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KONSEP DASAR RISET KEPERAWATAN

MUHAMAT NOFIYANTO, S.Kep., Ns., M.Kep.


Objectives
Definisi riset keperawatan
Pentingnya riset keperawatan
Paradigma dalam riset keperawatan: positivisme,
konstruktivisme
Definisi EBP
Sasaran EBP
Lanjutan...
Sumber-sumber evidence dalam praktik
keperawatan
Step-step dalam EBP
Tipe dan hierarki dalam evidence
Evidence Based Resources Models
Pengenalan penelitian kuantitatif dan kualitatif
Perbedaan penelitian kuantitatif dan kualitatif
Tujuan riset keperawatan
MOTTO SEORANG NURSE

NURSES MUST BECOME


LIFELONG LEARNERS
(
(pollt and beck)
PENDAHULUAN
Perawat pasien skill dan talents kualitas
layananpenekanan biaya, LOS, kesehatan,
kualitas hidup keamanan dan kepuasan klien

nurses must access and evaluate extensive clinical


information, and incorporate it into their clinical
decision-making
What Is Nursing Research?

Penyelidikan sistematis menggunakan metode


tertentu untuk menjawab pertanyaan/
memecahkan masalah
Tujuan utama: mengembangkan,
memurnikan, expand body of knowledge
Nursing research is...........
Penyelidikan sistematis, dirancang untuk
mengembangkan pengetahuan tentang isu-
isu penting untuk perawat, meliputi praktik
keperawatan, pendidikan keperawatan dan
administrasi keperawatan
Ilmu mempelajari tentang cara-cara
penelitian untuk mendapatkan jawaban
atau memecahkan masalah
Lanjutan.........
Penyelidikan yang sistematisdilakukan
melalui tahapan-tahapan ilmiah dengan
mengikuti kaidah-kaidah penulisan ilmiah
dalam memecahkan masalah/ mendapatkan
jawaban.
Menerapkan cara ilmiah untuk mendapatkan
data/informasi sebagaimana adanya dan
bukan sebagaimana seharusnya, dengan
tujuan dan kegunaan tertentu.
Lanjutan........

Ciri-ciri keilmuan yang meliputi 3 aspek :


rasional, empiris dan sistematis.
Isu-isu yang menjadi landasan dalam
pengembangan pengetahuan harus mengacu
pada bukti-bukti klinik terbaik dengan
mengacu pada praktik berbasis bukti.
THE PURPOSES OF NURSING RESEARCH
To answer questions or solve problems of relevance to
the nursing profession
basic research: to extend the base of knowledge in a
discipline, or to formulate or refine a theory.
Discovering general principles of human behavior and
biophysiologic processes
Applied research: focuses on finding solutions to
existing problems. designed to indicate how these
principles can be used to solve problems in nursing
practice.
Polit, Denise., Beck, CT. 2006.
TUJUAN AKHIR NR
Penemuan , pembuktian dan
pengembangan bermanfaat untuk
perkembangan ilmu dan tekhnik
keperawatan, bermanfaat untuk pasien dan
keluarga, bermanfaat untuk pendidikan
keperawatan serta semua hal yang terkait
dengan keperawatan.
Penelitian yang berfokus pada
penyakit dan terapi obat
hendaknya dihindari perawat.
The Importance of Research in Nursing

Penggunaan bukti klinis terbaik


perawatan pasien Adopsi EBP
being professionally accountable to
their clients
ONTOLOGIC Realitasnya apa?

Hubungan
PARADIGMS FOR
Epistemologic
penyelidik dg apa NURSING
yang ingin
dipelajari? RESEARCH

Peran nilai dalam


Axiologic
penyelidikan?

Methodologic
Cara memperoleh
pengetahuan?
The Positivist Paradigm

Menekankan rasional dan scientific logical


positivism
Ontologic: a reality out there that can be studied
and known
fundamental belief in an objective reality
to be as objective as possible in their pursuit of
knowledge.
Lanjutan......

