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Notes nursing research

  1. 1. Lecture Notes on Nursing Research Prepared By: Mark Fredderick R Abejo R.N, MAN   NURSING RESEARCH  Lecturer: Mark Fredderick R. Abejo RN, MAN ________________________________________________ NATURE OF RESEARCH Research Definition  Derived from the old French word “CERCHIER” meaning to seek or to search.  The prefix “re” means again and signifies replication of the search, implying that the person has to find out or to take another more careful look.  Is a scientific study or investigation that is pursued to discover theories and concepts based on new facts and information and its practical application.  Systematic collection and analysis of data to illuminate, describe or explain new facts and relationship and for the purposes of prediction or explanation.  An attempt to gain solutions to the problem. (Treece, 1986)  Refers to a problem solving process that utilizes scientific and develop ideas and theories that give meaningful answer to complex questions about human beings and the environment.  The Committee on Research of the Philippine Nurses Association has come up with its own definition of research: Research is an honest, scientific investigation undertaken for the purpose of discovering new facts or establishing new relationship among facts already known which will contribute to the present body of knowledge and can lead to an effective solution of existing problems. Theory – systematic, abstract explanation of some aspect of reality. Concepts – building blocks of theories Data – pieces of information obtained in the course of investigation Phenomenon – an event, happening, incident and observable facts. Nursing Research Definition  It is defined as a formal, systematic, rigorous and intensive process used for solutions to nursing problems or to discover and interpret new facts and trends in the clinical practice, nursing education and nursing administration. (Waltz and Bausell, 2001) Introduction to Nursing Research Systematic study and assessment of nursing problems or phenomena; finding ways to improve nursing practice and patient care through creative studies;initiating and evaluating change; and taking action to make new knowledge useful in nursing. (Vreeland, 1963 ) Includes the breadth and depth of the disciple of nursing and the rehabilitative, therapeutic and preventive aspects of nursing as well as the preparation of practitioners and personnel involved in the total nursing sphere. According to NCNR, nursing research is the testing of knowledge that can be used to guide nursing practice. It is concerned with examining questions and verifying interventions based on human experiences. The Goals of Nursing Research  Efficiency and effectiveness in nursing care.  Worthiness and value of the nursing profession.  Indentify, implementing and evaluating effective health care modalities.  Potential for providing quality care of clients. Sources of Knowledge in Nursing           Faith, Habits and Traditions Authority Borrowing Clinical / Personal Experience Trial and Error Intuition Role Modeling Logical Reasoning Assembled Information Disciplined Research Reason for Conducting Research in Nursing 1. Gather data or information on nursing situations or conditions about which little knowledge is available. 2. Provides scientific knowledge base from which nursing theories emerge and develop. 3. Helps correct, clarify and validate perceptions and expands these. 4. Provides theoretical and scientific basis for nursing practice. 5. Defines the parameters of nursing and identifies its boundaries. 6. Documents the social relevance and efficacy of nursing practice to people and health care providers. 7. Describes the characteristics of the nursing situation about which little knowledge is known. 8. Predicts probable outcomes of nursing decisions in relations to client care. 9. Provides knowledge for purposes of problem solving and decision making. 10. Develops and evaluates nursing theories, concepts and practices these for clarity and validity of nursing actions. 11. Prevents undesirable client reactions. 12. Develops a considerable degree of confidence. Abejo
  2. 2. Lecture Notes on Nursing Research Prepared By: Mark Fredderick R Abejo R.N, MAN General and Specific Purposes of Research Types of Research General Purposes Research in general, answer questions to solve problems. Provide tools for observation in order to generate knowledge as basis for predicting and controlling the phenomenon. Thus, a nurse can apply this knowledge in practice and prescribe accurately and professionally without untoward client response or reactions to nursing interventions. (Polit and Beck, 2004 ) 1. General Classification Specific Purposes Specifically, research aims to do the following tasks:  Description  Exploration  Explanation  Prediction  Control  Basic / Pure Research The researcher tries to find the truth about something. It is done for the intellectual pleasure of learning to search for knowledge for its own sake and eventually filter down the result into real life situation.  