Paradigm Shift in Nursing Research

1. Paradigm Shift in Nursing
Research
Prof. Dr. Ram Sharan Mehta
Medical-Surgical Nursing Department
College of Nursing, BPKIHS
Prof. Dr. Ram Sharan Mehta,BPKIHS 1
Research Conference on, “Changing Paradigm in Nursing Research”
Welcome

2. “Knowledge, like muscles, must be
nourished constantly and used frequently
to retain function. Learning like motion, is
more easily maintained if it's momentum
has not been interrupted.”
Prof. Dr. Ram Sharan Mehta,BPKIHS 2

3. Presentation Outlines:
• Introduction
• Situation analysis
• Plans and policies
• Gap and way forward
Gap and way forward
Prof. Dr. Ram Sharan Mehta,BPKIHS 3

4. Prof. Dr. Ram Sharan Mehta,BPKIHS 4

5. • Nursing is both an art and a science.
• Globally nurses comprise the largest healthcare workforce,
and nursing interventions can positively impact healthcare
delivery, Clinical, and economic outcomes.
• There are approximately 28 million nurses worldwide (ICN).
• In Nepal approximately one lakh nurses are working
• Despite efforts to promote evidence-based nursing, there
is a gap between research findings and clinical practice
Prof. Dr. Ram Sharan Mehta,BPKIHS 5

6. Prof. Dr. Ram Sharan Mehta,BPKIHS 6

7. Why Research is Important?
Research Provide scientific basis for:
• Description: about existing and new knowledge
• Explanation: about the existing knowledge in relation to the
effect and the outcome
• Prediction: predict the outcome of intervention
• Control: ability to write prescription
Prof. Dr. Ram Sharan Mehta,BPKIHS 7

8. Areas of Nursing Research:
Ultimate aim of Nursing Research is to Provide Quality Patient care
Areas:
• Service: Health Promotion & Disease Prevention
-Health Promotion: Diet, Exercise, Hand-washing, patient Safety,
Quality of Health Care, Nursing Staff etc.
- Disease Prevention: Quality Nursing Care, Resource use,
infection control, Oxygen use, IVI etc.
• Education: Student Learning, Teaching Learning, Quality Education
• Administration: Evaluation of Employee, Supervision, Communication
Prof. Dr. Ram Sharan Mehta,BPKIHS 8

9. There is no “best type” of research
or “best way” of doing research.
• It depend on:
- Context
- Assumptions
- paradigm
- Perspective
Decide the type of research
methodology to be used to study
phenomena.
Prof. Dr. Ram Sharan Mehta,BPKIHS 9

10. Research Paradigm:
(Philosophical Assumptions of Research)
Paradigm:
• Way of looking at the Phenomenon, Society, Nation & world
• School of thought
• Frame-work of thinking
• Set of assumptions
• Ideology or Mind Set
About how research ought to be conducted to find out truth.
Prof. Dr. Ram Sharan Mehta,BPKIHS 10

11. Paradigm
Paradigm consists of:
Ontology
Epistemology
methodology
Prof. Dr. Ram Sharan Mehta,BPKIHS 11

12. Prof. Dr. Ram Sharan Mehta,BPKIHS 12

13. 1. Ontology: Realism- Objective, real, facts
Relativism- Subjective, multiple response, interpretivism
2. Epistemology: Positivism- survey research, RCT, Exp/Quasi-exp study
Interpretivism- Case study: individual or Social,
Action Research (find Problem & solve),
Ethnographic studies etc.
3. Methodology: Quantitative- Math/Stat Calculation
Qualitative- Quality
Ontology + epistemology = Research Philosophy (fill Knowledge gap or Solve Problem)
Research Philosophy + Research methodology = Research Paradigm
Research Paradigm is important basis for research foundation
Prof. Dr. Ram Sharan Mehta,BPKIHS 13

14. Different Types of Research Paradigm
(Brief Review: Concepts & application in Nursing Research)
• Positivist Paradigm: (Auguste Comte, 1830-1842)
• Post-positivist paradigm: (Karl Popper, 1960-1970)
• Constructive (naturalistic) paradigm: (Jean Piaget, 1896-1980)
• Pragmatic Paradigm: (John Dewey, 1870)
• Interpretive paradigm: (Giambattista Vico, 18th Century)
• Modern Paradigm: (Francisco Goya, Late 19th to early 20th Century)
• Post-modern paradigm: (Jean-Francosis Lyotard, 1979)
• Neo-modernism Theory: 2001, Uphold Spiritual & Aesthetic Value in art.
• Critical Theory (ideology): (Max Horkheimer, 1937)
• Emancipatory Theory: ( Abraham Lincoln, 1863) (US: forever free slaves)
• Others:
Prof. Dr. Ram Sharan Mehta,BPKIHS 14

15. • Positivist Paradigm: (Auguste Comte, 1830-1842)
- Reality exists, Single Reality, Truth is Real
- Tight control of study,
- Deductive study (Specific to general)
- Objectivity and Quantification: Quantitative study
- Contrast to Subjectivity: Opinion, belief, and feeling
• Post-positivist paradigm: (Karl Popper, 1960-1970)
- Milder form of Positivism ( allow more interaction):
e.g. Interview using participatory observation.
- seek probabilistic evidence: survey, questionnaire,
case study.
Prof. Dr. Ram Sharan Mehta,BPKIHS 15

