Key points (from Understanding

Nursing Research Building an

Evidence-Based Practice)

Prepared by:
Snobia Manzoor
Post RN ,MPH
CHAPTER 1 Introduction to Nursing
Research
 The word research means “to search again” or “to examine
carefully.” More specifically, research is a diligent, systematic
inquiry, or study that validates and refines existing knowledge
and develops new knowledge.
 Clinical expertise is the knowledge and skills of the
healthcare professional who is providing care.
 Description involves identifying and understanding the
nature of phenomenon and relationships among them.
Conti………….
 Explanation clarifies the relationships and identifies
possible reasons why certain events occur.
 Prediction, one can estimate the probability of a specific
outcome in a given situation.
 Control is the ability to produce the desired results.
 Nightingale (1859) is recognized as the first nurse
researcher, with her initial studies focused on the importance
of a healthy environment in promoting patients’ physical and
mental well-being
Conti………….
 Knowledge is essential information, acquired in a variety of
ways.
 Authority is a person with expertise and power who is able
to influence opinion and behavior.
 Traditions include “truths” or beliefs based on customs and
trends.
 Borrowing in nursing use of knowledge from other fields
or disciplines to guide nursing practice.
Conti………….
 Trial and error is an approach with unknown outcomes
that is used in a situation of uncertainty
 Personal experience involves gaining knowledge by being
personally involved in an event, situation, or circumstance.
 Role modeling is learning by imitating the behaviors of an
expert.
 Intuition is an insight into or understanding of a situation
or event as a whole that usually cannot be explained logically.
Conti………
 Reasoning is the processing and organizing of ideas to reach
conclusions.
 Deductive reasoning moves from the general to the
specific.
 Inductive reasoning moves from the specific to the
general;
Conti………
 Quantitative research is a formal, objective, systematic
process in which numerical data are used to obtain
information about the world.
 Qualitative research is a systematic, subjective approach
used to describe life experiences and give them meaning
CLASSIFICATION OF RESEARCH METHODS
PRESENTED IN THIS TEXTBOOK
 Quantitative Research
 Descriptive
 Correlational
 Quasi-experimental
 Experimental
 Qualitative Research
 Phenomenological
 Grounded theory
 Ethnographic
 Exploratory-descriptive qualitative
 Historical
 Outcomes Research
PROCESSES USED TO SYNTHESIZE RESEARCH EVIDENCE
 Research evidence in nursing and health care is
synthesized by using the following processes:
 (1) systematic review;
 (2) meta-analysis;
 (3) meta-synthesis;
 (4) mixed-methods systematic review.
Conti……..
 Systematic review:
 Use of specific, systematic methods to synthesize research
evidence. usually includes quantitative studies, such as
randomized controlled trials (RCTs). ANALYSIS in narrative
and statistical form.
 Meta-analysis
 Synthesis of the results from analyze several previous studies
includes quantitative studies such as quasi-experimental and
experimental studies focus on intervention or correlational
studies focused on relationships. ANALYSIS in statistical
form.
Conti……..
 Meta-synthesis
 Systematic view of qualitative studies to expand
understanding and develop a unique interpretation
.ANALYSIS in narrative form.
 Mixed-methods systematic review
 Synthesis of findings from studies conducted with a variety of
methods quantitative, qualitative, and mixed-methods to
determine the current knowledge in an area. ANALYSIS in
narrative form.
Levels of Research Evidence
Nurses’ participation in research at
various levels of education.
 BSN
 MSN
 DNP
 PhD
 Post-Doctorate
 KEY CONCEPTS chapter #01
 Research is defined as diligent, systematic inquiry to validate and
refine existing knowledge and develop new knowledge.
 Nursing research is defined as a scientific process that validates and
refines existing knowledge and generates new knowledge that directly
and indirectly influences nursing practice.
 Evidence-based practice is the conscientious integration of best
research evidence with clinical expertise and patient needs and values
in the delivery of quality, safe, and cost-effective health care.
 The purposes of research in nursing include description,
explanation, prediction, and control of phenomena in practice.
 Nightingale was the first nurse researcher who developed empirical
knowledge to improve practice in the nineteenth century.
 Conti…………
 The conduct of clinical research continues to be a major focus in
the twenty-first century.
 Knowledge is acquired in nursing in a variety of ways, including
tradition, authority, borrowing, trial and error, personal experience,
role modeling, intuition, reasoning.
 The Quality and Safety Education for Nurses (QSEN) initiative
is focused on developing knowledge, skills, and attitudes (KSAs) of
students needed to attain the required competencies.
 Conti…………
 Quantitative research is a formal, objective, systematic process
using numerical data to obtain information about the world. This
research method is used to describe, examine relationships, and
determine cause and effect.
 Qualitative research is a systematic, subjective approach used
to describe life experiences and give them meaning.
 A third research method is outcomes research, which
focuses on examining the end results of care and determining the
changes needed in health status for the patient and healthcare
system.
Conti…………
 Nurses with a BSN, MSN, doctoral degree (DNP and
PhD), and post doctorate education have clearly
designated roles in research based on the breadth and depth
of the research knowledge gained during their educational
programs and their clinical expertise.
 Evidence-based guidelines are clinical guidelines that
have been developed based on the best research evidence
available in that area.
 The levels of research evidence are with the highest
quality of research evidence at one end (systematic
review)and weakest research evidence at the other( opinion).
 KEY CONCEPTS chapter #02
COMPARISON OF NURSING PROCESS AND RESEARCH PROCESS

