NURSING RESEARCHTrina C. Tan

Goal is to to provide a body of abstract knowledge growing out of scientific research and logical analysis and capable of being translated to nursing practice. Nursing Research is needed to generate knowledge about nursing education, nursing administration, health care services, characteristics of nurses, and nursing roles . Nursing Research is essential for the development of empirical knowledge that enables nurses to provide Evidenced-based Practice, to improved nursing care, patient outcomes, and the health care deliver system.

Purposes of Research: To describe a phenomenon that relates to the nursing profession. To explore - observe and record the phenomenon under study. To explain why a phenomenon occurs. To improve new knowledge or advance an existing one. To predict - the probability of a specific outcome can be estimated in a given situation. To control - the ability to write a prescription to prescribed the desired outcome

Classification of Research According to level of investigation 1. Exploratory 2. Descriptive 3. Experimental According to approach 1. Experimental 2. Non-experimental

According to measurement & data analysis 1. Quantitative 2. Qualitative According to time frame 1. Longitudinal 2. Cross sectional

According to motive or objective 1. Basic research 2. Applied research According to time line 1. Retrospective 2. Prospective

According to research environment 1. Field 2. Laboratory

Criteria of a Research Problem:1. Significance of a problem2. Researchability3. Feasibility Time Availability of the subjects Administrative control and group support Research Resources Fiscal Resources Experience of the researcher Ethical considerations4. Potentials of the Researcher - Interest and curiosity

Delimitations:1. Morals / Ethics2. Insufficient knowledge3. Time4. Cost5. Lack of administrative support

Sources of the Problem:n Fields of specializationn Instructional programn Reading programn Organizational structuren Organizational policies n New technologiesn Conflicting ideas and idealsn Journals, books, theses, mass median Theories and principlesn Problem areas in nursing

Criteria for choosing a problem1. External Criteria Novelty Availability of the subjects Institutional or administrative support Ethical considerations

Facilities and equipment2. Internal Criteria Motivation, interest, intellectual curiosity of the researcher Experience, training, professional qualifications Time factor Costs and returns Hazards, penalties and handicaps

Characteristics of Researchable Problems1. Originality2. Significance3. Manageability4. Measurability5. Resource Availability Variables are qualities , properties, or characteristics of people, things, events, or situations under study Ex. Height, weight, age, sex, blood type Independent variables are factors being manipulated by the researcher. Also called experimental, treatment, causal, or stimulus variables.

Dependent / Criterion / Effect / Response Variable – is the factor influenced by the independent variable. Correlated or intervening variable bears influence on the effect of the independent variable on the dependent variable.

Kinds of Variablesa. Explanatory – focus of the research Independent Dependent Interveningb. Extraneous – not the direct foci of the study1. Organismic - physiological, psychological, demographic factors that could affect the outcome of the study. Ex. age, sex, civil status, education, height, weight, ethnicity, religion2. Environmental – economic, anthropological, sociological and physical factors that influence the phenomenon under study Ex. climate, work setting, home setting, government composition, family composition

3. Continuous - have values along a continuum, can assume an infinite number of values between two points (not limited to a whole number values)

Ex. 1.25, 37.24. Discrete - has a finite number of values between any two points (whole number) Ex. Number of children - 2, RR 165. Abstract – factors that have different values which are quantitatively measured and statistically tested Ex. BP 120/80 to 180/1106. Categorical - discrete non-quantitative values Ex. Race (white, black, hispanic)7. Dichotomous – factors with only two values, used in comparative studies. Ex. male-female, smoker – non-smoker

8. Active – factors which the researcher creates and/or manipulates commonly used in

experimental studies. Ex. Experimental group receiving X solution Control group receiving Y solutio9. Attribute – pre-existing characteristics of the subjects which the researcher simply observes and measures Ex. Medical diagnosis, medications, blood type

Types of Hypothesis 1. Simple vs. Complex Hypothesis 2. Directional vs. Non-directional Hypotheses 3. Research vs. Statistical Hypotheses Criteria of Hypotheses a. Written in declarative sentences b. Written in the present tense c. Includes the population d. Includes the variables e. Reflects the problem statement f. Empirically testable

The greater the degree of sleep deprivation, the higher the anxiety level of medicine ward patients.

