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Nursing Research

Methods and critical appraisal for evidence-based practice.

• 10th Edition - September 14, 2021
• Authors: Geri LoBiondo-Wood, Judith Haber
• Language: English
• Other ISBN: 9780323829601 9 7 8 - 0 - 3 2 3 - 8 2 9 6 0 - 1
• Paperback ISBN: 9780323762915 9 7 8 - 0 - 3 2 3 - 7 6 2 9 1 - 5

Find out why this book is a student favorite! Providing a solid foundation in nursing research and evidence-based practice, Nursing Research: Methods and Critical Appraisal for E… Read more

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Find out why this book is a student favorite! Providing a solid foundation in nursing research and evidence-based practice, Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice, 10th Edition offers balanced coverage of both qualitative and quantitative research methodologies and an easy-to-read, easy-to-understand approach.　This edition features new content on trending topics, including the Next-Generation NCLEX® Exam (NGN), as well as improved usability, user-friendly learning aids, and full-text research articles to help you better understand how to apply research to everyday clinical practice.

• Balanced coverage explores the nursing research process and the EBP process, as well as qualitative and quantitative research methodologies.
• User-friendly writing style and engaging learning aids throughout the text include full-text research examples, Helpful Hints, EBP Tips, IPE Highlights, Research Vignettes, Clinical Judgment Challenges, Critical Appraisal Criteria , and more!
• Innovative format integrates examples from current, high-quality, relevant full-text research articles.
• "All-star" team of contributors is a widely respected collection of experts in nursing research and EBP.

Undergraduate nursing students (2017-2018 AACN enrollment data):

• BSN students (211,450)

RN-to-BSN students (133,494)

