Mandeep Kaur M.Sc.(Medical-Surgical Nursing) Lecturer, College of Nursing, DMC & H, Ludhiana.

Introduction

Research design is a broader plan to conduct a study. A research design is the framework and a systematic plan of what is to be done, how it will be done and how the data will be analyzed. It includes the descriptions of the research approaches, dependent and independent variables, sampling design and a planned format for the data collection, analysis and presentation.

Definitions
The research design is the master plan specifying the methods and procedures for collecting and analyzing the needed information in a research study.

Definitions
Research design can be defined as a blue print to conduct a research study, which involves the description of research approach, study setting, sapling size, sampling technique, tools and method of data collection and analysis to answer a is specific research questions or for testing research hypotheses.

Definitions
Research design is a plan of how, when and where data are to be collected and analyzed. Research design is the researchers overall plan for answering the research questions or testing the research hypothesis.

Elements of research design

four major elements
Qualitative

The Approach

Quantitative Or Both

With/ without a conceptual framework

Method of data analysis

ELEMENTS OF RESEARCH DESIGN

Population, sample & sampling technique

Tools & Method(s) of data collection

SELECTION OF RESEARCH DESIGN

In order to meet the aims and objectives of a study, researchers must select the most appropriate design.

Nature of research problem Purpose of study Researchers knowledge and experience Researchers motivation and interest Research ethics and principles Subjects/Participants Resources and availability of time Possible control on extraneous variables Users of study findings

TYPES OF RESEARCH DESIGN

Research designs are classified in two broad categories and further they have several subtypes.

Quantitative

Qualitative

EXPERIMENTAL RESEARCH DESIGNS

Most scientifically sophisticated research method.

According to Riley Experimental research design is a powerful design for testing hypotheses of causal relationship among variables. Ideally in the experimental design the investigator throw in a sharp relief of explanatory variables in which he is interested, controlling and manipulating the independent variable and observing its effect on the dependent variable and minimizing the effect of extraneous variables, which might confound his results.

I. Types of Experimental Research Designs

TYPES OF RESEARCH DESIGNS 1. True experimental design
- Posttest-only control design - Pretest-posttest control group design - Solomon four group design - Factorial design

MAIN FEATURES

Manipulation of independent variable, in presence of control group, randomization.

- Randomized block design

- Crossover design

2. Quasi-experimental design
- Non-randomized control group design
- Time-series design

Manipulation of independent variable but absence of either randomization or control group.

3. Pre-experimental designs
- One-shot case design
- One-group pretest-posttest design

Manipulation of independent variables but limited

control over extraneous variables, no randomization and control group.

True Experimental Designs

True experimental research designs are those, where researcher have complete control over the extraneous variables and can predict confidently that observed effect on the dependable variable is only due to manipulation of the independent variable. Essential characteristics A true experimental research design must essentially consists the following three characteristics

Manipulation

Refers to conscious control of the independent variable by the researcher through treatment or intervention(s) to observe its effect on dependent variable. Manipulation: The experimental condition Manipulation: The Control Condition - Alternate intervention - A placebo - Standard method of care - Different doses or intensities of treatment - Wait-list control group

Control
Control refers to the use of control group and controlling the effects of extraneous variables on the dependent variable, in which researcher is interested. In Control group number and characteristics of the subject taken are same as that of experimental group, but these subjects receive no experimental treatment or intervention at all and merely observation of dependent variable is made to compare with the experimental group, where experimental group receives planned treatment or intervention Some of the measures ensures the control on extraneous variable are: Matching-- A conscious matching of the subject characteristics in both the groups. Counter balancing-- All the subjects receive all the treatments, but the order of administration of treatment is varied. Homogeneity by statistical test-- Application of statistical test to find no significant difference in the basic characteristics of subjects, which may affect the dependent variables among different groups under study

Randomization Randomization means that every subject has an equal chance of being assigned to any group either experimental or control group. This is also known as random assignment of subjects, which involves the placement of study subjects on a random basis. Randomization is used in true experimental research designs to minimize the threat of internal validity of the study and to eliminate the effect of extraneous variables on dependent variables. Chances of systemic bias is eliminated. Methods of randomization: Basic randomization Cluster randomization Block Randomization

Type of true experimental designs

Post test only design Pretest- posttest only design Factorial design Randomized block design Crossover Design

1. Post-test only control design

Composed of two randomly assigned groups i.e. experimental and control but neither of which is pretested before the implementation of treatment on the experimental group. For example, to study the effect of an educational intervention related to urinary incontinence on the subsequent help seeking behavior of older adults.

2. Pre test- post test only design

In this research design subject are randomly assigned to experimental and control group and before treatment observation is made on dependent variable among both the groups (pre-test). For example, An experimental study to assess the effectiveness of cognitive behavioral therapy interventions for patients with breast cancer.

3. Factorial design:

In factorial design researcher manipulates two or more independent variables simultaneously to observe their effects(Interaction effects) on the dependent variables. This design is useful when there are more than two independent variables, called as factors to be tested.

