NJALA UNIVERSITY

COLLEGE OF MEDICAL SCIENCES - BO CAMPUS

SCHOOL OF NURSING

LECTURE NOTE ON:

INTRO. TO NURSING RESEARCH METHODOLOGY

26/03/2024

Higher Diploma in Nursing/ (S R N)

Second Year-2B

Prepared By:
Mr. Emmanuel S. Nyuma
Emmanuel.nyuma@njala.edu.sl
 Module Name: Health System Research
Course Title: Nursing Research
Credit hours: 3 Cr.
Module Code: RNP-227
Course delivered to: Higher Diploma Nursing Students
Course instructor: Emmanuel S. Nyuma (RN, BScN, MPH-UG)
This course will be accompanied by preparing a research proposal and describing
findings fully.

Course description
This course is considered a pre-requisite course for a research project.
It is based on principles, concepts, and theory of nursing research as well as methodology
to solve community problems.
Contents will include selecting a research project, statement of the problem, literature
review, objectives, methodology, analysis, discussion, and conclusion.

Course General Objective: - At the end of the course the student nurse be able to prepare a
complete research proposal and evaluate the quality of the research proposal.

Specific Objectives:
At the end of the course, the student can:
− Choose an appropriate research − Prepare a plan for the identification
project after considering important and use of project staff.
criteria for selection. − Prepare a budget for the project.
− Prepare a background statement − Plan for dissemination of study
concerning the problem selected for findings.
− the study − Develop a dissertation or paper
− Prepare a review of the literature writing approach.
related to the topic. − Apply research techniques in the
− Develop the research. nursing profession.
− Develop a project work plan adapted
to the local conditions.

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Course Content:
Unit 1: Introduction to the course ▪ Internal and external validity
▪ Importance of Nursing Research ▪ Characteristics of good design
▪ Historical evolution of Nursing ▪ The time dimensions.
research Unit 8- Data collection methods
▪ Future direction of nursing research Physiological /. biophysical measure
Unit 2: Over review of the research ▪ Observational methods
process ▪ Selection for phenomena for
▪ Basic research terminology observations
▪ Major steps in the research process ▪ The observer-observed relationships
▪ Organizations of a research project ▪ Observational methods unstructured
Unit 3- Selecting and identifying nursing observations
research problem. ▪ Observational methods –structured
▪ Sources of problem ▪ Evaluations of observational
▪ Developing and refining a research methods
topic ▪ Interview and questionnaire.
▪ Criteria for evaluating research ▪ The constructions of questionnaire
problem. ▪ Types of closed questions
▪ Statement of the research problem Unit 9 - Measurements and sampling
▪ Research example. ▪ Measurements principle
Unit 4- Locating and summarizing ▪ Levels of measurement
existing information on a problem. ▪ Advantages of measurements
▪ Purpose of a literature review ▪ Research example.
▪ Scope of literature review Unit 10. Reliability
▪ Sources of literature review ▪ Errors of measurements
▪ Writing of literature review ▪ Reliability
▪ Example of literature review ▪ Validity
▪ Summary Unit 11. Sampling
Unit 5. Formulating Hypothesis ▪ Basic sampling concepts
▪ Purpose The research hypothesis ▪ Nonprobability sampling
▪ Characteristics of workable ▪ Probability sampling
hypothesis ▪ Sample size.
▪ The derivation of workable ▪ Steps in sampling
hypothesis ▪ Research example.
▪ Wording hypothesis Unit 12. Communication in the research
▪ Testing hypothesis process
Unit 6 - Types of Nursing Research ▪ Interpretation of results
Approach and research design ▪ The research reports.
considerations ▪ The styles of a research reports
▪ Experimental Unit 13. Evaluating research reports
▪ Nonexperimental ▪ Evaluating the introduction.
▪ Some additional types of research ▪ Evaluating the research methods
▪ Nursing models approaches. ▪ Evaluation of the analysis and results
Unit 7 - Research design considerations ▪ Evaluation the discussion
▪ The concept of research control ▪ Evaluating other aspects of the report

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Teaching and Learning Methods
− Interactive lecture
− Take-home assignments
− In-class practical exercises
− Group discussions.
Attendance is strictly compulsory.

Assessment Methods
• Progressive assessment 10%
• Draft proposal development 40%
• Written Exam 50%

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Unit I: Introduction to Nursing Research

Research Cycle

Nursing Research: provides the foundation for Evidence-based Nursing practice.

Nursing research is defined as a systematic approach used to examine phenomena important to
nursing and nurses, that clinical practice be based on scientific knowledge.

Research utilization.
Through Research Utilization, efforts and knowledge obtained from
research is transformed into clinical practice, culminating in nursing practice that is evidence-
based, to help understand the importance of evidence-based practice.

Evidence Based Practice: The process of systematically finding, appraising, and using research
findings as the basis for clinical practice.
The introduction of evidence-based change into the direct provision of nursing care may occur at
the individual level of a particular nurse or at varied organizational or social levels.

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 Nursing research aimed at impacting the direct provision of nursing and health care to
recipients of nursing care,
Nursing research also is needed to generate knowledge in areas that affect nursing care
processes indirectly.
This helps to begin a nursing research adventure by developing an appreciation of the
significance of research in nursing and the research roles of nurses through a historical and
futuristic approach.