• Cover Image
• About the Authors
• Contributors
• To the Faculty
• To the Student
• Acknowledgments
• Table of Contents
• Part I Overview of Research and Evidence-Based Practice
• RESEARCH VIGNETTE
• 1 Integrating Research, Evidence-Based Practice, and Quality Improvement Processes
• LEARNING OUTCOMES
• NURSING RESEARCH, EVIDENCE-BASED PRACTICE, AND QUALITY IMPROVEMENT
• TYPES OF RESEARCH: QUALITATIVE AND QUANTITATIVE
• CRITICAL APPRAISAL SKILLS
• STRATEGIES FOR APPRAISING RESEARCH STUDIES
• OVERCOMING BARRIERS: USEFUL APPRAISAL STRATEGIES
• EVIDENCE-BASED PRACTICE AND RESEARCH
• RESEARCH ARTICLES: FORMAT AND STYLE
• SYSTEMATIC REVIEWS: META-ANALYSES, INTEGRATIVE REVIEWS, AND META-SYNTHESES
• CLINICAL GUIDELINES
• QUALITY IMPROVEMENT
• CLINICAL JUDGMENT CHALLENGES
• 2 Appraising Research Questions, Hypotheses, and Clinical Questions
• DEVELOPING AND REFINING A RESEARCH QUESTION: STUDY PERSPECTIVE
• THE FULLY DEVELOPED RESEARCH QUESTION
• STUDY PURPOSE, AIMS, OR OBJECTIVES
• DEVELOPING THE RESEARCH HYPOTHESIS
• RELATIONSHIP BETWEEN THE HYPOTHESIS AND THE RESEARCH DESIGN
• DEVELOPING AND REFINING A CLINICAL QUESTION: A CONSUMER’S PERSPECTIVE
• 3 Gathering and Appraising the Literature
• REVIEW OF THE LITERATURE
• SEARCHING FOR EVIDENCE
• FRAMING BACKGROUND QUESTIONS AND INITIAL SEARCHING
• FRAMING CLINICAL QUESTIONS and SEARCHING FOR PRIMARY EVIDENCE
• EVALUATING AND REFINING THE SEARCH STRATEGY
• ORGANIZING AND SCREENING RESULTS
• SYNTHESIZING AND COMMUNICATING RESULTS
• 4 Theoretical Frameworks for Research
• PRACTICE-THEORY-RESEARCH LINKS
• OVERVIEW OF THEORY
• THEORY TYPES
• Nursing Theories Used in Practice and Research
• HOW THEORY IS USED IN RESEARCH
• APPLICATION TO RESEARCH AND EVIDENCE-BASED PRACTICE
• Part II Processes and Evidence Related to Qualitative Research
• 5 Introduction to Qualitative Research
• WHAT IS QUALITATIVE RESEARCH?
• WHAT DO QUALITATIVE RESEARCHERS BELIEVE?
• DOES THE METHODOLOGY FIT WITH THE RESEARCH QUESTION BEING ASKED?
• COMPONENTS OF A QUALITATIVE RESEARCH STUDY
• DISCUSSION OF THE RESULTS AND IMPLICATIONS FOR EVIDENCE-BASED PRACTICE
• FOUNDATION OF QUALITATIVE RESEARCH
• 6 Qualitative Approaches to Research
• QUALITATIVE APPROACH AND NURSING SCIENCE
• QUALITATIVE RESEARCH METHODS
• SYNTHESIZING QUALITATIVE EVIDENCE: META-SYNTHESIS
• ISSUES IN QUALITATIVE RESEARCH
• 7 Appraising Qualitative Research
• CRITICAL APPRAISAL AND QUALITATIVE RESEARCH CONSIDERATIONS
• APPLICATION OF QUALITATIVE RESEARCH FINDINGS
• Part III Processes and Evidence Related to Quantitative Research
• 8 Introduction to Quantitative Research
• RESEARCH DESIGN—PURPOSE
• OBJECTIVITY IN THE RESEARCH QUESTION AND DESIGN
• CONTROL AND INTERVENTION FIDELITY
• QUANTITATIVE CONTROL AND FLEXIBILITY
• INTERNAL AND EXTERNAL VALIDITY
• 9 Appraising Experimental and Quasi-Experimental Designs
• RESEARCH PROCESS
• EXPERIMENTAL DESIGN
• QUASI-EXPERIMENTAL DESIGNS
• EVIDENCE-BASED PRACTICE
• 10 Appraising Nonexperimental Designs
• SURVEY DESIGNS
• RELATIONSHIP AND DIFFERENCE DESIGNS
• PREDICTION AND CAUSALITY IN NONEXPERIMENTAL RESEARCH
• ADDITIONAL TYPES OF QUANTITATIVE METHODS
• NONEXPERIMENTAL DESIGNS
• 11 Appraising Systematic Reviews and Clinical Practice Guidelines
• SYSTEMATIC REVIEW COMPONENTS
• REVIEW TYPES
• META-ANALYSIS
• INTEGRATIVE REVIEW
• COCHRANE COLLABORATION
• REPORTING GUIDELINES: SYSTEMATIC REVIEWS AND META-ANALYSIS
• CLINICAL PRACTICE GUIDELINES
• EVALUATING CLINICAL PRACTICE GUIDELINES
• 12 Appraising Sampling
• SAMPLING CONCEPTS
• TYPES OF SAMPLES
• SAMPLE SIZE
• 13 Appraising Legal & Ethical Issues
• ETHICAL AND LEGAL CONSIDERATIONS IN RESEARCH: A HISTORICAL PERSPECTIVE
• 14 Appraising Data Collection Methods
• MEASURING VARIABLES OF INTEREST
• DATA COLLECTION METHODS
• CONSTRUCTION OF NEW INSTRUMENTS
• 15 Appraising Reliability & Validity
• RELIABILITY, VALIDITY, AND MEASUREMENT ERROR
• RELIABILITY
• CLASSICAL TEST THEORY VERSUS ITEM RESPONSE THEORY
• HOW VALIDITY AND RELIABILITY ARE REPORTED
• ELIABILITY AND VALIDITY
• 16 Appraising Data Analysis: Descriptive & Inferential Statistics
• LEVELS OF MEASUREMENT
• DESCRIPTIVE STATISTICS
• INFERENTIAL STATISTICS
• 17 Understanding Research Findings
• 18 Appraising Quantitative Research
• STYLISTIC CONSIDERATIONS
• CRITICAL APPRAISAL OF A QUANTITATIVE RESEARCH STUDY
• THE RESEARCH STUDY
• DESIGN AND METHODS
• LIMITATIONS
• THE CRITICAL APPRAISAL
• INTRODUCTION
• Part IV Application of Research: Evidence-Based Practice
• 19 Strategies and Tools for Developing an Evidence-Based Practice
• EVIDENCE-BASED STRATEGY #1: ASKING A FOCUSED CLINICAL QUESTION
• EVIDENCE-BASED STRATEGY #2: SEARCHING THE LITERATURE
• EVIDENCE-BASED STRATEGY #3: SCREENING YOUR FINDINGS
• EVIDENCE-BASED STRATEGY #4: APPRAISE EACH ARTICLE’S FINDINGS
• EVIDENCE-BASED STRATEGY #5: APPLYING THE FINDINGS
• 20 Developing an Evidence-Based Practice
• OVERVIEW OF EVIDENCE-BASED PRACTICE
• STEPS OF EVIDENCE-BASED PRACTICE
• FUTURE DIRECTIONS
• 21 Quality Improvement
• TOTAL QUALITY MANAGEMENT/CONTINUOUS QUALITY IMPROVEMENT
• NURSES’ ROLE IN HEALTH CARE QUALITY IMPROVEMENT
• NATIONAL GOALS AND STRATEGIES FOR HEALTH CARE QUALITY IMPROVEMENT
• QUALITY STRATEGY LEVERS
• COMMON QUALITY IMPROVEMENT PERSPECTIVES AND MODELS
• QUALITY IMPROVEMENT STEPS AND TOOLS
• TAKING ON THE QUALITY IMPROVEMENT CHALLENGE AND LEADING THE WAY
• CRITICAL THINKING CHALLENGES
• No. of pages : 576
• Language : English
• Edition : 10
• Published : September 14, 2021
• Imprint : Elsevier
• Other ISBN : 9780323829601
• Paperback ISBN : 9780323762915

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1.4 History and Evolution of Nursing Theories

Learning objectives.

By the end of this section, you will be able to:

• Recognize the evolution of nursing theory
• Identify the elements of a nursing theory
• Discuss the domains of nursing philosophy in relation to clinical practice

A theory is a framework of related ideas intended to guide and support action. A nursing theory , therefore, is a structured and systematic framework composed of concepts, principles, and propositions that collectively guide and shape the understanding of nursing practice . Developed by nursing theorists, nursing theories provide a comprehensive foundation for nurses to conceptualize and interpret various aspects of health care, encompassing not only the delivery of patient care but also education, research, and administration within the nursing profession. At their core, nursing theories articulate fundamental principles and beliefs about the nature of nursing, health, and the dynamic interactions between nurses and their patients. These theories serve as invaluable guides for practitioners, educators, and researchers, contributing to the ongoing evolution and refinement of nursing knowledge and practice in response to the ever-changing landscape of health care (Alligood, n.d.; Gaines, 2023; Wayne, 2023).