For example, a researcher wants to observe the effects of two different protocols of mouth care on prevention of ventilator associated pneumonia when performed at different frequency in a day.
Frequency of mouth care 4 hourly (1) 6 hourly (2) 8 hourly (3) Protocols of the mouth care Chlorhexidine (1) Saline (2) 1 1 2 1 1 2 2 2 1 3 2 3

4. Randomized block design

When there are large number of experimental comparison groups, the randomized block design is used to bring homogeneity among selected different groups. This is simple method to reduce the variability between the treatment groups by a more homogenous combination of the subjects through randomized block design. For example, a researcher wants to examine the effect of three different antihypertensive drugs among patients with hypertension. In this example to ensure the homogeneity among the subjects under treatment, researcher randomly places the subjects in homogeneous group (blocks) like patients with primary hypertension, diabetic patients with hypertension, and renal patients with hypertension (Fig. 7.6).
Type of antihypertensive drugs A B C
Patients with primary hypertension (I) BLOCKS Diabetic patients with hypertension (II) Renal patients with hypertension (II)

A, I B, I C, I

A, II B, II C, II

A, III B, II C, III

5. Crossover design

In this design, subjects are exposed to more than one treatment, where subjects are randomly assigned to different orderings of treatment. It is also known as repeat measures design. Though crossover design is considered as extremely powerful research design but some time it is not effective because when subjects are exposed to two different conditions, they may be influenced in the second condition by their experience in the first condition. Example, when we are comparing the effectiveness of the chlorhexidine and saline mouth care protocol, first we implement the chlorhexidine mouth care protocol on group-I and saline mouth care protocol on subjects of group-II. Later treatment is crossed-over; where group-I receives the saline mouth care and group-II receive the chlorhexidine mouthcare.

Groups Group-I Group-II

Protocols of the mouth care Chlorhexidine (1) Saline (2) Saline (2) Chlorhexidine (1)

Advantages of true experimental design

Most powerful designs to establish the casual relationship between independent and dependent variables. Controlled environment in which the study is conducted can yield a greater degree of purity in observation. Conditions not found in a natural setting can be created in an experimental setting, where the independent variable is manipulated by investigator.

Disadvantages

Most of the tomes use of experimental research design is not possible in studies conducted on human beings due to ethical problems. Danger to physical and psychological health of the human subjects Many of the human variables do not have valid criterion measure to measure them like patient welfare or level of wellness. In natural setting like hospital or community it is not possible to impose the control over extraneous variables. Experiments are often impractical where the effect of independent variable may require a lengthy period of time before it emerges as a response in the criterion measures. Very difficult to get cooperation form the study participants Because the population for experiment involving human beings is often kept small, there is a question as to how representative the findings of such studies can be. In research involving human beings the phenomenon are usually so complex and driven from such a purity of causes that the simple experimental approach does not help.

Quasi-Experimental Research Design

Quasi-experimental research design involved the manipulation of independent variable to observe the effect on dependent variable but it lacks randomization.

Quasi experimental designs have property of manipulation Main characteristics

Manipulation of the independent variables to observe the effects on the dependent variables. Lack randomization

Type of quasi-experimental designs

1. Non randomized control group design: It is also knows as non-equivalent control group design. This design is identical to the pre-test post-test control group design, except there is no random assignment of subjects in experimental and control group. Experimental and control groups are selected without randomization and dependent variables are observed in experimental as well as control group. Later experimental group receive treatment and after that post-test observation of dependent variables are made in both the group to assess the effect of treatment on experiment group.
Exp. Group Pre-test

Treatment

Post-test

Control Group

Pre-test

Post-test

2. Time series design

This design is useful when experimenter wants to measure the effects of a treatment over a long period of time. Experimenter would continue to administer the treatment and measure the effects a number of times during the course of the experiment. Single subject research in which researcher carries out an experiment on one individual or on a small number of individuals by alternating between administering a treatment and then withdrawing the treatment to determine the effectiveness of the intervention.
Exp. Group O1 O2 O3
Treatmen t

O1

O2

O3

Advantages and disadvantages of quasi-experimental design

Advantages

More practical, feasible to conduct research studies in nursing More suitable for real word natural setting than true experimental research designs. Disadvantages

There is no control over the extraneous variable influencing the dependent variables. Absence of control group or lack of control over the research setting, make the results of this design less reliable and weak in establishment of casual relationship between independent and dependent variables.

Pre-Experimental Research Design

This research design is considered as very weak, because researcher has very little control over the research. Types of pre-experimental research design 1. One-shot case design: In this research design, a single experimental
group is exposed to an experimental treatment and observations are made after the implementation of treatment. There is no random assignment of subjects to experimental group and no control group.
Exp. Group Treatment Post-test

2. One group pre-test /post-test design: It is the simplest type of

quasi experimental design, where only one group of study subjects is selected as an experimental group. Than pre-test observation of the dependent variables is made before implementation of the treatment to the selected group and finally post-test observation of dependent variables is made to assess the effect treatment on the group.
Exp. Group Pre-test Treatment Post-test

NON EXPERIMENTAL RESEARCH DESIGN

The researcher observes the phenomenon as they occur naturally and does implementation any interventions.

It is a research design in which variables are not deliberately manipulated, nor the setting is controlled. In non experimental research, researchers collect data without making changes or introducing treatments. Data obtained are analyzed and the results may lead to the formation of hypothesis that can then be tested experimentally.

Need of Non-Experimental Design

Non-experimental research design is frequently used by the nurse researchers. Following are the main situation only non-experimental designs can be used to conduct a study. The studies in which the independent variables in non-manipulable. The studies in which it is unethical to manipulate the independent variable i.e. manipulation may cause physical or psychological harm to subjects. The studies or research situations where it is not practically possible to conduct an experimental.

Types of Non Experimental Research Design

There is lack of uniformity in classification of the non experimental research designs.
BROAD CATEGORIES 1. Descriptive design Phenomenon occurs in natural setting without imposing any control or manipulation. TYPES OF RESEARCH DESIGNS MAIN FEATURES

- Univariant descriptive design - Exploratory descriptive design - Comparative descriptive design

Univariant descriptive: Studies undertaken to describe the frequency of occurrence

of a phenomenon rather than to study relationship. Exploratory: Investigating the phenomenon and its related factors about which is not much known.

