NURSE AS RESEARCHERS
●
●
●
Nurses are expected to understand
and conduct research
Research evidence need as basis for
nursing profession practice
evidence”
typically
➢ “Best
comes
from
research
conducted by nurses and other
healthcare professionals.
Adopt to evidence- based practice
(EBP)
➢ EBPinvolves using the best
evidence as well as clinical
judgment
and
patient
preferences and circumstances
in
making
patient
care
decisions.
WHAT IS NURSING RESEARCH?
Systematic inquiry that relies on a
disciplined method to answer or solve
problems. Designed to generate evidence
about issues of importance to the nursing
profession(including
nursing
practice,
education, administration, and informatics).
IMPORTANCE OF RESEARCH IN
NURSING
●
●
●
●
●
●
Informs decision-making for patient
care
Reinforce the identity of Nursing as a
profession
Professional advancement
(credentialing & status)
Creation of new practice knowledge
Drives change in nursing practice
Bridge the gap between theory &
practice
The Consumer–Producer Continuum
➢
➢
Consumer of nursing research - one
who reads research reports or
research
summaries
to
keep
up-to-date on findings that might
affect their practice.
Producer of nursing research Nurses who conduct the research
Even if you never personally carry out a
study you may :
1.
2.
3.
4.
5.
Contribute to an idea for a clinical
study
Gather information for a study
Advise clients about participating in
research
Seek answers to a clinical problem
by searching for and appraising
research evidence
Discuss the implications of a study in
a journal club in your practice
setting.
HISTORY OF NURSING RESEARCH
The research in nursing began with
Florence Nightingale in the 1850. Her most
well-known research contribution involved an
analysis of factors affecting soldier mortality
and morbidity during the Crimean War. Most
early studies concerned nurses’ education
rather than patient care.
In the 1950s, research by nurses
began to accelerate. The American Nurses’
Foundation, which was devoted to the
promotion of nursing research, was founded.
Several Forces of nursing also helped
to shape the nursing research landscape in
the 1980. A group from the McMaster Medical
1
School in Canada designed a clinical learning
strategy that was called evidence-based
medicine (EBM), which promulgated the view
that research findings were superior to the
opinions of authorities as a basis of clinical
decision.
In 1993, the National Institute of
Nursing Research (NINR) was established,
helping to put nursing research more into the
mainstream of health research.
●
●
DR. LINDA H. AIKEN
Pioneering research: created an
evidence base showing patient outcomes
improve when:
●
Nurses are caring for fewer patients
●
having most nurses with bachelor’s
or higher qualifications
●
improving nurse work environments
●
FUTURE DIRECTIONS FOR NURSING
RESEARCH
●
●
●
●
Continued
focus
on
EBPImprovement will be needed both in
quality of studies and in nurses; skills
in locating, understanding, critically
appraising, and using relevant study
result.Translational
Research
involves research on how findings
from studies can best be translated
into practice
Accelerating emphasis on research
synthesis
(systematic
reviews)Research syntheses that integrate
research evidence across studies are
the cornerstone of EBP. Systematic
Reviews is an important type of
synthesis which rigorously integrates
research information on a research
question.
Expanded
local
research
in
healthcare
settings
Projects
designed to solve local problems are
increasing. Mechanisms need to be
developed to ensure that evidence
from
these
projects
becomes
available to others facing similar
problems.
Strengthening
inter-professional
collaboration collaborative efforts
could lead to nurse researchers
playing a more prominent role in
national and international policies.
Nurses should be full partners with
physicians and other healthcare
professionals in redesigning health
care
(Institute
of
Medicine’s
●
Influential 2010 - The Future of
Nursing)
Increased emphasis on patientcenteredness - a central concern in
health care, as well as in research.
Comparative
effectiveness
research
involves
direct
comparisons
of
alternative
treatments, has emerged as an
important tool for patient-centered
research.
Relatedly, greater interest in the
applicability of research - More
attention is being paid to figuring
out how study results can be applied
to individual patients or groups of
patients. A limitation of the current
EBP model is that- standard
strategies offer evidence on average
effects of healthcare interventions
under ideal circumstances.
