Dr. Fahad Aldhafiri I R M

NRSG 475
Dr. Fahad Aldhafiri
Understanding the importance of research to the profession of nursing
Discussing the application of the scientific method in nursing research
Identifying the ethical considerations related to human subject research
Understanding the research process in nursing studies
Distinguishing between quantitative and qualitative research
Discussing the relative merits of experimental and non experimental
approaches to research
Describing the relationship of theory to hypothesis development
Identifying and describing the sampling process in nursing research
Evaluating the relative merits of various research designs and data collection
Identifying common methods of establishing validity and reliability of data
collection tools
Discussing the applicability of the findings of a research study to nursing
Identifying researchable problems in nursing practice
Critiquing research studies for the logical consistency of each element of the
research process
The course of Research Methods in Nursing is
design to provides nursing students with
competencies necessary to design, conduct, read
,evaluate and interpret nursing research studies.
This course explores the basic concepts and steps
in the scientific research process with special
focus on research approaches relevant to nursing.
The course also focuses on using research
knowledge acquired in the understanding of
concepts related to Evidence-Based Nursing
Practice, problem solving, and critical thinking
related to nursing
Methodological foundations of health research
 Research planning
 Research designs
 Data collection
 Descriptive statistics
 Data analysis and inference
 Evaluation and dissemination of research results
Foundations of health research
 The research process
The scientific method is essential for conducting
research and evaluation aimed at producing
evidence, improving the effectiveness and costeffectiveness of health services.
Health research is a systematic and principled way
of obtaining evidence (data, information) for solving
health care problems and investigating health
issues. Research is systematic in that researchers
follow a sequential process.
The general aims of this chapter are to:
1. Examine the relationship between knowledge
and methods.
2. 2. Outline what constitutes the scientific
Two concepts drawn from philosophy are relevant
to our discussion: ontology and epistemology.
 Ontology refers to the question of what exists in
the world, what is ‘real’.
 Different knowledge systems take diverse
positions on what constitutes reality. In contrast
to the natural sciences, various traditional
interpretations hold different views on what
constitutes the reality.
For example, the notion of life force or qi/chi, a
central concept in traditional Chinese medicine,
is absent in contemporary Western medicine. Of
historical interest, is the classical Greek belief in
humors that was once central to Western
 The balance of humors was thought to determine
mental and physical wellbeing; however humors
are no longer seen as ‘real’ in Western medicine.
Epistemology is a field of philosophy concerned
with the nature, source and legitimacy of
knowledge. In the domain of health research we
are interested in knowledge as applicable to:
• Selecting and implementing practices.
• Producing and interpreting evidence.
• Constructing and applying theories to practice.
Before we begin discussion of scientific knowledge
and research it is useful, as a means of contrast, to
look at some other epistemological approaches.
Western health care is one of many approaches;
it is erroneous to believe that it is always the best
option for preventing, treating and managing
diseases. The World Health Organization (WHO
2010) defines traditional medicine as ‘the
knowledge, skills and practices based on the
theories, beliefs and experiences indigenous to
different cultures, used in the maintenance of
health and … treatment of physical and mental
Reasoning is commonly used to arrive at true
knowledge. It is assumed that, if the rules of logic are
applied correctly, then the conclusions are guaranteed
to be valid. As an example, let us look at the following
 1. All persons suffering from heart disease are males.
 2. Person X has heart disease.
 3. Therefore, person X is a male.
Logic guarantees that the conclusion (3) is true,
provided that the syllogism is in a valid form and the
premises (1) and (2) are true. Clearly, the limitation of
formal (that is, ‘content-independent’) reasoning is that
it works in practice only if we have means for
establishing the factual truth of the premises.
In the above example, conclusion (3) might be
empirically false, given that the premise (1) is
factually false. The origin of modern science
originates from ‘natural’ philosophy. Reasoning
and logic are very much a part of science.
However, we require reliable evidence to support
conclusions based on logic and mathematical
Science and the scientific method evolved over a
period of thousands of years (Fara 2009). Great
civilizations, such as Babylonia, China and India,
devised written languages and symbols for
numbers, to permanently record observations
and speculations about the world.
 This was an essential step in the development of
formal science. Disciplines such as astronomy,
mathematics and medicine were further
developed by Greek and Roman philosophers and
For example, the Roman physician Galen worked
as a surgeon treating injured gladiators and used
experimental methods to test hypotheses about
physiology and anatomy. Much of the classical
knowledge was lost during the dark ages, but an
important fraction was preserved and expanded
upon by Muslim and Christian scholars (Fara
The beginnings of modern Western science are
generally traced to the beginning of the 16th
century, a time in which Europe experienced
profound social changes and a resurgence of great
artists, thinkers and philosophers.
