Professional Documents
Culture Documents
INTRODUCTION TO RESEARCH
What is a university?
University is a place where ideas are collected, stored and utilized
NURSING RESEARCH
Chapter 1
Evolution of nursing
Definition of nursing research
Importance of nursing research
Roles of Nurses in Research
Researches were focused on importance of a healthy environment in promoting patient's physical and mental well-being, aspects of
environment such as ventilation, cleanliness, purity, water and diet to determine the influence on patient's health
Result of her research were Decrease in mortality rate within 6 months and use of statistics to support her argument for reforms in medical care in
military and civilian hospitals,
Recommendation
Education of nurses occurs in collegiate setting.
1950's – Increase in nurses with advanced degrees. Journal of Nursing Research was started. Research was included in curriculum
Studies from 1940-1950 Resulted into the formulation of Evaluative studies focused on types of care such as: a. comprehensive care b.
home care, and c. Progressive Patient care Results of these studies helped in the development of self-study manuals, quality assurance manuals of
today.
NURSING RESEARCH IN 1950 AND 1960 - Emergence of Research as a high priority which was support from nursing leaders Henderson and
Abdellah.
Research was introduced and the steps of research process at baccalaureate level by nursing schools and increased funding for research were
provided.
Resulted into an increased number of masters prepared nurses who took up research; some able to complete their thesis, thus enabling them to
conduct research.
Five thousand US dollars was awarded for federal research in 1955 (de Tornyay, 1977).
Prior to this, Nursing Research journal was published in 1952
Studies conducted during these two decades dealt with: a. nursing education; b. standards for nursing practice, c. nurses' characteristics;
(including nursing students’ characteristics); d. staffing patterns, (hospital personnel changes) & e. quality of care interaction between a dying patient
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NURSING RESEARCH IN 1960’s - Introduction of such terms as "conceptual framework”; "conceptual model," "nursing process,"
"theoretical base of nursing practice."
NURSING RESEARCH IN 1970 - One significant result of nursing research was observed in 1070’s when the groundwork for clinical research
was started, and it stays a priority up to the present (Burns and Grove, 1997). It could also be noted that results of reviewed studies published in
Nursing Research from 1970 to 1974 revealed: that 71 or 26% of the 275. Studies published focused on the improvement of nursing practice
(O'Connell and Duffey, 1976).
NURSING RESEARCH IN 1990 (PRESENT AND FUTURE) resulted into more on clinical researches with nursing diagnosis as framework.
The National Center for Nursing Research (NCNR) created in 1985 to fund nursing research activities was renamed the National Institute for
Nursing Research (NINR). This move under the direction of Dr. Hinshaw
Purpose of the move was: provides for better recognition of nursing as a research discipline and hopes for an increased funding for nursing research.
NINR research priorities that need funding to the year 2000: a. community-based nursing models; b. effectiveness of nursing interventions in
HIV/AIDS. C. cognitive impairment; d. living with chronic illness, and e. biobehavioral factors related to immunocompetence (NINR, 1993)
Focus of researches in 1990: health promotion, illness prevention, Primary care since everyone aims to attain an improved quality and
quantity of his life.
Outcomes research has come out as an important methodology which documents the effectiveness of health care services.
The primary concern of outcomes research in the 1980s was patient health status and cost related to medical care.
Recommendation of outcome research:
That patient outcome researches related to nursing that has received little attention in the early 1990s should become the major focus for
nursing studies in the future (Bowers, 1994; Johnson, 1993; Jones, 1993; Higgins, McCaughan, Griffiths and Carr-Hill, 1992, and Hegyvary, 1991).
1976 Stetlet & Marram Published guidelines on assessing research for use in practice
2 – A. DEFINITION OF RESEARCH
Unit 1 Chapter 2
• Being a major function of the higher education
– Is significant in the development of any country, especially in the generation of new ideas and knowledge for productivity. (Palispis
2004)
• National Aeronautics and Space Administration (NASA) has begun to appreciate the value of nursing research.
• According to Linda Plush, a NASA consultant, the administrators at NASA have started to realize that nurses often have more expertise
than physicians do (Domrose, 2005).
FUNCTIONS OF RESEARCH
• It helps us answer questions, solve problems and make decisions.
• It enables us to see and understand how and why a situation or a problem exists.
• It helps us discover new things and ideas.
• It allows us to validate existing theories or generate new ones.
• It helps us identify and understand the causes and effects of a situation or a phenomenon.
Improved
Conditions/welfare
RESEARCH
A) PROMOTE EVIDENCE-BASED NURSING PRACTICE (FROM "IMPROVEMENTS IN NURSING CARE) to foster optimum care for
clients
Evidence-based nursing practice (EBNP) means that nurses make clinical decisions based on:
The best research evidence, their clinical expertise, and the health care preferences of their patients/clients.
AIM OF EBNP:
1. To provide the best possible care based on the best available research.
2. To provide a service to society and this service should be based on accurate knowledge
To back up the importance of EBNP,
Sigma Theta Tau International, Honor Society of Nursing and Blackwell Publishing initiated a new journal in 2004 titled Worldviews on Evidence-
Based Nursing.
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• The scientific method is only one source of nursing knowledge. It is, however, generally considered to be the most reliable source of
knowledge.
SCIENTIFIC RESEARCH
Characteristics of Traditional scientific research:
2. Have many similarities between scientific research and the problem-solving approach that is familiar to all nurses.
Both processes include:
– identifying a problem area,
– establishing a plan,
– collecting data, and
– Evaluating the data.
