Module 1- Overview of nursing research: Definition, types, purposes, and goals The Importance of Research in Nursing / Reason for

on for Conducting Research in

Overview of the lesson: In this module it deals with nursing research and its Nursing
application to evidence base nursing practice and applying ethical principles to
1. Gather data or information on nursing situations or conditions about which
nursing research.
little knowledge is available.
Desired learning outcomes:
2. Provides scientific knowledge base from which nursing theories emerge and
At the end of the module, students should be able to: develop.

1. Explain the meaning of research. 3. Helps correct, clarify and validate perceptions and expands these.

2. Asses the role of Nurse in research participation 4. Provides theoretical and scientific basis for nursing practice.

3. Examine the importance of ethical consideration in research 5. Defines the parameters of nursing and identifies its boundaries.

4. Identify the different elements research ethics 6. Documents the social relevance and efficacy of nursing practice to people and
health care providers.
5. Explain the different elements of Informed Consent
7. Describes the characteristics of the nursing situation about which little
Definition of Nursing Research:
knowledge is known.
It is defined as a formal, systematic, rigorous and intensive process used for
8. Predicts probable outcomes of nursing decisions in relations to client care.
solutions to nursing problems or to discover and interpret new facts and trends in
the clinical practice, nursing education and nursing administration (Waltz & 9. Provides knowledge for purposes of problem solving and decision making.
Bausell, 2001). Includes the breadth and depth of the disciple of nursing and the
10. Develops and evaluates nursing theories, concepts and practices these for
rehabilitative, therapeutic and preventive aspects of nursing as well as the
clarity and validity of nursing actions.
preparation of practitioners and personnel involved in the total nursing sphere.
11. Prevents undesirable client reactions.
The Goals of Nursing Research:
12. Develops a considerable degree of confidence
Efficiency and effectiveness in nursing care. Worthiness and value of the nursing
profession. Identify, implementing and evaluating effective health care General Purposes:
modalities. Potential for providing quality care of clients.
Research in general, answer questions to solve problems. Provide tools for
Sources of Knowledge in Nursing: observation in order to generate knowledge as basis for predicting and
controlling the phenomenon. Thus, a nurse can apply this knowledge in practice
Faith, Habits and Traditions, Authority, Clinical / Personal Experience Borrowing
and prescribe accurately and professionally without untoward client response or
Trial and Error, Intuition, Role Modeling, Assembled Information, Logical
reactions to nursing interventions (Polit & Beck, 2004)
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Reasoning, Disciplined Research

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Specific Purposes:
 Specifically, research aims to do the following tasks: Allows one to study the variables pertinent to a specific situation. Descriptive
Research. The exploration and description of phenomena in real life situation.
Description
Exploration Provides an accurate account of characteristics of particular individuals, situations
Explanation or groups.
Prediction
3. According to Time Element: Historical Research
Control
• Describes what was? Descriptive Research
Types of Research:
4. According to Duration
1. General Classification
Longitudinal Study
-Basic / Pure Research
• Follows the subjects for a long period of time
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 Cross – sectional Study
eventually filter down the result into real life situation. Applied research seeks for
practical application of theoretical or abstract knowledge. The truth is adapted to • Takes information one at a time and may require subjects to recall past events
every situation. It results from present problems or from socially disorganized or feelings. It may contribute to a loss of accuracy and support bias. It is more
situations. It frequently raises theoretical questions that must be answered by often done than the longitudinal studies
basic/ pure research. Purpose of Conducting Applied Research: 5. According to Research Design
To solve a problem Correlational Research
To make a decision • Involves the systematic investigation of relationship between or among
To develop a new program, product, methods and procedure variables.

To evaluate program and methods. • This design is used to quantify the strength of the relationships in the real
world.
-Action Research
• This design is used to quantify the strength of the relationship between
The process involves the study of certain problem and from that experience, variables or in testing a hypothesis about a specific relationship.
decisions, actions and conclusion are drawn. Findings are limited to settings
actually studied. Experimental

2. According to Level of Investigation: • An objective, systematic, highly controlled investigation for the purpose of
predicting and controlling phenomena in nursing practice.
Exploratory Research
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• The researcher actively introduces some form of treatment and has greater
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control over extraneous variables.

