Research

NURSING RESEARCH
Prepared by:
Adrian R. Adriano, R.N., R.M., M.A.N.

RESEARCH
 From an etymological context, re-search simply
mean means “to search again”
 cerchier - meaning to seek or to search
 re – repetition

 A systematic, empirical, controlled and critical
investigation of a hypothetical proposition related to
natural phenomenon (Kerlinger)

RESEARCH
 An honest, scientific investigation undertaken for
the purpose of discovering new facts which will
contribute to the present body of knowledge and
can lead to effective solution of existing problems
(Philippine Nurses Association Research
Committee)

PURPOSES OF RESEARCH
 Description
 Research aims at describing a phenomenon that relates
to the nursing profession.
 It also observes, defines and documents nursing
situation inquiry

 Explanatory
 Research seeks clarification of a prevailing situation to
answer questions that ask “why” a phenomenon
occurred. “Why does this happen?”

 Exploration
 Research explores the phenomenon by observing and
recording events and situations occurring in that
phenomenon.
 It answers “what” questions on the phenomenon
searching for illustrative examples in order to become
familiar with the phenomenon and understand it more
precisely and accurately

 Experimentation
 Research anticipates possible psychological and
physiological reactions to nursing interventions.
 Research provides a basis for decisions by eliminating
barriers and sourcing ways and strategies that would
bring about effective client care outcomes

PHASES OF RESEARCH
 Conceptual Phase
 Design and Planning Phase

 Empirical Phase

 Analytical Phase

 Dissemination Phase

CONCEPTUAL PHASE
 Formulate and Delimit the Problem
 Review the Related Literature

 Develop a Theoretical/Conceptual Framework

 Define the Variables

 Formulate the Hypothesis

DESIGN AND PLANNING PHASE
 Select Research Design
 Formulate Treatment Program

 Identify the Population to be Studied

 Design the Sampling Plan

 Specify Methods to Measure Variables

 Apply Ethical Principles

 Review and Finalize Research Plan

EMPIRICAL PHASE
 Collect the Data
 Prepare Data for Analysis

ANALYTICAL PHASE
 Analyze the Data
 Interpret the Results

DISSEMINATION PHASE
 Communicate the Findings
 Utilize Research Evidence in Practice

STEP 1 – THE PROBLEM
 Problem –a situation in need of a solution

 Criteria of a Good Research Problem: FIRES
 Feasible
 Interest
 Researchable
 Ethical
 Significant

 Sources of a Good Research Problem: CLIENT
 C - Concepts
 L - Literatures
 I - Issues
 E - Essays
 N - Nursing Problems
 T - Theories

 Title
 A general idea of what the research study is all about
 A research title must be clearly stated, concise, and
should be limited to at most 15 words at least
(Neiswiadomy, 2008)

 Introduction
 Also known as the background of the study
 The introduction serves as the spring board for the
statement of the problem and includes:
 The context of the problem and its historical background
 Authoritative viewpoints on the problem

 The researcher‟s interest in working on the problem

 The purpose of the study in relation to the problem

 Statement of the Problem
 Refers to the question that the research seeks to
answer and is stated consists of:
 MAJOR PROBLEM – the main issue to be answered
 MINOR PROBLEMS – sub-problems which reflects the

objectives of the study
 And may be of two forms:
 INTERROGATIVE FORM - question form
 DECLARATIVE FORM – sentence form

 Purpose of the Study
 Describes the intent of the inquiry and the rationale for it
 GOALS – expressed in broad statement of purpose
 OBJECTIVES – expressed in a statement that pinpoints the

main concern or intent of the inquiry SMARTER
 S - SPECIFIC

 M - MEAURABLE

 A - ATTAINABLE

 R - REALISTIC/RESULT ORIENTED

 T - TIME-BOUND

 E - EVIDENCED-BASED

 R - REWARDING

 Assumptions
 Statements or assertions taken for granted or are
considered true eve if they have not yet to proven
scientifically and has three types:
 UNIVERSAL ASSUMPTIONS – beliefs taken as true by most
people, and still need testing or verification
 STUDY ASSUMPTIONS – assertions needed in the pursuit of

the study
 RESEARCH-BASED ASSUMPTION – generated by previous

research in a field of study

 Definition of Terms
 Facilitates better understanding of the study by
explaining the meaning of terms or variables as they are
used in the study and is of 2 types:
 CONCEPTUAL DEFINTION –
SUBJECTIVE/THEORETICAL/TEXTUAL DEFINITION a
definition universally understood taken from books,
encyclopedia, dictionary
 OPERATIONAL DEFINITION –

