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 Helsinski’s 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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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
becomes better
Verification of hunches Emerging interpretations
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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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
effect on the dependent variable for the
THE RESEARCH PROBLEM
population under study
Sources of Research Problems
o Directional
- Experience and clinical fieldwork
§ States specific relation of variables
- Nursing Literature
• Decreases
- Social Issues
• Increases
- Theory
• Promotes
- Ideas from external sources
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
continuum
design)
o 101.1,101.2,101.3
In international publications, population and locale may not be
- Discrete Variables
included
o One that has a finite number of values between
any two points, representing discrete quantities
Statement of the Problem
o 2 girlfriends, not 1 ½
- Declarative
- Categorical Variables
o “Staffing Ratios and Patient Care Outcomes in
o Take on only a handful discrete, non-
Tertiary Hospitals”
quantitative values
- Interrogative
o Gender, Marital status
o “What is the Effect of Staffing ratio on Patient
- Attribute Variables
Care Outcomes in Tertiary Hospitals in Manila?”
o Characteristics of research subjects
Significance of the Study o Weight, height, ethnic groups
- Active Variables
- To the person
- 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
Concept - subject matter of theories, building blocks of theories
further examined
Proposition - statement that explains the relationship between 2
Delimitation - purposeful choice of the researcher
Limitation - factors beyond the control of the researcher concepts
Conceptual Definition – definition that is based on dictionary

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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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Target Population - Cluster Sampling/Multi-Stage Sampling
- The aggregate of cases which the researcher would like to o Successive random sampling of units
make generalizations o The first unit to be drawn are large groupings
o Cluster can be selected by simple or stratified
Sampling and Sample methods
- Sampling - Systematic Sampling
o Refers to the process of selecting a portion of o Involves the section of every nth case from some list or
the population to represent the entire group, such as every 10th person on a patient list or
population every 100th person listed in the registry of licensed
- Sample nurses
o Consist of subset of a unit that represent a Sample Size
population - Factors to be considered
- Sampling Bias o Type of design used
o Refers to the systematic overrepresentation or § Descriptive Studies- 10% of the population
underrepresentation of some segments of the (for smaller population, a minimum of 20%)
population § Correlation Studies – 30 subjects
o The greater the heterogeneity of the population § Experimental – 15 subjects per group
with respect to the critical attributes, the greater o Type of sampling procedure used
the risk of sampling bias o Type of formula used for estimating optimum
- Sampling Plans sample size
o Non-probability Sampling § Slovin - n = N/1+Ne(desired margin of
§ Less likely to produce accurate and error)2
representative samples § Rule of 30 (Bruns and Grove, 2007)
§ Drawback: No way of estimating each § Rule of 10 - 10 samples for every
element’s probability of being included variable in the study (Schmidt & Brown,
in the sample 2009)
o Probability Sampling o Degree of precision required
§ With randomization o Heterogeneity of the attributes under
investigation
Methods of Sampling (Non-probability) o Relative frequency that the phenomenon of
- Convenience Sampling interest occurs in the population
o Accidental sampling o Projected cost of using a particular sampling
o Use of readily available or most convenient strategy
group of subjects for the sample EMPIRICAL PHASE
o Snowball or network sampling - involves data collection
§ Early sample are asked to identify other
potential subjects meeting the eligibility Data Collection Methods
criteria 1. Use of existing Data
§ Used when there is difficult to identify o A wealth of data gathered from non-research
potential subjects purposes can be exploited to answer research
- Quota Sampling questions
o The researcher identifies strata of the population o Hospital records, patients’ charts, 201 file(faculty
and determines the proportions of the elements profile), care plan statements(how patients are
needed for various segments of the population taken cared of), documents, reports
o With each stratum, the researcher selects
subjects by convenience sampling 2. Self-reports Data
o E.g. target sample size = 200; male- 15%, female- o Most widely used data collection method by
85% both quanti and quali nurse researchers
o Gathered orally (interview) or in writing
- Purposive Sampling (questionnaire)
o Judgment sampling o Strong directness and versatility
o Subjects are handpicked to be included in the o Yields information that would be difficult if not
sample based on the researcher’s knowledge impossible to gather by any other means
about the population o “Behaviors can be observed but only if
- Theoretical/Thematic Sampling participants engage in them publicly (battered
o Special type women, child abuse, sexual practices)
o Often used in in-depth qualitative research to o Disadvantage: Validity and accuracy (most
ensure the adequate representation of themes serious) – patients may be humiliated or
relating to the phenomenon under study ostracized by the society

Methods of Probability Sampling QUESTIONNAIRES INTERVIEWS

- Simple Random Sampling § Less costly and § Response rates tend to be
o Involves the selection of elements on a random basis requires less time to high
from a sampling frame administer § Audience- feasible with
- Stratified Random Sampling § Offers complete most people
o Variant of simple random sampling in which the anonymity § Clarity
population is first divided into 2 or more strata or § No interview bias § Depth of questioning
subgroups and the samples taken at random § Missing information
o Aim: To obtain a greater degree of representativeness

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§ Order of questioning is § Construct Validity- instrument’s
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 (Cronbach’s 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
temperature
§ Objectivity or neutrality of the data and
- Ratio
interpretations
§ Member checking o Shows ranking of events on scale with equal
intervals and absolute zeros. All arithmetic
4. Authenticity
operations are permissible. E.g. weight
§ The extent to which qualitative
researchers fairly and faithfully show a
Descriptive Analysis
range of different realities in the analysis
- Frequency Distribution – arrangement of scores and how
and interpretation of data
many times they appear: %
- Measures of Central Tendency
- Quantitative
o Mean- computing average/ most stable
o Validity
o Median- counting average
§ Degree to which an instruments
o Mode- inspecting average – most times they
measures what is suppose to measure appear
§ Face Validity- whether an instrument - Measures of Variability
appears to be measuring the o Range(highest-lowest), SD, variance (SD
appropriate construct squared)

DR. RENMIR JAN MAALA (NURSING RESEARCH)