1. NURSING RESEARCH:
DEFINITION
A systematic search for and validation of knowledge about issues of importance
to the Nursing profession (Polit & Hungler)
Research concerned with knowledge that directly or indirectly influences clinical
Nursing practice
Systematic, objective process of analyzing phenomena of importance to Nursing
PURPOSE OF NURSING RESEARCH
a. Basic
To generate new knowledge, to test or generate new theories
b. Applied
Use knowledge to solve immediate problems.
IMPORTANT GOALS FOR NURSING RESEARCH
Production of evidence-based practice
Credibility of the Nursing profession
Accountability for Nursing practice
Documentation of cost-effectiveness of care
TYPES OF RESEARCH
a. Quantitative Research
Objective, has tight controls, can generalize findings
Hard, replicable, reliable
Manipulation and control of phenomena
Verification of results using empirical data
Testing of hypothesis
Deductive
Limited existing theories
b. Qualitative Research
Subjective meaning of an experience to a person
Rich, real, deep, valid
In-depth description of people or events
Data gathered thru unstructured interviews and participant observation
Concerned with patterns and themes
Inductive
Must be open to new theories
Does not have clear-cut guidelines, and are actually harder to do for
novice researcher
ROLES OF A NURSE IN RESEARCH
1. Principal investigator
Demands preparation beyond BSN level
2. Member of research team
Data collector, administer experiments or interventions.
3. Identifier of researchable problems
Eg. Nurse at bedside can determine problem areas that may be
investigated on.
2. 4. Evaluator of research findings
Determines the usefulness of findings; beginning researchers should
critique research articles.
5. User of research findings
6. Patient or client advocate
7. Subject of studies
QUALITATIVE RESEARCH & QUANTITATIVE RESEARCH
A. QUALITATIVE RESEARCH
1. Phenomenological Studies
a. “Lived experience”
b. Examines human experiences through descriptions provided by the people
involved
c. Bracketing
• The researcher releases expectations and biases prior to doing the research
d. End purpose
• To determine themes and patterns of behavior, etc.
2. Ethnographic Studies
a. Collection and analysis of data about cultural groups
b. End purpose
• To develop cultural theories
c. Method
• Participant observation and interviews with “key informants”
3. Grounded Theory Studies
a. Data are collected and analyzed and then a theory is developed that is
grounded on the data
b. Method
• Purposeful sampling, done in field or naturalistic setting
c. Concerned with generation rather than testing the hypothesis
4. Historical Studies
a. Identification, location, evaluation, and synthesis of data of the past
b. End purpose
• To relate the past to the present and the future
c. Sources of data for historical research
c.1. Documents
source: Oral history, written research, diaries, eyewitness accounts,
pictorial services
c.2. Relics and artifacts
source: Physical evidence
d. Classification of sources can be:
d.1. Primary
An account of the event from the person himself
d.2. Secondary
Summarized or retold by another
e. Evaluation or Critism of the data
e.1. External
3. a. Authentically or genuineness of the source
e.2. Internal
a. Accuracy of the data in the source
5. Case study
• In-depth examination of people
B. QUANTITATIVE RESEARCH
Steps:
Step # 1. Identify the problem
a. Broad topic, narrowed down
b. May be the most difficult and will take the most amount of time
c. Sources of study problems
i. Personal experiences
ii. Literature sources
iii. Previous research
iv. Testing of theories
d. Characteristics of a good problem statement
i. Stated as a question
ii. Specifies the population and the variables
1. One-variable Studies
• Also called Univariate
• Eg. What is the primary motivation of student nurses in preparing the Licensure
examination?
2. Two-variable Studies
• Also called Bivariate
• Can be cause and effect in experimental studies. But in a correlational study,
the two variables are not “cause and effect” but may be two variables that are
compared or contrasted
3. Multiple-variable Studies
• Also called Multivariate
• Eg. Why do Nursing students fail on NLE?
iii. Emphirically testable
• Hearing, sight, taste, touch, smell
1. Ethicai and value issues, “right or wrong”, are not empirically testable but can
be measured based on their effect to a subject
• Eg. Should patients be allowed an unlimited number of visitors during their stay
in the hospital?” can be measured if “Is there a difference in the comfort level of
hospitalized patients who receive an unlimited number of visitors compared to
those limited to two visitors compared to those limited to two visitors per day?”
