HAND-OUT ON INRES 1, PART i (covering PRELIMS Topics) I. OVERVIEW OF NURSING RESEARCH: INTRODUCTION A.

Definition of Research, Nursing Research RESEARCH a systematic inquiry that uses disciplined methods to answer questions or solve problems NURSING RESEARCH- Systematic inquiry designed to develop trustworthy evidence about issues of importance to the nursing profession including nursing practice, education, administration, informatics (Polit & Beck) B. TYPES OF RESEARCH ACCORDING TO PURPOSE General Purpose: to answer questions or solve problems of relevance to the nursing profession BASIC/PURE RESEARCH-Research provides tools for observation in order to generate knowledge as basis for predicting & controlling the phenomenon; to extend the base of knowledge in a discipline ,or to formulate or refine a theory (without having explicit nursing applications in mind) APPLIED RESEARCH- Research done in order to apply this in practice; focuses on finding solutions to existing problems C. SPECIFIC PURPOSES OF RESEARCH Identification & Description: research describes a phenomenon that relates to the nursing profession as well as to observe, define and document nursing situations under inquiry Example: Nursing Care. Refers to services rendered by professional & non professional nursing personnel to respond to the health needs and problems of individuals, families and groups and communities intended to bring comfort and ease to clients Exploration: Research explores the phenomenon being investigated by observing and recording events or situations occurring in that phenomenon: it answers what questions Examples: What factors influence adjustment of patients to hospitalization? What factors relate to patients stress levels? How do nurses react to aggressive patients? Explanation: Research seeks clarification of a prevailing situation to answer questions that ask why a phenomenon occurred, Why did this happen? What could have happened if ?? Research is generally linked to theories as a method of clarifying , explaining & integrating ideas to determine the reasons for the existence of a particular phenomenon Examples: Why do older patients need more time than younger patients to recover? Why do younger children need more parenting than older children? Prediction and Control: Research anticipates possible psychological and physiological reactions to nursing interventions; supports nursing decisions by eliminating barriers & sourcing ways & strategies that would bring about effective client care outcomes -Prediction: Projects a situation/event that could arise from research investigation - Control: Puts up a barrier to hinder or minimize the effects of anticpated outcomes or reactions Example: Incidence of Down s syndrome in infants is expected to increase with the age of the mother?

Predict: Projection of the greater risk of a 40 year old or older woman compared to a 25-year in bearing a child with Down s Control: refers to nursing actions or interventions that respond to patient needs in order to prevent & eliminate potential health problems D. Evolution of Nursing Research- Ref. Polit, 1. From Nightingale to the 1960 s:: landmark publication, Notes in Nursing (1859)analysis of factors affecting soldier mortality & morbidity in Crimean War; mostly on nursing education; 1900-American Journal of Nursing begins publication; 1923- Golmark report;1936- Sigma theta tau funded nursing research;1940s govt-initiated studies of nursing education; 1950s- rapidly accelerating upswing in the US, an increase in the number of nurses with advanced eduacational degrees, establishment of nursing research center, increase in availability of funds, not very clinically oriented 2. Nursing Research in the 1970s: journals including Advances in Nursing Science, Research in Nursing & Health, Western Journal of Nursing Research; change of emphasis in nursing research from teaching, curriculum & nurses themselves to improve client care; 1976-Journal of Advanced Nursing published 3. Nursing Research in the 1980s- increase in the number of qualified nurse researchers, widespread availability of computers; 1983-published Annual Review of Nursing Research & creation of Center for Research in Nursing; 1986-National Center for Nursing Research; 1989- Agency for Health Care Policy & Research 4. Nursing Research in the 1990s- 1993- National Institute of Nursing Research; funding for nursing research has grown;major contributions to EBP emerged internationally 5. Future directions for Nursing Research-heightened focus on EBP;development of a stronger evidence base; greater emphasison systematic integrating reviews; expanded local research in health care settings; strengthening of multidisciplinarycollaboration; expanded dissemination of research findings E. Paradigms for Nursing Research- Positivist & Naturalistic Positivist Paradigm Reality exists Naturalistic Paradigm Reality is subjective;mentally constructed by individuals Inquirer interacts with those being researched

Inquirer is independent from those being researched; findings are not influenced by the researcher Values & biases are to be held in check; objectivity sought Deductive process; outsider knowledge For details, refer to Polit, p.14