Growing interest in defining and
ascertaining clinical significance
-Research findings increasingly must
meet the test of being clinically
significant.
Growing interest in precision health
care and symptom science - The
precision health care initiative is
helping advance nursing omic
research (e.g. genomic, microbiomic)
SOURCES OF EVIDENCE FOR NURSING
PRACTICE
●
●
●
Tradition & Authority - Decisions are
sometimes based on custom or
tradition.
Some
nursing
interventions are based on custom
and “unit culture” rather than sound
evidence. Reliance on authorities is
unavoidable
but
imperfect:
authorities
are
not
infallible,
particularly if their expertise is based
primarily on personal experience or
out-of-date materials.
Clinical experience trial and error Clinical experience is a functional
source of knowledge and plays an
important role in EBP . Yet personal
clinical
experience
has
some
limitations as a knowledge source
because each nurse’s experience is
too narrow to be generally useful.
Trial and Error may offer a practical
means of securing knowledge, but
the method tends to be haphazard
and solutions may be idiosyncratic.
Logical reasoning (inductive and
deductive)
Solutions to some
problems are developed by logical
reasoning,
which
combines
experience, the intellect, and formal
systems of thought. Inductive
resoninig
(developing
generalizations
from
specific
observations). Deductive reasoning
(developing specific predictions from
general principles)
●
Assembled
information
(e.g.,
quality improvement data) - In
making clinical decisions, healthcare
professionals rely on information
that has been assembled for various
purposes.
●
Disciplined research - Research
conducted
in
a
disciplined
framework is the best method of
acquiring knowledge. The current
emphasis on EBP requires nurses to
base their clinical practice to the
greatest
extent
possible
on
research-based findings rather than
on tradition, authority, institution, or
personal experience - although
nursing will always remain a rich
blend of art and science.
●
Others : coursework, textbooks,
experience, tradition and expert
opinion.
Because evidence is constantly evolving,
learning about the best practice nursing will
persist throughout the career.
PARADIGMS AND METHODS FOR
NURSING RESEARCH
PARADIGMS FOR NURSING RESEARCH
➔ Paradigm - is a worldview, a general
perspective on the complexities of
the world.
➔ Positivist
◆
Reality exists
◆
There is a real world driven
by natural causes
◆
There is a reality out there
that can be studied and
known.
➔ Constructivism/ Naturalistic
◆
Multiple realities
◆
Subjective,
mentally
constructed by individuals
◆
Based on perspective (like
why is it someone is more
considerate
than
the
other?)
HOW IS THE RESEARCHER RELATED TO
THOSE BEING STUDIED
➔ Positivist
◆
Independent from those
being studied
◆
Example: employ to gather
data
➔ Constructivism/ Naturalistic
◆
Interacts with those being
studied
◆
Researcher must be the
one to gather data and do
the interaction
WHAT IS THE ROLE OF VALUES IN THE
INQUIRY?
➔ Positivist
◆
Values held in check
◆
Objectivity sought
◆
Values are not significant,
we can control values.
◆
Example: Genders - Male
and Female
➔ Constructivism/ Naturalistic
◆
Subjectivity & values are
inevitable, desirable
◆
“The more I know, the more
it's desirable.”
◆
Can be regulated.
◆
No questionnaires, rather
do an interview.
WHAT ARE THE BEST METHODS FOR
OBTAINING EVIDENCE?
POSITIVISM (Qualitative Research)
●
●
●
●
●
●
●
●
●
Deductive process – hypothesis
Testing
Objective, quantifiable
Fixed design
Controls over context
Large, representative sample
Measured information
Statistical analysis
Seeks generalization
CONSTRUCTIVISM (Qualitative
Research)
●
●
●
Inductive process – hypothesis
Generation
Subjective, non-quantifiable
●
●
●
●
●
●
Flexible, emergent design
Context-bound
Small, information-rich samples
Narrative information
Qualitative Analysis
Seeks in-depth understanding
MULTIPLE PARADIGMS
Paradigms -viewed as lenses that help to
sharpen our focus on phenomena; not as
blinders that limit intellectual curiosity.
It is a worldview, a general
perspective on the complexities of the world.
