Research Based Practice and Evidence Based Research Practice in Nursing, Study Guides, Projects, Research of Nursing

Download Research Based Practice and Evidence Based Research Practice in Nursing and more Study Guides, Projects, Research Nursing in PDF only on Docsity! Nursing 673 evidence based discussion post Week 1 Describe the difference between Research Based Practice and Evidence Based Research Practice. In nursing, research is utilized to produce evidence that a specific way of practicing, educating, or administrating over other nurses is more beneficial than another. Nurses use research to provide evidence-based care that promotes quality patient care and positive outcomes. Research is a formal and scientific process of analyzing problems through scientific means for purposes of discovery and development of an organized body of knowledge. It is an attempt to find solutions to problems. The purpose of conducting research is to generate new knowledge or to validate existing knowledge based on theory. Nursing research is designed to develop evidence about matters of importance to nursing (Polit & Beck, 2011). Evidence-based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care (Polit & Beck, 2011). The EBP process is a method that allows the provider to assess research, clinical guidelines, and other information resources based on high quality findings and apply the results to practice. Unlike research, EBP is not about developing new knowledge or validating existing knowledge. EBP is about translating the evidence and applying it to clinical decision-making. Most of the best evidence stems from research, but EBP goes beyond research use and includes clinical expertise, as well as patient preferences and values. Describe an example of best practice evidence you are interested in as a EBP project for this class. Discuss whether this evidence reflects scientific or intuitive knowledge and rationale. Nurses hear many alarms in the course of their work, which can lead to desensitization to sound. Many healthcare devices feature audible alarms, such as beds, infusion pumps, cardiac monitors, ventilators, and mechanical vital sign machines. While these alarms are essential, research shows that 72% to 99% of alarms that go off do not indicate an emergency (Sendelbach & Funk, 2013). Alarm fatigue is a significant problem for healthcare consumers, nurses, and organizations. Patients and family members are being cared for in increasingly noisy units. Patients who are exposed to these noisier units are experiencing anxiety, sleep deprivation, and delirium (Honan et al., 2015). Not only are these noisy units not conducive to rest and healing, but they also cause distraction during care and delayed responses. Alarms are not the only noise the nurse have to contend with: overhead messages, carts being wheeled down halls, personal pagers and phones, and conversations all contribute to the elevation of noise levels on a unit. With nurses being bombarded with various alarms and other noises, they are unable to discern between noises that need responses and those that do not. Nurses report that this “noise pollution” facilitates distrust in alarms, contributing to slowed responses or nurses ignoring the alarms altogether (Honan et al., 2015). Healthcare facilities need to commit to eliminating alarm fatigue. They can assemble a team to collect data on the cases of false alarms and response times. After gathering information, nursing staff can create protocols to ensure suitable patient monitoring. Nurses should understand the various alarms in use throughout their healthcare facilities, so they can devise back-up plans to guarantee alarm response. So, an example of best practice evidence I am interested in is alarm fatigue and the clinical question I came up with is: What are the best methods to reduce nuisance alarms and prevent alarm fatigue among nurses? This evidence reflects scientific knowledge because it is based on scientific methods which are supported by adequate validation. There are four better quality care. If we are able to provide equipment that would not have faulty alarm systems, it would lead to less noise and a quieter environment for the patients and families resulting in a quicker recovery and happier people. Our priority in all patient care is patient safety, and so implementing my chosen topic would help with Magnet Status. References Grunwald, E., & Vital, C. J. (2016). Earning ANCC Magnet Recognition® the third time around. American Nurse Today, 11(9), 54-56. Retrieved from http://web.a.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/pdfviewer? vid=5&sid=480471cc-7414- 4dc9-8746-c86ecd406821%40sessionmgr4007. Honan, L., Funk, M., Maynard, M., Fahs, D., Clark, J.T., & David, Y. Nurses’ perspectives on clinical alarms. American Journal of Critical Care. 2015;24(5):387- 395. Retrieved from http://ajcc.aacnjournals.org/content/24/5/387. Polit, D. F., & Beck, C. T. (2011). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott, Williams, & Wilkins. Sendelbach, S., & Funk, M. (2013). Alarm fatigue: A patient safety concern. AACN Advanced Critical Care, 24(4), 378-386. doi:10.1097/NCI.0b013e3182a903f9. Bedside shift report: Implications for patient safety and quality of care Ofori-Atta, Judymae MSN, BSN, RN Nursing: August 2015 - Volume Maxson, P. M., Derby, K. M., Wrobleski, D. M., & Foss, D. M. (2012). Bedside Nurse-to-Nurse Handoff Promotes Patient Safety. MEDSURG Nursing, 21(3), 140-145. 45 - Issue 8 - p 1–4 doi: 10.1097/01.NURSE.0000469252. 96846.1a Cairns, L. L., Dudjak, L. A., Hoffmann, R. L., & Lorenz, H. L. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. The Journal Of Nursing Administration, 43(3), 160-165. doi:10.1097/NNA.0b013e318283dc02 Sand‐Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal Of Clinical Nursing, 23(19-20), 2854-2863. doi:10.1111/jocn.12575 Taylor, J. S. (2015). Improving Patient Safety and Satisfaction With Standardized Bedside Handoff and Walking Rounds. Clinical Journal Of Oncology Nursing, 19(4), 414-416. doi:10.1188/15.CJON.414-416 Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside Shift-to-Shift Nursing Report: Implementation and Outcomes. MEDSURG Nursing, 21(5), 281-292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/p dfviewer?vid=10&sid=a719f74e-205f-44c8-8ed7- d942adaa59f6@sessionmgr101 Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside Shift Reports. Journal Of Nursing Administration, 44(10), 541-545. doi:10.1097/NNA.0000000000000115 Caruso, E. M. (2007). The Evolution of Nurse- to-Nurse Bedside Report on a Medical- Surgical Cardiology Unit. MEDSURG Nursing, 16(1), 17-22. Retrieved from http://web.b.ebscohost.com.proxy.olivet. edu/ehost/detail/detail? vid=20&sid=a719f74e-205f-44c8-8ed7- d942adaa59f6%40sessionmgr101&bdata= JnNpdGU9ZWhvc3QtbGl2ZS ZzY29wZT1zaXRl#AN=24630808&db=c 9h the risk of ineffective communication contributes to errors. When a report is given at the bedside, there is an opportunity to visualize the patient and include the patient and family in an exchange of information and planning of care. Bedside report has been shown to decrease lapses in reported information and, thus, increase patient safety and satisfaction (Evans et al., 2012). Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside shift- to-shift nursing report: Implementation and outcomes. MEDSURG Nursing, 21(5), 281- 292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pd fviewer/pdfviewer? vid=10&sid=a719f74e-205f-44c8- 8ed7-d942adaa59f6@sessionmgr101 What do you think the benefit is to bedside reporting versus report outside the room? Three nurses stated the patient is more involved in his or her care and better able to understand. Two nurses responded that clarification of certain assessments such as wounds helped ensure continuity of care. Three nurses stated seeing the patient helped him or her to remember the pertinent information about the patient. Six nurses responded that verifying wound conditions and IV infusions/sites was important to report. Three nurses stated that patients often contain more information than their charts. Other responses include: assessing the patient’s status before assuming care, patients have helpful input, patients are happier when they are informed of their care, involving the patient keeps report professional and concise, and the patient can add any information forgotten during report. Only one nurse remarked that bedside report takes longer because the patient may have something to add and another nurse remarked that nurses want to complete report as quickly as possible so they can go home. In the post-intervention surveys nurses reported similar answers. Seven nurses stated that the patient is involved in his or her own care. Two nurses reported that the patient better understands his or her plan of care and has up-to-date information. Two nurses commented that visualization is beneficial and alerts the nurse to things that need attention. Visualizing the patient can trigger forgotten information and allows for an initial assessment including wounds, any lines or drains, and mental status to verify the oncoming nurse’s findings are consistent with the previous nurse’s findings. Including the patient allows for the patient to contribute to his or her care, bring up concerns, correct any misinformation or add any information that is not transferred between the nurses, and address issues immediately. There were comments from some nurses who did not support bedside reporting with reasons including reporting outside of the room is not disruptive to sleeping patients, gives the patients privacy when visitors are present, and allows sensitive material to be discussed. What is the important factor to be considered when providing bedside shift report? An important factor during the provision of bedside shift report is the involvement of the patient at the time of giving out a patient’s information and condition from one nurse to another. Qualitative research aims to get a better understanding through firsthand experience, truthful reporting, and quotations of actual conversations. It aims