16. • Constructive paradigm: (Jean Piaget, 1896-1980)
- Qualitative phenomenon: Empathy, belief, Value, feeling etc.
- Reality is multiple and subjective
- researcher interacts with those being researched
- subjectivity is desirable
- Emphasis: dynamic, holistic, individual aspects
- difficult to replicate, small sample size
• Pragmatic Paradigm: (John Dewey, 1870)
- Concern with practical issues, Learning by experience
- Real life problems, Single or Multiple reality
- Reality continuously change
- subjective in Nature, have multiple reality
- combine both Positivist + Constructivist approach
- use both quantitative and qualitative method: Mixed Method
• Critical Theory (ideology): (Max Horkheimer, 1937)
- each person has their own ideology,
- individual interpretation and explanation is vital
Prof. Dr. Ram Sharan Mehta,BPKIHS 16

17. Examples of research studies for differed Paradigm:
• Positivist: God Exist / God Not Exist, Yes/No
• Post-Positivist: Participant observation – Discharge teaching practice
among nurses
• Constructivist: Use both Qualitative and Quantitative – Burn out
among the nurses
• Pragmatist: Problems experience by night duty nurses
Problems experience by nurses in doctors round
Prof. Dr. Ram Sharan Mehta,BPKIHS 17

18. Paradigm Shift
Prof. Dr. Ram Sharan Mehta,BPKIHS 18
2008
Singapore
A change from one way
of thinking to another.

19. “Small shifts in your thinking, and
small changes in your energy, can
lead to massive alterations of your
end result.”
― Kevin Michel
Prof. Dr. Ram Sharan Mehta,BPKIHS 19

20. Examples of Paradigm shifts:
• Wearing Torn Cloth: now a days is fashion : buyer, seller, maker-feel Proud
(Mind Set)
• Self-talk in street alone: using ear phone. I have seen in Metro.
• Use of social-media for advertisement: FB, Instagram, Tik Tok etc.
• In Hospital Service: Health Insurance Policy
• Nurse: Sari, belt, cap dress Change as per comfortable
Prof. Dr. Ram Sharan Mehta,BPKIHS 20

21. Factors for Paradigm Shift:
• Evidence Based Research Result
• Social Change
• Nature of Learner
• Privatization
• National and International Needs
• Social Needs
• Human Needs
• Growing Storage of Knowledge …
Prof. Dr. Ram Sharan Mehta,BPKIHS 21

22. Factors for Paradigm Shift …
• Rapid changes in technology: Machines & Equipment
• Digital Health Care: mobile health, Telehealth, digital monitoring
• Globalization of health care industries
• Revolutionary changes in medical care: Drugs, therapies
• Sky rocketing cost of medical care
• Sicker patients increases
• Pay for performance: home care nurse, private nurse
• Geriatric Population
• Philosophy in life: paid geriatric homes
• Government policy: Health is Fundamental Right, Health Budget,
Health Insurance, Bipanna Nagrik Kosh etc.
Prof. Dr. Ram Sharan Mehta,BPKIHS 22

23. “Education is the Key to Unlock
the Golden Door of Freedom”
Prof. Dr. Ram Sharan Mehta,BPKIHS 23

24. Curriculum Design
Aims Teaching
Goals Contents Learning Evaluation
Objectives Activities
Epistemology
(the nature of
Knowledge)
Society/
Culture
The
individual
Learning
theories
Philosophical Assumptions

25. Superior Knowledge
Inferior Result
Prof. Dr. Ram Sharan Mehta,BPKIHS 25
Cause confusion & Frustration
(as Nurses Experience)
e.g. Nursing Curriculum : CN, BNS/BSN, MSN

26. Importance of Paradigm Shift:
•For inculcation of up to date knowledge
•For fulfilment of Human Needs
•For fulfilment of social Needs
•For intellectual development
•For: Social, Economic & Political development of Nation
Prof. Dr. Ram Sharan Mehta,BPKIHS 26
“No body want to read the old magazine”

27. Paradigm shift in clinical Nursing:
(After Covid -19)
• Telehealth
• Home-based care: Elderly, Rehabilitation, Palliative
• Expanded Nursing Skills: Nurse Led Health Clinics
• Autonomy: at bed side care
• More Connect with patient
• Focus on: community & public health Nursing
• Infection prevention policy: Isolation & Quarantine
• Advances in : cleaning, spraying and disinfection
• More focus on health care workers: asset
• Digital Technology: in surveillance, Health Education
• Focus on CNE
Prof. Dr. Ram Sharan Mehta,BPKIHS 27

28. Existing Focus on Research:
•Majority of nursing research conducted is Quantitative
•In Nursing Schools and Colleges more focus is given in
teaching quantitative study
•Hence, KAP ( knowledge, attitude and practice) study
is in more practice.
Prof. Dr. Ram Sharan Mehta,BPKIHS 28

