military personnel,” (para. 2), testing different medications for
illnesses and injuries, and advancing “the racial and ideological tenets of the Nazi
worldview” (para. 4). The first category of experiments conducted at Dachau, another
Nazi camp in nearby Germany, included high altitude experiments using low-pressure
chambers, freezing experiments to find treatments for hypothermia, and various
seawater experiments. Experiments for the second category involved injecting
patients with various compounds to test treatments for contagious diseases, such as
malaria, typhus, tuberculosis, typhoid fever, yellow fever, and infectious hepatitis.
Prisoners were also exposed to deadly gases such as phosgene and mustard gas. The
third category of experiments included the “mass sterilization of Jews, Roma, and
other groups Nazi leaders considered to be racially or genetically undesirable”
(USHMM, n.d.-b., para. 5). By the end of World War II, 6 million European Jews were
murdered, and thousands of prisoners were forced to endure incredible pain and
suffering without giving their consent for the acquisition of knowledge.

The Nazi physicians performed brutal medical experiments upon helpless
concentration camp inmates. These acts of torture were characterized by
several shocking features: (1) persons were forced to become subjects in very
dangerous studies against their will; (2) nearly all subjects endured incredible
suffering, mutilation, and indescribable pain; and (3) the experiments often
were deliberately designed to terminate in a fatal outcome for their victims.
(Cohen, n.d., para. 11)

The Nazi physicians were brought to justice before a military tribunal held in
Nuremberg, Germany. Knowledge generated by the Nazi physicians exists today and
can be used to generate new knowledge in several fields, but considerable debate
surrounds the use of this information. Physicians and scientists who “have sought to
use the Nazi research have … [examined at length] the social responsibility and

24250061 – Grand Canyon University ©

potential abuses of science” (Cohen, n.d., para. 3). Researchers today must ask
themselves whether it is appropriate to use the data.

Freezing Experiments

In another series of experiments, prisoners were placed into sub-zero water tanks to
investigate how long pilots would survive if shot down over freezing waters. The Nazi
physicians recorded data as prisoners were immersed and kept in frozen water for
hours. “The Nazis meticulously recorded the changes in body temperature, heart
rate, muscle response, and urine” (Cohen, n.d., para. 28). The data obtained
described end-stage hypothermia in humans. Many years later, hypothermia
research was performed involving cold-water survival suits to protect people from
boating accidents in frigid waters and rewarming frozen victims of the cold. The
scientists looking to save lives from hypothermia had concerns about whether or not
they should use the data generated by the Nazi experiments. The only data currently
available regarding extreme hypothermia is the data collected by Nazi physicians

High-Altitude Experiments

To simulate high altitude conditions, Nazi physicians used decompression chambers.
The chambers simulated altitudes as high as 68,000 feet. The physicians monitored
the subjects’ physiological responses as they succumbed to death. The victims’ brains
were dissected while they were still alive to demonstrate that high-altitude sickness
consisted of the formation of tiny air bubbles in the blood vessels of the brain. After
death, the brains were studied, and additional data was obtained (Cohen, n.d.).

Experiments on Twins

Twins were studied extensively in the concentration camps. Mengele studied identical
twins by injecting substances into one twin and when that twin died, he would kill the
other twin and look for differences upon autopsy. Mengele was obsessed with “the
Nazi ideology of racial purity and Aryanism led him to believe that he could unlock
the secrets of human reproduction and multiple births” (Cohen, n.d., para. 24)
through his research.

Whether the data gathered from these studies will help save lives in the present is
unknown. The experiments cannot be replicated, and the integrity of the data itself
may be in question. Applying data obtained in unethical studies also warrants
consideration toward the victims and their families. As a direct result of these
atrocities, regulations guiding research practice have been written.

Nuremberg Code

On October 18, 1945, 22 of Nazi Germany’s political, military, and economic leaders
were brought to trial in Nuremberg, Germany for war crimes, and crimes against
humanity. For the first time in history, an international military tribunal (IMT),

24250061 – Grand Canyon University ©

composed of representatives from the Allied countries as well as representatives
from Nazi-occupied countries, united to seek justice for victims.