to understand how the participants derive admit. Briefly mention the event/series of events that brought the patient to the hospital, followed by history and list of MD's on the case. Head to toe and IV access and fluids. Then we review orders and any upcoming procedures" (A. Lake, personal communicat ion, October 16, 2017). I did on my shift. Then finally family/social issues. Short sweet and to the point" (S. Roushia, personal communicati on, October 17, 2017). dressings, wounds. If I spoke with the doctor about anything significant. Abnormal labs and what I did about them. It's nice to pass on things like if you need to crush their meds in order for them to take them. I also mention if certain tests still need to be done or if they were already easier especially after a busy shift. It helps keep things/thou ght s/problems at hand" (C. Shewmon, personal communica tio n, October 16, 2017). es/I Vs, and wounds. Also I make sure to report the drips and/or any boluses I had to give the patients. I do go through a very brief head to toe of systems" (S. Deam, personal communic ati on, October 16, 2017). completed and any results if I know them" (S. Cummings, personal communicat ion, October 17, 2017). What is your favorite thing about bedside shift report? "Able to keep the patient and family informed on their plan of care" (A. Lake, personal communicat ion, October 16, 2017). "Shorter report time and able to involve the patient" (S. Roushia, personal communicat ion, October 17, 2017). "Keeping the patient up-to- date on their plan of care and condition" (S. Cummings, personal communicat ion, October 17, 2017). "Patient satisfaction scores increasing related to implementi ng bedside report" (C. Shewmon, personal communica tio n, October 16, 2017). "Able to answer patients questions while going through their plan of care, faster report, and having the patient and family involved" (S. Deam, personal communi cati on, October 16, 2017). What is a complicat io n related to bedside shift report? "The nurse giving report can tend to be walking and talking while giving you report which means you're trying to walk, avoid running in to things/peopl e and write on a clipboard" (A. Lake, personal communicat ion, October 16, 2017). "When rooms are doubled up, bedside report can lead to a breach in confidentiali ty" (S. Roushia, personal communicat ion, October 17, 2017). "Patients and families usually will ask questions about what you're saying, want explanations about medical terms you used or interject thinking they're being helpful by giving more details than you needed. This can make for longer report" (S. "The possibility of the patient being on the phone, watching a tv program, trying to sleep, visiting with family and friends, use the bathroom and you've essentially interrupted this and started a prolonged conversatio n in the room" (C. "It is complicat ed giving bedside report in a room with two patients due to confidenti alit y" (S. Deam, personal communi cati on, October 16, 2017). bedside report is an additional layer of patient safety" (S. Roushia, personal communicat ion, October 17, 2017). personal communic ati on, October 16, 2017). 4. Analyze the responses to your qualitative research for themes. Looking at the responses to the questions I asked I found that all five nurses knew what bedside report was. Most of the nurses included the same information in their bedside report including a brief head to toe assessment, IV's, lines, wounds, but several included the events that happened during their shift and if the doctor was called for any issues. Four of the five nurses mentioned their favorite thing about bedside report is being able to keep the patient involved in their plan of care. Asking about the complications of bedside report, several nurses mentioned the risk of confidentiality when their are two patients in a room. Also, another complication was difficulty writing down report while walking and standing at the bedside. Finally, with the last question on benefits on bedside report, most of the nurses mentioned being able to assess the patient together and covering any lines, wounds, and intravenous fluid rates and compatibility. Several of the nurses noticed an increase in patient satisfaction and safety. Also, bedside report allows the patient and family to be involved in their plan of care and ask questions. 