-
Researchers usually work within a paradigmthat is consistent
with their world view, andthat gives rise to the types of question
that excitetheir curiosity. The maturity of the concept of
inter-est also may lead to one or the other paradigm: whenlittle is
known about a topic, a qualitative approachis often more fruitful
than a quantitative one.
The progression of activities differs for quali-tative and
quantitative researchers; we discuss theflow of both in this
chapter. First, however, webriefly describe broad categories of
quantitativeand qualitative research.
MAJOR CLASSES OFQUANTITATIVE ANDQUALITAT IVE RESEARCH
Experimental and NonexperimentalStudies in Quantitative
Research
A basic distinction in quantitative studies is the dif-ference
between experimental and nonexperimen-tal research. In experimental
research, researchersactively introduce an intervention or
treatment. Innonexperimental research, on the other hand,
re-searchers collect data without making changes orintroducing
treatments. For example, if a re-searcher gave bran flakes to one
group of subjectsand prune juice to another to evaluate whichmethod
facilitated elimination more effectively, the
Overview of the ResearchProcess in Qualitative andQuantitative
Studies
study would be experimental because the re-searcher intervened
in the normal course of things.In this example, the researcher
created an activevariable involving a dietary intervention. If, on
theother hand, a researcher compared elimination pat-terns of two
groups of people whose regular eatingpatterns differedfor example,
some normallytook foods that stimulated bowel elimination andothers
did notthere is no intervention. Such astudy focuses on existing
attributes and is nonex-perimental.
Experimental studies are explicitly designed totest causal
relationships. Sometimes nonexperi-mental studies also seek to
elucidate or detectcausal relationships, but doing so is tricky and
usu-ally is less conclusive. Experimental studies offerthe
possibility of greater control over extraneousvariables than
nonexperimental studies.
Example of experimental research:Johnson (2001) tested the
effects of a sub-
maximal exercise protocol, in comparison with a near-maximal
voluntary contraction protocol,on continence control and muscle
contractionstrength among women with genuine stress
urinaryincontinence.
In this example, the researcher intervened bydesignating that
some women would receive thesubmaximal exercise protocol and others
wouldnot. In other words, the researcher controlled the
3
-
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 47
independent variable, which in this case was thetype of
protocol.
Example of nonexperimental research:Wong and her co-researchers
(2002)
searched for factors that contributed to hospitalreadmission in
a Hong Kong hospital. A readmittedgroup was compared with a
nonreadmitted groupof patients in terms of demographic
characteristicsand health conditions upon admission.
In this nonexperimental study, the researchersdid not intervene
in any way; they observed andmeasured subjects attributes. They
exploredwhether there were identifiable characteristics
andconditions that distinguished the two groups of pa-tients, with
the aim of discovering opportunities toreduce readmissions.
Research Traditions in Qualitative Research
Qualitative studies are often rooted in researchtraditions that
originate in the disciplines of an-thropology, sociology, and
psychology. Three suchtraditions have had especially strong
influences onqualitative nursing research and are briefly
describehere. Chapter 11 provides a fuller discussion ofalternative
research traditions and the methodsassociated with them.
The grounded theory tradition, which has itsroots in sociology,
seeks to describe and understandthe key social psychological and
structural processesthat occur in a social setting. Grounded theory
wasdeveloped in the 1960s by two sociologists, Glaserand Strauss
(1967). The focus of most grounded the-ory studies is on a
developing social experiencethesocial and psychological stages and
phases that char-acterize a particular event or episode. A major
com-ponent of grounded theory is the discovery of a corevariable
that is central in explaining what is going onin that social scene.
Grounded theory researchersstrive to generate comprehensive
explanations ofphenomena that are grounded in reality.
Example of a grounded theory study:Hauck and Irurita (2002)
conducted a
grounded theory study to explain the maternal
process of managing late stages of breastfeedingand weaning the
child from the breast.
Phenomenology, which has its disciplinaryroots in both
philosophy and psychology and isrooted in a philosophical tradition
developed byHusserl and Heidegger, is concerned with the
livedexperiences of humans. Phenomenology is an ap-proach to
thinking about what life experiences ofpeople are like and what
they mean. The phenome-nological researcher asks the questions:
What is theessence of this phenomenon as experienced bythese
people? Or, What is the meaning of the phe-nomena to those who
experience it?
Example of a phenomenological study:Sundin, Norberg, and Jansson
(2001) con-
ducted a phenomenological study to illuminate thelived
experiences of care providers who were highlyskilled communicators
in their relationships withpatients with stroke and aphasia.
Ethnography is the primary research traditionwithin
anthropology, and provides a framework for studying the meanings,
patterns, and experi-ences of a defined cultural group in a
holistic fash-ion. Ethnographers typically engage in
extensivefieldwork, often participating to the extent possiblein
the life of the culture under study. Ethnographicresearch is in
some cases concerned with broadlydefined cultures (e.g., Haitian
refugee communi-ties), but sometimes focuses on more
narrowlydefined cultures (e.g., the culture of
emergencydepartments). The aim of ethnographers is to learnfrom
(rather than to study) members of a culturalgroup, to understand
their world view as they per-ceive and live it.
Example of an ethnographic study:Powers (2001) undertook an
ethnographic
analysis of a nursing home residence, focusing onthe ethical
issues of daily living affecting nursinghome residents with
dementia.
MAJOR STEPS IN AQUANTITATIVE STUDY
In quantitative studies, researchers move from thebeginning
point of a study (the posing of a question)
-
48 PART 1 Foundations of Nursing Research
fascinate you or about which you have a passionateinterest or
curiosity.
Step 2: Reviewing the Related LiteratureQuantitative research is
typically conducted withinthe context of previous knowledge. To
build on ex-isting theory or research, quantitative
researchersstrive to understand what is already known about
aresearch problem. A thorough literature reviewprovides a
foundation on which to base new knowl-edge and usually is conducted
well before any dataare collected in quantitative studies. For
clinicalproblems, it would likely also be necessary to learnas much
as possible about the status quo of cur-rent procedures relating to
the topic, and to reviewexisting practice guidelines or
protocols.
A familiarization with previous studies can alsobe useful in
suggesting research topics or in identify-ing aspects of a problem
about which more researchis needed. Thus, a literature review
sometimes pre-cedes the delineation of the research problem.