Type: Simple

Infants born to cocaine-addicted mothers have the same birth weight as infants born to non-cocaine addicted mothers. Type: Research

There is no significant relationship between maternal cocaine addiction and birth weight of infants.

Type: NULL

Infants born to cocaine-addicted mothers do not have the same birth weight as infants born to non-cocaine addicted mothers. Type: NULL

Tall people eat more than short people Type: Simple

Tall people tend to eat more and weigh more than short people. Type: Complex

There is a change in the anxiety levels of preoperative patients after listening to a relaxation tape Type: Non-directional The anxiety levels of pre-operative patients are lower after listening to a relaxation tape. Type: Directional

Directional Hypotheses should contain a predictive term such as more than, greater than, decrease in, or positive correlation.

Theories are always speculative in nature and are never considered as true or proven. It helps improve analytical skills, broaden thinking, clarify values, assumptions and accuracy of decisions. Concept is the building block of theory, a word picture or basic idea of a phenomenon that symbolizes reality. Ex. Health Constructs are highly abstract, complex phenomena that are not observable. Ex. Wellness, Self-esteem Theoretical framework consists of theories, concepts, and constructs used as basis of the study.

Ex. Imogene King’s Goal Attainment

Conceptual framework consists of specific or well-defined concepts and constructs. Ex. Oxygenation Proposition is a statement or assertion of the relationship between concepts derived from theories based on empirical data Model is a symbolic representation of some phenomenon and represents some aspect of reality. Conceptual models is an ideas formulated in the mind, a picture of something that actually exists which are abstract and not generally observable in the empirical world. Ex. Orem’s Self-care model

Conceptual paradigm is a diagram that visually presents and interprets the underlying theory, principles and concepts of research. Ex. Halbert Dunn’s High-level Wellness Sources of Hypotheses: Problems, issues and concerns Theoretical framework Experiences Observations Related literature

Types of Research Design Non-Experimental1. Historical Research Design – seeks not only to discover events of the past but to relate it to the present and to future- method of collecting and evaluating evidence from the past- Easiest method because data are ready

2. Descriptive Design – a study that describes the nature of the phenomenon under investigation after a survey of trends, practices and conditions that relate to that phenomenonTypes of Descriptive Data Cross – sectional – it examines subjects at one point in time, and is conducted when time frame is of short duration. Ex-post facto – retrospective studies, data collected after a fact. Prospective data – events that occurred after the study design has been completed, but pursued over a long period of time into the future Also called longitudinal studies

3 Primary longitudinal designs

1. Trend studies - the general population is studied at different points over a long period of time. Participants are not the same at each period but they are representative of the population at that time.2. Cohort studies - focus on the same specific population each time data are collected, samples may be composed of different subjects but with similar characteristics.3. Panel studies - use the same respondents for each progressive time period that the data are collected.

Types of Descriptive Researcha. Surveys – self-reported data are collected from samples for purposes of describing populations in relation to specific given variablesMethods: Mailed questionnaires Face-to-face Telephone survey

b. Co-relational Studies – examines the extent of relationship between variables by determining how changes in one variable relate to changes in another variable.c. Comparative Studies – examine several intact groups to find out the difference between and among them in certain different variables of interest. Descriptive and inferential statistical analyses are used to examine differences between or among groupsd. Methodological Studies – concerned with the development, testing, and evaluation of research methods and instruments- also known as developmental or evaluative research

e. Case Study- in-depth analyses of a single subject for investigation- Individual study about a patient, a family, agency or institution- Examines only a single subject or smaller number of subject

f. Content analysis - the process of dissecting messages embodied in documentsg. Feasibility study – determine the viability of an undertaking or a business venture, establishing an institution or constructing infrastructure.