Nursing research
− Links education, theory, nursing practice) provides the basics for expanding the unique
body of scientific knowledge that forms the foundation of nursing practice.
− Nurses become knowledgeable consumers of research through educational processes and
practical experience,
− Must have a basic understanding of the research process and
− Have Critical appraisal skills that provide a standard for evaluating the strengths and
weaknesses of research studies before applying them to clinical practice.
− Nurses at all levels of educational preparation have a responsibility to participate in the
research process.
− The role of the graduate is to be a knowledgeable consumer of research.
− Research studies will emphasize clinical issues, problems, and outcomes.
− Priority will be given to research studies that focus on promoting health and developing
cost-effective healthcare systems.

Beginning of Nursing Research

Research in nursing began with Florence Nightingale with her landmark publication. “Notes on
Nursing” (1859).
▪ It described her views on environmental factors that promote physical and emotional
well-being.
▪ Her most widely known research contribution involved an analysis of factors affecting
soldier mortality and morbidity during the Crimean War.

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EARLY Research
Most studies in the early 1900s concerned nurses’ education.
Example:
▪ In 1923, a group called the Committee for the Study of Nursing Education, studied the
educational preparation of nurse teachers and administrators and the clinical experiences
of nursing students.
▪ Nursing research continues to develop at a rapid pace and will undoubtedly flourish in the
future.
▪ And the priority for nursing research in the future will be the promotion of excellence in
nursing practices.
Trends Towards the Future
▪ The future of nursing research will be to promote excellence in nursing science and
practice.
▪ Future nurses will intensify their research skills and use those skills to address emerging
issues of importance to the profession and the patients.

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More Focus on Evidence Based Research

Evidence-based research involves collecting, evaluating, and implementing evidence to

improve patient care and outcomes.

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Example

Well, implemented EVIDENCE-BASED INFECTION- CONTROL POLICIES have

helped to reduce hospital-acquired infections to a great extent.

EVP indicates that nurses should use a smaller-gauge catheter, which increases patient
comfort.
What is Research?
▪ Research is the systematic collection, analysis, and interpretation of data to generate new
knowledge and answer a certain question or solve a problem.
▪ Research is a scientific inquiry aimed at learning new facts, testing ideas, etc.
▪ It is the systematic collection, analysis, and interpretation of data to generate new
knowledge and answer a certain question or solve a problem.

Objectives of Research
▪ To discover answers to questions through the application of scientific procedures.
▪ To find out the truth, which is hidden, and which has not been discovered yet.
▪ Though each research study has its specific purpose, we may think of research objectives
as falling into several broad groupings:
− To gain familiarity with a phenomenon or to achieve new insights (exploratory
research studies).

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 − To portray accurately the characteristics of a particular individual, situation, or
group (descriptive research studies).
− To test a hypothesis of a causal relationship between variables (hypothesis testing
research studies).
Health Research
▪ Health Research, likewise, is a research effort to address health-related problems and
develop better solutions to mitigate the prevailing problem.
▪ Health research is the application of principles of health research.
▪ It is the generation of new knowledge using scientific methods to identify and deal with
health problems.
▪ Knowledge, both generalizable worldwide and locally specific, is essential to effective
action for health.

Purpose of Health Research

▪ To generate knowledge essential to effectively promote the health of the population.
▪ Without that knowledge, effective action is impossible because it has no logical or
empirical basis.
Research must be: (Research is done to find solutions to health problems)
− Purposeful: what do you want to be able to contribute?
− Targeted: Who are the audiences?
− Credible: consider sources of information, method of data collection, personnel
involved…
− Timely: Is the information needed?

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Unit 2: Over review of the research process
The Purpose of Doing Research
▪ The purposes of the research may be organized into three groups.
− explore a new topic,
− describe a social phenomenon, or
− explain why something occurs.
▪ Studies may have multiple purposes (e.g. both to explore and to describe) but one
purpose usually dominates.

Descriptive Research
− It presents a picture of the specific details of a situation, social setting, or relationship.
− It seeks to determine the answers to
− who, what, when, where, and how questions.
Goals of Descriptive Research
− Describe the situation in terms of its characteristics i.e. provide an accurate profile of a
group.
− Give a verbal or numerical picture (%) of the situation.
− Present background information.
− Create a set of categories or classify the information.
− sequence, set of stages; and
− Focus on ‘who,’ ‘what,’ ‘when,’ ‘where,’ and ‘how’ but not why?

Explanatory Research
- The desire to know “why,” to explain, is the purpose of explanatory research.
- It builds on exploratory and descriptive research and goes on to identify the reasons for
something that occurs.
- Explanatory research looks for causes and reasons.
• For example, descriptive research may
Descriptive research- E.g., 10% of the parents abuse their children,
Explanatory research- E.g., less educated parents are more likely to abuse their children.
Goals of Explanatory Research
− Explain things not just reporting. Why?
− Determine which of several explanations is best.
− Determine the accuracy of the theory; test a theory’s predictions or principle.
− Advance knowledge about the underlying process.
− Build and elaborate a theory; elaborate and enrich a theory’s predictions or principle.
− Extend a theory or principle to new areas, new issues, new topics.
− Provide evidence to support or refute an explanation or prediction.

