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I. Beck, Cheryl Tatano, author. II. Title.
[DNLM: 1. Nursing Research—methods. WY 20.5]
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5. TO
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7
Acknowledgments
This 10th edition, like the previous nine editions, depended on
the
contribution of dozens of people. Many faculty and students
who used the
text have made invaluable suggestions for its improvement, and
to all of
you we are very grateful. In addition to all those who assisted
us during the
past 35 years with the earlier editions, the following individuals
deserve
special mention.
We would like to acknowledge the comments of reviewers of
the
previous edition of this book, anonymous to us initially, whose
6. feedback
influenced our revisions. Faculty at Griffith University in
Australia made
useful suggestions and also inspired the inclusion of some new
content.
Valori Banfi, reference librarian at the University of
Connecticut, provided
ongoing assistance. Dr. Deborah Dillon McDonald was
extraordinarily
generous in giving us access to her NINR grant application and
related
material for the Resource Manual.
We also extend our thanks to those who helped to turn the
manuscript
into a finished product. The staff at Wolters Kluwer has been of
great
assistance to us over the years. We are indebted to Christina
Burns, Kate
Burland, Cynthia Rudy, and all the others behind the scenes for
their fine
contributions.
Finally, we thank our family and friends. Our husbands Alan
and
Chuck have become accustomed to our demanding schedules,
but we
recognize that their support involves a lot of patience and many
sacrifices.
8
Reviewers
7. Ellise D. Adams, PhD, CNM
Associate Professor
The University of Alabama in Huntsville
Huntsville, Alabama
Jennifer Bellot, PhD, RN, MHSA
Associate Professor and Director, DNP Program
Thomas Jefferson University
Philadelphia, Pennsylvania
Kathleen D. Black, PhD, RNC
Assistant Professor, Jefferson College of Nursing
Thomas Jefferson University
Philadelphia, Pennsylvania
Dee Campbell, PhD, APRN, NE-BC, CNL
Professor, Graduate Department
Felician College, School of Nursing
Lodi, New Jersey
Patricia Cannistraci, DNS, RN, CNE
Assistant Dean
Excelsior College
Albany, New York
Julie L. Daniels, DNP, CNM
Assistant Professor
Frontier Nursing University
9
Hyden, Kentucky
8. Rebecca Fountain, PhD, RN
Associate Professor
University of Texas at Tyler
Tyler, Texas
Teresa S. Johnson, PhD, RN
Associate Professor, College of Nursing
University of Wisconsin—Milwaukee
Milwaukee, Wisconsin
Jacqueline Jones, PhD, RN, FAAN
Associate Professor, College of Nursing
University of Colorado, Anschutz Medical Campus
Aurora, Colorado
Mary Lopez, PhD, RN
Associate Dean, Research
Western University of Health Sciences
Pomona, California
Audra Malone, DNP, FNP-BC
Assistant Professor
Frontier Nursing University
Hyden, Kentucky
Sharon R. Rainer, PhD, CRNP
Assistant Professor, Jefferson College of Nursing
Thomas Jefferson University
Philadelphia, Pennsylvania
Maria A. Revell, PhD, RN
Professor of Nursing
Middle Tennessee State University
Murfreesboro, Tennessee
10
9. Stephanie Vaughn, PhD, RN, CRRN
Interim Director, School of Nursing
California State University, Fullerton
Fullerton, California
11
Preface
Research methodology is not a static enterprise. Even after
writing nine
editions of this book, we continue to draw inspiration and new
material
from groundbreaking advances in research methods and in nurse
researchers’ use of those methods. It is exciting and uplifting to
share
many of those advances in this new edition. We expect that
many of the
new methodologic and technologic advances will be translated
into
powerful evidence for nursing practice. Five years ago, we
considered the
ninth edition as a watershed edition of a classic textbook. We
are
persuaded, however, that this 10th edition is even better. We
have retained
many features that made this book a classic textbook and
resource,
including its focus on research as a support for evidence-based
nursing, but
10. have introduced important innovations that will help to shape
the future of
nursing research.
NEW TO THIS EDITION
New Chapters
We have added two new chapters on “cutting-edge” topics that
are not
well covered in any major research methods textbook,
regardless of
discipline. The first is a chapter on an issue of critical
importance to health
professionals and yet inadequately addressed in the nursing
literature: the
clinical significance of research findings. In Chapter 20, we
discuss
various conceptualizations of clinical significance and present
methods of
operationalizing those conceptualizations so that clinical
significance can
be assessed at both the individual and group level. We believe
that this is a
“must-read” chapter for nurses whose research is designed to
inform
clinical practice. The second new chapter in this edition
concerns the
12
design and conduct of pilot studies. In recent years, experts
have written at
length about the poor quality of many pilot studies. Chapter 28
provides
11. guidance on how to develop pilot study objectives and draw
conclusions
about the appropriate next step—that is, whether to proceed to a
full-scale
study, make major revisions, or abandon the project. This
chapter is
included in Part 5 of this book, which is devoted to mixed
methods
research, because pilots can benefit from both qualitative and
quantitative
evidence.
New Content
Throughout the book, we have included material on
methodologic
innovations that have arisen in nursing, medicine, and the social
sciences
during the past 4 to 5 years. The many additions and changes
are too
numerous to describe here, but a few deserve special mention.
In
particular, we have totally revised the chapters on measurement
(Chapter
14) and scale development (Chapter 15) to reflect emerging
ideas about
key measurement properties and the assessment of newly
developed
instruments.
The inclusion of two new chapters made it challenging to keep
the
textbook to a manageable length. Our solution was to move
some content
in the ninth edition to supplements that are available online. In
fact, every
chapter has an online supplement, which gave us the
12. opportunity to add a
considerable amount of new content. For example, one
supplement is
devoted to evidence-based methods to recruit and retain study
participants.
Other supplements include a description of various
randomization
methods, an overview of item response theory, guidance on
wording
proposals to conduct pilot studies, and a discussion of quality
improvement studies. Following is a complete list of the
supplements for
the 31 chapters of this textbook:
1. The History of Nursing Research
2. Evaluating Clinical Practice Guidelines—AGREE II
3. Deductive and Inductive Reasoning
4. Complex Relationships and Hypotheses
5. Literature Review Matrices
6. Prominent Conceptual Models of Nursing Used by Nurse
Researchers,
13
and a Guide to Middle-Range Theories
7. Historical Background on Unethical Research Conduct
8. Research Control
9. Randomization Strategies
10. The RE-AIM Framework
11. Other Specific Types of Research
12. Sample Recruitment and Retention
13. Other Types of Structured Self-Reports
14. Cross-Cultural Validity and the Adaptation/Translation of
Measures
13. 15. Overview of Item Response Theory
16. SPSS Analysis of Descriptive Statistics
17. SPSS Analysis of Inferential Statistics
18. SPSS Analysis and Multivariate Statistics
19. Some Preliminary Steps in Quantitative Analysis Using
SPSS
20. Clinical Significance Assessment with the Jacobson-Truax
Approach
21. Historical Nursing Research
22. Generalizability and Qualitative Research
23. Additional Types of Unstructured Self-Reports
24. Transcribing Qualitative Data
25. Whittemore and Colleagues’ Framework of Quality Criteria
in
Qualitative Research
26. Converting Quantitative and Qualitative Data
27. Complex Intervention Development: Exploratory Questions
28. Examples of Various Pilot Study Objectives
29. Publication Bias in Meta-Analyses
30. Tips for Publishing Reports on Pilot Intervention Studies
31. Proposals for Pilot Intervention Studies
Another new feature of this edition concerns our interest in
readers’
access to references we cited. To the extent possible, the studies
we have
chosen as examples of particular research methods are published
as open-
access articles. These studies are identified with an asterisk in
the
reference list at the end of each chapter, and a link to the article
is included
in the Toolkit section of the Resource Manual. We hope that
these
revisions will help users of this book to maximize their learning
14. experience.
14
ORGANIZATION OF THE TEXT
The content of this edition is organized into six main parts.
• Part I—Foundations of Nursing Research and Evidence-Based
Practice introduces fundamental concepts in nursing research.
Chapter
1 briefly summarizes the history and future of nursing research,
discusses the philosophical underpinnings of qualitative
research versus
quantitative research, and describes major purposes of nursing
research.
Chapter 2 offers guidance on utilizing research to build an
evidence-
based practice. Chapter 3 introduces readers to key research
terms and
presents an overview of steps in the research process for both
qualitative and quantitative studies.
• Part II—Conceptualizing and Planning a Study to Generate
Evidence further sets the stage for learning about the research
process
by discussing issues relating to a study’s conceptualization: the
formulation of research questions and hypotheses (Chapter 4),
the
review of relevant research (Chapter 5), the development of
theoretical
and conceptual contexts (Chapter 6), and the fostering of
ethically
sound approaches in doing research (Chapter 7). Chapter 8
provides an
15. overview of important issues that researchers must attend to
during the
planning of any type of study.
• Part III—Designing and Conducting Quantitative Studies to
Generate Evidence presents material on undertaking quantitative
nursing studies. Chapter 9 describes fundamental principles and
applications of quantitative research design, and Chapter 10
focuses on
methods to enhance the rigor of a quantitative study, including
mechanisms of research control. Chapter 11 examines research
with
different and distinct purposes, including surveys, outcomes
research,
and evaluations. Chapter 12 presents strategies for sampling
study
participants in quantitative research. Chapter 13 describes using
structured data collection methods that yield quantitative
information.
Chapter 14 discusses the concept of measurement and then
focuses on
methods of assessing the quality of formal measuring
instruments. In
this edition, we describe methods to assess the properties of
point-in-
time measurements (reliability and validity) and longitudinal
measurements—change scores (reliability of change scores and
15
responsiveness). Chapter 15 presents material on how to
develop high-
quality self-report instruments. Chapters 16, 17, and 18 present
an
16. overview of univariate, bivariate, and multivariate statistical
analyses,
respectively. Chapter 19 describes the development of an
overall
analytic strategy for quantitative studies, including material on
handling
missing data. Chapter 20, a new chapter, discusses the issue of
interpreting results and making inferences about clinical
significance.