II. Nonexperi

Comparative: Comparing occurrence of a phenomenon in two or more groups.

2. Correlational/ Ex post facto

- Prospective design - Retrospective design

Cause & effect relationship Prospective: Examining relationship from cause to effect. Retrospective: Examining relationship from effect to cause. Examining the phenomenon in respect to the time. Cross-sectional: Examining the phenomenon only one point in time. Longitudinal: Examining the phenomenon more than one point in time

mental 3. Developmental research

- Cross-sectional design
- Longitudinal design
4. Epidemiological

Epidemiological is the investigation of the distribution and causes of diseases in a population.

Investigation in which self-reported data are collected from sample with the purpose of describing population on some variables of interest.

- Case-control studies
- Cohort studies

5. Survey research

Descriptive Research Designs

The purpose is to observe, describe, and document aspects of a situation as it naturally occurs and sometimes to serve as a starting point for hypothesis generation or theory development.
Main features Used to observe, documenting and describe a phenomenon occurring the natural setting without any manipulation or control. Designed to gain more information about characteristics within a particular field of inquiry. Provide a picture of a situation as it occur in natural setting Do not involve the manipulation of variables and variables are studies in as they exist in real world. Used to develop theories, identify problems with current practices, justify current practices, make judgments or determine what practices are doing in similar situations. Bias is prevented through operational definitions of variables, large sample size, random sampling techniques, valid and reliable research tools and formal data collection methods. Descriptive designs include identification of a phenomenon of interest, identifying the variables within the phenomenon, developing operational definitions of the variables, and describing the variables.

Types of descriptive research design

Univariant descriptive design Univariant descriptive designs are undertaken to describe frequency of occurrence of a phenomenon. This design is not necessarily focus on the study of a single variable, there may be study of one or more variables in a study. For example, a researcher is interested in assessing the experiences of patients suffering with rheumatoid

arthritis.

In this study, researcher may describe the frequency of different symptoms experienced by the patients suffering with rheumatoid arthritis and type of treatment they had during the course of disease etc. There are multiple variables in this research study.

Contd..

Exploratory design Exploratory design is used to identify, explore and describe the existing phenomenon and its related factors. In other words, it is not the simple description of the frequency of occurrence of a phenomenon but it is exploration of phenomenon and its related factors indepth to improve further understanding about a less understood phenomenon. For example, an exploratory study to assess the multifactorial dimensions of fall and home safety measures for elderly people living in selected communities in city Ludhiana.

Contd..

Comparative design Comparative design involves comparing and contrasting two or more samples of study subjects on one or more variables, often at a single point of time. This design is used to compare two distinct groups on the basis of selected attribute such as knowledge level, perceptions, and attitudes, physical or psychological symptoms and so on. For example, A comparative study on health problems among rural and urban older people in district Bikaner, Rajasthan.

Correlational/ Ex-post Facto Research Design

This is non experimental design where researcher examines the relationship between two or more variables in a natural setting without manipulation or control. Main features
Researchers examine the strength of relationships between variables Effect of independent variable is observed on dependent variable without manipulating the independent variable. No difficulty in identifying dependent and independent variables. Magnitude and direction of relationship of independent and dependent variable is measured by using the correlation coefficient statistical measure, where results rage between -1 to +1. Theoretically a positive relationship means increase in one variable leads to increase of another variable. While negative relationship means increase in one variable leads to decrease in another variable or vice versa. In epidemiological language these studies are known as cause and effect study; where cause and effect relationship is investigated in natural setting without imposing experimental interventions.

Types of correlational research design

Prospective research design Prospective research design is a design in which researcher relates the present to future. Starts with presumed cause and then go to presumed effects. In this research design, researcher observes phenomena from cause to effect. For example, a researcher is conducting a prospective correlational study on effect of maternal infection

during pregnancy on fetal development and pregnancy outcome.

In this study, researcher starts observing the pregnant women and collects the data from pregnant women regarding any history of infection among women during pregnancy; later observe fetal development and pregnancy outcome.

Contd..

Retrospective research design Retrospective research design is a design in which researcher study the current phenomenon by seeking information from past. Researcher linked the present phenomenon with past phenomenon. Researcher has backward approach to study a phenomenon, where researcher moves from effect to identify the causes.

For example, a retrospective correlational study on substance abuse related high risk
factors among traumatic head injury patients admitted in Neurosurgery ICU of DMCH, Ludhiana. In this study, fist researcher approach head injury patients and than try to identify that how many head injuries were happened under the influence of substance abuse?

Developmental Research Design

Developmental research design examines the phenomenon in respect to the time. Developmental research designs are generally used as adjunct research design with other research designs such as cross-sectional descriptive, longitudinal correlational research designs and so on.

Types of developmental research design

Cross-sectional design Cross-sectional research design in which researcher collects data at one point of time (one period of data collection). These studies are more easy and convenient to carry out. For example, a researcher in interested in assessing the awareness about Swine Flue among people of an area. Here researcher interactions only once to collect awareness related data from respondents.

Longitudinal design Longitudinal research design is used to collect data over an extended time period (long time study). Its value is ability to demonstrate change over time. For example, a researcher in interested in perception of nursing students towards nursing profession from beginning of nursing program to the end of the nursing program. In this example, it is appropriate to use the longitudinal research design to study this phenomenon.

Contd.

