N199

Nursing Research Overview

RESEARCH
 A systematic inquiry that uses disciplined methods to
answer questions or solve problems. (Polit and Beck,
2004)
 Ultimate goal: develop, refine, expand the body of
knowledge
VM Manila
November 15, 2010
 “A systematic search for knowledge about issues of
importance to nursing”
 “A study of the problems in practice relating to effects”
 “It is a systematic inquiry that validates and refines
existing knowledge and generates new knowledge that
directly and indirectly influences nursing practice. “

NURSING RESEARCH Diagram for Nursing Research (Manila, 2010)

 The nurse and the significance of research
 Nursing Research defined Existing New NURSING
 Paradigms and Methods in research Knowledge Knowledge PROFESSION
 Purposes of Nursing Research
 Challenges of Nursing Research
Systematic -education
Why should nurses do research?: The nurse and the Inquiry -administration
significance of research -informatics
 Professionalism - PRACTICE
o Explain and understand phenomena Validation
o Describe characteristics of a particular nursing
situation Refinement
o Inform clinical decision
 Accountability
o Provide basis for actions
Paradigms and Methods in Research
o Prevent undesired outcomes
Assumptions
o Produce positive patient-care outcomes
 Ontologic – nature of phenomena
 Social Relevance
 Epistologic – relationship of investigator  investigated
o Cost-effective care
 Axiologic - values implicated
o Benefit not only patients but also other
stakeholders  Methodologic – how phenomena occurs

“ 85% of health care practice has not been scientifically Two Alternative Paradigms
validated “ – Millenson, 1997
QUANTITATIVE QUALITATIVE
Sources of Evidence for Nursing Practice
 Traditions POSITIVIST NATURALISTIC
 Colleagues
o Authority
o Borrowing
o Role Modeling Comparison of Quantitative and Qualitative Research Designs
 Clinical experience
o Intuitions Quantitative Qualitative
o Trial and Error Generalizability Individual
o Logical Reasoning Empirical Evidence Experiences
 Inductive Systematic Progressive
 Deductive Field Control
 Assembled Information Objective Subjectively valued
 Disciplined Research One reality Multiple Realities
Reduction, control, Discovery, description,
Nursing Research Defined
prediction understanding
 “It is a systematic inquiry designed to develop knowledge
Measurable
about issues of importance to the nursing profession,
Mechanistic Organismic
including nursing practice, education, administration, and
Parts equal to whole Whole is greater than parts
informatics.”
Report statistical analyses Repirt rich narative
 “A systematic study of problems in patient care”
Researcher separate Researched part of research
process