Differences:
• Knowledge of nursing process will not enable you to conduct the research process.
– Research is more complex than nursing process.
– Research involves the rigorous application of a variety of research methods and requires the understanding of a unique language.
• The focus of research-is broader than nursing process.
• Example: Nursing process focuses on a specific client and his family:
3. Researcher should be knowledgeable about the world of nursing in order to identify a phenomenon requiring investigation.
Knowledge is obtained from clinical experience and research literature.
4. Theoretical underpinnings of the research process are mush stronger than nursing process.
All steps of the research process are logically linked and are also linked to the theoretical framework of the study.
5. The conduct of research requires greater precision, rigor and control than the implementation of the nursing process.
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4. Basic research seeks "knowledge for knowledge's sake.“ 4. Majority of nursing studies have been examples of applied
• basic research seeks to: research.
• generate or develop theories, 5. Studies have focused variables or factors which can be
• Immediate application of the results usually does not occur. changed by nursing interventions in order to achieve a desired
5. Basic research often uses laboratory animals as subjects. goal for patients and their families.
Examples of Pure/Basic Research Topics Applied research is an experimental study comparing the
"Factors Associated with Tardiness and Absenteeism among BSN III effectiveness of two methods.
Students" Examples of Applied Research Topics
"Attitudes Towards Health and Smoking Habits of Health Service Providers"., "The Effect of Gender Sensitivity Training on Men's
Involvement in Child Care"
“IN House Review: Its Effect on the Performance in the
board exam"
– The researcher compares what is found in real life with that of what is written in books.
• Examples: Pain management by staff nurses.
How do family members manage disclosure to a child who has acquired HIV
3. Ethnographic Research-
– Originated from anthropological perspective with focus on culture, life-ways in the natural setting.
– Ethnography means "Learning from people"
– It focuses on the question: "What is the culture of this group of people?“
– important criteria for Ethnographic research: Intensive field work, immersion, live-in activities
– Techniques to be used. Interview, direct participation and observation
4. Historical Research
• Examines the events of the past and how these events affect the present, used to determine the growth and development of a group,
organization or institution.
• Data are obtained from: documents, relics, artifacts, oral reports, maps, books, diaries, letters, etc.
• Sources of data: primary and secondary
• Evaluation of historical researches:
• a. External criticism - determine authenticity of collected data
• b. Internal criticism - evaluates the accuracy of data
5. Case Studies - In depth examination of experiences of a particular patient.
- The result is not generalized to other groups of people.
- Hypotheses are not tested.
- Subject selection is done with care as they may decide to discontinue their participation.
– Data evaluation is through content analysis or examining answers and messages.
PURPOSE OF RESEARCH PROCESS BASED ON KIND OF RESEARCH
Basic Research Applied Research
To extend the base knowledge Formulation or refinement of • To finding solutions for existing problems
theory • Focuses on factors which can be changed by intervention to
achieve a desired goal
For discovery of general principles For solving problems
Quantitative Research Qualitative Research
Associated with positivist tradition (there is reality out there that Associated with Naturalistic inquiry (reality is not a ft entity but rather a
can be studied and known) construction of individual participatory research.)
Gathers numerical values as its data Gathers narrative description as its data
Been placed in a separate category because the types of designs, methods, and sampling procedures used in these studies may be somewhat
different from those used in the traditional quantitative or qualitative studies.
For example,
Rather than exercising tight control over the sample, the goal might be deliberately:
To include a wide range of patients with varying levels of health status and co morbidities
To determine how effective an intervention or treatment might be for this varied group of people.
As outcomes research continues to emerge, you will want to seek further information in the latest clinical and research journals.
TRIANGULATION of METHODS
• Refers to the use of two or more research methods in the study of a particular phenomenon.
The combination of qualitative and quantitative methods enhances the technical ability to rule out conflicting explanations. (Hinds, 1989)
• The most reliable findings are located when using both methods. (Field and Morse, 1985)
Careful analysis of data from several sources and use of defining methods allows for richer, fuller description of a study than a single approach.
(Thurmono, 2001)
3 - IMPORTANCE OF NURSING RESEARCH
• The latest revision of the American Nurses Association guidelines and the AACN guidelines include:
– Expectations of those with postdoctoral preparation. Postdoctoral study involves agreements between: novice researchers, usually with
recent doctorates, and established investigators.
– These seasoned investigators agree to mentor the novices for a period of 2 or 3 years.
– Private and federal funding is available for postdoctoral preparation.
ROLES OF NURSES IN RESEARCH
1. Principal Investigator
Nurses can and should serve as principal investigators in scientific investigations.
To be a principal investigator, special research preparation is necessary.
It might be possible for a beginning researcher to conduct a small-scale survey study,
But preparation beyond the baccalaureate level is necessary for independent investigator status in most nursing research studies.
2. Member of a Research Team
Nurses can serve as members of a research team.
They may act as data collectors or administer the experimental intervention of the study.
As nurses increasingly participate in research,
It is possible that interest and enthusiasm to conduct their own investigations may grow.
3. Identifier of Researchable Problems
– All nurses, from associate degree to doctoral-level preparation, have the responsibility of trying to identify areas of needed research.
– Nurses at the bedside are particularly well situated to identify patient-related researchable problems.
