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NURSING RESEARCH I

Course Grade Components Research is a systematic inquiry that


uses disciplined methods to answer
Term exams ---------------------- 60% questions or solve problems.
Prelim ------- 15%
Midterm ---- 15%
To re-search a subject is literally to see it
Semi-final -- 15%
another way.
Final --------- 15%
You gather original information of your own,
or study the work of others, and evaluate it
Formal research proposal ------ 40%
from your own point of view and experience.
----------
Total ------------- 100%
Research is observation and critical study.
The research process is about asking
questions, finding answers, and making
Textbook: judgments.
It is collecting information in order to make
Nursing Research: Principles and
judgments and gain truth.
Methods (7/e) by Denise Polit &
Cheryl Beck
Systematic because it is
Submission of draft of Research - logical,
Proposal: - orderly, and
- results are explicitly stated so
March 17, 2014 that others may follow the steps
to verify the results
Target date of presentation of the Research is a systematic search for pertinent
Research Proposal to the Faculty panel: information on a specific topic or problem, its
analysis, and interpretation.
March 24-25, 2014
It is a refined and thorough technique for
Polit & Beck have a simple definition of thinking, employing specialized tools,
research: instruments, and procedures in order to
obtain a more adequate solution of a problem
than would be possible under ordinary
means.

It starts with a perceived problem, proceeds


to the collection of data at hand, and arrives
at decisions based on actual evidence.
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DEFINITION OF NURSING RESEARCH


The ultimate goal of research is to
develop, refine, and expand a body of Nursing research is a systematic
knowledge. inquiry designed to develop
knowledge about issues of
Research is not just going to the school importance to the nursing
library and copying from books what has profession, especially to guide
been written about a specific topic that nursing practice and to improve
your teacher has assigned. the health and quality of life of
nurses’ clients.
It is more than just searching the internet
for websites that say something about the
topic of interest. The primary task of a nurse researcher is
to produce usable knowledge that would
It is not just synthesizing the information benefit the practice of nursing and to
that you obtained from secondary sources whom the research project has been
and submitting it as a term paper (the directed.
more appropriate name rather than
‘research’). Today’s nurses must be capable of
reflecting on, evaluating and modifying
----------------- their clinical experience based on new
knowledge.
To undertake a research can sometimes be
frustrating and at other times enjoyable.
Frustrating because things may not work Research can be categorized as
out as expected and obstacles get in the either:
way.
 Basic or applied, or
On the other hand, the researcher finds a  Quantitative or qualitative
sense of achievement in having
completed a research project and in
having found the answers to some Basic research is undertaken to
bugging questions. extend the base of knowledge in a
discipline, or to formulate or refine
a theory.

Example: A researcher may perform


an in-depth study to better
understand normal grieving
processes, without having
explicit nursing applications
in mind.

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Example: A study on an expectant


Applied research focuses on
father’s experience of
finding solutions to existing
waiting outside the delivery
problems.
room

Example: A person’s near-death


experience (NDE), or an
out-of-body experience
Example: A study to determine the (OBE).
effectiveness of a nursing
intervention to ease
grieving.
THE IMPORTANCE OF RESEARCH
Basic research is appropriate for IN NURSING
discovering general principles of human
behavior and biophysiologic processes; Nurses are expected to adopt an
applied research is designed to indicate evidence-based practice (EBP).
how these principles can be used to
solve problems in nursing practice. EBP is defined as the use of the best
clinical evidence in making patient
Quantitative research is one care decisions.
where observations result from
some type of measurement and Research findings from rigorous studies
are formally analyzed with constitute the best type of evidence for
statistical procedures. guiding nurses’ decisions, actions, and
interactions with their clients.
Nurses’ actions and behaviors should be
Example: A study to the correlation based on evidence that such actions are:
between the number of
sticks of cigarette smoked - Clinically appropriate,
and the extent of lung - Cost effective, and
damage of a smoker - Result in positive outcome for clients

Qualitative research is an
The role of EBP is to:
investigation of phenomena,
- Improve the quality of health
typically in an in-depth and holistic
care
fashion, through the collection of
- Reduce health costs
rich narrative materials, using a
- Enhance patient safety
flexible research design.