Evolution of Nursing Theory

The evolution of nursing theory reflects the dynamic nature of the nursing profession, responding to changes in health care, advancements in research, and shifts in societal perspectives. Historically, nursing lacked recognition as an academic discipline or a fully realized profession. Before the development of nursing theories, the profession was characterized as a task-oriented occupation, with nurses operating under the direction and control of the medical profession. The significance of nursing theories lies in their explicit description of nursing, setting the foundation for practice and offering a framework that defines the purpose and role of nurses in healthcare settings. These theories serve as a rationale for nursing interventions, providing scientific reasons and a knowledge base to guide appropriate actions in care situations. Additionally, nursing theories contribute to the ongoing development of nursing practice, offering a basis for the further generation of knowledge and indicating the direction in which the profession should evolve (Alligood, n.d.; Gaines, 2023; Wayne, 2023).

By providing nurses with a sense of identity, nursing theories contribute to the acknowledgment and understanding of the unique contributions that nurses make to the healthcare service, fostering a common language for communication and practice. Nursing theories not only guide research but also influence EBP, contributing to the development of nursing education and training programs. Overall, nursing theories, education, research, and practice are interconnected, mutually influencing and shaping each other as the nursing profession continues to evolve (Alligood, n.d.; Gaines, 2023; Wayne, 2023).

Historical Nursing Theories

The earliest nursing theories emerged in the nineteenth century with the work of pioneers such as Florence Nightingale . Nightingale’s environmental theory (discussed in Nightingale’s Environmental Theory ) laid the groundwork for considering the impact of the environment on health. During this period, nursing was primarily seen as a task-oriented and apprenticeship-based profession. In the mid-twentieth century, nursing theories began to take a more systematic and conceptual form. Theories such as Virginia Henderson ’s nursing need theory (discussed in Henderson’s Nursing Need Theory ) and Hildegard Peplau ’s interpersonal relations theory (discussed in Peplau’s Theory of Interpersonal Relations ) emphasized the importance of understanding patient needs and interpersonal relationships in nursing practice .

In the late twentieth century, there was a proliferation of nursing theories addressing various aspects of nursing, health, and care. Betty Neuman’s systems model, Dorothea Orem ’s self-care deficit nursing theory (discussed in Orem’s Self-Care Deficit Nursing Theory ), and Madeleine Leininger’s culture care theory (discussed in Leininger’s Culture Care Theory ) are examples of theories developed during this period, reflecting a diversity of perspectives within the field. With the increasing emphasis on EBP, nursing theories have become more integrated with research over time. Theories such as Roy’s adaptation model (discussed in Roy’s Adaptation Model ) and the model of nursing as caring by Anne Boykin and Savina Schoenhofer highlight the importance of research in refining and validating theoretical concepts (Alligood, n.d.; Gaines, 2023; Wayne, 2023).

Many contemporary nursing theories in the twenty-first century have emphasized holistic and person-centered care. Theories like Jean Watson ’s theory of human caring (discussed in Watson’s Theory of Human Caring ) and Patricia Benner ’s “novice to expert” model of nursing (discussed in Patricia Benner ) underscore the significance of understanding the whole person and the nurse’s role in promoting well-being. In response to increasing globalization and cultural diversity, nursing theories have expanded to incorporate cultural competence and global health considerations. Leininger’s Culture Care Theory and the Transcultural Nursing Model exemplify this shift in focus. The current landscape of nursing theory has also seen an increasing emphasis on interdisciplinary collaboration. Theories, such as the general systems theory (discussed in General Systems Theory ), underscore the interconnected nature of systems, which can include not only biological and organizational systems but also interdisciplinary collaborations within the healthcare field.

Throughout their history, nursing theories have adapted to changes in healthcare delivery, technological advancements, and a deeper understanding of human experiences. Theories continue to evolve as nurses and theorists engage with new evidence, technologies, and societal challenges, ensuring the ongoing relevance and advancement of nursing knowledge and practice.

Elements of a Nursing Theory

A nursing theory typically consists of concepts, phenomena, definitions, and assumptions. These key elements work together to form a coherent and comprehensive framework that shapes the understanding and practice of nursing, providing a guide for nurses to approach patient care, education, and research.

A concept is an idea that serves as a foundational element of a theory, contributing to its overall structure and coherence. Concepts are like building blocks that capture essential aspects of nursing practice and collectively provide a theoretical framework that guides the profession. Concepts may be abstract, representing general notions rather than specific instances, or concrete , representing specific and tangible ideas or objects that can be directly observed or experienced. Regardless of whether a concept is abstract or concrete, it is accompanied by a precise definition to ensure clarity and consistency in interpretation (Wayne, 2023).

The interrelatedness of concepts within a nursing theory illustrates the dynamic relationships that exist among them, contributing to the theory’s coherence and ability to explain how the concepts influence each other. Concepts must be operationalized to make them observable, relevant, and transferable to research and clinical practice (Wayne, 2023). Examples of concepts that are fundamental to nursing are holism (individuals should be viewed and treated as whole beings), caring (nurses should give patients compassionate and empathetic attention), adaptation (people adjust to changes in the internal and external environments to maintain optimal health), and self-care (activities that individuals perform to maintain their own health and well-being).

A phenomenon is a specific aspect of interest or an observable occurrence that is the focus of theoretical exploration and study. Phenomena in nursing theories refer to whatever theorists seek to understand, describe, explain, or predict within the context of nursing practice. They are often complex and multifaceted, encompassing various dimensions of human health and nursing care (Wayne, 2023).

