NURSING RESEARCH Is a systematic inquiry designed to develop knowledge about issues of importance to the nursing profession, including nursing practice,

NURSING RESEARCH• Is a systematic inquiry designed to

develop knowledge about issues of importance to the nursing profession, including nursing practice, education, administration, and informatics.

PURPOSE OF NURSING RESEARCH

• To test, refine and advance the knowledge on which improved education, clinical judgment, and cost-effective, safe, ethical nursing care rests.

DEVELOPMENT AND PROGRESSION OF

NURSING RESEARCH

THE ORIGIN OF NURSING RESEARCH

• FLORENCE NIGHTINGALE – viewed as the person who first elevated nursing to the status of a PROFESSION, as presented in her first book NOTES ON NURSING (1859)

• Believed in the importance of “naming nursing” by the use of observed data to support the need for health-care reforms.

• Methodical Data gathering

A Look at Nursing Education• 1923 – Committee for

the Study of Nursing Education– Studied educational

preparation of nurse teachers, administrators, public health nurses and the clinical experiences of nursing students.

– Gold Mark Report – identified many inadequacies in the educational backgrounds of the group studied and concluded that advanced educational preparation was essential.

• 1940s (WWII) – tremendous need for educated nurses– Nursing education

practices were evaluated in the study commissioned by the National Nursing Council for War Service headed by Brown

– Brown revealed numerous inadequacies in nursing education and thus, recommended that education of nurses occur in the collegiate level.

CENTER FOR NURSING RESEARCH

• 1950s– Walter Reed Army

Institute of Research – center for nursing research

– Nursing Research (journal)

SOURCE FOR NATIONAL DATA

• 1986 – National Center for

Nursing Research

EVIDENCE-BASED PRACTICE• Defined as the use of

the best clinical evidence in making patient care decisions to achieve cost-effective, high quality care based on scientific inquiry.

PARADIGMS AND METHODS: QUANTITATIVE

AND QUALITATIVE RESEARCH

POSITIVIST PARADIGM

ASSUMPTION POSITIVIST PARADIGMOntologic (what is the nature of reality?)

Reality exists; there is a real world driven by real natural courses

Epistemologic (How is the inquirer related to those being researched?)

The inquirer is independent from those being researched; findings are not influenced by the researcher

Axiologic (What is the role of Values in the inquiry?)

Values and biases are to be held in check; objectivity is sought

Methodologic (How is knowledge obtained?)

Deductive process, emphasis on discrete, specific concepts; fixed design, tight controls over context, emphasis on measured, quantitative information; statistical analysis; seeks generalization

NATURALISTIC PARADIGM

ASSUMPTION NATURALISTIC PARADIGM

Ontologic (what is the nature of reality?)

Reality is multiple and subjective, mentally constructed by individuals

Epistemologic (How is the inquirer related to those being researched?)

The inquirer interacts with those being researched; findings are creation of the interactive process

Axiologic (What is the role of Values in the inquiry?)

Subjectivity and values are inevitable and desirable

Methodologic (How is knowledge obtained?)

Inductive process; emphasis on entirely of some phenomenon, holistic; emerging interpretations grounded in participants’ experiences; flexible design; context-bound; emphasis on narrative information

Qualitative analysis

RESEARCH METHODS

• Are the techniques used by researchers to structure a study and to gather and analyze information relevant to the research question.

THE SCIENTIFIC METHOD AND QUANTITATIVE

RESEARCH

• SCIENTIFIC METHOD – refers to a general set of orderly, disciplined procedures used to acquire information.

QUANTITATIVE RESEARCH• Uses deductive reasoning • Systematic • Uses control• Uses measurements• Researchers gather empirical evidence

(objective in nature)• Information gathered is usually (but not

always) quantitative/numerical• Uses statistical analysis• Cannot be used to answer moral or ethical

questions

NATURALISTIC METHODS AND QUALITATIVE

RESEARCH

• NATURALISTIC METHOD – attempt to deal with the issue of human complexity by exploring it directly.– Investigations place a heavy emphasis on

understanding the human experience as it is lived.

QUALITATIVE RESEARCH• Uses inductive reasoning• Used for theory development• Approach is flexible• Always takes place in the field• Concurrent collection and analysis of data• Gathers rich and in-depth information

(subjective in nature)• Report is written in narrative form• Involves small group of people or subjects• Cannot be used to answer moral or ethical

questions

KEY CONCEPTS AND TERMS IN QUANTITATIVE

AND QUALITATIVE RESEARCH

• People who are being studied– Quantitative – subjects, study

participants, respondents– Qualitative – informants, key

informants, study participants

• Sample – composed of the people being studied

• Person who undertakes the research– Quantitative – researcher,

investigator, scientist– Qualitative – researcher,

investigator

• Research Settings – specific places where data collection occurs– Quantitative – laboratory

setting, (sometimes) field settings

• Example: Pierce and Clancy (2001) studied the effects of hypoxia on diaphragm activity in anesthetized rats.

– Qualitative – naturalistic setting/field

• Example: Carlisle (2000) studied the search for meaning in the care giving experience among informal carers of people living with HIV and AIDS. The researcher gathered in-depth information from carers in their homes and in HIV/AIDS org.