Some research findings help eliminate nursing


The goal of most qualitative studies is to actions that do not achieve desired
develop a rich understanding of a research outcomes.
phenomenon as it exists in the real world, Other findings help identify practices that
and as it is constructed by individuals in the improve health care outcomes and contain
context of that world. costs as well.
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Example: ROLES OF NURSES IN RESEARCH

1. Consumers of nursing
research where nurses’
involvement in research is
indirect and at a minimum
-------- level.

Professional nursing practice requires the The use of research findings


generation of evidence. in a practice setting is referred
EBP is currently the primary approach to to as research utilization.
knowledge uptake for professional
practice, and is believed to support
efficiency and ensure that practice Consumers of nursing research read research
decisions result in the provision of effective reports to develop new skills and to keep up-
treatment. to-date on relevant findings that may affect
their practice.

Best practices based on sound research-


based evidence are undisputedly needed, 2. Producers of nursing
given the complexity of today’s healthcare research where nurses
environments and with reliance on rapidly- actively participate in
evolving technology, corporate priorities designing and implementing
with as focus on efficiency. research studies.

-------- Producers of nursing research constitute


practicing nurses who want to find what
The evolution of the EBP movement within works best for their clients.
healthcare has taken place over the last
three decades. ---------------
EBP has been identified as the integration of
best research evidence with clinical Between being a consumer and being a
expertise and patient values to facilitate producer, nurses engage in a variety of
clinical decision making. activities to improve their effectiveness and
enhance their professional lives.
These activities include:

 Attending research presentations at


professional conferences

Example: Seminars conducted


by the PNA and
medical groups
about new
developments in
patient care

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 Discussing the implications and relevance


of research findings with clients THE EVOLUTION OF NURSING
RESEARCH
 Giving clients information and advice about
participation in studies From Nightingale to the 1950s

 Assisting in the collection of research  Nightingale’s Notes on Nursing


information (e.g.,
distributing questionnaires to patients)  Most studies conducted between
1900-1940 concerned nurse’s
 Reviewing a proposed research plan with education, like:
respect to its feasibility in a clinical - education preparation of nurse
setting, and offering a clinical expertise to teachers, administrators,
improve the plan and health nurses
- the clinical experiences of
 Collaborating in the development of an nursing students
idea for a clinical research project
 In the 1950s:
 Participating on an institutional committee - the number of nurses with
that reviews the ethical aspects of advanced educational
proposed research before it is undertaken degrees increased, and
Nursing Research was first
 Evaluating completed research for its published in 1952
possible use in practice, and using it when - nursing research was more
appropriate introspective

Nurses with research skills can contribute to


nursing knowledge to improve every nurse’s
professional practice.  Florence Nightingale’s publication
Notes on Nursing (1859) describes her
early interest in environmental factors
that promote physical and emotional
well-being.

 Her research contributions were her


data collection and analysis relating to
factors affecting soldier mortality and
morbidity during the Crimean war.

 Little nursing research was


undertaken after Nightingale’s work.

 Studies concerning nursing education


continued in the 1940s, identifying
more inadequacies in nursing
education.

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In the 1950s nursing research was more into


Nursing Research in the 1970s
studying the nurse:
 The emphasis for nursing research
-Who is the nurse?
changed from nursing education to
-What does a nurse do?
client care; clinical problems were
-Why do individuals choose to enter
identified as the highest priorities.
nursing?
-What are the characteristics of the
ideal nurse?
-How do other groups perceive the  More journals on nursing research
nurse? came to be published.

Example of nursing research


Nursing Research in the 1960s breakthrough in the 1970s: Kathryn
Barnard’s neonatal and young child
development.
 Practice-oriented research on
various clinical topics began in Her work contributed to the early
earnest. interventions for children with disabilities.