2. Avoid words like “cause” and “effect”.
e. Is there a significant difference in the average weight of school age children
who eat fast food twice a week than those who eat fast food once a week?
f. Problem Statement Format:
i. Correlational Statement: Is there a correlation between X and Y in the
population?
4. ii. Comparative Statement: Is there a difference in Y between people in the
population with X characteristics and those who do not have X characteristics
iii. Experimental Study: Is there a difference in Y between group A who received
X treatment and group B who did not receive X treatment
g. Research problem considerations:
i. Ethical issues
ii. Significance to Nursing
iii. Personal motivation
iv. Researcher qualifications
v. Feasibility of the study
1. Time
2. Cost
3. Equipment and Supplies
4. Administrative support
5. Peer support
6. Availability of Subjects
Step # 2. Determine the purpose of the study
a. Define why the study ids being made (often mistakenly interchanged with problem
statement.
b. Must state the significance and use of the study results in order to get approval.
c. Eg. To develop a better understanding of the significance of consumption of fast food
in the growing number of cases of obesity and overweight among school aged children.
Step # 3. Review of Related Literature
a. Purpose
i. To determine what knowledge already exist on the topic to be studied
ii. To develop a conceptual and theoretical framework for the study
iii. To help the researcher plan the study methods (eg. Instrument and tools)
b. Primary vs. Secondary Sources
i. Written by the original researcher
(eg. The Thesis itself, or the article written by the researcher)
Seen in Nursing Journals
ii. Secondary Source
Summary of the research as written by someone other than the researcher
c. Review of related literature must be done on a continuous basis so as to ensure that
researcher’s informations are up to date.
Step # 4. Develop a Theoretical/Conceptual Framework
To assist in the selection of the study variables and in defining them
Research without a theory provides a set of isolated facts
Definition of terms:
i. Theory
Set of related statements that describes or explains phenomena in a
systematic way
5. Eg. Newton’s Theories of motion, Callista Roy Adaptation Theory
ii. Concept
a. A word picture or mental idea of phenomenon
b. Maybe concrete or abstract
c. The building blocks of theory
d. Eg. Thermometer, Hate, Anger
iii. Construct
Highly abstract, complex phenomenon
Cannot be directly observed by, must be inferred by certain concrete or
less abstract indicators
Eg. Wellness, Mental health, Self esteem, Assertiveness
iv. Proposition
Statement of assertion of the relationship between anger concept
Eg. Bacteria causes disease. There is a relationship between anger and
increase in BP”.
v. Empirical Generalization
When a similar pattern of events is found in the empirical data of a
number of different studies
Eg. Women are likely to pass the board exams than men
vi. Hypothesis
Researcher’s expectations about the study
vii. Model
Symbolic representation of some phenomenon or phenomena
Eg. Flowchart or diagram
Conceptual Models – made of concepts and propositions that state the
relationship between the concepts
a. Theoretical vs. Conceptual Framework
i. Theoretical framework
Broad, general explanation of the relationships between concept of interest in a
research study
Based on the existing theory
ii. Conceptual framework
• Explains relationship between concept but links concepts selected from several
theories, from previous research results, and from the researcher’s own
experience
• Eg. Maslows Hierarchy of Needs Theory and Job satisfaction theory
b. Theory Generation and Development
i. Deductive Reasoning
• Proceeds form general to specific
• Eg. Maslow’s Hierarchy of needs – job satisfaction scale
• Theory -> Propositional statement -> Hypothesis -> Empirical data
ii. Inductive Reasoning
Proceeds from specific to general
Empirical date -> Empirical Generalization -> Propositional statement -> theory
Eg. Observed that workers who receive low salaries have poor work
performance – job satisfaction theory
6. c. Two types of Theories
i. Grand Theory
Address a broad range of phenomena in the environment or humanity
ii. Middle-range Theory
Concerned only with a small area of the environment or human experiences
Middle range theories have been found to be more valuable to nursing research
than grand theories
Step # 5. Identify the Study Assumption
Assumptions
Beliefs that are held to be true but have not necessary been proven
Eg. Fast food makes you fat.
