Dramatic changes have occurred during my 40+ years of teaching research methods to nurses and nursing students, including important transformations within the profession, an explosive growth in published research by nurses, greater inter-professional collaboration, increased funding opportunities, and stunning methodologic and technologic advances.In this talk I will describe some of the major ways in which nursing research has evolved over the past 4 decades by tracing content revisions in my textbook Nursing Research: Generating and Assessing Evidence for Nursing Practice-now in its 10th edition and still the world's #1 textbook on research methods for nurses.The earliest editions of this book had no mention of such key concepts as evidence-based practice, mixedmethods research, complex interventions, and systematic reviews; now, entire chapters are devoted to these topics.Indeed, it was not until the 3rd edition of the book (1987) that qualitative research was given serious coverage, and now many chapters of the book describe methods for conducting high-quality qualitative inquiry.My presentation will focus especially on the key revisions I introduced in the 10th edition, which was published in 2016 (2017 copyright date).In particular, I will discuss a topic about which I have become passionate-the measurement and interpretation of clinical significance (distinct from statistical significance) in nursing studies.I will also describe revisions that I am planning to make in the 11th edition, which will be published in early 2020.In all editions published thus far, I have strived to provide guidance on how to do research with rigor and integrity-that is, how to "get it right" when answering a research question.In the 11th edition I plan to devote considerably more attention to what nurse researchers can do to "get it right" in asking their research questions.In this regard, I will provide an overview of strategies for improving the relevance and applicability of nursing research.

ObjectiveThe objective of this study was to ascertain if cognition helps to predict functional outcome in older comorbid stroke patients with severe loss of independence.DesignThis is a cross‐sectional study.SubjectsThe subjects of this study are patients who have suffered a stroke and who rehabilitated in the nursing homes' rehabilitation units and patients (n = 160) (mean age: 77; SD: 9.5) with a mean Barthel Index of 11.02.MethodDemographic, illness‐related, functional and cognitive data were selected at baseline.Main Assessment MeasuresFunctional abilities were tested using the Barthel Index. Cognitive functions were assessed using a wide variety of neuropsychological tests.ResultsPatients faced cognitive impairments especially in executive functioning and memory. Stepwise linear regression analysis shows that executive functioning (p = 0.050) and memory (p = 0.000; confidence interval −1.255, −0.403) are significantly associated with functional outcome.ConclusionFrom a clinical point of view, we suggest combining physical and cognitive training from the very early phase of recovery.

Background: Recovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained by the implementation of interventions, focused on strength, mobility and balance. Nurses carried out these exercises with the patients during their daily activities. The aim of the present study is to investigate if increased therapy time has a positive effect on cognition, mood (depression and anxiety), and ADL in stroke patients.Methods: A comparative single blind controlled study will be applied. Patients suffering from a stroke and staying on one of the rehabilitation units of the nursing homes are eligible for participation. Participants belong to the intervention group if they stay in two nursing homes where four interventions of the Clinical Nursing Rehabilitation Stroke Guideline were implemented. Participants who stay in two nursing homes where therapy is given according to the Dutch stroke Guideline, are included in the control group. Clinical neuropsychologists will assess patients' cognitive functioning, level of depression (mood) and anxiety. Nurses will assess a Barthel Index score on a weekly basis (ADL). These variables are measured at baseline, after 8 weeks and at the moment when participants are discharged from the nursing home.Discussion: The present study evaluates the effect of increased therapy time on cognition, mood (level of depression and anxiety), and ADL in stroke patients. When positive effects will be found this study can guide policy makers and practitioners on how to implement more therapy time on rehabilitation wards of nursing homes.

Objective: To increase autonomous practice time of patients on the stroke unit of a nursing home. Intervention: Nurses stimulated and coached patients with the help of four interventions (muscle strengthening, sitting balance and reach, getting up from a chair, walking) from the evidence-based Clinical Nursing Rehabilitation Stroke Guidelines. Design: An observational study. Practice time of elderly stroke patients in this study was compared with the time observed in our previous study in the same setting. Setting: Rehabilitation units of a nursing home in the Netherlands. Subjects: Seventeen frail stroke patients, including 8 men, 9 women, with a mean age of 75.8 (SD ± 9) and 17 subjects with the same characteristics who participated in a previous observational study. Main measures: Time spent on therapeutic activities was measured using the Behavioral Mapping method. Results: The time spent on therapeutic activities increased significantly from 103.5 minutes measured in our previous study to 156.5 minutes in this study ( Z = 2.86; P < 0.005; d′ = 1.09) The mean Barthel Index score was 8.8 (SD ± 4.1). The patients with more possibilities were more active, resulting in a significant positive Barthel Index–therapy time relationship ( r = 0.73, P ≤ 0.001). Conclusions: The autonomous practice time of older fragile comorbid stroke patients increased during the weekdays. Patients, stimulated and challenged by nurses, exercise harder and more according to their possibilities. Since this guideline was developed especially for nurses, nurses can stimulate stroke patients to contribute more to autonomous practice and therefore help their recovery.