Epidemiological Research Designs

Epidemiology is the study to investigate the distribution and causes of the diseases in population. Epidemiological studies are generally conducted to investigate causes of different diseases in either prospective approaches (causes to effect) or retrospective approach (effect to cause). However, in epidemiology different terminology is used to prospective and retrospective designs. Prospective studies are known as cohort studies and retrospective studies are called as case control studies. Case-control studies In this design, causes of a disease are investigated after the occurrence of a disease. For example, a researcher investigates the history of smoking in patients diagnosed with lung cancer. Cohort studies In this design, a longitudinal approach is used to investigate the occurrence of a disease in existing presumed causes. For example, a researcher longitudinally observes the smokers for developmental of lung cancer.

Survey Research Design

A survey is a research design, which is used to collect information from different subjects within the total population having same characteristics of interest.

If a survey is conducted on a sample of population it is named as sample survey If conducted on entire population it is called a population survey such as censuses etc.

Survey helps to collect wide range of data from sample such as action, attitude, opinion, perception, behaviour, awareness, practices etc. Main features

It enables the investigators to collect current information about whatever it is wish to study. Information in collected from a variety of subjects who resembles the total population. Mode of inquiry that relies heavily upon the validity of verbal reports. The information is obtained directly from the respondent by self-reporting questionnaires Personal interviews are regarded as most useful method of collecting survey data, because of the in-depth and quality of information can be obtained.

Types of the survey

Based on nature of phenomenon under study

Descriptive survey: Survey is undertaken to describe the frequency of occurrence of a phenomenon rather than to study relationship. Exploratory survey: Survey of a phenomenon and its related factors about which is not much known. Comparative survey: Comparing and contrasting the existence of phenomenon two or more groups. Correlational survey: Study of relationship between two or more variables in a natural setting without manipulation or control.

Contd.
Based on methods of data collection

Written survey: where data are collected by help of written structured tools, such as questionnaire, opinionnaire etc. Oral survey: where data is collected by using face to face or telephonic oral conversation or interview with respondents. Electronic survey: where data is collected by using electronic means such as electronic mails message, web forms and mobile SMS etc.

Advantage and disadvantages of non experimental research design

Advantages

They tend to be more close to reality. Most suitable for the nursing research studies. Number of the human characteristics are inherently not subject to experimental manipulation (e.g. Blood type, personality, health beliefs, medical diagnosis) the effects of these characteristics on other phenomena cannot be studied experimentally. Variables that could technically be manipulated There are many research situations in which it is simply not practical to conduct a true experiment. Constraints might involve insufficient time, lack of administrative approval, funds shortages and excessive inconvenience etc. Disadvantages They leave the actual reason for the associations found quite unclear. Non experimental studies are conducted for comparative purpose used the non randomly selected groups, which may not be homogenous and tend to posses the different traits or characteristic, which may affect the authenticity and generaliability of the study results.

OTHER ADDITIONAL RESEARCH DESIGNS

There are some of the research designs, which can not be categorized under either

experimental or non experimental research designs.

Some of such research designs are discussed under this heading; those are methodological studies, meta-analysis, secondary data analysis, outcome research, evaluation studies and operational research.

Methodological Studies
Methodological studies are conducted to develop, validate, test and evaluate the research instruments and methods. Basically a methodological research include following steps; however these steps require sound specified and exhaustive literature review to identify the theories, understanding the construct. Defining the behaviour or construct to measure. Formulating the items for tool. Developing instrument for user and respondent. Testing the reliability and validity of research tool.

Example, a researcher may conduct a methodological study to develop a pressure sore

risk assessment tool for patients admitted in orthopedic wards.

Meta-analysis

Combines the results of several studies that address a shared research hypothesis. Summarizes data from individual studies that concern a specific research question (i.e. each study is a separate data-point in the analysis). Meta-analysis is considered as the statistical analysis of a large collection of analyzed results from individual studies for the purpose of integrating the findings. When results of the several similar studies are analyzed together, the finding of such studies may be more effective or powerful. Meta-analysis studies starts with selecting studies with similar variables and population followed by identifying and coding study characteristics and statistically analyzing and reporting of the analyzed findings of the meta-analysis study.

Steps in conducting a meta-analysis

There are generally five steps in conducting the meta-analysis. Define hypothesis: first you must have a well-defined statement of the relationship between the variables under investigations Locate the studies: a meta-analysis is only informative if it adequately summarizes the existing literature, so a thorough literature search is critical to retrieve every relevant study, such as database searches, ancestry approach, descendancy approach, hand searching and the invisible college Input data: Gather empirical findings from primary studies (e.g. p-value, effect size etc.) and input into statistical database.. Calculate effect sizes: calculate the overall effect by converting all statistics to a common metric, making adjustments as necessary to correct for issues like sample-size or bias, and then calculating central tendency and variability. Analyze variables: if heterogeneity exists, you may want to analyze moderating variable in the database and analyzing either mean differences (for categorical variables).

For example, a meta-analysis study on the coping behaviour of the people with cancer diagnosis. In this study, researcher select quantitative studies with coping behaviour of the people with cancer, which are conducted on the similar age group and later carryout a statistical analysis on the results of the selected studies.

Secondary Data Analysis

A research design in which the data collected by one research are reanalyzed by another researcher, usually to test new hypotheses. In secondary data analysis studies, researchers analyze data collected in previous studies but they may have a new research question or may test new hypotheses. These studies are considered as most convenient, time saving and cost effective, because data collection is considered as the most difficult, time consuming and costly affair in a research activity. A secondary analysis can be performed with both quantitative and qualitative data. Example of quantitative study; As a researcher used data from a previous study of patients with chronic obstructive pulmonary disease to test an explanatory model of factors affecting functional status in this disorder. Example of qualitative study; A researcher did a secondary analysis of data from a qualitative study of clients with end stage renal disease. The original study was designed to examine how and by whom decisions about treatment modality were made, the secondary study examined factors that influenced the decisions.