4. Evaluator of Research Findings Every nurse should be involved in the evaluation of research findings. As research consumers, nurses have
the obligation to become familiar with research findings and determine the usefulness of these findings in the practice area. Beginning
researchers should critique research articles, first with the help of an experienced researcher and eventually on their own, through the use of
knowledge gained in a structured research course (either in their basic nursing education program or in a continuing education course).
5. User of Research Findings
• Through the years, nurses have tended to carry out nursing procedures and provide nursing care "the way we've always done. After
evaluating research findings, nurses should use relevant findings in their practice. The primary goal of nursing research is the improved care of
clients.
Research utilization and evidence-based nursing practice
– Are related because both processes place emphasis on research findings.
– However, nurses must be judicious in their use of research findings.
– The results of one small study conducted with a sample of 15 volunteers would not provide sufficient evidence for a change in nursing
practice.
However, nurses must be judicious in their use of research findings. The results of one small study conducted with a sample of 15 volunteers would
not provide sufficient evidence for a change in nursing practice.
4-B RESEARCH PRIORITIES FORTHE FUTURE
UNIT I
• Research priorities were developed by Professional nursing organizations and individual nurse leaders
• They were united in identifying the need for research that will help build a scientific knowledge base for nursing practice.
– In 1980 the ANA Commission on Nursing Research identified priorities for nursing research. Which were:
• health promotion and preventive health practices for all age groups,
• health care needs of high-risk groups,
• life satisfaction of individuals and families, and
• the development of cost-effective health care systems.
– In 1985 the ANA Cabinet on Nursing Research identified 10 priority areas. Which were:
• (a) promote health, well-being, and the ability to care for oneself among all age, social, and cultural groups;
• (b) minimize or prevent behaviorally and environmentally induced health problems that compromise the quality of life and
reduce productivity; and
• (c) minimize the negative effects of new health technologies on the adaptive abilities of individuals and families experiencing
acute or chronic health problems.
In November 1987 Dr. Ada Sue Hinshaw, director of the National Center for Nursing Research (NCNR), invited nursing organizations to identify
their research priorities.
Research priorities for people with Alzheimer's disease were identified at a research conference held in 1988 (Duffey, Hepburn,
Christensen, & Brugge-Wiger, 1989).
The top priority was given to research on:
– the management of physical problems (i.e., incontinence of bowel and bladder, falls, sleep disturbance, gait disturbance,
maintenance of adequate nutrition).
– Management of disruptive behaviors (i.e., agitation, wandering) was listed as the second priority.
The National Association of Orthopaedic Nurses identified a list of priorities in 1990 (Salmond, 1994).
They used a Delphi technique to survey experts in the field.
"Some of the highest ratings were given:
– to preventing confusion in elderly patients post-hip fracture,
– determining the most effective safety measures to use with the patient with acute confusional state, and
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– differentiating pain responses according to diagnoses, ages, and pain management interventions. In 1997 Sedlak et al. (1998)
These authors cautioned that as nursing promotes evidence-based practice; there is a need for clear research priorities.
– They called for mental health nursing experts and organizations to propose a national/international mental health research agenda.
The Emergency Nursing Association conducted a Delphi study on national research priorities for emergency nurses in the United States
(Bayley, MacLean, Desy, & McMahon, 2004).
Three rounds of mailed surveys were used to gather data.
Responses were received from 101 emergency nursing leaders.
The study was completed in summer 2001.
– Interventions for pain management received the highest ranking.
– Emergency nurses were also concerned with:
» staff shortages and overcrowding of emergency departments and the effects of these two conditions on patients.
A survey was conducted among members of the Oncology Nursing Society (ONS)
to determine research priorities for 2005 to 2008 (Berger et al, 2005).
Responses were received from 431 members.
The top 20 research priorities were identified:
quality of life,
participation in decision making about treatment in advanced disease,
patient/family education,
participation in decision making about treatment, and
pain management.
– Clinical nursing research is essential for the profession, However, other types of research are also needed.
• Grier (1982)
– patient care research had become the "sacred cow" for nursing research.
• Brown, Tanner, and Padrick (1984) wrote that research regarding:
– nurse characteristics,
– nursing education, and
– nursing administration should not be abandoned because these factors affect the care that nurses provide.
• Abdellah and Levine (1994) also called for studies other than clinical studies.
– They wrote that we need reliable tests to predict clinical performance by students and research on occupational choice.
– Clinical nursing research is essential for the profession, However, other types of research are also needed.
• Fitzpatrick (1999)
– contended that nursing education research should receive the same recognition as clinical research.
– She mentioned the pressure in recent years to transform nursing educational programs to meet changing health care needs and contended
that any changes should be based on research.
• Tucker-Alien (2003) wrote an editorial on nursing education research is not always respected.
– She called for nurse educators to conduct research:
» on both clinical issues and educational issues.
• Replication studies should be a high priority for nursing research. Which involve:
– repeating a study with all the essential elements of the original study held intact.
• Different samples and settings may be used.
– Replication studies in nursing have not been numerous,
• the lack of these studies has hindered the development of a cumulative body of nursing knowledge.
– This type of study is of particular importance in clinical nursing research.
• Because of the small nonrandom samples
SUMMARY of UNIT I
• Nursing research is defined as the systematic, objective process of analyzing phenomena of importance to nursing. It includes studies
concerning nursing practice, nursing education, nursing administration, and nurses themselves. Clinical nursing research is research that has the
potential for affecting the care of clients.
