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OBJECTIVES

 Foundations of Nursing research


 Importance of research
 Major phases of the research process
 Steps in the research study
 Research problem & Statement of the

problem
 Hypothesis
 Review of Related Literature
 Conceptual Framework & Model
 Quantitative Research Designs
 Sampling
 Ethics in Research
 Validity & Reliability
 Data Collection
 Evidenced Based Practice
 Research is systematic inquiry that
uses disciplined methods to answer
questions or solve problems.
 The ultimate goal of research is to develop,

refine, and expand a base of knowledge.


 Nursing research is systematic inquiry
designed to develop knowledge about
issues of importance to nurses, including
nursing practice, nursing education, and
nursing administration.
A scientific process that validates and refines
existing knowledge and generates new
knowledge that directly and indirectly
influences nursing practice.
 Diagnosis of Type 2 Diabetes
◦ FBS 160 mg/dl with positive
glucose tolerance test
◦ FBS of 126 mg/dl or greater on
two occasions
◦ Hemoglobin A1c greater 6.5
 Cloning of human tissue
 Treatment of HPN with Angiotensin
Receptor Blockers (ARBs) (Irbesartan,
Losartan)
 Treatment of Depression with SSRIs
(selective serotonin reuptake inhibitors)
 Withevidence based practice, research
provides the best clinical evidence in
making patient care decisions.
 Nurses are accepting the need
to base specific nursing actions
and decisions on evidence
indicating that the actions are
clinically appropriate and cost-
effective, and result in positive
outcomes for clients.
 Nurses who incorporate high-
quality research evidence into
their clinical decisions and advice
are being professionally
accountable to their clients.
 Another reason for nurses to engage
in research involves the spiraling
costs of health care and the cost-
containment practices being
instituted in health care facilities.
 nurses need to document the
effectiveness of their practice not only to
the profession but also to nursing care
consumers, health care administrators,
third-party payers (e.g., insurance
companies), and government agencies.
Research enables nurses to
 understand a particular nursing situation about which

little is known,
 assess the need for an intervention,
 identify factors that must be considered in planning

nursing care,
 predict the probable outcomes of certain nursing

decisions,
 control the occurrence of undesired outcomes,
 provide advice to enhance client health,
 and initiate activities to promote appropriate client

behavior.
 Numerous clinical practice changes over the
past 2 decades reflect the impact of research.
For example, a recent nursing study
documented that “kangaroo care” (the holding
of diaper-clad preterm infants skin-to-skin,
chest-to-chest by parents) is now widely
practiced in neonatal intensive care units
(NICUs) in the United States (Engler et al.,
2002), but this is a new trend.
 As recently as the early 1990s, only a minority of
NICUs offered kangaroo care options. The adoption
of this practice reflects the accumulating evidence
that early skin-to-skin contact has clinical benefits
without any apparent negative side effects
(Anderson et al., 2003). Some of that accumulated
evidence was developed in rigorous studies by nurse
researchers in the United States, Australia, Canada,
Taiwan, and other countries (Chwo et al., 2002).
The Evolution of
Research In
Nursing

Menu
 Florence
Nightingale

◦ Reformer
◦ Reactionary
◦ Researcher
 Crimean War: 1853-
56
 Collected data
 Used statistics,
graphs to present
data
 Based practice on
research findings
1900-1940 – researches were done on
nurse’s educational preparation –
Goldmark Report

Nursing Research Journal – 1952


1960’s – terms such as conceptual
frame-work, conceptual model,
nursing process theoretical base
of Nursing

International Journal of Nursing


Studies 1943
1970 - Research focused on client care search
for scientific base from which to practice
utilization of research findings
 Priority was focused on clinical problems
 Growing number of nurses with earned
doctorates