• Part IV—Designing and Conducting Qualitative Studies to
Generate Evidence presents material on undertaking qualitative
nursing studies. Chapter 21 is devoted to research designs and
approaches for qualitative studies, including material on critical
theory,
feminist, and participatory action research. Chapter 22 discusses
strategies for sampling study participants in qualitative
inquiries.
Chapter 23 describes methods of gathering unstructured self-
report and
observational data for qualitative studies. Chapter 24 discusses
methods
of analyzing qualitative data, with specific information on
grounded
theory, phenomenologic, and ethnographic analyses. Chapter 25
elaborates on methods qualitative researchers can use to
enhance (and
assess) integrity and quality throughout their inquiries.
• Part V—Designing and Conducting Mixed Methods Studies to
Generate Evidence presents material on mixed methods nursing
studies. Chapter 26 discusses a broad range of issues, including
asking
mixed methods questions, designing a study to address the
questions,
sampling participants in mixed methods research, and analyzing
17. and
integrating qualitative and quantitative data. Chapter 27
presents
innovative information about using mixed methods approaches
in the
development of nursing interventions. In Chapter 28, a new
chapter, we
provide guidance for designing and conducting a pilot study and
using
data from the pilot to draw conclusions about how best to
proceed.
• Part VI—Building an Evidence Base for Nursing Practice
provides
additional guidance on linking research and clinical practice.
Chapter
29 offers an overview of methods of conducting systematic
reviews that
support EBP, with an emphasis on meta-analyses,
metasyntheses, and
mixed studies reviews. Chapter 30 discusses dissemination of
evidence
—how to prepare a research report (including theses and
dissertations)
16
and how to publish research findings. The concluding chapter
(Chapter
31) offers suggestions and guidelines on developing research
proposals
and getting financial support and includes information about
applying
for NIH grants and interpreting scores from NIH’s new scoring
18. system.
KEY FEATURES
This textbook was designed to be helpful to those who are
learning how to
do research as well as to those who are learning to appraise
research
reports critically and to use research findings in practice. Many
of the
features successfully used in previous editions have been
retained in this
10th edition. Among the basic principles that helped to shape
this and
earlier editions of this book are (1) an unswerving conviction
that the
development of research skills is critical to the nursing
profession, (2) a
fundamental belief that research is intellectually and
professionally
rewarding, and (3) a steadfast opinion that learning about
research
methods need be neither intimidating nor dull. Consistent with
these
principles, we have tried to present the fundamentals of
research methods
in a way that both facilitates understanding and arouses
curiosity and
interest. Key features of our approach include the following:
• Research Examples. Each chapter concludes with one or two
actual
research examples designed to highlight critical points made in
the
chapter and to sharpen the reader’s critical thinking skills. In
addition,
many research examples are used to illustrate key points in the
19. text and
to stimulate ideas for a study. Many of the examples used in this
edition
are open-access articles that can be used for further learning
and
classroom discussions.
• Critiquing Guidelines. Most chapters include guidelines for
conducting a critique of each aspect of a research report. These
guidelines provide a list of questions that draw attention to
specific
aspects of a report that are amenable to appraisal.
• Clear, “user-friendly” style. Our writing style is designed to
be easily
digestible and nonintimidating. Concepts are introduced
carefully and
systematically, difficult ideas are presented clearly, and readers
are
assumed to have no prior exposure to technical terms.
• Specific practical tips on doing research. This textbook is
filled with
17
practical guidance on how to translate the abstract notions of
research
methods into realistic strategies for conducting research. Every
chapter
includes several tips for applying the chapter’s lessons to real-
life
situations. These suggestions are in recognition of the fact that
there is
20. often a large gap between what gets taught in research methods
textbooks and what a researcher needs to know to conduct a
study.
• Aids to student learning. Several features are used to enhance
and
reinforce learning and to help focus the student’s attention on
specific
areas of text content, including the following: succinct, bulleted
summaries at the end of each chapter; tables and figures that
provide
examples and graphic materials in support of the text
discussion; study
suggestions at the end of each chapter; a detailed glossary; and
a
comprehensive index for accessing information quickly.
TEACHING–LEARNING PACKAGE
Nursing Research: Generating and Assessing Evidence for
Nursing
Practice, 10th edition, has an ancillary package designed with
both
students and instructors in mind.
• The Resource Manual augments the textbook in important
ways. The
manual itself provides students with exercises that correspond
to each
text chapter, with a focus on opportunities to critique actual
studies.
The appendix includes 12 research journal articles in their
entirety, plus
a successful grant application for a study funded by the
National
Institute of Nursing Research. The 12 reports cover a range of
nursing
21. research ventures, including qualitative, quantitative, and mixed
methods studies, an instrument development study, an evidence-
based
practice translation project, and two systematic reviews. Full
critiques
of two of the reports are also included and can serve as models
for a
comprehensive research critique.
• The Toolkit to the Resource Manual is a “must-have”
innovation that
will save considerable time for both students and seasoned
researchers.
Included on thePoint, the Toolkit offers dozens of research
resources in
Word documents that can be downloaded and used directly or
adapted.
The resources reflect best-practice research material, most of
which
have been pretested and refined in our own research. The
Toolkit
18
originated with our realization that in our technologically
advanced
environment, it is possible to not only illustrate methodologic
tools as
graphics in the textbook but also to make them directly
available for use
and adaptation. Thus, we have included dozens of documents in
Word
files that can readily be used in research projects, without
requiring
22. researchers to “reinvent the wheel” or tediously retype material
from
this textbook. Examples include informed consent forms, a
demographic questionnaire, content validity forms, and a coding
sheet
for a meta-analysis—to name only a few. The Toolkit also has
lists of
relevant and useful websites for each chapter, which can be
“clicked”
on directly without having to retype the URL and risk a
typographical
error. Links to open-access articles cited in the textbook, as
well as
other open-access articles relevant to each chapter, are included
in the
Toolkit.
• The Instructor’s Resources on the Point include PowerPoint
slides
summarizing key points in each chapter, test questions that have
been
placed into a program that allows instructors to automatically
generate
a test, and an image bank.
It is our hope that the content, style, and organization of this
book
continue to meet the needs of a broad spectrum of nursing
students and
nurse researchers. We also hope that this book will help to
foster
enthusiasm for the kinds of discoveries that research can
produce and for
the knowledge that will help support an evidence-based nursing
practice.
23. DENISE F. POLIT, PhD, FAAN
19
CHERYL TATANO BECK, DNSc, CNM, FAAN
20
Contents
PART 1: FOUNDATIONS OF NURSING RESEARCH
Chapter 1: Introduction to Nursing Research in an Evidence-
Based
Practice Environment
Chapter 2: Evidence-Based Nursing: Translating Research
Evidence into
Practice
Chapter 3: Key Concepts and Steps in Qualitative and
Quantitative
Research
PART 2: CONCEPTUALIZING AND PLANNING A
STUDY TO GENERATE EVIDENCE FOR
NURSING
Chapter 4: Research Problems, Research Questions, and
Hypotheses
Chapter 5: Literature Reviews: Finding and Critiquing Evidence
24. Chapter 6: Theoretical Frameworks
Chapter 7: Ethics in Nursing Research
Chapter 8: Planning a Nursing Study
PART 3: DESIGNING AND CONDUCTING
QUANTITATIVE STUDIES TO GENERATE
EVIDENCE FOR NURSING
Chapter 9: Quantitative Research Design
Chapter 10: Rigor and Validity in Quantitative Research
Chapter 11: Specific Types of Quantitative Research
Chapter 12: Sampling in Quantitative Research
Chapter 13: Data Collection in Quantitative Research
Chapter 14: Measurement and Data Quality
21
Chapter 15: Developing and Testing Self-Report Scales
Chapter 16: Descriptive Statistics
Chapter 17: Inferential Statistics
Chapter 18: Multivariate Statistics
Chapter 19: Processes of Quantitative Data Analysis
Chapter 20: Clinical Significance and Interpretation of
Quantitative
Results
PART 4: DESIGNING AND CONDUCTING
QUALITATIVE STUDIES TO GENERATE
EVIDENCE FOR NURSING
Chapter 21: Qualitative Research Design and Approaches
Chapter 22: Sampling in Qualitative Research
Chapter 23: Data Collection in Qualitative Research
25. Chapter 24: Qualitative Data Analysis
Chapter 25: Trustworthiness and Integrity in Qualitative
Research
PART 5: DESIGNING AND CONDUCTING MIXED
METHODS STUDIES TO GENERATE
EVIDENCE FOR NURSING
Chapter 26: Basics of Mixed Methods Research
Chapter 27: Developing Complex Nursing Interventions Using
Mixed
Methods Research
Chapter 28: Feasibility Assessments and Pilot Tests of
Interventions Using
Mixed Methods
PART 6: BUILDING AN EVIDENCE BASE FOR
NURSING PRACTICE
Chapter 29: Systematic Reviews of Research Evidence: Meta-
Analysis,
Metasynthesis, and Mixed Studies Review
Chapter 30: Disseminating Evidence: Reporting Research
Findings
Chapter 31: Writing Proposals to Generate Evidence
Glossary
22
Appendix: Statistical Tables
26. Index
23
Check Out the Latest Book Authored by Research Expert
Dr. Polit
If you want to make thoughtful but practical decisions about the
measurement of health constructs, check out Dr. Polit and Dr.
Yang’s
latest book, a “gentle” introduction to and overview of complex
measurement content, called Measurement and the Measurement
of
Change.
This book is for researchers and clinicians from all health
disciplines
because measurement is vital to high-quality science and to
excellence in
clinical practice. The text focuses on the measurement of health
constructs,
particularly those constructs that are not amenable to
quantification by
means of laboratory analysis or technical instrumentation.
