I welcome this document, and commend it as of relevance to nurses and midwives across the WHO European Region, who must now – and increasingly in the future – seek an evidence base for their practice. To seek evidence is but the important first step, however; to understand and be able to evaluate the worth of research evidence is equally vital. This workbook will assist nurses and midwives to think analytically and critically, to weigh up such evidence as exists and then, if appropriate, to apply it in their practice. Inevitably, and rightly, this workbook requires the reader to consult other relevant texts. In some countries where nurses and midwives do not easily have access to research and library resources in their own language, this will be a major hurdle and challenge. Nevertheless, quite a number of such countries, particularly in the CCEE and NIS, have translated the LEMON materials, and also have a LEMON coordinator and/or LEMON group. For nurses and midwives in these countries, LEMON will be a very valuable aid in using this workbook. Annex 1 gives some specific references to help the reader link the text of the workbook with some of the chapters in LEMON. I should like to express the grateful thanks of the Nursing unit at the WHO Regional Office for Europe to the WHO collaborating centre in Manchester for making this workbook available to WHO. Ainna Fawcett-Henesy Regional Adviser for Nursing and Midwifery WHO Regional Office for Europe Introduction page 1 1. Introduction “What is research?”, “How do I begin to learn about research?” and “How do I begin to learn about the relevance of research to my clinical practice?”. The information contained in this document goes some way to answering these and similar questions. It is also designed to help nurses1 who wish to explore the knowledge that underpins certain aspects of nursing practice, with a view to maintaining or improving quality of care. Every nurse should become research-aware. Only a minority may wish or be able to conduct a research project, but it is important that all nurses know how to search for relevant publications and to evaluate them critically, so that they can clarify the rationale behind the care they give. 1.1 Learning objectives By the time you have read this workbook you should be able to: • conduct a literature search; • identify sources of information available in your country/local area; • make attempts at critical evaluation of research-based books, articles, reports and other publications; and • consider whether specific publications have implications for your clinical practice. After reading this document and doing some critical reading of research articles, you may feel ready to join or form a journal club. This is a group of people who meet informally to critique journal articles and discuss their relevance to clinical practice. You may also feel better equipped to adopt a critical attitude to any research projects taking place in your clinical situation. While this document may give you an awareness of research issues, however, it will not provide sufficient knowledge to make you competent in carrying out research. Before attempting to design or conduct your own research project you should, if possible: • take a research methods course; and/or • undertake further distance learning on research; and/or • read research textbooks; and/or • obtain guidance and support from an experienced researcher; and • (for quantitative research) get advice from a statistician. These matters are discussed further in Section 4, page 47. 1.2 What is research? “Research is a means of understanding, assessing and evaluating what we do as nurses” (1). 1 Throughout this document “nurse” and “nursing” are used as general descriptive terms. Terminology and definitions vary from country to country, and the term “nurse” should be understood to include all health workers doing nursingrelated work, including nurses, midwives and feldschers. page 2 Research awareness in nursing and midwifery: a workbook This quotation defines research in terms of its purpose or usefulness. According to this definition, research is important because it increases knowledge and encourages critical thinking about practice. Nursing research can enable nurses to examine and challenge established practices and to explore the effectiveness and value of new or proposed practices. Research findings may have implications for nurse education as well as nursing practice. Research can also be characterized as a process: “... research is a systematic way of asking questions, a systematic method of enquiry” (2). The key word in this quotation is “systematic”. Research must be conducted as a thorough and logical process if it is to produce credible findings that can be considered as an addition to existing knowledge. In particular, researchers need to demonstrate that they have considered and/or ruled out alternative explanations for their findings. The words “scientific” and “rigorous” are sometimes used in this context. The following World Health Organization (WHO) definition (3) highlights topics that are appropriate to nursing research. Nursing