 Non-Experimental A type of research conducted to describe and promote understanding of human
experiences.
• The researcher collects data without introducing any treatment or making any
Evolved from the behavioral and social sciences as a method of understanding
changes.
unique, dynamic, holistic nature of human beings.
• Non experimental research usually includes studies where the researcher’s
Approaches in Qualitative Research:
primary interest understands some human behavior in naturalistic contexts.
Phenomenological Research
Quasi – Experimental
Used to answer questions of meaning
• Is like experimental research because it actively introduces some form of
treatment or manipulation of an independent variable. Begin with accumulation of evidence when little topic is known or when studying
new topic, it involves gathering of fresh perspective.
• Unlike experimental research, however, it does not utilize randomization or
control group. The goal of phenomenological inquiry is to understand fully lived experience and
perceptions.
Nursing Research Methodologies
Aspects of Lived Experience involve:
Quantitative Research:
a. Lived Space (spatiality)
A formal, objective, systematic process in which numerical data are used to
obtain information about the world b. Live Body (corporeality)

This method is used to describe variables, examine relationships among variables c. Lived Time (temporality)
and determine cause and effect interactions between variables.
d. Live Human Relation (rationality)
Rigor in Quantitative
Grounded Theory Research
• Rigor is the striving for excellence in research and it requires discipline,
Method designed to inductively develop a theory-based observation of selected
adherence to detail and strict accuracy.
people.
Control in Quantitative
The primary purpose of grounded theory research is to develop a theory. The
• Involves the imposing of rules by the researcher to decrease the possibility of concepts and theories discovered through this research approach are derived
error. directly from the data.

Qualitative Research The following are the major premises of grounded theory:

A systematic, interactive, subjective approach used to describe life experiences a. Human’s act toward objects on the basis of the meaning those objects have for
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and give them meaning. them.

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b. Social meaning arise from social interaction

 c. 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 sources

Ethnographic Research

A tool for studying cultures

It has been associated with studies of primitive, foreign or remote cultures which
allow the researcher to acquire new perspectives beyond his/her own
ethnocentric perspective.

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

Case Study Characteristics of Research:

involves an in-depth description of essential dimension and processes of the It involves the gathering of new data from new sources or first-hand information.
phenomenon being studied.
It is directed towards the solution of a problem
Are means of providing in depth, evidence base discussion of clinical topics along
It is characterized by carefully designed procedures applying rigorous analysis
with practical information.
It emphasizes the development of generalizations, principles hypotheses and
COMPARISON ON PHASES OF QUANTITATIVE AND QUALITATIVE RESEARCH
theories that may be helpful in predicting future occurrences.

It requires expertise

It strives to be logical, applying every possible test to validate the procedures

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being employed.
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 It demands accurate observation and description of what is being studied. H - Honest

It is characterized by patient and unhurried activities. E - Economical

It requires innovative approaches and determination to succeed. R – Religious

It is carefully and accurately recorded and reported. Roles of Nurses in Research

Characteristics of the Good Nurse Researcher As Principal Investigators

Honest and Credible As Member of a Research Team

Intellectual Curiosity As Evaluator of Research Findings

Accurate in his/her data As Consumers of Research Findings

Organized and Systematic As Client Advocate in a Research Study

Prudence As Subject of Research

Logic

Self- Awareness Research in the Philippines

Healthy Criticism In the Philippines, nursing research prior to and during the 60’s was mostly on
nursing administration (51%), and nursing education (33%), while patient care
Intellectual Honestly
and related studies received minimal attention, with only 13% and 3%
Good Relationship with his/her respondents respectively. Teaching of research was integrated in the nursing curriculum in the
mid-sixties.
Qualities of a Good Researcher
An analysis of nursing studies done from 1935 to 1980 shows that of the 305
R - Research Oriented studies, 123 or 40% were on nursing service administration, 112 or 37% were on
E - Efficient nursing education, 47 or 15.5% were on patient care, and 23 or 7.5% were on
related studies
S - Scientific
In the Philippines today, nursing educators agreed that skill in research should be
E - Effective one of the core competencies of Bachelor of Science in Nursing.
A - Active Future Directions in Nursing (Polit & Beck, 2008)
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R - Resourceful • Heightened focus on evidence-based practice.