These health
24
constructs include a wide range of human attributes, such as
quality of life,
functional ability, self-efficacy, depression, and pain. Measures
of such
27. constructs are proliferating at a rapid rate and often without
adequate
attention paid to ensuring that standards of scientific rigor are
met.
In this book, the authors offer guidance to those who develop
new
instruments, adapt existing ones, select instruments for use in a
clinical
trial or in clinical practice, interpret information from
measurements and
changes in scores, or undertake a systematic review on
instruments. This
book offers guidance on how to develop new instruments using
both
“classical” and “modern” approaches from psychometrics as
well as
methods used in clinimetrics. Much of this book, however,
concerns the
evaluation of instruments in relation to three key measurement
domains:
reliability, validity, and responsiveness.
This text was designed to be useful in graduate-level courses on
measurement or research methods and will also serve as an
important
reference and resource for researchers and clinicians.
25
PART 1
FOUNDATIONS OF
NURSING RESEARCH
28. 26
1
Introduction to Nursing Research
in an Evidence-Based Practice
Environment
NURSING RESEARCH IN PERSPECTIVE
In all parts of the world, nursing has experienced a profound
culture
change. Nurses are increasingly expected to understand and
conduct
research and to base their professional practice on research
evidence—that
is, to adopt an evidence-based practice (EBP). EBP involves
using the
best evidence (as well as clinical judgment and patient
preferences) in
making patient care decisions, and “best evidence” typically
comes from
research conducted by nurses and other health care
professionals.
What Is Nursing Research?
Research is systematic inquiry that uses disciplined methods to
answer
questions or solve problems. The ultimate goal of research is to
develop
and expand knowledge.
Nurses are increasingly engaged in disciplined studies that
benefit
29. nursing and its clients. Nursing research is systematic inquiry
designed to
generate trustworthy evidence about issues of importance to the
nursing
profession, including nursing practice, education,
administration, and
informatics. In this book, we emphasize clinical nursing
research, that is,
research to guide nursing practice and to improve the health and
quality of
life of nurses’ clients.
Nursing research has experienced remarkable growth in the past
three
decades, providing nurses with a growing evidence base from
which to
practice. Yet many questions endure and much remains to be
done to
incorporate research innovations into nursing practice.
27
Examples of Nursing Research Questions:
• How effective is pressurized irrigation, compared to a
swabbing
method, in cleansing wounds, in terms of time to wound
healing, pain,
patients’ satisfaction with comfort, and costs? (Mak et al.,
2015)
• What are the experiences of women in Zimbabwe who are
living with
advanced HIV infection? (Gona & DeMarco, 2015)
30. The Importance of Research in Nursing
Research findings from rigorous studies provide especially
strong evidence
for informing nurses’ decisions and actions. Nurses are
accepting the need
to base specific nursing actions on research evidence indicating
that the
actions are clinically appropriate, cost-effective, and result in
positive
outcomes for clients.
In the United States, research plays an important role in nursing
in
terms of cred entialing and status. The American Nurses
Credentialing
Center (ANCC)—an arm of the American Nurses Association
and the
largest and most prestigious credentialing organization in the
United States
—developed a Magnet Recognition Program to acknowledge
health care
organizations that provide high-quality nursing care. As Reigle
and her
colleagues (2008) noted, “the road to Magnet Recognition is
paved with
EBP” (p. 102) and the 2014 Magnet application manual
incorporated
revisions that strengthened evidence-based requirements
(Drenkard, 2013).
The good news is that there is growing confirmation that the
focus on
research and evidence-based practice may have important
payoffs. For
example, McHugh and co-researchers (2013) found that Magnet
hospitals
31. have lower risk-adjusted mortality and failure to rescue than
non-Magnet
hospitals, even when differences among the hospitals in nursing
credentials and patient characteristics are taken into account.
Changes to nursing practice now occur regularly because of
EBP
efforts. Practice changes often are local initiatives that are not
publicized,
but broader clinical changes are also occurring based on
accumulating
research evidence about beneficial practice innovations.
Example of Evidence-Based Practice: Numerous clinical
practice changes
28
reflect the impact of research. For example, “kangaroo care”
(the holding of
diaper-clad infants skin to skin by parents) is now practiced in
many neonatal
intensive care units (NICUs), but this is a relatively new trend.
As recently as
the 1990s, only a minority of NICUs offered kangaroo care
options. Expanded
adoption of this practice reflects mounting evidence that early
skin-to-skin
contact has benefits without negative side effects (e.g.,
Ludington-Hoe, 2011;
Moore et al., 2012). Some of that evidence came from rigorous
studies
conducted by nurse researchers in several countries (e.g., Chwo
et al., 2002;
32. Cong et al., 2009; Cong et al., 2011; Hake-Brooks & Anderson,
2008). Nurses
continue to study the potential benefits of kangaroo care in
important clinical
trials (e.g., Campbell-Yeo et al., 2013).
The Consumer–Producer Continuum in Nursing Research
In our current environment, all nurses are likely to engage in
activities
along a continuum of research participation. At one end of the
continuum
are consumers of nursing research, who read research reports or
research
summaries to keep up-to-date on findings that might affect their
practice.
EBP depends on well-informed nursing research consumers.
At the other end of the continuum are the producers of nursing
research: nurses who design and conduct research. At one time,
most
nurse researchers were academics who taught in schools of
nursing, but
research is increasingly being conducted by nurses in health
care settings
who want to find solutions to recurring problems in patient care.
Between these end points on the continuum lie a variety of
research
activities that are undertaken by nurses. Even if you never
personally
undertake a study, you may (1) contribute to an idea or a plan
for a clinical
study; (2) gather data for a study; (3) advise clients about
participating in
research; (4) solve a clinical problem by searching for research
evidence;
33. or (5) discuss the implications of a new study in a journal club
in your
practice setting, which involves meetings (in groups or online)
to discuss
research articles. In all possible research001-related activities,
nurses who
have some research skills are better able than those without
them to make
a contribution to nursing and to EBP. An understanding of
nursing
research can improve the depth and breadth of every nurse’s
professional
practice.
29
Nursing Research in Historical Perspective
Table 1.1 summarizes some of the key events in the historical
evolution of
nursing research. (An expanded summary of the history of
nursing
research appears in the Supplement to this chapter on ).
Most people would agree that research in nursing began with
Florence
Nightingale in the 1850s. Her most well-known research
contribution
involved an analysis of factors affecting soldier mortality and
morbidity
during the Crimean War. Based on skillful analyses, she was
successful in
effecting changes in nursing care and, more generally, in public
health.
After Nightingale’s work, research was absent from the nursing
34. literature
until the early 1900s, but most early studies concerned nurses’
education
rather than clinical issues.
In the 1950s, research by nurses began to accelerate. For
example, a
30
nursing research center was established at the Walter Reed
Army Institute
of Research. Also, the American Nurses Foundation, which is
devoted to
the promotion of nursing research, was founded. The surge in
the number
of studies conducted in the 1950s created the need for a new
journal;
Nursing Research came into being in 1952. As shown in Table
1.1,
dissemination opportunities in professional journals grew
steadily
thereafter.
In the 1960s, nursing leaders expressed concern about the
shortage of
research on practice issues. Professional nursing organizations,
such as the
Western Interstate Council for Higher Education in Nursing,
established
research priorities, and practice-oriented research on various
clinical topics
began to emerge in the literature.
35. During the 1970s, improvements in client care became a more
visible
research priority and nurses also began to pay attention to the
clinical
utilization of research findings. Guidance on assessing research
for
application in practice settings became available. Several
journals that
focus on nursing research were established in the 1970s,
including
Advances in Nursing Science, Research in Nursing & Health,
and the
Western Journal of Nursing Research. Nursing research also
expanded
internationally. For example, the Workgroup of European Nurse
Researchers was established in 1978 to develop greater
communication
and opportunities for partnerships among 25 European National
Nurses
Associations.
Nursing research continued to expand in the 1980s. In the
United
States, the National Center for Nursing Research (NCNR) at the
National
Institutes of Health (NIH) was established in 1986. Several
forces outside
of nursing also helped to shape the nursing research landscape.
A group
from the McMaster Medical School in Canada designed a
clinical learning
strategy that was called evidence-based medicine (EBM). EBM,
which
promulgated the view that research findings were far superior to
the
opinions of authorities as a basis for clinical decisions,
36. constituted a
profound shift for medical education and practice, and has had a
major
effect on all health care professions.
Nursing research was strengthened and given more visibility
when
NCNR was promoted to full institute status within the NIH. In
1993, the
31
National Institute of Nursing Research (NINR) was established,
helping to
put nursing research more into the mainstream of health
research. Funding
opportunities for nursing research expanded in other countries
as well.
Current and Future Directions for Nursing Research
Nursing research continues to develop at a rapid pace and will
undoubtedly flourish in the 21st century. Funding continues to
grow. For
example, NINR funding in fiscal year 2014 was more than $140
million
compared to $70 million in 1999—and the competition for
available
funding is increasingly vigorous as more nurses seek support for
testing
innovative ideas for practice improvements.
Broadly speaking, the priority for future nursing research will
be the
promotion of excellence in nursing science. Toward this end,
37. nurse
researchers and practicing nurses will be sharpening their
research skills
and using those skills to address emerging issues of importance
to the
profession and its clientele. Among the trends we foresee for
the early 21st
century are the following:
• Continued focus on EBP. Encouragement for nurses to
engage in
evidence-based patient care is sure to continue. In turn,
improvements
will be needed both in the quality of studies and in nurses’
skills in
locating, understanding, critiquing, and using relevant study
results.
Relatedly, there is an emerging interest in translational
research—
research on how findings from studies can best be translated
into
practice. Translation potential will require researchers to think
more
strategically about long-term feasibility, scalability, and
sustainability
when they test solutions to problems.
• Development of a stronger evidence base through
confirmatory
strategies. Practicing nurses are unlikely to adopt an innovation
based
on weakly designed or isolated studies. Strong research designs
are
essential, and confirmation is usually needed through the
replication
(i.e., the repeating) of studies with different clients, in different
38. clinical
settings, and at different times to ensure that the findings are
robust.
