Unit-I Introduction

Mr Zafar Iqbal
MSN,MPH,BSN
Lecturer KMU-INS
Acknowledgement: Dr Dildar Muhammad
Associate Professor/Director KMU-INS
 Objectives

• Introduction: Overview
• Definitions.
• Ways of knowing: Sources of human knowledge
• Purposes of scientific research
• Limitations of scientific method
• Research Terminology
 Overview

Research and the Consumer

•Science produces knowledge

•This knowledge provides society with more

choices…or does it control our choices?

•Can be used to manipulate

•Can imply information which isn’t necessarily “fact”

 Overview

What do I believe???
•One study “says” to do one thing; another study
says that I should do the opposite!
•What is a person to do?
 Overview

Read the study?

•Do you simply accept the findings because they are
“scientific?”
• How do you know which studies are credible?

• This course will help!

 Overview

Why get excited about research?

“The essence of all research originates in curiosity -
a desire to find out how and why things happen”
•How can…?
•Why is…?
•What is the best way to…?
•What causes…? I wonder...
•What are the effects of…?
 Research

Means ‘to search again’ or ‘to examine carefully’.

Research is a diligent and systematic inquiry

undertaken to refine or validate existing knowledge and
generate new knowledge

The ultimate goal of research is the development of a

research body of knowledge for a discipline or
profession, such as nursing.
 Research

• “Research is the systematic collection,

analysis, and interpretation of data to;
Answer a certain question or Solve a problem
 Characteristics of Research

• It demands a clear statement of the problem;

• It requires a plan (it is not aimlessly "looking" for
something in the hopes that you will "come across a
solution");
• It builds on existing data, using both positive and
negative findings; and
• New data should be collected as required and be
organized in such a way that they answer the
original research question(s).
 Applications of Research

• Diagnostic & Therapeutics (improve diagnosis &

treatment)

• Policy (Improving health care system)

• Biotechnology (Develop technology)

• Health promotion & Disease prevention

 Types of Research

The philosophical approach to research is basically of two

types:

•Theoretical Research - based upon theory and

abstraction.

•Empirical Research - based upon observation and

experience/experimentation.
 Types of Research

• Empirical Research can be;

i.Qualitative
ii.Quantitative
Empirical Research
 Nursing Research

Nursing research is a scientific process that refines or

validates existing knowledge and generates new
knowledge that will directly or indirectly influence
nursing practice.
 Definitions
• Abdellah: “ A systematic detailed attempt to discover or
confirm facts that relate to a specific problem to improve
the practice and profession of nursing.”

• Polit and Hungler:“A systematic search for knowledge about

issues of importance to nursing.”

• Henderson: “A study of the problems in practice relating to

the effects of nursing.”

The ultimate goal of nursing research is to provide an

empirical basis to guide nursing practice, what is referred
to as evidence-based Practice (EBP).
 Importance of Research in Generating EBP
for Nursing
There are four types of research. Each type of research
provides the basis for the next level of inquiry.
1. Description:
Through descriptive research we try to identify and better
understand nursing phenomena and the relationships
among the phenomena.
Example: A qualitative study conducted in order ‘to
describe the experience of surviving prolonged
mechanical ventilation’. The results from this study
provide nurses insight into the psychological needs of
patients being weaned from ventilators. The implication
for practice include expanding the involvement of the
family in the weaning process and supporting patients in
their expression of religious and spiritual beliefs.
Importance of Research in Generating EBP
for Nursing (Cont.…)
2. Explanation: Explanation clarifies the relationship
among phenomena and identifies why certain events
occur.
An example of this is the research that has been done
to examine the relationship between nosocomial
infections, higher levels of morbidity and mortality, and
higher hospital costs.
Importance of Research in Generating
EBP for Nursing (Cont.…)
3. Prediction: This examines the probability of an
outcome occurring in specific situations. This type of
research is common in epidemiology in which specified
risk factors predict the occurrence of disease.

For example, obesity and inactivity predict higher rates

of heart disease.
 Importance of Research in Generating EBP
for Nursing (Cont…)
4. Control: Control is the ability to specify how to
produce a desired outcome. Control is dependent on
prediction.

