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Unit 1 nursing research MSc Nursing

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Nursing research introduction to PG nursing students

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Unit 1 nursing research MSc Nursing

  1. 1. DEEPA
  2. 2. Review: Problem solving and scientific method. Research –definition, characteristics, purposes, types of research, Basic research terms, Scope of nursing research, Overview of Research process, Significance of research in nursing, Historical Evolution of nursing research. Future trends in nursing research. Problems and challenges in nursing research, health and social research. Priorities for nursing research. Evidence based practice. Ethics in research 
  3. 3.  Looking for new knowledge, doing something new ??  Looking for facts  Measuring phenomenon, health states, including health and disease  Developing new – materials, products including drugs, processes, designs….  New models of delivery of health services
  4. 4.  Organised investigation of a problem  French word - re- cerche “ to search again”  A careful investigation or inquiry
  5. 5.  A systematic and objective analysis and recording of controlled observation that may lead to the development of generalisation of principles, theories, resulting in prediction and possible ultimate control of events  J. W. BEST
  6. 6.  It is a careful inquiry or examination seeking facts or principles , a diligent investigation to ascertain something  CLIFFORD WOODY
  7. 7.  It is an attempt to gain solutions to problems; more precisely it is the collection of data in a rigorously controlled situation for the purpose of prediction or explanation  TREECE AND TREECE
  8. 8. • Discovery – finding what existed • Inventions – new produce development that did not exist in nature • Innovation – new ways to solve old problems • Development – after invention to useful products and services • Testing new and old products/drugs and services • Evaluation of programs – wider outcomes and impacts, including unintended outcomes.
  9. 9. Generation of knowledge Problem solving Demands accurate observation and description Originality Empirical Logical
  10. 10. Replicable Theory development and testing Appropriate methodology Conducted on representative sample Good tools Recorded and reported Findings are made available to other scholars
  11. 11.  Orderly and systematic process  Based on current professional issues  Begin with clearly defined purposes  Emphasise to develop, refine and expand professional knowledge  Directed towards development or testing theories  Finding solution of problem  Dedicated to develop empirical evidence  Strives to collect first hand information and data
  12. 12.  Generate findings to refine and improve professional practices  Use of appropriate methodology  Conducted on representative sample  Conducted through appropriate use of methods and tools of data collection  Use of valid and reliable data collection tools  Carefully recorded and reported  Adequately and appropriately analysed research
  13. 13.  Patiently carried out activity  Researcher’s expertise, interest, motivation and courage  Adequately communicated
  14. 14. Observations, Research and Science relationship • Observations and thinking are basis for scientific development • Archimedes’s observations on water displaced in the bath tub – volume, density… principles of floating bodies ‐ 250 BC. • Renaissance (14‐17th centuries) was spearheaded by systematic observations of natural processes ‐> new thinking, writing, and correlating observations and theory • Galileo's observations on pendulum’s movement ‐ >measurement of time, Telescope ‐> planetary bodies…. • Newton's observation on apple falling ‐> gravitation • Before that Indian scientists observed, developed theories and written down… but forgotten…Arya Bhatt, Panini, …… • Observations, thinking, documentations, experimentation further development of theory, application to practice….. Basis of science
  15. 15. It is the systematic inquiry designed to develop trustworthy evidence about issues of importance to the nursing profession, including nursin g practic e, educat ion, adminis tration, and informa tics. POLIT AND BECK, 2008
  16. 16.  Build and expand the body of nursing knowledge  Validate and refine the existing nursing practice and  Make health care efficient and cost effective
  17. 17.  It is a systematic approach to the solution or alleviation of problems characterised by sequential execution of the following observation through action processes
  18. 18.  Inductive  Deductive  Analytic  Synthetic
  19. 19. PLAN •1. Clarify the problem •2. Break down the problem •3. Set a target •4. Analyze the root cause DO •5. Develop counter measures •6. Implement counter measures CHECK •7. Evaluate results and processes ACT •8. Standardize successful improvements
  20. 20. Research (Scientific) Problem solving Selecting the topic Identifying problem Quantitative or qualitative data, statistically analysed No statistical analysis Control factors other than variables in study No controls are imposed Generalisable Generalisation is not possible Replication and verification Entails no such requirements Disseminate the research findings Evaluation, revision and utilisation of the findings in specific situations, no dissemination. Finding process Learning and problem solving process
  21. 21. Specific problem- recognize, select & state Defining Collecting relevant information Formulation of hypothesis / solutions Evaluation of hypothesis Verifying validity Choosing alternatives if unsuccessful or till successful
  22. 22. 1. Basic and applied research 2. To achieve various levels of explanation 3. Research purposes linked to EBP
  23. 23.  Description  Exploration  Explanation  Prediction and control
  24. 24.  Discover knowledge of the discipline  Answers to question/ solution to a problem  Discovering and interpreting new facts  Establishes generalization and builds theory
  25. 25.  Formulating new phenomenon  Development of clinical interventions  Identification- novel insight  Promotes EBN
  26. 26.  Document cost effectiveness  Develop nursing principles and theories
  27. 27.  Treatment, Therapy or intervention  Diagnosis and assessment  Prognosis  Prevention of harm  Etiology or causation  Meaning and processes
  28. 28.  Forms of Research • Natural Science • Humanities • Economic • Social • Business
  29. 29. • Relies on the application of the scientific methods. • Searches for the “truth” • The knowledge generated is practically applicable. • Can be further classified according to different disciplines of academic or applications
  30. 30. • Employs a more relativist epistemology • It usually tries to understand a condition or question in the context of the issues and factors surrounding it, rather than trying to find out a single “true” answer to it • It focuses on the “context” – social, political, economical, ethnic, cultural
  31. 31.  Basic vs. Applied
  32. 32.  Type of applied research  Cyclical in nature
  33. 33. • A special category of applied or action research • Aims at maximizing the profit & minimizing the cost or expenses • Applying advanced analytical methods to help make better decisions.