The Nuremberg trials (see Figure 1.1) lasted from October 18, 1945 through October
1, 1946. All judgments against the Nazi leaders were completed on October 1, 1946.
Of the 22 Nazi leaders placed on trial, “twelve were sentenced to death, three to life
imprisonment, four to imprisonment ranging from 10 to 20 years, and three were
acquitted” (USHMM, n.d.-c., para. 3). Through the course of the trial, the IMT was able
to define the criminality of war, war crimes, and crimes against humanity. In a series
of 12 additional trials, more than 100 defendants were tried for war crimes.

Figure 1.1

Defendants at the Nuremberg, Germany War Crimes Trial

Photo credit: National Archives and Records Administration.

The doctors’ trial followed the trial of the Nazi leaders. The question of medical
experimentation on human beings was discussed. At the time, no rules or guidelines
existed to govern research on human subjects. In April of 1947, a list of guidelines
discussing voluntary consent as well as the rights, safety, and well-being of those

24250061 – Grand Canyon University ©

participating in research studies was prepared and submitted to the United States
Counsel for War Crimes. Initially, this list was called Permissible Medical Experiments,
and it contained six points defining legitimate research. Shortly thereafter, the six
points were expanded to 10 and was given the title the Nuremberg Code.

The Nuremberg Code was a landmark document and the first internationally
accepted code to govern scientific research. Among the key tenants was informed
consent and voluntary participation, which forms the basis for ethical conduct of
research today. According to the principle of informed consent, human subjects must
be informed of the purposes of the study, the possible risks and benefits associated
with the study, and maintain the right of refusal at any time even after a study has
been initiated. All forms of research must be conducted with integrity, transparency,
confidentiality, and minimal risk to participants.

Nuremberg Code
1. The voluntary consent of the human subject is absolutely essential.
2. The experiment should be such as to yield fruitful results for the

good of society, unprocurable by other methods or means of study,
and not random and unnecessary in nature.

3. The experiment should be so designed and based on the results of
animal experimentation and a knowledge of the natural history of
the disease or other problem under study that the anticipated
results will justify the performance of the experiment.

4. The experiment should be so conducted as to avoid all unnecessary
physical and mental suffering and injury.

5. No experiment should be conducted where there is an a priori
reason to believe that death or disabling injury will occur; except,
perhaps, in those experiments where the experimental physicians
also serve as subjects.

6. The degree of risk to be taken should never exceed that
determined by the humanitarian importance of the problem to be
solved by the experiment.

7. Proper preparations should be made, and adequate facilities
provided to protect the experimental subject against even remote
possibilities of injury, disability, or death.

8. The experiment should be conducted only by scientifically qualified
persons. The highest degree of skill and care should be required
through all stages of the experiment of those who conduct or
engage in the experiment.

24250061 – Grand Canyon University ©

9. During the course of the experiment the human subject should be
at liberty to bring the experiment to an end if he has reached the
physical or mental state where continuation of the experiment
seems to him to be impossible.

10. During the course of the experiment the scientist in charge must be prepared to
terminate the experiment at any stage, if he has probable cause to believe, in the
exercise of the good faith, superior skill and careful judgment required of him
that a continuation of the experiment is likely to result in injury, disability, or
death to the experimental subject (USHMM, n.d.-d).

Declaration of Helsinki (1964)

In June of 1964, the “World Medical Association developed the Declaration of
Helsinki as a statement of ethical principles to provide guidance to physicians and
other participants in medical research involving human subjects” (World Health
Organization, 2001, p. 373). The Declaration of Helsinki assured that protections of
basic rights were extended to all groups, regardless of whether the group consisted
of vulnerable populations. Historically, vulnerable populations included minority
groups, prisoners, women, and children. Since the Declaration of Helsinki, the
requirement is to state why any group, including vulnerable populations, were to be
excluded from the research trial. Transparency is important to conducting ethical
research. With the advancement of biomedical research, the public, as well as the
human subject, must be knowledgeable of available research trials as well as the
results of human subject research.