• Greater emphasis on systematic reviews. Systematic reviews
are a
cornerstone of EBP and will take on increased importance in all
health
disciplines. Systematic reviews rigorously integrate research
32
information on a topic so that conclusions about the state of
evidence
can be reached. Best practice clinical guidelines typically rely
on such
systematic reviews.
• Innovation. There is currently a major push for creative and
innovative
solutions to recurring practice problems. “Innovation” has
become an
important buzzword throughout NIH and in nursing
associations. For
example, the 2013 annual conference of the Council for the
Advancement of Nursing Science was “Innovative Approaches
to
Symptom Science.” Innovative interventions—and new methods
for
studying nursing questions—are sure to be part of the future
research
landscape in nursing.
• Expanded local research in health care settings. Small studies
39. designed
to solve local problems will likely increase. This trend will be
reinforced as more hospitals apply for (and are recertified for)
Magnet
status in the United States and in other countries. Mechanisms
will need
to be developed to ensure that evidence from these small
projects
becomes available to others facing similar problems, such as
communication within and between regional nursing research
alliances.
• Strengthening of interdisciplinary collaboration.
Collaboration of
nurses with researchers in related fields is likely to expand in
the 21st
century as researchers address fundamental health care
problems. In
turn, such collaborative efforts could lead to nurse researchers
playing a
more prominent role in national and international health care
policies.
One of four major recommendations in a 2010 report on the
future of
nursing by the Institute of Medicine was that nurses should be
full
partners with physicians and other health care professionals in
redesigning health care.
• Expanded dissemination of research findings. The Internet
and other
electronic communication have a big impact on disseminating
research
information, which in turn helps to promote EBP. Through
technologic
advances, information about innovations can be communicated
40. more
widely and more quickly than ever before.
• Increased focus on cultural issues and health disparities. The
issue of
health disparities has emerged as a central concern in nursing
and other
health disciplines; this in turn has raised consciousness about
the
33
cultural sensitivity of health interventions and the cultural
competence
of health care workers. There is growing awareness that
research must
be sensitive to the health beliefs, behaviors, and values of
culturally and
linguistically diverse populations.
• Clinical significance and patient input. Research findings
increasingly
must meet the test of being clinically significant, and patients
have
taken center stage in efforts to define clinical significance. A
major
challenge in the years ahead will involve getting both research
evidence
and patient preferences into clinical decisions, and designing
research
to study the process and the outcomes.
Broad research priorities for the future have been articulated by
many
41. nursing organizations, including NINR and Sigma Theta Tau
International.
Expert panels and research working groups help NINR to
identify gaps in
current knowledge that require research. The primary areas of
research
funded by NINR in 2014 were health promotion/disease
prevention,
eliminating health disparities, caregiving, symptom
management, and self-
management. Research priorities that have been expressed by
Sigma Theta
Tau International include advancing healthy communities
through health
promotion; preventing disease and recognizing social,
economic, and
political determinants; implementation of evidence-based
practice;
targeting the needs of vulnerable populations such as the poor
and
chronically ill; and developing nurses’ capacity for research.
Priorities also
have been developed for several nursing specialties and for
nurses in
several countries—for example, Ireland (Brenner et al., 2014;
Drennan et
al., 2007), Sweden (Bäck-Pettersson et al., 2008), Australia
(Wynaden et
al., 2014), and Korea (Kim et al., 2002).
SOURCES OF EVIDENCE FOR NURSING
PRACTICE
Nurses make clinical decisions based on knowledge from many
sources,
including coursework, textbooks, and their own clinical
experience.
42. Because evidence is constantly evolving, learning about best
practice
nursing perseveres throughout a nurse’s career.
Some of what nurses learn is based on systematic research, but
much of
it is not. What are the sources of evidence for nursing practice?
Where
34
does knowledge for practice come from? Until fairly recently,
knowledge
primarily was handed down from one generation to the next
based on
experience, trial and error, tradition, and expert opinion.
Information
sources for clinical practice vary in dependability, giving rise to
what is
called an evidence hierarchy, which acknowledges that certain
types of
evidence are better than others. A brief discussion of some
alternative
sources of evidence shows how research001-based information
is
different.
Tradition and Authority
Decisions are sometimes based on custom or tradition. Certain
“truths” are
accepted as given, and such “knowledge” is so much a part of a
common
heritage that few seek verification. Tradition facilitates
communication by
43. providing a common foundation of accepted truth, but many
traditions
have never been evaluated for their validity. There is concern
that some
nursing interventions are based on tradition, custom, and “unit
culture”
rather than on sound evidence. Indeed, a recent analysis
suggests that some
“sacred cows” (ineffective traditional habits) persist even in a
health care
center recognized as a leader in evidence-based practice
(Hanrahan et al.,
2015).
Another common source of information is an authority, a person
with
specialized expertise. We often make decisions about problems
with which
we have little experience; it seems natural to place our trust in
the
judgment of people with specialized training or experience. As
a source of
evidence, however, authority has shortcomings. Authorities are
not
infallible, particularly if their expertise is based primarily on
personal
experience; yet, like tradition, their knowledge often goes
unchallenged.
Example of “Myths” in Nursing Textbooks: A study suggests
that even
nursing textbooks may contain “myths.” In their analysis of 23
widely used
undergraduate psychiatric nursing textbooks, Holman and
colleagues (2010)
found that all books contained at least one unsupported
44. assumption (myth)
about loss and grief—that is, assumptions not supported by
research evidence.
Moreover, many evidence-based findings about grief and loss
failed to be
included in the textbooks.
35
Clinical Experience, Trial and Error, and Intuition
Clinical experience is a familiar, functional source of
knowledge. The
ability to generalize, to recognize regularities, and to make
predictions is
an important characteristic of the human mind. Nevertheless,
personal
experience is limited as a knowledge source because each
nurse’s
experience is too narrow to be generally useful. A second
limitation is that
the same objective event is often experienced and perceived
differently by
two nurses.
A related method is trial and error in which alternatives are
tried
successively until a solution to a problem is found. We likely
have all used
this method in our professional work. For example, many
patients dislike
the taste of potassium chloride solution. Nurses try to disguise
the taste of
the medication in various ways until one method meets with the
approval
45. of the patient. Trial and error may offer a practical means of
securing
knowledge, but the method tends to be haphazard and solutions
may be
idiosyncratic.
Intuition is a knowledge source that cannot be explained based
on
reasoning or prior instruction. Although intuition and hunches
undoubtedly
play a role in nursing—as they do in the conduct of research—it
is difficult
to develop nursing policies and practices based on intuition.
Logical Reasoning
Solution
s to some problems are developed by logical thought processes.
As a problem-solving method, logical reasoning combines
experience,
intellectual faculties, and formal systems of thought. Inductive
reasoning
involves developing generalizations from specific observations.
For
example, a nurse may observe the anxious behavior of (specific)
hospitalized children and conclude that (in general) children’s
separation
46. from their parents is stressful. Deductive reasoning involves
developing
specific predictions from general principles. For example, if we
assume
that separation anxiety occurs in hospitalized children (in
general), then we
might predict that (specific) children in a hospital whose
parents do not
room-in will manifest symptoms of stress. Both systems of
reasoning are
useful for understanding and organizing phenomena, and both
play a role
in research. Logical reasoning in and of itself, however, is
limited because
36
the validity of reasoning depends on the accuracy of the
premises with
which one starts.
Assembled Information
In making clinical decisions, health care professionals rely on
47. information
that has been assembled for a variety of purposes. For example,
local,
national, and international benchmarking data provide
information on such
issues as infection rates or the rates of using various procedures
(e.g.,
cesarean births) and can facilitate evaluations of clinical
practices. Cost
data—information on the costs associated with certain
procedures,
policies, or practices—are sometimes used as a factor in clinical
decision
making. Quality improvement and risk data, such as medication
error
reports, can be used to assess the need for practice changes.
Such sources
are useful, but they do not provide a good mechanism for
determining
whether improvements in patient outcomes result from their use.
Disciplined Research
Research conducted in a disciplined framework is the most
sophisticated
method of acquiring knowledge. Nursing research combines
48. logical
reasoning with other features to create evidence that, although
fallible,
tends to yield the most reliable evidence. Carefully synthesized
findings
from rigorous research are at the pinnacle of most evidence
hierarchies.
The current emphasis on EBP requires nurses to base their
clinical practice
to the greatest extent possible on rigorous research001-based
findings
rather than on tradition, authority, intuition, or personal
experience—
although nursing will always remain a rich blend of art and
science.
PARADIGMS AND METHODS FOR NURSING
RESEARCH
A paradigm is a worldview, a general perspective on the
complexities of
the world. Paradigms for human inquiry are often characterized
in terms of
the ways in which they respond to basic philosophical
questions, such as,
What is the nature of reality? (ontologic) and What is the
49. relationship
between the inquirer and those being studied? (epistemologic).
Disciplined inquiry in nursing has been conducted mainly
within two
37
broad paradigms, positivism and constructivism. This section
describes
these two paradigms and outlines the research methods
associated with
them. In later chapters, we describe the transformative paradigm
that
involves critical theory research (Chapter 21), and a pragmatism
paradigm that involves mixed methods research (Chapter 26).
The Positivist Paradigm
The paradigm that dominated nursing research for decades is
known as
positivism (also called logical positivism). Positivism is rooted
in 19th
century thought, guided by such philosophers as Mill, Newton,
50. and Locke.
Positivism reflects a broader cultural phenomenon that, in the
humanities,
is referred to as modernism, which emphasizes the rational and
the
scientific.
As shown in Table 1.2, a fundamental assumption of positivists
is that
there is a reality out there that can be studied and known (an
assumption
is a basic principle that is believed to be true without proof or
verification).