Disciplined procedures
Ex: seorang dengan serebrovaskular accident
pasti ada 1 atau lebih alasan yang dapat
diidentifikasi dan dimengerti
The Naturalistic Paradigm

reality is not a fixed entity but rather a


construction of the individuals participating in
the research
reality exists within a context, and many
constructions are possible.
knowledge is maximized when the distance
between the inquirer and the participants in the
study is minimized.
Lanjutan......

findings from a naturalistic inquiry are the


product of the interaction between the inquirer
and the participants.
The Scientific Method and Quantitative Research
disciplined procedures, specified plan, using
formal instruments to collect needed information
use mechanisms designed to control the study
gather empirical evidence: Observations of the
presence or absence of skin inflammation, the
heart rate of a patient, or the weight of a
newborn infant
Lanjutan......
Penelitian kuantitatifReductionist: reduces
human experience to only the few concepts
under investigation, and those concepts are
defined in advance by the researcher rather than
emerging from the experiences of those under
study.
Numeric
deductive reasoning
quantitative researchers are typically not as
interested in understanding why Ann Jones has
cervical cancer as in understanding what general
factors lead to this carcinoma in Ann and others

research methods cannot be used to answer moral


or ethical questions.
Naturalistic Methods and Qualitative Research
Exploring human complexity directly
understanding the human experience as it is
lived
Menekankan aspek pengalaman manusia yang
dinamik, holistik, dan individual dan mencoba
menangkap aspek tersebut seluruhnya ke dalam
konteks yang dialami responden
Pengumpulan data dan analisanya dilakukan
bersamaan
Lanjutan...........
narrative and subjective
inductive process
integrate information to develop a theory or
description that helps explicate processes under
observation.
Informasi lebih dalam dan luas terkait fenomena
yang kompleks
Nilai kemanusiaan merupakan instrumen utama
dalam memperoleh data
qualitative methods will play a more prominent
role in health care policy and development in the
future (Carey, 1997)

The subjectivity that enriches the analytic insights


of skillful researchers can yield trivial findings
among less competent inquirers

the generalizability of findings from naturalistic


inquiries????
Perbedaan Aksioma Antara Metode Penelitian Kualitatif dan Kuantitatif
AKSIOMA DASAR KUANTITATIF KUALITATIF
SIFAT REALITAS Konkrit, teramati, terukur Ganda, holistik, dinamis
HUBUNGAN PENELITI- independen interaktif
SUBJEK
HUBUNGAN VARIABEL Sebab-akibat Timbal balik
GENERALISASI Cenderung generalisasi Transferability (hanya
memungkinkan dalam
ikatan konteks dan
waktu)
PERANAN NILAI Bebas nilai Terikat nilai peneliti dan
sumber data
KUANTITATIF KUALITATIF
Verifying Generating Theory
hypothesis Rumusan masalah
Data non Verbal Data Verbal
Sampel informan
Satu Macam Sumber Banyak Macam Sumber Data
Satu Teknik Banyak Teknik Pengumpulan
Data
Non-Alami Seting Alami
Analisis Deduktif induktif
Linear Circular Procedure
Produk Proses
Instrumen Bukan Manusia Instrumen Manusia
Multiple Paradigms and Nursing Research
Ultimate goals: qualitative studies often serve as
a crucial starting point for more controlled
quantitative studies.
External evidence
Reliance on human cooperation
Ethical constraints
Fallibility of disciplined research: no single
study can ever definitively answer a research
question
Paradigma mana yang akan anda gunakan???

What are the effects of surgery on circadian


rhythms (biologic cycles)?
bagaimana proses pembelajaran mekanisme
koping orang tua pada anak yang meninggal?
Faktor-faktor yang mempengaruhi kelulusan
mahasiswa stikes A. Yani yogyakarta
DESIGNS AND RESEARCH EVIDENCE
BARRIERS TO USING RESEARCH IN NURSING PRACTICE