OBJECTIVE/PRACTICAL/FUNCTIONAL DEFINITION the
researcher‟s own definition of terms as used in the study
 LEXICAL/AUTHORITATIVE DEFINITION – taken from

authorities on the subjects or terms being defined

 Significance of the Study
 Cites the importance, responsiveness, or relevance of
the expected outcomes of the investigation and its
probable effects on a nursing theory or practice and
should benefit:
 NURSING PROFESSION
 PUBLIC

 NURSING SERVICE

 NURSING EDUCATION

 NURSING PRACTITIONERS

 NURSING STUDENTS

 HOSPITAL ADMINISTRATORS

 Scope and Delimitation
 SCOPE– spells the context of the study in terms of
subject, concepts, and specific characteristics of the
phenomenon, treatment, sampling and time frame
 DELIMITATION –sets the parameters of the study by
accepting what should be included, and rejecting what
should be excluded

STEP 2 – RELATED LITERATURE REVIEW
 Literature Review
 Consists of a collection of pertinent readings, published
or unpublished, data-based research reports or article,
in local or foreign settings and has two types:
 CONCEPTUAL/THEORETICAL LITERATURE – non-research
reference materials
 RESEARCH/EMPIRICAL LITERATURE – studies and

researches or theses dissertations whether published or
unpublished

 The primary purpose is to know what is already known
and unknown on the topic and has two sources:
 PRIMARY SOURCES – a research study written by the
original researcher
 SECONDARY SOURCES – a research study written by

someone other than the researcher

 Plagiarism – publication of another author's ideas, or
expressions as one's own original work
 SUMMARIZING – author‟s idea is shorten and expressed
briefly
 QUOTING – direct verbatim reproduction of the actual

statements of the author
 PARAPHRASING – material is stated in researcher‟s own
words
 ACKNOWLEDGING – citing the author of the material

 FOOTNOTES – citing reference at the bottom of the page

 ENDNOTES – placed at the end of the sentence of an

article, chapter, book or essay

 Electronic Literature Searches
 CINAHL – Cumulative Index to Nursing and Allied
Health Literature
 MEDLINE – Medical Literature Online
 Cochrane Database
 EMBASE – Excerpta Medica databse
 PsycINFO – Psychology Information

STEP 3 – FRAMEWORK
 Construct
 Highly abstract, complex phenomena that are not
observable
 Concept
 A basic idea about a phenomenon
 Proposition
 A statement of the relationship between concepts
 Theory
 A supposition or system of ideas that are interrelated
 Framework
 The structure of the idea or concept and how it is put
together

 Theoretical Framework
 A study based on a theory
 A structure which uses deductive reasoning to make
predictions about how phenomena would behave if the
theories were true

 Most Commonly used by nurse researchers
 MCGILL THEORY OF NURSING (Moyra Allen) –
Nursing is the science of health-promoting interactions

 OPEN SYSTEMS (Imogene King) – Personal systems,
interpersonal systems, and social systems are dynamic
and interacting within which transactions occurs

 THEORY OF CULTURE CARE DIVERSITY AND
UNIVERSAILITY (Madeline Leininger) – Caring is a
universal phenomenon but varies transculturally

 CONSERVATION MODEL (Myra Levine) –
Conservation of integrity contributes to maintenance of
a person‟ wholeness

 HEALTH CARE SYSTEMS MODEL (Betty Neuman) –
Each person is a complete system; the goal of nursing
is to assist in maintaining client system ability

 HEALTH AS EXPANDING CONSCIOUSNESS
(Margaret Newman) – Health is viewed as an expansion
of consciousness with health and disease parts of the
same whole; health is an evolving pattern of the whole
in time, space and movement

 SELF CARE (Dorothea Orem) – Self care activities are
what people do on their behalf to maintain health and
well-being