Applied Research Applied research seeks for practical application of theoretical or abstract knowledge. The truth is adapted to every situation. It results from present problems or from socially disorganized situations. It frequently raises theoretical questions that must be answered by basic/ pure research. Research Purpose Related to Evidence- Based Practice       Treatment, Therapy or Intervention Diagnosis and Assessment Prognosis Prevention of harm Etiology or causation Meaning and Process Purpose of Conducting Applied Research  To solve a problem  To make a decision  To develop a new program, product, methods and procedure  To evaluate program and methods.  Action Research The process involves the study of certain problem and from that experience, decisions, actions and conclusion are drawn. Findings are limited to settings actually studied. 2. According to Level of Investigation  Exploratory Research Allows one to study the variables pertinent to a specific situation.  Descriptive Research The exploration and description of phenomena in real life situation. Provides an accurate account of characteristics of particular individuals, situations or groups. 3. According to Time Element  Historical Research Describes what was?  Descriptive Research Describes what is? 4. According to Duration  Longitudinal Study Follows the subjects for a long period of time in order to observe change. Paradigms for Nursing Paradigms – an overall belief system, a view of the world that strives to make sense of the nature of reality and the basis of knowledge. MAJOR ASSUMPTIONS OF THE POSITIVIST AND NATURALISTIC PARADIGMS Positivist Paradigm Nature of reality Relationship bet. Researcher and those being researched The role of values in inquiry Best method for obtaining evidence Reality exist Naturalistic Paradigm Reality is multiple and subjective Inquirer is independent from those being researched Inquirer interacts with those being research Values and biases are to be held in check Subjectivity and value are inevitable Deductive processes Emphasis on discrete, specific concept Focus on objectives Verification of researchers predictions Fixed designed Outsider knowledge as external Measured Seek generalization Focus on the product Inductive processes Emphasize on whole Focus on the subjective Flexible Insider knowledge as internal Narrative information Seek in depth understanding Focus on the product and process Introduction to Nursing Research Abejo
  3. 3. Lecture Notes on Nursing Research Prepared By: Mark Fredderick R Abejo R.N, MAN  Cross – sectional Study Takes information one at a time and may require subjects to recall past events or feelings. It may contribute to a loss of accuracy and support bias. It is more often done than the longitudinal studies 5. According to Research Design  Correlational Research Involves the systematic investigation of relationship between or among variables. This design is used to quantify the strength of the relationships in the real world. This design is used to quantify the strength of the relationship between variables or in testing a hypothesis about a specific relationship.  Non Experimental The researcher collects data without introducing any treatment or making any changes. Non experimental research usually includes studies where the researcher’s primary interest is understanding some human behavior in naturalistic contexts. Qualitative Research A systematic, interactive, subjective approach used to describe life experiences and give them meaning. A type of research conducted to describe and promote understanding of human experiences. Evolved from the behavioral and social sciences as a method of understanding unique, dynamic, holistic nature of human beings. Approaches in Qualitative Research  Phenomenological Research Used to answer questions of meaning Begin with accumulation of evidence when little topic is known or when studying new topic it involves gathering of fresh perspective. The goal of phenomenological inquiry is to understand fully lived experience and perceptions. Aspects of Lived Experience involves: a. Lived Space (spatiality) b. Live Body (corporeality) c. Lived Time (temporality) d. Live Human Relation (relationality)  Grounded Theory Research Method designed to inductively develop a theory based observations of selected people. The primary purpose of grounded theory research is to develop a theory. The concepts and theories discovered through this research approach are derived directly from the data. The following are the major premises of grounded theory:  Humans act toward objects on the basis of the meaning those objects have for them.  Social meaning arise from social interaction  People use interpretive processes to handle and change meanings in dealing with their situations. Fundamental characteristic of grounded theory research is that data collection, data analysis and sampling of participants occur at the same time. In depth interview and observation are the most common data source.  