Experimental - the researcher tries to manipulate the variable to produce a certain consequence, effect, outcome or change1. True Experiment Manipulation

Control Random assignment Measurement of effects2. Quasi – experimental – an experiment that lacks one or more of the 4 properties of the true experiment.3. Pre-experimental design is a research design that does not include mechanisms to compensate for the absence of either randomization or a control group. Done as a preliminary study.

Control group is not subjected to any experimental treatment. Subjects performance is used as a basis for evaluating the performance of the experimental group. Experimental group is subjected to the treatment used by the researcher. Internal validity means the degree to which changes in the dependent variable can be attributed to the independent variable. External validity is the degree to which study results can be generalized and applied to other populations and settings.

Threats to Internal validity1. Selection bias2. History3. Maturation4. Testing5. Instrumentation change6. Mortality Threats to External validity1. Hawthorne effect2. Experimenter effect3. Reactive effect of the pre-test4. Halo effectThreats to Internal Validity History - an event that is not related to the planned study but occurs during the time of the study and could influence the responses of subjects to the treatment Selection threat is more likely to occur in studies in which randomization is not possible Maturation is unplanned and unrecognized changes can influence the findings of the study, as the subject grew older and wiser and more experienced during study

Mortality is due to subjects who drop out of a study before completion

Testing - threat may occur in studies where a pretest is given or where subjects have knowledge of baseline data. Subjects may remember the answers they put on the pretest and put the same answers on the posttest.

Instrumentation change - defference between the pre-test and post-test measurement may be caused by change in the accuracy of the instrument.Threats to External Validity Hawthorne effect - occurs when study participants respond in a certain manner because they are aware that they are being observed. Experimenter effect - when researcher characteristics or behaviors influence subject behaviors(Rosenthal effect for nonexperimental)

Reactive Effects of the Pretest - also called the measurement effect, occurs when subjects have been sensitized to the treatment while taking the pretestExperimental Design ExamplesO = Observation / MeasurementR = Random AssignmentX = Treatment / InterventionPretest / Post test R O1 X1 O2 R O1 X1 O2

Threats to all Internal Validity

Two-Group Posttest only R X1 O1 R X2 O1

Three Group R X1 O1 R X2 O1 R O1

Solomon Four Group R O1 X1 O2 R X1 O2 R O1 X2 O2 R X2 O2

Quasi-Experimental Design ExamplesO1 = Baseline Measurement

X = Treatment / InterventionO2 = Outcome Measurement

Nonequivalent Control Group O1 X O2 O1 O2

Threats to Internal Validity : history, testing,, maturation, and instrumentation changeThreats to external validity: Selection bias

O1,O2,O3 = Baseline Measurement at various levelsX = Treatment / InterventionO4,O5,O6 = Outcome measures at various intervals

Time-Series (simple) O1 O2 O3 X O4 O5 O6

Threats to Validity: History and Testing

Pre-Experimental DesignsOne-shot Case study - a single group is exposed to an experimental treatment and observed after the treatment

X 0 Threats to Internal Validity: history, maturation and selection bias

One group Pretest-Posttest design - provides a comparison between a group of subjects before and after the experimental treatment. O1 X O2

Threats to Internal Validity: history, maturation, testing, instrumentation change

Solomon 4 group design is considered to be the most prestigious experimental design because it minimizes threats to internal and external validity

One-shot Case Study is the weakest of all the experimental designs because it controls for no threats to internal validityQuantitative and Qualitativea. Quantitative – is concerned with the objective meaning of experience to an individual, that applies to both experimental and non-experimental studies that yield numerical data that can be subjected to statistical analysis.b. Qualitative – focuses on insights into the understanding of individual perceptions on the phenomenon under study

Types of Qualitative Research Phenomenological – examines human experience through description and analysis Ethnographic studies – refers to collection and analysis of data on the lifestyle and daily activities of ethnics. Grounded Theory Studies – refer to analysis of data leading to the development of a theory Historical studies – involve identification, location, evaluation and synthesis of past data Field Studies – consist of natural investigation done in the community areas.

