Evaluating Research for Evidence–Based Nursing Practice by J. Fawcett and J. Garity (Philadelphia: F. A. Davis,2009)

Whether choosing a nursing research textbook for a nursing course or clinical practice, the number of available textbooks is overwhelming. Research is not perceived to be an easy class especially for undergraduate students; the content can be difficult and lackluster for even seasoned researchers. The fundamental research concepts seem to be reiterated in about the same format more or less, regardless of the author and publisher. So, it was a pleasant surprise to find a unique perspective on the evaluation of nursing research in the text Evaluating Research for Evidence-Based Nursing Practice (Fawcett & Garity, 2009). This text presents an innovative way to seamlessly blend the language and understanding of nursing theory and research within a single textbook, using a simple framework, conceptual–theoretical–empirical (C-T-E), to learn and evaluate the C-T-E structures for research. Fawcett and Garity (2009) presented their stance that “one of the most compelling reasons to conduct research is to develop theories” (p. 6). Furthermore they differentiated between research to generate theories and research to test theories. This reviewer found the book a refreshing change in its presentation of nursing research content and an important contribution as nurses in practice often overlook the theoretical aspect of nursing. This book could be used to teach a nursing research course at the undergraduate or graduate level and would be a good resource for bedside clinicians new to the research process.

The book is divided into five main parts: introduction, conceptual models and theories, research methods, adequacy and utility of theories and conceptual models, and integrating research and practice. Instead of starting with the history of nursing research (typical of the first chapter in many research texts), the authors used the introduction, including the first four chapters, to construct a unique approach for learning and evaluating nursing research. Starting with a strong argument for an understanding of conceptual models and theories in nursing, Fawcett and Garity (2009) focused on reports of empirical research. They introduced the elements of the nursing research process within a framework that readers can use to evaluate reports of research. Using the C-T-E framework, a reader evaluates the conceptual model, middle-range theory, and empirical research methods for two types of structures: Theory-generating research, designed to generate middle-range theories, or theory-testing research, designed to test middle-range theories. Starting with part 2 through to part 4 of the book, the authors focused on evaluation of reports of research to teach the research process. There are three main questions addressed in each chapter: Where is the information? What is the information? and How good is the information? Chapters 5 and 6 provide evaluation strategies for the conceptual model and middle-range theory while chapters 7 through 12 provide a discussion of the elements of research methodologies, including design, sample, instrumentation, data collection, and analysis. Later in chapters 13 through 15, the authors addressed the utility of research as evidence (that is, theory). Finally, chapter 16 concludes the text with a practical discussion of integration of research into practice. Throughout the book, the authors built and reiterated the synthesis of research and theory so that at the conclusion, the reader should understand the authors’ assertion for theory-based practice. The reasoning behind their assertion is presented as “Research = Theory, Theory = Evidence, Practice = Research, Integration of research and practice = Evidence-based practice, Evidence-based practice = Theory-based practice” (Fawcett & Garity, 2009, p. 284). This reasoning is profound in that traditional research texts do not present research in this manner. In this nursing research textbook, theory is much more than a single chapter of how to evaluate a model or theoretical framework presented in a research report.

It is a challenge for new nurses and bedside clinicians to see a connection to theory within their daily practice. Nurse mentors, faculty, and leaders can use this book to teach research as theory and encourage the use of theory in clinical practice. By connecting every step of the nursing research process to theory, Fawcett and Garity (2009) demonstrated the relationship between theory and evidence and provided a guide to enhance the use of theory in practice. They put forth the idea that middle-range theory should be evaluated in every research study whether the author explicitly defines the theory or not. According to Fawcett and Garity (2009) “a middle-range theory is the basis for the specific aims for the research” (p. 25). It can be easy to evaluate the use of a middle-range theory when the researcher presents a clear association between the theoretical concepts and the variables of study. However, when the middle-range theory is only implied, Fawcett and Garity (2009) suggested “you may want to make up a name to increase your understanding of the theory” (p. 75). This suggestion has made this author reflect on traditional methods of teaching research in which there has not been such an explicit explanation of the relationship between middle-range theory and research or evidence-based practice. This reviewer had not previously considered articulating a middle-range theory from a research report’s statement of purpose when it is not explicitly presented, but after reading this text can now appreciate how the authors linked research and theory. In chapter 6, the authors provided questions of critique for readers of research to evaluate the middle-range theory. Using examples, they linked the following: conceptual model - conceptual model concepts - propositions linking the conceptual model concept to the empirical indicator—operational definition—middle-range theory concept. A critical evaluation of these links, that the authors named specification adequacy and linkage adequacy, will identify whether the researcher has integrated a conceptual model and middle-range theory into their work and if there is sufficient discussion of the theoretical framework. When insufficient detail is given in the report to determine adequacy, then the reader is advised to suppose linkages among the concepts.

In addition to the evaluation of the use of a middle-range theory, Fawcett and Garity (2009) outlined how to evaluate all elements in a research study so that the reader can identify how good the information is in the research report. Reading and evaluating research reports is an excellent way for nurses to learn about research and this text emphasizes its use. Fawcett and Garity (2009) used the term operational adequacy to teach critique of the methodological elements of the study (for example: design, sample, analysis, and others). They referred to empirical adequacy as a sufficient report of the study’s findings and how well the findings correspond to the middle-range theory. Pragmatic adequacy is the evaluation of the study findings (that is, theory) as useful for nursing practice. Finally, the authors instructed the reader to determine the legitimacy, which refers to the usefulness of the conceptual model for theory-generating or theory-testing. Evaluation of nursing research as a way to teach the elements of the nursing research process is not a new concept. However, Fawcett and Garity (2009) have created a unique organizational structure for evaluation by using the term adequacy and connecting a type of adequacy with each main component of a research report. The authors use exemplars from the literature and from their own work to show main ideas in the text and demonstrate adequacy.

From a logistical standpoint, this book is very easy to read. The content boxes are consistent in each chapter and include the three main questions (“Where is the information?,” “What is the information?” and “How good is the information?”) as well as examples. The content in each chapter provides enough depth for understanding the material but is not overwhelming. The amount of depth makes the book a manageable read for a novice and an ideal choice for use teaching evidence-based practice to bedside clinicians. In addition, the accompanying CD makes the book as comprehensive as needed. For example, chapter 12: Evaluation of data analysis techniques includes 10 pages and comprises content about statistical concepts, statistical techniques, and study validity. The accompanying course outline review for chapter 12 includes 90 slides that expand and detail the information from the text chapter. Similarly, there is an outline review for each chapter that enhances the content in the book. Additional content on the CD includes learning exercises, practice test questions, and research report critique templates.

This nursing research textbook brings a new twist to the understanding of standard research content. The thoughtful approach, presenting an explicit link between conceptual models, theory, and practice was enlightening and practical.