BUILDING BLOCKS OF A STUDY

• Phenomena – occurrence or events

• Concept – abstract ideas– Examples of phenomena and concepts: pain,

coping, and grief

• Constructs – abstractions that are systematically invented by a researcher– Example: self-care

THEORIES AND CONCEPTUAL FRAMEWORKS

• Theory – systematic, abstract explanation of some aspect of reality– Example: Nightingale’s Environmental Nursing Theory

• Conceptual Frameworks/Models – interrelated concepts or abstractions assembled together in a rational scheme by virtue of their relevance to a common theme.– Example: Betty Neuman's Health Care Systems Model

VARIABLES• Are something that varies

– Examples: weight, body temperature, income, anxiety level, etc

• Are central building blocks of a quantitative study

• Constant – opposite of variables

DEPENDENT and INDEPENDENT VARIABLES

• Independent variable – presumed cause• Dependent variable – presumed effect

• Independent and dependent variables are used to indicate direction of influence rather than causal link.– The effect of initial bath timing on the

temperature of newborns– The effect of sautéed garlic on the blood

pressure of elderly patients– The relationship between teacher’s qualification

and student education

RESEARCH DATA• Pieces of information

obtained in the course of investigation

– Quantitative data – numerical• Example: Thinking about the past week, how

depressed would you say you have been on a scale from 0-10, where 0 means “not at all” and 10 means “the most possible.”

– Subject 1 – 9– Subject 2 – 0– Subject 3 - 4

– Qualitative data – narrative descriptions• Example: tell me about how you’ve been feeling

lately. Have you felt sad or depressed at all, or have you generally been in good spirits?

– Participant – I’ve had a few ups and downs in the past week, but basically things are pretty even keel. I don’t have too many complaints.

CRITERIA IN STUDY QUALITY ASSESSMENT

• Reliability – refers to the accuracy and consistency of information obtained in the study

• Generalizability – asses the extent to which the findings can be applied to other groups and settings.

• Validity – complex concept that broadly concerns the soundness of the study’s evidence.– If methods used in

the study are really measuring the concept/s that they have to measure.

• Dependability – in qualitative studies, refers to evidence that is consistent and stable

• Confirmability – is similar to objectivity; it is the degree to which study results are derived from characteristics of participants and study context.

• Credibility – is achieved to the extent that the research method engender confidence in the truth of the data and in the researcher’s interpretations of the data.

• Transferability – the extent to which qualitative findings can be transferred to other settings.

RESEARCH CONTROL• Involve holding

constant other influences on the dependent variable so that the true relationship between the dependent and independent variables can be understood.

• Attempts to eliminate contaminating factors that might cloud the relationship between the variables of central interest.

– Example: Effect of sautéed garlic on the blood pressure of elderly patients – get subjects who are of almost the same age and engage in the same type of activities.

RANDOMNESS• A powerful tool in quantitative studies to

eliminate biases.

• Is not considered in qualitative studies

KEY TERMS USED IN QUANTITATIVE AND QUALITATIVE RESEARCH

CONCEPT QUANTITATIVE TERM QUALITATIVE TERM

Person Contributing Information

Subject, Study Participant, Respondent

Study participant, informant, key informant

Person undertaking the study

Researcher, investigator, scientist

Researcher, investigator

Being investigated Concepts, constructs, variables

Phenomena, concepts

System of organizing concepts

Theory, theoretical and conceptual framework,

Theory, conceptual framework

Information gathered Data (numerical) Data (narrative descriptions)

Connections bet. concepts

Relationships (cause-and-effect, functional)

Patterns of association

Quality of evidence Reliability, Validity, Generalizability, Objectivity

Dependability, Credibility, Transferability, Confirmability

MAJOR CLASSES OF QUANTITATIVE RESEARCH

• EXPERIMENTAL RESEARCH – type of research wherein researchers actively introduce an intervention or treatment.– Explicitly designed to test causal

relationships– Offer the possibility of greater control

EXPERIMENTAL RESEARCHExample:

A researcher gave bran flakes to one group of subjects and prune juice to another to evaluate which method facilitated more effective elimination.

MAJOR CLASSES OF QUANTITATIVE RESEARCH

• NONEXPERIMENTAL RESEARCH – type of research wherein researchers collect data without making changes or introducing treatment.

NONEXPERIMENTAL RESEARCH

Example: A researcher compared elimination patterns of two groups of people whose regular eating patterns differed – some normally took food that stimulated bowel elimination and others did not – there is no intervention.

MAJOR CLASSES OF QUALITATIVE RESEARCH

• GROUNDED THEORY – seeks to describe and understand the key social, psychological, and structural processes that occur in social setting– Focus is on a developing social experience – the

social or psychological stages and phases that characterize a particular event of episode.

GROUNDED THEORYHauck and Irurita (2002) conducted a grounded theory study to explain the maternal process of managing late stages of breastfeeding and weaning the child from the breast.

MAJOR CLASSES OF QUALITATIVE RESEARCH

• PHENOMENOLOGY – concerned with the lived experiences of humans– An approach to thinking about what life

experiences or people are like and what they mean.

– Answers the question: What is the meaning of the phenomena to those who experience it?

PHENOMENOLOGYExample: Sundin, Norberg, and Jansson (2001) conducted a phenomenological study to illuminate the lived experiences of care providers who were highly skilled communicators in their relationship with patients with stroke and aphasia.

MAJOR CLASSES OF QUALITATIVE RESEARCH

• ETHNOGRAPHY – provides a framework for studying the meaning, patterns, and experiences of a defined cultural group in a holistic fashion.

– Ethnographers typically engage in fieldwork and often participate to the extent possible in the life of the culture under study

– Aim is to learn from members of a cultural group.

ETHNOGRAPHY

Example: Powers (2001) undertook an ethnographic analysis of a nursing home residence focusing on the ethical issues of daily living affecting nursing home residents with dementia.