1980 – Recognition that research is an integral


part of Professional Nursing
 Establishment of National Center for
Nursing Research (NCNR), Nursing
Science Quarterly, Applied Nursing
Research in 1980
 1990 – National Institute of Nursing
Research (NINR)
 Nursing Research into the Mainstream
of nursing Activities
1. Future focus is on outcome research –
assess and document the
effectiveness of health care services
2. Future focus is on biophysiologic
research
3. Promotion of evidence based practice
research findings into research
1. Development of a stronger knowledge
base thru multiple, confirmatory
strategies, Replication of studies with
different clients in different clinical
settings and at different times to
ensure that the findings are robust.
 Trend is from in patient care to
ambulatory care.
Nursing Process Research Process
1. Assessment 1. Knowledge of the World of
a. Data Collection Nursing
b. Data Interpretation
2. Nursing Diagnosis 2. Problem & Purpose
Identification
3. Plan 3. Methodology
a. Goal Identification a. Design
b. Planned Interventions b. Sample
c. Measurement
4. Implementation 4. Data Collection & Analysis
5. Evaluation & Modification 5. Outcomes & Disseminating
Findings
1. Basic Research
2. Applied Research
3. Rigor
4. Control
Quantitative studies are basic or applied

• Basic Research: Concerned with


underlying mechanisms of an intervention.
Such as Effect of Pressure on tissues

• Applied Research: Concerned with effect


of the intervention on the patient. Such as
turning patient to relieve pressure
Excellence in research
involves:
•Discipline
•Adherence to detail
•Strict accuracy
•A methodology developed
with meticulous detail
• Precise measurement tools
•A representative sample
•A tightly controlled design
 Quantitative
research
 Qualitative
research
 Outcomes
research
 Intervention
 Descriptive Research
 Correctional Research
 Quasi-Experimental
Research
 Experimental
Research
• Natural or Field
Settings
• Partially Controlled

Settings
• Highly Controlled or

Laboratory Settings
 Traditions  Role
 Authority Modeling
 Borrowing  Intuition
 Trial &  Reasonin
Error
g
 Personal
Experience
 Research
Research Problem & Purpose

Literature Review

Study Framework

Objectives, Questions, or Hypotheses

Study Variables
Assumptions

Limitations

Research Design

Population & Sample

Methods of Measurement
Data Collection & Analysis

Research Outcomes

Communication of Findings
Epistemology The philosophy of
knowing
Methodology An approach to
knowing
Science is a way to learn the TRUTH.
The Positivist View of Research

• Science is a way to learn the TRUTH.


• Science is DETERMINISTIC.
The Positivist View of Research

• Science is a way to learn the TRUTH.


• Science is DETERMINISTIC.
• Science is MECHANISTIC.
The Positivist View of Research

• Science is a way to learn the TRUTH.


• Science is DETERMINISTIC.
• Science is MECHANISTIC.
• Science uses METHODS.
The Positivist View of Research

• Science is a way to learn the


TRUTH.
• Science is DETERMINISTIC.
• Science is MECHANISTIC.
• Science uses METHODS.
• Science only deals with what we
can see or measure – EMPIRICISM.
The Positivist View of Research

• Science is a way to learn the


TRUTH.
• Science is DETERMINISTIC.
• Science is MECHANISTIC.
• Science uses METHODS.
• Science only deals with what we
can see or measure –
EMPIRICISM.
• The best way to learn the truth is
to EXPERIMENT.
The Positivist View of Research
• Science is a way to learn the TRUTH.
• Science is DETERMINISTIC.
• Science is MECHANISTIC.
• Science uses METHODS.
• Science only deals with what we can
see or measure – EMPIRICISM.
• The best way to learn the truth is to
EXPERIMENT.
• Science is OBJECTIVE.
 Similarity between common sense and
science
 Similarity between common sense and
science
 NATURAL SELECTION model of knowing

Random Variation

Selective Retention
 Similarity between common sense and
science
 NATURAL SELECTION model of knowing
 MULTIPLE PERSPECTIVES and

TRIANGULATION
 Similarity between common sense and
science.
 NATURAL SELECTION model of knowing.
 MULTIPLE PERSPECTIVES and

