nursing research lec 09
TRANSCRIPT
OBJECTIVES Foundations of Nursing research Importance of research Major phases of the research process Steps in the research study Research problem & Statement of the
problem Hypothesis Review of Related Literature Conceptual Framework & Model
Quantitative Research Designs Sampling Ethics in Research Validity & Reliability Data Collection Evidenced Based Practice
Research is systematic inquiry that uses disciplined methods to answer questions or solve problems.
The ultimate goal of research is to develop, refine, and expand a base of knowledge.
Nursing research is systematic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practice, nursing education, and nursing administration.
A scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice.
Diagnosis of Type 2 Diabetes
◦ FBS 160 mg/dl with positive glucose tolerance test
◦ FBS of 126 mg/dl or greater on two occasions
◦ Hemoglobin A1c greater 6.5
Cloning of human tissue Treatment of HPN with Angiotensin
Receptor Blockers (ARBs) (Irbesartan, Losartan)
Treatment of Depression with SSRIs (selective serotonin reuptake inhibitors)
With evidence based practice, research provides the best clinical evidence in making patient care decisions.
Nurses are accepting the need to base specific nursing actions and decisions on evidence indicating that the actions are clinically appropriate and cost-effective, and result in positive outcomes for clients.
Nurses who incorporate high-quality research evidence into their clinical decisions and advice are being professionally accountable to their clients.
Another reason for nurses to engage in research involves the spiraling costs of health care and the cost-containment practices being instituted in health care facilities.
nurses need to document the effectiveness of their practice not only to the profession but also to nursing care consumers, health care administrators, third-party payers (e.g., insurance companies), and government agencies.
Research enables nurses to understand a particular nursing situation about which
little is known, assess the need for an intervention, identify factors that must be considered in planning
nursing care, predict the probable outcomes of certain nursing
decisions, control the occurrence of undesired outcomes, provide advice to enhance client health, and initiate activities to promote appropriate client
behavior.
Numerous clinical practice changes over the past 2 decades reflect the impact of research. For example, a recent nursing study documented that “kangaroo care” (the holding of diaper-clad preterm infants skin-to-skin, chest-to-chest by parents) is now widely practiced in neonatal intensive care units (NICUs) in the United States (Engler et al., 2002), but this is a new trend.
As recently as the early 1990s, only a minority of NICUs offered kangaroo care options. The adoption of this practice reflects the accumulating evidence that early skin-to-skin contact has clinical benefits without any apparent negative side effects (Anderson et al., 2003). Some of that accumulated evidence was developed in rigorous studies by nurse researchers in the United States, Australia, Canada, Taiwan, and other countries (Chwo et al., 2002).
The Evolution of Research In Nursing
Menu
Florence Nightingale
◦ Reformer◦ Reactionary◦ Researcher
Crimean War: 1853-56 Collected data Used statistics, graphs
to present data Based practice on
research findings
1900-1940 – researches were done on nurse’s educational preparation – Goldmark Report
Nursing Research Journal – 1952
1960’s – terms such as conceptual frame-work, conceptual model, nursing process theoretical base of Nursing
International Journal of Nursing Studies 1943
1970 - Research focused on client care search for scientific base from which to practice utilization of research findings
Priority was focused on clinical problemsGrowing number of nurses with earned
doctorates
1980 – Recognition that research is an integral part of Professional Nursing
Establishment of National Center for Nursing Research (NCNR), Nursing Science Quarterly, Applied Nursing Research in 1980
1990 – National Institute of Nursing Research (NINR)
Nursing Research into the Mainstream of nursing Activities
1. Future focus is on outcome research – assess and document the effectiveness of health care services
2. Future focus is on biophysiologic research
3. Promotion of evidence based practice research findings into research
4. Development of a stronger knowledge base thru multiple, confirmatory strategies, Replication of studies with different clients in different clinical settings and at different times to ensure that the findings are robust.
Trend is from in patient care to ambulatory care.
