Nursing Research

QUALITATIVE RESEARCH1. Phenomenological Studies

a. “Lived experience”b. Examines human experiences through descriptions provided by the people

involvedc. Bracketing

The researcher releases expectations and biases prior to doing the research.

d. End purpose To determine themes and patterns of behavior, etc.

2. Ethnographic Studiesa. Collection and analysis of data about cultural groups.b. End purpose

To develop cultural theories.c. Method

Participant observation and interviews with “key informants”3. Grounded Theory Studies

a. Data are collected and analyzed and then a theory is developed that is grounded on the data.

b. Method Purposeful sampling, done in field or naturalistic setting.

c. Concerned with generation rather than testing the hypothesis.4. Historical Studies

a. Identification, location, evaluation, and synthesis of data of the pastb. End purpose

To relate the past to the present and the future.c. Sources of data for historical research

1. Documentsa. Oral history, written research, diaries, eyewitness

accounts, pictorial services.2. Relics and artifacts

a. Physical evidence.d. Classification of sources can be:

1. Primarya. An account of the event from the person himself.

2. Secondarya. Summarized or retold by another.

e. Evaluation or Critism of the data1. External

a. Authentically or genuineness of the source2. Internal

a. Accuracy of the data in the source.5. Case study

In-depth examination of people.

QUANTITATIVE RESEARCHSteps:1. Identify the problem

a. Broad topic, narrowed downb. May be the most difficult and will take the most amount of timec. Sources of study problems

i. Personal experiencesii. Literature sourcesiii. Previous researchiv. Testing of theories

d. Characteristics of a good problem statementi. Stated as a questionii. Specifies the population and the variables

1. One-variable studies Also called Univariate. Eg. What is the primary motivation of student nurses in

preparing the Licensure examination?2. Two-variable studies

Also Bivariate. Can be cause and effect in experimental studies. But in a

correlational study, the two variables are not “cause and effect” but may be two variables that are compared or contrasted.

3. Multiple-variable studies. Also called Multivariate Eg. Why do nursing students fail on NLE?

iii. Emphirically testable Hearing, sight, taste, touch, smell.

1. Ethicai and value issues, “right or wrong”, are not empirically testable but can be measured based on their effect to a subject .

Eg. Should patients be allowed an unlimited number of visitors during their stay in the hospital?” can be measured if “Is there a difference in the comfort level of hospitalized patients who receive an unlimited number of visitors compared to those limited to two visitors compared to those limited to two visitors per day?”

2. Avoid words like “cause” and “effect”.e. Is there a significant difference in the average weight of school age children who eat fast food twice a week than those who eat fast food once a week?f. Problem Statement Format:

i. Correlational statement: Is there a correlation between X and Y in the population?

ii. Comparative statement: Is there a difference in Y between people in the population with X characteristics and those who do not have X characteristics.

iii. Experimental study: Is there a difference in Y between group A who received X treatment and group B who did not receive X treatment.

g. Research problem considerations:

i. Ethical issuesii. Significance to nursingiii. Personal motivationiv. Researcher qualificationsv. Feasibility of the study

1. Time2. Cost3. Equipment and Supplies4. Administrative support5. Peer support6. Availability of Subjects

2. Determine the purpose of the studya. Define why the study ids being made (often mistakenly interchanged with

problem statement).b. Must state the significance and use of the study results in order to get

approval.c. Eg. To develop a better understanding of the significance of consumption of

fast food in the growing number of cases of obesity and overweight among school aged children.

3. Review of Related Literaturea. Purpose

i. To determine what knowledge already exist on the topic to be studied.

ii. To develop a conceptual and theoretical framework for the study.iii. To help the researcher plan the study methods (eg. Instrument and

tools).b. Primary vs. Secondary sources

i. Written by the original researcher (eg. The Thesis itself, or the article written by the researcher). Seen in Nursing Journals.

ii. Secondary source Summary of the research as written by someone other than the

researcher.c. Review of related literature must be done on a continuous basis so as to ensure

that researcher’s informations are up to date.