Outcome Research
Outcome research is research that is planned to assess or record the end result of health care services.

Used in nursing to develop evidence based practice and improve nursing actions. Conducted in response to the increasing demand from public to justify care practices and system that improve patient outcome and cost of care. The focus of the outcome research is predominantly on patients health status and cost of care Aims to document effectiveness of health care services by a global assessment of nursing and health care services. Outcome research is the result of demands by the professional standards review organizations for quality assessment and quality assurance of nursing care.

Nursing care has shifted its focus as follows:

Outcome researches in necessary to develop evidence based practice and improve nursing actions. A link needs to be developed between outcomes and nursing actions, whether they are short-term, temporary or more long-term and permanent.

Example, An outcome research on the effectiveness of Quality Assurance Program (QAP) implemented in Nehru hospital, PGIMER, Chandigarh and Safdarjung hospital New Delhi. Example, An outcome research study on patients satisfaction with existing nursing care in DMCH, Ludhiana.

The design for a qualitative study is an emergent design

A design that emerge as the researcher makes ongoing decisions reflecting what has already has been learned. It has been mentioned by the eminent researcher thinkers that an emergent design in qualitative studies is not the result of researchers sloppiness or laziness, but rather of their desire to base the inquiry on the realities and viewpoints of those under study.

Importance of Qualitative Research Designs

Qualitative methodologies contributes in a discipline that is building a knowledge base in process of clarifying how nursing sciences should be developed, nurse scientists have suggested this contribution. Qualitative research methods enable researchers to study social and cultural phenomenon, so that it were developed in the social sciences. Qualitative research is an inductive approach for discovering or expanding knowledge. In this, it includes researchers involvement in the identification of meaning or relevance of a particular phenomenon to the individual. Qualitative strategies are useful for developing facts and concepts about an area of interest that has received little research attention.

Characteristics of qualitative research design

Phases of the Qualitative Research Design

The naturalistic inquiry processes go through three board phases while the researcher is in the field. Following are the three main phases of qualitative research designs. Orientation and overview phase: In qualitative research, researcher only knows what type of knowledge they expect to obtain by doing particular qualitative study. However, they do not have familiarity with phenomenon that will drive the inquiry forward. Therefore, initially researcher gets an overview of the salient features of interest. Focused exploration: The salient aspects of the phenomenon are more focused in this phase and then in-depth exploration of the salient aspects of the phenomenon is done during this phase. In this phase, a variety of people are invited to participate in the study and questions are asked from them to learn about phenomenon. Questions are asked based on the understanding developed during the first phase of the design. Confirmation and closure: Efforts are undertaken to establish that the findings are trustworthy, which are gathered. The qualitative researchers go back and discuss their understanding with the participants of the study. Therefore, the qualitative researchers confirms their findings by going back and discussing with study participants about their findings whether they are trustworthy or not and then study is closed.

Main Types of Qualitative Data Collection

Following are three main methods of data collection. People asked to verbally describe their experiences of phenomenon. People asked to write descriptions of their experiences of phenomenon. Descriptive observations of verbal and non-verbal behavior.

1. Interactive interviewing 2. Written descriptions by participants 3. Observation

Types of Qualitative Research Designs

Phenomenological research

Ethnographic research

Grounded theory

Historical research

Case study

Action Research

Phenomenological research
Phenomenology is a movement in philosophy that has been adapted by certain sociologists to raise an understanding of the relationship between states of individual consciousness and social life.

According to G.W.F. Hegel

Phenomenology is an approach to philosophy that begin with an exploration of a phenomenon (what presently itself to us in conscious experience), logical, ontological and metaphysical spirit that is behind phenomenon.

According to Edmun Husserl

Phenomenology is an approach to philosophy that takes the intuitive experience of phenomenon (what present itself to us in phenomenological reflection) as its starting point and tries to extract from it the essential features of experiences and the essence of what we experience

Characteristics of the phenomenological approach

This research simply involves to find out what is the essence of a particular phenomenon by these people and what does it mean? Data collection: The primary sources of data collection are the life world of the individuals being studied, in-depth interview are the most common means. Semi-structured, audiotaped interviews with participants. Participants are selected who have recently had the experience. Example, A recently diagnosed HIV patient, or a women who had s still birth in last three month and so on. Data analysis: The process of analysis involves the difficult task of contrasting and comparing the final data to determine what pattern, themes or threads emerge. In the final analysis, then wise researcher is seeks further knowledge about that lived experience in a concise fashion.

Types of the phenomenological research

Types of the phenomenological research as discussed below;

Descriptive phenomenology : It involves Bracketting,Intuiting,analyzing and describing. Interpretive phenomenological research: Bracketting does not necessarily occuring.Hermeneutic inquiry almost focus on meaning and interpretation: how socially and historically conditioned individuals interpret their world with their given context.

Example of phenomenological research:

1. A phenomenological study on live experiences of Tsunami victims in selected villages of state Tamil Nadu. 2. A Phenomenological study on psychological experiences of the victims in Bhopal Gas tragedy at Bhopal, Madhya Pradesh

Ethnographic research

Ethnography is a branch of human inquiry, which is associated with the field of anthropology that focuses on the culture of a group of people Ethnography is basically classified in two types; macro-ethnography and micro-ethnography.