29. Current Trends in Nursing and Health Research:
• Continue Focus on EBP: e.g. Chital Forceps
• Development of stronger evidence based through multiple confirmatory
strategy: e.g. Intermittent fasting increase cardiac load
• Greater emphasis of Systematic review: Meta-analysis
• Expanded local research in Health settings: e.g. Hill, Mountain, Terai
• Strengthening inter-disciplinary collaborations: e.g. HIV, Kala-azar
• Expanded dissemination of research findings: NHRC, this conference
• Increasing the visibility of nursing research: Conference, BSN, MSN
• Increasing focus on cultural issues and health disparities: e.g. FP & Muslim
Community, Food practices in Different communities…………..
Prof. Dr. Ram Sharan Mehta,BPKIHS 29

30. Current Trends in Nursing and Health Research …
• Focus on Qualitative Research
• Shared decision making: Group research - more ideas
• Feminism: female issues
• Focus on ethical issues: earlier it was ignored or not mandatory
• Use of new software's in data analysis: for both qualitative & Quantitative
• PhD degree in Nursing & Post-doc. Degree in Nursing
Other Trends in Health Science Research are:
• Use of Artificial Intelligence (AI) in Research: Proposal, Analysis, Presentation
• Focus on Rehabilitation of the subject: to recover from placebo or drug effect.
• Animal study to cell culture study
• Biochemical study to Molecular or Genetic study
• Focus on Nutritional study: e.g. Vitamin D, Folic Acid , Vitamin A etc.
• Others: many more
Prof. Dr. Ram Sharan Mehta,BPKIHS 30

31. Barriers in utilization of nursing research:
• Absence of published research on specific clinical issues
• Published research may have limitations (sample size, design): lack
generalization
• Nurses may lack experiences in reading and critiquing research
report
• Difficulty in interpreting study designs and statistical findings
• Health care system pays little attention to research in nursing
• Lack of access to research literature for bedside clinical nurse
• Staff-Nurse not read research journals
Prof. Dr. Ram Sharan Mehta,BPKIHS 31

32. What we can do?
Prof. Dr. Ram Sharan Mehta,BPKIHS 32

33. Managing change:
Reasonable man adapts himself to
world; the unreasonable one persists
in trying to adapt others to himself.
- Peter F Druker
History of Dinosaurs?
33
Prof. Dr. RS Mehta, BPKIHS

34. •An important paradigm (or worldview) shift is
occurring in science that affects the nature of
nursing education, practice, and research.
•The shift from positivism to postmodernism and
now to Neomodernism has received little
attention in US nursing and as such may forestall
many opportunities related to such change.
Prof. Dr. Ram Sharan Mehta,BPKIHS 34

35. Prof. Dr. Ram Sharan Mehta,BPKIHS 35

36. Prof. Dr. Ram Sharan Mehta,BPKIHS 36

37. Prof. Dr. Ram Sharan Mehta,BPKIHS 37

38. Life in 2050: Every thing in a Smart Card
(Connect with watch or Jewellery)
• Smart Card: Mobile, credit card, debit card, Voice calling, watching Videos,
Chatting, Surfing, News Paper etc.
• Smart phone will be obsolete
• Strong Digital Presence: 2030=70% Population, 2050=100% population
• Cloths: digitally connected (≥60%)
• Social Network Integration: Personality, History, Centralized data base
(e.g. YouTube News now a days - Comprehensive)
• Universal Translators: Different language interpretation by earphone,
Language will not barrier, no need to study, you can visit any country

39. we can not stop these change. So What we can do?
Paradigm Shift: Innovation Framework
(ABCDE)
A= Analyse, B= Brain Strom, C= Create, D= Deliver, E= Evaluate
• Paperless network ( paperless hospital, I have seen in Singapore, 2008)
• Self-driving Vehicle: US, Tesla Car, 50 KM radius, operate by mobile
application, I have seen in US in 2017
• Flying Vehicles, Drown Taxi, Drown Ambulance
• Superhuman Machines: Replace Human and robotic works
• Cooperate audit system: online system
• Virtual Vacation: Experience architecture- 3600 View(Football match-home)

40. Take Home Message:
• Priority should be given to Qualitative study
• Nursing faculty should train to teach qualitative study
• NHRC: must empower nurses in Nursing Research
• Advocacy/Action Role of Nursing Leader to strengthen Nursing
Research: with NHRC, MEC, NNC, MOHP, etc.
• Role of Professional organization (e.g. NAN): Advocacy,
Training, Conference, Grant, Co-ordination, Facilitation etc.
Prof. Dr. Ram Sharan Mehta,BPKIHS 40

41. “Paradigm shift is for the mindful; but
those who refuse to adopt to new
ways of looking at things will always
catch yesterday's train, flight or bus.”
― Dr. Lucas D. Shallua
Prof. Dr. Ram Sharan Mehta,BPKIHS 41

42. “Knowledge has a Beginnings
……….But No End”
Thank you
Prof. Dr. Ram Sharan Mehta,BPKIHS 42