Paradigms for human inquiry are often
characterized in terms of the ways in which
they respond to basic philosophical questions,
such as , “what is the nature of reality?” and
“what is the relationship between the inquirer
and those being studied ?”
EVIDENCE - BASED PRACTICE
Training Research Evidence into Practice
QUESTION
Tell whether the following statement is TRUE
or FALSE: •
➢ The use of study findings in a
practical application unrelated to the
original research is evidence-based
practice.
ANSWER
• FALSE •
Research utilization is the use of study
findings in a practical application unrelated to
the original research. Evidence-based practice
is basing clinical decisions on best possible
evidenc
PURPOSE OF NURSING RESEARCH
Answer questions or solve problems
of relevance to the nursing profession
Basic research (bench research)-
is
undertaken to discover general principles of
human
behavior
and
biophysiologic
processes.
●
extend the base of knowledge in a
discipline
●
formulate or refine a theory
BRIEF HISTORY OF EBP
●
Applied research • is aimed at examining
how basic principles can be used to solve
practice problems.
●
focuses on finding solutions to
existing problems
●
tends to be of greater immediate
utility for EBP
●
●
●
●
1972- Archibald L. Cochrane British
epidemiologist, criticized the health
profession
for
administering
treatments
not
supported
by
evidence (Cochrane, 1972)
1980s, the term evidence-based
medicine (EBM) was being used at
McMaster University Medical School
in Canada.
1992 to approve funding for “a
Cochrane Centre” to facilitate the
preparation of systematic reviews of
randomized controlled trials of
health care, eventually leading to the
establishment of the Cochrane
Collaboration in 1993 (The Cochrane
Collaboration,
1970s - The Conduct and Utilization
of Research in Nursing Project
(CURN) began (Horsley, Crane, &
Bingle, 1978).
2006 - National Institute for Nursing
Research (NINR) published • 10
landmark programs that have had a
major impact on health care
(www.nih/ninr.gov/).
FLORENCE
NIGHTINGALE:
CONTRIBUTIONS TO EBP
1.
2.
3.
4.
HER
Systematic data collection during
the Crimean war •
Exploring
differential
mortality
among population subgroups •
Care by trained or untrained nurses
Using evidence to guide policy
decisions
Evidence-Based Practice (EBP)
•
“A paradigm and life long problemsolving approach to clinical decision making
that involves the conscientious use of the best
avail able evidence (including a systematic
search for and critical appraisal of the most
relevant evidence to answer a clinical
question) with one’s own clinical expertise
and patient values and preferences to
improve
outcomes
for
individuals,
communities, and systems” (p. 753). Melnyk
and Fineout- Overholt (2019
MODELS OF EBP
● Stetler Model
Iowa Model
●
Johns Hopkins Model
●
ACE STAR Model (Academic
●
Center for Evidence Based
Practice)
ARCC Model
●
Rosswurm & Larrabee’s Mode
●
●
●
●
●
Caledonian Development Model
Evidence Based Practice Model
for Staff Nurse
Rogers’ Diffusion of InnovationDecision Model
PARIHS Framework
STEP 2:ACQUIRE RESEARCH EVIDENCE
RESOURCES FOR EBP
STEPS IN EVIDENCE-BASED
PRACTICE
STEP 1: ASK A WELL-WORDED CLINICAL
QUESTION
Triggers
➢
➢
PICO
problem- focused triggers—a clinical
practice problem in need of solution,
•
knowledgefocused
triggers—readings in the research
literature
A
clinical
question
incorporate at least three elements
1.
2.
3.
should
Patient (What are the characteristics
of patients?)
➢ Age, sex, ethnicity, etc.
➢ Condition, diseases, general
health status
●
Intervention
(What
are
the
interventions
or
therapies
of
interest?)
Education,
➢ Patient
diagnostics, treatment plan,
self-care, etc.
harmful
➢ Potentially
influence of concern
●
Comparison Intervention
➢ Placebo, etc.
Outcome
Expected and actual effects on
➢
patient
●
●
STEP 3: APPRAISE THE EVIDEN
“For
adult
surgical
inpatients
between the ages of 20 and 50
with
a
peripheral
intravenous
catheter, does the use of saline to flush the
peripheral IV maintain IV patency and
decrease phlebitis over 48 hours when
compared to heparin flushes?