Macro-ethnography is a study of broad defined culture Micro-ethnography is a study of more narrowly defined culture.

Ethnographic research is a method of conducting inquiry into the life process by studying individuals, artifacts or document in the natural setting. In health care research, ethnography provides access to health beliefs and health care practices in particular cultural or sub-cultural group. In nursing, several qualitative nursing phenomenons are studied by using ethnographic research. However, Madeleive Leininger has coined the
phrase ethno-nursing research, which defined as the study and analysis of the local or indigenous peoples view points, beliefs and practices about the nursing care behavior and process of designated cultures.

Characteristics of the ethnographic research

Learns about cultural group in which they are interested through the extensive field work. Labor-intensive and time consuming endeavor, where even month or years of field work in required. A certain level of intimacy with cultural group members is required to study culture. Intimacy can develop over time and by working together directly with those cultural group members who are active participant. Researcher as instrument is used in these ethnography studies, where researcher spends time with cultural group to collect data through informal interaction and observation rather then using a formal tool for data collection. Three type of information is sought in the ethnography studies; those are cultural behavior (what members of culture do), cultural artifacts (what members of the culture make and use) and cultural speech (what people in cultural group say). The ethnographer relies on various sources of data collection such as indepth interview, record analysis, observation of physical evidences (photographs, diaries, letters etc).

Examples of the Ethnography research studies 1. An ethnographic study on the features, critical attributes, processes and benefits of self-help groups of women living with chronic alcoholic husbands in selected villages of district Belgam, Karnataka. 2. An ethnographic study on socio-cultural belief of the people about antenatal, intranatal and postnatal care of women in selected Tribal communities of the sate Rajasthan.

Grounded theory

Grounded theory is an inductive technique developed for health-related topics by Gloser & Strauss (1967). Emerged from the discipline of sociology. Gounded theory means that the theory developed from the research is grounded or has its roots in the data from which it was derived. Grounded theory has become an important research method for the study of nursing theories of phenomenon relevant to nurses. It is an approach to study of social process and social structures. The main focus is on developing social experience- the social and psychological stages and phases that characterize a particular event or episode. According to Martin & Jurner (1986), Grounded theory is an inductive theory discovery methodology that allow the researcher to develop and theoretical account of the general features of a topic while simultaneously grounding the account in the empirical observation or data.

Characteristics of the grounded theory

Overview and phases of grounded theory Grounded theory begins with a research situation. Within that situation the task of researcher is to understand what is happening there (core variable) and how players manage their role. After each hour of data collection note down they key issues; this is labeled as note taking. Constant comparison is heart of process. First researcher compares interview (or other data) to interview (or other data). Theory emerges quickly when it has begun to emerge. Researcher compare data to theory and results of this comparison are written in the margin of the note-taking as coding. Researchers task is to identify categories and their properties. As researcher code, there may be links between categories or about a core category (a category which appears central to study) and proceeding this step provide researcher with theory. Researcher writes notes about it called as memoing. If this process saturates it is the time for sorting. Researcher groups memos, line with line and sequence them in whatever order will make researchers theory clearer.

Methodology: An important methodological technique in grounded theory is constant comparison. Example, A community health nurse is using grounded theory methodology to study scapegoating in dysfunctional families. The nurses limits the study to those families that have children (under 10). Observation for the purpose of collecting data occur primarily in the home. Family interaction and communication pattern are assessed through observation and interview as well as through role playing situation (manipulation) and observation of family members in their work or school environment. As data collection proceeds, nurses begin to from some hypotheses regarding scapegoating activity. During this process, nurses begin to categorize the data and code; it helped her in thinking conceptional families. Sources of data collection: A list of the possible sources that could be used in collecting data relevant to the life processes has shown in Figure

The data collection issues for grounded theory are

Fig. 7.16: Data collection issues in grounded theory

Issues
Methods of data collection

Grounded theory
Primarily individual interviews, sometimes group interviews, observation, participant journals,

documents, self report

Units of data collection Data collection points Individual subject Cross-sectional or longitudinal

Length of Time for data collection Typically moderate Data recording Interview notes/ audiotape recording/ memoing/ observation notes.

Salient features

Building rapport, encouraging candor, listening

while preparing what to ask next, keeping on tarck and handling emotions.

Types of the grounded theory

There are mainly two type of grounded theory and these are: Substantive theory: It is grounded in data on a specific substantive area, such as postpartum depression. Formal theory: Substantive theory serve as a springboard for it which involve developing a higher, more abstract level of theory from a compilation of substantive grounded theory studies regarding a particular phenomenon.

Examples of the grounded theories research studies 1. A study on the response and adaptation process of patients diagnosed with cancer in Nehru hospital, PGIMER, Chandigarh. 2. A grounded theory research on the adaptation of people with accidental permanent physical disabilities in All India Institute of Medical Sciences, New Delhi.

Historical research design

The systematic collection and critical evaluation of data relating to past occurrence is also a tradition that relies primarily on qualitative data. Historical research is undertaken to answer questions concerning causes, effects, or trends relating to past events that may shed light on present behavior or practices.

Characteristics of historical research design

It involves the careful study and analysis of data about past events. It is a critical investigation of events, development, experiences of the past, the careful weighing of evidence of the validity of courses of information on the past Purpose is to gain a clearer understanding of the impact of the past on present and future events related to the life process. Involves the review of written materials but may include oral documentation as well. Historical research typically relies on available data The result of the historical research studies contribute to a clear understanding of pasts, present or future events as they relate to Nursing, Health Care and the life process. Historical method of research covers the following subdivisions such as Historical, Legal, Documentary, Bibliographical, Biographical, Ideational, Institutional, and Organizational. An important existing data source for nurse researchers is records, Hospital records, nursing charts, physicians, order sheets and care plan statements all constitute rich data sources.