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C - Creative
 • Development of stronger evidence-base through rigorous methods and multiple Evidence-based practice evolves from the integration of the best research
evidence with clinical expertise and patient needs and values (Sachett, et al.,
• Confirmatory strategies.
2000).
• Greater emphasis on systematic integration of reviews.

• Expanded local research in healthcare settings.

• Strengthening of multidisciplinary collaboration among nurse researchers.

• Expanded dissemination of research findings.

• Increasing the visibility of nursing researchers.

• Increased focus on cultural issues and health disparities.

Purposes of Nursing Research

RA 9173 Section 28 (e) states that: It shall be the duty of the nurse to: (e)
Undertake nursing and health human resource development training and
research which shall include, but not limited to the development of advance
nursing practice.

• Identification

• Description

• Exploration

• Explanation

• Prediction

• Control

Evidence-based Practice in Nursing

The ultimate goal of nursing is to provide evidence-based care that provides

quality outcomes for patients and their families, healthcare providers, and the
healthcare system (Craig & Smith, 2007; Pearson et. Al., 2007)
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Evidence-based practice is the conscientious use of current best evidence of

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making clinical decisions about patient care (Sacheet et al., 2000).

 Steps in EBP:
1. Identify a problem from practice and turn it into a specific question.
2. Find the best available evidence that relates to the specific question.
3. Critically appraise the evidence for its validity, usefulness and methodological
rigor.
4. Identify and use the current best evidence, and together with the patient or
client’s preferences and the practitioner’s expertise and experience, apply it to
the situation.
5. Evaluate the effect on the patient or client, and reflect on the nurse’s own
performance
ETHICAL ASPECTS OF NURSING RESEARCH
The Need for Ethical Guidelines
When humans are used as study participants—as they usually are in nursing
research—care must be exercised in ensuring that the rights of those humans are
protected. The requirement for ethical conduct may strike you as so self-evident
as to require no further comment, but the fact is that ethical considerations have
not always been given adequate attention. In this section, we consider some of
the reasons that ethical guidelines became imperative.
Codes of Ethics
During the past four decades, largely in response to the human rights violations
described earlier, various codes of ethics have been developed. One of the first
internationally recognized efforts to establish ethical standards is referred to as
the Nuremberg Code, developed after the Nazi atrocities were made public in the
Nuremberg trials. Several other international standards have subsequently been
developed, the most notable of which is the Declaration of Helsinki, which was
adopted in 1964 by the World Medical Association and then later revised, most
recently in 2000.
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Most disciplines have established their own code of ethics. The American Nurses’
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Association (ANA) put forth a document in 1995 entitled Ethical Guidelines in the
Conduct, Dissemination, and Implementation of Nursing Research (Silva, 1995).
Box 7-1 presents the nine ethical principles outlined in that document. The
American Sociological Association published a revised Code of Ethics in 1997.
Guidelines for psychologists were published by the American Psychological
Association (1992) in
Ethical Principles of Psychologists and Code of Conduct. Although there is
considerable overlap in the basic principles articulated in these documents, each
deal with problems of particular concern to their respective disciplines.
In the United States, an important code of ethics was adopted by the National
Commission for the Protection of Human Subjects of Biomedical and Behavioral
74Research (1978). The commission, established by the National Research Act
(Public Law 93–348), issued a report in 1978 that served as the basis for
regulations affecting research sponsored by the federal government. The report,
sometimes referred to as the Belmont Report, also served as a model for many of
the guidelines adopted by specific disciplines. The Belmont Report articulated
three primary ethical principles on which standards of ethical conduct in research
are based: beneficence, respect for human dignity, and justice.
Ethical Principles for Protecting Study Participants
The three major ethical principles incorporated into most guidelines are
beneficence, respect for human dignity, and justice.
• Beneficence involves the protection of participants from physical and
psychological harm, protection of participants from exploitation, and the
performance of some good.
Respect for human dignity involves the participants’ right to self-determination,
which means participants have the freedom to control their own activities,
including study participation.
• Respect for human dignity also encompasses the right to full disclosure, which
means that researchers have fully described to prospective participants their
rights and the full nature of the study. When full disclosure poses the risk of
biased results, researchers sometimes use covert data collection or concealment
(the collection of information without the participants’ knowledge or consent) or
 deception (either withholding information from participants or providing false
information). If deception or concealment is deemed necessary, extra precautions
should be used to minimize risks and protect other rights.
• Justice includes the right to fair treatment (both in the selection of participants
and during the course of the study) and the right to privacy. Privacy can be
maintained through anonymity (wherein not even researchers know participants’
identities) or through formal confidentiality procedures that safeguard the
information participants provide
PROCEDURES FOR PROTECTING STUDY PARTICIPANTS
Informed consent
Informed consent procedures, which provide Prospective participants with
