Nursing Research

Nursing Research - Disciplined Research

- Involves a systematic search for knowledge about issues of Most sophisticated method of acquiring
importance to the nursing profession knowledge
- Research on the process of care and clinical problems Findings from rigorous research investigations are
encountered in the practice of nursing considered to be at the pinnacle of the
- Clinical Nursing Research evidence hierarchy for establishing an evidence-
o Hug Therapy based practice
o Coping dynamics of Adolescents with ADHD
Purposes of Nursing Research
Research in Nursing - Identification - what is the phenomenon?
- Broader study of people and the nursing profession - Description- observe, count, classify, delineate the
including historical, ethical and policy studies phenomenon
- Focused on ethical issues in nursing - Exploration - investigates the full nature of a phenomenon,
o Core Competency Standards its manifestations and factors affecting it
o Patient Satisfaction among Surgical Patients - Explanation - attempts to explain the why or underlying
cause/explains systemic relationship
Evidence-Based Practice - Prediction- what will happen if?
- Conscious and judicious use of current best evidence in - Control - how can the phenomenon be altered?
the care of patients and delivery of health care services
(Titler, 1999) ETHICAL CONSIDERATIONS IN RESEARCH
- Conscientious use of current based evidence in making Nuremburg Code
clinical decisions about patient care - First internationally accepted effort to set up formal ethical
standards governing human research subjects
Levels of Evidence - Requires informed consent for all cases
- Level 1
Systematic review of Randomized Clinical Trials Helsinskis Declaration
Systematic review of non-randomized trials - Differentiates 2 major types of research:
- Level 2 o That which is essentially therapeutic
Single RCT o That which essentially directed toward
Single non-randomized trial developing knowledge and has no therapeutic
- Level 3 value
Systematic review of correlational or Belmont Report
observational studies - Articulated 3 primary ethical principles
- Level 4 - Principles of Beneficence
Single correlational or observational study o Freedom from harm
- Level 5 o Freedom from exploitation
Systematic review of descriptive or qualitative or Involvement in research should not
physiologic studies place subjects at a disadvantage or
- Level 6 expose to situations they have not been
Single descriptive or qualitative or physiologic explicitly prepared
studies Assures subjects that their participation
- Level 7 will not be used against them
Opinions of authorities, experts, committees o Balancing benefits and risks (benefit-Risk Ratio)
May sometimes be outdated Approve: greater benefits
Reject: greater risks
Importance of Research in Nursing
- ULTIMATE GOAL: To improve the practice of its members so - Principle of respect for Human Dignity
that services provided to its clientele will be maximally o Informed consent
effective o The right to self-determination
- Enhance professionalism Right to voluntarily decide whether or
- Proof of accountability not to participate in a study
- Strengthen social relevance of nursing o The right to full disclosure
- Basis for sound decision making Describe nature of study, procedure,
method of collection, risks, benefits,
Sources of Human Knowledge discomforts it will entail,
- Tradition Right to refuse treatment
Certain truths are accepted as given on the basis - Principle of Justice
of inherited customs or tradition o Right to privacy
- Authority
Refer to people with specialized expertise Safeguards to Privacy
Not enough when used alone - Confidentiality
- Experience and trial and error and intuition o Information gathered will not be publicly
Own experiences represent a familiar and reported in a way that identifies the subject
functional source of knowledge o Information is accessible only to the researchers
- Logical Reasoning - Anonymity
Combines experience, intellectual faculties and o Even the researcher cannot link the subject with
formal system of thought the information reported
- Assembled information o Do not use the name of the patient- use
Benchmarking data numbers or codes

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 Nursing Research
Right to Fair Treatment - Solomon four group design
- Non-discriminatory selection of subjects/participants o More effective in doing experimental design
- Respect for cultural and other forms of diversity o We want to make sure that the changes in the
- Non-prejudicial treatment of individuals who decline to dependent variable was caused by the
participate or withdraw from the study independent variable and not because of other
- Honoring all agreements made between the researcher competing reasons (internal validity)
and subject (adherence to procedures and payment of o Combination of pretest post-test and post-test
stipends) only design
- Access to research personnel to clarify information