Examples of phenomena include the experience of pain, coping mechanisms for chronic illness, nurse-patient interactions, health promotion strategies, and cultural competence in nursing. Theories in nursing are developed to explore, describe, explain, or predict these phenomena, providing a structured framework for understanding the complexities of health care. Phenomena are not only the subjects of theoretical exploration but also the catalysts for advancing EBP, guiding nursing research, and enhancing the quality of patient care. As nurses engage with and seek to address phenomena, theoretical frameworks offer valuable perspectives and insights, contributing to the ongoing evolution and refinement of nursing knowledge.

Definitions

A definition is a clear and precise explanation of the meaning attributed to a specific concept or term within the theoretical framework. Definitions serve to establish a shared understanding among theorists, researchers, educators, and practitioners who engage with the theory . The clarity of definitions is essential for consistency in communication and application of the theory across diverse contexts (Wayne, 2023).

Definitions within nursing theories aim to articulate the intended meaning of key concepts, ensuring that these concepts are interpreted and used in a standardized manner. Clear definitions contribute to the conceptual clarity and coherence of a nursing theory , fostering a common language within the nursing discipline. They provide a foundation for theoretical development, research design, and practical application of the theory in clinical settings. As nursing theories evolve, definitions may be refined or expanded to accommodate new insights and understandings within the dynamic field of health care (Wayne, 2023).

Assumptions

An assumption is a foundational belief or proposition that is accepted without direct empirical evidence. For instance, assumptions may revolve around the inherent worth of individuals, the impact of the environment on health, or the nurse’s role in promoting well-being. While assumptions are not subjected to direct testing, they lay the groundwork for the theoretical framework, providing a lens through which the theorist explores, explains, and contributes to the evolving body of nursing knowledge. As nursing theories advance, assumptions may be reevaluated in light of new evidence and insights, ensuring the ongoing relevance and applicability of the theoretical perspectives within the dynamic field of health care (Wayne, 2023).

The Domains of Nursing Philosophy

In its broadest sense, philosophy involves the exploration of fundamental questions about existence, values, and the human experience through critical inquiry and reflection. When applied to nursing, a nursing philosophy becomes the compass that guides a nurse’s practice, encompassing beliefs about the nature of nursing, patient care, ethical considerations, and the nurse’s role within the healthcare system (Alligood, n.d.; Gaines, 2023; Wayne, 2023). Clinical nursing incorporates philosophy by grounding actions in foundational beliefs, proven theories, and EBPs, facilitating a more comprehensive and patient-centered approach to care.

A theoretical domain refers to a broad and overarching area of theoretical exploration or study. It encompasses a set of concepts, assumptions, and other principles that collectively form a comprehensive framework for understanding and explaining phenomena within that particular domain (Wayne, 2023).

The domains of nursing philosophy are commonly articulated through the concepts of person, environment, health, and nursing. These domains provide a framework, known as a metaparadigm , a set of overarching concepts and principles that are key to understanding a particular discipline or field of study. A metaparadigm represents the most abstract level of a theoretical structure and serves as a unifying element that guides the development of theories within the discipline. The nursing metaparadigm is a conceptual framework that emphasizes the interconnectedness of the person, environment, health, and the unique role of nursing in facilitating and optimizing the health and well-being of individuals within their broader contexts (Gaines, 2023; Wayne, 2023).

Perspective on Person

The person domain , often referred to as the patient or client domain, is the central focus of nursing philosophy. This domain emphasizes the individual as a holistic being with physical, psychological, social, cultural, and spiritual dimensions. It acknowledges each individual’s inherent dignity, autonomy , and interconnectedness with the environment (Gaines, 2023; Wayne, 2023).

Nursing philosophy underscores the importance of approaching patients with a person-centered perspective, considering not only their physical health but also their values, preferences, and experiences. Person-centered care recognizes the uniqueness of each individual and aims to provide care that is tailored to their specific needs, values, and preferences. The domain of the person reflects a commitment to providing individualized and culturally competent care that respects the uniqueness of each individual.

Real RN Stories

Recognizing the importance of person.

Nurse: Gannon, BSN Clinical setting: Medical-surgical unit Years in practice: 17 Facility location: Suburban city in Alabama

I specifically remember this particular patient who exemplified the nursing metaparadigm concept of a person. This individual was an older woman facing a complex web of chronic illnesses and emotional challenges. Despite her frailty and physical limitations, she maintained a vibrant spirit and a deep sense of resilience.

As her nurse, my focus extended beyond merely addressing her physical symptoms; it encompassed understanding her unique life history, values, and aspirations. Through therapeutic communication, I discovered her love for painting, which had been a lifelong passion. Recognizing the significance of maintaining her identity beyond the confines of illness, I collaborated with the healthcare team to incorporate art therapy into her care plan. We were able to contact volunteer services and request some crayons, colored pencils, watercolors, and paper. You should have seen her face when I walked in with the supplies. You could see the joy on her face.

This approach not only provided relief from physical discomfort but also cared for her emotional well-being. By acknowledging her as a holistic being with individual needs and aspirations, we created an environment that supported her overall health and quality of life. This experience reinforced my commitment to viewing each patient as a unique person with multifaceted dimensions.

Perspective on Environment

The environment domain encompasses the surroundings, context, and external factors that influence a person’s well-being. This domain recognizes that health is not solely determined by individual factors but is also shaped by the broader physical, social, cultural, economic, and global environment ( Table 1.2 ) (Gaines, 2023; Wayne, 2023). Nurses consider the impact of these environmental factors on the health and well-being of the person and adapt care accordingly.