1. Research-Related Barriers
2. Nurse-Related Barriers
3. Organizational Barriers
4. Barriers Related to the Nursing
Profession
Examples of nursing research questions:
What are the factors that determine the length of
stay of patients in the intensive care unit
undergoing coronary artery bypass graft surgery
?(Doering, Esmailian, Imperial-Perez, &
Monsein, 2001)
How do adults with acquired brain injury
perceive their social interactions and
relationships? (Paterson & Stewart, 2002)?
The Importance of Research in Nursing
Menggunakan best clinical evidence dalam
pengambilan keputusan merawat pasien adopt
an evidence-based practice (EBP)
Apa yang di adopt??
Hasil penelitian yang teliti/rigid/bagus
pengambilan keputusan, actions, interaksi
klien kompeten dalam skil, efektif biaya,
outcome posistif tanggung jawab secara
profesional untuk klien. Pembiayaan efektif
The ConsumerProducer Continuum in Nursing Research

Research
utilization

Consumers of Producers
nursing of nursing
research research
NURSING RESEARCH:
PAST, PRESENT, AND
FUTURE
The Early Years: From Nightingale to the 1990s
Notes on Nursing (1859), describes her early
interest in environmental factors that promote
physical and emotional well-being
data collection and analysis relating to factors
affecting soldier mortality and morbidity during
the Crimean War. Based on her skillful analyses
and presentations, she was successful in
effecting some changes in nursing careand,
more generally, in public health.
The Early Years: From Nightingale to the 1990s
Most studies conducted between 1900 and 1940
concerned nurses education.
The American Journal of Nursing, first published in
1900, began on a limited basis to publish some studies
in the 1930s. The increasing number of studies being
conducted during the 1950s,
The 1960s was the period during which terms such as
conceptual framework, conceptual model, nursing
process, and theoretical base of nursing practice began
to appear in the literature
The Early Years: From Nightingale to the 1990s
Nursing research began to advance worldwide in the
1960s. The International Journal of Nursing Studies
began publication in 1963, and the Canadian Journal of
Nursing Research was first published in 1968.
Several additional journals that focus on nursing
research were established in the 1970s, including
Advances in Nursing Science, Research in Nursing &
Health, the Western Journal of Nursing Research, and
the Journal of Advanced Nursing clinical problems
were identified as the highest priorities
The Early Years: From Nightingale to the 1990s
Stetler and Marram (1976) offered guidance on
assessing research for application in practice
settings.
the first volume of the Annual Review of Nursing
Research was published in 1983.
1986 of the National Center for Nursing Research
(NCNR) at the National Institutes of Health (NIH)
by congressional mandate to promoteand
financially supportresearch training and research
The Early Years: From Nightingale to the 1990s
Nursing science came into its maturity during the
1990s.
in 1993, the National Institute of Nursing Research
(NINR) was born. the Canadian Health Services
Research Foundation was established in 1997
Several research journals were established during the
1990s, including Qualitative Health Research, Clinical
Nursing Research, Clinical Effectiveness, and Outcomes
Management for Nursing Practice.
The Early Years: From Nightingale to the 1990s

in 1993: the Cochrane Collaboration, an


international network of institutions and
individuals, maintains and updates systematic
reviews of hundreds of clinical interventions to
facilitate EBP.
Future Directions for
Nursing Research
Promotion of evidence-based practice.

Increased focus on biophysiologic research.

Increased focus on outcomes research: cost-


effective care that achieves positive outcomes
without compromising quality.
Development of a stronger knowledge base
through multiple, confirmatory
strategiesConfirmation is usually needed
through the deliberate replication (i.e., the
repeating) of studies with different clients
Strengthening of multidisciplinary collaboration.
Expanded dissemination of research findings
Increasing the visibility of nursing research.
special areas of research
opportunity
Chronic illnesses or conditions (e.g.,
management of chronic pain; care of children
with asthma; adherence to diabetes self-
management)
Behavioral changes and interventions (e.g.,
research in informal caregiving; disparities of
infant mortality; effective sleep in health and
illness)
Responding to compelling public health
concerns (e.g., reducing health disparities in
cancer screening; end-of-life/palliative care)
TAHUKAH ANDA??????
Tindakan apa yang tepat untuk mencegah
pneumonia pada pasien yang dipasang ventilasi
mekanik?
Tehnik membalut luka seperti apa yang paling efektif
untuk luka bakar???
Metode pendidikan kesehatan seperti apa yang
efektif untuk merubah perilaku masyarakat?
Metode apa yang paling efektif untuk
menumbuhkan minat siswa dalam belajar?
SERING PRAKTIK????
Nursing students are taught how best to
practice nursing, and best-practice learning
continues throughout nurses careers.
Some of what students and nurses learn is
based on systematic research, but MUCH of it is
not. In fact, Millenson (1997)
The Fact estimated that 85%
is.....
of health care practice has not been
scientifically validated.
Lanjutan.............
Perawat di seluruh dunia perlu terus untuk mencari
solusi, pilihan, dan hasil bagi pasien yang mewakili
pengetahuan terbaik yang tersedia secara
internasional
Terus meningkatkan dan memvalidasi asuhan
keperawatan.