- Access to appropriate professional assistance in case of According to Time Frame
injury/damage 1. Cross-sectional Study
Paradigm o Data collected at one point in time
- World view
- A general perspective on the complexities of the real 2. Longitudinal Study
world, with certain assumptions about reality o Repeated data collection at an extended time
Key Paradigms for Nursing Research interval
- Positivist o Data collected at different points in time
- Naturalist o Threats to Internal Validity
Attrition- subjects gradually decrease
POSITIVIST NATURALIST over time
Fixed design Flexible design History- an event prior to data collection
Discrete, specific concepts Holistic at a specified period of time which may
Deductive processes Inductive processes affect the result
Control over context Context-bound Maturity as one grows older one
Verification of hunches Emerging interpretations becomes better
Quantitative information Qualitative information
According to measurement of independent and dependent variable
Seeks generalizations Seeks patterns
1. Retrospective
o Begins with a dependent variable and looks
TYPES OF RESEARCH
backward for its causes and antecedent
According to Motive
o Answer a current variable (present) using the past
1. Basic Research - just to know/ to generate knowledge
2. Prospective
2. Applied Research - to make the new knowledge useful
o Study begins with an independent variable and
and practical
looks forward for its effects
o Use intervention (present) and go in time to
According to Level of Investigation
predict what will happen in the future
1. Exploratory- identifying the variables
2. Descriptive - finding out whether the variables are
According to Measurement
associated/related
1. Quantitative Research
3. Experimental - finding out the effects of variables to each
o Investigation of phenomena that lends
other
themselves to precise measurements and
quantification often involving a rigorous and
According to Design or Approach
controlled design
A. Non-experimental
2. Qualitative Research
1. Historical - use past events to answer a problem
o Investigation of phenomena; typically an in
2. Survey - use interview, observation and questionnaire to
depth and holistic fashion through the collection
gather public opinion
of rich narrative materials using a flexible
3. Case Study - gathers data in detail about an individual or
research design
groups of individual and usually presented in narrative form
*Is there an intervention? If no = non-experimental; if yes =
4. Methodological - to test a tool, method or procedure
experimental
5. Analytical - use logical analysis of records and ideas
THE RESEARCH PROCESS
B. Experimental
5 Major Phases of the Research Process
1. True Experiment -strict control of all variables
1. Conceptualizing Phase
o Randomization- randomized selection of subjects
2. Design and Planning Phase
o Control- control over context
3. Empirical Phase - longest (spends most of time, Polit and
o Manipulation- treatment which you give to
Beck)
experimental group and withhold to control
4. Analytical Phase
group
5. Dissemination Phase
2. Quasi-experimental - control overcomes the variables
3. Pre-experimental manipulation of independent variable,
Phase I: Conceptual Phase
no randomization or control group, limited control over
- Researcher develops the formal question to be
extraneous variables
investigated in the study
1. Formulating and delimiting the problem
Experimental Research Designs
2. Reviewing the related literature
- True experiment/Pre-test-Post-test Design
3. Undertaking a clinical fieldwork
- Post test only design
4. Defining the framework and developing conceptual
o Used when it is impossible to measure the
definitions
variable before the intervention
5. Formulating hypothesis

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 Nursing Research
Phase II: Design and Planning Phase Hypothesis
- Strategies to be used to collect and analyze the data to - Tentative prediction or explanation of the relation
address the research question and evaluate decisions between 2 or more variables
before implementation - 3 Criteria:
6. Selecting a research design o Only one variable, condition, relationship and
7. Developing protocols for the intervention (for only one statistical analysis should be addressed
experimental research) in each hypothesis
8. Identifying the population to be studied o The variable, condition or relationship must be
9. Designing the sample plan testable
10. Specifying the methods to measure the research variables o The aim of the research guides what is included
11. Developing methods for safeguarding human/animal in the hypothesis
rights - Parts
12. Finalizing and reviewing the research plan o Independent Variable- cause
o Dependent Variable- effect
Phase III: Empirical Phase o Relationship
13. Data gathering o The population to which the relationship applies
14. Preparing data for analysis
Phase IV: Analytical Phase Types of Hypothesis