4. Develop a Theoretical/Conceptual Framework. To assist in the selection of the study variables and in defining

them. Research without a theory provides a set of isolated facts.

Definition of terms:i. Theory

Set of related statements that describes or explains phenomena in a systematic way.

Eg. Newton’s Theories of motion, Callista Roy Adaptation Theory.

ii. Concepta. A word picture or mental idea of phenomenon.b. Maybe concrete or abstract.c. The building blocks of theoryd. Eg. Thermometer, Hate, Anger

iii. Construct Highly abstract, complex phenomenon. Cannot be directly observed by, must be inferred by certain

concrete or less abstract indicators. Eg. Wellness, Mental health, Self esteem, Assertiveness.

iv. Proposition Statement of assertion of the relationship between anger

concept. Eg. Bacteria causes disease. There is a relationship between

anger and increase in BP”.v. Empirical Generalization

When a similar pattern of events is found in the empirical data of a number of different studies.

Eg. Women are likely to pass the board exams than men.vi. Hypothesis

Researcher’s expectations about the study.vii. Model

Symbolic representation of some phenomenon or phenomena. Eg. Flowchart or diagram. Conceptual Models – made of concepts and propositions that

state the relationship between the concepts.

d. Theoretical vs. Conceptual framework

i. Theoretical framework Broad, general explanation of the relationships between

concept of interest in a research study. Based on the existing theory.

ii. Conceptual framework Explains relationship between concept but links concepts

selected from several theories, from previous research results, and from the researcher’s own experience.

Eg. Maslows Hierarchy of Needs Theory and Job satisfaction theory.

e. Theory Generation and Development

i. Deductive reasoning Proceeds form general to specific. Eg. Maslow’s Hierarchy of needs – job satisfaction scale. Theory -> Propositional statement -> Hypothesis -> Empirical

data.ii. Inductive reasoning

Proceeds from specific to general Empirical date -> Empirical Generalization -> Propositional

statement -> theory. Eg. Observed that workers who receive low salaries have poor

work performance – job satisfaction theory.f. Two types of theories

i. Grand theory Address a broad range of phenomena in the environment or

humanity.ii. Middle-range theory

Concerned only with a small area of the environment or human experiences.

Middle range theories have been found to be more valuable to nursing research than grand theories.

5. Identify the Study Assumption Assumptions

o Beliefs that are held to be true but have not necessary been proven.

o Eg. Fast food makes you fat. Three types of assumptions:

i. Universal assumptions Beliefs assumed to be true by a large percentage of society. Eg. “Fast food makes you fat”.

ii. Assumptions based on theory or research findings Using another research finding assumptions as the basis of

one’s study. Eg. An existing research finding may have stated an

assumption that children who eat fast food twice a week tend to be twice more likely to become overweight than children who eat only once a week.

iii. Assumptions that are necessary to carry out the study In the mentioned research, the assumption that children who

study in elementary schools are of “school-age”.6. Acknowledge the Limitation of the study

a. Limitations Uncontrolled variables that may affect the study results and limit the

generalizability of the findings. Extraneous Variables

Also called Confounding or uncontrolled

Variables over which the researcher either has no control or chooses not to exercise control.

Eg. The attitudes and beliefs of parents of children involved in the study is not being something that the researcher can control.

In experimental studies, uncontrolled variables are referred to as threats to internal and external validity.

b. Delimitations Limitations placed on the research by the researcher himself.

c. Scope The extent to which the study will be made.

7. Formulate the Hypothesis

Hypothesiso Predicts the relationship between two or more variables.o Problem statements ask the question, hypothesis gives a

predicted answer.

Characteristics of a hypothesis

i. Declarative formii. Written in present tenseiii. Reflects the problem statementiv. Contains the population and the variablesv. Must be testable or empirically verifiable

c. Two main types of variables:

a. Independent – the causeb. Dependent – the effect

Classification of Hypothesis

i. Simple vs. Complex

Simplea. Relationship between one independent and one dependent variable.