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The Uses of Research
− To advance general knowledge.
− To solve specific problems.

Types / Classification of Research

Classification based on purpose.
1. Basic/fundamental/pure research (also called academic research or pure research or
fundamental research)
2. Applied/operational/action-oriented research.
Classification is based on the nature of the research.
1. Qualitative
2. Quantitative

Basic research/fundamental/pure research

• Its primary objective is the advancement of knowledge and the theoretical understanding
of the relations among variables.
• Basic research provides the foundation for further research.
Applied research.
• Is research that seeks to solve practical problems?
• concentrates on finding solutions to immediate problems of a practical nature.
• In health, applied research is necessary to identify priority problems and to design and
evaluate policies and programs that will deliver the greatest health benefits, making optimal
use of available resources.
• Conducted when a decision must be made about a specific real-life problem.

Quantitative vs. Qualitative:

▪ Quantitative research is based on the measurement of quantity or amount.
▪ It applies to phenomena that can be expressed in terms of quantity.
▪ Qualitative research, on the other hand, is concerned with qualitative phenomena, i.e.,
phenomena relating to or involving quality or kind.
▪ Quantitative research is more concerned with questions about:
how much? How many? How often? To what extent? etc.
▪ Qualitative research is concerned with finding the answers to questions which begin with:
why? How? In what way?

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Nature of Research
Systematic – plan, identify, design, collect data, evaluate.
Logical – examine procedures to evaluate conclusions.
Empirical – decisions are based on data (observation)
Reductive – general relationships are established from data.
Replicable – actions are recorded.

The main components of any research work

− Preparing a research proposal
− Fieldwork (i.e., data collection)
− Analyzing data and preparing a research report

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Topic selection
Health research topics
• Description of health problems
• Evaluation of interventions
• Analysis of possible causes and solutions

Selection of Research Topic

1) Relevance: priority, magnitude of problem
2) Avoidance of duplication
3) Feasibility: complexity, manpower, time, equipment, money…
4) Political commitment: interest and support to utilize results.
5) Applicability (cost-effectiveness): availability of resources
6) Timeliness: the urgency of data needed for making a decision
7) Ethical acceptability

The Research Topic/ Question

Getting a research topic
• Which aspect of the discipline interests you a lot
• What have you observed in your field that you have questions about?
• What articles have you read that have raised questions in your mind?
• What are current issues in the field?
• What are stakeholder needs?
• What does the literature say?
Some Research Topics
− Health-seeking behavior of nurses − Gender-related violence
− Mothers’ management of acute − Medication administration errors
childhood illnesses among nurses
− Birth-related morbidities in women. − None utilization of the nursing
− Disclosure of HIV status process among nurses etc.
Steps in Conducting Research
Research is a process that takes place in a series of steps:
1) Formulating the research 5) Selecting the research design
question or problem 6) Selecting the population,
2) Defining the purpose of the sample, and setting
study 7) Conducting a pilot study
3) Reviewing related literature 8) Collecting the data
4) Formulating hypotheses and 9) Analyzing the data
defining variables 10) Communicating conclusio

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Planning Research (Developing Proposal)
• The development of a health project goes through several stages.
• Formulation of the research proposal is the major task in the process of developing a research
project.
Research Proposal
▪ A research proposal is a document that presents a plan for a project to reviewers for
evaluation.
▪ Its purpose is to convince reviewers that you are capable of successfully conducting the
proposed research project.

Writing a proposal is important.

• To clearly define the problem under study
• To avoid reinventing the wheel
• To depict the methodology to be used
• To be cost and time-conscious
• To be clear about what to expect in the end.

Good Research Proposal

• Have a clear statement of the problem.
• Have clear plans: objectives & methods.
 • Have a clear vision of the outcome.
• Builds on existing data.
Sections of a Research Proposal
1. Abstract 7. Methodology
2. Introduction 8. Expected outcome.
3. Problem statement 9. Budget
4. Justification 10. Timeline
5. Aims and objectives. 11. References
6. Literature Review

Sections of a Research Report

1. Abstract 7. Methodology
2. Introduction 8. Results and Discussion
3. Problem statement 9. Summary, Conclusion and
4. Justification Recommendations
5. Aims and Objectives 10. References
6. Literature Review

Types of Research Reports

− Journal article.
− Dissertation/Thesis
− Research paper.
− Oral or Visual presentation
Writing your Proposal/Dissertations
1. Get the requirements from the 8. Look at other proposals and
department. dissertations.
2. Start writing early. 9. Finish writing early.
3. Ensure computer literacy. 10. Get your supervisor’s input early.
4. Get a computerized reference 11. Get backups.
management system. 12. Give the abstract and introduction an
5. Make use of ‘downtime.’ extra polish.
6. Plan carefully. 13. Never trust hardware.
7. Set a page budget and deadlines. 14. Allow plenty of time for printing,
copying, and binding.
Plagiarism
• Getting dual credit for the same work
• Presenting someone’s work as your own.
– Deliberate copying of completed work.
– Copying exact words (with or without referencing)

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Effects of plagiarism
• Loss of reputation
• Loss of degree/diploma or certificate
• Failure

Avoiding plagiarism
• Read and paraphrase.
• Put quotations in italics or inverted commas and reference them.
• Limit the length and extent of quotations.