Three Types of Assumptions:
i. Universal Assumptions
Beliefs assumed to be true by a large percentage of society
Eg. “Fast food makes you fat”.
ii. Assumptions based on theory or research findings
Using another research finding assumptions as the basis of one’s study
Eg. An existing research finding may have stated an assumption that children
who eat fast food twice a week tend to be twice more likely to become
overweight than children whoeat only once a week.
iii. Assumptions that are necessary to carry out the study
In the mentioned research, the assumption that children who study in
elementary schools are of “school-age”
Step # 6. Acknowledge the Limitation of the study
a. Limitations
Uncontrolled variables that may affect the study results and limit the
generalizability of the findings
Extraneous Variables
Also called Confounding or uncontrolled
Variables over which the researcher either has no control or chooses not to
exercise control
Eg. The attitudes and beliefs of parents of children involved in the study is not
being something that the researcher can control.
In experimental studies, uncontrolled variables are referred to as threats to
internal and external validity
b. Delimitations
Limitations placed on the research by the researcher himself
c. Scope
The extent to which the study will be made
Step # 7. Formulate the Hypothesis
a. Hypothesis
Predicts the relationship between two or more variables
Problem statements ask the question, hypothesis gives a predicted answer
b. Characteristics of a Hypothesis
7. i. Declarative form
ii. Written in present tense
iii. Reflects the problem statement
iv. Contains the population and the variables
v. Must be testable or empirically verifiable
c. Two Main Types of Variables:
1. Independent – the cause
2. Dependent – the effect
d. Classification of Hypothesis
i. Simple vs. Complex
Simple
- Relationship between one independent and one dependent variable
Complex
- Relationship between two or more independent or dependent variables
- An interaction effect would concern the action of two variables in conjunction
with each other
ii. Null vs. Research
Null
- No relationship exists between two variables
Research
- There is a relationship, states the expected relationship
iii. Nondirectional vs. Directional
Non-directional
- Mere prediction that a relationship exists
Directional
- Researcher further predicts the type of relationship
Which types of research require hypothesis?
i. Experimental, correlational, comparative studies, require hypothesis
1. Eg. Children who eat fast sood twice a week are morelikely to be overweight
that those who eat fast food only once a month.
ii. Descriptive studies, exploratory studies
1. Do not necessarily require hypothesis
2. Eg. A description of the lifestyles, customs and practices of indigent Manobos
from Central Mindanao.
Step # 8. Define Study Variables and Terms
Importance
To make the meaning of terminologies and variables clearer to the researcher
and the reader
To allow for replication of the study
8. Types of Research Definitions:
A. Operational Definitions
Indicates how a variable will be observed or measured
Eg. Weight – can be measured in kilograms or pounds.
B. Dictionary Definitions or Theoretical Definitions
C. Obtained from literature sources
Eg. School-age-child – any child from age 7 to 12. Fast food – any food
that is consumed in eating establishments that are served within a
considerably short period of time.
Step # 9. Select the Research Design
a. Research Design
The PLAN for how the study will be conducted.
b.Will it examine cause-and-effect or will it only describe existing situations.
Two major types:
i. Qualitative
ii. Quantitative
Can be Experimental and Non-experimental
Experimental vs. Non-experimental studies
a. Experimental
Concerned with cause and effect relationships
Highly respected in the scientific world
Must have: Manipulation or control of independent variable, random selection
of subjects, measurement of independent and dependent variable
More control can be exercised over extraneous variables
In Nursing experimental, a nursing intervention is usually introduced
i. Validity of Experimental Design. Extraneous variables (confounding or intervening or
study limitations).
Those which the researcher cannot control or chooses not to control
A. Internal validity
Degree to which changes in dependent variable can be directly attributed to
the independent variable
Can have the following as threats to validity:
a. Selection Bias
Results are due to subject differences before the independent variables was
manipulated
b. History
Some event other than the experimental treatment occurs during the study
that influenced the dependent variable
c. Maturation
Changes that occur within the subjects during an experiment study influences
the study results
9. d. Instrumentation Change
Difference between the pretest and the post test measurement caused by a
change in the accuracy of the instrument of thejudge’s ratings
Avoided by trial runs, or training sessions for judges prior to rating
e. Mortality
Subject dropout rate is different between the experimental and comprison
group
B. External Validity
Degree to which the study results can be generalized to other people and
other settings. Threats include:
i. Hawthrone effect
Study participants respond in a certain manner because there are aware that
they are being observed
ii. Experimenter effect
Researcher characteristics or behavior influence subject behavior
In non-experimental research, this is called the Rosenthal Effect
Reactive effects of the pre-test (measurement effect)
1. Subjects have already been sensitized by the pre-test and may affect post-test
results.