The Declaration of Helsinki continues to be an important document for research
oversight. It mandates that not only are the successes discussed, but the failures are
acknowledged as well. People have the right to know the inconclusive results. “The
scientific enterprise must openly acknowledge that science improves through both
failure and success” (Ndebele, 2013, para. 6). Researchers must be transparent with
human subjects regarding the possible risks and benefits of the study, so the human
subject can make an informed decision on whether to participate in the study. Part of
the informed consent process involves giving the human subject sufficient
information in a nonthreatening environment. The human subject must not be
coerced or intimidated to participate in the research trial and must be given
adequate time to make a decision. The researchers must respect the subject’s
autonomy, ensuring that participation in the study is a choice. Informed consent is
not only about signing a consent document, but it is a process that lasts from the
beginning until the end of the study. The human subject can leave the study at any
time without having any obligation to the person conducting the research study.

Tuskegee Syphilis Study (1932–1972)

24250061 – Grand Canyon University ©

The Tuskegee Syphilis Study, officially titled the “Tuskegee Study of the Untreated
Syphilis in the Negro Male” involved 600 African American men (Centers for Disease
Control and Prevention [CDC], 2017).

Figure 1.2

Physician with Tuskegee Study Participant

Photo credit: Centers for Disease Control and Prevention

Researchers told the men they were being treated for “bad blood,” a local term
used to describe several ailments, including syphilis, anemia, and fatigue. In
truth, they did not receive the proper treatment needed to cure their illness. In
exchange for taking part in the study, the men received free medical exams,
free meals, and burial insurance. Although originally projected to last 6
months, the study actually went on for 40 years. (CDC, 2017, para 2)

In 1972, the Associated Press reported on the Tuskegee Study, leading to public
outcry. A review of the study was done by an advisory panel appointed by the
assistant secretary for Health and Scientific Affairs. The panel found the men who
had participated in the study had done so voluntarily; however, the panel found that
the researchers never informed the men of the real purpose of the study, and the
men were never given the appropriate treatment for syphilis even though one
existed. In 1973, a lawsuit was filed for the participants and their families, and a year
later, the parties reached $10 million settlement. By 1975, the men and their
descendants were promised lifetime medical benefits and burial services. In 1997,

24250061 – Grand Canyon University ©

President Bill Clinton offered a public apology to all the men and their families for the
horrible treatment they received by the United States government (CDC, 2017).

Figure 1.3

President Bill Clinton and Tuskegee Study Patient Herman Shaw

Photo credit: Centers for Disease Control and Prevention

Willowbrook Study (mid 1950s to early 1970s)

In 1942, the Willowbrook School, a state school for the mentally disabled, was built on
Staten Island, New York. The school housed 6,000 mentally handicapped children in a
facility built to house 4,000 children. Many of the residents were orphaned with no
one to speak for them or oversee the care they received. Hepatitis ran rampant at the
overcrowded facility. In addition to poor conditions, medical researchers Saul
Krugman and Robert McCollum carried out their own experiments there from the
late 1950s to the 1970s, injecting hepatitis into the children identified as “mentally
defective” to observe the natural course of the illness. “The children were deliberately
infected with hepatitis in order to test the effects of gamma globulin, a practice
justified by the researchers on the grounds that the children would probably contract
the disease in any case” (Bence, 2011, para. 5). The study continued for 15 years and
was officially closed in 1987 following public investigations of the mistreatment of
children residing at the Willowbrook School. One of the most important
consequences of the study was the development of the National Research Act of

24250061 – Grand Canyon University ©

1974, which requires all research institutions receiving federal support to establish
institutional review boards (IRBs) to review and approve research.

Brooklyn’s Jewish Chronic Disease Hospital (1960s)

Brooklyn’s Jewish Chronic Disease Hospital (JCDH) in New York, was the site of
another unethical research trial. Elderly patients and those in need of long-term care
were the primary patient population of JCDH. Dr. Chester Southam had suggested to
physicians associated with JCDH “a collaborative research project with the JCDH.
Southam hoped to initiate an evaluation of the immunologic status of patients with
chronic non-neoplastic diseases, as revealed by promptness of rejection of
subcutaneous cancer-cell homografts” (Hornblum, 2013, para. 5). Without informed
consent, Southam injected live cancer cells into 22 elderly and long-term patients of
JCDH to study how those patients reacted to the injections. Southam wanted to
research if healthy patients would react the same way as those that were ill. Southam
told the human subjects in the study they were receiving live human cells that were
growing in a test tube. Southam conducted the study, but he asked three of his
colleagues, Dr. Avir Kagan, Dr., David Leichter, and Dr. Perry Frersko, to join him in his
research (Hornblum, 2013). Kagan, Leichter, and Frersko all refused to take part in
the experiment and complained to the New York State Board of Regents. The three
doctors thought Southam was acting like a Nazi physician by using human beings as
guinea pigs. In 1963, the New York State Board of Regents found Southam guilty of
fraud and unprofessional conduct (Hornblum, 2013).

