Nursing Research Lec 09

OBJECTIVES Foundations of Nursing research  Importance of research  Major phases of the research process  Steps in the research study  Research problem & Statement of the problem  Hypothesis  Review of Related Literature  Conceptual Framework & Model 

Quantitative Research Designs  Sampling  Ethics in Research  Validity & Reliability  Data Collection  Evidenced Based Practice 

Research is systematic inquiry that uses disciplined methods to answer questions or solve problems.  The ultimate goal of research is to develop, refine, and expand a base of knowledge. 

 Nursing

research is systematic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practice, nursing education, and nursing administration.

A

scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice.

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Diagnosis of Type 2 Diabetes ◦ FBS 160 mg/dl with positive glucose tolerance test ◦ FBS of 126 mg/dl or greater on two occasions ◦ Hemoglobin A1c greater 6.5

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Cloning of human tissue

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Treatment of HPN with Angiotensin Receptor Blockers (ARBs) (Irbesartan, Losartan)

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Treatment of Depression with SSRIs (selective serotonin reuptake inhibitors)

 With

evidence based practice, research provides the best clinical evidence in making patient care decisions.

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Nurses are accepting the need to base specific nursing actions and decisions on evidence indicating that the actions are clinically appropriate and costeffective, and result in positive outcomes for clients.

 Nurses

who incorporate highquality research evidence into their clinical decisions and advice are being professionally accountable to their clients.

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Another reason for nurses to engage in research involves the spiraling costs of health care and the costcontainment practices being instituted in health care facilities.

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nurses need to document the effectiveness of their practice not only to the profession but also to nursing care consumers, health care administrators, third-party payers (e.g., insurance companies), and government agencies.

Research enables nurses to  understand a particular nursing situation about which little is known,  assess the need for an intervention,  identify factors that must be considered in planning nursing care,  predict the probable outcomes of certain nursing decisions,  control the occurrence of undesired outcomes,  provide advice to enhance client health,  and initiate activities to promote appropriate client behavior.

 Numerous

clinical practice changes over the past 2 decades reflect the impact of research. For example, a recent nursing study documented that “kangaroo care” (the holding of diaper-clad preterm infants skin-to-skin, chest-to-chest by parents) is now widely practiced in neonatal intensive care units (NICUs) in the United States (Engler et al., 2002), but this is a new trend.

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As recently as the early 1990s, only a minority of NICUs offered kangaroo care options. The adoption of this practice reflects the accumulating evidence that early skin-to-skin contact has clinical benefits without any apparent negative side effects (Anderson et al., 2003). Some of that accumulated evidence was developed in rigorous studies by nurse researchers in the United States, Australia, Canada, Taiwan, and other countries (Chwo et al., 2002).

The Evolution of Research In Nursing

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Florence Nightingale ◦ Reformer ◦ Reactionary ◦ Researcher

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Crimean War: 185356 Collected data Used statistics, graphs to present data Based practice on research findings

1900-1940 – researches were done on

nurse’s educational preparation – Goldmark Report Nursing Research Journal – 1952

1960’s

– terms such as conceptual frame-work, conceptual model, nursing process theoretical base of Nursing

International

Studies 1943

Journal of Nursing

1970 - Research focused on client care search for scientific base from which to practice utilization of research findings  Priority was focused on clinical problems  Growing number of nurses with earned doctorates 1980 – Recognition that research is an integral part of Professional Nursing

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Establishment of National Center for Nursing Research (NCNR), Nursing Science Quarterly, Applied Nursing Research in 1980 1990 – National Institute of Nursing Research (NINR) Nursing Research into the Mainstream of nursing Activities

1. Future focus is on outcome research –

assess and document the effectiveness of health care services 2. Future focus is on biophysiologic research 3. Promotion of evidence based practice research findings into research

1.

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Development of a stronger knowledge base thru multiple, confirmatory strategies, Replication of studies with different clients in different clinical settings and at different times to ensure that the findings are robust. Trend is from in patient care to ambulatory care.

Nursing Process

Research Process

1. Assessment a. Data Collection b. Data Interpretation 2. Nursing Diagnosis

1. Knowledge of the World of Nursing

2. Problem & Purpose Identification 3. Plan 3. Methodology a. Goal Identification a. Design b. Planned Interventions b. Sample c. Measurement 4. Implementation 4. Data Collection & Analysis 5. Evaluation & Modification 5. Outcomes & Disseminating Findings

1. Basic Research 2. Applied Research 3. Rigor 4. Control

Quantitative studies are basic or applied •

Basic Research: Concerned with underlying mechanisms of an intervention. Such as Effect of Pressure on tissues

•

Applied Research: Concerned with effect of the intervention on the patient. Such as turning patient to relieve pressure

Excellence in research involves: •Discipline •Adherence to detail •Strict accuracy

•A

methodology developed with meticulous detail

• Precise

measurement tools

•A

representative sample

•A

tightly controlled design

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Quantitative research

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Qualitative research

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Outcomes research

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Intervention

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Descriptive Research

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Correctional Research

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Quasi-Experimental Research

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Experimental Research

• Natural

or Field Settings • Partially Controlled Settings • Highly Controlled or Laboratory Settings

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Traditions Authority Borrowing Trial & Error Personal Experience

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Role Modeling Intuition Reasonin g Research

Research Problem & Purpose Literature Review Study Framework Objectives, Questions, or Hypotheses Study Variables

Assumptions Limitations Research Design Population & Sample Methods of Measurement

Data Collection & Analysis Research Outcomes Communication of Findings

Epistemology The philosophy of knowing Methodology An approach to knowing

Science

is a way to learn the TRUTH.