 Nursing practice began to advance


worldwide Nursing Research in the 1980s

 More attention was given to the


type of research questions being
 Research terminology began to asked, the methods of collecting
appear, such as: conceptual and analyzing information being
framework, conceptual model, nursing used, the linking of research to
process, and theoretical base of theory, and the utilization of
nursing practice research findings in practice.

Example of nursing research  EBP was introduced which


breakthrough in the 1960s: In the promulgated that scientific research
early 1960s, doctors did not advice findings were far superior to the
women that they had breast cancer opinions of authorities as a basis for
even after mastectomy. clinical decisions.

Research findings in 1967 by Jeanne


Quint changed all that in her research  Establishment in the US of the
on subjective experiences after National Center for Nursing Research
diagnosis with a life-threatening (NCNR) which promoted and
illness. financially supported research training
and research projects relating to
patient care.

 Formal projects were conducted to


increase research utilization.

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Example of nursing research Future Direction of Nursing Research


breakthrough in the 1980s: Dorothy
Booten, et. al., developed and tested
 Increased focus on outcomes
a model of site transitional care for
research.
patients who are at health risk as a
Result of early discharge from
hospitals.

 Increased focus on biophysical


Nursing Research in the 1990s research.

 Conference on Research Priorities


(CORP) established the following  Promotion of EBP.
priorities for research:

-low birth weight  Development of a stronger


-human immunodeficiency virus knowledge base through multiple,
(HIV) infection confirmatory strategies.
-long-term care
-symptom management
-nursing informatics
 Strengthening of multi-disciplinary
-health promotion, and
collaboration.
-technology dependence

 Expanded dissemination of research


Example of nursing research breakthrough in findings.
the 1990s: Barbara Swanson and Janice
Zweller conducted studies that have led to  Increasing the visibility of nursing
discoveries in environmental management as research.
a means of improving immune system status.

Outcomes research is designed to


assess and document the effectiveness of
health care services.

- cost-effective care without


compromising quality

-----------------------
- biologic and physiologic phenomena
to develop better clinical evidence

-----------------------
- translate research findings into
practice

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One of the challenges is for nurses to utilize


the research available and to adopt EBP. SOURCES OF EVIDENCE FOR
NURSING RESEARCH
-----------------------
Development of a stronger knowledge
1. Tradition
- replication of studies with different clients 2. Authority
in different clinical settings, and at 3. Clinical experience, trial and error,
different times and intuition
------------------------ 4. Logical reasoning
Strengthening of multi-disciplinary 5. Assembled information
collaboration 6. Disciplined research

- Integrate breakthroughs in human


genetics into lifestyle and health care Some of what students and nurses learn is
interventions based on systematic research.
------------------------ However, much of it (about 85%) come from
Expanded dissemination alternative sources of evidence.

- technological advances (e.g., internet and Tradition


other electronic communication) to
promote EBP Example: Biting the foot of a convulsing
child
- there is a need for nurses to know and
apply new scientific information Example: Not allowing any part of a
----------------- person with fever to touch
Increasing the visibility water

- most people are unaware that nurses are


scholars and researchers; they are not
recognized for their expertise. Authority --- Trust in the judgment of
people who are authoritative because of
specialized training or experience.

Like tradition, their knowledge often goes


unchallenged.

-------------------------

Clinical Experience, Trial and Error, and


Intuition

 Nurses’ own clinical experiences is


a functional source of knowledge.
But it has limitations as a type of
evidence.

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1. Each individual’s experience is Example: A nurse may observe the


fairly restricted anxious behavior of
(specific) hospitalized
Example: A nurse may notice that 2 or children and conclude that
3 cardiac patients follow (in general) children’s
similar postoperative sleep separation from their
patterns; but does one parents is stressful.
nurse’s observation justify
broad changes in nursing ---------------------------
care? Example: If we assume that
separation anxiety occurs in
2. The same objective event is hospitalized children (in
usually perceived differently by general), then we might
two individuals. predict that (specific)
children in Hospital X whose
 Trial and error may offer a practical parent do not room in will
means of securing knowledge, but it is manifest symptoms of
haphazard. stress.

