Introduction To Nursing --using research results Develop and test

Research in patient care community based

or education nursing models
Nursing Research
Definitions Why do research? Assess effectiveness of
nursing interventions
Diers • Professionalism with HIV

“A systematic study of • Accountability Develop and test

problems in patient approaches to remediate
care.” • Social Relevance cognitive impairment

Abdellah Evolution of Nursing Assess coping with

Research chronic illness
“A systematic detailed
attempt to discover or Education/Recruitment Methods for promoting
confirm facts that relate immunocompetence
to a specific problem to Administration/Staffing
improve the practice and Epistemology
profession of nursing.” Practice
Sources of Human
Polit and Hungler Methodology/Theory based Knowledge
research
“A systematic search for or “how we know what
knowledge about issues Current Trends we know”
of importance to
nursing.” Health Promotion Sources of Knowledge

Henderson Nursing Decision Making Tradition or tenacity

“A study of the problems Effectiveness of Nursing Authority

in practice relating to Intervention in Selected
the effects of nursing.” Health Problems Experience

Nature of Research Prevention Intuition

Research is empirical. All Case Studies/Qualitative Trial and Error

knowledge is derived Research
from sense experience Logical Reasoning
which can be scrutinized Ethnographic Studies
and tested. Induction
Conferences for
Ways to “use” nursing Research Priorities Deduction
research:
#1 through 1994 Scientific Method
--journal clubs
HIV Epistemology
--critique research for
patient care purposes Long term care Sources of Human
Knowledge
--explaining research to Low birth weight
clients or “how we know what
Symptom management we know”
--data collection for
others Nursing informatics Sources of Knowledge

--reviewing methodology Technology Tradition or tenacity

for IRB
Health Promotion Authority
--finding research
problems #2 through 1999 Experience
Intuition must make the same analysis
mistakes or discoveries
Trial and Error over and over again conclusion

Logical Reasoning Logical Reasoning Control

• Inductio Induction--developing In trying to isolate

n generalizations from relationships among
specific observations phenomena, scientists must
• Deductio control phenomena and
n Induction factors not under study.
→→→→
Scientific Method Empiricism
Specifics
Tradition/tenacity Evidence rooted in
Generalizations objective reality and
Something we know gathered directly or
because we have always ←←←← indirectly through the
known it. human senses.
Deduction
Advantages: Research is based in
Deduction--developing REALITY
Efficient, provides a specific predictions from
foundation of truths general principles Empiricism

Disadvantages: Scientific Method Evidence rooted in

objective reality and
Most traditions have not The most advanced method gathered directly or
been evaluated for their of acquiring knowledge that indirectly through the
value humans have developed. human senses.