Perspective on Health

The health domain goes beyond the absence of illness. In nursing philosophy , health is a dynamic and holistic concept that encompasses the overall well-being of the person, including physical, mental, social, and spiritual dimensions. The understanding of health in nursing philosophy is broad, recognizing that individuals exist on a continuum of wellness and that health is influenced by various factors. The focus is on promoting optimal health, which includes preventing illness but also supporting individuals in achieving their highest level of functioning and quality of life (Gaines, 2023; Wayne, 2023).

Health emphasizes preventive measures and wellness promotion, placing a strong emphasis on patient education and empowerment. Cultural sensitivity is paramount, as nursing philosophy recognizes that diverse cultural perspectives influence perceptions of health and that nursing must ensure care aligns with the individual’s cultural beliefs and practices related to health and well-being. By placing the person at the center of care, nurses collaborate with patients to set goals and develop care plans that align with the individual’s personal definitions of health and well-being. By supporting individuals in building resilience and coping mechanisms to maintain or restore their health, nurses may positively influence the individual’s ability to adapt and cope with life’s challenges.

Perspective on Nursing

The nursing domain is a fundamental and central concept that defines the unique role, purpose, and responsibilities of the nursing profession. This domain encompasses the art and science of nursing, outlining the scope of practice and guiding principles that underpin the delivery of care. It captures the essence of the profession, guiding nurses in their dedication to providing high-quality, ethical, and person-centered care that positively impacts the health and well-being of those served (Gaines, 2023; Wayne, 2023).

At its core, nursing is envisioned as a holistic and person-centered discipline, extending beyond the treatment of illness to encompass the promotion of health, the prevention of disease, and the enhancement of overall well-being for individuals and communities. Nurses operate with a commitment to delivering care that is both comprehensive and individualized, recognizing the intricate interplay of physical, emotional, social, cultural, and spiritual dimensions in each person. Advocacy and empowerment are integral elements, with nurses championing the rights and voices of their patients, fostering autonomy , and facilitating shared decision-making. The philosophy underscores the importance of health promotion, compassionate interactions, and continuous pursuit of knowledge through evidence-based practices. Ethical considerations form a foundation for nursing practice, emphasizing integrity, confidentiality , and delivery of care that aligns with moral principles.

Relation to Clinical Judgment

You have seen the term clinical judgment several times in this chapter, but what exactly does it mean? Essentially, clinical judgment utilizes nursing knowledge, critical thinking, and clinical reasoning, drawing from evidence, theories, and interdisciplinary insights to make informed and patient-centered decisions. It involves the practical application of the domains of nursing philosophy : person, environment, health, and nursing. Together, these domains comprise a conceptual framework that informs clinical judgment, guiding nurses to make sound decisions and provide effective care. They provide a holistic perspective, emphasizing individualized care, consideration of environmental influences, promotion of health, and adherence to the principles of nursing.

More concretely, clinical judgment involves the nurse’s ability to assess and understand the unique characteristics, needs, and responses of each individual receiving care. By recognizing the holistic aspects of the person, including their physical, emotional, social, and cultural dimensions, nurses can make informed and person-centered decisions, tailoring interventions to the individual’s specific context. Clinical judgment also requires nurses to consider environmental factors—including the patient’s physical, social, and cultural contexts—when assessing and planning care. Understanding the impact of the environment on an individual’s health and well-being helps nurses adapt interventions, identify potential challenges, and create a setting conducive to optimal patient outcomes. The domain of health guides nurses in setting goals, preventing complications, and promoting well-being. Continually assessing the patient’s health status enables the nurse to determine the most appropriate intervention at a given time. Finally, the domain of nursing directly informs clinical judgment by defining the scope of nursing practice. Nurses draw on their knowledge, skills, and ethical principle s to make decisions aligned with the philosophy of nursing.

Clinical Judgment Measurement Model

Take action: using clinical judgment to address environmental factors.

A patient recovering from surgery was becoming increasingly agitated and disoriented. The attending nurse recognized environmental cues in the room such as loud noises, bright lights, and constant interruptions in sleep and concluded the patient was likely experiencing delirium. The nurse collaborated with the healthcare team to adjust the environment, such as reducing the noise level, dimming the lights in the room, and clustering care so the patient could sleep with fewer interruptions. After implementing these strategies, the nurse noted significant improvements to the patient’s mental clarity and overall well-being, demonstrating the importance of recognizing and addressing environmental factors in patient care.

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Nursing Research 11th Edition

• NEW! Quality Improvement and Improvement Science chapter provides methods and frameworks to help students develop and assess improvement projects.
• NEW! Applicability, Generalizability, and Relevance: Toward Practice-Based Evidence chapter details cutting-edge strategies to meet the growing need for patient-centered, practice-based evidence.
• UPDATED! Revised content throughout reflects the latest methodologic approaches to ranking evidence, verifying systematic reviews, using meta-aggregation, and more.
• Critical appraisal guidelines help students focus on specific aspects of a report for the most effective appraisal.
• Clear, user-friendly writing style introduces concepts logically and clarifies difficult ideas.
• Specific research tips translate abstract notions into practical strategies to help students confidently apply chapter lessons in real-life situations.
• Research examples throughout the text illustrate key points and stimulate critical thinking.
• A comprehensive index provides fast, efficient access to precise information.
• Tables, figures, and bulleted summaries reinforce essential chapter concepts at a glance.
• ISBN-10 1975110641
• ISBN-13 978-1975110642
• Edition 11th
• Publisher LWW
• Publication date February 12, 2020
• Language English
• Dimensions 7 x 1 x 9 inches
• Print length 814 pages
• See all details

From the Publisher

Nursing Research, 11th Edition

This authoritative, approachable textbook shows how nursing research is applicable across today’s changing healthcare field.