• Nursing knowledge has come from tradition, authority, trial and error, and scientific research. Scientific research uses empirical data (data
gathered through the senses) and is a systematic, orderly, and objective method of seeking information.
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• Basic research, also called pure research, is concerned with generating new knowledge; applied research seeks solutions to immediate
problems. Most nursing studies have been applied research. Many studies, however, contain elements of both basic and applied research.
• The most important goal for conducting nursing research is the promotion of evidence-based nursing practice.
• Evidence-based nursing practice (EBNP) means that nurses make clinical decisions based on the best research evidence, their clinical
expertise, and the health care preferences of their patients/clients.
• Other goals for conducting nursing research are to ensure credibility of the nursing profession, provide accountability for nursing
practice, and document the cost effectiveness of nursing care.
• Quantitative research is concerned with objectivity, tight controls over the research situation, and the ability to generalize findings.
Qualitative research is concerned with the subjective meaning of an experience to an individual. Outcomes research focuses on measurable outcomes
of interventions with certain patient populations.
• Nurses act as principal investigators, members of research teams/identifiers of researchable problems, evaluators of research findings,
users of research findings, client advocates during studies, and subjects/participants in research. Research utilization focuses on the implementation
of findings from specific research studies.
• Because nurses were not prepared to conduct research, many of the early nursing studies were conducted by members of other
disciplines
• . Some of these studies, such as the Goldmark Report in 1923 and the
• Brown Report in 1948, contributed important information about nursing and nursing education.
• As nurses began to receive advanced degrees, these degrees were generally in the field of education. Many of the studies conducted by the
first nurse researchers in this country, therefore, were in the area of nursing education.
• Although Florence Nightingale recommended clinical nursing research in the mid-1800s, this type of research was scarce until the 1970s.
Many nursing organizations have identified clinical nursing research priorities for the future.
• Also, replication studies are needed in nursing.
• Replication studies involve repeating a study with all the essential elements of the original study held intact.
• The National Institute of Nursing Research (NINR) was established in 1993. Funding by Congress has increased from $16 million in
1986 to the National Center for Nursing Research, the precursor to the NINR, to over $138 million to NINR in 2005.
• NURSING RESEARCH ON THE WEB
• For additional online resources, research - activities, and exercises, go to www. prenhall.com/nieswiadomy.
E. Ethics in research
ETHICAL STANDARDS IN RESEARCH
• Ethics is generally concerned with rules and principles to govern the complex nature of human behaviors.
• Since nursing research employs human beings and subjects, ethical guidelines should care for the rights of the subjects to be protected
against misconduct (if any), in research.
• The same consideration applies to nurses as well who will be involved in research, either
as subjects or investigators.
E Ethics in research
. Feminists assert, and rightly, that women have as much right to know what will happen in their bodies when they take a certain drug as men do.
This is the principle of social justice.
• The operationalization of this principle is to include both men and women in any study of human beings.
• Problems Involving Ethics
• Informed Consent
• Balancing Potential Benefit against Actual Cost
• Maintaining Anonymity and Confidentiality
• Federal Guidelines on the Submission of Proposals for Review
• Ethical Principles Underlying Protection of Human Subjects
• Recommended Readings
Nuremberg trials
• The movement to protect human rights in research began after the Nuremberg trials that followed World War II.
• The world was so appalled by the biomedical experiments conducted on concentration camp prisoners that a code of behavior for researchers
was drafted.
Nuremberg Code
• Problems resulting from biomedical research were the subject of hearings in 1973.
• Two of the most famous were the Tuskegee case and Willowbrook case.
• The Willowbrook case concerned an experimental in which children living in an institution for the mentally retarded we injected with
hepatitis virus.
• In the Tuskegee case, black male prisoners we used for a classic experimental design for treatment of syphilis. One group infected men
received no treatment, and their disease progressed to stage syphilis. These cases, among others, raised several ethical issues requiring a set of
guidelines and principles on which to judge the ethical nature research.
In 1974, Congress This commission explored basic The Belmont Report summarized the basic ethical principles
established the ethical issues of human subjects developed the informed consent
National Commission in research and identified • to keep subjects informed throughout a research
for the Protection of principles to assist with the project including risks and benefits fully in order
Human Subjects of planning and conducting of to ensure subjects' understanding. These
Biomedical and ethical research. recommendations applied to all health-related
Behavioral Research. research including nursing studies.
Canada, the Tri- Guiding Ethical Principles for • standards widely accepted in the international
Council Policy health research. community.
Statement • protection of human subjects
The International developed a "Code for Nurses I 1953 recent update (2000)
Council of Nurses
Nuremberg Code
• Problems resulting from biomedical research were the subject of hearings in 1973.
• But you may ask "Why do we need to bother about ethical guidelines for research? Aren't people protected by law?"
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• The law is a written mandate for behavior, based on what people believe is good and bad behavior—their ethics.
• Before writing down laws, people must decide what they believe in.
• Frequently, laws are a set of instructions on what you are not allowed to do rather than a set of instructions on what you should
do.
• Ethics outlines a set of principles that can be used to determine which actions are right and which are wrong.
• Ethical judgments are the decisions a person makes on whether a particular act is right or wrong.
• ethical theory provides a means of understanding ethical principles and bioethics is the application of general moral principles to
the area of health/illness action and events.
• When an action deriving from an ethical principle becomes law, people can be punished for immoral behavior.