The knowledge obtained is often


unrecorded and, hence, inaccessible in Assembled Information ---
subsequent clinical situations. information collected for a variety of
purposes

Examples: -benchmarking data at the local,


Intuition is a type of knowledge that national and international level
cannot be explained on the basis of
reasoning or prior instruction. -cost data --- costs associated
with certain procedures, policies,
It is difficult to develop policies and practices or practices
for nurses on the basis of intuition.
-quality improvement and risk
data, such as medication error
Logical Reasoning reports and evidence on
incidence and prevalence.
1. Inductive reasoning is the
process of developing
generalizations from specific Disciplined Research
observations.
 Most sophisticated method of
acquiring evidence

 Combines aspects of logical reasoning


with other features to create evidence
2. Deductive reasoning is the
that tends to be more reliable than
process of developing specific
other methods of knowledge
predictions from general principles.
acquisition.

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PURPOSES OF NURSING RESEARCH Description (or descriptive


research) focuses on prevalence,
1. Identification and description incidence, size, and other measurable
2. Exploration attributes of the phenomenon.
3. Explanation
4. Prediction and control
Description of phenomena is another
important purpose of research.
Identification is unique to qualitative In a descriptive study, researchers
research. ask questions about frequencies or
prevalence of variables, or their average
In quantitative research, the values.
phenomenon has been previously studied
or defined; or, has already been Examples: -patients’ stress and coping
described. -pain management
-health beliefs
-rehabilitation success
Identification and Description
Description can be a major purpose for
Qualitative researchers sometimes study both qualitative and quantitative
phenomena about which little is known. researches.
In some cases, so little is known that the
phenomenon has yet to be clearly Qualitative researchers use in-depth
identified, defined or conceptualized. methods to describe the dimensions,
The in-depth probing nature of qualitative variations, and importance of
research is well suited to the task of phenomena.
answering such questions as:
Most quantitative studies asks questions
‘What is the phenomenon?’ about relationships
and
‘What is its name?’ Example: Descriptive.
What % of women
Example: ADD breastfeed their infants?

Example: In 1999, a study was Inferential.


conducted on midlife (40- - Is there a relationship between
53 year-old) women’s miscarriage and depression?
perception of their - Is there a difference in depression
changing bodies. levels of pregnant women who
miscarry and those who do not?
- Does having a miscarriage contribute
to depression?
- Does depression contribute to a
miscarriage?
- Or, does some other factor influence
both?

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Explanation
Exploration (or exploratory research) Explanatory research seeks to understand
investigates the full nature of the the foundations of specific natural
phenomenon, the manner in which it is phenomena, and to explain systematic
manifested, and other factors to which it relationships among phenomena.
is related.
It attempts to offer understanding of the
Exploration underlying causes or full nature of a
phenomenon.
Like descriptive research, exploratory
research begins with a phenomenon of Example: Researchers tested a
interest; but rather than simply observing model to explain exercise
and describing it, exploratory research behavior among older
investigates the full nature of the adults on the basis of
phenomenon, the manner in which it is social support, age, and
manifested, and other factors to which it is self-efficacy expectations.
related.
Prediction and Control
Example: A descriptive quantitative
study of patients’ Many phenomena defy explanations, but it
preoperative stress might is possible to control phenomena based on
seek to document the research findings, even in the absence of
degree of stress patients complete understanding.
experience before surgery
and the percentage of Example: Research has shown that
patients who actually risk of abnormalities in a
experience it. child increases, the closer
the parents are to being
An exploratory study might blood relatives
ask the following:
We can practically control
-What factors diminish or the outcome by educating
increase a patient’s the young people about
stress? the possible outcome, or
-Is stress related to the by discouraging close blood
patient’s cultural relatives from marrying
backgrounds? each other

Explanation (or explanatory


research) seeks to explain systematic
relationships among phenomena.

REFERENCES/NURSING RESEARCH 1/DISCUSSION/NR1 LECTURE NOTES 1, INTRODUCTION.doc