Question

We begin our journey into discovering the new world of research and evidence-based practice (EBP) by exploring our past. After completing the required readings and lesson, answer the following:

• Explain how research has evolved since the Florence Nightingale era.
• Discuss how research and EBP are different; include how you believe research supports EBP for nursing.
• Describe one past/historical unethical breach of research conduct; then, share how you would ensure care of a study participant using one ethical or legal research consideration (guideline/principle).

Answer 1

In a modern healthcare setting, “research” presumes the use of the scientific method. The researcher makes an observation, studies the available literature, and constructs a hypothesis. They use this information—their own experience and/or that of others—to design and implement a randomized, controlled experiment, then analyze the data to draw their conclusions. Some steps will be different based on how practically and ethically controls can be used in any given research study. For example, just as a researcher would not injure a control group of patients in such a way as to have an analog to their experimental group, they would not divide a group of people undergoing cancer treatment into experiment and control, discover that their new treatment works very well, then withhold that treatment from the control group. Appropriate research conduct demands a stop to such an experiment so that the control group can be offered the treatment. It’s important to remember that patients participating in modern research studies must give their informed consent, be made aware of their diagnosis, and be allowed to quit if they wish.

Research has not always worked this way. An example of a historical breach of research conduct is the Tuskegee Study of Untreated Syphilis in the Negro Male. The name of the study should tip you off to its troubling experimental design. Over forty years, from 1932 to 1972, a group of 600 low-income African-American sharecroppers took part in a research study that was purportedly designed to find solutions for “bad blood,” illnesses like anemia and syphilis that disproportionately affected poor black men at the time. Among many other ethical breaches, the men were not told if they were found to have syphilis, as 2/3 of them were, nor were they told that the researchers had no intention to treat them. In fact, they explicitly said they would be treating them, which is why the men agreed to take part in the invasive, painful procedures associated with the study, such as scheduled blood draws and spinal taps.

By the end of the 1940s, scientists not affiliated with Tuskegee discovered the curative effect of penicillin on syphilis. The Tuskegee researchers withheld this information and treatment from their participants. They wanted to learn more about the disease process, the organs involved, and the pathology of the subjects’ deaths. Ethically-minded researchers who learned about the deeply-flawed Tuskegee experiment informed journalists of the nature of the study, and the CDC’s role in it. The result was a congressional order to end the experiment and new regulations for clinical research, including the need for informed consent.

Research is a scientific investigation. Evidence-based practice is research-informed clinical decision making. The nursing process itself is a form of the scientific method: assessing, diagnosing, planning, implementing, and evaluating. Research conclusions inform every step of the nursing process, from the effect of hand hygiene on hospital-acquired infections to when and why to place a patient in reverse Trendelenburg position. When research evolves, evidence-based practice evolves. Consider Homan’s sign, once thought to be a primary indicator of deep vein thrombosis. Research studies now suggest that Homan’s sign is unreliable in diagnosing DVT, so nursing programs now teach more accurate diagnostics, like ultrasonography. Evidence-based practice encourages nurses to stay current on research in order to improve patient outcomes.