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Introduction to Nursing Research

Research

Means ‘to search again’ or ‘to examine carefully’.

Research is a diligent and systematic inquiry


undertaken to refine or validate existing knowledge
and generate new knowledge

The ultimate goal of research is the development of


a research body of knowledge for a discipline or
profession, such as nursing.
Nursing Research
Nursing research is a scientific process that refines
or validates existing knowledge and generates
new knowledge that will directly or indirectly
influence nursing practice.

The ultimate goal of nursing research is to provide


an empirical basis to guide nursing practice,
what is referred to as evidence-based Practice
(EBP).
Importance of Research in Generating EBP
for Nursing
There are four types of research. Each type of research
provides the basis for the next level of inquiry.
1. Description:
Through descriptive research we try to identify and
better understand nursing phenomena and the
relationships among the phenomena.
Example: A qualitative study conducted in order ‘to
describe the experience of surviving prolonged
mechanical ventilation’. The results from this study
provide nurses insight into the psychological needs of
patients being weaned from ventilators. The implication
for practice include expanding the involvement of the
family in the weaning process and supporting patients in
their expression of religious and spiritual beliefs.
Importance of Research in
Generating EBP for Nursing
(Cont…)
2. Explanation:
Explanation clarifies the relationship among
phenomena and identifies why certain events
occur.

An example of this is the research that has been


done to examine the relationship between
nosocomial infections, higher levels of morbidity
and mortality, and higher hospital costs.
Importance of Research in
Generating EBP for Nursing
(Cont…)
3. Prediction:
This examines the probability of an outcome
occurring in specific situations. This type of
research is common in epidemiology in which
specified risk factors predict the occurrence of
disease.

For example, obesity and inactivity predict higher


rates of heart disease.
Importance of Research in Generating
EBP for Nursing (Cont…)
4. Control:
Control is the ability to specify how to produce a
desired outcome. Control is dependent on
prediction.

For example, the incidence of heart disease is


reduced when levels of obesity and inactivity are
controlled or when people are a normal weight and
they exercise.
Ways of Acquiring Knowledge in
Nursing
Tradition: This represents knowledge based on truths
and beliefs that come from customs and trends.
Developed with past experience, however, units are
set according to traditional rules might not be
effective and efficient. Need research for quality of
life instructions.

Authority: A person with expertise and power who is


able to influence opinion and behavior.
But may have the information that may not validate
from research
Ways of Acquiring Knowledge in
Nursing
Borrowing: Borrowing is nursing involves the
appropriation and use of knowledge from other fields
or discipline to guide nursing practice.
But difficulties to set boundaries

Trial & Error: Trial & Error is an approach with


unknown outcome that is used in a situation of
uncertainty in which other sources of knowledge are
unavailable.
But the time and patients health are on risk
Ways of Acquiring Knowledge in
Nursing
Role modeling: Is learning by imitating the behaviors of an
expert. Mentorship

Personal Experience: It involves gaining knowledge by


being personally involved in an event, a situation or a
circumstances.
1) Novice: No experience
2) Advance beginner: Experience at some extent
3) Competent: Able to generate and achieve long range
goals.
4) Proficient: Well experienced and could tackle the
patient as a whole, family and community
5) Expert: Well exposed and faster in her/his approach
Ways of Acquiring Knowledge
in Nursing
Intuition: Intuition is an insight or understanding of a
situation or event as a whole that usually can not be
explained logically.
Gut feeling; this does not mean a lack of knowledge
rather a deep knowledge.

Reasoning: Reasoning is the process and organizing of ideas


in order to reach conclusion:
a) Inductive : Specific to general
b) Deductive: General to specific
What are nurses' roles in the research
process?

According to professional nursing organizations,


such as the American Nurses Association, the
level of research involvement increases with
each successive level of advanced educational
preparation.

However, having BSN preparation does not


preclude (exclude) being able to participate in
higher levels of research.
Research involvement with
the educational preparation
Doctoral Degree
Extend scientific basis
Develop methods to measure nursing phenomena
Provide leadership

Master's degree
Conduct investigations
Facilitate access to clients
Collaborate with other investigators
Facilitate research
Provide consultation
Analyze and reformulate problems
Research involvement with the educational
preparation (Cont…)

Baccalaureate degree
Apply findings to practice
Share findings
Interpret and evaluate research for practice.