Protection of Human Participants
The research experiments described in this chapter demonstrate the potential for
harm when research is practiced without consideration to human protections, in
particular the protection of vulnerable groups. In 1962, Congress passed the
Kefauver-Harris amendments to the Federal Food, Drug, and Cosmetic Act that
required new drugs to be evaluated for safety and required informed consent when
testing investigational drugs (National Academies Press, 2004b). Informed consent is
not only a document the research subject signs; it is an ongoing process. The
informed consent process remains ongoing for as long as the subject is participating
in the study. The informed consent document must contain the purpose of the study,
the risks and possible benefits of the study, the length of time participation is
expected, and alternative treatments the subject can choose. Informed consent is
ongoing, meaning the participant can withdraw from the study at any time.

Belmont Report (1978)

In 1974, the National Research Act was established, which brought about the creation
of the National Commission for the Protection of Human Subjects of Biomedical and
Behavioral Research. The commission provides ethical and policy analysis related to
human research, including the Belmont Report (National Academies Press, 2004a).
The Belmont Report “identified three fundamental ethical principles applicable to

24250061 – Grand Canyon University ©

research with humans—respect for persons, beneficence, and justice—which
translated respectively into provisions for informed consent, assessment of risk and
potential benefits, and selection of participants” (National Academies Press, 2004a, p.
6).

Figure 1.4

Fundamental Principles of the Belmont Report

Consent should be obtained from fully informed participants and special
consideration should be given to vulnerable persons. Vulnerable populations are
groups of people who may lack the capacity to give consent or lack the capacity to
understand. The informed consent must fully explain the study, and the participant
should be given the opportunity to ask the researcher questions. Giving informed
consent to participate is totally voluntary, and the participant can withdraw from the
study without explanation at any time. All human beings have right to autonomy.
There are vulnerable populations that, at times, must be excluded from participating
in a research study. Those who are incapable of consent could have the informed
consent of their legal guardian. All approvals for research studies are obtained from
an IRB or ethics board to include vulnerable populations, such as:

Racial or ethnic minorities;
Children;
Pregnant women;
Human fetuses;
Neonates;

24250061 – Grand Canyon University ©

Human in vitro fertilization;
Employees;
Military persons and students in hierarchical organizations;
Terminally ill, comatose, and physically and intellectually challenged
individuals;
Institutionalized, elderly individuals, and visual or hearing impaired;
Socioeconomically disadvantaged;
Underinsured;
Immigrants;
Prisoners; and
LGBTQI persons (Waisel, 2013).

Belmont Report: Basic Ethical Principles
Respect for Persons

Respect for persons incorporates at least two ethical convictions: first, that
individuals should be treated as autonomous agents, and second, that
persons with diminished autonomy are entitled to protection. The principle
of respect for persons thus divides into two separate moral requirements:
the requirement to acknowledge autonomy and the requirement to protect
those with diminished autonomy. (U.S. Department of Health & Human
Services [HHS], n.d., para. 14)

Beneficence

Persons are treated in an ethical manner not only by respecting their
decisions and protecting them from harm, but also by making efforts to
secure their well-being. Such treatment falls under the principle of
beneficence. The term “beneficence” is often understood to cover acts of
kindness or charity that go beyond strict obligation. In this document,
beneficence is understood in a stronger sense, as an obligation. Two general
rules have been formulated as complementary expressions of beneficent
actions in this sense: (1) do not harm and (2) maximize possible benefits and
minimize possible harms. (HHS, n.d., para. 19)

Justice

Who ought to receive the benefits of research and bear its burdens? This is a
question of justice, in the sense of “fairness in distribution” or “what is
deserved.” An injustice occurs when some benefit to which a person is