The following points represent the essential
characteristics of the early scientific world view:
• Realism: a position which holds that the world exists
independently of our beliefs. For example, the planets
are large objects which circle about the sun, regardless
of what observations astronomers make about their
• Determinism: the assumption that events in the
world occur according to regular laws and identifiable
• Empiricism: the conviction that discovery ought to be
conducted through observation and the truth of
knowledge verified through evidence.
• Scepticism: an attitude which fosters questioning the
truth of any proposition; even those made by great
authorities. All aspects of knowledge, including
methods, became open to questioning, critique and
Considering Figure 1.1, let us start with
observations. The description of phenomena
involving the precise, unbiased recording of
observations of aspects of persons, objects and
events forms the empirical basis of all branches
of science. Observations can be expressed as
either verbal descriptions or sets of
The perceptions of the investigator must be
transformed into descriptive statements and
measurements that can be understood and
replicated by other investigators.
 Some research is based on observation made with
instruments (such as recording electrodes,
microscopes and standardized clinical tests),
while other research calls for observation
unaided by instruments.
Although advances in instrumentation have
contributed enormously to scientific knowledge,
the use of complex instrumentation is not a
necessary feature of scientific observation.
 Rather, the key attributes of scientific
observation are accuracy and replicability by
other scientists. When observations are
appropriately summarized and are confirmed by
others, they form the factual bases of scientific
Statements representing observations or
measurements are integrated into explanatory
systems called hypotheses and theories.
 The logic underlying scientific generalizations is
called induction. Induction involves asserting
general propositions (hypotheses, theories) about
a class of phenomena on the basis of a limited
number of observations of select elements.
 For example, having observed that penicillin is
useful for curing pneumonia in a limited set of
patients, we make the generalization ‘the
administration of penicillin cures pneumonia (in
all patients)’.
 The
administration of penicillin cures
pneumonia’ is an example of an
hypothesis. Scientific hypotheses are
statements that specify the expected
relationship between two or more sets of
 In this instance, the first variable relates
to the administration of penicillin and the
second set of variables relates to beneficial
changes in patients with pneumonia.
 For
example, the ‘beneficial changes in
the symptoms of patients with pneumonia’
will include a reduction in temperature in
degrees centigrade. When hypotheses
acquire strong empirical support, they
may be called laws.
 Therefore the statement, ‘the
administration of penicillin cures
pneumonia’, can be considered a law on
the grounds that many patients with
pneumonia have been effectively treated.
Scientific theories are essentially conjectures
representing our current state of knowledge
about the world.
 Hypotheses are integrated into more general
explanatory systems called theories.
 A theory will clarify the relationships between
diverse classes of observations and hypotheses.
 For example, a theory to explain why drugs
called antibiotics are effective in curing some
infectious diseases integrates evidence from
diverse sources such as microbiology,
pharmacology, cell physiology and clinical
In health care, theories are important for
explaining the causes of health and illness and
predicting the probable effectiveness of treatment
outcomes. For example, the theory of AIDS is
based on the assumption that signs and
symptoms of the disease are caused by the HIV
retrovirus, which is transmitted by bodily fluids
(e.g. blood, semen). This theory guides practices
such as screening of blood and promoting safe sex
to control the pandemic.
A scientific theory will lead to a set of empirically
verifiable statements or hypotheses.
In addition to being generalizations based on
evidence, hypotheses are also deduced logically from
the statements and/or models which specify the
causal relationships postulated by the theories.
For instance, if we hold the theory that the patterns
of activity of a set of neurones in the occipital lobe
mediate visual sensation in humans, then the
hypothesis follows that the activation of these
neurones (say, by electrical stimulation) will lead to
the report of visual sensations. Such hypotheses have
been the bases for subsequent spectacular clinical
advances such as artificial vision through cortically
implanted electrodes.
After the evidence has been collected, the
investigator decides whether or not the findings
are consistent with the predictions of the
 If the hypothesis is supported by the evidence,
then the theory from which the hypothesis was
deduced is strengthened or verified. When the
data are not consistent with the predictions, the
theories from which the hypotheses were deduced
are falsified.
 If a theory can no longer predict or explain
evidence in its empirical domain, it becomes less
useful and is usually later discarded in favour of
new, more powerful theories.
Therefore, scientific theories are not held to be
absolute truths, but rather as provisional
explanations of available evidence. An essential
characteristic of a scientific proposition is that it
should be ‘falsifiable’. That is, there should be a
clear empirical outcome that could, if found, show
that the proposition was false.
 For example, consider the previous statement,
‘the administration of penicillin cures
pneumonia’. This statement is clearly falsifiable
because there is the possibility that penicillin will
not work.