The text helps students learn how to perform research or how to critically appraise research reports for use in practice.

• Critical appraisal guidelines help students focus on specific aspects of a report for effective appraisals.
• Specific research tips translate abstract notions into practical strategies to help students confidently apply chapter lessons in real situations.
• A comprehensive index provides fast access to precise information.

Product details

• Publisher ‏ : ‎ LWW; 11th edition (February 12, 2020)
• Language ‏ : ‎ English
• Hardcover ‏ : ‎ 814 pages
• ISBN-10 ‏ : ‎ 1975110641
• ISBN-13 ‏ : ‎ 978-1975110642
• Item Weight ‏ : ‎ 2.7 pounds
• Dimensions ‏ : ‎ 7 x 1 x 9 inches
• #4 in Nursing Research & Theory (Books)
• #6 in Medical Informatics (Books)
• #14 in Core

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Denise f. polit.

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Nursing Research Priorities

Research priorities.

The ANA Enterprise Research Priorities are strategically designed to address critical challenges and opportunities in nursing and healthcare. These priorities focus on enhancing healthcare access, improving safety and quality of care, and promoting the health and well-being of nurses. They also emphasize the importance of diversity, equity, and inclusion, the development of professional identity, and environmental sustainability. Together, these research priorities aim to drive impactful changes that will shape the future of nursing and healthcare on a global scale. Download the full document to learn more about how these priorities are guiding innovative research and advancing the profession.

ANA Enterprise Research Council

The ANA Enterprise Research Advisory Council provides expert guidance and recommendations to the Institute for Nursing Research & Quality Management on matters of global importance, aimed at shaping the future of nursing and healthcare. By fostering a culture of inquiry and advancing interprofessional, practice-based research, the Council drives transformative initiatives that align with the ANA Enterprise's mission to lead the profession forward.

Composed of volunteer experts, the Council unites diverse nursing voices to steer research efforts that strengthen the global impact of nursing. It ensures that frontline nurses' perspectives are central to advancing healthcare innovations. Historically focused on building research capacity, fostering collaboration, and enhancing data governance, the Council's priorities now emphasize workforce development, nurse well-being, diversity and inclusion (DEIB), expanding the scope of practice, and demonstrating the value of nursing.

Research Advisory Council

Jen bonamer.

PhD, RN, AHN-BC, NPD-BC

Nursing Professional Development – Research Specialist Education, Professional Development & Research Department Sarasota Memorial Health Care System

Jen Bonamer works as a Nursing Professional Development – Research Specialist at Sarasota Memorial Hospital in Sarasota Florida. She leads the nursing research and evidence-based practice programs and is actively focused on supporting healthy work environments and clinician well-being. Jen received her BSN from the University of Florida (Gainesville) and practiced for ten years in pediatrics (general practice and hematology/oncology/bone marrow transplant). She completed the University of South Florida’s (Tampa) Nursing BS to PhD program with her master’s of science degree (nursing education) and PhD (nursing). She is certified in both nursing professional development and advanced holistic nursing. Jen is an active member in the American Nurses Association – Enterprise (ANAE) Research Advisory Council and an independent contractor of peer review services for the Magnet program.

Catherine H. Ivory

PhD, RN-BC, NEA-BC, FAAN

Associate Nurse Executive, Nursing Excellence Vanderbilt University Medical Center

Cathy Ivory, PhD, RN-BC, NEA-BC, FAAN, Associate Nurse Executive, oversees the Office of Nursing Excellence for the Vanderbilt Health System. Through collaboration across all VUMC and Vanderbilt University entities, The Office of Nursing Excellence is responsible for professional, evidence-based nursing practice, VUMC’s shared governance and Magnet activities, and all aspects of inquiry that translates evidence into practice and improves quality, safety, patient experience, and the delivery of cost effective care across settings. Dr. Ivory facilitates nursing research activities and connects nurse investigators with collaborators across the broader research enterprise at Vanderbilt.

Dr. Ivory has more than 25 years of experience as a staff nurse, clinical specialist, system-level nursing administrator, educator, and health services researcher. Dr. Ivory’s clinical focus is perinatal nursing and she served as the 2014 President of the Association of Women’s Health, OB and Neonatal Nurses (AWHONN), representing more than 300,000 nurses who care for women and newborns. She also holds two ANCC board certifications, one as an informatics nurse (RN-BC) and one as an advanced nurse executive (NEA-BC). She was inducted as a fellow in the American Academy of Nursing in 2017.

Dr. Ivory holds a BSN, an MSN in nursing administration/healthcare informatics, and a PhD in nursing science. Her research interests include implementation science and using data generated by nurses to quantify their role in patient care, patient safety, and patient outcomes. She is passionate about the nursing profession, nursing informatics, evidence-based nursing practice, and research.

David W. Price

MD, FAAFP, FACEHP, FSACME

Professor, Family Medicine, University of Colorado Anschutz School of Medicine Senior Advisor to the President and CEO, American Board of Family Medicine Medical Education and Quality Improvement Consultant and Coach Associate, Wentz/Miller Global Services

Dr. Price is Senior Advisor to the President, American Board of Family Medicine. He is also Professor of Family Medicine at the University of Colorado School of Medicine.