24250061 – Grand Canyon University ©

entitled is denied without good reason or when some burden is imposed
unduly. Another way of conceiving the principle of justice is that equals
ought to be treated equally. (HHS, n.d., para. 23)

Institutional Review Board

An IRB or ethics board is an “appropriately constituted group that has been formally
designated to review and monitor biomedical research involving human subjects. In
accordance with FDA regulations, an IRB has the authority to approve, require
modifications in (to secure approval), or disapprove research” (U.S. Food and Drug
Administration [USDA], 2018, para. 2). Their role is to ensure that the rights of
research participants are protected and that the investigator has complied with the
rules and regulations of conducting research within the United States. The IRB is
composed of at least five men and women with varying backgrounds and expertise,
one of whom must not have a scientific background.

Code of Federal Regulations

The Federal Register, which is part of the National Archives and Records
Administration, published a set of general rules and regulations, called the Code of
Federal Regulations (CFRs). There are 50 titles, representing areas of federal
regulation. The first set of CFRs was published in 1938. The titles of interest in
research for the protection of human subjects include:

45 CFR 46, Protection of Human Subjects
21 CFR 50, Informed Consent
21 CFR 56, Institutional Review Boards

Table 1.1

Code of Federal Regulations

Code Title Description

45 CFR 46 Protection of Human
Subjects

Offers basic protections to
human subjects involved in
both biomedical and
behavioral research
conducted or supported by
U.S. Department of Health
& Human Services (HHS);
risks to subjects are
minimized; selection of

24250061 – Grand Canyon University ©

subjects is equitable (HHS,
2009)

21 CFR 50 Informed Consent “No investigator may
involve a human being as a
subject in research covered
by these regulations unless
the investigator has
obtained the legally
effective informed consent
of the subject or the
subject’s legally authorized
representative” (USDA,
2017a, para. 1)

21 CFR 56 Institutional Review
Boards

IRB is an appropriately
constituted group that has
been formally designated
to review and monitor
biomedical research
involving human subjects.
In accordance with FDA
regulations, an IRB has the
authority to approve,
require modifications, or
disapprove research. This
group review serves an
important role in the
protection of the rights and
welfare of human research
subjects (USDA, 2018, para.
2).

The Office for Human Research Protections (OHRP) was established in 2000 to
“protect human subjects in biomedical and behavioral research and to provide
leadership for all federal agencies that conduct or support human subjects research
under the Federal Policy for the Protection of Human Subjects, also known as the
Common Rule” (HHS, 2016a, para. 1). The Common Rule is the U.S. policy for the
protection of human subjects and was published in 1991. “The Common Rule outlines
the basic provisions for Institutional Review Boards, informed consent, and
Assurances of Compliance” (HHS, 2016b, para. 2).

24250061 – Grand Canyon University ©

Health Insurance Portability and Accountability Act of
1996

Health Insurance Portability and Accountability Act of 1996 (HIPAA) was
legislation passed to protect patient data and included security provisions for
safeguarding medical information. This federal law or privacy rule provides people
with rights over their health information and sets rules and limits on who can look at
or use this information. “The Privacy Rule applies to all forms of individuals’ protected
health information, whether electronic, written, or oral. The Security Rule is a Federal
law that requires security for health information in electronic form” (HHS, 2017b,
para. 1).

History of Nursing Research
Florence Nightingale was the first nurse researcher. Her first research study took
place during the Crimean War in 1854. The war took place on the outskirts of
Constantinople, Turkey. Nightingale started collecting data about the injured soldiers,
including information about their injuries and whether they died. She took what she
learned, applied her knowledge of statistics to the data she collected, and came up
with some very significant results. The statistics showed that hundreds of the soldiers
were dying from communicable and infectious diseases. She took her knowledge
about cleanliness and the importance of a clean environment and applied it to
current war environment. Nightingale believed if the environment was kept clean, the
soldiers would not be exposed to infection or communicable diseases (Karimi & Alavi,
2015). With the knowledge gained from collecting data on the soldiers and their
causes of death, Nightingale saved the lives of many men and women. In 1859,
Florence Nightingale published Notes on Nursing, which described how environment
can affect and promote health. This was basically the first nursing research article
ever published. It took many years before any more nursing research was performed.
Twenty years later, the committee for the Study of Nursing Education issued the
Goldmark Report, which “identified educational inadequacies of nurses and believed
that advanced educational preparation was essential for nursing. As more nurses
received university-based education, studies were conducted concerning nursing
students—their characteristics, problems, and satisfactions—became more
numerous” (Nieswiadomy, 2014., p. 1-1.). Still, until the 1930s, nursing as a profession
did not made any effort to promote research.