Step 3: Undertaking Clinical FieldworkIn addition to refreshing
or updating clinical knowl-edge based on written work, researchers
embarkingon a clinical nursing study benefit from spendingtime in
clinical settings, discussing the topic withclinicians and health
care administrators, and ob-serving current practices. Sterling
(2001) notes thatsuch clinical fieldwork can provide perspectives
onrecent clinical trends, current diagnostic proce-dures, and
relevant health care delivery models; itcan also help researchers
better understand affectedclients and the settings in which care is
provided. Inaddition to expanding the researchers clinical
andconceptual knowledge, such fieldwork can bevaluable in
developing methodologic tools forstrengthening the study. For
example, in the courseof clinical fieldwork researchers might learn
whatextraneous variables need to be controlled, or mightdiscover
the need for Spanish-speaking researchassistants.
As with literature reviews, clinical fieldworkmay serve as a
stimulus for developing researchquestions and may be the first step
in the processfor some researchers.
to the end point (the obtaining of an answer) in afairly linear
sequence of steps that is broadly similaracross studies. In some
studies, the steps overlap,whereas in others, certain steps are
unnecessary.Still, there is a general flow of activities that is
typi-cal of a quantitative study. This section describesthat flow,
and the next section describes how quali-tative studies differ.
Phase 1: The Conceptual Phase
The early steps in a quantitative research project typ-ically
involve activities with a strong conceptual orintellectual element.
These activities include reading,conceptualizing, theorizing,
reconceptualizing, andreviewing ideas with colleagues or advisers.
Duringthis phase, researchers call on such skills as creativ-ity,
deductive reasoning, insight, and a firm ground-ing in previous
research on the topic of interest.
Step 1: Formulating and Delimiting the ProblemOne of the first
things a researcher must do is de-velop a research problem and
research questions.Good research depends to a great degree on
goodquestions. Without a significant, interesting prob-lem, the
most carefully and skillfully designed re-search project is of
little value.
Quantitative researchers usually proceed fromthe selection of a
broad problem area to the devel-opment of specific questions that
are amenable toempirical inquiry. In developing a research
ques-tion to be studied, nurse researchers must pay closeattention
to substantive issues (Is this researchquestion significant, given
the existing base ofknowledge?); clinical issues (Could findings
fromthis research be useful in clinical practice?); andmethodologic
issues (How can this question bestbe studied to yield high-quality
evidence?). Theidentification of research questions must also
takeinto consideration practical and ethical concerns.
TIP: A critical ingredient in developinggood research questions
is personal interest.
We offer this advice to those of you who plan to un-dertake a
research project: Begin with topics that
-
Step 4: Defining the Framework andDeveloping Conceptual
DefinitionsTheory is the ultimate aim of science in that it
tran-scends the specifics of a particular time, place, andgroup of
people and aims to identify regularities inthe relationships among
variables. When quantita-tive research is performed within the
context of atheoretical frameworkthat is, when previous the-ory is
used as a basis for generating predictions thatcan be tested
through empirical researchthe find-ings may have broader
significance and utility.
Even when the research question is not em-bedded in a theory,
researchers must have a clearsense of the concepts under study.
Thus, an impor-tant task in the initial phase of a project is the
de-velopment of conceptual definitions.
Step 5: Formulating HypothesesA hypothesis is a statement of the
researchers ex-pectations about relationships between the
vari-ables under investigation. Hypotheses, in otherwords, are
predictions of expected outcomes; theystate the relationships
researchers expect to find asa result of the study.
The research question identifies the conceptsunder investigation
and asks how the conceptsmight be related; a hypothesis is the
predicted an-swer. For example, the initial research questionmight
be phrased as follows: Is preeclamptic tox-emia in pregnant women
associated with stress fac-tors present during pregnancy? This
might be trans-lated into the following hypothesis: Pregnantwomen
with a higher incidence of stressful eventsduring pregnancy will be
more likely than womenwith a lower incidence of stress to
experiencepreeclamptic toxemia. Most quantitative studiesare
designed to test hypotheses through statisticalanalysis.
Phase 2: The Design and Planning Phase
In the second major phase of a quantitative re-search project,
researchers make decisions aboutthe methods and procedures to be
used to addressthe research question, and plan for the actual
collection of data. Sometimes the nature of thequestion dictates
the methods to be used, but moreoften than not, researchers have
considerable flexi-bility to be creative and make many
decisions.These methodologic decisions usually have
crucialimplications for the validity and reliability of thestudy
findings. If the methods used to collect andanalyze research data
are seriously flawed, then theevidence from the study may be of
little value.
Step 6: Selecting a Research DesignThe research design is the
overall plan for obtaininganswers to the questions being studied
and for han-dling some of the difficulties encountered during
theresearch process. A wide variety of research designsis available
for quantitative studies, including numer-ous experimental and
nonexperimental designs.
In designing the study, researchers specifywhich specific design
will be adopted and whatcontrols will be used to minimize bias and
enhancethe interpretability of results. In quantitative stud-ies,
research designs tend to be highly structured,with tight controls
over extraneous variables.Research designs also indicate other
aspects of theresearchfor example, how often subjects will
bemeasured or observed, what types of comparisonswill be made, and
where the study will take place.The research design is essentially
the architecturalbackbone of the study.
Step 7: Developing Protocols for the InterventionIn experimental
research, researchers actively in-tervene and create the
independent variable, whichmeans that people in the sample will be
exposed todifferent treatments or conditions. For example, ifwe
were interested in testing the effect of biofeed-back in treating
hypertension, the independent vari-able would be biofeedback
compared with eitheran alternative treatment (e.g., relaxation
therapy),or with no treatment. The intervention protocolfor the
study would need to be developed, specify-ing exactly what the
biofeedback treatment wouldentail (e.g., who would administer it,
how fre-quently and over how long a period the treatmentwould last,
what specific equipment would be used,
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 49
-
50 PART 1 Foundations of Nursing Research
probability sampling methods, which use randomprocedures for
selecting subjects. In a probabilitysample, every member of the
population has anequal probability of being included in the
sample.With nonprobability sampling, by contrast, thereis no way of
ensuring that each member of the pop-ulation could be selected;
consequently, the risk ofa biased (unrepresentative) sample is
greater. Thedesign of a sampling plan includes the selection ofa
sampling method, the specification of the samplesize (i.e., number
of subjects), and the developmentof procedures for recruiting
subjects.