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Subjects Participants
Context free Context dependent
Purposes of Nursing Research
 Identification and Description
Identification
o “What is this phenomenon?”
o “What is its name?”
o Example: Dewar (2003)
 in-depth study in Canada to determine
how individuals were able to live with
catastrophic illnesses and injuries.
 She called one of the strategies they
used boosting – people’s efforts to
improve their self-esteem, which
helped
Description
o “How prevalent is the phenomenon?”
o “What is the characteristics of the
phenomenon?”
o “What are the dimensions of the
phenomenon?”
o “What variations exist?”
o Example: Bohachick, Taylor, Sereika, Reeder,
and Anton (2002)
 Conducted a study to describe
quantitative changes in psychological
well- being and psychological resources
6 months after a heart transplantation
 Exploration
o “What factors are related to the phenomenon?”
o “What is really happening?”
o Example: Reynolds and Neidig (2002):
 studied the incidence and severity of
nausea accompanying combinative
antiretroviral therapies among HIV-
infected patients, and explored
patterns of nausea in relation to
patient characteristics.
 Explanation
o Systematic relationships, associations, causation
o “How does the phenomenon work?”
o Example (McGinley, 2004):
 undertook a study designed to explain
women’s use of hormone replacement
therapy on the basis of their health
beliefs and views about menopause.
 Prediction and Control
o “Will the intervention alter the phenomenon?”
o “How can we alter the prevalence of the
phenomenon?”
o Example:
 Research showed that the incidence of
Down syndrome in infants increases with
the age of the mother. Therefore, we can
N199
Nursing Research Overview
VM Manila
November 15, 2010
predict that a woman aged 40 years is at
higher risk of bearing a child with Down’s
syndrome than a woman aged 25 years. The
incidence of Down’s may be partially
controlled by educating women about the
risks.
Challenges in Nursing Research
1. Conceptual
2. Financial
3. Administrative
4. Practical
5. Clinical
6. Methodologic
o Measurement
o Control
Methodologic Challenges – Measurement Problems
 Quantitative: Validity & Reliability
 Qualitative: Trustworthiness
Methodologic Problems – Control Problems
 Holding extraneous variables constant
 Reducing Bias
ETHICS IN RESEARCH
The Nuremberg Code
1. Voluntary consent of the human subject
2. Experiment results should be for the good of society
3. Experiment on humans should be based on animal
experimentation
4. Experiment should avoid unnecessary physical and
mental suffering/injury
5. Experiment should not be done if it will cause
death/disability
6. Risk must not exceed humanitarian importance of
research
7. Proper preparations & adequate facilities
8. Experiment done only by qualified persons
9. Subjects must be free to end participation
10. Scientist must be prepared to terminate the experiment
at any stage, if needed
Declaration of Helsinki
 Developed by the World Medical Association (WMA),
adopted 1964, amended 6 times (1975, 1983, 1989,
1996, 2000, 2008)
 Expanded the 10 Nuremberg principles
 Basic text for international guidelines such as CIOMS,
EHO Guidelines for GCP for trials, ICH Tripartite
Belmont Report
 Ethical Principles and Guidelines for the Protection of
Human Subjects of Research (April 18, 1979)
 articulated 3 primary ethical principles:
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o Beneficence
o Respect for persons/human dignity
o Justice
Principle of Beneficence
 Freedom from harm including physical, psychological and
economic harm
 Freedom from psychological harm can be observed by:
o Carefully phrasing questions
o Debriefing sessions- permit participants to ask
questions or air complaints after data are
collected
 Obligation to maximize benefits and minimize harm
Beneficence: Risk-Benefit Ratio
 May want to consider how comfortable s/he would feel if
it were family members participating in the study
 Risks are commensurate with the benefit
 The selection of a significant topic is the first step in
ensuring that the research is ethical
N199
Nursing Research Overview
VM Manila
November 15, 2010
Institutional Review Board (IRB)
 IRB conducts ethical review of all studies involving
human subjects
 In cases where the study involves only minimal risk an
expedited review maybe done (done by only one
member of IRB)
REFERENCES
 Burns, N. and Grove, S.K. (2007). Understanding Nursing
Research: Building an Evidence-Based practice (4th ed.).
St. Louis, MO: Elsevier Saunders.
 Polit, D.F. and Beck, C.T. (2006). Essentials of nursing
research: methods, appraisal, and utilization (6th ed.).
Philadephia, PA: Lippincott
 Schiller, Rosemary (2010). Nursing Research Definitions.
www39.homepage.villanova.edu.
 Tejero, Lourdes (2009). Nursing Research Overview.
Lecture slides for Nursing Research, N199 SY 2009-2010.

Principle of Respect for Human Dignity Where do you search for Research Topics?
 Right to self-determination  Your own thoughts, observations and experiences
 Participants have the right to ask questions or to refuse  Review of literature
to give information  Theories/ concepts e.g. role theory, the sick role, the
 Participants have the right to terminate their nurse’s role, the interaction between the patient’s role
participation and the nurse’s role
 Right to full- disclosure  Testing assessment and intervention strategies

Respect for Human Dignity: Freedom from Exploitation UPCN research priorities
 Should not place participants at a disadvantage or expose  Nursing information system
them to situations for which they have not been  Human resource supply and demand
prepared  Health promotion
 Assurance that data gathered will not be used against  Elderly care
participants  Chronically- ill clients
 The researcher should not exploit the nurse-patient  MDGs
bond; participants must understand that the nurse is the
researcher Criteria for Selecting a Research Topic
 Relevance and significance
Vulnerable Groups for Research
 Avoidance of duplication
 Children
 Feasibility- personnel, time, equipment, money,
 Mentally/emotionally disabled persons
availability of study participants
 Physically disabled persons
 Political Acceptability
 Prisoners
 Ethical acceptability
 Hospitalized persons (may feel pressured to participate)
 Capability of researcher
 Pregnant women

Principle of Justice
 The right to fair treatment before, during and after
participation in the study
 The right to privacy
 Informed consent
 Informed consent must be documented
 Prospective participants must have ample time to review
the consent form

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