Adherents of positivism assume that nature is basically ordered
and regular
and that reality exists independent of human observation. In
other words,
the world is assumed not to be merely a creation of the human
mind. The
related assumption of determinism refers to the positivists’
belief that
phenomena are not haphazard but rather have antecedent causes.
If a
person has a cerebrovascular accident, the researcher in a
positivist
51. tradition assumes that there must be one or more reasons that
can be
potentially identified. Within the positivist paradigm, much
research
activity is directed at understanding the underlying causes of
phenomena.
38
Positivists value objectivity and attempt to hold personal beliefs
and
biases in check to avoid contaminating the phenomena under
study. The
positivists’ scientific approach involves using orderly,
disciplined
procedures with tight controls of the research situation to test
hunches
about the phenomena being studied.
Strict positivist thinking has been challenged, and few
researchers
adhere to the tenets of pure positivism. In the postpositivist
paradigm,
52. there is still a belief in reality and a desire to understand it, but
postpositivists recognize the impossibility of total objectivity.
They do,
however, see objectivity as a goal and strive to be as neutral as
possible.
Postpositivists also appreciate the impediments to knowing
reality with
certainty and therefore seek probabilistic evidence—that is,
learning what
the true state of a phenomenon probably is, with a high degree
of
39
likelihood. This modified positivist position remains a dominant
force in
nursing research. For the sake of simplicity, we refer to it as
positivism.
The Constructivist Paradigm
The constructivist paradigm (often called the naturalistic
paradigm)
began as a countermovement to positivism with writers such as
53. Weber and
Kant. Just as positivism reflects the cultural phenomenon of
modernism
that burgeoned after the industrial revolution, naturalism is an
outgrowth
of the cultural transformation called postmodernism.
Postmodern thinking
emphasizes the value of deconstruction—taking apart old ideas
and
structures—and reconstruction—putting ideas and structures
together in
new ways. The constructivist paradigm represents a major
alternative
system for conducting disciplined research in nursing. Table 1.2
compares
the major assumptions of the positivist and constructivist
paradigms.
For the naturalistic inquirer, reality is not a fixed entity but
rather is a
construction of the individuals participating in the research;
reality exists
within a context, and many constructions are possible.
Naturalists thus take
the position of relativism: If there are multiple interpretations
54. of reality
that exist in people’s minds, then there is no process by which
the ultimate
truth or falsity of the constructions can be determined.
The constructivist paradigm assumes that knowledge is
maximized
when the distance between the inquirer and those under study is
minimized. The voices and interpretations of study participants
are crucial
to understanding the phenomenon of interest, and subjective
interactions
are the primary way to access them. Findings from a
constructivist inquiry
are the product of the interaction between the inquirer and the
participants.
Paradigms and Methods: Quantitative and Qualitative
Research
Research methods are the techniques researchers use to
structure a study
and to gather and analyze information relevant to the research
question.
The two alternative paradigms correspond to different methods
for
55. developing evidence. A key methodologic distinction is between
quantitative research, which is most closely allied with
positivism, and
qualitative research, which is associated with constructivist
inquiry—
40
although positivists sometimes undertake qualitative studies,
and
constructivist researchers sometimes collect quantitative
information. This
section provides an overview of the methods associated with the
two
paradigms.
The Scientific Method and Quantitative Research
The traditional, positivist scientific method refers to a set of
orderly,
disciplined procedures used to acquire information. Quantitative
researchers use deductive reasoning to generate predictions that
are tested
in the real world. They typically move in a systematic fashion
56. from the
definition of a problem and the selection of concepts on which
to focus to
the solution of the problem. By systematic, we mean that the
investigator
progresses logically through a series of steps, according to a
specified plan
of action.
Quantitative researchers use various control strategies. Control
involves imposing conditions on the research situation so that
biases are
minimized and precision and validity are maximized. Control
mechanisms
are discussed at length in this book.
Quantitative researchers gather empirical evidence—evidence
that is
rooted in objective reality and gathered through the senses.
Empirical
evidence, then, consists of observations gathered through sight,
hearing,
taste, touch, or smell. Observations of the presence or absence
of skin
inflammation, patients’ anxiety level, or infant birth weight are
57. all
examples of empirical observations. The requirement to use
empirical
evidence means that findings are grounded in reality rather than
in
researchers’ personal beliefs.
Evidence for a study in the positivist paradigm is gathered
according to
an established plan, using structured methods to collect needed
information. Usually (but not always) the information gathered
is
quantitative—that is, numeric information that is obtained from
a formal
measurement and is analyzed statistically.
A traditional scientific study strives to go beyond the specifics
of a
research situation. For example, quantitative researchers are
typically not
as interested in understanding why a particular person has a
stroke as in
understanding what factors influence its occurrence in people
generally.
58. 41
The degree to which research findings can be generalized to
individuals
other than those who participated in the study is called the
study’s
generalizability.
The scientific method has enjoyed considerable stature as a
method of
inquiry and has been used productively by nurse researchers
studying a
range of nursing problems. This is not to say, however, that this
approach
can solve all nursing problems. One important limitation—
common to
both quantitative and qualitative research—is that research
cannot be used
to answer moral or ethical questions. Many persistent,
intriguing questions
about human beings fall into this area—questions such as
whether
euthanasia should be practiced or abortion should be legal.
59. The traditional research approach also must contend with
problems of
measurement. To study a phenomenon, quantitative researchers
attempt to
measure it by attaching numeric values that express quantity.
For example,
if the phenomenon of interest is patient stress, researchers
would want to
assess if patients’ stress is high or low, or higher under certain
conditions
or for some people. Physiologic phenomena such as blood
pressure and
temperature can be measured with great accuracy and precision,
but the
same cannot be said of most psychological phenomena, such as
stress or
resilience.
Another issue is that nursing research focuses on humans, who
are
inherently complex and diverse. Traditional quantitative
methods typically
concentrate on a relatively small portion of the human
experience (e.g.,
60. weight gain, depression) in a single study. Complexities tend to
be
controlled and, if possible, eliminated, rather than studied
directly, and this
narrowness of focus can sometimes obscure insights. Finally,
quantitative
research within the positivist paradigm has been accused of an
inflexibility
of vision that does not capture the full breadth of human
experience.
Constructivist Methods and Qualitative Research
Researchers in constructivist traditions emphasize the inherent
complexity
of humans, their ability to shape and create their own
experiences, and the
idea that truth is a composite of realities. Consequently,
constructivist
studies are heavily focused on understanding the human
experience as it is
lived, usually through the careful collection and analysis of
qualitative
42
61. materials that are narrative and subjective.
Researchers who reject the traditional scientific method believe
that it
is overly reductionist—that is, it reduces human experience to
the few
concepts under investigation, and those concepts are defined in
advance by
the researcher rather than emerging from the experiences of
those under
study. Constructivist researchers tend to emphasize the
dynamic, holistic,
and individual aspects of human life and attempt to capture
those aspects
in their entirety, within the context of those who are
experiencing them.
Flexible, evolving procedures are used to capitalize on findings
that
emerge in the course of the study. Constructivist inquiry usually
takes
place in the field (i.e., in naturalistic settings), often over an
extended time
62. period. In constructivist research, the collection of information
and its
analysis typically progress concurrently; as researchers sift
through
information, insights are gained, new questions emerge, and
further
evidence is sought to amplify or confirm the insights. Through
an
inductive process, researchers integrate information to develop
a theory or
description that helps illuminate the phenomenon under
observation.
Constructivist studies yield rich, in-depth information that can
elucidate
varied dimensions of a complicated phenomenon. Findings from
in-depth
qualitative research are typically grounded in the real-life
experiences of
people with first-hand knowledge of a phenomenon.
Nevertheless, the
approach has several limitations. Human beings are used
directly as the
instrument through which information is gathered, and humans
are
63. extremely intelligent and sensitive—but fallible—tools. The
subjectivity
that enriches the analytic insights of skillful researchers can
yield trivial
and obvious “findings” among less competent ones.
Another potential limitation involves the subjectivity of
constructivist
inquiry, which sometimes raises concerns about the
idiosyncratic nature of
the conclusions. Would two constructivist researchers studying
the same
phenomenon in similar settings arrive at similar conclusions?
The situation
is further complicated by the fact that most constructivist
studies involve a
small group of participants. Thus, the generalizability of
findings from
constructivist inquiries is an issue of potential concern.
Multiple Paradigms and Nursing Research
43
64. Paradigms should be viewed as lenses that help to sharpen our
focus on a
phenomenon, not as blinders that limit intellectual curiosity.
The
emergence of alternative paradigms for studying nursing
problems is, in
our view, a healthy and desirable path that can maximize the
breadth of
evidence for practice. Although researchers’ worldview may be
paradigmatic, knowledge itself is not. Nursing knowledge would
be thin if
there were not a rich array of methods available within the two
paradigms
—methods that are often complementary in their strengths and
limitations.
We believe that intellectual pluralism is advantageous.
We have emphasized differences between the two paradigms
and
associated methods so that distinctions would be easy to
understand—
although for many of the issues included in Table 1.2,
differences are more
on a continuum than they are a dichotomy. Subsequent chapters
65. of this
book elaborate further on differences in terminology, methods,
and
research products. It is equally important, however, to note that
the two
main paradigms have many features in common, only some of
which are
mentioned here:
• Ultimate goals. The ultimate aim of disciplined research,
regardless of
the underlying paradigm, is to gain understanding about
phenomena.
Both quantitative and qualitative researchers seek to capture the
truth
with regard to an aspect of the world in which they are
interested, and
both groups can make meaningful—and mutually beneficial—
contributions to evidence for nursing practice.
• External evidence. Although the word empiricism has come
to be allied
with the classic scientific method, researchers in both traditions
gather
and analyze evidence empirically, that is, through their senses.
66. Neither
qualitative nor quantitative researchers are armchair analysts,
depending on their own beliefs and worldviews to generate
knowledge.
• Reliance on human cooperation. Because evidence for
nursing research
comes primarily from humans, human cooperation is essential.