NURSING PROCESS RESEARCH PROCESS

Assessment Data collection (objective and Problem and purpose identification

subjective data) Data interpretation

Nursing diagnosis Literature review

Plan Setting goals Planning interventions Methodology, Design ,Sample ,Data

collection ,Data analysis

Implementation Implementation

Evaluation and modification Outcomes, communication, and synthesis of

study findings to promote evidence-based
nursing practice
 Conti…………
 The research purpose is generated from the problem and
identifies the specific focus or goal of the study.
 A research problem is an area of concern in which there is
a gap in the knowledge needed for nursing practice.
 Researchers conduct a review of relevant literature
to generate a picture of what is known and not known about
a particular problem.
 A framework is basis for a study that enables the researcher
to link the findings to nursing’s body of knowledge.
Conti…………
 Research design is a blueprint for the conduct of a study
that maximizes control over factors that could interfere with
the study’s desired outcome
 A pilot study is often a smaller version of a proposed study.
 The population is all elements that meet certain criteria in
a study
 A sample is a subset of the population selected for a
particular study.
Conti…………
 Data collection is the precise, systematic gathering of
information relevant to the research.
 Data analysis reduces, organizes, and gives meaning to the
data.
 Interpretation of research outcomes involves examining
the results from data analysis, identifying study limitations,
exploring the significance of the findings.
 Research outcomes include the findings, limitations,
conclusions, and suggestions for further research.
Conti…………
 Quantitative research is the traditional research approach
in nursing; it includes descriptive, correlational, quasi-
experimental, and experimental types of research.
 Basic, or pure, research is a scientific investigation that
involves for knowledge’s sake, or for the pleasure of learning
and finding truth. • Applied, or practical, research is a
scientific investigation conducted to generate knowledge that
will directly influence or improve clinical practice.
The content of a research report includes
six parts—
 Abstract
 Introduction
 Statement of the problem
 Statement of the purpose
 Brief literature review
 Methods
 Identification of the research design
 Discussion of the data collection process
 Results
 data analysis
 Presentation of results in tables
 Discussion of major findings
 Presentation of conclusions
 Recommendations for further research
 Reference
KEY CONCEPTS chapter #03
 Qualitative research is a systematic approach used to
describe life experiences and give them meaning.
 Qualitative data are words, instead of numbers.
 Rigor in qualitative research requires critically
appraising the study for congruence with the philosophical
perspective; appropriateness of the collection, analysis, and
interpretation of data; and logic of the findings in the
research report.
Conti…………
 A phenomenological researcher examines an
experience and provides interpretations that enhance the
meaning to those who have lived the experience.
 Grounded theory researchers explore underlying social
processes through relationships and describe the deeper
meaning .
 Ethnographic researchers observe and interview people
within a culture to understand the environment, people,
power relations, and communication patterns of a work
setting, community, or ethnic group.
Conti…………
 Focused ethnography.
 Nurses, however, may not observe a culture over months or
years, but may observe an organizational culture for a shorter
time to learn about the culture of a hospital or healthcare
organization. This type of study is called a focused
ethnography.
 Observation is a fundamental method of gathering data for
qualitative studies, In studies that use observation, notes
taken during or shortly after observations are called field
notes.
 Conti…………
 The most commonly used textual data in qualitative studies are
transcripts of recorded interviews and focus groups.
Transcription is at the heart of the qualitative research process,
because a “verbatim transcript captures participants’ own
words, language, and expressions” and allows the researcher to