Step 10: Specifying Methods to Measure the Research
VariablesQuantitative researchers must develop methods toobserve or
measure the research variables as accu-rately as possible. Based on
the conceptual defini-tions, the researcher selects or designs
appropriatemethods of operationalizing the variables andcollecting
data. A variety of quantitative data col-lection approaches exist.
Biophysiologic mea-surements often play an important role in
clinicalnursing research. Through self-reports, anotherpopular
method of data collection, subjects areasked directly about their
feelings, behaviors,attitudes, and personal traits (for example, in
an in-terview with research personnel). Another tech-nique is
observation, wherein researchers collectdata by observing and
recording aspects ofpeoples behavior.
Data collection methods vary in the degree ofstructure imposed
on subjects. Quantitative ap-proaches tend to be fairly structured,
involving theuse of a formal instrument that elicits the
sameinformation from every subject. Sometimes re-searchers need to
develop their own instruments,but more often they use or adapt
measuring instru-ments that have been developed by others. Thetask
of measuring research variables and develop-ing a data collection
plan is a complex and chal-lenging process that permits a great
deal ofcreativity and choice. Before finalizing the datacollection
plan, researchers must carefully evaluatewhether the chosen methods
capture key conceptsaccurately.
and so on) and what the alternative conditionwould be. The goal
of well-articulated protocols isto have all subjects in each group
treated in thesame way. (In nonexperimental research, of
course,this step would not be necessary.)
Step 8: Identifying the Population to be StudiedBefore selecting
subjects, quantitative researchersneed to know what characteristics
participantsshould possess. Researchers and others using
thefindings also need to know to whom study resultscan be
generalized. Thus, during the planningphase of quantitative
studies, researchers mustidentify the population to be studied. The
termpopulation refers to the aggregate or totality ofthose
conforming to a set of specifications. For ex-ample, we might
specify nurses (RNs) and resi-dence in the United States as
attributes of interest;the study population would then consist of
all li-censed RNs who reside in the United States. Wecould in a
similar fashion define a population con-sisting of all children
younger than 10 years of agewith muscular dystrophy in Canada, or
all thechange-of-shift reports for the year 2002 inMassachusetts
General Hospital.
Step 9: Designing the Sampling PlanResearch studies almost
always rely on a sample ofsubjects, who are a subset of the
population. It isclearly more practical and less costly to collect
datafrom a sample than from an entire population. Therisk, however,
is that the sample might not ade-quately reflect the populations
behaviors, traits,symptoms, or beliefs.
Various methods of obtaining samples areavailable. These methods
vary in cost, effort, andskills required, but their adequacy is
assessed bythe same criterion: the representativeness of
theselected sample. That is, the quality of the samplefor
quantitative studies depends on how typical, orrepresentative, the
sample is of the population withrespect to the variables of concern
in the study.Sophisticated sampling procedures can producesamples
that have a high likelihood of being repre-sentative. The most
sophisticated methods are
-
Step 11: Developing Methods for Safeguarding Human/Animal
RightsMost nursing research involves human subjects, al-though some
studies involve animals. In eithercase, procedures need to be
developed to ensurethat the study adheres to ethical principles.
For ex-ample, forms often need to be developed to docu-ment that
subjects participation in the study wasvoluntary. Each aspect of
the study plan needs to bereviewed to determine whether the rights
of sub-jects have been adequately protected. Often that re-view
involves a formal presentation to an externalcommittee.
Step 12: Finalizing and Reviewing the Research PlanBefore
actually collecting research data, researchersoften perform a
number of tests to ensure thatplans will work smoothly. For
example, they mayevaluate the readability of any written materials
todetermine if people with below-average readingskills can
comprehend them, or they may need totest whether technical
equipment is functioningproperly. If questionnaires are used, it is
importantto know whether respondents understand questionsor find
certain ones objectionable; this is usually re-ferred to as
pretesting the questionnaire. Duringfinal study preparations,
researchers also have to de-termine the type of training to provide
to those re-sponsible for collecting data. If researchers
haveconcerns about their study plans, they may under-take a pilot
study, which is a small-scale version ortrial run of the major
study.
Normally, researchers have their researchplan critiqued by
peers, consultants, or other re-viewers to obtain substantive,
clinical, or method-ologic feedback before implementing the
plan.When researchers seek financial support for thestudy, a
proposal typically is submitted to a fund-ing source, and reviewers
of the proposed planusually suggest improvements. Students
conduct-ing a study as part of a course or degree requirementhave
their plans reviewed by faculty advisers.Even under other
circumstances, however, re-searchers are well advised to ask
individualsexternal to the project to assess preliminary plans.
Experienced researchers with fresh perspectivescan often be
invaluable in identifying pitfalls andshortcomings that otherwise
might not have beenrecognized.
Phase 3: The Empirical Phase
The empirical portion of quantitative studies in-volves
collecting research data and preparing thosedata for analysis. In
many studies, the empiricalphase is one of the most time-consuming
parts ofthe investigation, although the amount of timespent
collecting data varies considerably from onestudy to the next. If
data are collected by distribut-ing a written questionnaire to
intact groups, thistask may be accomplished in a matter of
days.More often, however, data collection requires sev-eral weeks,
or even months, of work.
Step 13: Collecting the DataThe actual collection of data in a
quantitative studyoften proceeds according to a preestablished
plan.The researchers plan typically specifies proce-dures for the
actual collection of data (e.g., whereand when the data will be
gathered); for describingthe study to participants; and for
recording infor-mation. Technological advances in the past
fewdecades have expanded possibilities for automatingdata
collection.
A considerable amount of both clerical and ad-ministrative work
is required during data collec-tion. Researchers typically must be
sure, for exam-ple, that enough materials are available to
completethe study; that participants are informed of the timeand
place that their presence may be required; thatresearch personnel
(such as interviewers) are con-scientious in keeping their
appointments; thatschedules do not conflict; and that a suitable
sys-tem of maintaining confidentiality of informationhas been
implemented.
Step 14: Preparing the Data for AnalysisAfter data are
collected, a few preliminary activitiesmust be performed before
data analysis begins. Forinstance, it is normally necessary to look
throughquestionnaires to determine if they are usable.
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 51
-
52 PART 1 Foundations of Nursing Research
Step 16: Interpreting the ResultsBefore the results of a study
can be communicatedeffectively, they must be systematically
interpreted.Interpretation is the process of making sense ofthe
results and of examining their implications. Theprocess of
interpretation begins with an attempt toexplain the findings within
the context of the theo-retical framework, prior empirical
knowledge, andclinical experience.