information needed to make a reasoned decision about participation, normally
involve signing a consent form to document voluntary and informed participation.
In qualitative studies, consent may need to be continually renegotiated with
participants as the study evolves, through process consent.
The Contents of Informed Consent
Fully informed consent involves communicating the following pieces of
information to participants:
1. Participant status. Prospective participants need to understand clearly the
distinction between research and treatment. They should be told which health
care activities are routine and which are implemented specifically for the study.
They also should be informed that data they provide will be used for research
purposes.
2. Study goals. The overall goals of the research should be stated, in lay rather
than technical terms. The use to which the data will be put should be described.
3. Type of data. Prospective participants should be told the type of data that will
be collected.
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4. Procedures. Prospective participants should be given a description of the data
collection procedures, and of the procedures to be used in any innovative
treatment.
5. Nature of the commitment. Information should be provided regarding
participants’ estimated time commitment at each point of contact, and the
number of contacts within specified timeframes.
6. Sponsorship. Information on who is sponsoring or funding the study should be
noted; if the research is part of an academic requirement, this information should
be shared.
7. Participant selection. Researchers should explain how prospective participants
were selected for recruitment, and how many people will be participating.
8. Potential risks. Prospective participants should be informed of any foreseeable
risks (physical, psychological, social, or economic) or discomforts that might be
incurred as a result of participation, and any efforts that will be taken to minimize
risks. The possibility of unforeseeable risks should also be discussed, if
appropriate. If injury or damage is possible, treatments that will be made
available to participants should be described. When risks are more than minimal,
prospective participants should be encouraged to seek the advice of others
before consenting.
9. Potential benefits. Specific benefits to participants, if any, should be described,
as well as information on possible benefits to others.
10. Alternatives. If appropriate, researchers should provide information about
alternative procedures or treatments that might be advantageous to participants.
11. Compensation. If stipends or reimbursements are to be paid (or if treatments
are offered without fee), these arrangements should be discussed
12. Confidentiality pledge. Prospective participants should be assured that their
privacy will at all times be protected. If anonymity can be guaranteed, this should
be noted.
 13. Voluntary consent. Researchers should indicate that participation is strictly
voluntary and that failure to volunteer will not result in any penalty or loss of
benefits.
14. Right to withdraw and withhold information. Prospective participants should
be told that even after consenting they have the right to withdraw from the study
and to refuse to provide any specific piece of information. Researchers may, in
some cases, need to provide participants with a description of circumstances
under which researchers would terminate the overall study.
15. Contact information. The researcher should provide information on whom
participants could contact in the event of further questions, comments, or
complaints.
Risk/Benefit Assessment
In designing a study, researchers must carefully assess the risks and benefits that
would be incurred. The assessment of risks and benefits that individual
participants might experience should be shared with them so that they can
evaluate whether it is in their best interest to participate. Box 7-2 summarizes the
major risks and benefits of research participation. In evaluating the anticipated
risk/benefit ratio of a study design, researchers might want to consider how
comfortable they would feel if their own family members were participating in
the study.
The risk/benefit ratio should also be considered in terms of whether the risks to
participants are commensurate with the benefit to society and the nursing
profession in terms of the quality of evidence produced. The general guideline is
that the degree of risk to be taken by those participating in the research should
never exceed the potential humanitarian benefits of the knowledge to be gained.
Thus, the selection of a significant topic that has the potential to improve patient
care is the first step in ensuring that research is ethical. All research involves
some risks, but in many cases, the risk is minimal. Minimal risk is defined as risks
anticipated to be no greater than those ordinarily encountered in daily life or
during routine physical or psychological tests or procedures. When the risks are
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not minimal, researchers must proceed with caution, taking every step possible to
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reduce risks and maximize benefits. If the perceived risks and costs to participants
outweigh the anticipated benefits of the study, the research should be either
abandoned or redesigned.
In quantitative studies, most of the details of the study are usually spelled out in
advance, and therefore a reasonably accurate risk/benefit ratio assessment can
be developed. Qualitative studies, however, usually evolve as data are gathered,
and it may therefore be more difficult to assess all risks at the outset of a study.
Qualitative researchers thus must remain sensitive to potential risks throughout
the research process.
MAJOR POTENTIAL BENEFITS TO PARTICIPANTS
• Access to an intervention that might otherwise be unavailable to them
• Comfort in being able to discuss their situation or problem with a friendly,
objective person
• Increased knowledge about themselves or their conditions, either through
opportunity for introspection and self-reflection or through direct interaction
with researchers
• Escape from normal routine, excitement of being part of a study
• Satisfaction that information they provide may help others with similar
