Nursing Research
Nursing Research
Involves a systematic search for knowledge about issues of
importance to the nursing profession
Research on the process of care and clinical problems
encountered in the practice of nursing
Clinical Nursing Research
o
Hug Therapy
o
Coping dynamics of Adolescents with ADHD
Research in Nursing
Broader study of people and the nursing profession
including historical, ethical and policy studies
Focused on ethical issues in nursing
o
Core Competency Standards
o
Patient Satisfaction among Surgical Patients
Evidence-Based Practice
Conscious and judicious use of current “best” evidence in
the care of patients and delivery of health care services
(Titler, 1999)
Conscientious use of current based evidence in making
clinical decisions about patient care
Levels of Evidence
Level 1

Systematic review of Randomized Clinical Trials

Systematic review of non-randomized trials
Level 2

Single RCT

Single non-randomized trial
Level 3

Systematic review of correlational or
observational studies
Level 4

Single correlational or observational study
Level 5

Systematic review of descriptive or qualitative or
physiologic studies
Level 6

Single descriptive or qualitative or physiologic
studies
Level 7

Opinions of authorities, experts, committees

May sometimes be outdated
Importance of Research in Nursing
ULTIMATE GOAL: To improve the practice of its members so
that services provided to its clientele will be maximally
effective
Enhance professionalism
Proof of accountability
Strengthen social relevance of nursing
Basis for sound decision making
Sources of Human Knowledge
Tradition

Certain truths are accepted as given on the basis
of inherited customs or tradition
Authority

Refer to people with specialized expertise

Not enough when used alone
Experience and trial and error and intuition

Own experiences represent a familiar and
functional source of knowledge
Logical Reasoning

Combines experience, intellectual faculties and
formal system of thought
Assembled information

Benchmarking data
University of Santo Tomas – College of Nursing / JSV
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Disciplined Research

Most sophisticated method of acquiring
knowledge

Findings from rigorous research investigations are
considered to be at the pinnacle of the
evidence hierarchy for establishing an evidencebased practice
Purposes of Nursing Research
Identification - what is the phenomenon?
Description- observe, count, classify, delineate the
phenomenon
Exploration - investigates the full nature of a phenomenon,
its manifestations and factors affecting it
Explanation - attempts to explain the why or underlying
cause/explains systemic relationship
Prediction- what will happen if?
Control - how can the phenomenon be altered?
ETHICAL CONSIDERATIONS IN RESEARCH
Nuremburg Code
First internationally accepted effort to set up formal ethical
standards governing human research subjects
Requires informed consent for all cases
Helsinski’s Declaration
Differentiates 2 major types of research:
o
That which is essentially therapeutic
o
That which essentially directed toward
developing knowledge and has no therapeutic
value
Belmont Report
Articulated 3 primary ethical principles
Principles of Beneficence
o
Freedom from harm
o
Freedom from exploitation

Involvement in research should not
place subjects at a disadvantage or
expose to situations they have not been
explicitly prepared

Assures subjects that their participation
will not be used against them
o
Balancing benefits and risks (benefit-Risk Ratio)

Approve: greater benefits

Reject: greater risks
-
-
Principle of respect for Human Dignity
o
Informed consent
o
The right to self-determination

Right to voluntarily decide whether or
not to participate in a study
o
The right to full disclosure

Describe nature of study, procedure,
method of collection, risks, benefits,
discomforts it will entail,