Associate Degree
Collect data
Identify problems
Appreciate the value of research
Nursing Research Priorities
To Improve:

• Nursing as a profession

• Nursing practice

• Patient outcomes
Nursing Research Priorities
(Cont…)
• Evaluates and improves nursing care based on
new and credible knowledge;
• Provides evidence on which to base our nursing
care, or EBP;
• Offers quality and cost containment practices;
• Continuous growth of nursing profession;
• Helps nursing to achieve its own professional
identity;
• Helps to identify the boundaries of nursing;
• Defines the parameters of nursing.
Nursing Research Process
• Research Problem and • Research Design;
Purpose; • Population and Sample;
• Literature Review; • Methods of Measurement;
• Study Framework; • Data Collection;
• Research Objectives; • Data Analyses;
Questions, or Hypotheses; • Research Outcomes;
• Study Variables; • Disseminate of outcomes;
• Assumptions; • Limitations.
Nursing Research Process
Research Problem and Purpose.

Literature Review.

Study Framework.

Research Objectives, Questions, or Hypotheses.

Study Variables.

Assumptions.

Research Design
Nursing Research Process
Population and Sample

Methods of Measurement

Data Collection

Data Analyses

Research Outcomes.

Disseminate of outcomes

Limitations.
Do you think is there any similarities &
differences in Nursing Process &
Research Process?
Comparison of the Nursing
Process & Research Process
Nursing Process Research Process

Assessment Knowledge of the world of nursing


•Data Collection
•Data Interpretation
Nursing Diagnosis Plan Problem, & Purpose Identification
Goal Identification Methodology
Planned Instruction Design
Sample
Measurement
Implementation Data Collection & Analysis
Evaluation & Modification Outcome & Dissemination findings
What is research process……???
• Series of various actions, which are
necessary to effective research work.
• Research process consist of a number of
closely related activities.
• Various steps involved in a research
process are not mutually exclusive;nor
they are separate & distinct.
Steps involved in research
process…..
• 1ST STEP-Establishing the needs for
research
• 2ND STEP-Defining the problem
• 3RD STEP-Formation and Development
Working Hypothesis
• 4TH STEP- Determining research design
• 5TH STEP-Identifying information types
and source
contd..
• 6TH STEP-Determining methods of assessing
data
• 7TH STEP-Designing data collection form
• 8TH STEP-Determining sample plan and size
• 9TH STEP-Data collection
• 10TH STEP-Analyzing data
• 11TH STEP-Preparing and presenting final
research report
• 12th STEP: Dissimination of information
History in Nursing Research
• 1930s through 1940s the focus was on nursing education
• 1950s through 1960s the focus was on nurses and nursing roles
• 1970s through 1990s the focus has been on clinical problems
History in Nursing Research
1850 Nursing research began with Florence Nightingale.
1859 Florence Nightingale studied aspect of the environment
such as ventilation, cleanliness, purity of water, and diet
to determine the influence on patient’s health.
During the Crimean War her research related to deaths
and disability among the soldiers resulted in an amazing
decrease in the mortality rate from 43% to 2%.
1900 First Journal Published “ American Journal of Nursing’
(AJN)
1920s & Case studies began appearing in this journal (AJN)
1930s
1923 First doctoral program for nurses in Teacher College at
Columbia University
History in Nursing Research
1950 American Nurse Association (ANA) initiated a five year
study on nursing functions and activities.
1952 First Journal of Nursing Research published.
1953 The institute of Research and services in Nursing
education established at teachers collage Columbia
University, New York.
1959 The findings from ANA study were used to develop
statement on functions, standards, and qualification for
professional nurses.
1959 Clinical research began expanding as nursing specialty
groups, such as community health, psychiatric-mental
health, medical-surgical, pediatrics, & obstetrics.
1950s & Introduced research in nursing schools at the
1960s baccalaureate & MScN level
History in Nursing Research

1963 Additional research journal, International Journal of


Nursing Studies, was published
1965 ANA sponsored the first series on nursing research
conferences
1967 Image: Journal of nursing scholarly, first published
Late Nurses were involved in the development of models,
1960s & conceptual frameworks, & theories to guide nursing
1970s practice
1970s Research in Nursing, first published
1978 Western Journal of Nursing Research, first published
History in Nursing Research

1980's Clinical research became the important design in


research
Saw many new journals being published e.g. Cancer
nursing; Pediatric nursing, Dimension of critical care
nursing etc.., Applied nursing research.
Clinical research written priority of the 80's
Increase funding for nursing research.
The ANA achieved a victory by establishing the National
Center for Nursing Research in 1985.
History in Nursing Research

1999 Priorities of National Center for Nursing Research


1999 includes:
•Community Based nursing models.