15. Analyzing the data - Null Hypothesis
16. Interpreting the results o A statement that there will be no difference, no
Phase V: Dissemination Phase change (same), or no effect on the dependent
17. Communicating the findings variable for the population under study
18. Utilizing findings in practice - Alternative Hypothesis
o A statement that there will be a change, an
THE RESEARCH PROBLEM effect on the dependent variable for the
Sources of Research Problems population under study
- Experience and clinical fieldwork o Directional
- Nursing Literature States specific relation of variables
- Social Issues Decreases
- Theory Increases
- Ideas from external sources Promotes
o Non-directional
Criteria of Good Research Problems Does not specify the relationship of the
- S - significance of the study variables
- A- availability of the subjects Just specifies that there is a relationship
- R - researchability of the problem o Simple
Predicts relationship between 1
Feasibility of the Research Problem dependent with 1 independent variable
- Accessibility of subjects (most important factor if one is o Complex
feasible) 2 or more dependent and independent
- Time allotment variables
- Limitation of tools * Only alternative hypotheses are categorized either simple or
- Limitation of subjects complex
- Interest of researcher ensure sustainability of completion
- Novelty New! Variables
- Central building blocks of quantitative studies
Title look for variables, population and Setting/Research locale/ - Continuous Variables
maximum is 10 words; the fewer the words the better (do not put o Have values that can be represented in a
design) continuum
In international publications, population and locale may not be o 101.1,101.2,101.3
included - Discrete Variables
o One that has a finite number of values between
Statement of the Problem any two points, representing discrete quantities
- Declarative o 2 girlfriends, not 1
o Staffing Ratios and Patient Care Outcomes in - Categorical Variables
Tertiary Hospitals o Take on only a handful discrete, non-
- Interrogative quantitative values
o What is the Effect of Staffing ratio on Patient o Gender, Marital status
Care Outcomes in Tertiary Hospitals in Manila? - Attribute Variables
o Characteristics of research subjects
Significance of the Study o Weight, height, ethnic groups
- To the person - Active Variables
- To the profession o Variables that the researcher creates
- To society at large o Type of exercises
Assumption statement considered to be true and need not be
further examined Concept - subject matter of theories, building blocks of theories
Delimitation - purposeful choice of the researcher Proposition - statement that explains the relationship between 2
Limitation - factors beyond the control of the researcher concepts
Conceptual Definition definition that is based on dictionary

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 Nursing Research
Operational Definition made by the researcher as used in the Practice-Theory-Research Links
study - Research are used to improve practice
Hypothesis- shrewd guess or tentative explanation of the - Research is used to generate a theory
relationship between 2 variables - Theory used as a framework for research
- Practice can be used to generate a theory
Conceptual Model - Theory is used as a framework for practice
- Pictorial Representation of a proposition
- Representation of interaction among and between DESIGNING AND PLANNING PHASE
concepts Research Designs
QUANTITATIVE QUALITATIVE
Conceptual Framework Researcher, Investigator,
- Paradigm or a representation of predictive relationship scientist researcher
between theoretical and operational concepts as Subjects, Informants,
indicated by the theory respondents participants
Theory Phenomenon,
- General explanation of a phenomena Concepts, variables
concept
- Grand or Macro Textual, nominal
o Florence nightingale Numerical data
data
- Mid-ranges Statistics Thematic analysis
o Dorothy Johnson Types of Qualitative Research
o Callista Roy 1. Phenomenological Study
- Micro-range - Most useful when the task is to understand an
o Levels of competence experience as those having the experience
Laws/Principles understand it
- Guiding rules supported over time and proven through - Used to answer questions of meaning
research - The Lived experiences of Children of Absentee
Parents
REVIEW OF RELATED LITERATURE 2. Historical Research
Purposes of Literature Review - Solving current problems using past events
- Identification of research problem and - Thomasian Nursing Icons: 7 Decades of Making a
development/refinement of research questions/hypothesis Difference in Nursing (Eugenio, Estepa,
- Determination of what is known and any gaps or Evangelista et al, 2008)
inconsistencies in a body of research 3. Grounded Theory
- Determination of a need to replicate prior study in a - Research method designed to inductively
different setting and population: to develop a stronger develop a theory based on observations of the