Detecting plagiarism
• Google
• Plagiarism checking software.
Essentials for a Researcher
• Access to a computer (preferably owned)
• Knowledge of basic software (MS Word, MS Excel, MS PowerPoint)
• Software for data entry and analysis (SPSS, Stata, EpiInfo, Qualitative analysis software)
• Software for organizing references (Reference Manager, End Note, Mendeley etc.)
Elements of a focused research question
− P----Population or patients
− I-----Intervention
− C----Comparison
− O----Outcome
E.g., What is the effect of community drama on attitudes and choices regarding family
planning among women in the reproductive age group?

Objectives of the Study

Meaning of ‘objectives’
− The objective(s) of a study is what the study is seeking to achieve.
− Closely linked to the research question(s)

Classifying objectives
– Commonly, research objectives are classified into general objectives & specific
objectives.
– The general & specific objectives are logically connected.
– The specific objectives are commonly considered as smaller portions of the general
objectives.
– It is important to ascertain that the general objective is closely related to the statement of
the problem.

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General objective(s)
– What is the overarching goal of the research?
– What is the main question that you intend to answer at the end of the research?
Specific objectives
– What questions will you be answering in the process leading up to answering your main
question?
Writing your general objective
Keep them Simple:
–S--specific
–I--immediate (why do this project now.)
–M--measurable (what quantitative/qualitative info will you gather)
–P--practical (realistic/feasible)
–L--logical (build to achieving goal)
–E--evaluable (significance, how will you assess impact)
Choice of words for the aims (The key role of verbs)
The aims section is the part that summarizes the action part of the proposal.
Common words used.
✓ Determine ✓ To compare
✓ Measure ✓ To verify
✓ Assess ✓ To calculate
✓ Evaluate ✓ To describe
Do not use vague non-action verbs such as:
✓ To appreciate …
✓ To understand…
✓ To believe
Writing objectives
Topic: In the assessment of the prevalence of premarital sexual practices and factors contributing
to premarital sex among student nurses in the department of nursing, Njala University.
General Objective
The general objective or purpose of the research is identified in general terms.
– E.g., To assess the prevalence of premarital sexual practices and factors contributing to
premarital sexual practices among department of nursing students, NU.
Specific Objectives
Identify in greater detail the specific aims of the research project often breaking down what is
to be accomplished into smaller logical components.

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Examples:
1) To determine the prevalence of premarital sexual practices among college students.
2) To determine factors contributing to premarital sex among NU students’ nurses
3) To identify the utilization of condoms for dual protection among college students

SMART Objectives
– Specific: identifies concrete events or actions that will take place
– Measurable: quantifies the number of resources, activity, or change to be expended and
achieved
– Appropriate: logically relates to the overall problem statement and desired effects of the
program
– Realistic: Provides a realistic dimension that can be achieved with the available
resources and plans for implementation
– Time-based: specifies a time within which the objective will be achieved

Problem Identification
• Research is done with a certain purpose.
• The purpose of research may be to solve a problem, improve a program or get new
knowledge.
• The first task of a researcher is identifying research problems.

The Research Problem

What is a problem?
▪ . . . any situation where a gap exists between the actual and the desired state.
▪ A problem does not necessarily mean that something is seriously wrong.
▪ It could simply indicate an interest in improving an existing situation.
▪ Thus, problem definitions can include both existing problems in the current situation as
well as the quest for idealistic states in the future.
–The nursing or public health problem under study
–Linked to the research topic.
–Need to be specific.
• Job satisfaction among nurses
• Malaria mortality in children under 5 vs Malaria etc.
Where can we get research problems?
▪ Sometimes students face difficulties …to get research problems though they are standing
on a lot of problems.

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 ▪ it is not due to the absence of research problems, but rather due to the difficulty of
identifying research problems.
▪ We can get research problems in different ways from deferent sources: -
✓ From careful environmental observation and from our day-to-day activities
✓ From reading
✓ From discussion
✓ From the social, political, and economic changes
✓ From personal interest
✓ From scarcity of information

When you can answer the following questions, you are ready to conduct research that leads
to a paper.
1. What problem do you want to solve? 5. What is new about your approach?
2. Who cares about this problem and why? 6. Who will care if you succeed?
3. What have others done to solve this 7. How long will it take?
problem and why is that 8. How can you demonstrate that this is a
inadequate? good solution?
4. What is your proposed solution to this
problem?

• All research is set in motion by the existence of a problem.

