NURS 500 Week 1 Discussion Board Forum 1, Research and Evidence-Based Practice Example

Discussion Board Forum 1: Where Research Fits in Evidence-Based Nursing Practice

NURS 500 Research, Discussion Board Forum 1

Thread by [Student Name]

The unit and the colleagues described in this thread are composites written for a model post.

Last month a nurse manager on our medical unit asked the staff whether the new hourly rounding sheet the manager had introduced counted as research, because a family member had asked to see "the results of the study." The question was a good one, and the honest answer was no. The rounding sheet was a quality improvement change on one unit, built on evidence that other hospitals had already published. Mixing up those categories is common, and it matters for an advanced practice nurse because each one carries different rules, different methods and different claims about what the findings mean.

Gray and Grove (2021) describe nursing research as a diligent, systematic inquiry that validates and refines existing knowledge and generates new knowledge that can be applied beyond the setting where it was produced. That generalizability is the defining feature. A study on our unit would need a research question, a design chosen before data collection, a protocol approved by an institutional review board and a plan to share results so other nurses could judge them. Evidence-based practice is different: it is the conscientious use of the best research evidence together with clinical expertise and the values of the patient (Gray & Grove, 2021). A nurse practicing from evidence may never collect a single data point; the work is finding, appraising and applying what others have already shown. Quality improvement sits beside both. It tests a change in a local system, measures whether the change helped there, and adjusts quickly, without claiming the result holds anywhere else.

The distinction matters because nurses cannot apply evidence they cannot recognize or appraise. Melnyk et al. (2018) surveyed 2,344 practicing nurses from 19 hospitals and health systems across the United States and found that, on average, the nurses rated themselves as not yet competent on every one of the 24 competencies the survey measured. Competency was strongly associated with beliefs about evidence-based practice and with having a mentor, and only moderately associated with knowledge alone. That finding fits what I see at the bedside: nurses value evidence but often have no one to show them how to read a methods section or decide whether a study fits their patients. For an MSN-prepared nurse, NURS 500 is where that mentoring role begins.

Scripture gives this work a reason that goes deeper than a job requirement. "An intelligent heart acquires knowledge, and the ear of the wise seeks knowledge" (English Standard Version Bible, 2001/2016, Proverbs 18:15). The verse describes knowledge that is sought on purpose and tested, not absorbed by habit. A nurse who checks whether a practice rests on evidence, and who knows when a question requires real research instead of a quick local trial, is doing exactly that seeking. It is also a way of loving the patient, because care built on tested knowledge protects people from well-meant routines that do not work.

In practice, the rounding sheet should be reported as quality improvement, with its local data shared honestly, while the nurses keep reading the published trials behind hourly rounding. If the unit later wanted to know whether rounding reduces falls for patients with delirium specifically, that question would deserve a research design and an IRB review.

Reply to Danielle

Danielle, your point that evidence-based practice protects patients from "the way we have always done it" is well taken, and your example of the unit that kept checking gastric residual volumes after the evidence changed is a good one. I would add that the barrier is often not stubbornness but the absence of someone who can translate a study into a protocol. Melnyk et al. (2018) found that nurses' competency in evidence-based practice was most strongly associated with their beliefs and with having a mentor, more than with knowledge alone. That suggests the fix for your unit's residual checks may be less about another in-service and more about pairing staff with a nurse who can walk through the evidence and answer the "what if" questions that keep old habits in place. Proverbs 27:17 says, "Iron sharpens iron, and one man sharpens another" (English Standard Version Bible, 2001/2016). Mentoring is that kind of sharpening: it changes practice because people trust the person showing them the evidence. As future MSN nurses we will probably be that person on our units. Do you think your unit would accept a peer mentor more readily than an educator from outside the unit? In my experience a respected staff nurse can move a practice change further in a month than a policy memo moves it in a year, mostly because colleagues can ask that nurse the questions they would never ask in a meeting.

Reply to Marcus

Marcus, I appreciated your explanation of why quality improvement projects usually do not need full IRB review. One nuance from the reading is worth adding: the line between quality improvement and research depends on intent, not on the method. Gray and Grove (2021) explain that research is designed to produce generalizable knowledge, so a project that begins as a local improvement effort turns into research once the team means to offer its results as knowledge other settings can use, and from that point it needs review. Your sepsis screening example could cross that line if the team decided to compare outcomes across three hospitals and submit the results to a journal. Asking the question early protects patients and protects the nurses doing the work. It also reflects the integrity Paul describes in 2 Corinthians 8:21: "we aim at what is honorable not only in the Lord's sight but also in the sight of man" (English Standard Version Bible, 2001/2016). Being honest about what a project is, and what it can claim, is part of that honor. Would your organization's review board want to see the screening protocol before or after the first round of data? Many hospitals now publish a short checklist that helps nurses decide, and it would be useful to know whether yours has one before the project grows.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gray, J. R., & Grove, S. K. (2021). Burns and Grove's the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.

Melnyk, B. M., Gallagher-Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first U.S. study on nurses' evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16-25. https://doi.org/10.1111/wvn.12269