theories (must ask from the authors) world of selected people
- Identification or development of a new refined clinical - Minimum of 30 informants
intervention to test through the empirical research - Being strong: how black west Indian Canadian
- Identification of suitable designs or data collection women manages depression
methods 4. Ethnographic Research
- Identification of experts in the field - Describe cognitive models or patterns of
behavior of people within a culture
Types of Information to Seek - Seeks to understand another way of life from the
- Primary Source natives experience
o Research reports which are descriptions of - Presence must be recognized by the people;
studies written by the researchers courtesy call
- Secondary Source - Transcultural Nursing (Leininger)
o Not written by the researchers - E.g. Factors Causing Work-Related Stresses
o Try to get hold of the primary source as much as Among Filipino Nurses Working in London (Del
possible Rosario, 2009)
5. Case Study
Steps for Searching Literature - Involves an in-depth description of essential
- Determine concept, issues, topic dimensions and processes of the phenomenon
- Identify variables and terms under study
- Conduct computer search - Two Cases of Battered Women
- Weed out irrelevant sources before printing Bracketing to avoid holding previous knowledge regarding the
- Organize sources from printout for retrieval phenomenon
- Retrieve relevant sources
- Copy articles Determine the Population
- Conduct preliminary reading and weed out irrelevant Population
sources - The entire aggregation of cases that meet a designated
- Critically read each source set of criteria
- Synthesize critical summaries of each article Eligibility Criteria
- The exact criteria by which it could be decided whether
Types of Resources an individual would or would not be classified as a
- Print member of the population in question
- Internet/Online Database Accessible Population
- Conform to the eligibility criteria + accessibility

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 Nursing Research
Target Population
- The aggregate of cases which the researcher would like to
make generalizations
Sampling and Sample
- Sampling
o Refers to the process of selecting a portion of
the population to represent the entire
population
- Sample
o Consist of subset of a unit that represent a
population
- Sampling Bias
o Refers to the systematic overrepresentation or
underrepresentation of some segments of the
population
o The greater the heterogeneity of the population
with respect to the critical attributes, the greater
the risk of sampling bias
- Sampling Plans
o Non-probability Sampling
Less likely to produce accurate and
representative samples
Drawback: No way of estimating each
elements probability of being included
in the sample
o Probability Sampling
With randomization
Methods of Sampling (Non-probability)
- Convenience Sampling
o Accidental sampling
o Use of readily available or most convenient
group of subjects for the sample
o Snowball or network sampling
Early sample are asked to identify other
potential subjects meeting the eligibility
criteria
Used when there is difficult to identify
potential subjects
- Quota Sampling
o The researcher identifies strata of the population
and determines the proportions of the elements
needed for various segments of the population
o With each stratum, the researcher selects
subjects by convenience sampling
o E.g. target sample size = 200; male- 15%, female-
85%
- Purposive Sampling
o Judgment sampling
o Subjects are handpicked to be included in the
sample based on the researchers knowledge
about the population
- Theoretical/Thematic Sampling
o Special type
o Often used in in-depth qualitative research to
ensure the adequate representation of themes
relating to the phenomenon under study
Methods of Probability Sampling
- Simple Random Sampling
o Involves the selection of elements on a random basis
from a sampling frame
- Stratified Random Sampling
o Variant of simple random sampling in which the
population is first divided into 2 or more strata or
subgroups and the samples taken at random
o Aim: To obtain a greater degree of representativeness
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- Cluster Sampling/Multi-Stage Sampling
o Successive random sampling of units
o The first unit to be drawn are large groupings
o Cluster can be selected by simple or stratified
methods
- Systematic Sampling
o Involves the section of every nth case from some list or
group, such as every 10th person on a patient list or
every 100th person listed in the registry of licensed
nurses
Sample Size
- Factors to be considered
o Type of design used
Descriptive Studies- 10% of the population
(for smaller population, a minimum of 20%)
Correlation Studies 30 subjects
Experimental 15 subjects per group
o Type of sampling procedure used
o Type of formula used for estimating optimum
sample size
Slovin - n = N/1+Ne(desired margin of
error)2
Rule of 30 (Bruns and Grove, 2007)