To
understand people’s characteristics and experiences, researchers
must
persuade them to participate in the investigation and to speak
and act
candidly.
• Ethical constraints. Research with human beings is guided by
ethical
principles that sometimes interfere with research goals. As we
discuss
44
in Chapter 7, ethical dilemmas often confront researchers,
67. regardless of
paradigms or methods.
• Fallibility of disciplined research. Virtually all studies have
some
limitations. Every research question can be addressed in many
ways,
and inevitably, there are trade-offs. The fallibility of any single
study
makes it important to understand and critique researchers’
methodologic decisions when evaluating evidence quality.
Thus, despite philosophic and methodologic differences,
researchers
using traditional scientific methods or constructivist methods
share overall
goals and face many similar challenges. The selection of an
appropriate
method depends on researchers’ personal philosophy and also
on the
research question. If a researcher asks, “What are the effects of
cryotherapy on nausea and oral mucositis in patients undergoing
chemotherapy?” the researcher needs to examine the effects
through the
careful measurement of patient outcomes. On the other hand, if
68. a
researcher asks, “What is the process by which parents learn to
cope with
the death of a child?” the researcher would be hard pressed to
quantify
such a process. Personal worldviews of researchers help to
shape their
questions.
In reading about the alternative paradigms for nursing research,
you
likely were more attracted to one of the two paradigms. It is
important,
however, to learn about both approaches to disciplined inquiry
and to
recognize their respective strengths and limitations. In this
textbook, we
describe methods associated with both qualitative and
quantitative research
in an effort to assist you in becoming methodologically
bilingual. This is
especially important because large numbers of nurse researchers
are now
undertaking mixed methods research that involves gathering and
analyzing
69. both qualitative and quantitative data (Chapters 26–28).
THE PURPOSES OF NURSING RESEARCH
The general purpose of nursing research is to answer questions
or solve
problems of relevance to nursing. Specific purposes can be
classified in
various ways. We describe three such classifications—not
because it is
important for you to categorize a study as having one purpose or
the other
but rather because this will help us to illustrate the broad range
of
45
questions that have intrigued nurses and to further show
differences
between qualitative and quantitative inquiry.
Applied and Basic Research
Sometimes a distinction is made between basic and applied
research. As
70. traditionally defined, basic research is undertaken to enhance
the base of
knowledge or to formulate or refine a theory. For example, a
researcher
may perform an in-depth study to better understand normal
grieving
processes, without having explicit nursing applications in mind.
Some
types of basic research are called bench research, which is
usually
performed in a laboratory and focuses on the molecular and
cellular
mechanisms that underlie disease.
Example of Basic Nursing Research: Kishi and a
multidisciplinary team of
researchers (2015) studied the effect of hypo-osmotic shock of
epidermal cells
on skin inflammation in a rat model, in an effort to understand
the physiologic
mechanism underlying aquagenic pruritus (disrupted skin
barrier function) in
the elderly.
Applied research seeks solutions to existing problems and tends
71. to be
of greater immediate utility for EBP. Basic research is
appropriate for
discovering general principles of human behavior and
biophysiologic
processes; applied research is designed to indicate how these
principles
can be used to solve problems in nursing practice. In nursing,
the findings
from applied research may pose questions for basic research,
and the
results of basic research often suggest clinical applications.
Example of Applied Nursing Research: S. Martin and colleagues
(2014)
studied whether positive therapeutic suggestions given via
headphones to
children emerging from anesthesia after a tonsillectomy would
help to lower
the children’s pain.
Research to Achieve Varying Levels of Explanation
Another way to classify research purposes concerns the extent
to which
studies provide explanatory information. Although specific
72. study goals can
46
range along an explanatory continuum, a fundamental
distinction (relevant
especially in quantitative research) is between studies whose
primary
intent is to describe phenomena, and those that are cause-
probing—that
is, designed to illuminate the underlying causes of phenomena.
Within a descriptive/explanatory framework, the specific
purposes of
nursing research include identification, description, exploration,
prediction/control, and explanation. For each purpose, various
types of
question are addressed—some more amenable to qualitative than
to
quantitative inquiry and vice versa.
Identification and Description
Qualitative researchers sometimes study phenomena about
73. which little is
known. In some cases, so little is known that the phenomenon
has yet to be
clearly identified or named or has been inadequately defined.
The in-depth,
probing nature of qualitative research is well suited to the task
of
answering such questions as, “What is this phenomenon?” and
“What is its
name?” (Table 1.3). In quantitative research, by contrast,
researchers begin
with a phenomenon that has been previously studied or
defined—
sometimes in a qualitative study. Thus, in quantitative research,
identification typically precedes the inquiry.
47
Qualitative Example of Identification: Wojnar and Katzenmeyer
(2013)
studied the experiences of preconception, pregnancy, and new
motherhood for
lesbian nonbiologic mothers. They identified, through in-depth
74. interviews with
24 women, a unique description of a pervasive feeling they
called otherness.
Description is another important research purpose. Examples of
phenomena that nurse researchers have described include
patients’ pain,
confusion, and coping. Quantitative description focuses on the
incidence,
size, and measurable attributes of phenomena. Qualitative
researchers, by
contrast, describe the dimensions and meanings of phenomena.
Table 1.3
shows descriptive questions posed by quantitative and
qualitative
researchers.
Quantitative Example of Description: Palese and colleagues
(2015)
conducted a study to describe the average healing time of stage
II pressure
ulcers. They found that it took approximately 23 days to achieve
complete
reepithelialization.
75. 48
Qualitative Example of Description: Archibald and colleagues
(2015)
undertook an in-depth study to describe the information needs
of parents of
children with asthma.
Exploration
Exploratory research begins with a phenomenon of interest, but
rather than
simply observing and describing it, exploratory research
investigates the
full nature of the phenomenon, the manner in which it is
manifested, and
the other factors to which it is related. For example, a
descriptive
quantitative study of patients’ preoperative stress might
document the
degree of stress patients feel before surgery and the percentage
of patients
who are stressed. An exploratory study might ask: What factors
diminish
76. or increase a patient’s stress? Are nurses’ behaviors related to a
patient’s
stress level? Qualitative methods are especially useful for
exploring the
full nature of a little-understood phenomenon. Exploratory
qualitative
research is designed to shed light on the various ways in which
a
phenomenon is manifested and on underlying processes.
Quantitative Example of Exploration: Lee and colleagues (2014)
explored
the association between physical activity in older adults and
their level of
depressive symptoms.
Qualitative Example of Exploration: Based on in-depth
interviews with
adults living on a reservation in the United States, D. Martin
and Yurkovich
(2014) explored American Indians’ perception of a healthy
family.
Explanation
The goals of explanatory research are to understand the
77. underpinnings of
natural phenomena and to explain systematic relationships
among them.
Explanatory research is often linked to theories, which are a
method of
integrating ideas about phenomena and their interrelationships.
Whereas
descriptive research provides new information and exploratory
research
provides promising insights, explanatory research attempts to
offer
49
understanding of the underlying causes or full nature of a
phenomenon. In
quantitative research, theories or prior findings are used
deductively to
generate hypothesized explanations that are then tested. In
qualitative
studies, researchers search for explanations about how or why a
phenomenon exists or what a phenomenon means as a basis for
developing
78. a theory that is grounded in rich, in-depth evidence.
Quantitative Example of Explanation: Golfenshtein and
Drach001-Zahavy
(2015) tested a theoretical model (attribution theory) to
understand the role of
patients’ attributions in nurses’ regulation of emotions in
pediatric hospital
wards.
Qualitative Example of Explanation: Smith-Young and
colleagues (2014)
conducted an in-depth study to develop a theoretical
understanding of the
process of managing work-related musculoskeletal disorders
while remaining
at the workplace. They called this process constant negotiation.
Prediction and Control
Many phenomena defy explanation. Yet it is frequently possible
to make
predictions and to control phenomena based on research
findings, even in
the absence of complete understanding. For example, research
has shown
79. that the incidence of Down syndrome in infants increases with
the age of
the mother. We can predict that a woman aged 40 years is at
higher risk of
bearing a child with Down syndrome than is a woman aged 25
years. We
can partially control the outcome by educating women about the
risks and
offering amniocentesis to women older than 35 years of age.
The ability to
predict and control in this example does not depend on an
explanation of
why older women are at a higher risk of having an abnormal
child. In
many quantitative studies, prediction and control are key
objectives.
Although explanatory studies are powerful in an EBP
environment, studies
whose purpose is prediction and control are also critical in
helping
clinicians make decisions.
Quantitative Example of Prediction: Dang (2014) studied
factors that
80. 50
predicted resilience among homeless youth with histories of
maltreatment.
Social connectedness and self-esteem were predictive of better
mental health.
Research Purposes Linked to Evidence-Based Practice
The purpose of most nursing studies can be categorized on a
descriptive–
explanatory dimension as just described, but some studies do
not fall into
such a system. For example, a study to develop and rigorously
test a new
method of measuring patient outcomes cannot easily be
classified on this
continuum.
In both nursing and medicine, several books have been written
to
facilitate evidence-based practice, and these books categorize
studies in
terms of the types of information needed by clinicians (DiCenso
81. et al.,
2005; Guyatt et al., 2008; Melnyk & Fineout-Overholt, 2011).
These
writers focus on several types of clinical concerns: treatment,
therapy, or
intervention; diagnosis and assessment; prognosis; prevention
of harm;
etiology; and meaning. Not all nursing studies have one of these
purposes,
but most of them do.
Treatment, Therapy, or Intervention
Nurse researchers undertake studies designed to help nurses
make
evidence-based treatment decisions about how to prevent a
health problem
or how to manage an existing problem. Such studies range from
evaluations of highly specific treatments or therapies (e.g.,
comparing two
types of cooling blankets for febrile patients) to complex
multisession
interventions designed to effect major behavioral changes (e.g.,
nurse-led
smoking cessation interventions). Such intervention research
plays a
82. critical role in EBP.
