nursing research lec 09

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)

With evidence 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 problemsGrowing 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

4. 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 ProcessNursing Process Research ProcessResearch Process1.1. Assessment Assessment 1.1. Knowledge of the World of Knowledge of the World of

a. Data Collectiona. Data Collection NursingNursingb.b. Data InterpretationData Interpretation

2.2. Nursing DiagnosisNursing Diagnosis 2.2. Problem & Purpose Problem & Purpose IdentificationIdentification

3.3. PlanPlan 3.3. MethodologyMethodologya.a. Goal IdentificationGoal Identification a.a. DesignDesignb.b. Planned InterventionsPlanned Interventions b.b. SampleSample

c.c. MeasurementMeasurement4.4. ImplementationImplementation 4.4. Data Collection & AnalysisData Collection & Analysis5.5. Evaluation & ModificationEvaluation & Modification 5.5. Outcomes & Disseminating Outcomes & Disseminating

FindingsFindings

1. Basic Research1. Basic Research

2. Applied Research2. Applied Research

3. Rigor3. Rigor

4. Control4. 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

research

Descriptive Research

Correctional Research

Quasi-Experimental Research

Experimental Research

•Natural or Field Settings

•Partially Controlled Settings

•Highly Controlled or Laboratory Settings

Traditions Authority Borrowing Trial &

Error Personal

Experience

Role Modeling

Intuition Reasonin

g Research

Research Problem & PurposeResearch Problem & Purpose

Literature ReviewLiterature Review

Study FrameworkStudy Framework

Objectives, Questions, or HypothesesObjectives, Questions, or Hypotheses

Study VariablesStudy Variables

AssumptionsAssumptions

LimitationsLimitations

Research DesignResearch Design

Population & SamplePopulation & Sample

Methods of MeasurementMethods of Measurement

Data Collection & AnalysisData Collection & Analysis

Research OutcomesResearch Outcomes

Communication of FindingsCommunication of Findings

EpistemologyEpistemology The The philosophyphilosophy of of knowingknowing

MethodologyMethodology An An approachapproach to to knowingknowing

� Science is a way to learn the TRUTH.

� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.

The Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of Research

� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.



� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.

� Science is a way to learn the Science is a way to learn the TRUTH.TRUTH.

� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.� Science only deals with what we Science only deals with what we

can see or measure – EMPIRICISM.can see or measure – EMPIRICISM.


� Science is a way to learn the Science is a way to learn the TRUTH.TRUTH.

� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.� Science only deals with what we Science only deals with what we

can see or measure – can see or measure – EMPIRICISM.EMPIRICISM.

� The best way to learn the truth is The best way to learn the truth is to EXPERIMENT.to EXPERIMENT.


� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.� Science only deals with what we can Science only deals with what we can

see or measure – EMPIRICISM.see or measure – EMPIRICISM.� The best way to learn the truth is to The best way to learn the truth is to

EXPERIMENT.EXPERIMENT.� Science is OBJECTIVE.Science is OBJECTIVE.

The Positivist View of ResearchThe Positivist View of Research

Similarity between common sense and science


NATURAL SELECTION model of knowing

Random VariationRandom Variation

Selective RetentionSelective Retention


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 CommitmentMoney CommitmentResearchers’ ExpertiseAvailability of Subjects,

Facility, & EquipmentEthical 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 cardiac surgery?

Definition: Formal statement of the expected relationships among variables.

Simple versus Complex Nondirectional versus Directional

Associative versus CasualStatistical versus Research

Simple: 2 VariablesA > 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.

Attitudes of 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

Nurse orientation program will reduce absenteeism.

There will be no change in absenteeism as a result of orientation.

There will be less absenteeism as a result of orientation.

Causal Causal hypothesishypothesisCausal Causal hypothesishypothesis

Alternative Alternative (one-tail):(one-tail):

Alternative Alternative (one-tail):(one-tail):

Null:Null:Null:Null:

Nurse orientation program will reduce absenteeism.

There will be no change in absenteeism as a result of orientation program .

There will be less absenteeism as a result of orientation

Causal hypothesisCausal hypothesisCausal hypothesisCausal hypothesis

AlternativeAlternative::AlternativeAlternative::


00 ++--

No changeNo change

LessLess

AbsenteeismAbsenteeism

Our new drug treatment will cause a difference in depression.

There will be no change in depression as a result of treatment.

There will be a change in depression as a result of treatment.

Causal Causal hypothesishypothesisCausal Causal hypothesishypothesis

Alternative:Alternative:Alternative:Alternative:






Alternative:Alternative:Alternative:Alternative:


00 ++--

No changeNo change

LessLess MoreMore

DepressionDepression





Alternative:Alternative:


A “two-tail” hypothesisA “two-tail” hypothesis

00 ++--

No changeNo change

LessLess MoreMore

DepressionDepression

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 VariablesDependent VariablesResearch Variables or Concepts

Extraneous VariablesDemographic Variables

Leads to or causes something else

Is affected by other variable(s)

Independent:Independent:Independent:Independent:

Dependent:Dependent:Dependent:Dependent:

Academic Academic achievementachievementAcademic Academic achievementachievement

IndependentIndependentIndependentIndependent DependentDependentDependentDependent

Family Family structurestructureFamily Family structurestructure Academic Academic

achievemeachievementnt

Academic Academic achievemeachievementnt


Family Family structurestructureFamily Family structurestructure

Economic Economic statusstatusEconomic Economic statusstatus




Variable:Variable: Any observation that can take different values

AttributeAttribute: A specific value on a variable

Variable: Sex or genderAttribute: Female; male

Family structureFamily structure


SchoolinSchoolinggSchoolinSchoolingg




Family structureFamily structureFamily structureFamily structure

Economic Economic statusstatusEconomic Economic statusstatusSchoolingSchoolingSchoolingSchooling

Special Special tutoringtutoringSpecial Special tutoringtutoring

Academic Academic achievemenachievementt





SchoolingSchoolingSchoolingSchooling





NotNotmanipulablemanipulable



SchoolingSchoolingSchoolingSchooling


Academic Academic achievementachievement

Academic Academic achievementachievement

IndependenIndependenttIndependenIndependentt

DependenDependenttDependenDependentt

ManipulablManipulablee

NotNotmanipulablmanipulablee

Theory or ideaTheory or ideaTheory or ideaTheory or idea


RealityRealityRealityReality



Self-esteemSelf-esteemSelf-esteemSelf-esteem




I feel good about myself...I feel good about myself...

11 22 33 44 55SDSD DD NN AA SASA



Operational definitionOperational definition


I feel good about myself...I feel good about myself...

11 22 33 44 55SDSD DD NN AA SASA


OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition







IndicatorsIndicators





Each Each indicator is indicator is a a falliblefallible reflection reflection of the of the construct.construct.

Variable: AgreementAttribute: 1 = strongly disagree

2 = disagree3 = neutral4 = agree5 = strongly agree

ExampleExampleExampleExample

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

OutcomeEffectResponse

nursing research lec 09

Documents

nursing practice

impact of research

based practice research

highquality research

planning nursing care

nursing education

nursing administration

research process steps