  34. 34. • Business management • Engineering • Economics • Agriculture • Financial institutions • City planning • Transportation • Crime investigations • Health
  35. 35. • How many beds in a hospital/speciality • How to minimize waiting time in OPD? • How to reduce interval between two operations • How best to deliver some medicine to the target community • How to optimize the supply for vaccine in an immunization program
  36. 36. • Primary – Collecting the data from primary sources like patients, users, practitioners, environment etc • Secondary – Collecting the data from secondary sources like hospital records, government records, meteorological records, Survey reports etc
  37. 37.  Research confined to the laboratories‐ Most of the biochemical, pharmacological, Genetic studies – Many are at cellular level.  Research conducted in the community, field program operations etc – Most of the public health researches are in field.  Clinical Trials – may be a combination of both.
  38. 38. • Descriptive Research is a fact finding investigation which is aimed at describing the characteristics of individual, situation or a group (or) describing the state of affairs as it exists at present. • Analytical Research is primarily concerned with testing hypothesis and specifying and interpreting relationships, by analyzing the facts or information already available. • Experimental Research is considered by some people as a distinct group of analytical research
  39. 39. Quantitative Research • Deals with numbers and try to quantify and measure a particular phenomena. • Often uses statistical methods aimed at establishing significance. • Aims to find the “true cause”. • Tries to answer questions “how many” or “how much”.
  40. 40. • Primarily does not deal with numbers but the nature of data. • Follows an “interpretivist” approach instead of a statistical one. • Aims to understand a phenomenon in its proper “context”. • Tries to answer questions like “what”, “why” and “how”.
  41. 41. Diagnostic Research – It is also called clinical research which aims at identifying the causes of a problem, frequency with which it occurs and the possible solutions for it. Exploratory Research – It is the preliminary study of an unfamiliar problem, about which the researcher has little or no knowledge. It is aimed to gain familiarity with the problem, to generate new ideas or to make a precise formulation of the problem. Hence it is also known as formulative research.
  42. 42. Experimental Research – It is designed to assess the effect of one particular variable on a phenomenon by keeping the other variables constant or controlled. Historical Research – It is the study of past records and other information sources, with a view to find the origin and development of a phenomenon and to discover the trends in the past, in order to understand the present and to anticipate the future
  43. 43. • Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions (e.g., drugs, diagnostics, devices, therapy protocols) • These are usually conducted in 4 phases ‐ I to IV on human subjects (preceded by animal experiments and basic research in laboratories)
  44. 44. We can classify research in many ways but these are not watertight compartments • Such classifications are more for broad conceptualisation • In practice, many a times there are a lots of overlapping
  45. 45.  Conceptual and Empirical research
  46. 46.  Any other types of research?  Applications in Nursing?
  47. 47.  Nursing service  Nursing education  Nursing administration  Nursing informatics
  48. 48.  Influences current and future practices  Adequately trained nurses can conduct quality clinical research  Leads to EBN practice  Provide description, explanation, prediction and control of nursing situations in nursing practice  Identifies cost effective practices  Problem solving
  49. 49.  WORLD VIEW/ GENERAL PERSPECTIVE OF THE COMPLEXITIES OF REAL WORLD  BASIC PHILOSOPHICAL QUESTIONS ◦ Ontologic –what is the nature of reality? ◦ Epistemologic- what is the relationship with the inquirer and that being studied? ◦ Axiologic- what is the role of values in inquiry? ◦ Methodologic – how should the inquirer obtain knowledge?