TRIANGULATION.
 Observation is THEORY-LADEN.
 Similarity between common sense and
science.
 NATURAL SELECTION model of knowing.
 MULTIPLE PERSPECTIVES and
TRIANGULATION.
 Observation is THEORY-LADEN
 NONREDUCTIONIST.
 Believe there’s a reality that we should try
to ‘get right’
 Critical of our ability to ever get it perfectly

right
Research
Problem &
Purpose
 Major concepts
 Focused on areas of
concern
 Key issues for practice,
education, &
administration
 Examples: Chronic pain,
Acute pain, Self-care,
Coping, Health Promotion,
Respiratory pathology
 Area of Concern
 Gap in the knowledge base
for practice
◦ Not previously studied
◦ Conflicting findings
◦ Omission of a group of
subjects
 Significant for Nursing
“Patients’ concerns about reporting
pain and using analgesics… are
barriers to adequate pain
management…Despite extensive
attention to issues of pain
management…few studies have
been conducted testing impact of
intervention on cancer pain…”
Ward et al. (2000). An individualized intervention to
overcome patient-related barriers to pain management
in women with gynecologic cancers. Research in
Nursing & Health, 23(5), p. 394.
 Little is known about...
◦ Findings of previous
studies are conflicting
◦ Few studies of this have
been done
 Nursing Practice
 Researcher and Peer
Interaction
 Literature Review
 Theory
 Research Priorities
 Clear, concise statement
 Goal, aim, focus, or
objective
of the study
 Includes variables,
population,
& setting
 The purpose of this study was
to
◦ describe...
◦ determine differences
between groups...
◦ examine relationships
among...
◦ determine the effect of...
“The purpose of this pilot
study was to determine if
information about analgesic
side effects and information
to counter misconceptions
would enhance pain
management in…women with
gynecologic cancer.”
Ward et al. (2000). An individualized intervention
to overcome patient-related barriers to pain
management in women with gynecologic cancers.
Research in Nursing & Health, 23(5), p. 394.
Current policy at most hospitals
requires the use of routine flushing of
heparin locks after administration of
medication or flushing heparin locks
every 8 hours when not being used for
medication administration. However,
there is disagreement on whether
flushes of low doses of heparin are
necessary to maintain the patency of
heparin locks....
The purpose of this study was to
evaluate the effectiveness of
normal saline versus normal saline
containing
10 U/mL of heparin for
maintaining heparin-loc sites.
The purpose of this study
was “to describe, at the level
of the nursing care unit, the
relationships among total
hours of nursing care,
registered nurse (RN) skill
mix, and adverse patient
outcomes” (Blegen et al.,
1998).
The higher the RN
skill mix, the lower
the incidence of
adverse occurrence
on inpatient
care units.
 Time Commitment
 Money Commitment
 Researchers’ Expertise
 Availability of Subjects,

Facility, & Equipment


 Ethical Considerations
Definition:
Objectives are declarative
statements which focus on
the identification and the
description of variables or
concepts and sometimes on
determination of
relationships of variables.
The objectives of “this study were
to: (a) describe the self-reported
physical & mental health, disability
level, & social support of persons
chronically ill with multiple
sclerosis; and (b) contrast rural &
urban residents in relation to health
description, social support, &
perception of health.”
Definition:
Research questions are
interrogative statements that
focus on what variables or
concepts are to be described
and what relationships might
exist among them.
What is the
relationship between
reported depressive
symptoms and rate of
return to work for
patients following
cardiac surgery?
What is the
relationship of anxiety
and compliance with
medications and
follow-up
appointments for
patients following
Definition:
Formal statement of
the expected
relationships among
variables.
 Simple versus Complex
 Nondirectional versus

Directional
 Associative versus Casual
 Statistical versus

Research
 Simple: 2 Variables
A > B
 Complex Hypothesis: More
than 2 Variables

A
B
C
Attitudes of pediatric
nurses toward
mentally retarded
clients are more
favorable than those
of medical–surgical
nurses.
Attitudesof pediatric
nurses toward mentally
retarded clients are
related to number of
years in practice.
Research Hypothesis
(alternative): States
what researcher thinks
is true
Null Hypothesis: States

no difference or
relationship exists
 Statement of relationship between an
independent and dependent variable
 Describes a cause and effect
 Usually stated in two forms
● The null hypothesis

● The alternative hypothesis

 The two forms are


● Mutually exclusive

● Exhaustive
Causal Nurse orientation program will
reduce absenteeism.
hypothesis

There will be no change in


Null: absenteeism as a result of
orientation.