Nursing ProcessNursing Process Research ProcessResearch Process1.1. Assessment Assessment 1.1. Knowledge of the World of Knowledge of the World of
a. Data Collectiona. Data Collection NursingNursingb.b. Data InterpretationData Interpretation
2.2. Nursing DiagnosisNursing Diagnosis 2.2. Problem & Purpose Problem & Purpose IdentificationIdentification
3.3. PlanPlan 3.3. MethodologyMethodologya.a. Goal IdentificationGoal Identification a.a. DesignDesignb.b. Planned InterventionsPlanned Interventions b.b. SampleSample
c.c. MeasurementMeasurement4.4. ImplementationImplementation 4.4. Data Collection & AnalysisData Collection & Analysis5.5. Evaluation & ModificationEvaluation & Modification 5.5. Outcomes & Disseminating Outcomes & Disseminating
FindingsFindings
1. Basic Research1. Basic Research
2. Applied Research2. Applied Research
3. Rigor3. Rigor
4. Control4. Control
Quantitative studies are basic or applied
• Basic Research: Concerned with underlying mechanisms of an intervention. Such as Effect of Pressure on tissues
• Applied Research: Concerned with effect of the intervention on the patient. Such as turning patient to relieve pressure
Excellence in research involves:•Discipline•Adherence to detail•Strict accuracy
• A methodology developed with meticulous detail
• Precise measurement tools• A representative sample• A tightly controlled design
Quantitative research
Qualitative research Outcomes research Intervention
research
Descriptive Research
Correctional Research
Quasi-Experimental Research
Experimental Research
•Natural or Field Settings
•Partially Controlled Settings
•Highly Controlled or Laboratory Settings
Traditions Authority Borrowing Trial &
Error Personal
Experience
Role Modeling
Intuition Reasonin
g Research
Research Problem & PurposeResearch Problem & Purpose
Literature ReviewLiterature Review
Study FrameworkStudy Framework
Objectives, Questions, or HypothesesObjectives, Questions, or Hypotheses
Study VariablesStudy Variables
AssumptionsAssumptions
LimitationsLimitations
Research DesignResearch Design
Population & SamplePopulation & Sample
Methods of MeasurementMethods of Measurement
Data Collection & AnalysisData Collection & Analysis
Research OutcomesResearch Outcomes
Communication of FindingsCommunication of Findings
EpistemologyEpistemology The The philosophyphilosophy of of knowingknowing
MethodologyMethodology An An approachapproach to to knowingknowing
� Science is a way to learn the TRUTH.
� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.
The Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of Research
� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.
The Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of Research
The Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of Research
� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.
� Science is a way to learn the Science is a way to learn the TRUTH.TRUTH.
� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.� Science only deals with what we Science only deals with what we
can see or measure – EMPIRICISM.can see or measure – EMPIRICISM.
The Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of Research
� Science is a way to learn the Science is a way to learn the TRUTH.TRUTH.
� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.� Science only deals with what we Science only deals with what we
can see or measure – can see or measure – EMPIRICISM.EMPIRICISM.
� The best way to learn the truth is The best way to learn the truth is to EXPERIMENT.to EXPERIMENT.
The Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of ResearchThe Positivist View of Research
� Science is a way to learn the TRUTH.Science is a way to learn the TRUTH.� Science is DETERMINISTIC.Science is DETERMINISTIC.� Science is MECHANISTIC.Science is MECHANISTIC.� Science uses METHODS.Science uses METHODS.� Science only deals with what we can Science only deals with what we can
see or measure – EMPIRICISM.see or measure – EMPIRICISM.� The best way to learn the truth is to The best way to learn the truth is to
EXPERIMENT.EXPERIMENT.� Science is OBJECTIVE.Science is OBJECTIVE.
The Positivist View of ResearchThe Positivist View of Research
Similarity between common sense and science
Similarity between common sense and science
NATURAL SELECTION model of knowing
Random VariationRandom Variation
Selective RetentionSelective Retention
Similarity between common sense and science
NATURAL SELECTION model of knowing MULTIPLE PERSPECTIVES and
TRIANGULATION
Similarity between common sense and science.
NATURAL SELECTION model of knowing. MULTIPLE PERSPECTIVES and
TRIANGULATION. Observation is THEORY-LADEN.
Similarity between common sense and science.
NATURAL SELECTION model of knowing. MULTIPLE PERSPECTIVES and
TRIANGULATION. Observation is THEORY-LADEN NONREDUCTIONIST.
Believe there’s a reality that we should try to ‘get right’
Critical of our ability to ever get it perfectly right
Research Problem & Purpose
Major concepts Focused on areas of concern Key issues for practice,
education, & administration Examples: Chronic pain,
Acute pain, Self-care, Coping, Health Promotion, Respiratory pathology
Area of Concern Gap in the knowledge base
for practice◦ Not previously studied◦ Conflicting findings◦ Omission of a group of
subjects Significant for Nursing
“Patients’ concerns about reporting pain and using analgesics… are barriers to adequate pain management…Despite extensive attention to issues of pain management…few studies have been conducted testing impact of intervention on cancer pain…”
Ward et al. (2000). An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers. Research in Nursing & Health, 23(5), p. 394.
Little is known about...
◦ Findings of previous studies are conflicting
◦ Few studies of this have been done
Nursing Practice Researcher and Peer
Interaction Literature Review Theory Research Priorities
Clear, concise statement Goal, aim, focus, or
objective of the study
Includes variables, population, & setting
The purpose of this study was to ◦ describe...◦ determine differences
between groups...◦ examine relationships
among...◦ determine the effect of...