  50. 50.  Intellectual pluralism
  51. 51. A beautiful thing about learning is that nobody can take it away from you
  52. 52. Future trends • Heightened focus on EBP • Development of stronger evidence base • Emphasis on SR • Expanded local research in health care settings
  53. 53. Improved patient outcomes Patient preferences and circumstances Best available clinical evidence Awareness of clinical setting & resource constraints Individual clinical expertise EBP
  54. 54. Future trends
  55. 55.  Strengthening of multidisciplinary collaboration  Expanded dissemination of research findings  Increasing visibility of nursing research  Increased focus on cultural issues and health disparities
  56. 56.  Inadequate knowledge  Lack of qualified guide  Difficulty in controlling external variables  Lack of time  Lack of standardized tools  Reliability of disciplined research  Studying many variables  Ethical problems  Lack of support from administrative set up  Financial constraints
  57. 57.  Fallibility of disciplined research  Handling multiple variables  Difficulty in control of external variables  Minimal possibility of lab research  lack of standardized tools  Measuring qualitative phenomenon through quantitative means  Lack of interest among the nurses and other health personnel  Ethical constraints
  58. 58.  Health promotion and disease prevention  Promotion of health of vulnerable and marginalized communities  Patient safety and quality of health care  Development of EBP and translational research  Promotion of health of older people  Patient centered care and care co ordination  Palliation and end of life care  Care implications of genetic testing and therapeutics
  59. 59.  Capacity development of nurse researchers  Nurses working environment  STTI 2005
  60. 60. • Evidence is materials and observations collected to demonstrate “truth” or what works • What looks apparent and obvious may not be true – sun moving around the earth !! • Evidence is systematically collected information (measurement ) to support or disprove a hypothesis or theory • Two types of evidence ‐ direct evidence and circumstantial evidence • Observations lead to theory – theory leads to observations or experimentation to confirm theory • Experimentation provides strongest evidence
  61. 61.  Sources ◦ Tradition and authority ◦ Clinical experience, trial and error and intuition ◦ Logical reasoning ◦ Assembled information ◦ Disciplined research
  62. 62.  “Evidence‐based medicine (EBM) or evidence‐based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making.  It seeks to assess the strength of the evidence of risks and benefits of treatments and diagnostic tests. This helps clinicians understand whether or not a treatment will do more good than harm.”
  63. 63.  How evidence grows: No evidence, to some evidence, substantial evidence, review of evidence, meta‐analysis, overall recommendation.  Authority based policies and programs – vs. evidence based policies and programs.  Systematic evaluation of evidence is new science – but clinical trials are not new – first trial was done by James Lind 1747 on 12 sailors on board a ship to see effect of limes and oranges on Scurvy (bleeding gums)
  64. 64. Observations – basis of most clinical science developments – disease and syndromes defined by observed symptoms and signs – systematic observations on series of similar cases • Observations during epidemics ‐ John Snow on Cholera… Observational studies – without interventions – special studies to understand natural progress of disease • Smoking and lung cancer or CVD studies • Observational studies following natural events or accidents Study of Interventions / programs – interventions happening – scientists measure the impact – Effect of program by comparing with non‐program areas, Before after Studies. Experimental studies – specific interventions introduced to measure effectiveness or impact with well planned study design – effect of new drugs – clinical trials or community trials
  65. 65. • Observations of association – air from swamps‐> Malaria • Case series – systematic case observations and compilation • Ecological studies – salt intake and hypertension, heat wave /temperature and mortality… • Case control studies – contraceptives and heart and vascular diseases, smoking and cancer • Cohort studies – smoking and cancer, cholesterols and heart disease • Trials – non randomized – new treatments – patient chooses • Trials Randomized • Blinded randomized, multicentre, multi‐country trials
  66. 66.  Phase I  Conceptual Phase Formulating and delimiting the problem Reviewing the related literature Undertaking clinical fieldwork Developing conceptual framework Formulating hypotheses
  67. 67.  Phase II  Design and planning phase Selecting a research design Developing intervention protocols Identifying the population Designing the sampling plan Specifying methods to measure research variables Developing methods to safe guard subjects Finalizing the research plan
  68. 68.  Phase III  Empirical phase Collecting the data Preparing the data for analysis
  69. 69.  Phase IV  Analytic phase Analyzing the data Interpreting the results
  70. 70.  Phase V  Dissemination phase Communicating the findings Utilizing the findings in practice
  71. 71. Planning Developing data collection strategies Gathering and analysing data Disseminating findings
  72. 72.  Every study involving human subjects raises a unique set of ethical issues. A practical way to address these issues is to work from the regulations of federal agencies that fund research and guidelines of the Indian Nursing Council
  73. 73. How long does it take for body parts to freeze when people are kept naked outdoors in subfreezing temperatures? What signs and symptoms are seen when people are kept in tanks of ice water for 3 hours? These questions were asked by so-called researchers in Germany in the early 1940s.
  74. 74. During 1942 and 1943, prisoners’ wounds were deliberately infected with bacteria. Infection was aggravated by the forcing of wood shavings and ground glass into the wounds. Contd..
  75. 75. Sulfanilamide was then given to these prisoners to determine the effectiveness of this drug. Some subjects died and others suffered serious injury. Many nurses participated in these unethical experiments. (Bonifazi 2004)
  76. 76. Between June and September 1944, photographs and body measurements were taken of 112 Jewish prisoners. Then they were killed, and their skeletons were defleshed. Contd..