For example, the incidence of heart disease is reduced

when levels of obesity and inactivity are controlled or
when people are a normal weight and they exercise.
Ways of Acquiring Knowledge in Nursing

• Tradition: This represents knowledge based on

truths and beliefs that come from customs and
trends.
• Developed with past experience, however,
units are set according to traditional rules.
might not be effective and efficient.
• Need research for quality of life instructions.

• Authority: A person with expertise and power who

is able to influence opinion and behavior.
But may have the information that may not
validate from research
Ways of Acquiring Knowledge in Nursing

• Borrowing: Borrowing is nursing involves the

appropriation and use of knowledge from other
fields or discipline to guide nursing practice.
But difficulties to set boundaries

• Trial & Error: Trial & Error is an approach with

unknown outcome that is used in a situation of
uncertainty in which other sources of knowledge are
unavailable.
But the time and patients health are on risk
Ways of Acquiring Knowledge in Nursing
• Role modeling: Is learning by imitating the behaviors of
an expert. Mentorship
• Personal Experience: Personal experience involves
gaining knowledge by being personally involved in an
event, a situation or a circumstances.
1) Novice: No experience
2) Advance beginner: Experience at some extent
3) Competent: Able to generate and achieve long range
goals.
4) Proficient: Well experienced and could tackle the
patient as a whole, family and community
5) Expert: Well exposed and faster in her/his approach
Ways of Acquiring Knowledge in Nursing
• Intuition: Intuition is an insight or understanding of a
situation or event as a whole that usually can not be
explained logically.
Gut feeling, this does not mean a lack of knowledge
rather a deep knowledge.

• Reasoning: Reasoning is the process and organizing of

ideas in order to reach conclusion:
a) Inductive : Specific to general
b) Deductive: General to specific
Ways of Acquiring Knowledge in Nursing
• Scientific Method: The most advanced method of
acquiring knowledge that humans have developed.
• Order
• Control
• Empiricism
• Generalization
• Theoretical Formulation

Scientific Meth
 Scientific Method

The most advanced method of acquiring knowledge

that humans have developed.
Order: Systematic prescribed order in order to have
reproducibility and confidence in the results
• Problem identified
• Defined
• Predictions of outcome
• Information collected according to design
• Analysis
• Conclusion
 Scientific Method

The most advanced method of acquiring knowledge that

humans have developed.
Control: In trying to isolate relationships among
phenomena, scientists must control phenomena and factors
not under study.

Empiricism: Evidence rooted in objective reality and gathered

directly or indirectly through the human senses.
the theory that all knowledge is based on experience derived
from the senses. Research is based in REALITY
 Scientific Method

The most advanced method of acquiring knowledge

that humans have developed.
Generalization: No research is ever done just to
benefit the subjects, in order to have value it must
be generalizable to a wider population.

Theoretical Formulation: Theories is process of

organizing, integrating and deriving abstract
conceptualization about the manner in which
phenomena are interrelated.
 Purposes of Scientific Research

Mnemonic : DEEP identification.

•Description
•Exploration
•Explanation
•Prediction and Control
•Identification
 Principles of Research

• The benefit for collection of knowledge;

• The benefit for humanity;

• The benefit for the patients / population:

i.e. – recovery of disease
- improvement of health
- prevention of disease
 Terminologies

• Concepts/Constructs: Refined general or abstract

idea “good health” “nursing care”
• Conceptual Framework: A series of concepts or
ideas connected by statements about the
relationships that exist among them
• Operational Definition: Specifications of the
specific and explicit operations which the
researcher must perform in order to collect the
required information
“Operationalizing the concept”
 Limitations of Scientific Method

• Values or ethics

• Human complexity

• Measurement problems

• Control

• Ethical considerations
What are nurses' roles in the research
process?

According to professional nursing organizations, such

as the American Nurses Association, the level of
research involvement increases with each successive
level of advanced educational preparation.
Research involvement with the
educational preparation (Cont.…)

Baccalaureate degree
Apply findings to practice
Share findings
Interpret and evaluate research for practice.