“decode behavior, processes, and cultural meanings.
 Coding is the process of reading the data, breaking text down
into subparts.
KEY CONCEPTS chapter #04
 Four experimental projects have been highly publicized
for their unethical treatment of human subjects:
 (1) the Nazi medical experiments;
 (2) the Tuskegee Syphilis Study;
 (3) the Willow brook Study
 (4) the Jewish Chronic Disease Hospital Study.
 Two historical documents, the Nuremberg Code and
Declaration of Helsinki, have had a strong impact on the conduct
of research.
 The HIPAA Privacy Rule (2007a) was enacted to protect the
privacy of people’s health information
Conti…………
 Informed consent involves
 D C CV
 (1) transmission of essential study information to the potential subject,
 (2) comprehension of that information by the potential subject,
 (3) competence of the potential subject to give consent
 (4) voluntary consent by the potential subject to participate in the study.
 An institutional review board consists of a committee who examine
studies for ethical concerns with three levels of review—
 Exempt review
 Expedited review
 Complete review
 Conti…………
 The following guidelines can be used to critically
appraise the ethical aspects of a study. These
guidelines include
 (1) examination of the benefit-risk ratio of the study
 (2) IRB approval
 (3) informed consent
 (4) protection of subjects’ human rights.
 Research misconduct is defined as “the, falsification, or
plagiarism in performing, or in reporting research results
KEY CONCEPTS chapter #05
 The research problem is an area of concern in which there is a
gap in the knowledge base needed for nursing practice.
 The research purpose is a concise, clear statement of the
specific goal or focus of the study.
 Study feasibility is evaluated by examining the researchers’
expertise, money commitments, availability of subjects, facilities,
and equipment, and the study’s ethical considerations.
 A hypothesis is the formal statement of the expected
relationship(s) between two or more variables in a specified
population
Conti…………
 Hypotheses can be described using four categories:
 (1) associative versus causal;
 (2) simple versus complex;
 (3) nondirectional versus directional;
 (4) statistical versus research.
 Variables are qualities, properties, or characteristics of
persons, things, or situations that change or vary.
 An independent variable is manipulated or varied by the
researcher to create an effect on the dependent variable.
 A dependent variable is the outcome.
 KEY CONCEPTS chapter #06
 The literature is reviewed to complete an assignment for a
course and summarize knowledge for use in practice.
 A checklist for reviewing the literature includes:
preparing, conducting the search, processing the information,
and writing the review.
 Well-written literature reviews are syntheses of what is
known and not known.
 Careful checking of the review for grammatical correctness
and logical flow are essential to producing a quality product.
 The reference list must be accurate and complete to allow
readers to retrieve the cited sources.
KEY CONCEPTS chapter #07
 A theory is an integrated set of concepts on which further
activity is based.
 Conceptual models or grand nursing theories are
very broadly explain phenomena of interest.
 Middle range and tentative theories are less abstract
and narrower in scope than conceptual models.
 A framework is logical structure of meaning, such as a
portion of a theory, that guides the development of the study,
and enables the researcher to link the findings to nursing’s
body of knowledge.
 Conti……….
 Frameworks for studies may come from grand nursing
theories, middle range theories, research findings, non-nursing
theories, and scientific theories.
 Scientific theories are derived from physiology, genetics,
pathophysiology, and physics and are supported by extensive
evidence.
 Practice theories are a type of middle range theories that are
more specific.
 Maps or models; one strategy for expressing a theory or
framework is a diagram with graphically displayed. These
diagrams are sometimes called maps or models.
KEY CONCEPTS chapter #08
 A research design is a blueprint for conducting a
quantitative study that maximizes control over factors that