• A potential research situation arises when three conditions exist:
– A perceived discrepancy exists between what is and what should be.
– A question exists about why there is a discrepancy.
– At least two possible and plausible answers exist to the question.
What is the size of the nursing or public health problem being studied?
– Globally
– Regionally
– Locally
What are the effects of the problem being studied?
– At the individual level
– Nursing effect
– Public health effect

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A good problem statement should include the following key components:
▪ A concise statement of the situation that need to be changed.
– States what is the problem?
– Quantifies the problem.
– What is causing the problem?
– What are the consequences of the problem?
▪ Who/what is affected?
▪ What links the problem to the purpose of the project?
▪ Who and how many people does it affect?
▪ How big is the problem? (This can be stated as a disease burden)
Causes
▪ What is the key problem? Why does it exist?
▪ Is there more than one cause?
▪ Are the causes interdependent?
Consequences
▪ What are the consequences of the problem?
▪ Are there political, cultural, and economic effects?
Problem Tree Analysis

1. Discuss and agree the problem or issue to be analysed

2. Identify the causes of the focal problem –these become the roots
3. Identify the consequences –which become the branches

Example:
• Problem situation: In district “Z” (population 150,000) there are 2 health centers, 1
hospital and 15 health stations and all of them function smoothly. However, at the end of
the year it was found that the EPI coverage was only 25%.
• Discrepancy: Although district “Z” had 100% availability of health services and at least
80% of the children should have had full vaccinations the EPI coverage was only 25% as
seen above.
Problem question: What factors influence the low EPI coverage in district “Z”?

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Possible answers:
• Mothers might have problems for not attending in the EPI sessions.
• The MCH, EPI, FHC, etc… programs might not have been integrated; hence children
might have missed opportunities in getting immunization.

Writing a Statement of the problem

Includes:
• Magnitude: frequency and distribution: Affected geographical areas & population groups
affected by the problem.
• Causes of the problem: What is the current knowledge of the problem and its causes? Is
there consensus? controversy? conclusive evidence?
• Possible solutions: In what ways have solutions to the problem been attempted? What has
been proposed? What are the results?
• Unanswered questions: What remains to be answered? What areas have not been possible
to understand, determine, verify, or test?
• If necessary, a short list of definitions of crucial concepts

Justification or Significant of the Study

It is also called significant of the study, purpose of the study and rational of the study.
• Why is your research needed?
E.g.
✓ Others not large enough
✓ Different populations
✓ Different intervention
✓ No study done before.

In summary,
– Also known as the significance of the study
– Seeks to ‘sell’ the study.
– Convince the reader of the importance of the study.
– The section that would make a person choose to fund a study.
– Why is your research needed? E.g.
• Others not large enough
• Different populations
• Different intervention

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Writing the justification section
Why does the study need to be done?
– Global/National/Local research agenda
What benefits will come out of doing the study?
– Individual/National/Global level
What will be the negative effects of not finding the answer to your research question?
– Individual/ National/Global level
How will your study results bring about change?
– Effect on the practice of health/ health system.
– Effect on individual.

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Literature Review
What is a literature review?
▪ Literature: Printed information about something
▪ Review: Consider carefully
- Starting point to refine statement of the problem.
- Part of the introduction of research
▪ Review of the literature
- classification and evaluation of what have written, organized according to guiding
concept.

1. This section must be based on peer reviewed journal or other published materials that are
accessible in public domain (use non-published materials in the Statement of the
problem/introduction if necessary but not in the literature review section).
2. Group findings from several studies (literature) according to common theme rather than
discussing individual paper: themes could be qualitative versus quantitative approaches,
magnitude of the problem, risk factors, effectiveness of interventions etc.
3. Provide strong "umbrella" sentences at the beginnings of paragraphs, "signposts"
throughout, and brief "so what" summary sentences at intermediate points in the review.

Why/use of LR (aims)
- To know all the work which has been done on your research topic.
- To discover all the different aspects of your research topic
- To identify the different methods that have been used to study your research topic.
- To identify the answered and unanswered questions related to your research topic.
- To increase your theoretical foundation so that you can refine all the stages of the research
process up to this point.
- Prevent duplicating.
- It increases your knowledge and helps to refine the statement of the problem.
- Become more familiar with the various types of methods.
- It provides a framework for establishing the importance of the study.
- It serves as a benchmark for comparing the results with other findings.
- Describe the characteristics of a previous study (where, when, who conduct it, findings,
conclusion…)
- Comment on strengths and limitations of studies and findings.
- Identify the knowledge GAP.

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Stages of literature review
▪ Perform a literature review.
▪ Write a literature review.
▪ The most crucial part of the research process
▪ The quality of the whole work depends on the quality of your literature review.

Caution
No definite writing should be done until the literature review has been performed.
Performing the literature review
– Identify keywords and search terms related to your research question.
– Identify general textbooks, journal articles and other reading material related to your
topic that you are aware of
– Read through the general material and put down the different aspects of your topic that
you have identified from your reading.
– Refine your keywords and search terms based on your reading.
– Perform an electronic search.
The electronic search
Some useful databases
– Google Scholar
– HINARI
– PubMed
– Science Direct
– African Journals Online
– JSTOR etc.

Writing a literature review

– Place information under topical headings.
– Summarize information with appropriate referencing.
– Aim to educate your reader on the basics of the research topic.
– Address the methodology of the research.
– Avoid plagiarism.

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Referencing
Referencing is a standardised method of acknowledging sources of information and ideas that
you have used in your research or assignment in a way that uniquely identifies their source.
Avoid Plagiarism: - The use of another person’s work without acknowledgement.
A reference list: - is a list of sources that you have quoted from or cited in your text.

Referencing systems
Several referencing systems are in common use today including:
– Vancouver (number).
– Harvard - (author, date).
– APA (American Psychological Association)
– MLA (Modern Linguistics Association)

A. Vancouver system
For an article, the following information should be noted:
• Author(s)’ Surname followed by initials. Title of article. Name of Journal. Year,
Volume(number): page numbers of article.
– Example: Sengayi M, Dwane N, Marinda E, Sipambo N, Fairlie L,
Moultrie H. Predictors of loss to follow-up among children in the first and second years of
antiretroviral treatment in Johannesburg, South Africa. Global health action. 2013;6(1):19248.