5. Summarize the findings of your mini qualitative research. While conducting this mini qualitative research I found a positive pattern with the implementation of bedside shift report. The benefits of bedside reporting include patients' increased knowledge of their condition and treatment, improved patient and family satisfaction, and increased teambuilding between staff (Evans, Grunawait, McClish, Wood, & Friese, 2012). Most of the nurses noticed after implementing bedside report an increase in patient satisfaction scores. I think the biggest benefit to bedside report is the ability to keep the patient and family informed in their plan of care. Shift change was included in The Joint Commission's 2009 National Patient Safety Goals, which requires that shift hand-offs must include up-to-date information about the care, treatment, current condition, and recent or anticipated changes in the patient (Joint Commission, 2012). Bedside reporting is the notion of giving change-of-shift report to the oncoming nurse in the presence of the patient. By implementing bedside reporting we are allowing our patients to make informed choices. Involving the patient and their family in the change-of- shift report allows them to gather information on the patient’s condition and plan for the day. Having the patient involved in change-of-shift report allows for patient satisfaction and improves patient safety. Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside shift- to-shift nursing report: Implementation and outcomes. MEDSURG Nursing, 21(5), 281- 292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pd fviewer/pdfviewer? vid=10&sid=a719f74e-205f-44c8- 8ed7-d942adaa59f6@sessionmgr101 Joint Commission. (2012). National public safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx Polit, D. F., & Beck, C. T. (2011). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott, Williams, & Wilkins. http://littletonnhhospital.org/images/NursesPages/files/Nursing%20Handoffs- Ensuring%20Safe %20Pasage%20for%20Patients.pdf Bedside shift report: Implications for patient safety and quality of care Ofori-Atta, Judymae MSN, BSN, RN Nursing: August 2015 - Volume 45 - Issue 8 - p 1–4 doi: 10.1097/01.NURSE.0000469252. 96846.1a to your questions. I know ED nurses see a lot of patients throughout the day, but when they mention how boarding patients tires them and takes their time away from other patients it surprises me. Working on another unit and dealing with a nurse-patient ratio of 1:7 causes me not to have time with all of my patients and I deal with this on a daily basis, while some emergency departments most likely deal with boarding patients on occasion. It is important for us to stray away from boarding patients because boarding increases patients' morbidity, lengths of hospital stay, and mortality ("ED boarding," 2013). ED boarding creates patient safety issues, increases risk of mortality. (2013). Hospital Case Management, 21(3), 29-31. Retrieved from http://web.a.ebscohost.com.proxy.olivet.edu/ehost/pdfviewer/pd fviewer? vid=9&sid=b53bd55b-72a7-4a0d-aa59-28d9c7096d7d %40sessionmgr4007 Week 4 Quantitative methods emphasize objective measurements and the statistical, mathematical, or numerical analysis of data collected through polls, questionnaires, and surveys, or by manipulating pre-existing statistical data using computational techniques (Polit & Beck, 2011). The goal in conducting quantitative research study is to determine the relationship between one thing and another within a population. Quantitative research designs are either descriptive or experimental. A descriptive study establishes only associations between variables; an experimental study establishes causality. 1. Formulate a research hypothesis you would like to test on a small group. Shift change was included in The Joint Commission's 2009 National Patient Safety Goals, which requires that shift hand-offs must include up-to-date information about the care, treatment, current condition, and recent or anticipated changes in the patient (Joint Commission, 2012). Involving the patient and their family in bedside shift report improves patient and staff satisfaction and patient safety. 2. Develop five questions that include quantifiable questions with your hypothesis in mind. Include at least two questions with a Likert scale. A written survey will work best (Satisfaction with specific type of environment is always good). You should not use open-ended questions. #1 Do you implement bedside shift report when you are at work? Always, sometimes, Never #2 I enjoy involving patients in their plan of care? The choices of the Likert scale were given for the choice of 1-totally agree, 2- agree, 3-neutral, 4-disagree, 5-totally disagree #3 How satisfied are you with bedside shift report? The choices of the Likert scale were given for the choice of 1-extremely satisfied, 2-satisfied, 3-neutral, 4-unsatisfied, 5- extremely unsatisfied #4 Have you noticed improvement in patient satisfaction scores after implementing bedside shift report? Yes or no #5 Has bedside shift report improved patient safety? presence of the patient. By implementing bedside reporting we are allowing our patients to make informed choices. Involving the patient and their family in the change-of-shift report allows them to gather information on the patient’s condition and plan for the day. Having the patient involved in change-of- shift report allows for patient satisfaction and improves patient safety. 