If research hypotheses have been supported,an explanation of the
results may be straightfor-ward because the findings fit into a
previouslyconceived argument. If hypotheses are not sup-ported,
researchers must explain why this mightbe so. Is the underlying
conceptualization wrong,or was it inappropriate for the research
problem?Or do the findings reflect problems with the re-search
methods rather than the framework (e.g.,was the measuring tool
inappropriate)? To pro-vide sound explanations, researchers not
onlymust be familiar with clinical issues, prior re-search, and
conceptual underpinnings, but mustbe able to understand
methodologic limitations ofthe study. In other words, the
interpretation of thefindings must take into account all available
evi-dence about the studys reliability and validity.Researchers
need to evaluate critically the deci-sions they made in designing
the study and to rec-ommend alternatives to others interested in
thesame research problem.
Phase 5: The Dissemination Phase
The analytic phase brings researchers full circle: itprovides
answers to the questions posed in the firstphase of the project.
However, researchers respon-sibilities are not complete until the
study results aredisseminated.
Step 17: Communicating the FindingsA study cannot contribute
evidence to nursing prac-tice if the results are not communicated.
The mostcompelling hypothesis, the most rigorous study, themost
dramatic results are of no value to the nursingcommunity if they
are unknown. Anotherandoften finaltask of a research project,
therefore, is
Sometimes forms are left almost entirely blank orcontain other
indications of misinterpretation ornoncompliance. Another step is
to assign identifica-tion numbers to the responses or observations
ofdifferent subjects, if this was not done previously.
Coding of the data is typically needed at thispoint. As noted in
Chapter 2, coding involvesthe translation of verbal data into
numeric form,according to a specified plan. This might mean
as-signing numeric codes to categorical variablessuch as gender
(e.g., 1 for females and 2 formales). Coding might also be needed
to categorizenarrative responses to certain questions. For
exam-ple, patients verbatim responses to a questionabout the
quality of nursing care they received dur-ing hospitalization might
be coded into positivereactions (1), negative reactions (2),
neutral reac-tions (3), or mixed reactions (4). Another
prelimi-nary step involves transferring the data from writ-ten
documents onto computer files for subsequentanalysis.
Phase 4: The Analytic Phase
Quantitative data gathered in the empirical phaseare not
reported in raw form. They are subjected toanalysis and
interpretation, which occurs in thefourth major phase of a
project.
Step 15: Analyzing the DataThe data themselves do not provide
answers to re-search questions. Ordinarily, the amount of
datacollected in a study is rather extensive; researchquestions
cannot be answered by a simple perusalof numeric information. Data
need to be processedand analyzed in an orderly, coherent
fashion.Quantitative information is usually analyzedthrough
statistical procedures. Statistical analysescover a broad range of
techniques, from simpleprocedures that we all use regularly (e.g.,
comput-ing an average) to complex and sophisticated meth-ods.
Although some methods are computationallyformidable, the underlying
logic of statistical testsis relatively easy to grasp, and
computers haveeliminated the need to get bogged down with de-tailed
mathematic operations.
-
the preparation of a research report that can beshared with
others.
Research reports can take various forms: termpapers,
dissertations, journal articles, presentationsat professional
conferences, and so on. Journal ar-ticlesreports appearing in such
professional jour-nals as Nursing Researchusually are the
mostuseful because they are available to a broad, inter-national
audience. There is also a growing numberof outlets for research
dissemination on the Internet.
Step 18: Utilizing the Findings in PracticeMany interesting
studies have been conducted bynurses without having any effect on
nursing prac-tice or nursing education. Ideally, the concludingstep
of a high-quality study is to plan for its uti-lization in practice
settings. Although nurse re-searchers may not themselves be in a
position toimplement a plan for utilizing research findings,they
can contribute to the process by including intheir research reports
recommendations regardinghow the evidence from the study could be
incorpo-rated into the practice of nursing and by
vigorouslypursuing opportunities to disseminate the findingsto
practicing nurses.
Organization of a QuantitativeResearch Project
The steps described in the preceding section repre-sent an
idealized conception of what researchersdo. The research process
rarely follows a neatlyprescribed pattern of sequential
procedures.Developments in one step, for example, may re-quire
alterations in a previously completed activity.Nevertheless, for
the quantitative researcher, care-ful organization is very
important.
Almost all research projects are conductedunder some time
pressure. Students in researchcourses have end-of-term deadlines;
government-sponsored research involves funds granted for aspecified
time. Those who may not have such for-mal time constraints (e.g.,
graduate students work-ing on theses or dissertations) normally
have theirown goals for project completion. Setting up atimetable
in advance may be an important means of
meeting such goals. Having deadlines for taskseven tentative
oneshelps to impose order and de-limits tasks that might otherwise
continue indefi-nitely, such as problem selection and
literaturereviews.
It is not possible to give even approximate fig-ures for the
relative percentage of time that shouldbe spent on each task in
quantitative studies. Someprojects require many months to develop
andpretest the measuring instruments, whereas otherstudies use
previously existing ones, for example.The write-up of the study may
take many months oronly a few days. Clearly, not all steps are
equallytime-consuming. It would make little sense simplyto divide
the available time by the number of tasks.
Let us suppose a researcher was studying thefollowing problem:
Is a womans decision to havean annual mammogram related to her
perceivedsusceptibility to breast cancer? Using the organiza-tion
of steps outlined earlier, here are some of thetasks that might be
undertaken:*
1. The researcher, who lost her mother to breastcancer, is
concerned that many older womendo not get a mammogram regularly.
Her spe-cific research question is whether mammo-gram practices are
different for women whohave different views about their
susceptibilityto breast cancer.
2. The researcher reviews the research literatureon mammograms,
factors affecting mammog-raphy decisions, and interventions
designedto promote it.
3. The researcher does clinical fieldwork by dis-cussing the
problem with nurses and otherhealth care professionals in various
clinicalsettings (health clinics, private obstetrics andgynecology
practices) and by informally dis-cussing the problem with women in
a supportgroup for breast cancer victims.
4. The researcher examines frameworks for con-ceptualizing the
problem. She finds that the
*This is, of course, only a partial list of tasks and is
designed toillustrate the flow of activities; the flow in this
example is moreorderly than would ordinarily be true.
