Evidence for nursing practice: a clarification of the issues

There has been considerable confusion and unease within the nursing profession about the emphatic push for all healthcare to be 'evidence-based'. In particular, there has been anxiety that the emphasis on evidence ignores practitioners' skills and individual patient preferences. This paper attempts to clarify the main issues surrounding evidence-based nursing. These include its epidemiological origins and purpose, the meaning and limits of 'evidence', the need for individual skills and expertise in the use of evidence, and the strengths and weaknesses of different kinds of evidence. It aims to debunk the misconception that randomized controlled trials are synonymous with evidence, and to increase critical awareness of the nature of evidence in nursing.     

Physical assessment: a continuing need for clarification

PROBLEM. Physical assessment skills are a mainstay of the nursing process and are taught to pre‐licensure learners. Little research has been conducted on the skills that are actually used in practice compared to those that are taught in pre‐licensure education. METHOD. This article provides an integrated literature review regarding physical assessment skills and their practical application. FINDINGS. Physical assessment skills are consistently referred to as part of the first step of the nursing process, but further clarification about which skills are included in the definition is needed. CONCLUSIONS. Further research is needed to clarify if what is taught is actually used and to what extent in clinical practice.     

Towards clarification of convergent concepts: sense of coherence, will to meaning, locus of control, learned helplessness and hardiness

The multidisciplinary field of stress and stress-related health outcomes has generated theoretical and practical knowledge which is of interest to nurses Theoretical developments which have assumed a prominent role in the study of stress, health and coping include the identification of various 'stress buffers', several of which bear a strong conceptual resemblance to one another Antonovsky has developed a Salutogenic Model of stress and resistance, which is presented in this paper The model's central concept, the sense of coherence, is described and analysed The sense of coherence, with its three components (meaningfulness, comprehensibility and manageability), is then compared and contrasted with similar concepts The convergent theoretical notions which are distinguished from Antonovsky's coherence are will to meaning, locus of control, learned helplessness and hardiness It is hoped that this analysis will provide greater conceptual clarity for nurses who study and use these concepts in education, practice or research     

Delayed clarification: information, clarification and ethical decisions in critical care in Norway

Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision-making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision-making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants.     

Patients' control and the information imperative: clarification and confirmation

This study is a replication and extension of research on the types of activities which contribute to patients' sense of control during their hospitalization. The original research involving two samples, each consisting of 30 medical-surgical patients in a military medical facility, revealed that in addition to being informed, patients found control through fulfilling the patient role, being involved in decision-making processes, and directing interpersonal and environmental interactions (Dennis, 1987). Through a similar use of Q-methodology, this sample of 30 adults, hospitalized with a greater diversity of medical-surgical diagnosis in a civilian medical center, demonstrated control-related perspectives that were similar to their military medical center counterparts. Information about diagnosis, treatment, and the lifestyle implications of the disease process was central to facilitating patients' sense of control. Data from the 90 subjects comprising all three subsamples across both studies were integrated through second-order factor analysis, a procedure unique to Q-methodology. This analysis clarified and confirmed four types of patient control orientations: patient role fulfillment, health care decision making, personal integrity preservation, and global self-determination.     

Use of analysis of covariance in clinical trials: a clarification

Criteria are discussed for using analysis of covariance (ANCOVA) and t-tests in analysis of clinical trials. Revisions are suggested in the guidelines given recently by Egger et al. (Controlled Clin Trials 6:12-24, 1985). Specifically, if one assumes that treatment groups have been successfully balanced by randomization, then ANCOVA is more powerful than the t-test under a broad range of conditions; this is true even in the model assumed by the t-test, and regardless of the presence of measurement error. If the balance cannot be assumed, then under certain conditions the t-test should be preferred over ANCOVA on grounds of validity.     

Research misconduct knowledge and associated factors among nurses in China: A national cross-sectional survey

AimTo measure the knowledge level of research misconduct and explore its associated factors among nurses.BackgroundEngagement in research misconduct by nurses may transfer to professional misconduct in the clinical setting, thereby jeopardizing the quality of patient care. We still know little about the research misconduct situation among nurses. Previous attempts also hardly reflected participants' real knowledge level of research misconduct.MethodsWe applied multistage sampling (province, hospital, and participants) in this cross-sectional survey, and recruited 4112 nurses from 200 tertiary hospitals in 25 provinces.ResultsThe average knowledge score of the participants was 15.99 ± 5.79. Associated factors of scientific misconduct knowledge score included career situation, educational level, fertility status, research activities index, and perceived consequences for research misconduct.ConclusionIt is urgent and necessary to design continuing research integrity training for nurses. Hospital managers and policy-makers should pay more attention to key trainees, including newcomers, nurses from less developed groups and institutions, and those from clinical departments. Training designers should also consider how to help nurses with offspring balance their family and work, and should not neglect the training for nurses with extensive research experience. In addition to conveying knowledge and information, the training can integrate cognitive education of research misconduct to improve the effect.     

Caring research and concepts: a selected review of the literature

• ? A selected review of the literature on caring in nursing is presented. The review relies on the work of the major theorists in this area.
• ? The major conceptualizations of caring are compared and contrasted, along with some of the research approaches which have been applied to investigate the phenomenon of caring in nursing.
• ? The outcome of quantitative and qualitative research on caring is described and the justification for an extension of the quantitative work, through the development of an appropriate inventory and the application of multivariate statistical analysis, is discussed.

     

The effect of scientific misconduct on the results of clinical trials: a Delphi survey

OBJECTIVES: To discover what types of scientific misconduct are most likely to influence the results of a clinical trial. DESIGN: Delphi survey of expert opinion with three rounds of consultation. SETTING: Non-industry clinical trial "community". PARTICIPANTS: Experts identified from invitees to a previous MRC consultation on clinical trials. 32 out of the 40 experts approached agreed to participate. RESULTS: We identified thirteen forms of scientific misconduct for which there was majority agreement (>50%) that they would be likely or very likely to distort the results and majority agreement (>50%) that they would be likely or very likely to occur. Of these, the over-interpretation of 'significant' findings in small trials, selective reporting and inappropriate subgroup analyses were the main themes. CONCLUSIONS: According to this expert group, the most important forms of scientific misconduct in clinical trials are selective reporting and the opportunistic use of the play of chance. Data fabrication and falsification were not rated highly because it was considered that these were unlikely to occur. Registration and publication of detailed clinical trial protocols could make an important contribution to preventing scientific misconduct.