Complex Relationship between two or more independent or dependent variables. An interaction effect would concern the action of two variables in

conjunction with each other.

ii. Null vs. Research

Nulli. No relationship exists between two variables.

Researchii. There is a relationship, states the expected relationship.

iii. Nondirectional vs. Directional

Nondirectionaliii. Mere prediction that a relationship exists.

Directionaliv. Researcher further predicts the type of relationship.

Which types of research require hypothesis?

i. Experimental, correlationa, comparative studies, require hypothesis.1. Eg. Children who eat fast sood twice a week are morelikely to be

overweight that those who eat fast food only once a month.

ii. Descriptive studies, exploratory studies1. Do not necessarily require hypothesis.2. Eg. A description of the lifestyles, customs and practices of indigent

Manobos from Central Mindanao.

8. Define Study Variables and terms

Importanceo To make the meaning of terminologies and variables

clearer to the researcher and the reader.o To allow for replication of the study.

Types of Research Definitions:

Operational definitionso Indicates hoow a variable will be observed or measured.o Eg. Weight – can be measured in kilograms or pounds.

Dictionary definitions or Theoretical definitions Obtained from literature sources Eg. School-age-child – any child from age 7 to 12. Fast food – any

food that is consumed in eating establishments that are served within a considerably short period of time.

9. Select the Research Designa. Research design

i. The PLAN for how the study will be conducted.

b.Will it examine cause-and-effect or will it only describe existing situations. Two major types

i. Qualitativeii. Quantitative

a. Can be Experimental and non-experimental

Experimental vs. Non-experimental studies

a. Experimental Concerned with cause and effect relationships. Highly respected in the scientific world. Must have: Manipulation or control of independent variable, random

selection of subjects, measurement of independent and dependent variable.

More control can be exercised over extraneous variables. In nursing experimental, a nursing intervention is usually introduced.

i. Validity of Experimental Design. Extraneous variables (confounding or intervening or study limitations). Those which the researcher cannot control or chooses not to

control.

Internal validityo Degree to which changes in dependent variable can be

directly attributed to the independent variable.o Can have the following as threats to validity:

Selection Biaso Results are due to subject differences before the independent

variables was manipulated.

Historyo Some event other than the experimental treatment occurs

during the study that influenced the dependent variable.

Maturationo Changes that occur within the subjects during an experiment

study influences the study results.

Instrumentation Change

o Difference between the pretest and the post test measurement caused by a change in the accuracy of the instrument of the judge’s ratings.

o Avoided by trial runs, or training sessions for judges prior to rating.

Mortalityo Subject dropout rate is different between the experimental and

comprison group.

External Validityi. Degree to which the study results can be generalized to other people

and other settings. Threats include:

i. Hawthrone effect1. Study participants respond in a certain manner

because there are aware that they are being observed.

ii. Experimenter effecti. Researcher characteristics or behavior influence subject behavior.ii. In non-experimental research, this is called the Rosenthal Effect.

iii. Reactive effects of the pre-test (measurement effect)1. Subjects have already been sensitized by the pre-test and may affect

post-test results.

Types of Experimental Designs

a. True Experimental Researcher has great deal of control over the research

situation. 3 criteria: Manipulation of variables; One experimental

and one comparison group (control group). Subjects are randomly assigned

i. Pretest-Posttest Control Group DesignR O1 X O2 (experimental group)R O1 O2 (control group)

i. Subjects are randomly assigned to groupsii. Pretest given to both groups

iii. Experimental groups receives treatment, control group the usual or no treatment

iv. Posttest given to both groups.

ii. Posttest only Control Group Design

R X O1 (Experimental Group)R O1 (Control Group)

a. Subjects are randomly assigned to groupsb. Experimental group receives treatment, control group the usual or no treatment.c. Posttest given to both groups.

b. Quasiexperimental Missing one criteria for true experimental design.