  77. 77. One purpose of this study was to determine if photographs from live human being could be used to predict skeletal size. The skeleton collection was to be displayed at the Reich University of Strasbourg. (Nuremberg Military Tribunals, 1949)
  78. 78.  Infecting women prisoners with syphilis, having them impregnated by male prisoners, then dissecting the live babies and mothers.  Draining the blood from prisoners’ veins and substituting horse blood. Contd..
  79. 79.  Exploding gas gangrene bombs next to prisoners tied to stakes.  Vivisecting prisoners to compile data on the human endurance of pain. (Scientific Atrocities, 1996, Japan)
  80. 80. Of the 600 black male subjects, 399 had syphilis, and 201 did not have the disease. Those subjects with active cases were given no treatment. All subjects were given free medical exams, free meals, and burial expenses. Contd…
  81. 81. Even after penicillin was accepted as the treatment of choice for syphilis in 1945, subjects were still given no treatment. This unethical study became common knowledge 40 years after it was begun. On May 16, 1997, president Bill Clinton made a public apology on behalf of the nation. (CDC 2006)
  82. 82. It is common knowledge that smallpox is no threat to the world. Few people remember, or even know, that Edward Jenner deliberately exposed an 8 year old child to cowpox to try out his new vaccine for smallpox. (Hayter, 1979)
  83. 83. In July 1963, doctors at the Jewish Chronic Disease Hospital in Brooklyn, New York, injected live cancer cells into 22 elderly patients. The study was designed to measure patients’ ability to reject foreign cells. The patients were told that they were being given skin tests. (Katz, 1972)
  84. 84. In 2005, it was revealed that government-funded researchers tested experimental AIDS drugs on hundreds of foster children. (Solomon, 2005)
  85. 85. Ethics is the science that deals with rightness and wrongness of actions. Bioethics is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health . (Aiken, 2004)
  86. 86. Moral behavior is defined as conduct that results from serious critical thinking about how individuals ought to treat others. Moral behavior reflects the way a person interprets basic respect for other persons, such as the respect for autonomy, freedom, justice, honesty, and confidentiality. (Pappas, 2003)
  87. 87. Values are ideals or concepts that give meaning to the individual ’s life. (Aiken, 2004)
  88. 88. A right is defined as “ a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit of service”. (Levy and Rubenstein 1996)
  89. 89.  Nuremberg code: 1947  Helsinki Declaration: 1975  Belmont Report: 1979  CIOMS Council for International Organisations of Medical Sciences : 1982  ICMR (Indian Council of Medical Research) Guidelines: 1980, revised 2000  CTRI – Clinical Trial Registry of India
  90. 90. The development of appropriate ethical guidelines are complex as it concerns with human behaviour. Ethical principles changes with time and newer knowledge. Because of public outcry against the atrocities committed in Germany in 1940s, the Nuremberg code was developed in 1947.
  91. 91. The Nuremberg code  Researcher must inform subjects about the study  Research must be for the good of society  Research must be based on animal experiments, if possible contd…
  92. 92.  Researcher must try to avoid injury to research subjects  Researcher must be qualified to conduct research  Subjects or the researcher can stop the study if problems occur.
  93. 93. Based on the preliminary efforts of the Council for International Organisations of Medical Sciences (CIOMS) in 1964 at Helsinki, the World Medical Association formulated general principles and specific guidelines on use of human subjects in medical research, known as the Helsinki Declaration
  94. 94.  National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.  The Belmont Report summarizes ethical principles and guidelines for research involving human subjects.  Three core principles ◦ respect for persons ◦ Beneficence ◦ justice.  Three primary areas of application ◦ informed consent ◦ assessment of risks and benefits ◦ selection of subjects.
  95. 95. Respect for person Beneficence Justice Belmont principles
  96. 96.  Requires investigators to treat subjects as autonomous individuals and obtain their informed consent  Research subjects must be regarded not as passive sources of data, but as individuals whose welfare and rights must be respected.
  97. 97.  requires investigators to design protocols that will provide valid and generalisable knowledge  ensure that the benefits of the research are proportionate to the risks assumed by the subjects.  wellbeing of the subjects must be protected.
  98. 98.  Level 1: No anticipated effects: no positive or negative effects for the subjects
  99. 99.  Level 2: Temporary discomfort considered minimal risk studies  discomfort is simulate to that which the subject would experience in his/her daily life and cease with termination of the study
  100. 100.  Level 3: Unusual levels of temporary discomfort during the study and after the study has terminated  Level 4: Risk of permanent damage, potential for subject to suffer permanent damage
  101. 101.  Level 5: Certain permanent damage; no experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur...
  102. 102. requires that the benefits and burden of research be distributed fairly . Research participants assume some risk in order to benefit the society as a whole. Therefore no single group, especially not disadvantaged, vulnerable or minority groups should be asked to bear a disproportionate share of risk.