• The law is normally in a "catch-up" position in relation to ethical values and practices. Ethical values and practices change
over time and there may be a need to enact laws to ensure that these are observed.
• The question of do-not-resuscitate (DNR) protocols is a good example of a change in practice based on ethics.
• The development of laws to ensure that DNR protocols are allowed in particular circumstances is occurring throughout the west.
• telling subjects that they are being tested for one thing when they are being tested for something else
• not telling control subjects that they have received a placebo when they have
come for the experimental item (such as birth-control methods), telling subjects that someone else is being observed and not they as
subjects, and not telling subjects that they are involved in a research project even when they ask.
• Deception of research subjects is unethical nor Coercion of Subjects to Participate
The assumption behind the concept of informed consent is that, given sufficient information on which to base a decision, the subject's
consent to participate is made freely. However, there are various ways in which consent may be partly, or even wholly, coerced by the
circumstances under which it is obtained.
• Many times, the researcher is in a position to influence subjects' participation in the study. For instance, the researcher may be
the subject's employer or teacher and thus may exert considerable control. An employer or a teacher may require that individuals
participate as a condition of remaining employed or passing a course. Without question, this is coercion
Another type of coercion occurs when individuals are required to give consent to participate in research in order to be accepted for treatment
at a particular health care facility.
This might happen in medical centers and specialty hospitals such as those specializing in the treatment of catastrophic illnesses.
The individual is likely to feel that the "last chance" of being accepted rests with that institution and, therefore, feels compelled to consent
to anything.
Coercion also occurs when people are given the option to refuse but with the sense that refusal will not go unpunished.
For instance, when a nursing supervisor brings questionnaires to a nursing unit, distributes them, and says she will be back to pick them up
in an hour, at least some of the nurses are likely to feel that a refusal will offend their supervisor, even though they are given the option,
perhaps thinking it will have an effect on their days off or their shift rotation.
Health care clients are particularly vulnerable to requests to participate in research when the person making the request is someone on
whom the individual must depend for critical needs.
The physician and the primary nurse can easily take advantage of an individual's vulnerability.
The ethical position is to recognize that people are never obligated to assist with research.
Many times it may seem obvious that it will be to the advantage of the individual to participate in the research. Perhaps the individual will
benefit from extra nursing care or a special teaching program. Perhaps employees will reap the benefits of shorter working hours, less shift
rotation, or improved supervision. While this may be true, it is still the individual's right to decide. Thus, although the advantages of
participation can be mentioned as part of the information needed for informed consent, the decision should never be made for that person.
Withholding Benefits from Control Subjects
This issue is particularly critical for studies in which the new treatment would be of value to all the subjects, including the control group, or
when a control group is deprived of something the members of the group had access to earlier in order to obtain a more accurate assessment
of the new treatment.
Both instances provide ethical dilemmas for researchers. Remember, however, the majority of control groups suffer no deprivation.
Sometimes problems with control group deprivation occur because of the overzealousness of an inexperienced researcher, when, in fact, they are
not necessary.
For example, in a study to test the effectiveness of a preoperative teaching program on postoperative anxiety, the nursing staff was told not
to answer any questions from the participants in the treatment or the families in the control group. This overzealousness deprived the
control group of expected privileges and introduced a new variable—withholding of information—which was not part df the research
question. This kind of mistake can easily be identified in the proposal if the researcher addresses the topic of human rights for all subjects,
including the control group.
In some experimental studies, the benefit of the experimental variable is so obvious that those who are cooperating with the researcher in
carrying out the study will refuse to deprive the control group of the benefit.
This kind of study is particularly difficult for nurses to carry out, as their primary responsibility is the care of people and not
experimentation. Dedicated nurses would find it difficult to deprive a group of individuals of an obvious beneficial treatment, such as a
simple relaxation exercise that relieves postoperative pain. If this difficulty could be predicted, perhaps control data should be collected
before introducing the experimental variable, thus avoiding the problem for the attending nurse.
Sometimes, withholding benefits from the control group can be rectified at the end of the experiment by making the benefits available at that
time.
A method of teaching diabetics that has proved immensely successful could be provided for the control patients after the data have been
collected. Remember, however, that this effort must be planned in advance along with the actual experiment, so that time and money are
budgeted for carrying it out.
INVASION OF PRIVACY
All research has the potential of being invasive, whether it is simple observation and recording of behavior or an experimental design.
If you, the, researcher, decide to take movies of persons leaving a bar, a church, or a jail,! you may unintentionally be taking movies of
people who don't want others to I know where they were. When you show these movies publicly, you are invading the privacy of the
persons you have photographed. When you go to people's homes for interviews, particularly when the topic is sensitive, you are again
invading individuals' privacy. These persons have a right to refuse to participate in your research or to have all identifying data about
themselves removed from your study.
Another violation of privacy is observing individuals on units when they are living in a health care facility such as a long term or continuing care
institution.
These individuals have as much right to privacy in the hospital as you do in your home. Because their privacy is limited, it must be
protected even more. Hospital records are private documents—not to be shared for the sake (A curiosity. As private citizens, we have the
right not to have our private lives
INFORMED CONSENT
spread all over the front page of a newspaper or be placed on TV for the purpose of research. Without our permission, researchers simply don't have
the right to violate that principle of INFORMED CONSENT
Just as all patients entering the health care delivery system have the right to know what will happen to them and to sign a consent form for any
procedures, so do the participants in a research project.