Types of Experimental Designs:
a. True Experimental
Researcher has great deal of control over the research situation
3 criteria: Manipulation of variables; One experimental and one comparison
group (control group)
Subjects are randomly assigned
i. Pretest-Posttest Control Group Design
R O1 X O2 (experimental group)
R O1 O2 (control group)
i. Subjects are randomly assigned to groups
ii. Pretest given to both groups
iii Experimental groups receives treatment, controlgroup the usual or no
treatment
iv. Posttest given to both groups
ii. Posttest only Control Group Design
R X O1 (Experimental Group)
R O1 (Control Group)
i. Subjects are randomly assigned to groups
ii. Experimental group receives treatment, control group the usual or no
treatment
iii. Posttest given to both groups
b. Quasiexperimental
Missing one criteria for true experimental design
Non-equivalent control group design
Similar to pretest posttest control group design but there is no random
assignments of subjects
Biggest threat: Selection bias
Time-series designs
10. Researchers periodically observes measures the subjects. Experimental
treatment is administered between two of the observations. 01 02 03 X 04 05
06
c. Pre-experimental design
Weak researcher has little control over the research
i. One-shot case study
Single group is exposed to an experimental treatment and observed after the
treatment
TX X O
ii. One-group pretest-posttest design
Provides a comparison between a group of subjects before and after the
experimental treatment
01 X 02
g. Types of Non-experimental Research design
i. Correlational Studies
Researcher extent to which one variable (X) is related to another variable
1. Correlation Coefficient
Researcher extent to which one variable (X) is related to another variable
a. + Relationship
Also called Direct
As the value of one variable increases, the value of the other variable also
increases
b. – Relationship
Also called Inverse
As the variable of one value increase, the value of the other variable
decreases
ii. Survey Studies
Self report data are collected from samples with purpose of describing
populations on some variables of interest.
iii. Comparative Studies
Examine the differences between intact groups on some dependent variable of
interest
Almost similar to experimental but has no manipulation of variables
Experimental studies are rarely done in nursing research since this will usually
involve experimentation with human beings, and arethus perceived as having
ethical issues
Eg. In the case of making the research on the weight gain of school age
children who frequently eat fast food, we cannot conduct experimental study
since doing so can endanger the health of the subjects.
1. Retrospective Studies
Dependent variable identified in the present, and the independent variable
that occurred in the past is determined.
2. Prospective Studies
Independent variable is identified at the present time, and the subjects are
followed in the future to observe the dependent variable
Eg. Fast food and weight gain.
3. Ex post facto Studies
11. Data are collected “after the fact” variations in the independent study are
studied after the variations have occurred, rather than at the time of the
occurrence.
iv. Methodological Studies
Concerned with the development, testing, and evaluation of research
instruments and methods
Eg. Post partum depression screening scale.
Step # 10. Identify the population
a. Population
Complete set of individuals or objects the posses some common
characteristics that is of interest to the researcher
i. Target Population
Also called Universe
The group of people or objects to which the researcher wishes to generalize
the findings of the study.
ii. Accessible Population
That group which is actually available for the study
iii. The accessible population must possess the characteristics similar to the
target population, and vice versa
Step # 11. Select the sample
a. Sample
A subgroup chosen to represent the population and used to make
generalizations about the population
b. Two major types of sampling
i. Probability
Everyone in the population has the chance of being selected.
1. Sample Random Sampling
Ensures that each element of the population has an equal and
independent chance of being chosen
Identify the sample population and list all the elements of the population
(sampling frame)
Table of random numbers
2. Stratified Random Sampling
Population is divided into subgroups or strata, according to some
variable/s of importance. After this, a simple random sample is taken from
each of the subgroups.
a. Proportional Stratified
b. Disproportional Stratified
3. Cluster Random Sampling
Large groups or samples become the sampling units
Eg. Geographical area, school, etc.
4. Systematic Random Sampling
a. Sample is taken from every kth element of the population.
12. b. Eg. 1,000 population and researcher needs 100 samples, then: (k interval
= N/n) 1,000/100 = 10. Every 10th person in the list will be taken as
sample.
ii. Non-probability Sampling Methods
Sample elements are chosen from the population by non-random methods.