•Effectiveness of nursing interventions in HIV/AIDS.

•Cognitive impairment.

•Living with chronic illness.


Paradigms and methods for
Nursing Research

•Positivist paradigm
•Constructivist paradigm
What Is a Paradigm?
•A world view; outlook, style, viewpoint, or a
general perspective on the complexities of the real
world, with certain assumptions about reality

•Paradigms are lenses that help us to sharpen our


focus on a phenomena of interest; they are not
blinder that limit our intellectual curiosity

•Key paradigms for nursing research:


– Positivist paradigm
– Constructivist/Naturalistic paradigm
Positivist Paradigm
• It is the paradigm of the 19th century, guided by the work of these
philosophers as Comte, Newton, and Locke.

• The positivist assume that the world is based on some reality which
has to be studied and known

• Assumption is a basic principle/truth that is not to be challenged and is


believed to be true without proof or verification. Objective reality exists
independent of human observation

• Determinism: Phenomena are not haphazard or random events but


have antecedent cause. This type of research is directed to understand
the underlying causes of natural phenomena. OBJECTIVITY

• If a person develops lung cancer, the scientist assumes that there may
be one or more reasons that can be potentially identified and
understood.
Naturalistic Paradigm
• It begins as countermovement to positivism with writers
such as Weber & Kant.

• The naturalistic assume that reality is not fixed entity but it


is the outcome of the subjects’ activity.

• There is relativism: multiple interpretations exist in the


individuals minds, and then there is no process by which
the ultimate/final truth or falsity can be determined (there is
no final truth or falsity) SUBJECTIVITY

• The naturalistic assumes that knowledge is maximized


when the distance between the researcher and the
participants in the study is minimized.
The Nature of Reality?

• Positivist assumption: Reality exists;


there is a real world driven by natural
causes

• Naturalistic assumption: Reality is


multiple and subjective, constructed by
individuals
Type of assumption Positivist paradigm Constructivist paradigm

The nature of reality Reality exists Multiple realities

Relationship between Independent from participants Part of the research process


researcher and participants

Values in inquiry Objectivity Subjectivity

Best methods .deductive .inductive


. Discrete-specific concepts .emphasis on the whole
.objective, quantifiable .subjective, non-quantifiable
.researcher predictions .emergent insight from
.fixed, specified design participant experiences
.control over context .contextualized
. Quantitative information .narrative information
.statistical analysis .qualitative analysis
.Seek generalizations .seeks in-depth-understanding
Qualitative Research:
 Systematic, subjective approach used to describe life
experiences and give them meaning.
 It involves finding out what people think and how
they feel - or at any rate, what they say they think and
how they say they feel.
 This kind of information is subjective. It involves
feelings and impressions, rather than numbers.
Quantitative Research:
Formal, objective, systematic process used to describe, test
relationship and examine cause and effect interactions among
variables
• Methodologies are fundamentally different
• But not fundamentally opposed
• Can be used in conjunction
Quantitative Qualitative
• Limited Exploratory

• Hypothesis Testing Theory Generation


• Specific Holistic
• Statistical Interpretative
• Numeric Textual/ Verbal
• Absolute Truth
Truth is dynamic
Quantitative
 Descriptive Research
Qualitative
 Correlational Research  Phenomenological
Research
 Cohort studies
 Grounded Theory
 Experimental Research
Research
 Quasi-experimental
Research  Ethnographic Research
 True experimental  Historical Research
Research
• Basic or Pure Research
• Applied or Practical Research
• Action Research
• Outcome Research
It is a process in which data are scientifically collected
to advance knowledge (new, existing) without particular
reference to its immediate or practical use.
 It generates, rests, expands theories that describe,
explain, or predict the phenomenon of interest to the
discipline without regard to its later use.