4.
5.
Quality: To what ex tent is the
evidence valid—that is, how serious is
the risk of bias?
. Magnitude: How large is the effect of
the intervention or influence (I) on the
out come (O) in the population of
interest (P)? Are the effects clinically
significant?
Quantity: How much evidence is
there? How many studies have been
conducted, and did those studies
involve a large number of study
participants?
Consistency: How con sis tent are the
findings across various studies?
Applicability: To what ex tent is the
evidence relevant to my clinical
situation and patients
STEP 4:APPLY THE EVIDENCE
STEP 5: ASSESS THE OUTCOMES
COMES OFTHE PRACTICE CHANG
Practice Question, Evidence, Translation
(PET
KEY-TERMS AND BUILDING-BLOCKS
SETTINGS
●
Naturalistic settings – field; homes;
qualitative research
●
Laboratory settings- controlled
●
Site- the overall location for the
research
●
Entire
community
Institution
Multisite studies- multiple sites;
more diverse sample
Building Blocks of Research
●
Abstractions – e.g. pain, fatigue,
stress and obesity
●
Construct - abstraction inferred
from situations or behaviors
●
Phenomena – term used in
qualitative research • Concepts- are
abstractions
of
observable
phenomena, and researchers’ world
views shapes how concepts are
defined.
●
●
●
●
Kerlinger and Lee (2000) distinguish
concepts from constructs by noting
that constructs are abstractions that
are deliberately and systematically
invented
(constructed)
by
researchers.
For example, self-care in Orem’s
model of health maintenance is a
construct.
Construct
and
concept:
used
interchangeably
By convention, a construct refers to
a more complex abstraction than a
concept.
THEORIES. CONCEPT MODELS AND
VARIABLES
Theories and Conceptual Models
●
●
●
●
Theory- is a systematic, abstract
explanation of some aspect of reality
knit concepts together into
a coherent system
Conceptual
modelconceptual
frameworks, or conceptual schemes
(we use the terms inter changeably)
are a less formal means of
organizing
phenomena
than
theories
Quantitative Research
Based on theory, they make
predictions
about
how
phenomena will behave in
the real world if the theory
is true.
Specific
predictions
deduced from theory are
tested through research;
results are used to support,
reject, or modify the theory.
Qualitative Research
conceptual or sensitizing
frameworks - provides an
orienting world view
framework helps to guide
the inquiry and to interpret
gathered information
VARIABLES
●
Variables- something that varies
any quality of a person,
group, or situation that
varies or takes on different
values.
-
●
●
are the building blocks of
quantitative studies
Example of variables:
Weight, anxiety, and blood
pressure
are
variables—each varies from
one person to another
Quantitative researchers seek to
understand how or why things vary,
and to learn if differences in one
variable are related to differences in
another.
Heterogenous and homogeneous variables
●
Heterogeneous
When
an attribute is
extremely varied in the
group under study
●
Homogeneous
If the amount of variability
is limited
●
Degree
of
variability
or
heterogeneity of a group of people
has implications for study design.
Inherent and created variables
●
Variables may be:
●
Inherent characteristics of people:
age, blood type, or weight
●
Created Variables
Example:
If a researcher tests the effectiveness
of patient-controlled analgesia as
opposed to intramuscular analgesia
in relieving pain aftersurgery, some
patients would be given patientcontrolled analgesia and others
would
receive
intramuscular
analgesia.
Method of pain management is a
variable because different patients
get different analgesic methods.
Continuous, Discrete, and Categorical
Variables
●
Continuous variables - have values
along a continuum and, in theory,
can assume an infinite number of
values between two points.
Ex. Weight
●
Discrete variable - has a finite
number of values between any two
points,
representing
discrete
quantities
-
●
Ex. Number of children in
the family
Categorical variables – discrete
non-quantitative values
Ex. Blood types: A, B, AB, O
When categorical variables
take on only two values,
they
are
dichotomous
variables
Dependent and Independent Variables
●
Independent
variablethe
presumed cause
●
Dependent variable- the presumed
effect
Some researchers use the
term
outcome
variable—the
variable
capturing the outcome of
interest—in
lieu
of
dependent variable.