Authority Scientific Method Research is based in

REALITY
We know a thing because Order
some authoritative source Generalization
says it is so Control
No research is ever done
Authorities are not infallible, Empiricism just to benefit the
so always question subjects, in order to
authority--what is the Generalization have value, it must be
evidence that this is true? generalizable to a wider
Theoretical Formulation population.
Experience
Order Theoretical formulation
Our own experiences may
be too limited to generalize Systematic prescribed order Theories are manner of
from in order to have organizing, integrating
reproducibility and and deriving abstract
Intuition It just “ seems” confidence in the results conceptualization about
right the manner in which
problem identified phenomena are
Trial and error interrelated.
defined
Haphazard LIMITS OF SCIENTIFIC
predictions of METHOD
unsystematic oucome
Values or ethics
inefficient information
collected Human complexity
usually unrecorded according to
design Measurement problems
Control Example: Can the occurrence of
the phenomenon be
Ethical considerations A study to determine controlled?
how individuals were
PARADIGMS FOR able to live with The variability of critical
NURSING RESEARCH catastrophic illnesses care nurses’
and injuries. hemodynamic decision-
ONTOLOGIC-What is the making in the 2-hour
nature of reality? Description period after cardiac
surgery.
EPISTEMOLOGIC-What is
the relationship between An in-depth study to
the inquirer and that observe, count, describe the experience
being studied? delineate, elucidate and of alcohol addiction
classify. among male members of
AXIOLOGIC-What is the a group.
role of values in inquiry? A study on the incidence
and severity of nausea Workplace stressors and
METHODOLOGIC-How accompanying demographic
should the inquirer combinative characteristics that were
obtain knowledge? antiretroviral therapies the best predictors of
among HIV-infected physical and mental
POSITIVIST PARADIGM patients. health of Japanese
hospital nurses.
Nature is ordered and Exploration
regular and can be Types of Research by
predicted. What factors are related Utility
to the phenomenon?
NATURALISTIC OR BASIC RESEARCH
PHENOMENOLOGIC What are the
PARADIGM antecedents of the APPLIED RESEARCH
phenomenon?
Reality not fixed but COMMERCIAL
exists within a context, What is the full nature of DEVELOPMENT
many interpretations are the phenomenon?
possible. Nothing is RELATIONSHIPS
absolutely true or false, What is really going on?
only within a context. CAUSAL vs
What is the process by ASSOCIATIONAL
QUANTITATIVE which the phenomenon
RESEARCH vs evolves or is
experienced? RELATIONSHIPS
QUALITATIVE RESEARCH
Prediction & Control
PURPOSES OF RESEARCH CAUSAL vs ASSOCIATIONAL
What will happen if we
Identification alter a phenomenon or Requirements for
introduce an causality
Description intervention?
concomitant variation
Exploration If phenomenon X occurs,
will phenomenon Y temporal sequencing
Explanation follows?
absence of competing
Prediction and Control How can we make the explanations
phenomenon happen, or
Identification alter its nature STEPS IN THE RESEARCH
prevalence? PROCESS
What is this (Quantitative Research)
phenomenon?
What is its name? CONCEPTUAL PHASE
1. Formulating and 3. Identify Site/Setting Specifications of the
Delimiting the Problem specific and explicit
4. Obtain Access operations which the
2. Reviewing the researcher must perform in
Literature 5. Obtain and Test order to collect the required
Equipment information
3. Developing a
Theoretical Framework 6. Begin Data “Operationalizing the
Collection/Analysis concept”
4. Identifying the
Research Variables 7. Identify Variables
Themes/Categories
5. Formulating Something which varies
Hypotheses 8.
Triangulation/Saturation An abstract entity which
DESIGN AND PLANNING takes on different values.
PHASE 9. Formulate
Hypotheses/Theories DATA
6. Selecting a Research
Design 10. Communicate Pieces of information
Findings obtained in the course of
7. Specifying the the study
Population TERMINOLOGY
Hypothesis
8. Operationalizing the CONCEPTS/CONSTRUCTS
Variables Research--A statement of
CONCEPTUAL FRAMEWORK the expectations of the
9. Conducting the Pilot researcher concerning the
Study/Making Revisions OPERATIONAL DEFINITION relationships of the
variables under study HR
EMPIRICAL PHASE VARIABLES
Null or Statistical--states
10. Selecting the Sample DATA that there is no relationship
among the variables HO
11. Collecting the Data HYPOTHESIS (research or
null/statistical) Problem Statement
12. Organizing Data for
Analysis PROBLEM STATEMENT A the research question or a
statement about the
ANALYTIC PHASE RESEARCH DESIGNS purpose of the study.

13. Analyzing the Data SAMPLE/POPULATION Research Designs

14. Interpreting the Concepts/Constructs Basic designs are

Results experimental and non
Refined general or abstract experimental (or
DISSEMINATION PHASE idea descriptive)

15. Communicating “good health” Sample/Population

Results
“nursing care” Sample--the subjects
STEPS IN THE RESEARCH participating in the study
PROCESS Conceptual Framework
(Qualitative Research) Population--the whole
A series of concepts or
universe of possible
Circular and Flexible ideas connected by
subjects
statements about the
1. Define/Clarify Broad relationships that exist Target population--the
Topic among them group to whom the
researcher wishes to
2. Review of the Operational Definitions
generalize the results of the
Literature? study
RESEARCH REPORTS REVIEW OF THE STATISTICAL
LITERATURE SIGNIFICANCE
ABSTRACT
THEORETICAL THEMES (Qualitative
INTRODUCTION FRAMEWORK Research)

METHOD SIGNIFICANCE OF DISCUSSION

PROBLEM
RESULTS INTERPRETATION
METHOD
DISCUSSION IMPLICATIONS
SUBJECTS
REFERENCES LIMITATIONS
RESEARCH DESIGN
Abstract REFERENCES
INSTRUMENTS AND
An abbreviated summary of DATA COLLECTION All of the literature used
the research problem, in writing the research
methodology, findings and STUDY PROCEDURES article. Should contain
significance. mostly recent and
RESULTS primary sources.
INTRODUCTION
STATISTICAL TESTS
PURPOSE, RESEARCH USED
QUESTIONS,
HYPOTHESES VALUE OF THE STATISTIC

Concern For Human Prisoners . Invitation to participate

Rights Reflected In:
Children .Why subject selected
Ethics in Research
Mentally Incapacitated .Procedures which will be
When Ethics and used
Scientific Rigor Collide, Elderly
Ethics Must Prevail. .Explanation of subjects
Indigent part in study
Ethics in Research
Unborn .Discomfort, stress,
inconvenience, or loss of
Classification of Dead dignity or autonomy
Research re: discussion
of human rights: People lacking in .Risk/benefit ratio
education or skills.
Behavioral .Standard treatment
. Informed Consent-- witheld