  103. 103.  Beneficence ‐ a practitioner/researcher should act in the best interest of the patient/participant  Non‐maleficence ‐ "first, do no harm”  Autonomy ‐ the participant has the right to refuse the intervention or opt out from the research study  Justice ‐ concerns the distribution of scarce health resources and the decision of who gets what treatment  Dignity ‐ the patient/participant (and the person treating the patient) have the right to dignity.  Truthfulness and honesty ‐ the concept of informed consent has increased in importance since the historical events of the Nuremberg trials and Tuskegee Syphilis Study
  104. 104.  Abstract of a SR in the field of Non communicable disease  Research priorities by ICN,INC, KUHS  Mention instances that you have noticed which violated the principles of ethics.  Describe the process of INFORMED CONSENT
  105. 105.  Means that participants have adequate information about the research, comprehend that information and have the ability to consent to or decline participation voluntarily.  Complying with HIPAA rules  Health Insurance Portability and Accountability Act
  106. 106.  Participant status  Study goals  Type of data  Procedures  Nature of commitment  Sponsorship  Participant selection
  107. 107.  Potential risks  Potential benefits  Alternatives  Compensation  Confidentiality pledge  Voluntary consent  Right to withdraw and withhold information  Contact information
  108. 108.  Researchers are identified and credentials presented  Compensation if any  Offer answers  Means of obtaining study results  Documentation of informed consent
  109. 109.  Comprehension of the informed consent  Documentation of informed consent  Authorization to access private health information
  110. 110.  Anonymity  Confidentiality in the absence of anonymity  Certificates of confidentiality
  111. 111.  Ask questions and air complaints  After the data collection thanking the participants  Referrals to appropriate health, social and psychological services
  112. 112.  Children  Mentally and emotionally disabled people  Severely ill or physically disabled people  Terminally ill  Institutionalized people  Pregnant women
  113. 113.  Institutional review boards  Requirements
  114. 114.  Whether clinically significant  Properly designed
  115. 115.  When animals are used
  116. 116.  Or scientific misconduct  Fabrication, falsification, or plagiarism in proposing, performing or reviewing or in reporting research results
  117. 117. Guidelines of DHHS  Risks to subjects are minimised and proportionate to the anticipated benefits and knowledge.  Data are monitored to ensure safety of subjects  Selection of subjects is equitable  Informed consent is obtained, if appropriate  Confidentiality is adequately protected
  118. 118. ETHICAL GUIDELINES FOR BIOMEDICAL RESEARCH ON HUMAN PARTICIPANTS- ICMR REPORT
  119. 119. Researchers need to be aware of the Health Insurance Portability and Accountability Act (HIPPA, 2003). This act protects an individual’s health information. This ensures participant taking part voluntarily and is aware of what is about to happen.
  120. 120. Participants must be given all necessary information that might affect their willingness to participate. The investigators must disclose information that will be relevant to the subject’s decision whether or not to participate. contd..
  121. 121. Necessary information  Informed consent ◦ The nature of research project ◦ Procedures of the study ◦ The potential risks & benefits of the study  Assurances that participation is voluntary  Protection of confidentiality  Questions about the study
  122. 122.  Plagiarism  Fabrication & falsification  Non publication of data  Faulty data gathering procedure  Poor data storage and retention  Misleading authorship  Sneaky publication practices
  123. 123. Guidelines for Nurses  Advocacy  Privacy  Confidentiality  Debriefing  Anonymity
  124. 124.  An independent review board comprises medical/scientific and non‐medical /nonscientific members  9‐15 members  Review every research proposal on human subjects IT IS MANDATORY THAT ALL PROPOSALS ON BIOMEDICAL RESEARCH INVOLVING HUMAN SUBJECTS SHOULD BE CLEARED BY AN APPROPRIATELY CONSTITUTED INSTITUTIONAL ETHICS COMMITTEE
  125. 125.  How essential is the research?  Informed consent‐ voluntariness  Non exploitation of vulnerable population  Privacy and confidentiality ( HIV/AIDS)  Minimal risks and dangers for subjects  Reasonable risk ‐ benefit ratio  Professional competence of investigator/researcher
  126. 126.  Accountability and transparency  Institutional arrangements/adequate clinical monitoring to ensure safety  Emergency care provision  Totality of responsibility  Compliance of GCP (Good Clinical Practice)  Informed consent document‐ contents
  127. 127. Critiquing the Ethical Aspects i) Was the study approved by an Institutional Review Board (IRB)? ii) Was informed consent obtained from the subjects? iii) Is there information about provisions for anonymity or confidentiality? contd…
  128. 128. iv) Were vulnerable subjects used? v) Does it appear that subjects might have been coerced into acting as subjects? vi) Is it evident that the benefits of participation in the study outweighed the risks involved?
  129. 129. vii) Were subjects provided the opportunity to ask questions about the study and told how to contact the researcher if other questions arose? viii) Were subjects told how they could get the results of the study?
  130. 130. Conducting research ethically requires protection of human rights of subjects. Human rights that require protection in research include - self determination, privacy, anonymity & confidentiality and fair treatment. Research need to be conducted with ethical guidelines.
  131. 131.  Evidence Based Nursing and prepare notes..