●
Variability varies
investigators may study the
extent to which patients’
pain
(the
dependent
variable)
depends
on
different nursing actions
(the independent variable)
Question:
Is it common to design studies with multiple
independent and dependent variables?
●
Answer: Yes
●
For example, a researcher may
compare the effects of two methods
of nursing care for children with
cystic fibrosis.
●
Several dependent variables could
be used to assess treatment
effectiveness, such as length of
hospital stay, number of recurrent
respiratory infections, and so on.
Are Variables
independent?
inherently
dependent
or
●
●
●
●
No
A dependent variable in one study
could be an independent variable in
another.
For example, a study might examine
the effect of a nurse-initiated
exercise
intervention
(the
independent
variable)
on
osteoporosis
(the
dependent
variable).
Another study might investigate the
effect
of
osteoporosis
(the
independent variable) on bone
fracture incidence (the dependent
variable).
CONCEPTUAL AND OPERATIONAL
DEFINITION
conceptual definition- presents the abstract
or theoretical meaning of the concepts being
studied.
➢ The classic example is the concept of
caring.
and
colleagues
(1990)
➢ Morse
scrutinized the works of numerous
writers to determine how caring was
defined, and identified five different
classes of conceptual definition: as a
human trait, a moral imperative, an
affect, an interpersonal relationship,
and a therapeutic intervention.
➢ Researchers undertaking studies
concerned
with caring need to
➢
make clear which
conceptual
definition they have adopted— both
to themselves and to their readers.
In qualitative studies, conceptual
definitions of key phenomena may
be the major end product of the
endeavor, reflecting the intent to
have the meaning of concepts
defined by those being studied.
Operational definition
●
In quantitative studies, however,
researchers
clarify and define
concepts at the outset.
●
This
is
necessary
because
quantitative
researchers must
indicate how the variables will be
observed and measured.
●
An operational definition of a
concept specifies
the operations
that researchers must perform to
measure it.
●
Operational definitions should be
congruent
with
conceptual
definitions.
Definition of caring
“Caring is the process by which the
nurse becomes responsive to another person
as a unique individual, perceives the other’s
feelings, and sets that person apart from the
ordinary” (Cronin, & Harrison, 1998) Based in
Jwan Watson’s framework of caring
●
Example: We might operationally
define weight as the amount that an
object weighs, to the nearest full
pound.
●
●
●
This definition designates that
weight will be measured using one
system
(pounds) rather than
another (grams).
We could also specify that weight
will be measured using a spring
scale with
participants fully
undressed after 10 hours of fasting.
This operational definition clearly
indicates what we mean by the
variable weight.
Examples of conceptual and operational
definitions
●
Rafferty et al. (2017) developed a
measure called the Culture of Care
Barometer (CoCB) to measure the
culture of care in health care
organizations.
●
They defined “culture of care”
conceptually as the shared beliefs,
norms, and routines through
which the environment of a health
care
organization
can
be
interpreted and understood.
●
This construct was operationalized
in the CoCB through a series of 30
questions to staff. Two examples are,
“I have the resources I need to do
a good job” and “I feel supported
to develop my potential.”
DATA AND RELATIONSHIP
●
●
●
●
Research data (singular, datum) are
the pieces of information obtained
in a study.
In quantitative studies, researchers
identify
variables,
develop
conceptual
and
operational
definitions, and then collect relevant
data.
Quantitative
researchers
collect
primarily
quantitative data—data in numeric
form.
●
●
In qualitative studies, researchers
collect qualitative data, that is,
narrative descriptions.
Narrative
information
can
be
obtained by having conversations
with
participants, by making
detailed notes about how people
behave in naturalistic settings, or by
obtaining narrative records, such as
diaries.
●
●
●
●
RELATIONSHIPS
●
●
●
●
●
A relationship is a bond or a
connection between phenomena.
For example, researchers repeatedly
have found a relationship between
cigarette smoking and lung cancer.