Non-equivalent control group designo Similar to pretest posttest control group

design but there is no random assignments of subjects.

o Biggest threat: Selection bias.

Time-series designs Researchers periodically observes measures the

subjects. Experimental treatment is administered between two of the observations. 01 02 03 X 04 05 06.

c. Pre-experimental design Weak researcher has little control over the

research.

i. One-shot case study Single group is exposed to an experimental treatment and observed

after the treatment. TX X O

ii. One-group pretest-posttest design Provides a comparison between a group of subjects before and

after the experimental treatment. 01 X 02

g. Types of Non-experimental Research design

i. Correlational Studies

Researcher extent to which one variable (X) is related to another variable.

1. Correlation Coefficient Researcher extent to which one variable (X) is related to

another variable.a. + Relationship

Also called Direct As the value of one variable increases, the value of

the other variable also increases.

b. – Relationship Also called Inverse As the variable of one value increase, the value of the

other variable decreases.

ii. Survey studies Self report data are collected from samples with purpose of

describing populations on some variables of interest.

iii. Comparative studies

Examine the differences between intact groups on some dependent variable of interest.

Almost similar to experimental but has no manipulation of variables.

Experiemental studies are rarely done in nursing research since this will usually involve experimentation with human beings, and are thus perceived as having ethical issues.

Eg. In the case of making the research on the weight gain of school age children who frequently eat fast food, we cannot conduct experimental study since doing so can endanger the health of the subjects.

1. Retrospective studies Dependent variable identified in the present, and the

independent variable that occurred in the past is determined.

2. Prospective studies Independent variable is identified at the present time, and

the subjects are followed in the future to observe the dependent variable

Eg. Fast food and weight gain.

3. Ex post facto studies Data are collected “after the fact” variations in the

independent study are studied after the variations have occurred, rather than at the time of the occurrence.

iv. Methodological Studies Concerned with the development, testing, and evaluation of

research instruments and methods. Eg. Post partum depression screening scale.

10. Identify the population

a. Population Complete set of individuals or objects the posses some common

characteristics that is of interest to the researcher.

i. Target population Also called Universe. The group of people or objects to which the researcher

wishes to generalize the findings of the study.

ii.Accessible population That group which is actually available for the study.

iii. The accessible population must posses the characteristics similar to the target population, and vice versa.

11. Select the sample

a. Sample A subgroup chosen to represent the population and used to make

generalizations about the population.

b. Two major types of sampling

i. Probability Everyone in the population has the chance of being selected.

1. Sample Random Sampling Ensures that each element of the population has an equal and

independent chance of being chosesn.

Identify the sample population and list all the elements of the population (sampling frame).

Table of random numbers.

2.Stratified Random Sampling Population is divided into subgroups or strata, according to some

variable/s of importance. After this, a simple random sample is taken from each of the subgroups.

a. Proportional stratifiedb. Disproportional stratified

3. Cluster Random Sampling Large groups or samples become the sampling units. Eg. Geographical area, school, etc.

4. Systematic Random Samplinga. Sample is taken from every kth element of the population.b. Eg. 1,000 population and researcher needs 100 samples, then:

(k interval = N/n) 1,000/100 = 10. Every 10th person in the list will be taken as sample.

ii. Non-probability Sampling Methods Sample elements are chosen from the population by non-random

methods. More likely to produce biased samples.

1. Convenience sampling Accidental or incidental. Choosing readily available people or objects for a study.

Snowball samplingo Study subjects help refer additional subjects.

2. Quota Sampling Similar to stratified random but selection not random. Basis of stratification is determined by the researcher. Eg. 50% females, 50% male.

3. Purposive samplinga. Judgmental samplingb. Handpicking of subjects.

c. Time frame for studying the samplei. Longitudinal study

Follows the subject over a period of time (6 months or more). More accurate study of changes that occur over time

1. Cohort study Persons are studied who have been born during a particular

time period.

ii. Cross-sectional study Examines the subjects at one point in time. Less expensive and easier to conduct

Eg. Use of marijuana in high school freshmen vs. seniors, etc.12. Conduct a pilot study

Maniature, trial version of the planned study. Can prevent a researcher from conducting a large-scale study that might be an expensive disaster.