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 53
-
54 PART 1 Foundations of Nursing Research
13. Data are collected by conducting telephoneinterviews with
the research sample.
14. Data are prepared for analysis by codingthem and entering
them onto a computer file.
15. Data are analyzed using a statistical softwarepackage.
16. The results indicate that the hypothesis is sup-ported;
however, the researchers interpretationmust take into consideration
that many womenwho were asked to participate in the study de-clined
to do so. Moreover, the analysis revealedthat mammogram use in the
sample was sub-stantially higher than had been reported in ear-lier
studies.
17. The researcher presents an early report on herfindings and
interpretations at a conference ofSigma Theta Tau International.
She subse-quently publishes the report in the WesternJournal of
Nursing Research.
18. The researcher seeks out clinicians to discusshow the study
findings can be utilized inpractice.
The researcher in this study wants to conductthis study over a
2-year period. Figure 3-1 presentsa hypothetical schedule for the
research tasks to becompleted. (The selection of the problem is not
in-cluded because the research topic has already beenidentified.)
Note that many steps overlap or are un-dertaken concurrently. Some
steps are projected toinvolve little time, whereas others require
monthsof work.
In developing a time schedule of this sort, anumber of
considerations should be kept in mind,including researchers level
of knowledge andmethodologic competence. Resources available
toresearchers, in terms of research funds and person-nel, greatly
influence time estimates. In the presentexample, the researcher
almost certainly would haverequired funding from a sponsor to help
pay for thecost of hiring interviewers, unless she were able
todepend on colleagues or students.
It is also important to consider the practical as-pects of
performing the study, which were not all enu-merated in the
preceding section. Obtaining supplies,securing permissions, getting
approval for using
Health Belief Model (see Chapter 6) is relevant, and this helps
her to develop a con-ceptual definition of susceptibility to
breastcancer.
5. Based on what the researcher has learned, thefollowing
hypothesis is developed: Womenwho perceive themselves as not
susceptible tobreast cancer are less likely than other womento get
an annual mammogram.
6. The researcher adopts a nonexperimental re-search design that
involves collecting datafrom subjects at a single point in time.
She de-signs the study to control the extraneous vari-ables of age,
marital status, and general healthstatus.
7. There is no intervention in this study (the de-sign is
nonexperimental) and so this step doesnot need to be
undertaken.
8. The researcher designates that the populationof interest is
women between the ages of 50and 65 years living in Canada who have
notbeen previously diagnosed as having anyform of cancer.
9. The researcher decides to recruit for the re-search sample
200 women living in Toronto;they are identified at random using a
tele-phone procedure known as random-digitdialing.
10. The research variables will be measuredthrough self-report;
that is, the independentvariable (perceived susceptibility),
dependentvariable (mammogram history), and extrane-ous variables
will be measured by asking thesubjects a series of questions. The
researcherdecides to use existing measures of key vari-ables,
rather than developing new ones.
11. A human subjects committee at the re-searchers institution
is asked to review theresearch plans to determine whether thestudy
adheres to ethical standards.
12. Plans for the study are finalized: the methodsare reviewed
and refined by colleagues withclinical and methodologic expertise;
the datacollection instruments are pretested; and in-terviewers who
will collect the data aretrained.
-
forms or instruments, hiring staff, and holding meet-ings are
all time-consuming, but necessary, activities.
Individuals differ in the kinds of tasks that ap-peal to them.
Some people enjoy the preliminaryphase, which has a strong
intellectual component,whereas others are more eager to collect the
data, atask that is more interpersonal. Researchers should,however,
allocate a reasonable amount of time todo justice to each
activity.
ACTIVIT IES IN AQUALITAT IVE STUDY
As we have just seen, quantitative research in-volves a fairly
linear progression of tasksresearchers plan in advance the steps to
be taken tomaximize study integrity and then follow thosesteps as
faithfully as possible. In qualitative stud-ies, by contrast, the
progression is closer to a circlethan to a straight linequalitative
researchers are
continually examining and interpreting data andmaking decisions
about how to proceed based onwhat has already been discovered.
Because qualitative researchers have a flexibleapproach to the
collection and analysis of data, it is impossible to define the
flow of activities preciselythe flow varies from one study to
another,and researchers themselves do not know ahead oftime exactly
how the study will proceed. The fol-lowing sections provide a sense
of how qualitativestudies are conducted by describing some
majoractivities and indicating how and when they mightbe
performed.
Conceptualizing and Planning aQualitative Study
Identifying the Research ProblemLike quantitative researchers,
qualitative researchersusually begin with a broad topic area to be
studied.
F I G U R E 3 . 1 Project timetable in calendar months.
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 55
0 2 4 6 8 10 12 14 16 18 20 22 24
0 2 4 6 8 10 12 14 16 18 20 22 24
Conceptual Phase
Planning Phase
Empirical Phase
Analytic Phase
Dissemination Phase
Step 2Step 3Step 4
Step 5
Step 6Step 8*
Step 9
Step 10Step 11
Step 12
Step 14
Step 13
Step 15
Step 16
Step 17Step 18
* Note that Step 7 was not necessary because this study did not
involve an intervention.
-
56 PART 1 Foundations of Nursing Research
perhaps some clinical fieldwork) to identify the mostsuitable
and information-rich environment for theconduct of the study. For a
qualitative researcher, anideal site is one in which (1) entry is
possible; (2) arich mix of people, interactions, and situations
relat-ing to the research question is present; and (3) the
re-searcher can adoptand maintainan appropriaterole vis--vis study
participants. It is critical to ap-praise the suitability of the
site (and the settingswithin the site where data will be
collecting) beforeentering the field.
In some cases, researchers may have access tothe site selected
for the study. In others, however, re-searchers need to gain entre
into the site or settingswithin it. A site may be well suited to
the needs of theresearch, but if researchers cannot get in, the
studycannot proceed. Gaining entre typically involves ne-gotiations
with gatekeepers who have the authorityto permit entry into their
world. Gaining entre re-quires strong interpersonal skills, as well
as familiar-ity with the customs and language of the site. In
ad-dition, certain strategies are more likely to succeedthan
others. For example, gatekeepers might be per-suaded to be
cooperative if it can be demonstratedthat there will be direct
benefits to them or their con-stituentsor if a great humanitarian
purpose will beserved. Researchers also need to gain the
gatekeep-ers trust, and that can only occur if researchers
arecongenial, persuasive, forthright about research re-quirements
(e.g., how much time the fieldwork willrequire), andperhaps most
importantexpressgenuine interest in and concern for the situations
ofthe people in the site. In qualitative research, gainingentre is
likely to be an ongoing process of establish-ing relationships and
rapport with gatekeepers andothers at the site, including
prospective informants.
