Clinical practice provides a wealth of experience from which research problems can be derived. The nurse may observe a particular event or pattern and become curious about why it occurs, as well as its relationship to other factors in the patient’s environment.
Health professionals observe that despite improvements in symptom management for cancer patients receiving chemotherapy, side effects remain highly prevalent. Symptoms such as nausea/vomiting, diarrhea, constipation, and fatigue are common, and patients report that they negatively affect functional status and quality of life, including costly and distressing hospitalizations. A study by Traeger et al. (2015) tested a model integrated into outpatient care for patients with breast cancer, lung cancer, and colorectal cancer, designed to reduce symptom burden to be delivered by each patient’s oncology team nurse
practitioner that included telephone follow-up, symptom assessment, advice, and triage according to actual clinical practice. The aim was to ensure optimal patient-NP management of side effects early in the course of care.
Critical appraisal of the scientific literature
Critical appraisal of studies in journals may indirectly suggest a clinical problem by stimulating the reader’s thinking. The nurse may observe the outcome data from a single study or a group of related studies that provide the basis for developing a pilot study, quality improvement project, or clinical practice guideline to determine the effectiveness of this intervention in their setting.
At a staff meeting with members of an interprofessional team at a cancer center, it was noted that the center did not have a standardized clinical practice guideline for mucositis, a painful chemotherapy side effect involving the oral cavity that has a negative impact on nutrition, oral hygiene, and comfort. The team wanted to identify the most effective approaches for treating adults and children experiencing mucositis. Their search for, and critical appraisal of, existing research studies led the team to develop an interprofessional mucositis guideline that was relevant to their patient population and clinical setting (NYU Langone Medical Center, 2016).
Gaps in the literature
A research idea may also be suggested by a critical appraisal of the literature that identifies gaps in the literature and suggests areas for future study. Research ideas also can be generated by research reports that suggest the value of replicating a particular study to extend or refine the existing scientific knowledge base.
Obesity is a widely recognized risk factor for many conditions treated in primary care settings including type 2 diabetes, cardiovascular disease, hypertension, and osteoarthritis. Although weight and achieving a healthy weight for children and adults is a Healthy People 2020 goal and a national priority, the prevalence of obesity remains high, and there is little research on targeted interventions for weight loss in primary care settings. Therefore, the purpose of a study by Thabault, Burke, and Ades (2015) was to evaluate an NP-led motivational interviewing IBT program implemented in an adult primary care practice with obese patients to determine feasibility and acceptance of the intervention.
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