Nursing Research in the 20th Century

In the 1930s, research studies performed by nurses were beginning to be published,
but the studies’ sole focus was on nursing education. The Sigma Theta Tau
International (STTI) honor society, committed to educational improvement and
scholarship, believed in the advancement of nursing research and created a
foundation for research grants for nurses (Sigma Global Nursing Excellence, 2018). In

24250061 – Grand Canyon University ©

1936, STTI became the first organization to award money to nurses to perform
research.

For many years, nursing education and how much education was necessary for
nurses to receive were the only topics that were studied. In 1948, Ester Lucile Brown
published a report on the inadequacies of nursing education and found that it should
occur in the collegiate setting. In the same report, Brown encouraged nurses to learn
about conducting research. In the 1950s, a surge in nursing research led to the
creation of the Nursing Research journal, which was first published in 1952. Nursing
Research provided a way for nurses conducting research to disseminate the
information obtained from their studies. An editorial in the first issue cited its two
purposes: “To inform members of the nursing profession and allied professions of
the results of scientific studies in nursing, and to stimulate research in nursing”
(Sarkis & Conners, 1986, p. 122).

Around the same time nursing began publishing information from research studies,
the Walter Reed Army Institute of Research increased funding for the American
Nurses Association (ANA). With the increase in funding, the American Nurses
Foundation was established. The focus of the foundation was to promote nursing
research. By the 1960s, nursing leaders were concerned with the lack of nursing
research, so several professional nursing organizations were established, such as the
Western Interstate Council for Higher Education in Nursing. This organization focused
solely on nursing research and facilitating resource sharing among higher education
systems of the West. In 1965, the ANA began sponsoring nursing research
conferences and established the first national nursing archives at Boston University’s
Mugar Memorial Library (Murphy, 1993).

By the 1970s, there was substantial growth of nursing studies and discussion
regarding research. There were also new journals that reported on nursing research,
such as Advances in Nursing Science, Research in Nursing & Health, and the Western
Journal of Nursing Research. In the United States, there was an emphasis on research
and the need for evidence to support the utilization of research findings. There was
also an increase in the number of nurse researchers both nationally and
internationally. “The Workgroup of European Nurse Researchers was established in
1978 to develop greater communication and opportunities for systematic
partnerships among the 25 European national nurses’ associations involved” (Polit &
Beck, 2008, p. 8). In 1972, the ANA established the Commission on Research and the
Council of Nurse Researchers.

In 1972, the Council of Nurse Researchers held its first conference in Denver,
Colorado. Its purpose was to advance research activities among nurses. The
members of this council were composed of nurses who were members of the ANA
and had earned master’s level degrees or higher. The members believed in the
importance of exchanging ideas and recognizing the importance of research. The
conference gave nurse researchers a platform in which to share and discuss research
findings.

Nursing Research Agencies & Institutes

24250061 – Grand Canyon University ©

Nursing research began to change in the 1980s when the journals Conduct and
Utilization of Research in Nursing and the Annual Review of Nursing Research began
publication. Through these journals devoted to publishing nursing research findings,
nursing research was given more visibility in the national spotlight. By 1986, the
National Center for Nursing Research (NCNR) was established as part of the National
Institutes of Health by congressional mandate. President Ronald Reagan vetoed the
establishment of the NCNR, but through the lobbying efforts of nurse-scientists,
Congress overrode the veto. The purpose of the NCNR was to support nursing
research related to patient care (Polit & Beck, 2008).