Right to refuse treatment
Principle of Justice
o
Right to privacy
Safeguards to Privacy
Confidentiality
o
Information gathered will not be publicly
reported in a way that identifies the subject
o
Information is accessible only to the researchers
Anonymity
o
Even the researcher cannot link the subject with
the information reported
o
Do not use the name of the patient- use
numbers or codes
Nursing Research
Right to Fair Treatment
Non-discriminatory selection of subjects/participants
Respect for cultural and other forms of diversity
Non-prejudicial treatment of individuals who decline to
participate or withdraw from the study
Honoring all agreements made between the researcher
and subject (adherence to procedures and payment of
stipends)
Access to research personnel to clarify information
Access to appropriate professional assistance in case of
injury/damage
Paradigm
World view
A general perspective on the complexities of the real
world, with certain assumptions about reality
Key Paradigms for Nursing Research
Positivist
Naturalist
POSITIVIST
Fixed design
Discrete, specific concepts
Deductive processes
Control over context
Verification of hunches
Quantitative information
Seeks generalizations
NATURALIST
Flexible design
Holistic
Inductive processes
Context-bound
Emerging interpretations
Qualitative information
Seeks patterns
TYPES OF RESEARCH
According to Motive
1. Basic Research - just to know/ to generate knowledge
2. Applied Research - to make the new knowledge useful
and practical
According to Level of Investigation
1. Exploratory- identifying the variables
2. Descriptive - finding out whether the variables are
associated/related
3. Experimental - finding out the effects of variables to each
other
According to Design or Approach
A. Non-experimental
1. Historical - use past events to answer a problem
2. Survey - use interview, observation and questionnaire to
gather public opinion
3. Case Study - gathers data in detail about an individual or
groups of individual and usually presented in narrative form
4. Methodological - to test a tool, method or procedure
5. Analytical - use logical analysis of records and ideas
B. Experimental
1. True Experiment -strict control of all variables
o
Randomization- randomized selection of subjects
o
Control- control over context
o
Manipulation- treatment which you give to
experimental group and withhold to control
group
2. Quasi-experimental - control overcomes the variables
3. Pre-experimental – manipulation of independent variable,
no randomization or control group, limited control over
extraneous variables
Experimental Research Designs
True experiment/Pre-test-Post-test Design
Post test only design
o
Used when it is impossible to measure the
variable before the intervention
University of Santo Tomas – College of Nursing / JSV
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Solomon four group design
o
More effective in doing experimental design
o
We want to make sure that the changes in the
dependent variable was caused by the
independent variable and not because of other
competing reasons (internal validity)
o
Combination of pretest post-test and post-test
only design
According to Time Frame
1. Cross-sectional Study
o
Data collected at one point in time
2.
Longitudinal Study
o
Repeated data collection at an extended time
interval
o
Data collected at different points in time
o
Threats to Internal Validity

Attrition- subjects gradually decrease
over time

History- an event prior to data collection
at a specified period of time which may
affect the result

Maturity – as one grows older one
becomes better
According to measurement of independent and dependent variable
1.
2.
Retrospective
o
Begins with a dependent variable and looks
backward for its causes and antecedent
o
Answer a current variable (present) using the past
Prospective
o
Study begins with an independent variable and
looks forward for its effects
o
Use intervention (present) and go in time to
predict what will happen in the future
According to Measurement
1. Quantitative Research
o
Investigation of phenomena that lends
themselves to precise measurements and
quantification often involving a rigorous and
controlled design
2. Qualitative Research
o
Investigation of phenomena; typically an in
depth and holistic fashion through the collection
of rich narrative materials using a flexible
research design
*Is there an intervention? If no = non-experimental; if yes =
experimental
THE RESEARCH PROCESS
5 Major Phases of the Research Process
1. Conceptualizing Phase
2. Design and Planning Phase
3. Empirical Phase - longest (spends most of time, Polit and
Beck)
4. Analytical Phase
5. Dissemination Phase
Phase I: Conceptual Phase
Researcher develops the formal question to be
investigated in the study
1. Formulating and delimiting the problem
2. Reviewing the related literature
3. Undertaking a clinical fieldwork
4. Defining the framework and developing conceptual
definitions
5. Formulating hypothesis
Nursing Research
Phase II: Design and Planning Phase
Strategies to be used to collect and analyze the data to
address the research question and evaluate decisions
before implementation
6. Selecting a research design
7. Developing protocols for the intervention (for
experimental research)
8. Identifying the population to be studied
9. Designing the sample plan
10. Specifying the methods to measure the research variables
11. Developing methods for safeguarding human/animal
rights
12. Finalizing and reviewing the research plan
Phase III: Empirical Phase
13. Data gathering
14. Preparing data for analysis
Phase IV: Analytical Phase
15. Analyzing the data
16. Interpreting the results
Phase V: Dissemination Phase
17. Communicating the findings
18. Utilizing findings in practice
THE RESEARCH PROBLEM
Sources of Research Problems
Experience and clinical fieldwork
Nursing Literature
Social Issues
Theory
Ideas from external sources
Criteria of Good Research Problems
S - significance of the study
A- availability of the subjects
R - researchability of the problem
Feasibility of the Research Problem
Accessibility of subjects (most important factor if one is
feasible)
Time allotment
Limitation of tools
Limitation of subjects
Interest of researcher – ensure sustainability of completion
Novelty – New!
Title – look for variables, population and Setting/Research locale/
maximum is 10 words; the fewer the words the better (do not put
design)
In international publications, population and locale may not be
included
Statement of the Problem
Declarative
o
“Staffing Ratios and Patient Care Outcomes in
Tertiary Hospitals”
Interrogative
o
“What is the Effect of Staffing ratio on Patient
Care Outcomes in Tertiary Hospitals in Manila?”
Significance of the Study
To the person
To the profession
To society at large
Assumption – statement considered to be true and need not be
further examined
Delimitation - purposeful choice of the researcher
Limitation - factors beyond the control of the researcher
University of Santo Tomas – College of Nursing / JSV
Hypothesis
Tentative prediction or explanation of the relation
between 2 or more variables
3 Criteria:
o
Only one variable, condition, relationship and
only one statistical analysis should be addressed
in each hypothesis
o
The variable, condition or relationship must be
testable
o
The aim of the research guides what is included
in the hypothesis
Parts
o
Independent Variable- cause
o
Dependent Variable- effect
o
Relationship
o
The population to which the relationship applies
Types of Hypothesis
Null Hypothesis
o
A statement that there will be no difference, no
change (same), or no effect on the dependent
variable for the population under study
Alternative Hypothesis
o
A statement that there will be a change, an
effect on the dependent variable for the
population under study
o
Directional