6. Post your questions, responses, and analysis along with a spreadsheet (on which you have done your statistical tests- do not just copy and paste data) and graph showing your data and findings. The spreadsheet should at least have your data, mean, mode, median, standard deviation, and a graph. See attached Excel document at the bottom Referenc es Evans, D., Grunawait, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside shift- to-shift nursing report: Implementation and outcomes. MEDSURG Nursing, 21(5), 281- 292. Retrieved from http://web.b.ebscohost.com.proxy.olivet.edu/ehost/pd fviewer/pdfviewer? vid=10&sid=a719f74e-205f-44c8- 8ed7-d942adaa59f6@sessionmgr101 Joint Commission. (2012). National public safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx Polit, D. F., & Beck, C. T. (2011). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott, Williams, & Wilkins. Frances, I found your quantitative research on this topic to be very interesting and informative. I find that disinfectant caps are very useful in preventing infections in central lines. The use of an antiseptic barrier cap is associated with a lower incidence central line- associated bloodstream infection (CLABSI) and is an intervention worth adding to central-line maintenance bundles (Voor in 't holt et al., 2017). I recently left a hospital that utilized the disinfectant caps and our infection rates for central lines decreased. The facility I work at now does not utilize the caps and I am trying to push for the use of them. Also, my cousin recently had a central line for intravenous antibiotics and the caps were not used on his peripherally inserted central catheter (PICC) line and he ended up becoming septic. They ended up culturing the PICC line and found out the infection originated from the line. I personally find these caps beneficial, useful, and easy to use. Frances did you hand these surveys out to nurses at your facility? I am asking because I am wondering if your facility utilizes them and if so, have you noticed a decrease in the infection rates of central lines? Referenc e Voor in ’t holt, A. F, Helder, O. K., Vos, M. C., Schafthuizen, L., Sulz, S., Hoogen, A., Ista, E. (2017). Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis. International Journal of Nursing Studies, 69, 34 – 40. doi: http://dx.doi.org/10.1016/j.ijnurstu.2017.01.007 process enables staff to solicit patient preferences around participation, e.g. to identify family members to include; if the patient is sleeping do they want to be awakened; if in a semi- private room, would they prefer to opt out, etc. This early notification also enables family members to plan ahead to participate. During each shift change, the patient and patient- approved family are proactively invited to participate in the report. Unless explicitly invited in, many patients will continue to perceive the process as a purely staff- to-staff exchange. Visitors can be invited to relocate to a family lounge area during the report if the patient has indicated a preference that they not be included. To fully leverage bedside shift report as an opportunity for more effective communication between the patient and his/her providers, it is essential that information is communicated in a way the patient can understand. Staff should avoid highly technical language and abbreviations, adopting instead simple language that makes sense to patients and family members— with strategies for assessing comprehension adopted as well. It is a common misstep to take for granted that patients and family will actively participate in bedside shift report simply because the report is occurring in their presence. Strategies for promoting bedside shift report as an interactive dialogue among nurses and the patient and family include explicitly asking them if they have any questions, encouraging them to share their understanding of the plan moving forward in their own words, and using specific prompts to encourage them to express any concerns and their personal goals for treatment. Periodic observation of the practice in action by clinical leaders is a recommended safeguard against a gradual retreat to old habits and a way to validate that each of the above components of bedside shift report is being carried out consistently. For many organizations, patients, and family members adoption of bedside shift report is a significant disruption of familiar habits and patterns. It lifts the veil on what has customarily been an exclusive, staff-centric practice, symbolically and demonstrably elevating the role that patients play as members of their own care team (Wakefield,Ragan, Brandt, & Tregnago, 2012). This is not merely a shift in practice, but fundamentally a shift in culture —in how we cast patients and family members as participants in healthcare delivery systems. Given this, even the most comprehensive set of written guidelines will fail to generate the desired impact in the absence of a cultural underpinning that promotes patient and family engagement. The quality of an organization’s bedside shift report practices must be evaluated from this broader perspective. 