Ethnographic Research A tool for studying cultures It has been associated with studies of primitive, foreign or remote cultures which allows the researcher to acquire new perspectives beyond his/her own ethnocentric perspective. Experimental An objective, systematic, highly controlled investigation for the purpose of predicting and controlling phenomena in nursing practice. The researcher actively introduces some form of treatment and has greater control over extraneous variables.    Quasi – Experimental Is like experimental research because it actively introduces some form of treatment or manipulation of an independent variable. Unlike experimental research, however, it does not utilize randomization or control group. Nursing Research Methodologies  Quantitative Research A formal, objective, systematic process in which numerical data are used to obtain information about the world. This method is used to describe variables, examine relationships among variables and determine cause and effect interactions between variables. Rigor in Quantitative Rigor is the striving for excellence in research and it requires discipline, adherence to detail and strict accuracy. Control in Quantitative Involves the imposing of rules by the researcher to decrease the possibility of error. Introduction to Nursing Research Abejo
  4. 4. Lecture Notes on Nursing Research Prepared By: Mark Fredderick R Abejo R.N, MAN   Narrative Research Focus on story as the object of inquiry, to determine how individuals make sense of events in their lives. The data can be collected as a story or filed notes. It may be used for comparison among groups, to learn about a social phenomenon or historical period or to explore a personality COMPARISON OF QUANTITATIVE AND QUALITATIVE RESEARCH Quantitative Design / Planning Phase Empirical Analytical Phase Dissemination Phase Selecting research design Develop protocol for intervention Design sampling plan Develop methods to safeguard rights Collecting data Preparing data analysis Analyze the data Interpreting the results Communicating findings Utilizing findings in practice Introduction to Nursing Research Qualitative Topic identification Situation appraisal Develop hypotheses Framework development Objective formulation Research plan formulation Analytical Objectives Data analysis and interpretation Conclusion Communicating and utilizing the findings Instrument use more flexible, repetitious style of eliciting and categorizing responses to questions To quantify variation To predict causal relationship To describe characteristics of a population Question Format Data Format Flexibility in Design Data gathering and collection Seek to explore phenomena Use highly structured methods such as questionnaires, survey and structured observation COMPARISON ON PHASES OF COMPARISON OF QUANTITATIVE AND QUALITATIVE RESEARCH Quantitative Formulating problem Review related lit. Defining framework Formulating hypotheses Seek to confirm hypotheses about phenomenon Instrument use more rigid style of eliciting and categorizing response to question General Framework Case Study Involves an in-depth description of essential dimension and processes of the phenomenon being studied. Are means of providing in depth, evidence base discussion of clinical topics along with practical information Conceptual Phase Qualitative Close - ended Use semi structured methods such as in depth interviews, focus groups and participant observation To describe variation To describe and explain relationship To describe individual experiences To describe group norms Open – ended Numerical Study design is stable from beginning to end Textual Some aspects of the study are flexible. Participant responses do not influence or determine how and which questions researchers ask next Participant responses affect how and which questions researchers ask next Study design is subject to statistical assumptions and conditions. Study design is repetitious, that is, data collection and research question are adjusted according to what is learned. Abejo
  5. 5. Lecture Notes on Nursing Research Prepared By: Mark Fredderick R Abejo R.N, MAN CONTRAST OF QUANTITATIVE AND QUALITATIVE RESEARCH APPROACHES Element View of reality View of time Context Researcher Approach Population Studied Measures Observations Quantitative Reality is objective and can be seen and measured Reality is relatively constant Reality can be separated from context Objective, detached Samples that represent overall populations, as subjects Human behavior or other observable phenomena Analyze reality as definable variables Design Preconceived and highly controlled Analysis Descriptive and inferential statistics Use inference to generalize from a sample to a defined population Objective, impersonal reports in which researcher’s opinions are