Alternative There will be less absenteeism


as a result of orientation.
(one-tail):
Causal hypothesis Nurse orientation program
will reduce absenteeism.
There will be no change in
Null: absenteeism as a result of
orientation program .

Alternative: There will be less


absenteeism as a result of
orientation
No change

Less
- 0 +
Absenteeism
Our new drug treatment
Causal will cause a difference in
hypothesis depression.

There will be no change in


Null: depression as a result of
treatment.

There will be a change in


Alternative: depression as a result of
treatment.
Our new drug treatment will cause
Causal hypothesis a difference in depression.

There will be no change in


Null: depression as a result of
treatment.

There will be a change in


Alternative: depression as a result of
treatment.
No change

Less More
- 0 +
Depression
Causal hypothesis Our new drug treatment will cause a
difference in depression.

There will be no change in


Null: depression as a result of
treatment
.
Alternative: There will be a change in depression
as a result of treatment.
No change

A “two-tail” hypothesis
Less More
- 0 +
Depression
Cancer patients with
chronic pain who listen
to music with positive
suggestions of pain
reduction have less
reported pain than those
who do not listen to
music.
There is no difference in
the amount of pain
experienced by cancer
patients with chronic
pain who listen to music
with positive suggestion
of pain reduction & those
who do not.
Definition:
Qualities, properties, or
characteristics of persons,
things, or situations that
are manipulated or
measured in research.
 Independent Variables
 Dependent Variables
 Research Variables or

Concepts
 Extraneous Variables
 Demographic Variables
Independent:Leads to or causes something
else

Dependent: Is affected by other


variable(s)
Independent Dependent

Academic
achievement
Independent Dependent

Family
structure Academic
achieveme
nt
Independent Dependent
Family
structure

Economic Academic
status achieveme
nt
Variable: Any observation that
can take different values
Attribute:
Attribute A specific value on a
variable
Variable: Sex or gender
Attribute: Female; male
Independent Dependent

Family
structure
Economic Academic
status achieveme
nt
Schoolin
g
Independent Dependent

Family structure

Economic Academic
status achievemen
Schooling t

Special
tutoring
Independent Dependent

Family
Not structure
manipulable
Economic Academic
status achievemen
Schooling t

Special
tutoring
Independen Dependen
t t
Family
Not structure
manipulabl
e Economic
Academic
status
achievement
Schooling
Manipulabl
e Special
tutoring
Theory or idea
Theory or idea

Reality
Theory or idea Self-esteem

Reality
Theory or idea Self-esteem

I feel good about myself...

Reality 1 2 3 4 5
SD D N A SA
Theory or idea Self-esteem

Operational definition

I feel good about myself...

Reality 1 2 3 4 5
SD D N A SA
Self-esteem
Self-esteem

Operational Operational
definition definition

Operational
definition
Self-esteem

Operational Operational
definition definition

Indicators Operational
definition
Each
indicator is
a fallible
Self-esteem
reflection
of the
construct.

Operational Operational
definition definition

Operational
definition
Example
Variable: Agreement
Attribute: 1 = strongly disagree
2 = disagree
3 = neutral
4 = agree
5 = strongly agree
 Conceptual Definition:
•The abstract meaning of a
variable that usually is based
on theory.
 Operational Definition:
•A way of defining a variable
that makes it measurable or
manipulatable in the real world.
 Conceptual
Definition of
Coping Behavior
•Coping behaviors are actions
directed toward managing
internal and environmental
demands that tax or exceed a
person’s resources (Lazarus &
Folkman, 1984).
 Operational
Definition of
Coping Behavior
• Coping behaviors were measured
with the Ways of Coping Checklist
(WCC), a 68-item scale that contains
eight subscales: one problem-
focused scale, six emotion-focused
scales, and one problem- and
emotion-focused scale (O’Brien,
1993).
 Concept Pain: Uncomfortable sensory
and emotional experience...

 Variables Related to Pain


•Intensity of post-op pain
•Degree of emotional distress
associated with post-op pain
•Perception of pain
•Treatment
•Stimulus
•Manipulated
•Experimental
•Grouping
Outcome
Effect
Response

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