In the late 1980s, the McMaster Medical School in Canada designed a clinical learning
strategy that was called evidence-based medicine (EBM). EBM supported the view
that research findings were better than the opinions of experts. In 1989, the U.S.
government established the Agency for Health Care Policy and Research to support
research conducted to improve the quality of care and safety for the patient.
Evidence-based practices (EBPs) are now utilized to guide patient care. In 1993, the
NCNR became the National Institute of Nursing Research (NINR), one of 27 institutes
within the National Institutes of Health (NIH). There are several new journals being
established in response to the growth of nursing research. There are also in-depth
nursing research studies being conducted and published to contribute to
generalizable knowledge.

Research Agencies & Institutes

There are many agencies under the umbrella of the U.S. Department of Health and
Human Services (HHS) that provide oversight and funding for nursing research (see
Table 1.2). The two main agencies that will be discussed are the Agency for
Healthcare and Research Quality (AHRQ) and the NIH. Each institute under the
umbrella of the NIH conducts and supports research, research training, and
dissemination of information. It is through the dissemination of research information
that the full potential of EBP can be realized. Dissemination occurs when research
findings are received and communicated to health care providers.

Table 1.2

Research Agencies and Institutes Associated with the U.S. Department of Health & Human
Services

Agency for Healthcare and Research Quality (AHRQ)

Agency/Institute Year
Established

National Guideline Clearinghouse (NGC) 1998
National Institutes of Health (NIH)

24250061 – Grand Canyon University ©

Agency/Institute Year
Established

National Cancer Institute 1937

National Eye Institute (NEI) 1968

National Heart, Lung, and Blood Institute (NHLBI) 1948

National Human Genome Research Institute (NHGRI) 1989

National Institute on Aging (NIA) 1974

National Institute on Alcohol Abuse and Alcoholism (NIAAA) 1970

National Institute of Allergy and Infectious Diseases (NIAID) 1948

National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS)

1986

National Institute of Biomedical Imaging and Bioengineering (NIBIB) 2000

Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD)

1962

National Institute on Deafness and Other Communication
Disorders (NIDCD)

1988

National Institute of Dental and Craniofacial Research (NIDCR) 1948

National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK)

1950

National Institute on Drug Abuse (NIDA) 1974

National Institute of Environmental Health Sciences (NIEHS) 1969

National Institute of General Medical Sciences (NIGMS) 1962

National Institute of Mental Health (NIMH) 1949

National Institute on Minority Health and Health Disparities
(NIMHD)

1993

National Institute of Neurological Disorders and Stroke (NINDS) 1950

National Institute of Nursing Research (NINR) 1986

National Library of Medicine (NLM) 1956

Note. Adapted from “Research at HHS Operating Divisions,” by the U.S. Department of Health & Human Services,
2015.

24250061 – Grand Canyon University ©

Knowledge
Knowledge and acquiring knowledge is essential for nursing research. Performing
research, whether it is about nursing practice or patient care, is all about the
acquisition and dissemination of new knowledge. The role of the nurse continues to
evolve as nurses’ work in many different settings with different responsibilities.
“Although each role carries different responsibilities, the primary goal of a
professional nurse remains the same: to be the client’s advocate and provide optimal
care on the basis of evidence obtained through research” (Tingen, Burnett,
Murchison, & Zhu, 2009, para. 2).

Empirical knowledge is knowledge acquired through experimentation and
observation. Nurses acquire new knowledge by generating and disseminating
information learned through research. Nurses perform research studies for many
reasons. More and more nurses are moving away from the bedside and working in
the community to prevent illnesses. Evidence-based profession is one of the biggest
changes for nursing research. Clinicians and practitioners are becoming more aware
of the role research plays in enhancing knowledge for the benefit of the patient and
the nurse. Research reaches the global nursing community and can potentially
influence practice at more than a local level (Haigh, Smith, Gelling, Barnason, &
Jackson, 2015). “Nursing research is vital to the practice of professional nursing, and
the importance of its inclusion during undergraduate instruction cannot be
overemphasized” (Tingen et al., 2009, para. 5).