States specific relation of variables

Decreases

Increases

Promotes
o
Non-directional

Does not specify the relationship of the
variables

Just specifies that there is a relationship
o
Simple

Predicts relationship between 1
dependent with 1 independent variable
o
Complex

2 or more dependent and independent
variables
* Only alternative hypotheses are categorized either simple or
complex
Variables
Central building blocks of quantitative studies
Continuous Variables
o
Have values that can be represented in a
continuum
o
101.1,101.2,101.3
Discrete Variables
o
One that has a finite number of values between
any two points, representing discrete quantities
o
2 girlfriends, not 1 ½
Categorical Variables
o
Take on only a handful discrete, nonquantitative values
o
Gender, Marital status
Attribute Variables
o
Characteristics of research subjects
o
Weight, height, ethnic groups
Active Variables
o
Variables that the researcher creates
o
Type of exercises
Concept - subject matter of theories, building blocks of theories
Proposition - statement that explains the relationship between 2
concepts
Conceptual Definition – definition that is based on dictionary
Nursing Research
Operational Definition – made by the researcher as used in the
study
Hypothesis- shrewd guess or tentative explanation of the
relationship between 2 variables
Conceptual Model
Pictorial Representation of a proposition
Representation of interaction among and between
concepts
Conceptual Framework
Paradigm or a representation of predictive relationship
between theoretical and operational concepts as
indicated by the theory
Theory
General explanation of a phenomena
Grand or Macro
o
Florence nightingale
Mid-ranges
o
Dorothy Johnson
o
Callista Roy
Micro-range
o
Levels of competence
Laws/Principles
Guiding rules supported over time and proven through
research
REVIEW OF RELATED LITERATURE
Purposes of Literature Review
Identification of research problem and
development/refinement of research questions/hypothesis
Determination of what is known and any gaps or
inconsistencies in a body of research
Determination of a need to replicate prior study in a
different setting and population: to develop a stronger
theories (must ask from the authors)
Identification or development of a new refined clinical
intervention to test through the empirical research
Identification of suitable designs or data collection
methods
Identification of experts in the field
Types of Information to Seek
Primary Source
o
Research reports which are descriptions of
studies written by the researchers
Secondary Source
o
Not written by the researchers
o
Try to get hold of the primary source as much as
possible
Steps for Searching Literature
Determine concept, issues, topic
Identify variables and terms
Conduct computer search
Weed out irrelevant sources before printing
Organize sources from printout for retrieval
Retrieve relevant sources
Copy articles
Conduct preliminary reading and weed out irrelevant
sources
Critically read each source
Synthesize critical summaries of each article
Types of Resources
Print
Internet/Online Database
University of Santo Tomas – College of Nursing / JSV
Practice-Theory-Research Links
Research are used to improve practice
Research is used to generate a theory
Theory used as a framework for research
Practice can be used to generate a theory
Theory is used as a framework for practice
DESIGNING AND PLANNING PHASE
Research Designs
QUANTITATIVE
Researcher,
scientist
Subjects,
respondents
Concepts, variables
Numerical data
QUALITATIVE
Investigator,
researcher
Informants,
participants
Phenomenon,
concept
Textual, nominal
data
Thematic analysis
Statistics
Types of Qualitative Research
1. Phenomenological Study
Most useful when the task is to understand an
experience as those having the experience
understand it
Used to answer questions of meaning
“The Lived experiences of Children of Absentee
Parents”
2. Historical Research
Solving current problems using past events
Thomasian Nursing Icons: 7 Decades of Making a
Difference in Nursing (Eugenio, Estepa,
Evangelista et al, 2008)
3. Grounded Theory
Research method designed to inductively
develop a theory based on observations of the
world of selected people
Minimum of 30 informants
“Being strong: how black west Indian Canadian
women manages depression”
4. Ethnographic Research
Describe cognitive models or patterns of
behavior of people within a culture
Seeks to understand another way of life from the
natives’ experience
Presence must be recognized by the people;
courtesy call
Transcultural Nursing (Leininger)
E.g. Factors Causing Work-Related Stresses
Among Filipino Nurses Working in London (Del
Rosario, 2009)
5. Case Study
Involves an in-depth description of essential
dimensions and processes of the phenomenon
under study
“Two Cases of Battered Women”
Bracketing – to avoid holding previous knowledge regarding the
phenomenon
Determine the Population
Population
The entire aggregation of cases that meet a designated
set of criteria
Eligibility Criteria
The exact criteria by which it could be decided whether
an individual would or would not be classified as a
member of the population in question
Accessible Population
Conform to the eligibility criteria + accessibility
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
element’s 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%, female85%
-
-
Purposive Sampling
o
Judgment sampling
o
Subjects are handpicked to be included in the
sample based on the researcher’s 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
University of Santo Tomas – College of Nursing / JSV
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
 Less costly and
requires less time to
administer
 Offers complete
anonymity
 No interview bias
INTERVIEWS
 Response rates tend to be
high
 Audience- feasible with
most people
 Clarity
 Depth of questioning
 Missing information
Nursing Research
 Order of questioning is
flexible
 Qualitative research
Interviews may be: Structured, Semi-structured, Non- structured
3.
Observation
o
Characteristics and condition of individuals