 THEORY OF HUMAN BECOMING (Rosemarie Rizzo
Parse) – Health and meaning are co-created by
indivisible humans and their environment

 SCIENCE OF UNITARY HUMAN BEINGS (Martha
Rogers) – The individual is a unified whole in constant
interaction with the environment

 ADAPTATION MODEL (Sister Callista Roy) – Humans
are adaptive systems that cope with change through
adaptation

 THEORY OF CARING (Jean Watson) – Caring is the
moral idea, and entails mind-body-soul engagement
with one another

 BECKER”S HEALTH BELIEF MODEL (1976) – a
framework for explaining people‟s health-related
behavior

 LAZARUS AND FOLKMAN‟S THEORY OF STRESS
AND COPING (1984) – explain people‟s methods of
dealing with stress, posts that coping strategies are
learned

 AJZEN THEORY OF PLANNED BEHAVIIOR (1980)-
provides a framework for understanding the
relationships among a person‟s attitude, intentions, and
behavior

 BANDURA‟S SOCIAL COGNITIVE THEORY (1997) –
explains human behavior using the concepts of self-
efficacy, outcome expectations, and incentives

 Conceptual Framework
 A study based on a specified conceptual model

STEP 4 – DEFINING VARIABLES
 Variables
 Measurable qualities, properties, or characteristics of
people, things, events, or situations under study that
vary from one subject to another and can be classified
as:
 EXPLANATORY VARIABLES
 EXTRANEOUS VARIABLES

 Explanatory Variables
 Refers to the variables under study that varies or
assumes different values
 INDEPENDENT VARIABLES – (CAUSE) factors manipulated
by the researcher also called
EXPERIMENTAL/TREATMENT/CAUSAL/STIMULUS
VARIABLES
 DEPENDENT VARIABLES – (EFFECT) factors that are
affected by the independent variable also called
CRITERION/EFFECT/RESPONSE/OUTCOME VARIABLES
 INTERVENING VARIABLES – factors that can come between
the IV and DV and can influence the latter also called
CORRELATED/MEDIATOR VARIABLE

 Extraneous Variables
 Or EXOGENOUS VARIABLES are not the direct foci of
the study but tends to affect the result to certain extent
and has two types
 ORGANISMIC VARIABLES – physiological, psychological and
demographic factors of the population
 ENVIRONMENTAL VARIABLES – economic, anthropological,

sociological, and physical factors that influence the
phenomenon under study

STEP 5 – FORMULATING HYPOTHESIS
 Hypothesis
 Statements of the researcher‟s expectations regarding
relationship between and among variables under
investigation and can either be:
 SIMPLE HYPOTHESIS – states an expected relationship
between 1 independent variable and one dependent variable
also known as UNIVARIATE HYPOTHESIS
 COMPLEX HYPOTHESIS – predicts the relationship between
two or more independent variables and 2 or more dependent
variables also known as MULTIVARIATE HYPOTHESIS

 Hypothesis
 An intellectual proposition formulated to explain
observed facts or conditions in order to guide the
investigation further and can either be:
 RESEARCH HYPOTHESIS – statements of expected outcome
between variables also known as
SUBSTANTIVE/DECLARATIVE/ALTERNATIVE HYPOTHESIS
 NULL HYPOTHESIS – states that there is no significant
relationship between the independent and dependent variable
also known as STATISTICAL/SCIENTIFIC HYPOTHESIS

 Hypothesis
 It must be empirically testable and verifiable, which
means that it is capable of being tested in the “real
world” by observations gathered through the human
senses and can either be:
 DIRECTIONAL HYPOTHESIS – specifies clearly the
characteristics or qualities of the variables, the nature and
extent of relationship between variables and the expected
outcome of such relationship
 NON-DIRECTIONAL HYPOTHESIS - merely predicts the type

of relationship but does not predict the nature and extent of
relationship the specific qualities of the variables

STEP 6 – RESEARCH DESIGN
 Research Design
 The researcher‟s overall plan of how the study will be
conducted
 Contains details such as type of data to be collected,
the techniques or the means used to obtain these data,
basis of choosing subjects, how to determine sampling
size, instruments to be used
 The BLUEPRINT of the study and can either be:
 QUANTITATIVE
 QUALITATIVE