The Positivist View of Research • •

Science is a way to learn the TRUTH. Science is DETERMINISTIC.

The Positivist View of Research • • •

Science is a way to learn the TRUTH. Science is DETERMINISTIC. Science is MECHANISTIC.

The Positivist View of Research • • • •

Science is a way to learn the TRUTH. Science is DETERMINISTIC. Science is MECHANISTIC. Science uses METHODS.

The Positivist View of Research • • • • •

Science is a way to learn the TRUTH. Science is DETERMINISTIC. Science is MECHANISTIC. Science uses METHODS. Science only deals with what we can see or measure – EMPIRICISM.

The Positivist View of Research • • • • •

•

Science is a way to learn the TRUTH. Science is DETERMINISTIC. Science is MECHANISTIC. Science uses METHODS. Science only deals with what we can see or measure – EMPIRICISM. The best way to learn the truth is to EXPERIMENT.

The Positivist View of Research • • • • • • •

Science is a way to learn the TRUTH. Science is DETERMINISTIC. Science is MECHANISTIC. Science uses METHODS. Science only deals with what we can see or measure – EMPIRICISM. The best way to learn the truth is to EXPERIMENT. Science is OBJECTIVE.

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Similarity between common sense and science

Similarity between common sense and science  NATURAL SELECTION model of knowing 

Random Variation

Selective Retention

Similarity between common sense and science  NATURAL SELECTION model of knowing  MULTIPLE PERSPECTIVES and TRIANGULATION 

Similarity between common sense and science.  NATURAL SELECTION model of knowing.  MULTIPLE PERSPECTIVES and TRIANGULATION.  Observation is THEORY-LADEN. 

Similarity between common sense and science.  NATURAL SELECTION model of knowing.  MULTIPLE PERSPECTIVES and TRIANGULATION.  Observation is THEORY-LADEN  NONREDUCTIONIST. 

Believe there’s a reality that we should try to ‘get right’  Critical of our ability to ever get it perfectly right 

Research Problem & Purpose

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Major concepts Focused on areas of concern Key issues for practice, education, & administration Examples: Chronic pain, Acute pain, Self-care, Coping, Health Promotion, Respiratory pathology

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Area of Concern Gap in the knowledge base for practice ◦ Not previously studied ◦ Conflicting findings ◦ Omission of a group of subjects Significant for Nursing

“Patients’ concerns about reporting pain and using analgesics… are barriers to adequate pain management…Despite extensive attention to issues of pain management…few studies have been conducted testing impact of intervention on cancer pain…” Ward et al. (2000). An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers. Research in Nursing & Health, 23(5), p. 394.

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Little is known about... ◦ Findings of previous studies are conflicting ◦ Few studies of this have been done

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Nursing Practice

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Researcher and Peer Interaction

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Literature Review

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Theory

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Research Priorities

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Clear, concise statement Goal, aim, focus, or objective of the study Includes variables, population, & setting

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The purpose of this study was to ◦ describe... ◦ determine differences between groups... ◦ examine relationships among... ◦ determine the effect of...

“The purpose of this pilot study was to determine if information about analgesic side effects and information to counter misconceptions would enhance pain management in…women with gynecologic cancer.” Ward et al. (2000). An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers. Research in Nursing & Health, 23(5), p. 394.

Current policy at most hospitals requires the use of routine flushing of heparin locks after administration of medication or flushing heparin locks every 8 hours when not being used for medication administration. However, there is disagreement on whether flushes of low doses of heparin are necessary to maintain the patency of heparin locks....

The purpose of this study was to evaluate the effectiveness of normal saline versus normal saline containing 10 U/mL of heparin for maintaining heparin-loc sites.

The purpose of this study was “to describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes” (Blegen et al., 1998).

The higher the RN skill mix, the lower the incidence of adverse occurrence on inpatient care units.

 Time

Commitment  Money Commitment  Researchers’ Expertise  Availability of Subjects, Facility, & Equipment  Ethical Considerations

Definition: Objectives are declarative statements which focus on the identification and the description of variables or concepts and sometimes on determination of relationships of variables.

The objectives of “this study were to: (a) describe the self-reported physical & mental health, disability level, & social support of persons chronically ill with multiple sclerosis; and (b) contrast rural & urban residents in relation to health description, social support, & perception of health.”