Research Design in Qualitative StudiesAs we have seen,
quantitative researchers do notcollect data until the research
design has beenfinalized. In a qualitative study, by contrast, the
re-search design is often referred to as an emergentdesigna design
that emerges during the course ofdata collection. Certain design
features are guidedby the qualitative research tradition within
whichthe researcher is working, but nevertheless few
However, qualitative researchers usually focus on anaspect of a
topic that is poorly understood and aboutwhich little is known.
Therefore, they do not develophypotheses or pose highly refined
research questionsbefore going into the field. The general topic
area maybe narrowed and clarified on the basis of self-reflection
and discussion with colleagues (or clients),but researchers may
proceed with a fairly broad re-search question that allows the
focus to be sharpenedand delineated more clearly once the study is
under-way. (Qualitative researchers may also decide to focuson a
topic that has been extensively researched quan-titatively, but has
had little qualitative attention.)
Doing Literature ReviewsThere are conflicting opinions among
qualitative re-searchers about doing a literature review at the
out-set of a study. At one extreme are those who believethat
researchers should not consult the literature be-fore collecting
data. Their concern is that prior stud-ies or clinical writings
might influence researchersconceptualization of the phenomena under
study.According to this view, the phenomena should beelucidated
based on participants viewpoints ratherthan on any prior
information. Those sharing thisviewpoint often do a literature
review at the end ofthe study rather than at the beginning. Others
feelthat researchers should conduct at least a prelimi-nary
up-front literature review to obtain some pos-sible guidance
(including guidance in identifyingthe kinds of biases that have
emerged in studyingthe topic). Still others believe that a full
up-front lit-erature review is appropriate. In any case,
qualita-tive researchers typically find a relatively smallbody of
relevant previous work because of the typesof question they
ask.
Selecting and Gaining Entre Into Research SitesDuring the
planning phase, qualitative researchersmust also select a site that
is consistent with the topicunder study. For example, if the topic
is the healthbeliefs of the urban poor, an inner-city
neighborhoodwith a high percentage of low-income residents mustbe
identified. In making such a decision, researchersmay need to
engage in anticipatory fieldwork (and
-
qualitative studies have rigidly structured designsthat prohibit
changes while in the field. As previ-ously noted, qualitative
designs are not concernedwith the control of extraneous variables.
The fullcontext of the phenomenon is considered an im-portant
factor in understanding how it plays out inthe lives of people
experiencing it.
Although qualitative researchers do not alwaysknow in advance
exactly how the study will progressin the field, they nevertheless
must have some senseof how much time is available for field work
andmust also arrange for and test needed equipment,such as tape
recorders or videotaping equipment.Other planning activities
include such tasks as hiringand training interviewers to assist in
the collection ofdata; securing interpreters if the informants
speak adifferent language; and hiring appropriate consul-tants,
transcribers, and support staff.
Addressing Ethical IssuesQualitative researchers, like
quantitative researchers,must also develop plans for addressing
ethicalissuesand, indeed, there are special concerns inqualitative
studies because of the more intimatenature of the relationship that
typically developsbetween researchers and study
participants.Chapter 7 describes some of these concerns.
Conducting the Qualitative Study
In qualitative studies, the tasks of sampling, datacollection,
data analysis, and interpretation typi-cally take place
iteratively. Qualitative researchersbegin by talking with or
observing a few peoplewho have first-hand experience with the
phenome-non under study. The discussions and observationsare
loosely structured, allowing for the expressionof a full range of
beliefs, feelings, and behaviors.Analysis and interpretation are
ongoing, concur-rent activities that guide choices about the kinds
ofpeople to sample next and the types of questions toask or
observations to make. The actual process ofdata analysis involves
clustering together relatedtypes of narrative information into a
coherentscheme. The analysis of qualitative data is anintensive,
time-consuming activity.
As analysis and interpretation progress,researchers begin to
identify themes and categories,which are used to build a rich
description or theoryof the phenomenon. The kinds of data obtained
andthe people selected as participants tend to becomeincreasingly
focused and purposeful as the concep-tualization is developed and
refined. Concept devel-opment and verification shape the
samplingprocessas a conceptualization or theory develops,the
researcher seeks participants who can confirmand enrich the
theoretical understandings, as well asparticipants who can
potentially challenge them andlead to further theoretical
development.
Quantitative researchers decide in advance howmany subjects to
include in the study, but qualitativeresearchers sampling decisions
are guided by thedata themselves. Many qualitative researchers
usethe principle of data saturation, which occurswhen themes and
categories in the data becomerepetitive and redundant, such that no
new informa-tion can be gleaned by further data collection.
In quantitative studies, researchers seek to col-lect
high-quality data by using measuring instru-ments that have been
demonstrated to be accurateand valid. Qualitative researchers, by
contrast,must take steps to demonstrate the trustworthinessof the
data while in the field. The central feature ofthese efforts is to
confirm that the findings accu-rately reflect the experiences and
viewpoints ofparticipants, rather than perceptions of the
re-searchers. One confirmatory activity, for example,involves going
back to participants and sharingpreliminary interpretations with
them so that theycan evaluate whether the researchers
thematicanalysis is consistent with their experiences.Another
strategy is to use triangulation to convergeon a thorough depiction
of the target phenomena.
An issue that qualitative researchers sometimesneed to address
is the development of appropriatestrategies for leaving the field.
Because qualitativeresearchers may develop strong relationships
withstudy participants and entire communities, theyneed to be
sensitive to the fact that their departurefrom the field might seem
like a form of rejection orabandonment. Graceful departures and
methods ofachieving closure are important.
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 57
AQ4
-
58 PART 1 Foundations of Nursing Research
Disseminating Qualitative Findings
Qualitative nursing researchers also strive to sharetheir
findings with others at conferences and injournal articles.
Qualitative findings, because oftheir depth and richness, also lend
themselves morereadily to book-length manuscripts than do
quanti-tative findings. Regardless of researchers positionabout
when a literature review should be con-ducted, they usually include
a summary of priorresearch in their reports as a means of
providingcontext for the study.