Advantages of Experimental design1. Explains and establishes casual relationships of variables2. Increases purity of observations3. Creates conditions in the experimental setting that approximates natural setting.4. Free from pressures of daily life when conducted in a controlled unit. Disadvantages of Experimental design1. Dangerous2. Difficult to create conditions 3. Time constraints4. Non-cooperation of subjects5. Population constraints6. Generalization may not be reliable if done in an artificial setting

Advantages of Non-experimental research1. Retrospective and less expensive2. Adequate time3. Cooperation is easy to obtain4. Funding may be available

Disadvantages of non-experimental research1. Not capable of estimating causal relationship2. Cannot be applied to new product or procedure3. Is not useful in development of theories, principles and concepts.4. Oftentimes not considered as true research and may not get financial support.

Universe is a totality of elements to which research findings may apply, also refers to target population. Population refers to accessible group of individuals from which the sample will be drawn by the researcher Target population is the group of individuals or objects about which speculative information is desired.

Respondent population is the group of individuals or respondents chosen to provide data and information needed.

Stratum is a mutually exclusive segment of the population distinguished by traits or qualifications. Sampling unit is a specific area or place which can be used during the sampling process. Sampling frame is a complete list of sampling units from which the sample is drawn. Sampling design is the scheme that specifies the number of samples drawn from the population. Sampling criteria - also referred to as eligibility criteria

Types of Sampling1. Probability Sampling - involves random selection of subjects or elements of the population.Types of Probability Samplinga. Simple random sampling – each has an equal chance or probability of being chosen as subjects of the study.

b. Stratified random sampling – involves taking certain area of the population, dividing it into strata (sub-population), and taking a random sample of each section.c. Cluster sampling – successive selection of random samples from larger to smaller units by either simple random or stratified random methods.d. Systematic random sampling – choose every 10th name in a list of students.

2. Non-probability sampling – subjects are selected in a non-random way.

Types of Non-probability samplinga. Accidental or Convenience sampling – utilizes the most convenient group of people or objects.

b. Purposive or judgmental sampling - subjects are not randomly picked out but hand-picked based on researcher’s experiencec. Quota sampling – dividing the population into subpopulation, but the researcher makes a decision regarding the best type of sample.

d. Snowball sampling – consists of the identification of a few persons who meet the requisite characteristics of the study and who in turn, lead to other persons who may be interviewed.

Sample is also called subjects or respondents of the study. Steps in Sampling1. Identify the target population or universe2. Identify your respondent population3. Specify the criteria for respondent selection4. Specify the sampling design5. Recruit the subjects Scale of measurement refers to a device that assigns code numbers to subjects in order to place them in a continuum

SAMPLING METHOD COMMON APPLICATIONSimple Random Quantitative ResearchStratified Random Quantitative ResearchCluster Quantitative ResearchSystematic Quantitative Research

SAMPLING METHOD COMMON APPLICATIONConvenience Quantitative & QualitativeQuota Sampling Quantitative and rarely QualitativePurposive Qualitative and sometimes quantitativeNetwork Qualitative and sometimes quantitative

Quantitative enumeration of variables – scale of measurement Qualitative description of variablesa. Nominal scale – categorizes and ranks data to determine frequency of occurrence, according to levels of measurementb. Ordinal scale –used in ordering observations, according to magnitude or intensity.

Types of Ordinal scale1. Likert scale – agree or disagree2. Graphic rating scale – highest to lowest, or most to least3. Guttman scale – cumulative statements4. Semantic differential – emotional-evaluative component. Bad-good5. Interval level of measurement – real numbers, specify distance between ranks.6. Ratio level of measurement – distance between ranks is specified up to zero point level

Instruments – are specially prepared tools or devices used to collect needed data or information and facilitate observation and measurement of research variables

Types of Research Instruments a. Questionnaire – most frequently used b. Interview guide – next most used research instrument

Type of Questions asked in the Interview Guide/Interview Schedule 1. Structured – for formal interviews, allows little flexibility for the respondents reaction 2. Unstructured – questions are so framed as to allow the researcher flexibility in questioning the subject

