NUR 590 Topic 3 Discussion Question 1
NUR 590 Topic 3 Discussion Question 1
Discuss the significance of frameworks or models in guiding research or evidence-based practice projects. How can choosing an incorrect framework or model create bias in research?
The present day’s health practice depends largely on continuous change for progressive improvement. Evidence-based practice (EBP) projects play an instrumental role in integrating current, relevant scientific knowledge to improve clinical outcomes. However, the outcomes are not standard and require guidance. Models are used to guide evidence-based practice (EBP) projects, and it is important to choose the most appropriate model.
Concerning the significance of models in guiding EBP projects, it is important to consider that change integration should be systematic. Time and resources to be used and who to involve should be defined in precision. Moullin et al. (2020) explained that change implementation frameworks provide change leaders with a structure for describing, guiding, analyzing, and implementing evaluation efforts. Doing so facilitates the advancement of generalizable implementation of scientific knowledge. Generally, a model that guides an EBP project shows how the main processes follow each other. The overall approach is well defined, and critical elements such as the problem focus, significance, outcome, timeline, implementation, and evaluation are outlined in precision.
Failing to choose the correct model has huge implications and can create bias in research. In agreement with Wyant (2017), organizations and change leaders must select the EBP model that best fits their care context. Choosing an incorrect model leads to a situation where the model used does not align with improvement goals and does not address priority clinical problems. Implementation and evaluation are done wrongly, and outcomes are misinterpreted. Eventually, outcomes and data may be highly opinionated as change leaders try to force favorable results after using a lot of time and resources. To avoid bias and implement change appropriately, change leaders should do an in-depth study of models and choose the most appropriate as clinical problems necessitate.
Moullin, J. C., Dickson, K. S., Stadnick, N. A., Albers, B., Nilsen, P., Broder-Fingert, S., … & Aarons, G. A. (2020). Ten recommendations for using implementation frameworks in research and practice. Implementation Science Communications, 1(1), 1-12. https://doi.org/10.1186/s43058-020-00023-7
Wyant, T. (November 21, 2017). Adopt an evidence-based practice model to facilitate practice change. ONSVOICE. https://voice.ons.org/news-and-views/adopt-an-evidence-based-practice-model-to-facilitate-practice-change
The models or framework could help nurses and other healthcare providers to translate the research findings into clinical practice while improving patient outcomes. Numerous evidence-based practice models are available to help nurses organize and systemically track progress in the implementation of evidence into practice. These models provide a step-by-step guide on how to take a clinical problem and match it with an intervention based on research to make an organizational or departmental change to practice (Brown.C. G.2014). Use of an established framework for implementation provides a structure to implementation efforts and increase the likelihood of project success and sustainability over time. Failure to utilize these approaches has the potential to create a secondary gap in knowledge translation within clinical settings (Tucker et al 2021).
Brown. C .G(2014). The lowa model of Evidence-Based Practice to promote Quality care An Illustrated Example in Oncology Nursing. Clinical Journal of Oncology Nursing vol (18) https://cjon.ons.org/files/987UI80063M01166.
Tucker. S, McNett. M, Mazurek. M. B, Hanarahan. K, Hunter. S.C, Kim. B, Callen. L & Kitson. A (2021). Implementation science: Application of Evidence-Based practice Models to Improve Healthcare Quality. Worldviews on Evidence-Based Nursing. 18:76-84. https://doi.org/10.1111/wvn.12495.
A framework is fashioned from the existence of a method and a model. It contains a structure that outlines the indication of how the results were generated, even though it does not show the complete detail of the research. Most of the frameworks have one or more models that are based on the modelling techniques of the research and the project. With the different frameworks methods, the user has more freedom on the user of the framework and can use the models and techniques, which are there in the research. The model is also still slightly different from the framework, although it seems the same as the framework. A model is used to elaborate or show the mechanism and the operation of several processes of processing things. On the other side, a framework shows an empirical relationship between all the aspects of an inquiry in the scientific theory or any further research (Hogg et al., 2007). It also elaborates on the hinders of the approach and other genera aspects which coordinates the framework.
A model is defined as something, which is used to represent any other thing or phenomenon. It primarily replaces the original product. The model has two main types, the physical and conceptual models. The physical model can be seen or touched; it is a material existing thing. While the conceptual model is the existence of something just as an idea or an imagination in ounce’s mind. The framework or model can create bias in research, mainly if not used in the right way of concept concerning the research being done (Younas & Maddigan, 2019). Although this method of analysis is highly reliable in any project, it needs a further reach to the project’s information to save on time and resources used. In addition, the data must be in plenty and well understood to come out with the right thing needed by the research. With this, you avoid the bias in research projects that lead to destruction and waste of resources and time.
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Hogg, W., Rowan, M., Russell, G., Geneau, R., & Muldoon, L. (2007). Framework for primary care organizations: The importance of a structural domain. International Journal for Quality in Health Care, 20(5), 308–313. https://doi.org/10.1093/intqhc/mzm054
Younas, A., & Maddigan, J. (2019). Proposing a policy framework for nursing education for fostering compassion in nursing students: A critical review. Journal of Advanced Nursing, 75(8), 1621–1636. https://doi.org/10.1111/jan.13946s
Nursing, as a profession, advances based on the quality of outcomes produced. Evidence based practice is designed to improve outcomes. To increase nursing knowledge, more evidence-based research needs to be created and applied. Research frameworks aid in EPB by giving new EPB researchers a place to start and guide the research process. Frameworks are significant by directing thought, action, planning and recruitment.