KUALITAS LAYANAN PRAKTIK TERBAIK


TUGAS KITA

Banyak tanya, Objektif vs Penilaian


lihat lebih dari subjektif, berdasar
satu sisi berdasar bukti alasan,

Makna di balik Sadar bahwa


fakta, isu dari bukti-bukti
fakta dibutuhkan
EBP
Evidence-based practice can be thought
of as requiring "the integration of the
best research evidence with our clincial
expertise and our patient's unique values
and circumstances." (Straus, et al., 2005)
Using the best available research findings
to make clinical decisions that are most
effective and beneficial for patients.
(Chitty, 2005).
Goals of EBP
Provide practicing nurses with evidence-based
data
Resolve problems in the clinical setting
Achieve excellence in care delivery
Introduce innovation
Reduce variations in nursing care
Assists with efficient and effective decision-
making
SOURCES OF EVIDENCE FOR NURSING PRACTICE

Disciplined
Research

Assembled
Information

Logical Reasoning
CLINICAL EXPERIENCE, TRIAL AND
ERROR,
AND INTUITION

AUTHORITY

TRADISI
Step Evidence- Based Practice
1. Asking Focused Question ( Patients
problem)Prevention,diagnosis,prognosis,therapy,
causation, et al.
2. Finding the Evidence (Clinical article)
Penemuan terbaru untuk menjawab pertanyaan
penelitian.
3. Critical Appraisal Validity dan usefulness
4. Making a Decision Integrasi kejadian klinik
dengan pasien.
5. Evaluating Performance Efektifitas dan efisiensi
The cognitive continuum.

Thompson, C. et al. Evid Based Nurs 2004;7:68-72

Copyright 2004 BMJ Publishing Group Ltd.


TYPES OF EVIDENCE
AND EVIDENCE
HIERARCHIES
Evidence Based Resources Models

Claude Moore Health Sciences Library,


2003
Useful websites for systematic reviews
l The Cochrane Library www.cochrane.org
l The Joanna Briggs Institute
www.joannabriggs.edu.au/pubs/systematic_reviews
.php
l The Campbell Collaboration
www.campbellcollaboration.org
l The Centre for Evidence-Based Medicine
www.cebm.net
l The NHS Centre for Reviews and Dissemination
www.york.ac.uk/inst/crd
l Bandolier www.medicine.ox.ac.uk/bandolier
l PubMed Clinical Queries: Find Systematic Reviews
UTILIZING RESEARCH: PUTTING
RESEARCH EVIDENCE INTO
NURSING PRACTICE
RESEARCH UTILIZATION VERSUS EVIDENCEBASED
PRACTICE
Referensi
Polit & Beck. (2006). Essentials of nursing Research.
Methods, Appraisal and Utilization. 6th ed. Lippincott
William&Wilkins: Philadelphia
Burls, Amanda. (2009). What is Critical Appraisal. 2nd
Ed. University of Oxford.
Imron Moch & Munif Amrul,2010. Metodologi
Penelitian Bidang Kesehatan. CV. Sagung Seto,Jakarta
Polit, Denise., Beck, CT. 2006. Nursing Research
Principles and Methods. -7th Ed. Philadelpia:
Lippincott.
Sugiyono, (2011), Metode Penelitian Kuantitatif
Kualitatif dan R & D, Alfabeta, Bandung.
Bogdan, Robert,C., Biklen, S.K., 1998. Qualitative
Research in Education, an Introduction toTheory and
Methods, Third Edition, Boston, Allyn and Bacon
TERIMA KASIH
SEMOGA
BERMANFAAT