Rule of 10 - 10 samples for every
variable in the study (Schmidt & Brown,
2009)
o Degree of precision required
o Heterogeneity of the attributes under
investigation
o Relative frequency that the phenomenon of
interest occurs in the population
o Projected cost of using a particular sampling
strategy
EMPIRICAL PHASE
- involves data collection
Data Collection Methods
1. Use of existing Data
o A wealth of data gathered from non-research
purposes can be exploited to answer research
questions
o Hospital records, patients charts, 201 file(faculty
profile), care plan statements(how patients are
taken cared of), documents, reports
2. Self-reports Data
o Most widely used data collection method by
both quanti and quali nurse researchers
o Gathered orally (interview) or in writing
(questionnaire)
o Strong directness and versatility
o Yields information that would be difficult if not
impossible to gather by any other means
o Behaviors can be observed but only if
participants engage in them publicly (battered
women, child abuse, sexual practices)
o Disadvantage: Validity and accuracy (most
serious) patients may be humiliated or
ostracized by the society
QUESTIONNAIRES INTERVIEWS
Less costly and Response rates tend to be
requires less time to high
administer Audience- feasible with
Offers complete most people
anonymity Clarity
No interview bias Depth of questioning
Missing information
 Nursing Research
Order of questioning is Construct Validity- instruments
flexible adequacy in measuring the focal
Qualitative research construct (What does this instrument
measure?)
Content Validity - degree to which an
instrument has an appropriate sample
Interviews may be: Structured, Semi-structured, Non- structured of items for the construct being
measured
3. Observation How representative are the
o Characteristics and condition of individuals questions in this test
Decubitus ulcers Determined by experts
o Activities and Behaviors Criterion-related Validity- relationship
o Skill attainment and performance between instrument and external
Structured observation checklist to criterion
determine. The key issue is whether an
o Verbal communication instrument is a useful predictor
o Nonverbal communication of future other behaviors,
o Environmental characteristics experiences, or conditions
Internal Validity the changes in the
4. Bio-physiologic Measures dependent variable is due to an effect
o Basic physiologic process of an independent variable that there
o Physiologic outcomes of nursing care are no other competing reasons
o Evaluation of nursing interventions External Validity the findings can be
o Product assessment (e.g. sterilium) generalized in other samples/settings
o Studies of physiologic correlates (intervention and o Reliability
outcome) exercise then CBG Repeatability
Consistency
Types of Physiologic Measurements Ability to yield the same results upon
- In vivo repeated administration of the
Those performed directly or on living organisms instrument
O2 saturation, ultrasound, BP, temp Closer it is to 1, the more reliable it is
- In vitro (Cronbachs alpha) Minimum level is 0.7
Laboratory tests
ANALYZING PHASE
Criteria of an Effective Instrument - Measurement - assignment of numbers to objects
- Qualitative according to rules
- Trustworthiness
o Degree of confidence qualitative researchers Levels of Measurement
have in their data - Nominal Data
o Used to classify objects or numbers according to
o 4 Criteria categories
1. Transferability o Gender, hair color, marital status
The extent to which qualitative findings - Ordinal Data
can be transferred to other settings or o Used to show relative ranking of objects or
groups events
Analogous to generalizability o Self-assisted, partially assisted, totally assisted
2. Dependability - Interval Data
Analogous to reliability o Shows ranking of events on scale with equal
Stability of data over time and over intervals between the numbers. Zero point
conditions remains arbitrary and not absolute
3. Confirmability o Temperature, Zero does not mean absence of
Objectivity or neutrality of the data and temperature
interpretations - Ratio
Member checking o Shows ranking of events on scale with equal
4. Authenticity intervals and absolute zeros. All arithmetic
The extent to which qualitative operations are permissible. E.g. weight
researchers fairly and faithfully show a
range of different realities in the analysis Descriptive Analysis
and interpretation of data - Frequency Distribution arrangement of scores and how
many times they appear: %
- Quantitative - Measures of Central Tendency
o Validity o Mean- computing average/ most stable
Degree to which an instruments o Median- counting average
measures what is suppose to measure o Mode- inspecting average most times they
Face Validity- whether an instrument appear
appears to be measuring the - Measures of Variability
appropriate construct o Range(highest-lowest), SD, variance (SD
squared)

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