Types of Questions Asked 1. Open-ended – respondents are given flexibility enough to answer questions or specify indicators other than those listed in the questionnaires 2. Close-ended – respondents answer a number of alternative responses called dichotomous items. Types of Close-ended questions a. Dichotomous b. Multiple choice c. Cafeteria questions d. Rank-order questions e. Checklist

Advantages of the Use of Questionnaires 1. Facilitates data gathering 2. Easy to test data for reliability and validity 3. Less time consuming than interview and observation 4. Preserves the anonymity and confidentiality of the respondents reactions Disadvantages 1. Costly 2. Response rate may be low 3. Respondents may provide only socially acceptable answers. 4. There is less chance to clarify ambiguous answers 5. Respondents must be literate and with no physical handicaps 6. Rate of retrieval is low because retrieval itself is difficult

Advantages of Interviews 1. Response are broad and varied 2. Respondents can give complete answers if questions are well structured 3. Verbal and non-verbal behavior can be observed 4. There is flexibility in questions asked

Disadvantages 1. Time consuming and expensive 2. Difficult to set schedule

3. Respondents’ answer may be influenced by the interviewer’s behavior 4. Interviewers need training for the interviewees

Field test or Dry-Run – it is the trial version of the study. Pre-test respondents are part of the population with similar characteristics to those of the actual study subjects, but they will not participate in the actual survey. Statistics is a branch of knowledge used to summarize and present numerical data and numerical characteristics of population.

Statistical Tools for Treatment Data 1. Percentage – computed to determine the proportion of a part to a whole, such as a given number of respondents in relation to the entire population. ex. Variables such as age, height, income etc. 2. Ranking – used to determine the order of decreasing or increasing magnitude of variables.

3. Weighted mean refers to the overall average of responses/perceptions of the study respondents. Used when the variables being studied are abstrct or continuous and cannot be counted individually.

4. Arithmetic mean or average weighted mean describes the central tendency of the given criteria or variables.Mean - averageMedian - middle score of a set of dataMode - most frequently observed score

5. Standard Deviation determines the homogeneity or sameness of degree or dimension of given variables or the heterogeneity or degree of dispersal of variance of variables.6. When the variability of population is desired to be known, measures of variability such as the range, quartile deviation, average deviation or standard deviation may be used.Range - subtracting the lowest score from the highestStandard deviation - square root of varianceVariance - measure of the spread of scores around the mean

6. T-test compares the reactions and responses to perceptions of the respondent groups in the study on the phenomenon under investigation7. The One-Way Analysis of Variance or ANOVA determines if the mean of the responses /perceptions of or among the respondent groups differ significantly

8. Chi square is used to determine the significance of the difference between the reactions or opinions of two distinct groups. Ex. The difference between the reaction of the male and those of the females is to be studied.

Presentation of Findings 1. Narrative Form – consist of direct quotes, summary of findings, meanings and implications of the study, presented objectively, clearly and concisely. 2. Tables – means for organizing data, to make these easily understood and interpreted. 3. Figures – terms used to indicate any type of visual presentation other than the table STEPS IN RESEARCH PROCESSSTEP 1: Selecting the Problem Area Defining and stating the Problem Formulating the Hypothesis STEP 2: Review of the Related LiteratureSTEP 3: Research Design Writing the Research ProposalSTEP 4: Selecting the Sample / SubjectsSTEP 5: Collecting DataSTEP 6: Classifying, Analyzing and Interpreting the DataSTEP 7: Reporting the ResultsCONTENTS OF A THESISChapter I - The Problem Introduction State ment of the Problem Theoretical Framework Assumptions Hypotheses Significance of the Study Scope and Limitation of the Study Definition of Terms

Chapter II - Review of Related Literature and StudiesChapter III - Methodology and Research Design Research Methods and Techniques Sampling Design Research Instruments Data Collection Statistical Treatment of DataChapter IV - Presentation, Analysis, and Interpretation of DataChapter V - Summary, Conclusions and Recommendations

GOOD LUCK!!!