Definition: Research questions are interrogative statements that focus on what variables or concepts are to be described and what relationships might exist among them.

What is the relationship between reported depressive symptoms and rate of return to work for patients following cardiac surgery?

What is the relationship of anxiety and compliance with medications and follow-up appointments for patients following

Definition: Formal statement of the expected relationships among variables.

 Simple

versus Complex  Nondirectional versus Directional  Associative versus Casual  Statistical versus Research

 Simple:

2 Variables

A

> B

 Complex

Hypothesis: More than 2 Variables A B C

Attitudes

of pediatric nurses toward mentally retarded clients are more favorable than those of medical–surgical nurses.

Attitudes

of pediatric nurses toward mentally retarded clients are related to number of years in practice.

Research

Hypothesis (alternative): States what researcher thinks is true Null Hypothesis: States no difference or relationship exists

 Statement

of relationship between an independent and dependent variable  Describes a cause and effect  Usually stated in two forms ● The null hypothesis ● The alternative hypothesis  The two forms are ● Mutually exclusive ● Exhaustive

Causal hypothesis Null: Alternative (one-tail):

Nurse orientation program will reduce absenteeism. There will be no change in absenteeism as a result of orientation. There will be less absenteeism as a result of orientation.

orientation program Causal hypothesis Nurse will reduce absenteeism. Null: Alternative:

There will be no change in absenteeism as a result of orientation program . There will be less absenteeism as a result of orientation No change

Less

-

0 Absenteeism

+

Causal hypothesis Null:

Alternative:

Our new drug treatment will cause a difference in depression. There will be no change in depression as a result of treatment. There will be a change in depression as a result of treatment.

Causal hypothesis Null: Alternative:

Our new drug treatment will cause a difference in depression. There will be no change in depression as a result of treatment. There will be a change in depression as a result of treatment.

No change

Less More -

0

Depression

+

Causal hypothesis Null: Alternative:

Our new drug treatment will cause a difference in depression. There will be no change in depression as a result of treatment . There will be a change in depression as a result of treatment. No change

A “two-tail” hypothesis Less -

More 0

Depression

+

Cancer patients with chronic pain who listen to music with positive suggestions of pain reduction have less reported pain than those who do not listen to music.

There is no difference in the amount of pain experienced by cancer patients with chronic pain who listen to music with positive suggestion of pain reduction & those who do not.

Definition: Qualities, properties, or characteristics of persons, things, or situations that are manipulated or measured in research.

 Independent

Variables  Dependent Variables  Research Variables or Concepts  Extraneous Variables  Demographic Variables

Independent:Leads to or causes something else

Dependent: Is affected by other variable(s)

Independent

Dependent

Academic achievement

Independent Family structure

Dependent

Academic achieveme nt

Independent

Dependent

Family structure

Economic status

Academic achieveme nt

Variable:

Any observation that can take different values Attribute: A specific value on a Attribute variable

Variable: Attribute:

Sex or gender Female; male

Independent Family structure Economic status Schoolin g

Dependent

Academic achieveme nt

Independent

Dependent

Family structure Economic status Schooling Special tutoring

Academic achievemen t

Not manipulable

Independent

Dependent

Family structure Economic status Schooling Special tutoring

Academic achievemen t

Independen t Not manipulabl e

Family structure Economic status Schooling

Manipulabl e

Dependen t

Special tutoring

Academic achievement

Theory or idea

Theory or idea

Reality

Theory or idea

Reality

Self-esteem

Theory or idea

Self-esteem

I feel good about myself...

Reality

1 SD

2 D

3 N

4 A

5 SA

Theory or idea

Self-esteem Operational definition

I feel good about myself...

Reality

1 SD

2 D

3 N

4 A

5 SA

Self-esteem

Self-esteem

Operational definition

Operational definition Operational definition

Self-esteem

Operational definition

Indicators

Operational definition Operational definition

Each indicator is a fallible Self-esteem reflection of the construct. Operational definition

Operational definition Operational definition

Example Variable: Agreement Attribute: 1 = strongly disagree 2 = disagree 3 = neutral 4 = agree 5 = strongly agree

 Conceptual

Definition:

•The abstract meaning of a variable that usually is based on theory.  Operational

Definition:

•A way of defining a variable that makes it measurable or manipulatable in the real world.

 Conceptual

Definition of Coping Behavior •Coping behaviors are actions directed toward managing internal and environmental demands that tax or exceed a person’s resources (Lazarus & Folkman, 1984).

 Operational

Definition of Coping Behavior • Coping behaviors were measured with the Ways of Coping Checklist (WCC), a 68-item scale that contains eight subscales: one problemfocused scale, six emotion-focused scales, and one problem- and emotion-focused scale (O’Brien, 1993).

 Concept

Pain: Uncomfortable sensory

and emotional experience...  Variables

Related to Pain

•Intensity of post-op pain •Degree of emotional distress associated with post-op pain •Perception of pain

•Treatment •Stimulus •Manipulated •Experimental •Grouping

Outcome Effect Response