 Quantitative
 Associated with quantity
 Can perform mathematics
 And can be:
 EXPERIMENTAL
 QUASI-EXPERIMENTAL

 NON-EXPERIMENTAL

 Experimental Research Design
 An inquiry about the cause and effect relationship, and
is conducted in a specialized setting such as laboratory,
experimental unit, or research center and possess the
following characteristics
 MANIPULATION – the researcher subjects the respondents of
the study to a particular situation
 RANDOMIZATION – every subject has an equal chance of

being assigned to experimental or control group
 CONTROL – the researcher imposes certain conditions over

the experimental situation by assigning groups

 TRUE EXPERIMENTAL
 PRE-TEST POST-TEST CONTROL GROUP DESIGN
 POST-TEST ONLY CONTROL GROUP DESIGN
 SOLOMON FOUR GROUP DESIGN
 ONE SHOT CASE STUDY
 ONE GROUP PRE-TEST POST-TEST DESIGN

 TRUE EXPERIMENTAL
 Subjects are randomly assigned to the experimental
group and the control group to achieve treatment
equality of the group

 PRE-TEST POST-TEST CONTROL GROUP DESIGN
 Subjects are randomly assigned to experimental and
control group, and both groups are exposed to both pre-
test and post-test

 POST-TEST ONLY CONTROL GROUP DESIGN
 Subjects are randomly assigned to experimental and
control group, and both groups are exposed to post-test
alone

 SOLOMON FOUR GROUP DESIGN
 Subjects are randomly assigned to 2 experimental and 2
control group. 1 group from experimental and 1 group
from control group are pre-tested, the 2 experimental
groups receives treatment, and all the groups are given
post-test

 Pre-experimental Research Design
 ONE SHOT CASE STUDY
 A single group is exposed to an experimental treatment
and observed after the treatment

 Pre-experimental Research Design
 ONE GROUP PRE-TEST POST-TEST DESIGN
 Comparison between a group before and after the
experimental treatment

 Quasi-Experimental Research Design
 One of the elements of true experimental research is
missing
 NON-EQUIVALENT CONTROL GROUP DESIGN – like
pre-test post-test control group design
 TIME SERIES DESIGN – conducts repeated
observation before and after the intervention

 Non-Experimental Research Design
 No manipulation of variables and can be:
 DESCRIPTIVE – observe and describe a situation
 CORRELATIONAL – examine the strength of relationship

 COMPARATIVE – examine the difference between groups

 CROSS-SECTIONAL DESIGN
 Involves the collection of data at one point in time

 LONGITUDINAL DESIGN
 Studies designed to collect data at more than one point
in time over an extended period of time

 Qualitative Research Design
 PHENOMENOLOGICAL
 Deals with experiences of individuals within their lives,
the interpretations and meanings of individual
experiences
 LIVED EXPERIENCES OF CALL CENTER AGENTS
WITH HIV

 ETHNOGRAPHIC
 Deals with the holistic view of the culture, mapping the
cognitive world of a culture, and the culture‟s shared
meanings
 THE LIFESTYLE, BELIEFS, AND HEALTH HABITS OF
THE AETAS OF MT. PINATUBO

 HISTORICAL
 Description and interpretation of historical events
 NURSES PERFORMING SURGICAL ASEPSIS
DURING WORLD WAR II

 GROUNDED THEORY – involving the discovery of
theory through the analysis of data
 SYNTHESIS OF FINDINGS OF 14 STUDIES, WITH
THE GOAL OF IDENTIFYING COMMON ELEMENTS
OF INDIVIDUAL EFFORTS TO CHANGE A VARIETY
OF UNHELTHY EFFORTS. IDENTITY SHIFT WAS
DISCOVERED AS A PROCESS

 CASE STUDY
 An in-depth study or extensive study of a person
individual and group
 CASE STUDY OF THE NEEDS AND PROBLEMS OF
PATIENT X WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE

 Validity
 The degree to which an instrument measures what it is
supposed to measure.
 INTERNAL VALIDITY – the degree to which changes in the
dependent variable can be attributed to the independent
variable
 EXTERNAL VALIDTY – concerns the degree to which study

results can be generalized to other people and other settings

 INTERNAL VALIDITY
 The degree to which changes in the dependent variable
can be attributed to the independent variable
 MATURATION – changes that occur within the subjects
during an experimental design
 ATTRITION – dropout of subjects
 MORTALITY – different dropout rate in experimental
and control group
 BIAS –when results are attributed to experimental
treatment but is already present before the treatment

 INTERNAL VALIDITY
 INTRUMENTATION CHANGE – concerns the difference
between the pretest and post test due to difference of
instrument
 TESTING – refers to the influence of the pretest or
knowledge of baseline data on post-test scores
 HISTORY – occurs when some event besides the
experimental treatment occurs during the course of a
study and this event influences the dependent variable

 EXTERNAL VALIDTY
 Concerns the degree to which study results can be
generalized to other people and other settings
 HAWTHORNE EFFECT – occurs when participants
respond in a certain manner because they know they
are being observed
 EXPERIMENTER EFFECT – when researcher
characteristics influence subject behavior
 ROSENTHAL EFFECT – changes in response due to
presence of higher authority
 HALO EFFECT – changes in treatment due to positive
perception of researcher
 HORNS EFFECT – due to negative perception

STEP 6 – SAMPLING
 Sampling
 Process of selecting representative portion of the
population to represent the entire population

STEP 7 – SAMPLING
 Terminologies
 UNIVERSE – totality of elements to which research
findings may apply
 ELEMENTS – entities which make up the sample and
the population
 POPULATION – accessible group of individuals from
which the sample will be drawn by the researcher
 SAMPLE – s portion of the population from which the
data will be solicited
 SAMPLE SIZE – the number of samples drawn from the
entire population

STEP 7 – SAMPLING
 Random Sampling
 Or PROBABILITY SAMPLING involves random
selection of subjects in the population
 SIMPLE RANDOM SAMPLING – selection of samples on
random basis
 STRATIFIED RANDOM SAMPLING – divides the population

into homogenous subgroups
 CLUSTER SAMPLING – or MULTI-STAGE SAMPLING
successive selection or random samples from larger to smaller
units
 SYSTEMATIC SAMPLING – or SEQUENTIAL SAMPLING is

the selection of samples according to a predetermined
modality

STEP 7 – SAMPLING
 Non-random Sampling
 Or NON-PROBABILITY SAMPLING involves selection
in a non-random way
 CONVENIENCE SAMPLING – or ACCIDENTAL SAMPLING
uses the most readily available group of people
 QUOTA SAMPLING – establishment of desired proportions for

some variables of interest according to specific characteristics
 PURPOSIVE SAMPLING – or JUDGMENT SAMPLING the
subjects are handpicked based on certain qualities for the
purpose of the study
 SNOWBALL SAMPLING – or NETWORK/REFERRAL/CHAIN

involves identifying few persons who meet the inclusion criteria
of the study to gain access to other subjects

STEP 8 – ETHICAL CONSIDERATIONS
 Ethics
 Came form the Greek word „ethikos‟ meaning „the rules
of conduct recognized in certain associations or
departments of human life”
 Nursing research uses human beings as subjects
hence, the researcher must exercise caution to protect
the rights of the subjects against undue impositions

 Nuremberg Code
 Stipulated the following as essential requirements of
ethical research which are voluntary consent,
withdrawal of subjects from study, protection of subjects
from physical and mental suffering, injury, disability and
death, balance of benefits and risk

 Declaration of Helsinki
 Introduce distinction between therapeutic and non-
therapeutic research.
 THERAPEUTIC RESEARCH – patient could benefit from
experimental treatment that have beneficial results
 NON-THERAPEUTIC RESEARCH – generation of new

knowledge which might produce beneficial to future patients
but less likely to the actual subjects

 Belmont Report
 Identified the basic ethical principles in research
involving human subjects
 BENEFICENCE
 JUSTICE

 RESPECT FOR HUMAN DIGNITY

 Code of Ethics for Nurses
 Guide for action based on social values and needs
which served as the standards for nurses‟ performance
worldwide

 5R‟s of the Research Subjects
 Right to informed consent
 Right not to be harmed
 Right to confidentiality and anonymity
 Right to full disclosure
 Right to refuse or withdraw from participation