  132. 132.  Burns and Grove 5 th edition 2005  Polit and Beck 8th edition 2012  Wood and Haber 6th edition 2006  Schmidt and Brown 2009
  133. 133. LITERATURE REVIEW
  134. 134.  Scientific knowledge grows day by day  Multiplication of research information  Studies are undertaken with the context of an existing base of knowledge  Researcher’s work to be built on the work of others (Kaplan,1964)
  135. 135.  Consists of all written sources relevant to the selected topic  Availability of research information continues to escalate  Computerized data bases
  136. 136. Definitions  An organized written presentation of what has been published on a topic by the scholars – Burns & Grove (2005)  An account of what has been published by accredited scholars and researchers – Taylor(2011)
  137. 137.  Is not a list of published studies  Presents identified themes & trends  Critically analyses the available literature on the topic  Evaluates the studies based on the focus of your study
  138. 138.  Sources that are important in providing in- depth knowledge needed to make changes in nursing practice or to study a selected problem
  139. 139.  Increase in number of nursing journals  Availability of computerized data bases  Review process has become more enlightening & challenging
  140. 140.  Discovers knowledge  Conveys to the reader what is currently known regarding the topic of interest  Determines gaps , consistencies and inconsistencies  Discovers unanswered questions  Describes the strengths & weaknesses of designs, instruments used in studies
  141. 141.  Determines the need to replicate a study  For development of new/refined interventions  Identifies relevant framework designs & methods  Identifies the source of funding & the experts in the field  Assists in interpreting study findings
  142. 142.  Major review is done at the beginning of the research process & limited review during the generalization of research report
  143. 143.  Purpose & timing depend on the type of study  Phenomenological research – Experiences of individual within their life world. ◦ after the data collection & analysis  Grounded theory research – social structural process within a social setting. ◦ minimal relevant review in the beginning of the study  Ethnographical research – Holistic view of culture. ◦ done early in research process to give background for the study  Historical research –description and interpretation of historical events. ◦ an initial review to select the research problem & to develop research questions
  144. 144.  Broad – to become knowledgeable about the research problem  Narrow – to predominantly relevant sources
  145. 145.  Types of sources & information available  Approximate depth and breadth of review  Time frame for conducting review
  146. 146.  Theoretical literature  Empirical literature
  147. 147.  It consists of concept analysis, models, theories & conceptual frameworks that support a selected research problem and purpose  It reflects the current understanding of the research problem  Theoretical literature can be found in the serials, periodicals & monographs
  148. 148.  Comprises of relevant studies in journals & books as well as unpublished theses  Empirical literature reviewed depends on the study problem & the type of research conducted
  149. 149.  Primary sources  Secondary sources
  150. 150.  A primary source is written by a person who is responsible for originating or generating the ideas published  Research publications written by the person or people who conducted the research/ theorists who developed the theory
  151. 151.  Secondary source –Research reports prepared by someone other than the original researcher  Problems - Interpretation is influenced by the author’s perception & may be biased - Possibility of errors - Fails to provide the details of study
  152. 152. DEPTH AND BREADTH OF REVIEW  Depth – number & quality of sources referred on a topic  Breadth – number of different topics examined
  153. 153. FACTORS AFFECTING DEPTH & BREADTH OF REVIEW  Researcher’s background - new investigator & experienced investigator  Complexity of research project - numerous variables & complex methodologies  Availability of sources - articles, journals & books
  154. 154. TIME FRAME FOR LITERATURE REVIEW • Depends on the type of problem, sources available & goals of the scholar • No set length of time for review • Narrower the focus of study – lesser time is needed • Set a time frame for literature review
  155. 155. Formulate and refine 1* & 2* qns Devise search strategy Search for, identify & retrieve potl 1* source materials
  156. 156. Search for, identify & retrieve potl 1* source materials Screen sources for relevance and appropriate ness Read source materials Discard irrelevant or inappropriate ref Identify new references, leads Document search decisions and actions
  157. 157. Abstract, encode information from the studies Critique, evaluate the studies Analyse integrate information, search for themes Prepare synthesis /critical summary
  158. 158.  Searching the literature  Reading the literature  Writing the literature
  159. 159. “A systematic and explicit approach to the identification, retrieval and bibliographical management of independent studies for the purpose of locating information on a topic, synthesizing conclusions, identifying areas for future studies and developing guidelines for clinical practice” - Auston, Cahn & Selden (1992)
  160. 160.  Develop a search strategy to retrieve as much relevant literature as possible  Develop a strategy based on time & finances available
  161. 161.  Develop a search strategy  Select data bases to search  Select key words  Systematically record references  Use reference management software  Locate relevant literature  Perform complex searches  Select search fields  Select electronic journals  Search the internet  Finding every relevant sources
  162. 162. Cooper (1998)  Bibliographic databases  Ancestory approach – use the citations from relevant studies & track down earlier research  Decendancy approach – search forward to find recent studies  Grey literature – refers to studies with limited distribution (conference papers, unpublished reports, dissertations)