Subjectivity & values are inevitable and desirable

Inductive processes; Insider knowledge

F. ROLES OF NURSES IN RESEARCH Fundamentals of Nursing Research, Neiswiadomy,2008.pp.11-13

Principal Investigator- needs special training Member of a research team Identifier of researchable problems Evaluator of research findings- (may also be considered a critic but would need more training & experience) User/ consumer of research findings Patient/client advocate during studies Subject/participant /respondent in studies G. SOURCES OF EVIDENCES IN NURSING RESEARCH 1. Tradition (customs and unit culture ) & authority 2. Clinical experience (ability to generalize, make predictions based on observations); trial & error, intuition 3. Logical reasoning-( problem-solving method combines experience, intellectual faculties, & formal systems of thought) Inductive reasoning- process of developing generalizations from specific observations; deductive reasoning- process of developing specific predictions from general principles 4. Assembled information- e.g. benchmaking data, cost data, quality improvement & risk data 5. Disciplined researchH. EVIDENCE-BASED NURSING PRACTICE - Definiton: conscientious use of current best evidence in making clinical decisions about patient care - Emphasis on identifying the best available research evidence and integrating it with other factors - Resources for evidence-based practice- (1)systematic reviews (cornerstone of EBP);most common type of systematic review was traditional narrative (qualitative);meta-analysis-(technique for integrating quantitative research finding statistically); (2) clinical practice guidelines ( specific practice recommendations and prescriptions for evidence-based decision making; (3) Other preappraised evidence- research evidence that has been carefully selected from primary studies & evaluated for use by clinicians - Models & Theories for EBP 1 Diffusion of Innovations Theory/ Stetler- focus on the use of research from the perspective of individual clinicians 2..Iowa Model- focus on institutional EBP efforts ( see Figure 2.2- Polit, p.38)

II.

OVERVIEW OF THE RESEARCH PROCESS A. Major Steps of Quantitative & Qualitative Research

Identification and Definition of a Research Problem

S ta tem e n t of Re se ar ch Pro bl em / O bjec tive s Th e o reti cal / Co n ce ptu a l F ra m ew or k Fo rm u la tio n S ta tem e n t o f Re se ar ch Pro bl e m / O bje ctive s

Hypothesis Formulation Choosing Appropriate Research Design Identification of Target Population & Sampling Data Collection
Pre pa ra tio n of R ese a rch I n stru m e n t R el ia bi li ty T esti n g a nd Va li da tio n Re li ab il ity T esti n g a n d Va li da tio n Re li a bi lity T esti n g an d Va lid a tio n

Data Processing (Editing, Coding, Encoding, Creation of Data Files Tabulation Data Analysis and Interpretation (Statistical Analysis, Interpretation, Generalization Report Preparation and Information Dissemination

A-1. QUANTITATIVE RESEARCH (Polit, pp.64-68; Figure 3.1. p.65) Phase 1: The Conceptual Phase Step 1: Formulating & delimiting the Problem Step 2: Reviewing the related literature Step 3: Undertaking Clinical Fieldwork Step 4: Defining the framework and developing the conceptual definitions Step 5: Formulating Hypothesis Phase 2: The Design & Planning Phase Step 6:Selecting a Research Design Step 7: Developing Protocols for Intervention Step 8: Identifying the Population Step 9: Designing the Sampling Plan Step 10: Specifying Methods to Measure the Research variables Step 11: Developing methods to safeguard human or animal rights Step 12: Reviewing & finalizing the research plan Phase 3: The Empirical Phase Step 13: Collecting the data Step 14: Preparing the data for analysis Phase 4: The Analytic Phase Step 15: Analyzing the Data Step 16: Interpreting the results Phase 5: The Dissemination Phase Step 17: Communicating the findings Step 18: Utilizing the findings in practice A-2: ACTIVITIES IN A QUALITATIVE STUDY (Polit, pp.68-71, Figure 3.2, p.69) Conceptualizing and Planning a qualitative study( Identifying the research problem, doing a literature

Review, selecting and gaining entre into research sites) Conducting the qualitative study Disseminating qualitative findings B. Classification of Research 1. According to philosophy : Positivist and Naturalistic 2. According to the nature of design: Quantitative and Qualitative Elements Quantitative Qualitative Approach Deductive Inductive Purpose Theory testing, prediction, Describing multiple realities, establishing facts, hypothesis testing developing deep understanding, capturing everyday life & human perspectives Research focus Isolates variables, uses large samples, Examines full context, interacts with collects data using tests & formal participants, collects data face to face instruments from participants (interviews) Research Plan Developed before the study is Begins with initial ideas that evolve as initiated, structured; proposal is researcher learns more about formal participants and settings, flexible; proposal is tentative Data Analysis Mainly statistical, quantitative Mainly interpretive, descriptive