The protection of the rights of the research subject revolves around the concept of informed consent.
Informed consent has three major elements:
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If, for instance, you are reporting findings in an attitude study of staff nurses, and you cross-tabulate them by shift, unit, and position, you
may find that there is only one R.N. on the night shift of a particular unit, and her responses will be easily identified. To maintain
anonymity, you may be required to omit some of your data analysis from the published report.
These potential difficulties in maintaining confidentiality can be avoided by planning ahead.
It is not enough just to avoid promising what you "can't deliver." The key is on the research to inform the subject that some or all of the
data will become public knowledge or that some individuals other than the researcher will have access to them. Otherwise, the subject has
the right to assume that all data will be kept confidential.
Evidence-based nursing - integrates the best evidence from research with :clinical expertise, patient preferences, and existing resources into
decision making about the health care of individual patients.
Evidence-Based Nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise
and patient preferences."
[Source: University of Minnesota Evidence Based Nursing page]
– Magnet hospitals: research and evidence-based practice mandates –
• "Quality patient care is provided through sustaining excellence in nursing services."
– Solves problems encountered by nurses by carrying out four steps below...
•
OUTCOMES RESEARCH or EVIDENCED-BASED NURSING PRACTICE
Focus:
• the need to answer the growing demand of justifying: the quality of interventions, systems of care as regards improving patient lives, and
spiraling cost of health care.
Definition:
• Translating knowledge into practice
Chapter 2 Importance of building an evidence-based nursing research
7. Evidence based practice allows nurses to enrich their clinical training and experience with up to date research.
– With the large amount of research and information that exists in the medical field, learning the skills of evidence based practice allows
nurses to: search for, assess, and apply the literature to their clinical situations.
three aspects of evaluation in appraising quality are structure, process, and outcome.
For beginners, outcomes research is not advised because examination of all aspects will be needing large samples of various structures, each one
with the different processes being compared and large samples of subjects who have experienced the outcomes of those processes.
Even seasoned researchers may encounter difficulties in doing outcomes research because the funding and the cooperation necessary to attain
this goal are not that so available at present (Burns and Grove, 1997).
– To do so, the definition should present relevant data from service statistics and related literature.
Question to be considered:
• Will answers to the research questions help advance knowledge?
• Will the answers help in improving practices/behaviors/performance?
• Will answers improve human condition?
2. A research problem must be feasible.
– Feasibility means the availability of money, time, appropriate tools and devices and personnel.
• It may be relevant, but if funds are not available and there are no skilled researchers or data, it would not be feasible.
3. A research problem must be clear.
– The statement should be clear.
– Major variables should be measurable.
– The use of ambiguous terms should be avoided.
4. A research problem must be ethical.
– The conduct of the study must not pose any danger, embarrassment, hurt or risk to the respondents.
– Information needed to answer the research questions can be collected without violating the rights of the source/s of information.
– The privacy of respondents must be protected.
to explain them.
• 7. It includes information for identification of relevant criterion measures and data to used to accomplish the stated purpose of the
study.
• 8. It provides a framework within which to hang findings from the investigation.
• 9. It provides bases for conclusions and recommendations to be derived from the findings.
• 10. It portrays the potential relationship of the "bit of knowledge" anticipated as an outcome of the investigation to other knowledge in
the area of interest. 'It provides for contribution to the "body of knowledge" rather than adding one more bit to the many unrelated bits and pieces of
knowledge.
•
REVIEWING LITERATURE
A review of literature is a process of:collecting, selecting, and reading books, journal articles, reports abstracts, and other reference materials,
including electronic sources (CD-ROM) and the world wide web (www/http) to get relevant information about the problem under investigation.
– a waste of time
– Is a series of references.
• Only literatures used to substantiate the background of problem is included in the literature review
• Rationale for incorporating review of literature:
– To substantiate what you say through literatures through direct personal quotes
• Thus the need to separate RRL is just a waste of time
Why Review Literature?
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1. Specific Objectives –
– It specifies the variables to be studied,
– the variables are expressed in measurable terms
– and it suggests the type of analysis to be done.
Example:
Title: Extent of Caring Behavior of Student Nurses in Rendering Care in the Clinical Area
• General Objective: This study aims to find out the extent of caring behavior of student nurses in rendering care in the clinical area.
• Specific objectives: Specifically, this study aims to answer the following:
• What is the extent of caring behavior of student nurses in the clinical area along four aspects which are physical, psychological, social and
spiritual as perceived by student nurses and patients.
• Is there a significant difference on the caring, behavior of duty nurses in the different clinical areas like CDP, EENT, Gyne, Medicine,
ortho and surgery?
• Is there a significant difference in the extent of <»n;ng behaviore of^ent nurses in the dffierent clinical areas when the following vana&es
are considered. Year
Example 2:
Title: Demographic and Socoeconomic Determinants of Health-seeking behavior of the elderly in Baguio City
• General Objective- This study will be conducted to identify demographic and Determinants of health seeking behaviors of the elderly in
Baguio City.
– to describe,
– to compare, etc.
Hypothesis independent variable and one dependent to success in the nurses' board examination.
variable.
FORMULATION OF RESEARCH FRAMEWORK
• Framework for study is simply an explanation, based on the literature you have read, of how the variables in your study are expected
to relate to each other and why.
• • In explaining the existence of a problem, a research may be based on a theory.
• The connection between theory and the problem is explained in the theoretical framework.