2. When beginning this course there was a level of anxiety related to….? Now I feel………Or\When beginning this course, I felt very confident with …? Now I feel…? When beginning this course there was a level of anxiety related to not being confident in myself on conducting research and writing papers. I have had a lot of experience with writing papers, but never had a professor who was published grading the papers. I know with most things practice makes perfect and I believe I have grown in my writing and research abilities due to this class. Now I feel a little more confident in my writing abilities and in conducting a research proposal. I feel this class has strengthened my understanding and expanded my knowledge in the area of research and evidence based practice. The class has also provided direction on how to better execute research. 3. How do you foresee that your project could enhance your nursing practice? Describe what you have gained personally, professionally, and spiritually during this course and thus far in the program. Performing a change of shift report at the patient’s bedside is beneficial for both the patient and the nurse and provides an opportunity to increase patients and family collaboration in the plan of care, promotes patient safety and improves communication between the nurses. Today, patients have access to a massive amount of information; they are more knowledgeable about their health and want to be involved in the planning of their care. Bedside change of shift report expands beyond just the communication process between the nurses. It encompasses caring, connecting and communicating with patients and family. Performing a change-of-shift report at the patient’s bedside is a best practice and insures quality hand-off. It increases patient satisfaction, promotes patient safety, gives patients opportunity to ask questions, correct any misconceptions and be more involved in their care (Sand-Jecklin & Sherman, 2014). Bedside reporting will enhance my nursing practice by providing my patients more safety and satisfaction. Keeping my patients safe and involved in their plan of care are important Benjamin, I was also anxious when I saw the two papers we had to complete. After seeing the sample papers, I was not sure where I would find time to get them completed. The class did break down each section nicely and made getting the papers completed on time. I think it is nice to see that your colleagues were involved with this project along with you and you all have a passion for similar ideas. It must be pretty exciting for your facility to be getting ready for your magnet accreditation. It would be nice for your facility to be open to new research and studies because it has been established that if evidence based practice (EBP) can be implemented, it will improve patient outcomes while decreasing patient care costs (Brower, 2017). EBP has shown to improve patient outcomes by decreasing patient morality morbidity, medical errors and healthcare delivery based primarily on geographical demographics (Brower, 2017). Brower, E. J. (2017). Origins of evidence-based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-18. Monika, After reading all our peers posts, it is nice to know that I was not alone with feeling the way I was in the beginning of this class. It is nice to see that most of us have built a level of confidence with research and writing papers. My hospital just started bedside shift report a couple months back now. I mentioned in a previous post that my colleagues were not implementing bedside report at the beginning, but after we had more education and reinforcement on it we have been completing this task on each shift. Our manager makes her daily rounds on the patients and has had positive feedback on bedside reporting and the patient satisfaction scores have improved. I am happy to hear your hospital put bedside reporting in place earlier this year because improving communication and reporting methods have been shown to improve patient care and satisfaction levels while decreasing the number of sentinel events reported by hospitals (Evans, 2013). Evans, M. M. (2013). Bedside reporting: Is it enhancing nursing care?. Med-Surg Matters, 22(5), 3. http://studylib.net/doc/17661963/consent-to-participate-in-a- research-study Week 6 1. Many research studies actually use a mixed methods approach to their endeavor. What are some of the advantages and disadvantages of utilizing a mixed methods approach? Quantitative approaches to research include hard numbers and provable results, such as experiments and surveys. Qualitative research is more subjective, often including observation and interpretation of data. Recent approaches to research design include using both qualitative and quantitative research, a mixed- methodology research design. Mixed methods research is a methodology for conducting research that involves collecting, analyzing, and integrating quantitative and qualitative research. Most mixed- methodology research begins with a qualitative observation of an event or phenomenon (Polit & Beck, 2011). Qualitative study offers the opportunity to provide subtle details that outline a problem. The research then uses a quantitative tool, like a survey, to validate or invalidate observations