  163. 163.  Written search strategy saves time . It helps to - avoid going back along paths you have already searched - retrace your steps - search new paths  Initial search should be wide & later narrow the focus of search  Get consultation for literature search approach
  164. 164.  A bibliographical database is a compilation of citations relevant to a specific discipline or from a variety of disciplines  Three distinct types - Indexes & abstracts - Full text reprint services - Link citations  Data bases - Printed form - Electronic data base
  165. 165.  CINAHL (Cumulative Index to Nursing and Allied Health Literature) Pubmed  MEDLINE (Medical Literature Online)  ISI (Institute for Scientific Information Web of Knowledge)  British Nursing Index- Nursing and Allied Health Source (ProQuest)  Cochrane Database of Systematic Reviews  HaPI (Health and Psychological Instruments Database)  Dissertation Abstracts Online
  166. 166.  Contains citations of nursing literature published after 1955  Referred as “Red Books” by nursing scholars  Covers English language, Nursing and Allied Health journals, books, book chapters, dissertations & selected conference proceedings  Electronic version contains database from 1982 to the present (more than one million records)  Accessed online http://www.cinahl.com or by CD-ROM
  167. 167.  Developed by US National Library of Medicine (NLM) – Free access  Covers about 5000 Medical, Nursing and Health journals  15 million records from mid 1960’s  From 1999, Abstracts of Cochrane collaboration became available  Is an online database with free access through PubMed web www.ncbi.nlm.gov/entrez/query.fcgi
  168. 168.  Maintains multidisciplinary resources called the web of knowledge  Offers integrated searching  Covers most fields of social & applied sciences including medicine and nursing
  169. 169.  Cancer Lit  Cochrane database of systematic review  Dissertations abstract online  Psych Info  Ovid sp  Science direct
  170. 170.  Key words are the major concepts or variables that must be included in your search  To determine the key words, identify concepts, variables, population, interventions, measurement methods or relevant outcomes  Subject headings and phrases can be used  Think of alternative terms (synonyms)  Note down the key words in the written search plan
  171. 171.  Truncating words allow to locate more citations related to the term  Do not truncate terms to less than four letters – will give unwanted references  Pay attention to variant spellings  Frequently cited author’s name can be used to perform search  Use a journal title in case of well known journal in that particular topic/field
  172. 172.  Name of databases used  Exclusion & inclusion criteria used  Date of performing search  Exact search strategy used  Key words used  Combining strategies used  Number of articles found  Percentage of relevant articles  Websites visited & links pursued  Authors contacted for further information  Develop a table of record and save it in the computer
  173. 173.  As per the format used in the reference list  APA (American Psychological Association,2001), Vancouver  Cross check the sources cited two or three times to prevent errors  Use reference management software
  174. 174.  To track the references you have obtained  To store information on all search fields  As you read insert comments  It also organizes the references into the reference style you intend to use  Eg ProCite till May 13 now EndNote
  175. 175.  Mapping is the feature that allows you to search for topics using your own keywords rather that the Medical Subject Headings
  176. 176.  Initiate search using key words identified  Citations are listed with the most recent ones first  Proceed to next key word  Plan for complex search
  177. 177.  Combines two or more concepts or synonyms in one search  Three most common ways - Boolean operators - Locational operators - positional operators  Truncation symbols - !, +, $,*,? AND #
  178. 178.  Permit grouping of ideas, selection of places to search,& to show relationship within a data base record  Examine “Help Screen” to see whether the operators are available and how they are used
  179. 179.  3 words – AND, OR and NOT  Often capitalized  Used with the identified concepts  OR is commonly used
  180. 180.  AND- delimits the search  OR- expands the search  NOT- narrows the search  Truncation symbols  *- wom*n,  Wild card symbols- ?, *-behavio?r, organi*ation  Alternative spellings
  181. 181.  Identify terms in specific areas  Article name, journal & author name  Subject headings, abstracts, cited references, publication type, instruments used
  182. 182.  To look for requested terms  Highly dependent on data base search software  Common ones are – NEAR, WITH & ADJ (adjacent)
  183. 183. Search topic Hits Pain 3,35,949 Pain AND Child* AND Nur 2054 Limit to English 1834 Limit to entries with abstracts 1430 Limit to nursing journals 794 Limit to 2001-2010 399
  184. 184.  Limits - vary with the data base - limit the years of search - limit within particular years & get the hits - depends on the time limit - full text articles are better  Helps to avoid irrelevant & non useful material
  185. 185.  Have more current information  Need to subscribe to online journals  Can access full text article  Articles are reviewed & published within 3 months  List of current electronic nursing journals are available at www.4nursingjournals.com
  186. 186.  Unlikely to find relevant studies but may get information relevant to background & significance  Advantage – information are current  Disadvantage – accuracy is questionable & no screening process  Important to check the source  Identify the best search engine
  187. 187.  Coding  Read, categorise, code key variables, record them  Literature review protocol  Literature review matrices - Methodologic matrix - Results matrix - Evaluation matrix
  188. 188. TYPES OF REVIEW MATRIX  Methodologic Matrix –How have researchers studied this research question?  Results Matrix –What have researchers found?  Evaluation Matrix – How much confidence we have in the evidence?