Associate Degree
Collect data
Identify problems
Appreciate the value of research
Research Involvement with the
Educational preparation
Doctoral Degree
Extend scientific basis
Develop methods to measure nursing phenomena
Provide leadership

Master's degree
Conduct investigations
Facilitate access to clients
Collaborate with other investigators
Facilitate research
Provide consultation
Analyze and reformulate problems
 Nursing Research Priorities
To Improve:

• Nursing as a profession

• Nursing practice

• Patient outcomes
 Nursing Research Priorities (Cont.…)

• Evaluates and improves nursing care based on new

and credible knowledge;
• Provides evidence on which to base our nursing care,
or EBP;
• Offers quality and cost containment practices;
• Continuous growth of nursing profession;
• Helps nursing to achieve its own professional identity;
• Helps to identify the boundaries of nursing;
• Defines the parameters of nursing.
 Nursing Research Process

Research Problem and Purpose.

Literature Review.

Study Framework.

Research Objectives, Questions, or Hypotheses.

Study Variables.

Assumptions.

Research Design
Nursing Research Process
Population and Sample

Methods of Measurement

Data Collection

Data Analyses

Research Outcomes.

Disseminate of outcomes

Limitations.
Do you think is there any similarities &
differences in Nursing Process &
Research Process?
 Comparison of the Nursing Process &
Research Process
Nursing Process Research Process

Assessment Knowledge of the world of nursing

•Data Collection
•Data Interpretation
Nursing Diagnosis Plan Problem, & Purpose Identification
Goal Identification Methodology
Planned Instruction Design
Sample
Measurement
Implementation Data Collection & Analysis
Evaluation & Modification Outcome & Dissemination findings
 History in Nursing Research
• 1930s through 1940s the focus was on nursing
education.
• 1950s through 1960s the focus was on nurses and
nursing roles.
• 1970s through 1990s the focus has been on clinical
problem.
 History in Nursing Research
1850 Nursing research began with Florence Nightingale.
1859 Florence Nightingale studied aspect of the environment
such as ventilation, cleanliness, purity of water, and diet
to determine the influence on patient’s health.
During the Crimean War her research related to deaths
and disability among the soldiers resulted in an amazing
decrease in the mortality rate from 43% to 2%.
1900 First Journal Published “ American Journal of Nursing’
(AJN)
1920s & Case studies began appearing in this journal (AJN)
1930s
1923 First doctoral program for nurses in Teacher College
at Columbia University
 History in Nursing Research
1950 American Nurse Association (ANA) initiated a five year
study on nursing functions and activities.
1952 First Journal of Nursing Research published.
1953 The institute of Research and services in Nursing
education established at teachers collage Columbia
University, New York.
1959 The findings from ANA study were used to develop
statement on functions, standards, and qualification for
professional nurses.
1959 Clinical research began expanding as nursing specialty
groups, such as community health, psychiatric-mental
health, medical-surgical, pediatrics, & obstetrics.
1950s & Introduced research in nursing schools at the
1960s baccalaureate & MScN level
 History in Nursing Research

1963 Additional research journal, International Journal of

Nursing Studies, was published
1965 ANA sponsored the first series on nursing research
conferences
1967 Image: Journal of nursing scholarly, first published
Late Nurses were involved in the development of models,
1960s & conceptual frameworks, & theories to guide nursing
1970s practice
1970s Research in Nursing, first published
1978 Western Journal of Nursing Research, first published
 History in Nursing Research

1980's Clinical research became the important design in

research
Saw many new journals being published e.g. Cancer
nursing; Pediatric nursing, Dimension of critical care
nursing etc.., Applied nursing research.
Clinical research written priority of the 80's
Increase funding for nursing research.
The ANA achieved a victory by establishing the
National Center for Nursing Research in 1985.
 History in Nursing Research

1999 Priorities of National Center for Nursing Research

1999 includes:
•Community Based nursing models.

•Effectiveness of nursing interventions in HIV/AIDS.

•Cognitive impairment.

•Living with chronic illness.

 Paradigms and methods for Nursing
Research

•Positivist paradigm
•Constructivist paradigm
 What Is a Paradigm?
• A world view; outlook, style, viewpoint, or a general
perspective on the complexities of the real world, with
certain assumptions about reality

• Paradigms are lenses that help us to sharpen our focus

on a phenomena of interest; they are not blinder that
limit our intellectual curiosity

• Key paradigms for nursing research:

• Positivist Paradigm
• Constructivist/Naturalistic paradigm
 Positivist Paradigm
• It is the paradigm of the 19th century, guided by the work of
these philosophers as Comte, Newton, and Locke.
• The positivist assume that the world is based on some reality
which has to be studied and known
• Assumption is a basic principle/truth that is not to be
challenged and is believed to be true without proof or
verification. Objective reality exists independent of human
observation
• Determinism: Phenomena are not haphazard or random
events but have antecedent cause. This type of research is
directed to understand the underlying causes of natural
phenomena. OBJECTIVITY
• If a person develops lung cancer, the scientist assumes that
there may be one or more reasons that can be potentially
identified and understood.
 Naturalistic Paradigm
• It begins as countermovement to positivism with writers such as
Weber & Kant.
• The naturalistic assume that reality is not fixed entity but it is
the outcome of the subjects’ activity.
• There is relativism: multiple interpretations exist in the
individuals minds, and then there is no process by which the
ultimate/final truth or falsity can be determined (there is no
final truth or falsity) SUBJECTIVITY

• The naturalistic assumes that knowledge is maximized

when the distance between the researcher and the
participants in the study is minimized.
 The Nature of Reality

• Positivist assumption: Reality exists; there is a

real world driven by natural causes

• Naturalistic assumption: Reality is multiple and

subjective, constructed by individuals
Type of assumption Positivist paradigm Constructivist paradigm

The nature of reality Reality exists Multiple realities

Relationship between Independent from participants Part of the research process

researcher and participants

Values in inquiry Objectivity Subjectivity

Best methods .deductive .inductive

. Discrete-specific concepts .emphasis on the whole
.objective, quantifiable .subjective, non-quantifiable
.researcher predictions .emergent insight from
.fixed, specified design participant experiences
.control over context .contextualized
. Quantitative information .narrative information
.statistical analysis .qualitative analysis
.Seek generalizations .seeks in-depth-understanding
 Nursing Research Methods

Quantitative Research/scientific method

Qualitative Research/constructivist method

Outcomes Research
 Nursing Research Methods

NURSING RESEARCH

Qualitative research Quantitative research Outcome

research

- Phenomenological - Descriptive
- Grounded theory - Correlational
- Ethnographic - Quasi-experimental
- Historical - Experimental
 Types of Quantitative Research
Descriptive Research

Correlational Research

Quasi-Experimental Research

Experimental Research
 Types of Qualitative Research

Phenomenological Research

Grounded Theory Research

Ethnographic Research

Narrative research

Case Study
 Outcomes Research
Is focused on examining the end results of care or
determining the changes in health status for the patient.

Four essential areas:

The patients responses to medical/nursing int.
Functional maintenance/improvement of physical
functioning for the patient.
Financial outcome achieved with the provision of
health care services.

Patients satisfaction with the health outcomes care

received and the health care provider.
 How is evidence-based practice (EBP)
Developed
• EBP is developed through a combination of research
approaches.
• Through qualitative research we are able to better
understand the patient's and family's experiences
with health and illness.
• Quantitative research provides a mechanism for
testing the effectiveness of nursing interventions.
• Finally, outcomes research focuses on the provision of
quality, cost-effective care.
Below are descriptions of several research problems. Indicate whether
you think the problem is best suited to a qualitative or quantitative
approach, and explain your rationale.

a. What is the decision-making process of patients with prostate cancer weighing treatment
options?
b. What effect does room temperature have on the colonization rate of bacteria in urinary
catheters?
c. What are sources of stress among nursing home residents?
d. Does therapeutic touch affect the vital signs of hospitalized patients?
e. What is the meaning of hope among Stage IV cancer patients?
f. What are the effects of prenatal instruction on the labor and delivery outcomes of
pregnant women?
g. What are the healthcare needs of the homeless, and what barriers do they face in having
those needs met?

5. What are some of the limitations of quantitative research? What are

some of the limitations of qualitative research? Which approach seems
best suited to address problems in which you might be interested? Why is
that?
 References

Burns, N. & Grove, S. K. (2007). Understanding nursing research.

(4th ed.).Philadelphia: W.B. Saunders.
PAGE, A. (1999). Nursing research. Retrieved October 3, 2007,
fromhttp://www.nipissingu.ca/faculty/arohap/aphome/NURS4016
/Lectures/CHAPTppt.PPT.
Polit, D, F. (2014). Essentials of Nursing Research, appraising
evidence for Nursing practice (8th ed). Lippincott Williams and
Wilkins.