problems or conditions
• Direct monetary or material gains through stipends or other incentives
MAJOR POTENTIAL RISKS TO PARTICIPANTS
• Physical harm, including unanticipated side effects
• Physical discomfort, fatigue, or boredom
• Psychological or emotional distress resulting from self-disclosure, introspection,
fear of the unknown, discomfort with strangers, fear of eventual repercussions,
anger or embarrassment at the type of questions being asked
• Social risks, such as the risk of stigma, adverse effects on personal relationships,
loss of status
 • Loss of privacy
• Loss of time
• Monetary costs (e.g., for transportation, child care, time lost from work)
Privacy and Confidentiality Procedures
The Right to Privacy.
Virtually all research with humans involves intruding into personal lives.
Researchers should ensure that their research is not more intrusive than it needs
to be and that participants’ privacy is maintained throughout the study.
Participants have the right to expect that any data they provide will be kept in
strictest confidence. This can occur either through anonymity or through other
confidentiality procedures. Anonymity occurs when even the researcher cannot
link participants to their data. For example, if questionnaires were distributed to
group nursing home residents and were returned without any identifying
information on them, responses would be anonymous. As another example, if a
researcher reviewed hospital records from which all identifying information (e.g.,
name, address, social security number, and so forth) had been expunged,
anonymity would again protect participants’ right to privacy. Whenever it is
possible to achieve anonymity, researchers should strive to do so.
When anonymity is impossible, appropriate confidentiality procedures need to be
implemented. A promise of confidentiality is a pledge that any information
participants provide will not be publicly reported in a manner that identifies them
and will not be made accessible to others. This means that research information
should not be shared with strangers nor with people known to the participants
(e.g., family members, physicians, other nurses), unless the researcher has been
given explicit permission to share it.
Researchers can take a number of steps to ensure that breaches of
confidentiality do not occur, including the following:
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• Obtain identifying information (e.g., name, address) from participants only
when essential.
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• Assign an identification (ID) number to each participant and attach the ID
number rather than other identifiers to the actual data.
• Maintain identifying information in a locked file.
• Restrict access to identifying information to a small number of people on a
need-toknow basis.
• Enter no identifying information onto computer files.
• Destroy identifying information as quickly as practical.
• Make research personnel sign confidentiality pledges if they have access to data
or identifying information.
• Report research information in the aggregate; if information for a specific
participant is reported, take steps to disguise the person’s identity, such as
through the use of a fictitious name.
Qualitative researchers may need to take extra steps to safeguard the privacy of
them participants. Anonymity is almost never possible in qualitative studies
because researchers typically become closely involved with participants.
Moreover, because of the in-depth nature of qualitative studies, there may be a
greater invasion of privacy than is true in quantitative research. Researchers who
spend time in the home of a participant may, for example, have difficulty
segregating the public behaviors that the participant is willing to share from the
private behaviors that unfold unwittingly during the course of data collection. A
final issue is adequately disguising participants in research reports. Because the
number of respondents is small, qualitative researchers may need to take
considerable precautions to safeguard identities. This may mean more than
simply using a fictitious name—it may also mean not sharing detailed information
about informants’ characteristics, such as their occupation and diagnosis.
Authorization to Access Private Information
This is applicable only when accessing patient information which can be
incorporated in the consent form or a separate form should be used. The person
concerned should sign the authorization of which it shall include (1) who will
 receive the information, (2) what type of information will be disclosed, and (3)
What further disclosures the researcher anticipates.
Communication, Debriefings, and Referrals
Should include that the researcher should be gracious and polite and should
phrase questions tactfully, and should be sensitive to cultural and linguistic
diversity. May use the following techniques:
• Debriefing sessions – after data collection is completed this is done to permit
participants to ask questions or air complaints.
• Communication – communicate with participants after study is completed to let
them know that their participation was appreciated. Either by mailing them a
summary or advising them of an appropriate website).
• Referrals – to appropriate health, social, or psychological services when
necessary. Like when studying about stress, participants with high level of stress
should be referred to a psychologist.
Conflict of Interest
A conflict of interest exists when two or more contradictory interests relate to an
activity by an individual or an institution. The conflict lies in the situation, not in
any behavior or lack of behavior of the individual. That means that a conflict of
interest is not intrinsically a bad thing.
Examples include a conflict between financial gain and meticulous completion
and reporting of a research study or between responsibilities as an investigator
and as a treating physician for the same trial participant.
Transparency
The notion of transparency is an overarching concern for establishing the quality
of qualitative research. At its most basic, transparency is the benchmark for
writing up research and the presentation and dissemination of findings; that is,
the need to be explicit, clear, and open about the methods and procedures used.
Vulnerability Assessment