B. The Harvard System

• Using the Harvard system, reference to sources is made at an appropriate place in the text by
stating:
– surname (of author(s).
– year of publication.
– page number(s), (optional)

• Vogal L. C., Swinkels W. et al. (1976). Operational Study of the Outpatient Department at the
Government Hospital, Kimbu Kenya, East African medical Journal, 53(3).

• Surname, initials, Date of publication, title of article, name of journal, volume and issue
number, page.

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Study Design
A study design is a specific plan or protocol for conducting the study, which allows the
investigator to translate the conceptual hypothesis into an operational one.
– Arrangement of conditions for the collection & analysis of data
– It is the overall structure of the study.

Types of Study Designs

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 – Descriptive studies focus on the frequency and distribution of disease.
– Analytic studies focus in elucidating the determinants of disease.
– Descriptive study is one of the basic types of epidemiology. describing the frequency and
distribution of diseases by time, place, and person.

Analytic versus non-analytic

A non-analytic or descriptive study design does not try to quantify the relationship.
▪ A non-analytic study design gives us a picture of what is happening in a population, e.g.,
the prevalence, incidence, or experience of a group.
– Example: case reports, case series, qualitative studies, and surveys (cross-
sectional) studies.
▪ Non-analytic study measures the frequency of occurrence of several factors, and hence
the size of the problem under investigation.
An analytic study attempts to quantify the relationship or association between two factors, that is,
the effect of an intervention or exposure on an outcome.

Analytic study:
1. Experimental
2. Quasi-experimental and
3. Non-experimental (observational studies) - Case-control study, cohort, cross-sectional
studies

a. Experimental Studies
▪ A study in which one group in which an intervention is made is compared with another
group in which there is no intervention.
▪ The intervention is designed by the investigator before implementation.
▪ Subjects are randomized into control and intervention groups.
▪ Strongest for demonstrating causality as it controls all other factors affecting the outcome
but is most expensive and are not always feasible.
▪ Example: Clinical Trial where the investigator introduces some treatment to cause a
change in the outcome

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Types of Experimental Studies
– Randomized trials
– Randomized clinical trials.

b. Observational Studies
▪ Studies in which associations between a factor of interest and a particular disease or
outcome are investigated.
▪ Studies in which the investigator does not make any intervention on the study
subjects.

Types of observational studies

– Cohort studies
– Case-control studies
– Cross-sectional studies

i. Cohort studies
▪ The classic cohort study involves follow-up of a group of exposed and unexposed
individuals to compare the incidence of disease or death in both groups.
The study population for a cohort study
▪ Select a group of people who have been exposed or who possess the factor being studied.
▪ Select a second group who are unexposed or do not possess the factor being studied.
▪ Follow both groups up for a specified period.
▪ Identify those in either group with the outcome of interest.

Types of Cohort Study

Prospective cohort study
▪ The study population is selected today and followed forward in time until disease or
outcome of interest develops.
Retrospective cohort study
▪ A group of selected individuals (united by some common factor) is selected, some of
whom have the outcome of interest and others who do not.
▪ Old records collected before the condition developed are retrieved and those with factors
under investigation identified.
Advantages of cohort study
1. They can provide information on a wide range of outcome.
2. The time sequence of events can be assessed.
3. Possible to measure the incidence of disease directly.
4. Possible to collect detailed information on exposure on a wide range of outcomes.

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 5. Study exposure to rare factors.
6. The effect of changes in exposure over time on the outcome can be studied.
7. There is reduced recall and selection bias compared to case-control study.
8. Ethically safe
9. Subjects can be matched.
10. Easier and cheaper than RCT

Disadvantages of cohort study

1. In general cohort study follow individuals over a long time and therefore costly to
perform
2. For rare outcomes, very large sample size is needed.
3. As follow up increases, study subjects may be loss to follow up leading to bias results.
4. It is possible that the disease outcome and their probabilities or etiology of the disease
may change over time.
Characteristics of observational studies
Prospective
– Data collected from the start of the study onwards.
Retrospective
– Data are collected on information which was recorded (occurred) in the past.
Longitudinal
– Looks at information on individuals over time.
Cross-sectional
– Collects information on individuals at a single point in time.
ii. Case-Control Studies
▪ Case-control studies are studies in which a group of people with a particular
outcome/disease (cases) are selected and compared with a group of people without the
outcome/disease (controls) to determine the existence of an association between an
exposure/factor and the outcome/disease.
Design of a case-control study
▪ Identify a group of individuals with the disease or outcome.
▪ Identify a group of individuals without the disease.
▪ Determine the proportion of exposed and unexposed people in each group.
▪ Calculate the measure of association.
Advantages
1. They are generally relatively quick, cheap, and easy to perform.
2. They are suitable for rare diseases.
3. A wide range of risk factors can be investigated.
4. fewer subjects are needed than cross-sectional studies.