Example of a Study Aimed at Treatment/Therapy: Ling and co-
researchers
(2014) tested the effectiveness of a school-based healthy
lifestyle intervention
designed to prevent childhood obesity in four rural elementary
schools.
Diagnosis and Assessment
A burgeoning number of nursing studies concern the rigorous
development
51
and evaluation of formal instruments to screen, diagnose, and
assess
patients and to measure important clinical outcomes. High-
quality
instruments with documented accuracy are essential both for
clinical
practice and for further research.
83. Example of a Study Aimed at Diagnosis/Assessment: Pasek and
colleagues
(2015) developed a prototype of an electronic headache pain
diary for children
and evaluated the clinical feasibility of the diary for assessing
and
documenting concussion headache.
Prognosis
Studies of prognosis examine outcomes associated with a
disease or health
problem, estimate the probability they will occur, and predict
the types of
people for whom the outcomes are most likely. Such studies
facilitate the
development of long-term care plans for patients. They provide
valuable
information for guiding patients to make lifestyle choices or to
be vigilant
for key symptoms. Prognostic studies can also play a role in
resource
allocation decisions.
Example of a Study Aimed at Prognosis: Storey and Von Ah
(2015) studied
84. the prevalence and impact of hyperglycemia on hospitalized
leukemia patients,
in terms of such outcomes as neutropenia, infection, and length
of hospital
stay.
Prevention of Harm and Etiology (Causation)
Nurses frequently encounter patients who face potentially
harmful
exposures as a result of environmental agents or because of
personal
behaviors or characteristics. Providing useful information to
patients about
such harms and how best to avoid them depends on the
availability of
accurate evidence about health risks. Moreover, it can be
difficult to
prevent harms if we do not know what causes them. For
example, there
would be no smoking cessation programs if research had not
provided firm
evidence that smoking cigarettes causes or contributes to a wide
range of
health problems. Thus, identifying factors that affect or cause
illness,
85. 52
mortality, or morbidity is an important purpose of many nursing
studies.
Example of a Study Aimed at Identifying and Preventing
Harms: Hagerty
and colleagues (2015) undertook a study to identify risk factors
for catheter-
associated urinary tract infections in critically ill patients with
subarachnoid
hemorrhage. The risk factors examined included patients’ blood
sugar levels,
patient age, and levels of anemia requiring transfusion.
Meaning and Processes
Designing effective interventions, motivating people to comply
with
treatments and health promotion activities, and providing
sensitive advice
to patients are among the many health care activities that can
greatly
86. benefit from understanding the clients’ perspectives. Research
that
provides evidence about what health and illness mean to clients,
what
barriers they face to positive health practices, and what
processes they
experience in a transition through a health care crisis are
important to
evidence-based nursing practice.
Example of a Study Aimed at Studying Meaning: Carlsson and
Persson
(2015) studied what it means to live with intestinal failure
caused by Crohn
disease and the influence it has on daily life.
TIP: Several of these EBP-related purposes (except diagnosis
and
meaning) fundamentally call for cause-probing research. For
example,
research on interventions focuses on whether an intervention
causes
improvements in key outcomes. Prognosis research asks if a
disease or
health condition causes subsequent adverse outcomes, and
87. etiology
research seeks explanations about the underlying causes of
health
problems.
ASSISTANCE FOR USERS OF NURSING
RESEARCH
This book is designed primarily to help you develop skills for
conducting
research, but in an environment that stresses EBP, it is
extremely
53
important to hone your skills in reading, evaluating, and using
nursing
studies. We provide specific guidance to consumers in most
chapters by
including guidelines for critiquing aspects of a study covered in
the
chapter. The questions in Box 1.1 are designed to assist you in
using the
information in this chapter in an overall preliminary assessment
88. of a
research report.
BOX 1.1 Questions for a Preliminary
Overview of a Research Report
1. How relevant is the research problem in this report to the
actual practice
of nursing? Does the study focus on a topic that is a priority
area for
nursing research?
2. Is the research quantitative or qualitative?
3. What is the underlying purpose (or purposes) of the study—
identification, description, exploration, explanation, or
prediction and
control? Does the purpose correspond to an EBP focus such as
treatment, diagnosis, prognosis, harm/etiology, or meaning?
4. Is this study fundamentally cause-probing?
5. What might be some clinical implications of this research?
To what type
of people and settings is the research most relevant? If the
89. findings are
accurate, how might I use the results of this study?
TIP: The Resource Manual that accompanies this book offers
particularly rich opportunities to practice your critiquing skills.
The
Toolkit on thePoint with the Resource Manual includes Box 1.1
as a
Word document, which will allow you to adapt these questions,
if
desired, and to answer them directly into a Word document
without
having to retype the questions.
RESEARCH EXAMPLES
Each chapter of this book presents brief descriptions of studies
conducted
54
by nurse researchers, focusing on aspects emphasized in the
chapter.
90. Reading the full journal articles would prove useful for learning
more
about the studies, their methods, and the findings.
Research Example of a Quantitative Study
Study: The effects of a community-based, culturally tailored
diabetes
prevention intervention for high-risk adults of Mexican descent
(Vincent
et al., 2014)
Study Purpose: The purpose of the study was to evaluate the
effectiveness of a 5-month nurse-coached diabetes prevention
program
(Un Estilo de Vida Saludable or EVS) for overweight Mexican
American adults.
Study Methods: A total of 58 Spanish-speaking adults of
Mexican
descent were recruited to participate in the study. Some of the
participants, at random, were in a group that received the EVS
intervention, while others in a control group did not receive it.
The EVS
intervention used content from a previously tested diabetes
91. prevention
program, but the researchers created a community-based,
culturally
tailored intervention for their population. The intervention,
which was
offered in community rooms of churches, consisted of an
intensive
phase of eight weekly 2-hour sessions, followed by a
maintenance phase
of 1-hour sessions for the final 3 months. Those in the group not
receiving the intervention received educational sessions broadly
aimed
at health promotion in general. The researchers compared the
two
groups with regard to several important outcomes, such as
weight loss,
waist circumference, body mass index, and self-efficacy.
Outcome
information was gathered three times—at the outset of the study
(prior
to the intervention), 8 weeks later, and then after the program
ended.
Key Findings: The analysis suggested that those in the
intervention group
92. had several better outcomes, such as greater weight loss,
smaller waist
circumference, and lower body mass index, than those in the
control
group.
Conclusions: Vincent and her colleagues (2014) concluded that
implementing the culturally tailored program was feasible, was
well-
received among participants (e.g., high rates of program
retention), and
55
was effective in decreasing risk factors for type 2 diabetes.
Research Example of a Quantitative Study
Study: Silent, invisible, and unacknowledged: Experiences of
young
caregivers of single parents diagnosed with multiple sclerosis
(Bjorgvinsdottir & Halldorsdottir, 2014)
93. Study Purpose: The purpose of this study was to study the
personal
experience of being a young caregiver of a chronically ill parent
diagnosed with multiple sclerosis (MS).
Study Methods: Young adults in Iceland whose parents were
diagnosed
with MS were recruited through the Icelandic National Multiple
Sclerosis Society, and 11 agreed to be included in the study.
Participants
were interviewed in their own homes or in the home of the lead
researcher, whichever they preferred. In-depth questioning was
used to
probe the experiences of the participants. The main interview
question
was: “Can you tell me about your personal experience being a
young
caregiver of a chronically ill parent with MS?” Several
participants were
interviewed twice to ensure rich and deep descriptions for a
total of 21
interviews.
Key Findings: The young caregivers felt that they were invisible
and
94. unacknowledged as caregivers and received limited support and
assistance from professionals. Their responsibilities led to
severe
personal restrictions and they felt they had lived without a true
childhood because they were left to manage adult-like
responsibilities at
a young age. Their role as caregiver was demanding and
stressful, and
they felt unsupported and abandoned.
Conclusions: The researchers concluded that health
professionals should
be more vigilant about the needs for support and guidance for
children
and adolescents caring for chronically ill parents.
SUMMARY POINTS
• Nursing research is systematic inquiry to develop knowledge
about
issues of importance to nurses. Nurses are adopting an
evidence-
56
95. based practice (EBP) that incorporates research findings into
their
clinical decisions.
• Nurses can participate in a range of research-related
activities that
span a continuum from being consumers of research (those who
read
and evaluate studies) and producers of research (those who
design
and undertake studies).
• Nursing research began with Florence Nightingale but
developed
slowly until its rapid acceleration in the 1950s. Since the 1970s,
nursing research has focused on problems relating to clinical
practice.
• The National Institute of Nursing Research (NINR),
established at
the U.S. National Institutes of Health in 1993, affirms the
stature of
96. nursing research in the United States.
• Contemporary emphases in nursing research include EBP
projects,
replications of research, research integration through systematic
reviews, multisite and interdisciplinary studies, expanded
dissemination efforts, and increased focus on health disparities.
• Disciplined research is a better evidence source for nursing
practice
than other sources, such as tradition, authority, personal
experience,
trial and error, intuition, and logical reasoning.
• Nursing research is conducted mainly within one of two
broad
paradigms—worldviews with underlying assumptions about
reality:
the positivist paradigm and the constructivist paradigm.
• In the positivist paradigm, it is assumed that there is an
objective
reality and that natural phenomena are regular and orderly. The
related assumption of determinism is the belief that phenomenas
result from prior causes and are not haphazard.
97. • In the constructivist (naturalistic) paradigm, it is assumed
that
reality is not fixed but is rather a construction of human minds;
thus,
“truth” is a composite of multiple constructions of reality.
• The positivist paradigm is associated with quantitative
research—
the collection and analysis of numeric information. Quantitative
research is typically conducted within the traditional scientific
method, which is a systematic, controlled process. Quantitative
researchers gather and analyze empirical evidence (evidence
collected through the human senses) and strive for
generalizability of
57
their findings beyond the study setting.
• Researchers within the constructivist paradigm emphasize
understanding the human experience as it is lived through the
collection and analysis of subjective, narrative materials using
98. flexible procedures that evolve in the field; this paradigm is
associated with qualitative research.