Behavior Person Agrees in Writing .Confidentiality or

to Participate as a Anonymity
Attitudes subject with knowledge
of potential or real risks .Compensation
Knowledge and/or benefits.
.Right of refusal or
Perceptions Must have ample withdrawal
opportunity to read and
Therapeutic consider risks, etc. If .Assurance of debriefing
vs. oral consent--must have
Non Therapeutic a witness .Signature validating
consent
Groups prone to 12 Components of
exploitation: Informed Consent
Rights of Human Scientific research is a
Subjects: systematic, controlled,
empirical and critical
1. Informed Consent investigation of natural
phenomena guided by
2. Freedom from Harm theory and hypotheses
about a presumed relations
3. Confidentiality, among such phenomena.
Anonymity
Nature of Research
4. Privacy
Research is empirical.
5. Freedom from
Coercion all knowledge is derived
from sense experience
6. Maintenace of Dignity
and Self Respect Research is systematic
Scientific Method:
Identifying the problem
Reviewing information
Collecting data
Analyzing data
Drawing conclusions
Research must be valid
What is validity of research?
-based on facts and
evidence
-capable of being justified
Validity involves:
Internal validity – is the
extent to which results can
be interpreted accurately
and with confidence
External Validity – is the
extent to which results can
be generalized to
population, situations, and
conditions
Research should be reliable.
concerns
on the
replicabilit
y and
consisten
cy of
Research
methods
& results
Internal validity – refers to
the extent that data
collections, analysis &
interpretation are
consistent given the same
conditions
External validity – deals
with the issue of whether or
not independent
researchers can replicate
studies in the same or
similar settings
Do the data collectors
agree?
Do the two or more
observers agree when
recording the same
performance?
Will researchers be able to
replicate studies, and if so,
will the results be
consistent?
Research may take
different forms.
Basic or applied
Quantitative or qualitative
Classification of Research
Basic –
Its main purpose is adding
to the existing body of
knowledge.
Ex:
A study to better
understand normal grieving
processes without having
explicit nursing application
in mind.
Applied Research
the solution to a specific
problem or for providing
information for decision
making at the local setting.
EX:
A study to determine the
effectiveness of a nursing
intervention to ease
grieving.
General Methodology
Qualitative Research-
follows the naturalists
paradigm, that research
should be done in the
natural setting and that the
meanings derived from
research are specific to that
setting & its condition.
Quantitative Research – Has
its roots from positivism
and is more closely
associated with scientific
method
The Importance of
Research in Nursing
Evidence-based Practice
(EBP)
the use of the best clinical
evidence in making patient
care decisions.
Spiraling costs of health
care and the cost-
containment practices
being instituted health care
facilities.
Help in a broad array of
problem-solving situations
Nursing actions and
decisions are based on
evidence indicating that the
actions are clinically
appropriate and cost-
effective, and result in
positive outcomes for
clients.
Roles of Nurses in Research
Users(Consumers) – Nurses
whose involvement in
research is indirect.
Producers of Research –
Nurses who design and
undertake research
Sources of Evidence for
Nursing Practice
Tradition & Authority
Clinical Experience &
Intuition
Trial & Error
Assembled Information
Disciplined Research
Purposes of Nursing
Research
Identification
What is this phenomenon?
What is its name?
Example:
A study to determine how
individuals were able to live
with catastrophic illnesses
and injuries.
How prevalent is the
phenomenon?
How often does the
phenomenon occur?
What are the characteristics
of the phenomenon?
What are the dimensions of
the phenomenon?
What variations exists?
What is important about the
phenomenon?
Example:
A study to describe some of
the experiences and
physiologic changes that
people went through in the
midst of stressful upheaval
on September 11, 2001.
An in-depth study to
describe the experience of
alcohol addiction among
male members of a group.
Description
observe, count, delineate,
elucidate and classify.
Example:
A study on the incidence
and severity of nausea
accompanying combinative
antiretroviral therapies
among HIV-infected
patients.
The variability of critical
care nurses’ hemodynamic
decision-making in the 2-
hour period after cardiac
surgery.
Exploration
What factors are related to
the phenomenon?
What are the antecedents
of the phenomenon?
What is the full nature of
the phenomenon?
What is really going on?
What is the process by
which the pehnomenon
evolves or is experienced?
----
What will happen if we alter
a phenomenon or introduce
an intervention?
If phenomenon X occurs,
will phenomenon Y follows?
How can we make the
phenomenon happen, or
alter its nature prevalence?
Can the occurrence of the
phenomenon be controlled?
Example:
Workplace stressors and
demographic characteristics
that were the best
predictors of physical and
mental health of Japanese