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Disadvantages
1. Recall bias.
2. If disease precedes exposure, causation cannot be inferred.
3. Selection of control groups is difficult.

iii. Cross-Sectional Studies

– Cross-sectional studies are simply a snapshot of the outcome/disease situation at a point
in time.
– They could be referred to as prevalence studies.
– Can measure odds ratios from cross-sectional studies.

Types of cross-sectional studies

Descriptive
– Cross-sectional Study that collects information only on the prevalence of a condition
Analytical
– Cross-sectional study that seeks to determine the association between possible risk
factors and a disease or outcome.

Design of cross-sectional studies

▪ Define the population to study.
▪ Gather data on exposure and disease at the same time.
▪ Sort out data into the analysis table.
▪ Calculate prevalence.
▪ Calculate odds ratios.
Advantages
• Cheap and simple
• Ethically safe.
Disadvantages
• Establishes association at most, not causality.
• Recall bias susceptibility.
• Confounders may be unequally distributed.

Sample Size
▪ Sample size calculations are important to ensure that estimates are obtained with the
required precision or confidence.
▪ This is the smallest difference between the group means or proportions which would be
clinically or biologically important.
▪ The sample size should be set so that if such a difference exists, then it is very likely that
a statistically significant result would be obtained.

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Sampling Design
What is sampling?
• Sampling: The process of drawing a sample of units from a population to estimate the
characteristics of that population.
• Larger samples give more precise estimates of the population characteristics.

Sampling Methods

• Probability Sampling
– Every element in the target population or universe [sampling frame] has an equal
probability of being chosen in the sample for the survey being conducted.
– Scientific, operationally convenient and simple in theory.
– Results may be generalized.
• Non-Probability Sampling
– Every element in the universe [sampling frame] does not have equal probability of
being chosen in the sample.
– Operationally convenient and simple in theory.
– Results may not be generalized.
Types of Sampling Methods

Simple random sampling is a method of probability sampling in which every unit has an equal
non-zero and known chance of being selected.

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Systematic random sampling is a method of probability sampling in which the defined target
population is ordered, and the sample is selected according to position using a skip interval
Stratified random sampling is a method of probability sampling in which the population is
divided into different subgroups and samples are selected from each subgroup.

Difference Between Cluster and Stratified Sampling

Multi-stage Sample Designs

• Many surveys use complex sample designs that combine several of the above elements in
a multi-stage sampling framework.
• Sometimes the population is too large and scattered for it to be practical to make a list of
the entire population from which to draw.

Non-Probability Sampling
• Convenience sampling
– Drawn at the convenience of the researcher. Common in exploratory research.
Does not lead to any conclusion.
• Judgmental sampling
– Sampling based on some judgment, gut feelings, or experience of the researcher.
If inference drawing is not necessary, these samples are quite useful.
• Quota sampling
– An extension of judgmental sampling. It is something like a two-stage judgmental
sampling. Quite difficult to draw.
• Snowball sampling
– Used in studies involving respondents who are rare to find.
– To start with, the researcher compiles a short list of sample units from various
sources. Each of these respondents are contacted to provide names of other
probable respondents.

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Writing the Introductory Chapter (Chapter One)
– Introduction
– Problem statement
– Objectives
– Justification

Introduction
– From general to particular
– Use review papers in citations.

Content of introduction
– What is known about the subject?
– What is not known about the subject?
– End by stating your question and how you set out to answer it.
– Link your question to what new knowledge this study brings or how the results affect
practice.

Introduction checklist
• Does the introduction
– Identify a gap in scientific knowledge.
– Show why the study was necessary.
– Briefly summarize the approach
– Show what is new and important about the study.
– ‘sell’ the study.

Note:
– The introduction simply leads your reader into your subject.
– Present major highlights of your research topic
– Do not write a literature review at this stage.
– Avoid repeating things that you have written in the introduction in your literature review
chapter.

Writing the Literature Review (Chapter Three)

• Search widely.
• Reference all literature that you refer to in your review.
• Evaluate the relevance of the literature to your study.
• Include information directly relevant to your study.
• There should be logical sequence in writing literature review (you can also create sub-
sections)
• Be concise.
• It could be thematic or chronological.

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Writing the Methodology (Chapter Three)
Study Setting: focus on the description that is most related to the study. Include map if possible
(1-2 Paragraphs)
▪ Location, Physical features (climate, altitude...), Population size and composition
▪ Infrastructures -education, health, communication…
▪ Economy

Study design: Describe the specific study design to be utilized to address the objectives of the
study (1 paragraph)

Study population: describe the source population and the actual study population. Indicate the
inclusion and exclusion criteria (1-2 paragraphs)

Sample size: calculate sample size for each specific objectives with different assumptions; show
your formula and results (1 paragraph, 1 summary table)

Sampling procedures: describe your sampling procedure in detail; if multistage sampling is used
describe the sampling at each level (1-2 paragraphs, 1 figure showing sampling procedure)

Data collection procedures - describe:

– the data source (record, interview e.g. questionnaire, observation),
– data collection tool (content, language, and source),
– measurements (tools for measuring, standards…),
– who will collect data (gender, age, qualification, and experience…),
– where data will be collected (at home, at work, at a health facility …),
– when will be data collected (about calendar time, or service rendered in a health
facility…),
– data quality control (training, pre-testing, supervision…) (5-8 paragraphs)