“The purpose of this pilot study was to determine if information about analgesic side effects and information to counter misconceptions would enhance pain management in…women with gynecologic cancer.”
Ward et al. (2000). An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers. Research in Nursing & Health, 23(5), p. 394.
Current policy at most hospitals requires the use of routine flushing of heparin locks after administration of medication or flushing heparin locks every 8 hours when not being used for medication administration. However, there is disagreement on whether flushes of low doses of heparin are necessary to maintain the patency of heparin locks....
The purpose of this study was to evaluate the effectiveness of normal saline versus normal saline containing 10 U/mL of heparin for maintaining heparin-loc sites.
The purpose of this study was “to describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes” (Blegen et al., 1998).
The higher the RN skill mix, the lower the incidence of adverse occurrence on inpatient care units.
Time CommitmentMoney CommitmentResearchers’ ExpertiseAvailability of Subjects,
Facility, & EquipmentEthical Considerations
Definition: Objectives are declarative statements which focus on the identification and the description of variables or concepts and sometimes on determination of relationships of variables.
The objectives of “this study were to: (a) describe the self-reported physical & mental health, disability level, & social support of persons chronically ill with multiple sclerosis; and (b) contrast rural & urban residents in relation to health description, social support, & perception of health.”
Definition: Research questions are interrogative statements that focus on what variables or concepts are to be described and what relationships might exist among them.
What is the relationship between reported depressive symptoms and rate of return to work for patients following cardiac surgery?
What is the relationship of anxiety and compliance with medications and follow-up appointments for patients following cardiac surgery?
Definition: Formal statement of the expected relationships among variables.
Simple versus Complex Nondirectional versus Directional
Associative versus CasualStatistical versus Research
Simple: 2 VariablesA > B
Complex Hypothesis: More than 2 Variables
A B
C
Attitudes of pediatric nurses toward mentally retarded clients are more favorable than those of medical–surgical nurses.
Attitudes of pediatric nurses toward mentally retarded clients are related to number of years in practice.
Research Hypothesis (alternative): States what researcher thinks is true
Null Hypothesis: States no difference or relationship exists
Statement of relationship between an independent and dependent variable
Describes a cause and effect Usually stated in two forms
The null hypothesis The alternative hypothesis
The two forms are Mutually exclusive Exhaustive
Nurse orientation program will reduce absenteeism.
There will be no change in absenteeism as a result of orientation.
There will be less absenteeism as a result of orientation.
Causal Causal hypothesishypothesisCausal Causal hypothesishypothesis
Alternative Alternative (one-tail):(one-tail):
Alternative Alternative (one-tail):(one-tail):
Null:Null:Null:Null:
Nurse orientation program will reduce absenteeism.
There will be no change in absenteeism as a result of orientation program .
There will be less absenteeism as a result of orientation
Causal hypothesisCausal hypothesisCausal hypothesisCausal hypothesis
AlternativeAlternative::AlternativeAlternative::
Null:Null:Null:Null:
00 ++--
No changeNo change
LessLess
AbsenteeismAbsenteeism
Our new drug treatment will cause a difference in depression.
There will be no change in depression as a result of treatment.
There will be a change in depression as a result of treatment.
Causal Causal hypothesishypothesisCausal Causal hypothesishypothesis
Alternative:Alternative:Alternative:Alternative:
Null:Null:Null:Null:
Our new drug treatment will cause a difference in depression.
There will be no change in depression as a result of treatment.
There will be a change in depression as a result of treatment.
Causal hypothesisCausal hypothesisCausal hypothesisCausal hypothesis
Alternative:Alternative:Alternative:Alternative:
Null:Null:Null:Null:
00 ++--
No changeNo change
LessLess MoreMore
DepressionDepression
Our new drug treatment will cause a difference in depression.
There will be no change in depression as a result of treatment.
There will be a change in depression as a result of treatment.
Causal hypothesisCausal hypothesisCausal hypothesisCausal hypothesis
Alternative:Alternative:
Null:Null:Null:Null:
A “two-tail” hypothesisA “two-tail” hypothesis
00 ++--
No changeNo change
LessLess MoreMore
DepressionDepression
Cancer patients with chronic pain who listen to music with positive suggestions of pain reduction have less reported pain than those who do not listen to music.
There is no difference in the amount of pain experienced by cancer patients with chronic pain who listen to music with positive suggestion of pain reduction & those who do not.
Definition: Qualities, properties, or characteristics of persons, things, or situations that are manipulated or measured in research.