hospital nurses.
Prediction & Control
Future Emphases of Nursing
Research
EBP & Research Utilization
Projects
Replications of Research
Integrative Reviews
Multidisciplinary studies
Expanded dissemination
efforts
Outcomes research
Assignment
5 Research examples:
Read on
Preliminary steps in the
research process
Designs for nursing
research
to develop a strong
research question from
your ideas, you should
ask yourself these
things:
Do I know the field and its
literature well?
What are the important
research questions in my
field?
What areas need further
exploration?
Could my study fill a gap?
Lead to greater
understanding?
Has a great deal of research
already been conducted in
this topic area?
Has this study been done
before? If so, is there room
for improvement?
Is the timing right for this
question to be answered? Is
it a hot topic, or is it
becoming obsolete?
If you are proposing a
service program, is the
target community
interested?
Most importantly, will my
study have a significant
impact on the field?
A strong research idea
should pass the “so what”
test. Think about the
potential impact of the
research you are proposing.
What is the benefit of
answering your research
question? Who will it help
(and how)? If you cannot
make a definitive statement
about the purpose of your
research, it is unlikely to be
funded.
A research focus shis too
large a question to answer.
It would beould be narrow,
not broad-based.
For example, “What can be
done to prevent substance
abuse?” better to begin
with a more focused
question such as
“What is the relationship
between specific early
childhood experiences and
subsequent substance-
abusing behaviors?”
A well-thought-out and
focused research question
leads directly into your
hypotheses. What
predictions would you make
about the phenomenon you
are examining?
Strong hypotheses:
Give insight into a research
question;
Are testable and
measurable by the
proposed experiments;
Spring logically from the
experience of the staff;
Normally, no more than
three primary hypotheses
should be proposed for a
research study. A proposal
that is hypothesis-driven is
more likely to be funded
than a “fishing expedition”
or a primarily descriptive
study.
Make sure you:
Provide a rationale for your
hypotheses—where did
they come from, and why
are they strong?
Provide alternative
possibilities for the
hypotheses that could be
tested—why did you choose
the ones you did over
others?
If you have good
hypotheses, they will lead
into your Specific Aims.
Specific aims are the steps
you are going to take to
test your hypotheses and
what you want to
accomplish in the course of
the grant period. Make
sure:
Your objectives are
measurable and highly
focused;
Each hypothesis is matched
with a specific aim.
The aims are feasible, given
the time and money you
are requesting in the grant.
An example of a specific
aim would be “Conduct a
rigorous empirical
evaluation of the online
grant writing tutorial,
comparing outcome and
process measures from two
groups—those with
exposure to the tutorial and
those without.”
Research Questions
Should be stated as a
question, e.g., "Is there a
relationship between a
person's age and their
favourite day of the week?"
Should involve the
relationship or difference
between two or more
variables (i.e., an
independent and a
dependent variable), e.g.,
IV = age, DV = favourite
day of the week.
In the Introduction, you
should clearly define each
of the target constructs (IVs
and DVs) and in the Method
explain how each of them is
operationalised (measured).
Introduce the RQ within the
first two pages of the
Introduction, then go on to
review relevant theoretical
and research literature, and
then restate/justify the RQ
towards the end of the
introduction and use this to
lead in to the statement of
hypotheses.
Should relate to the
research literature and a
problem/issue to be solved.
Serves to provide an overall
focus the study - it is the
study's goal.
Leads into specific, testable
hypotheses.
Choose the best working
thesis for the proposed
research paper.
Thesis A: There are many
causes of anorexia nervosa.
Thesis B: Anorexia nervosa
has both emotional and
social causes which work
hand-in-hand.
Thesis C: Anorexia nervosa Aims and objectives
occurs most often in young 1. Identify the different
women aged 13 - 22. methods of family planning.
2. Know the benefits of
Are the dying person's family planning.
anxiety levels towards 3. Understand the
death reduced if certain complications of family
stages are exhibited in planning.
certain sequences? 4. Determine the situation
of women.
"What is the effect of 5. Analyze the impact of
something on something family planning on women.
else?"
"As a person gets older the
amount of their body that is
muscle mass decreases."
What is the effect of
environmental variables on
typing accuracy?
Can changes in diet and
upbringing
compensate for genetic
abnormalities?
What causes some children
to be bullies?
When do children become
aware
that other people have
thought
processes of their own, and
what
makes this awareness
possible?
The Impact of Parent’s Food
and Lifestyle Choices on the
Obesity among children
The Impact of Family
Planning on Women