Decubitus ulcers
o
Activities and Behaviors
o
Skill attainment and performance

Structured observation checklist to
determine….
o
Verbal communication
o
Nonverbal communication
o
Environmental characteristics
4.
Bio-physiologic Measures
o
Basic physiologic process
o
Physiologic outcomes of nursing care
o
Evaluation of nursing interventions
o
Product assessment (e.g. sterilium)
o
Studies of physiologic correlates (intervention and
outcome)– exercise then CBG
Types of Physiologic Measurements
In vivo

Those performed directly or on living organisms

O2 saturation, ultrasound, BP, temp
In vitro

Laboratory tests
Criteria of an Effective Instrument
Qualitative
Trustworthiness
o
Degree of confidence qualitative researchers
have in their data
o
-
4 Criteria
1. Transferability

The extent to which qualitative findings
can be transferred to other settings or
groups

Analogous to generalizability
2. Dependability

Analogous to reliability

Stability of data over time and over
conditions
3. Confirmability

Objectivity or neutrality of the data and
interpretations

Member checking
4. Authenticity

The extent to which qualitative
researchers fairly and faithfully show a
range of different realities in the analysis
and interpretation of data
Quantitative
o
Validity

Degree to which an instruments
measures what is suppose to measure

Face Validity- whether an instrument
appears to be measuring the
appropriate construct
University of Santo Tomas – College of Nursing / JSV
Construct Validity- instrument’s
adequacy in measuring the focal
construct (What does this instrument
measure?)

Content Validity - degree to which an
instrument has an appropriate sample
of items for the construct being
measured

How representative are the
questions in this test

Determined by experts

Criterion-related Validity- relationship
between instrument and external
criterion

The key issue is whether an
instrument is a useful predictor
of future other behaviors,
experiences, or conditions

Internal Validity – the changes in the
dependent variable is due to an effect
of an independent variable that there
are no other competing reasons

External Validity – the findings can be
generalized in other samples/settings
Reliability

Repeatability

Consistency

Ability to yield the same results upon
repeated administration of the
instrument

Closer it is to 1, the more reliable it is
(Cronbach’s alpha) Minimum level is 0.7

o
ANALYZING PHASE
Measurement - assignment of numbers to objects
according to rules
Levels of Measurement
Nominal Data
o
Used to classify objects or numbers according to
categories
o
Gender, hair color, marital status
Ordinal Data
o
Used to show relative ranking of objects or
events
o
Self-assisted, partially assisted, totally assisted
Interval Data
o
Shows ranking of events on scale with equal
intervals between the numbers. Zero point
remains arbitrary and not absolute
o
Temperature, Zero does not mean absence of
temperature
Ratio
o
Shows ranking of events on scale with equal
intervals and absolute zeros. All arithmetic
operations are permissible. E.g. weight
Descriptive Analysis
Frequency Distribution – arrangement of scores and how
many times they appear: %
Measures of Central Tendency
o
Mean- computing average/ most stable
o
Median- counting average
o
Mode- inspecting average – most times they
appear
Measures of Variability
o Range(highest-lowest), SD, variance (SD
squared)