• The theoretical framework may be further explained and illustrated in concrete terms using a Conceptual framework
• It presents a theory that explains why a problem under study exists, and the connection between certain factors and the problem.
Theoretical framework –
– When the variables have been studied before and have been found to be related to one another
– It has an available theory that will provide an explanation for the action of your variables or
– There is a proposed explanation given by another author to explain the findings of a study of the same variable.
• This framework will then be tested by the researcher & will either be supported or refuted by the result of the study.
• Conceptual framework.
– when the explanation is based on literature and researches about the variables, or
– When the literature does not contain a particular theory that explains the relationship among your variables.
Framework levels: (update: basic steps in planning research by Wood et al., 2006)
L • are based on the findings of level II • always have theoretical frameworks to explain what the researcher
E studies, you always know the expects to find.
V relationship of the variables in • The prediction can be supported by theoritical framework that explains
E advance & can predict its direction. why the variables affect one another.
L
III
VARIABLES
- It is a concept that stands for a variation within a class of objects or persons.
- A characteristic or property that can take different values or attributes.
- Variables are the basic elements which are measured in a study.
- They are observable and measurable.
Examples: age, sex, status, income, type/place of work, type of school, degree of malnutrition, educational attainment, etc.
Types of Variables
1. Dependent - It is the "assumed effect" it is the change that .* occurs in the study population when one or more factors are changed or when an
intervention is introduced. Usually the problem itself is the dependent variable.
2. Independent - It is the "assumed cause", the assumed reason for any "change" or variation in a dependent variable.
3. Intervening - It is a factor that works "between" the dependent and independent variables.
– It can weaken or strengthen the effect of the independent on the dependent variable.
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Examples:
Title: The relationship between Exposure to mass media and smoking among student nurses.
Independent v. Dependent v
A persons smoking habits is assumed to change or vary depending upon his exposure to mass media.
Variables – are Drawn diagramrnatically, the relationship between the independent and dependent variable
– It is similar to the stimulus-response model developed in the field of psychology (Pavlovian theory) where a stimulus (S) applied to an organism
(O) will produce a response (R).
S O R
Independent variables target population dependent variable
IV TP DV
Presence or absence of pre-op Surgical patients Level of anxiety High or low
instruction
2. Directional Hypothesis
There would be significant increase in the rate of healing of decubitus ulcer in subjects who receive regular,
application of topical insulin than those who do not
IV TP DV
Use or non use of Patients with decubiti Rate of healing
Topical insulin (increase or not)
3. Null Hypothesis - No significant difference in test means will be found to exist between students having a
hospital laboratory experience and students having a free day preceding the day of test administration.
IV TP DV
kind of day preceding exam student taking exam student taking exam
-with laboratory experience
-free day
IV TP DV
Type of education program Graduate of both BSN & GN degree of proficiency at the
bedside
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IV TP DV
Kind of treatment disturbed mental effectivity rate
• Tranquilizer
• shock therapy
Defining Variables.
1. Operational definition- how it is used in the study.
– Gives specific meaning to the variable
– Clarifies how a variable or a term is used and measured in the study.
– A variable must be defined in terms of events/units of measurement that are observed by the senses
– It specifies how a term or variable is interpreted in the study and sets the procedure for measuring the variable
– operational definition of a variable may differ from that employed in another study
• Ex:
– Age - refers to the respondent’s current age.
– Educational attainment - refers to the highest grade/ year completed by respondent.
– Student Nurse - It refers to 3rd or 4th year level nursing student
– Patient - refers to clients confined in BGHMC or BEGH and have been cared for/handled by student nurses.
Defining Terms
To define terms, the researcher must look first to his statement of purpose.
This must delineate the phenomena about:
– which information will be sought,
– the subjects to be studied and
– the setting
The statement of purpose - identifies these entities in general terms.
The definition of terms, however, makes each one specific and pertinent to particular investigation.
Scope, Limitations, and Delimitations
Scope - deals with the extent of the study to be made
limitations are perceived weakness of the study and are identified, discussed and reported. –
– Includes those that are recognized but are beyond the control of-the researcher and those that are oversights; and anticipated.
– These are valuable in future references of literature review
Certain limitations of the research are:
1. Limitation of the researcher himself such as insufficient background and skills to study the subject area, 'identify the problem or carry through
the research process.
2. Lack of available information regarding the study to be undertaken.
3 Insufficiencies of tools of measurement to assess and analyze data.
Delimitations - are restrictions the researcher places on the study prior to the data gathering and could enter in at every decision point as the
study is being made.
– These are intermeshed with the operational definitions in the written research report.
• Researchers should point out the limitations themselves and should alert the reader to these difficulties such as:
– the impact of sampling deficiencies,
– design constraints,
– data quality problems, and
• The reader will then know that these limitations were not ignored in the development of the interpretations.
Assumptions
• An assumption is a statement describing a fact or condition that is accepted as being true on the basic of logic and reason.
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– The reason for accepting the conditions on this basis is so that the investigation may get on with study he wishes to do without having
to stop to demonstrate that the stated conditions are needed as logic or reason would lead knowledgeable people to believe them to be.
• Examples of Assumption:
• 1. All nurses like to give adequate nursing, care, however, there factors that prevent them from devoting their full time to the care of
patients.
• 2. The patient who faces surgery has fears and anxieties which may be manifested or not
• 3. Nurses can detect the fear and anxieties manifested by pre-surgical patient.