Steps of historical research

Use of the historical research approach is highlighted by discrete steps. First step Data collection:- Historical sources of data are usually classified into two main categories. Primary sources:- Primary sources are first hand information such as:

Remains or relic, associated with persons, group, period or event. Fossils, skeletons, tools, weapons, utensils, clothing, buildings, furniture, pictures, painting , coins and art objects are examples of these unconscious remains that were not deliberately intended for use in transmitting information or as records. Oral or written testimony or the records kept and written by actual participants in an event or actual witnesses of the same. These sources are consciously produced for the purpose of transmitting information to be used in the future. Documents classified as primary sources are constitutions, characters, laws, court, rulings, official records, autobiographic letters, and diaries contracts, deeds, wills, license, declaration, certificates, bills, receipts, newspapers, magazines, advertisement, maps, inscriptions, diagrams, books, pamphlets, films, pictures, paintings, recordings and research reports.

Secondary sources: These are the reports of persons who related the testimony of an actual witness of an event or actual participants in the same. The writer of the secondary source, who was not on the seen of the event. Example, most of the history books and encyclopedia.

Second step Criticism of the data:- Which necessitates a comprehensive review of gathered materials. This is an arduous task requiring a sense of skepticism about the accuracy of the documents in question. Christy (1975) describes the analytic process of document review as a two pronged activity:External Criticism:-The establishment of validity by determining the authenticity of the source.

External criticism is covered basically with the authenticity and genuineness of the data. It is preliminary and preparatory step, providing data to be used in the second phase known as internal criticism. External criticism primarily deals with data relating to form and appearance rather than meaning of contents while internal criticism weights the testimony of document in relation to truth. The nurse ascertained that all documents were original. First hand oral and written accounts were accepted as valid. Signatures and date on materials were carefully reviewed, when each document selected for review clearly met the criteria for authenticity, it was then accepted as appropriate for further analysis and interpretation.

Internal criticism:- The determination of reliability by correctly interpreting the content of the document.

Use of original, authentic sources awareness of one's own biases, the substantiation of the document in question by another collaborating source are a few of the safeguards used to ensure that interpretations are correct. To ensure reliability, the nurse examined each document to make sure that the meaning of facts and statement was clearly understood. After the authenticity or genuiness of a historical document or relic has been established the next question is to establish the validity of its contents or to determine the accuracy and value of the statement made. In performing internal criticism, historians must make several determinations which required historical knowledge beyond perusal of the materials in question. Evidence bearing on the accuracy of historical data might include one of the following.

Comparison with other people's accounts of the same event to determine degree of agreement. Knowledge of time at which the document was produced. Knowledge of the point of view or biases of the written and. Knowledge of the degree of competence of the written to record events authoritatively and accurately.

Step Three

Presentation of the facts: After evaluating the authenticity and accuracy of historical data, the research must being to pull the material to gather to analyze them and to test the research hypotheses.

Historical researchers must be extremely careful at this point since the analysis of historical involves logical processes rather than statistical ones Historical composition is a synthetic and constructive process that involves the mechanical problems of document, the logical problem of arrangement of topics and sub-topics and philosophical problem of interpretation. The earlier practice in historical writing presented a strictly chronological type of organization. Such organization involved a series of events broken up into short time units. The writing used to be in nature of calendar and of dates, events and names. The chapters were marked off by a period of a few months or a few years, depending upon the changes of some important nature or occurrence of some significant events. The organization of historical material can be done in another way also be by topical, thematic or functional arrangement. Good history of education observes the conditions of good, story telling shows purposes and meaning and provides back ground from better understanding of current educational problems.

The writing history demands careful avoidance of the following factors:

Over significant of facts. Over generalizations from insufficient evidence. Failure to distinguish between significant and trivial facts. Tendency to use secondary data. Tendency to accept statements as essentially authentic when several of observers agree. Personal bias. A dull and colorless style. Failure to interpret words and expressions in the light of their usage in earlier times.

Determining the interrelationship among facts and the meaning of the data gathered, reviewed and recorded in the final step in historical research. The three steps identified:

Scrutiny of these materials should assist in the construction of the "storey" of facts regarding these leaders. These researchers have done intensive analysis of the image of professional nurses through the examination of various documents. Intensive examination of these historical materials has allowed the nurse historical researcher to identify varying images during different time periods. The result of their analysis has been a systematic evaluation of image problems currently emitting within the profession.

Examples of the historical research studies 1. A historical research on the development of nursing in India. 2. A historical study on inception and development of Punjab Nurses Registration Council. 2. A historical research on the development of nursing education in India.

Action Research
Action research is a form of applied research that tries to empower people through a process that constructs and uses knowledge. It tries to find practical solutions to problems existing in the framework of an organization. It increases understanding of how change in ones actions or practices can mutually benefit nurses within an organization. Emerged in 1940s, it was started by Kurt Lewin, a social psychologist and is closely related to critical research. The problem is researched, changed and re-researched, within the research by the participants and researchers. It is actively coresearched by those who are hoped to be helped. Taking action through planning and fact-finding brings about future and organizational change.