(Basavanthappa, 2010, Polit & Beck, 1997)

Examples of pure research would be: determining the


gravitational constant in the "law of universal
gravitation,"
• It is a research that is designed to produce findings that
can be used to remediate or modify a given situation.
• It is a scientific investigation conducted to generate
knowledge that will directly influence or improve
clinical practice (Abdellah & Levine, 1979).
• Applied research is designed to solve practical
problems, rather than to acquire knowledge for
knowledge's sake.
 The purpose of applied research is to solve problems,
make decisions or predict control outcomes in real-
life situations.
 The findings from applied studies can also be
valuable to policymakers as a basis for making
changes to address social problems (Miller,1991)
Examples:
 Applied researchers may investigate ways to treat or cure
a specific disease: e.g. Testing nursing interventions for
pain management
• Basic research is undertaken to extend the base of
knowledge in a discipline or to formulate or refine a
theory.
• For example, a researcher may perform an in-depth
study to better understand normal grieving processes,
without having explicit nursing applications in mind.
• Applied research focuses on finding solutions to
existing problems.
• For example. A study to determine the effectiveness of
a nursing intervention to ease grieving would be
applied research.
• It is a way of doing research and working on solving a
problem at the same time.” OR” It is a cyclic process
containing both investigation and the use of its
findings.
• Action research is “learning by doing” - a group of
people identify a problem, do something to resolve it,
see how successful their efforts were, and if not
satisfied, try again.
• Steps in action research are Assessment, Objectives,
Change, Implement, Final assessment and Conclusion
Example:
Analysis of people’s health problems in a particular area
by health professionals with the aim of producing
appropriate treatment and health promotion programs
 In nursing, action research has often been seen as an
appropriate way to try to bring about changes in clinical
practice.
 Nurses working together to research the effects of new aseptic
dressing procedure to discover its benefits, is an example of
action research.
• Outcomes research is focused on examining the end
results of patient care or determining the changes in
health status for the patient
(Rettig, 1991)
Examples
 Financial outcomes achieved with the provision of
health care services
 Patient’s satisfaction with health outcomes, care
received and health care providers
• The increasing cost of health generated many questions
about quality and effectiveness of health care services
and patient’s outcome related to those services.
• Consumers want to know what services they are
purchasing and if these services will improve their
health.
• Health care policy makers want to know if the care is
cost- effective and of high-quality
• These concerns promoted the conduct of outcomes
research
Nursing Research Methods

Quantitative Research/scientific method

Qualitative Research/constructivist method

Outcomes Research
Nursing Research Methods

NURSING RESEARCH

Qualitative research Quantitative research Outcome


research

- Phenomenological - Descriptive
- Grounded theory - Correlational
- Ethnographic - Quasi-experimental
- Historical - Experimental
Types of Quantitative Research

Descriptive Research

Correlational Research

Quasi-Experimental Research

Experimental Research
Types of Qualitative Research

Phenomenological Research
Grounded Theory Research
Ethnographic Research
Narrative research
Case Study
Outcomes Research

Is focused on examining the end results of care


or determining the changes in health status for
the patient.
Four essential areas:
The patients responses to medical/nursing int.
Functional maintenance/improvement of
physical functioning for the patient.
Financial outcome achieved with the provision
of health care services.
Patients satisfaction with the health outcomes
care received and the health care provider.
How is evidence-based practice
(EBP) developed
• EBP is developed through a combination of
research approaches.
• Through qualitative research we are able to
better understand the patient's and family's
experiences with health and illness.
• Quantitative research provides a mechanism for
testing the effectiveness of nursing interventions.
• Finally, outcomes research focuses on the
provision of quality, cost-effective care.
RESEARCH PROCESS
IN FLOW CHART

REVIEW THE
2
1 LITERATURE 3 4

REVIEW CONCEPT
DEFINE
&THEORIES FORMULATE
RESEARCH DESIGN
HYPOTHES
PROBLEM RESEARCH
REVIEW PREVIOUS
RESEARCH FINDINGS

5 6 7

COLLECT ANALYSIS DATA


INTERPRET
DATA (TEST HYPOTHESES
F F AND REPORT
IF ANY)
References
Burns, N. & Grove, S. K. (2007). Understanding nursing
research. (4th ed.).Philadelphia: W.B. Saunders.
PAGE, A. (1999). Nursing research. Retrieved October 3,
2007,
fromhttp://www.nipissingu.ca/faculty/arohap/aphome/NUR
S4016/Lectures/CHAPTppt.PPT.
Polit, D, F. (2014). Essentials of Nursing Research,
appraising evidence for Nursing practice (8th ed).
Lippincott Williams and Wilkins.