could interfere with the validity of the findings.
 Four common types of quantitative designs are used
in nursing—descriptive, correlational, quasi-experimental,
and experimental.
 Descriptive and correlational designs are conducted to
describe and examine relationships among variables. These
types of designs are also called nonexperimental designs.
 Conti……….
 Cross-sectional design involves examining a group of subjects
simultaneously in various stages of development, levels of
educational, severity of illness, or stages of recovery to describe
changes in a phenomenon across stages.
 Longitudinal design involves collecting data from the same
subjects at different points in time and might also be referred to
as repeated measures.
 The essential elements of experimental research are
 (1) the random assignment of subjects to groups
 (2) the researcher’s manipulation of the independent variable
 (3) the researcher’s control of the experimental situation and
setting, including a control group.
 Conti……….
• Randomized controlled trial (RCT) design is noted to
be the strongest methodology
• As research methodologies continue to evolve in nursing,
mixed-methods approaches are being conducted to use
the strengths of both qualitative and quantitative research
designs.
KEY CONCEPTS chapter #09
 Generalization extends the findings from the sample under
study to the larger population.
 The target population is the entire set of individuals or
elements who meet the sampling criteria.
 An accessible population is the portion of the target
population to which the researcher has reasonable access.
 Inclusion sampling criteria are the characteristics that the
subject or element must possess to be part of the target
population.
 Exclusion sampling criteria are those characteristics that can
cause a person or element to be excluded from the target
population.
 Conti……….
 The two main types of sampling plans are probability
and nonprobability.
 Important factors to consider in determining
sample size for qualitative studies include (1) scope
of the study, (2) nature of the topic, (3) design of the study.
 Factors to consider in making decisions about
sample size in quantitative studies include (1) the
type of study, (2) number of variables, (3) data analysis
techniques.
 Three common settings for conducting nursing
research are natural, partially controlled, and highly
controlled.
 KEY CONCEPTS chapter #10
 Reliability in measurement is concerned with the consistency of the
measurement technique.
 The validity of an instrument is a determination of the extent to
which the instrument reflects accuracy and measure what is supposed
to measure .
 Readability level focuses on the study participants’ ability to read
and comprehend the content of an instrument, which adds to the
reliability and validity of the instrument.
 Diagnostic and screening tests are examined for sensitivity,
specificity, and likelihood ratios.
 Common measurement approaches used in nursing
research include physiological measures, observation, interviews,
questionnaires, and scales.
 Conti……….
 The scale, a form of self-report, is a more precise means of
measuring phenomena than a questionnaire such as Likert scale,
rating scale.
 There are four possible outcomes of a screening test for
a disease: (1) true positive, which is an accurate identification
of the presence of a disease; (2) false positive, which indicates
that a disease is present when it is not; (3) true negative, which
indicates accurately that a disease is not present; or (4) false
negative.
 Conti……….
 THE QUALITY OF DIAGNOSTIC AND SCREENING
TESTS
 Sensitivity
 The ability of the test to identify correctly those who have the
disease from all the patients having that disease.
 A highly sensitive test is very good at identifying the disease in a
patient. If a test is highly sensitive, it has a low percentage of false
negatives.
 Specificity
 The ability of the test to identify correctly those who do not
have the disease from all the non diseased.
 A highly specific test is very good at identifying the patients
without a disease. If a test is very specific, it has a low percentage
of false positives.
DETERMINING THE QUALITY OF
MEASUREMENT METHODS
 Reliability
 Validity
 Readability
 Accuracy
 Precision