Both qualitative and quantitative
studies examine relationships, but in
different ways.
In quantitative studies, researchers
examine the relationship between
the independent and dependent
variables.
The research question asks whether
variation in the dependent variable
is systematically related to variation
in the independent variable.
Notes:
Dependent Variable: growth rate of COVID-19
Independent Variables: Mask wearing and
lockdowns
●
Quantitative studies can address
one or more of the following
questions about relationships:
Does
a
relationship
between
variables exist? (e.g., is mask wearing
and physical distancing related to
COVID-19 risk?)
What is the direction of the
relationship between variables? (e.g.,
are people who wear face masks and
do physical distancing more likely or
less likely to get COVID-19 than those
who do not?)
How strong is the relationship
between the variables? (e.g., how
powerful is the link between mask
wearing
and
distancing
and
COVID-19 Risk? How much lower is
the COVID-19 risk for those who wear
face masks and apply physical
distancing?)
What is the nature of the
relationship between variables? (e.g.,
do face masks & distancing reduce
COVID-19 Risk? Does some other
factor reduce COVID-19 Risk?)
Notes:
According to The Lancet, the chance of
transmission without masks and respirators is
17.4 percent and this falls to just 3.1 percent
when they are worn. Eye protection can also
reduce the chance of infection from 16
percent to 5.5 percent. The authors of the
study caution that even when all these
measures are combined, they fail to offer
complete protection and that others are
necessary, especially
hand hygiene.
hand
washing/good
Experimental Research
One type of relationship is called
cause-and-effect (or causal) relationship.
a
functional (or an associative) relationship
Qualitative researchers seek patterns of
association as a way to
illuminate the
underlying meaning and dimensionality of
phenomena.
MAJOR CLASSES OF QUANTITATIVE
AND QUALITATIVE RESEARCH
Quantitative Research: Experimental and
Nonexperimental Studies
●
Clinical trial (randomized controlled
trial or RCT)
●
observational study
Qualitative
Research:
Disciplinary
Traditions
●
Qualitative descriptive research
●
grounded theory tradition
●
Phenomenology
●
Ethnography
Nonexperimental research
Grounded theory research
●
grounded theory
tradition, with
roots in sociology, seeks to describe
and
understand the key social
psychological processes that occur
in a social setting
●
Grounded theory was developed in
the 1960s by two sociologists, Glaser
and Strauss (1967).
Phenomenology, rooted in a philosophical
tradition
developed by Husserl and
Heidegger,
is
concerned
with
lived
experiences of humans
●
The phenomenological researcher
asks the questions: What is the
essence of this phenomenon as
experienced by these people? Or,
what is the
meaning of the
phenomenon to those
who
experience it?
Ethnography is the primary research tradition
within anthropology, and provides
a
framework for studying the lifeways and
experiences of a defined cultural group.
●
Ethnographers strive to learn from
members of a cultural group, to
understand their world view, and to
describe their customs and norms.
●
●
6. Steps in Qualitative and
Research Study
Quantitative
Step 11: Developing Methods to
Safeguard the Subjects
Step 12: Finalizing the Research Plan
Phase 3: The Empirical Phase
●
Step 13: Collecting the Data
●
Step 14: Preparing the Data for
Analysis
Steps in Quantitative Study
Phase 4: The Analytic Phase
●
Step 15: Analyzing the Data
●
Step 16: Interpreting the Results
Phase 1: The Conceptual Phase
●
Step 1: Formulating and Delimiting
the Problem
●
Step 2: Reviewing the Related
Literature
●
Step
3:
Undertaking
Clinical
Fieldwork
●
Step
4:
Defining
the
Framework/Developing Conceptual
Definitions
●
Step 5: Formulating Hypothesis
Phase 2: Design and Planning Phase
●
Step 6: Selecting a Research Design
●
Step 7: Developing Intervention
Protocols
●
Step 8: Identifying the Population
●
Step 9: Designing the Sampling Plan
●
Step 10: Specifying methods to
measure research variables
Phase 5: The Dissemination Phase
●
Step
17:
Communicating
the
Findings
●
Step 18: Utilizing the Findings in
Practice
Activities in a Qualitative Study