  189. 189. METHODOLOGIC MATRIX  Authors  Publication year  Country  Dependent variables  Independent variables  Study designs  Sample size  Sampling method  Data collection method
  190. 190. RESULT MATRIX  Authors  Publication year  Dependent variables - pain perception - use of analgesics - Effect of nursing intervention  Others – association & relationships
  191. 191. EVALUATION MATRIX  Authors  Publication years  Major strengths  Major weaknesses  Quality score
  192. 192. SUMMARY- SEARCHING THE REVIEW  DEF  PURPOSES  STRATEGIES  APPROACHES  STEPS  STRATEGY DEVELOPING  SELECT DATABASE  SELECT KEYWORDS
  193. 193. CONTD  RECORD SEARCH- REF MANAGEMENT SW  LOCATE RELEVANT LITERATURE  COMPLEX SEARCHES  LIMIITING SEARCHES  SEARCHING E JOURNALS AND INTERNET  RECORDING MECHANISMS ◦ PROTOCOL ◦ MATRICES
  194. 194.  Skimming resources  Comprehending resources  Analyzing resources  Synthesizing resources
  195. 195.  Quickly reviewing a source to gain a broad overview of its content  Read title, author’s name, abstract or introduction & the major headings  Finally review the conclusion or summary  Helps to make a preliminary judgement about the value of the source  Helps to determine whether it is primary or secondary source
  196. 196.  Requires complete reading of an article carefully  Highlight the content you consider important  Relevant categories are identified for sorting & organizing sources  These categories serve as a guide for writing the literature review
  197. 197.  Can determine the value of a source for a particular study  Analysis takes place in two ways - Critique individual studies - Making comparisons among studies
  198. 198.  Basis for developing review of literature section  Involves clarifying the meaning obtained from the source as a whole  Can cluster & interrelate ideas from several sources  Avoid using direct quote, instead paraphrase (expressing the ideas clearly in your own words)  The meanings obtained from all sources are then combined or clustered to the proposed study
  199. 199.  Sorting sources  Developing the written review  Checking references
  200. 200.  Is challenging  Relevant sources  Organizing the review – meaningful  Structure in such a way that the presentation is logical, demonstrates meaningful thematic integration & leads to a conclusion about the state of evidence on the topic
  201. 201. Major sections  Introduction  Discussion of theoretical literature  Discussion of empirical literature  Summary
  202. 202.  Definition of the topic of review  Context  Purpose / objectives  Scope  Structure
  203. 203.  Include emerging themes, solutions, gaps, point out recent trends, Divergent perspectives  Give structure or narrative thread ◦ Chronological; by themes; by sector / domains / sub- groups; by development of ideas or along a process; by themes)  Use sub-headings organized in proper layers  Signposting  Adduce evidence - citation  Quotes  Paraphrase  Style – detached narration, a dialogue with the literature,  Use tables to compare two or more perspectives, methods, profile of participants
  204. 204.  Summarize major and most convincing contributions of significant studies  Evaluate the current state of the evidence in the field  Point out gaps  Point out issues pertinent to future study  Provide insight into the relationship between the central topic review and a larger area of study
  205. 205.  Check for accuracy & completeness  Errors should be avoided  Spelling of author’s name  Check all citations within the text & each citation in the reference list  Year of citation
  206. 206.  Must be comprehensive & thorough incorporating up to date references  Systematic  Reproducible  Absence of bias  “sum of its parts”
  207. 207.  To point out what is known already, how dependable the studies are, what are the gaps that exists in the body of research and the contribution the present study would make
  208. 208.  Is a critical step in the research process  Is challenging
  209. 209.  Burns, N., & Grove, K. S. (2005). The practice of nursing research: Conduct, critique and utilization (5th ed.). Missouri: Elsevier Publication.  Munshall, P. L. (2001). Nursing Research: A qualitative perspective. Sudbury, MA: Jones & Bartlett  Polit, F. D., & Beck, T. C. (2011). Nursing research generating and assessing evidence fir nursing practice (8th ed.). New Delhi: Wolters Kluwer (India) Pvt. Ltd.
  210. 210.  Taylor, T. (2011). The literature review: A few tips on conducting it. Retrieved June 6, 2011 from http://wwwwriting utoronto ca/advice/specific – types-of-listing/literature-review.  UNC Education Department. (2011). Literature reviews. Retrieved June 14, 2011 from http://wwwunc edu/depts/wcweb/handouts/literature_review html.
  211. 211.  Online search engines, databases, reviews, and index Cochrane Review (http://www.cochrane.org/reviews/)  PubMed; Medline, Medline Central http://www.ncbi.nlm.nih.gov/pmc/  Medlars (http://indmed.nic.in/; http://medind.nic.in/  JSTOR (http://www.jstor.org/)  ProQuest (www.proquest.com/)  Current Contents (http://thomsonreuters.com/products_services/scien ce/science_products/a-z/current_contents_connect/  Social Science Citation Index (http://thomsonreuters.com/products_services/scien ce/science_products/a- z/social_sciences_citation_index/)  Popline (http://www.popline.org/)  Google Scholar

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