Intuitive Insight and Understanding

There are situations in which nurses may have an intuition or insight that, when
used, leads to understanding about a particular problem. “Intuition has been
understood as an experience-based and gradual process, whereas insight is regarded
as a genuinely discontinuous phenomenon” (Zander, Ollinger, & Volz, 2016, para. 1).
Nurses can contribute ideas through a combination of both personal and profession
experiences. It is through different ways of thinking that possible solutions to
problems can be found. Awareness of a problem through insight or intuition can lead
to experimental designs used to gain empirical evidence. Performing research
through experimental methods or data collected via observation creates empirical
evidence or empirical knowledge. By sensing the correct solution without solid data
or reasons is sometimes the way new ideas are born and new evidence is found.

Research Process and Methodology
When nursing professionals perform research, a basic, 10-step process is used (see

Table 1.3

). Once a hypothesis is developed, nurse researchers make decisions about
the approach necessary to carry out the research. The outcomes of research aim to
answer specific questions about the nature of things in the world around us,
individual and collective experiences, and that which we can observe.

Table 1.3

24250061 – Grand Canyon University ©

Basic Research Process

Step 1 Develop a hypothesis.

Step 2 Perform literature review to support the problem being investigated.

Step 3 Determine the research design (quantitative, qualitative, or mixed
methods).

Step 4 Determine participant selection, treatment or procedure to be studied,
any instruments or surveys to be used, and methods or type of analysis
to be performed.

Step 5 Determine threats to internal and external validity.

Step 6 Collect and organize data.

Step 7 Analyze data.

Step 8 Interpret the results and data analysis.

Step 9 Publish results.

Step 10 Disseminate the information, contributing to nursing’s body of
knowledge

Evidence-Based Practice

s

EBP is the clinical application or utilization of research (see Figure 1.5). “Evidence-
based practice (EBP) is a problem-solving approach to the delivery of health care that
integrates the best evidence from studies and patient care data with clinician
expertise and patient preferences and values” (American Journal of Nursing, 2016,
para. 1). Nurses use EBP to provide patients with safe, quality care and to improve
outcomes. When developing EBP, one is looking at research already conducted. The
nurse must first develop a PICOT statement or question (see Table 1.4). The
question can be associated with either a quality improvement project or lead to EBP.
When formulating a PICOT question for an EBP project, the nurse researcher must
gather information and have an idea as to why the study should be performed. After
the PICOT is developed, the nurse researcher must decide what information is
needed to answer the question.

Figure 1.5

Evidence-Based Practice

24250061 – Grand Canyon University ©

Table 1.4

PICOT Question

P Patients/problem What is the problem and/or the patient population
being studied?

I Intervention Will a new medication be prescribed? Will there be a
change in a treatment or a procedure?

C Comparison Will it be compared to a routine drug, treatment, or
procedure?

O Outcome What is to be accomplished? What are the desired o

24250061 – Grand Canyon University ©

utcomes?

T Time For how long will the data will be
collected?

PICOT Example

Gina, a BSN-prepared RN, is the manager of the geriatric unit 3-South. In the
past 3 months, the 3-South unit has had 5 patients develop sacral pressure
ulcers. The patients are turned every 2 hours and this practice and
frequency is documented. The number of hospital-acquired pressure ulcers
must be decreased. Gina believes if patients are turned more frequently,
such as every 90 minutes instead of every 2 hours, there will be fewer
pressure ulcers. Gina determines the following factors to develop a PICOT
question:

Patients/problem = Patients in the 3-South unit who require turning
and positioning
Intervention = Turned and positioned every 90 minutes
Comparison = Patients who are turned every 2 hours
Outcome = No pressure ulcers
Time = 3 months

Based on this information, Gina develops a PICOT question: Will patients
who are turned every 90 minutes instead of every 2 hours be free of
pressure ulcers?

Check for Understanding

Nurses are unhappy with the poor patient satisfaction scores on 3-North.
Edward, a BSN-prepared RN and manager of 3-North, knows his nurses work
hard, but the patient scores are low. Edward wonders if patient satisfaction
scores will improve if he or the other unit manager makes daily rounds on all
patients. Edward decides to perform an EBP project on leader rounding and the

• Page 1
• Page 2
• Page 3
• Page 4
• Page 5
• Page 6
• Page 7
• Page 8
• Page 9
• Page 10
• Page 11
• Page 12
• Page 13
• Page 14
• Page 15
• Page 16
• Page 17
• Page 18
• Page 19
• Page 20
• Page 21