More likely to produce biased samples.
1. Convenience Sampling
Accidental or incidental
Choosing readily available people or objects for a study
Snowball sampling
Study subjects help refer additional subjects
2. Quota Sampling
Similar to stratified random but selection not random
Basis of stratification is determined by the researcher
Eg. 50 % females, 50 % male
3. Purposive Sampling
a. Judgmental sampling
b. Handpicking of subjects
c. Time frame for studying the sample
i. Longitudinal Study
Follows the subject over a period of time (6 months or more).
More accurate study of changes that occur over time
1. Cohort Study
Persons are studied who have been born during a particular time
period
ii. Cross-sectional Study
Examines the subjects at one point in time
Less expensive and easier to conduct
Eg. Use of marijuana in high school freshmen vs. seniors, etc.
Step # 12. Conduct a pilot study
Miniature, trial version of the planned study. Can prevent a researcher from
conducting a large-scale study that might be an expensive disaster.
Objectives
To examine issues related to the design, sample size, data collection procedures and
data analysis approaches
Can be used to test an instrument, evaluate the study phenomenon. Etc.
Step # 13. Collect the data
a. Data
Pieces of information or facts that are collected in scientific investigations
b. What data will be collected? Who will collect the data? Where will the data be
collected? When will the data be collected? How will the data be collected? (Why, is
answered by the purpose of the study or the research design, and is not part of this).
13. c. The choice of data collection method is determined by the study hypothesis or
research question of the study.
d. Criteria for selection of data collection instrument
Practicality of the instrument
Reliability of the instrument
• Consistency and stability
Validity of the instrument
Ability to gather data that is intended to gather. Concerns that content of the
instrument. Will the instrument gather data that is needed in the research
e. Data collection methods
i. Questionnaires
Paper and pencil, self-report instrument
Contains questions the respondents are asked to answer in writing
1. Guidelines in wording questions
i. Affirmative rather than negative (never say never)
ii. Avoid ambiguous questions (many, generally, few, often)
iii. Avoid double negative questions
iv. Neutral wording
v. Double-barreled questions
2. Types of questions
a. Demographic
Data on the characteristics of the subjects
Demographic or attribute variables
Age, educational background, religion
b. Open-ended questions
Essay, fill-in-the-blank
c. Closed-ended questions
Respondent is asked to choose from given alternatives.
Must be collectively exhaustive (all possible answer provided) and
mutually exclusive ( no overlap between categories)
d. Contingency questions
Items that is relevant for some respondents and not for others
Eg. If yes.
e. Filler questions
Items in which the researcher has no direct interest but are included in a
questionnaire to reduce the emphasis on the specific purpose of other
questions.
ii. Interviews
Interviewer obtains responses from a subject in a face-to-face encounter or through
a telephone call.
1. Unstructured interview
Interviewer given a great deal of freedom to direct the course of the interview
Conducted more like a normal conversation
Probes
14. Additional prompting questions that encourage the respondent to elaborate on
the topic.
2. Structured interviews
Asking the same questions in the same order and in the same manner of all
respondents in the study
Even subtle changes in the wording of the interview may not be permitted
3. Semi-structured interview
Interviewers are generally required to ask a certain number of specific
questions but additional probing questions are allowed or even encouraged
iii. Observation Method
Gathering data through visual observations
Can be psychomotor skills, habits, non-verbal communication
1. Structured vs. Unstructured Observations
a. Structured
Carried out when the researcher has prior knowledge about the phenomenon
of interest
Uses a checklist
b. Unstructured
Researcher attempts to describe events or behaviors as they occur, with no
preconceived idea of what will be seen
2. Event sampling vs. time sampling
a. Event
Observation of an entire event
Eg. Bed making techniques of student nurses.
b. Time
Observation of events or behaviors during specified times
Eg. Appetite of patients during scheduled meals.