Objectives To examine issues related to the design, sample size, data

collection procedures and data analysis approaches.

Can be used to test an instrument, evaluate the study phenomenon. Etc.

13. Collect the data

a. Data Pieces of information or facts that are collected in scientific

investigations.

b. What data will be collected? Who will collect the data? Where will the data be collected? When will the data be collected? How will the data be collected? (Why, is answered by the purpose of the study or the research design, and is not part of this).

c. The choice of data collection method is determined by the study hypothesis or research question of the study.

d. Criteria for selection of data collection instrument

Practicality of the instrument Reliability of the instrument

Consistency and stability Validity of the instrument

Ability to gather data that is intended to gather. Concerns that content of the instrument. Will the instrument gather data that is needed in the research.

e. Data collection methods

i. Questionnaires Paper and pencil, self-report instrument. Contains questions the respondents are asked to answer in

writing.

1. Guidelines in wording questions

i. Affirmative rather than negative (never say never).ii. Avoid ambiguous questions (many, generally, few, often)

iii. Avoid double negative questionsiv. Neutral wordingv. Double-barreled questions

2. Types of questions

a. Demographic Data on the characteristics of the subjects. Demographic or attribute variables. Age, educational background, religion.

b. Open-ended questions Essay, fill-in-the-blank

c. Closed-ended questions Respondent is asked to choose from given alternatives. Must be collectively exhaustive (all possible answer provided) and mutually

exclusive ( no overlap between categories)

d. Contingency questions Items that is relevant for some respondents and not for

others. Eg. If yes..

e. Filler questionsa. Items in which the researcher has no direct interest but are

included in a questionnaire to reduce the emphasis on the specific purpose of other questions.

ii. Interviewsb. Interviewer obtains responses from a subject in a face-to-face

encounter or through a telephone call.

1. Unstructured interviewc. Interviewer given a great deal of freedom to direct the course

of the interview.d. Conducted more like a normal conversation.

Probeso Additional prompting questions that encourage the

respondent to elaborate on the topic.

2. Structured interviews Asking the same questions in the same order and in the

same manner of all respondents in the study. Even subtle changes in the wording of the interview may

not be permitted.

3. Semi-structured interview

Interviewers are generally required to ask a certain number of specific questions but additional probing questions are allowed or even encouraged.

iii. Observation method Gathering data through visual observations. Can be psychomotor skills, habits, non-verbal communication.

1. Structured vs. Unstructured Observations

a. Structured Carried out when the researcher has prior knowledge about

the phenomenon of interest. Uses a checklist.

b. Unstructured Researcher attempts to describe events or behaviors as they

occur, with no preconceived idea of what will be seen.

2. Event sampling vs. Time sampling

a. Event Observation of an entire event. Eg. Bed making techniques of student nurses.

b. Time Observation of events or behaviors during specified times. Eg. Appetite of patients during scheduled meals.

3. Relationship between observer and subjectsa. Non-participant observer-overt

Observer openly identifies himself and provides subjects with information about the types of data that will be collected.

b. Non-participant observer-covert Generally not ethical. Observer does not let participant know of his activity.

Eg. Public behavior (can be ethical)

c. Participant observer-overt Involved with the subjects openly and subjects know that

they are being observed by the same. Eg. Immersion with families while observing their day-to-

day lifestyle.

d. Participant observer-covert “Plant”, “Spy” Observer interacts with the subjects and observes their

behavior without their knowledge. Rarely ethical.

iv. Physiological Measures Involve in the collection of physical data from the subjects. Generally more objective and accurate than many of the other data

collection methods.

v. Attitude scales Self-report, data collection instruments that ask respondents to report their

attitudes or feelings on a continuum.