undetectable Generalization Reports Qualitative Reality is constructed by the individual Reality is continuously constructed Reality is embedded in its context Links between concepts Logical reasoning processes Quality of evidence Parts/phases of research output Personally involved Individual cases, represented as informants. Patterns Deductive reasoning Inductive reasoning Reliability, validity, generalization Statement of the problems Results Literature review Sampling Study framework Main problem Specific problem Interview guide Data analysis Method Trustworthiness Aim of the study Findings Reconnaissance Selection Study simulacrum Central question Issues Aide memoir Mode of analysis Design Study the meaning that individuals create  Outcome Research This method examines the results of care and measures the change in health status of clients. The following are areas that require investigation through outcome research:  Clinical client response to medical and nursing interventions.  Functional maintenance or improvement of physical functioning  Financial outcomes achieved with most efficient use of resources.  Perceptual client’s satisfaction with outcomes, care received and providers.  Intervention Research Involves the investigation of the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in natural setting. Intervention research should be theory driven, which means that the theory determines the nature of the intervention, the health professionals to deliver the intervention, the setting where the intervention is to be provided, the type of client to receive the intervention and the selection and measurement of outcome variables. Make holistic observations of the total context Emergent and fluid, adaptable to informant’s views Analytic induction to determine meaning Transfer knowledge from case analysis to similar cases Interpretative reports that reflect the researcher’s reconstruction of the meaning of the data JARGONS QUANTITATIVE AND QUALITATIVE RESEARCH APPROACHES Concepts Person contributing information Quantitative Study participant Qualitative Study participant Respondents Person undertaking the study That which is being studied Researcher, investigator Informant, Key informant Researcher, investigator Concepts Variables Phenomena Concepts Variables Information gathered Data (numeric value) Data (narrative descriptions) Introduction to Nursing Research Relationships (causal,functional) Components of Scientific Research  Order and system  Control  Empiricism  Generalization Characteristics of Research    It involves the gathering of new data from new sources or first-hand information. It is directed towards the solution of a problem It is characterized by carefully designed procedures applying rigorous analysis Abejo
  6. 6. Lecture Notes on Nursing Research Prepared By: Mark Fredderick R Abejo R.N, MAN        It emphasizes the development of generalizations, principles hypotheses and theories that may be helpful in predicting future occurrences. It requires expertise It demands accurate observation and description of what is being studied. It strives to be logical, applying every possible test to validate the procedures being employed. It is characterized by patient and unhurried activities. It requires innovative approaches and determination to succeed. It is carefully and accurately recorded and reported. Qualities of a Good Researcher R - Research Oriented E - Efficient S - Scientific E - Effective A - Active R - Resourceful C - Creative H - Honest E - Economical R - Religous Limitations of Research      Result of faulty planning and implementation of the project. The individual researcher The scope of knowledge or information available about the topic and the problem under study also must be considered. Sources of data The tools of measurement may be inadequate or entirely lacking. The Consumer-Producer Continuum in Nursing Research Consumer of Research  Producer of Research The consumers of research are nurses at one end of the continuum whose involvement in research is indirect. These nurses: Reasons for Lack of Clinical Research 1. 2. 3. 4. 5. 6. 7. Identify clinical problems in nursing practice Use library and information technology resources. Read research reports to develop new skills and search for relevant findings that affect practice. Participates in journal clubs Use research to solve clinical problems Use research in clinical decisions Collaborate in developing an idea for a research project. Reviews a research proposal for feasibility and offer suggestion to improve the plan. Assist in data collection Participate in research study or survey Lead a journal club or ground discussion. Participate in unit or service based research councils. Nurses tend to feel that they are “too busy to care for patients”. Unless the nurse has had academic training in theoretical conceptualizations, research may not seem important. Unless the importance of research is felt and recognized, nurses may not be able to identify researchable problems. Many nurse do not have the academic training needed to feel confident in doing clinical research. The ethics or research tends to researchers. Fear of harming a patient is also a hindrance to some researchers. Unless administrators are research-oriented, the nursing staff feels the futility of support for nursing research, hence, there is no motivation to pursue this. Research takes time, time costs money which must be budgeted.  