Quantitative reports almost never present rawdatathat is, data
in the form they were collected,which are numeric values.
Qualitative reports, bycontrast, are usually filled with rich
verbatim pas-sages directly from participants. The excerpts areused
in an evidentiary fashion to support or illus-trate researchers
interpretations and theoreticalformulations.
Example of raw data in a qualitative report:Scannell-Desch
(2000) studied the hard-
ships and personal strategies of 24 female Vietnamwar nurses.
One of the emotional hardships theyexperienced had to do with the
youth of the patientsand the severity of their injuries. The
researchersupported this with the following quote from anarmy
nurse:
I had to amputate the leg of one patient. That was the firsttime
I ever had to do that. His leg was hanging by a tis-sue band. I was
new here, and the doctor yelled at me toget the damn thing off.
Doctors take legs off, nursesdont do that. He yelled at me again
and said, You doit. (pp. 533534).
Like quantitative researchers, qualitative nurseresearchers want
their findings used in nursing prac-tice and subsequent research.
Qualitative findingsoften are the basis for formulating hypotheses
thatare tested by quantitative researchers, and for devel-oping
measuring instruments for both research andclinical purposes.
Qualitative findings can also pro-vide a foundation for designing
effective nursing in-terventions. Qualitative studies help to
shapenurses perceptions of a problem or situation andtheir
conceptualizations of potential solutions.
RESEARCH EXAMPLES
In this section, we illustrate the progression ofactivities and
discuss the time schedule of twostudies (one quantitative and the
other qualitative)conducted by the second author of this book.
Project Schedule for a Quantitative Study
Beck and Gable (2001) undertook a study to evalu-ate the
accuracy of the newly developedPostpartum Depression Screening
Scale (PDSS) inscreening new mothers for this mood disorder.
Phase 1. Conceptual Phase: 1 MonthThis phase was the shortest,
in large part becausemuch of the conceptual work had been done
inBeck and Gables (2000) first study, in which theyactually
developed the screening scale. The litera-ture had already been
reviewed, so all that wasneeded was to update the review. The same
frame-work and conceptual definitions that had been usedin the
first study were used in the new study.
Phase 2. Design and Planning Phase: 6 MonthsThe second phase was
time-consuming. It includednot only fine-tuning the research
design, but gain-ing entre into the hospital where subjects were
re-cruited and obtaining approval of the hospitalshuman subjects
review committee. During this pe-riod, Beck met with statistical
consultants and aninstrument development consultant numeroustimes
to finalize the study design.
Phase 3. Empirical Phase: 11 MonthsData collection took almost a
year to complete.The design called for administering the PDSS to150
mothers who were 6 weeks postpartum, andthen scheduling a
psychiatric diagnostic interviewfor them to determine if they were
suffering frompostpartum depression. Women were recruitedinto the
study during prepared childbirth classes.Recruitment began 4 months
before data collec-tion because the researchers had to wait until
6weeks after delivery to gather data. The nurse
-
psychotherapist, who had her own clinical practice,was able to
come to the hospital (a 2-hour drive forher) only 1 day a week to
conduct the diagnostic in-terviews; this contributed to the time
required toachieve the desired sample size.
Phase 4. Analytic Phase: 3 MonthsStatistical tests were
performed to determine a cut-off score on the PDSS above which
mothers wouldbe identified as having screened positive for
post-partum depression. Data analysis also was under-taken to
determine the accuracy of the PDSS inpredicting diagnosed
postpartum depression.During this phase, Beck met with the
statisticiansand instrument development consultant to
interpretresults.
Phase 5. Dissemination Phase: 18 MonthsThe researchers prepared
a research report and sub-mitted the manuscript to the journal
NursingResearch for possible publication. Within 4 monthsit was
accepted for publication, but it was inpress (awaiting publication)
for 14 months beforebeing published. During this period, the
authorspresented their findings at regional and interna-tional
conferences. The researchers also had to pre-pare a summary report
for submission to theagency that funded the research.
Project Schedule for a Qualitative Study
Beck (2002) conducted a grounded theory study onmothering twins
during the first year after delivery.Total time from start to
finish was approximately 2 years.
Phase 1. Conceptual Phase: 3 MonthsBeck became interested in
mothers of multiples asa result of her quantitative studies on
postpartumdepression. The findings of these studies had re-vealed a
much higher prevalence of postpartum de-pression among mothers of
multiples than amongthose of singletons. Beck had never studied
multi-ple births before, so she needed to review that liter-ature
carefully. Gaining entre into the research site
(a hospital) did not take long, however, because shehad
previously conducted a study there and wasknown to the hospitals
gatekeepers. The key gate-keeper was a nurse who was in charge of
the hos-pitals support group for parents of multiplesanurse with
whom Beck had developed an excellentrapport in the previous study
(the nurse was one ofthe childbirth educators who had helped
recruitmothers for the postpartum depression study).
Phase 2. Design and Planning Phase: 4 MonthsAfter reviewing the
literature in the conceptualphase, a grounded theory design was
selected. Theresearcher met with the nurse who headed the sup-port
group to plan the best approach for recruitingmothers of twins into
the study. Plans were alsomade for the researcher to attend the
monthlymeetings of the support group. Once the designwas finalized,
the research proposal was submittedto and approved by both the
hospitals and univer-sitys human subjects review committees.
Phase 3. Empirical/Analytic Phases 10 monthsData collection and
data analysis phases occurredsimultaneously in this grounded theory
study. Beckattended the parents of multiples support groupfor 10
months. During that period, she conductedin-depth interviews with
16 mothers of twins intheir homes, and analyzed her rich and
extensivedata. Becks analysis indicated that life on holdwas the
basic problem mothers of twins experi-enced during the first year
of their twins lives. Asmothers attempted to resume their own
lives, theyprogressed through a four-stage process that Beckcalled
releasing the pause button.
Phase 4 Dissemination Phase: 6+ MonthsA manuscript was written
describing this study andsubmitted for publication in a journal.
The manu-script was published in 2002 in the journalQualitative
Health Research. In addition to dis-seminating the results as a
journal article, Beckpresented the findings at a regional nursing
re-search conference.
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 59
-
60 PART 1 Foundations of Nursing Research
steps to safeguard the rights of subjects; and(12) finalizing
the research plan, by conferringwith colleagues, pretesting
instruments, and, insome cases, conducting a pilot study.