Variables of the study

- Dependent and independent variables
Types of Variables
1. independent variable (IV)…
– what you (or nature) manipulate in some way
2. dependent variable (DV)…
– what you presume to be influenced by the IV

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 Example

Dependent Vs Independent

Data Management: describe the data handling, entry, and cleaning procedures (1 paragraph)
Data Collection Methods (primary and secondary data)
- Sources of data
- Types of data collection methods
- Factors considered in the choice of method.
- Data collection tool

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Types of data collection
Quantitative data collection methods (in numbers)
- Using available information (secondary data)
- Interviewing
- Administering questionnaires (Closed questions, Open-ended questions, Semi-opened
questions)
Qualitative data collection methods (in words)
- Focus group discussion (FGD)
- In-depth interview (IDI)
- Observation
Data Analysis procedures: describe the actual analysis you will perform to answer the specific
objective of the study (1-2 paragraphs)

Ethical consideration: discuss the ethical concerns specific to your study and describe the
procedures you will follow to minimize risk to study participants (1-2 paragraphs)
The methods of a research project is the core of the study.
Components of a research design that should be addressed in the method section:
Study area, Study period, Study design, Population, Sample size determination and sampling
procedures, Variables, Data collection, Data processing and analysis, Ethical considerations,
Data quality assurance, and Operational definitions.

Writing the Results (Chapter Four)

▪ Purpose → to describe the results of data analysis that are relevant to the study.
▪ Systematic presentation of your findings about the research objective is crucial.

Two different ways of presenting findings

1) an integrated presentation of all the data by objective
2) presentation of data by research instrument (separate analysis is indicated for objectives that
are covered by

▪ Describe what you found, not what you did.

▪ Present results in a logical sequence
▪ Consider sub-sections.
▪ Less is often better (a table or figure is worth thousand words)
▪ Make sure all numbers in text are consistent with tables/figures.

Discussion (chapter 4 cont.)

▪ Purpose → to interpret your results & justify your interpretation.

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Guidelines for constructing the discussion.
▪ Findings can be discussed by objective or cluster of related variables or themes, which.
should lead to conclusion & possible recommendation.
▪ Focus on the main results related to the specific objectives.
▪ Emphasize on what is new or different.
▪ Restate the main finding.
▪ Interpret the result in context of literature.
▪ State the limitations of the study.
▪ State conclusions & recommendations.

Summary, Conclusions & Recommendations (Chapter Five)

-Conclusions should be short, as they have been elaborately discussed in the discussion
section.
- Recommendations are usually placed in roughly the same sequence as the conclusion.
- Recommendations may at the same time be summarized according to the groups towards
- which they are directed
Example
✓ Policy makers
✓ Managers at district or lower level
✓ Staff who could implement the activities.
✓ The community at large

Abstract
• The abstract will be the first (and for busy decision-makers most likely the only) part of
your study that will be read.
• Writing abstracts demands thorough reflection and is time-consuming.
Purpose of abstract
To highlight key points from the major sections of the manuscript
• Abstract can be structured or unstructured (always check the instruction of the
institution/journal)
• Remember that only few words are allowed to be included in the abstract (usually 250-
300 words)
• Emphasize on what is new and useful.

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Chapter One (Introduction) 3.3 Study Population
1.0 Introduction 3.4 Inclusion and Exclusion Criteria
3.5 Sample Size
1.1 Background of the study
3.6 Description of Study Variables
1.2 Statement of the Problem
3.7 Sampling Method
1.3 Research Questions
3.8 Data Collection Method
1.4 General and Specific Objectives
3.9 Data Collection Instruments
1.5 Significance of the Study
3.10 Data Analysis
1.6 Delimitation of the study
3.11 Ethical Considerations
1.7 Limitations of the study
1.8 Definition of operational terms Chapter Four (Results)

Chapter Two (Literature Review) 4.0 Introduction

4.1 ………
2.0 Introduction
2.1 …. Chapter Five (Summary, Conclusion and
Recommendations)
Chapter Three (Research Methods) 5.0 Introduction
3.0 Introduction 5.1 Summary
3.1 Study Area 5.2 Conclusion
3.2 Study Design 5.3 Recommendations

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 ASSIGNMENT
Write a research proposal on any nursing problem in Sierra Leone.

You can choose from a wide range of nursing research problems. Some of the nursing problems
include but are not limited to the following: healthcare research problems, nursing intervention
practices, child nursing, midwifery, elderly care, primary healthcare nursing, the advantages
and disadvantages of free health care, diversity in the healthcare industry, gender gap in
caregiving, and the impact of technological advancement on healthcare services.

A perfectly written research proposal should be unique and have well-framed, in-depth
information with cohesion.

Your assignment must be in line with the following requirements.

- 10 pages
- 1.5 line spacing, Times New Roman, and a font of 12 is required
- References should not be more than 10 years old.
- Include a cover page with a title for the assignment, student name and ID, date of submission,
course title and code, and lecturer.
- Note: the cover page and list of references are excluded from the required page limit for this
assignment
- Deadline for submission is 15th June 2024, at 12 pm
- Weight: 40%
- Submission email: emmanuel.nyuma@njala.edu.sl

Please note, that your work will be checked for plagiarism.