made during the qualitative phase. This approach relegates qualitative analysis to an exploratory tool and doesn’t maximize quantitative analysis as a tool to both explore and define a problem and potential solutions. A mixed- approach design uses the strengths of both methodologies to provide a broader perspective on the overall issue. Mixed-method design expands the research in a way that a single approach can’t. The process of offering a statistical analysis, along with observation, makes the research more comprehensive. There is simply more information from which to develop more hypotheses. There are some advantages and disadvantages to this approach. expectations of and relationship with health service providers; day-to-day health practices and lifestyle choices; and overall health outcomes. Religion is usually seen as shared beliefs and customary practices. Most religions have traditional beliefs and practices relating to healthy living, illness and death. Spirituality means something different for everybody and consequently there can be no single definition. It relates to how we find meaning and connection, and the resources we use to replenish ourselves and cope with adversity. Thinking about religion and spirituality as dimensions of a person’s spiritual worldview helps us to be responsive to the complex and diverse ways in which people personalize their beliefs. This means we are less likely to make assumptions about their needs, wishes and practices based on a generalized term on their admission sheets. It also helps us to develop a better understanding of the patient and their context, assists in the development of treatment plans, and lets patients know that we are concerned with the whole person. As busy professionals working in a rushed health care system, we do not have the luxury of engaging with every patient we meet. However, we are usually aware of a patient’s medical context. This knowledge can inform the degree to which we judge spirituality may be significant. While finishing my final proposal I will make sure to take into consideration the patients and nurses religious and spiritual beliefs and treat them as a whole. I know that these components can have an effect on how a patient responds to their treatment plan. 3. How are the above beliefs manifested in the ethical considerations of research subjects? Ethical considerations in research are critical. Ethics are the norms or standards for conduct that distinguish between right and wrong. They help to determine the difference between acceptable and unacceptable behaviors. Ethical behavior is also critical for collaborative work because it encourages an environment of trust, accountability, and mutual respect among researchers. Researchers must also adhere to ethical standards in order for the public to support and believe in the research. The public wants to be assured that researchers followed the appropriate guidelines for issues such as human rights, animal welfare, compliance with the law, conflicts of interest, safety, and health standards. The handling of these ethical issues greatly impact the integrity of the research project and can affect whether or not the project receives funding. Because ethical considerations are so important in research, many professional associations and agencies have adopted codes and policies that outline ethical behavior and guide researchers. These codes and policies provide basic guidelines, but researchers will still be faced with additional issues that are not specifically addressed and this will require decision-making on the part of the researcher in order to avoid misconduct. One of the most important ethical considerations in research is the use of human subjects (Ingham- Broomfield, 2017). To address these considerations, most institutions and organizations have developed an Institutional Review Board (IRB) (Shore et al., 2011). An IRB is a panel of people who help to ensure the safety of human subjects in research and who assist in making sure that human rights are not violated. They review the research methodology in grant proposals to assure that ethical practices are being utilized. The use of an IRB also helps to protect the institution and the researchers against potential legal implications from any behavior that may be deemed unethical (Shore et al., 2011). Referenc es Creswell, J. (2014). Research design: Qualitative, quantitative, and mixed methods approaches. Los Angeles, CA: Sage Publications, Inc. Ingham-Broomfield, R. (. (2017). A nurses' guide to ethical considerations and the process for ethical approval of nursing research. Australian Journal of Advanced Nursing, 35(1), 40-47. Polit, D. F., & Beck, C. T. (2011). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott, Williams, & Wilkins. Shore, N., Brazauskas, R., Drew, E., Wong, K. A., Moy, L., Baden, A. C., & ... Seifer, S. D. (2011). Understanding community-based processes for research ethics review: A national study. American Journal of Public Health, 101(S1), S359-64. doi:10.2105/AJPH.2010.194340 Monika,