3. According to time dimension: Cross-sectional and Longitudinal Longitudinal study- a study in which data are collected at more than one point in time over an
extended period. There are several types of longitudinal studies: a. trend studies are investigations in which samples from a population are studied over time with respect to some phenomenon. Different samples are selected at repeated intervals but the samples are always drawn from the same population. Trend studies permit researchers to examine patterns and rates of change over time and to predict future developments. Trend studies typically are based on surveys. b. cohort studies are king of trend studies in which specific subpopulation are examined over time. The samples are drawn from specific age-related subgroups. c. Panel studies same people are used to supply data at two or more points in time. It refers to the sample of subjects providing data. Because this studies examine the same sample, the researchers can identify individuals who did and did not change and then examine characteristics that differentiate the two groups. Cross sectional studies involve the collection of data at one point in time: the phenomena under study are captured during one period of data collection. These designs are sometimes used for time related purposes, but results may be ambiguous

III.

MAJOR PHASES OF THE RESEARCH PROCESS A. CONCEPTUAL PHASE ( Formulation of Research Problems-general & specific, Theoretical/conceptual framework, hypothesis formulation) RESEARCH PROBLEM 1. Sources of Research problems: Personal experiences; inquire from health practitioners; ask experts; interview health leaders; ask recognized academicians; attend conferences, symposia; inquire from other agencies; read the literature; surf the internet

2. Characteristics of a Good Research Problem: 2.1.Significance of the problem: Evidence from the study should have the potential of contributing meaningfully to nursing practice. Within the context of the existing body of evidence, the new study should be the right next step. The right next step could involve an original idea for a line of inquiry, but it could also involve a replication or a study to answer previously asked questions with a greater rigor or with different types of people. Significance of the problem is established if result of the study indicates the following: a. b. c. d. e. the inquiry helps solve persistent, prevailing problems it relates to and is useful to a particular group of people it makes a difference between post and current theory and practice it further refines already established concepts, conditions, practices, and situations it contribute to the stockpile of knowledge in the particular field

2.2.Researchability of the problem: Not all problems are amenable to research inquiry. Questions of moral or ethical nature, although provocative, are incapable of being researched. 2.3.Feasibility of the problem (viability) A third consideration in evaluating a problem concerns feasibility, which encompasses several issues. Not all of the following factors are relevant for every problem, but they should be kept in mind in making a final decision. Feasibility is the potential researchability of the problem which makes it a good subject for subject inquiry. 2.4.Researcher interest: Even if the tentative problem is researchable, significant, and feasible, there is one more criterion: your own interest in the problem. Genuine interest in and curiosity about the chosen problem are critical prerequisites to a successful study.

3. Criteria for selecting problem: qualifications of researcher; availability of data; time constraint; availability of resources; significance of the topics; newness of topic 4. Criteria for formulating the Research Problem: a. b. c. d. e. f. g. h. i. Write in question form Name specific problem area Phrase the topic into something workable & manageable Limit the scope to realistic parameters; not too narrow nor too broad Use wordings that are unbiased, objective and not emotion-laden Cite clearly the relationship of the variables to be studied Use phrases and wordings that are measurable and can be proven empirically Indicate the data and techniques to answer the question Observe correct grammar for clarity

2. REVIEWING THE RELATED LITERATURE & STUDIES

3. DEVELOPING THE RESEARCH FRAMEWORK

Both theories and conceptual models can be used to derive hypotheses Both theories and conceptual models are tentative in nature. Both theories and conceptual models are invented by humans

Theory refer t an abstract generalization that offers a systematic explanation about how phenomena are interrelated. It is also defined or described as a series of propositions regarding interrelationships among concepts. Conceptual models/framework/schemes represent a less formal attempt at organizing phenomena than theories. Conceptual models like theories deal with abstractions that are assembled by virtue of their relevance to a common theme. What is absent from conceptual model is the deductive system of propositions that assert and explain a Relationship among concepts. Conceptual models provide a perspective regarding interrelated phenomena, but are more loosely structured that theories. Conceptual models just like theories can serve as a springboard for generating research hypotheses.

4. FORMULATING HYPOTHESIS
directional hypothesis is one that specifies not only the existence but the expected direction of the relationship between variables. The research hypothesis is a directional hypothesis because there is an explicit prediction of a significant increase in the rate of healing of decubitus ulcer in those who received regular application of topical insulin than those who do not received it. Hypotheses derived from theory are almost always Directional because theories explain phenomena, thus providing a rationale for expecting variables to be related in certain ways. Non-directional hypothesis does not stipulate the direction o the relationship. Null Hypothesis state that there is no relationship between the independent and dependent variables