Data collection methods

In action research involves the following methods of data collection; Interview Observation Story telling Socio-drama Drawing and painting Plays and skits Other creative ways like Explore lives, Tell stories, and Recognize own strengths

Importance of action research in nursing

Research has the ability to exert power especially if, research involves collaboration by study participants and the researcher. The research process can improve nursing practice and nursing researchers. The habit of thinking, ability to work harmoniously with others and professional spirit will improve. Nursing knowledge, actions and consciousness will benefit from action research, as it will help to recognizing strengths and areas of improvement. Action research is of particular importance to the nursing field especially in the Indian setup as its objectives are:

To solve a problem by enriching the field of application of a discipline To collaborate with several disciplines for solving the problem To study the individual cases without the objective to generalize To recognizes that other variables are constantly changing To try to say how things can be changed To report in common language

Examples of the action research studies 1. An action research on the practicability of western nursing practices protocol in pubic and private Indian healthcare organizations. 2. An action research on the use of proposed well being support program to solve somatic morbidity among chronic mentally-ill patients in a selected mental hospital in North India.

Case study

Case studies are in-depth examination of people, place or institution. Robson defines case study as the development of detailed, intensive knowledge about a single case or a small number of related cases. This strategy is of particular interest, if researcher wishes to gain a rich understanding of the context of the research and its processes. In nursing sciences case study method in used since a long to study a single or group of patients in-depth with a specific conditions to generate nursing knowledge to solve nursing problems of patients suffering with specific disease condition. For example, How nurse and pregnant women manage a pain during delivery process. Basically case studies are considered as qualitative research studies, however, they could be either quantitative or qualitative research study based on the purpose of the study and phenomenon under study. Case study data are collected by observation or by the personal interview method. Generally analysis in case study design does not involve sophisticated quantitative and statistical techniques

Examples of the case studies design

1. A case study on the availability and utilization of the emergencies services in civil hospital, Ludhiana, Punjab. 2. A case study on the organization and functioning of the civil hospital, Jalandhar, Punjab.

FURTHER READING

Beck CT. Replication strategies for nursing research. Burns N & Grover S.K. The practices of nursing research: conduct, critique and utilization. 5th ed. Philadelphia: Saunders, 2005. Dormire SL, Yarandi H. Predictors of risk for adolescent childbearing. Applied Nursing Research, 2001;14(2):81-86. Johnson RL. Gender differences in health-promoting lifestyle of African Americans. Public Health Nursing, 2005;22(2):130-137. Orem DE. Nursing concept of practice, 6th Ed. Philadelphia PA: Mosby, 2001. Ulseter AA, Antle BJ. In the darkness there can be light: A familys adaptation to a childs blindness. Journal of Visual Impairment & Blindness, 2005;99(4):209-218.

Contd.

Velsor-Friendrich B, Pigott T, Louloudes A. The effect of a school based intervention on the self care and health of African-American inner city school children with asthma. Journal of Pediatric Nursing, 2004;19(4):247256. Williams SA, Schreier Am. The role of education in managing fatigue, anxiety and sleep disorder in women undergoing chemotherapy for breast cancer. Applied Nursing Research, 2005;18(3):138-147. Slade M, Kuipers E, Priebe S. Mental health services research methodology. International Review of Psychiatry, 2002;14(1):12-18. Ingersoll GL, McIntosh E, Williams M. Nurse-sensitive outcome of advanced practice. Journal of Advanced Nursing, 2000;32(5):1272-1281. Donohue R. Nurse practitioner-client interaction as resources exchange in a womens health clinic. Journal of Advanced Nursing, 2003;12(5):717-725. Donalek JG. Demysatisfying nursing research: phenomenology as a qualitative research method. Urology Nursing, 2004;24:516-517. Jacelon CS, ODell KK. Case and grounded theory as qualitative research methods. Urology Nursing, 2005;25:49-52.

Contd.

Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002. Polit FD, Hungler BP. Nursing Research: Principles and methods. 5th ed. Philadelphia: J.B. Lippincott company 1995. Poilt FD, Beck CT. Nursing Research: Generating and assessing evidence for nursing practices. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2008. Macnee CL. Understanding Nursing Research: reading and using research in practice. 1st ed. Philadelphia: Lippincott Williams & Wilkins, 2004. Kader P. Nursing Research: Principles, process and issues. New York: Palgrave Macmillan publishers, 1997. Bayley EM, Maclean SL, Desy P, McMahon M. ENAs Delphi study on national research priorities for emergency nurses in the United States, Journal of Emergency Nursing 2004;30:12-21.

Contd

Burns N, Grover SK. Understanding Nursing Research: Building and evidencebased practices. 4th ed. Noida: Reed Elsevier India Private Limited, 2008. Burns N, Grove S. The practice of nursing research: conduct, critique and utilization. 5th ed. St. Louis: Elsevier Saunders, 2005. Sharma SK, Choudhary A. Substance abuse related high risk factors among traumatic head injury patients. Nursing & Midwifery Research Journal July 2008;4(3): 96-101. Sharma SK, Kaur K. A descriptive study on dietary pattern and biophysical profile among nursing students. Nursing & Midwifery Research Journal April 2009;5(2): 80-88. Sharma SK, Gupta J, Walia I, Sen R. Prevalence of pin site infection among patients with external skeletal fixation. Nursing & Midwifery Research Journal April 2005; 1 (2):124- 130. Sharma SK, Kuar K, Kaur M. Awareness of HIV/ AIDS among newly admitted nursing students. Nursing & Midwifery Research Journal Jan 2006;2(1): 32-38. Sharma SK, Kaur K, Garg R. Factors affecting bowel movements in critically ill patients. Nursing & Midwifery Research Journal April 2007;3(2): 71-78.