Independent VariablesDependent VariablesResearch Variables or Concepts
Extraneous VariablesDemographic Variables
Leads to or causes something else
Is affected by other variable(s)
Independent:Independent:Independent:Independent:
Dependent:Dependent:Dependent:Dependent:
Academic Academic achievementachievementAcademic Academic achievementachievement
IndependentIndependentIndependentIndependent DependentDependentDependentDependent
Family Family structurestructureFamily Family structurestructure Academic Academic
achievemeachievementnt
Academic Academic achievemeachievementnt
IndependentIndependentIndependentIndependent DependentDependentDependentDependent
Family Family structurestructureFamily Family structurestructure
Economic Economic statusstatusEconomic Economic statusstatus
Academic Academic achievemeachievementnt
Academic Academic achievemeachievementnt
IndependentIndependentIndependentIndependent DependentDependentDependentDependent
Variable:Variable: Any observation that can take different values
AttributeAttribute: A specific value on a variable
Variable: Sex or genderAttribute: Female; male
Family structureFamily structure
Economic Economic statusstatusEconomic Economic statusstatus
SchoolinSchoolinggSchoolinSchoolingg
Academic Academic achievemeachievementnt
Academic Academic achievemeachievementnt
IndependentIndependentIndependentIndependent DependentDependentDependentDependent
Family structureFamily structureFamily structureFamily structure
Economic Economic statusstatusEconomic Economic statusstatusSchoolingSchoolingSchoolingSchooling
Special Special tutoringtutoringSpecial Special tutoringtutoring
Academic Academic achievemenachievementt
Academic Academic achievemenachievementt
IndependentIndependentIndependentIndependent DependentDependentDependentDependent
Family Family structurestructureFamily Family structurestructure
Economic Economic statusstatusEconomic Economic statusstatus
SchoolingSchoolingSchoolingSchooling
Special Special tutoringtutoringSpecial Special tutoringtutoring
Academic Academic achievemenachievementt
Academic Academic achievemenachievementt
IndependentIndependentIndependentIndependent DependentDependentDependentDependent
NotNotmanipulablemanipulable
Family Family structurestructureFamily Family structurestructure
Economic Economic statusstatusEconomic Economic statusstatus
SchoolingSchoolingSchoolingSchooling
Special Special tutoringtutoringSpecial Special tutoringtutoring
Academic Academic achievementachievement
Academic Academic achievementachievement
IndependenIndependenttIndependenIndependentt
DependenDependenttDependenDependentt
ManipulablManipulablee
NotNotmanipulablmanipulablee
Theory or ideaTheory or ideaTheory or ideaTheory or idea
Theory or ideaTheory or ideaTheory or ideaTheory or idea
RealityRealityRealityReality
Theory or ideaTheory or ideaTheory or ideaTheory or idea
RealityRealityRealityReality
Self-esteemSelf-esteemSelf-esteemSelf-esteem
Theory or ideaTheory or ideaTheory or ideaTheory or idea
RealityRealityRealityReality
Self-esteemSelf-esteemSelf-esteemSelf-esteem
I feel good about myself...I feel good about myself...
11 22 33 44 55SDSD DD NN AA SASA
Theory or ideaTheory or ideaTheory or ideaTheory or idea
RealityRealityRealityReality
Operational definitionOperational definition
Self-esteemSelf-esteemSelf-esteemSelf-esteem
I feel good about myself...I feel good about myself...
11 22 33 44 55SDSD DD NN AA SASA
Self-esteemSelf-esteemSelf-esteemSelf-esteem
Self-esteemSelf-esteemSelf-esteemSelf-esteem
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
Self-esteemSelf-esteemSelf-esteemSelf-esteem
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
IndicatorsIndicators
Self-esteemSelf-esteemSelf-esteemSelf-esteem
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
OperationalOperationaldefinitiondefinitionOperationalOperationaldefinitiondefinition
Each Each indicator is indicator is a a falliblefallible reflection reflection of the of the construct.construct.
Variable: AgreementAttribute: 1 = strongly disagree
2 = disagree3 = neutral4 = agree5 = strongly agree
ExampleExampleExampleExample
Conceptual Definition:•The abstract meaning of a variable that usually is based on theory.
Operational Definition:•A way of defining a variable that makes it measurable or manipulatable in the real world.
Conceptual Definition of Coping Behavior•Coping behaviors are actions directed toward managing internal and environmental demands that tax or exceed a person’s resources (Lazarus & Folkman, 1984).
Operational Definition of Coping Behavior•Coping behaviors were measured with the Ways of Coping Checklist (WCC), a 68-item scale that contains eight subscales: one problem-focused scale, six emotion-focused scales, and one problem- and emotion-focused scale (O’Brien, 1993).
Concept Pain: Uncomfortable sensory and emotional experience...
Variables Related to Pain•Intensity of post-op pain•Degree of emotional distress associated with post-op pain
•Perception of pain
•Treatment•Stimulus•Manipulated•Experimental•Grouping
OutcomeEffectResponse