Dr. Price spent 29 years in the Kaiser Permanente (KP) system in several roles, including Director of Medical Education for the Colorado Region and the (national) Permanente Federation; physician investigator with the KP Colorado Institute of Health Research; Co-director of the Kaiser Colorado Center for Health Education, Dissemination and Implementation research; Clinical Lead for Kaiser National Mental Health Guidelines; member of the Kaiser National Guideline Directors Group, and Chair of Family Medicine for the Colorado Permanente Medical Group. He served on the ABFM Board of Directors from 2003 – 2008, where he chaired the R&D and Maintenance of Certification committees and was Board Chair from 2007-2008. He is a former Senior Vice-President at the American Board of Medical Specialties. He is a past Director of the Accreditation Council for Continuing Medical Education, a past-president of the Colorado Academy of Family Physicians, past chair of the AAMC Group on Educational Affairs section on Continuing Education and Improvement, and currently serves on the AAMC Integrating Quality Initiative steering committee. He is widely published and has spoken nationally and internationally and published in areas ranging from continuing medical education/professional development, quality and practice improvement, mental health, and evidence-based medicine.

Dr. Price received his M.D. degree from Rutgers Medical School in 1985 and completed his Family Medicine Residency and chief residency at JFK Medical Center, Edison, NJ, in 1988. He is a fellow of the American Academy of Family Physicians, the Alliance for Continuing Education in the Health Professions, and the Society of Continuing Medical Education (SACME) and the recipient of the 2018 SACME Distinguished Service in CME Award.

Marianne Weiss

Professor Emerita of Nursing Marquette University College of Nursing

Dr. Weiss is Professor Emerita of Nursing at Marquette University in Milwaukee, WI. She holds a Bachelor of Science in Nursing degree from McGill University in Montreal, Canada, and Master of Science in Nursing and Doctor of Nursing Science degrees from the University of San Diego. Prior to joining the faculty of Marquette University, she held positions as clinical nurse specialist and nurse researcher in women’s services for a large healthcare system.

Dr. Weiss continues to be an active nurse researcher and research consultant. Her program of research focuses on the contribution acute care nurses make to patient outcomes. Much of her work has focused on discharge preparation, assessment of discharge readiness, and post-discharge outcomes across the range of patients discharged from acute care hospitals. Her funded research studied the impact of nurse staffing on quality and cost measures of the discharge transition from hospital to home. Dr. Weiss was the Principal Investigator for the READI multi-site study, commissioned by ANCC and conducted at 33 Magnet hospitals, that investigated implementation of discharge readiness assessment as a standard nursing practice for hospital discharge. Other related research focuses on nurse staffing, continuity of care, and nurse characteristics such as education and certification that contribute to nurse performance in achieving patient outcomes. Her goal is to document the critical role and value hospital nurses bring to patient care and outcomes during and after hospitalization.

Instrument development has been an important aspect of her work on discharge readiness. Dr. Weiss has developed and tested research scales to measure quality of discharge teaching, discharge readiness, and post-discharge coping difficulty. She has conducted tool validation studies in adult-medical surgical patients, parents of hospitalized children, and postpartum mothers. These scales have been translated into more than 15 languages and are being used extensively in clinical practice and research. Dr. Weiss collaborates frequently with researchers worldwide on the science of discharge preparation. She has published extensively with US and international colleagues.

Olga Yakusheva

Professor of Nursing and Public Health Department of Systems, Populations and Leadership Department of Health Management and Policy University of Michigan School of Nursing and School of Public Health

Dr. Yakusheva is an economist with research interests in health economics and health services research. Yakusheva's area of expertise is econometric methods for causal inference, data architecture, and secondary analyses of big data. The primary focus of Yakusheva’s research is the study of economic value of nursing/nurses. Yakusheva pioneered the development of a new method for outcomes-based clinician value-added measurement using the electronic medical records. With this work, Yakusheva was able to measure, for the first time, the value-added contributions of individual nurses to patient outcomes. This work has won her national recognition earning her the Best of AcademyHealth Research Meeting Award in 2014 and a Nomination in 2018. Yakusheva is currently a PI on a AHRQ funded R01 measuring the continuity of interprofessional ICU care and an ANF/ANCC funded research grant measuring the value-added contribution of specialty nurse certifications to nurse performance and patient outcomes.

Yakusheva is a team scientist who has contributed methodological expertise to many interdisciplinary projects including hospital readmissions, primary care providers, obesity, pregnancy and birth, and peer effects on health behaviors and outcomes

Yakusheva holds a PhD in economics, an MS in economic policy, and a BS in applied mathematics.

Colleen K Snydeman

Executive Director, Office of Quality, Safety, Informatics, & Practice and the Inaugural MGH Endowed Scholar in Nursing Practice, Nursing & Patient Care Services, Massachusetts General Hospital

Dr. Snydeman’s expertise and leadership are dedicated to delivering safe, evidenced-based, high quality patient care through the continuous improvement of practice and positive outcomes with a focused commitment to the safety and well-being of the workforce. As the executive director of Massachusetts General Hospital’s Patient Care Services Office of Quality, Safety, Informatics, & Practice I provide oversight for quality and safety programs, improvement initiatives and outcomes associated with quality nursing care (falls, pressure injuries, central line blood stream infections, catheter associated urinary tract infections, and assaults on nursing personnel). I oversee a team of nine quality and informatics specialists and have a formal, non-direct reporting relationship with 75 unit based clinical nurse specialist and nurse practice specialists.

During the unprecedented COVID-19 era I led and supported a full implementation of Circle Up Huddles in all PCS inpatient areas, implementation of hospital-wide Proning Teams (recognized by Johnson & Johnson as a top ten innovation), pressure injury research, qualitative research on the experiences of bedside nurses and respiratory therapists, and implementation of resiliency and wellbeing strategies. In collaboration with RGI analytics, we have developed an algorithm using live streaming electronic health record data to alert nurses on their iphones to changes in patient’s fall risk and the associated interventions needed to prevent falls. Preliminary statistical findings are promising.