• Basic research is designed to extend the knowledge base for
the sake
of knowledge itself. Applied research focuses on discovering
solutions to immediate problems.
• A fundamental distinction, especially relevant in quantitative
research, is between studies whose primary intent is to describe
phenomena and those that are cause-probing—that is, designed
to
illuminate underlying causes of phenomena. Specific purposes
on the
description/explanation continuum include identification,
description,
exploration, prediction/control, and explanation.
• Many nursing studies can also be classified in terms of a key
EBP
aim: treatment/therapy/intervention; diagnosis and assessment;
prognosis; harm and etiology; and meaning and process.
STUDY ACTIVITIES
99. Chapter 1 of the Resource Manual for Nursing Research:
Generating and
Assessing Evidence for Nursing Practice, 10th edition, offers
study
suggestions for reinforcing concepts presented in this chapter.
In addition,
the following questions can be addressed in classroom or online
discussions:
1. Is your worldview closer to the positivist or the
constructivist
paradigm? Explore the aspects of the two paradigms that are
especially
consistent with your worldview.
2. Answer the questions in Box 1.1 about the Vincent et al.
(2014) study
described at the end of this chapter. Could this study have been
undertaken as a qualitative study? Why or why not?
3. Answer the questions in Box 1.1 about the Bjorgvinsdottir
and
Halldorsdottir (2014) study described at the end of this chapter.
Could
100. 58
this study have been undertaken as a quantitative study? Why or
why
not?
STUDIES CITED IN CHAPTER 1
Archibald, M. M., Caine, V., Ali, S., Hartling, L., & Scott, S.
(2015). What is left
unsaid: An interpretive description of the information needs of
parents of
children with asthma. Research in Nursing & Health, 38, 19–28.
Bäck-Pettersson, S., Hermansson, E., Sernert, N., & Bjökelund,
C. (2008).
Research priorities in nursing—A Delphi study among Swedish
nurses. Journal
of Clinical Nursing, 17, 2221–2231.
Bjorgvinsdottir, K., & Halldorsdottir, S. (2014). Silent,
101. invisible and
unacknowledged: Experiences of young caregivers of single
parents diagnosed
with multiple sclerosis. Scandinavian Journal of the Caring
Sciences, 28, 38–
48.
Brenner, M., Hilliard, C., Regan, G., Coughlan, B., Hayden, S.,
Drennan, J., &
Kelleher, D. (2014). Research priorities for children’s nursing
in Ireland.
Journal of Pediatric Nursing, 29, 301–308.
*Campbell-Yeo, M., Johnston, C., Benoit, B., Latimer, M.,
Vincer, M., Walker,
C., . . . Caddell, K. (2013). Trial of repeated analgesia with
kangaroo mother
care (TRAKC trial). BMC Pediatrics, 13, 182.
Carlsson, E., & Persson, E. (2015). Living with intestinal
failure by Crohn disease:
Not letting the disease conquer life. Gastroenterology Nursing,
38, 12–20.
Chwo, M. J., Anderson, G. C., Good, M., Dowling, D. A.,
102. Shiau, S. H., & Chu, D.
M. (2002). A randomized controlled trial of early kangaroo care
for preterm
infants: Effects on temperature, weight, behavior, and acuity.
Journal of
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*Cong, X., Ludington-Hoe, S., McCain, G., & Fu, P. (2009).
Kangaroo care
modifies preterm infant heart rate variability in response to heel
stick pain.
Early Human Development, 85, 561–567.
Cong, X., Ludington-Hoe, S., & Walsh, S. (2011). Randomized
crossover trial of
kangaroo care to reduce behavioral pain responses in preterm
infants.
Biological Research for Nursing, 13, 204–216.
Dang, M. T. (2014). Social connectedness and self-esteem:
Predictors of resilience
in mental health among maltreated homeless youth. Issues in
Mental Health
Nursing, 35, 212–219.
103. DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Evidence-based
nursing: A guide to
clinical practice. St. Louis, MO: Elsevier Mosby.
59
Drenkard, K. (2013). Change is good: Introducing the 2014
Magnet Application
Manual. Journal of Nursing Administration, 43, 489–490.
Drennan, J., Meehan, T., Kemple, M., Johnson, M., Treacy, M.,
& Butler, M.
(2007). Nursing research priorities for Ireland. Journal of
Nursing Scholarship,
39, 298–305.
Golfenshtein, N., & Drach001-Zahavy, A. (2015). An
attribution theory
perspective on emotional labour in nurse-patient encounters: A
nested cross-
sectional study in paediatric settings. Journal of Advanced
Nursing, 71(5),
1123–1134.
104. Gona, C., & DeMarco, R. (2015). The context and experience of
becoming HIV
infected for Zimbabwean women: Unheard voices revealed.
Journal of the
Association of Nurses in AIDS Care, 26, 57–68.
Guyatt, G., Rennie, D., Meade, M., & Cook, D. (2008). Users’
guide to the
medical literature: Essentials of evidence-based clinical practice
(2nd ed.).
New York: McGraw Hill.
Hagerty, T., Kertesz, L., Schmidt, J., Agarwal, S., Claassen, J.,
Mayer, S., . . .
Shang, K. (2015). Risk factors for catheter-associated urinary
tract infections in
critically ill patients with subarachnoid hemorrhage. Journal of
Neuroscience
Nursing, 47, 51–54.
Hake-Brooks, S., & Anderson, G. (2008). Kangaroo care and
breastfeeding of
mother-preterm dyads 0–18 months: A randomized controlled
trial. Neonatal
105. Network, 27, 151–159.
Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson,
C., Greiner, J., . . .
Williamson, A. (2015). Sacred cows gone to pasture: A
systematic evaluation
and integration of evidence-based practice. Worldview on
Evidence-Based
Nursing, 12, 3–11.
Holman, E., Perisho, J., Edwards, A., & Mlakar, N. (2010). The
myths of coping
with loss in undergraduate psychiatric nursing books. Research
in Nursing &
Health, 33, 486–499.
*Institute of Medicine. (2010). The future of nursing: Leading
change, advancing
health. Washington, DC: The National Academies Press.
Kim, M. J., Oh, E. G., Kim, C. J., Yoo, J. S., & Ko, I. S. (2002).
Priorities for
nursing research in Korea. Journal of Nursing Scholarship, 34,
307–312.
106. Kishi, C., Minematsu, T., Huang, L., Mugita, Y., Kitamura, A.,
Nakagami, G., . . .
Sanada, H. (2015). Hypo-osmotic shock-induced subclinical
inflammation of
skin in a rat model of disrupted skin barrier function. Biological
Research for
Nursing, 17, 135–141.
Lee, H., Lee, J., Brar, J., Rush, E., & Jolley, C. (2014). Physical
activity and
depressive symptoms in older adults. Geriatric Nursing, 35, 37–
41.
Ling, J., King, K., Speck, B., Kim, S., & Wu, D. (2014).
Preliminary assessment
60
of a school-based healthy lifestyle intervention among rural
elementary school
children. Journal of School Health, 84, 247–255.
Ludington-Hoe, S. M. (2011). Thirty years of kangaroo care
107. science and practice.
Neonatal Network, 30, 357–362.
Mak, S., Lee, M., Cheung, J., Choi, K., Chung, T., Wong, T., . .
. & Lee, D.
(2015). Pressurised irrigation versus swabbing method in
cleansing wounds
healed by secondary intention: A randomized controlled trial
with cost
effectiveness analysis. International Journal of Nursing Studies,
52, 88–101.
Martin, D., & Yurkovich, E. (2014). “Close knit” defines a
healthy native
American Indian family. Journal of Family Nursing, 20, 51–72.
Martin, S., Smith, A., Newcomb, P., & Miller, J. (2014). Effects
of therapeutic
suggestion under anesthesia on outcomes in children post-
tonsillectomy.
Journal of Perianesthesia Nursing, 29, 94–106.
*McHugh, M. D., Kelly, L. A., Smith, H. L., Wu, E. S., Vanak,
J., & Aiken, L. H.
(2013). Lower mortality in Magnet hospitals. Medical Care, 51,
108. 382–388.
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based
practice in
nursing and healthcare: A guide to best practice (2nd ed.).
Philadelphia:
Lippincott Williams & Wilkins.
*Moore, E., Anderson, G., Bergman, N., & Dowswell, T.
(2012). Early skin-to-
skin contact for mothers and their health newborn infants.
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Palese, A., Luisa, S., Ilenia, P., Laquintana, D., Stinco, G., &
DeLiulio, P. (2015).
What is the healing time of stage II pressure ulcers? Findings
from a secondary
analysis. Advances in Skin and Would Care, 28, 79–75.
Pasek, T., Locasto, L., Reichard, J., Fazio Sumrok, V., Johnson,
E., & Kontos, A.
(2015). The headache electronic diary for children with
concussion. Clinical
Nurse Specialist, 29, 80–88.
109. Reigle, B. S., Stevens, K., Belcher, J., Huth, M., McGuire, E.,
Mals, D., & Volz,
T. (2008). Evidence-based practice and the road to Magnet
status. The Journal
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Smith-Young, J., Solberg, S., & Gaudine, A. (2014). Constant
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Managing work-related musculoskeletal disorders while
remaining in the
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Storey, S., & Von Ah, D. (2015). Prevalence and impact of
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*A link to this open-access journal article is provided in the
Toolkit for
this chapter in the accompanying Resource Manual.
62
111. T
2
Evidence-Based Nursing:
Translating Research Evidence into
Practice
his book will help you to develop the skills you need to
generate and
evaluate research evidence for nursing practice. Before we
delve into
the “how-tos” of research, we discuss key aspects of evidence-
based
practice (EBP) to clarify the key role that research plays in
nursing.
BACKGROUND OF EVIDENCE-BASED
NURSING PRACTICE
This section provides a context for understanding evidence-
based nursing
practice and two closely related concepts, research utilization
and