The empirical phase involves (13) collectingdata; and (14)
preparing data for analysis.
The analytic phase involves (15) analyzing datathrough
statistical analysis; and (16) interpret-ing the results.
The dissemination phase entails (17) commu-nicating the findings
through the preparation ofresearch reports that can be presented
orally orpublished in written form, most often as jour-nal
articles; and (18) efforts to promote the useof the study evidence
in nursing practice.
The conduct of quantitative studies requirescareful planning and
organization. The prepara-tion of a timetable with expected
deadlines fortask completion is recommended.
The flow of activities in a qualitative study ismore flexible
and less linear.
Qualitative researchers begin with a broad ques-tion regarding
the phenomenon of interest, oftenfocusing on a little-studied
aspect.
In the early phase of a qualitative study, re-searchers select a
site and seek to gain entreinto it and into the specific settings
in whichdata collection will occur. Gaining entre typi-cally
involves enlisting the cooperation of gate-keepers within the
site.
The research design of qualitative studies is typ-ically an
emergent design. Once in the field, re-searchers select informants,
collect data, andthen analyze and interpret them in an
iterativefashion; field experiences help in an ongoingfashion to
shape the design of the study.
Early analysis leads to refinements in samplingand data
collection, until saturation (redun-dancy of information) is
achieved.
Qualitative researchers conclude by disseminat-ing findings that
can subsequently be used to (1)shape the direction of further
studies (includingmore highly controlled quantitative studies);
(2)guide the development of structured measuringtools for clinical
and research purposes; and (3)shape nurses perceptions of a problem
or situa-
SUMMARY POINTS
A basic distinction in quantitative studies is between
experimental and nonexperimental re-search. In experimental
research, researchersactively intervene or introduce a
treatment,whereas in nonexperimental research, re-searchers make
observations of existing situa-tions and characteristics without
intervening.
Qualitative research often is strongly rooted in re-search
traditions that originate in the disciplinesof anthropology,
sociology, and psychology.Three such traditions have had strong
influenceon qualitative nursing research: grounded
theory,phenomenology, and ethnography.
Grounded theory seeks to describe and under-stand key social
psychological and structuralprocesses that occur in a social
setting.
Phenomenology is concerned with the livedexperiences of humans
and is an approach tothinking about what the life experiences of
peo-ple are like.
Ethnography provides a framework for study-ing the meanings,
patterns, and experiences of adefined cultural group in a holistic
fashion.
The steps involved in conducting a quantitativestudy are fairly
standard; researchers usuallyprogress in a linear fashion from
asking re-search questions to answering them.
The main phases and steps in a quantitativestudy are the
conceptual, planning, empirical,analytic, and dissemination
phases.
The conceptual phase involves (1) defining theproblem to be
studied; (2) doing a literature re-view; (3) engaging in clinical
fieldwork forclinical studies; (4) developing a framework
andconceptual definitions; and (5) formulating hy-potheses to be
tested.
The planning phase entails (6) selecting a re-search design; (7)
developing interventionprotocols if the study is experimental; (8)
spec-ifying the population; (9) developing a sam-pling plan; (10)
specifying methods to measurethe research variables, through such
approachesas self-report, observation, or the use ofbiophysiologic
methods; (11) undertaking
-
tion and their conceptualizations of potentialsolutions.
STUDY ACTIVIT IES
Chapter 3 of the Study Guide to AccompanyNursing Research:
Principles and Methods, 7thedition, offers various exercises and
study sugges-tions for reinforcing concepts presented in
thischapter. In addition, the following study questionscan be
addressed:
1. In quantitative studies, the same measurementsare made of all
subjects. What do you thinkresearchers are trying to achieve by
this degreeof structure? Why might such structure not beappropriate
in qualitative studies?
2. Which type of research do you think is easier
toconductqualitative or quantitative research?Defend your
response.
3. Suppose you were interested in studying fa-tigue in patients
on chemotherapy. (This couldinvolve either a quantitative or a
qualitativeapproach.) Suggest some possible clinicalfieldwork
activities that would help you con-ceptualize the problem and
develop a researchstrategy.
SUGGESTED READINGS
Methodologic References
Creswell, J. W. (1998). Qualitative inquiry and researchdesign:
Choosing among five traditions. ThousandOaks, CA: Sage.
Glaser, B. G., & Strauss, A. L. (1967). The discovery
ofgrounded theory: Strategies for qualitative research.Chicago:
Aldine.
Kerlinger, F. N., & Lee, H. B. (2000). Foundations of
be-havioral research. (4th ed.). Orlando, FL: HarcourtCollege
Publishers.
Sterling, Y. M. (2001). The clinical imperative in
clinicalnursing research. Applied Nursing Research, 14,4447.
Studies Cited in Chapter 3
Beck, C. T. (2002). Releasing the pause button:Mothering twins
during the first year of life.Qualitative Health Research, 12,
593608.
Beck, C. T., & Gable, R. K. (2000). PostpartumDepression
Screening Scale: Development and psy-chometric testing, Nursing
Research, 49, 272282.
Beck, C. T., & Gable, R. K. (2001). Further validation ofthe
Postpartum Depression Screening Scale. NursingResearch, 50,
155164.
Hauck, Y. L., & Irurita, V. F. (2002). Constructing
com-patibility: Managing breast-feeding and weaningfrom the mothers
perspective. Qualitative HealthResearch, 12, 897914.
Johnson, V. Y. (2001). Effects of a submaximal exerciseprotocol
to recondition the pelvic floor musculature.Nursing Research, 50,
3341.
Powers, B. A. (2001). Ethnographic analysis of everydayethics in
the care of nursing home residents withdementia. Nursing Research,
50, 332339.
Scannell-Desch, E. A. (2000). Hardships and personalstrategies
of Vietnam war nurses. Western Journal ofNursing Research, 22,
526550.
Sundin, K., Norberg, A., & Jansson, L. (2001). Themeaning of
skilled care providers relationship withstroke and aphasia
patients. Qualitative HealthResearch, 11, 308321.
Wong, F., Ho, M., Chiu, I., Lui, W., Chan, C., & Lee,
K.(2002). Factors contributing to hospital readmissionin a Hong
Kong regional hospital. Nursing Research,51, 4049.
CHAPTER 3 Overview of the Research Process in Qualitative and
Quantitative Studies 61