Speroni et al. (2020) state a nurse’s critical thinking skills are important for implementation and transition into practice. Additionally, understanding theories and frameworks for implementation and why EPB is so important (Speroni, 2020). There is so much room for health care improvement, that the research opportunities are endless… if we have the researchers/nurses to explore the possibilities.
Thought processes can bias research. Bluetow, 2019) speak about apophenia, the unconscious correlation of items which are not connected, which is a possibility for qualitative research. A pattern can be found anywhere if it is looked for (Bluetow, 2019). Bluetow (2019) reflects the goal of her paper was to remind folks of our unconscious bias.
Other risk factors for bias includes observational bias. For example, observers watching for hand hygiene should not be connected to a hand sanitizer producing company, as background viewpoints may interfere with the impartiality.
Recruitment can also bias a project. While unintentional, anyone who volunteers for a project has a motivation for the project. In addition, making sure a variety of background is represented, because different viewpoint can identify different problems or bias.
Buetow, S. (2019). Apophenia, unconscious bias and reflexivity in nursing qualitative research. International Journal of Nursing Studies, 89, 8–13. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2018.09.013
Speroni, K. G., McLaughlin, M. K., & Friesen, M. A. (2020). Use of Evidence‐based Practice Models and Research Findings in Magnet‐Designated Hospitals Across the United States: National Survey Results. Worldviews on Evidence-Based Nursing, 17(2), 98–107. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12428
Implementing frameworks or models in evidence-based research projects progresses the theoretical approach towards understanding and exploring the ways implementations can be successful or have errors. Models support by evidence-based practice creates a process that breaks down translated research turning it into clinical practices. Models use a level to detail the stages of evidenced-based practice (Nilsen, 2017). This process includes asking (determine the issue), attaining (analyze current literature), appraising (attentively examine evidence), applying (identify the need for a change of implementations), and assessing (determine if outcomes were successful).
Frameworks affect various areas and dimensions of a study before introducing a methodological approach towards research (Moullin et al., 2020). When addressing framework biases, it focuses on statistical research design and experimental planning. Identifying biases offer strategies for minimizing this degree of prejudice in statistical method, which poses a danger to accurate conclusions.
Moullin, J. C., Dickson, K. S., Stadnick, N. A., Albers, B., Nilsen, P., Broder-Fingert, S., Mukasa, B., & Aarons, G. A. (2020). Ten recommendations for using implementation frameworks in research and practice. Implementation Science Communications, 1(1). https://doi.org/10.1186/s43058-020-00023-7
Nilsen, P. (2017). Making sense of implementation theories, models, and frameworks. Implementation Science, 10(1). https://doi.org/10.1186/s13012-015-0242-0
Evidence-based projects are best supported with specific frameworks/models that guide the research and results of the study. As with any type, each study has its advantages and disadvantages. However, beginning with a PICO(T) analytical research question instead of a descriptive PO question is certainly a good start on the path of data and analysis (NDPCHS, 2021). Under the umbrella of analytic studies are experimental and observational analytic studies. Cohort studies, cross sectional (analytic) studies and case-controlled studies fall under the observational analytic category (NDPCHS, 2021). Experimental studies include both randomised parallel groups as well as randomised crossover studies. Some of these studies may overlap, depending on the research question.
This being said, it is important to understand the value of selecting the appropriate framework or model when seeking to answer an evidence-based practice question. For example, one must consider whether or not a PO question is more appropriate than a PICOT, if the aim of the question is to merely describe a population. However, if an intervention and outcome associated is to be measured, a randomly allocated version of this deems itself worthy of a randomised control trial (NDPCHS, 2021). Advantages to this specific study type includes an unbiased distribution of those involved. Disadvantages may include volunteer scarcity and ethical issues. Through evaluation of randomised control trials, crossover design, cohort studies, case-control studies, cross-sectional studies and more, it is certainly important to select the appropriate design in order to elicit valid and reliable data leading to results, discussion and outcome analysis (NDPCHS, 2021). Furthermore, completion of a study itself may solely rely on whether or not the correct framework was selected to begin with.
If an incorrect framework or model is selected, it can potentially lead to bias in the research. This may lend itself to less valuable or potentially less revered results in the academic world (NDPCHS, 2021). For example, selection of a case control study may lend itself to a risk for potential bias in the realm of recall and selection. Should a specific disease-diagnosed patient population be evaluated, this limited grouping may lend itself to a “hindsight is 20/20” perspective, where more information is perceived to have been known prior than was actually known (NDPCHS, 2021). Overall, it’s critical to evaluate and select appropriate study frameworks in order to elicit reliable, valid and meaningful results from the research.
Nuffield Department of Primary Care Health Sciences (2021). Study Designs. Https://www.cebm.ox.ac.uk/resources/ebm-tools/study-designs