Chapter 1
• Introduction
– Orient reader on what prompted the researcher to under take the study.
– Brief Narrative intro of the nature & background of the problem area in general & the rationale for the study
Question to be considered:
• Will answers to the research questions help advance knowledge?
• Will the answers help in improving practices/behaviors/performance?
• Will answers improve human condition?
2. A research problem must be feasible.
– Feasibility means the availability of money, time, appropriate tools and devices and personnel.
• It may be relevant, but if funds are not available and there are no skilled researchers or data, it would not be feasible.
3. A research problem must be clear.
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DATA INTERPRETATION
1. Review the objectives, hypothesis and the theoretical/conceptual framework.
2. describe the data. Focus on the extreme numbers( highest and lowest). Enumerating the tabulated data should be avoided.
3 The data serves as serves as supporting facts to the text.
4. If hypothesis is being tested, it should be stated that the hypothesis is either rejected or accepted.
– One may also state that “ the findings support / do not support the hypothesis that…”the generalization must be supported by the data from
the Table.
5. The findings of related studies should be compared with results of the study.
– Do the findings contradicts or supports findings of previous study?
– What are the contradictions ?
– What are the possible reasons for the contradictions?
QUALITATIVE ANALYSIS
• Results of key informant interview and focus group discussion are summarized, categorized and described.
– No statistical analysis is required.
• In addition to descriptions, relevant direct quotes of the respondents may be included in the analysis.
– Unique situations and views or "voices" of the respondents or key informants can be directly quoted and included in the
discussion.
ORGANIZING AND PROCESSING THE DATA
The main steps in transforming the data from their raw state to a furnished product include:
1. editing the raw material,
2. coding,
3. scoring and sealing the data and
4. summarizing the data into statistical tables.
– These data are processed either by mechanical or electronic equipment.54
The main summary measures are: -
1. For qualitative data - rates, percentage
2. For quantitative data: ,
a.. Measures of central tendency: mean, median, mode
b., Measures of variation: range, standard, deviation
• Methods used in ORGANIZING AND PROCESSING THE DATA
1. The use of electronic data should be explored in the planning stage of the study.
2. Planning for the processing of the data - is important so that errors may be avoided and that the researcher will not proceed through the costly
data collection procedures only to find that the data gathered not serve to answer the questions earlier posed.
• He should be able to sort from all phenomena only those of pertinence to his cancer, to determine if these really exist and the extent to
which they exist.
• The first concern in planning organization patterns for the data - will have been identified by the statement of the purpose of the study.
– The investigator will think first of the data he will need to test his hypothesis, to answer his questions, -or to describe the
many elements composing the situation he proposed to explore.
– He will attempt to visualize ways to arrange those data most closely pertaining to the primary purpose of his study.
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• They must be so arranged as to serve as a basis for generalization of what the data tell about the particular facet of the problem that he has
chose to study.
3. The researcher moves facts from the researcher tools to one of more organized forms so that he can view at one glance the relationship of the
specific facts among a group of subjects.
4. examine organized data to determine that they meet a series of criteria.51
Recommendations for nursing, psychosocial and education practice should be evaluated with caution.
• Whether mentioned by the author or not, the reader should keep in mind possible confounding which could limit generalizability of the
conclusions.
three .questions asked in determining the significance of a study to nursing
(Fleming and Hayter (1974),
• 1. Has the collected facts useful to nursing?
• 2. Has the study solved a nursing problem?
• 3. has the study expanded nursing knowledge?
Implications CONCLUSIONS AND RECOMMENDATION
• The researcher draws meaning from his conclusions and states them as possible needs of the population in general.
– Thus, if a study showing the babies born of mothers who had prenatal care weighed more and were healthier than those who did not have
prenatal care,
• The implications is that prenatal care is necessary to have healthy babies.
WRITE THE RESEARCH REPORT
• The study is not considered finished until a written report of the results have been completed.
– The report of the study serves as a guide for implementations and also furnishes a mode! for planning are or additional investigations.
• The report may be prepared for subsequent publication in a professional journal or it may serve as a source of information within a
hospital, a public health agency, or a country.
– The style of the report is determined by its purpose and readership.
• The main purpose of the written report is to disseminate information on the findings.
– Sharing both the method and findings of an .investigation increases the value of study.
– If a series of studies is planned, the written reports of all the studies will serve as a source of future reference.
– This type oft investigation reporting is as economical way of keeping other agencies informed because information is shared, studies will
not be duplicated.
• Organizing Materials For Writing'
1. Initially, it is helpful to write down the major points of the study ,in chronology order.
– This may be done as each step carried out or it ,may be done following the analysis of data.
The chronology serves as
• A blueprint, or guide, for preparing a detailed outline.
– It also furnishes the divisions and subdivisions for the written report format,
– The preliminary steps gives the author the opportunity to see relationship of content and subject matter.
• 2. Following the chronological listing, the next step in organizing the material for the report is preparing a detailed outline.
– Although this outline is the basis for the organization of the report, it should not place undue restrictions on the author's style of writing.
– In this manner all related material may be included under the appropriate heading.
Applying the Results
• If soundly designed and implemented, research is successful in providing new insights, or introducing, the results have meaning
beyond the specific setting which generated the data. These may be applicable to hospitals, nurses, schools or students.
• If the researcher believes sufficiently in the importance of the implications of his research and if genuine change is ever to come about
after research, then he must agitate for actions the research suggests.