3. Relationship between observer and subjects
a. Non-participant observer-overt
Observer openly identifies himself and provides subjects with information
about the types of data that will be collected.
b. Non-participant observer-covert
Generally not ethical
Observer does not let participant know of his activity
Eg. Public behavior (can be ethical)
c. Participant observer-overt
Involved with the subjects openly and subjects know that they are being
observed by the same
Eg. Immersion with families while observing their day-to- day lifestyle.
d. Participant observer-covert
“Plant”, “Spy”
Observer interacts with the subjects and observes their behavior without
their knowledge. Rarely ethical
iv. Physiological Measures
15. Involve in the collection of physical data from the subjects
Generally more objective and accurate than many of the other data collection
methods
v. Attitude scales
Self-report, data collection instruments that ask respondents to report their attitudes
or feelings on a continuum
1. Likert Scale
Uses five or seven responses for each item ranging from Strongly Agree (5) to
strongly disagree (1)
Negatively worded questions are rated scored reverse
2. Semantic Differential Scales
Asks subjects to indicate their position or attitude about some concept along a
continuum between two adjectives
vi. Psychological Tests
1. Personality Inventories
Self-report measures used to assess the differences in personality traits, needs,
or values of people
2. Projective Techniques
Subject is presented with an ambiguous stimuli, subject describes what the
stimuli appear to represent
Eg. Rorschach Inkblot Test.
vii. Delphi Technique
Uses several rounds of questions to seek a consensus on a particular topic from a
group of experts
To obtain group consensus without a face-to-face meeting
viii. Visual Analogue Scale
ix. Pre-existing Data
Use of existing information that has not been collected for research purposes
Eg. Patient’s chart
Step # 14. Organize the Data for Analysis
a. Tabulation and evaluation
b. Plans for organizing the data should be made prior to data collection. Plans for
analyzing the data should be made prior to data collection
c. Determine if questionnaires have been completed correctly. What to do with missing
data. Audio tapes transcribed.
Step # 15. Analyze the data – statistical concepts
i. Frequency Distribution
Simply counting the occurrence of values or scores represented in the data
Appropriate for tabulating all types of data (nominal, ordinal, interval, ratio)
If range of score is less than 20, each score can be listed individually, when the
range is large you can group them into “class intervals”
ii. Graphic Presentations
Have visual appeal that may cause readers to analyze the data more closely
1. Bar graph
Used to represent frequency distribution with nominal data or some type of
ordinal data
16. May be horizontal or vertical
2. Histogram
Uses bars to represent the frequency distribution of a variable that is measured
at the ordinal, interval, or ratio level
Has X and Y axis
3. Frequency Polygon
Graph that uses dots connected with straight lines to represent the frequency
distribution or ordinal, interval, or ratio data
The class intervals are on the horizontal axis, the frequency on the vertical axis
iii. Percentages
Represents the proportion of a subgroup to a total group
Minimum number for the computation of percentages should be at least 20
Measures of Central Tendency
Statistics that describe the average, typical, or most common value for a group
of data
1.Mode
Category or value that occurs most often in a set of data under consideration
If the data gathered are nominal this is referred to as “nominal class”
Maybe unimodal, bimodal, multimodal
2. Median
Middle score or value in a group of data
If number of values is even, the midpoint between the two middle values is the
median. If the number of values is uneven, then the median is the middle value
3. Mean
The average sum of a set of values found by adding all values and dividing by
the total number of values
X = Total of all values or number of values
c. Measures of Variability
Measures how spread out values are in a distribution of values.
1. Range
Distance between the highest and lowest value in a group of values or scores
Eg. Highest 60, lowest 40, the range is 20
2. Percentile
A datum point below which lies a certain percentage of the values in a frequency
distribution
Eg. NCEE Score, Weight for Age charts in Pediatrics
3. Standard Deviation
Most widely used when interval or ratio data are obtained
Indicates the average deviation or variation of all values in a set of values from
the mean values of those data
4. Variance
Standard deviation squared
5. Z-score
17. d. Measures of Relationships
Measures the correlation between variables
1. Correlation Coefficients
Pairing the value of each subjects on one variable with the value on another
variable
Eg. Athletic ability vs. IQ level. Anxiety level vs. pulse rates
2. Scatter Plots
Scatter diagram or scatter gram
Graphic representation of the relationship between two variables (X and Y axis)
Step # 16. Interpret the findings
a. Made in light of the study hypothesis or research question and the theoretical
framework.
Step # 17. Communicate the findings
a. The final step in the research process and yet the most important one for nursing. No
matter how significant the findings may be, they are of little value to the nursing
profession if not communicated to other collegues.
b. Best method to reach a large number of nurses is the publication in research
journals.
c. May also be done through oral presentations. Poster sessions. Books. Research
seminars.