Recruitment Vulnerable subjects require additional protection. These people may be

vulnerable because they are not able to make a truly informed decision about
Recruitment methods must take into account privacy concerns. Lack of pressure
study participation (e.g., children); because their circumstances make them
or undue influence – Participation in research must be voluntary. Thus, the study
believe free choice is constrained (e.g., prisoners); or because their circumstances
should be introduced in a manner that allows participants adequate time and
heighten the risk of physical or psychological harm (e.g., pregnant women, the
ability to freely consider whether or not they wish to take part.
terminally ill).
Incentives and Compensation
Institutional Reviews, Boards and External Reviews
Provide a review of the amount and method of compensations, financial
• External review of the ethical aspects of a study by a human subjects committee
incentives or reimbursements of study-related expenses. Declare if there is
or Institutional Review Board (IRB) is highly desirable and may be required by
monetary consideration or if not, what are other options in giving back to the
either the agency funding the research or the organization from which
respondents.
participants are recruited.
Collaborative Study Terms of Reference
• In studies in which risks to participants are minimal, an expedited review
If the study is collaborative in nature in a case of multi-country/multiinstitutional (review by a single member of the IRB) may be substituted for a full board review;
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studies. Discuss about intellectual property rights, publication rights, information in cases in which there are no anticipated risks, the research may be exempted
and responsibility sharing, transparency and capacity building. from review.
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 • Researchers are always advised, even in the absence of an IRB review, to
consult with at least one external adviser whose perspective allows an objective
evaluation of the ethics of a proposed study.

• Researchers need to give careful thought to ethical requirements throughout

the study’s planning and implementation and to ask themselves continually
whether safeguards for protecting humans are sufficient

Learning Activities:

1. Create an Informed Consent utilizing the elements of Ethical Consideration.

2. What is the significance of research in medical profession?

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