1. Likert Scale Uses five or seven responses for each item ranging from

Strongly Agree (5) to strongly disagree (1). Negatively worded questions are rated scored reverse.

2. Semantic Differential Scales Asks subjects to indicate their position or attitude about some

concept along a continuum between two adjectives.

vi. Psychological Tests

1. Personality Inventories Self-report measures used to assess the differences in

personality traits, needs, or values of people.

2. Projective Techniques Subject is presented with an ambiguous stimuli, subject

describes what the stimuli appear to represent. Eg. Rorschach Inkblot Test.

vii. Delphi Technique Uses several rounds of questions to seek a consensus on a particular topic

from a group of experts. To obtain group consensus without a face-to-face meeting.

viii. Visual Analogue Scaleix. Preexisting Data

Use of existing information that has not been collected for research purposes.

Eg. Patient’s chart

14. Organize the Data for Analysis

a. Tabulation and evaluationb. Plans for organizing the data should be made prior to data collection. Plans for analyzing the data should be made prior to data collection.c. Determine if questionnaires have been completed correctly. What to do with missing data. Audio tapes transcribed.

15. Analyze the data – statistical concepts

i. Frequency distribution Simply counting the occurrence of values or scores represented in the

data. Appropriate for tabulating all types of data (nominal, ordinal, interval,

ratio). If range of score is less than 20, each score can be listed individually,

when the range is large you can group them into “class intervals”

ii. Graphic Presentations Have visual appeal that may cause readers to analyze the data more

closely.

1. Bar graph Used to represent frequency distribution with nominal data or

some type of ordinal data. May be horizontal or vertical.

2. Histogram Uses bars to represent the frequency distribution of a variable

that is measured at the ordinal, interval, or ratio level. Has X and Y axis.

3. Frequency polygon Graph that uses dots connected with straight lines to represent

the frequency distribution or ordinal, interval, or ratio data. The class intervals are on the horizontal axis, the frequency on

the vertical axis.

iii. Percentages

Represents the proportion of a subgroup to a total group. Minimum number for the computation of percentages should be atleast

20.

b. Measures of Central Tendency Statistics that describe the average, typical, or most common value for

a group of data.

i. Mode Category or value that occurs most often in a set of data under

consideration. If the data gathered are nominal this is referred to as “nominal

class”. Maybe unimodal, bimodal, multimodal.

ii. Median Middle score or value in a group of data. If number of values is even, the midpoint between the two

middle values is the median. If the number of values is uneven, then the median is the middle value.

iii. Mean The average sum of a set of values found by adding all values

and dividing by the total number of values. X = Total of all values or number of values.

c. Measures of Variability Measures how spread out values are in a distribution of values.

i. Range Distance between the highest and lowest value in a group of

values or scores. Eg. Highest 60, lowest 40, the range is 20.

ii. Percentile A datum point below which lies a certain percentage of the

values in a frequency distribution. Eg. NCEE Score, Weight for Age charts in Pediatrics.

iii. Standard Deviation Most widely used when interval or ratio data are obtained. Indicates the average deviation or variation of all values in a

set of values from the mean values of those data.

iv. Variance Standard deviation squared.

v. Z-score

d. Measures of Relationships Measures the correlation between variables.

i. Correlation Coefficients Pairing the value of each subjects on one variable with the

value on another variable. Eg. Athletic ability vs. IQ level. Anxiety level vs. pulse rates.

ii. Scatter Plots Scatter diagram or scattergram Graphic representation of the relationship between two

variables (X and Y axis).

16. Interpret the findings

a. Made in light of the study hypothesis or research question and the theoretical framework.

17. Communicate the findings

a. The final step in the research process and yet the most important one for nursing. No matter how significant the findings may be, they are of little value to the nursing profession if not communicated to other collegues.

b. Best method to reach a large number of nurses is the publication in research journals.

c. May also be done through oral presentations. Poster sessions. Books. Research seminars.