Characteristics of the Good Nurse Researcher           Honest and Credible Intellectual Curiosity Accurate in his/her data Organized and Systematic Prudence Logic Self- Awareness Healthy Criticism Intellectual Honestly Good Relationship with his/her respondents Designing and implementing studies Conducting studies Disseminating research findings Appraising the clinical relevance of research findings. Provides leadership for integrating findings in clinical practice. Nursing Research Function of Nurses 1. Introduction to Nursing Research The producers of research at the other end of the continuum are the nurses who actively participate in: Guidelines for the Investigative Associate Degree in Nursing Demonstrates awareness of the value or relevance of research in nursing Assists in identifying problem areas in nursing practice. Assists in collection of data within an established structured format. Abejo
  7. 7. Lecture Notes on Nursing Research Prepared By: Mark Fredderick R Abejo R.N, MAN 2. Baccalaureate Degree in Nursing Reads, interprets and evaluates research for applicability to nursing practice. Identifies nursing problems that need to be investigated and participates in the implementation of scientific studies. Uses nursing practice as a means of gathering data and refining and extending practice. Applies established findings of nursing and other health related research to nursing practice. Shares research findings with colleagues. 3. Master’s Degree in Nursing Analyzes and reformulates nursing practice problems so that scientific knowledge and scientific methods can be used to find solutions. Provides expertise in clinical problems by providing knowledge about the way clinical services are delivered which enhances quality and clinical relevance of nursing. Facilitates investigation of problems in clinical settings by contributing to a climate of supportive investigative activities, collaborating with others in investigations and enhancing nurse’s access to clients and data. Investigates for the purpose of monitoring the quality of nursing practice in a clinical setting. Assists others in applying scientific knowledge in nursing practice. 4. Ethics in research requires honesty and accuracy of data. The researcher must guarantee factual and evidenced based data. There should be no “plagiarism” such as presenting the ideas or words of another as one’s own, nor distort or fabricate data for purposes of completing the research on time. The Philippine Copyright Law (R.A No. 8293 ) protects the intellectual property rights of authors and artist . Doctorate Degree in Nursing or Related Discipline Provides leadership for the integration of scientific knowledge with others types of knowledge for the advancement of practice. Conducts investigations to evaluate the contributions of nursing activities to the well-being of clients. Develops methods to monitor the quality of nursing practice in a clinical setting and to evaluate contributions of nursing activities to the well-being of clients. Role of Nurses in Research       As Principal Investigators As Member of a Research Team As Evaluator of Research Findings As Consumers of Research Findings As Client Advocate in a Research Study As Subject of Research _________________________________________ References: 1. 2. Ethics in Research 3.   4.   Informed Consent Beneficence and Non-maleficence Freedom from any Physical and Psychological Harm Freedom from Exploitation Respect for Human Dignity The right to self determination The right to full disclosure Anonymity and Confidentiality Justice and Fairness Introduction to Nursing Research 5. 6. 7. Venzon. 2004. Introduction to Nursing Research: Quest for Quality Nursing, 1st ed. Philippines: C&E Publishing Inc. Barrientos-Tan. 2006. A Research Guide in Nursing Education, 3rd ed. Philippines: Visual Print Enterprises. Reyes & Layug. 2009. Comprehensive Reviewer for the Nurse Licensure Exam, Philippines: East West Educational Specialists, C&E Publishing Inc. Brink & Wood. 2001. Basic Steps in Planning Nursing Research, 5th ed. Philippines: Jones and Bartlett Publisher Inc. Burns & Grove. 2007. Understanding Nursing Research : Building an Evidence-Based Practice, 4th ed. China; Elsevier, Health Sciences. LoBiondo-Wood & Haber. 2006. Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice, 6th ed. USA: Mosby Inc. Polit & Beck. 2008. Nursing Research: Generating and Assessing Evidence for Nursing Practice, 8th ed. Philadelphia: Lippincott Williams & Wilkins. Abejo