STEP 9 – DATA COLLECTION
 Data Collection
 Methods researcher to generate new data by the used
of instruments/measures

 Questionnaires
 Most common research instrument
 Involves use of pen and paper
 DEMOGRAPHIC – data of the subject
 OPEN-ENDED – essay; fill in the blanks
 CLOSED-ENDED – two alternative questions, multiple
choice
 CONTINGENCY – relevant for some and not for other
respondents

 Interview
 Second most common research instrument
 STRUCTURED – specific questions will only be asked
and no additional questions
 SEMI-STRUCTURED – free to probe to major questions
 UNSTRUCTURED – ordinary question

 Observation
 Most direct means if you are interested on the behavior
of the respondents
 NONPARTICPANT OBSERVER (OVERT) – openly
identifies that she or he is conducting research
 NONPARTICIPANT OBSERVER (COVERT) – is one
who does not identify himself to the subjects
 PARTICIPANT OBSERVER (OVERT) – involved with
participants openly
 PARTICIPANT OBSERVER (COVERT) – observer
interacts with the participants without the respondents
knowledge

STEP 10 – ORGANIZATION OF DATA
 Levels of Measurement
 NOMINAL – lowest level of measurement which
categorize attributes
 ORDINAL – ranks objects based on their relative
standing of an attribute
 INTERVAL – occurs when researchers can specify the
ranking of objects on an attribute and the distance
between those objects
 RATIO – highest level of measurement which, unlike
interval scales, have a rational, meaningful zero

STEP 11 – ANALYSIS OF DATA
 Statistics
 DESCRIPTIVE STATISTICS – used to synthesize and
describe data
 INFERENTIAL STATISTICS - Provides a means of
drawing conclusions about a population which are
based on the laws of probability

 Central Tendency
 Relates to the way in which quantitative data are
specified in its central value
 MEAN – the sum is equal to the sum of all values divided by
the number of participants
 MEDIAN – the point in a distribution that divides the score in

half
 MODE – the number that occurs most frequently

 Variability
 "the state or characteristic of being variable", describes
how spread out or closely clustered a set of data is
 RANGE – the highest score minus the lowest score in a
distribution
 STANDARD DEVIATION – summarizes the average amount of

deviation of values from the mean.
 VARIANCE – refers to index of variability. Standard deviation
squared

 Bivariate Descriptive Statistics
 Describes the relationship between two variables
 CONTIGENCY TABLES – two dimensional frequency
distribution in which the frequencies of two variables are cross-
tabulated
 CORRELATION COEFFICIENT – relation of two variables

 PRODUCT-MOMENT CORRELATION COEFFICIENT –

PEARSON R computed with interval or ratio measures
 SPEARMAN‟S RANK ORDER CORRELATION –

SPEARMAN RHO for ordinal measures

STEP 12 – DISSEMINATION
 Final step in research process process

STEP 13- UTILIZING FINDINGS
 Final step in research process for the researcher

HISTORICAL LANDMARKS OF NURSING
RESEARCH
 1859
 NOTES ON NURSING – describes Nightingale‟s
interest in environmental factors that promote physical
and emotional well-being
 1900
 American Nurses Journal begins publication
 1930
 American Journal of Nursing publishes clinical case
studies
 1952
 The journal Nursing Research begins publication

RESEARCH
 1955
 Inception of the American Nurse‟s Foundation to
sponsor nursing research
 1963
 International Journal of Nursing Studies begins
publication
 1965
 American Nurse‟s Association begins sponsoring
nursing research conferences
 1969
 Canadian Journal of Nursing Research begins
publication

RESEARCH
 1971
 ANA establishes a Commission on Research
 1972
 ANA establishes its Council of Nurse Researchers
 1978
 The journals Research in Nursing and Health and
Advances in Nursing begin publication
 1983
 Annual Review of Nursing Research begins publication
 1987
 The journal Scholarly Inquiry for Nursing Practice begins
publication

RESEARCH
 1989
 US agency for Health Care Policy and Research is
established
 1992
 The journal Clinical Nursing Research begins
publication
 1994
 The journal Qualitative Health Research begin
 2004
 The journal Worldviews on Evidence-Based Nursing
begins publication

Research

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