I have over forty years of progressive nursing leadership experience. My background in nursing leadership and critical care nursing led to my dissertation work using a quasi-experimental pre/post-test design with intervention and control groups to measure the impact of a theory based adverse event nurse peer review program on safety culture and the recovery of medical errors in the critical care setting. A linear mixed model analysis suggested that critical care nurses who participated in the program had a more critical view of safety culture and work environment, along with increased accountability and responsibility for their role in using strategies to keep patients safe. Further interdisciplinary safety research is underway.

Johana Rocio, Fajardo (Almansa)

Advanced Heart Failure & Transplant Nurse Practitioner, Duke University Hospital

As a doctor of nursing practice with a specialty in heart failure, transplant and mechanical support, my research is focused on improving patient outcomes through the development and implementation of best practices for the care of advanced heart failure patients. My clinical activities are centered on reducing healthcare inequities and improving Health Related Quality of Life (HRQoL) throughout the disease trajectory by optimizing interdisciplinary management and transitional care. Additionally, I have worked on database creation for both clinical and academic purposes as well as leveraging information technology to promote clinical practice standardization, minimize medical errors, and reduce cost of care.

Lastly, I have assisted in the establishment of centers of excellence by building the organizational, clinical, and educational infrastructures to deliver integrative, efficient, and specialized care to the Amyloidosis and Sarcoidosis populations. Furthermore, I have participated as a keynote speaker at national and international medical symposiums and have served as editor in chief and writer of textbooks. During my tenure as an Assistant Professor at Georgetown University School of Medicine, my research focused on the implementation of translational and organizational research to address specific issues in clinical practice and patient care delivery. Additionally, my work in the utilization of Inotropic support in rare cardiomyopathies was recognized as innovative in the field. By providing evidence and simple clinical approaches, this body of work has changed the standards of care for rare cardiomyopathy patients and will continue to provide assistance in relevant medical settings well into the future. I have served in the capacity of Principal Investigator, Co-Investigator, task leader, and technical consultant on projects supported by the government, industry and internal funding sources. In addition, I have successfully collaborated in randomized clinical trial conduction (e.g. patient screening, enrollment, and monitoring), and produced peer-reviewed publications.

Kathy Casey

PhD, RN, NPD-BC

Professional Development Specialist, Denver Health Adjunct Professor, University of Colorado, College of Nursing Adjunct Faculty, Colorado Christian University

Kathy Casey, PhD, RN, NPD-BC, is nationally and internationally known for her Casey-Fink Survey design work supporting graduate nurse role transition, nurse retention, and readiness for professional practice.

Kathy is certified in Nursing Professional Development, and currently serves as a Professional Development Specialist at Denver Health, in Denver, Colorado. She is an Adjunct Professor at the University of Colorado College of Nursing and Adjunct Faculty teaching EBP and Research at Colorado Christian University. Kathy is a lead appraiser for the American Nurses Credentialing Center Practice Transition Accreditation Program (PTAP).

In March 2023, Kathy received the Association for Nursing Professional Development's Marlene Kramer Lifetime Achievement Award for her contributions and research on survey development for use in education and practice programs. In October 2023, Kathy will be inducted as a fellow in the American Academy of Nursing.

Kathy received her Bachelor of Science in Nursing from Pacific Lutheran University, her Master's Degree in Nursing Administration from the University of Colorado, College of Nursing, and her Doctorate in Nursing Education from the University of Northern Colorado, School of Nursing.

Kortney James

PhD, RN, PNP-C

Dr. Kortney James is a PhD prepared nurse and Associate Health Policy Researcher at RAND Corporation. Her research focuses on improving access to quality reproductive health services to minoritized populations. Dr. James is also the Associate Editor of the Nursing for Women's Health Journal, a role in which she is committed to recruiting and supporting manuscripts and research that reflect diverse perspectives and identities. Dr. James recently completed a postdoctoral fellowship in the National Clinician Scholars Program, a continuation of the Robert Wood Johnson Foundation, in the School of Medicine at the University of California, Los Angeles. During her postdoctoral fellowship Dr. James has published several manuscripts in high impact journals. Select publications include "NIH funding: Hone efforts to tackle structural racism" featured in Nature and "Factors associated with postpartum maternal functioning in Black women," featured in Journal of Clinical Medicine. Thus far, Dr. James has been awarded $230,000 to support her research related to Black perinatal mental health. She received $30,000 from the Iris Cantor UCLA Women's Health Center to support her mixed methods study that aims to identify and understand culturally and racially relevant influences on their journey to healing from perinatal mood and anxiety disorders. Dr. James also received $200,000 from the American Nurses Foundation to implement an educational intervention to support ambulatory care nurses and other healthcare staff to care for Black pregnant and postpartum people’s mental health needs with culturally relevant resources. Dr. James has a wide range of clinical experience in acute inpatient care, primary care, and public health. Dr. James is a pediatric nurse practitioner with over a decade of experience in acute newborn care and pediatric primary care. Dr. James has extensive experience in perinatal care due to her time as a registered nurse in the highest volume birthing hospital in the country with an average of around 25,000 births a year (and counting). Dr. James has also held an executive leadership position in the Office of Nursing, Maternal Child Health, and Infectious Disease divisions at the Georgia Department of Public Health in Atlanta, GA.

Ultimately, Dr. James' mission is to co-create solutions with Black women and people capable of pregnancy to achieve health equity.

For questions or inquiries please contact the ANCC Research Council members at [email protected] .

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